Bioimpedância em doenças infecciosas: revisão crítica / Bioimpedance in infectious diseases: critical review

Objetivo: verificar se o ângulo de fase, obtido por bioimpedância elétrica, pode ser utilizado como indicador prognóstico em doenças infecciosas e em quais dessas doenças seu uso está adequadamente embasado pela literatura científica. Métodos: revisão integrativa realizada por meio das bases de dados, como google acadêmico, na BVS Brasil, nas bases SciELO, LILACS e Pubmed, utilizando o termo para busca (bioimpedância e doenças infectocontagiosas e bioimpedância) AND (bioimpedance and infectious diseases OR bioimpedance). A seleção dos estudos foi feita, considerando artigos originais completos disponíveis on-line, em inglês, espanhol e português, publicados entre 2007 e 2021. Resultados: todos os estudos considerados (793) foram realizados em adultos com doença infecciosa. Destes 28 (3,5%) foram separados para leitura aprofundada sobre o perfil metodológico, e apenas quatro (0,50%) do total de artigos consideraram o ângulo de fase como índice prognóstico para doenças infeciosas, ambos em pacientes HIV + hospitalizados. Conclusão: A bioimpedância vem sendo considerada como instrumento de avaliação de estado nutricional em pacientes com doenças infecciosas. Mas o uso do ângulo de fase vem sendo pouco estudado como índice prognóstico para essa população, não podendo ser considerado adequadamente embasado para uso clínico na população com doença infecciosa, o que suscita maior atenção a esta população e a necessidade de maior investigação científica.

Objective: to verify if the phase angle obtained by electrical bioimpedance can be used as a prognostic indicator in infectious diseases and in which infectious diseases its use is adequately supported by scientific literature. Methods: integrative review conducted using databases such as Google Scholar, BVS Brazil, SciELO, LILACS and Pubmed, using the search term (bioimpedance and infectious diseases and bioimpedance) AND (bioimpedance and infectious diseases OR bioimpedance). The selection of studies was made considering complete original articles available online, in English, Spanish and Portuguese, published between 2007 and 2021. Results: all studies considered (793) were carried out in adults with infectious disease. Of these, 28 (3.5%) were separated for in-depth reading on the methodological profile, and only four (0.50%) of the total articles considered the phase angle as a prognostic index for infectious diseases, both in hospitalized HIV + patients. Conclusion: Bioimpedance has been considered as an instrument to assess nutritional status in patients with infectious diseases. However, the use of the phase angle has been little studied as a prognostic index for this population, and cannot be considered adequately substantiated for clinical use in the population with infectious disease, which raises more attention to this population and the need for further scientific investigation.

Iron intake is positively associated with viral load in antiretroviral naïve Brazilian men living with HIV.

BACKGROUND: Iron homeostasis contribute for the human immunodeficiency virus (HIV) pathogenesis. OBJECTIVES: We assessed the iron intake pattern in antiretroviral naïve Brazilian men living with HIV correlating with clinical and nutritional parameters. METHODS: The iron consumption mean was estimated according to a food frequency questionnaire (FFQ), and a 3-day food record (3dFR) submitted to the patients. HIV viral load, CD4+ T cell counts, serum iron, haematological and anthropometrics parameters were recorded. FINDINGS: Fifty-one HIV-infected adult men naïve for antiretroviral therapy (ART) were enrolled. The mean age of participants was 35 (SEM ± 1.28) years old, with mean time of HIV-1 infection of 1.78 (0-16.36, min-max) years. Majority (41.18%) had complete secondary, and 21.57% had tertiary educational level. The income was around 1x (54.90%) to 2x (41.18%) minimum wage. Fifty-four percent showed normal weight, while 40% were overweight. The patients showed normal mean values of haematological parameters, and mean serum iron was 14.40 µM (SEM ± 0.83). The FFQ showed moderate correlation with the 3dFR (ρ = 0.5436, p = 0.0009), and the mean values of iron intake were 10.55(± 0.92) mg/day, recorded by FFQ, and 15.75(± 1.51) mg/day, recorded by 3dFR. The iron intake, recorded by FFQ, negatively correlated with serum iron (ρ = -0.3448, p = 0.0132), and did not have influence in the CD4+ T cell counts [e.B 0.99 (0.97-1.01, 95% confidence interval (CI), p = 0.2]. However, the iron intake showed a positive effect in HIV viral load [e.B 1.12 (1.02-1.25, 95%CI), p < 0.01]. MAIN CONCLUSIONS: This study draws attention for the importance of iron intake nutritional counseling in people living with HIV. However, more studies are required to clarify the association between high iron intake and HIV infection and outcome.

Nutritional status of human T-lymphotropic virus 1 patients: A retrospective study.

BACKGROUND & AIMS: The nutritional status of people with human T-lymphotropic virus (HTLV-1) infection has been poorly described because it involves a neglected disease. The few studies that have been conducted mostly involve people with neurologic consequences and the possible clinical evolutions of the disease. The aim of this study was to describe the nutritional status of patients with HTLV-1, including those with associated myelopathy/tropical spastic paraparesis, and to evaluate food security in these patients. METHODS: A retrospective observational study was conducted in people with HTLV-1 admitted to a referral hospital. We collected data from 17 medical records, including anthropometric data (i.e., body mass index, mid-upper arm circumference, triceps skinfold, and mid-arm muscle circumference), laboratory test results (i.e., haemoglobin, haematocrit, albumin, globulin, iron fixation capacity, and iron), the Subjective Global Assessment (SGA) method, and food security (Brazilian Food Insecurity Scale) data. The data were analysed using the R-project software. To evaluate possible associations between the outcomes and predictors (age at hospitalisation, food security, presence of children <18 years of age living in the household, income, schooling, ANSG, BMI, difference between ideal weight and hospitalisation, TSF, MUAC ICU days, hospitalisation outcome, rehospitalisation in the first year after discharge, interval between readmissions, death, associated conditions, constipation upon admission), we used Kruskal-Wallis, Mann-Whitney, Fisher's exact, chi-square tests with continuity correction, and Spearman's correlation coefficient. Hypothesis tests were considered statistically significant when p ≤ 0.05. RESULTS: The mean age of the patients was 57 (52-60) years. The patients were predominantly women (59%) and had an income lower than the local minimum wage with at least 6 years of schooling (52.3%). Only 18.2% of patients were eutrophic according to their BMI and 23.5% of patients were malnourished based on the SGA method. Patients predominantly had food security (64.7%) and good intestinal functions (64.7%) during their hospital stay. CONCLUSION: Despite having a limited number of patients in this study, HTLV-1 patients admitted to hospital are at high risk of malnutrition based on the scores from the SGA method.

Desnutrição e Qualidade de Vida em Pessoas Vivendo com HIV/AIDS / Malnutrition and Quality of Life in People Living with HIV/AIDS

Objetivo: explorar a associação entre o estado nutricional e os aspectos relacionados à qualidade de vida em pessoas vivendo com HIV/AIDS (PVHA) em tratamento antirretroviral. Materiais e Métodos: estudo seccional com uma amostra de 83 pacientes selecionada nos ambulatórios de doenças infecciosas de um instituto de referência para tratamento do HIV/AIDS. Os participantes foram avaliados quanto ao estado nutricional (avaliação nutricional subjetiva global - ANSG) e aos aspectos relacionados à qualidade de vida (questionário Item Short-Form Health Survey -SF-36) por uma fisioterapeuta treinada da equipe multidisciplinar de terapia nutricional. O estudo foi aprovado pelo Comitê de Ética e Pesquisa e todos os participantes assinaram termo de consentimento livre e esclarecido. Resultados: A maioria era do sexo masculino (56,6%), tinha concluído o ensino médio (54,2%), era ativo profissionalmente (54,2%), e ganhava pelo menos um salário mínimo (92,8%). Um terço da amostra tinha desnutrição leve ou moderada, e relatou presença de algum sintoma gastrintestinal. Grande parte dos pacientes apresentava perda de tecido adiposo (65%) e de massa muscular (34,9%) e 40,9% tinham deficiência funcional relacionada ao estado nutricional. Os pacientes classificados como desnutridos, tiveram piores resultados com relação aos componentes da ANSG e menores escores nos domínios da qualidade de vida (capacidade funcional, vitalidade, e limitação por aspectos físicos, emocionais e sociais). Conclusão: A desnutrição parece interferir negativamente na qualidade de vida de PVHA, e o uso de um instrumento de triagem rápida do estado nutricional, como a ANSG, por uma equipe interdisciplinar pode identificar precocemente pacientes que precisam de rápida intervenção nutricional. (AU)

Objective: To explore the association between nutritional status and aspects related to quality of life in people living with HIV/AIDS (PLHA) under antiretroviral treatment. Material and Methods: This was a crosssectional study with a convenience sample of 83 adults. Subjects were randomly selected at the infectious diseases outpatient's clinics at a reference institute for the treatment of HIV/AIDS. Nutritional status (subjective global assessment - SGA) and issues relating to quality of life (questionnaire Short-Form Health Survey Item -SF-36) were assessed by a trained physiotherapist of the nutritional therapy multidisciplinary team. The study was approved by the Research Ethics Committee and all participants signed an informed consent form. Results: Most study subjects were males (56.6%), had completed high school (54.2%), were professionally active (54.2%), with an income of at least one minimum wage (92.8%). A third of the sample had mild or moderate malnutrition and reported presence of some gastrointestinal symptoms. Most patients showed loss of subcutaneous fat (65%) and muscle mass (34.9%), and 40.9% of them had functional impairment related to nutritional status. As expected, patients classified as malnourished showed worse results in relation to SGA components and lower scores in some domains of quality of life (functional capacity, energy, and physical, emotional and social limitations). Conclusion: Malnutrition appears to interfere negatively on PLHA's quality of life, and the use of a rapid screening tool to assess nutritional status, such as SGA, by an interdisciplinary team can early identify patients in need of a quick nutritional intervention. (AU)

Omega-3 supplementation on inflammatory markers in patients with chronic Chagas cardiomyopathy: a randomized clinical study.

BACKGROUND: Several studies have been focusing on the effect of omega-3 polyunsaturated fatty acids on modulation of inflammatory markers in several cardiopathies. Although immunoregulatory dysfunction has been associated to the chronic cardiac involvement in Chagas disease, there is no study examining the effects of omega-3 supplementation in these patients. We investigated the effects of omega-3 PUFAs on markers of inflammation and lipid profile in chronic Chagas cardiomyopathy patients. METHODS: The present study was a single-center double-blind clinical trial including patients with chronic Chagas cardiomyopathy. Patients were randomly assigned to receive omega-3 PUFAs capsules (1.8g EPA and 1.2g DHA) or placebo (corn oil) during an 8-week period. Cytokines, fasting glucose, lipid, and anthropometric profiles were evaluated. RESULTS: Forty-two patients (23 women and 19 men) were included in the study and there were only two losses to follow-up during the 8-week period. Most of sociodemographic and clinical characteristics were similar between the groups at baseline, except for the cytokines IL-1ß, IL-6, IL-8, IL-10, IL-17α, and IFNγ. The omega-3 PUFAs group demonstrated greater improvements in serum triglycerides (-21.1 vs. -4.1; p = 0.05) and IL-10 levels (-10.6 vs. -35.7; p = 0.01) in comparison to controls after 8 weeks of intervention. No further differences were observed between groups. CONCLUSION: Omega-3 PUFAs supplementation may favorably affect lipid and inflammatory profile in chronic Chagas cardiomyopathy patients, demonstrated by a decrease in triglycerides and improvements on IL-10 concentration. Further studies examining the clinical effects of omega-3 fatty acids supplementation in chronic Chagas cardiomyopathy are necessary. TRIAL REGISTRATION: NCT01863576.

Educação alimentar e nutricional para o controle de comorbidades em pessoas com doenças infecciosas / Food and nutrition education for control of comorbidities among people with infectious diseases / Educación alimentaria y nutricional para el control de comorbidades en personas con enfermedades infecciosas

Objetivo: Relatar a experiência da implantação de práticas de educação alimentar e nutricional (EAN) em grupo, para melhoria de adesão às orientações nutricionais, para pessoas com doenças infecciosas. Síntese de dados: Trata-se de um relato de experiência de atividade de educação alimentar e nutricional realizada no período de abril a novembro de 2015, no Instituto Nacional de Infectologia Evandro Chagas (INI/ Fiocruz), Rio de Janeiro. Doze indivíduos portadores de doenças infecciosas e parasitárias, de ambos os sexos, com diagnósticos de excesso de peso e de síndrome metabólica participaram de sete oficinas temáticas mensais. Foram abordados temas relevantes para o tratamento da síndrome metabólica e do excesso de peso por meio de rodas de conversa, dinâmicas e distribuição de folhetos explicativos. Durante as oficinas, foram identificados de forma clara comportamentos alimentares que não correspondiam à orientação nutricional prévia fornecida na consulta individual e que dificultavam o controle das condições clínicas presentes na síndrome metabólica e excesso de peso. Nas oficinas, os participantes consolidaram o conhecimento sobre práticas alimentares saudáveis e, com a troca de experiência, sentiram-se mais seguros e motivados para superarem as dificuldades durante o tratamento nutricional. Conclusão: Observou-se que os participantes consolidaram seus conhecimentos e a autonomia para escolhas alimentares saudáveis e, com a troca de experiência, sentiram-se mais seguros e motivados para superarem as dificuldades durante o tratamento nutricional. Portanto, a implementação da EAN em grupo foi efetiva na melhora da adesão às orientações nutricionais, refletindo em novos relatos de práticas alimentares saudáveis.

Objective: To report the experience of implementing Food and Nutrition Education (FNE) Practices in group, for improvement of nutrition counseling acceptance among patients with infectious diseases. Data synthesis: This is an experience report of food and nutrition education activity carried out from April to November 2015 at the Evandro Chagas National Institute of Infectious Diseases (INI/Fiocruz). Twelve individuals carrying infectious and parasitic diseases, of both genders, diagnosed with overweight and metabolic syndrome, took part in seven monthly thematic workshops. Themes of relevance to the treatment of metabolic syndrome and overweight were approached by means of group chats and dynamics, and explanatory brochure distribution. During the workshops, eating behaviors were clearly identified, which were not in conformity with the nutrition counseling provided in previous individual appointments and hampered the control of the clinical conditions experienced in metabolic syndrome and overweight. In the workshops, the participants consolidated the knowledge of healthy eating habits and, by exchanging experiences, they felt more confident and motivated to overcome the difficulties during nutrition treatment. Conclusion: It was observed that the participants consolidated their knowledge and autonomy for healthy food choices and, with the exchange of experience, they felt more confident and motivated to overcome the difficulties during the nutrition treatment. Therefore, the implementation of FNE in group was effective in improving nutrition counseling acceptance, which brings forward new reports of healthy eating practices.

Objetivo: Describir la experiencia de la aplicación de prácticas de educación alimentaria y nutricional (EAN) en grupo para mejorar la adhesión de las orientaciones nutricionales en personas con enfermedades infecciosas. Síntesis de los datos: Se trata de un relato de experiencia de la actividad de educación alimentaria y nutricional realizada en el periodo entre abril y noviembre de 2015, en el Instituto Nacional de Enfermedades Infecciosas Evandro Chagas (INI / Fiocruz), Rio de Janeiro. Doce personas com enfermidades infecciosas y parasitarias de ambos sexos y diagnostico de exceso de peso y del síndrome metabólico participaron en siete talleres temáticos mensuales. Fueron discutidos temas de interés para el tratamiento del síndrome metabólico y el sobrepeso a través de ruedas de conversación, dinámicas y distribución de folletos. Durante los talleres fueron claramente identificadas las conductas alimentarias que no correspondían con la orientación nutricional previa proporcionada en la consulta individual, lo que hace que sea difícil controlar las condiciones clínicas presentes en el síndrome metabólico y el sobrepeso. En los talleres, los participantes consolidaron el conocimiento sobre prácticas saludables de alimentación y con el intercambio de experiencias se sintieron más seguros y motivados para superar las dificultades en el tratamiento nutricional. Conclusión: Hemos observado con la aplicación del EAN en grupo, una mejora efectiva en la adhesión de las orientaciones nutricionales reflejadas en los nuevos informes de prácticas de alimentación saludables. También observamos que la frecuencia y la regularidad de la vigilancia nutricional tienen un papel crucial en el éxito del tratamiento nutricional.

Oral drugs at a hospital unit: adequacy for use via enteral feeding tubes. / Medicamentos orais de uma unidade hospitalar: adequação ao uso por cateteres enterais.

OBJECTIVE:: to describe the profile of standardized oral drugs at a hospital unit and assess their adequacy for use via enteral feeding tubes, according to recommendations from the literature. METHOD:: descriptive study, with data on drugs collected from the Pharmacy Service Dispensing System. Specific recommendations for the use of these drugs via enteral feeding tubes were found after searches in literary databases, books, manuals, guidelines and package insert collections. RESULTS:: among the 236 dispensed oral drugs, 86% were in solid form; of those, 32 were "non-crushable", with the liquid form available at the institution. Twenty-eight drugs with potential interactions with enteral nutrition were identified. Sixty percent of those presented specific recommendations on their administration via enteral feeding tube. CONCLUSION:: the joint participation of multidisciplinary nutritional therapy and care teams and the implementation of programs for continuous training are suggested strategies for the prevention of potential problems in the administration of drugs in the hospital setting.

Medicamentos orais de uma unidade hospitalar: adequação ao uso por cateteres enterais / Medicamentos orales de una unidad hospitalaria: adecuación al uso utilizando sondas gástricas / Oral drugs at a hospital unit: adequacy for use via enteral feeding tubes

RESUMO Objetivo: descrever o perfil de medicamentos orais padronizados em uma unidade hospitalar e verificar sua adequação quanto ao uso por cateteres enterais, de acordo com recomendações da literatura. Método: estudo descritivo, com dados sobre medicamentos coletados do Sistema de Dispensação do Serviço de Farmácia. As recomendações específicas para uso de tais medicamentos por cateteres enterais foram obtidas após busca em bases literárias, livros, manuais, guidelines e bulários. Resultados: dos 236 medicamentos orais dispensados, 86% estavam na forma sólida; destes, 32 eram "não trituráveis", havendo disponibilidade da forma líquida na instituição. Foram identificados 28 medicamentos com potenciais interações com a nutrição enteral. Sessenta porcento deles apresentavam recomendações específicas sobre sua administração por cateter enteral. Conclusão: a participação conjunta das equipes multidisciplinares de terapia nutricional e de assistência e a implementação de programas para treinamento contínuo constituem estratégias sugeridas para a prevenção de potenciais problemas na administração de medicamentos no espaço hospitalar.

RESUMEN Objetivo: describir el perfil de medicamentos orales estandarizados en una unidad hospitalaria y verificar su adecuación respecto del uso vía sondas gástricas, según recomendaciones de la literatura. Método: estudio descriptivo, con datos sobre medicamentos recolectados del Sistema de Dispensación del Servicio de Farmacia. Las recomendaciones específicas de uso por sondas gástricas fueron obtenidas por búsqueda en bases de literatura, libros, manuales, guidelines y vademécums. Resultados: De los 236 medicamentos orales dispensados, 86% se presentaban en forma sólida; de ellos, 32 eran "no triturables", existiendo disponibilidad de la forma líquida en la institución. Fueron identificados 28 medicamentos con potenciales interacciones con la nutrición enteral. El 60% incluía recomendaciones específicas sobre administración por sonda gástrica. Conclusión: la participación conjunta de equipos multidisciplinarios de terapia nutricional y de atención y la implementación de programas de capacitación permanente constituye estrategias sugeridas para prevenir potenciales problemas en administración de medicamentos en el ámbito hospitalario.

ABSTRACT Objective: to describe the profile of standardized oral drugs at a hospital unit and assess their adequacy for use via enteral feeding tubes, according to recommendations from the literature. Method: descriptive study, with data on drugs collected from the Pharmacy Service Dispensing System. Specific recommendations for the use of these drugs via enteral feeding tubes were found after searches in literary databases, books, manuals, guidelines and package insert collections. Results: among the 236 dispensed oral drugs, 86% were in solid form; of those, 32 were "non-crushable", with the liquid form available at the institution. Twenty-eight drugs with potential interactions with enteral nutrition were identified. Sixty percent of those presented specific recommendations on their administration via enteral feeding tube. Conclusion: the joint participation of multidisciplinary nutritional therapy and care teams and the implementation of programs for continuous training are suggested strategies for the prevention of potential problems in the administration of drugs in the hospital setting.

Dieta hiperlipídica rica em ácidos graxos trans na lactação altera a fisiologia materna e programa a composição corporal, a trigliceridemia e o perfil hormonal em ratos adultos / Hiperlipidic diet rich with trans fatty acids in lactation alter maternal physiology and program body composition, triglyceridemia and hormonal profile in adult rats

Com base no conceito de programação metabólica é de suma importância o estudo sobre alterações do balanço energético e dos percentuais de macronutrientes da dieta materna e suas relações com o desempenho lactacional e o desenvolvimento da prole. Assim, pretendemos testar em um mundo animal a hipótese de que uma dieta hiperlipídica rica em ácidos graxos trans na lactação pode programar o peso e composição corporais e os perfis lipídico e hormonal. Ratas Wistar de 3 meses de idade, lactantes, foram divididas em 2 grupos: controle - ração normal (23 porcento de proteína, 66 porcento de carboidrato e 11 porcento de lipídeo) e dieta - ração hiperlipídica rica em ácidos graxos trans (15 porcento de proteína, 55 porcento de carboidrato e 30 porcento de lipídeo), permanecendo neste tratamento até o final da lactação. Após o desmame, os filhotes receberam ração normal. Monitoramos peso corporal e ingestão alimentar. A composição bioquímica do leite foi avaliada aos 21 dias da lactação. As ratas lactantes foram sacrificadas aos 21 dias e as proles aos 180 dias de idade. A dieta hiperlipídica rica em ácidos graxos trans produziu alterações importantes na fisiologia materna: menor ingestão alimentar até o desmame (diferença de 30 porcento aos 21 dias; p<0,01) e menor ingestão calórica durante a maior parte da lactação (p<0,001), menor peso corporal (diferença de 11 porcento aos 21 dias; p<0,05), com 51 porcento a mais de gordura corporal (p<0,005) e 71 porcento a mais de tecido adiposo visceral (p<0,005), maior leptina sérica (57 porcento; p<0,05), e maiores triglicerídeo (47 porcento; p<0,05), e maiores triglicerídeo (47 porcento; p<0,05) e colesterol (16 porcento; p<0,05) séricos, assim como maiores índices aterogênicos de Castelli I (67 porcento; p<0,05) e II (2x; p<0,01). Estas ratas apresentaram menor corticosteronemia (36 porcento; p<0,05) e maior conteúdo adrenal de catecolaminas (39 porcento; p<0,05). Esta dieta também levou a alterações importantes da função...

Based on the concept of metabolic programming, energetic balance and macronutrients of maternal diet are associated with lactational performance and newborn development. Thus, we intend to show, on an animal model, if during lactation a maternal high-fat diet rich in trans-fatty acid can program body composition and lipid and hormonal profile of the offspring. Three months-old Wístar rats were divided into control diet (C) of high-fat high-trans-fatty acids diet (D) groups, during lactation. After weaning, all pups received control diet. Body weight and foof intake were monitored. Milk composition were analyzed at day 21. At weaning (21 days of lactation), dams were sacrificed, while the offspring were killed when they were 180 days-old. High-fat and high-trans-fatty acids diet produced in the mother: lower food intake (30 percent on day 21; p<0,01) and lower caloric intake (p<0,001), lower body weight (11 percent on day 21; p<0,05), with higher total body fat (51 percent; p<0.005), higher visceral adipose tissue (71 percent; p<0,005), hyperleptinaemia (57 percent; p<0,05), hypertriglyceridaemia (47 percent; p<0,05) and hypercholesterolaemia (16 percent; p<0,05), and higher Castelli index I (67 percent; p<0,05) and II (2x; p<0,01). These dams also show lower serum corticosterone (36 percent; p<0,05) and higher adrenal catecholamines content (39 percent; p<0,05). This diet leads to important changes on the thyroid function with hither serum TSH (100 percent; p<0,005) and T3 (27 percent; p<0,005), higher liver D1 (100 percent; p<0,005) and thyroid D1 (50 percent; p<0,005) and D2 (94 percent; p<0,005) activities, and higher liver GPDm activity (50 percent). Milk presented lower cholesterol and tryglicerides concentrations (62 percent; p<0,001; for both). There were no differences on food intake of body weight between adult offspring on day 180, but rats whose mothers were fed a high-fat high-trans-fatty acid diet showed higher total body fat...