Environmental pollutants as risk factors for autism spectrum disorders: a systematic review and meta-analysis of cohort studies.

BACKGROUND: Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition affecting communication, social interaction, and behavior. Evidence suggests that environmental pollutants are associated with ASD incidence. This review aimed to analyze the effect of environmental pollutants on ASD. METHODS: Systematic review and meta-analysis of cohort studies evaluated the association between exposure to environmental pollutants and ASD. We searched COCHRANE CENTRAL, MEDLINE, CINAHL, LILACS, EMBASE, PsycINFO, Web of Science, SciELO, and gray literature from inception to January 2023. The model used for meta-analysis was inverse variance heterogeneity (IVhet). The effect measures were the beta coefficient (ß) and the relative risk (RR) with their 95% confidence intervals (95% CI). Sensitivity analyses were carried out using an instrument to screen or diagnose autism. RESULTS: A total of 5,780 studies were identified; 27 were included in the systematic review, and 22 were included in the meta-analysis. These studies included 1,289,183 participants and 129 environmental pollutants. Individual meta-analyses found a significant association between nitrogen dioxide RR = 1.20 (95% CI: 1.03 to 1.38; I2: 91%), copper RR = 1.08 (95% CI: 1.03 to 1.13; I2: 0%), mono-3-carboxy propyl phthalate ß = 0.45 (95% CI: 0.20 to 0.70; I2: 0%), monobutyl phthalate ß = 0.43 (95% CI: 0.13 to 0.73; I2: 0%) and polychlorinated biphenyl (PCB) 138 RR = 1.84 (95% CI: 1.14 to 2.96; I2:0%) with ASD. Subgroup meta-analyses found a significant association with carbon monoxide RR = 1.57 (95% CI: 1.25 to 1.97; I2: 0%), nitrogen oxides RR = 1.09 (95% CI: 1.04 to 1.15; I2: 34%) and metals RR = 1.13 (95% CI: 1.01 to 1.27; I2:24%). CONCLUSION: This study found positive associations nitrogen dioxide, copper, mono-3-carboxypropyl phthalate, monobutyl phthalate, and PCB 138, and the development of ASD, likewise, with subgroups of pollutants carbon monoxide, nitrogen oxides, and metals. Therefore, it is important to identify these risk factors in children and adolescents to contribute to ASD and identify prevention strategies effectively.

Efficacy of Remote Psychological Interventions for Patients with Anxiety and Depression Symptoms: Systematic Review and Meta-Analysis.

Background: Anxiety and depression are common mental disorders that are highly prevalent worldwide. Clinical trials have found that telehealth interventions result in increased accessibility and improved mental treatment effectiveness. However, a few comprehensive syntheses of evidence from randomized clinical trials that have been conducted to evaluate remote psychological vs face-to-face interventions for anxiety and depression are not conclusive. The objective of this work was to evaluate the efficacy of remote psychological interventions for patients with anxiety and depression symptoms. Methods: Randomized clinical trials with the following criteria were included: participants aged ≥5 years, of both sexes, and who underwent psychological therapy to treat anxiety and or depression symptoms. They were randomized to receive the same psychological treatment remotely or face-to-face. Review studies, animal studies, pilot studies, and studies with patients diagnosed with chronic diseases were excluded. Searches were performed on March 2024 in the following databases: MEDLINE, EMBASE, LILACS, CENTRAL, CINAHL, Web of Science, SciELO, APA PsycINFO, and Scopus. The meta-analysis was conducted using the random-effects model, and the standardized mean difference with the 95% confidence interval (CI) was used to estimate the effect. Results: Six studies were included in this systematic review. The meta-analysis showed no statistically significant difference when comparing remote or face-to-face treatment for depression (SMD of -0.10 [95% CI: -0.57 to 0.37; I2: 77%]) and anxiety (SMD of -0.06 [95% CI: -0.34 to 0.21; I2: 0%]) symptoms. Conclusion: Our meta-analysis indicates that remote psychotherapy demonstrates comparable efficacy to face-to-face care in mitigating symptoms of depression and anxiety. It allows patients to select the best modality for their daily routines, promoting greater engagement and adherence to treatment.

The role of environmental pollutants in body composition: Systematic review and meta-analysis.

The effects of environmental pollution are associated with higher rates of mortality, morbidity, and years of life lost. It is known that these produce alterations in the human body, including changes in body composition. Research has focused on the association between contaminants and BMI through cross-sectional studies. The objective of this study was to synthesize the evidence for the association of pollutants on different measures of body composition. The PECOS strategy was defined, in which "P": participants of any age, sex, or ethnicity, "E": a higher level of environmental pollution, "C": a lower level of environmental pollution, "O": body composition measurements and "S": longitudinal studies. Studies from the following databases were included: MEDLINE, EMBASE, SciELO, LILACS, Scopus, Web of Science, SPORTDiscus, and gray literature from inception to January 2023.3069 studies were identified, 18 were included in the systematic review, and 13 in the meta-analysis. These studies included 8.563 people, 47 environmental contaminants, and 16 measures of body composition. The meta-analysis by subgroup found that the association between dioxins, furans, PCBs, and waist circumference was ß = 1.0 (95% CI: 0.85 to 1.16; I2: 95%), and the sum of four skinfolds ß = 1.02 (95% CI: 0.88 to 1.16; I2: 24%). The association between pesticides and waist circumference was ß = 1.00 (95% CI: 0.68 to 1.32; I2: 98%), and the fat mass was ß = 0.99 (95% CI: 0.17 to 1.81; I2: 94%). Pollutants, especially endocrine-disrupting chemicals, among which dioxins, furans, PCBs, and pesticides, are associated with changes in body composition, mainly with waist circumference and the sum of four skinfolds.

68Ga-Prostate-specific membrane antigen (psma) positron emission tomography (pet) in prostate cancer: a systematic review and meta-analysis.

INTRODUCTION: Prostate cancer (PC) is the second most commonly diagnosed cancer in males. 68Ga-PSMA PET/CT, a non-invasive diagnostic tool to evaluate PC with prostate-specific membrane antigen (PSMA) expression, has emerged as a more accurate alternative to assess disease staging. We aimed to identify predictors of positive 68Ga-PSMA PET and the accuracy of this technique. MATERIALS AND METHODS: Diagnostic accuracy cross-sectional study with prospective and retrospective approaches. We performed a comprehensive literature search on PubMed, Cochrane Library, and Embase database in search of studies including PC patients submitted to radical prostatectomy or radiotherapy with curative intent and presented biochemical recurrence following ASTRO 1996 criteria. A total of 35 studies involving 3910 patients submitted to 68-Ga-PSMA PET were included and independently assessed by two authors: 8 studies on diagnosis, four on staging, and 23 studies on restaging purposes. The significance level was α=0.05. RESULTS: pooled sensitivity and specificity were 0.90 (0.86-0.93) and 0.90 (0.82-0.96), respectively, for diagnostic purposes; as for staging, pooled sensitivity and specificity were 0.93 (0.86-0.98) and 0.96 (0.92-0.99), respectively. In the restaging scenario, pooled sensitivity and specificity were 0.76 (0.74-0.78) and 0.45 (0.27-0.58), respectively, considering the identification of prostate cancer in each described situation. We also obtained specificity and sensitivity results for PSA subdivisions. CONCLUSION: 68Ga-PSMA PET provides higher sensitivity and specificity than traditional imaging for prostate cancer.

Body composition parameters can better predict body size dissatisfaction than body mass index in children and adolescents.

PURPOSE: Recent studies suggest that body mass index is not a reliable enough measurement for body composition in individuals, particularly in older and younger people. However, most research on body image has used the body mass index (BMI) as a physiological predictor of body satisfaction, particularly in children. The aim of this study was to investigate whether body composition is a better predictor of body size dissatisfaction in children than BMI. METHODS: This is a cross-sectional study. Healthy children and adolescents aged 5-19 years, sex male and female, were recruited using a convenience sample in Brazil. BMI was measured according to the international standardization method and body composition was measured by bioelectrical impedance analysis (BIA) with a portable device model (BIA InBodyS10 multi-frequency, USA). Body size dissatisfaction was assessed using the Kakeshita's Figure Rating Scale for Brazilian Children. Data were analyzed with logistic regression analysis. RESULTS: A total of 547 participants were evaluated, including 54% females and 67% Caucasian, with a mean age of 11.4 ± 3.8 years. The mean BMI was 20.5 ± 4.6 kg/m2, and the mean percentages of fat and lean mass were 23.01 ± 10.59% and 72.84 ± 10.03%, respectively. In the multivariable model, only body composition was significantly associated with body size dissatisfaction (odds ratio: 1.849 (1.085-3.149, p = 0.024) and 1.828 (1.043-3.202, p = 0.035), respectively). CONCLUSIONS: Body composition measures can better predict body size dissatisfaction in children and adolescents than BMI. This result may be relevant for the design of future studies on physiological indicators and body satisfaction. LEVEL OF EVIDENCE: Level V, cross-sectional study.

Phase angle of bioimpedance as a marker of inflammation in cardiovascular diseases: A systematic review.

OBJECTIVE: The aim of this systematic review was to investigate whether phase angle (PhA) of bioelectrical impedance is associated with inflammatory markers in cardiovascular diseases (CVDs). METHODS: A search was performed in the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Latin American Caribbean Health Sciences Literature (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus; and in the gray literature up to January 2022. Studies with individuals with CVDs were included, to evaluate the association between PhA and the inflammatory markers interleukin (IL)-6, IL-10, IL-18, IL-1ß, IL-33, tumor necrosis factor (TNF)-α, C-reactive protein (CRP), toll-like receptor (TLR) 2, TLR 4, nuclear factor κB, pathogen-associated molecular pattern molecules, lipopolysaccharides, interferon-γ-inducing factor, and JAK STAT. RESULTS: We identified 755 articles and, after an eligibility analysis, 5 studies were included. The inflammatory markers investigated in the studies were CRP, TNF-α, and IL-33. In patients with CVDs, PhA was negatively associated with CRP and TNF-α in 80% and 100% of the studies, respectively. CONCLUSIONS: The present results suggested that PhA is inversely associated with inflammatory markers in individuals with CVDs, and its clinical use is encouraged for better therapeutic planning.

Variation of modulation and expression of biomarkers associated with inflammation in bariatric surgery patients: A systematic review and meta-analysis.

BACKGROUND: Bariatric surgery is an effective intervention that causes a series of metabolic changes related to inflammatory processes; however, the variation of biomarkers related to these processes is not entirely understood. Our objective was to investigate the variation of modulation and expression of biomarkers associated with inflammation in patients who underwent bariatric surgery. METHODS: We searched the MEDLINE (via PubMed), EMBASE (via Elsevier), Cochrane Central Register of Controlled Trials, Latin American and Caribbean Literature on Health Sciences (via virtual health library), Cumulative Index to Nursing and Allied Health Literature (via EBSCO), Web of Science core collection, and Scopus (via Elsevier) databases, and the gray literature was examined from inception to January 2022. Three pairs of reviewers performed data screening, extraction, and quality assessment independently. Meta-analysis with random effects models was used for general, subgroup, and sensitivity analyses. The I2 statistic was used to assess heterogeneity between studies. RESULTS: In total, 96 articles were included in this systematic review; of these, 87 studies met the criteria for the meta-analysis, involving 3,533 participants. Five biomarkers were included in the meta-analysis (tumor necrosis factor alpha; interleukin 6; leptin; interleukin 1 beta, and lipopolysaccharides). Only leptin showed a significant decrease in the first month after surgery (mean difference -20.71; [95% confidence interval: -28.10 to -13.32, P < .0001; I2 = 66.7%), with moderate heterogeneity. The 12 months after surgery showed a significant decrease in tumor necrosis factor alpha (mean difference -0.89; [95% confidence interval: -1.37 to -0.42], P = .0002; I2 = 94.7%), interleukin 6 (mean difference -1.62; [95% confidence interval: -1.95 to -1.29], P < .0001; I2 = 94.9%), leptin (mean difference -28.63; [95% confidence interval: -34.02 to -23.25], P < .0001; I2 = 92.7%), and interleukin 1 beta (mean difference -2.46; [95% confidence interval: -4.23 to -0.68], P = .006; I2 = 98.3%), all with high heterogeneity. The type of surgery did not show significant differences for the biomarkers at the first month and 12 months, and the results have not changed with high-quality studies. In the 12-month measurement, variations in tumor necrosis factor alpha and leptin were associated with body mass index. CONCLUSION: The findings of this meta-analysis suggest that Roux-en-Y gastric bypass and sleeve gastrectomy bariatric surgeries are associated with a significant reduction in leptin at 1 month after bariatric surgical intervention and tumor necrosis factor alpha, leptin, and interleukin 1 beta after 12 months.

Brazilian Reference Percentiles for Bioimpedance Phase Angle of Healthy Individuals.

Objectives: The present study was designed to estimate phase angle percentile curves for a broad age range of healthy individuals. Methods: This is a cross-sectional study of healthy Brazilian individuals aged five to 80. InBodyS10 was used to assess phase angle. Reference curves were stratified by sex and estimated using Generalized additive models for location, scale, and shape as a continuous function of age. The phase angle determinants analyzed were physical activity, age, BMI, and SES variables. Results: Data were analyzed from 2,146 individuals, 1,189 (55.2%) of whom were female. In both sexes, the phase angles showed a similar pattern (an increasing trend from childhood to the teenage phase, followed by stabilization during adult ages and a decrease in old adults). In female, the relationship between phase angle and age were associated with BMI and family income. In the male, the relationship between phase angle and age were associated with skin color and family income. Conclusions: To the best of our knowledge, it is the first attempt to apply the GAMLSS technique to estimate phase angle percentiles in a healthy population covering most of the life cycle. We also showed that there are different phase angle determinants according to sex.

Reference percentiles for bioimpedance body composition parameters of healthy individuals: A cross-sectional study.

OBJECTIVES: The aim of this study was to estimate the percentage distribution of body composition parameters for healthy people at different ages from the assessment of electrical bioimpedance. METHODS: A cross-sectional study of healthy Brazilian aged 5 years and older. Were evaluated: total body fat; percent body fat; fat-free mass; percent lean mass; fat mass index; and fat-free mass index. RESULTS: Of 1240 participants, with a median age of 27.0 years, 52.5% were female, and 73.7% were Caucasian. Most of the body composition variables were associated with age. The fat-free mass increased from youth to adult and decreased in the elderly in both sexes, with higher values in males than in females. In males, the percentage of lean mass has higher values in adolescence compared to childhood, and in adults compared to the elderly, when analyzed from the 50th percentile. In women, fat-free mass compared to adulthood, values were higher in childhood and lower in older ages. CONCLUSIONS: The study is the first to describe the Brazilian reference values for most clinical parameters of bioimpedance in percentiles stratified by different life cycles and sex. These findings can be very useful in clinical practice for health promotion and monitoring the nutritional status of the individual.

Consuming a low-calorie amount of routine food and drink does not affect bioimpedance body fat percentage in healthy individuals.

OBJECTIVES: Bioimpedance analysis is a simple, safe, and relatively inexpensive method to assess body composition. The bioimpedance guidelines recommend that the test be performed after fasting and avoiding the consumption of liquids. Studies have verified the effects of consuming liquids and food on bioimpedance; however, these studies used preestablished meals and hydration. The aim of the present study is to identify whether ad libitum food and liquid intake interfere with body composition parameters estimated via bioimpedance. METHODS: The evaluations were carried out over 2 d. On the first d, the hydration protocol was applied and on the second d, the food protocol. In both cases, bioimpedance was performed after an 8-h overnight fast. The test was repeated 30 min after the intake of liquids or food depending on the protocol. The reproducibility between the pre- and posttest evaluations was assessed using the Bland-Altman method. We considered deviations of up to 5% in the limits of agreement to be clinically acceptable. RESULTS: In the hydration protocol, the mean difference in fat percentage (FP) was -0.50 (P = 0.05), the lower limit of agreement was -3.60%, and the upper limit of agreement was 2.61%. In the food protocol, the mean difference in FP was 0.002 (P = 0.99), the lower limit of agreement was -3.20%, and the upper limit of agreement was 3.20%. CONCLUSIONS: Our study shows that ad libitum food and liquid intake do not cause a change above clinically acceptable levels in the FP estimated by bioimpedance.

Can skinfold thickness equations be substituted for bioimpedance analysis in children?

OBJECTIVE: The aim of the present study was to evaluate the agreement between the most used skinfold thickness equations with multi-frequency bioimpedance analysis in the prediction of body fat levels in children. METHOD: A cross-sectional study of healthy Brazilian community-dwelling individuals. The anthropometric assessment included height, body mass, arm circumference, and waist circumference. The percentage of body fat was obtained by measuring skinfold thickness equations and using bioimpedance analysis, and skinfold thickness was measured using a scientific skinfold caliper. Bland-Altman plot analysis was used to verify the agreement between the methods. RESULTS: There were 439 children and adolescents evaluated, with a mean age of 11.6±3.7 years. The mean body fat by bioimpedance analysis was 22.8%±10.4%, compared to 22.4%±8.8% by Slaughter (1), 20.4%±9.2% by Slaughter (2), 19.6%±4.4% by Goran, and 24.7%±10.0% by Huang equations. Bland-Altman plot analysis revealed limits of agreement greater than 8% between the bioimpedance analysis approach and equations, exceeding the clinically acceptable limit predefined a priori. None of the equations had good agreement with bioimpedance analysis. CONCLUSION: It was concluded that skinfold thickness and bioimpedance analysis should not be used interchangeably in children and adolescents.

Reference values for the phase angle of the electrical bioimpedance: Systematic review and meta-analysis involving more than 250,000 subjects.

BACKGROUND & AIMS: The bioimpedence phase angle has been considered as a predictor for morbidity and mortality in different clinical situations, although reference values from a large healthy population are lacking. The aim of this meta-analysis is to estimate mean phase-angle values in healthy individuals. METHODS: This meta-analysis systematically searched MEDLINE, EMBASE, The Cochrane Controlled Trials Register, SCIELO, LILACS, CINAHL, Web of Science and gray literature for studies estimating mean phase angles. Quality of evidence was assessed for all studies and subgroup (males and females) meta-analysis stratified by age group according to literature (up to 2; 3-5; 6-12; 13-15; 16-18; 19-28; 29-38; 39-48; 49-58; 59-69; 70-80 and >80 years of age) were conducted using random-effects models. RESULTS: A total of 46 studies including 249,844 subjects were selected for the present analysis. Males show a pooled estimate of the mean phase angle of 3.6 (95% CI: 3.0-4.1) for infants (0-2 y), increasing progressively to 7.3 (95% CI: 7.0-7.5) at the teenage phase (16-18 y), stabilizing during adult ages (18-38) and decreasing progressively with ongoing years with an estimate of 5.3 (95% CI: 4.5-6.0) for elderly above 80 years old. Similarly, females start from 3.7 (95% CI: 3.2-4.3) for infants (0-2 y), increasing progressively to 6.4 (95% CI: 6.1-6.8) at the teenage phase (16-18 y), stabilizing during adult ages (18-48) and decreasing progressively with ongoing years with an estimate of 5.4 (95% CI: 5.3-5.6) for elderly above 80 years old. Also, males have higher estimates than females for all age groups except for infants (0-2) and subjects older than 80 years old. Heterogeneity was high for all age groups. CONCLUSIONS: In both sexes, phase-angle values have a similar pattern that start from infants, increase progressively up to the teenage phase, stabilize during adult ages, and then decrease progressively in older subjects and the elderly.

Association between phase angle from bioelectrical impedance analysis and level of physical activity: Systematic review and meta-analysis.

OBJECTIVE: To evaluate the relationship between physical activity and phase angle. DESIGN: Systematic Review and Meta-analysis. DATA SOURCES: Electronic searches of MEDLINE (via PUBMED), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), SciELO, LILACS, SPORTDiscus, Scopus, and Web of Science from inception to December 10th, 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: The PICOS strategy was defined, in which "P" corresponded to participants of any age, sex or ethnicity, "I" indicated any type of physical activity program, "C" denoted lack of exercise or irregular physical activity, "O" corresponded to the phase angle obtained by bio-impedance, and "S" indicated longitudinal or cross-sectional studies. RESULTS: In cross-sectional studies the phase angle was higher among the active individuals (MD = 0.70; 95% CI: 0.48, 0.92, P < 0.001), with low heterogeneity (I2 = 0%; P = 0.619). In longitudinal studies, the mean of the difference of phase angles from the baseline was significantly higher for the active group than the control group (MD = 0.30; 95% CI: 0.11, 0.49, P = 0.001), with low heterogeneity (I2 = 13%, P = 0.331). No evidence of publication bias was found and the overall risk of bias was moderate to high. SUMMARY/CONCLUSION: The positive association of physical activity with phase angle reinforces the importance of routinely including exercise in health care. We also identified the need for further studies to define with different types, intensities and frequencies of exercises should be conducted in order to find the best dose-effect relationship.

Health-related quality of life in post-infectious bronchiolitis obliterans: agreement between children and their proxy.

OBJECTIVE: To assess the level of agreement in health-related quality of life between children with Post-infectious Bronchiolitis Obliterans and their parent (so-called proxy). METHODS: Participants aged between 8and 17 years who had been previously diagnosed with Post-infectious Bronchiolitis Obliterans were regularly followed up at a pediatric pulmonology outpatient clinic. Parents or legal guardians (caregivers) of these patients were also recruited for the study. A validated and age-appropriate version of the Pediatric Quality of Life Inventory 4.0 was used for the assessment of health-related quality of life. Caregivers completed the corresponding proxy versions of the questionnaire. The correlation between self and proxy reports of health-related quality of life was determined by intra-class correlation coefficient and dependent t-tests. RESULTS: The majority of participants were males (79.4%), and the average age was 11.8 years. Intra-class correlations between each of the Pediatric Quality of Life Inventory 4.0 domains and the total score were all lower than 0.6, with a range between 0.267 (poor) and 0.530 (fair). When the means of each domain and the total score of the questionnaires were compared, caregivers were observed to have a significantly lower health-related quality of life score than children, with the exception of the social domain in which the difference was not significant. However, the differences in score exceeded the critical threshold difference of four points in all other domains. CONCLUSION: Proxies of children and adolescents with Post-infectious Bronchiolitis Obliterans appear to consistently perceive their children as having lower health-related quality of life than how the patients perceive themselves.

Evidence on nutritional assessment techniques and parameters used to determine the nutritional status of children and adolescents: systematic review.

This article aims to review systematically the evidence on nutritional assessment techniques and parameters used to determine the nutritional status of children and adolescents. The literature review and the selection of publications were performed using the Medline, Lilacs, SciELO, Embase, personal files. 17 studies were identified, 7 addressed the anthropometric indices as the main outcome, 7 analyzed the growth and development of children and adolescents through growth curves, and the remainder surveyed body composition. In general, all met the quality criteria, unless 6 of the articles who did not discuss the limitations. The literature review suggests several techniques and parameters that can be applied to determine the nutritional status of children and adolescents from different countries. Growth graphs are essential to assess the health of children, but depend greatly of the growth tables used. Although BMI can be practical, it does not distinguish body fat from lean mass. The best interpretation of anthropometry will depend of valid reference values for age range of the study population. BIA is a quick feasible method, but the measurement has some various nationalities.

Health-related quality of life in patients with bronchiolitis obliterans.

OBJECTIVE: To evaluate the overall health-related quality of life in patients with bronchiolitis obliterans. METHODS: Participants with a diagnosis of post-infectious bronchiolitis obliterans, who were being followed-up at two specialized outpatient clinics of Pediatric Pulmonology in Porto Alegre, Brazil, and controls aged between 8 and 17 years, of both genders, were included in the study. Controls were paired by gender, age, and socioeconomic level in relation to the group of participants with post-infectious bronchiolitis obliterans. The version of the Pediatric Quality of Life Inventory (PedsQ) tool validated for Brazil was applied for the assessment of Health-related Quality of Life, through an interview. The comparison of the Health-related Quality of Life means between the groups was performed using Student's t-test for independent samples and the chi-squared test, for categorical variables. RESULTS: 34 patients diagnosed with post-infectious bronchiolitis obliterans and 34 controls participated in the study. The mean age of the children included in the study was 11.2±2.5 years, and 49 (72%) of them were males. The groups showed no significant differences in relation to these variables. The quality of life score was significantly and clinically lower in the post-infectious bronchiolitis obliterans group when compared with controls in the health (72.36±15.6, 81.06±16.4, p=0.031) and school domains (62.34±20.7, 72.94±21.3, p=0.043), as well as in the total score (69.53±14.9, 78.02±14.8, p=0.024), respectively. CONCLUSION: Patients with post-infectious bronchiolitis obliterans presented lower health-related quality of life scores when compared with healthy individuals in the total score and in the health and school domains.

Reference percentiles for bioimpedance body composition parameters of healthy individuals: A cross-sectional study

Abstract Objectives: The aim of this study was to estimate the percentage distribution of body composition parameters for healthy people at different ages from the assessment of electrical bioimpedance. Methods: A cross-sectional study of healthy Brazilian aged 5 years and older. Were evaluated: total body fat; percent body fat; fat-free mass; percent lean mass; fat mass index; and fat-free mass index. Results: Of 1240 participants, with a median age of 27.0 years, 52.5% were female, and 73.7% were Caucasian. Most of the body composition variables were associated with age. The fat-free mass increased from youth to adult and decreased in the elderly in both sexes, with higher values in males than in females. In males, the percentage of lean mass has higher values in adolescence compared to childhood, and in adults compared to the elderly, when analyzed from the 50th percentile. In women, fat-free mass compared to adulthood, values were higher in childhood and lower in older ages. Conclusions: The study is the first to describe the Brazilian reference values for most clinical parameters of bioimpedance in percentiles stratified by different life cycles and sex. These findings can be very useful in clinical practice for health promotion and monitoring the nutritional status of the individual.

Association between children and adolescents' body composition with family income / Associação entre a composição corporal de crianças e adolescentes e renda familiar

ABSTRACT Objective To evaluate the association between children and adolescents' body composition with family income. Methods Cross-sectional study, participants between 5 and 19 years were included. A standardized questionnaire assessed socioeconomic variables. The outcome variables were z-score of Body Mass Index and bioimpedance parameters (skeletal muscle mass, fat-free mass, and fat percentage) and predictor variables (age, sex, race, place of residence, father's education, birth weight and breastfeeding) were analyzed using the quantile regression model and data from the 50th percentile are presented. The tests were bidirectional and the differences were considered significant with p<0.05. Results Among the 529 participants included, 284 (53.6%) were female and the mean age was 11.41±3.9 years. The Body Mass Index z-score was the only outcome that did not show differences between sexes (p=0.158). In the crude model, lower family income was associated with lower skeletal muscle mass (Difference=-7.70; 95% CI -9.32 to -5.89), p<0.001), lower fat-free mass (Difference= -13.40; 95% CI -16.40 to -10.39, p<0.001) and the lowest percentage of fat was associated with lower family income (Difference= -5.01, 95% CI -9.91 to -0.11, p=0.027). The z-score of BMI was not associated with family income. Conclusion Family income is directly associated with lower fat-free mass, fat percentage, and skeletal muscle mass in children and adolescents.

RESUMO Objetivo Avaliar a associação entre a composição corporal de crianças e adolescentes com a renda familiar. Métodos Estudo transversal, foram incluídos participantes entre 5 e 19 anos. As variáveis socioeconômicas foram avaliadas por meio de questionário padronizado. As variáveis de desfecho foram escore Z do índice de massa corporal e parâmetros de bioimpedância (massa muscular esquelética, massa livre de gordura e percentual de gordura) e variáveis preditoras (idade, sexo, raça, local de residência, escolaridade do pai, peso ao nascer e aleitamento materno) foram analisados pelo modelo de regressão quantílica e são apresentados os dados do percentil 50. Os testes foram bidirecionais, e as diferenças foram consideradas significativas com p<0,05. Resultados Entre os 529 participantes incluídos, 284 (53,6%) eram do sexo feminino e a média de idade foi de 11,41±3,9 anos. O escore Z do índice de massa corporal foi o único desfecho que não apresentou diferenças entre os sexos (p=0,158). No modelo bruto, uma menor renda familiar foi associada a menor massa muscular esquelética (Diferença= -7,70; IC 95% -9,32 a -5,89), p<0,001), menor massa livre de gordura (Diferença= -13,40; IC 95% -16,40 a -10,39, p<0,001) e o menor percentual de gordura associou-se à menor renda familiar (Diferença= -5,01, IC 95% -9,91 a -0,11, p=0,027). O escore Z do IMC não foi associado à renda familiar. Conclusão A renda familiar está diretamente associada à menor massa magra, ao percentual de gordura e à massa muscular esquelética em crianças e adolescentes.

Effects of Diet on Telomere Length: Systematic Review and Meta-Analysis.

BACKGROUND: The goal of this systematic review and meta-analysis is to determine the effect of diet on telomere length. METHODS: We searched the following databases: MEDLINE, Embase, LILACS, CINAHL, ISI Web of Science, and Scopus, as well as the Cochrane Central Register of Controlled Trials and the National Institutes of Health, from inception to December 2016. Articles that assessed effects of diet on telomere length were included. RESULTS: A total of 2,128 studies were identified, 30 were read in full, and 7 were systematically reviewed. Five RCTs were included in the meta-analysis, covering 9 diets; a total of 533 participants were included. Study heterogeneity (I2) was 89%, and differences were not identified regarding average telomere lengths (mean difference 1.06; 95% CI -1.53 to 3.65). CONCLUSION: The available evidence suggests that there is no effect of diet on telomere length, but the strong heterogeneity in the type and duration of dietary interventions does not allow any final statement on the absence of an effect of diet on telomere length.

Can skinfold thickness equations be substituted for bioimpedance analysis in children?

Abstract Objective: The aim of the present study was to evaluate the agreement between the most used skinfold thickness equations with multi-frequency bioimpedance analysis in the prediction of body fat levels in children. Method: A cross-sectional study of healthy Brazilian community-dwelling individuals. The anthropometric assessment included height, body mass, arm circumference, and waist circumference. The percentage of body fat was obtained by measuring skinfold thickness equations and using bioimpedance analysis, and skinfold thickness was measured using a scientific skinfold caliper. Bland-Altman plot analysis was used to verify the agreement between the methods. Results: There were 439 children and adolescents evaluated, with a mean age of 11.6 ± 3.7 years. The mean body fat by bioimpedance analysis was 22.8% ± 10.4%, compared to 22.4% ± 8.8% by Slaughter (1), 20.4% ± 9.2% by Slaughter (2), 19.6% ± 4.4% by Goran, and 24.7% ± 10.0% by Huang equations. Bland-Altman plot analysis revealed limits of agreement greater than 8% between the bioimpedance analysis approach and equations, exceeding the clinically acceptable limit predefined a priori. None of the equations had good agreement with bioimpedance analysis. Conclusion: It was concluded that skinfold thickness and bioimpedance analysis should not be used interchangeably in children and adolescents.