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1.
Ann Hepatol ; 28(1): 100769, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36216309

RESUMO

INTRODUCTION AND OBJECTIVES: Cardiovascular disease (CVD) is the major cause of death in non-alcoholic fatty liver disease (NAFLD), a clinical condition without any approved pharmacological therapy. Probiotics are often indicated for the disease, but their results are controversial in part due to the poor quality of studies. Thus, we investigated the impact of 24-week probiotics supplementation on cardiovascular risk (CVR) in biopsy-proven non-alcoholic steatohepatitis (NASH) patients. PATIENTS AND METHODS: Double-blind, placebo-controlled, single-center study (NCT03467282), adult NASH, randomized for 24 weeks daily sachets of probiotic mix (109CFU of Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus paracasei and Bifidobacterium lactis) or placebo. Clinical scores (atherogenic indexes, atherosclerotic cardiovascular disease-ASCVD and systematic coronary risk evaluation-SCORE), biochemistry, miR-122, miR-33a, plasminogen activator inhibitor-1 (PAI-1), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), were determined before and after the intervention. RESULTS: Forty-six patients were enrolled (23 received probiotics and 23 placebo), with a mean age of 51.7 years, most of them females and whites. Clinical and demographic features were similar between the groups at the baseline. The Median NAFLD activity score was 4.13 in both groups. Fibrosis was mild in most patients (15.2% and 65.2% F0 and F1, respectively). Treatment did not promote any clinically significant changes in body mass index or laboratory, including lipid and glucose profile. High CVR patients through atherogenic indexes decreased from baseline in both groups, as well as PAI-1 and miR-122 levels, although there was no difference between probiotics and placebo. CONCLUSIONS: A 24-week probiotic mix administration was not superior to placebo in reducing CVR markers in patients with NASH.


Assuntos
Doenças Cardiovasculares , MicroRNAs , Hepatopatia Gordurosa não Alcoólica , Probióticos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/terapia , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Inibidor 1 de Ativador de Plasminogênio/uso terapêutico , Biomarcadores/análise , Resultado do Tratamento , Fatores de Risco , Probióticos/uso terapêutico , Biópsia , Método Duplo-Cego
2.
J Hum Nutr Diet ; 36(1): 116-125, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-35822512

RESUMO

BACKGROUND: The mid-arm circumference (MAC) is an accessible, quick, and inexpensive measurement, which can be performed at the bedside only with a measuring tape. In this sense, the present study aims to suggest MAC cut-off values to assess the nutritional status and its association with mortality of hospitalised patients with decompensated cirrhosis. METHODS: A prospective cohort study was performed with decompensated cirrhotic patients. Nutritional status was assessed by MAC and Subjective Global Assessment (SGA). Considering the SGA as the reference standard and based on receiver operating characteristic curve analysis, the MAC cut-off values with the best sensitivity and specificity were selected. Predictors of mortality were identified using multivariate analysis. RESULTS: The study included 100 patients with a mean ± SD age of 60.1 ± 10.3 years. The median follow-up time was 11.2 months and overall mortality was 60%. Considering malnutrition assessed by SGA as the reference standard, the area under the curve of MAC for women and men was 0.947 (95% confidence interval [CI] = 0.878-1.000) and 0.813 (95% CI = 0.694-0.932). The MAC cut-off values of ≤ 28 cm for women and ≤ 30 cm for men reached a sensitivity and specificity of 85.5% and 71%, respectively. According to multivariate analysis, a low MAC was significantly associated with mortality (hazard ratio = 2.41; 95% CI = 1.20-4.84). CONCLUSIONS: The MAC cut-off values had satisfactory accuracy for men and women in predicting malnutrition. Additionally, a low MAC was an independent predictor of mortality. Thus, these MAC cut-off values can be used as the first step of nutritional assessment to prioritise patients who require more detailed assessment.


Assuntos
Desnutrição , Avaliação Nutricional , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Estudos Prospectivos , Estado Nutricional , Desnutrição/diagnóstico , Desnutrição/etiologia , Sensibilidade e Especificidade , Antropometria
3.
J Am Coll Nutr ; 39(2): 163-170, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31241423

RESUMO

Objective: Alcoholic liver disease (ALD) is among the leading causes of death from liver disease. Among the factors involved in its pathogenesis are inflammation and increased intestinal permeability. The aim of this study was to assess the effect of Lactobacillus rhamnosus GG (LGG) on hepatic lipid accumulation, activation of inflammasomes, and gut permeability markers in experimental model of ALD with zebrafish.Methods: An experiment was conducted to assess the effective LGG dose capable of promoting intestinal colonization. Animals were divided into three groups (n = 64/group): ethanol group (E), ethanol + probiotic group (EP), and control group (C). Groups E and EP were exposed to 0.5% ethanol concentration for 28 days. At the end of this period, animals were euthanized, and livers were collected for Oil Red staining and assessment of the inflammasome system. Intestines were collected for evaluation of gut permeability markers.Results: The dose of 1.55 × 106 UFC LGG/fish/d promoted intestinal colonization. Group EP presented lower hepatic lipid accumulation, lower il-1ß expression, and higher cldn15a expression when compared to group E.Conclusions: Supplementation with LGG was protective for hepatic steatosis in ALD model. In addition, LGG influenced the modulation of the inflammatory response and markers of gut permeability, improving the gut barrier structure.


Assuntos
Inflamassomos/fisiologia , Mucosa Intestinal/metabolismo , Lacticaseibacillus rhamnosus/fisiologia , Hepatopatias Alcoólicas/terapia , Probióticos/uso terapêutico , Peixe-Zebra , Animais , Modelos Animais de Doenças , Etanol/administração & dosagem , Fígado Gorduroso/terapia , Microbioma Gastrointestinal/fisiologia , Expressão Gênica/fisiologia , Inflamassomos/genética , Lacticaseibacillus rhamnosus/crescimento & desenvolvimento , Metabolismo dos Lipídeos/fisiologia , Fígado/metabolismo , Permeabilidade
4.
Clin Nutr ESPEN ; 61: 420-426, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38777464

RESUMO

BACKGROUND: Exclusion diets are common practices among individuals with Inflammatory Bowel Disease (IBD). Reports that certain foods trigger or worsen symptoms are recurrent but lack evidence. The aim of the study was to identify which foods were most frequently avoided by patients with Crohn's Disease (CD) and Ulcerative Colitis (UC) and whether the consumption of any food group was associated with disease activity. METHODS: Cross-sectional study with adult patients seen at an outpatient clinic in a tertiary public hospital. Dietary intake and eating habits were accessed through questionnaires administered via telephone interview. Disease activity and symptoms were assessed using the Harvey-Bradshaw Index (IHB) for CD and the Lichtiger Index (LI) for UC. Poisson regression with a robust variance estimator was used to estimate prevalence ratios. Analyzes were performed using SPSS - Statistical Package for the Social Sciences. RESULTS: The study included 145 patients. Of these, 69.7% avoided certain foods, with citrus fruits and raw vegetables among the most avoided (16.8% and 13.8%, respectively). Regular consumption of fruits (PR = 0.56; CI 95% 0.32-0.97; p = 0.042) and vegetables (PR = 0.56; CI 95% 0.32-0.98; p = 0.045) was associated with a 44% lower prevalence of the active phase of the disease, compared to those who do not consume these foods, adjusted for age, sex and type of disease. Other food items did not present significant associations in the adjusted model. CONCLUSIONS: Fruit and vegetable intake appears to have a protective role in the recurrence of IBD. Excluding foods is a common practice, even among patients in remission, and this should be combated as it can lead to nutritional losses. It is important to reinforce with patients the benefits of a varied and less restrictive diet.


Assuntos
Dieta , Comportamento Alimentar , Frutas , Doenças Inflamatórias Intestinais , Verduras , Humanos , Estudos Transversais , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Prevalência , Doenças Inflamatórias Intestinais/epidemiologia , Doença de Crohn/epidemiologia , Colite Ulcerativa/epidemiologia , Inquéritos e Questionários , Adulto Jovem
5.
Front Nutr ; 11: 1362694, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38600992

RESUMO

Background and aim: Considering the increasing prevalence of non-alcoholic steatohepatitis (NASH) and treatment gaps, this study aimed to evaluate the effect of probiotic supplementation on liver function markers, nutritional status, and clinical parameters. Methods: This double-blind, randomized clinical trial (ClinicalTrials.gov ID: NCT0346782) included adult outpatients with biopsy-proven NASH. The intervention consisted of 24 weeks of supplementation with the probiotic mix Lactobacillus acidophilus (1 × 109 CFU) + Lactobacillus rhamnosus (1 × 109 CFU) + Lactobacillus paracasei (1 × 109 CFU) + Bifidobacterium lactis (1 × 109 CFU), or placebo, twice a day. The following parameters were evaluated: demographic and clinical data, transient elastography (FibroScan), liver enzymes, NAFLD fibrosis score, fatty liver index, laboratory assessment, serum concentration of toll-like receptor-4 (sTLR-4) and cytokeratin 18 (CK-18), anthropometric data, dietary intake, and physical activity. Regarding data analysis, the comparison between the groups was based on the delta of the difference of each variable analyzed (value at the end of treatment minus the baseline value) using the t-test for independent samples or the Mann-Whitney U-test. Results: Forty-four patients with NASH completed the trial (51.4 ± 11.6 years). At baseline, 87% of participants had a mild liver fibrosis degree on biopsy, normal values of liver enzymes, transient elastography values consistent with grade 1 fibrosis in both groups, increased waist circumference (WC), a BMI of 30.97 kg/m2, and 76% presented with metabolic syndrome (MetS). After the intervention, no differences were observed between the probiotic and placebo groups in terms of MetS, WC, BMI scores, or liver enzyme levels (p > 0.05 for all). The elastography values remained consistent with grade 1 fibrosis in both groups. Although CK-18 was reduced in both groups, a larger effect size was noted in the probiotic group (D = 1.336). sTLR-4 was also reduced in both groups, with no difference between groups (p = 0.885). Conclusion: Intervention with probiotics in the early stages of NASH demonstrated no significant change in hepatic and clinical parameters. Clinical trial registration: ClinicalTrials.gov, identifier NCT0346782.

6.
Nutrition ; 125: 112471, 2024 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-38797043

RESUMO

OBJECTIVES: Muscle loss is one of the phenotypic criteria of malnutrition, is highly prevalent in patients with cirrhosis, and is associated with adverse outcomes. Mid-arm muscle circumference (MAMC) estimates the skeletal muscle mass and is especially helpful in cases of fluid overload. This study aimed to propose MAMC cutoff points for patients with cirrhosis and demonstrate its association with 1-year mortality. METHODS: This is an analysis of cohort databases from five reference centers in Brazil that included inpatients and outpatients with cirrhosis aged ≥18 y. The nutritional variables obtained were the MAMC (n = 1075) and the subjective global assessment (n = 629). We established the MAMC cutoff points stratified by sex based on the subjective global assessment as a reference standard for malnutrition diagnosis, considering the sensitivity, specificity, and Youden index. An adjusted Cox regression model was used to test the association of MAMC cutoff points and 1-year mortality. RESULTS: We included 1075 patients with cirrhosis, with a mean age of 54.8 ± 11.3 y; 70.4% (n = 757) male. Most patients had alcoholic cirrhosis (47.1%, n = 506) and were classified as Child-Pugh B (44.7%, n = 480). The MAMC cutoff points for moderate and severe depletion were ≤21.5 cm and ≤24.2 cm; ≤20.9 cm and ≤22.9 cm for women and men, respectively. According to these cutoff points, 13.8% (n = 148) and 35.1% (n = 377) of the patients had moderate or severe MAMC depletion, respectively. The 1-year mortality rate was 17.3% (n = 186). In the multivariate analysis adjusted for sex, age, MELD-Na, and Child-Pugh scores, a severe depletion in MAMC was an independent increased risk factor for 1-year mortality (HR: 1.71, 95% CI: 1.24-2.35, P < 0.001). Each increase of 1 cm in MAMC values was associated with an 11% reduction in 1-year mortality risk (HR: 0.89, 95% CI: 0.85-0.94, P < 0.001). CONCLUSIONS: Low MAMC classified according to the new cutoff points predicts mortality risk in patients with cirrhosis and could be used in clinical practice.

7.
Br J Nutr ; 110(9): 1601-10, 2013 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-23551992

RESUMO

A diet rich in fibre seems to protect against the metabolic syndrome (MetS), but there is scarce information about the role of fibre intake in patients with the MetS and diabetes. The aim of the present study was to evaluate the effects of soluble fibre from partially hydrolysed guar gum (PHGG) on the MetS and cardiovascular risk factors in patients with type 2 diabetes. In the present randomised controlled clinical trial, forty-four patients with type 2 diabetes (males 38·6 %, age 62 (SD 9) years, diabetes duration 14·2 (SD 9·6) years) and the MetS underwent clinical, laboratory and dietary evaluations at baseline, 4 and 6 weeks. All patients followed their usual diet and the intervention group (n 23) received an additional 10 g/d of PHGG. In the intervention group, waist circumference (WC), glycated Hb (HbA1c), 24 h urinary albumin excretion (UAE) and serum trans-fatty acids (FA) were reduced in comparison with baseline after 4 and 6 weeks: WC 103·5 (SD 9·5) to 102·1 (SD 10) to 102·3 (SD 9·7) cm; HbA1c 6·88 (SD 0·99) to 6·64 (SD 0·94) to 6·57 (SD 0·84) %; 24 h UAE 6·8 (interquartile range 3·0-17·5) to 4·5 (interquartile range 3·0-10·5) to 6·2 (interquartile range 3·0-9·5) mg; trans-FA 71 (interquartile range 46-137) to 67 (interquartile range 48-98) to 57 (interquartile range 30-110) mg/l (P< 0·05 for all). The only change in the control group was weight reduction: 77·0 (SD 13·5) to 76·2 (SD 13·3) to 76·1 (SD 13·4) kg (P= 0·005). Other MetS components (blood pressure, TAG, HDL-cholesterol, fasting plasma glucose), total and LDL-cholesterol, C-reactive protein and endothelin-1 did not change in either group. In patients with type 2 diabetes and the MetS, the addition of PHGG to the usual diet improved cardiovascular and metabolic profiles by reducing WC, HbA1c, UAE and trans-FA.


Assuntos
Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/dietoterapia , Fibras na Dieta/uso terapêutico , Suplementos Nutricionais , Galactanos/uso terapêutico , Mananas/uso terapêutico , Síndrome Metabólica/dietoterapia , Gomas Vegetais/uso terapêutico , Idoso , Albuminúria/tratamento farmacológico , Doenças Cardiovasculares/metabolismo , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/metabolismo , Fibras na Dieta/farmacologia , Feminino , Galactanos/farmacologia , Hemoglobinas Glicadas/metabolismo , Humanos , Masculino , Mananas/farmacologia , Síndrome Metabólica/tratamento farmacológico , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Gomas Vegetais/farmacologia , Ácidos Graxos trans/sangue , Circunferência da Cintura/efeitos dos fármacos
8.
Nutr Clin Pract ; 38(1): 187-198, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35118703

RESUMO

BACKGROUND: The aim of this study was whether the Food Intake Visual Scale (FIVS) can be used in clinical practice to measure food intake in patients with decompensated cirrhosis. METHODS: A cross-sectional study was performed with patients with cirrhosis between April 2017 and July 2019. The food intake was assessed through the 1-day diet record (DR) and according to FIVS, which consists of pictures of four plates of food at different levels of consumption: "about all," "half," "a quarter," or "nothing." The analysis of variance test with Bonferroni multiple comparison analysis was used to compare the mean energy intake through the DR according to the FIVS categories. RESULTS: This study included 94 patients with a mean age of 60.29 ± 9.33 years. Patients with lower food intake according to the FIVS categories also had lower mean energy and macronutrient intake according to the DR: patients eating "about all" (n = 49, 52.1%) consumed a mean of 1526.58 ± 428.27 kcal/day, patients eating "half" (n = 16, 17%) consumed a mean of 1282.08 ± 302.83 kcal/day, patients eating "a quarter" (n = 25, 26.6%) consumed a mean of 978.96 ± 468.81 kcal/day, and patients eating "nothing" (n = 4, 4.3%) consumed a mean of 353.59 ± 113.16 kcal/day (P < .001). CONCLUSION: The results of this study demonstrate that FIVS can be implemented in clinical practice to measure food intake in patients with decompensated cirrhosis as a substitute for the DR because it is a noninvasive, low-cost, quick, reliable, and easy bedside method for obtaining data.


Assuntos
Ingestão de Alimentos , Avaliação Nutricional , Humanos , Pessoa de Meia-Idade , Idoso , Estudos Transversais , Ingestão de Energia , Dieta
9.
Clin Nutr ESPEN ; 54: 34-40, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36963881

RESUMO

BACKGROUND & AIMS: Ascites impairs the correct diagnosis and nutritional management in patients with cirrhosis, because the body weight, which is needed for nutritional assessment and calculation of nutritional needs, is overestimated. To adjust the weight in patients with ascites, dietetic guidances indicate substracting 2.2-14 kg or 5-15% of the measured body weight according to the degree of ascites, however, there is a lack of evidence to substantiate these values. The aim of this study was to develop new prediction equations to estimate the dry weight, comparing them with the currently used weight adjustments in patients with refractory cirrhotic ascites. METHODS: Cross-sectional study, that included patients with decompensated cirrhosis undergoing large-volume paracentesis. Patients were submitted to nutritional risk screening, nutritional assessment, and anthropometric measurements that included body weight, abdominal circumference (both measured before and after paracentesis) height, and upper mid-arm circumference. The volume of ascitic fluid drained was also registered. For the predictions of dry weight, linear regression models were performed using as predictor variables: height, pre-paracentesis weight, pre-paracentesis abdominal circumference, or mid-upper arm circumference, and as response variable: post-paracentesis weight. The capacity of these models to predict the post-paracentesis weight was evaluated by comparing it with the currently used predictions through the intraclass correlation coefficient (ICC) and the mean squared error (MSE). RESULTS: Nineteen patients were included, 15 male, and 18 with high nutritional risk and malnutrition. The difference between post-paracentesis weight and pre-paracentesis weight was -5.0 (-3.6 to -9.9) kg, similar to ascitic fluid volume drained. Two equations were developed to predict post-paracentesis weight. ICC values showed that both prediction equations were strongly correlated (r > 0.94) with post-paracentesis weight. Our models also showed lower MSEs (<17.97), compared with the current predictions (MSEs <64.19, when the pre-paracentesis weight is adjusted from absolute values and MSEs <33.24 when adjusted from percentage values), indicating a more accurate prediction. CONCLUSION: The predictive equations from this study may be better options for dry weight estimation in patients with refractory cirrhotic ascites since they showed higher reliability compared to the currently used weight adjustment. External validation in a larger sample is still needed to confirm the clinical applicability of these equations.


Assuntos
Ascite , Paracentese , Humanos , Masculino , Ascite/etiologia , Paracentese/efeitos adversos , Estudos Transversais , Reprodutibilidade dos Testes , Peso Corporal , Cirrose Hepática/complicações
10.
Br J Nutr ; 108(1): 155-62, 2012 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-22142820

RESUMO

The role of each Dietary Approaches to Stop Hypertension (DASH) diet component in blood pressure (BP) of patients with diabetes is still uncertain. The aim of the present study was to evaluate possible associations of the recommended food groups of the DASH diet eating plan with BP values in patients with type 2 diabetes. In the present cross-sectional study, 225 patients with type 2 diabetes (age 61·1 (SD 10·4) years; diabetes duration 13·1 (SD 9·1) years; males 48·4 %; BMI 28·5 (SD 4·3) kg/m(2); HbA1c 7·1 (SD 1·3) %; systolic BP 136·7 (SD 20·0) mmHg; diastolic BP 78·4 (SD 11·8) mmHg) without dietary counselling during the previous 6 months had their dietary intake assessed by 3 d weighed-diet records. Patients were divided into two groups according to BP tertiles: LOW BP (first tertile) and HIGH BP (second plus third tertiles). Multivariate logistic regression models demonstrated that the daily intake of 80 g of fruits per 4184 kJ (1000 kcal) (OR 0·781; 95 % CI 0·617, 0·987; P = 0·039) or 50 g of vegetables per 4184 kJ (1000 kcal) (OR 0·781; 95 % CI 0·618, 0·988; P = 0·040) reduced the chance of the presence of HIGH mean BP (MBP ≥ 92 mmHg) by 22 % each, adjusted for possible confounders. In conclusion, fruit and vegetables were the food groups of the DASH diet associated with reduced BP values in patients with type 2 diabetes, and their consumption might play a protective role against increased BP values.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Alimentos/classificação , Hipertensão/dietoterapia , Hipertensão/prevenção & controle , Adulto , Idoso , Pressão Sanguínea , Estudos Transversais , Dieta , Comportamento Alimentar , Feminino , Frutas , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Fatores de Risco , Verduras
11.
Arq Gastroenterol ; 59(4): 522-530, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36515339

RESUMO

BACKGROUND: The intake of dietary supplements and medicinal plants is very popular worldwide. However, these products are not innocuous, and their intake can cause severe damage to health, especially liver injury. OBJECTIVE: This study aims to describe the clinical cases of dietary supplements-induced liver injury (DSILI) and herb-induced liver injury (HILI), identifying the main products involved and the clinical outcomes related to them. METHOD: A literature search was performed in PubMed, EMBASE, Google Scholar, and LILACS databases, using the search terms: "Chemical and Drug-Induced Liver Injury", "Dietary Supplements" and "Herbal" and their synonyms. RESULTS: 189 articles were included in the study, totaling 428 clinical cases of drug-induced liver injury. The most frequent agents of liver injury were Herbalife® products, associated with 50 cases, Polygonum multiflorum, with 25 cases, Hydroxycut® products, and green tea, both associated in 19 cases, and Oxyelite Pro® and kava tea, both associated with 16 cases. Most individuals required hospitalization (82.6%) and an important number of cases evolved to death (3.6%), liver transplantation (8.9%), or chronic liver disease (1.9%). CONCLUSION: The indiscriminate use of dietary supplements and herbal products was associated with an alarming number of cases of liver injury. The mechanisms through which each of the products causes liver damage still need to be better understood, but this review is a warning about the risk associated with the use of products considered harmless by a large part of the population.


Assuntos
Doença Hepática Crônica Induzida por Substâncias e Drogas , Doença Hepática Induzida por Substâncias e Drogas , Plantas Medicinais , Humanos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Suplementos Nutricionais/efeitos adversos
12.
Clin Nutr ; 40(6): 4275-4283, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33551215

RESUMO

BACKGROUND & AIMS: Non-Alcoholic Fatty Liver Disease (NAFLD) has been linked to fructose intake (FI). The aim of this study was to evaluate whether the dietary FI from different food sources (added/industrial processing and natural/intrinsic to food) is associated with NAFLD and risk of hepatic fibrosis (HF). METHODS: Cross-sectional study with 128 patients with NAFLD underwent clinical, functional, laboratory, nutritional and dietary intake by 3-day-diet-record evaluation. The proportions (in grams/milliliters) of foods and beverages in the diet for each subject was computed from the database NUTTAB and classified by their processing level according to the NOVA classification to identify the source of fructose. RESULTS: The mean age was 54.0 ± 11.9 years; 72.7% were women, and BMI 32.6 ± 5.4 kg/m2. Total fructose (TF) intake was 21.6 g, natural fructose (NF) 14.8 g and added fructose (AF) 6.8 g. TF, NF, and AF intakes not differ in patients with steatosis, steatohepatitis and cirrhosis (p-values 0.140; 0.101; 0.739, respectively), and not justify HF according NAFLD score, in view of the low correlation power found (r2 0.009; 0.040; 0.051) respectively for TF, NF and AF. Patients presented elevated cardiometabolic risk due to the prevalence of 78.0% intermediate/high risk of HF; 96.8% over waist-to-height ratio (WHtR), 79.7% of metabolic syndrome (MetS), 65.6% low hand grip strength (HGS), and 70.3% had sarcopenic obesity. CONCLUSIONS: Patients had low FI compared to the amounts presented in other occidental countries and studies. No association was found between FI and NAFLD or risk of HF.


Assuntos
Dieta/efeitos adversos , Ingestão de Alimentos/fisiologia , Frutose/efeitos adversos , Cirrose Hepática/etiologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Adulto , Idoso , Estudos Transversais , Dieta/métodos , Inquéritos sobre Dietas , Feminino , Humanos , Fígado/metabolismo , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/etiologia
13.
Dig Dis Sci ; 55(6): 1610-4, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19690957

RESUMO

BACKGROUND: Reflux symptoms are common in pregnancy, but their association with fat ingestion is unclear. AIM: To investigate an association of dietary fats with heartburn and regurgitation in pregnancy. METHODS: This is a prospective study in which 89 pregnant women (gestational age 34 +/- 4 weeks) attending a low-risk prenatal outpatient clinic were asked to provide information on the frequency they experienced heartburn and regurgitation. Fat ingestion was estimated by means of a 24-h diet record. Symptomatic patients were compared with those with no reflux symptoms (n = 20). RESULTS: Heartburn once a week or more often occurred in 56 of the 89 patients (63%). The ingested amount of polyunsaturated fatty acids was higher in patients with heartburn (11.2 +/- 6.4 vs. 7.7 +/- 3.5 mg; P = 0.022) than in controls after adjusting for age, gain weight during pregnancy, ingestion of caffeine and vitamin C, and total energetic intake. The ingestion of monounsaturated fatty acids was higher in patients with heartburn, but with a borderline statistical significance (16.1 +/- 11 vs. 11.8 +/- 6.5 mg; P = 0.061). No association was observed between the consumption of fats and regurgitation. CONCLUSIONS: This study suggests that heartburn in the third trimester of pregnancy is associated with the ingestion of polyunsaturated fatty acids.


Assuntos
Ácidos Graxos Insaturados/efeitos adversos , Refluxo Gastroesofágico/etiologia , Azia/etiologia , Complicações na Gravidez/etiologia , Adolescente , Adulto , Estudos de Casos e Controles , Registros de Dieta , Ácidos Graxos Insaturados/administração & dosagem , Feminino , Idade Gestacional , Humanos , Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Adulto Jovem
14.
Nutr Clin Pract ; 35(6): 1061-1069, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33058222

RESUMO

BACKGROUND: This study aimed to evaluate the nutrition status through phase angle (PA) and its association with mortality in patients with decompensated cirrhosis. METHODS: A prospective cohort study was performed with hospitalized decompensated cirrhotic patients. Nutrition status was assessed by PA, bioelectrical impedance vector analysis (BIVA), and Subjective Global Assessment (SGA) within 72 hours of hospital admission. The best PA cutoff point for malnutrition diagnosis was determined by ROC curve analysis, considering the SGA as the reference standard. Predictors of 6-month mortality were identified using Cox proportional hazards models, adjusted for Child-Pugh and MELD scores, and hepatocellular carcinoma. RESULTS: This study included 97 patients, 63% male (n = 61), with a mean age of 60.1 ± 10.3 years. The median follow-up time of patients was 11.2 months (IQR, 2.4-21). Overall mortality was 58.8% (n = 57) and 6-month mortality was 35.1% (n = 34). Nutrition assessment according to BIVA indicated a risk for cachexia and normal hydration. Patients with values of PA ≤5.52° were considered malnourished. Malnourished patients according to PA (58.8%, n = 57) had a higher risk of 6-month mortality (HR = 3.44; 95% CI, 1.51-7.84; P = .003), and each increase of 1° in PA values was associated with a reduction of 53% in 6-month mortality risk. CONCLUSIONS: The PA is an independent predictor of 6-month mortality in patients with decompensated cirrhosis. Therefore, PA may be useful to assess the nutrition status and identify patients at the highest risk of mortality in clinical practice.


Assuntos
Cirrose Hepática , Desnutrição , Avaliação Nutricional , Idoso , Impedância Elétrica , Feminino , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/mortalidade , Masculino , Desnutrição/complicações , Pessoa de Meia-Idade , Estado Nutricional , Estudos Prospectivos
15.
Nutr Rev ; 77(9): 601-613, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31188447

RESUMO

CONTEXT: Obesity has been linked to the intestinal microenvironment. Diet plays an important role in obesity and has been associated with microbiota. OBJECTIVE: This systematic review sought to evaluate the scientific evidence on the effect of dietary modification, including supplementation with prebiotics and probiotics, on microbiota diversity in obesity. DATA SOURCES: A systematic search was performed in the MEDLINE and EMBASE databases. Studies were considered eligible if they were clinical trials evaluating dietary intervention and microbiota, body weight, or clinical parameters in obesity. DATA EXTRACTION: Data were extracted by 2 independent reviewers. RESULTS: From 168 articles identified, 20 were included (n = 931 participants). Increased phyla abundance after food interventions was the main finding in relation to microbiota. Regarding the impact of interventions, increased insulin sensitivity, reduced levels of inflammatory markers, and reduced body mass index were shown in several studies. CONCLUSIONS: Interventions that modulate microbiota, especially prebiotics, show encouraging results in treating obesity, improving insulin levels, inflammatory markers, and body mass index. Because the studies included in this review were heterogeneous, it is difficult to achieve conclusive and definitive results.

16.
Trials ; 20(1): 580, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601229

RESUMO

BACKGROUND: Recently factors in the relationship between gut microbiota, obesity, diabetes and the metabolic syndrome have been suggested in the development and progression of nonalcoholic steatohepatitis (NASH). In this sense, this work aims to evaluate the effects of probiotic supplementation on intestinal microbiota modulation, degree of hepatic steatosis and fibrosis, inflammation, gut permeability, and body composition. METHODS: This double-blind, randomized clinical trial will include adult outpatients with a diagnosis of NASH confirmed by biopsy with or without transient elastography. All patients will undergo a complete anamnesis to investigate their alcohol consumption, previous history, medications, nutritional assessment (dietary intake and body composition), sarcopenia, physical activity level and physical and functional capacity, cardiovascular risk, biochemical parameters for assessment of inflammatory status, lipid profile, hepatic function, gut permeability, and assessment of microbiota. These procedures will be performed at baseline and repeated after 24 weeks (at the end of the study). Through the process of randomization, patients will be allocated to receive treatment A or treatment B. Both patients and researchers involved will be blinded (double-blind study). The intervention consists of treatment with a probiotic mix (Lactobacillus acidophillus + Bifidobacterium lactis + Lactobacillus rhamnosus + Lactobacillus paracasei, 1 x 109 CFU for each) and the placebo which is identical in all its characteristics and packaging. Patients will be instructed to consume two sachets/day during 24 weeks and to report any symptoms or side effects related to the use of the sachets. Adherence control will be carried out through the patient's notes on a form provided, and also by checking the number of sachets used. DISCUSSION: The final results of study will be analyzed and disseminated in 2020. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03467282 . Registered on 15 March 2018.


Assuntos
Bifidobacterium animalis/crescimento & desenvolvimento , Microbioma Gastrointestinal , Lactobacillus/crescimento & desenvolvimento , Hepatopatia Gordurosa não Alcoólica/terapia , Probióticos/uso terapêutico , Brasil , Método Duplo-Cego , Humanos , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/microbiologia , Probióticos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
17.
Clin Res Hepatol Gastroenterol ; 43(2): 140-147, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30301681

RESUMO

BACKGROUND: Cardiovascular disease is a major cause of death in post-liver transplantation (LT). The aim of this study was to evaluate LT patients as to the carotid intima-media thickness (CIMT) and its association with nutritional status, dietary intake, metabolic profile and cardiovascular risk factors. METHODS: In this cross-sectional study, adult patients with more than 12 months of post-transplant follow-up underwent clinical, laboratory, functional and nutritional evaluation by 3-day-diet-record, anthropometry and dynamometry. CIMT was evaluated by Doppler ultrasonography. RESULTS: Sixty-nine post-LT patients [males 61%, median of age 59 (51-64) years were included; median time post-liver transplantation 2.8 (1.4-6.3) years]. High prevalence of malnutrition was found (45% of arm muscle area < p15 and 71% of handgrip strength < p30). Excess weight was present in 72% of patients, body mass index ≥ 30 kg/m2 in 35% and metabolic syndrome in 51%. Abnormal CIMT was found in 54% of the sample. Patients with abnormal CIMT presented higher cardiovascular risk Score, LDL cholesterol, higher prevalence of high-sensitive C-reactive protein ≥ 1 mg/L and higher intake of saturated and trans fatty acids (P < 0.05 for all). CONCLUSIONS: Abnormal IMT was commonly found in LT patients presenting at the same time with overweight and dynapemia. These results were associated with higher LDL-cholesterol levels, high-sensitive C-reactive protein ≥ 1 mg/L and higher intake of saturated and trans fatty acids. Preventive measures, including dietary advice, are required for all post-liver transplantation patients to minimize cardiovascular risk.


Assuntos
Doenças Cardiovasculares/etiologia , Espessura Intima-Media Carotídea , Transplante de Fígado , Debilidade Muscular/etiologia , Complicações Pós-Operatórias/etiologia , Idoso , Índice de Massa Corporal , Proteína C-Reativa/análise , LDL-Colesterol/sangue , Estudos Transversais , Registros de Dieta , Ácidos Graxos/administração & dosagem , Feminino , Força da Mão , Humanos , Masculino , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/epidemiologia , Estado Nutricional , Obesidade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , Fatores de Tempo , Ácidos Graxos trans/administração & dosagem
18.
Nutr Hosp ; 35(1): 140-147, 2018 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-29565162

RESUMO

INTRODUCTION: Occidental diet and metabolic profile seems to increase hepatic fibrosis (HF) in patients with chronic hepatitis C virus (HCV) infection, but there is scarce information about the diet components and their role in this setting. OBJECTIVES: This study aims to evaluate the dietary intake, metabolic profile, presence of metabolic syndrome (MetS) and cardiovascular risk in patients with chronic HCV infection according to the presence of fibrosis. METHODS: Cross-sectional study which 58 patients with HCV infection without active antiviral therapy and non-cirrhotic were assessed. All patients were subjected to clinical, laboratorial and dietary evaluation, and classified according to the METAVIR score. Patients were divided as the presence of hepatic fibrosis. RESULTS: In this sample, fifty-five percent of patients were females, the average age was 51.6 ± 9.7 years, and 79.3% were carriers of HCV genotype 1. Patients with HF presented higher energy, and fat intake as well as higher glycemic load of meals in comparison to those without HF. Patients with HF presented higher systolic and diastolic arterial pressure and higher levels of insulin. CONCLUSIONS: In conclusion, patients with HF had higher total daily energy and total fat intakes, and worse metabolic profile, characterized by a higher insulin resistance and blood pressure.


Assuntos
Carga Glicêmica , Hepatite C/complicações , Cirrose Hepática/etiologia , Adulto , Estudos Transversais , Dieta , Gorduras na Dieta/efeitos adversos , Ingestão de Alimentos , Feminino , Humanos , Resistência à Insulina , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco
19.
Clin. biomed. res ; 43(1): 21-29, 2023.
Artigo em Português | LILACS | ID: biblio-1435602

RESUMO

Introdução: No Brasil, existem poucos estudos com recicladores de Unidades de Triagem de Resíduos (UTRs). Vários fenômenos sociais têm sido associados ao aumento da Insegurança Alimentar (IA) em países menos desenvolvidos. O estudo tem como objetivo descrever a prevalência de insegurança alimentar em recicladores.Métodos: Estudo transversal realizado com adultos associados de duas UTRs na cidade de Porto Alegre, sul do Brasil, entre 2017 a 2018. Todas as coletas ocorreram nas UTRs. Os indivíduos tiveram seu estado nutricional avaliado por medidas antropométricas através da aferição de peso, altura e circunferência da cintura. A taxa de Insegurança Alimentar foi avaliada pela Escala Brasileira de Insegurança Alimentar (EBIA) e o risco para uso de substâncias foi avaliado pelo Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).Resultados: Foram avaliados 123 sujeitos, com idade média de 35 ± 13,4 anos, sendo 66% do sexo feminino. Foi identificada uma taxa de IA de 74%, sendo que destes, 16% apresentaram Insegurança Alimentar Grave. Cerca de 57% dos participantes apresentaram sobrepeso ou obesidade e 48% circunferência da cintura aumentada. Em relação ao uso de substâncias, 60,5% relataram abuso de tabaco e 14% de álcool.Conclusão: São necessárias intervenções multidisciplinares para prevenir as situações encontradas e a implementação de políticas públicas voltadas para os atos de promoção da saúde na população de recicladores. É fundamental que tanto a sociedade, quanto o governo reconheçam a existência destes problemas para que medidas efetivas possam ser instituídas.


Introduction: In Brazil, there are few studies with recyclers of Waste Sorting Units (WSUs). Several social phenomena have been associated with increased food insecurity (FI) in less developed countries. The study aims to describe food insecurity prevalence in recyclers.Methods: Cross-sectional study conducted with adults from two WSUs in the city of Porto Alegre, southern Brazil, between 2017 and 2018. All data assessment occurred in WSUs. Anthropometric measurements were assessed by weight, height and waist circumference. Food insecurity was assessed with the Brazilian Food Insecurity Scale (EBIA) and substance use was evaluated by the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).Results: 123 subjects were evaluated, with a mean age of 35 ± 13.4 years, 66% of which were female. A FI rate of 74% was identified, and of these, 16% had Severe Food Insecurity. About 57% of participants were overweight or obese and 48% presented high waist circumference. Regarding substance use, 60.5% were classified for tobacco abuse and 14% for alcohol abuse.Conclusion: Multidisciplinary interventions are needed to prevent all health issues encountered as well as implementation of public policies for the recyclers' health promotion. It is essential that both society and the government recognize the existence of these problems so that measures can be carried out by health institutions.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Avaliação Nutricional , Populações Vulneráveis/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico
20.
Arq Bras Endocrinol Metabol ; 51(9): 1425-33, 2007 Dec.
Artigo em Português | MEDLINE | ID: mdl-18209884

RESUMO

The role of diet in metabolic syndrome (MS) has been studied regarding each one of its components: obesity, high blood pressure, dyslipidemia, and abnormal glucose metabolism. However, few studies evaluated the effects of diet in the presence of MS as a unique independent disease. The aim of this manuscript was to review the role of dietary factors and dietary recommendations for MS. Recently some studies demonstrated that intake of whole-grain foods were negatively associated with MS. Foods with high glycemic index were positively associated with insulin resistance and the prevalence of MS. Following a Mediterranean-style diet caused a reduction in the number of MS components. Also, the adoption of the DASH diet improved the profile of all MS components. A total daily energy intake to obtain and/or to maintain a desirable weight is recommended for patients with MS. The fat content, especially from saturated fat, and cholesterol must be reduced and the intake of whole-grain foods, fruits, and vegetables must be increased. Probably, dietary fibers have an important role in the management of MS. New studies to evaluate the role of diet in the presence and development of MS are needed.


Assuntos
Fibras na Dieta/administração & dosagem , Síndrome Metabólica/dietoterapia , Obesidade/complicações , Doenças Cardiovasculares/etiologia , Diabetes Mellitus/etiologia , Gorduras na Dieta/administração & dosagem , Grão Comestível/efeitos adversos , Humanos , Síndrome Metabólica/complicações , Síndrome Metabólica/prevenção & controle , Obesidade/dietoterapia , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto
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