Associations between nutritional markers and inflammation in hemodialysis patients

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Three-year follow-up study of respiratory and systemic manifestations of chronic obstructive pulmonary disease

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Different nutritional-state indicators of HIV-positive individuals undergoing antiretroviral therapy

This study aimed at learning about the nutritional profile of HIV-positive individuals undergoing antiretroviral therapy and at comparing the performance of nutritional-state indicators. A transversal study was performed on 94 patients attending the Tropical Diseases Outpatient Hospital of Botucatu Medical School (FMB)-UNESP. The body mass index (BMI) and the classification by Papini-Berto (PB) were used to evaluate nutritional state, aiming at detecting malnutrition and obesity. The waist-to-hips ratio (W/HR) and waist circumference (WC) were adopted for identification of abdominal obesity and lipodystrophy. According to BMI, most of the individuals were eutrophic, followed by 30.9% overweight and 6.4% malnourished. By using the PB classification, the frequency of malnourished increased (22.3%). The analysis of the PB classification in relation to BMI indicated that the former presented high sensitivity and good specificity for malnutrition diagnosis, namely 100% and 83%, respectively. The prevalence of abdominal obesity was 7.44% according to WC, and a higher prevalence (38.3%) was observed when taking W/HR into account. There was significant positive association between nutritional diagnosis according to PB and T CD4(+) lymphocyte. The results support the use of PB classification for malnutrition detection as well as that of BMI and W/HR for overweight and fat redistribution.

Fatores de risco para osteoporose em mulheres na pós-menopausa do sudeste brasileiro

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Fatores de risco para macrossomia fetal em gestações complicadas por diabete ou por hiperglicemia diária

OBJETIVO: identificar fatores de risco para a macrossomia fetal na população de gestantes portadoras de diabete ou hiperglicemia diária. MÉTODOS: estudo retrospectivo, tipo caso-controle, incluindo 803 pares de mães e recém-nascidos desta população específica, distribuídos em dois grupos: macrossômicos (casos, n=242) e não macrossômicos (controles, n=561). Foram comparadas variáveis relativas à idade, paridade, peso e índice de massa corporal (IMC), ganho de peso (GP), antecedentes de diabete, hipertensão arterial e tabagismo, tipo e classificação do diabete e indicadores do controle glicêmico no terceiro trimestre. As médias foram avaliadas pelo teste F e as variáveis categorizadas foram submetidas à análise univariada, utilizando-se o teste do chi². Os resultados significativos foram incluídos no modelo de regressão múltipla, para identificação do risco independente de macrossomia, considerando-se OR, IC 95% e valor de p. Para todas as análises foi estabelecido o limite de significância estatística de 5% (p<0,05). RESULTADOS: observou-se associação significativa entre macrossomia e GP maior que 16 kg, IMC >25 kg/m², antecedentes pessoais, obstétricos e, especificamente, o de macrossomia, classificação nos grupos de Rudge (IB e IIA + IIB), média glicêmica (MG) >120 mg/dL e média de glicemia pós-prandial >130 mg/dL no terceiro trimestre. Na análise de regressão múltipla, o GP >16 kg (OR=1,79; IC 95%: 1,23-1,60), o IMC >25 kg/m² (OR=1,83; IC 95%: 1,27-2,64), o antecedente pessoal de diabete (OR=1,56; IC 95%: 1,05-2,31) e de macrossomia (OR=2,37; IC 95%: 1,60-3,50) e a MG >120 mg/dL no terceiro trimestre (OR=1,78; IC 95%: 1,13-2,80) confirmaram risco independente para macrossomia nestas gestações de risco. CONCLUSÃO: o GP superior a 16 kg, o IMC maior ou igual a 25 kg/m², a MG superior a 120 mg/dL no terceiro trimestre e a presença de antecedentes pessoais de diabete ou de macrossomia foram identificados como fatores de risco para macrossomia fetal em gestantes portadoras de diabete ou de hiperglicemia diária.

Indicadores antropométricos e as doenças crônicas não transmissíveis em mulheres na pós-menopausa da região Sudeste do Brasil

OBJETIVO: avaliar a influência dos indicadores antropométricos sobre os marcadores de risco cardiovascular e metabólico para doenças crônicas não-transmissíveis em mulheres na pós-menopausa. MÉTODOS: realizou-se estudo clínico transversal, com 120 mulheres sedentárias na pós-menopausa (com idades entre 45 e 70 anos e última menstruação há, pelo menos, 12 meses). Foram excluídas as diabéticas insulino-dependentes e usuárias de estatinas ou terapia hormonal até seis meses prévios. Para avaliação antropométrica, foram obtidos peso, estatura, índice de massa corpórea (IMC=peso/altura²) e circunferência da cintura (CC). As variáveis metabólicas avaliadas foram colesterol total (CT), HDL, LDL, triglicérides (TG), glicemia e insulina, para os cálculos do índice aterogênico plasmático (IAP) e resistência insulínica (Homeostasis model assessment-insulin resistance, HOMA-IR). Na análise estatística, utilizara-se análise de variância one-way (ANOVA) e Odds Ratio (OR). RESULTADOS: os dados médios caracterizaram amostra com sobrepeso, com obesidade central e dislipidêmica. Sobrepeso e obesidade estiveram presentes em 77,1% e deposição central de gordura ocorreu em 87,3% das participantes. Os valores médios de CT, LDL e TG estavam acima do recomendável em 67,8, 55,9 e 45,8% das mulheres, respectivamente, com HDL abaixo dos valores adequados em 40,7%. Valores de CC >88 cm ocorreram em 14,8% das mulheres eutróficas, 62,5% no grupo com sobrepeso e 100% nas obesas (p>0,05). Os valores médios de IAP, TG e HOMA-IR aumentaram significativamente com o aumento do IMC e da CC, enquanto que o HDL diminuiu (p<0,05). Na presença da CC >88 cm, encontrou-se risco de 5,8 (IC95%=2,3-14,8), 2,61 (IC95%=1,2-5,78), 3,4 (IC95%=1,2-9,7) e 3,6 (IC95%=1,3-10,3) para HDL reduzido, hipertrigliceridemia, IAP elevado e resistência a insulina, respectivamente (p<0,05). O IMC >30 kg/m² associou-se apenas com HDL reduzido (OR=3,1; IC95%=1,44-6,85). CONCLUSÕES: a associação de duas medidas antropométricas (CC e IMC) foi eficiente para adequado diagnóstico de obesidade relacionada a alterações metabólicas em mulheres na pós-menopausa. Contudo, a simples avaliação da CC pode ser indicativo do risco cardiovascular e metabólico das doenças crônicas não transmissíveis.

Associations between healthy eating patterns and indicators of metabolic risk in postmenopausal women

Background: Since human diets contain many components that may work synergistically to prevent or promote disease, assessing diet quality may be informative. The purpose of this study was to investigate the association between quality diet, by using Healthy Eating Index (HEI), and metabolic risk indicators in postmenopausal women.Methods: This cross-sectional study included a total of 173 Brazilian women, aged 45-75 years, seeking healthcare at a public outpatient center. Food consumption assessed by 24 h-recall food inquiry was used to calculate HEI scores: >80 implied diet good, 80-51 diet needed improvement, and <51 diet poor. Anthropometric data included: body mass index (BMI = weight/height(2)), waist-circumference (WC), body fat (%BF) and lean mass (%LM). Data on total cholesterol (TC), high density lipoprotein cholesterol (HDLC), low density lipoprotein cholesterol (LDLC), and triglycerides (TG) were also collected. Fisher's Exact test, and logistic regression method (to determine odds ratio, OR) were used in the statistical analysis.Results: Overweight and obesity were observed in 75.7% of the participants. Excessive %BF (> 35%) was observed in 56.1%, while %LM was reduced (<70%) in 78.1%. WC was elevated (= 88 cm) in 72.3%. Based on HEI values, diet quality was good in 3% (5/173), needed improvement in 48.5% (84/173), and was poor in 48.5% (84/173) of the cases. In this group, 75% of women had high intakes of lipids (> 35%), predominantly saturated and monounsaturated fat. on average, plasma TC, LDLC, and TG levels were higher than recommended in 57.2%, 79.2% and 45.1% of the women, respectively, while HDLC was low in 50.8%. There was association between HEI scores and the %BF that it was higher among women with HEI score < 80 (p = 0.021). There were not observed significant risk associations between HEI and lipid profile.Conclusion: Among the Brazilian postmenopausal women attending a public outpatient clinic, diet was considered to need improvement or to be of poor quality, attributed to high saturated fat ingestion, which probably caused a negative impact on metabolic risk indicators, namely body composition.

Assessment of risk factors for low bone mineral density in Brazilian postmenopausal women

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Quality of life in women with vulvar cancer submitted to surgical treatment: a comparative study

Objectives: To investigate the occurrence and severity of lymphoedema of the lower extremities (LLE), quality of life (QoL), and urinary and sexual dysfunction in women with vulvar cancer submitted to surgical treatment.Study design: Twenty-eight patients with vulvar cancer submitted to vulvectomy and inguinofemoral lymphadenectomy and 28 healthy, age-matched women (control group) were evaluated. The occurrence and severity of LLE were determined by Miller's Clinical Evaluation. QoL, urinary function and sexual function were assessed by the EORTC QLQ-C30, SF-ICIQ and FSFI questionnaires, respectively. The differences between groups and correlations were assessed using Student's r-test, Chi-squared test, Mann-Whitney U-test and Spearman's rho test.Results: The groups were similar in terms of marital status, educational status, menopausal status, hormone therapy and height. The occurrence and severity of LLE were higher in women with vulvar cancer compared with the control group (p < 0.001 and p = 0.003, respectively). A significant association was found between the severity of LLE and advanced age (p = 0.04), and the severity of LLE and higher body mass index (BMI; p = 0.04) in patients with vulvar cancer. In the patients with vulvar cancer, there was a significant correlation between the severity of LLE and worse QoL in the following domains: physical, cognitive, emotional, social, fatigue, pain, sleep and financial questions (p < 0.05). There was no difference in urinary function between the two groups (p = 0.113). Age and number of deliveries were the only variables associated with the occurrence of urinary incontinence (p = 0.01). Urinary incontinence was present in women with a mean age of 74.9 +/- 4.6 years and a mean of 7.3 +/- 1.3 normal deliveries. There was no difference between the groups in terms of the sexual function. Multivariate analysis showed an association between sexual function and age (p = 0.01), and sexual function and being in a stable relationship (p = 0.02).Conclusion: Patients submitted to vulvectomy or inguinofemoral lymphadenectomy for vulvar cancer are at higher risk of developing LLE compared with healthy, age-matched women. This has a negative effect on QoL, but does not interfere with urinary or sexual function. (C) 2012 Elsevier B.V. All rights reserved.

Mild gestational hyperglycaemia as a risk factor for metabolic syndrome in pregnancy and adverse perinatal outcomes

Objective The aims of this study were to evaluate the prevalence of metabolic syndrome (MS) in a cohort of pregnant women with a wide range of glucose tolerance, pre-pregnancy risk factors for MS during pregnancy and the effects of MS in the occurrence of adverse perinatal outcomes.Research Design and Methods One hundred and thirty six women with positive screening for gestational diabetes (GDM) were classified by two diagnostic methods: glycaemic profile and 100 g oral glucose tolerance test (OGTT) as normoglycaemic, mild gestational hyperglycaemic, GDM, and overt GDM. Markers of insulin resistance were measured between 24-28 and 36th week of gestation, and 6 weeks after delivery.Results The prevalence of MS was 0; 20.0; 23.5 and 36.4% in normoglycaemic, mild hyperglycaemic, GDM and overt GDM groups, respectively. Previous history of GDM with or without insulin use, body mass index (BMI) >= 25, hypertension, family history of diabetes in first-degree relatives, non-Caucasian ethnicity, history of prematurity and polyhydramnios were statistically significant pre-pregnancy predictors for MS in the index pregnancy, that by its turn increased the occurrence of adverse perinatal outcomes (p = 0.01).Conclusions The prevalence of MS increases with the worsening of glucose tolerance and is an independent predictor of adverse perinatal outcomes; impaired glycaemic profile identifies pregnancies with important metabolic abnormalities that are linked to the occurrence of adverse perinatal outcomes even in the presence of a normal OGTT, in patients that are not currently classified as having GDM. Copyright (C) 2008 John Wiley & Sons, Ltd.

Resting energy expenditure and carbohydrate oxidation are higher in elderly patients with COPD: a case control study

Background: Elderly patients with chronic obstructive pulmonary disease (COPD) usually have a compromised nutritional status which is an independent predictor of morbidity and mortality. To know the Resting Energy Expenditure (REE) and the substrate oxidation measurement is essential to prevent these complications. This study aimed to compare the REE, respiratory quotient (RQ) and body composition between patients with and without COPD.Methods: This case-control study assessed 20 patients with chronic obstructive pulmonary disease attending a pulmonary rehabilitation program. The group of subjects without COPD (control group) consisted of 20 elderly patients attending a university gym, patients of a private service and a public healthy care. Consumption of oxygen (O-2) and carbon dioxide (CO2) was determined by indirect calorimetry and used for calculating the resting energy expenditure and respiratory quotient. Body mass index (BMI) and waist circumference (WC) were also measured. Percentage of body fat (%BF), lean mass (kg) and muscle mass (kg) were determined by bioimpedance. The fat free mass index (FFMI) and muscle mass index (MMI) were then calculated.Results: The COPD group had lower BMI than control (p = 0.02). However, WC, % BF, FFMI and MM-I did not differ between the groups. The COPD group had greater RQ (p = 0.01), REE (p = 0.009) and carbohydrate oxidation (p = 0.002).Conclusions: Elderly patients with COPD had higher REE, RQ and carbohydrate oxidation than controls.

Prevalência de sobrepeso/obesidade em crianças e adolescentes com constipação crônica funcional

OBJETIVO: Avaliar a prevalência do sobrepeso/obesidade em um grupo de crianças com constipação crônica funcional. MÉTODOS: Estudo retrospectivo com 257 crianças de dois a 15 anos com constipação crônica funcional diagnosticada segundo critérios de Roma II, atendidas consecutivamente em clínica terciária de gastroenterologia pediátrica. Informações demográficas, clínicas, diagnósticas e antropométricas foram obtidas de prontuários. O índice de massa corporal (IMC) foi calculado e utilizou-se a referência do Centers for Disease Control para determinar o percentil de IMC para idade e gênero. Crianças com percentil de IMC>85 foram consideradas com sobrepeso/obesidade; as com percentis > 5 e <85 foram classificadas como eutróficas. RESULTADOS: Para as variáveis sociodemográficas e clínicas, não houve diferença estatisticamente significante entre os subgrupos sobrepeso/obesidade e eutrofia. A prevalência de crianças constipadas com sobrepeso/obesidade foi de 24,4%. A média dos percentis do subgrupo sobrepeso/obesidade foi 94,4±4,3; a das eutróficas foi 45,3±24,2. A prevalência de sobrepeso/obesidade foi similar em ambos os sexos e grupos etários (<7 anos e >7 anos). CONCLUSÕES: Os subgrupos dos eutróficos e sobrepeso/obesidade foram homogêneos nas características sociodemográficas e clínicas, sugerindo que tais variáveis não influenciaram na prevalência do excesso de peso. A prevalência estimada de sobrepeso/obesidade entre as crianças com constipação crônica funcional está dentro dos valores esperados para a população pediátrica brasileira.

Indicadores antropométricos como marcadores de risco para anormalidades metabólicas

O objetivo do presente trabalho foi avaliar qual indicador antropométrico apresenta maior relação com as anormalidades metabólicas em participantes de um programa de Mudança de Estilo de Vida. Tratou-se de uma pesquisa do tipo exploratória, transversal e analítica, na qual foram avaliados 273 adultos e idosos (idade superior a 40 anos) quanto ao Índice de Massa Corporal (IMC), circunferência cintura (CC), % gordura corporal (GT) e % massa muscular (%MM). Foi colhida amostra de sangue em jejum para dosagem de colesterol total e frações, triacilglicerol e glicose. Foram realizadas análises estatísticas para diferenciação entre os grupos e determinação de associações. O nível de significância adotado foi de p<0,05. Ao avaliar as anormalidades metabólicas como variável dependente e IMC, CC, GT, %MM como variáveis independentes, observamos que a CC foi o indicador antropométrico que mostrou melhor associação com todas as anormalidades metabólicas (p<0,0001), seguida da %MM. Conclui-se que as anormalidades metabólicas comumente associadas à obesidade apresentam como principal marcador de risco antropométrico a CC e não o IMC. Dado um mesmo valor de CC, sobrepesos e obesos apresentaram riscos à saúde comparáveis aos indivíduos eutróficos.

Sagital abdominal diameter, but not waist circumference is strongly associated with glycemia, triacilglycerols and HDL-c levels in overweight adults

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The role of salt abuse on risk for hypercalciuria

Background: Elevated sodium excretion in urine resulting from excessive sodium intake can lead to hypercalciuria and contribute to the formation of urinary stones. The aim of this study was to evaluate salt intake in patients with urinary lithiasis and idiopathic hypercalciuria (IH).Methods: Between August 2007 and June 2008, 105 lithiasic patients were distributed into 2 groups: Group 1 (n = 55): patients with IH (urinary calcium excretion > 250 mg in women and 300 mg in men with normal serum calcium); Group 2 (n = 50): normocalciuric patients (NC). Inclusion criteria were: age over 18 years, normal renal function (creatinine clearance >= 60 ml/min), absent proteinuria and negative urinary culture. Pregnant women, patients with intestinal pathologies, chronic diarrhea or using corticoids were excluded. The protocol of metabolic investigation was based on non-consecutive collection of two 24-hour samples for dosages of: calcium, sodium, uric acid, citrate, oxalate, magnesium and urinary volume. Food intake was evaluated by the three-day dietary record quantitative method, and the Body Mass Index (BMI) was calculated and classified according to the World Health Organization (WHO). Sodium intake was evaluated based on 24-hour urinary sodium excretion.Results: The distribution in both groups as regards mean age (42.11 +/- 10.61 vs. 46.14 +/- 11.52), weight (77.14 +/- 16.03 vs. 75.99 +/- 15.80), height (1.64 +/- 0.10 vs. 1.64 +/- plusorminus 0.08) and BMI (28.78 +/- 5.81 vs. 28.07 +/- 5.27) was homogeneous. Urinary excretion of calcium (433.33 +/- 141.92 vs. 188.93 +/- 53.09), sodium (280.08 +/- 100.94 vs. 200.44.93 +/- 65.81), uric acid (880.63 +/- 281.50 vs. 646.74 +/- 182.76) and magnesium (88.78 +/- 37.53 vs. 64.34 +/- 31.84) was significantly higher in the IH group (p < 0.05). There was no statistical difference in calcium intake between the groups, and there was significantly higher salt intake in patients with IH than in NC.Conclusions: This study showed that salt intake was higher in patients with IH as compared to NC.