EATING HABITS AND NUTRITIONAL STATUS OF PATIENTS WITH CELIAC DISEASE IN SOUTH BRAZIL.

•Most patients with celiac disease from South Brazil do not consume gluten. •Patients with celiac disease are more careful about gluten cross-contamination in their homes than in restaurants. •Patients with celiac disease from South Brazil have adopted good eating habits with a balanced gluten-free diet. •Nutritional status improved after diagnosis of celiac disease according to body mass index. Background - Celiac disease is defined as a chronic autoimmune disease that affects the small intestine in genetically predisposed people, triggered by exposure to gluten. The only treatment for celiac disease to date is a lifelong gluten-free diet. Eating habits of celiacs play an important role in their nutritional status.Objective - To evaluate the eating habits and nutritional status of patients with celiac disease in Rio Grande do Sul.Methods - This is a cross-sectional study with patients diagnosed with celiac disease residing in Rio Grande do Sul (Brazil) over 18 years of age. An online questionnaire was applied with calls through social networks and also by the Associação dos Celíacos do Brasil - Rio Grande do Sul Section. Sociodemographic data, history of celiac disease, general medical history, reported weight and height and food consumption data (SISVAN food frequency questionnaire and general questions) were collected. Results - The sample consisted of 142 individuals with a mean age of 39.75±11.5 years, 94.4% were women and 93% were white. The patients showed care regarding a gluten-free diet, with the majority not ingesting gluten (82.2%) and being careful regarding cross-contamination by gluten in their homes (85.9%) and in restaurants (62, 4%). Most patients also had good eating habits, with frequent consumption of fruits, vegetables, meats, eggs and low frequency of processed foods and fats. Body weight before and after the diagnosis of celiac disease did not show significant changes (62.3±13.8 versus 63.6±11.7 kg; P=0.147); however, there was an improvement in the classification of nutritional status by body mass index (malnourished: 11.6% before versus 2.3% after; P=0.016). Conclusion - Most celiac disease patients in this study have good eating habits with a balanced gluten-free diet and improved nutritional status after diagnosis according to body mass index classification.

Hábitos alimentares e estado nutricional de pacientes com doença celíaca do sul do Brasil / Eating habits and nutritional status of patients with celiac disease in south brazil

ABSTRACT Background: Celiac disease is defined as a chronic autoimmune disease that affects the small intestine in genetically predisposed people, triggered by exposure to gluten. The only treatment for celiac disease to date is a lifelong gluten-free diet. Eating habits of celiacs play an important role in their nutritional status. Objective: To evaluate the eating habits and nutritional status of patients with celiac disease in Rio Grande do Sul. Methods: This is a cross-sectional study with patients diagnosed with celiac disease residing in Rio Grande do Sul (Brazil) over 18 years of age. An online questionnaire was applied with calls through social networks and also by the Associação dos Celíacos do Brasil - Rio Grande do Sul Section. Sociodemographic data, history of celiac disease, general medical history, reported weight and height and food consumption data (SISVAN food frequency questionnaire and general questions) were collected. Results: The sample consisted of 142 individuals with a mean age of 39.75±11.5 years, 94.4% were women and 93% were white. The patients showed care regarding a gluten-free diet, with the majority not ingesting gluten (82.2%) and being careful regarding cross-contamination by gluten in their homes (85.9%) and in restaurants (62, 4%). Most patients also had good eating habits, with frequent consumption of fruits, vegetables, meats, eggs and low frequency of processed foods and fats. Body weight before and after the diagnosis of celiac disease did not show significant changes (62.3±13.8 versus 63.6±11.7 kg; P=0.147); however, there was an improvement in the classification of nutritional status by body mass index (malnourished: 11.6% before versus 2.3% after; P=0.016). Conclusion: Most celiac disease patients in this study have good eating habits with a balanced gluten-free diet and improved nutritional status after diagnosis according to body mass index classification.

RESUMO Contexto: A doença celíaca é definida como uma doença crônica autoimune que afeta o intestino delgado em pessoas geneticamente predispostas, desencadeada pela exposição ao glúten. O único tratamento para doença celíaca até o momento é uma dieta isenta de glúten por toda a vida, levando em consideração que os hábitos alimentares de celíacos desempenham um papel importante em seu estado nutricional. Objetivo: Avaliar os hábitos alimentares e o estado nutricional de pacientes com doença celíaca do Rio Grande do Sul. Métodos: Trata-se de um estudo transversal com 142 pacientes com diagnóstico de doença celíaca residentes no Rio Grande do Sul (Brasil) e maiores de 18 anos. Para realização deste estudo, foi aplicado um questionário on-line com divulgação através de redes sociais e também pela Associação dos Celíacos do Brasil - Seção Rio Grande do Sul. Foram coletados dados sociodemográficos, histórico da doença celíaca, história clínica geral, peso e altura referidos e dados de consumo alimentar através de questionário de frequência alimentar do SISVAN e questões gerais. Resultados: A amostra foi constituída por 142 indivíduos com idade média de 39,75±11,5 anos, sendo 94,4% mulheres e 93% de etnia branca. Os participantes apresentaram cuidados em relação a dieta isenta de glúten, sendo que a maioria não ingere glúten (82,2%) e possuem cuidados em relação a contaminação cruzada por glúten em suas casas (85,9%) e em restaurantes (62,4%). A maioria da amostra também apresentou bons hábitos alimentares, com o consumo frequente de frutas, legumes, verduras, carnes, ovos e pouco frequente de industrializados e gorduras. O peso corporal antes e após o diagnóstico de doença celíaca não apresentou mudanças significativas (62,3±13,8 versus 63,6±11,7 kg; P=0,147); entretanto, houve melhora na classificação do estado nutricional pelo índice de massa corporal (11,6% versus 2,3% de desnutridos; P=0,016). Conclusão: A maioria dos pacientes com doença celíaca deste estudo apresentam bons hábitos alimentares com uma dieta isenta de glúten balanceada e com melhora do estado nutricional após o diagnóstico de acordo com a classificação do índice de massa corporal.

What is Known About Dietary Interventions and Body Weight Management After Kidney Transplantation? A Scoping Review.

OBJECTIVE: Several studies report weight gain after kidney transplantation, which is commonly related to poor outcomes. However, recommendations for dietary interventions aiming to manage these patients' weight are still scarce in the literature. Thus, this review seeks to describe the state of literature on the effect of dietary interventions on weight after kidney transplantation. DESIGN: Scoping review. METHODS: This review was designed according to the recommendations for scoping reviews elaborated by the Joanna Briggs Institute. Studies assessing the effect of dietary interventions on body weight after kidney transplantations were searched in MEDLINE, EMBASE, and Clinicaltrials.gov databases up to June 28, 2021. Two independent reviewers summarized the data collected. RESULTS: Thirteen (503 patients) of the 4.983 articles identified in the searched databases were included in our study. Most studies were published before 2010 and presented incomplete methodology descriptions. Nutritional counseling and dietary prescriptions according to the Step 1 diet of the American Heart Association (AHA) were the most common interventions. Only 2 studies evaluated changes in body weight as primary outcome. Three studies were randomized clinical trials (RCT), and none of these found the adopted interventions to demonstrate benefits. CONCLUSION: Our scoping review evinced a scarcity of data available in the literature addressing this topic. Most studies were not controlled and presented poor methodological quality. Moreover, these studies included small sample sizes, so that the assessment of dietary interventions in these patients still lacks power for definitive conclusions. Prospective RCT should be conducted to define effective in preventing weight gain or weight loss after kidney transplant.

Assessment of the Knowledge of Phosphorus and Potassium in Hemodialysis Patients.

We aimed to determine the knowledge of potassium and phosphorus in patients undergoing hemodialysis (HD) and to associate it with serum levels and other clinical variables. This cross-sectional study included 73 patients of both sexes, who were over 18 years old and had undergone HD for at least 3 months at Hospital Geral de Caxias do Sul, Caxias do Sul, Brazil, between January and April 2019. Knowledge of phosphorus and potassium was measured by a questionnaire composed of 16 multiple choice questions (two general, seven about phosphorus, and seven about potassium) applied by the interviewer. For each mineral, a maximum of nine points could be scored. The mean ± standard deviation of correct answers was 9.78 ± 2.99 points for all questions, being higher for potassium (6.75 ± 1.65 points) than phosphorus (4.64 ± 2.10 points; P <0.001). A positive correlation was found between specific knowledge of phosphorus and its serum levels (r = 0.305; P = 0.009), but not for potassium (r = 0.101; P = 0.395). The number of correct answers positively correlated with the level of education (r = 0.390; P = 0.001) and negatively with age (r = -0.372; P = 0.001). The HD patients had intermediate levels of knowledge of phosphorus and potassium, with greater knowledge of potassium. Patients with higher serum phosphorus levels demonstrated greater knowledge about it, whereas this pattern was not observed for potassium levels. Knowledge of phosphorus and potassium was associated with younger patients and a higher level of education.

Conhecimento Nutricional de Adultos e Idosos do Município de Caxias do Sul-RS / Nutritional Knowledge of Residents of the City of Caxias do Sul-RS, Brazil

Introdução: Conhecimento nutricional é a noção de conceitos e processos relacionados à nutrição e saúde, incluindo associações de conhecimentos sobre dieta e saúde, dieta e doenças, fontes de nutrientes e recomendações dietéticas. Objetivo: Avaliar o conhecimento nutricional da população de Caxias do Sul e investigar suas associações com variáveis sociodemográficas e dados antropométricos. Métodos: Estudo transversal incluindo moradores do município de Caxias do Sul, entre 18 e 80 anos. Através de questionário on-line, foram coletados dados sociodemográficos e antropométricos dos participantes. Para avaliar o conhecimento nutricional, foram utilizadas as seções 2 e 4 do questionário GNKQ (General NutritionKnowledgeQuestionnaire for Adults). As 26 questões possuíam diversos itens e cada item assinalado corretamente recebeu 1 ponto, totalizando 57 pontos possíveis. O conhecimento nutricional foi classificado em baixo (até 19 pontos), médio (entre 20 e 38 pontos) e alto (acima de 39 pontos). Resultados: O conhecimento nutricional médio da amostra foi 39,9 ± 6,1 pontos. A maioria dos participantes foi classificada como detentores de alto conhecimento nutricional (n=184; 61,1%, média 43,8 ± 3,6 pontos). Houve diferença estatística entre gêneros (p<0,001), renda (p=0,009), escolaridade (p=0,015) e profissionais e estudantes de Nutrição (p<0,001). Mulheres, pessoas com renda mais elevada e grau de escolaridade maior, bem como estudantes e profissionais de Nutrição apresentaram maior conhecimento nutricional. Conclusão: A amostra de adultos e idosos de Caxias do Sul-RS possui um bom conhecimento nutricional, com maiores pontuações entre as participantes do sexo feminino, maior renda, maior escolaridade e profissionais ou estudantes de Nutrição.

Introduction: Nutritional knowledge is the understanding of the concepts and processes of nutrition and health, including combinations of knowledge about diet and health, diet and diseases, nutritional sources, and dietary recommendations. Objective: To assess the nutritional knowledge of the population from Caxias do Sul and investigate their associations with sociodemographic and anthropometric data. Methods: Cross-sectional study including residents of Caxias do Sul, between 18 and 80 years old. Through an online questionnaire, sociodemographic and anthropometric data were collected. To evaluate the nutritional knowledge, sections 2 and 4 from GNKQ (General Nutrition Knowledge Questionnaire for adults) were used. The 26 questions had several items and each item marked correctly received 1 point, totaling 57 possible points. The nutritional knowledge was classified as low (up to 19 points), medium (between 20 and 38 points) and high (above 39 points). Results: The sample nutritional knowledge was 39.9 ± 6.1 points. Most of the participants were classified as high nutritional knowledge (n=184; 61.1%, average 43.8 ± 3.6 points). There was a statistical difference between gender (p<0.001), income (p=0.009), schooling (p=0.015) and nutrition students or dietitians (p<0.001). Women, people with higher income and schooling, as well as nutrition students or dietitians demonstrated higher nutritional knowledge. Conclusions: The sample of adults and older people from Caxias do Sul-RS has considerable nutritional knowledge, with a higher score between female participants, higher income, higher level of education, and nutrition students or dietitians.

Effect of vegetarian diets on renal function in patients with chronic kidney disease under non-dialysis treatment: A scoping review / Efeito de dietas vegetarianas na função renal em pacientes com doença renal crônica sob tratamento não-dialítico: Uma revisão do escopo

Abstract Vegetable protein diets (VPDs) in chronic kidney disease (CKD) patients may be related to beneficial biological actions and possibly clinical impact. This is a scoping review that merge studies that evaluated the effect of a vegetarian diet on kidney function in adults with CKD under non-dialysis treatment. The evaluated outcome was the impact in renal function assessed by eGFR or creatinine clearance. MEDLINE (accessed by PubMed) was searched up to September 8, 2020. Data were extracted by two independent reviewers, who also assessed the quality of the studies. Of 341 retrieved articles, 4 studies assessing 324 patients were included in the analysis. One study showed that a very low-protein ketoanalogue-supplemented vegetarian diet had benefits in relation to a conventional low-protein diet, while the other three studies demonstrated no difference in kidney function between the evaluated diets. Additional studies are needed to assess the benefits of vegetarian diets for further recommendations in CKD management.

Resumo As dietas de proteína vegetal (VPDs, do inglês vegetable protein diets) em pacientes com doença renal crônica (DRC) podem estar relacionadas a ações biológicas benéficas e possivelmente ao impacto clínico. Esta é uma revisão de escopo que reúne estudos que avaliaram o efeito de uma dieta vegetariana na função renal em adultos com DRC sob tratamento não-dialítico. O desfecho analisado foi o impacto na função renal avaliado pela TFGe ou pelo clearance de creatinina. O MEDLINE (acessado via PubMed) foi pesquisado até 8 de Setembro de 2020. Os dados foram extraídos por dois revisores independentes, que também avaliaram a qualidade dos estudos. De 341 artigos recuperados, foram incluídos na análise 4 estudos avaliando 324 pacientes. Um estudo mostrou que uma dieta vegetariana hipoproteica suplementada com cetoanálogos teve benefícios em relação a uma dieta hipoproteica convencional, enquanto os outros três estudos não demonstraram diferença na função renal entre as dietas avaliadas. São necessários estudos adicionais a fim de avaliar os benefícios de dietas vegetarianas para maiores recomendações no manejo da DRC.

Effect of vegetarian diets on renal function in patients with chronic kidney disease under non-dialysis treatment: A scoping review.

Vegetable protein diets (VPDs) in chronic kidney disease (CKD) patients may be related to beneficial biological actions and possibly clinical impact. This is a scoping review that merge studies that evaluated the effect of a vegetarian diet on kidney function in adults with CKD under non-dialysis treatment. The evaluated outcome was the impact in renal function assessed by eGFR or creatinine clearance. MEDLINE (accessed by PubMed) was searched up to September 8, 2020. Data were extracted by two independent reviewers, who also assessed the quality of the studies. Of 341 retrieved articles, 4 studies assessing 324 patients were included in the analysis. One study showed that a very low-protein ketoanalogue-supplemented vegetarian diet had benefits in relation to a conventional low-protein diet, while the other three studies demonstrated no difference in kidney function between the evaluated diets. Additional studies are needed to assess the benefits of vegetarian diets for further recommendations in CKD management.

Avaliação do consumo de frutas em pacientes com diabetes mellitus tipo 2 / Fruit consumption in patients with type 2 diabetes mellitus

Introdução: O impacto do consumo de frutas sobre a saúde de pacientes com diabetes mellitus tipo 2 (DM2) requer investigações. O objetivo deste estudo foi avaliar o consumo de frutas em pacientes com DM2 e identificar a sua associação com parâmetros de controle glicêmico.Métodos: Foram incluídos 197 pacientes ambulatoriais com DM2, submetidos à avaliação clínica, sociodemográfica, antropométrica, laboratorial e de consumo alimentar. A ingestão alimentar total e o consumo de frutas foram avaliados por questionário quantitativo de frequência alimentar. Os pacientes com menor e maior consumo de frutas (de acordo com a mediana) foram comparados.Resultados: A média do consumo de frutas foi de 593,66 ± 330,74 g/dia. Entre os menores e maiores consumidores de frutas, os valores de glicemia (169,42 ± 70,83 vs. 158,62 ± 64,56 mg/dL; p = 0,273) e hemoglobina glicada (8,39 ± 1,68 vs. 8,68 ± 2,38%; p = 0,319) não foram diferentes, assim como as demais variáveis. Os pacientes com maior consumo de frutas apresentaram maior ingestão de energia (p < 0,001), carboidratos (p < 0,001) e fibras (p = 0,006) e uma menor ingestão de proteínas (p = 0,015), lipídeos totais (p = 0,040) e seus tipos. O grupo que mais consumiu frutas apresentou uma maior ingestão de vitamina C (p < 0,001) e potássio (p < 0,001) e um menor consumo de sódio (p = 0,001). Foi observado ainda uma correlação negativa entre o consumo de frutas e o índice glicêmico da dieta (p = 0,05).Conclusão: Não houve diferença na glicemia em jejum e no valor de hemoglobina glicada entre os pacientes com DM2 com maior e menor consumo de frutas.

Introduction: The impact of fruit consumption on the health of patients with type 2 diabetes mellitus (T2DM) warrants investigation. The aim of this study was to evaluate fruit consumption in patients with T2DM and to identify its association with glycemic control parameters.Methods: We included 197 outpatients with T2DM who underwent clinical, sociodemographic, anthropometric, laboratory, and food consumption assessments. A food frequency questionnaire was used to assess total food intake and fruit consumption. Patients with lower and higher fruit consumption (according to the median) were compared.Results: Average fruit consumption was 593.66 ± 330.74 g/day. Blood glucose (169.42 ± 70.83 vs. 158.62 ± 64.56 mg/dL; p = 0.273) and glycated hemoglobin (8.39 ± 1.68% vs. 8.68 ± 2.38%; p = 0.319) levels did not differ between the lower and higher fruit consumption groups, nor did the other variables. Patients with higher fruit consumption had a higher intake of energy (p < 0.001), carbohydrates (p < 0.001), and fibers (p = 0.006) but a lower intake of proteins (p = 0.015) and total and different types of lipids (p = 0.040). The higher consumption group had higher vitamin C (p < 0.001) and potassium (p < 0.001) intake and lower sodium intake (p = 0.001). We identified a negative correlation between fruit consumption and the diet's glycemic index (p = 0.05).Conclusion: Fasting blood glucose and glycated hemoglobin levels did not differ between the higher and lower fruit consumption groups.

Impacto da pandemia sobre mudanças alimentares de pacientes com diabetes mellitus tipo 2: uma revisão sistemática / The impact of the pandemic on food consumption in patients with type 2 diabetes mellitus: a systematic review

Introdução: O confinamento gerado pela pandemia do COVID-19 causou mudanças no comportamento e consumo alimentar dos indivíduos. Em pacientes com diabetes mellitus tipo 2 (DM2) essas alterações requerem investigações. O objetivo desta revisão sistemática foi avaliar o consumo alimentar em pacientes com DM2 durante o confinamento da pandemia de COVID-19 e identificar as mudanças que ocorreram neste período.Métodos: Para a busca foi utilizada a base de dados PubMed (MEDLINE) na data 04 de fevereiro de 2022 utilizando a estratégia: (diabetes mellitus OR diabetes) AND (pandemic OR COVID-19 OR SARS-Cov-2) AND (diet OR eating OR feeding behavior). Foram incluídos artigos originais observacionais, publicados a partir do ano 2020 sem restrição de idioma, que reportassem os efeitos do bloqueio da pandemia do COVID-19 na alteração na alimentação em pacientes com DM2. A seleção dos artigos e extração de dados foi realizada por dois revisores independentes.Resultados: A busca inicial resultou em 349 estudos. Após aplicação dos critérios de elegibilidade, foram incluídos 10 estudos, totalizando 1.917 indivíduos. Houve resultados positivos como aumento do consumo de frutas e vegetais e consumo de comida caseira, e negativos como no aumento no consumo de alimentos açucarados, ultraprocessados e lanches não saudáveis.Conclusão: Houve mudanças mistas no consumo alimentar dos participantes com DM2 durante a pandemia.

Introduction: The COVID-19 lockdown has affected people's food consumption pattern. In patients with type 2 diabetes mellitus (T2DM), these changes need to be investigated. This systematic review aimed to evaluate changes in food consumption in patients with T2DM during the COVID-19 lockdown.Methods: We searched PubMed (MEDLINE) database on February 4, 2022, using the following search strategy: (diabetes mellitus OR diabetes) AND (pandemic OR COVID-19 OR SARS-CoV-2) AND (diet OR eating OR feeding behavior). We selected original observational studies published after 2020, without language restrictions, reporting the effects of the COVID-19 lockdown on the dietary pattern of patients with T2DM. Study selection and data extraction were conducted by two independent reviewers.Results: The initial search yielded 349 studies. After applying the eligibility criteria, 10 studies were included in this review, comprising 1,917 patients. Positive results included increases in fruit and vegetable intake and homemade meal consumption. Negative results included an increase in sugar, ultraprocessed food, and unhealthy snack consumption.Conclusion: There were both positive and negative changes in the food consumption pattern of patients with T2DM during the COVID-19 pandemic.

Could serum zonulin be an intestinal permeability marker in diabetes kidney disease?

Zonulin is a protein associated with the tight junction complex opening at the intestinal epithelium, previously linked to obesity, cardiovascular diseases, type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). However, its role in CKD has not been totally elucidated. This study aimed to evaluate zonulin levels in subjects with diabetic kidney disease (DKD). This case-control study included two cases groups: 1) Advanced DKD cases: T2DM patients with estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2; 2) Albuminuric T2DM cases: diabetic patients with urinary albumin excretion (UAE) >30mg/g creatinine, but with eGFR>60ml/min/1.73m2. Two control groups were also included: 1) T2DM controls: patients with T2DM without impaired kidney function; 2) Non-T2DM controls: subjects without T2DM and normal renal function. Serum levels of zonulin were measured by ELISA. Eighty-six individuals were included. Zonulin levels was different among study groups (P = 0.003). T2DM controls presented higher zonulin levels than non-T2DM controls [(131.35 (83.0-170.5) vs. 87.25 (54.7-111.8), P = 0.018] and advanced DKD cases [63.72 (45.03-106.0); P = 0.007]. Zonulin showed a positive correlation with eGFR (r = 0.222; P = 0.040), total cholesterol (r = 0.299; P = 0.034), LDL (r = 0.258; P = 0.021), and negative with albuminuria (r = -0.243; P = 0.024) and body fat (r = -0.271; P = 0.014). In the multivariate logistic regression analyses, zonulin levels were independently associated to renal outcomes [OR 0.99 (0.98-0.99, P = 0.012)] after 5-year inclusion. In conclusion, increased zonulin levels in patients with TD2M without renal disease suggest an impaired intestinal permeability. Moreover, its association with renal outcomes could indicate its use as a disease monitoring marker. However, the mechanisms behind this association should be better understood.

Risk factors associated with weight gain after kidney transplantation: A cohort study.

BACKGROUND: Renal transplantation is the best modality of renal replacement therapy for patients with end-stage renal disease. However, it is associated with weight gain and metabolic abnormalities, which adversely impact transplant outcomes. OBJECTIVE: The objective of this study was to identify the risk factors of one-year weight gain after renal transplantation. METHODS: A retrospective cohort study was conducted with 374 patients that underwent kidney transplantation between January 2006 and July 2013. Clinical and laboratory variables were collected from electronic records, and the outcome of interest was weight gain during the first year after renal transplantation. The data were reported as mean ± standard deviation, median (interquartile range) or number of subjects (%). The association between variables were assessed via chi-square test and ANOVA. For analysis of risk factors related to the outcomes of interest, multivariable logistic regression models were used. RESULTS: There were 181 (48.4%) female patients, 334 (89.3%) with white ethnicity and the mean age was 44.4 ± 12.8 years. The mean BMI pre-transplant was 24.7 ± 4.1 kg/m2, and 35 (9.9%) patients were classified as obese; 119 (33.6%) as overweight; 187 (52.8%) as normal weight; and 13 (3.7%) as malnourished. After one year of follow-up, the mean BMI was 26.2 ± 5.0 kg/m2, and 61 (17.3%) patients were classified as obese; 133 (37.8%) as overweight; 148 (42.0%) as normal weight; and 10 (2.8%) as malnourished. Weight gain was observed in 72.7% patients, and the average increase was 7.12 ± 5.9 kg. The female gender, lower pre-transplant body weight, lower number of hospitalizations, and a kidney received from a living donor were associated with weight gain by more than 5% in the first year post-transplant. CONCLUSION: Female gender and lower pre-transplant body weight were independently associated with weight gain by more than 5% in the first year after kidney transplantation; lower rates of hospitalization and donation from living donors were also risk factors for this outcome.

Plasma progranulin levels in obese patients before and after Roux-en-Y gastric bariatric surgery: a longitudinal study.

BACKGROUND: Bariatric surgery stands out as the most effective long-term intervention for sustainable weight loss and metabolic improvement in patients with severe obesity. Progranulin was recently identified as an adipokine related to obesity and inflammation, revealing a metabolic function and proinflammatory properties. OBJECTIVE: To evaluate plasma progranulin levels before and after 6 months of bariatric surgery in Roux-en-Y gastric bypass (RYGB). SETTING: Tertiary referral hospital, southern Brazil. METHODS: This was a prospective longitudinal study, including 23 obese patients who underwent RYGB. Demographic and clinical characteristics, body composition, and resting energy expenditure were evaluated. Plasma progranulin was determined with enzyme-linked immunosorbent assays in a peripheral blood sample collected before and 6 months after the surgical procedure. RESULTS: The participants were mostly women (78.3%), with a mean age of 42.3 ± 10.8 years and baseline body mass index of 48.8 ± 10.4 kg/m2. Regarding the anthropometric parameters, there were differences in the pre- and post-RYGB values, with reduction of weight, body mass index, body fat percentage, and cervical and abdominal circumferences. All laboratory parameters improved, such as lipid profile and fasting glycemia, and resting energy expenditure values decreased significantly. Plasma progranulin levels decreased from 47.6 ± 13.5 ng/mL before RYGB to 40.4 ± 9.9 ng/mL after 6 months of surgery (P = .005). The reduction of progranulin did not correlate with body composition or laboratory data. CONCLUSIONS: Plasma progranulin levels significantly reduced 6 months after RYGB, but it could not be explained by changes in anthropometry, body composition, or glycemic or lipid profile.

Effects of dietary counseling on sodium restriction in patients with chronic kidney disease on hemodialysis: A randomized clinical trial.

Reducing dietary sodium has the potential to benefit patients with chronic kidney disease on hemodialysis (HD). This study was aimed to evaluate the effects of dietary counseling on sodium restriction and its relationship with clinical, dietary, and quality of life parameters in patients on HD treatment. This study was designed as a randomized clinical trial. The study included 87 patients on HD, divided into intervention (n = 47) and control (n = 40) groups. Anthropometric, clinical, sodium intake, and quality of life data were evaluated in both groups at four-time points: baseline (T0), 90 days (T3), 180 days (T6), and 365 days (T12). The intervention group received dietary counseling at the beginning and throughout the study. There were no between-group differences regarding anthropometric, clinical, and quality of life data at any of the time points. The mean age was 59 ± 14 years, and most of the patients were men (61%) and had hypertension (90%). Total sodium (g) and processed meat (mg sodium) intake significantly decreased in both groups [intervention: T0 = 3.5 (2.3-4.7); T12 = 2.0 (0.7-2.5); P <0.0001; control: T0 = 3 (1.5-4.9); T12 = 2.0 (0.8-3.3); P = 0.001; and intervention: T0 = 78 (25-196); T12 = 21 (0-78); P = 0.003; control: T0 = 97 (31-406); T12 = 44 (0-152); P = 0.004, respectively] . There was a significant decrease in the consumption of packaged seasonings (mg sodium) [T0 = 130 (0-854); T12 = 0 (0-0); P = 0.015] and instant noodles [T0 = 19 (0-91); T12 = 0 (0-0); P = 0.017] in the intervention group. Dietary counseling was effective in changing dietary habits. In both groups, there was a reduction in total sodium intake, which was greater in the intervention group. Moreover, a decrease in the intake of salty foods, such as packaged seasonings and instant noodles, was only observed in the intervention group.

Body Fat Estimation in Kidney Transplant Recipients: Skinfolds Thickness Compared With Dual-Energy X-Ray Absorptiometry.

OBJECTIVE(S): The aim of the study was to compare the method of estimating the body fat percentage (BF%) by skinfold thickness to dual-energy X-ray absorptiometry (DEXA) in kidney transplant recipients. DESIGN AND METHODS: This is a longitudinal study that evaluated patients at 3 (n = 46) and 12 months (n = 37) after kidney transplantation at Hospital de Clínicas in Porto Alegre, Brazil. The Durnin and Womersley equation was used to estimate the body density, and the Siri equation was used to estimate BF%, using measurements of 4 skinfolds: biceps, triceps, subscapular, and suprailiac. DEXA was used as a reference. Paired t-test, Pearson correlation coefficient, Bland and Altman plots, and receiver operating characteristic curves adjusted by gender were used for statistical assessment. RESULTS: There was a positive correlation between the methods at 3 (r = 0.783; P < .001) and at 12 months (r = 0.824; P < .001) after transplantation. The BF% values were underestimated by skinfolds when compared with DEXA at 3 (29.43 ± 9.64% vs. 33.16 ± 8.74%; P < .001) and 12 months (29.84 ± 8.40% vs. 33.93 ± 9.13%; P < .001). According to the Bland and Altman analyses, the mean difference between both methods was 3.72 ± 6.11% (95% confidence interval: -15.7 to 8.3%) at 3 months and 4.09 ± 5.24% (95% confidence interval: -14.4 to 6.2%) at 12 months. The skinfold equation was a good predictor of high fat percentage when compared with DEXA at 3 (area under the curve and 95% confidence interval = 0.873 [0.766-0.980]; P = .004) and 12 months after kidney transplantation (area under the curve and 95% confidence interval = 0.857 [0.731-0.983]; P = .004). CONCLUSION(S): The skinfold thickness underestimated the BF% when compared with DEXA, but the 2 methods presented a modest correlation and agreement at 3 and 12 months after kidney transplantation. The skinfold thickness also presented a modest performance to detect patients with increased BF% at both times.

Supplementation of Probiotics and Its Effects on Physically Active Individuals and Athletes: Systematic Review.

The aim of this study was to conduct a systematic review of the effects of probiotic supplementation on physically active individuals. The participants, interventions, comparisons, outcome and study design inclusion criteria were (a) studies involving healthy adults or older subjects of both sexes who did physical exercise (including athletes and physically active individuals), (b) interventions with probiotics, (c) inclusion of a control group, (d) outcomes not previously defined, and (e) clinical trials and randomized clinical trials, with no language or date restrictions. The search was conducted in the following scientific databases: MEDLINE, Embase, SciELO, Scopus, and Lilacs. Search terms were "Probiotics" OR "Prebiotics" OR "Microbiota" AND "Exercise" OR "Athletes." The articles were first screened by title and abstract by two independent reviewers and disagreements resolved by a third reviewer. Data were extracted independently by the same two reviewers; results were extracted in duplicate and then compared to avoid errors. A total of 544 articles were retrieved and 24 were included. A total of 1,680 patients were included, most of them being male (n = 1,134, 67.5%), with a mean age of 30.9 ± 6.1 years. Following probiotic supplementation, positive effects have been reported for several outcomes including respiratory tract infection, immunologic markers, and gastrointestinal symptoms in both athletes and nonathletes. However, published studies have distinct protocols and measured outcomes, and some of them have small sample size and failed to prove beneficial effect on probiotic supplementation, leading to inconclusive results for standardized supplementation protocols.

Association between progranulin serum levels and dietary intake.

INTRODUCTION: Progranulin (PGRN) is secreted by adipose tissue and has been linked to obesity, insulin resistance and type 2 diabetes mellitus. There is evidence that a high fat diet increases PGRN expression in rodent adipose tissue. In humans, the relationship between diet composition and concentration of PGRN is still unknown. OBJECTIVE: To investigate the association between dietary intake and serum PGRN levels. METHODS: This is an exploratory cross-sectional study including 85 subjects. Demographic, clinical, laboratory and anthropometric data were collected. Serum PGRN was determined by enzyme-linked immunosorbent assay after overnight fasting. Dietary intake was assessed by food frequency questionnaire validated for Brazilian southern population. Focused principal component analyses (FPCA) was used to verify the association of dietary components and food groups with PGRN levels. Sensitivity analyses were performed including only subjects with reporting according to the Goldberg and Black cut-offs of energy intake-energy expenditure ratio between 0.76 and 1.24. RESULTS: The median PGRN was 51.96 (42.18 to 68.30) ng/mL. Analyzing all sample, the FPCA showed no association of serum PGRN with total energy, protein, carbohydrate, fat and its types, fiber intake and dietary glycemic index; but a significant and positive association between solid fats and PGRN levels (p<0.05). Including only subjects with reporting according cut-off of energy intake-energy expenditure ratio between 0.76 and 1.24, FCPA showed significant and positive association of serum PGRN with saturated fatty acids and solid fats intake (p<0.05). In this subgroup, PGRN correlated with saturated fatty acids (r = 0.341; p = 0.031). Solid fats intake was independently associated to serum PGRN (beta = 0.294; p = 0.004) in multivariate model. CONCLUSION: The dietary intake of solid fats, mainly represented by saturated fatty acids, is associated to serum PGRN concentration in human subjects.

Utilização de leite materno em lactário por bebês internados em unidades de terapia intensiva / Utilización de la leche materna en lactario de bebés ingresados en unidades de cuidados intensivos / Use of breast milk from milk dispensary by babies in neonatal intensive care units

OBJETIVO: Avaliar a quantidade de leite materno coletado e com destino à Unidade de Terapia Intensiva (UTI) Neonatal, em um hospital amigo da criança, no Sul do Brasil. MÉTODOS: Estudo observacional, transversal e analítico, realizado no lactário do Hospital Geral de Caxias do Sul, no período de julho a dezembro de 2016. Foram coletados dados da quantidade de leite materno, considerando: entrada total para todos os setores, entrada e saída com destino à UTI Neonatal, desprezos por alta/óbito, degelo vencido e validade expirada. As variáveis categóricas estão apresentadas em números absolutos e percentuais e variáveis contínuas, como média ± desvio padrão. Realizou-se análise estatística através do programa Statistical Package for Social Sciences (SPSS), versão 20.0, considerando significância estatística p<0,05. RESULTADOS: O valor de entrada total no lactário foi de 177.053 mL, a entrada de leite materno para a UTI Neonatal apresentou-se em 153.898 mL, e teve como saída 87,21% desse volume. Os números de desprezo representaram 4,04, 1,14 e 0,55%, respectivamente, sendo por alta/óbito, degelo e validade. A média diária do semestre de esgota para a UTI Neonatal foi 836,40±382,67 mL, e a média diária de utilização de leite materno para a UTI Neonatal de 729,44±341,54 mL. CONCLUSÃO: O lactário apresentou alta porcentagem de esgota e utilização de leite materno e baixo desprezo, demonstrando bom controle de armazenamento e sua importância dentro do hospital amigo da criança. (AU)

OBJECTIVE: To assess the amount of breast milk collected and destined for the Neonatal Intensive Care Unit (ICU) at a baby-friendly hospital in the South of Brazil. METHODS: An analytical, observational cross-sectional study, carried out in the milk dispensary of Caxias do Sul General Hospital, in the period from July to December 2016. Data on the amount of breast milk was collected, considering: total intake for all hospital units, entry and exit of milk destined for the Neonatal ICU, and discarded amounts due to discharge/death, expired thaw and expired validity. Categorical variables are presented in absolute numbers and percentages and continuous variables as mean ± standard deviation. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS), version 20.0, considering p<0.05 as statistical significance level. RESULTS: The total milk intake to the milk dispensary was 177,053 mL; the breast milk entry to the Neonatal ICU was 153,898 mL, and 87.21% of this volume was used. The disposal figures due to discharge/death, thaw and validity represented 4.04, 1.14 and 0.55%, respectively. The mean daily milk expression in the semester for the Neonatal ICU was 836.40 ± 382.67 mL, and the mean daily consumption of human milk for the Neonatal ICU was 729.44 ± 341.54 mL. CONCLUSION: The milk dispensary presented a high percentage of human milk expresstion and consumption and a low disposal, demonstrating a good storage control and its value within the baby-friendly hospital. (AU)

OBJETIVO: Evaluar la cantidad de leche materna extraída y destinada a la Unidad de Cuidados Intensivos (UCI) Neonatal de un hospital amigo del niño en el Sur de Brasil. MÉTODOS: Estudio observacional, transversal y analítico realizado en el lactario del Hospital General de Caxias del Sur en el período entre julio y diciembre de 2016. Se recogieron los datos de la cantidad de leche materna considerando la entrada total para todos los sectores, la entrada y salida para la UCI Neonatal, el desprecio por la alta/el óbito, el deshielo caducado y la validez espirada. Las variables categóricas se presentan con valores absolutos y porcentuales y las variables continuas con la media ± desviación típica. Se realizó un análisis estadístico a través del programa Statistical Package for Social Sciences (SPSS) versión 20.0 con la estadística significativa de p<0,05. RESULTADOS: El valor de la entrada total en el lactario ha sido de 177.053 ml, la entrada de la leche materna para la UCI Neonatal ha sido de 153.898 ml y la salida del 87,21% de ese volumen. Los números del desprecio representaron el 4,04, 1,14 y el 0,55%, respectivamente, por la alta/el óbito, el deshielo y la validez. La media diaria del semestre de la leche agotada para la UCI Neonatal ha sido de 836,40±382,67 ml y la media de la utilización de la leche materna para la UCI Neonatal a diario de 729,44±341,54 ml. CONCLUSIÓN: El lactario presentó alto porcentaje de la leche agotada y de la utilización de la leche materna y bajo desprecio lo que señala un buen control de almacenamiento y su importancia para el hospital amigo del niño. (AU)

Progranulin serum levels in human kidney transplant recipients: A longitudinal study.

BACKGROUND: The adipokine progranulin has metabolic proprieties, playing a role in obesity and insulin resistance. Its levels seems to be dependent of renal function, since higher progranulin concentration is observed in patients with end-stage kidney disease. However, the effect of kidney transplantation on progranulin remains unknown. OBJECTIVE: To assess the serum progranulin levels in kidney transplant recipients before and after kidney transplantation. METHODS: Forty-six prospective kidney transplant recipients were included in this longitudinal study. They were evaluated before transplantation and at three and twelve months after transplantation. Clinical, anthropometric and laboratorial measurements were assessed. Progranulin was determined with enzyme-linked immunosorbent assays. RESULTS: Serum progranulin significantly decreased in the early period after transplantation (from 72.78 ± 2.86 ng/mL before transplantation to 40.65 ± 1.49 ng/mL at three months; p<0.01) and increased at one year (53.15 ± 2.55 ng/mL; p<0.01 vs. three months), remaining significantly lower than before transplantation (p<0.01) (pover time<0.01). At one year after transplantation, there was a significant increase in body mass index, trunk fat and waist circumference compared to immediate period after transplantation. Progranulin was associated with waist circumference and fasting plasma glucose after adjusted for age, gender, study period, glomerular filtration rate, interleukin-6, high sensitivity C reactive protein and adiponectin. CONCLUSION: Progranulin serum levels are increased before transplantation and a reduction is observed in the early period after transplantation, possibly attributed to an improvement in renal function. At one year after transplantation, an increment in progranulin is observed, seems to be independent of glomerular filtration, and remained significantly lower than before transplantation.

Effect of an intensive nutrition intervention of a high protein and low glycemic-index diet on weight of kidney transplant recipients: study protocol for a randomized clinical trial.

BACKGROUND: Excessive weight gain is commonly observed within the first year after kidney transplantation and is associated with negative outcomes, such as graft loss and cardiovascular events. The purpose of this study is to evaluate the effect of a high protein and low glycemic-index diet on preventing weight gain after kidney transplantation. METHODS: We designed a prospective, single-center, open-label, randomized controlled study to compare the efficacy of a high protein (1.3-1.4 g/kg/day) and low-glycemic index diet versus a conventional diet (0.8-1.0 g/kg/day of protein) on preventing weight gain after kidney transplantation. A total of 120 eligible patients 2 months after transplantation will be recruited. Patients with an estimated glomerular filtration rate through the modification of diet of renal disease (MDRD) formula < 30 mL/min/1.73 m2 or urinary albumin excretion > 300 mg/24 h will be excluded. Patients' diets will be allocated through simple sequential randomization. Patients will be followed-up for 12 months with nine clinic appointments with a dietitian and the evaluations will include nutritional assessment (anthropometrics, body composition, and resting metabolic rate) and laboratory tests. The primary outcome is weight maintenance or body weight gain under 5% after 12 months. Secondary outcomes include body composition, resting metabolic rate, satiety sensation, kidney function, and other metabolic parameters. DISCUSSION: Diets with higher protein content and lower glycemic index may lead to weight loss because of higher satiety sensation. However, there is a concern about the association of high protein intake and kidney damage. Nevertheless, there is little evidence on the impact of high protein intake on long-term kidney function outcome. Therefore, we designed a study to test if a high protein diet with low-glycemic index will be an effective and safe nutritional intervention to prevent weight gain in kidney transplant patients. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT02883777 . Registered on 3 August 2016.

Serum and Urinary Progranulin in Diabetic Kidney Disease.

Progranulin has been recognized as an adipokine related to obesity, insulin resistance and type 2 diabetes mellitus (T2DM). There are scarce data regarding progranulin and kidney disease, but there are some data linking diabetic kidney disease (DKD) and increased progranulin levels. We aimed to better describe the relationship between serum and urinary progranulin levels and DKD in T2DM. This is a case-control study including four groups of subjects: 1) Advanced DKD cases: T2DM patients with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2; 2) Albuminuric DKD cases: T2DM patients with urinary albumin excretion (UAE) ≥30 mg/g creatinine and eGFR ≥60 mL/min/1.73m2; 3) Diabetic controls: T2DM patients with UAE <30 mg/g creatinine and eGFR ≥60 mL/min/1.73m2; and 4) Non-diabetic controls: individuals without T2DM. Progranulin was determined by enzyme-linked immunosorbent assay. One hundred and fourteen patients were included (23 advanced DKD cases, 25 albuminuric DKD cases, 40 diabetic controls and 26 non-diabetic controls). Serum progranulin was increased in advanced DKD compared to other groups [70.84 (59.04-83.16) vs. albuminuric cases 57.16 (42.24-67.38), diabetic controls 57.28 (42.08-70.47) and non-diabetic controls 44.54 (41.44-53.32) ng/mL; p<0.001]. Urinary progranulin was decreased in advanced DKD cases compared to albuminuric cases [10.62 (6.30-16.08) vs. 20.94 (12.35-30.22); diabetic controls 14.06 (9.88-20.82) and non-diabetic controls 13.51 (7.94-24.36) ng/mL; p = 0.017]. There was a positive correlation between serum progranulin and body mass index (r = 0.27; p = 0.004), waist circumference (r = 0.25; p = 0.007); body fat percentage (r = 0.20; p = 0.042), high-sensitive C reactive protein (r = 0.35; p<0.001) and interleukin-6 (r = 0.37; p<0.001) and a negative correlation with eGFR (r = -0.22; p = 0.023). Urinary progranulin was positively associated with albuminuria (r = 0.25; p = 0.010). In conclusion, progranulin is affected by a decrease in eGFR, being at a higher concentration in serum and lower in urine of DKD patients with T2DM and eGFR <60 mL/min/1.73m2. It is also associated with markers of obesity and inflammation.