Prevenção primária de doenças cardiovasculares na obesidade infantojuvenil: efeito anti-inflamatório do exercício físico

Abstract

A pandemia da obesidade juvenil e do sedentarismo está relacionada com o maior risco de doenças cardiovasculares no futuro. Ambas com fisiopatologia inflamatória, essas condições têm atraído significativa atenção científica. O início dos eventos que agridem o endotélio vascular pode ocorrer na infância, porém, sinais clínicos da aterosclerose geralmente só aparecem na fase adulta. O tecido adiposo é hoje reconhecido por seu papel ativo, induzindo a produção de citocinas pró e anti-inflamatórias, como o fator de necrose tumoral-alfa, as interleucinas 1, 6 e 10, a proteína C-reativa e outras. Há várias evidências de que os níveis sanguíneos dessas citocinas se encontram mais altos em indivíduos com excesso de peso, inclusive crianças e adolescentes. A prevenção precoce, desde a infância, apresenta-se como a melhor maneira de evitar os danos da obesidade na fase adulta, enquanto o potencial da prática regular de exercícios físicos tem se mostrado surpreendente. Sua ação anti-inflamatória se manifesta através de menores concentrações séricas de interleucina 6, de proteína C-reativa e leptina, além de aumentos na adiponectina. Observa-se escassez de estudos randomizados e controlados avaliando as relações entre obesidade, inflamação e exercícios para a população jovem. Com resultados às vezes controversos, a maioria das conclusões é procedentede estudos com adultos. O objetivo desta revisão é avaliar o papel anti-inflamatório, e assim cardioprotetor, da atividade física regular na obesidade infantojuvenil.Palavras-chave: obesidade/metabolismo, estilo de vida, doenças cardiovasculares/prevenção & controle, inflamação. aBStRaCtNowadays, juvenile obesity and physical inactivity are pandemic conditions which relate to a greater future risk of cardiovascular diseases. From an inflammatory point of view, they have attracted massive scientific attention. The beginning of the events related to atherosclerosis may occur in childhood, generating endothelial and metabolic dysfunction; however, the symptoms usually only appear later on, in adulthood. The fat tissue is recognized as being metabolically active, stimulating the production of inflammatory cytokines, such as the tumoral necrosis factor, interleukines 1, 6 and 10, C-reactive protein, among others. There is plenty of evidence that the serum levels of these citokines are higher in overweight individuals, including children and adolescents. Early prevention as young as possible is the best way to avoid future consequences of obesity. In this context, the potential benefits of regular physical exercise have been surprising. Researchers have shown evidence of antiinflammatory responses, including lower levels of interleukine 6, C-reactive protein, leptin, besides higher levels of adiponectins after engagement in regular physical activity. However, we still have few controlled randomized studies addressing the relations between obesity, inflammation and exercise for the pediatric population. There are controversial findings in this field, and many of them come from adult st...

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