Programa Bolsa Família na coorte de nascimentos de Pelotas, 2004: focalização e impactos no IMC/Idade, obesidade e composição corporal de crianças

Introdução: O Programa Bolsa Família é a principal estratégia brasileira para amenizar a pobreza e vulnerabilidade social, com diferentes impactos na vida dos beneficiários. O aumento da renda, em função do benefício, poderia trazer resultados positivos na alimentação, uma vez que possibilitam uma maior diversidade da dieta. Porém, poderia trazer resultados negativos como a ingestão excessiva de energia e consequente aumento da adiposidade. As avaliações dos impactos do programa em termos de obesidade e massa gorda de crianças são inexistentes. Objetivo: Avaliar o impacto do Programa Bolsa Família no estado nutricional (IMC/idade) e na composição corporal aos 6 anos de idade entre as crianças da Coorte de Nascimentos de Pelotas (RS), 2004. Métodos: Os dados foram provenientes da integração dos bancos da Coorte de Nascimentos de Pelotas de 2004 e do Cadastro Único do Governo Federal. Foi realizada análise descritiva da cobertura e focalização do programa, com informações do nascimento e dos 6 anos de idade (n=4231). Considerou-se focalização o percentual de elegíveis entre o total de beneficiários e cobertura o percentual de famílias elegíveis que são beneficiárias do programa. Nos modelos de impacto (n=3446), as exposições principais foram o recebimento do benefício: beneficiário em 2010, no período de 2004-2010; o valor médio mensal recebido e o tempo de recebimento. Foram gerados modelos de regressão linear para os desfechos score-Z do índice de massa corporal por idade (IMC/I), percentual e índice de massa gorda (IMG), e percentual e índice de massa livre de gordura (IMLG); e de Poisson, com ajuste robusto, para o desfecho obesidade (score-Z IMC/I 2), todos estratificados por sexo. As informações antropométricas e de composição corporal (BOD POD) foram obtidas do acompanhamento aos 6-7 anos de idade. Potenciais fatores de confusão foram identificados por modelo hierárquico e por um diagrama causal (DAG). Para analisar os impactos foram usadas como medidas de efeito a diferença de médias na regressão linear múltipla (IMC/I, por cento MG, IMG, por cento MLG e IMLG, variáveis contínuas) e a razão de prevalência (obesidade, variável binária). Para permanecer no modelo, considerou-se valor p0,20. A análise dos dados foi realizada por meio do software STATA. Resultados: Entre 2004-2010, a proporção de famílias beneficiárias na coorte aumentou (11 por cento para 34 por cento ) enquanto, de acordo com a renda familiar, a proporção de famílias elegíveis diminui (29 por cento para 16 por cento ). No mesmo período, a cobertura do programa aumentou tanto pela renda familiar quanto pelo IEN. Já a focalização caiu de 78 por cento para 32 por cento de acordo com a renda familiar e, de acordo com o IEN, manteve-se em 37 por cento . A média (não ajustada) de IMC e de MG dos não beneficiários foi superior a dos não beneficiários tanto em meninos quanto em meninas. Meninos do 3º tercil de valor per capita recebido e meninas com menos de 7 meses de benefício em 2010 tiveram IMC maior do que, respectivamente, aqueles dos demais tercis e daquelas com mais de 7 meses de benefício em 2010; esse padrão foi semelhante para obesidade. Meninas não beneficiárias tiveram MG maior do que as beneficiárias e superior também aos meninos, independente de ser beneficiário ou não. Em relação à MLG observou-se um comportamento contrário, no qual meninas beneficiárias tiveram maior MLG, quando comparadas com meninas não beneficiárias e, meninos quando comparados com meninas. Nos modelos de regressão ajustados, não houve diferença significativa entre beneficiários e não beneficiários em nenhum desfecho. Conclusões: De acordo com os resultados, as famílias que receberam maiores valores per capita parecem incluir crianças com maior média de IMC. O programa, nessa análise, parece não ter impacto sobre a composição corporal das crianças, nem em termos de massa gorda, tampouco em termos de massa livre de gordura.

Avaliação da musculatura inspiratória e expiratória na doença pulmonar obstrutiva crônica leve e grave comparada aos indivíduos saudáveis

Introdução: A DPOC é uma doença respiratória prevenível e tratável, caracterizada por limitação persistente ao fluxo aéreo, hiperinsuflação e aprisionamento aéreo. A dispneia e a intolerância aos esforços, decorrentes destas alterações fisiopatológicas sofre influência de vários fatores. Dentre estes, o recrutamento e a sobrecarga imposta aos músculos inspiratórios e expiratórios são de fundamental importância, porém a participação destes ainda não foi completamente elucidada em diferentes gravidades da doença. Objetivos: O objetivo principal deste estudo foi avaliar a mecânica ventilatória, e o grau de recrutamento da musculatura inspiratória e expiratória na DPOC leve e grave, na condição de repouso e durante um teste máximo de exercício, comparado a um grupo de indivíduos saudáveis. Metodologia: Trata-se de um estudo transversal envolvendo 36 indivíduos, sendo 24 pacientes portadores de DPOC e 12 voluntários sadios. As avaliações foram divididas em 2 visitas. No D1, foram realizadas uma avaliação clínica, avaliação de dispneia (mMRC) e de qualidade de vida (SGRQ), além da prova de função pulmonar completa. Na 2ª visita, realizada com intervalo de 1 semana, foram avaliadas: as pressões respiratórias máximas estáticas por meio de métodos volitivos (PImax, PEmax, SNIP, Pes sniff, Pga sniff e Pdi sniff) e não volitivos (Twitch cervical bilateral e T10); avaliação da sincronia toracoabdominal por pletismografia de indutância; avaliação do recrutamento dos músculos inspiratórios e expiratórios ao repouso pela eletromiografia de superfície; e, posteriormente, um teste de exercício cardiopulmonar incremental para estudo de todas essas variáveis no esforço. Resultados: Foram avaliados 24 pacientes (12 leves e 12 graves) e 12 indivíduos saudáveis da mesma faixa etária. A maioria dos pacientes apresentava comprometimento significativo da qualidade de vida e os pacientes do grupo grave eram mais sintomáticos. A função pulmonar encontrava-se alterada na maioria dos pacientes. Destes, 79,2% apresentavam aprisionamento aéreo e 70,8% tinham redução da DLCO. Tais alterações foram semelhantes nos 2 grupos de pacientes. A força muscular estática medida por métodos volitivos e não volitivos estava reduzida nos 2 grupos e mostrou relação com o VEF1. No exercício, a dispneia foi o principal motivo para interrupção do teste em 70% dos pacientes. A HD esteve presente em 87,5% dos pacientes. O comportamento das pressões respiratórias foi significativamente diferente entre os 3 grupos. Os pacientes com DPOC apresentaram maior atividade diafragmática (Pdi) comparado aos controles e a participação da musculatura expiratória também foi maior neste grupo, principalmente nos graves. Apesar disso, os pacientes com DPOC apresentaram uma eficiência mecânica reduzida, ou seja, esse incremento da força muscular foi insuficiente para manter uma ventilação adequada para uma determinada carga. Com o aumento da demanda ventilatória, houve recrutamento precoce e progressivo dos músculos inspiratórios e expiratórios durante o exercício. O trabalho resistivo e o expiratório foram significativamente diferentes entre os controles e os pacientes com DPOC desde o início do exercício. Como consequência destas alterações, a intensidade da dispneia durante o TECP foi maior nos pacientes com DPOC (leve e grave) para a mesma carga e mesma ventilação-minuto (VE), quando comparada aos indivíduos do grupo-controle. Conclusões: O conjunto destes achados demonstra que o comprometimento dos músculos inspiratórios e expiratórios contribuiu significativamente para a dispneia e a intolerância ao exercício tanto no DPOC leve quanto no DPOC grave. E que este comprometimento pode não ser detectado com os testes máximos de força ao repouso

Alpha-lipoic acid does not acutely affect resistance and conduit artery function or oxidative stress in healthy men

Aims Alpha-lipoic acid (ALA) is a thiol compound with antioxidant properties used in the treatment of diabetic polyneuropathy. ALA may also improve arterial function, but there have been scant human trials examining this notion. This project aimed to investigate the effects of oral and intra-arterial ALA on changes in systemic and regional haemodynamics, respectively. Methods In study 1, 16 healthy older men aged 58 +/- 7 years (mean +/- SD) received 600 mg of ALA or placebo, on two occasions 1 week apart, in a randomized cross-over design. Repeated measures of peripheral and central haemodynamics were then obtained for 90 min. Central blood pressure and indices of arterial stiffness [augmentation index (AIx) and estimated aortic pulse wave velocity] were recorded non-invasively using pulse wave analysis. Blood samples obtained pre- and post-treatments were analysed for erythrocyte antioxidant enzyme activity, plasma nitrite and malondialdehyde. In study 2 the effects of incremental cumulative doses (0.5, 1.0, 1.5 and 2.0 mg ml(-1) min(-1)) of intra-arterial ALA on forearm blood flow (FBF) were assessed in eight healthy subjects (aged 31 +/- 5 years) by conventional venous occlusion plethysmography. Results There were no significant changes on any of the central or peripheral haemodynamic measures after either oral or direct arterial administration of ALA. Plasma ALA was detected after oral supplementation (95% confidence intervals 463, 761 ng ml(-1)), but did not alter cellular or plasma measures of oxidative stress. Conclusions Neither oral nor intra-arterial ALA had any effect on regional and systemic haemodynamics or measures of oxidative stress in healthy men.

Haemodynamic assessment following inferior vena cava resection without replacement

Background: Treatment of bulky retroperitoneal malignancy may require en bloc resection of the infrarenal inferior vena cava. A number of reconstructive options are available to the surgeon but objective haemodynamic assessment of the peripheral venous system following resection without replacement is lacking. The aim of the present paper was thus to determine the symptomatic and haemodynamic effects of not reconstructing the resected infrarenal inferior vena cava. Methods: A retrospective descriptive study was carried out at Princess Alexandra Hospital in Queensland. Five patients underwent resection of the thrombosed infrarenal inferior vena cava as part of retroperitoneal lymph node dissection for testicular cancer (n = 3), radical nephrectomy for renal cell carcinoma (n = 1) and thrombosed inferior vena cava aneurysm (n = 1). Clinical effects were determined via the modified venous clinical severity score and venous disability score. Haemodynamic data were obtained postoperatively using venous duplex ultrasound and air plethysmography. Results: None of the present patients scored >2 (out of 30) on the modified venous clinical severity score or >1 (out of 3) on the venous disability score. Haemodynamic studies showed only minor abnormalities. Conclusions: Not reconstructing the resected thrombosed infrarenal inferior vena cava results in minor signs and symptoms of peripheral venous hypertension and only minor abnormalities on haemodynamic assessment.

Effects of aldosterone on forearm vasculature in treated chronic heart failure

The nongenomic effects of aldosterone in disease states associated with endothelial dysfunction may differ from those in healthy subjects. The effects of locally infused aldosterone on the forearm blood flow and volume were studied in optimally treated patients with chronic heart failure (CHF). At baseline and after incremental intrabrachial aldosterone, forearm blood flow was assessed using conventional strain gouge plethysmography, and forearm venous volume was assessed by radionuclide plethysmography. Constriction of the resistance vasculature of the forearm without significant effect on forearm venous capacitance was demonstrated in response to aldosterone in patients treated for CHF. (C) 2005 by Excerpta Medica Inc.

Body composition in children in remission from acute lymphoblastic leukemia

Background: Changes in body composition are commonly reported in pediatric survivors of acute lymphoblastic leukemia (ALL). However, the effect of ALL and of its treatment on body composition in children in remission from ALL has not been fully examined with the use of a reference method. Objectives: We aimed to determine the body composition and composition of fat-free mass (FFM) in children in remission from ALL. We also aimed to compare the effects that prednisolone and dexamethasone had on the body composition of an ALL survivor population. Design: This cross-sectional study measured height, weight, body volume, total body water, and bone mineral content in 24 children in remission from ALL and 24 age-matched, healthy control subjects. Body composition and FFM composition were evaluated by using the 4-component model. Results: The mean body mass index and fat mass index were significantly (P = 0.05 for both) higher in the ALL survivors than in age-matched control subjects. The composition of the FFM in the 2 treatment groups was not observed to differ significantly. Examination of the composition of FFM made it evident that children in remission from ALL had both significantly greater hydration (P = 0.001) and lower density (P = 0.0001) of FFM than did the control children. Conclusions: Children in remission from ALL may develop excess body fat. To measure body composition accurately in an ALL population, the high hydration and low density of FFM in this population should be taken into consideration.

Development of a non-intrusive system to monitor radial pulse wave velocity

Understanding arterial distensibility has shown to be important in the pathogenesis of cardiovascular abnormalities like hypertension. It is also known that arterial pulse wave velocity (PWV) is a measure of the elasticity or stiffness of peripheral arterial blood vessels. However, it generally requires complex instrumentations to have an accurate measurement and not suited for continual monitoring. In this paper, it describes a simple and non-intrusive method to detect the cardiovascular pulse from a human wrist above the radial artery and a fingertip. The main components of this proposed method are a piezoelectric transducer and a photo-plethysmography circuitry. 5 healthy adults (4 male) with age ranging from 25 to 38 years were recruited. The timing consistency of the detected pulsations is first evaluated and compared to that obtained from a commercial electrocardiogram. Furthermore, the derived PWV is then assessed by the predicted values attained from regression equations of two previous similar studies. The results show good correlations (p < 0.05) and similarities for the former and latter respectively. The simplicity and non-invasive nature of the proposed method can be attractive for even younger or badly disturbed patients. Moreover, it can be used for prolonged monitoring for the comfort of the patients.

A three dimensional surface measurement and reconstruction system for respiratory function analysis

Respiration is a complex activity. If the relationship between all neurological and skeletomuscular interactions was perfectly understood, an accurate dynamic model of the respiratory system could be developed and the interaction between different inputs and outputs could be investigated in a straightforward fashion. Unfortunately, this is not the case and does not appear to be viable at this time. In addition, the provision of appropriate sensor signals for such a model would be a considerable invasive task. Useful quantitative information with respect to respiratory performance can be gained from non-invasive monitoring of chest and abdomen motion. Currently available devices are not well suited in application for spirometric measurement for ambulatory monitoring. A sensor matrix measurement technique is investigated to identify suitable sensing elements with which to base an upper body surface measurement device that monitors respiration. This thesis is divided into two main areas of investigation; model based and geometrical based surface plethysmography. In the first instance, chapter 2 deals with an array of tactile sensors that are used as progression of existing and previously investigated volumetric measurement schemes based on models of respiration. Chapter 3 details a non-model based geometrical approach to surface (and hence volumetric) profile measurement. Later sections of the thesis concentrate upon the development of a functioning prototype sensor array. To broaden the application area the study has been conducted as it would be fore a generically configured sensor array. In experimental form the system performance on group estimation compares favourably with existing system on volumetric performance. In addition provides continuous transient measurement of respiratory motion within an acceptable accuracy using approximately 20 sensing elements. Because of the potential size and complexity of the system it is possible to deploy it as a fully mobile ambulatory monitoring device, which may be used outside of the laboratory. It provides a means by which to isolate coupled physiological functions and thus allows individual contributions to be analysed separately. Thus facilitating greater understanding of respiratory physiology and diagnostic capabilities. The outcome of the study is the basis for a three-dimensional surface contour sensing system that is suitable for respiratory function monitoring and has the prospect with future development to be incorporated into a garment based clinical tool.

Dietary enrichment by almond supplementation: effects on risk factors for cardiovascular disease

Cardiovascular disease (CVD) is the leading cause of death in Europe responsible for more than 4.3 million deaths annually. The World Health Organisation funded the Monica project (1980s-1990s) which monitored ten million subjects aged 22-6Syrs, and demonstrated that coronary heart disease (CHD) mortality declined over 10 years, was due in two thirds of cases to reduced incidence of CHD (reduced risk behaviours e.g. poor diet and smoking) and one third by improved treatments. Epidemiological evidence suggests diets rich in antioxidants decrease incidence of CVD. Regular consumption of nuts, rich in vitamin E and polyphenols reduces atherosclerosis, an important risk for heart disease. Intervention studies to date using alpha tocopherol (an active component of vitamin E) have not consistently proved beneficial. This thesis aims to investigate the effect of almond supplementation on vascular risk factors in healthy young males (18-3Syrs); mature males and female(>SOyrs); and males considered at increased risk of CVD (18-3Syrs) in a cohort of 67 subjects. The effects of almond intake were assessed after 2Sg/d for four weeks followed by SOg/d for four weeks and compared to a control group which did not consume almonds or change their diet. Cardiovascular risk was assessed by plasma lipid profiles, apolipoprotein A1, plasma nitrates/nitrates, vascular flow, BMl, blood pressure, sVCAM-1 and protein oxidation. Systolic and diastolic blood pressures were reduced in almond supplemented volunteers but not in controls. Dietary monounsaturated fatty acids, polyunsaturated fatty acid content and total dietary fats were increased by almond supplementation. Neither sVCAM-1, venous occlusion plethysmography nor plasma nitrite levels were affected by almond intake in any independent group. No significant changes in plasma lipids, and apolipoprotein A1 were observed. In conclusion almonds supplementation caused a reduction in blood pressure that may be due to increased sensitivity of the baroreceptors after increased monounsaturated fatty acid intake.

A comparison of breathing patterns of normal full term infants in supine versus right side-lying during quiet and active behavioral sleep states

This study investigated the effect of sleep position on breathing patterns of normal full term infants during quiet and active behavioral sleep states. Tidal volume, percent contribution of rib cage to tidal volume, and respiration rate were measured via respiratory inductive plethysmography (RIP) and pneumotachograph (PNT) in ten infants sleeping in supine versus right side-lying. Data was collected immediately following two consecutive feedings. Paired t tests and ANOVA comparisons showed no significant differences between the two postures (p $<$.05) in mean tidal volume (supine, M = 19.16, right side, M = 22.45), percent contribution of rib cage to tidal volume (supine, M = 30.55, right side M = 33.20), or respiration rate (supine, M = 49.13, right side, M = 49.37) during quiet sleep. Comparisons also showed no significant differences between the two postures (p $<$.05) in mean tidal volume (supine, M = 18.89, right side, M = 20.12), percent contribution of rib cage to tidal volume (supine, M = 6.43, right side, M = 6.97) or respiration rate (supine, M = 62.18, right side, M = 61.04) during active sleep. Therefore, no differences were found in the three respiratory variables measured between the supine and right side-lying positions. These findings suggest that infants may be positioned in either sleep position without detriment to respiratory function. This information may benefit occupational therapists and other health professionals involved in the education of parents on infant positioning and their respective advantages. ^

Resting energy expenditure, macronutrient utilization, and body composition in term infants after corrective surgery of major congenital anomalies: a case-study

Introduction - Knowledge on the metabolic changes and nutritional needs during the postsurgical anabolic phase in infants is scarce. This analysis explores the associations of resting energy expenditure (REE) and macronutrient utilization with body composition of full-term infants, during catch-up growth after corrective surgery of major congenital anomalies. Methods - A cohort of full-term appropriate for-gestational-age neonates subjected to corrective surgery of major congenital anomalies were recruited after gaining weight for at least one week. REE and macronutrient utilization, measured by respiratory quotient (RQ), were assessed by indirect calorimetry using the Deltatrac II Metabolic Monitor ®. Body composition, expressed as fat-free mass (FFM), fat mass (FM) and adiposity defined as percentage of FM (% FM), was measured by air displacement plethysmography using the Pea Pod ®. Results - Four infants were included at 3 to 5 postnatal weeks. Recommended energy and macronutrient intakes for healthy term infants were provided. Through the study, the median (min-max) REE (Kcal/Kg FFM/d) was 70.8 (60.6-96.1) and RQ was 0.99 (0.72-1.20). Steady increases in both body weight and FFM were associated with initial decrease in FM and adiposity followed by their increase. Low RQ preceded decrease in adiposity. Conclusion - The marked adiposity depletion, not expected during steady weight gain in the postsurgical period, prompts us to report this finding. The subsequent adiposity catch-up was associated with relatively high REE and RQ, suggesting preferential oxidation of carbohydrates and preservation of lipids for fat storage.