Association of phase angle values and sarcopenia in older patients with heart failure.

BACKGROUND: Sarcopenia presents an accelerated and accentuated muscle loss in patients with heart failure (HF), leading to a worse prognosis for these patients. This study sought to assess the association of phase angle (PA) values with sarcopenia and its components, as well as to establish a PA cutoff point to predict outcomes such as hospitalization and mortality in older adult patients with HF. METHODS: Sarcopenia diagnosis followed the European Working Group on Sarcopenia in Older People criteria. Anthropometric, bioelectrical impedance (PA and body composition), functional capacity and inflammatory markers were assessed. RESULTS: Included patients were predominantly male (67%) and White, with a mean age of 69 ± 7 years, and a predominance of New York Heart Association I and II functional classes (82.1%) and reduced left ventricular ejection fraction (70.8%). Of the total sample, 23.6% were identified as sarcopenic. Mean PA values were lower in patients with sarcopenia (4.9 ± 0.9 and 6.0 ± 0.8°; P < 0.001). The cutoff point detected for sarcopenia in the receiver operating characteristic curve was 5.45°, which is an independent predictor for sarcopenia. PA values below this cutoff point were also associated with each of the sarcopenic components evaluated. PA proved to be an independent predictor for hospitalization (P = 0.042) in the entire sample studied. CONCLUSION: PA is associated with diagnostic components of sarcopenia and the cutoff point 5.45° proved to be an independent predictor of sarcopenia and hospitalization >3 years in older adult patients with HF.

Body composition of patients with autism spectrum disorder through bioelectrical impedance.

BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in sociability, communication, and limited repertoire of interests and behaviors. OBJECTIVES: We aimed to investigate the nutritional status through bioelectrical impedance analysis (BIA) and antrophometrics variables in 63 ASD children and adolescents (10.5 ± 4.1 years; 81% male). MATERIALS AND METHODS: Anthropometric variables were weight, height, and waist circumference (WC); body composition (fat mass, fat free mass) and phase angle (PA) were obtained through BIA. RESULTS: The body mass index showed a prevalence of overweight, obesity and underweight of 38.9, 36.5 and 15.8%, respectively. According to the body fat percentual, obesity prevalence was 49.2%, and 49.2% showed WC > 80th percentile for age. Eleven patients presented lower PA values than references. CONCLUSION: According to the these parameters, a large percentual of ASD children and adolescents in this sample had total overweight and obesity and truncal adiposity, which causes concern, as well as the percentage of underweight participants.

ANTHROPOMETRIC PROFILE AND NUTRITIONAL INTAKE IN PATIENTS WITH EPILEPSY.

BACKGROUND: quality of life impairments are common in patients with epilepsy, especially due to cardiovascular comorbidities, overweight and obesity. OBJECTIVES: to evaluate the nutritional status of patients with epilepsy based on anthropometric measurements and dietary intake. METHODS: this cross-sectional study involved 72 patients recruited by convenience from the Epilepsy Clinic of the Clinical Hospital of Porto Alegre, Brazil. The sample consisted of patients of both genders, aged over 18 years, who had been diagnosed with epilepsy for at least one year. The following variables were investigated: anthropometric measurements (weight and height for the assessment of BMI and nutritional status, waist circumference for the assessment of cardiovascular risk); nutritional intake based on a food frequency questionnaire; socioeconomic status based on the Brazilian Economic Classification Criteria. RESULTS: the prevalence of overweight/obesity was 66.7%, and 85.4% of the women had a high cardiovascular risk. Patients displayed a low frequency of seizure control (41.7%), high carbohydrate and protein intakes, as well as low mono- and polyunsaturated fatty acid intakes (including omega 3 and 6 fatty acids). No differences in nutritional status or intake were observed between patients with controlled versus uncontrolled seizures. CONCLUSIONS: patients with epilepsy have comorbidities risks, as evidenced by their tendency to overweight and obesity, and abdominal obesity. Although seizure control did not appear to be related to nutritional status and intake, the presence of such comorbidities underscores the need for nutritional monitoring and intervention in these patients, with a special focus on macronutrient redistribution and on dietary fatty acid levels.

Introducción: la calidad de vida alterada es común en los pacientes con epilepsia, especialmente debido a las comorbilidades cardiovasculares, el sobrepeso y la obesidad. Objetivos: evaluar el estado nutricional de los pacientes con epilepsia en base a mediciones antropométricas y la ingesta alimentaria. Métodos: este estudio transversal involucró a 72 pacientes reclutados por conveniencia en la Clínica de Epilepsia del Hospital de Clínicas de Porto Alegre, Brasil. La muestra consistió en pacientes de ambos sexos, mayores de 18 años, que habían sido diagnosticados de epilepsia durante al menos un año. Variables investigadas: medidas antropométricas (peso y talla para la evaluación del estado nutricional y el IMC, circunferencia de la cintura para la evaluación del riesgo cardiovascular); la ingesta nutricional en base a un cuestionario de frecuencia de alimentos; nivel socioeconómico basado en los Criterios de Clasificación Económica del Brasil. Resultados: la prevalencia de sobrepeso/obesidad fue del 66,7%, y el 85,4% de las mujeres tenían un alto riesgo cardiovascular. Los pacientes presentaron una baja frecuencia de control de las crisis (41,7%), alta ingesta de carbohidratos y proteínas, así como baja ingesta de ácidos grasos mono y poliinsaturados (incluyendo ácidos grasos omega 3 y 6). No se observaron diferencias en el estado nutricional ni el consumo entre los pacientes con convulsiones controlados o no controlados. Conclusiones: los pacientes con epilepsia tienen riesgos de comorbilidades, como se evidencia por su tendencia al sobrepeso/obesidad y obesidad abdominal. Aunque el control de las crisis no parece estar relacionado con el estado nutricional y la ingesta, la presencia de tales comorbilidades apunta la necesidad de vigilancia nutricional e intervención en estos pacientes, con un enfoque especial en la redistribución de macronutrientes y en los niveles de ácidos grasos en la dieta.

Phase angle as a prognostic marker in patients with critical illness.

BACKGROUND: Phase angle (PA) is interpreted as an indicator of cell membrane integrity and a prognostic indicator in some clinical situations. This study aims to evaluate PA as a prognostic marker in critically ill patients admitted to the intensive care unit (ICU) and associate this marker with length of hospital stay, mortality, and clinical scores. METHODS: A cohort study was conducted with 95 patients aged ≥18 years admitted to the ICU, who were assessed in terms of prognostic indexes (Acute Physiology and Chronic Health Evaluation II [APACHE II] and Sequential Organ Failure Assessment [SOFA]), clinical evolution (ICU discharge, death, and length of ICU stay), and PA. RESULTS: Patients were predominantly male (63.1%) and had a mean age of 63.7 ± 14.6 years; length of stay of 4 days (range, 3-9 days); mortality of 15.8%; mean APACHE II and SOFA scores of 17.3 ± 8.2 and 6.1 ± 3.1 points, respectively; and mean PA of 4.91 ± 1.36°. An association was observed between females and PA <5.1° (P = .035), which was the cutoff point determined from the receiver operating characteristic curve. PA was correlated with APACHE II score (r = -0.241; P = .02). This correlation became moderate only when patients without sepsis were considered (r = -0.506; P < .001). CONCLUSIONS: PA seems to be a good prognostic marker for patients without sepsis. The weak correlation between PA and APACHE II score and the lack of association with other clinical outcomes are limitations for interpreting the prognostic value of PA in the entire study sample.

Adequacy of energy and nutrient intake in patients with heart failure.

BACKGROUND: Nutritional factors have a significant influence on the prognosis of patients with heart failure (HF). OBJECTIVE: The goal of the present study was to assess the food intake of stable patients with HF. METHODS: Patients of both genders aged over 18 years with a confirmed diagnosis of HF were recruited and matched with healthy individuals for age, sex and BMI. Food records and weighing were used to assess participant nutritional intake. DRIs and NCEP-ATP III recommendations were used to evaluate the adequacy of nutritional intake. RESULTS: Sixty-five percent of the 40 patients in the sample and 48% of the 25 control subjects were men. The mean age in both groups was 54±8 years and mean BMI was categorized as overweight. Carbohydrate, trans fatty acid and sodium intake were higher in the HF group as compared to control subjects (p=0.006, p.

Introducción: Factores nutricionales tienen una influencia significativa en el pronóstico de pacientes con insuficiencia cardíaca (IC). Objetivos: Evaluar la ingesta de alimentos de pacientes con IC estable. Métodos: Pacientes de ambos sexos, mayores de 18 años, con diagnóstico confirmado de IC fueron reclutados y emparejados por edad, sexo y IMC con individuos sanos. La ingesta nutricional fue evaluada mediante el registro alimentario y pesaje de acuerdo con las recomendaciones de las DRIs y NCEP-ATP III para la evaluación de la adecuación de la ingesta nutricional. Resultados: El 65% de los 40 pacientes con IC y el 48% de los 25 individuos control eran hombres. La edad media en los grupos fue de 54±8 años y los valores del IMC fueron indicativos de sobrepeso. La ingesta de carbohidratos, ácidos grasos trans y sodio fue mayor en el grupo IC que en el grupo control (p=0,006, p.

Nutritional status, food intake and cardiovascular disease risk in individuals with schizophrenia in southern Brazil: a case-control study.

OBJECTIVES: To verify food consumption patterns and presence of risk anthropometric parameters in schizophrenic patients, trying to assess some modifiable cardiovascular risk. METHOD: Twenty-five schizophrenic outpatients, attended at the Hospital de Clínicas de Porto Alegre, Brazil, and 25 healthy controls matched by sex, age and body mass index (BMI) were included. Demographic (age, sex and socioeconomic status), anthropometric (weight, height and waist circumference), clinical (antipsychotics) and dietary consumption data (food frequency questionnaire) were obtained. RESULTS: There was a 40% frequency of overweight and 40% of obesity as verified by BMI, and 80% of increased risk of metabolic complications as measured by waist circumference. Most of the patients (68%) used atypical antipsychotics and no association was found between the distribution of the nutritional status according to BMI and type of antipsychotic used. There was a higher intake of total calories, calories and protein per kilogram of body weight, percentage of carbohydrates, and lower intake of omega-6, phytosterols, vitamin A and α-tocopherol by cases. Cholesterol and sodium intake did not differ between groups (365 ± 152 mg of cholesterol in cases and 313 ± 146 mg in controls; (3499 ± 1695 mg sodium by cases and 2874 ± 800 by controls). CONCLUSION: In this sample of schizophrenic patients there was a higher intake of calories and lower consumption of α-tocoferol and phitosterols, compared to controls. There was also elevated sodium, and cholesterol intake, and high frequency of overweight and central obesity.

Clinical and molecular evidence of the consumption of broccoli, glucoraphanin and sulforaphane in humans.

INTRODUCTION: Sulforaphane (SFN) is an isothiocyanate derived from glucoraphanin (GRA), which is found in great amounts especially in broccoli. Its consumption has been reported to be associated with a lower risk of myocardial infarction and cancer development. Additionally, its effects have been studied in neurodegenerative diseases, diabetes, and atherosclerosis, most of the times using animal models and cell cultures. OBJECTIVES: Given the promising results of SFN, this review aimed to investigate evidence documented in human intervention studies with broccoli, GRA and SFN. METHODS: A search was performed on PubMed and Virtual Health Library databases by two independent researchers using the descriptors "broccoli" or "glucoraphanin" or "sulforaphane", which should appear on the study's title or abstract. This review included randomized clinical trials performed in humans that were published in English and Portuguese from 2003 to 2013 and that considered clinical and molecular parameters of cell damage as outcomes of interest. RESULTS: Seventeen studies were selected, and the predominant type of intervention was broccoli sprouts. More consistent results were obtained for the clinical parameters blood glucose and lipid profile and for molecular parameters of oxidative stress, indicating that there was an improvement in these parameters after intervention. Less solid evidence was found with regard to decreased inflammation, Helicobacter pylori colonization, and protection against cancer. CONCLUSION: Although being relevant, the evidence for the use of broccoli, GRA and SFN in humans are limited; thus, further intervention studies are needed to evaluate outcomes more consistently and reach better grounded conclusions.

Introducción: El sulforafano (SFN) es un isotiocianato derivado de la glucorafanina (GRA), encontrada en gran cantidad especialmente en el brócolis. Su consumo está asociado a un menor riesgo de infarto del miocardio y de cáncer. Además, sus efectos están siendo estudiados en enfermedades neurodegenerativas, diabetes y aterosclerosis, casi siempre utilizando modelos animales y cultivos celulares. Objetivos: Debido a los resultados prometedores del compuesto SFN, esta revisión buscó investigar evidencias ya documentadas en intervenciones con brócoli, GRA y SFN en humanos. Métodos: Se realizó una búsqueda en las bases de datos PubMed y Biblioteca Virtual en Salud, por dos investigadores independientes, utilizando los descriptores "broccoli" o "glucoraphanin" o "sulforaphane", que debían constar en el título o resumen del trabajo. Se incluyeron ensayos clínicos randomizados realizados en humanos, publicados en inglés y portugués entre 2003 y 2013, y que consideraron como desenlaces de interés parámetros clínicos y moleculares de daño celular. Resultados: Se seleccionaron 17 estudios y el tipo de intervención predominante fueron brotes de brócoli. Los resultados más consistentes fueron obtenidos con los parámetros clínicos glicemia y perfil lipídico y los parámetros moleculares de estrés oxidativo, que presentaron mejora después de la intervención. Se encontraron evidencias menos sólidas respeto a la disminución de la inflamación, de la colonización por Helicobacter pylori y protección contra cáncer. Conclusión: Aunque relevantes, las evidencias del uso de brócoli, GRA y SFN en humanos son limitadas, siendo necesarios más estudios de intervención para avaluar los desenlaces de forma más consistente y producir conclusiones mejor fundamentadas.

Body mass index, abdominal obesity, body fat and migraine features in women.

BACKGROUND: Studies seeking to establish an association between migraine and anthropometric parameters have thus far been inconclusive. Furthermore, drugs used for migraine prophylaxis may be associated with changes in body weight. OBJECTIVE: To investigate the potential association of anthropometric parameters and body fat percentage with attack patterns and use of prophylactic medication in migraineurs. METHODS: Cross-sectional study that assessed the body mass index, waist circumference, body fat percentage and related clinical variables (characteristics of attacks and the use of prophylactic medication) in female outpatients with migraine. RESULTS: 166 female migraineurs aged ≥18 years (mean age, 45 ± 14 years) were included in the study. Migraine without aura was most prevalent (71.7%). Mean body mass index and body fat percentage were 27.8±6.0 kg/m² and 36.4 ± 8.3% respectively. Body mass index and waist circumference were weakly correlated with frequency of attacks over 6 months (rs = 0.162, p < 0.05 and rs = 0.187, p < 0.05 respectively). These correlations remains weak considering only premenopausal women, but disappear in the older women. Stratification of analysis by migraine type field shows a moderate correlation between migraine with aura and frequency of attacks over 6 months and body mass index (rs = 0.369, p < 0.05), as well as waist circumference (rs = 0.423, p < 0.01). Patients who were on prophylactic medication had higher body mass index, waist circumference, and body fat percentage values (p < 0.01, Student t-test). CONCLUSION: This study revealed a potential, though tenuous association between migraine and anthropometric parameters and frequency of attacks, which does not reflect on the duration, severity, and disability of attacks, with patterns differing by migraine type, reproductive age and prophylactic medication.

Introducción: Los estudios que tratan de establecer una asociación entre la migraña y los parámetros antropométricos hasta ahora han sido poco concluyentes. Además, los fármacos utilizados para la profilaxis de la migraña pueden estar asociados con cambios en el peso corporal. Objetivos: Investigar la posible asociación de los parámetros antropométricos y el porcentaje de grasa corporal con patrones de ataque y el uso de la profilaxis en los pacientes con migraña. Métodos: Estudio transversal que evaluó el índice de masa corporal, circunferencia de cintura, porcentaje de grasa corporal y las variables clínicas (características de los ataques y uso de medicación) en mujeres con migraña. Resultados: 166 mujeres con migraña ≥18 años (edad media, 45 ± 14 años) fueron incluidos en el estudio. Migraña sin aura era más frecuente (71,7%). La media del índice de masa corporal y porcentaje de grasa corporal fueron 27,8 ± 6,0 kg/m2 y 36,4 ± 8,3%, respectivamente. Índice de masa corporal y la circunferencia de cintura se correlacionaron débilmente con la frecuencia de los ataques durante 6 meses (rs = 0,162, p < 0,05 y r = 0,187, p < 0,05, respectivamente). Estas correlaciones se mantiene débil considerando sólo las mujeres premenopáusicas, pero desaparecen en las mujeres mayores. La estratificación de los análisis por tipo migraña muestra una correlación moderada entre la migraña con aura y la frecuencia de los ataques de más de 6 meses y el índice de masa corporal (rs = 0,369, p < 0,05), así como la circunferencia de cintura (rs = 0,423, p < 0,01) . Los pacientes que estaban tomando medicamentos profilácticos tuvieron un mayor índice de masa corporal, circunferencia de la cintura, y los valores de porcentaje de grasa corporal (p < 0,01, prueba t de Student). Conclusiones: Este estudio reveló un potencial, aunque débil asociación entre la migraña y los parámetros antropométricos y la frecuencia de ataques, que no refleja la duración, la gravedad y la incapacidad de los ataques, que tienen diferentes modelos según el tipo de migraña, la edad reproductiva y la medicación profiláctica.

Does phase angle correlate with hyperhomocysteinemia? A study of patients with classical homocystinuria.

The role of the phase angle in hyperhomocysteinemia has yet to be assessed. Classical homocystinuria is a rare genetic disease characterized by severe hyperhomocysteinemia, as well as increased levels of methionine and reduced levels of cysteine. The objective of this study was to investigate the potential relationship between phase angle and homocysteine, cysteine, and methionine levels in patients with classical homocystinuria. Eight patients were included in the study. Phase angle was measured with a tetrapolar bioimpedance analyzer. Serum homocysteine, cysteine, and methionine levels were measured by HPLC. Only three patients had adequate metabolic control of their disease. Median phase angle was 5.9° (range = 5.4°-8.5°). There was a significant correlation between phase angle and levels of homocysteine (r = -0.807, p = 0.015), methionine (r = -0.711, p = 0.048), and cysteine (r = 0.836, p = 0.010). Was also positively correlated with BMI and arm muscle circumference (p < 0.05). Two patients had phase angles below the 5th percentile, and only one above the 50th percentile. Our findings suggest that cellular integrity is affected in patients with high homocysteine levels, thus indicating that phase angle could be a valuable indicator of prognosis and classical homocystinuria. It also suggests a role for this indicator in other forms of hyperhomocysteinemia and other inborn errors of metabolism.