Validation of the Portuguese Version of the Kansas City Cardiomyopathy Questionnaire-12.

The Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) is a simple, feasible, and sensitive questionnaire developed in English for assessing the health status (symptoms, function, and quality of life) of patients with heart failure (HF). We aimed to assess the internal consistency and construct validity of the Portuguese version of KCCQ-12. We administered the KCCQ-12, the Minnesota Living Heart Failure (MLHFQ), and the New York Heart Association (NYHA) classification by telephone. Internal consistency was assessed with Cronbach's Alpha (α-Cronbach) and construct validity with correlations to the MLHFQ and NYHA. Internal consistency was high (α-Cronbach = 0.92 for the Overall Summary score and 0.77-0.85 for the subdomains). Construct validity was supported by finding high correlations between the KCCQ-12 Physical Limitation and the Symptom Frequency domains with the physical domain of the MLHFQ (r = -0.70 and r = -0.76, p < 0.001 for both) and the Overall Summary scale with NYHA classifications (r = -0.72, p < 0.001). The Portuguese version of KCCQ-12 has high internal consistency and shows a convergent construct validity with other measures quantifying the health status of patients with chronic HF and can be used confidently in Brazil for research and clinical care.

IMPACT OF KRAS MUTATIONS IN CLINICAL FEATURES IN COLORECTAL CANCER.

BACKGROUND: KRAS mutations are important events in colorectal carcinogenesis, as well as negative predictors of response to EGFR inhibitors treatment. AIM: To investigate the association of clinical-pathological features with KRAS mutations in colorectal cancer patients treated. METHODS: Data from 69 patients with colorectal cancer either metastatic at diagnosis or later, were retrospectively analyzed. The direct sequencing and pyrosequencing techniques were related to KRAS exon 2. The mutation diagnosis and its type were determined. RESULTS: KRAS mutation was identified in 43.4% of patients. The most common was c.35G>T (p.G12V), c.35G>A (p.G12D) and c.38G>A (p.G13D). No correlation was found between KRAS mutation and age (p=0.646) or gender (p=0.815). However, mutated group had higher CEA levels at admission (p=0.048) and codon 13 mutation was associated with involvement of more than one metastatic site in disease progression (p=0.029). Although there was no association between primary tumor site and mutation diagnosis (p=0.568), primary colon was associated with worse overall survival (p=0.009). CONCLUSION: The KRAS mutation was identified in almost half of patients. Mutated KRAS group had higher levels of CEA at admission and the mutation at codon 13 was associated with involvement of more than one metastatic site in the course of the disease. Colon disease was associated with the worst overall survival.

Intraoperative ventilation strategies for obese patients undergoing bariatric surgery: systematic review and meta-analysis.

BACKGROUND: Obesity is a global epidemic, and it is widely known that increased Body mass index (BMI) is associated with alterations in respiratory mechanics. Bariatric surgery is established as an effective treatment for this condition. OBJECTIVE: To assess the safety and effectiveness of different ventilation strategies in obese patients undergoing bariatric surgery. METHODS: A systematic review of randomized clinical trials aimed at evaluating ventilation strategies for obese patients was carried out. Primary outcomes: in-hospital mortality, adequacy of gas exchange, and respiration mechanics alterations. RESULTS: Fourteen clinical trials with 574 participants were included. When recruitment maneuvers (RM) vs Positive end-expiratory pressure (PEEP) were compared, RM resulted in better oxygenation p = 0.03 (MD 79.93), higher plateau pressure p < 0.00001 (MD 7.30), higher mean airway pressure p < 0.00001 (MD 6.61), and higher compliance p < 0.00001 (MD 21.00); when comparing RM + Zero end-expiratory pressure (ZEEP) vs RM + PEEP 5 or 10 cmH2O, RM associated with PEEP led to better oxygenation p = 0.001 (MD 167.00); when comparing Continuous Positive Airway Pressure (CPAP) 40 cmH2O + PEEP 10 cmH2O vs CPAP 40 cmH2O + PEEP 15 cmH2O, CPAP 40 + PEEP 15 achieved better gas exchange p = 0.003 (MD 36.00) and compliance p = 0.0003 (MD 3.00). CONCLUSION: There is some evidence that the alveolar recruitment maneuvers associated with PEEP lead to better oxygenation and higher compliance. There is no evidence of differences between pressure control ventilation (PCV) and Volume control ventilation (VCV).

Impact of kras mutations in clinical features in colorectal cancer / Impacto das mutações kras e características clínicas em câncer colorretal

ABSTRACT Background: KRAS mutations are important events in colorectal carcinogenesis, as well as negative predictors of response to EGFR inhibitors treatment. Aim: To investigate the association of clinical-pathological features with KRAS mutations in colorectal cancer patients treated. Methods: Data from 69 patients with colorectal cancer either metastatic at diagnosis or later, were retrospectively analyzed. The direct sequencing and pyrosequencing techniques were related to KRAS exon 2. The mutation diagnosis and its type were determined. Results: KRAS mutation was identified in 43.4% of patients. The most common was c.35G>T (p.G12V), c.35G>A (p.G12D) and c.38G>A (p.G13D). No correlation was found between KRAS mutation and age (p=0.646) or gender (p=0.815). However, mutated group had higher CEA levels at admission (p=0.048) and codon 13 mutation was associated with involvement of more than one metastatic site in disease progression (p=0.029). Although there was no association between primary tumor site and mutation diagnosis (p=0.568), primary colon was associated with worse overall survival (p=0.009). Conclusion: The KRAS mutation was identified in almost half of patients. Mutated KRAS group had higher levels of CEA at admission and the mutation at codon 13 was associated with involvement of more than one metastatic site in the course of the disease. Colon disease was associated with the worst overall survival.

RESUMO Racional: Mutações KRAS são eventos importantes na carcinogênese colorretal como preditores negativos de resposta ao tratamento. Objetivo: Investigar a associação de características clinicopatológicas com mutações no KRAS em pacientes com câncer colorretal tratados. Métodos: Sessenta e nove pacientes com câncer colorretal metastáticos ao diagnóstico ou posteriormente foram analisados. As técnicas de sequenciamento direto e pirosequenciamento foram relacionadas ao éxon 2 do KRAS e o diagnóstico da mutação e seu tipo foram determinados. Resultados: A mutação KRAS foi identificada em 43,4% dos pacientes, c.35G>T (p.G12V), c.35G>A (p.G12D) e c.38G>A (p.G13D). Não foi encontrada correlação entre a mutação KRAS e a idade (p=0,646) ou o gênero (p=0,815). No entanto, o grupo mutado apresentou níveis mais altos de CEA na admissão (p=0,048). A mutação do códon 13 foi associada ao envolvimento de mais de um local metastático na progressão da doença (p=0,029); não houve associação entre o local primário do tumor e o diagnóstico de mutação (p=0,568); a doença primária do cólon foi associada com pior sobrevida global (p=0,009). Conclusão: A mutação KRAS foi identificada em quase metade dos pacientes. O grupo KRAS mutado apresentou níveis mais altos de CEA na admissão e a mutação no códon 13 foi associada ao envolvimento de mais de um local metastático no curso da doença. A doença do cólon foi associada com pior sobrevida global.

Immunoexpression of TS, p53, COX2, EGFR, MSH6 and MLH1 biomarkers and its correlation with degree of differentiation, tumor staging and prognostic factors in colorectal adenocarcinoma: a retrospective longitudinal study.

BACKGROUND: There are cases of colorectal tumors that, although small, show more aggressive evolution than large tumors. This motivated us to study whether there are any proteins capable of alerting about these changes. The aim here was to correlate the immunoexpression of the TS, p53, COX2, EGFR, MSH6 and MLH1 biomarkers in tumors in patients with colorectal adenocarcinoma, with the degree of cell differentiation, tumor staging and clinical-pathological prognostic factors. DESIGN AND SETTING: Retrospective observational study at a public tertiary-level hospital. METHODS: We analyzed tissue-microarray paraffin blocks of tumor tissues that had been resected from 107 patients. We used Fisher's exact test to study associations between tumor differentiation/staging and the immunoexpression of biomarkers. We also used Kaplan-Meier estimation, the log-rank test and the adjusted Cox regression model to investigate the patients' overall survival (in months) according to biomarkers and disease-free interval. RESULTS: The degree of tumor differentiation and tumor staging were not associated with the biomarkers, except in cases of patients in stages III or IV, in which there was a correlation with MLH1 expression (P=0.021). Patient survival and disease-free interval were not associated with the biomarkers. CONCLUSION: There were no associations between the degree of tumor differentiation, staging, length of survival or disease-free interval and the immunoexpression of the TS, p53, COX2, EGFR or MSH6 tumor markers. In advanced cases of colorectal adenocarcinoma (stages III and IV), there was a higher percentage of MLH1-negative results.

Age and leptinemia association with anxiety and depression symptoms in overweight middle-aged women.

OBJECTIVE: The aim of the study was to investigate the effect of menopause and of postmenopausal stages on depression and anxiety symptoms, and whether these symptoms associate with anthropometric, metabolic, and hormonal parameters in midlife women. METHODS: Postmenopausal women (age 50-65), either at early (EPM, n=33) or late (LPM, n = 23) postmenopause, and 23 premenopausal controls (PreM, age 40-50), matched for BMI with the PM groups, were studied. Blood biochemical and hormonal determinations, bioimpedance anthropometry, and depression and anxiety symptoms (Beck's depression [BDI] and anxiety [BAI] inventories) were conducted. RESULTS: The BAI score was higher in both PM groups than in the PreM group. In contrast, only the LPM group showed a significantly elevated BDI score. All groups presented overweight and abdominal obesity, having similar BMI and waist/hip ratio values. Both PM groups showed insulin resistance, whereas only the LPM group presented decreased skeletal muscle mass and basal metabolic rate. Correlation analysis, including all 79 middle-aged women, showed age, percentage body fat, waist/hip ratio, and leptinemia to correlate positively with the anxiety and depression scores. Multivariate regression showed leptin and age to associate positively with depressive- and anxious-like symptoms. CONCLUSIONS: Postmenopausal women presented impaired body composition, energy expenditure, insulin sensitivity, and mental symptoms, in comparison to similarly overweight premenopausal women. Among all the overweight midlife women, these symptoms were more strongly associated with age and leptin levels than with reproductive aging itself. The data indicate that, among overweight middle-aged women with abdominal obesity, the aging process and the development of leptin resistance are associated with impairment of mental health.

Intrauterine Growth Restriction Programs the Hypothalamus of Adult Male Rats: Integrated Analysis of Proteomic and Metabolomic Data.

Programming of hypothalamic functions regulating energy homeostasis may play a role in intrauterine growth restriction (IUGR)-induced adulthood obesity. The present study investigated the effects of IUGR on the hypothalamus proteome and metabolome of adult rats submitted to 50% protein-energy restriction throughout pregnancy. Proteomic and metabolomic analyzes were performed by data independent acquisition mass spectrometry and multiple reaction monitoring, respectively. At age 4 months, the restricted rats showed elevated adiposity, increased leptin and signs of insulin resistance. 1356 proteins were identified and 348 quantified while 127 metabolites were quantified. The restricted hypothalamus showed down-regulation of 36 proteins and 5 metabolites and up-regulation of 21 proteins and 9 metabolites. Integrated pathway analysis of the proteomics and metabolomics data indicated impairment of hypothalamic glucose metabolism, increased flux through the hexosamine pathway, deregulation of TCA cycle and the respiratory chain, and alterations in glutathione metabolism. The data suggest IUGR modulation of energy metabolism and redox homeostasis in the hypothalamus of male adult rats. The present results indicated deleterious consequences of IUGR on hypothalamic pathways involved in pivotal physiological functions. These results provide guidance for future mechanistic studies assessing the role of intrauterine malnutrition in the development of metabolic diseases later in life.

Painful procedures and analgesia in the NICU: what has changed in the medical perception and practice in a ten-year period? / Procedimentos dolorosos e analgesia em UTI Neonatal: o que mudou na opinião e na prática profissional em dez anos?

ABSTRACT OBJECTIVE: To compare the use of analgesia versus neonatologists' perception regarding analgesic use in painful procedures in the years 2001, 2006, and 2011. METHODS: This was a prospective cohort study of all newborns admitted to four university neonatal intensive care units during one month in 2001, 2006, and 2011. The frequency of analgesic prescription for painful procedures was evaluated. Of the 202 neonatologists, 188 answered a questionnaire giving their opinion on the intensity of pain during lumbar puncture, tracheal intubation, mechanical ventilation, and postoperative period using a 10-cm visual analogic scale (VAS; pain >3 cm). RESULTS: For lumbar puncture, 12% (2001), 43% (2006), and 36% (2011) were performed using analgesia. Among the neonatologists, 40-50% reported VAS >3 for lumbar puncture in all study periods. For intubation, 30% received analgesia in the study periods, and 35% (2001), 55% (2006), and 73% (2011) of the neonatologists reported VAS >3 and would prescribe analgesia for this procedure. As for mechanical ventilation, 45% (2001), 64% (2006), and 48% (2011) of patient-days were under analgesia; 56% (2001), 57% (2006), and 26% (2011) of neonatologists reported VAS >3 and said they would use analgesia during mechanical ventilation. For the first three post-operative days, 37% (2001), 78% (2006), and 89% (2011) of the patients received analgesia and more than 90% of neonatologists reported VAS >3 for major surgeries. CONCLUSIONS: Despite an increase in the medical perception of neonatal pain and in analgesic use during painful procedures, the gap between clinical practice and neonatologist perception of analgesia need did not change during the ten-year period.

RESUMO OBJETIVO: Confrontar o uso de analgesia versus a percepção de neonatologistas quanto ao emprego de analgésicos para procedimentos dolorosos em 2001, 2006 e 2011. MÉTODOS: Coorte prospectiva de todos recém-nascidos internados em quatro unidades universitárias. Avaliou-se a frequência do emprego de analgésicos para procedimentos dolorosos por um mês dos anos de estudo. Dos 202 neonatologistas atuantes nas unidades nos três períodos, 188 assinalaram em escala analógica visual de 10 cm (dor >3 cm) a intensidade da dor sentida pelo recém-nascido na punção lombar, intubação traqueal, ventilação mecânica e no pós-operatório. RESULTADOS: Para punção lombar, 12%, 43% e 36% foram feitas com analgesia em 2001, 2006 e 2011 e 40-50% dos neonatologistas referiam indicar analgésicos na punção lombar nos três períodos. Na intubação, 30% foram feitas sob analgesia nos três períodos e 35% (2001), 55% (2006) e 73% (2011) dos médicos diziam indicar analgésicos. Quanto à ventilação mecânica, 45-64% dos ventilados-dia estavam sob analgesia nos três períodos e 56% (2001), 57% (2006) e 26% (2011) dos neonatologistas diziam usar analgésicos. Dos pacientes-dia nos três primeiros dias de pós-operatório, 37% (2001), 78% (2006) e 89% (2011) receberam alguma dose de analgésico. Mais de 90% dos médicos referiam usar analgesia para essa situação. CONCLUSÕES: Entre 2001 e 2011, ocorreu aumento no uso de analgésicos para procedimentos dolorosos nas unidades neonatais e uma percepção mais acentuada por parte dos médicos de que o recém-nascido sente dor, mas o lapso entre a prática clínica e a percepção médica quanto à presença de dor persistiu.

Painful procedures and analgesia in the NICU: what has changed in the medical perception and practice in a ten-year period?

OBJECTIVE: To compare the use of analgesia versus neonatologists' perception regarding analgesic use in painful procedures in the years 2001, 2006, and 2011. METHODS: This was a prospective cohort study of all newborns admitted to four university neonatal intensive care units during one month in 2001, 2006, and 2011. The frequency of analgesic prescription for painful procedures was evaluated. Of the 202 neonatologists, 188 answered a questionnaire giving their opinion on the intensity of pain during lumbar puncture, tracheal intubation, mechanical ventilation, and postoperative period using a 10-cm visual analogic scale (VAS; pain >3cm). RESULTS: For lumbar puncture, 12% (2001), 43% (2006), and 36% (2011) were performed using analgesia. Among the neonatologists, 40-50% reported VAS >3 for lumbar puncture in all study periods. For intubation, 30% received analgesia in the study periods, and 35% (2001), 55% (2006), and 73% (2011) of the neonatologists reported VAS >3 and would prescribe analgesia for this procedure. As for mechanical ventilation, 45% (2001), 64% (2006), and 48% (2011) of patient-days were under analgesia; 56% (2001), 57% (2006), and 26% (2011) of neonatologists reported VAS >3 and said they would use analgesia during mechanical ventilation. For the first three post-operative days, 37% (2001), 78% (2006), and 89% (2011) of the patients received analgesia and more than 90% of neonatologists reported VAS >3 for major surgeries. CONCLUSIONS: Despite an increase in the medical perception of neonatal pain and in analgesic use during painful procedures, the gap between clinical practice and neonatologist perception of analgesia need did not change during the ten-year period.

Streptococcus agalactiae in Brazil: serotype distribution, virulence determinants and antimicrobial susceptibility.

BACKGROUND: Group B Streptococcus (GBS) remains a major cause of neonatal sepsis and is also associated with invasive and noninvasive infections in pregnant women and non-pregnant adults, elderly and patients with underlying medical conditions. Ten capsular serotypes have been recognized, and determination of their distribution within a specific population or geographical region is important as they are major targets for the development of vaccine strategies. We have evaluated the characteristics of GBS isolates recovered from individuals with infections or colonization by this microorganism, living in different geographic regions of Brazil. METHODS: A total of 434 isolates were identified and serotyped by conventional phenotypic tests. The determination of antimicrobial susceptibility was performed by the disk diffusion method. Genes associated with resistance to erythromycin (ermA, ermB, mefA) and tetracycline (tetK, tetL, tetM, tetO) as well as virulence-associated genes (bac, bca, lmb, scpB) were investigated using PCR. Pulsed-field gel electrophoresis (PFGE) was used to examine the genetic diversity of macrolide-resistant and of a number of selected macrolide-susceptible isolates. RESULTS: Overall, serotypes Ia (27.6%), II (19.1%), Ib (18.7%) and V (13.6%) were the most predominant, followed by serotypes IV (8.1%) and III (6.7%). All the isolates were susceptible to the beta-lactam antimicrobials tested and 97% were resistant to tetracycline. Resistance to erythromycin and clindamycin were found in 4.1% and 3% of the isolates, respectively. Among the resistance genes investigated, tetM (99.3%) and tetO (1.8%) were detected among tetracycline-resistant isolates and ermA (39%) and ermB (27.6%) were found among macrolide-resistant isolates. The lmb and scpB virulence genes were detected in all isolates, while bac and bca were detected in 57 (13.1%) and 237 (54.6%) isolates, respectively. Molecular typing by PFGE showed that resistance to erythromycin was associated with a variety of clones. CONCLUSION: These findings indicate that GBS isolates circulating in Brazil have a variety of phenotypic and genotypic characteristics, and suggest that macrolide-resistant isolates may arise by both clonal spread and independent acquisition of resistance genes.

L-arginine abolishes the hypothalamic serotonergic activation induced by central interleukin-1ß administration to normal rats.

IL-1ß-induced anorexia may depend on interactions of the cytokine with neuropeptides and neurotransmitters of the central nervous system control of energy balance and serotonin is likely to be one catabolic mediator targeted by IL-1ß. In the complex interplay involved in feeding modulation, nitric oxide has been ascribed a stimulatory action, which could be of significance in counteracting IL-1ß effects.The present study aims to explore the participation of the nitric oxide and the serotonin systems on the central mechanisms induced by IL-1ß and the relevance of their putative interactions to IL-1ß hypophagia in normal rats.Serotonin levels were determined in microdialysates of the ventromedial hypothalamus after a single intracerebroventricular injection of 10 ng of IL-1ß , with or without the pre-injection of 20 µg of the nitric oxide precursor L-arginine. IL-1ß significantly stimulated hypothalamic serotonin extracellular levels, with a peak variation of 130 ± 37% above baseline. IL- 1ß also reduced the 4-h and the 24-h food intakes (by 23% and 58%, respectively). The IL-1ß-induced serotonergic activation was abolished by the pre-injection of L-arginine while the hypophagic effect was unaffected.The data showed that one central effect of IL-1ß is serotonergic stimulation in the ventromedial hypothalamus, an action inhibited by nitric oxide activity. It is suggested that, although serotonin participates in IL-1ß anorexia, other mechanisms recruited by IL-1ß in normal rats are able to override the absence of the serotonergic hypophagic influence.

Obstructive sleep apnea prevents the expected difference in craniofacial growth of boys and girls.

OBJECTIVES: It was to compare cephalometric measures of mouth-breather boys and girls and with the cephalometric pattern observed in obstructive sleep apnea syndrome (OSAS) patients. METHODS: Craniofacial measurements of lateral cephalometric radiographs obtained from 144 children aged 7-14 years were compared between boys and girls, and both were compared to cephalometric pattern of OSAS patients. RESULTS: Mouth-breather boys and girls had no gender differences regarding to craniofacial morphology while nose-breather boys and girls showed those expected differences. Nose-breather boys presented a more retruded mandible and proinclined upper incisor when compared to nose-breather girls, but mouth-breather boys and girls had no differences. The measure NS.GoGn was the only variable with an interaction with gender and breathing. CONCLUSIONS: There were no cephalometric difference in mouth breather-boys and girls related to normal growth, suggesting that oral breathing make the same craniofacial morphology and both have craniofacial morphology close to that of OSAS patients.

Obstructive sleep apnea prevents the expected difference in craniofacial growth of boys and girls / A apneia obstrutiva do sono impede a esperada diferença de crescimento cranofacial de meninos e meninas

OBJECTIVES: It was to compare cephalometric measures of mouth-breather boys and girls and with the cephalometric pattern observed in obstructive sleep apnea syndrome (OSAS) patients. METHODS: Craniofacial measurements of lateral cephalometric radiographs obtained from 144 children aged 7-14 years were compared between boys and girls, and both were compared to cephalometric pattern of OSAS patients. RESULTS: Mouth-breather boys and girls had no gender differences regarding to craniofacial morphology while nose-breather boys and girls showed those expected differences. Nose-breather boys presented a more retruded mandible and proinclined upper incisor when compared to nose-breather girls, but mouth-breather boys and girls had no differences. The measure NS.GoGn was the only variable with an interaction with gender and breathing. CONCLUSIONS: There were no cephalometric difference in mouth breather-boys and girls related to normal growth, suggesting that oral breathing make the same craniofacial morphology and both have craniofacial morphology close to that of OSAS patients.

OBJETIVOS: Foi comparar medidas cefalométricas entre meninos e meninas respiradores bucais com o padrão cefalométrico de pacientes com síndrome da apneia obstrutiva do sono (SAOS). MÉTODOS: Medidas craniofaciais de radiografias cefalométricas laterais de 144 crianças com idade entre 7 e 14 anos foram comparadas entre meninos e meninas, e estas comparadas com o padrão cefalométrico de pacientes com SAOS. RESULTADOS: Meninos e meninas respiradores bucais não apresentaram diferenças em relação à morfologia craniofacial, enquanto meninos e meninas respiradores nasais mostraram as diferenças fisiologicamente esperadas. Meninos respiradores nasais apresentaram mandíbula mais retraída e incisivos superiores inclinados para frente quando comparados com meninas respiradoras nasais, mas os respiradores bucais não apresentaram diferenças. A medida NS.GoGn foi a única variável com interação entre gênero e tipo de respiração. CONCLUSÕES: Não houve diferença cefalométrica entre os respiradores bucais em relação ao crescimento craniofacial, sugerindo que a respiração bucal determina a mesma morfologia, e ambos os gêneros têm morfologia craniofacial semelhante àquela dos pacientes com SAOS.

Influence of the nutritional intervention in complementary feeding practices in infants / Influência da orientação nutricional nas práticas de alimentação complementar em lactentes

The objective of the present study was to evaluate the effectiveness of nutritional guidance to lactating infants undergoing the phase of complementary feeding introduction and to verify the association of food practices with age and maternal education. It is a descriptive historical cohort study in which secondary data were evaluated from 92 lactating infants who had at least 3 nutritional counselings at the "Center for Promotion and Support of Breastfeeding" from the Federal University of Sao Paulo (UNIFESP), between October 2005 and March 2010. The information of food consumption was obtained from 24 hours food records which were qualitatively analyzed according to the presence of food groups (cereals/tubers, beef/egg, legumes, fruits/vegetables). The nutritional guidance for the introduction of the complementary food was based on the 10 Steps of a Healthy Diet for Brazilian Children under 2 years of age from the Health Ministry. For the Block Non-parametric Variance Analyses children were separated in 2 groups (Lac A = those who were already on a supplementary feeding; Lac B = those who were not on a supplementary feeding). The means and standard deviations of the number of food groups consumed at moments 0,1 and 2 for Lac A were 2.3 (SD = 0.8); 2.9 (SD = 0.8) and 3.2 (SD = 0.6), respectively. For Lac B at times 1 and 2 were 2.6 (SD = 0.9) and 3.1 (SD = 0.7), respectively. There was a statistic increase of the food groups with time for Lac A (moments 0 - 1 (p = 0.001), 0 - 2 (p < 0.001), 1 - 2 (p = 0.033)) and Lac B (moments 1 - 2 (p < 0.001)). Among the inadequate offered foods, those which had reduction were sugar (from 22.2 percent to 8.7 percent) and "petit suisse" cheese (from 11.1 percent to 4.3 percent). No relation between the presence of food groups and age and maternal education was observed. The nutritional orientation over time was effective what resulted in a better quality of the complementary feeding, independent of ...(AU)

Avaliar a efetividade da orientação nutricional de lactentes em fase de introdução da alimentação complementar e verificar a associação das práticas alimentares com idade e escolaridade materna. Estudo de coorte histórica descritiva, avaliando-se dados secundários de 92 lactentes que realizaram pelo menos três consultas nutricionais, atendidos no Centro de Incentivo e Apoio ao Aleitamento Materno da Universidade Federal de São Paulo, no período de outubro de 2005 a março de 2010. As informações de consumo alimentar foram obtidas a partir dos Recordatórios Alimentares de 24 horas, analisados qualitativamente segundo a presença dos grupos alimentares (cereais/tubérculos, carnes/ovos, leguminosas, frutas/legumes/verduras). A orientação nutricional para a introdução da alimentação complementar foi baseada nos Dez Passos da Alimentação Saudável para Crianças Brasileiras Menores de Dois Anos, do Ministério da Saúde. Para a análise de variância em blocos não paramétrica separaram-se as crianças em dois grupos (grupo Lac A= que já recebiam alimentação complementar e grupo Lac B = que ainda não recebiam alimentação complementar). As médias e desvios-padrão do número de grupos alimentares consumidos nos momentos 0, 1 e 2 para o Lac A foram 2,3 (dp = 0,8), 2,9 (dp = 0,8) e 3,2 (dp = 0,6), respectivamente, enquanto que para o Lac B nos momentos 1 e 2 foram 2,6 (dp = 0,9) e 3,1 (dp = 0,7), respectivamente. Estatisticamente houve um aumento significativo dos grupos alimentares com o tempo para o Lac A (momentos 0 - 1 (p = 0,001), 0 - 2 (p <0, 001), 1 - 2 (p = 0,033)) e o Lac B (momentos 1 - 2 (p < 0,001)). Dentre os alimentos inadequados consumidos, aqueles que tiveram redução foram o açúcar de adição (de 22,2 por cento para 8,7 por cento) e o queijo petit suisse (de 11,1 por cento para 4,3 por cento). Não se observou relação entre a presença dos grupos alimentares com a idade e a escolaridade materna. A orientação nutricional ao longo do tempo foi ...(AU)

Influence of the nutritional intervention in complementary feeding practices in infants

Avaliar a efetividade da orientação nutricional de lactentes em fase de introdução da alimentação complementar e verificar a associação das práticas alimentares com idade e escolaridade materna. Estudo de coorte histórica descritiva, avaliando-se dados secundários de 92 lactentes que realizaram pelo menos três consultas nutricionais, atendidos no Centro de Incentivo e Apoio ao Aleitamento Materno da Universidade Federal de São Paulo, no período de outubro de 2005 a março de 2010. As informações de consumo alimentar foram obtidas a partir dos Recordatórios Alimentares de 24 horas, analisados qualitativamente segundo a presença dos grupos alimentares (cereais/tubérculos, carnes/ovos, leguminosas, frutas/legumes/verduras). A orientação nutricional para a introdução da alimentação complementar foi baseada nos Dez Passos da Alimentação Saudável para Crianças Brasileiras Menores de Dois Anos, do Ministério da Saúde. Para a análise de variância em blocos não paramétrica separaram-se as crianças em dois grupos (grupo Lac A= que já recebiam alimentação complementar e grupo Lac B = que ainda não recebiam alimentação complementar). As médias e desvios-padrão do número de grupos alimentares consumidos nos momentos 0, 1 e 2 para o Lac A foram 2,3 (dp = 0,8), 2,9 (dp = 0,8) e 3,2 (dp = 0,6), respectivamente, enquanto que para o Lac B nos momentos 1 e 2 foram 2,6 (dp = 0,9) e 3,1 (dp = 0,7), respectivamente. Estatisticamente houve um aumento significativo dos grupos alimentares com o tempo para o Lac A (momentos 0 - 1 (p = 0,001), 0 - 2 (p <0, 001), 1 - 2 (p = 0,033)) e o Lac B (momentos 1 - 2 (p < 0,001)). Dentre os alimentos inadequados consumidos, aqueles que tiveram redução foram o açúcar de adição (de 22,2 por cento para 8,7 por cento) e o queijo petit suisse (de 11,1 por cento para 4,3 por cento). Não se observou relação entre a presença dos grupos alimentares com a idade e a escolaridade materna. A orientação nutricional ao longo do tempo foi efetiva, resultando na m...

Desenvolvimento e pré-teste de um questionário de frequência alimentar para graduandos / Development and pretesting of a food frequency questionnaire for undergraduate students

Objetivo Desenvolver e aplicar em um projeto-piloto um questionário de frequência alimentar quantitativo de autopreenchimento destinado a graduandos da área da saúde. Métodos Trata-se de um estudo transversal realizado em 151 universitários de ambos os sexos, usuários do ambulatório de Nutrição do Corpo Discente da Universidade Federal de São Paulo, Brasil. O questionário inicial foi composto a partir dos alimentos e preparações informados no Registro Alimentar de Três Dias. As informações em medidas caseiras foram transformadas em gramas ou mililitros com o auxílio de tabelas, e os alimentos foram ordenados segundo a porcentagem de contribuição para o valor energético total informado. Foram selecionados 198 ali-mentos responsáveis por 95 por cento do consumo energético e agrupados em 77 itens alimentares de acordo com a similaridade nutricional. O tamanho das porções alimentares foi classificado conforme o valor do percentil 50 da distribuição dos pesos correspondentes às medidas caseiras referidas. Definiu-se como porção pequena, aquela cujo valor foi igual ou inferior ao percentil 25; como média, o percentil 50 e grande, o valor igual ou superior ao percentil 75. Resultados Após o pré-teste do questionário inicial, o questionário final resultou em uma lista com 89 alimentos, agrupados em 70 itens alimentares. As instruções para o autopreenchimento foram refeitas, objetivando-se um melhor preenchimento. Conclusão Após as modificações realizadas, o questionário de frequência alimentar quantitativo encontra-se pronto para o estudo de validação e calibração.

Objective The objective of this study was to develop and pretest a self-administered, quantitative food frequency questionnaire for undergraduate students of the health sciences. Methods This is a cross-sectional study with 151 undergraduate students of both genders from the Students' Healthcare Service of the Universidade Federal de São Paulo, Brazil. The first version of the food frequency questionnaire was based on the foods and preparations listed in the 3-day food records. Tables were used to convert cooking units into grams or milliliters and the foods were ranked according to their percentage contribution to the total calorie intake. The 198 foods responsible for 95 percent of the energy intake were selected and grouped into 77 food items according to nutritional resemblance. Serving size was classified according to the 50th percentile of the weight distribution corresponding to the cooking units. Serving size was defined as small (S) when £25th percentile; average (A) when equal to the 50th percentile and large (L) when ≥75th percentile. Results The pretest of the first version of the questionnaire resulted in a final version with a list of 89 foods, grouped into 70 food groups. The instructions for filling out the questionnaire were rewritten to get better answers from the students. Conclusion After these changes, the quantitative food frequency questionnaire is ready for the validation and calibration study.

Identificação de risco cardiovascular em pacientes atendidos em abulatório de nutrição / Cardiovascular risk identification among patients treated at an outpatient nutrition clinic

Fundamentos: As doenças cardiovasculares são a principal causa de óbitos no Brasil. Cerca de 80 por cento dos casos poderiam ser evitados por meio de modificações no estilo de vida e alimentação. Objetivos: Descrever o consumo alimentar e fatores de risco cardiovascular presentes em pacientes ambulatoriais. Métodos: Estudo transversal incluindo 103 pacientes de ambos os sexos sem histórico de evento cardiovascular ou miocardiopatias. Foram utilizados dados de consumo alimentar, antropométricos, bioquímicos, de hábitos de vida e condições de saúde e o algoritmo de Framingham. Resultados: A idade média foi 51,91 +- 13,25 anos, predominando o sexo feminino. Da população estudada, 61,17 por cento eram obesos (31,91 +-5,96kg/m² adultos; 30,09+-4,87kg/m² idosos) e 92,23 por cento apresentaram aumento da circunferência da cintura, ambos mais prvalentes entre as mulheres. Na avaliação do consumo, verificou-se: dieta hipoglicídica (48,89+-9,01 por cento VCT) com alto consumo de ácidos graxos saturados...