Qualidade da dieta e fatores associados em pacientes adultos e idosos atendidos em um ambulatório de nutrição na cidade de Recife, Pernambuco / Diet quality and associated factors in adult and elderly patients treated in a nutrition outpatient clinic in the city of Recife, Pernambuco

O consumo alimentar atual, caracterizado pelo aumento da ingestão de alimentos de alta densidade calórica e baixo valor nutricional pode influenciar negativamente no estado nutricional e surgimento de agravos à saúde. Este estudo teve como objetivo avaliar a qualidade da dieta e fatores associados em pacientes adultos e idosos atendidos num ambulatório de nutrição. Trata-se de um estudo transversal realizado de maio a outubro de 2021 no ambulatório de nutrição do Instituto de Medicina Integral Prof. Fernando Figueira em Recife, Pernambuco. Foram coletadas as informações do perfil sociodemográfico e econômico, estilo de vida, variáveis clínicas e estado nutricional, no momento do atendimento nutricional (primeira consulta e/ou consulta de acompanhamento). A avaliação do consumo alimentar foi realizada por meio da análise do Índice de Qualidade da Dieta Revisado (IQDR). A amostra foi composta por 102 pacientes, e foi evidenciada uma maior frequência de excesso de peso/obesidade e risco cardiovascular muito elevado. Com relação ao IQDR, 72,6% da amostra apresentam dieta saudável. O tempo de acompanhamento foi correlacionado positivamente com a qualidade da dieta (ρ 0,199; p<0,045); e quanto à glicemia de jejum, houve uma correlação negativa com o consumo de cereais totais (ρ -0,229; p<0,050), e positiva com o consumo de leite e derivados (ρ0,265; p<0,023). No que se refere às variáveis antropométricas, evidenciou-se correlações negativas com o consumo de hortifrútis e cereais integrais. O consumo alimentar é considerado complexo e necessita da avaliação dos fatores que possam interferir no mesmo. O acompanhamento nutricional, a modificação e a melhora da qualidade da alimentação, favorecem à adoção de um estilo de vida mais saudável, relacionando-se com a prevenção e/ou o controle das doenças crônicas não transmissíveis e suas complicações.

Current food consumption, characterized by increased intake of high-density foods and low nutritional value can negatively influence nutritional status and the emergence of health problems. This study aimed to evaluate the quality of the diet and associated factors in adult and elderly patients treated in a nutrition outpatient clinic. This is a cross-sectional study conducted from May to October 2021 at the Nutrition Outpatient Unit of the Fernando Figueira Institute of Integral Medicine in Recife, Pernambuco. The information of the sociodemographic and economic profile, lifestyle, clinical variables, and nutritional status was collected at the time of nutritional consultation (first consultation and/or follow-up consultation). The evaluation of food consumption was performed through the analysis of the Diet Quality Index - Revised (DQI-R). The sample consisted of 102 patients, and there was a higher frequency of overweight/obesity and very high cardiovascular risk. Regarding DQI-R, 72.6% of the sample has a healthy diet. The follow-up time was positively correlated with the quality of the diet (ρ 0.199; p <0.045); and regarding fasting blood glucose, there was a negative correlation with the consumption of total cereals (ρ -0.229; p <0.050) and a positive correlation with the consumption of milk and derivatives (ρ 0.265; p <0.023). Regarding anthropometric variables, negative correlations with the consumption of whole grains and cereals was demonstrated. Food consumption is considered complex and requires the evaluation of factors that may interfere with it. Nutritional monitoring, modifying, and improving the quality of food, favors the adoption of a healthier lifestyle, which relates to the prevention and/or control of chronic non-communicable diseases and their complications.

Comparison between GLIM and PG-SGA methods in the nutritional assessment of hospitalized oncological patients / Comparação entre os métodos GLIM e ASG-PPP na avaliação nutricional de pacientes oncológicos hospitalizados

ABSTRACT Objective The aim of this study was to compare the Global Leadership Initiative on Malnutrition and Subjective Global Assessment methods produced by the patient in the nutritional assessment of cancer in-patients. Methods Cross-sectional study with a prospective variable, conducted with patients admitted to a public hospital in Pernambuco, Brazil. The application of these tools and the diagnosis of malnutrition were performed within the first 48 hours of admission. Sociodemographic, clinical and laboratory data were obtained from the medical records and weight, height, arm circumference, triceps skinfold and handgrip strength data were collected. Results The 82 patients evaluated included mostly men aged ≥ 60 years with less than 8 years education. Malnutrition frequency was 93.7% according to the Subjective Global Assessment and including 23.2% severe malnutrition while, according to the Global Leadership Initiative on Malnutrition, 50% of the patients were considered severely malnourished. Malnutrition by the Global Leadership Initiative on Malnutrition showed a sensitivity of 82.9% and when associated with handgrip strength sensitivity was 90.8%, considering the Subjective global assessment produced by the patient as a reference; on the other hand, the specificity was 16.7% independently of adding handgrip strength. None of the anthropometric variables was associated with the reference tool. Conclusion The Global Leadership Initiative on Malnutrition proved to be a very sensitive tool for diagnosing malnutrition when compared to the gold standard, particularly for severe malnutrition, but with little specificity. The need for a comprehensive nutritional assessment in the clinical practice was confirmed, using the parameters available and not interpreting them separately.

RESUMO Objetivo O objetivo deste estudo foi comparar os métodos Global Leadership Initiativeon Malnutrition e Avaliação Subjetiva Global Produzida pelo Próprio Paciente na avaliação nutricional de pacientes oncológicos hospitalizados. Métodos Estudo transversal com uma variável prospectiva, realizado com pacientes internados em um hospital público de Pernambuco. A aplicação dessas ferramentas e o diagnóstico de desnutrição foram realizados nas primeiras 48 horas de admissão. Dados sociodemográficos, clínicos e laboratoriais foram obtidos do prontuário, e dados com peso, altura, circunferência do braço, prega cutânea tricipital e força de preensão palmar foram coletados. Resultados Dos 82 pacientes avaliados, a maioria eram homens com idade ≥60 anos com menos de 8 anos de estudo. A frequência de desnutrição foi de 93,7% pela Avaliação Subjetiva Global; destes, 23,2% com desnutrição grave. Já pela Global Leadership Initiative on Malnutrition, 50% dos pacientes foram considerados desnutridos graves. A desnutrição pela Global Leadership Initiative on Malnutrition apresentou uma sensibilidade de 82,9% e de 90,8% quando associada à força de preensão palmar considerando a Avaliação Subjetiva Global Produzida pelo Próprio Paciente como referência. Por sua vez, a especificidade foi de 16,7% independentemente de adicionar a força de preensão palmar. Nenhuma das variáveis antropométricas apresentou associação com a ferramenta de referência. Conclusão A Global Leadership Initiative on Malnutrition mostrou-se uma ferramenta bastante sensível para diagnosticar desnutrição quando comparada ao padrão ouro, principalmente para desnutrição grave, porém pouco específica. Ratificou-se a necessidade de uma avaliação nutricional ampla na prática clínica, utilizando os parâmetros disponíveis e não os interpretando de forma isolada.

Nutritional parameters and clinical outcomes of patients admited with COVID-19 in a university hospital / Parâmetros nutricionais e desfechos clínicos de pacientes admitidos com COVID-19 em um hospital universitário

ABSTRACT Objective To evaluate the relationship between nutritional parameters and clinical factors and the outcome of patients diagnosed with COVID-19. Methods This is a prospective longitudinal study involving patients with COVID-19 infection admitted to a University Hospital in Pernambuco. The sample consisted of individuals aged ≥20 years who tested positive for COVID-19 infection. Nutritional risk was assessed using the recommended screening procedure for this group and the nutritional status using the Body Mass Index. Demographic and clinical variables were transcribed from the medical records. Result There was a predominance of adult inpatients between 20 and 59 years of age (95% CI: 64.6-76.0); nutritional risk was observed in 91.6% of patients and overweight in 58.9% of patients. Age ≥60 years (p=0.03), presence of malignancies and inadequate nutrition (p<0.001) were independent risk factors for in-hospital death. It was also observed that only arterial hypertension (OR 2.34, 95% CI 1.32-4.13, p=0.003) and overweight (OR 1.84, 95% CI 1.05-3.21, p=0.032) were considered independent risk factors for admission of the patients in the Intensive Care Unit. Conclusion Although overweight is a risk factor for admission in the Intensive Care Unit, it was not possible to observe it as a factor for mortality, requiring further studies to determine the mechanisms that interfere in the association between obesity and mortality in those patients.

RESUMO Objetivo Avaliar a relação dos parâmetros nutricionais e fatores clínicos com o desfecho dos pacientes diagnosticados com COVID-19. Métodos Trata-se de um estudo longitudinal prospectivo envolvendo pacientes com infecção por COVID-19 internados em um Hospital Universitário de Pernambuco. A amostra foi constituída por indivíduos com idade ≥20 anos que tiveram resultado positivo para infecção por COVID-19. O risco nutricional foi avaliado por meio de triagem recomendada para este grupo e o estado nutricional por meio do Índice de Massa Corpórea. As variáveis demográficas e clínicas foram transcritas dos prontuários. Resultados Houve predomínio de pacientes adultos entre 20 e 59 anos (95% IC: 64,6-76,0) internados, o risco nutricional foi observado em 91,6% e o excesso de peso em 58,9% dos pacientes. A idade >60 anos (p=0,03), a presença de câncer e aporte nutricional inadequado (p<0,001) foram fatores de risco independente para morte hospitalar. Observou-se também que apenas a hipertensão arterial (OR 2,34, 95% IC 1,32-4,13, p=0,003) e o excesso de peso (OR 1,84, 95% IC 1,05-3,21, p=0,032) foram considerados fatores de risco independentes para a internação do paciente na Unidade de Terapia Intensiva. Conclusão Embora o excesso de peso seja um fator de risco para admissão na Unidade de Terapia Intensiva, não foi possível observá-la como um fator para mortalidade, se fazendo necessários estudos para determinar os mecanismos que interferem na associação entre a obesidade e letalidade desses pacientes.

Association between diet quality index, food and nutrient intake and metabolic parameters in adolescents from Recife, northeastern Brazil.

Nutritional studies shifted the focus of attention to the analysis of food quality, addressing general diet considering the foods, food groups and nutrients included. This study evaluates the association between diet quality index, food and nutrient intake and metabolic parameters of adolescents from Recife, northeastern Brazil. It is a cross-sectional study involving adolescents aged 12 to 19 years. Food intake was assessed using the FFQ to estimate the adapted Diet Quality Index for Adolescents for Brazilians (DQIA-BR-A). The analysis included metabolic parameters (glucose, lipid profile, apo A1 and B, α-1-acid glycoprotein, retinol, ß-carotene, α-tocopherol, 25-hydroxyvitamin D and parathormone). Multiple linear regression analysis between the DQIA-BR-A and daily nutrient intake showed a positive correlation (R2adjusted = 0·29) for linoleic fatty acid, Ca and folate and a negative correlation for oleic fatty acid, carbohydrates and vitamins B2 and C, in addition to a low correlation (R2adjusted < 0·07) with all metabolic parameters. However, the DQIA-BR-A correlated significantly (R2adjusted = 0·62; P < 0·001) with food intake. In this way, the DQIA-BR-A can be considered as an accurate and useful instrument for assessing the overall quality of adolescent diets. The diet of the adolescents was considered to be of moderate quality. Changes are required to ensure a balanced diet, considering the high-sugar intake and consumption of sweets as well as the low consumption of vegetables, milk and dairy products, oils, fats and seeds. Such changes should prioritise the consumption of foods rich in essential fatty acids and poor in saturated fat.

Prevalence and factors associated with fat-soluble vitamin deficiency in adolescents.

BACKGROUND: fat-soluble vitamin deficiency may be a health problem not recognized in children and adolescents. OBJECTIVE: to estimate the prevalence and factors associated with the deficiency of vitamins A, D and E among adolescent students from Northeastern Brazil. METHODS: transversal study with adolescents aged 12 to 19 of both genders. A questionnaire to collect socioeconomic and lifestyle data and food intake was applied to adolescents. Then, an anthropometric evaluation and a blood sampling were performed to analyze serum concentrations of retinol, ß-carotene, α-tocopherol and 25-hydroxy vitamin D (25[OH]D). RESULTS: the intake of vitamins A (50.3%), E (94.0%) and D (99.8%), as well as α-tocopherol (88.1%), ß-carotene (74.1%), 25(OH)D (50.9%) and retinol (46.6%) serum levels were mostly deficient/insufficient. An increased risk of α-tocopherol deficiency was observed in girls (PR = 1.11) and an increased risk of 25(OH)D deficiency was observed in boys (PR = 1.41). An increased likelihood of ß-carotene (PR = 1.14) and 25(OH) D (PR = 1.38) insufficiency was observed in overweight individuals. CONCLUSIONS: the adolescents had a deficit in the intake and in serum levels of fat-soluble vitamins. The greatest risk of inadequacy was associated with gender and weight excess. However, the behavior of fat-soluble vitamins in adolescents needs further research.

Preditores antropométricos de hipertensão arterial sistêmica em mulheres afrodescendentes / Anthropometric predictors of hypertension in afro-descendant women

OBJETIVOS: Investigar a associação entre parâmetros antropométricos e hipertensão arterial sistêmica e identificar os melhores preditores antropométricos dessa condição em mulheres afrodescendentes, de comunidades remanescentes de quilombos. MÉTODOS: Estudo transversal realizado com mulheres quilombolas do Estado de Alagoas. Foram investigados pressão arterial, parâmetros antropométricos (índice de massa corporal, circunferência da cintura, razão cintura-quadril, razão cintura-estatura, índice de conicidade, gordura corporal), variáveis sociodemográficas, tabagismo e paridade. As associações entre parâmetros antropométricos e hipertensão arterial sistêmica foram averiguadas por meio da regressão de Poisson com ajuste robusto da variância. A capacidade desses parâmetros em predizer a presença de hipertensão arterial sistêmica foi analisada por meio de curvas ROC (Receiver Operating Characteristic). RESULTADOS: Foram avaliadas 1.553 mulheres, com idades entre 20 e 59 anos. A prevalência de hipertensão arterial sistêmica foi 35,8% e a de excesso de peso foi 48,5%. A presença de hipertensão arterial sistêmica associou-se a índice de massa corporal, circunferência da cintura, razão cintura-quadril, razão cintura-estatura e gordura corporal, mesmo após o ajuste para idade, classe socioeconômica e tabagismo. A partir das curvas ROC, foram encontrados os seguintes pontos de corte: índice de massa corporal ≥26,2 kg/m², circunferência da cintura ≥81,6 cm, razão cintura-quadril ≥0,84, razão cintura-estatura ≥0,54, índice de conicidade ≥1,20 e gordura corporal ≥35,4%. Gordura corporal, razão cintura-quadril e razão cintura-estatura apresentaram igual capacidade em predizer a hipertensão arterial sistêmica. CONCLUSÕES: Todos os indicadores de obesidade global e os de obesidade central, excetuando-se o índice de conicidade, associaram-se à hipertensão arterial sistêmica nessa amostra de mulheres afrodescendentes quilombolas. Os melhores preditores antropométricos de hipertensão arterial sistêmica foram porcentagem de gordura corporal, razão cintura-quadril e razão cintura-estatura. Essas medidas tiveram igual, embora baixo, poder discriminatório para a presença de hipertensão arterial sistêmica nessa população.

AIMS: To determine the association between anthropometric parameters and systemic arterial hypertension and to identify the best anthropometrics predictors of this disease in afro-descendant women from remaining quilombo communities. METHODS: A cross-sectional study was conducted with quilombola women from Alagoas State. Blood pressure, anthropometric parameters (body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio, conicity index, body fat), sociodemographic variables, smoking and parity were investigated. The associations between anthropometric parameters and systemic arterial hypertension were investigated using Poisson regression with robust variance adjustment. The ability of these parameters to predict the presence of systemic arterial hypertension was analyzed using Receiver Operating Characteristic (ROC) curves. RESULTS: A total of 1,553 women, aged between 20 and 59 years, were evaluated. The prevalence of systemic arterial hypertension was 35.8% and that of overweight was 48.5%. The presence of systemic arterial hypertension was associated with body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio, and body fat, even after adjusting for age, socioeconomic class, and smoking status. From the ROC curves, the following cutoff points were found: body mass index ≥26.2 kg/m², waist circumference ≥81.6 cm, waist-to-hip ratio ≥0.84, waistto-height ratio ≥0.54, conicity index ≥1.20 and body fat ≥35.4%. Body fat, waist-to-hip ratio and waist-to-waist ratio were equally able to predict systemic arterial hypertension. CONCLUSIONS: All indicators of global obesity and those of central obesity, except for the conicity index, were associated with systemic arterial hypertension in this sample of Afro-descendant quilombola women. Percentage of body fat, waist-to-hip ratio and waist-to-height ratio were the best anthropometric predictors of systemic arterial hypertension. These measures had equal, albeit low, discriminatory power for the presence of systemic arterial hypertension in this population.

The effect of vitamin A supplementation with 400 000 IU vs 200 000 IU on retinol concentrations in the breast milk: A randomized clinical trial.

BACKGROUND & AIMS: The vitamin A nutritional status is marginal for most of the newborns, and the prevention of that deficiency is promoted by breastfeeding. The Ministry of Health of Brazil established the National Vitamin A Supplementation Program, giving mega-doses of this nutrient to women right after delivery, in order to provide adequate vitamin A content in the breast milk and The International Vitamin A Consultative Group has supported the recommendation, to supplement with 400 000 IU of VA immediately after delivery. This study compares retinol concentrations in breast milk (colostrum, 2 and 4 months) from mothers supplemented during immediate postpartum with 400 000 IU versus 200 000 IU of vitamin A. METHODS: A randomized, controlled, triple-blind trial, conducted in two public maternities in Recife, Northeast Brazil. Two hundred and ten mothers were recruited and allocated into two treatment groups: 400 000 IU or 200 000 IU of Vitamin A and monitored for 4 months. RESULTS: There was no significant difference between retinol concentrations in breast milk between treatment groups (400 000 IU vs 200 000 IU) in the studied period: 2 months (p = 0.790) and 4 months (p = 0.279), although a progressive reduction of concentrations throughout the study was observed in both treatment groups, 400 000 IU (p < 0.0001) and 200 000 IU (p < 0.0001). CONCLUSIONS: The absence of an additional effect of a higher dosage justifies the 200 000 IU supplementation, according to the World Health Organization. Registered under ClinicalTrials.gov Identifier No. NCT00742937.