Effectiveness of a two-component nutritional strategy for blood pressure control in individuals with hypertension users of a public health system: a randomized controlled clinical trial.

OBJECTIVE: To evaluate the effectiveness of a nutritional strategy based on two components and adapted for the public health system on blood pressure, cardiometabolic features, self-care, qualify of life and diet quality in individuals with hypertension. METHODS: NUPRESS was an open-label, parallel-group, superiority randomized controlled clinical trial in which participants at least 21 years with hypertension and poorly controlled blood pressure were randomly assigned (1 : 1 allocation ratio) to either an individualized dietary prescription according to nutritional guidelines (control group, n  = 205); or a two-component nutrition strategy, including a goal-directed nutritional counseling and mindfulness techniques (NUPRESS [intervention] group, n  = 205). Primary outcomes were SBP (mmHg) after 24 weeks of follow up and blood pressure control, defined as either having SBP more than 140 mmHg at baseline and achieving 140 mmHg or less after follow-up or having SBP 140 mmHg or less at baseline and reducing the frequency of antihypertensive drugs in use after follow-up. RESULTS: In total, 410 participants were randomized and submitted to an intention-to-treat analysis regarding primary outcomes. Both groups decreased blood pressure, but after adjusting for baseline values, there was no significant difference between them on SBP [intervention-control difference: -0.03 (-3.01; 2.94); P  = 0.98] nor blood pressure control [odds ratio 1.27 (0.82; 1.97); P  = 0.28]. No differences between groups were also detected regarding secondary and tertiary outcomes. CONCLUSION: There was no difference between a two-component nutritional strategy and an established dietary intervention on blood pressure in participants with hypertension.

Food intake, plasma copeptin and cardiovascular risk in patients with type 2 diabetes: A cross-sectional analysis.

BACKGROUND AND AIM: Increased consumption of ultra-processed foods has been linked to both mortality and cardiovascular risk. Copeptin levels may serve as potential risk markers for cardiovascular death and events. This cross-sectional analysis seeks to assess the potential correlation between the intake of ultra-processed foods and copeptin levels in outpatients diagnosed with type 2 diabetes, based on estimates of cardiovascular risk. METHODS AND RESULTS: Outpatients underwent clinical and nutritional assessments. Dietary information was gathered using a validated quantitative food frequency questionnaire, and the consumption of all foods, beverages, and food products was assessed according to the NOVA food classification system. Fasting plasma-EDTA samples were collected and preserved at -80 °C. Plasma copeptin measurements were analyzed using an enzyme-linked immunosorbent assay based on the competition principle. Participants were categorized into two groups: high risk and very high risk, based on cardiovascular risk calculated by the HEARTS calculator. A total of 190 participants were included in the evaluation, with an average age of 60 ± 9 years, glycated hemoglobin of 8.4 ± 1.4%, and a diabetes duration of 11 (5-19) years. Patients at a very high cardiovascular risk exhibited higher plasma copeptin levels compared to those at high cardiovascular risk. Notably, 92.1% of patients reported consuming more than 10% of total energy intake from ultra-processed foods, although this proportion did not differ between the two groups. CONCLUSION: This patient sample reported elevated consumption of ultra-processed foods; nevertheless, the correlation between ultra-processed foods and plasma copeptin has not been substantiated.

Association of specialized enteral nutrition with glycemic control and clinical outcomes in critically ill patients: A meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the association of glycemic-control formulae (GCF) with measurements of glycemic control and clinical outcomes compared to standard enteral formulae (SF) in critically ill patients. DATA SOURCES: MEDLINE, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials were searched from inception up to January, 2021. STUDY SELECTION: RCTs that assessed the effects of GCF relative to SF in adult critically ill patients. DATA EXTRACTION: Measurements of glycemic control were the primary outcomes. Secondary outcomes included insulin requirements, mechanical ventilation (MV), length of intensive care unit (ICU) stay and mortality. Two authors independently extracted data and assessed risk of bias using the Cochrane's RoB 2 tool and the GRADE approach was used to assess the quality of evidence. DATA SYNTHESIS: Ten studies (12 reports, 685 patients) were included. The use of GCFs was associated with lower blood glucose (WMD, -16.06 mg/dL; 95% CI -23.48 to -8.63; I2 = 47%) and lower daily administered insulin (WMD, -7.20 IU; 95% CI -13.92 to -0.48; I2 = 53%). Glycemic variability, measured by the coefficient of variation, was also associated with the use of GCFs (WMD, -6.84%; 95% CI, -13.57 to -0.11; I2 = 95%). In contrast, analyses for length of ICU stay (WMD, -0.12, 95% CI -1.77 to 1.52; I2 = 0%), duration of MV (WMD, -0.34 days; 95% CI, -1.72 to 1.04; I2 = 0%) and mortality (RR, 1.13; 95% CI 0.82 to 1.56; I2 = 0%) were not statistically significant. Quality of evidence ranged from low to very low, and only one study was judged as at low risk of bias. CONCLUSIONS: In this meta-analysis, GCFs were significantly associated with lower insulin requirements and improved glycemic control. Although results for clinical outcomes were not statistically significant, there is insufficient evidence to confirm or exclude important differences due to serious imprecision in the effect estimates and overall low quality of evidence. The effects of GCFs on clinical outcomes require confirmation in larger randomized trials.

Diet Quality and Glycemic Control in Patients with Type 2 Diabetes.

BACKGROUND: The overall diet quality of individuals and populations can be assessed by dietary indexes based on information from food surveys. Few studies have evaluated the diet quality of individuals with type 2 diabetes or its potential associations with glycemic control. OBJECTIVE: To evaluate the relationship between diet quality and glycemic control. DESIGN: Cross-sectional study with consecutive enrollment from 2013 to 2016. PARTICIPANTS: Outpatients with type 2 diabetes treated at a university hospital in southern Brazil. MAIN OUTCOME MEASURES: Dietary information was obtained by a quantitative food frequency questionnaire validated for patients with diabetes. Overall diet quality was evaluated by the Healthy Eating Index 2010. Glycemic control was assessed by fasting plasma glucose and glycated hemoglobin. STATISTICAL ANALYSES: A receiver operating characteristic curve was constructed to find the optimal Healthy Eating Index cutoff point to discriminate diet quality, considering good glycemic control as glycated hemoglobin level <7%. Patients were then classified as having lower vs higher diet quality, and the two groups were compared statistically. Logistic regression models were constructed with glycated hemoglobin level ≥7% as the dependent variable, adjusted for age, current smoking, diabetes duration and treatment, physical activity, body mass index, high-density lipoprotein cholesterol level, and energy intake. RESULTS: A total of 229 patients with type 2 diabetes (median age=63.0 years [interquartile range=58.0 to 68.5 years]; diabetes duration=10.0 years [interquartile range=5 to 19 years]; body mass index 30.8±4.3; and glycated hemoglobin=8.1% [interquartile range=6.9% to 9.7%]) were evaluated. A Healthy Eating Index score >65% yielded the best properties (area under the receiver operator characteristic curve=0.60; sensitivity=71.2%; specificity=52.1%; P=0.018). Patients with lower-quality diets were younger and more likely to be current smokers than patients with higher-quality diets. After adjusting for confounders, patients with lower-quality diets had nearly threefold odds of poorer glycemic control (2.92; 95% CI 1.27 to 6.71; P=0.012) than those in the higher-quality diet group. CONCLUSIONS: Lower diet quality, defined as an Healthy Eating Index 2010 score <65%, was associated with poor glycemic control in this sample of outpatients with type 2 diabetes.

Plasma glucose and insulin responses after consumption of breakfasts with different sources of soluble fiber in type 2 diabetes patients: a randomized crossover clinical trial.

Background: The amount and quality of carbohydrates are important determinants of plasma glucose after meals. Regarding fiber content, it is unclear whether the intake of soluble fibers from foods or supplements has an equally beneficial effect on lowering postprandial glucose.Objective: The aim of our study was to compare the acute effect of soluble fiber intake from foods or supplements after a common meal on postprandial plasma glucose and plasma insulin in patients with type 2 diabetes (T2D).Design: A randomized crossover clinical trial was conducted in patients with T2D. Patients consumed isocaloric breakfasts (mean ± SD: 369.8 ± 9.4 kcal) with high amounts of fiber from diet food sources (total fiber: 9.7 g; soluble fiber: 5.4 g), high amounts of soluble fiber from guar gum supplement (total fiber: 9.1 g; soluble fiber: 5.4 g), and normal amounts of fiber (total fiber: 2.4 g; soluble fiber: 0.8 g). Primary outcomes were postprandial plasma glucose and insulin (0-180 min). Data were analyzed by repeated measures ANOVA and post hoc Bonferroni test.Results: A total of 19 patients [aged 65.8 ± 7.3 y; median (IQR), 10 (5-9) y of T2D duration; glycated hemoglobin 7.0% ± 0.8%; body mass index (in kg/m2) 28.2 ± 2.9] completed 57 meal tests. After breakfast, the incremental area under the curve (iAUC) for plasma glucose [mg/dL · min; mean (95% CI)] did not differ between high fiber from diet (HFD) [7861 (6257, 9465)] and high fiber from supplement (HFS) [7847 (5605, 10,090)] (P = 1.00) and both were lower than usual fiber (UF) [9527 (7549, 11,504)] (P = 0.014 and P = 0.037, respectively). iAUCs [µIU/mL · min; mean (95% CI)] did not differ (P = 0.877): HFD [3781 (2513, 5050)], HFS [4006 (2711, 5302), and UF [4315 (3027, 5603)].Conclusions: Higher fiber intake was associated with lower postprandial glucose at breakfast, and the intake of soluble fiber from food and supplement had a similar effect in patients with T2D. This trial was registered at clinicaltrials.gov as NCT02204384.

Increased protein intake is associated with uncontrolled blood pressure by 24-hour ambulatory blood pressure monitoring in patients with type 2 diabetes.

OBJECTIVE: To analyze possible associations of dietary components, especially protein intake, with blood pressure (BP) during ambulatory BP monitoring (ABPM) in patients with type 2 diabetes. METHODS: In this cross-sectional study, BP of outpatients with type 2 diabetes was evaluated by 24-hour ABPM (Spacelabs 90207) and usual diet by 3-day weighed diet records. Patients were divided into 2 groups according to their daytime ABPM: uncontrolled BP (systolic BP ≥ 135 mmHg or diastolic BP ≥ 85 mmHg) and controlled BP (systolic BP < 135 mmHg and diastolic BP < 85 mmHg). Logistic regression models unadjusted and adjusted for possible confounders (covariates) were used to analyze the association of protein and uncontrolled BP. RESULTS: A total of 121 patients with type 2 diabetes aged 62.3 years, 54.5% of whom were women, were studied. The uncontrolled BP group had higher glycated hemoglobin (HbA1C) values (8.4 ± 2.0 vs 7.6 ± 1.3%; p = 0.04) and consumed more protein (20.0 ± 3.8 vs 18.2 ± 3.6% of energy; p = 0.01) and meat, (2.6 [1.45, 2.95] vs 2.0 [1.49, 2.90] g/kg weight; p = 0.04) than the controlled BP group. In a multivariate analysis, protein intake (% of energy) increased the chance for uncontrolled BP (odds ratio [OR] = 1.16; 95% confidence interval [CI], 1.02, 1.30; p = 0.02), adjusted for body mass index (BMI), HbA1C, low-density lipoprotein (LDL) cholesterol, number of antihypertensive medications, and ethnicity. Meat consumption higher than 3.08 g/kg weight/day more than doubled the chance for uncontrolled BP (OR = 2.53; 95% CI, 1.01, 7.60; p = 0.03). CONCLUSION: High protein intake and meat consumption were associated with high daytime ABPM values in patients with type 2 diabetes. Reducing meat intake might represent an additional dietary intervention in hypertensive patients with type 2 diabetes.

Adiposity markers and risk of coronary heart disease in patients with type 2 diabetes mellitus.

BACKGROUND: This cross-sectional study aimed to evaluating the association between body adiposity markers and high-risk of coronary heart disease (CHD) in patients with type 2 diabetes. METHODS: Recent adiposity markers [waist-to-height ratio, conicity index (C-index) and body adiposity index] and traditional markers [BMI, waist circumference and waist-to-hip ratio (WHR)] were measured. The 10-year risk of fatal CHD was estimated according to UKPDS risk engine scores. Patients were divided into high (CHD risk ≥20%; n = 99) or low-moderate (CHD risk <20%; n = 321) risk groups. Multiple logistic regression models were performed to analyze associations between CHD risk (outcome) and adiposity markers. RESULTS: A total of 420 patients with type 2 diabetes (61.9 ± 9.5 years; 53.5% females; HbA1c 7.6 ± 1.6%) were evaluated. The high risk group had greater proportions of elevated C-index and BMI values than patients with low-moderate risk. No between-group differences in other adiposity markers were observed. In multiple logistic regression models, only C-index values ≥1.35 were associated with CHD risk >20% (OR = 1.69; 95% CI 1.03-2.78; P = 0.039) after adjusting for confounders (sedentary lifestyle, diabetic nephropathy, serum creatinine, and diabetes duration). The association between WHR and CHD risk did not hold in this sample. CONCLUSIONS: The C-index was the body adiposity marker best associated with high risk of fatal CHD in these patients with type 2 diabetes.

Effect of dietary lipids on circulating adiponectin: a systematic review with meta-analysis of randomised controlled trials.

Different dietary interventions have been identified as potential modifiers of adiponectin concentrations, and they may be influenced by lipid intake. We identified studies investigating the effect of dietary lipids (type/amount) on adiponectin concentrations in a systematic review with meta-analysis. A literature search was conducted until July 2013 using databases such as Medline, Embase and Scopus (MeSH terms: 'adiponectin', 'dietary lipid', 'randomized controlled trials (RCT)'). Inclusion criteria were RCT in adults analysing adiponectin concentrations with modification of dietary lipids. Among the 4930 studies retrieved, fifty-three fulfilled the inclusion criteria and were grouped as follows: (1) total dietary lipid intake; (2) dietary/supplementary n-3 PUFA; (3) conjugated linoleic acid (CLA) supplementation; (4) other dietary lipid interventions. Diets with a low fat content in comparison to diets with a high-fat content were not associated with positive changes in adiponectin concentrations (twelve studies; pooled estimate of the difference in means: -0·04 (95% CI -0·82, 0·74) µg/ml). A modest increase in adiponectin concentrations with n-3 PUFA supplementation was observed (thirteen studies; 0·27 (95% CI 0·07, 0·47) µg/ml). Publication bias was found by using Egger's test (P= 0·01) and funnel plot asymmetry. In contrast, CLA supplementation reduced the circulating concentrations of adiponectin compared with unsaturated fat supplementation (seven studies; -0·74 (95% CI -1·38, -0·10) µg/ml). However, important sources of heterogeneity were found as revealed by the meta-regression analyses of both n-3 PUFA and CLA supplementation. Results of new RCT would be necessary to confirm these findings.

Fiber intake and glycemic control in patients with type 2 diabetes mellitus: a systematic review with meta-analysis of randomized controlled trials.

This systematic review with meta-analysis of randomized controlled trials (RCT) aimed to analyze the effect of fiber intake on glycemic control in patients with type 2 diabetes. Databases were searched up to November 2012 using the following medical subject headings: diabetes, fiber, and randomized controlled trial. Absolute changes in glycated hemoglobin and fasting plasma glucose were reported as differences between baseline and end-of-study measures. Pooled estimates were obtained using random-effects models. Of the 22,046 articles initially identified, 11 (13 comparisons; range of duration, 8-24 weeks) fulfilled the inclusion criteria, providing data from 605 patients. High-fiber diets, including diets with foods rich in fiber (up to 42.5 g/day; four studies) or supplements containing soluble fiber (up to 15.0 g/day; nine studies), reduced absolute values of glycated hemoglobin by 0.55% (95% CI -0.96 to -0.13) and fasting plasma glucose by 9.97 mg/dL (95% CI -18.16 to -1.78). In conclusion, increased fiber intake improved glycemic control, indicating it should be considered as an adjunctive tool in the treatment of patients with type 2 diabetes.

Effect of diet on adiponectin levels in blood.

Dietary management has been considered an alternative means of modulating adiponectin levels. The purpose of this review is to examine the scientific evidence regarding the effect of diet on adiponectin levels in blood. Clinical trials were selected from Medline until April 2010 using the following MeSH terms: adipokines OR adiponectin AND diet OR lifestyle. A total of 220 articles were identified in the initial search, and 52 studies utilizing three different methods of dietary management were included in the present review: low-calorie diets (n = 9 studies), modification of diet composition (n = 33), and diet plus exercise (n = 10). Daily intake of fish or omega-3 supplementation increased adiponectin levels by 14-60%. Weight loss achieved with a low-calorie diet plus exercise increased adiponectin levels in the range of 18-48%. A 60-115% increase in adiponectin levels was obtained with fiber supplementation. In conclusion, dietary management can be an effective therapeutic means of increasing adiponectin levels. Studies investigating different forms of adiponectin and changes in the types of adipose tissue are necessary in order to elucidate the mechanisms involved in the modulation of adiponectin levels.

The Ala54Thr polymorphism of the FABP2 gene influences the postprandial fatty acids in patients with type 2 diabetes.

CONTEXT: The Ala54Thr polymorphism of FABP2 gene increases affinity of intestinal fatty acid-binding protein 2 for long-chain dietary fatty acids (FA) in subjects without diabetes. OBJECTIVE: Our objective was to evaluate whether the Ala54Thr polymorphism of the FABP2 gene influences the FA composition in chylomicrons after a standard meal in patients with type 2 diabetes. METHODS: This clinical trial studied 11 patients with TT and 15 patients with AA genotypes for Ala54Thr polymorphism of FABP2 gene selected from a Brazilian type 2 diabetic cohort. FA in chylomicrons (gas chromatography), plasma glucose, and serum triglycerides were measured after an overnight fast at baseline and, after a standard test meal, at 2-h intervals during 8 h. RESULTS: During the test meal, the curves response of unsaturated FA of patients with TT genotype were different from patients with AA genotype: only patients with TT genotype exhibited an increase, with a postprandial peak at 6 h in monounsaturated FA [0.479 (0.248-0.709) to 1.674 (0.698-2.650) g/liter], polyunsaturated FA [0.338 (0.154-0.522) to 1.827 (0.389-3.265) g/liter], and trans-unsaturated FA [0.025 (0.013-0.037) to 0.122 (0.040-0.205) g/liter] (generalized estimating equations for repeated measurements: P<0.05 for all). The increase of saturated FA did not reach statistical significance. Diabetes treatment, previous diet, FA at baseline, and the increase of plasma glucose and triglycerides during the test meal were not different between TT and AA genotypes. CONCLUSIONS: The TT genotype in Ala54Thr polymorphism of FABP2 gene in patients with type 2 diabetes increased dietary FA absorption, and this might increase the susceptibility to the effects of dietary lipids.

[Role of dietary lipids in diabetic nephropathy]. / Papel dos lipídeos da dieta na nefropatia diabética.

The aim of the present study was to review the possible role of dietary lipids in diabetic nephropathy (DN), taking into account associated abnormalities of serum lipids and interaction of dietary and genetic aspects. Dietary lipids may have an important role in the development and progression of DN. The fat diet composition has been associated with DN, particularly with microalbuminuria, serum lipids abnormalities, and endothelial function. However, the beneficial effect of fat intake modification for these patients is not fully established, especially regarding hard outcomes, such as DN incidence and progression, kidney failure, and death. Moreover, genetic factors may influence the response of serum lipids to fat intake. The identification of specific genetic polymorphisms associated with this interaction could allow adoption of individual nutritional strategies in DN.

[Systematic review of weight loss diets: role of dietary components]. / Revisão sistemática de dietas de emagrecimento: papel dos componentes dietéticos.

Being overweight is the sixth most important risk factor for chronic non-transmissible diseases. Many publications have been produced in recent years to evaluate the best weight loss alternative. The aim of this systematic review was to critically assess the role of dietary components (macronutrients and/or foods) in weight loss diets in adults recently described in the literature. Randomized clinical trials, with at least one year of follow-up, were selected in MedLine (in Portuguese, English and Spanish languages) from 2004 to 2009. Among the 23 studies included with different types of diets, 13 presented a rate of withdrawal from the study > or = 25% in at least one of the diets. In conclusion, most diets where the weight loss was > 5% of initial weight were energy restricted. Furthermore, following low carbohydrate or Mediterranean diets can be an alternative to isolated energy restriction, but these data are yet to be confirmed.

Papel dos lipídeos da dieta na nefropatia diabética: [revisão] / Role of dietary lipids in diabetic nephropathy: [review]

O objetivo do presente manuscrito foi revisar o possível papel dos lipídeos dietéticos na nefropatia diabética (ND), considerando as alterações do perfil lipídico associadas e a interação entre aspectos dietéticos e genéticos. Os lipídeos dietéticos podem ter um papel importante no desenvolvimento e na progressão da ND. A composição das gorduras da dieta tem sido associada com a ND, particularmente à microalbuminúria e às anormalidades lipídicas e de função endotelial. Entretanto, ainda não está comprovado o benefício da modificação da ingestão de gorduras em pacientes com ND, em especial sobre desfechos definitivos, como incidência e progressão da ND, insuficiência renal e morte. Além disso, a resposta do perfil lipídico à ingestão de gorduras pode ser influenciada por fatores genéticos. A identificação de polimorfismos genéticos específicos associados a essa interação poderá permitir a individualização de estratégias nutricionais na ND.

The aim of the present study was to review the possible role of dietary lipids in diabetic nephropathy (DN), taking into account associated abnormalities of serum lipids and interaction of dietary and genetic aspects. Dietary lipids may have an important role in the development and progression of DN. The fat diet composition has been associated with DN, particularly with microalbuminuria, serum lipids abnormalities, and endothelial function. However, the beneficial effect of fat intake modification for these patients is not fully established, especially regarding hard outcomes, such as DN incidence and progression, kidney failure, and death. Moreover, genetic factors may influence the response of serum lipids to fat intake. The identification of specific genetic polymorphisms associated with this interaction could allow adoption of individual nutritional strategies in DN.

Revisão sistemática de dietas de emagrecimento: papel dos componentes dietéticos / Systematic review of weight loss diets: role of dietary components

O excesso de peso corporal é o sexto mais importante fator de risco para doenças crônicas não transmissíveis. Inúmeras publicações foram produzidas nos últimos anos para avaliar a melhor alternativa para perda de peso. O objetivo desta revisão sistemática foi analisar criticamente o papel dos componentes dietéticos (macronutrientes e/ou alimentos) nas dietas de emagrecimento para indivíduos adultos descritas recentemente na literatura. Foram selecionados ensaios clínicos randomizados com pelo menos um ano de acompanhamento publicados no MedLine (língua portuguesa, inglesa e espanhola) de 2004 a 2009. Dos 23 estudos com diferentes tipos de dietas, 13 apresentaram taxa de abandono > 25 por cento em pelo menos uma das dietas. Em conclusão, nos estudos em que a perda ponderal foi > 5 por cento do peso inicial, essa perda foi associada à restrição de energia proveniente da dieta. Além disso, o seguimento de dieta com restrição de carboidratos ou mediterrânea poderia representar uma alternativa à restrição energética, devendo esses dados ainda ser confirmados.

Being overweight is the sixth most important risk factor for chronic non-transmissible diseases. Many publications have been produced in recent years to evaluate the best weight loss alternative. The aim of this systematic review was to critically assess the role of dietary components (macronutrients and/or foods) in weight loss diets in adults recently described in the literature. Randomized clinical trials, with at least one year of follow-up, were selected in MedLine (in Portuguese, English and Spanish languages) from 2004 to 2009. Among the 23 studies included with different types of diets, 13 presented a rate of withdrawal from the study > 25 percent in at least one of the diets. In conclusion, most diets where the weight loss was > 5 percent of initial weight were energy restricted. Furthermore, following low carbohydrate or Mediterranean diets can be an alternative to isolated energy restriction, but these data are yet to be confirmed.

Avaliação da introdução precoce da alimentação complementar em crianças de 0 a 24 meses atendidas em uma unidade básica de saúde / Assessment of early introduction of complementary food for children aged to 0 to 24 months who visit a health care unit

Objetivo: Verificar a frequência, os principais alimentos e motivos da introdução precoce da alimentação complementar, além do uso de mamadeira e chupeta em crianças de 0 a 24 meses. Métodos: Estudo transversal com crianças de 0 a 24 meses de idade atendidas numa Unidade Básica de Saúde. No período de junho a agosto de 2006, aplicou-se um questionário às mães ou acompanhantes sobre a alimentação complementar das crianças. Foi considerada precoce a introdução de alimentos sólidos e/ou líquidos em adição ou substituição ao leite materno antes dos seis meses de idade. Resultados: Das 109 crianças avaliadas, 78% receberam precocemente a introdução dos alimentos complementares, sendo chá o alimento predominante. O principal motivo relatado pelas mães foi “cólica do lactente”. A duração média do aleitamento materno exclusivo foi de 73 ± 30 dias. As crianças que usavam chupeta foram amamentadas por um período menor (218 ± 21 dias) em relação às crianças que não usavam chupeta (305 ± 25 dias; p= 0,026). O ganho médio de peso das crianças que receberam precocemente os alimentos complementares foi maior do que das crianças que receberam os alimentos complementares a partir dos seis meses de idade (22 ± 8 vs. 17 ± 4 g/dia; p = 0,007). Conclusão: Encontramos elevada freqüência na introdução precoce dos alimentos complementares. Houve tendência significativa entre o uso de mamadeira e a redução da duração do aleitamento materno. O uso de chupeta levou a um menor tempo de aleitamento materno.

Background: To verify the frequency, main foods and reasons for the early introduction of complementary food, besides using bottle feeding and pacifiers for children aged 0 to 24 months. Methods: Cross-sectional study with children aged 0 to 24 months, who visit a Basic Health Care Unit. During the period from June to August 2006 a questionnaire was applied to the mothers or caregivers concerning the complementary feeding of the infants. The introduction of solid and/or liquid foods besides or in place of breast milk before the age of six months was considered early. Results: Seventy-eight percent of the 109 children evaluated were introduced early to complementary foods, mainly to tea. The main reason reported by the mothers was “infant colic”. The mean duration of breastfeeding was 73 ± 30 days. The children who used a pacifier were breastfeed for less time (218 ± 21 days) compared to the children who did not use a pacifier (305 ± 25 days; p= 0.026). The children who received complementary food early gained more weight than those who received the complementary foods from the age of six months onwards (22 ± 8 vs. 17 ± 4 g/day; p = 0.007). Conclusion: We found a high frequency of early introduction of complementary foods. There was a significant tendency between the use of the bottle and the reduction of the duration of breastfeeding. The use of a pacifier led to a shorter time of breastfeeding.

Sources of protein and polyunsaturated fatty acids of the diet and microalbuminuria in type 2 diabetes mellitus.

BACKGROUND: Albuminuria excretion rate above the reference range and below albustix positive proteinuria (20-199 microg/min) is known as microalbuminuria and has been associated with an increased risk of death and progression to renal failure. Besides hyperglicemia and high blood pressure levels, dietary factors can also influence albuminuria. OBJECTIVE: To evaluate possible associations of dietary components (macronutrients and selected foods) with microalbuminuria in type 2 diabetic patients. METHODS: In this cross-sectional study, 119 normoalbuminuric [NORMO; 24-h urinary albumin excretion (UAE) < 20 microg/min; immunoturbidimetry] and 62 microalbuminuric (MICRO; UAE 20-199 microg/min) type 2 diabetic patients, attending the Endocrine Division, Hospital de Clínicas de Porto Alegre (Brazil), without previous dietary counseling, underwent 3-day weighed-diet records, and clinical and laboratory evaluation. RESULTS: MICRO patients consumed more protein (20.5 +/- 4.4 vs. 19.0 +/- 3.5% of total energy; p = 0.01) with a higher intake from animal sources (14.5 +/- 4.7 vs. 12.9 +/- 3.8% of total energy; p = 0.015) than NORMO patients. The intakes of PUFAs (8.6 +/- 2.9 vs. 9.7 +/- 3.3% of total energy; p < 0.03), PUFAs from vegetable sources (7.3 +/- 3.4 vs. 8.6 +/- 3.7% of total energy; p = 0.029), plant oils [0.2 (0.1-0.6) vs. 0.3 (0.1-0.9) mg/kg weight; p = 0.02] and margarines [3.3 (0-75.7) vs. 7.0 (0-51.7) g/day; p = 0.01] were lower in MICRO than in NORMO. In multivariate logistic regression models, adjusted for age, gender, presence of hypertension and fasting plasma glucose, intake of total protein (% of total energy; OR 1.104; 95% CI 1.008-1.208; p = 0.032) was positively associated with microalbuminuria. The intakes of total PUFAs (% of total energy; OR 0.855; 95%CI 0.762-0.961; p = 0.008), PUFAs from vegetable sources (% of total energy; OR 0.874; 95%CI 0.787-0.971; p = 0.012) and plant oils (mg/kg weight; OR 0.036; 95% CI 0.003-0.522; p = 0.015) were negatively associated with microalbuminuria. CONCLUSIONS: In type 2 diabetic patients, the high intake of protein and the low intake of PUFAs, particularly from plant oils, were associated with the presence of microalbuminuria. Reducing protein intake from animal sources and increasing the intake of lipids from vegetable origin might-reduce the risk of microalbuminuria.

Endothelial dysfunction and serum fatty acid composition in patients with type 2 diabetes mellitus.

The aim of this study was to evaluate the possible association between serum fatty acids composition and endothelial dysfunction in patients with type 2 diabetes mellitus. A cross-sectional study was conducted with 125 normo- or microalbuminuric type 2 diabetes mellitus patients with serum creatinine <1.5 mg/dL. Serum fatty acids composition (gas chromatography), serum levels of endothelin-1 (ET-1) (enzyme-linked immunosorbent assay), fibrinogen, serum C-reactive protein, lipids, homeostasis model assessment resistance index (HOMA-R), and 24-hour urinary albumin excretion rate were measured. Serum levels of ET-1 were positively correlated with saturated fatty acids (r = 0.257, P = .025) and negatively correlated with polyunsaturated fatty acids (PUFAs) (r = -0.319, P = .005). Serum ET-1 levels were also positively correlated with systolic blood pressure, waist circumference, total cholesterol levels, triglycerides, and HOMA-R. In multiple linear regression models, only saturated fatty acids (R(2) = 0.317, P = .002) or PUFAs (R(2) = 0.314, P = .001) remained associated with ET-1 levels. Models were adjusted for systolic blood pressure, HOMA-R, waist circumference, triglycerides, body mass index, and smoking habit. The serum total PUFA levels showed an inverse correlation with urinary albumin excretion rate (r = -0.248, P = .012). In conclusion, in type 2 diabetes mellitus patients, the serum fatty acids composition was independently related to endothelial function evaluated by serum ET-1. Saturated fatty acids were associated with endothelial dysfunction (high levels of ET-1), whereas PUFAs had a protective role in endothelial function.

Fatty acid composition of serum lipid fractions in type 2 diabetic patients with microalbuminuria.

OBJECTIVE: To determine the fatty acid composition of serum phospholipid, triglyceride, and cholesterol ester fractions and to analyze the lipid profile of microalbuminuric type 2 diabetic patients. RESEARCH DESIGN AND METHODS: A case-control study was conducted with 72 patients: 37 were normoalbuminuric (urinary albumin excretion rate [UAER] <20 microg/min), and 35 were microalbuminuric (UAER 20-200 microg/min). After 4 weeks of a standardized diet, the fatty acid composition of phospholipid, triglyceride, and cholesterol ester fractions was determined by gas chromatography. Total cholesterol and triglycerides were measured by enzymatic-colorimetric methods; cholesterol HDL by double precipitation with heparin, MnCl(2), and dextran sulfate; and apolipoprotein B by immunoturbidimetry. RESULTS: Microalbuminuric patients showed a lower proportion of polyunsaturated fatty acids (24.8 +/- 11.0%), especially of the n-6 family (21.7 +/- 10.5%), in triglyceride fraction than normoalbuminuric patients (34.1 +/- 11.3%, P = 0.001 and 31.4 +/- 11.5%, P < 0.001, respectively). Patients with microalbuminuria also presented higher levels of saturated fatty acids in triglyceride fraction (43.4 +/- 18.0% vs. 34.7 +/- 13.1%, P = 0.022). In the logistic regression analysis, only the proportion of polyunsaturated fatty acids in triglyceride fraction remained significantly associated with microalbuminuria (odds ratio [OR] 0.92, 95% CI 0.85-0.98, P = 0.019). Total cholesterol, HDL cholesterol, triglyceride, and apolipoprotein B levels were similar in normo- and microalbuminuric patients. CONCLUSION: Microalbuminuria in type 2 diabetic patients is associated with low polyunsaturated fatty acid contents in serum triglyceride fraction. This association may represent a risk factor for cardiovascular disease and may contribute to the progression of renal disease.