Efeito positivo da perda moderada de peso por intervenção nutricional nos componentes do domínio de frequência em pacientes de alto risco cardiovascular e regime multimedicamentoso / Positive effect of moderate weight loss through nutritional intervention on frequency domain components in patients at high cardiovascular risk and multidrug regimen

INTRODUÇÃO: Intervenções para o tratamento da obesidade, incluindo a mudança de hábitos de vida, que incluam a melhora de hábitos alimentares, de sedentarismo e de saúde mental, são evidenciados como benéficos para prevenção e tratamento de doenças cardiovasculares e melhora da função autonômica do coração. OBJETIVO: Avaliar a efetividade de um programa de reeducação alimentar e melhoria de qualidade de vida sobre os indicadores de adesão às orientações dietéticas, o estilo de vida, variáveis antropométricas e a função autonômica do coração. MÉTODOS: Pacientes com obesidade de ambos os sexos, encaminhados a um ambulatório de nutrição de um Instituto de Cardiologia para emagrecimento, foram acompanhados mensalmente, durante 3 meses. Foram aplicados dois questionários para avaliar as mudanças no estilo de vida (IPAQ-versão reduzida e PHQ-9), e foi realizado o eletrocardiograma para avaliação da Variabilidade da Frequência Cardíaca (VFC), antes e após o período de acompanhamento. ESTATÍSTICA: As variáveis categóricas foram expressas como frequência e comparadas pelo teste do Qui-quadrado. As variáveis numéricas foram expressas como média ± EPM e intervalo de 95% de confiança de Wald, foram usadas equações de estimação generalizadas (EEG). Todos os testes estatísticos foram bicaudais e o nível de significância adotado foi P< 0,05. RESULTADOS: Foram avaliados 24 pacientes com obesidade (IMC > 30kg/ m2 ), com idade média de 62 anos (min ­ máx: 42 ­ 80 anos, DP: 10 anos). A adesão aos hábitos alimentares saudáveis teve aumento médio de 21,3% para 66,5% (P< 0,001). O IPAQ demonstrou que, ao final do estudo houve aumento da prática de atividade física (P=0,023), e houve redução significativa no escore de PHQ-9 após a intervenção (P=0,022), indicando melhora na saúde mental dos pacientes. Notou-se que o programa de intervenção foi eficaz em reduzir significativamente o peso corporal (média de 5,4%) comparado ao período basal (P=0,043), IMC (P=0,029) e a circunferência da cintura (P=0,031). Foi identificada existência de associação entre a variação de perda de peso e de diminuição do IMC com as variabilidades observadas nos componentes do domínio da frequência, tanto entre os indivíduos adultos (P=0,003), quanto entre indivíduos idosos (P=0,034). CONCLUSÕES: A intervenção em qualidade de vida e reeducação alimentar utilizada no presente estudo foi capaz de promover a melhora tanto na saúde mental quanto o aumento da atividade física dos pacientes, redução dos parâmetros antropométricos e a melhora na VFC, especificamente nos componentes do domínio da frequência.

Insufficient Answer During the Public Health Emergency: A Lesson from the Persistence of Food Insecurity in Low-Income Communities.

Cohort study in deprived communities to investigate the persistence of food insecurity (FI) during the COVID-19 was conducted. Sample were derived from a list of mobile phone numbers provided by community leaders and local nonprofit organizations. Temporal trends and prevalence ratios of FI persistence, categorized as "never," "occasional FI," "consistent FI," were calculated. A total of 302 households completed three assessments, the majority nonwhite women. During the follow-up, families covered by social assistance increased; however, their income decreased (p < 0.05). 33% were "consistent," and 46% "occasional" FI. Permanent difficulties accessing gas canisters, hygiene products, and hand sanitizers were observed.

Vascular dysfunction programmed in male rats by topiramate during peripubertal period.

AIM: The present study evaluated whether topiramate (TPM) treatment during the peripubertal period affects vascular parameters of male rats and whether oxidative stress plays a role in these changes. MAIN METHODS: Rats were treated with TPM (41 mg/kg/day, gavage) or vehicle (CTR group) from the postnatal day (PND) 28 to 50. At PND 51 and 120 the rats were evaluated for: thoracic aorta reactivity to phenylephrine, in the presence (Endo+) or absence of endothelium (Endo-), to acetylcholine and to sodium nitroprusside (SNP), aortic thickness and endothelial nitric oxide synthase (eNOS) expression. In serum were analyzed: the antioxidant capacity by ferric reducing antioxidant power assay; endogenous antioxidant reduced glutathione, and superoxide anion. Results were expressed as mean ± s.e.m., differences when p < 0.05. STATISTICS: Two-way ANOVA (and Tukey's) or Student t-test. KEY FINDINGS: At PND 51, the contraction induced by phenylephrine in Endo+ ring was higher in TPM when compared to CTR. At PND 120, the aortic sensitivity to acetylcholine in TPM rats was reduced in comparison with CTR. The aortic eNOs expression and the aortic thickness were similar between the groups. At PND 51 and 120, TPM group presented a decrease in antioxidants when compared to CTR groups and at PND 120, in TPM group the superoxide anion was increased. SIGNIFICANCE: Taken together, the treatment of rats with TPM during peripubertal period promoted permanent impairment of endothelial function probably mediated by oxidative stress.

High glycemia and resistin normalized in children with double burden of malnutrition: a cross-sectional study.

The coexistence of stunting and excess weight in the same individual is defined as a double burden of malnutrition (DBM) and is associated with noncommunicable diseases. In this study, we evaluated the impact of DBM on adipokine concentrations and metabolic profiles in children compared with weight excess alone. Children were allocated to the weight excess group (n = 23) (height-for-age (HAZ) > 0.0 and < 2.0 Z-score and body mass index-for-age (BMI/A) > 1.0 Z-score) or DBM (n = 22) group (HAZ < -1.0 Z-score (including mild stunting) and BMI/A > 1.0 Z-score). Lipid, glycemic profile, resistin, plasminogen activator inhibitor-1, leptin, and adiponectin concentrations were analyzed. Glycemia was significantly higher in the DBM group compared to the weight excess group (5.05 (4.76-5.31) mmol/L vs. 4.57 (4.35-4.81) mmol/L), although no differences were found in insulin and homeostasis model assessment of insulin resistance (HOMA-IR). Adipokine concentrations did not differ between the groups. However, the DBM group showed higher resistin concentrations normalized by body fat mass than those of the weight excess group (1.44 (0.98-1.93) ng/mL vs. 0.76 (0.55-1.45) ng/mL). Insulin and HOMA-IR showed a negative correlation with adiponectin (r = -0.590 and -0.624, respectively, both p < 0.01). DBM was associated with increased glucose and resistin concentrations adjusted by fat mass compared to that associated with excess weight alone. Therefore, this association between mild stunting and weight excess has deleterious potential for long-term metabolic function, highlighting an additional precaution against weight gain in children, especially in those with stunting.

Infrared Imaging of the Brain-Eyelid Thermal Tunnel: A Promising Method for Measuring Body Temperature in Afebrile Children.

(1) Infrared thermography of the inner canthus of the eye has emerged as a promising tool for temperature screening and fever diagnosis. Its non-invasive nature lends itself well to mass screening in diverse settings such as schools, public transport, and healthcare facilities. Swift and accurate temperature assessment plays a pivotal role in the early identification of potential fever cases, facilitating timely isolation, testing, and treatment, thereby mitigating the risk of disease transmission. Nonetheless, the reliability of this approach in the pediatric population, especially when compared to conventional thermometry methods, remains unexplored. This preliminary study aimed to evaluate the concordance between the temperature of the inner canthus of the eye (Tic,eye), referred to as the brain-eyelid thermal tunnel (BTT°), with axillary and tympanic methods in afebrile children. (2) Methods: A cohort of 36 children, matched in a 1:1 ratio for gender and age, underwent comprehensive assessments encompassing anthropometric data, blood pressure evaluations, axillary (Tax) and tympanic (Tty) temperature measurements, as well as BTT° infrared thermography. (3) Results: The findings revealed a high level of concordance among the tympanic, axillary, and BTT° measurement methods. Bland-Altman plots showed that the bias was minimal, and no statistically significant differences were observed when comparing BTT° with axillary (p = 0.136) and tympanic (p = 0.268) measurements. Passing-Bablok regression scatter plots further confirmed the agreement, aligning the fitted regression line closely with the identity line for both axillary versus BTT° and tympanic (Tty) versus BTT° comparisons. (4) Conclusions: This study holds significant implications for public health, especially in the context of infectious disease outbreaks such as COVID-19. BTT° infrared thermography of the inner canthus of the eye (Tic,eye) reliably measures body temperature in afebrile children in controlled settings; nevertheless, its practical application necessitates the adaptation of biothermodynamic parameters to accommodate diverse environmental conditions.

Treatment with topiramate in rats during childhood causes testicular structural impairment at adulthood.

Topiramate (TOP) is a psychotropic drug prescribed for the treatment of epilepsy in children older than 2 years of age and for migraine prophylaxis in adolescents. There is evidence that TOP promotes negative effects on the reproductive system of male rats. This study aimed to evaluate the immediate and late treatment effects of TOP during childhood and adolescence on the male rat reproductive system. Two experimental groups received 41 mg/kg of TOP daily, by gavage, from postnatal day (PND) 16 to 28 (TOPc group) or from PND 28 to 50 (TOPa group). Control groups (CTRc group or CTRa group) received water daily. Half of the anim-als were evaluated 24 h after the end of treatment (PND 29 and PND 51, respectively) and the remainder were evaluated in adulthood (PND120). The following parameters were determined: anogenital distance, sperm evaluation, testis' histomorphometry and plasma testosterone concentration. At PND 120, the volume (CTRc:62.58 ± 2.13; TOPc: 54.54 ± 2.10*%, p = 0.018) and total length (CTRc: 25.48 ± 1.61; TOPc: 18.94 ± 2.41*, p = 0.035) of seminiferous tubules were decreased and the volume of interstitial tissue (CTRc:37.41 ± 2.13; TOPc: 45.45 ± 2.09*%, p = 0.018) and number of Leydig cells/testis (CTRc: 277.00 ± 36.70; TOPc: 400.20 ± 13.23*, p = 0.013) were increased in the TOPc group. The other parameters remained similar between the groups. Therefore, the present study contributes to our understanding that childhood treatment with TOP has an impact on the rat reproductive system in adulthood, suggesting that this period is more sensitive to TOP exposure than adolescence.

Association of selenium status with endothelial activation during acute systemic inflammation in children.

BACKGROUND & AIMS: Evidence that selenium has a role in endothelial function comes mainly from experimental research, but few clinical studies have examined the pathophysiology of selenium in endothelial activation. We aimed to investigate whether there are associations between selenium status and the magnitude of endothelial activation and the severity of multiple organ dysfunction during the acute phase of systemic inflammatory response syndrome (SIRS) in children. METHODS: A prospective cohort study was carried out in 109 children with SIRS admitted to a pediatric ICU (PICU). Erythrocyte and plasma selenium were measured on admission and selenoprotein P and soluble plasma forms of the intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), sP-selectin, and endoCAM on days 1, 2 and 3 of hospitalization. Generalized estimating equations models were adjusted for clinical severity parameters, C-reactive protein, procalcitonin, and serum lactate. The effect of selenium status on organ dysfunction was defined by the Pediatric Logistic Organic Dysfunction (PELOD-2) during the PICU stay. RESULTS: Erythrocyte selenium was associated with sP-selectin and endoCAM, but not with ICAM-1 and VCAM-2. An increase of 10 µg/L in erythrocyte selenium resulted in increases of 43.2 ng/mL (p = 0.001) in sP-selectin and of 0.04 ng/mL (p < 0.001) in endoCAM. Erythrocyte selenium was also associated with a decrease in PELOD-2 (p = 0.015). Plasma selenium was not related to any of the outcomes. CONCLUSIONS: Erythrocyte selenium is associated with endothelial activation in the early phase of the systemic inflammatory response in children, and has a protective effect on multiple organ dysfunction during their PICU stay. Registered at: www.clinicaltrials.gov (NCT00708799).

Thyroid axis hormones and anthropometric recovery of children/adolescents with overweight/obesity: A scoping review.

Introduction: Thyroid hormones exert multiple physiological effects essential to the maintenance of basal metabolic rate (BMR), adaptive thermogenesis, fat metabolism, growth, and appetite. The links between obesity and the hormones of the thyroid axis, i.e., triiodothyronine (T3), thyroxine (T4), and thyrotropin (TSH), are still controversial, especially when considering children and adolescents. This population has high rates of overweight and obesity and several treatment approaches, including nutritional, psychological, and physical exercise interventions have been used. Understanding the importance of the hormones of the thyroid axis in the recovery from overweight and obesity may help directing measures to the maintenance of a healthy body composition. The present scoping review was carried out to analyze studies evaluating these hormonal levels throughout interventions directed at treating overweight and obesity in children and adolescents. The main purpose was to ascertain whether the hormones levels vary during weight loss. Methods: We selected for analysis 19 studies published between 1999 and 2022. Results: Most of the studies showed that changes in different anthropometric indicators, in response to the multidisciplinary interventions, correlated positively with free T3 (fT3), total T3 (TT3), and TSH. With respect to free T4 (fT4) and total T4 (TT4). Discussion: The most common finding was of unchanged levels and, hence, no significant association with weight loss. Moreover, thyroxine supplementation has failed to affect the response to the interventions. Further studies are necessary to elucidate the relevance of the variations in hormone levels to the establishment of overweight/obesity and to the recovery from these conditions in children/adolescents. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42020203359.

Leptin and adiponectin concentrations in infants with low birth weight: relationship with maternal health and postnatal growth.

Health in pregnancy and infancy can affect the risk of chronic non-communicable diseases. We aimed to describe leptin and adiponectin concentrations in low birth weight (LBW) infants and identify possible associations with maternal nutritional status, adequacy for gestational age, nutritional recovery, and current dietary intake. A cross-sectional study with LBW infants (9-12 months) including maternal background and pre-pregnancy nutritional condition was performed. From the Infants: anthropometry at birth and current was expressed as z-score (weight: WAZ, length, head circumference), nutritional recovery, dietary intake, leptin, and adiponectin blood concentrations. The mean age of the 54 infants was 10.0 ± 1.5 months, 32 (59.3%) were female, 36 (66.7%) preterm, 23 (42.6%) small for gestational age (SGA), and 25 pregnancies (46.3%) were twin. Almost all (98%) of the infants intake energy and protein above the recommendation, and 47 (87.6%) consumed ultra-processed foods. At the time of the assessment, 8 (14.8%) were overweight and 4 (7.4%) had short stature. SGA infants showed faster weight recovery (WAZ 1.54; 95% CI 1.17, 1.91; p = 0.001), higher leptin's concentration (3.0 ng/ml (1.7, 3.0) versus 1.6 ng/ml (0.9, 2.6); p = 0.032)), and leptin/adiponectin ratio (0.13 ± 0.08 versus 0.07 ± 0.07; p = 0.018). The pre-gestational BMI was a modifier of the effect of WAZ on leptin levels (p = 0.027) in LBW infants. Higher pre-gestational BMI increased the effect of WAZ variation (birth and current) on leptin levels. Concluding, LBW infants showed early changes in leptin and adiponectin concentrations, influenced by maternal (pre-gestational BMI), intrauterine (gestational age adequacy - SGA), and postnatal weight gain. This combination of factors may increase the risk of NCD for this group of children.

Topiramate treatment in Wistar rats during childhood induces sex-specific vascular dysfunction in adulthood.

The present study determined whether treatment during childhood with topiramate (TPM), a new generation antiepileptic drug, results in altered aortic reactivity in adult male and female rats. We also sought to understand the role of endothelium-derived contractile factors in TPM-induced vascular dysfunction. Male and female Wistar rats were treated with TPM (41 mg/kg/day) or water (TPM vehicle) by gavage during childhood (postnatal day, 16-28). In adulthood, thoracic aorta reactivity to phenylephrine (phenyl), as well as aortic thickness and expression of cyclooxygenases (COX-1 and COX-2), NOX2, and p47phox were evaluated. The aortic response to phenyl was increased in male and female rats from the TPM group when compared with the control group. In TPM male rats, the hyperreactivity to phenyl was abrogated by the inhibition of NADPH oxidase and COX-2, while in female rats, responses were restored only by inhibition of COX-2. In addition, TPM male rats presented aortic hypertrophy and increased expression of NOX-2 and p47phox, while TPM female rats showed increased COX-2 aortic expression. Taken together, for the first-time, the present study provides evidence that treatment with TPM during childhood causes vascular dysfunction in adulthood, and that the mechanism underlying the vascular effects of TPM is sex-specific.

Emerging evidence for the opposite role of circulating irisin levels and brown adipose tissue activity measured by infrared thermography in anthropometric and metabolic profile during childhood.

Irisin is an adipomyokine that increases browning of adipose tissue and thermogenesis, thereby protecting against obesity and insulin resistance. However, the correlation between irisin, brown adipose tissue (BAT), and childhood obesity, as well as its association with an increased risk of developing metabolic diseases, has not been completely elucidated. This study aimed to investigate the association between irisin levels and BAT activity measured by infrared thermography among children and verify their correlation with anthropometric and metabolic parameters. This study included 42 children with normal weight and 18 overweight/obese children. Anthropometric data, irisin levels, lipid and glucose profile were evaluated. The percentage of the thermally active portion of the supraclavicular area (%AreaSCR) before and after a cold stimulus was measured by infrared thermography, and the differences between the percentages of thermally active (Δ%AreaSCR) was calculated as an index of BAT activation. The results were correlated with anthropometric and metabolic parameters. Circulating irisin levels was positive correlated with age (rho=0.327, P= 0.011), body mass index (BMI) (rho=0.707, P<0.001), waist circumference (rho=0.624, P<0.001), total cholesterol (rho=0.361, P=0.044), triglycerides (rho=0.419, P=0.001), and low-density lipoprotein cholesterol (LDLc) (rho=0.381, P= 0.003). Active BAT was negatively correlated with BMI, waist circumference, triglycerides, LDLc and irisin levels. We observed that normal weight children increased significantly the Δ% AreaSCR as compared to overweight/obese children. In conclusion, circulating irisin levels and BAT activity appear to have opposing roles, since normal weight children had greater BAT activity and lower circulating levels of irisin.

Imbalance between the circulating endothelium-derived apoptotic microparticles and the endothelial colony-forming units of progenitor cells in patients undergoing diagnostic coronary angiography.

PURPOSE: The involvement of the circulating endothelium-derived microparticles (EMPs) and the endothelial progenitor cells (EPCs) has been shown in the pathogenesis of coronary artery disease (CAD). The current study aimed to explore whether the Friesinger index is associated with the levels of the apoptotic CD144+/CD31+/annexin V+ â€‹EMPs and the number of endothelial colony-forming units of progenitor cells in patients undergoing coronary angiography. PATIENTS AND METHODS: Fifty-seven patients with a median age of 62 years (range: 48-84 years) were enrolled. Quantification of the apoptotic CD144+/CD31+/annexin V+ EMPs was performed by flow cytometry. The number of endothelial colony-forming units defined by CFU-Hill was assessed by cell culture. RESULTS: There was a positive correlation between the Friesinger index and the circulating levels of the apoptotic CD144+/CD31+/annexin V+ EMPs (rho=0.817, p<0.001), whereas a negative correlation was found with the number of CFU-Hill (rho â€‹= â€‹- 0.649, p<0.001). Multivariable logistic analysis showed that the risk of having moderate/severe CAD was five times greater among male patients (OR:5.32; 95% CI: 1.19 - 16.33; p=0.038) and almost one and a half times higher among those with a higher level of apoptotic CD144+/CD31+/annexin V+ EMPs (OR:1.74; 95% CI: 1.23 - 2.28; p=0.001). Finally, the circulating levels of apoptotic EMPs labelled for CD144+/CD31+/annexin V+ presented a good discrimination of moderate/severe CAD, with an AUC of 0.85 (95% CI â€‹= â€‹0.74 - 0.96; p< 0.001). CONCLUSIONS: Moderate or severe CAD is associated with increased levels of apoptotic EMPs and reduced EPC colony-forming capacity, increasing the occurrence of endothelial injuries.

Imbalance between the circulating endothelium-derived apoptotic microparticles and the endothelial colony-forming units of progenitor cells in patients undergoing diagnostic coronary angiography

PURPOSE: The involvement of the circulating endothelium-derived microparticles (EMPs) and the endothelial progenitor cells (EPCs) has been shown in the pathogenesis of coronary artery disease (CAD). The current study aimed to explore whether the Friesinger index is associated with the levels of the apoptotic CD144þ/CD31þ/ annexin Vþ EMPs and the number of endothelial colony-forming units of progenitor cells in patients undergoing coronary angiography. Patients and METHODS: Fifty-seven patients with a median age of 62 years (range: 48­84 years) were enrolled. Quantification of the apoptotic CD144þ/CD31þ/annexin Vþ EMPs was performed by flow cytometry. The number of endothelial colony-forming units defined by CFU-Hill was assessed by cell culture. RESULTS: There was a positive correlation between the Friesinger index and the circulating levels of the apoptotic CD144þ/CD31þ/annexin Vþ EMPs (rho»0.817, p< 0.001). CONCLUSIONS: Moderate or severe CAD is associated with increased levels of apoptotic EMPs and reduced EPC colony-forming capacity, increasing the occurrence of endothelial injuries.

High uric acid levels in overweight and obese children and their relationship with cardiometabolic risk factors: what is missing in this puzzle?

OBJECTIVES: The prevalence of hyperuricemia, a common disorder, has been increasing. Moreover, the association between obesity, serum uric acid levels, and cardiometabolic markers in children is unclear. Therefore, this study aimed to analyze the inter-relationships between these factors in a sample of children aged 6-12 years. METHODS: We evaluated 764 children and stratified them according to their body mass index (BMI). Blood pressure and uric acid, creatinine, lipid, and glycemic profiles were evaluated, and the estimated glomerular filtration rate (eGFR) and the homeostatic model assessment for insulin resistance (HOMA-IR) index were calculated. RESULTS: There was a significant linear trend of increasing systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), total cholesterol, low-density lipoprotein cholesterol (LDLc), uric acid, insulin levels, and HOMA-IR index values corresponding with overweight and obese groups; however, high-density lipoprotein cholesterol (HDLc) levels decreased with increasing obesity. The mean creatinine level and eGFR were similar across all BMI groups. Uric acid levels were significantly correlated with BMI (r=0.527), waist circumference (r=0.580), SBP (r=0.497), DBP (r=0.362), TG (r=0.534), total cholesterol (r=0.416), LDLc (r=0.286), HDLc (r=-0.248), insulin (r=0.613), and HOMA-IR index (r=0.607). Multiple regression analyses showed that BMI (B=0.071; SE=0.012; p<0.001), TG (B=0.004; SE=0.001; p<0.001), LDLc (B=0.003; SE=0.001; p=0.006), and insulin (B=0.066; SE=0.007; p<0.001) (R2=0.460) were significant predictors of increased uric acid levels and explained 46% of the variability in uric acid in these children. CONCLUSIONS: Our findings suggest that overweight or obese children are more likely to have higher uric acid levels. Moreover, several cardiometabolic risk factors were strongly associated with high uric acid levels.

Acute kidney injury: Incidence, risk factors, and outcomes in severe COVID-19 patients.

BACKGROUND: COVID-19 is a multisystemic disorder that frequently causes acute kidney injury (AKI). However, the precise clinical and biochemical variables associated with AKI progression in patients with severe COVID-19 remain unclear. METHODS: We performed a retrospective study on 278 hospitalized patients who were admitted to the ward and intensive care unit (ICU) with COVID-19 between March 2020 and June 2020, at the University Hospital, São Paulo, Brazil. Patients aged ≥ 18 years with COVID-19 confirmed on RT-PCR were included. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We evaluated the incidence of AKI, several clinical variables, medicines used, and outcomes in two sub-groups: COVID-19 patients with AKI (Cov-AKI), and COVID-19 patients without AKI (non-AKI). Univariate and multivariate analyses were performed. RESULTS: First, an elevated incidence of AKI (71.2%) was identified, distributed across different stages of the KDIGO criteria. We further observed higher levels of creatinine, C-reactive protein (CRP), leukocytes, neutrophils, monocytes, and neutrophil-to-lymphocyte ratio (NLR) in the Cov-AKI group than in the non-AKI group, at hospital admission. On univariate analysis, Cov-AKI was associated with older age (>62 years), hypertension, CRP, MCV, leucocytes, neutrophils, NLR, combined hydroxychloroquine and azithromycin treatment, use of mechanical ventilation, and vasoactive drugs. Multivariate analysis showed that hypertension and the use of vasoactive drugs were independently associated with a risk of higher AKI in COVID-19 patients. Finally, we preferentially found an altered erythrocyte and leukocyte cellular profile in the Cov-AKI group compared to the non-AKI group, at hospital discharge. CONCLUSIONS: In our study, the development of AKI in patients with severe COVID-19 was related to inflammatory blood markers and therapy with hydroxychloroquine/azithromycin, with vasopressor requirement and hypertension considered potential risk factors. Thus, attention to the protocol, hypertension, and some blood markers may help assist doctors with decision-making for the management of COVID-19 patients with AKI.

High prevalence of food insecurity, the adverse impact of COVID-19 in Brazilian favela.

OBJECTIVE: To investigate food insecurity (FI) prevalence in two favelas in Brazil in the early weeks of the social distancing policy, from 27 March 2020 to 1 June 2020. DESIGN: A cross-sectional study using an online questionnaire to elicit information on socio-economic and demographic characteristics, the types of stores visited to buy food, and FI screening. The FI experience was evaluated according to the Brazilian Food Insecurity Scale. Factors associated with moderate or severe FI were investigated using the logistic regression model. SETTING: São Paulo city, Brazil. PARTICIPANTS: Totally, 909 householders. RESULTS: Eighty-eight per cent of the households included young women working as cleaners or kitchen assistants and in sales services. One-fifth of the participants were involved in the federal cash transfer programme, called Bolsa Família. There were 92 % households with children. The most frequent experience reported was uncertainty about food acquisition or receiving more (89 %), eating less than one should (64 %), not being able to eat healthy and nutritious food (46 %), and skipping a meal (39 %). Forty-seven per cent of the participants experienced moderate or severe FI. Factors associated with moderate and severe FI were low income, being a Bolsa Família recipient, having a low level of education and living in a household without children. CONCLUSIONS: Half of the participants experienced moderate or severe FI, and almost 10 % experienced hunger. Our data suggest that families with children were at a lower risk of moderate to severe FI. It is possible that nationally established social programmes such as Bolsa Família were protecting those families.

Hyperlipidic diet affects body composition and induces anxiety-like behaviour in intrauterine growth-restricted adult mice.

NEW FINDINGS: What is the central question of this study? What is the effect in male and female offspring of a protein-deficient diet producing intrauterine growth restriction (IUGR) in maternal mice on morphometric, metabolic and behavioural parameters before and after a challenge with a fat diet? What is the main finding and its importance? Male and female mice presented different growth trajectories after birth. IUGR favoured increased adiposity in male mice, and high-fat diet-induced anxiety-like behaviour in female mice. ABSTRACT: As there is sexual dimorphism in the response to maternal manipulations, we aimed to analyse the effects of intrauterine growth restriction (IUGR) in both sexes on morphometric, metabolic and behavioural parameters throughout postnatal development, and after challenge with a hyperlipidic diet. Female Swiss mice (n = 59) were distributed into two groups (SD: standard diet, n = 26; and PDD: isocaloric protein-deficient diet, n = 33), 2 weeks before mating and during the gestational period. After birth, offspring from SD and PDD dams were cross-fostered and nurtured by SD dams until postnatal day (PND) 28. At PND 60 all animals were challenged with a hypercaloric diet for 4 weeks. Offspring birth weight was significantly reduced in the PDD group compared to the SD group (P = 0.0001), but only male offspring presented a rapid catch-up during the first 21 days of development. Although no differences in body weight were observed between groups after the challenge with the hyperlipidic diet, an increase in the relative perigonadal white adipose tissue (P = 0.009) and a decrease in gross gastrocnemius muscle weight (P = 0.010) were observed in the PDD males. In relation to behavioural tests, there was an increase in locomotion in both sexes (P = 0.0001), and a decrease in female grooming (P = 0.006) in the PDD group. Additionally, females from the PDD group showed increased hyperlipidic food intake. In conclusion, IUGR affected both sexes, with females showing prominent behavioural modifications and males presenting altered body composition elicited by a hyperlipidic diet.

Is low birth weight an additional risk factor for hypertension in paediatric patients after kidney transplantation?

Hypertension (HTN) remains a common complication after kidney transplantation among paediatric patients. Although low birth weight (LBW) has been implicated as an important risk factor for cardiovascular diseases, its effect on transplantation patients has not yet been addressed. It is essential to determine whether children with LBW who undergo transplantation are more likely to develop post-transplantation HTN. For this study, the medical records of 96 kidney recipients were retrospectively examined. A total of 83 patients fulfilled the inclusion criteria. Overall, post-transplantation HTN was observed in 54% of the recipients. Multivariate logistic regression revealed that time from transplantation >14 months (odds ratio (OR) 3.6; 95% confidence interval (CI) 1.31-10.06; P = 0.013), current CKD (OR 2.6; 95% CI 1.01-7.20; P = 0.045), presence of LBW (OR 3.6; 95% CI 1.04-12.32; P = 0.044) and current overweight/obesity (OR 3.7; 95% CI 1.02-13.91; P = 0.047) were associated with post-transplantation HTN. In conclusion, our data provide evidence for the first time that LBW is a significant predictive factor in the development of post-transplantation HTN. This finding has important clinical implications as it serves to alert clinicians about this additional risk factor in paediatric patients undergoing kidney transplant.

Detrimental Impact of Low Birth Weight on Circulating Number and Functional Capacity of Endothelial Progenitor Cells in Healthy Children: Role of Angiogenic Factors.

OBJECTIVE: To provide a comprehensive assessment of the relationship of birth weight with both endothelial progenitor cell function and angiogenic factors in children. STUDY DESIGN: Anthropometric measures, biochemical profile, endothelial progenitor cell number, endothelial progenitor cell colony-forming units, vascular endothelial growth factor-A, and nitric oxide plasma levels of 58 children aged 7-11 years were determined. RESULTS: A positive correlation was observed between birth weight and circulating endothelial progenitor cell number (r= 0.461; P= .001), endothelial progenitor cell colony-forming units (r= 0.512; P < .001), vascular endothelial growth factor-A (r= 0.407; P= .002), and nitric oxide (r= 0.547; P < .001) levels, whereas the adjustment for prematurity, family history of cardiovascular disease, and systolic blood pressure levels did not modify these associations. CONCLUSION: Low birth weight was associated with a decrease in the circulating/functional capacity of endothelial progenitor cells among healthy children, independent of traditional cardiovascular risk factors. This detrimental impact was accompanied by lower circulating levels of angiogenic factors.

Intervenção sobre fatores de risco emcrianças e adolescentes / Risk factor intervention in children and adolescents

As doenças cardiovasculares estão entre as principais causas de mortalidade no mundo e não afligem apenas os adultos. Muitos trabalhos têm demonstrado que elas já podem ser vistas na infância. Entre os fatores de risco para a doença cardiovascular, pode-se destacar a dislipidemia, o baixo peso ao nascer e a obesidade infantil. A detecção de dislipidemia na infância é crucial, por ser considerada a fase estratégica para a implementação de medidas de prevenção da aterosclerose no âmbito populacional. Embora as causas ambientais ou poligênicas sejam as mais frequentes, é importante a identificação de formas genéticas como a hipercolesterolemia familiar e hipertrigliceridemias de base genética, pois medidas relacionadas aos hábitos de vida e terapêutica medicamentosa devem ser iniciadas preco-cemente, evitando-se complicações e mudando a história natural dos desfechos clínicos. Outros estudos têm demonstrado que o baixo peso ao nascer também contribui para o desenvolvimento tardio de hipertensão arterial, doença coronariana e disfunção endotelial. Possivelmente, por conta das agressões ao sistema vascular em desenvolvimento. No en-tanto, os mecanismos ainda são incertos. Evidências sugerem que alguns biomarcadores, tais como os níveis de ácido úrico e homocisteína e a baixa concentração de óxido nítrico observados em crianças com baixo peso ao nascer, podem estar associados a alterações deletérias na vida adulta. Por fim, o terceiro fator que deve ser considerado é a obesidade infantil. Essa desordem tem causa multifatorial e pode favorecer o surgimento das etapas iniciais da aterosclerose, como a disfunção endotelial, já na infância. Porém, é um fator de risco modificável, e as estratégias de prevenção e intervenção baseiam-se, na maioria dos casos, em mudanças do estilo de vida, como alimentação saudável e exercício físico.

Cardiovascular disease is one of the leading causes of mortality in the world and does not affect adults alone. Many papers have shown that it can already be seen in childhood. The most significant risk factors for cardiovascular disease include dyslipidemia, low birth weight and childhood obesity. Screening for dyslipidemia in childhood is crucial as this is considered a strategic phase for the implementation of measures aimed at preventing atherosclerosis in the population setting. Although environment or polygenic causes are the most common, it is important to identify genetic forms such as familial hypercholesterolemia and hypertriglyceridemia, since measures related to lifestyle and pharmacotherapy must be initiated early in life to avoid complications and change the natural history of clinical outcomes. Other studies have shown that low birth weight also contributes to the late development of hypertension, coronary artery disease and endothelial dysfunction, possible due to injury to the developing vascular system. However, the mechanisms are still uncertain, and evidence suggests that some biomarkers, such as uric acid and homocysteine levels, and the low concentration of nitric oxide observed in low birthweight children, may be associated with deleterious changes in adulthood. Finally, the third factor to be considered is childhood obesity. This disorder has a multifactorial etiology and may favor the onset of the first stages of atherosclerosis, such as endothelial dysfunction, in young children. However, it is a modifiable risk factor, and prevention and intervention strategies are largely based on lifestyle changes such as healthy diet and exercise