Weak association between urea-creatinine ratio and c-reactive protein with nutritional risk in Intensive Care Unit patients with COVID-19: A cross-sectional study with 589 patients.

BACKGROUND: COVID-19 is a systemic infection with a significant impact on nutrition risk and the hematopoietic system. The neutrophil-lymphocyte ratio (NLR) may have prognostic value in determining severe cases of COVID-19 and the urea-creatinine ratio (UCR) is currently being studied as a potential biomarker of catabolism associated with critical illness. The aim was to assess the association between the NLR, UCR and C-reactive protein (CRP) with nutritional risk in hospitalized patients with COVID-19. METHODS: This is a retrospective cross-sectional study that assessed 589 hospitalized patients with COVID-19, 18 years of age or older, of both sexes. Nutritional risk was assessed by Nutritional Risk Screening (NRS, 2002) and NLR by neutrophils divided by lymphocyte count. The UCR was calculated by the ratio between urea and creatinine and quantified by the calorimetric biochemical method and CRP by the immunoturbidimetric method. Differences between groups were applied by the Mann-Whitney U test and the automated binary regression test. RESULTS: Of the 589 patients, 87.4% were at nutritional risk. When evaluating patients admitted to the ICU, 91.9% were at nutritional risk. Patients with NRS ≥3 are older, with lower body mass and BMI, higher NLR and UCR and lower CRP values. However, 73% of patients admitted to the ward were at nutritional risk, and only age differed between groups, being higher in patients with NRS ≥3. Logistic regression showed a weak association between nutritional risk in NRS and UCR (Model 1) (OR=0.96, p=0.003) and NRS with CRP (Model 1) (OR=1.01, p<0.001) in patients in the ICU. On the other hand, the logistic regression in ward patients found association only for CRP in both models (Model 1, OR=1.01, p=0.041) and (Model 2, OR=1.01, p=0.031). CONCLUSION: We found a low association between nutritional risk and UCR and CRP in patients admitted to the ICU, while in the ward patients the nutritional risk also had weak association with CRP.

Association of Calf Circumference with Clinical and Biochemical Markers in Older Adults with COVID-19 Admitted at Intensive Care Unit: A Retrospective Cross-Sectional Study.

BACKGROUND: COVID-19 is an infectious disease characterized by a severe catabolic and inflammatory state, leading to loss of muscle mass. The assessment of muscle mass can be useful to identify nutritional risk and assist in early management, especially in older adults who have high nutritional risks. The aim of this study was to evaluate the association of calf circumference (CC) with clinical and biochemical markers and mortality in older adults with COVID-19 admitted to the intensive care unit (ICU). METHODS: A retrospective cross-sectional study was conducted in a public hospital. CC was adjusted for body mass index (BMI), reducing 3, 7, or 12 cm for a BMI of 25-29.9, 30-39.9, and ≥40 kg/m2, respectively, and classified as reduced when <33 cm for women and <34 cm for men. Pearson's correlation between BMI and CC was performed to assess the association between variables. Regression analysis was adjusted for sex, age, and BMI variables. Cox regression was used to assess survival related to CC. RESULTS: A total of 208 older adults diagnosed with COVID-19 admitted to ICU were included, of which 84% (n = 176) were classified as having reduced CC. These patients were older, with lower BMI, higher nutritional risk, malnourished, and higher concentration of urea and urea-creatinine ratio (UCR) compared with the group with normal CC. There was an association between edematous patients at nutritional risk and malnourished with reduced CC in the Cox regression, either adjusted or not for confounding. CONCLUSIONS: CC was not associated with severity, biochemical markers, or mortality in older adults with COVID-19 admitted to the ICU, but it was associated with moderately malnourished patients assessed by subjective global assessment (SGA).

Effects of whey protein supplementation on adiposity, body weight, and glycemic parameters: A synthesis of evidence.

AIMS: The aim of this review was to analyze the evidence of whey protein supplementation on body weight, fat mass, lean mass and glycemic parameters in subjects with overweight or type 2 diabetes mellitus (T2DM) undergoing calorie restriction or with ad libitum intake. DATA SYNTHESIS: Overweight and obesity are considered risk factors for the development of chronic noncommunicable diseases such as T2DM. Calorie restriction is a dietary therapy that reduces weight and fat mass, promotes the improvement of glycemic parameters, and decreases muscle mass. The maintenance of muscle mass during weight loss is necessary in view of its implication in preventing chronic diseases and improving functional capacity and quality of life. The effects of increased protein consumption on attenuating muscle loss and reducing body fat during calorie restriction or ad libitum intake in overweight individuals are discussed. Some studies have demonstrated the positive effects of whey protein supplementation on improving satiety and postprandial glycemic control in short term; however, it remains unclear whether long-term whey protein supplementation can positively affect glycemic parameters. CONCLUSIONS: Although whey protein is considered to have a high nutritional quality, its effects in the treatment of overweight, obese individuals and those with T2DM undergoing calorie restriction or ad libitum intake are still inconclusive.

Neutrophil-to-lymphocyte ratio is not associated with risk of sarcopenia in elderly COVID-19 patients.

BACKGROUND: To assess the existence of association between neutrophil to lymphocyte ratio (NLR) and the risk of sarcopenia in COVID-19 patients. METHODS: A retrospective cross-sectional study was conducted in a university hospital with patients with an active COVID-19 infection admitted to the nursing ward or intensive care unit (ICU) between September to December 2020. Sarcopenia risk was assessed using the Strength, Assistance for walking, Rise from a chair, Climb stairs and Falls (SARC-F). Biochemical analyses were assessed by circulating of C-reactive protein, D-dimer, neutrophils, lymphocytes count and NLR. Sixty-eight patients were evaluated and divided into tertiles of NLR values and the association between NLR and sarcopenia risk were tested using the linear regression analyses and p<0.05 were considered as significant. RESULTS: Sixty-eight patients were evaluated and divided in NLR tertiles being the 1st (men=52.2%; 71.1±9.0 y; NLR: 1.1-3.85), 2nd (women=78.3%; 73.2±9.1 y; NLR: 3.9-6.0) and 3rd (men=72.7%; 71.7±10.4 y; NLR: 6.5-20.0). There was a difference between the tertiles in relation to the first to the biochemical parameters of total neutrophils count (p=0.001), C-reactive protein (p=0.012), and D-dimer (p=0.012). However, no difference was found in linear regression analysis between tertiles of NLR and SARC-F, if in total sample (p=0.054) or divided by sex, if men (p=0.369) or women (p=0.064). CONCLUSION: In elderly patients hospitalized with COVID-19, we do not find an association between the risk of sarcopenia and NLR.

Krill Oil Supplementation Does Not Change Waist Circumference and Sagittal Abdominal Diameter in Overweight Women: A Pilot Balanced, Double-Blind, and Placebo-Controlled Clinical Trial.

An excess of body fat is one of the biggest public health concerns in the world, due to its relationship with the emergence of other health problems. Evidence suggests that supplementation with long-chain polyunsaturated fatty acids (omega-3) promotes increased lipolysis and the reduction of body mass. Likewise, this clinical trial aimed to evaluate the effects of supplementation with krill oil on waist circumference and sagittal abdominal diameter in overweight women. This pilot, balanced, double-blind, and placebo-controlled study was carried out with 26 women between 20 and 59 years old, with a body mass index >25 kg/m2. The participants were divided into the control (CG) (n = 15, 3 g/daily of mineral oil) and krill oil (GK) (n = 16, 3 g/daily of krill oil) groups, and received the supplementation for eight weeks. Food intake variables were obtained using a 24 h food recall. Anthropometric measurements (body mass, body mass index, waist circumference, and sagittal abdominal diameter) and handgrip strength were obtained. After the intervention, no changes were found for the anthropometric and handgrip strength variables (p > 0.05). Regarding food intake, differences were found for carbohydrate (p = 0.040) and polyunsaturated (p = 0.006) fatty acids, with a reduction in the control group and an increase in krill oil. In conclusion, supplementation with krill oil did not reduce the waist circumference and sagittal abdominal diameter. Therefore, more long-term studies with a larger sample size are necessary to evaluate the possible benefits of krill oil supplementation in overweight women.

Acute supplementation with whey protein or collagen does not alter appetite in healthy women: a randomised double-blind and crossover pilot study.

Protein quality has an important role in increasing satiety. Evidence suggests that whey protein (WP) provides satiety via gastrointestinal hormone secretion. Hydrolysed collagen supplementation can also stimulate the production of incretins and influence satiety and food intake. Thus, we sought to compare the effect of acute supplementation of WP or hydrolysed collagen on post-intervention appetite and energy consumption. This was a randomised, double-blind, crossover pilot study with ten healthy adult women (22·4 years/old) who were submitted to acute intake (single dose) of a beverage containing WP (40 g of concentrated WP) or hydrolysed collagen (40 g). Subjective appetite ratings (feelings of hunger, desire to eat and full stomach) were measured using the Visual Analog Scale (VAS), energy intake was quantified by ad libitum cheese bread consumption 2 hours after supplementation and blood was collected for leptin and glucose determination. There was no difference between treatment groups in the perception of hunger (P = 0·983), desire to eat (P = 0·326), full stomach feeling (P = 0·567) or food consumption (P = 0·168). Leptin concentrations at 60 min post supplementation were higher when subjects received hydrolysed collagen (P = 0·006). Acute supplementation with hydrolysed collagen increased leptin levels in comparison with WP, but had no effect on appetite measured by feelings of hunger, desire to eat, full stomach feeling (VAS) or energy consumption.

Whey Protein Supplementation Compared to Collagen Increases Blood Nesfatin Concentrations and Decreases Android Fat in Overweight Women: A Randomized Double-Blind Study.

Protein supplements are usually used to control body weight, however, the impact of protein quality on body fat attenuation is unknown. We investigated the effects of isocaloric isoproteic supplementation of either whey protein (WG) or hydrolysed collagen supplementation (CG) on dietary intake, adiposity and biochemical markers in overweight women. METHODS: In this randomized double-blind study, 37 women, [mean ± SE, age 40.6 ± 1.7 year; BMI (kg/m2) 30.9 ± 0.6], consumed sachets containing 40 g/day of concentrated whey protein (25 g total protein, 2.4 leucine, 1.0 valine, 1.5 isoleucine, n = 17) or 38 g/day of hydrolysed collagen (26 g total protein, 1.02 leucine, 0.91 valine, 0.53 isoleucine, n = 20) in the afternoon snack. The compliance was set at >70% of the total theoretical doses. The dietary intake was evaluated by a 6-day food record questionnaire. At the beginning and after eight weeks of follow-up, body composition was evaluated by using dual-energy X-ray absorptiometry and lipid profile, insulin resistance, C-reactive protein, adiponectin, leptin and nesfastin plasma concentrations were analyzed. RESULTS: Supplements were isocaloric and isoproteic. There were no differences in caloric intake (p = 0.103), protein (p = 0.085), carbohydrate (p = 0.797) and lipids (p = 0.109) intakes. The branched chain amino acids (BCAA) (GC: 1.8 ± 0.1 g vs. WG: 5.5 ± 0.3 g, p < 0.001) and leucine intake (CG: 0.1 ± 0.1 g vs. WG: 2.6 ± 0.1 g, p < 0.001) were higher in WG compared to CG. BMI increased in the CG (0.2 ± 1.1 kg/m2, p = 0.044) but did not change in WG. WG decreased the android fat (-0.1 ± 0.3 kg, p = 0.031) and increased nesfatin concentrations (4.9 ± 3.2 ng/mL, p = 0.014) compared to CG. CONCLUSIONS: Whey protein supplementation in overweight women increased nesfatin concentrations and could promote increase of resting metabolic rate as part of body composition improvement programs compared to collagen supplementation for 8 weeks. Additionally, our findings suggest that collagen may not be an effective supplement for overweight women who are attempting to alter body composition.

High-Protein Diet Containing Dairy Products is Associated with Low Body Mass Index and Glucose Concentrations: A Cross-Sectional Study.

The aim was to evaluate whether the ingestion of a high protein diet containing dairy protein is associated with anthropometric indicators of adiposity and blood glucose. METHODS: A cross-sectional study was conducted with volunteers of 20-89 years of age who performed leisure physical activity. We assessed dietary intake, body mass index (BMI), waist circumference (WC), triceps skinfold thickness (TSFT), random blood glucose as well as sociodemographic and behavioral variables. RESULTS: A total of 418 individuals were evaluated. The consumption of a high-protein diet (1.80 ± 0.49 g/kg/day) was found in 37.8% of individuals, which showed lower BMI, WC, TSFT and blood glucose concentrations compared to those with a low-protein diet (0.56 ± 0.18 g/kg/day). Dairy products consumption was inversely associated with BMI when adjusted for sex and age (odds ratio (OR): 0.79, 95% confidence interval (CI): 0.68-0.93, p = 0.004) and by sex, age, fiber and energy (OR: 0.79; 95% CI: 0.67-0.92; p = 0.004), and with blood glucose when adjusted for sex and age (OR: 0.86; 95% CI: 0.74-0.99; p = 0.042). Cheese consumption was inversely associated with blood glucose when adjusted for sex and age (OR: 0.73, 95% CI: 0.55-0.96, p = 0.023) and by sex, age, calories and fibers (OR: 0.74, 95% CI: 0.56-0.98, p = 0.036). Two portions of cheeses/day reduced the risk of having high blood glucose levels by approximately 80%. CONCLUSION: A high-protein diet containing dairy food, in particular two servings of cheese, was associated with low BMI and random glucose concentration.

Acute Epigallocatechin 3 Gallate (EGCG) Supplementation Delays Gastric Emptying in Healthy Women: A Randomized, Double-Blind, Placebo-Controlled Crossover Study.

Background: Epigallocatechin 3 Gallate (EGCG) appears to act in appetite control through hormonal modulation. However, there is a lack of elucidation of EGCG's action mechanisms, especially in humans. The aim of this study was to evaluate the effects of acute EGCG supplementation on gastric emptying and its relation to blood hormones, glucose and appetite perceptions in healthy women. Methods: 22 healthy adult women were included in a randomized, double-blind, placebo-controlled crossover study. On two separate occasions, 1 week apart from each other, we offered 800 mg of corn starch (placebo) or 752 mg of EGCG. Appetite was assessed through gastric emptying; perceptions of hunger, desire to eat and satiation; and plasma insulin, adiponectin, leptin and glucose concentrations. The evaluations were carried out in fasting, 30, 90 and 150 min after supplementation. Results: EGCG supplementation induced higher relative gastric volume at 30 and 90 min. Satiation at 90 min was higher in the EGCG group. Adiponectin concentrations at 150 min were higher with EGCG, but no difference was found for glucose, insulin and leptin concentrations. Conclusions: Acute EGCG supplementation is able to delay gastric emptying in healthy women to a small, but statistically significant extent. This study was registered at the Brazilian Registry of Clinical Trials (ReBEC) as RBR-9svwrv.

High out-of-clinic blood pressure is associated with adiposity indicators in leisure physical activity practitioners in Midwest Brazil.

BACKGROUND: Several diseases, such as obesity, hypertension and type 2 diabetes are frequently associated with metabolic abnormalities, high costs of healthcare and morbi-mortality; thus the aim of this study was to investigate the relationship between out-of-clinic high blood pressure and chronic disease-associated adiposity indicators in practitioners of leisure physical activity. METHODS: A cross-sectional study with 414 subjects of both genders aged 24-65 years. Data were collected by trained interviewers in five public parks. Body Mass Index (BMI), triceps skinfold and waist circumference (WC) were evaluated. Exercise training, smoking status, alcohol consumption and hypertension diagnosis were self-reported. Casual glycemia concentrations were collected and blood pressure was measured out-of-clinic once during the study. Participants with systolic ≥140 mmHg and diastolic ≥90 mmHg blood pressures were classified as high blood pressure. All analyses were adjusted for age and sex. RESULTS: High-blood pressure was diagnosed in 31.4% (n = 130), but 34 (8.3%) from patients took medication anti-hypertensive and were previously hypertension diagnosed. Participants with high blood pressure had a higher BMI (25.66 vs. 26.87 kg/m2; p = 0.012), WC (90.92 vs. 95.02 cm; p = 0.001), and systolic and diastolic blood pressure (p <  0.0001) when compared to subjects with normal blood pressure. Logistic regression analysis revealed that overweight status assessed by BMI, triceps skinfold and WC increases the high blood pressure probability by approximately 1.61 (95 CI%: 1.06-2.45), 1.02 (95%CI: 1.01-1.05) and 1.61 (95%CI: 1.06-2.45), respectively. CONCLUSIONS: Adiposity indicators are associated with high out-of-clinic blood pressure measured in practitioners of leisure physical activity.

Low Handgrip Strength Is Not Associated with Type 2 Diabetes Mellitus and Hyperglycemia: a Population-Based Study.

Type 2 diabetes mellitus (DM) is commonly linked to muscle weakness and metabolic abnormalities which increase healthcare costs. The study was undertaken to investigate if low handgrip strength, as a marker of muscle weakness, is associated with hyperglycemia and/or DM in Brazilian subjects. In a cross-sectional design, 415 individuals of both sexes (46.7% male) were interviewed by a questionnaire and the DM diagnostic was self-reported. Anthropometric measurements, such as weight, height, body mass index (BMI), arm circumference, mid-arm and calf circumference and handgrip strength, were obtained by trained nutritionists. Blood glucose concentrations were determined by portable monitor analysis. Student's t-test was applied to compare DM cases with non-diabetic individuals, and logistic regression analysis was performed to verify the odds for becoming diabetic or having altered glycemia and p < 0.05 was considered as significant. From 415 subjects, 9.2% (n = 35) were classified as DM. DM patients had significantly higher age, BMI, casual glycemia and lower handgrip strength and normalized (to body weight) handgrip strength (NHS) when compared with non-diabetic patients. Individuals with low NHS have 2.7 odds ratio to DM without adjustment for covariate (crude model, p = 0.006) and have 2.7 times higher the likelihood of DM than individuals with high NHS after adjusting for age (model 1, p = 0.006); however, this association disappeared after further adjusting for sex. In conclusion, low handgrip strength normalized or not to body weight, was not associated with hyperglycemia and DM diagnosis.

Acute Caffeinated Coffee Consumption Does not Improve Time Trial Performance in an 800-m Run: A Randomized, Double-Blind, Crossover, Placebo-Controlled Study.

INTRODUCTION: Studies evaluating caffeinated coffee (CAF) can reveal ergogenic effects; however, studies on the effects of caffeinated coffee on running are scarce and controversial. AIM: To investigate the effects of CAF consumption compared to decaffeinated coffee (DEC) consumption on time trial performances in an 800-m run in overnight-fasting runners. METHODS: A randomly counterbalanced, double-blind, crossover, placebo-controlled study was conducted with 12 healthy adult males with experience in amateur endurance running. Participants conducted two trials on two different occasions, one day with either CAF or DEC, with a one-week washout. After arriving at the data collection site, participants consumed the soluble CAF (5.5 mg/kg of caffeine) or DEC and after 60 min the run was started. Before and after the 800-m race, blood pressure and lactate and glucose concentrations were measured. At the end of the run, the ratings of perceived exertion (RPE) scale was applied. RESULTS: The runners were light consumers of habitual caffeine, with an average ingestion of 91.3 mg (range 6⁻420 mg/day). Time trial performances did not change between trials (DEF: 2.38 + 0.10 vs. CAF: 2.39 + 0.09 min, p = 0.336), nor did the RPE (DEC: 16.5 + 2.68 vs. CAF: 17.0 + 2.66, p = 0.326). No difference between the trials was observed for glucose and lactate concentrations, or for systolic and diastolic blood pressure levels. CONCLUSION: CAF consumption failed to enhance the time trial performance of an 800-m run in overnight-fasting runners, when compared with DEC ingestion. In addition, no change was found in RPE, blood pressure levels, or blood glucose and lactate concentrations between the two trials.