Iron incorporation in red blood cells of pediatric sickle cell anemia: a stable isotope pilot investigation.

BACKGROUND/OBJECTIVES: Sickle cell anemia (SCA) is marked by hypoxia, inflammation, and secondary iron overload (IO), which potentially modulate hepcidin, the pivotal hormone governing iron homeostasis. The aim was to evaluate the iron incorporation in red blood cells (RBC) in SCA pediatric patients, considering the presence or absence of IO. SUBJECTS/METHODS: SCA children (n = 12; SCAtotal) ingested an oral stable iron isotope (57Fe) and iron incorporation in RBC was measured after 14 days. Patients with ≥1000 ng/mL serum ferritin were considered to present IO (SCAio+; n = 4) while the others were classified as being without IO (SCAio-; n = 8). Liver iron concentration (LIC) was determined by Magnetic Resonance Imaging (MRI) T2* method. RESULTS: The SCAio+ group had lower iron incorporation (mean ± SD: 0.166 ± 0.04 mg; 3.33 ± 0.757%) than SCAio- patients (0.746 ± 0.303 mg; 14.9 ± 6.05%) (p = 0.024). Hepcidin was not different between groups. Iron incorporation was inversely associated with serum ferritin level (SCAtotal group: r = -0.775, p = 0.041; SCAio- group: r = -0.982; p = 0.018) and sickle hemoglobin (HbS) presented positive correlation with iron incorporation (r = 0.991; p = 0.009) in SCAio- group. LIC was positively associated with ferritin (SCAtotal: r = 0.921; p = 0.026) and C reactive protein (SCAio+: r = 0.999; p = 0.020). CONCLUSION: SCAio+ group had lower iron incorporation in RBC than SCAio- group, suggesting that they may not need to reduce their intake of iron-rich food, as usually recommended. Conversely, a high percentage of HbS may indirectly exacerbate hypoxia and seems to increase iron incorporation in RBC. TRIAL REGISTRATION: This trial was registered at www.ensaiosclinicos.gov.br . Identifier RBR-4b7v8pt.

Iron absorption in adults with sickle cell anemia: a stable-isotope approach.

PURPOSE: Iron absorption in sickle cell anemia (SCA) remains unclear and studies in adults with SCA are scarce. The aim of this study was to evaluate the iron absorption SCA adults and its association with iron status and hepcidin concentration. METHODS: SCA patients (n = 13; SCAtotal) and control participants (n = 10) ingested an oral stable iron isotope (57Fe). Iron absorption was measured by inductively coupled plasma mass spectrometry (ICP-MS) 14 days after isotope administration. Patients with ≥ 1000 ng/mL serum ferritin were considered to present iron overload (IO) (SCAio+; n = 3) and others classified without IO (SCAio-; n = 10). RESULTS: Iron absorption in the control group ranged from 0.3 to 26.5% (median = 0.9%), while it varied from 0.3 to 5.4% in SCAio+ (median = 0.5%) and from 0.3 to 64.2% in the SCAio- (median = 6.9%). Hepcidin median values were 14.1 ng/mL (3.0-31.9 ng/mL) in SCAio-, 6.2 ng/mL (3.3-7.8 ng/mL) in SCAio + and 6.2 ng/mL (0.6-9.3 ng/mL) in control. Iron absorption was associated with ferritin level (r = - 0.641; p = 0.018) and liver iron concentration (LIC; r = - 0.786; p = 0.036) in the SCAtotal group. CONCLUSION: Our data suggest that SCAio- individuals may be at risk of developing primary IO. Simultaneously, secondary IO may induce physiological adaptation, resulting in reduced iron absorption. Further studies evaluating intestinal iron absorption using larger sample sizes should be conducted to help establish a safe nutrition approach to be adopted and to ensure the security of food-fortifying public policies for these patients. TRIAL REGISTRATION: This trial was registered at www.ensaiosclinicos.gov.br (Identifier RBR-4b7v8pt).

Factors associated with variability in skeletal muscle radiodensity in patients with metastatic cancer.

OBJECTIVES: This study aimed to explore factors associated with skeletal muscle radiodensity (SMD) variability in patients with metastatic cancer. METHODS: This study included 393 patients (median age 61 y, 70% women) who had computed tomography (CT) scans within 30 days of inclusion in the study. SMD was evaluated from CT by averaging the Hounsfield unit value of the total muscle area. Skeletal muscle index (SMI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and total adipose tissue index (TATI) were also assessed by CT. Additionally, age, sex, race/skin color, disease characteristics, comorbidities, inflammatory markers, handgrip strength (HGS), and body mass index (BMI) were recorded and evaluated in the linear regression analysis to identify factors associated with SMD variability. RESULTS: Multivariate explanatory models having SMD as an independent variable were performed and included BMI (model 1, r2 = 0.699), TATI (model 2, r2 = 0.712) or VATI and SATI (model 3, r2 = 0.706) in addition to age, race/skin color, tumor site, kidney disease, serum albumin, HGS, and SMI as dependent variables. For all models, lower SMD was associated with higher age, BMI, and adiposity measurements, kidney disease, White race/skin color, and lower serum albumin, HGS, and SMI. The primary tumor site also contributed to changes in SMD in all models, specifically those located in the gastrointestinal tract, gynecologic, and bone and connective tissue. CONCLUSION: In this group of patients with metastatic cancer, lower SMD was associated with older age, White race/skin color, and an overall worse clinical condition.

Human colostrum in vitro protein digestion: peptidomics by liquid chromatography-Orbitrap-high-resolution MS and prospection for bioactive peptides via bioinformatics.

Breast milk is known to contain bioactive peptides that are released during digestion, being a major source of bioactive peptides to the new-born, some of which act against invading pathogens. However, the formation of bioactive peptides during digestion of human colostrum remains largely uninvestigated. This study aimed to investigate the formation of peptides during simulated digestion of human colostrum from adult women and to prospect antimicrobial peptides. For this purpose, we used high-resolution MS to monitor the release of peptides during in vitro digestion. Bioinformatics was used for the prospection of antimicrobial activity of peptides. During simulated digestion (oral, gastric and duodenal phases), 2318 peptide sequences derived from 112 precursor proteins were identified. At the end of simulated digestion, casein-derived peptide sequences were the most frequently observed. Among precursors, some proteins were seen for the first time in this study. The resulting peptides were rich in proline, glutamine, valine and leucine residues, providing characteristic traits of antimicrobial peptides. From bioinformatics analysis, seven peptides showed potentially high antimicrobial activity towards bacteria, viruses and fungi, from which the latter was the most prominent predicted activity. Antimicrobial peptides released during digestion may provide a defence platform with controlled release for the new-born.

The association between low skeletal muscle mass and low skeletal muscle radiodensity with functional impairment, systemic inflammation, and reduced survival in patients with incurable cancer.

BACKGROUND AND AIMS: Factors associated with the concomitant occurrence of low muscle mass and low muscle radiodensity are unclear. This study investigated whether different skeletal muscle phenotypes are associated with functional impairment, serum inflammatory markers, and survival in patients with incurable cancer. METHODS: Three hundred and twenty-six patients (median age, 60 years; 67.5% female) who had abdominal or pelvic computed tomography (CT) scans up to 30 days before the initial assessment were enrolled in the study. CT images were used for the assessment of skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD). Optimal stratification analysis was used to derive cohort-specific cutoff points to define SMI and SMD groups with a higher risk for mortality (SMI, males <45.0 cm2 /m2 and females <44.0 cm2 /m2 ; SMD, males <34 Hounsfield units [HU] and females <30 HU). Based on these cutoffs, participants were classified into four phenotypes: low-risk SMI + low-risk SMD, high-risk SMI + low-risk SMD, low-risk SMI + high-risk SMD, and high-risk SMI + high-risk SMD. RESULTS: Phenotypes with high-risk SMI or high-risk SMD, especially when combined, were associated with low handgrip strength, poor performance status, higher C-reactive protein, and lower serum albumin levels. The phenotypes with high-risk SMD, regardless of low-risk SMI (hazard ratio [HR], 1.74; 95% CI, 1.05-2.88) or high-risk SMI (HR, 1.99; 95% CI, 1.29-3.05) were associated with higher 90 days' mortality risk. CONCLUSION: In patients with incurable cancer, phenotype groups with high-risk SMI and high-risk SMD, particularly when combined, were associated with worse functional impairment and inflammation. Moreover, high-risk SMD was associated with increased mortality risk.

Factors associated with anemia and vitamin A deficiency in Brazilian children under 5 years old: Brazilian National Survey on Child Nutrition (ENANI-2019) / Fatores associados à anemia e deficiência de vitamina A em crianças brasileiras menores de cinco anos: Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) / Factores asociados con la anemia y la deficiencia de vitamina A en niños brasileños menores de cinco años: Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019)

Abstract: Factors associated with anemia and vitamin A deficiency were investigated in 7,716 children 6-59 months of age studied in the Brazilian National Survey on Child Nutrition (ENANI-2019). We adopted a hierarchical approach based on a United Nations Children's Fund (UNICEF) theoretical model with three levels, stratifying by age (6-23; 24-59 months). Prevalence ratio (PR) and 95% confidence interval (95%CI) were estimated. Enabling determinants: a higher prevalence of anemia was observed in children 6-23 months whose mothers had ≤ 7 years of schooling (PR = 1.92; 95%CI: 1.10; 3.34), < 20 years old (PR = 2.47; 95%CI: 1.34; 4.56) or 20-30 years old (PR = 1.95; 95%CI: 1.11; 3.44), mixed-race (PR = 1.57; 95%CI: 1.06; 2.23); and in children 24-59 months in the North Region (PR = 3.11; 95%CI: 1.58; 6.13). A higher prevalence for vitamin A deficiency was observed in children 6-23 months from Central-West (PR = 2.32; 95%CI: 1.33; 4.05), and in children 24-59 months living in the North (PR = 1.96; 95%CI: 1.16; 3.30), South (PR = 3.07; 95%CI: 1.89; 5.01), and Central-West (PR = 1.91; 95%CI: 1.12; 3.25) and whose mothers were 20-34 years (PR = 1.62; 95%CI: 1.11; 2.35). Underlying determinants: the presence of more than one child < 5 years old in the household was associated with a higher prevalence of anemia (PR = 1.61; 95%CI: 1.15; 2.25) and vitamin A deficiency (PR = 1.82; 95%CI: 1.09; 3.05) in children 6-23 months. Immediate determinants: consumption of 1-2 groups of ultra-processed foods in children 24-59 months (PR = 0.44; 95%CI: 0.25; 0.81) and lack of breastfeeding in the day before in children 6-23 months (PR = 0.56; 95%CI: 0.36; 0.95) were associated with lower prevalence of anemia and vitamin A deficiency. Public policies focused on geographically and socially vulnerable groups are needed to promote equity.

Resumo: Fatores associados a anemia e deficiência de vitamina A foram investigados em 7.716 crianças de 6-59 meses de idade parte da Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019). Adotamos uma abordagem hierárquica baseada em um modelo teórico do Fundo das Nações Unidas para a Infância (UNICEF) com três níveis estratificados por idade (6-23; 24-59 meses). Foram estimadas razões de prevalência (RP) e intervalos de 95% de confiança (IC95%). Determinantes habilitadores: observamos maior prevalência de anemia em crianças de 6-23 meses de idade cujas mães tinham ≤ 7 anos de escolaridade (RP = 1,92; IC95%: 1,10; 3,34), < 20 anos de idade (RP = 2,47; IC95%: 1,34; 4,56) ou 20-30 anos de idade (RP = 1,95; IC95%: 1,11; 3,44), cor parda (RP = 1,57; IC95%: 1,06; 2,23); e em crianças de 24-59 meses de idade na Região Norte (RP = 3,11; IC95%: 1,58; 6,13). Encontramos maior prevalência de deficiência de vitamina A em crianças de 6-23 meses de idade no Centro-oeste (RP = 2,32; IC95%: 1,33; 4,05) e em crianças de 24-59 meses de idade residentes nas regiões Norte (RP = 1,96; IC95%: 1,16; 3,30), Sul (RP = 3,07; IC95%: 1,89; 5,01) e Centro-oeste (RP = 1,91; IC95%: 1,12; 3,25) cujas mães tinham entre 20-34 anos de idade (RP = 1,62; IC95%: 1,11; 2,35). Determinantes subjacentes: a presença de mais de uma criança < 5 anos de idade no domicílio se associou a maior prevalência de anemia (RP = 1,61; IC95%: 1,15; 2,25) e deficiência de vitamina A (RP = 1,82; IC95%: 1,09; 3,05) em crianças de 6-23 meses de idade. Determinantes imediatos: o consumo de 1-2 grupos de alimentos ultraprocessados em crianças de 24-59 meses de idade (RP = 0,44; IC95%: 0,25; 0,81) e o não aleitamento materno no dia anterior em crianças de 6-23 meses de idade (RP = 0,56; IC95%: 0,36; 0,95) foram associados com a menor prevalência de anemia e deficiência de vitamina A. Políticas públicas focadas em grupos geográfica e socialmente vulneráveis são necessárias para promover equidade.

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Genetic, sociodemographic and lifestyle factors associated with serum 25-hydroxyvitamin D concentrations in Brazilian adults: the Pró-Saúde Study / Fatores genéticos, sociodemográficos e de estilo de vida nas concentrações séricas de 25-hidroxivitamina D em adultos brasileiros: o Estudo Pró-Saúde / Factores genéticos, sociodemográficos y estilo de vida asociados con la concentración sérica 25-hidroxivitamina D en adultos brasileños: Estudio Pro-Salud

This study aims to investigate factors associated with serum 25-hydroxyvitamin D [25(OH)D] concentration in Brazilian adults considering sociodemographic and lifestyle factors, as well as vitamin D-related single nucleotide polymorphisms (SNPs). This is a cross-sectional study (n = 491; 34-79y; 251 women), nested within a prospective cohort (Pró-Saúde Study). Associations between serum 25(OH)D and sociodemographic characteristics, diet, use of supplement, physical activity, season of blood collection, body fat, skin type, sun exposure index, and SNPs CYP2R1-rs10741657 and GC-rs2282679 were explored by multiple linear regression. The prevalence of serum 25(OH)D < 50nmol/L was 55%. Serum 25(OH)D was lower among women (β = -4.38; 95%CI: -8.02; -0.74), those with higher visceral fat (β = -4.02; 95%CI: -5.92; -2.12), and those with AC and CC genotypes for GC-rs2282679 (β = -6.84; 95%CI: -10.09; -3.59; β = -10.63; 95%CI: -17.52; -3.74, respectively). Factors directly associated with serum 25(OH)D included summer (β = 20.14; 95%CI: 14.38; 25.90), intermediate skin type (β = 6.16; 95%CI: 2.52; 9.80), higher sun exposure (β = 0.49; 95%CI: 0.22; 0.75), vitamin D intake (β = 0.48; 95%CI: 0.03; 0.93), and physical activity (β = 4.65; 95%CI: 1.54; 7.76). Besides physical activity, diet, and sun exposure, non-modifiable factors, such as GC genotypes must be considered when evaluating vitamin D insufficiency in mixed-race populations. Moreover, high visceral fat in association with poorer vitamin D status deserve attention given that both conditions are unfavorably related with chronic and acute health outcomes.

Este estudo teve como objetivo investigar fatores associados com as concentrações séricas de 25-hidroxivitamina [25(OH)D] em adultos brasileiros de acordo com fatores sociodemográficos e de estilo de vida, assim como de polimorfismos de nucleotídeo único (SNPs) relacionados à vitamina D. Este é um estudo transversal (n = 491; 34-79 anos; 251 mulheres) aninhado em uma coorte prospectiva (Estudo Pró-Saúde). Associações entre a 25(OH)D sérica e características sociodemográficas, consumo alimentar, uso de suplementos, atividade física, estação do ano na coleta da amostra de sangue, gordura corporal, fototipo de pele, índice de exposição solar e SNPs CYP2R1-rs10741657 e GC-rs2282679, explorados por regressão multilinear. A prevalência de 25(OH)D sérica < 50nmol/L foi 55%. A concentração sérica de 25(OH)D foi menor entre mulheres (β = -4,38; IC95%: -8,02; -0,74), indivíduos com mais gordura visceral (β = -4,02; IC95%: -5,92; -2,12) e genótipos AC e CC para GC-rs2282679 (β = -6,84; IC95%: -10,09; -3,59 e β = -10,63; IC95%: -17,52; -3,74, respectivamente). Os fatores associados diretamente à 25(OH)D sérica incluíram os meses de verão (β = 20,14; IC95%: 14,38; 25,90), fototipo intermediário (β = 6,16; IC95%: 2,52; 9,80), maior exposição solar (β = 0,49; IC95%: 0,22; 0,75), ingestão de vitamina D (β = 0,48; IC95%: 0,03; 0,93) e atividade física (β = 4,65; IC95%: 1,54; 7,76). Além de atividade física, dieta e exposição solar, fatores não modificáveis, tais como variantes do gene GC devem ser considerados na avaliação da deficiência de vitamina D em populações miscigenadas. Além disso, merece atenção a associação entre a gordura visceral elevada e o pior estado de vitamina D, uma vez que ambas as condições implicam em desfechos de saúde desfavoráveis, tanto crônicos quanto agudos.

Nuestro objetivo fue investigar factores asociados con la concentración sérica 25-hidroxivitamina D [25(OH)D] en adultos brasileños, considerando factores sociodemográficos y de vida, así como también los polimorfismos de nucleótido único relacionados con la vitamina D (SNPs). Se trata de un estudio transversal (n = 491; 34-79 años; 251 mujeres), anidado dentro de una cohorte prospectiva (Estudio Pro-Salud). Se investigaron las asociaciones entre concentración sérica 25(OH)D y características sociodemográficas, ingesta alimentaria, uso de suplementos, actividad física, estación del año de recogida de muestras de sangre, grasa corporal, tipo de piel, índice de exposición al sol, y SNPs CYP2R1-rs10741657 y GC-rs2282679 mediante una regresión múltiple lineal. La prevalencia sérica 25(OH)D < 50nmol/L fue 55%. La 25(OH)D sérica fue menor entre las mujeres (β = -4,38; IC95%: -8,02; -0,74), quienes tenían alta grasa visceral (β = -4,02; IC95%: -5,92; -2,12), genotipos AC y CC para GC-rs2282679 (β = -6,84; IC95%: -10,09; -3,59 y β = -10,63; IC95%: -17,52; -3,74, respectivamente). Los factores directamente asociados con la concentración sérica 25(OH)D incluyeron verano (β = 20,14; IC95%: 14,38; 25,90), tipo de piel intermedia (β = 6,16; IC95%: 2,52; 9,80), más alta exposición al sol (β = 0,49; IC95%: 0,22; 0,75), toma de vitamina D (β = 0,48; IC95%: 0,03; 0,93) y actividad física (β = 4,65; IC95%: 1,54; 7,76). Además de la actividad física, dieta y exposición al sol, los factores no modificables, tales como genotipos GC, necesitan tenerse en cuenta cuando se está evaluando la insuficiencia de vitamina D en poblaciones mestizas. Asimismo, las implicaciones de la asociación de una alta grasa visceral con un estatus más pobre de vitamina D merece que se le preste atención, puesto que ambas condiciones de salud están relacionadas desfavorablemente con resultados de salud graves y crónicos.

Diabetes and hypertension are associated with lowered cognitive performance among middle-aged Brazilian adults: cross-sectional analyses nested in the longitudinal Pró-Saúde study.

BACKGROUND: Cardiovascular risk factors are frequently associated with lowered cognitive performance among elderly people, but rarely among middle-aged adults. OBJECTIVES: To investigate associations between cardiovascular risk factors (age, physical inactivity, smoking, alcohol use, hypertension and diabetes) and lower cognitive performance among middle-aged (45-64 years) Brazilian adults. DESIGN AND SETTING: Cross-sectional study nested within the Pró-Saúde cohort. From 2,876 baseline study participants (1999), we randomly selected 488 participants and gave them validated and standardized cognitive tests (2012). METHODS: We used multiple linear and logistic regression analyses to detect associations of cardiovascular risk factors with crude scores in cognitive tests on memory (word test) and executive function (verbal fluency tests), and with overall cognitive performance scores, respectively. RESULTS: All cognitive test scores presented statistically significant inverse associations with age and direct associations with education. There was no association between lower cognitive performance and smoking or alcohol use. In both 1999 and 2012, after adjusting for sex, age and schooling, being physically active was inversely associated with lower performance regarding late memory. For individuals with diabetes in 1999, there was an association with lower performance regarding executive function, while there was a borderline association for those reporting it only in 2012. Having a diagnosis of hypertension since 1999 was associated with lower performance regarding both memory and executive functions, while reporting hypertension in 2012 was associated with lower performance regarding executive function. CONCLUSIONS: Aging, low schooling and cardiovascular risk factors may represent life course disadvantages associated with cognitive decline even among middle-aged Brazilian adults.

Diabetes and hypertension are associated with lowered cognitive performance among middle-aged Brazilian adults: cross-sectional analyses nested in the longitudinal Pró-Saúde study

ABSTRACT BACKGROUND: Cardiovascular risk factors are frequently associated with lowered cognitive performance among elderly people, but rarely among middle-aged adults. OBJECTIVES: To investigate associations between cardiovascular risk factors (age, physical inactivity, smoking, alcohol use, hypertension and diabetes) and lower cognitive performance among middle-aged (45-64 years) Brazilian adults. DESIGN AND SETTING: Cross-sectional study nested within the Pró-Saúde cohort. From 2,876 baseline study participants (1999), we randomly selected 488 participants and gave them validated and standardized cognitive tests (2012). METHODS: We used multiple linear and logistic regression analyses to detect associations of cardiovascular risk factors with crude scores in cognitive tests on memory (word test) and executive function (verbal fluency tests), and with overall cognitive performance scores, respectively. RESULTS: All cognitive test scores presented statistically significant inverse associations with age and direct associations with education. There was no association between lower cognitive performance and smoking or alcohol use. In both 1999 and 2012, after adjusting for sex, age and schooling, being physically active was inversely associated with lower performance regarding late memory. For individuals with diabetes in 1999, there was an association with lower performance regarding executive function, while there was a borderline association for those reporting it only in 2012. Having a diagnosis of hypertension since 1999 was associated with lower performance regarding both memory and executive functions, while reporting hypertension in 2012 was associated with lower performance regarding executive function. CONCLUSIONS: Aging, low schooling and cardiovascular risk factors may represent life course disadvantages associated with cognitive decline even among middle-aged Brazilian adults.

Prevalência de anemia e deficiência de vitamina A e consumo de ferro e de vitamina A entre crianças usuárias do Sistema Único de Saúde na cidade do Rio de Janeiro, Brasil / Prevalence of anemia and vitamin A deficiency and iron and vitamin A intake in children that use the Brazilian Unified National Health System in Rio de Janeiro, Brazil / Prevalencia de anemia, deficiencia de vitamina A, y consumo de hierro y de vitamina A entre niños pacientes del Sistema Único de Salud en la ciudad de Río de Janeiro, Brasil

Estratégias nacionais para o controle de anemia e deficiência de vitamina A em crianças estão baseadas em estimativas de suas prevalências produzidas em âmbito nacional em 2006 com métodos não validados para este grupo etário e com nível de desagregação para macrorregiões. Com o intuito de subsidiar a gestão local para o (re)direcionamento de medidas de controle desses agravos, o presente trabalho apresenta estimativas de sua prevalência e, também, de marcadores de consumo alimentar de fontes de micronutrientes e do uso de suplementos de vitaminas e minerais em amostra probabilística de crianças de 6 a 59 meses, usuárias da atenção básica de saúde do Município do Rio de Janeiro, Brasil (n = 536). Foram coletadas amostras de sangue venoso para análise de hemoglobina, ferritina e retinol sérico e dados sobre o consumo alimentar, o uso de suplementos de vitaminas e minerais e as características sociodemográficas. As prevalências de anemia, anemia ferropriva e deficiência de vitamina A foram de, respectivamente, 13,7%, 5,5% e 13%. Quase todas as crianças haviam consumido alimentos ricos em ferro no dia anterior à entrevista, sendo altas as prevalências de consumo de fontes de origem animal. Somente 49,4% haviam consumido alimentos ricos em vitamina A. As prevalências de uso de algum suplemento, de suplemento com ferro e com vitamina A foram de, respectivamente, 51%, 14,7% e 24,4%. Os resultados apontam a necessidade de redirecionamento das estratégias de prevenção e controle de anemia e deficiência de vitamina A. Estudos futuros são necessários para examinar a evolução desses indicadores, tendo em vista as políticas de austeridade que entraram em vigor nos últimos anos e a crise econômica decorrente da pandemia da COVID-19.

Brazilian national strategies for the control of anemia and vitamin A deficiency in children are based on estimates of their nationwide prevalence rates in 2006 with methods not validated for this age group and with disaggregation at the level of major geographic regions. To back local administrations in (re)directing control measures for these two disorders, the current study presents estimates of their prevalence and markers of dietary intake of sources of micronutrients and use of vitamin and mineral supplements in a probabilistic sample of children 6 to 59 months of age, users of primary healthcare in the city of Rio de Janeiro, Brazil (n = 536). Venous blood samples were drawn for analysis of hemoglobin, ferritin, and serum retinol, besides collection of data on food consumption, use of vitamin and mineral supplements, and sociodemographic characteristics. Prevalence rates for anemia, iron deficiency anemia, and vitamin A deficiency were 13.7%, 5.5%, and 13%, respectively. Nearly all the children had consumed iron-rich food the day before the interview, with high prevalence of animal sources. Only 49.4% had consumed foods high in vitamin A. The prevalence rates for use of any supplement, iron supplements, and vitamin A supplements were 51%, 14.7%, and 24.4%, respectively. The findings point to the need to redirect the strategies for prevention and control of anemia and vitamin A deficiency. Future studies are necessary to examine trends in these indicators, focusing on austerity policies implemented in recent years and the economic crisis resulting from the COVID-19 pandemic.

Las estrategias brasileñas para el control de anemia y deficiencia de vitamina A en niños están basadas en estimaciones de sus prevalencias, producidas en el ámbito nacional en 2006 con métodos no validados para este grupo etario, y con un nivel de desagregación en las macrorregiones. Con el fin de apoyar la gestión local para la (re)orientación de medidas de control de esos problemas de salud, este trabajo presenta estimaciones de su prevalencia y, también, de los marcadores de consumo alimentario de fuentes de micronutrientes y del uso de suplementos de vitaminas y minerales, en una muestra probabilística de niños de 6 a 59 meses, pacientes de atención básica de salud del Municipio de Río de Janeiro, Brasil (n = 536). Se recogieron muestras de sangre venosa para el análisis de hemoglobina, ferritina y retinol sérico, así como datos sobre el consumo alimentario, de suplementos de vitaminas y minerales, así como de características sociodemográficas. Las prevalencias de anemia, anemia ferropénica y deficiencia de vitamina A fueron de, respectivamente, 13,7%, 5,5% y 13%. Casi todos los niños habían consumido alimentos ricos en hierro el día anterior a la entrevista, siendo altas las prevalencias de consumo de fuentes de origen animal. Solamente un 49,4% habían consumido alimentos ricos en vitamina A. Las prevalencias de consumo de algún suplemento, de suplemento con hierro y de suplemento con vitamina A fueron de, respectivamente, 51%, 14,7% y 24,4%. Los resultados apuntan la necesidad de reorientar las estrategias de prevención y control de la anemia y deficiencia de vitamina A. Se necesitan estudios futuros para examinar la evolución de esos indicadores, teniendo en vista las políticas de austeridad que entraron en vigor en los últimos años y la crisis económica a consecuencia de la pandemia de COVID-19.

Methodological aspects of the micronutrient assessment in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey / Aspectos metodológicos da avaliação de micronutrientes no Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019): inquérito domiciliar de base populacional / Aspectos metodológicos de la evaluación de micronutrientes en el Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019): encuesta domiciliaria de base poblacional

This article aims to present methodological aspects on the collection, analyses, coverage, challenges, and the lessons learned from laboratory assessment of micronutrients on the Brazilian National Survey on Child Nutrition (ENANI-2019). This is a household survey on a probability sample of children under five years of age from 123 Brazilian municipalities in all 26 states and the Federal District. Blood samples were drawn by venipuncture at the homes of children 6 to 59 months of age. This procedure was performed by experienced phlebotomists from the laboratories located in the selected municipalities and scheduled in advance. Blood and serum levels were measured for biomarkers of nutritional status, using the services of a clinical test laboratory with nationwide coverage, for the following micronutrients: iron (hemoglobin and ferritin), zinc, selenium, folic acid, and vitamins A, B1, B6, B12, D, and E. C-reactive protein was analyzed as a marker of inflammation. A barcode identifier was used to track the blood samples and to link the biochemical test results to the other data collected in the survey. A total of 14,558 children were studied. Of the 12,598 eligible children, 8,829 (70.1%) had blood samples drawn. Of the total number of children who had samples drawn, 91.8% (n = 8,025) have results for at least nine of the 12 analyses performed. Coverage of the analysis varied from 95% (for vitamins A and E) to 84.2% (for folic acid). Aliquots of whole blood and serum were stored in a biorepository for future analyses. The results of this pioneering study in the country will back the formulation and, when necessary, the reorientation of public policies in food and nutrition.

O objetivo deste artigo é apresentar os aspectos metodológicos referentes à coleta e análise de dados laboratoriais do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019), a cobertura das análises laboratoriais, os desafios enfrentados e as lições aprendidas. Trata-se de um inquérito populacional de base domiciliar de crianças menores de cinco anos realizado em 123 municípios dos 26 estados da Federação e o Distrito Federal. A coleta de sangue por punção venosa foi realizada em domicílio em crianças com idade entre 6 e 59 meses, por coletador experiente de laboratório(s) existente(s) nos municípios amostrados. Foram determinadas as concentrações sanguíneas e séricas de biomarcadores do estado nutricional utilizando os serviços de um laboratório de análises clínicas com abrangência nacional para os seguintes micronutrientes: ferro (hemoglobina e ferritina), zinco, selênio, ácido fólico, vitaminas A, B1, B6, B12, D e E. A proteína C reativa foi analisada como marcador de inflamação. Um código de barras identificador das amostras de sangue foi utilizado para o rastreio da amostra e para a junção dos resultados dos exames bioquímicos com os demais dados coletados na pesquisa. Foram estudadas 14.558 crianças. Das 12.598 elegíveis, 8.829 (70,1%) realizaram coleta de sangue. Do total de crianças que realizaram coleta de sangue, 91,8% (n = 8.025) têm resultados para pelo menos nove das 12 análises realizadas. A cobertura por análise variou de 95% (para vitaminas A e E) a 84,2% (para ácido fólico). Os resultados deste estudo pioneiro subsidiarão a formulação e, quando for o caso, o redirecionamento de políticas públicas de alimentação e nutrição.

El objetivo de este artículo es presentar aspectos metodológicos, respecto a la recogida y análisis de datos de laboratorio del Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019), así como la cobertura de los mismos, los desafíos enfrentados y lecciones aprendidas. Se trata de una encuesta poblacional de base domiciliaria con niños menores de cinco años, realizada en 123 municipios de los 26 estados de la Federación y el Distrito Federal. La recogida de sangre por punción venosa se realizó en domicilios con niños, de edades comprendidas entre los 6 y los 59 meses, con la intervención de un flebotomista con experiencia en laboratorio(s) existente(s) en los municipios de muestra. Se determinaron las concentraciones sanguíneas y séricas de biomarcadores del estado nutricional, utilizando los servicios de un laboratorio de análisis clínicos con alcance nacional para los siguientes micronutrientes: hierro (hemoglobina y ferritina), zinc, selenio, ácido fólico, vitaminas A, B1, B6, B12, D y E. La proteína C reactiva se analizó como marcador de inflamación. Un código de barras identificador de las muestras de sangre se utilizó para el rastreo de la muestra y para la conjunción de los resultados de los exámenes bioquímicos con los demás datos recogidos en la investigación. Se estudiaron 14.558 niños. De los 12.598 elegibles, a 8.829 (70,1%) se les sacó sangre. Del total de niños, a quienes se les tomó muestras de sangre, un 91,8% (n = 8.025) obtuvieron resultados para por lo menos nueve de los 12 análisis realizados. La cobertura por análisis varió de un 95% (para vitaminas A y E), a un 84,2% (para ácido fólico). Los resultados de este estudio pionero apoyarán la formulación y, cuando fuera necesario, la redirección de políticas públicas de alimentación y nutrición.

Protective factors in mature human milk: a look into the proteome and peptidome of adolescent mothers' breast milk.

The characterisation of proteome and peptidome of adolescent mothers' breast milk brings important information to both mother's and infant's health; however, it has not been investigated. Bioactive peptides derived from milk proteins have numerous functions. The bioactivity of breast milk peptides includes anti-inflammatory and antimicrobial activities and regulation of gastrointestinal function. We aimed to characterise the proteome and peptidome of mature breast milk of adolescent mothers and investigate whether it is affected by lactational period. We used a combination of electrophoretic and nano-scale LC-quadrupole time-of-flight MS/MS (nLC-Q-TOF-MS/MS) techniques and bioinformatics to explore the proteome of human skimmed milk expressed by lactating adolescents in two groups according to postpartum period (up to 3 and over 5 weeks postpartum). This is the first study that analysed the proteome of adolescent mothers' breast milk produced during two periods of lactation using 1D-electrophoresis combined with nLC-Q-TOF-MS/MS analysis. Our results showed that the protein composition of adolescent milk varies independently of lactation stage and showed high inter-individual variation. A total of 424 proteins were identified in skimmed milk, of which 137 proteins were common to both groups. Most of the peptides found in adolescents' breast milk were not derived from major proteins in milk. Association maps showed several interactions between groups of peptides that pointed to the relevance of breast milk peptides to neonatal defensive system.

Smoking status affects bioimpedance-derived phase angle in men but not in women: The Pró-Saúde Study, Brazil.

OBJECTIVE: Phase angle (PhA) is determined by bioelectrical impedance (BIA) and it is interpreted as an index of cell membrane integrity. Smokers are susceptible to systemic oxidative stress and often adopt unhealthy habits, which may contribute to cellular damage. This unfavorable conjuncture may result in lower PhA in smokers. The aim of this study was to investigate the association between PhA and smoking status. METHODS: This cross-sectional study included 247 (48%) adult men. Body composition and PhA were determined using dual-energy x-ray absorptiometry and BIA, respectively. Blood sampling, food habits, and smoking status information were collected. Statistical analyses were performed for each sex separately. Analysis of covariance controlling for body mass index and age compared PhA values across smoking categories. Multiple linear regression determined whether smoking status was a PhA predictor. RESULTS: PhA was lower in male current smokers (6.6 ± 0.13°) compared with never-smokers (7 ± 0.06°; P = 0.038). The ratio of extracellular to intracellular water was higher in current (P = 0.003) and former male smokers (P = 0.006) compared with never-smokers. Body composition did not differ in male and female smoking categories. Male current smokers ingested more calories, protein, carbohydrates, and alcohol than never and former smokers (P < 0.05). Current female smokers had higher alcohol consumption compared with never smokers (P = 0.019). Male current smokers presented lower than never-smokers (unstandardized ß coefficient = -0.202; 95% confidence interval, -0.359 to -0.046). Smoking status was associated with PhA decrease only in men. CONCLUSION: The results from the present study suggest that being a current smoker results in lower PhA in men, even when controlling for other variables.

Consumo alimentar segundo o grau de processamento e características sociodemográficas: Estudo Pró-Saúde / Food consumption according to degree of processing and sociodemographic characteristics: Estudo Pró-Saúde, Brazil

RESUMO: Objetivo: Investigar o consumo alimentar segundo o grau de processamento e associações com características sociodemográficas. Métodos: Estudo transversal de subamostra do Estudo Pró-Saúde, com 520 funcionários públicos de campi universitários, Rio de Janeiro, 2012-13. Questionário de frequência alimentar foi utilizado para classificar o consumo alimentar: 1) in natura, minimamente processados, preparações culinárias à base desses alimentos; 2) alimentos processados; 3) alimentos ultraprocessados. Determinou-se a contribuição energética relativa de cada grupo, e foi utilizado modelo de regressão seemingly unrelated equations regression (SUR) para estimar associações com as características sociodemográficas. Resultados: O grupo de alimentos in natura (1) contribuiu com 59% do consumo energético e foi diretamente associado à idade [45-49 anos (β = 1,8 intervalo de confiança de 95% - IC95% -1,2; 4,8); 50-54 (β = 1,5 IC95% -1,5; 4,5); 55-59 (β = 2,9 IC95% -0,4; 6,3) e ≥ 60 (β = 4,6 IC95% 1,1; 8,2)], comparado à idade ≤ 44. Em contraste, ultraprocessados contribuíram com 27% e foram inversamente associados à idade [45-49 (β = -1,7 IC95% -4,3; 0,9); 50-54 (β = -1,8 IC95% -4,3; 0,9); 55-59 (β = -4,9 IC95% -8,0; -2,0); ≥ 60 (β = -4,5 IC95% -7,6; -1,5)]. Sexo, renda e escolaridade não foram associados ao consumo alimentar. Conclusão: Adultos mais jovens apresentaram maior consumo de ultraprocessados, indicando a necessidade de intervenções principalmente nessa faixa etária. A ausência de associação com demais características sociodemográficas pode ser por conta da influência de fatores contextuais.

ABSTRACT: Objective: To investigate the food consumption according to the degree of processing and associations with sociodemographic characteristics. Methods: A cross-sectional study of the Estudo Pró-Saúde (Pro-Health Study), with 520 civil servants of university campuses, Rio de Janeiro, 2012-13. A food frequency questionnaire was used to classify food consumption: 1) in natura, minimally processed, food preparations based on these foods; 2) processed foods; 3) ultra-processed foods. The relative energy contribution of each group was determined, and a seemingly unrelated equations regression (SUR) regression model was used to estimate associations with sociodemographic characteristics. Results: The in natura food group (1) contributed with 59% of the energy consumption and was directly associated with age [45-49 years (β = 1.8 confidence interval of 95% - 95%CI -1.2; 4.8); 50-54 (β = 1.5 95%CI -1.5; 4.5); 55-59 (β = 2.9 95%CI -0.4; 6.3) and ≥ 60 (β = 4.6 95%CI 1.1; 8.2)], compared to age ≤ 44. In contrast, the group of ultra-processed foods contributed 27% and were inversely associated with age [45-49 (β = -1.7 95%CI -4.3; 0.9); 50-54 (β = -1.8 95%CI -4.3; 0.9); 55-59 (β = -4.9 95%CI -8.0; -2.0); ≥ 60 (β = -4.5 95%CI -7.6; -1.5)]. Gender, income and schooling were not associated with food consumption. Conclusion: Younger adults had higher consumption of ultra-processed foods, indicating the need for interventions mainly in this age group. The absence of association with other sociodemographic characteristics may be due to the influence of contextual factors.

Physical activity benefits bone density and bone-related hormones in adult men with cervical spinal cord injury.

Severe bone loss is a recognized complication of chronic spinal cord injury (SCI). Physical exercise contributes to bone health; however, its influence on bone mass of cervical SCI individuals has not been investigated. The aim of this study was to investigate the influence of physical activity on bone mass, bone metabolism, and vitamin D status in quadriplegics. Total, lumbar spine (L1-L4), femur and radius bone mineral density (BMD) were assessed in active (n = 15) and sedentary (n = 10) quadriplegic men by dual energy X-ray absorptiometry. Concentrations of 25-hydroxyvitamin D [25(OH)D], PTH, IGF1, osteocalcin and NTx were measured in serum. After adjustments for duration of injury, total body mass, and habitual calcium intake, bone indices were similar between groups, except for L1-L4 BMD Z score that was higher in the sedentary group (P < 0.05). Hours of physical exercise per week correlated positively with 25(OH)D (r = 0.59; P < 0.05) and negatively with PTH (r = -0.50; P < 0.05). Femur BMD was negatively associated with the number of months elapsed between the injury and the onset of physical activity (r = -0.60; P < 0.05). Moreover, in the active subjects, both L1-L4 BMD Z score (r = 0.72; P < 0.01) and radius BMD (r = 0.59; P < 0.05) were positively associated with calcium intake. In this cross-sectional study, both the onset of physical activity after injury and the number of hours dedicated to exercise were able to influence bone density and bone-related hormones in quadriplegic men. Our results also suggest a positive combined effect of exercise and calcium intake on bone health of quadriplegic individuals.

Organic grape juice intake improves functional capillary density and postocclusive reactive hyperemia in triathletes.

OBJECTIVE: The aim of this study was to evaluate the effect of organic grape juice intake on biochemical variables and microcirculatory parameters in triathlon athletes. INTRODUCTION: The physiological stress that is imposed by a strenuous sport, such as a triathlon, together with an insufficient amount of antioxidants in the diet may cause oxidative imbalance and endothelial dysfunction. METHODS: Ten adult male triathletes participated in this study. A venous blood sample was drawn before (baseline) and after 20 days of organic grape juice intake (300 ml/day). Serum insulin, plasma glucose and uric acid levels, the total content of polyphenols, and the erythrocyte superoxide dismutase activity were determined. The functional microcirculatory parameters (the functional capillary density, red blood cell velocity at baseline and peak levels, and time required to reach the peak red blood cell velocity during postocclusive reactive hyperemia after a one-min arterial occlusion) were evaluated using nailfold videocapillaroscopy. RESULTS: Compared with baseline levels, the peak levels of serum insulin ( p = 0.02), plasma uric acid ( p = 0.04), the functional capillary density ( p = 0.003), and the red blood cell velocity (p < 0.001) increased, whereas the plasma glucose level (p,0.001), erythrocyte superoxide dismutase activity ( p = 0.04), and time required to reach red blood cell velocity during postocclusive reactive hyperemia ( p = 0.04) decreased after organic grape juice intake. CONCLUSION: Our data showed that organic grape juice intake improved glucose homeostasis, antioxidant capacity, and microvascular function, which may be due to its high concentration of polyphenols. These results indicate that organic grape juice has a positive effect in endurance athletes.

Organic grape juice intake improves functional capillary density and postocclusive reactive hyperemia in triathletes

OBJECTIVE: The aim of this study was to evaluate the effect of organic grape juice intake on biochemical variables and microcirculatory parameters in triathlon athletes. INTRODUCTION: The physiological stress that is imposed by a strenuous sport, such as a triathlon, together with an insufficient amount of antioxidants in the diet may cause oxidative imbalance and endothelial dysfunction. METHODS: Ten adult male triathletes participated in this study. A venous blood sample was drawn before (baseline) and after 20 days of organic grape juice intake (300 ml/day). Serum insulin, plasma glucose and uric acid levels, the total content of polyphenols, and the erythrocyte superoxide dismutase activity were determined. The functional microcirculatory parameters (the functional capillary density, red blood cell velocity at baseline and peak levels, and time required to reach the peak red blood cell velocity during postocclusive reactive hyperemia after a one-min arterial occlusion) were evaluated using nailfold videocapillaroscopy. RESULTS: Compared with baseline levels, the peak levels of serum insulin ( p = 0.02), plasma uric acid ( p = 0.04), the functional capillary density ( p = 0.003), and the red blood cell velocity (p < 0.001) increased, whereas the plasma glucose level (p,0.001), erythrocyte superoxide dismutase activity ( p = 0.04), and time required to reach red blood cell velocity during postocclusive reactive hyperemia ( p = 0.04) decreased after organic grape juice intake. CONCLUSION: Our data showed that organic grape juice intake improved glucose homeostasis, antioxidant capacity, and microvascular function, which may be due to its high concentration of polyphenols. These results indicate that organic grape juice has a positive effect in endurance athletes.