Melatonin for sleep disorders in people with autism: Systematic review and meta-analysis.

Melatonin is a potential therapeutic intervention for improving sleep quality in people with autistic spectrum disorder (ASD). We investigate the effect of using melatonin as a sleep disorder treatment in people with ASD. Interventionist studies were searched in seven databases. A total of 595 references were identified, 15 of which were eligible for the systemic review and meta-analysis. Melatonin use presented a positive effect on total sleep time (standardized mean difference- SMD = 0.78; 95%CI = 0.35; 1.21; I2 = 91%), on sleep latency (SMD = 1.23; 95%CI = 0.35; 2.11; I2 = 94%), and on sleep efficiency (SMD = -0.70; 95%CI = -1.23; -0.16; I2 = 91%) when comparing the intervention group with the placebo/control group via the global analysis. According to the global analysis, the wake after sleep onset and night awakening parameters were not statistically significant. Melatonin has possible efficacy over total time, latency, and efficiency sleep parameters.

Effect of a gluten-free diet on bone mineral density in children and adolescents with celiac disease: Systematic review and meta-analysis.

Studies suggest an association between a gluten-free diet (GFD) and bone health in celiac disease (CD). However, the evidence on this relationship in children and adolescents is limited. Thus, this systematic review and meta-analysis aimed to analyze the effect of GFD on the bone health and anthropometric profile of children and adolescents with CD. Five databases were searched up to January, 2022 to identify relevant studies. The studies' methodological quality was evaluated using two scales. The Hedge's g standardized mean differences (SMD) with 95% confidence intervals were estimated using a random-effects model. The GRADE approach was used to assess the quality of evidence. Twenty-eight studies were included in the final review. GFD increased bone mineral content (BMC) (SMD = 0.39; 95%CI = 0.16, 0.62) and bone mineral density (BMD) (SMD = 0.29; 95%CI = 0.10, 0.47) in CD individuals. Difference in mean BMC and BMD between children and adolescents with CD versus healthy individuals was -0.49 (95%CI = -0.76, -0.22) and -0.47 (SMD = -95%CI = -0.72, -0.22), respectively. There was no difference in BMI and body fat among celiac children and adolescents versus healthy controls. In conclusion, GFD was associated with higher BMC and BMD in children and adolescents with CD.

Dietary patterns and cardiovascular risk factors among Brazilians: A population-based study in Viçosa, Minas Gerais.

OBJECTIVE: The aim of this study was to identify dietary patterns (DPs) and analyze their association with cardiovascular risk factors including metabolic biomarkers and markers of inflammation and oxidative stress in a cross-sectional population-based study with 959 Brazilian adults from Viçosa. METHODS: Food consumption was assessed by food frequency questionnaire, and DPs were identified by principal component analysis. A self-administered questionnaire was applied to assess sociodemographic and behavioral variables. RESULTS: Four distinct DPs were identified: Western, Snacks and Processed Food, Healthy, and Traditional Brazilian. Comparing the highest to the lowest tertile of each DP: Snacks and Processed Food DP was associated with a significantly higher diastolic blood pressure (ß = 2.81; 95% confidence interval [CI], 0.48-5.14), waist circumference (ß = 4.75; 95% CI, 2.77-6.73), body mass index (ß = 1.65; 95% CI, 0.63-2.67), neck circumference (ß = 0.74; 95% CI, 0.15-1.34), uric acid (ß = 0.32; 95% CI, 0.13-0.51), and C-reactive protein (ß = 0.31; 95% CI, 0.07-0.55). The Healthy DP was associated with lower Homeostatic Model Assessment of Insulin Resistance (HOMA-IR; ß = -0.17; 95% CI, -0.34 to -0.008), lower tumor necrosis factor-α (odds ratio [OR] = 0.46; 95% CI, 0.26-0.84), lower interleukin (IL)-8 (OR = 0.50; 95% CI, 0.28-0.91), and lower catalase (OR = 0.36; 95% CI, 0.16-0.78). The Traditional Brazilian DP was associated with lower high-density lipoprotein (HDL) cholesterol (ß = -5.04; 95% CI, -7.60 to -2.48), non-HDL cholesterol (ß: -10.25; 95% CI, -19.07 to -1.43), and superoxide dismutase (OR = 0.52; 95% CI, 0.32-0.87), and higher uric acid (ß = 0.24; 95% CI, 0.01-0.48), IL-12p70 (OR = 2.55; 95% CI, 1.23-5.32), IL-1ß (OR = 2.22; 95% CI, 1.01-4.89), IL-10 (OR = 2.03; 95% CI, 1.05-3.93), and ferric reducing ability of plasma (OR = 2.23; 95% CI, 1.16-4.27). CONCLUSIONS: The Snacks and Processed Food DP was associated with increases in several risk factors for cardiovascular disease, and the Healthy DP with lower HOMA-IR scores, tumor necrosis factor-α, IL-8, and catalase. A diet based on rice and beans (Traditional Brazilian) may have a protective role against non-HDL cholesterol while presenting other risks related to inflammation and oxidative stress, as shown by a direct association with the interleukins IL-12p70, IL-1ß, and IL-10 and an inverse association with superoxide dismutase.

Non-specific effect of omega-3 fatty acid supplementation on autistic spectrum disorder: systematic review and meta-analysis.

METHODS: We searched seven databases and found 13 eligible controlled trials that use omega-3 supplementation in children and adolescents with ASD.Data extraction: We collected details on study design, intervention time, supplement dosage, and the autism assessment scale. Meta-analyses and subgroup analysis were conducted according to the autism symptoms. RESULTS: Omega-3 and omega-6 supplementation improved ASD symptoms according to the Aberrant Behavior Checklist (standard mean difference - SMD = -0.13; CI 95% = -0.34, -0.02). However, using subgroup analysis, we observed no efficacy in terms of improvements in hyperactivity (SMD = -0.03; CI 95%: -0.43, 0.36), irritability (SMD = -0.18; CI 95%: -0.51, 0.15), stereotypy (SMD = -0.03; CI 95%: -0.43, 0.36), inappropriate speech (SMD = -0.68; CI 95%: -1.49, 0.14), lethargy (SMD = -0.22; CI 95%: -0.58, 0.14), and social function (SMD = -0.71; IC 95%: -1.56, 0.14). W-3 and w-6 supplementation also showed no efficacy according to the Social Responsiveness Scale (SMD = 0.08; CI 95%: -0.23, 0.39). The adverse effects were classified as mild and equally distributed between the placebo and intervention groups. CONCLUSIONS: Despite w-3 and w-6 supplementation showing minimal beneficial effects in the treatment of autism, the subgroup analyses indicated that there is a lack of evidence on the beneficial role of w-3 and w-6 in treating ASD.Systematic Review Registration: PROSPERO number CRD42020146116.

Food consumption according to degree of food processing, behavioral variables, and sociodemographic factors: Findings from a population-based study in Brazil.

OBJECTIVES: This study aimed to investigate the consumption levels of foods at different degrees of processing and their associations with sociodemographic and behavioral characteristics of Brazilian adults. METHODS: This is a cross-sectional, population-based study involving 976 adult individuals (ages 20 to 59 y) of both sexes, living in the municipality of Viçosa, Minas Gerais State, Brazil. Participants were selected using a probabilistic sampling technique. Consumed foods were categorized into four groups: unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultraprocessed foods. Associations were tested using linear regression. RESULTS: Unprocessed and minimally processed foods accounted for 61.3% of the total energy intake and were positively associated with age and negatively associated with level of education (ß = -6.86; 95% confidence interval [CI] [-10.16 to -3.57]) and sedentary behavior (ß = 3.24; 95% CI [-5.88 to -0.61]). Ultraprocessed foods accounted for 23.6% of the total energy intake, and consumption was negatively associated with age and positively associated with sedentary behavior (ß = 0.005; 95% CI [0.00008-0.01]) and tertiary education (ß = 5.42; 95% CI [2.71-8.13]). CONCLUSIONS: Ultraprocessed foods contribute more to the daily energy intake of younger individuals, and ultraprocessed food consumption is positively associated with sedentary activity and level of education.

Does the relationship between 25-hydroxyvitamin D status and bone mass vary according to skin color in adults? Results of a Brazilian population-based study.

Skin color has been indicated as an important factor in determining serum concentrations of 25-hydroxyvitamin D [25(OH)D], and consequently bone health. However, studies are controversial and scarce for mixed populations. PURPOSE/INTRODUCTION: To analyze the association of 25(OH)D with bone mineral content (BMC) and bone mineral density (BMD); and to investigate the presence of interaction with skin color in Brazilian adults. METHODS: This is a cross-sectional, population-based study conducted with adult individuals (20-59 years) of both genders. Bone health was assessed by dual energy radiological absortometry. Vitamin D status was measured using serum 25(OH)D. Skin color and other variables in the adjusted model were collected using a questionnaire and anthropometric assessment. Associations and interactions were evaluated using linear regression models stratified according to gender. RESULTS: Non-white men with vitamin D deficiency (< 20.0 ng/mL) have less bone mass than those with insufficiency and sufficiency for the femoral neck and hip sites. According to the adjusted regression analysis, the deficient status of 25(OH)D in men was associated with worse bone health for the lumbar spine sites (ß = - 0.1; p = 0.006), femoral neck (ß = - 0.08; p = 0.006), and hip (ß = - 0.08; p = 0.009). No statistically significant associations were observed between 25(OH)D and bone health in women. In addition, no statistical interaction was identified between skin color and vitamin D status in relation to bone health (p > 0.05 for all tests) in either gender and for all bone sites evaluated. CONCLUSION: Deficient vitamin D status is associated with lower bone mass in adults with differences observed according to gender, but not according to skin color.

Absolute and Relative Changes in Ultra-processed Food Consumption and Dietary Antioxidants in Severely Obese Adults 3 Months After Roux-en-Y Gastric Bypass.

INTRODUCTION: Patients that undergo Roux-en-Y gastric bypass (RYGB) experience a dramatic change in food consumption; however, it is unknown whether food consumption changes in relation to the level of food processing. OBJECTIVE: The aim of this work was to evaluate the relationship between ultra-processed food intake, dietary antioxidant capacity, and cardiometabolic risk factors in patients who underwent RYGB. METHODS: This study included 58 obese patients who underwent RYGB bariatric surgery. Data collection was done pre-operatively and at 3 months post-surgery. The foods consumed were documented using a 3-day 24-h dietary recall, and food intake was classified based on NOVA and dietary total antioxidant capacity (TAC). Anthropometric and biochemical data as well as information on body composition were also collected. Metabolic syndrome (MS) was classified in accordance with the International Diabetes Federation. RESULTS: Ultra-processed foods amounted to 27.2% and 19.7% of the total calories consumed during pre- and post-surgery periods, respectively. Regarding post-surgery, the caloric contribution of unprocessed or minimally processed foods increased, from 55.7 to 70.2% (p = 0.000). The TAC of foods consumed is inversely proportional to that of ultra-processed foods. Obvious changes were observed in all the anthropometric variables, lipid profile, glycemia, insulin resistance, and MS. CONCLUSION: Our results indicate that bariatric surgery is able to promote improvement in the diet quality of patients, reducing the consumption of ultra-processed foods and increasing the intake of unprocessed foods. The TAC of foods consumed is inversely proportional to that of ultra-processed ones.

Visceral adiposity index is a better predictor of unhealthy metabolic phenotype than traditional adiposity measures: results from a population-based study.

OBJECTIVE: The present study aimed to investigate whether the visceral adiposity index (VAI) is an effective predictor to identify unhealthy metabolic phenotype by comparing normal-weight and overweight individuals. DESIGN: A population-based cross-sectional study. Data were collected by interviews, anthropometric evaluation, dietetic, clinical and laboratory tests. The area under the receiver-operating characteristic curve (AUC) and prevalence ratio (PR), obtained from Poisson regression, were used to compare the predictive capacity of the obesity indicators evaluated (VAI, BMI, waist and neck circumference, waist-to-height and waist-to-hip ratios) and their association with the unhealthy metabolic phenotype. All analyses were stratified by sex and by nutritional status. SETTING: Viçosa, Minas Gerais, Brazil.ParticipantsA total of 854 Brazilian adults (20-59 years old) of both sexes. RESULTS: VAI was the best predictor for unhealthy metabolic phenotype among men (AUC = 0·865) and women (AUC = 0·843) at normal weight. VAI also had the best predictive capacity among overweight women (AUC = 0·903). Among overweight men, its accuracy (AUC = 0·830) was higher than that of waist-to-hip ratio. In the adjusted regression models, VAI was the indicator most strongly associated with the unhealthy metabolic phenotype, especially among those with normal weight (PR = 6·74; 95 % CI 3·15, 14·42 for men; PR = 7·14; 95 % CI 3·79, 13·44 for women). CONCLUSIONS: VAI has better predictive capacity in detecting unhealthy metabolic phenotype than conventional anthropometric indicators, regardless of nutritional status and sex.

Visceral adiposity index associated with behavioral and inflammatory parameters in adults: a population based study.

INTRODUCTION: the visceral adiposity index (VAI) is an indicator of fat distribution and function which is considered a predictor of cardiometabolic risk. OBJECTIVE: analyze the factors associated with VAI in Brazilian adults. METHODS: a cross-sectional population-based study was conducted with 854 adults, in Viçosa, MG, Brazil. A questionnaire was applied and anthropometric measurements, body composition and biochemical data were collected. Ordinal logistic regression was used to evaluate the factors associated with VAI. RESULTS: the increase in percentage of fat, uric acid concentration and ultra-sensitive C reactive protein in the blood was positively associated with VAI in males. The level of physical activity in leisure was negatively associated. Among women, the increase in age, neck circumference, sitting time of more than 300 minutes, increased serum uric acid concentration and ultra-sensitive C reactive protein were associated with VAI. CONCLUSION: except for age, all other factors associated with VAI are modifiable, suggesting that adopting early intervention measures that promote changes in habits and alter the risk of increased visceral adiposity and consequently the appearance of comorbidities should be encouraged.

HYPERTRIGLYCERIDEMIC WAIST PHENOTYPE AND CARDIOMETABOLIC ALTERATIONS IN BRAZILIAN ADULTS.

AIMS: the present study aims to evaluate the prevalence of cardiometabolic changes according to the hypertriglyceridemic waist (HW) phenotype in Brazilian adults. METHODS: it is a population based transversal study with 976 adults (n = 533 women) 20-59 years old. Phenotype was defined by triglycerides concentration (TGL) ≥ 150 mg/dl and waist circumference (WC) ≥80 cm in females and ≥ 90 cm in males. All the analyses were adjusted according to the study design and pondered by gender, age and schooling. A descriptive analysis was performed through averages and ratios; their respective confidence intervals were herein presented (CI 95%). The prevalence of cardiometabolic changes due to the presence of HW and to gender was calculated and compared by means of Pearson's chi-square test. Statistic significance level was 0.05. The probability of coronary event risk was estimated in 10 years and calculated from Framinghan score, using Kernel density graph. RESULTS: no difference in phenotype prevalence between genders was observed. Higher averages in all the cardiometabolic risk factors analyzed and higher probability of evolving to a cardiovascular event in 10 years were observed in individuals with the HW phenotype. Lower HDL values were only verified in this group. CONCLUSION: the HW phenotype is an important cardiovascular risk sign and allows the premature identification of individuals with higher risk, so that its use in clinical practice must be encouraged, mainly because it is a simple low cost asset.

Objetivos: evaluar la prevalencia de alteraciones cardiometabolicas segun el fenotipo cintura hipertrigliceridemica (CH) en adultos brasilenos. Métodos: estudio transversal, de base poblacional, con 976 (n = 533 mujeres) individuos de 20 a 59 anos. El CH fue definido por un aumento en las concentraciones de trigliceridos y en la circunferencia de la cintura (CC). Todos los analisis fueron ajustados por el efecto del diseno del estudio y ponderados por genero, edad y escolaridad. Fue realizado un análisis descriptivo de promedio y presentados sus respectivos intervalos de confianza (IC 95%). La prevalencia de las alteraciones cardiometabolicas segun la presencia o no del fenotipo CH y segun el sexo fue calculada y comparada a traves del test chi-cuadrado de Pearson. El nivel de significancia estadistica adoptado fue de 0,05. Se estimo la probabilidad de riesgo de evento coronario en 10 anos, a partir del score de Framinghan a traves del grafico de densidad de Kernel. Resultados: la prevalencia del fenotipo CH en la muestra fue de 17,32% (IC 95% 13,54-21,89), no se observo diferencia entre sexos. Se observaron mayores promedios para todos los factores de riesgo cardiometabolico analizados en aquellos con CH. Solo Se verificaron menores valores medianos para el HDL en este grupo. Los individuos con CH presentaban mayor probabilidad de evolucionar hacia un evento cardiovascular en 10 anos que aquellos sin el fenotipo. Conclusión: el fenotipo CH constituye un importante marcador precoz del riesgo cardiovascular. Su utilizacion en la practica clinica debe ser incentivada, ya que se trata de una herramienta sencilla y de bajo coste.