Adolescentes modelos de passarela: como é o consumo alimentar deste grupo?

OBJETIVO: Avaliar a adequação da ingestão de energia, macro e micronutrientes em adolescentes modelos de passarela. MÉTODOS: Estudo transversal de 33 adolescentes modelos e 33 não modelos, de 15 a 18 anos, pareadas por idade e índice de massa corpórea (IMC). A ingestão alimentar foi avaliada por meio de registro alimentar de três dias, sendo calculados os valores médios de energia, em kcal, os valores proporcionais dos macronutrientes em relação ao valor calórico total da dieta consumida, bem como os valores médios/medianos dos seguintes micronutrientes: cálcio, ferro, zinco, fósforo, magnésio, folato, vitamina D, vitamina C, vitamina A e vitamina E. RESULTADOS: Verificou-se que 24% das adolescentes do estudo apresentaram IMC abaixo dos valores mínimos para a idade. A média de ingestão de energia foi menor entre as modelos, em comparação às adolescentes não modelos (1.480,93±582,95 versus 1.973,00±557,63 kcal) (p<0,05). A ingestão de gorduras acima do recomendado foi semelhante entre os grupos - 30,3% das adolescentes modelos e 36,4% das adolescentes não modelos (p>0,05). O consumo inadequado de micronutrientes como o cálcio, ferro, zinco, magnésio, fósforo, vitaminas lipossolúveis, folato e ácido ascórbico ocorreu em ambos os grupos. CONCLUSÕES: A baixa ingestão energética (kcal) entre as modelos e a ingestão insuficiente de minerais e vitaminas alertam para que as agências de modelos comprometam-se com a saúde dessas adolescentes, garantindo um acompanhamento médico e nutricional.

Cálcio dietético: estratégias para otimizar o consumo

O cálcio é um nutriente essencial necessário em diversas funções biológicas. Estudos têm demonstrado a associação entre o baixo consumo de cálcio e doenças crônicas, entre elas osteoporose, câncer de colón, hipertensão arterial e obesidade. Entretanto, grande parte da população brasileira apresenta consumo de cálcio abaixo do recomendado. Este artigo objetiva revisar os fatores endógenos (idade e estado hormonal) e exógenos (fitatos, oxalatos, sódio, compostos bioativos e vitamina D) que influenciam a absorção do cálcio, bem como as principais metodologias utilizadas para avaliar a absorção e biodisponibilidade desse nutriente. Discorre-se sobre os possíveis fatores para o baixo consumo de cálcio: 1) Hábito alimentar - substituição de leite por bebidas com baixo teor de cálcio como o refrigerante, refeições realizadas fora de casa e a não realização de refeições como o café da manhã; 2) Alto custo dos alimentos fontes de cálcio. Além disso, este artigo discute as estratégias para otimizar o consumo do cálcio, que incluem: 1) Aumentar o conhecimento sobre a importância do consumo de cálcio para a saúde e as principais fontes alimentares desse nutriente; 2) Aumentar a disponibilidade de alimentos fortificados com cálcio; 3) Uso de suplementos em grupos específicos - quando e como administrar os sais de cálcio.

Listas de alimentos relacionadas ao consumo alimentar de um grupo de idosos: análises e perspectivas

INTRODUÇÃO: A despeito do aumento expressivo da população idosa nos últimos anos, são escassos os estudos brasileiros relacionados ao consumo alimentar desses indivíduos. OBJETIVOS: Propor uma lista de alimentos mais consumidos por idosos residentes na Zona Leste de São Paulo e analisar os alimentos que contribuem para o consumo de nutrientes relevantes ao estado nutricional e, consequentemente, à saúde dos idosos. MÉTODOS: Foram avaliados 100 indivíduos acima de 60 anos, frequentadores de um centro de referência. Para caracterização do estado nutricional foi calculado o Índice de Massa Corporal (IMC). Para elaboração das listas de alimentos foram aplicados dois recordatórios alimentares de 24 horas (RA24h) em duas estações diferentes do ano, que foram analisados quanto à frequência de consumo de cada alimento e quanto à contribuição percentual de energia, macronutrientes, fibras, cálcio e vitamina D. RESULTADOS: Com relação ao estado nutricional, 52% apresentaram o IMC < 28 kg/m²; 15% entre 28 e 30 kg/m²; 26% entre 30 e 35 kg/m² e 7% com IMC > 35 kg/m². O aspecto positivo da dieta foi a preservação de hábitos saudáveis como o consumo de arroz e feijão, e também de vegetais verde-escuros. Como aspecto negativo observou-se que a dieta dos idosos é monótona, pois poucos alimentos contribuem para o consumo de vários nutrientes. Além disso, houve um elevado consumo de carboidratos refinados em detrimento do consumo de alimentos integrais. CONCLUSÕES: As listas de alimentos obtidas, além de permitirem a reflexão sobre intervenções educativas, permitem o desenvolvimento subsequente de um Questionário de Frequência Alimentar específico para esse grupo.

Deficiência de vitamina A em pré-escolares da cidade do Recife, Nordeste do Brasil

RESUMO. O objetivo deste estudo foi avaliar a prevalência de deficiência de vitamina A (DVA) em pré-escolares da cidade do Recife, Nordeste Brasileiro. A amostra foi composta por 344 crianças, de 24 a 60 meses, de ambos os sexos, em 18 creches públicas da cidade do Recife, em 2007. O estado nutricional de vitamina A foi avaliado pelos indicadores bioquímico (retinol sérico) e dietético (inquérito de consumo alimentar) e o status pondo-estatural através dos índices antropométricos peso/idade (P/I), altura/idade (A/I) e peso/altura (P/A). A prevalência de níveis de retinol sérico baixos (<0,70μmol/L) foi de 7,7 por cento (IC 95 por cento 4,88 – 11,81), caracterizando a DVA como problema de saúde pública do tipo leve, segundo critérios da Organização Mundial de Saúde. Por outro lado, 29,6 por cento (IC 95 por cento 24,22 – 35,63) das crianças apresentaram níveis aceitáveis ou marginais (0,70 a 1,04μmol/L) de retinol. Em relação ao consumo de vitamina A, os valores abaixo da EAR (Estimated Average Requirement), de 210μg/dia para crianças de 24 a 47 meses e de 275μg/dia para crianças de 48 a 96 meses de idade foi de 8,1 por cento e 21,3 por cento, respectivamente. As prevalências de déficits antropométricos (<-2 escores –Z) nos pré-escolares foram de 2,5 por cento para o indicador P/I, de 8,6 por cento quanto ao A/I e de 1,5 por cento em relação ao P/A. Os dados acima evidenciam a importância da institucionalização para o adequado estado nutricional das crianças e manutenção dos estoques adequados de vitamina A. Todavia, são necessários mais estudos enfocando pré-escolares não institucionalizados, ou seja, crianças que vivem fora do ambiente privilegiado das creches

Fatores de risco para quedas recorrentes entre mulheres e homens brasileiros: o Estudo Brasileiro sobre Osteoporose (BRAZOS)

Estimar a freqüência de quedas recorrentes e identificar os principais fatores de risco associados. O BRAZOS é o primeiro estudo epidemiológico realizado em amostragem representativa da população brasileira. Dados antropométricos, hábitos de vida, fratura prévia, quedas, dieta, atividade física e qualidade de vida foram avaliados em 2.420 indivíduos adultos. Quedas recorrentes foram referidas por 15,5% dos homens e 25,6% das mulheres. Nas mulheres, os fatores de risco associados com quedas recorrentes foram idade, fratura prévia, sedentarismo, pior qualidade de vida, diabete mellitus e uso atual de benzodiazepínicos. Nos homens, foram idade, pior qualidade de vida, consumo de bebidas alcoólicas, diabete mellitus, fratura prévia e uso atual de benzodiazepínicos. Maior ingestão de vitamina D desempenhou efeito protetor sobre o risco de quedas recorrentes. Esses achados demonstram elevada prevalência de quedas recorrentes e enfatizam a necessidade de uma abordagem multidisciplinar a fim de minimizá-las bem como de suas conseqüências como as fraturas por osteoporose

Metabolic osteopathy in celiac disease: importance of a gluten-free diet

Reduced bone mineral density (BMD) is frequently found in individuals with untreated celiac disease (CD), possibly due to calcium and vitamin D malabsorption, release of pro-inflammatory cytokines, and misbalanced bone remodeling. A gluten-free diet (GFD) promotes a rapid increase in BMD that leads to complete recovery of bone mineralization in children. Children may attain normal peak bone mass if the diagnosis is made and treatment is given before puberty, thereby preventing osteoporosis in later life. A GFD improves, but rarely normalizes, BMD in patients diagnosed with CD in adulthood. In some cases, nutritional supplementation may be necessary. More information on therapeutic alternatives is needed

Nutrional aspects of the prevention and treatment of osteoporosis

A osteoporose é um problema de saúde global, caracterizada por baixa massa óssea e deterioração da microarquitetura do tecido ósseo, com consequente aumento da fragilidade óssea e suscetibilidade a fraturas. A nutrição desempenha um papel fundamental na redução do risco de osteoporose por seu efeito sobre todos os fatores relacionados à fragilidade óssea, principalmente no desenvolvimento e na manutenção da massa óssea. Uma adequada ingestão de cálcio, vitamina D e proteína leva à redução da remodelação óssea, à maior retenção de cálcio, à redução da perda óssea relacionada à idade e à redução do risco de fraturas. Evidências recentes indicam que uma alimentação saudável, incluindo a ingestão de produtos lácteos (principalmente os desnatados), frutas e verduras, e uma quantidade adequada de carnes, peixes e aves, está relacionada positivamente com a saúde óssea. Além disso, a suplementação de vitaminas e minerais deve ser monitorada de perto, por profissionais de saúde, uma vez que pode ter efeitos adversos e ser insuficiente para assegurar uma eficaz proteção à saúde óssea

Short-term nutritional counseling reduces body mass index, waist circumference, triceps skinfold and triglycerides in women with metabolic syndrome

Background: It is recognized that the growing epidemic of metabolic syndrome is related to dietary and lifestyle changes. Objective: The purpose of this study was to evaluate short-term application of nutritional counseling in women with metabolic syndrome. Methods: This follow-up study was conducted from September to November 2008 with thirty three women >= 35 years old screened clinically for nutritional counseling. Dietary intake was reported, and biochemical and body composition measures were taken at baseline and after three months of follow-up. Results: Of the 33 women evaluated, 29 patients completed the study. The prevalence of type 2 diabetes mellitus, hypertension, dyslipidemia, and obesity was high at 38%, 72.4%, 55.2%, and 75.8%, respectively. At the end of three-months of follow-up, a significant decline in body mass index, waist circumference, triceps skinfold, and triglycerides was observed, as was an increase in calcium and vitamin D intake. The multiple regression analysis showed that changes in body mass index, triceps skinfold, waist circumference and triglyceride levels after nutritional intervention were positively associated with changes in anthropometric (loss of body weight) and biochemical (decrease of TG/HDL-c ratio) parameters. Moreover, waist circumference changes were negatively associated with changes in calcium and vitamin D intake. Conclusion: Short-term nutritional counseling improved some factors of metabolic syndrome. Moreover, the increases in calcium and vitamin D consumption can be associated with the improvement in markers of metabolic syndrome.

Identification of Novel Immunoregulatory Molecules in Human Thymic Regulatory CD4(+)CD25(+) T Cells by Phage Display

Thymic CD4(+)CD25(+) cells play an important role in immune regulation and are continuously developed in the thymus as an independent lineage. How these cells are generated, what are their multiple pathways of suppressive activity and which are their specific markers are questions that remain unanswered. To identify molecules involved in the function and development of human CD4(+)CD25(+) T regulatory cells we targeted thymic CD4(+)CD25(+) cells by peptide phage display. A phage library containing random peptides was screened ex vivo for binding to human thymic CD4(+)CD25(+) T cells. After four rounds of selection on CD4(+)CD25(+) enriched populations of thymocytes, we sequenced several phage displayed peptides and selected one with identity to the Vitamin D Receptor (VDR). We confirmed the binding of the VDR phage to active Vitamin D in vitro, as well as the higher expression of VDR in CD4(+)CD25(+) cells. We suggest that differential expression of VDR on natural Tregs may be related to the relevance of Vitamin D in function and ontogeny of these cells.

Early Control of PTH and FGF23 in Normophosphatemic CKD Patients: A New Target in CKD-MBD Therapy?

Background and objectives: Levels of parathyroid hormone (PTH) and the phosphaturic hormone FGF23, a fibroblast growth factor (FGF) family member, increase early in chronic kidney disease (CKD) before the occurrence of hyperphosphatemia. This short-term 6-wk dose titration study evaluated the effect of two phosphate binders on PTH and FGF23 levels in patients with CKD stages 3 to 4. Design, setting, participants, and measurements: Patients were randomized to receive over a 6-wk period either calcium acetate (n = 19) or sevelamer hydrochloride (n = 21). Results: At baseline, patients presented with elevated fractional excretion of phosphate, serum PTH, and FGF23. During treatment with both phosphate binders there was a progressive decline in serum PTH and urinary phosphate, but no change in serum calcium or serum phosphate. Significant changes were observed for FGF23 only in sevelamer-treated patients. Conclusions: This study confirms the positive effects of early prescription of phosphate binders on PTH control. Prospective and long-term studies are necessary to confirm the effects of sevelamer on serum FGF23 and the benefits of this decrease on outcomes. Clin J Am Soc Nephrol 5: 286-291, 2010. doi: 10.2215/CJN.05420709

Is Coronary Artery Calcification Associated with Vertebral Bone Density in Nondialyzed Chronic Kidney Disease Patients?

Background and objectives Low bone mineral density and coronary artery calcification (CAC) are highly prevalent among chronic kidney disease (CKD) patients, and both conditions are strongly associated with higher mortality. The study presented here aimed to investigate whether reduced vertebral bone density (VBD) was associated with the presence of CAC in the earlier stages of CKD. Design, setting, participants, & measurements Seventy-two nondialyzed CKD patients (age 52 +/- 11.7 years, 70% male, 42% diabetics, creatinine clearance 40.4 +/- 18.2 ml/min per 1.73 m(2)) were studied. VBD and CAC were quantified by computed tomography. Results CAC > 10 Agatston units (AU) was observed in 50% of the patients (median 120 AU [interquartile range 32 to 584 AU]), and a calcification score >= 400 AU was found in 19% (736 [527 to 1012] AU). VBD (190 +/- 52 Hounsfield units) correlated inversely with age (r = -0.41, P < 0.001) and calcium score (r = -0.31, P = 0.01), and no correlation was found with gender, creatinine clearance, proteinuria, lipid profile, mineral parameters, body mass index, and diabetes. Patients in the lowest tertile of VBD had expressively increased calcium score in comparison to the middle and highest tertile groups. In the multiple logistic regression analysis adjusting for confounding variables, low VBD was independently associated with the presence of CAC. Conclusions Low VBD was associated with CAC in nondialyzed CKD patients. The authors suggest that low VBD might constitute another nontraditional risk factor for cardiovascular disease in CKD. Clin J Am Soc Nephrol 6: 1456-1462, 2011. doi: 10.2215/CJN.10061110

RANKL is a mediator of bone resorption in idiopathic hypercalciuria

Background and objectives: This study aimed to determine the expression of osteoprotegerin, receptor activator of nuclear factor kappa B ligand, interleukin-la, transforming growth factor-beta, and basic fibroblast growth factor in stone-forming patients with idiopathic hypercalciuria. Design, setting, participants, & measurements: Immunohistochemical analysis was performed in undecalcified bone samples previously obtained from 36 transiliac bone biopsies of patients who had idiopathic hypercalciuria and whose histomorphometry had shown lower bone volume, increased bone resorption, and prolonged mineralization lag time. Results: Bone expression of receptor activator of nuclear factor kappa B ligand and osteoprotegerin was significantly higher in patients with idiopathic hypercalciuria versus control subjects. Transforming growth factor-beta immunostaining was lower in patients with idiopathic hypercalciuria than in control subjects and correlated directly with mineralization surface. Interleukin-la and basic fibroblast growth factor staining did not differ between groups. Receptor activator of nuclear factor kappa B ligand bone expression was significantly higher in patients who had idiopathic hypercalciuria and exhibited higher versus normal bone resorption. Conclusion: A higher expression of receptor activator of nuclear factor kappa B ligand in bone tissue suggests that increased bone resorption in patients with idiopathic hypercalciuria is mediated by receptor activator of nuclear factor kappa B ligand. Osteoprotegerin bone expression might have been secondarily increased in an attempt to counteract the actions of receptor activator of nuclear factor kappa B ligand. The low bone expression of transforming growth factor-beta could contribute to the delayed mineralization found in such patients.

Fibroblast Growth Factor 23 in Hemodialysis Patients: Effects of Phosphate Binder, Calcitriol and Calcium Concentration in the Dialysate

Background: Fibroblast growth factor 23 (FGF23) concentrations increase early in chronic kidney disease (CKD), and the influence of current CKD-mineral and bone disorder (MBD) therapies on serum FGF23 levels is still under investigation. Methods: In this post-hoc analysis of a randomized clinical trial, phosphate binders and calcitriol were washed out of 72 hemodialysis patients who were then submitted to bone biopsy, coronary tomography and biochemical measures, including FGF23. They were randomized to receive sevelamer or calcium acetate for 1 year and the prescription of calcitriol and the calcium concentration in the dialysate were adjusted according to serum calcium, phosphate and PTH and bone biopsy diagnosis. Results: At baseline, bone biopsy showed that 58.3% had low-turnover bone disease, whereas 38.9% had high-turnover bone disease, with no significant differences between them with regard to FGF23. Median baseline FGF23 serum levels were elevated and correlated positively with serum phosphate. After 1 year, serum FGF23 decreased significantly. Repeated measures ANOVA analysis showed that the use of a 3.5-mEq/l calcium concentration in the dialysate, as well as the administration of calcitriol and a calcium-based phosphate binder were associated with higher final serum FGF23 levels. Conclusions: Taken together, our results confirm that the current CKD-MBD therapies have an effect on serum levels of FGF23. Since FGF23 is emerging as a potential treatment target, our findings should be taken into account in the decision on how to manage CKD-MBD therapy. Copyright (C) 2010 S. Karger AG, Basel

Skeletal Microstructural Abnormalities in Postmenopausal Women With Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is associated with osteoporosis and fragility fractures. The objectives of this study were to assess static and dynamic indices of cancellous and cortical bone structure in postmenopausal women with COPD. Twenty women with COPD who had not received chronic oral glucocorticoids underwent bone biopsies after double tetracycline labeling. Biopsies were analyzed by histomorphometry and mu CT and compared with age-matched controls. Distribution of the patients according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) was: Type I (15%), Type II (40%), Type III (30%), and Type IV (15%). Mean (+/-SD) cancellous bone volume (15.20 +/- 5.91 versus 21.34 +/- 5.53%, p = .01), trabecular number (1.31 +/- 0.26 versus 1.77 +/- 0.51/mm, p = .003), and trabecular thickness (141 +/- 23 versus 174 +/- 36 mu m, p = .006) were lower in patients than in controls. Connectivity density was lower in COPD (5.56 +/- 2.78 versus 7.94 +/- 3.08 mu m, p = .04), and correlated negatively with smoking (r = -0.67; p = .0005). Trabecular separation (785 +/- 183 versus 614 +/- 136 mu m, p = .01) and cortical porosity (4.11 +/- 1.02 versus 2.32 +/- 0.94 voids/mm(2); p < .0001) were higher in COPD while cortical width (458 +/- 214 versus 762 +/- 240 mu m; p < .0001) was lower. Dynamic parameters showed significantly lower mineral apposition rate in COPD (0.56 +/- 0.16 versus 0.66 +/- 0.12 mu m/day; p = .01). Patients with more severe disease, GOLD III and IV, presented lower bone formation rate than GOLDI and II (0.028 +/- 0.009 versus 0.016 +/- 0.011 mu m(3)/mu m(2)/day;p = 04). This is the first evaluation of bone microstructure and remodeling in COPD. The skeletal abnormalities seen in cancellous and cortical bone provide an explanation for the high prevalence of vertebral fractures in this disease. (C) 2010 American Society for Bone and Mineral Research.

Effect of paricalcitol and calcitriol on aortic wall remodeling in uninephrectomized ApoE knockout mice

Becker LE, Koleganova N, Piecha G, Noronha IL, Zeier M, Geldyyev A, Kokeny G, Ritz E, Gross ML. Effect of paricalcitol and calcitriol on aortic wall remodeling in uninephrectomized ApoE knockout mice. Am J Physiol Renal Physiol 300: F772-F782, 2011. First published December 15, 2010; doi:10.1152/ajprenal.00042.2010.-Despitean only minor reduction in the glomerular filtration rate, uninephrectomy (UNX) markedly accelerates the rate of growth of atherosclerotic plaques in ApoE-/- mice. It has been suggested that vitamin D receptor (VDR) activation exerts an antiproliferative effect on vascular smooth muscle cells, but the side effects may limit its use. To assess a potentially different spectrum of actions, we compared the effects of paricalcitol and calcitriol on remodeling and calcification of the aortic wall in sham-operated and UNX ApoE-/- mice on a diet with normal cholesterol content. Sham-operated and UNX mice were randomly allotted to treatment with solvent, calcitriol (0.03 mu g/kg) or paricalcitol (0.1 mu g/kg) 5 times/wk intraperitoneally for 10 wk. Semithin (0.6 mu m) sections of the aorta were analyzed by 1) morphometry, 2) immunohistochemistry, and 3) Western blotting of key proteins involved in vascular calcification and growth. Compared with sham-operated animals (5.6 +/- 0.24), the wall-to-lumen ratio (x100) of the aorta was significantly higher in solvent-and calcitriol-treated UNX animals (6.64 +/- 0.27 and 7.17 +/- 0.81, respectively, P < 0.05), but not in paricalcitol-treated UNX (6.1 5 +/- 0.32). Similar differences were seen with respect to maximal plaque height. Expression of transforming growth factor (TGF)-beta 1 in aortic intima/plaque was also significantly higher in UNX solvent and UNX calcitriol compared with sham-operated and UNX paricalcitol animals. Treatment with both paricalcitol and calcitriol caused significant elevation of VDR expression in the aorta. While at the dose employed paricalcitol significantly reduced TGF-beta expression in plaques, calcitriol in contrast caused significant vascular calcification and elevated expression of related proteins (BMP2, RANKL, and Runx2).