Adequação do consumo de ácidos graxos entre pacientes em prevenção cardiovascular secundária / Adequacy of Fatty Acids Consumption Among Individuals in Secondary Cardiovascular Prevention

FUNDAMENTO: A adesão à uma alimentação adequada em macronutrientes é fundamental para a prevenção secundária de doenças cardiovasculares. OBJETIVO: Avaliar a prevalência de adesão às recomendações de consumo de ácidos graxos para prevenção e tratamento de doenças cardiovasculares, e estimar se a presença de determinados fatores de risco cardiovascular estaria associada à adesão. MÉTODOS: Estudo transversal com os dados de linha de base de 2358 participantes do estudo "Brazilian Cardioprotective Nutritional Program Trial". Dados de consumo alimentar, e fatores de risco cardiovascular foram avaliados. Foi considerada, de acordo com a Sociedade Brasileira de Cardiologia, uma ingestão adequada de ácidos graxos poli-insaturados (AGPI) ≥10% do consumo total de energia diária, para ácidos graxos monoinsaturados (AGM), 20% e para ácidos graxos saturados (AGS), <7%. Na análise estatística foi considerando nível de significância de 5%. RESULTADOS: Nenhum participante aderiu a todas as recomendações de forma simultânea e mais da metade (1482 [62,9%]) não aderiu a nenhuma recomendação. A adesão exclusivamente à recomendação de AGS foi a mais prevalente, sendo cumprida por 659 (28%) dos participantes, seguida da adesão exclusivamente à recomendação de AGP (178 [7,6%]) e de AGM (5 [0,2%]). Não houve associação entre o número de comorbidades e a adesão às recomendações nutricionais (p =0,269). Os participantes da região Nordeste do país apresentaram maior proporção de adesão às recomendações para consumo de AGS (38,42%), e menor para ingestão de AGPI (3,52%) (p <0,001) em comparação às demais. CONCLUSÕES: Na amostra avaliada, evidenciou-se baixa adesão às recomendações nutricionais para consumo de ácidos graxos.

Factors associated with diet quality among Brazilian individuals with cardiovascular diseases

BACKGROUND: An individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors. METHODS: This is a cross-sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann-Whitney or Pearson's chi-squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal-Wallis was used. For the confounding analysis, a multinomial regression model was used. p < 0.05 was considered statistically significant. RESULTS: In total, 2360 individuals were evaluated: 58.5% male and 64.2% elderly. The median (interquartile range [IQR]) of the mAHEI was 24.0 (20.0-30.0), ranging from 0.4 to 56.0 points. When comparing the odds ratios (ORs) for the low (first tertile) and medium (second tertile) diet quality groups with the high-quality group (third tertile), it was observed that there was an association between diet quality with a family income of 1.885 (95% confidence intervals [CI] = 1.302-2.729) and 1.566 (95% CI = 1.097-2.235), as well as physical activity of 1.391 (95% CI = 1.107-1.749) and 1.346 (95% CI = 1.086-1.667), respectively. In addition, associations were observed between diet quality and region of residence. CONCLUSIONS: A low-quality diet was associated with family income, sedentarism and geographical area. These data are extremely relevant to assist in coping with cardiovascular disease because they enable an assessment of the distribution of these factors in different regions of the country.

Orange juice intake by obese and insulin-resistant subjects lowers specific plasma triglycerides: a randomized clinical trial

BACKGROUND & AIMS: Dyslipidaemia is usually common in obesity, insulin resistance, and type 2 diabetes mellitus. Clinical trials suggest that orange juice may have a positive impact on lipid metabolism and blood lipid profiles; however conflicting results have been reported. Here, we applied a combined untargeted/targeted lipidomic analysis of plasma to examine the impact of orange (Citrus sinensis) juice intake on the lipidome profile of obese and insulin-resistant subjects. METHODS: Twenty-five participants, both sexes, aged 40-60 years, with obesity and insulin resistance (homeostasis model assessment of insulin resistance (HOMA-IR) index >2.71) ingested 400 mL of orange juice 'Pera' (C. sinensis) for 15 d. Cardiometabolic biomarkers, anthropometric parameters, blood pressure, and plasma lipidomic analysis results were assessed at the beginning and end of the intervention. RESULTS: After the 15-d intervention, a significant decrease was observed in the diastolic blood pressure and blood lipid profile. Among plasma lipidomes, 316 lipid molecules were identified, with the triglycerides (TGs) subclass being the most abundant (n = 106). Plasma lipidome profiling revealed a major signature of the intervention; with concentrations of 37 TG species decreasing after intervention. Qualitatively, oleic and linoleic acids were among the most prevalent fatty acids linked to the altered TG species, representing 50% of TG chains. Modulated TG species were positively correlated with total TG and very low-density lipoprotein levels, as well as systolic and diastolic blood pressure. A strong inter-individual trend was observed, wherein, compared with less responsive subjects, the high responsive subjects displayed the highest decrease in the concentrations of altered TG species, as as well as systolic blood pressure (decrease of 10.3 ± 6.8 mmHg) and body weight (decrease of 0.67 ± 0.71 kg). CONCLUSIONS: These findings suggest that orange juice has a positive impact on lipid metabolism, mainly regarding the composition of TG-specific fatty acid chains and cholesterol esters, protecting against insulin resistance. Furthermore, lipidomics may help clarify alterations at the molecular level after an intervention, contributing to improve the evaluation of the link between dyslipidaemia, insulin resistance, and nutrition.

The effect of the a regional cardioprotective nutritional program on inflammatory biomarkers and metabolic risk factors in secondary prevention for cardiovascular disease, a randomised trial

BACKGROUND & AIMS: To evaluate the effect of the Brazilian Cardioprotective Diet Program (BALANCE Program) on inflammatory biomarkers, involved in the pathophysiology of the atherosclerosis, on inflammatory biomarkers, cardiovascular risk factors, and on plasma fatty acids in cardiovascular disease secondary prevention patients. METHODS: In this substudy of the BALANCE Program randomized clinical trial, a total of 369 patients aged 45 years or older, who have experienced cardiovascular disease in the previous 10 years, were included. These patients were randomized into two groups and followed up for six months: BALANCE Program group and control group (conventional nutrition advice). In the initial and six-month final visits, anthropometry (body weight, height and waist circumference), food intake evaluation by 24-h dietary recall, plasma inflammatory biomarkers (IL-6, IL-8, IL-10, IL-12, tumor necrosis factor-a, adiponectin, and C-reactive protein levels), blood pressure, glycemia, insulinemia, lipid profile, and plasma fatty acids levels were evaluated. RESULTS: The BALANCE Program group showed increased plasma alpha-linolenic acid levels (P » 0.008), reduction in waist circumference (P » 0.049) and BMI (P » 0.032). No difference was observed among plasma inflammatory biomarkers and clinical data. CONCLUSION: After six months of follow-up, BALANCE Program led to a significant reduction on BMI and waist circumference in individuals in secondary prevention for cardiovascular disease. Although plasmatic alpha-linolenic acid has increased, there was no impact on plasma inflammatory biomarkers. Clinical trial registration: NCT01620398.

Adesão ao tratamento de obesidade em um ambulatório de cardiologia do Estado de São Paulo / Adherence to obesity treatment in a cardiology clinic in the State of São Paulo

INTRODUÇÃO: Assim como as demais doenças crônicas, a obesidade, exige do paciente mudanças no estilo de vida para evitar sua progressão. A não adesão às recomendações mostra-se um problema para todos os profissionais de saúde, uma vez que para se obter sucesso no tratamento é importante que o paciente seja aderente às orientações. Considerando a escassez de estudos que avaliem a adesão aos tratamentos de obesidade, o presente trabalho buscou auxiliar no entendimento dessa temática. O OBJETIVO foi avaliar a adesão dos pacientes com obesidade ao tratamento nutricional proposto em um ambulatório de nutrição especializado em cardiologia. MÉTODOS: A amostra foi composta por 101 indivíduos, homens e mulheres, adultos e idosos de 25-84 anos, atendidos em ao menos quatro consultas na especialidade de obesidade e síndrome metabólica do ambulatório de nutrição. A adesão ao tratamento foi mensurada através de instrumento elaborado pela equipe do ambulatório de nutrição, contendo metas globais organizadas em: peso, circunferência abdominal (CA), atividade física, dieta, açúcar, sódio, gorduras saturadas/trans, fibras e proteínas. Análise Estatística: Trata-se de um estudo descritivo, observacional com a utilização de medidas de tendência central (média) e de variabilidade (desvio padrão). RESULTADOS: Considerando a média dos quatro atendimentos, a adesão às metas globais, em ordem decrescente foram: consumo de sódio (75%), gorduras saturadas/trans (65,64%), açúcar (60%), proteína (56%), dieta (49,01%), perda de peso (46,78%), fibras (43,66%), redução de CA (38,61%) e atividade física (22,44%) com menor percentual de adesão. A expectativa é de que a média de adesão total seja de no mínimo 60% para um bom resultado. A adesão total foi calculada somando-se as metas globais e dividindo pelo número de metas. A média de adesão total do primeiro ao quarto atendimento foram: 45,09%, 46,24%, 47,09% e 43,04%, respectivamente. CONCLUSÃO: O presente trabalho mostrou um baixo percentual de adesão ao modelo de acompanhamento proposto. As inúmeras variáveis relacionadas à adesão do tratamento demonstram que para a melhoria das medidas antropométricas e diminuição do risco cardiovascular é necessário um grande esforço dos nutricionistas e dos demais profissionais de saúde para a educação nutricional da população, enfatizando a importância do autocuidado e desta forma, reduzindo a progressão e/ou surgimento de doenças crônicas como a obesidade.

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)

Análise do consumo alimentar e do estado nutricional de indivíduos submetidos à cirurgia cardíaca eletiva em hospital público de referência em Cardiologia / Analysis of dietary intake and nutritional status of subjects submitted to elective cardiac surgery at a public reference hospital in Cardiology

INTRODUÇÃO: As doenças cardiovasculares representam a principal causa de morte no mundo. Seus fatores de risco são divididos em modificáveis e não-modificáveis. Diversos estudos clínicos vêm demonstrando a influência positiva da dieta na prevenção primária e secundária de eventos cardiovasculares. Dada a importância já documentada de uma dieta equilibrada, assim como do estado nutricional adequado na manutenção da saúde cardiovascular, este estudo objetivou avaliar a adequação da dieta habitual e do estado nutricional de pacientes submetidos a cirurgia cardíaca eletiva em hospital especializado em Cardiologia. MÉTODO: Estudo de caráter descritivo e transversal, com amostra de conveniência, composta por 38 indivíduos adultos, de ambos os sexos, encaminhados para cirurgia eletiva de revascularização do miocárdio, troca de válvula ou cirurgia combinada (revascularização do miocárdio e troca de válvula). A coleta de dados ocorreu no ambulatório de Nutrição do Instituto Dante Pazzanese de Cardiologia, anteriormente à cirurgia cardíaca, sendo realizada coleta de dados demográficos, tipo de cirurgia, antecedentes clínicos, consumo alimentar e avaliação nutricional. RESULTADOS: Na amostra avaliada, 68,42% dos pacientes estavam em sobrepeso e obesidade, segundo o índice de massa corporal. O percentual de gordura corporal apresentou valores acima da normalidade em 96,87% dos pacientes, com circunferência abdominal de risco elevado e muito elevado em 75,68%. Na avaliação habitual da dieta, a adequação no consumo de macronutrientes foi de 47,37%, 2,6% e 44,74% para carboidratos, proteínas e lipídeos respectivamente. Quanto aos ácidos graxos saturados, 36,84% dos pacientes apresentaram consumo superior ao recomendado. Foi observado baixo consumo de frutas, verduras e legumes por 89,48% dos pacientes e, consequentemente, de fibras dietéticas por 97,37%. CONCLUSÃO: Conclui-se que a amostra, composta por pacientes com excesso de peso, percentual de gordura elevado, alto risco cardiovascular e submetidos à cirurgia cardíaca eletiva, apresentou um padrão alimentar com baixo consumo de frutas, verduras, legumes e fibras dietéticas, necessitando de acompanhamento nutricional individualizado. (AU)

Association between plasma fatty acids and inflammatory markers in patients with and without insulin resistance and in secondary prevention of cardiovascular disease, a cross-sectional study

BACKGROUND: Proinflammatory biomarkers levels are increased among patients with cardiovascular disease, and it is known that both the presence of insulin resistance and diet may influence those levels. However, these associations are not well studied among patients with established cardiovascular disease. Our objective is to compare inflammatory biomarker levels among cardiovascular disease secondary prevention patients with and without insulin resistance, and to evaluate if there is any association between plasma fatty acid levels and inflammatory biomarker levels among them. METHODS: In this cross-sectional sub-study from the balance Program Trial, we collected data from 359 patients with established cardiovascular disease. Plasma fatty acids and inflammatory biomarkers (interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12, high sensitive C-reactive protein (hs-CRP), adiponectin, and tumor necrosis factor (TNF)-alpha) were measured. Biomarkers and plasma fatty acid levels of subjects across insulin resistant and not insulin resistant groups were compared, and general linear models were used to examine the association between plasma fatty acids and inflammatory biomarkers. RESULTS: Subjects with insulin resistance had a higher concentration of hs-CRP (p = 0.002) and IL-6 (p = 0.002) than subjects without insulin resistance. Among subjects without insulin resistance there was a positive association between stearic fatty acid and IL-6 (p = 0.032), and a negative association between alpha-linolenic fatty acid and pro-inflammatory biomarkers (p < 0.05). Among those with insulin resistance there was a positive association between monounsaturated fatty acids and arachidonic fatty acid and adiponectin (p < 0.05), and a negative association between monounsaturated and polyunsaturated fatty acids and pro-inflammatory biomarkers (p < 0.05), as well as a negative association between polyunsaturated fatty acids and adiponectin (p < 0.05). Our study has not found any association between hs-CRP and plasma fatty acids.

Association between polyunsaturated fatty acids and inflammatory markers in patients in secondary prevention of cardiovascular disease

OBJECTIVE: The aim of this study was to assess the association between polyunsaturated fatty acids (PUFAs) and inflammatory biomarkers among patients in secondary prevention of cardiovascular disease (CVD). METHODS: In this cross-sectional substudy from BALANCE Program Trial, we have collected data from 364 patients with established CVD. Twenty-four-hour dietary recalls and plasma FA concentrations were analyzed to estimate the FA intake. Inflammatory biomarkers measurement consisted of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12, C-reactive protein, adiponectin, and tumor necrosis factor-α. After log-transformation of inflammatory biomarkers, multivariate-adjusted general linear model was used to examine the effect of FA intake. The association was adjusted for body mass index, waist circumference, energy, smoking status, age, total cholesterol, low-density lipoprotein cholesterol, physical activity, and calcium channel blockers.RESULTS:PUFAs were inversely associated with C-reactive protein levels (P = 0.006) and with IL-1 β. The increase of 1 g/1000 kcal in PUFAs, omega-3, and omega-6 reduces, on average, 6%, 48%, and 8% respectively, the mean concentration of IL-1 β...

Unsaturated fatty acids improve atherosclerosis markers in obese and overweight non-diabetic elderly patients

BACKGROUND: Several studies have demonstrated the benefits of replacing trans and saturated fats with unsaturated fatty acids on cardiovascular diseases. We aimed to demonstrate the effect of polyunsaturated and monounsaturated fat supplementation on the biochemical and endothelial markers of atherosclerotic disease in obese or overweight non-diabetic elderly patients. METHOD: Seventy-nine patients were randomly divided into three groups: flaxseed oil, olive oil, and sunflower oil; patients in each group received 30 mL of oil for 90 days. Patients were subjected to anthropometric and bioimpedance assessments; biochemical and endothelial evaluations were performed through ultrasonography of the brachial artery and carotid artery for endothelium-dependent dilation and intima-media thickness assessment, respectively, before and after the intervention. The participants' usual diet remained unchanged...

Envelhecimento, sarcopenia e nutrição: uma abordagem teórico-prática / Aging, sarcopenia and nutrition: a theoretical-practical approach

Envelhecimento, sarcopenia e nutrição são áreas relacionadas à Saúde e que possuem uma grande integração clínica e científica no dia a dia de ambulatório e manuseio clínico hospitalar de pacientes em Nutrição e cuidados multidisciplinares.Os profissionais continuadamente estão recebendo um maior número de pacientes da terceira idade, identificando, inclusive, necessidades diversas dentro desse grupo. Necessidades de apoio nutricional, educação para atividade física e motivação para um estilo de vida saudável.O envelhecimento e as modificações de metabolismo, composição corporal, e a mudança dos hábitos nutricionais requerem atuações integrativas e extremamente focadas na prevenção da perda muscular, inexorável na vivência de quem atinge a terceira idade.Este livro busca, por meio de profissionais extremamente dedicados em atenção clínica e em inúmeros projetos de pesquisa, fornecer as melhores ferramentas de diagnóstico e tratamento.O conceito multiprofissional perde campo didático na medida em que neste livro estamos identificando a focalização nas características transdisciplinares da atenção à saúde e na prevenção das doenças.Na verdade, no formato inovador e adequado a uma realidade prática, o projeto editorial deve fazer parte de todo planejamento de serviços voltados à terceira idade e ser um marco nas definições estratégicas dos profissionais de saúde...

Síndrome metabólica em adultos: prevalência e concordância entre critérios diagnósticos / Metabolic syndrome in adults: prevalence and concordance between criteria diagnoses

Introdução: A síndrome metabólica (SM) é caracterizada poralterações fisiopatológicas que aumentam o risco de doenças cardiovasculares.Objetivo: Avaliar a frequência de síndrome metabólicaem adultos de acordo com critérios diagnósticos e analisar qualparâmetro a identificou melhor. Método: Estudo de 124 pacientesdo ambulatório de nutrição clínica de um Instituto de Cardiologia deSão Paulo. O diagnóstico de síndrome metabólica foi determinadode acordo com os critérios do National Cholesterol Education Program- Adult Treatment Panel III (NCEP/ATPIII) e da InternationalDiabetes Federation (IDF) para todos os pacientes. Utilizou-se testequi-quadrado para análise das diferenças entre as variáveis categóricas.A média das variáveis numéricas foi comparada por teste deMann Whitney para amostras independentes com nível de significânciade 0,05 ou 5%. Para testar a concordância entre os critérios,utilizou-se o coeficiente Kappa. Resultados: Participaram do estudo61 homens e 63 mulheres. O grupo apresentou percentuais elevadosde pré-obesidade (31,5%), obesidade (64,5%) e alterações do perfilglicídico (62,9%). Diferenças estatísticas significantes entre os sexosforam encontradas nas frequências de hipertensão arterial (p = 0,01)e circunferência elevada (p = 0,00). A concordância geral entre oscritérios foi muito boa (Kappa = 0,897; p = 0,000). Observou-seque 92,6% dos pacientes que foram diagnosticados com SM peloATPIII também o foram pela IDF. Conclusão: A concordância entreos critérios para diagnósticos da SM indicou que ambos podem serutilizados na prática clínica.

Introduction: Metabolic Syndrome (MS) is characterized by pathophysiologicalchanges that increase the risk of cardiovascular disease.Objective: To evaluate the frequency of metabolic syndrome inadults according to criteria diagnoses and analyze which parameterbest identified it. Method: The study of 124 patients from the ClinicalNutrition Institute of Cardiology in São Paulo. The diagnosis ofmetabolic syndrome was determined according to the criteria of theNational Cholesterol Education Program - Adult Treatment Panel III(NCEP/ATPIII) and International Diabetes Federation (IDF) for allpatients. The chi-square analysis of differences between categoricalvariables was used. The average numerical variables were comparedby Mann-Whitney test for independent samples with significancelevel of 0.05 or 5%. The Kappa coefficient was used to evaluate theconcordance between both criteria. Results: The study included 61men and 63 women. The group had high percentages of pre-obesity(31.5%), obesity (64.5%) and abnormal glucose profile (62.9%).Statistically significant differences between sexes were found inthe frequencies of hypertension (p = 0.01) and high circumference(p = 0.00). The overall agreement between the criteria was verygood (Kappa = 0.897, p = 0.000). It was observed that 92.6% ofpatients who were diagnosed with MS by ATPIII were also by IDF.Conclusion: The agreement between the criteria for diagnosis ofMS indicated that both can be used in clinical practice.

Risco da ingesta exagerada de sódio na utilização de espessante para disfagia / Risk of excessive sodium intake in the use of a thickener for dysphagia

A disfagia orofaríngea é um distúrbio de deglutição decorrente de causas neurológicas e/ou estruturais que pode ocasionar alteração da interação social, prazer alimentar do indivíduo, desnutrição, desidratação, quadros infecciosos pulmonares e outros de alta morbidade...