Consumo de Castanha-do-Brasil reduz o N-óxido de trimetilamina (TMAO) e a inflamação em um paciente com síndrome cardiorrenal: uma comunicação breve / Brazil nut consumption reduces trimethylamine-n-oxide (TMAO) and inflammation in a patient with cardiorenal syndrome: a brief communication

Introdução: A disbiose intestinal é uma característica comum na síndrome cardiorrenal e está associada ao aumento de toxinas urêmicas, como o N-óxido de trimetilamina (TMAO), que estão envolvidas com a inflamação e mortalidade cardiovascular. A castanha-do-Brasil (semente típica brasileira) possui propriedades anti-inflamatórias e antioxidantes, mas não há evidências dos seus efeitos na modulação da microbiota intestinal e redução de toxinas urêmicas. Objetivo: Avaliar o impacto do consumo de castanha-do-Brasil nos níveis de TMAO e marcadores de inflamação em um paciente com síndrome cardiorrenal. Métodos: Um paciente com doença arterial coronariana (66 anos e IMC, 26 kg/m2), estágio 3 da DRC (TFGe 36 mL/min), recebeu uma castanha-do-Brasil por dia durante três meses. Resultados: Os níveis plasmáticos de TMAO e a expressão de mRNA de NF-κB foram reduzidos e a atividade da glutationa peroxidase (GPx) aumentou após esta intervenção. Conclusão: A prescrição de castanha-do-Brasil pode ser uma estratégia promissora para mitigar as complicações relacionadas à síndrome cardiorrenal. Este caso apoia o conceito de "alimento como remédio" visando o fenótipo urêmico na síndrome cardiorrenal.

Introduction: Gut dysbiosis is a common feature in cardiorenal syndrome, and it is linked to increased uremic toxins, like trimethylamine-n-oxide (TMAO), which are involved with inflammation and cardiovascular mortality. Brazil nut (typical Brazilian seed) has anti-inflammatory and antioxidant properties, but there is no evidence of the effects of gut microbiota modulation and reduction of uremic toxins. Objective: To assess the impact of Brazil nut consumption on TMAO levels and inflammation markers in a patient with cardiorenal syndrome. Methods: Acoronary artery disease patient(66 years and BMI, 26 kg/m2),stage-3 of CKD (eGFR 36 mL/min), receivedone Brazil nut per day for three months. Results: TMAO plasma levels and NF-κB mRNA expression were reduced, and glutathione peroxidase (GPx) activity increased after this intervention. Conclusion: Brazil nut prescription may be a promising strategy to mitigate complications related tothe cardiorenal syndrome. This case supports the concept of "Food as medicine" targeting the uremic phenotype in cardiorenal syndrome.

Consumption of oils and anthocyanins may positively modulate PPAR-γ expression in chronic noncommunicable diseases: A systematic review.

Peroxisome proliferator-activated receptor-gamma (PPAR-γ) plays a central role in health and is an essential cardioprotective factor because of its effect on lipid and glucose metabolism, inflammation, and oxidative stress. We hypothesized that nutritional strategies positively regulate PPAR-γ expression in patients with noncommunicable diseases (NCDs). A systematic search was conducted using PubMed, Scientific Electronic Library Online (SciELO), and LILACS databases from May 2020 to January 2021. Eligibility criteria included placebo-controlled randomized clinical trials in adults with chronic diseases involving nutritional strategies, which performed PPAR-γ analysis (majority on mononuclear cells) before and after the intervention. The exclusion criteria included studies published more than 10 years ago, studies not published in English or Spanish, theses, reviews, and other study designs. The review was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Methodological quality was assessed based on 7 criteria obtained from the Cochrane Handbook. A total of 7 studies were included that reported the effects of different nutritional strategies (such as anthocyanins, fish oil, Berberis vulgaris juice, ketogenic diet, flaxseed oil, olive oil) on 346 patients with NCDs (such as type 2 diabetes, hypertension, obesity, and cancer) between 18 and 85 years of age. These results suggest that anthocyanins, flaxseed oil, and olive oil may function as putative PPAR-γ agonists.

Effects of Low Protein Diet on Nuclear Factor Erythroid 2-Related Factor 2 Gene Expression in Nondialysis Chronic Kidney Disease Patients.

OBJECTIVE(S): Low protein diets (LPD; 0.6 g/kg/day), prescribed for nondialysis chronic kidney disease (CKD) patients, have demonstrated numerous benefits. LPDs may modulate inflammation and oxidative stress through the nuclear factor erythroid 2-related factor 2 (Nrf2), which encodes antioxidant and phase II detoxifying enzymes. LPDs also inhibit or antagonize nuclear factor kB (NF-kB) activity, which orchestrates inflammatory and oxidative stress responses. The objective of this study was to evaluate the effects of LPD on Nfr2 and NF-κB messenger RNA (mRNA) expression in nondialysis CKD patients. METHODS: In this longitudinal study, a LPD was prescribed for 30 nondialysis CKD patients for 6 months. Peripheral blood mononuclear cells were isolated, and quantitative real-time polymerase chain reaction analysis was performed to evaluate Nrf2, NF-κB, and NADPH quinine oxidoreductase-1 mRNA expression. Thiobarbituric acid-reactive substance (TBARS) levels, a marker of lipid peroxidation, were also evaluated. RESULTS: (Age 55.5 ± 14.0 years; body mass index 29.1 ± 5.9 kg/m2; glomerular filtration rate 35.6 ± 12.2 mL/minute). After 6 months of nutritional intervention, Nrf2 mRNA expression increased from 0.85 (0.47-1.56) to 1.28 (0.63-2.63) nmol/mL (P = .03), and TBARS levels were significantly decreased from 1.78 (1.31-2.38) to 1.30 (1.07-2.22) nmol/mL (P = .04). NF-κB mRNA expression showed no significant difference after 6 months, but the Nrf2/NF-κB ratio was increased. CONCLUSION(S): In this study, a LPD appeared to modulate Nrf2 expression and decrease the levels of TBARS in nondialysis CKD patients. However, more studies are needed to confirm the effectiveness of LPD on the modulation of transcription factors involved with oxidative stress and inflammation in nondialysis CKD patients.

Does high intensity exercise affects irisin plasma levels in hemodialysis patients? A pilot study.

BACKGROUND: Irisin is a recently identified exercise-induced hormone that stimulates the "browning" of the white adipose tissue, at least in mice. In chronic kidney disease (CKD) patients, irisin regulation is not fully understood, and little attention has been given to the effects of exercise on irisin levels in these patients. The purpose of this study was to assess the effects of high intensity exercise on irisin plasma levels in CKD patients under hemodialysis (HD). METHODS: Fifteen HD patients (5 men, 44.4 ± 15.1 years old) were studied and served as their own controls. High intensity (single session) intradialytic strength exercises consisted of three sets of ten repetitions with four different movements in both lower limbs during 30 minutes. Blood samples were collected on different days (exercise and non-exercise day) at exactly the same time (30 and 60 minutes after the start of dialysis session). Plasma irisin levels were measured by ELISA assay and anthropometric and biochemical parameters were evaluated. RESULTS: Irisin plasma levels were significantly reduced in both exercise day (125.0 ± 18.5 to 117.4 ± 15.0 ng/mL, p=0.02) and non-exercise day (121.5 ± 13.7 to 115.4 ± 17.2 ng/mL, p=0.02) after 60 minutes of dialysis. CONCLUSION: These data suggest that intense intradialytic strength exercise was unable to increase the circulating concentration of irisin in HD patients. Moreover, our data show that after one hour of dialysis session, irisin plasma levels may be reduced.

Does high intensity exercise affects irisin plasma levels in hemodialysis patients? A pilot study / O exercício físico de alta intensidade afeta os níveis plasmáticos de irisina em pacientes em hemodiálise? Um estudo piloto

ABSTRACT Background: Irisin is a recently identified exercise-induced hormone that stimulates the "browning" of the white adipose tissue, at least in mice. In chronic kidney disease (CKD) patients, irisin regulation is not fully understood, and little attention has been given to the effects of exercise on irisin levels in these patients. The purpose of this study was to assess the effects of high intensity exercise on irisin plasma levels in CKD patients under hemodialysis (HD). Methods: Fifteen HD patients (5 men, 44.4 ± 15.1 years old) were studied and served as their own controls. High intensity (single session) intradialytic strength exercises consisted of three sets of ten repetitions with four different movements in both lower limbs during 30 minutes. Blood samples were collected on different days (exercise and non-exercise day) at exactly the same time (30 and 60 minutes after the start of dialysis session). Plasma irisin levels were measured by ELISA assay and anthropometric and biochemical parameters were evaluated. Results: Irisin plasma levels were significantly reduced in both exercise day (125.0 ± 18.5 to 117.4 ± 15.0 ng/mL, p=0.02) and non-exercise day (121.5 ± 13.7 to 115.4 ± 17.2 ng/mL, p=0.02) after 60 minutes of dialysis. Conclusion: These data suggest that intense intradialytic strength exercise was unable to increase the circulating concentration of irisin in HD patients. Moreover, our data show that after one hour of dialysis session, irisin plasma levels may be reduced.

RESUMO História: A irisina é um hormônio induzido pelo exercício recentemente identificado que estimula o "escurecimento" do tecido adiposo branco, pelo menos em camundongos. Nos pacientes com doença renal crônica (DRC), a regulação da irisina não é totalmente compreendida, e pouca atenção tem sido dada aos efeitos do exercício sobre os níveis de irisina nesses pacientes. O objetivo deste estudo foi avaliar os efeitos do exercício de alta intensidade sobre os níveis plasmáticos de irisina em pacientes com DRC em hemodiálise (HD). Métodos: 15 pacientes em HD (5 homens, 44,4 ± 15,1 anos) foram estudados e serviram como os próprios controles. Os exercícios de resistência intradialítica de alta intensidade (sessão única) consistiram em três séries de dez repetições com quatro movimentos diferentes em ambos os membros inferiores durante 30 minutos. As amostras de sangue foram coletadas em dias diferentes (dia de exercício e dia sem exercício) exatamente no mesmo horário (30 e 60 minutos após o início da sessão de diálise). Os níveis de irisina plasmática foram medidos por ensaio ELISA e os parâmetros antropométricos e bioquímicos foram avaliados. Resultados: Os níveis plasmáticos de irisina foram significativamente reduzidos tanto nos dias de exercício (125,0 ± 18,5 a 117,4 ± 15,0 ng/mL, p=0,02) quanto nos dias sem exercício (121,5 ± 13,7 a 115,4 ± 17,2 ng / mL, p=0,02), após 60 minutos de diálise. Conclusão: esses dados sugerem que o exercício intenso de resistência intradialítica não aumentou a concentração circulante de irisina em pacientes sob HD. Além disso, nossos dados mostram que após uma hora de sessão de diálise, os níveis plasmáticos de irisina podem ser reduzidos.

Red meat intake in chronic kidney disease patients: Two sides of the coin.

Red meat is an important dietary source of high biological value protein and micronutrients such as vitamins, iron, and zinc that exert many beneficial functions. However, high consumption of animal protein sources, especially red meat, results in an increased intake of saturated fat, cholesterol, iron, and salt, as well as an excessive acid load. Red meat intake may lead to an elevated production of uremic toxins by the gut microbiota, such as trimethylamine n-oxide (TMAO), indoxyl sulfate, and p-cresyl sulfate. These uremic toxins are associated with increased risk for cardiovascular (CV) mortality. Limiting the intake of red meat in patients with chronic kidney disease (CKD) thus may be a good strategy to reduce CV risk, and may slow the progression of kidney disease. In the present review, we discuss the role of red meat in the diet of patients with CKD. Additionally, we report on a pilot study that focused on the effect of a low-protein diet on TMAO plasma levels in nondialysis CKD patients.

Association between serum ferritin and lipid peroxidation in hemodialysis patients.

INTRODUCTION: Iron supplementation is one of the recommendations found in patients with chronic kidney disease (CKD), however, an overload of this mineral can contribute to oxidative stress, a condition closely related to the cardiovascular risk in these patients, as well as disease progression. OBJECTIVE: The objective of this study was to investigate whether ferritin levels are associated with oxidative stress marker MDA in patients on hemodialysis (HD). METHODS: Twenty HD patients (55.0 ± 15.2 years, time of dialysis 76.5 ± 46.3 months, BMI 23.6 ± 3.0 kg/m2) were compared with 11 healthy subjects (50.9 ± 8.0 years, BMI 23.8 ± 1.9 kg/m2). Malondialdehyde (MDA) was measured by reaction with thiobarbituric acid and routine biochemical data were obtained from medical records. RESULTS: MDA levels were significantly higher in HD patients compared to the control group (13.2 ± 5.3 nmol/mL vs. 5.1 ± 2.7nmol/mL, p < 0.01). Twelve patients (60%) had ferritin values greater than the 500 ng/mL and there was a positive correlation between ferritin and MDA in HD (r = 0.66, p = 0.005, n = 17) patients. CONCLUSION: The excess iron stores in HD patients results in increased lipid peroxidation, and consequently contributes to increased oxidative stress in these patients.

Associação entre níveis de ferritina e peroxidação lipídica em pacientes em hemodiálise / Association between serum ferritin and lipid peroxidation in hemodialysis patients

Resumo Introdução: A suplementação de ferro é uma das importantes recomendações em pacientes com doença renal crônica (DRC), contudo, uma sobrecarga desse mineral pode contribuir para o estresse oxidativo, condição essa bastante relacionada com o risco cardiovascular nesses pacientes. Objetivo: O objetivo desse trabalho foi investigar se os níveis de ferritina estão associados ao estresse oxidativo avaliado pelo malondialdeído (MDA) em pacientes em hemodiálise (HD). Métodos: Vinte pacientes em tratamento de HD (55,0 ± 15,2 anos, tempo de diálise de 76,5 ± 46,3 meses, IMC 23,6 ± 3,0 kg/m2) foram comparados com 11 indivíduos saudáveis (50,9 ± 8,0 anos, IMC 23,8 ± 1,9 kg/m2). O nível de MDA foi medido pela reação com o ácido tiobarbitúrico e os dados bioquímicos de rotina foram obtidos por meio do prontuário médico. Resultados: Os pacientes em HD apresentaram elevados níveis de MDA (13,2 ± 5,3 nmol/mL) quando comparados aos indivíduos saudáveis (5,1 ± 2,7 nmol/mL; p < 0,01). Doze pacientes (60%) apresentaram valores de ferritina superiores a 500 ng/mL e houve correlação positiva entre ferritina e MDA nos pacientes HD (r = 0,66; p = 0,005; n = 17). Conclusão: O excesso dos estoques de ferro em pacientes em HD resulta em um aumento da peroxidação lipídica e, consequentemente, contribui para um maior estresse oxidativo nesses pacientes. .

Abstract Introduction: Iron supplementation is one of the recommendations found in patients with chronic kidney disease (CKD), however, an overload of this mineral can contribute to oxidative stress, a condition closely related to the cardiovascular risk in these patients, as well as disease progression. Objective: The objective of this study was to investigate whether ferritin levels are associated with oxidative stress marker MDA in patients on hemodialysis (HD). Methods: Twenty HD patients (55.0 ± 15.2 years, time of dialysis 76.5 ± 46.3 months, BMI 23.6 ± 3.0 kg/m2) were compared with 11 healthy subjects (50.9 ± 8.0 years, BMI 23.8 ± 1.9 kg/m2). Malondialdehyde (MDA) was measured by reaction with thiobarbituric acid and routine biochemical data were obtained from medical records. Results: MDA levels were significantly higher in HD patients compared to the control group (13.2 ± 5.3 nmol/mL vs. 5.1 ± 2.7nmol/mL, p < 0.01). Twelve patients (60%) had ferritin values greater than the 500 ng/mL and there was a positive correlation between ferritin and MDA in HD (r = 0.66, p = 0.005, n = 17) patients. Conclusion: The excess iron stores in HD patients results in increased lipid peroxidation, and consequently contributes to increased oxidative stress in these patients. .

Prolonged flaxseed flour intake decreased the thickness of the aorta and modulates some modifiable risk factors related to cardiovascular disease in rats.

UNLABELLED: Cardiovascular diseases are a major public health problem. Different risk factors have been recognized as the main causes of the development and progression of cardiovascular diseases. Flaxseed is a source of dietary fiber, lignans, and alpha-linolenic acid. The aim of this study was to evaluate the effects of prolonged supplementation with flaxseed flour as preventive therapy on cardiovascular risk parameters in healthy Wistar rats. MATERIAL AND METHODS: Female Wistar rats were divided into two groups after giving birth and during lactation period: the control group was fed with diet based on casein and the flaxseed group was fed with diet based on casein containing 25% of flaxseed flour. At weaning, 10 male offspring from each group continued to receive the same diets from their mothers during 250 days. The body weight, visceral fat mass, cholesterol, triglycerides, HDL, VLDL, glucose and thickness of the aorta were analyzed. RESULTS: The body weight, visceral fat mass, cholesterol, triglycerides, HDL, VLDL, glucose and thickness of the aorta values were statistically lower when compared to control group. CONCLUSION: The data suggest that flaxseed flour supplementation in healthy wistar rats for a prolonged period may decrease the thickness of the aorta and may be used as a preventive measure in modulating some modifiable risk factors related to cardiovascular disease.

Las enfermedades cardiovasculares son un problema de salud pública. Diferentes factores de riesgo han sido reconocidos como las principales causas del desarrollo y la progresión de las enfermedades cardiovasculares. La linaza es una fuente de fibra dietética, lignanos, y el ácido alfa-linolénico. El objetivo de este estudio fue evaluar los efectos de la suplementación prolongada con harina de linaza como tratamiento preventivo de los parámetros de riesgo cardiovascular en ratas Wistar saludables. Material y métodos: Ratas hembras Wistar fueron divididas en dos grupos después de dar a luz y durante el perío do de lactancia: el grupo de control fue alimentado con una dieta basada en caseína y el grupo de la linaza se alimentó con una dieta basada en caseína que contiene 25% de harina de linaza. Al destete, 10 ratas macho de la camada de cada grupo siguió recibiendo las mismas dietas de sus madres durante 250 días. El peso corporal, la masa grasa visceral, colesterol, triglicéridos, HDL, VLDL, la glucosa y el grosor de la aorta fueron analizado. Resultados: El peso corporal, la masa grasa visceral, colesterol, triglicéridos, HDL, VLDL, la glucosa y el grosor de la aorta esos valores fueron estadísticamente menor en comparación con el grupo control. Conclusión: Los datos sugieren que la suplementación con harina de linaza en ratas Wistar saludables durante un período prolongado puede disminuir el espesor de la aorta y puede ser utilizado como una medida preventiva en la modulación de algunos factores de riesgo modificables relacionados con la enfermedad cardiovascular.

Prolonged consumption of flaxseed flour increases the 17ß-estradiol hormone without causing adverse effects on the histomorphology of Wistar rats' penis.

Consumption of foods rich in phytoestrogens such as flaxseed has increased due to its chemoprotective effects, especially those related to the cardiovascular system. The flaxseed has components that can interfere with development of male reproductive system. This study aims to investigate the possible effects of prolonged consumption of flaxseed flour on hormonal and histomorphologic penis parameters of adult Wistar rats. Rat dams were divided into two groups during lactation period: the control group that was fed with diet based on casein and the flaxseed group that was fed with diet based on casein containing 25% of flaxseed . At weaning, 10 male offspring from each group continued to receive the experimental diets until 250 days old. Rats fed with diet containing flaxseed showed increased concentrations of 17ß-estradiol (p=0.01) but no changes in testosterone concentrations. With regard to histomorphometric analysis of the penis, supplemented rats had lower values for the total area of the corpus spongiosum (p=0.01). All other analyzed parameters wer e similar as the control. Results showed that the use of flaxseed flour did not cause adverse effects on the penis morphology but increases the 17ß-estradiol hormone, when consumed in integral form for a prolonged period.

Impact of flaxseed intake upon metabolic syndrome indicators in female Wistar rats.

PURPOSE: To evaluate whether the prolonged consumption of flaxseed minimize the factors that trigger MS in healthy rats. METHODS: Pregnant rats were divided immediately after delivery into two groups during the lactation period, a control group (CG) receiving casein-based diet with 17% of protein, and a Flaxseed group (FG) with casein-based diet plus 25% of flaxseed. At weaning, 12 offspring of each group continued to receive the same feed but with 10% of protein up to 200 days old. RESULTS: FG showed a significant reduction in body weight (p=0.001), total cholesterol levels (p<0.0001), triglycerides (p=0.0001), and glucose (p=0.001). CONCLUSION: The flaxseed alters the indicators related to development of metabolic syndrome, because it has beneficial effects on lipids and glucose profiles and prevents the excess of body weight gain.

Impact of flaxseed intake upon metabolic syndrome indicators in female Wistar rats / Impacto do consumo da linhaça sobre os indicadores da síndrome metabólica em ratos fêmeas Wistar

PURPOSE: To evaluate whether the prolonged consumption of flaxseed minimize the factors that trigger MS in healthy rats. METHODS: Pregnant rats were divided immediately after delivery into two groups during the lactation period, a control group (CG) receiving casein-based diet with 17% of protein, and a Flaxseed group (FG) with casein-based diet plus 25% of flaxseed. At weaning, 12 offspring of each group continued to receive the same feed but with 10% of protein up to 200 days old. RESULTS: FG showed a significant reduction in body weight (p=0.001), total cholesterol levels (p<0.0001), triglycerides (p=0.0001), and glucose (p=0.001). CONCLUSION: The flaxseed alters the indicators related to development of metabolic syndrome, because it has beneficial effects on lipids and glucose profiles and prevents the excess of body weight gain.

OBJETIVO: Avaliar se o consumo prolongado de linhaça pode minimizar os fatores que desencadeiam síndrome metabólica em ratos fêmeas saudáveis. MÉTODOS: Ratos fêmeas grávidas foram distribuidas após o parto em dois grupos durante o período de lactação: grupo controle (GC) recebendo dieta à base de caseína com 17% de proteína, e um grupo Linhaça (GL), com dieta à base de caseína adicionada de 25% de semente de linhaça. Ao desmame, 12 filhotes de cada grupo continuaram a receber as rações citadas acima, porém com 10% de proteína, até os 200 dias de vida. RESULTADOS: O GL mostrou uma redução significativa do peso corporal (p=0,001), no colesterol total (p<0,0001), triglicerídeos (p=0,0001) e na glicemia (p=0,001). CONCLUSÃO: A linhaça altera os indicadores relacionados ao desenvolvimento da síndrome metabólica por ter efeitos benéficos no perfil lipídico e glicêmico, e previne o excesso de ganho de peso corporal.

Efeitos do consumo prolongado de linhaça (Linum usitatissimum) nos indicadores de peso, hematológicos, bioquímicos e sistema reprodutor de ratos wistar / Effects of prolonged consumption of flaxseed (Linum usitatissimum) in weight indicators, hematological, biochemical and reproductive system of male Wistar rats

A semente de linhaça é uma rica fonte de diglicosidio secoisolariciresinol, que possui capacidade de se ligar aos receptores de estrogênio, podendo interferir no balanço hormonal, no crescimento e desenvolvimento do sistema genital masculino. O presente estudo teve como objetivo avaliar efeitos do consumo prolongado de uma dieta contendo 25% de semente de linhaça sobre o desenvolvimento corporal, parâmetros hematológicos imunes e bioquímicos e morfologia do sistema reprodutor de ratos Wistar na vida adulta...A semente e/ou seus componentes têm capacidade de reduzir o ganho de peso corporal, melhorar os indicadores bioquímicos e auxiliar no controle de fatores de risco associados ao desenvolvimento de doenças crônico degenerativas. A semente também parece retardar o aparecimento de alterações fisiológicas que ocorrem na próstata com o envelhecimento.

Efeitos do consumo materno da semente de linhaça durante a lactação no perfil lipídico e na morfologia da próstata de ratos na idade adulta / Effects of maternal consumption of flaxseed during lactation on lipid profile and the morphology of the rat prostate in adulthood

O consumo de linhaça tem aumentado devido ao fato da semente conter componentes que proporcionaram efeitos benéficos na saúde e prevenção de doenças. Sendo uma importante fonte de lignana, um fitoestrógeno, que pode causar alterações no aparelho reprodutor masculino. O presente estudo avaliou os efeitos da administração desta semente durante a lactação sobre o crescimento, parâmetros bioquímicos e morfologia da próstata dos filhotes machos na vida adulta. Inicialmete foram utilizadas ratas grávidas Wistar, provenientes de Laboratório de Nutrição Experimental/UFF, mantidos em biotério com temperatura (21-33º C) e ciclo claro-escuro (12/12h) controlados, recebendo água e ração ad libitum...Não foram observadas alterações na morfologia da próstata nos dois grupos analisados. De acordo com os resultados apresentados a administração de semente de linhaça durante a lactação não promove alterações histológicas nos alvéolos prostáticos, mas programa para redução do risco cardiovascular na idade adulta, através da melhora do perfil lipídico.