Lymphocyte to High-density Lipoprotein Cholesterol Ratio is Positively Associated with Pre-diabetes, Metabolic Syndrome, and Non-traditional Cardiometabolic Risk Markers: A Cross-sectional Study at Secondary Health Care.

High scores of lymphocyte-to-high-density lipoprotein cholesterol ratio (lymphocyte-to-HDL-c) may be a new indicator of inflammation and metabolic syndrome. Here, we investigated the associations of the lymphocyte-to-HDL-c with traditional and non-traditional cardiometabolic risk markers in subjects at high cardiovascular risk. This study is a cross-sectional analysis with subjects assisted in a Secondary Health Care (n = 581, age = 63.06 ± 13.86 years; 52.3% women). Lymphocyte-to-HDL-c ratio were assessed by routine laboratory tests. Anthropometric and/or biochemical variables were used to calculate traditional (body mass index - BMI, and waist-to-height ratio - WHtR) and non-traditional (lipid accumulation product index-LAP, visceral adiposity index-VAI, deep-abdominal-adipose-tissue index-DAAT, atherogenic index of plasma-AIP, and waist-hypertriglyceridemic phenotype-HTGW) cardiometabolic risk markers. Furthermore, anthropometric measurement waist circumference (WC), blood pressure, metabolic syndrome (MS), and biochemical markers (lipid and glycemic profile) were considered traditional markers of cardiometabolic risk. Pearson's chi-square test, Poisson regression with robust variance, or multinomial logistic regression were performed (α = 0.05). Individuals with a high lymphocyte-HDL-c ratio (> 0.84, 3rd tertile) were associated with the HTGW phenotype, high VAI, high LAP, hypertriglyceridemia, high AIP, high very low-density lipoprotein-cholesterol (VLDL-c), pre-diabetes, and 3 and 4 MS components compared with individuals in the first tertile, independent of confounders. Our findings supported the lymphocyte-to-HDL-c ratio as a potential biomarker during the screening of subjects at high cardiovascular risk.

Prevalence and factors associated with dietary adherence in individuals with type 2 diabetes mellitus in Brazil: a systematic review with meta-analysis / Prevalência e fatores associados à adesão à dieta em indivíduos com diabetes mellitus tipo 2 no Brasil: Uma revisão sistemática com meta-análise

Introduction: Low adherence to the treatment is a major challenge faced by health professionals during the management of type 2 diabetes. Objective: To assess the prevalence and risk factors related to dietary adherence in individuals living with type 2 diabetes in Brazil. Material and Methods: PubMed, Embase, Cochrane Library and SciELO/Lilacs were searched without restriction to a year of publication and language. Results: From 3713 studies, 14 articles involving 2962 individuals living with type 2 diabetes were eligible. The combined proportion of adherence to the diet was 41% (95% CI: 0.267-0.562, p< 0.001; I2= 98.81%, p<0.001), with the highest 78% and lowest 3%. The combined proportion of nonadherence to the diet was 51% (95% CI: 0.268-0.754, p<0.001; I²= 99.25%, p<0.001), with the highest being 98% and the lowest being 9%. The main risk factors for nonadherence to nutritional treatment were low education, low income, and multimorbidity. Conclusion: Low adherence to the diet is a concern during nutritional counseling of individuals living with type 2 diabetes in Brazil.

Introdução: A baixa adesão ao tratamento é um dos principais desafios enfrentados pelos profissionais de saúde durante a gestão da diabetes tipo 2. Objetivo: Avaliar a prevalência e os fatores de risco relacionados à adesão à dieta em indivíduos vivendo com diabetes mellitus tipo 2 no Brasil. Material e Métodos: Foram pesquisadas as bases de dados PubMed, Embase, Cochrane Library e SciELO/Lilacs, sem restrição de ano de publicação e idioma. Resultados: De 3713 estudos, 14 artigos envolvendo 2962 indivíduos vivendo com diabetes mellitus tipo 2 foram elegíveis. A proporção combinada de adesão à dieta foi de 41% (IC 95%: 0,267-0,562, p<0,001; I2= 98,81%, p<0,001), sendo a maior 78% e a menor 3%. A proporção combinada de não adesão à dieta foi de 51% (IC 95%: 0,268-0,754, p<0,001; I²= 99,25%, p<0,001), sendo a mais elevada de 98% e a mais baixa de 9%. Os principais fatores de risco para a não adesão ao tratamento nutricional foram a baixa escolaridade, a baixa renda e a multimorbidade. Conclusão: A baixa adesão à dieta é uma preocupação durante o aconselhamento nutricional de indivíduos vivendo com diabetes mellitus tipo 2 no Brasil.

Breastfeeding versus free distribution of infant formulas by the Public Health System.

OBJECTIVE: To characterize the situation of breastfeeding and the adequacy of prescription of infant formulas to infants assisted by a secondary care program of the Public Health System. METHODS: This is a cross-sectional study with analysis of medical records of 350 infants from zero to 6 months, followed up between February to April 2019. RESULTS: The possibility of breastfeeding was present in 97.0% of mothers and no infant presented an acceptable medical condition for proscription of breastfeeding. Despite this, only 47.2% of cases were on exclusive breastfeeding before being referred to the program. Regarding the reasons for the introduction of infant formulas, complementation to breast milk was the most present (75.8%), followed by mothers returning to the job market (20.1%). The general rates of inadequacy of those prescribed were 65% before arriving at the program, increasing to 69% (standard formulas) and 80% (formulas for special purposes) during follow-up. CONCLUSION: The low rate of exclusive breastfeeding and the indiscriminate prescription of infant formulas are a concern for damage to maternal-child healthcare and sound finances of the Public Health System.

Breastfeeding versus free distribution of infant formulas by the Public Health System / Aleitamento materno versus distribuição gratuita de fórmulas infantis pelo Sistema Único de Saúde

ABSTRACT Objective: To characterize the situation of breastfeeding and the adequacy of prescription of infant formulas to infants assisted by a secondary care program of the Public Health System. Methods: This is a cross-sectional study with analysis of medical records of 350 infants from zero to 6 months, followed up between February to April 2019. Results: The possibility of breastfeeding was present in 97.0% of mothers and no infant presented an acceptable medical condition for proscription of breastfeeding. Despite this, only 47.2% of cases were on exclusive breastfeeding before being referred to the program. Regarding the reasons for the introduction of infant formulas, complementation to breast milk was the most present (75.8%), followed by mothers returning to the job market (20.1%). The general rates of inadequacy of those prescribed were 65% before arriving at the program, increasing to 69% (standard formulas) and 80% (formulas for special purposes) during follow-up. Conclusion: The low rate of exclusive breastfeeding and the indiscriminate prescription of infant formulas are a concern for damage to maternal-child healthcare and sound finances of the Public Health System.

RESUMO Objetivo: Caracterizar a situação de aleitamento materno e da adequação de prescrição de fórmulas infantis a lactentes assistidos por um programa de Atenção Secundária do Sistema Único de Saúde. Métodos: Trata-se de estudo transversal pela análise de prontuários de 350 lactentes de zero a 6 meses, acompanhados entre fevereiro a abril de 2019. Resultados: A possibilidade de aleitamento materno esteve presente em 97,0% das mães, e nenhum lactente apresentou condição médica aceitável para a proscrição do aleitamento materno. Apesar disso, apenas 47,2% dos casos estavam em aleitamento materno exclusivo antes do encaminhamento ao programa. Em relação aos motivos da introdução das fórmulas infantis, a complementação ao leite materno foi o mais presente (75,8%), seguido da volta da mãe ao mercado de trabalho (20,1%). As taxas gerais de inadequação dentre os prescritos foram de 65% antes da chegada ao programa, passando para 69% (fórmulas padrão) e 80% (fórmulas para fins especiais) durante o acompanhamento. Conclusão: A baixa taxa de aleitamento materno exclusivo e a prescrição indiscriminada de fórmulas infantis são preocupantes por causar prejuízos à saúde maternoinfantil e financeira do Sistema Único de Saúde.

Dietary fat and gut microbiota: mechanisms involved in obesity control.

Obesity is a serious global health problem that is directly related to various morbidities manifestation. Intestinal dysbiosis has been implicated on obesity pathogenesis. Diet composition can alter gut microbiota, regardless of energy intake. Dietary fatty acids quality may affect gut microbiota composition, which in turn may affect host metabolic health. The mechanisms by which the different type of FFA modulate gut microbiota is yet poor elucidate and there is a lack of studies regard to this. Fatty acids may act in cell membrane, interfere with energy production, inhibit enzymatic activities, impair nutrient absorption and generate toxic compounds to cells, leading to growth inhibition or even bacterial death. The beneficial effect of the consumption of n-3 polyunsaturated fatty acids (PUFA) and conjugated linoleic acid (CLA) on microbiota, unlike n-6 PUFA and saturated fatty acids has been suggested. n-3 PUFA consumption promotes desirable changes on obese intestinal microbiota making it similar to that of normal weight individuals. More studies are needed to better understand the effect of CLA on microbiota and host health. Long term human controlled clinical trials must be conducted to allow us to understand the complex interaction between dietary fat, intestinal microbiota and obesity.

Effects of coconut oil consumption on energy metabolism, cardiometabolic risk markers, and appetitive responses in women with excess body fat.

PURPOSE: Virgin coconut oil (VCO) is a medium-chain fatty acid source with popularly attributed benefits on obesity management. However, its role on obesity requires elucidation due to its saturated nature. In the study herein, we investigated acute effects of VCO consumption on energy metabolism, cardiometabolic risk markers, and appetitive responses in women with excess body fat. METHODS: Fifteen adult women with excess body fat (37.43 ± 0.83%) participated in this randomized, crossover, controlled study. Two isocaloric mixed breakfasts containing 25 mL of VCO or control (extra-virgin olive oil-C) were evaluated. Resting energy expenditure (REE), fat oxidation rate (FOR), diet induced thermogenesis (DIT) and appetitive subjective responses were assessed at fasting and postprandial periods (up to 240 min). Cardiometabolic risk markers were assessed at fasting and up to 180 min postprandially. RESULTS: VCO did not affect REE, FOR, and DIT compared to C. In addition, VCO did not cause deleterious change in triglycerides, total cholesterol, HDL-c, LDL-c, triglycerides/HDL-c ratio, uric acid, glucose and Homeostasis Model Assessment of Insulin Resistance Index (HOMA-IR) (P time×treatment > 0.05). However, VCO suppressed less hunger (P time×treatment = 0.003), total satiety (P iAUC = 0.021) and total fullness (P iAUC = 0.035) responses than C. CONCLUSIONS: VCO consumption did not acutely change energy metabolism and cardiometabolic risk markers when added to a mixed breakfast but promoted less appetitive responses.

Impact of dietary fat on gut microbiota and low-grade systemic inflammation: mechanisms and clinical implications on obesity.

Dietary fat strongly affects human health by modulating gut microbiota composition and low-grade systemic inflammation. High-fat diets have been implicated in reduced gut microbiota richness, increased Firmicutes to Bacteroidetes ratio, and several changes at family, genus and species levels. Saturated (SFA), monounsaturated (MUFA), polyunsaturated (PUFA) and conjugated linolenic fatty acids share important pathways of immune system activation/inhibition with gut microbes, modulating obesogenic and proinflammatory profiles. Mechanisms that link dietary fat, gut microbiota and obesity are mediated by increased intestinal permeability, systemic endotoxemia, and the activity of the endocannabinoid system. Although the probiotic therapy could be a complementary strategy to improve gut microbiota composition, it did not show permanent effects to treat fat-induced dysbiosis. Based upon evidence to date, we believe that high-fat diets and SFA consumption should be avoided, and MUFA and omega-3 PUFA intake should be encouraged in order to regulate gut microbiota and inflammation, promoting body weight/fat control.

Ingestão de açúcar de adição por estudantes daárea da saúde em uma instituição de ensino de Viçosa, Brasil / Added sugar intake of health area students in an educationalinstitution of Viçosa, Brazil

Evidências mostram que o consumo excessivo de açúcares, pode comprometer a qualidade da alimentação impactandonegativamente na saúde. Assim, o objetivo do presente estudo foi avaliar o consumo de macronutrientes e adequaçãodo consumo de açúcar por estudantes da área da saúde da Universidade Federal de Viçosa, Brasil. Participaram desteestudo 157 mulheres e 30 homens, com faixa etária de 21,3 ± 3,4 anos, apresentando IMC e CC médios de 22,03 ±4,03 kg.m-2 e 72,95 ± 8,96 cm, respectivamente. Foram aplicados questionários semiestruturados e procedeu-se àsavaliações antropométricas e dietéticas dos indivíduos. Os resultados revelaram alta ingestão média diária de açúcarde adição (69,21 ± 5,25 g) que, consequentemente, aumentou o teor de frutose da alimentação (36,22 ± 29,78 g),além de uma baixa ingestão de fibras (15,51 ± 7,30 g). Verificou-se que a ingestão média de açúcar de adição estevesignificativamente (p<0,05) associada ao peso corporal (0,172; p=0,041), IMC (0,181; p=0,031) e consumo dosmacronutrientes e cálcio (0,247; p=0,003). Deve-se considerar a necessidade de implementação de medidas que visempromover mudanças comportamentais importantes no que diz respeito à alimentação de graduandos dos cursos desaúde.

Evidence shows that excessive sugar consumption may impair the quality of feeding affecting negatively on health. Theobjective of this study was evaluated the intake of macronutrients and adequacy of sugar consumption by healthcarestudents of Federal University of Viçosa, Brazil. The study included 157 women and 30 men, aged 21.3 ± 3.4 years,with mean body mass index (BMI) of 22.03 ± 4.03 kg m-2 and waist circumference (WC) of 72.95 ± 8.96 cm. Semistructuredquestionnaires were administered and proceeded to anthropometric and dietary assessments of individuals.The results revealed high average daily intake of added sugar (69.21 ± 5.25 g) which consequently increased the fructosecontent of feeding (36.22 ± 29.78 g), and a low intake of fiber (15.51 ± 7.30 g). It was found that the average intakeof added sugar was significantly (p <0.05) associated to body weight (0.172, p = 0.041), BMI (0.181, p = 0.031) andconsumption of macronutrients and calcium (0.247; p = 0.003). Should consider the need to implement measures topromote significant behavioral changes with regard to the supply of undergraduate health courses.

Vitamin D: link between osteoporosis, obesity, and diabetes?

Vitamin D (1,25(OH)2D3) is a steroid hormone that has a range of physiological functions in skeletal and nonskeletal tissues, and can contribute to prevent and/or treat osteoporosis, obesity, and Type 2 diabetes mellitus (T2DM). In bone metabolism, vitamin D increases the plasma levels of calcium and phosphorus, regulates osteoblast and osteoclast the activity, and combats PTH hypersecretion, promoting bone formation and preventing/treating osteoporosis. This evidence is supported by most clinical studies, especially those that have included calcium and assessed the effects of vitamin D doses (≥800 IU/day) on bone mineral density. However, annual megadoses should be avoided as they impair bone health. Recent findings suggest that low serum vitamin D is the consequence (not the cause) of obesity and the results from randomized double-blind clinical trials are still scarce and inconclusive to establish the relationship between vitamin D, obesity, and T2DM. Nevertheless, there is evidence that vitamin D inhibits fat accumulation, increases insulin synthesis and preserves pancreatic islet cells, decreases insulin resistance and reduces hunger, favoring obesity and T2DM control. To date, there is not enough scientific evidence to support the use of vitamin D as a pathway to prevent and/or treat obesity and T2DM.

Use of the glycemic index in nutrition education / Uso do índice glicêmico na educação nutricional

Recently, the lack of studies providing practical guidance for the use of the glycemic index has been indicated as the cause of its little use in nutrition education. The aim of this study is to give instructions on the use of the glycemic index as a tool to be used in nutrition education to estimulate the consumption of low glycemic index foods. Studies published over the past 12 years, in addition to classic studies on this topic, found in the databases MedLine, ScienceDirect, SciELO and Lilacs exploring the importance of the glycemic index and the factors that affect the glycemic index were selected for this article. The preparation of lists grouping foods according to their glycemic index should be based on information found in tables and specific web sites. This is an interesting strategy that must be very carefully conducted, considering the eating habits of the assisted people. To reduce the postprandial blood glucose response, high glycemic index foods should be consumed in association with the following foods: high protein and low fat foods, good quality oils and unprocessed foods with high fiber content. Caffeine should also be avoided. The glycemic index should be considered as an additional carbohydrate-selection tool, which should be part of a nutritionally balanced diet capable of promoting and/or maintaining body weight and health.

Recentemente, a falta de artigos que visam fornecer orientação quanto ao uso do índice glicêmico foi apontada como causa de sua baixa utilização na educação nutricional. O objetivo do presente trabalho é oferecer suporte para o uso do índice glicêmico como ferramenta a ser adotada na educação nutricional, para estimular o consumo preferencial de alimentos que apresentem menores valores nesse indicador. Foram selecionados estudos publicados nos últimos doze anos, além de estudos clássicos referentes ao tema, indexados nos bancos de dados MedLine, ScienceDirect, SciELO e Lilacs, que exploraram a importância do índice glicêmico e os fatores que interferem em seu valor. A elaboração de listas agrupando os alimentos segundo o índice glicêmico deve ser feita com base nas informações encontradas em tabelas e sites específicos. Essa é uma estratégia interessante que deve ser conduzida de maneira criteriosa, considerando-se os hábitos alimentares do público assistido. Para resultar em resposta glicêmica pós-prandial mais baixa, os produtos de alto índice glicêmico devem ser ingeridos em associação com alimentos ricos em proteína e pobres em gordura, com óleos de boa qualidade, com alimentos menos processados por ricos em fibras, evitando-se os com alto teor em cafeína. O índice glicêmico deve ser considerado uma ferramenta adicional para a escolha de alimentos fonte de carboidratos, os quais devem ser incluídos em uma dieta nutricionalmente equilibrada, capaz de promover e/ou manter tanto o peso corporal adequado quanto a saúde.