Visceral adiposity indices and cardiometabolic risk markers in patients with hypertension.

Objective: Arterial hypertension (AH) is a risk factor for cardiovascular diseases (CVD). We sought to evaluate the association between two adiposity indices (visceral adiposity index [VAI] and lipid accumulation product [LAP]) with traditional markers of cardiometabolic risk in hypertensive patients. Materials and methods: This is a cross-sectional study with 1,273 subjects with hypertension treated as outpatients at a university hospital. The VAI and LAP were calculated using formulas stratified by sex. Cardiometabolic risk variables were considered: overweight, risk for waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHA), and altered biochemical test values. The predictive effect of independent variables on outcomes was assessed by multivariate linear regression analysis. There was statistical significance when p ≤ 0.05. Results: Higher cardiometabolic risk (according to BMI, WHR, WHA, and altered biochemical parameters) was associated with higher values of VAI and LAP with statistical significance (p ≤ 0.05). The regression models used explained 30.7% and 10.5% of the changes in LAP and VAI, respectively. Conclusion: LAP and VAI are associated with cardiometabolic risk parameters in the individuals evaluated, suggesting that these indices can be used to screen for CVD risk in individuals with AH.

Body Mass Index Profile of Adult Patients with Inflammatory Bowel Disease in a Multicenter Study in Northeastern Brazil.

Purpose: Inflammatory bowel disease (IBD) is a disease of increasing prevalence in developing countries. Obesity has emerged as a potential risk for IBD; however, the data in the literature are conflicting, and relevant studies in Brazil are limited. Here, we report body mass index profile (BMI) of patients with IBD treated at reference centers in three states of northeastern Brazil. Patients and Methods: Observational descriptive study conducted from January 2021 through December 2021 in patient with IBD. Results: Of 470 patients with IBD, 194 (41%) were classified as normal weight, 42 (9%) as underweight, 155 (33%) as overweight, and 79 (17%) as obese; CD patients were significantly more likely to be underweight than UC patients (p=0.031)Overweight patients were older (median age: 47 years) than normal-weight and underweight patients at diagnosis (38.5 and 35.5 years, respectively [p<0.0001]). IBD onset and diagnosis among overweight and obese individuals were associated with older age. More extensive disease behavior patterns predominated in UC, while forms associated with complications were prevalent in CD, irrespective of nutritional status. There was a higher frequency of compatible symptoms with axial joint inflammation among obese patients (p=0.005) and a lower frequency of compatible symptoms with peripheral joint inflammation in underweight patients (p=0.044) than in patients of normal weight. No significant difference in the frequency of different drug or surgical treatments was observed among the groups. Conclusion: Despite the predominance of overweight and obesity in patients with IBD, no differences in the patterns of disease were seen between the overweight and normal-weight groups; however, obesity was associated with IBD onset in older adults and a higher frequency compatible symptom with axial joint inflammation. These data reinforce the importance of monitoring the nutritional status of IBD patients and the need for a multidisciplinary approach, as recommended in the current guidelines.

HYPERTRIGLYCERIDEMIC WAIST AND ASSOCIATED FACTORS IN CHILDREN AND ADOLESCENTS WITH TYPE 1 DIABETES MELLITUS.

OBJECTIVE: To assess the frequency of the hypertriglyceridemic waist phenotype and its associated factors in children and adolescents with type 1 diabetes mellitus. METHODS: This is an observational analytical study with individuals with type 1 diabetes mellitus, aged 5 to 18 years, of both genders, followed in a university hospital in the Brazilian Northeast. Weight, height, and waist circumference were measured, and the lipid profile and glycated hemoglobin were analyzed. The hypertriglyceridemic waist phenotype was defined by the simultaneous presence of increased waist circumference (≥90th percentile for age and gender) and elevated serum triglyceride levels (≥75 mg/dL for children and ≥90 mg/dL for adolescents). We also investigated the family history of cardiovascular diseases and diabetes, as well as sociodemographic and behavioral variables. In the statistical inference tests, the proportions were compared by Pearson's chi-square test -and/-or Fisher's exact test, being significant p<0.05. RESULTS: A total of 102 patients were evaluated, most of them females (54.9%) and adolescents (66.7%). The frequency of hypertriglyceridemic waist was 23.5%, which was associated with females (p=0.043), overweight (p=0.023), hypercholesterolemia (p=0.002), high LDL (p=0.001), and borderline VLDL (<0.001). CONCLUSIONS: The frequency of the hypertriglyceridemic waist phenotype was associated with females, atherogenic lipid profile, and overweight, indicating the importance of the nutritional monitoring of this population, aiming at reducing future cardiovascular diseases.

[Frequency of sarcopenia, cachexia, and associated factors in patients with chronic kidney disease in dialysis treatment]. / Frecuencia de la sarcopenia, la caquexia y los factores asociados en los pacientes con enfermedad renal crónica en terapia dialítica.

INTRODUCTION: Introduction: sarcopenia and cachexia are syndromes that result in a reduction of skeletal muscle mass, being associated with the aging process and many chronic diseases. Objective: to assess the frequency of sarcopenia as well as of cachexia and their associated factors in patients in dialysis treatment. Methodology: a cross-sectional study conducted in two dialysis treatment centers in Recife between March and September 2016. The diagnosis of sarcopenia was made according to the criteria issued by the Sarcopenia European Consensus, while that of cachexia was made in consonance with the Society for Cachexia and Wasting Disorders (SCWD). The association variables were demographic (age and sex), laboratory (C-reactive protein, serum albumin, hemoglobin, parathyroid hormone, serum creatinine), and anthropometric indicators (body mass index BMI, arm circumference AC, midarm muscular circumference MMC, triceps skinfold thickness TST). Results: the study involved 66 patients, 43.9 % men, 56.1 % women, with a mean age of 53.15 ± 15.24 years; 43.9 % were elderly subjects. Sarcopenia occurred in 59.1 % of patients; of these, 15.2 % presented with severe sarcopenia. Pre-sarcopenia was found in 4.5 %. With regard to cachexia, 15.2 % were diagnosed with this syndrome. The variables associated with sarcopenia were reduced serum albumin (p = 0.013) and cachexia (p = 0.039), and those associated with cachexia were female gender (p = 0.036) and BMI (p < 0.001). Conclusion: the main finding of the present study was the high frequency of sarcopenia found in patients on treatment with dialysis. In the patients studied, sarcopenia was significantly associated with a decrease in serum albumin. Reduced serum albumin is a predictor of mortality in patients on renal replacement therapy. A high frequency of sarcopenia has been observed among study patients. Thus, the tools currently available to assess muscle mass and muscle strength should be implemented as much as possible in clinical practice to enable the incorporation of appropriate preventive and therapeutic interventions.

INTRODUCCIÓN: Introducción: la sarcopenia y la caquexia son síndromes que producen una reducción de la masa muscular esquelética y que se asocian al proceso de envejecimiento y a muchas enfermedades crónicas. Objetivo: verificar la frecuencia de la sarcopenia, la caquexia y los factores asociados en pacientes en tratamiento dialítico. Metodología: estudio transversal realizado en dos centros de tratamiento dialítico de Recife entre marzo y septiembre de 2016. El diagnóstico de sarcopenia se realizó según el criterio del Consenso Europeo de Sarcopenia, mientras que el de caquexia se hizo por el criterio de la Society for Cachexia and Wasting Disorders (SCWD). Las variables de asociación fueron demográficas (sexo y edad), analíticas (proteína C-reactiva, albúmina sérica, hemoglobina, paratohormona y creatinina sérica) y antropométricas: índice de masa corporal (IMC), circunferencia del brazo (CB), circunferencia muscular del brazo (CMB) y pliegue cutáneo tricipital (PCT). Resultados: se estudió a 66 pacientes: el 43,9 % eran hombres y el 56,1 % mujeres, con una media de edad de 53,15 ± 15,24 años. El 43,9 % eran ancianos. La sarcopenia estuvo presente en el 59,1 % de los pacientes y, entre estos, el 15,2 % presentaban sarcopenia grave. La pre-sarcopenia se verificó en el 4,5 %. En cuanto a la caquexia, se diagnosticó en el 15,2 %. Las variables asociadas a la sarcopenia fueron la albúmina sérica reducida (p = 0,013) y la caquexia (p = 0,039); las relacionadas con la caquexia fueron el sexo femenino (p = 0,036) y el IMC (p < 0,001). Conclusión: la principal constatación es la elevada frecuencia de la sarcopenia en los pacientes que realizan terapia dialítica. En los pacientes estudiados, la sarcopenia se asoció significativamente a la disminución de la albúmina sérica. La albúmina sérica reducida es un predictor de mortandad en los pacientes en terapia renal sustitutiva. La frecuencia de la sarcopenia fue elevada en los pacientes estudiados. De este modo, las herramientas actualmente disponibles para evaluar la masa y la fuerza muscular deben aplicarse en la medida de lo posible en la práctica clínica, viabilizando la incorporación de las intervenciones preventivas y terapéuticas apropiadas.

Discriminative power of an adapted version of Nutritional Risk Screening 2002 applied to Brazilian older adults.

OBJECTIVE: To investigate the discriminative power of Nutritional Risk Screening 2002. METHODS: A cross sectional study involving one hundred participants aged ≥60 years. The original and adapted versions of Nutritional Risk Screening 2002 and the Mini Nutritional Assessment were used. Nutritional Risk Screening 2002 adaptation consisted of a lower age cutoff (60 years or older) for addition of one extra point to the final score. RESULTS: Screening using Nutritional Risk Screening 2002 revealed higher nutritional risk among patients aged ≥70 years (p=0.009), whereas screening using the adapted version of Nutritional Risk Screening 2002 revealed similar nutritional risk in both age groups (60-69 years and ≥70 years; p=0.117). Frequency of nutritional risk was highest when the Mini Nutritional Assessment was administered (52.7%), followed by the adapted and original versions of Nutritional Risk Screening 2002 (35.5% and 29.1%, respectively). CONCLUSION: The adapted version of Nutritional Risk Screening 2002 was more effective than the original version. However, further studies are needed to confirm these findings.

Consumption of ultraprocessed foods, nutritional status, and dyslipidemia in schoolchildren: a cohort study.

This study evaluates the relation between consumption of ultraprocessed foods, nutritional status, and dyslipidemia in schoolchildren from Recife/PE, Brazil. This is a cohort study conducted in 2008-2009 and 2012-2013, with 238 students recruited from the public school system of the city of Recife, Northeast Brazil. Demographic data, stage of sexual maturation, socioeconomic, lifestyle, anthropometric, and lipid profiles were collected. There was a high prevalence of overweight, abdominal obesity, and dyslipidemia in both the time periods. The number of teenagers sufficiently active was higher in 2012-2013. There was a positive correlation between the consumption of ultraprocessed foods and age in 2008-2009. In 2008-2009, high consumption of ultraprocessed foods occurred in the majority of adolescents with normal total serum cholesterol values. In 2012-2013, low maternal schooling proved to be an important factor for a lower consumption of ultraprocessed foods. The consumption of ultraprocessed foods showed no direct relationship with overweight, abdominal obesity, and dyslipidemia in adolescents.

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.

Visceral adiposity indices and cardiometabolic risk markers in patients with hypertension

Abstract Objective: Arterial hypertension (AH) is a risk factor for cardiovascular diseases (CVD). We sought to evaluate the association between two adiposity indices (visceral adiposity index [VAI] and lipid accumulation product [LAP]) with traditional markers of cardiometabolic risk in hypertensive patients. Materials and methods: This is a cross-sectional study with 1,273 subjects with hypertension treated as outpatients at a university hospital. The VAI and LAP were calculated using formulas stratified by sex. Cardiometabolic risk variables were considered: overweight, risk for waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHA), and altered biochemical test values. The predictive effect of independent variables on outcomes was assessed by multivariate linear regression analysis. There was statistical significance when p ≤ 0.05. Results: Higher cardiometabolic risk (according to BMI, WHR, WHA, and altered biochemical parameters) was associated with higher values of VAI and LAP with statistical significance (p ≤ 0.05). The regression models used explained 30.7% and 10.5% of the changes in LAP and VAI, respectively. Conclusion: LAP and VAI are associated with cardiometabolic risk parameters in the individuals evaluated, suggesting that these indices can be used to screen for CVD risk in individuals with AH.

Factors that influence the redox state in children: An exploratory study.

OBJECTIVE: The aim of the present study was to investigate the association of the redox state via malondialdehyde (MDA) as a lipid peroxidation biomarker and hydrophilic antioxidant capacity (HAC) with dietary, anthropometric, demographic, socio-economic and clinical variables as well as the serum concentrations of vitamins in children aged 20-36 months. This cross-sectional study was conducted from May 2013 to May 2014 and included a total of 100 children. METHODS: The variables studied included anthropometric measurements, dietary intake by the Food Frequency Questionnaire (FFQ), socio-demographic features, clinical attributes, serum redox status, and serum vitamin concentrations. RESULTS: Children with a family income above the minimum wage and adequate body mass index (BMI) presented higher HAC. The MDA concentration was higher in children older than 24 months. Breastfeeding for up to 120 days provided greater antioxidant capacity. Children classified in the 2nd tertile for "fruit and vegetables" and "milk and dairy products" consumption showed lower levels of MDA. There was a positive correlation of MDA with serum vitamin A levels. These results show that among children in the 20-36 months age group, family income, breastfeeding, BMI and intake of fruits and vegetables can have an influence on the imbalance of the redox state. CONCLUSION: One strategy to prevent the imbalance between oxidants and antioxidants could be for health professionals to raise awareness among families, as such knowledge could repress/prevent the progression/initiation of several diseases in adult life.

Eating disorders in the preoperative phase of bariatric surgery / Transtornos alimentares durante o pré-operatório de cirurgia bariátrica

Introduction: Bariatric surgery is considered the most effective obesity treatment. Obese patients have a high prevalence of eating disorders. Objectives: Evaluate the occurrence of eating disorders and eating patterns in candidates for bariatric surgery and associate eating disorders with sociodemographic and clinical characteristics. Methods: A retrospective study was conducted using electronic charts of candidates for bariatric surgery. Data were collected on sex, age, marital status, schooling, occupation, non-communicable diseases, body mass index (BMI), eating disorders, and eating patterns. Results: Among the 281 patients evaluated, eating disorders were detected in 26.7%; 10.3% had binge eating disorder, 6.6% had bulimia nervosa, and 5.3% had the night-eating syndrome. The specific eating patterns were overeating (46.6%), binge eating during periods of stress (9.3%), eating sweets (4%), and snaking (1.3%). BMI ranged from 35.38 to 59.03 kg/m² (mean: 44.37 ± 5.89). All individuals (100%) had systemic arterial hypertension, and 23.3% had type 2 diabetes mellitus or dyslipidemia. Conclusions: The frequency of eating disorders was low in the sample studied, the most common of which was binge eating disorder. Non-communicable diseases were associated with eating disorders. Among the eating patterns observed, the most frequent was overeating (AU)

Introdução: A cirurgia bariátrica é considerada o tratamento mais eficaz para a obesidade. Pacientes obesos possuem elevada prevalência de transtornos alimentares. Objetivos: Avaliar a presença de transtornos alimentares e padrões alimentares em candidatos à cirurgia bariátrica, associando os transtornos alimentares aos dados sociodemográficos e clínicos. Métodos: Estudo retrospectivo de cunho documental, com base em prontuários eletrônicos de pacientes candidatos à cirurgia bariátrica. Foram obtidas variáveis como sexo, idade, estado civil, nível de escolaridade, ocupação, doenças crônicas não transmissíveis, índice de massa corporal (IMC), transtorno e padrão alimentar. Resultados: Dos 281 pacientes avaliados, foi detectado 26,7% de transtornos alimentares, sendo 10,3% transtorno de compulsão alimentar periódica, 6,6% de bulimia nervosa e 5,3% de síndrome do comer noturno. Os padrões alimentares específicos encontrados foram: glutões (46,6%), compulsivos alimentares em períodos de estresse (9,3%), comedores de doces (4%) e beliscadores (1,3%). O IMC variou de 35,38 a 59,03 kg/m² (44,37±5,89), com 100% do grupo apresentando Hipertensão Arterial Sistêmica e 23,3% com Diabetes Mellitus tipo 2 ou dislipidemia. Conclusões: Constatou-se baixa frequência de transtornos alimentares na amostra estudada, sendo o transtorno de compulsão alimentar periódica o mais observado. Doenças crônicas não transmissíveis foram associadas com a presença de transtornos alimentares. Dentre os padrões alimentares observados, os glutões foram os mais frequentes (AU)

Triagem nutricional por meio da avaliação subjetiva global produzida pelo próprio paciente (ASG-PPP) em câncer ginecológico / Nutritional screening through patient-generated subjective global assessment (PG-SGA) in gynecological cancer

O câncer é considerado importante causa de morbimortalidade, estando relacionado ao comprometimento da condição nutricional, que por sua vez, repercute diretamente no manejo clínico e na qualidade de vida. Neste contexto, buscou-se identificar o estado nutricional de mulheres com câncer ginecológico e investigar a associação do estado nutricional por triagem nutricional específica com o estado nutricional pelo índice de massa corporal (IMC), faixa etária e características clínicas através de um estudo transversal, realizado nas enfermarias de ginecologia e oncologia de um hospital universitário, durante julho a dezembro de 2017. Foram avaliadas pacientes com idade ≥ 20 anos, diagnosticadas com câncer ginecológico. O estado nutricional foi identificado utilizando-se a avaliação subjetiva global produzida pelo próprio paciente (ASG-PPP) que classifica em bem nutrido, desnutrição moderada ou desnutrição grave. A altura e peso atual foram obtidos através de balança mecânica e o peso usual foi referido pelas pacientes, sendo utilizados na determinação do IMC e no percentual de peso perdido. Foram estudadas 60 mulheres, com idade média de 54,5 ± 14,17 anos, com diagnóstico predominante de câncer de útero (68,3%). O estadiamento IV foi o mais prevalente (65%), a frequência de desnutrição foi elevada (68,3%), principalmente entre as idosas (81,5%), a perda ponderal ocorreu em 60% do grupo e a necessidade de intervenção nutricional em 91,7% dos casos. Constatou-se nesta amostra de mulheres adultas e idosas, elevada frequência de desnutrição através da ASG-PPP, esses achados ressaltam a importância desta ferramenta na identificação do estado nutricional em pacientes com câncer ginecológico.

Cancer is considered an important cause of morbidity and mortality, and is related to the impairment of nutritional status, which in turn directly affects clinical management and quality-of-life. In this context, we sought to identify the nutritional status of women with gynecological cancer and to investigate the association of nutritional status by specific screening with nutritional status according to body mass index (BMI), age group, and clinical characteristics through a cross-sectional study, carried out in the gynecology and oncology wards of a university hospital, from July to December 2017. Patients aged ≥ 20 years old, diagnosed with gynecological cancer were evaluated. Nutritional status was identified using the patient-generated subjective global assessment (PG-SGA), which classifies well nourished, moderately malnourished, or severely malnourished individuals. Current height and weight were obtained using a mechanical scale and the usual weight was reported by the patients, which were used to determine the BMI and the percentage of weight lost. Sixty women were studied, with a mean age of 54.5 ± 14.17 years old, with a predominant diagnosis of uterine cancer (68.3%). Stage IV was the most prevalent (65%), the frequency of malnutrition was high (68.3%), especially among the elderly (81.5%), weight loss occurred in 60% of the group, and there was a need for intervention in 91.7% of cases. In this sample of adult and elderly women, a high frequency of malnutrition through the PG-SGA was identified. These findings highlight the importance of this tool in the identification of nutritional status in patients with gynecological cancer.

Excessive weight--muscle depletion paradox and cardiovascular risk factors in outpatients with inflammatory bowel disease.

BACKGROUND: Evidence suggests a nutritional transition process in patients with inflammatory bowel disease. Obesity, which was once an uncommon occurrence in such patients, has grown in this population at the same prevalence rate as that found in the general population, bringing with it an increased risk of cardiovascular disease. Objective The aim of the present study was to determine the nutritional status and occurrence of cardiovascular risk factors in patients with inflammatory bowel disease. METHODS: A case-series cross-sectional study was conducted involving male and female adult outpatients with inflammatory bowel disease. Data were collected on demographic, socioeconomic, clinical and anthropometric variables as well as the following cardiovascular risk factors: sedentary lifestyle, excess weight, abdominal obesity, medications in use, comorbidities, alcohol intake and smoking habits. The significance level for all statistical tests was set to 5% (P< 0.05). RESULTS: The sample comprised 80 patients with inflammatory bowel disease, 56 of whom (70.0%) had ulcerative colitis and 24 of whom (30.0%) had Crohn's disease. Mean age was 40.3±11 years and the female genre accounted for 66.2% of the sample. High frequencies of excess weight (48.8%) and abdominal obesity (52.5%) were identified based on the body mass index and waist circumference, respectively, in both groups, especially among those with ulcerative colitis. Muscle depletion was found in 52.5% of the sample based on arm muscle circumference, with greater depletion among patients with Crohn's disease (P=0.008). The most frequent risk factors for cardiovascular disease were a sedentary lifestyle (83.8%), abdominal obesity (52.5%) and excess weight (48.8%). CONCLUSION: The results of the complete anthropometric evaluation draw one's attention to a nutritional paradox, with high frequencies of both - muscle depletion, as well as excess weight and abdominal obesity.

Use of alcohol before and after bariatric surgery.

OBJECTIVE: to assess alcohol intake in the bariatric surgery pre and postoperative periods. METHODS: Patients were interviewed at Surgery Clinic of the Hospital das Clínicas da Universidade Federal de Pernambuco - HC/UFPE (Brazil) from July 2011 to March 2012. We analyzed socioeconomic, anthropometric and clinical variables. We used the Alcohol Use Disorders Identification Test (AUDIT C). RESULTS: One hundred nineteen patients were enrolled (mean age: 41.23+11.30 years), with a predominance of the female gender (83.2%), non-Caucasian race (55%), married individuals or in a stable union (65.5%), with a high school education (40.3%)and active in the job market (37%). Weight and body mass index (BMI) were 128.77+25.28 Kg and 49.09+9.26 Kg/m2,respectively in the preoperative period (class II obesity) and 87.19+19.16 Kg and 33.04+6.21 Kg/m2, respectively in the postoperative period (class I obesity) (p<0.001). Hypertension was the most frequent disease in the pre (66.6%) and postoperative (36.5%) periods. The prevalence of alcohol use was 26.6% in the preoperative period, of which 2.2% of high risk, and 35.1% in the postoperative period, of which 1.4% of probable dependence; this difference did not achieve statistical significance (p=0.337). CONCLUSION: The prevalence of abusive alcohol intake and/or probable dependence was low in both the pre and postoperative periods, with little evidence of risky consumption among the patients submitted to bariatric surgery.

Prevalence of Alcohol Abuse Before and After Bariatric Surgery Associated With Nutritional and Lifestyle Factors: A Study Involving a Portuguese Population.

BACKGROUND: It has been hypothesized that the metabolism of alcohol is altered following bariatric surgery. However, few studies have evaluated preoperative and postoperative alcohol use. The aims of the study were to characterize alcohol use in the preoperative period and 2 years postoperatively as well as to identify factors associated. METHODS: A study was conducted using data from the electronic charts of patients submitted to laparoscopic adjustable gastric banding (LAGB) and Roux-en-Y gastric bypass (RYGB) surgery in the city of Porto, Portugal. Associations with the following variables were analyzed: age, marital status, schooling, alcohol use, body mass index, binge eating disorder, and lifestyle habits. RESULTS: Among the 659 patients, 42.0 % completed the 2 years of follow-up. A total of 90.2 % were women; 67.4 % underwent LAGB, and 32.6 % underwent RYGB. The frequency of alcohol use was 24.2 % in the preoperative period and 9.4 % in the postoperative period (p = 0.000). Daily alcohol intake was two drinks in the preoperative period and 1.8 drinks in the postoperative period. Significant associations were found between postoperative alcohol use and the male gender (p = 0.001), age ≥ 45 years (p = 0.018), and preoperative BMI <40 kg/m(2) (p = 0.028). No significant associations were found with the surgical technique. No previous nondrinkers became drinkers, and no patients increased the quantity or frequency of alcohol intake in the postoperative period. CONCLUSIONS: The prevalence of alcohol use in the sample was low. Moreover, a lower prevalence rate was found in the postoperative period, independently of surgical technique, clinical factors, and percentage of weight loss.

Discriminative power of an adapted version of Nutritional Risk Screening 2002 applied to Brazilian older adults / Poder diagnóstico discriminativo da versão adaptada do Nutritional Risk Screening 2002 administrada em idosos brasileiros

ABSTRACT Objective: To investigate the discriminative power of Nutritional Risk Screening 2002. Methods: A cross sectional study involving one hundred participants aged ≥60 years. The original and adapted versions of Nutritional Risk Screening 2002 and the Mini Nutritional Assessment were used. Nutritional Risk Screening 2002 adaptation consisted of a lower age cutoff (60 years or older) for addition of one extra point to the final score. Results: Screening using Nutritional Risk Screening 2002 revealed higher nutritional risk among patients aged ≥70 years (p=0.009), whereas screening using the adapted version of Nutritional Risk Screening 2002 revealed similar nutritional risk in both age groups (60-69 years and ≥70 years; p=0.117). Frequency of nutritional risk was highest when the Mini Nutritional Assessment was administered (52.7%), followed by the adapted and original versions of Nutritional Risk Screening 2002 (35.5% and 29.1%, respectively). Conclusion: The adapted version of Nutritional Risk Screening 2002 was more effective than the original version. However, further studies are needed to confirm these findings.

RESUMO Objetivo: Avaliar o poder de discriminação diagnóstica da ferramenta Nutritional Risk Screening 2002. Métodos: Estudo transversal com cem participantes com idade ≥60 anos. Foram aplicados o Nutritional Risk Screening 2002 original, o Nutritional Risk Screening 2002 adaptado e o Mini Nutritional Assessment. A adaptação do Nutritional Risk Screening 2002 consistiu em diminuir o critério de idade, incluindo pontuação adicional para 60 anos de idade ou mais. Resultados: Maior risco nutricional ocorreu nos ≥70 anos quando aplicado o Nutritional Risk Screening 2002 original (p=0,009), enquanto o Nutritional Risk Screening 2002 adaptado apresentou risco nutricional semelhante em ambos os grupos (60-69 anos e ≥70 anos; p=0,117). A frequência de risco nutricional foi maior no Mini Nutritional Assessment (52,7%), seguido do Nutritional Risk Screening 2002 adaptado (35,5%) e do Nutritional Risk Screening 2002 original (29,1%). Conclusão: A adaptação do Nutritional Risk Screening 2002 mostrou-se descritivamente mais eficaz do que a original, porém mais estudos devem ser realizados para confirmar os achados.

Hypertriglyceridemic waist and associated factors in children and adolescents with type 1 diabetes mellitus / Cintura hipertrigliceridêmica e fatores associados em crianças e adolescentes portadores de diabetes melito tipo 1

ABSTRACT Objective: To assess the frequency of the hypertriglyceridemic waist phenotype and its associated factors in children and adolescents with type 1 diabetes mellitus. Methods: This is an observational analytical study with individuals with type 1 diabetes mellitus, aged 5 to 18 years, of both genders, followed in a university hospital in the Brazilian Northeast. Weight, height, and waist circumference were measured, and the lipid profile and glycated hemoglobin were analyzed. The hypertriglyceridemic waist phenotype was defined by the simultaneous presence of increased waist circumference (≥90th percentile for age and gender) and elevated serum triglyceride levels (≥75 mg/dL for children and ≥90 mg/dL for adolescents). We also investigated the family history of cardiovascular diseases and diabetes, as well as sociodemographic and behavioral variables. In the statistical inference tests, the proportions were compared by Pearson's chi-square test ­and/­or Fisher's exact test, being significant p<0.05. Results: A total of 102 patients were evaluated, most of them females (54.9%) and adolescents (66.7%). The frequency of hypertriglyceridemic waist was 23.5%, which was associated with females (p=0.043), overweight (p=0.023), hypercholesterolemia (p=0.002), high LDL (p=0.001), and borderline VLDL (<0.001). Conclusions: The frequency of the hypertriglyceridemic waist phenotype was associated with females, atherogenic lipid profile, and overweight, indicating the importance of the nutritional monitoring of this population, aiming at reducing future cardiovascular diseases.

RESUMO Objetivo: Avaliar a frequência do fenótipo cintura hipertrigliceridêmica e analisar seus fatores associados em crianças e adolescentes portadores de diabetes melito tipo 1. Métodos: Trata-se de um estudo observacional analítico com indivíduos com diabetes melito tipo 1, de cinco a 18 anos de idade, de ambos os sexos, acompanhados em um hospital universitário do Nordeste brasileiro. Foram realizadas medidas de peso, altura e circunferência da cintura, além da análise do perfil lipídico e da hemoglobina glicada. O fenótipo cintura hipertrigliceridêmica foi definido pela presença simultânea da circunferência da cintura aumentada (≥percentil 90 por idade e sexo) e dos níveis séricos de triglicerídeos elevados (≥75 mg/dL para crianças e ≥90 mg/dL para adolescentes). Investigaram-se, ainda, os antecedentes familiares para doenças cardiovasculares e diabetes, e também variáveis sociodemográficas e comportamentais. Nos testes de inferência estatística, as proporções foram comparadas pelo teste do qui-quadrado de Pearson e/ou exato de Fisher, sendo significante p<0,05. Resultados: Foram avaliados 102 pacientes, com predomínio do sexo feminino (54,9%) e de adolescentes (66,7%). A frequência de cintura hipertrigliceridêmica foi de 23,5%; a qual apresentou associação com o sexo feminino (p=0,043), excesso de peso (p=0,023), hipercolesterolemia (p=0,002), LDL elevado (p=0,001) e VLDL em valores limítrofes (<0,001). Conclusões: A frequência do fenótipo cintura hipertrigliceridêmica foi associada ao sexo feminino, ao perfil lipídico aterogênico e ao excesso ponderal, evidenciando a importância do acompanhamento nutricional dessa população, visando à redução de agravos cardiovasculares futuros.

[Sensibility of anthropometric-laboratory markers of protein-energy malnutrition in cirrhotic patients]. / Sensibilidade de indicadores da desnutrição protéico-energética em cirróticos com vários graus de disfunção hepatocelular.

AIM: The prevalence and severity of protein-energy malnutrition (PEM) were investigated through the anthropometric (body mass index, triceps and subescapular skinfolds and upper arm circumferences) and blood measures in 117 cirrhotic patients. The sensitivity and specificity of single or combined PEM markers were tested among Child A (n=18), Child B (n=42) and Child C (n=57) adults (51+/-13y). RESULTS: Were calculated as z score and considered deficient when z< or =-1.28SD according to local standards. The most deficient markers where albumin (93%), hemoglobin (90%), upper arm circumference (61%), triceps (55%) and subescapular (53%) skinfolds. By combining upper arm circumference with triceps or subescapular skinfolds, PEM were detected in 63% of patients varying from 39-44% (Child A) to 64-68% (Child B or C). CONCLUSION: Thus the pattern of PEM present in cirrhosis is predominantly in their protein compartment and worsened with the severity of hepatocellular insuficiency. Upper arm circumference can be used as sensitive markers of presence and severity of PEM in cirrhotic patients but showing low specificity for discriminate PEM among Child grades (B and C) of hepatocellular dysfunctions.

[Protein-energy malnutrition in the gastrectomized patient]. / Desnutrição protéico-energética no paciente gastrectomizado.

BACKGROUND: Gastrectomy leads to nutritional consequences that although expected, are not usually measured due to methodological limitations. AIM: To assess the protein-energy deficiency degrees estimated by isolated or combined indicators. PATIENTS AND METHODS: There were studied 71 patients, who had undergone partial (n = 53) or total (n = 18) gastrectomy in the last 6-24 months (M1) or 24-60 months (M2). The dietary intake, body composition and biochemical data were estimated and compared between groups and moments. RESULTS: The surgeries were undertaken after complications of peptic ulcer (68%) or due to gastric cancers (32%). Weight loss was referred by 70% of patients and higher (16 +/- 5 x 10 +/- 6 kg) in total gastrectomy group. The patients showed anthropometric deficits along with normal albumin and low energy intake, suggesting chronic-energy deficiency. Hematocrit, hemoglobin and iron showed the most prominent reductions. Anemia was installed earlier and worsened in the total gastrectomy group. Thus, when combining hemoglobin + albumin, + total lymphocyte count + arm circumference and subscapular skinfold, the protein-energy deficiency prevalence was higher and more severe than when hemoglobin was omitted. The protein-energy deficiency occurred earlier and it was more severe in total gastrectomy patients, while in partial gastrectomy the protein-energy deficiency increased in the late post-operative period. CONCLUSION: The protein-energy deficiency resulted from gastrectomy is more marasmus-like coarsing with anemia, both installed earlier and severer in total gastrectomy than partial gastrectomy but ending up similarly at the late postoperatory.

Clinical-nutritional evolution of older women submitted to Roux-en-Y gastric bypass.

The aim of the present study was to describe the clinical- nutritional evolution of older women submitted to Roux-en-Y gastric bypass surgery. A concurrent, retrospective study was conducted involving a sample of 16 older women with morbid obesity submitted to Rouxen- Y gastric bypass surgery between 1997 and 2010. Weight, body mass index (BMI), percentage of weight loss (%WL) and percentage of excess weight loss (%EWL) were evaluated three, six and 12 months after surgery. Preoperative comorbidities, postoperative clinical-nutritional manifestations and peri-operative mortality were also investigated. Mean age was 62.02 ± 2.02 years. A progressive reduction was found in mean body weight (116.04 ± 22.99 to 80.96 ± 21.43 Kg) and BMI (47.13 ± 8.19 to 33.42 ± 9.31 Kg/m²), with a consequent %WL of 28.60 ± 8.59% and %EWL of 64.79 ± 3.99% throughout the one-year follow-up period (p < 0.05). All patients has diseases associated with obesity, the most frequent of which were arterial hypertension (n = 16), arthropathy (n = 11), dyslipidemia (n = 9) and diabetes (n = 7). The following clinical-nutritional symptoms were reported: alopecia (n = 9), nausea/vomiting (n = 7), constipation (n = 5) and food intolerance (n = 4). One patient was diagnosed with malnutrition one year after surgery. No deaths occurred within 30 days after surgery. At the one-year evaluation, surgical success was evidenced by the significant reductions in mean weight and BMI and the more than 50% loss of excess weight.

El objetivo de este estudio fue la descripción de la evolución clinico-nutricional de mujeres mayores sometidas a cirugía de bypass gástrico en Y de Roux. Se desarrolló un estudio concurrente, retrospectivo, que incluyó una muestra de 16 mujeres mayores con obesidad mórbida sometidas a bypass gástrico en Y de Roux entre 1997 y 2010. Se evaluó el peso, índice de masa corporal (IMC), porcentaje de pérdida de peso (%WL) y porcentaje de pérdida de peso excesivo (%EWL) tres, seis y doce meses después de la cirugía. También se investigó las comorbilidades preoperatorias, manifestaciones clínico-nutricionales postoperatorias y mortalidad perioperatoria. La edad media fue 62,02 ± 2,02 años. Se detectó una reducción progresiva en el peso medio corporal (116,04 ± 22,99 a 80,96 ± 21,43 Kg) e IMC (47,13 ± 8,19 a 33,42 ± 9,31 Kg/ m2), con un consequente porcentaje de pérdida de peso (%WL) de 28,60 ± 8,59% y %EWL de 64,79 ± 3,99% a lo largo del periodo de seguimiento de un año (p < 0,05). Todas las pacientes tenían enfermedades relacionadas con obesidad, siendo la más frecuente hipertensión arterial (n = 16), artropatía (n = 11), dislipidemia (n = 9) y diabetes (n = 7). Se comunicaron los siguientes síntomas clínico-nutricionales: alopecia (n = 9), nausea/vómitos (n = 7), estreñimiento (n = 5) e intolerancia a la comida (n = 4). Una paciente fue diagnosticada de malnutrición un año después de la cirugía. No se registraron muertes tras 30 días de la cirugía. En la evaluación a un año, el éxito quirúrgico quedó constatado por las reducciones significativas en peso medio e IMC, además de más de un 50% de pérdida de peso excesivo.

Alcohol intake in lactating women assisted in a University Hospital.

OBJECTIVE: To determine the prevalence of alcohol intake and the degree of alcohol-related risk among nursing mothers attended at the Child Care Service of Hospital das Clínicas of Universidade Federal de Pernambuco, Brazil. METHODS: A cross-sectional study was carried out with 157 nursing mothers enrolled in the Child Care Program of the university hospital. A questionnaire was administered addressing demographic and socioeconomic variables, type and duration of breastfeeding, smoking habits and consumption of foods considered as appetizers. The Alcohol Use Disorders Identification Test (AUDIT C) was applied for assessing alcohol consumption in the previous 12 months. Pearson's chi-square test and Fisher's exact test were used for statistical analysis. RESULTS: Twelve percent of the nursing mothers reported consuming alcoholic beverages, 100% of whom were classified as being at low risk for alcohol use disorders. The frequency of nursing mothers who consumed appetizers during alcohol consumption was 100%, the most common of which was cheese - 18 (95%). CONCLUSIONS: The prevalence of alcohol intake was low in the nursing mothers analyzed. The users exhibited a low risk for alcohol disorders and a high frequency of the consumption of appetizers during alcohol consumption.