Hemodiálise : qualidade de vida e parâmetros nutricionais

Tese de doutoramento, Ciências e Tecnologias da Saúde (Nutrição), Universidade de Lisboa, Faculdade de Medicina, 2014

Nutrição clínica aplicada à alimentação escolar

Relatório de estágio de mestrado, Nutrição Clínica, Universidade de Lisboa, Faculdade de Medicina, 2015

Big and beautiful: attractiveness and health ratings of the female body by male "fat admirers"

This study examined the body weight and waist-to-hip ratio (WHR) preferences of “fat admirers” (FAs), that is, individuals who are sexually attracted to heavier partners. Fifty-six heterosexual men involved in the FA community rated a series of line drawings that varied in three levels of body weight and six of WHR for physical attractiveness and health. The results showed significant main effects of body weight and WHR, as well as a significant body weight × WHR interaction for both health ratings. In general, there was a preference for heavyweight figures and high WHRs for ratings of attractiveness and normal-weight figures and mid-ranging WHRs for ratings of health. Limitations of the study and explanations for fat admiration are discussed.

Circulating pancreatic polypeptide concentrations predict visceral and liver fat content

CONTEXT AND OBJECTIVE: No current biomarker can reliably predict visceral and liver fat content, both of which are risk factors for cardiovascular disease. Vagal tone has been suggested to influence regional fat deposition. Pancreatic polypeptide (PP) is secreted from the endocrine pancreas under vagal control. We investigated the utility of PP in predicting visceral and liver fat. PATIENTS AND METHODS: Fasting plasma PP concentrations were measured in 104 overweight and obese subjects (46 men and 58 women). In the same subjects, total and regional adipose tissue, including total visceral adipose tissue (VAT) and total subcutaneous adipose tissue (TSAT), were measured using whole-body magnetic resonance imaging. Intrahepatocellular lipid content (IHCL) was quantified by proton magnetic resonance spectroscopy. RESULTS: Fasting plasma PP concentrations positively and significantly correlated with both VAT (r = 0.57, P < .001) and IHCL (r = 0.51, P < .001), but not with TSAT (r = 0.02, P = .88). Fasting PP concentrations independently predicted VAT after controlling for age and sex. Fasting PP concentrations independently predicted IHCL after controlling for age, sex, body mass index (BMI), waist-to-hip ratio, homeostatic model assessment 2-insulin resistance, (HOMA2-IR) and serum concentrations of triglyceride (TG), total cholesterol (TC), and alanine aminotransferase (ALT). Fasting PP concentrations were associated with serum ALT, TG, TC, low- and high-density lipoprotein cholesterol, and blood pressure (P < .05). These associations were mediated by IHCL and/or VAT. Fasting PP and HOMA2-IR were independently significantly associated with hepatic steatosis (P < .01). CONCLUSIONS: Pancreatic polypeptide is a novel predictor of visceral and liver fat content, and thus a potential biomarker for cardiovascular risk stratification and targeted treatment of patients with ectopic fat deposition.

Body fat MRS

The increasing levels of obesity, and its associated comorbidities, have prompted a reassessment of the techniques used for assessing body fat, including content, distribution, and composition. Magnetic resonance spectroscopy (MRS) is one among the many invaluable in vivo tools available today to evaluate the role of body fat in health and disease. However, although MRS has become a powerful technique for assessing ectopic fat in vivo, it has had limited use in other areas of research associated with body fat. MRS has found some success as a fast method to determine whole body adiposity in rodent models of disease, as well as a noninvasive method of obtaining an index of the overall composition of body fat in human subjects. Its more significant use has been in the understanding of bone marrow fat content, where important advances have been made, especially in longitudinal studies. In conclusion, in the area of body fat, MRS continues to be an adjunct technique to more precise and versatile MRI methods.

Intake of dairy products in relation to periodontitis in older Danish adults

This cross-sectional study investigates whether calcium intakes from dairy and non-dairy sources, and absolute intakes of various dairy products, are associated with periodontitis. The calcium intake (mg/day) of 135 older Danish adults was estimated by a diet history interview and divided into dairy and non-dairy calcium. Dairy food intake (g/day) was classified into four groups: milk, cheese, fermented foods and other foods. Periodontitis was defined as the number of teeth with attachment loss ≥3 mm. Intakes of total dairy calcium (Incidence-rate ratio (IRR) = 0.97; p = 0.021), calcium from milk (IRR = 0.97; p = 0.025) and fermented foods (IRR = 0.96; p = 0.03) were inversely and significantly associated with periodontitis after adjustment for age, gender, education, sucrose intake, alcohol consumption, smoking, physical activity, vitamin D intake, heart disease, visits to the dentist, use of dental floss and bleeding on probing, but non-dairy calcium, calcium from cheese and other types of dairy food intakes were not. Total dairy foods (IRR = 0.96; p = 0.003), milk (IRR = 0.96; p = 0.028) and fermented foods intakes (IRR = 0.97; p = 0.029) were associated with reduced risk of periodontitis, but cheese and other dairy foods intakes were not. These results suggest that dairy calcium, particularly from milk and fermented products, may protect against periodontitis. Prospective studies are required to confirm these findings.

Liver fat in adults with GH deficiency: comparison to matched controls and the effect of GH replacement

CONTEXT: Existing data regarding the association between growth hormone deficiency (GHD) and liver fat content are conflicting. OBJECTIVE: We aimed i) to assess intrahepatocellular lipid (IHCL) content in hypopituitary adults with GHD compared to matched controls and ii) to evaluate the effect of growth hormone (GH) replacement on IHCL content. DESIGN: Cross-sectional comparison and controlled intervention study. PATIENTS, PARTICIPANTS: Cross-sectional comparison: 22 hypopituitary adults with GHD and 44 healthy controls matched for age, BMI, gender and ethnicity. Intervention study: 9 GHD patients starting GH replacement (GH Rx group), 9 GHD patients not starting replacement therapy (non-GH Rx group). INTERVENTION: Intervention study:GH replacement for 6 months in the GH Rx group, dosage was titrated to achieve normal IGF-1 levels. MAIN OUTCOME MEASURES: IHCL content determined by proton magnetic resonance spectroscopy (1 H MRS). RESULTS: Cross-sectional comparison: There was no difference in IHCL content between GHD patients and healthy controls (1.89% (0.30, 4.03) vs. 1.14% (0.22, 2.32); p=0.2), the prevalence of patients with hepatic steatosis (IHCL of ≥ 5.56%) was similar in the two groups (22.7% vs. 15.9%; chi square probability = 0.4). Intervention study: The change in IHCL content over 6 months did not differ between the GH Rx group and the non-GH Rx group (-0.63 ± 4.53% vs. +0.11 ± 1.46%; p=0.6). CONCLUSIONS: In our study liver fat content and the prevalence of hepatic steatosis did not differ between hypopituitary adults with GHD and matched controls. In GHD patients GH replacement had no effect on liver fat content.

Anthropometric evaluation and micronutrients intake in patients submitted to laparoscopic Roux-en-Y gastric bypass with a postoperative period of ≥1 year

Backgroung - Bariatric surgery is indicated as the most effective treatment for morbid obesity; the Roux-en-Y gastric bypass (RYGB) is considered the procedure of choice. However, nutritional deficiency may occur in the postoperative period as a result of reduced gastric capacity and change in nutrients absorption in the gastrointestinal tract. The prescription of vitamin and mineral supplementation is a common practice after RYGB; however, it may not be sufficient to prevent micronutrient deficiencies. The aim of this study was to quantify the micronutrient intake in patients undergoing RYGB and verify if the intake of supplementation would be enough to prevent nutritional deficiencies. Methods - The study was conducted on 60 patients submitted to RYGB. Anthropometric, analytical, and nutritional intake data were assessed preoperatively and 1 and 2 years postoperatively. The dietary intake was assessed using 24-h food recall; the values of micronutrients evaluated (vitamin B12, folic acid, iron, and calcium) were compared to the dietary reference intakes (DRI). Results - There were significant differences (p < 0.05) between excess weight loss at the first and second year (69.9 ± 15.3 vs 9.6 ± 62.9 %). In the first and second year after surgery, 93.3 and 94.1 % of the patients, respectively, took the supplements as prescribed. Micronutrient deficiencies were detected in the three evaluation periods. At the first year, there was a significant reduction (p < 0.05) of B12, folic acid, and iron intake. Conclusions - Despite taking vitamin and mineral supplementation, micronutrient deficiencies are common after RYGB. In the second year after surgery, micronutrient intake remains below the DRI.

Relationship of milk intake and physical activity to abdominal obesity among adolescents

Background: Diet and physical activity (PA) are recognized as important factors to prevent abdominal obesity (AO), which is strongly associated with chronic diseases. Some studies have reported an inverse association between milk consumption and AO. Objective: This study examined the association between milk intake, PA and AO in adolescents. Methods: A cross-sectional study was conducted with 1209 adolescents, aged 15–18 from the Azorean Archipelago, Portugal in 2008. AO was defined by a waist circumference at or above the 90th percentile. Adolescent food intake was measured using a semi-quantitative food frequency questionnaire, and milk intake was categorized as ‘low milk intake’ (<2 servings per day) or ‘high milk intake’ ( 2 servings per day). PA was assessed via a self-report questionnaire, and participants were divided into active (>10 points) and low-active groups ( 10 points) on the basis of their reported PA. They were then divided into four smaller groups, according to milk intake and PA: (i) low milk intake/low active; (ii) low milk intake/active; (iii) high milk intake/low active and (iv) high milk intake/active. The association between milk intake, PA and AO was evaluated using logistic regression analysis, and the results were adjusted for demographic, body mass index, pubertal stage and dietary confounders. Results: In this study, the majority of adolescents consumed semi-skimmed or skimmed milk (92.3%). The group of adolescents with high level of milk intake and active had a lower proportion of AO than did other groups (low milk intake/low active: 34.2%; low milk intake/active: 26.9%; high milk intake/low active: 25.7%; high milk intake/active: 21.9%, P = 0.008). After adjusting for confounders, low-active and active adolescents with high levels of milk intake were less likely to have AO, compared with low-active adolescents with low milk intake (high milk intake/low active, odds ratio [OR] = 0.412, 95% confidence intervals [CI]: 0.201– 0.845; high milk intake/active adolescents, OR = 0.445, 95% CI: 0.235–0.845).Conclusion: High milk intake seems to have a protective effect on AO, regardless of PA level

Plaster body wrap: effects on abdominal fat

Background Abdominal fat is associated with metabolic disorders, leading to cardiovascular risk factors and numerous diseases. This study aimed to analyze the effect of plaster body wrap in combination with aerobic exercise on abdominal fat. Methods Nineteen female volunteers were randomly divided into intervention group (IG; n = 10) performing aerobic exercise with plaster body wrap, and control group (CG; n = 9) performing only exercise. Subcutaneous and visceral fat were measured using ultrasound; subcutaneous fat was also estimated on analysis of skinfolds and abdominal perimeters. Results At the end of the 10-sessions protocol, the IG demonstrated a significant decrease (p ≤ 0.05) in subcutaneous fat at the left anterior superior iliac spine (ASIS) level and in iliac crest perimeter measurements. A large intervention effect size strength (0.80) was found in subcutaneous fat below the navel and a moderate effect size strength on the vertical abdominal skinfold (0.62) and the perimeter of the most prominent abdominal point (0.57). Comparing the initial and final data of each group, the IG showed a significant decrease in numerous variables including visceral and subcutaneous fat above and below the navel measured by ultrasound (p ≤ 0.05). Conclusion Plaster body wrap in combination with aerobic exercise seems to be effective for abdominal fat reduction.

Seasonal patterns of polycyclic aromatic hydrocarbons in digestive gland and arm of octopus (Octopus vulgaris) from the Northwest Atlantic

Among organic pollutants existing in coastal areas, polycyclic aromatic hydrocarbons (PAHs) are of great concern due to their ubiquity and carcinogenic potential. The aim of this study was to evaluate the seasonal patterns of PAHs in the digestive gland and arm of the common octopus (Octopus vulgaris) from the Northwest Atlantic Portuguese coast. In the different seasons, 18 PAHs were determined and the detoxification capacity of the species was evaluated. Ethoxyresorufin O-deethylase (EROD) and ethoxycoumarin O-deethylase (ECOD) activities were measured to assess phase I biotransformation capacity. Individual PAH ratios were used for major source (pyrolytic/petrogenic) analysis. Risks for human consumption were determined by the total toxicity equivalence approach. Generally, low levels of PAHs were detected in the digestive gland and in the arm of octopus, with a predominance of low molecular over high molecular weight compounds. PAHs exhibited seasonality in the concentrations detected and in their main emission sources. In the digestive gland, the highest total PAH levels were observed in autumn possibly related to fat availability in the ecosystem and food intake. The lack of PAH elimination observed in the digestive gland after captivity could be possibly associated to a low biotransformation capacity, consistent with the negligible/undetected levels of EROD and ECOD activity in the different seasons. The emission sources of PAHs found in the digestive gland varied from a petrogenic profile observed in winter to a pyrolytic pattern in spring. In the arm, the highest PAH contents were observed in June; nevertheless, levels were always below the regulatory limits established for food consumption. The carcinogenic potential calculated for all the sampling periods in the arm were markedly lower than the ones found in various aquatic species from different marine environments. The results presented in this study give relevant baseline data for environmental monitoring of organic pollution in coastal areas.

Commercial squids: Characterization, assessment of potential health benefits/risks and discrimination based on mineral, lipid and vitamin E concentrations

The most consumed squid species worldwide were characterized regarding their concentrations of minerals, fatty acids, cholesterol and vitamin E. Interspecific comparisons were assessed among species and geographical origin. The health benefits derived from squid consumption were assessed based on daily minerals intake and on nutritional lipid quality indexes. Squids contribute significantly to daily intake of several macro (Na, K, Mg and P) and micronutrients (Cu, Zn and Ni). Despite their low fat concentration, they are rich in long-chain omega-3 fatty acids, particularly docosahexaenoic (DHA) and eicosapentanoic (EPA) acids, with highly favorable ω-3/ω-6 ratios (from 5.7 to 17.7), reducing the significance of their high cholesterol concentration (140–549 mg/100 g ww). Assessment of potential health risks based on minerals intake, non-carcinogenic and carcinogenic risks indicated that Loligo gahi (from Atlantic Ocean), Loligo opalescens (from Pacific Ocean) and Loligo duvaucelii (from Indic Ocean) should be eaten with moderation due to the high concentrations of Cu and/or Cd. Canonical discriminant analysis identified the major fatty acids (C14:0, C18:0, C18:1, C18:3ω-3, C20:4ω-6 and C22:5ω-6), P, K, Cu and vitamin E as chemical discriminators for the selected species. These elements and compounds exhibited the potential to prove authenticity of the commercially relevant squid species.

Prevalência de obesidade infanto-juvenil : associação com os hábitos alimentares, actividade física e comportamentos sedentários dos adolescentes escolarizados de Portugal Conti

RESUMO Nos países industrializados observam-se elevadas prevalências de pré- obesidade e obesidade em jovens e adolescentes, com consequências negativas para a saúde. A obesidade é apontada como o distúrbio nutricional mais frequente em crianças e adolescentes nos países desenvolvidos e é resultado da acumulação excessiva ou anormal de gordura no tecido adiposo. Segundo a I.O.T.F. considera- se que uma criança tem pré-obesidade quando o seu percentil de I.M.C. está entre o p88 e p99 para as raparigas e entre o p90 e o p99 para os rapazes. Considerase que tem obesidade quando o percentil de I.M.C. é superior ao p99, para ambos os sexos. A prevalência de pré-obesidade e obesidade em crianças e adolescentes tem vindo a aumentar a nível mundial a um ritmo alarmante, sobretudo nos países desenvolvidos e em alguns segmentos de países em desenvolvimento. Estudos demonstram que a obesidade em crianças e adolescentes se encontra fortemente correlacionada com o aumento da morbilidade e mortalidade, reflectindo-se numa variedade de situações patológicas com risco de persistência no adulto. Dada a sua extrema importância em termos de Saúde Pública, as tendências para a pré- obesidade e obesidade em crianças e adolescentes devem ser monitorizadas com especial atenção. Os hábitos alimentares e o gasto energético são factores que influenciam a obesidade e o seu controlo. Há estudos que concluem que existe uma associação directa entre estes factos e a presença de obesidade e outros apresentam conclusões contrárias. Pretendeu-se determinar a prevalência de excesso de peso (pré-obesidade e obesidade) infantojuvenil em Portugal e associá-la com os hábitos alimentares, actividade física e comportamentos sedentários dos adolescentes. A população em estudo é todos os adolescentes, de ambos os sexos, que frequentam o ensino básico (2º e 3º ciclos) e secundário oficial de Portugal Continental (n=5708). Todos os elementos em estudos foram avaliados antropometricamente (peso e altura) e responderam a um questionário de hábitos alimentares e frequência alimentar, actividade física e comportamentos sedentários. Como resultados do estudo verificou-se que a prevalência de pré- obesidade infanto-juvenil em Portugal é de 22,6% e a prevalência de obesidade de 7,8%. Quer a obesidade quer a pré-obesidade apresentam indicadores superiores nos rapazes (p=0,01) e nos adolescentes mais jovens (p=0,00). Em relação aos hábitos alimentares estudados é de referir que a frequência de consumo de refeições fora de casa é muito similar entre o grupo normoponderal e o grupo com excesso de peso sendo a refeição da ceia consumida por um número muito superior de adolescentes normoponderais comparativamente com os que apresentam excesso de peso (p=0,01). Em relação à ingestão de determinados alimentos ou grupos alimentícios, verificou-se que, regra geral, o consumo de alimentos de características nutricionais de baixa qualidade (gordura saturada, sal e açucares simples) era superior no grupo normoponderal comparativamente ao grupo com excesso de peso (refrigerantes, snacks, fast-food, cereais açucarados, sobremesas doces) (p<0,05). Em relação à actividade física, o número de horas semanais de actividade física diminui do grupo normoponderal para o grupo com excesso de peso. Dentro do grupo com excesso de peso, os obesos apresentam ainda uma média inferior em relação aos pré-obesos. Poderemos afirmar que quanto maior o índice de actividade física menor o percentil de I.M.C., mostrando-se assim a actividade física como um factor protector de um peso saudável (p<0,05). Quando solicitado que caracterizassem o estilo de vida e a habilidade desportiva, verificou-se que nos grupos com excesso de peso se caracterizavam em indicadores mais baixos do que os normoponderais (p<0,05). No que diz respeito aos comportamentos sedentários, verifica-se que são mais prevalentes nos grupos com excesso de peso do que no grupo normoponderal (p<0,05). Em conclusão, os resultados da prevalência de obesidade obtidos assemelham-se aos resultados obtidos noutros estudos, constituindo um dado revelador de uma situação bastante preocupante em termos de Saúde Pública. Em relação aos hábitos alimentares as diferenças não são significativas entre os diferentes grupos (normoponderal, pré-obesidade e obesidade). A actividade física apresentou-se como um factor protector do aumento de peso com uma associação directa com o estado nutricional (I.M.C.). Verificou-se que os adolescentes em Portugal que apresentavam indicadores mais elevados de actividade física eram aqueles que se encontravam com peso normal. Os comportamentos sedentários apresentaram-se como um factor propício ao desenvolvimento do excesso de peso estando directamente relacionados com o percentil de I.M.C. Os comportamentos sedentários mais frequentes são o visionamento televisivo e o computador/internet. Assim, poder-se-á fundamentar a necessidade de medidas interventivas a este nível com o intuito de controlar os indicadores encontrados. ABSTRACT In the industrialized countries high prevalences of pre-obesity and obesity are observed in youngsters and adolescents, with negative health consequences. Obesity is pointed as the most frequent nutritional disturbance in children and adolescents in developed countries and results from the excessive or abnormal accumulation of fat in the adipose tissue. According to the IOTF a child is pre-obese when the BMI percentile is between p88 and p99 for girls and between p90 and p99 for boys. Obesity is considered when the BMI percentile is above p99 for both sexes. The prevalence of pre-obesity and obesity in children and adolescents has been rising alarmingly worldwide, especially in developed countries and some segments of developing countries. Studies indicate that obesity in children and adolescents is strongly associated with increased morbidity and mortality resulting in a variety of pathological situations with risk of persistence in adulthood. Given its major Public Health importance, pre-obesity and obesity trends in children and adolescents should be monitored with special attention. Eating habits and energy expenditure are factors that influence obesity and its control. Some studies conclude that there is a direct association between these factors and the presence of obesity and others present opposite conclusions. It was intended to determine the prevalence of overweight (pre-obesity and obesity) in children and youth in Portugal and to associate it with eating habits, physical activity and sedentary behaviors of adolescents. The population in study is constituted by all adolescents of both sexes that attend basic (2nd and 3rd grade) and secondary official education of continental Portugal (n=5708). All participants in study were anthropometrically evaluated (weight and height) and answered a questionnaire of eating habits and food frequency, physical activity and sedentary behaviors. The study results indicate a prevalence of pre-obesity in children and youth in Portugal of 22.6% and a prevalence of obesity of 7.8%. Both obesity and pre-obesity present higher indicators in boys (p=0.01) and younger adolescents (p=0.00). In relation to the studied eating habits it should be noted that the frequency of consumption of meals away from home is very similar between the normal weight group and the overweight group. Moreover, the supper meal is consumed by a much larger number of normal weight adolescents as compared to the ones with overweight (p=0.01). Regarding the intake of certain foods or food groups, it was found that, in general, the consumption of foods with characteristics of low nutritional quality (saturated fat, salt and simple sugars) was higher in the normoponderal group compared with the overweight group (soft drinks, snacks, fast-food, sugary cereals, desserts) (p<0.05). In respect to physical activity, the number of weekly hours of physical activity decreases from the normoponderal group to the group with overweight. Within the group with overweight, obese subjects also present a lower average than pre-obese subjects. As we can affirm that the higher the physical activity index the lower the BMI percentile, physical activity appears as a protective factor for a healthy weight (p<0.05). When they were asked to characterize their lifestyle and sports ability, it was found that overweight groups characterized themselves with lower indicators than the normoponderal group (p<0.05). Regarding sedentary behaviors, it appears that they were more prevalent in groups with overweight than in the normoponderal group (p<0.05). In conclusion, the results of the obesity prevalence attained are similar to the results obtained in other studies, revealing a very worrying situation in terms of Public Health. In relation to the eating habits there were no significant differences between the groups (normoponderal, pre-obesity and obesity). Physical activity appears as a protective factor from weight gain with a direct association with nutritional status (BMI). It was found that young people in Portugal who had the highest indicators of physical activity were those who presented normal weight. The sedentary behaviors were presented as a factor conducive to the development of overweight being directly related to the BMI percentile. The most frequent sedentary behaviors were television viewing and computer/internet

Modelos Teóricos de Difusão Dérmica: abordagens matemáticas e computacionais para terapias transdérmicas da Obesidade

É de senso comum que os nutrientes são fundamentais à vida e que a subnutrição leva à acumulação de gorduras que pode chegar a casos de obesidade, tendo como consequência inúmeras complicações de saúde. Diferentes estruturas neuroanatómicas do cérebro têm um papel essencial no comportamento digestivo. A ação de várias moléculas de sinalização (hormonas, neurotransmissores e neuropéptidos) resulta na regulação da ingestão de alimentos, sendo que, por exemplo, algumas hormonas podem aumentar a sensação de saciedade podendo diminuir o apetite e a ingestão calórica. A descoberta de hormonas envolvidas no balanço energético proporcionou novas oportunidades para desenvolver meios para o tratamento da obesidade. A transferência de medicação antiobesidade por via tópica ou transdérmica é um desafio pois a pele funciona como uma barreira natural e protetora. Sendo uma barreira com uma grande área de superfície e de fácil acessibilidade, a pele tem potencial interesse na libertação de fármacos específicos a cada terapia. Vários métodos têm sido estudados de modo a permitir um aumento da permeabilidade de moléculas terapêuticas para o interior da pele e através da pele. As biotecnologias transdérmicas são um campo de interesse cada vez maior, devido as aplicações dérmicas e farmacêuticas que lhes estão subjacentes. Existem vários modelos computacionais e matemáticos em uso que permite uma visão mais abrangente de puros dados experimentais e até mesmo permite a extrapolação prática de novas metodologias de difusão dérmica. Contudo, eles compreendem uma complexa variedade de teorias e suposições que atribuem a sua utilização para situações específicas. Este trabalho, primeiramente analisa, de forma extensiva, as várias metodologias teóricas para o estudo da difusão dérmica e sistematiza as suas características, realizando depois a fase prévia duma nova abordagem computacional para o estudo da difusão dérmica, que determina características microscópicas de moléculas capazes de provocar a perda de peso, tais como a Leptina e/ou os seus agonistas.