Mid-arm muscle circumference cutoff points in patients with cirrhosis: Low muscle mass related to malnutrition predicts mortality.

OBJECTIVES: Muscle loss is one of the phenotypic criteria of malnutrition, is highly prevalent in patients with cirrhosis, and is associated with adverse outcomes. Mid-arm muscle circumference (MAMC) estimates the skeletal muscle mass and is especially helpful in cases of fluid overload. This study aimed to propose MAMC cutoff points for patients with cirrhosis and demonstrate its association with 1-year mortality. METHODS: This is an analysis of cohort databases from five reference centers in Brazil that included inpatients and outpatients with cirrhosis aged ≥18 y. The nutritional variables obtained were the MAMC (n = 1075) and the subjective global assessment (n = 629). We established the MAMC cutoff points stratified by sex based on the subjective global assessment as a reference standard for malnutrition diagnosis, considering the sensitivity, specificity, and Youden index. An adjusted Cox regression model was used to test the association of MAMC cutoff points and 1-year mortality. RESULTS: We included 1075 patients with cirrhosis, with a mean age of 54.8 ± 11.3 y; 70.4% (n = 757) male. Most patients had alcoholic cirrhosis (47.1%, n = 506) and were classified as Child-Pugh B (44.7%, n = 480). The MAMC cutoff points for moderate and severe depletion were ≤21.5 cm and ≤24.2 cm; ≤20.9 cm and ≤22.9 cm for women and men, respectively. According to these cutoff points, 13.8% (n = 148) and 35.1% (n = 377) of the patients had moderate or severe MAMC depletion, respectively. The 1-year mortality rate was 17.3% (n = 186). In the multivariate analysis adjusted for sex, age, MELD-Na, and Child-Pugh scores, a severe depletion in MAMC was an independent increased risk factor for 1-year mortality (HR: 1.71, 95% CI: 1.24-2.35, P < 0.001). Each increase of 1 cm in MAMC values was associated with an 11% reduction in 1-year mortality risk (HR: 0.89, 95% CI: 0.85-0.94, P < 0.001). CONCLUSIONS: Low MAMC classified according to the new cutoff points predicts mortality risk in patients with cirrhosis and could be used in clinical practice.

Predicting dry weight in patients with cirrhotic ascites undergoing large-volume paracentesis.

BACKGROUND & AIMS: Ascites impairs the correct diagnosis and nutritional management in patients with cirrhosis, because the body weight, which is needed for nutritional assessment and calculation of nutritional needs, is overestimated. To adjust the weight in patients with ascites, dietetic guidances indicate substracting 2.2-14 kg or 5-15% of the measured body weight according to the degree of ascites, however, there is a lack of evidence to substantiate these values. The aim of this study was to develop new prediction equations to estimate the dry weight, comparing them with the currently used weight adjustments in patients with refractory cirrhotic ascites. METHODS: Cross-sectional study, that included patients with decompensated cirrhosis undergoing large-volume paracentesis. Patients were submitted to nutritional risk screening, nutritional assessment, and anthropometric measurements that included body weight, abdominal circumference (both measured before and after paracentesis) height, and upper mid-arm circumference. The volume of ascitic fluid drained was also registered. For the predictions of dry weight, linear regression models were performed using as predictor variables: height, pre-paracentesis weight, pre-paracentesis abdominal circumference, or mid-upper arm circumference, and as response variable: post-paracentesis weight. The capacity of these models to predict the post-paracentesis weight was evaluated by comparing it with the currently used predictions through the intraclass correlation coefficient (ICC) and the mean squared error (MSE). RESULTS: Nineteen patients were included, 15 male, and 18 with high nutritional risk and malnutrition. The difference between post-paracentesis weight and pre-paracentesis weight was -5.0 (-3.6 to -9.9) kg, similar to ascitic fluid volume drained. Two equations were developed to predict post-paracentesis weight. ICC values showed that both prediction equations were strongly correlated (r > 0.94) with post-paracentesis weight. Our models also showed lower MSEs (<17.97), compared with the current predictions (MSEs <64.19, when the pre-paracentesis weight is adjusted from absolute values and MSEs <33.24 when adjusted from percentage values), indicating a more accurate prediction. CONCLUSION: The predictive equations from this study may be better options for dry weight estimation in patients with refractory cirrhotic ascites since they showed higher reliability compared to the currently used weight adjustment. External validation in a larger sample is still needed to confirm the clinical applicability of these equations.

LIVER INJURY INDUCED BY HERBAL AND DIETARY SUPPLEMENTS: A POOLED ANALYSIS OF CASE REPORTS.

BACKGROUND: The intake of dietary supplements and medicinal plants is very popular worldwide. However, these products are not innocuous, and their intake can cause severe damage to health, especially liver injury. OBJECTIVE: This study aims to describe the clinical cases of dietary supplements-induced liver injury (DSILI) and herb-induced liver injury (HILI), identifying the main products involved and the clinical outcomes related to them. METHOD: A literature search was performed in PubMed, EMBASE, Google Scholar, and LILACS databases, using the search terms: "Chemical and Drug-Induced Liver Injury", "Dietary Supplements" and "Herbal" and their synonyms. RESULTS: 189 articles were included in the study, totaling 428 clinical cases of drug-induced liver injury. The most frequent agents of liver injury were Herbalife® products, associated with 50 cases, Polygonum multiflorum, with 25 cases, Hydroxycut® products, and green tea, both associated in 19 cases, and Oxyelite Pro® and kava tea, both associated with 16 cases. Most individuals required hospitalization (82.6%) and an important number of cases evolved to death (3.6%), liver transplantation (8.9%), or chronic liver disease (1.9%). CONCLUSION: The indiscriminate use of dietary supplements and herbal products was associated with an alarming number of cases of liver injury. The mechanisms through which each of the products causes liver damage still need to be better understood, but this review is a warning about the risk associated with the use of products considered harmless by a large part of the population.

Lesão hepática induzida por ervas e suplementos alimentares: uma análise agrupada de estudos de caso / Liver injury induced by herbal and dietary supplements: a pooled analysis of case reports

ABSTRACT Background: The intake of dietary supplements and medicinal plants is very popular worldwide. However, these products are not innocuous, and their intake can cause severe damage to health, especially liver injury. Objective: This study aims to describe the clinical cases of dietary supplements-induced liver injury (DSILI) and herb-induced liver injury (HILI), identifying the main products involved and the clinical outcomes related to them. Method: A literature search was performed in PubMed, EMBASE, Google Scholar, and LILACS databases, using the search terms: "Chemical and Drug-Induced Liver Injury", "Dietary Supplements" and "Herbal" and their synonyms. Results: 189 articles were included in the study, totaling 428 clinical cases of drug-induced liver injury. The most frequent agents of liver injury were Herbalife® products, associated with 50 cases, Polygonum multiflorum, with 25 cases, Hydroxycut® products, and green tea, both associated in 19 cases, and Oxyelite Pro® and kava tea, both associated with 16 cases. Most individuals required hospitalization (82.6%) and an important number of cases evolved to death (3.6%), liver transplantation (8.9%), or chronic liver disease (1.9%). Conclusion: The indiscriminate use of dietary supplements and herbal products was associated with an alarming number of cases of liver injury. The mechanisms through which each of the products causes liver damage still need to be better understood, but this review is a warning about the risk associated with the use of products considered harmless by a large part of the population.

RESUMO Contexto: O consumo de ervas medicinais e suplementos alimentares é muito popular no mundo. Contudo, esses produtos não são inócuos e sua ingestão pode causar danos à saúde, especialmente dano hepático. Objetivo: Descrever os casos clínicos de lesão hepática induzida por ervas e suplementos alimentares, identificando os principais produtos envolvidos e as manifestações relacionadas a eles. Métodos: A busca na literatura foi realizada na base de dados PubMed, EMBASE, Google Escolar e LILACS usando as seguintes palavras-chaves: "Chemical and Drug-Induced Liver Injury", "Dietary Supplements", e "Herbal", incluindo seus sinônimos. Resultados: Foram incluídos 189 artigos no estudo, totalizando 428 casos clínicos de lesão hepática induzida por drogas. Os agentes de lesão hepática mais frequentes foram produtos Herbalife, associados a 50 casos, Polygonum Multiflorum, a 25 casos, produtos Hydroxycut e chá verde, ambos associados a 19 casos, e produtos Hydroxycut e chá verde, associados a 16 casos. A maioria dos indivíduos necessitou de hospitalização (82,6%) e um número importante de casos evoluiu para óbito (3,6%), transplante hepático (8,9%) ou doença hepática crônica (1,9%). Conclusão: O uso indiscriminado de suplementos alimentares e ervas foi associado com um número alarmante de casos de lesão hepática. Os mecanismos pelos quais cada um dos produtos causa danos ao fígado ainda precisam ser melhor compreendidos, mas esta revisão é um alerta sobre o risco associado ao uso de produtos considerados inofensivos por grande parte da população.

Effect of probiotic supplementation in nonalcoholic steatohepatitis patients: PROBILIVER TRIAL protocol.

BACKGROUND: Recently factors in the relationship between gut microbiota, obesity, diabetes and the metabolic syndrome have been suggested in the development and progression of nonalcoholic steatohepatitis (NASH). In this sense, this work aims to evaluate the effects of probiotic supplementation on intestinal microbiota modulation, degree of hepatic steatosis and fibrosis, inflammation, gut permeability, and body composition. METHODS: This double-blind, randomized clinical trial will include adult outpatients with a diagnosis of NASH confirmed by biopsy with or without transient elastography. All patients will undergo a complete anamnesis to investigate their alcohol consumption, previous history, medications, nutritional assessment (dietary intake and body composition), sarcopenia, physical activity level and physical and functional capacity, cardiovascular risk, biochemical parameters for assessment of inflammatory status, lipid profile, hepatic function, gut permeability, and assessment of microbiota. These procedures will be performed at baseline and repeated after 24 weeks (at the end of the study). Through the process of randomization, patients will be allocated to receive treatment A or treatment B. Both patients and researchers involved will be blinded (double-blind study). The intervention consists of treatment with a probiotic mix (Lactobacillus acidophillus + Bifidobacterium lactis + Lactobacillus rhamnosus + Lactobacillus paracasei, 1 x 109 CFU for each) and the placebo which is identical in all its characteristics and packaging. Patients will be instructed to consume two sachets/day during 24 weeks and to report any symptoms or side effects related to the use of the sachets. Adherence control will be carried out through the patient's notes on a form provided, and also by checking the number of sachets used. DISCUSSION: The final results of study will be analyzed and disseminated in 2020. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03467282 . Registered on 15 March 2018.

Obesity, dynapenia and high cardiovascular risk co-exist in post-liver transplant setting: results of a cross-sectional study.

BACKGROUND: Cardiovascular disease is a major cause of death in post-liver transplantation (LT). The aim of this study was to evaluate LT patients as to the carotid intima-media thickness (CIMT) and its association with nutritional status, dietary intake, metabolic profile and cardiovascular risk factors. METHODS: In this cross-sectional study, adult patients with more than 12 months of post-transplant follow-up underwent clinical, laboratory, functional and nutritional evaluation by 3-day-diet-record, anthropometry and dynamometry. CIMT was evaluated by Doppler ultrasonography. RESULTS: Sixty-nine post-LT patients [males 61%, median of age 59 (51-64) years were included; median time post-liver transplantation 2.8 (1.4-6.3) years]. High prevalence of malnutrition was found (45% of arm muscle area < p15 and 71% of handgrip strength < p30). Excess weight was present in 72% of patients, body mass index ≥ 30 kg/m2 in 35% and metabolic syndrome in 51%. Abnormal CIMT was found in 54% of the sample. Patients with abnormal CIMT presented higher cardiovascular risk Score, LDL cholesterol, higher prevalence of high-sensitive C-reactive protein ≥ 1 mg/L and higher intake of saturated and trans fatty acids (P < 0.05 for all). CONCLUSIONS: Abnormal IMT was commonly found in LT patients presenting at the same time with overweight and dynapemia. These results were associated with higher LDL-cholesterol levels, high-sensitive C-reactive protein ≥ 1 mg/L and higher intake of saturated and trans fatty acids. Preventive measures, including dietary advice, are required for all post-liver transplantation patients to minimize cardiovascular risk.

Is dietary glycemic load associated with liver fibrosis in hepatitis C?

INTRODUCTION: Occidental diet and metabolic profile seems to increase hepatic fibrosis (HF) in patients with chronic hepatitis C virus (HCV) infection, but there is scarce information about the diet components and their role in this setting. OBJECTIVES: This study aims to evaluate the dietary intake, metabolic profile, presence of metabolic syndrome (MetS) and cardiovascular risk in patients with chronic HCV infection according to the presence of fibrosis. METHODS: Cross-sectional study which 58 patients with HCV infection without active antiviral therapy and non-cirrhotic were assessed. All patients were subjected to clinical, laboratorial and dietary evaluation, and classified according to the METAVIR score. Patients were divided as the presence of hepatic fibrosis. RESULTS: In this sample, fifty-five percent of patients were females, the average age was 51.6 ± 9.7 years, and 79.3% were carriers of HCV genotype 1. Patients with HF presented higher energy, and fat intake as well as higher glycemic load of meals in comparison to those without HF. Patients with HF presented higher systolic and diastolic arterial pressure and higher levels of insulin. CONCLUSIONS: In conclusion, patients with HF had higher total daily energy and total fat intakes, and worse metabolic profile, characterized by a higher insulin resistance and blood pressure.

Is dietary glycemic load associated with liver fibrosis in hepatitis C? / ¿Está asociada la carga glucémica en la dieta con la fibrosis hepática en la hepatitis C?

Introduction: Occidental diet and metabolic profile seems to increase hepatic fibrosis (HF) in patients with chronic hepatitis C virus (HCV) infection, but there is scarce information about the diet components and their role in this setting. Objectives: This study aims to evaluate the dietary intake, metabolic profile, presence of metabolic syndrome (MetS) and cardiovascular risk in patients with chronic HCV infection according to the presence of fibrosis. Methods: Cross-sectional study which 58 patients with HCV infection without active antiviral therapy and non-cirrhotic were assessed. All patients were subjected to clinical, laboratorial and dietary evaluation, and classified according to the METAVIR score. Patients were divided as the presence of hepatic fibrosis. Results: In this sample, fifty-five percent of patients were females, the average age was 51.6 ± 9.7 years, and 79.3% were carriers of HCV genotype 1. Patients with HF presented higher energy, and fat intake as well as higher glycemic load of meals in comparison to those without HF. Patients with HF presented higher systolic and diastolic arterial pressure and higher levels of insulin. Conclusions: In conclusion, patients with HF had higher total daily energy and total fat intakes, and worse metabolic profile, characterized by a higher insulin resistance and blood pressure (AU)

Introducción: en pacientes infectados crónicamente por el virus de la hepatitis C (VHC), la dieta occidental y el perfil metabólico parecen aumentar la fibrosis hepática (FH), sin embargo, existe poca información sobre los componentes de la dieta y su papel en este contexto. Objetivos: evaluar la ingesta dietética, el perfil metabólico, la presencia de síndrome metabólico (SAT) y el riesgo cardiovascular en pacientes con VHC crónico según la presencia de fibrosis. Métodos: estudio transversal en el que se evaluaron 58 pacientes con VHC sin terapia antiviral activa ni cirrótica. Todos los pacientes fueron sometidos a evaluación clínica, de laboratorio y dietética, y fueron clasificados según la puntuación METAVIR. Los pacientes se dividieron según la presencia de FH. Resultados: en esta muestra el 55% de los pacientes eran mujeres, con edad promedio de 51,6 +/- 9,7 anos, siendo el 79,3% portadores del genotipo 1 del VHC. Los alimentos de los pacientes con FH presentaron una mayor proporción de energía y grasa, así como mayor carga glucémica en comparación con las personas sin FH. Los pacientes con circunferencia de la cintura presentaron mayor presión arterial sistólica y diastólica y mayores niveles de insulina. Conclusión: en conclusión, los pacientes con FH presentaron un consumo mayor de energía y grasas diario total, y peor perfil metabólico, caracterizado por mayor resistencia a la insulina y presión arterial (AU)

Sedentary Lifestyle and High-Carbohydrate Intake are Associated with Low-Grade Chronic Inflammation in Post-Menopause: A Cross-sectional Study.

Introduction Cardiovascular disease (CVD) is the leading cause of death in post menopausal women, and inflammation is involved in the atherosclerosis process. Purpose to assess whether dietary pattern, metabolic profile, body composition and physical activity are associated with low-grade chronic inflammation according to high-sensitivity C-reactive protein (hs-CRP) levels in postmenopausal women. Methods ninety-five postmenopausal participants, with no evidence of clinical disease, underwent anthropometric, metabolic and hormonal assessments. Usual dietary intake was assessed with a validated food frequency questionnaire, habitual physical activity was measured with a digital pedometer, and body composition was estimated by bioelectrical impedance analysis. Patients with hs-CRP ≥10 mg/L or using hormone therapy in the last three months before the study were excluded from the analysis. Participants were stratified according to hs-CRP lower or ≥3 mg/L. Sedentary lifestyle was defined as walking fewer than 6 thousand steps a day. Two-tailed Student's t-test, Wilcoxon-Mann-Whitney U or Chi-square (χ(2)) test were used to compare differences between groups. A logistic regression model was used to estimate the odds ratio of variables for high hs-CRP. Results participants with hs-CRP ≥3 mg/L had higher body mass index (BMI), body fat percentage, waist circumference (WC), triglycerides, glucose, and homeostasis model assessment of insulin resistance (HOMA-IR) (p = 0.01 for all variables) than women with hs-CRP <3 mg/L. Also, women with hs-CRP ≥3 mg/L had a higher glycemic load diet and lower protein intake. Prevalence of sedentary lifestyle (p < 0.01) and metabolic syndrome (p < 0.01) was higher in women with hs-CRP ≥3 mg/L. After adjustment for age and time since menopause, the odds ratio for hs-CRP ≥3 mg/L was higher for sedentary lifestyle (4.7, 95% confidence interval [95%CI] 1.4-15.5) and carbohydrate intake (2.9, 95%CI 1.1-7.7). Conclusions sedentary lifestyle and high-carbohydrate intake were associated with low-grade chronic inflammation and cardiovascular risk in postmenopause.

Sedentary Lifestyle and High-Carbohydrate Intake are Associated with Low-Grade Chronic Inflammation in Post-Menopause: A Cross-sectional Study / Sedentarismo e alto consumo de carboidratos associados à inflamação crônica de baixo grau na pós-menopausa: um estudo transversal

Abstract Introduction Cardiovascular disease (CVD) is the leading cause of death in post menopausal women, and inflammation is involved in the atherosclerosis process. Purpose to assess whether dietary pattern, metabolic profile, body composition and physical activity are associated with low-grade chronic inflammation according to highsensitivity C-reactive protein (hs-CRP) levels in postmenopausal women. Methods ninety-five postmenopausal participants, with no evidence of clinical disease, underwent anthropometric, metabolic and hormonal assessments. Usual dietary intake was assessed with a validated food frequency questionnaire, habitual physical activity was measured with a digital pedometer, and body composition was estimated by bioelectrical impedance analysis. Patients with hs-CRP ≥ 10 mg/L or using hormone therapy in the last three months before the study were excluded from the analysis. Participants were stratified according to hs-CRP lower or ≥3 mg/L. Sedentary lifestyle was defined as walking fewer than 6 thousand steps a day. Two-tailed Student's t-test, Wilcoxon-Mann-Whitney U or Chi-square (x 2) test were used to compare differences between groups. A logistic regression model was used to estimate the odds ratio of variables for high hs-CRP. Results participants with hs-CRP ≥ 3 mg/L had higher body mass index (BMI), body fat percentage, waist circumference (WC), triglycerides, glucose, and homeostasis model assessment of insulin resistance (HOMA-IR) (p = 0.01 for all variables) than women with hs-CRP <3 mg/L. Also, women with hs-CRP ≥3 mg/L had a higher glycemic load diet and lower protein intake. Prevalence of sedentary lifestyle (p < 0.01) and metabolic syndrome (p < 0.01) was higher in women with hs-CRP ≥3 mg/L. After adjustment for age and time since menopause, the odds ratio for hs- CRP ≥3 mg/L was higher for sedentary lifestyle (4.7, 95% confidence interval [95%CI] 1.4-15.5) and carbohydrate intake (2.9, 95%CI 1.1-7.7). Conclusions sedentary lifestyle and high-carbohydrate intake were associated with low-grade chronic inflammation and cardiovascular risk in postmenopause.

Resumo Introdução A doença cardiovascular é a principal causa de morte em mulheres na pós-menpausa e inflamação está envolvida com o processo de aterosclerose. Objetivo avaliar se o padrão alimentar, o perfilmetabólico, a composição corporal e a atividade física estão associados à inflamação crônica de baixo grau, de acordo com os níveis de proteína C-reativa (PCR-us), em mulheres na pós-menopausa. Métodos noventa e cinco participantes pós-menopáusicas foram submetidas a avaliações antropométrica, metabólica e hormonal. A ingestão alimentar foi avaliada por meio de questionário de frequência alimentar, a atividade física habitual, com pedômetro digital, e a composição corporal, por bioimpedância elétrica. Pacientes com PCR-us ≥10 mg/L ou em uso de terapia hormonal nos últimos três meses antes do estudo foram excluídas. As participantes foram estratificadas de acordo PCR-us inferior ou ≥3 mg/L. Pacientes com menos de 6 mil passos/dia foram consideradas sedentárias. Para análise estatística foram utilizados teste t de Student, Wilcoxon-Mann- Whitney U ou Qui-quadrado (x 2), além de modelo de regressão logística para estimar a razão de chances para PCR-us elevada. Resultados participantes com PCR-us ≥3 mg/L apresentaram maior índice de massa corporal (IMC), percentual de gordura corporal, circunferência da cintura, triglicerídeos, glicose e índice de insulino-resistência (HOMA-IR) (p = 0,01) comparadas às mulheres com PCR-us <3 mg/L. O grupo PCR-us ≥3 mg/L apresentou uma dieta com maior carga glicêmica e menor ingestão de proteínas. A prevalência de sedentarismo e síndrome metabólica foi maior em mulheres com PCR-us ≥3 mg/L (p < 0,01). Após ajuste para idade e tempo de menopausa, a razão de chances para PCR-us ≥3mg/L foi maior nas sedentárias (4,7, intervalo de confiança de 95% [95%CI] 1,4-15,5) e com maior ingestão de carboidratos (2,9, 95%CI 1.1-7,7). Conclusões Sedentarismo e alta ingestão de carboidratos foram associados com inflamação crônica de baixo grau e risco cardiovascular em mulheres na pósmenopausa.

REDUCED HAND GRIP STRENGTH IN OVERWEIGHT AND OBESE CHRONIC HEPATITIS C PATIENTS.

BACKGROUND: Hepatitis C is a liver disease that causes significant changes in metabolism, and also has an impact on nutritional status. OBJECTIVE: To evaluate the nutritional status and cardiovascular risk in patients with chronic hepatitis C. METHODS: This cross-sectional study investigated 58 patients with chronic hepatitis C, non-cirrhotic and were not under active pharmacological treatment. Patients with significant alcohol consumption (greater than 10 g ethanol/day) were excluded. Patients underwent nutritional assessment through anthropometric measurements and functional assessment using hand grip strength by dynamometry. The physical activity was assessed using the International Physical Activity Questionnaire. Patients also underwent clinical and laboratory evaluation. Cardiovascular risk was calculated by the Framingham score. RESULTS: The mean age of patients was 51.6±9.7 years, 55.2% were female, and 79.3% had genotype 1. The most prevalent degree of fibrosis was F1 (37.9%) followed by F2 (27.6%) and F3 (1.7%). The prevalence of overweight/obesity considering the body mass index was 70.7%. However, 57.7% of men and 68.8% of women were considered malnourished according to hand grip strength. These patients also had waist circumference (93.5±10.7 cm) and neck circumference (37.0±3.6 cm) high. Almost 60% of patients were considered sedentary or irregularly active. In relation to cardiovascular risk, 50% of patients had high risk of suffering a cardiovascular event within 10 years. CONCLUSION: Although most patients with hepatitis C presented overweight, associated with high cardiovascular risk, they also have reduced functional capacity, indicative of protein-caloric commitment. Therefore, body mass index can not be considered the only method of assessment for nutritional diagnosis of patients with liver disease. Adopting methods such as hand grip strength can be important for a better understanding of nutritional status of these patients.

Reduced hand grip strength in overweight and obese chronic hepatitis c patients

ABSTRACT Background Hepatitis C is a liver disease that causes significant changes in metabolism, and also has an impact on nutritional status. Objective To evaluate the nutritional status and cardiovascular risk in patients with chronic hepatitis C. Methods This cross-sectional study investigated 58 patients with chronic hepatitis C, non-cirrhotic and were not under active pharmacological treatment. Patients with significant alcohol consumption (greater than 10 g ethanol/day) were excluded. Patients underwent nutritional assessment through anthropometric measurements and functional assessment using hand grip strength by dynamometry. The physical activity was assessed using the International Physical Activity Questionnaire. Patients also underwent clinical and laboratory evaluation. Cardiovascular risk was calculated by the Framingham score. Results The mean age of patients was 51.6±9.7 years, 55.2% were female, and 79.3% had genotype 1. The most prevalent degree of fibrosis was F1 (37.9%) followed by F2 (27.6%) and F3 (1.7%). The prevalence of overweight/obesity considering the body mass index was 70.7%. However, 57.7% of men and 68.8% of women were considered malnourished according to hand grip strength. These patients also had waist circumference (93.5±10.7 cm) and neck circumference (37.0±3.6 cm) high. Almost 60% of patients were considered sedentary or irregularly active. In relation to cardiovascular risk, 50% of patients had high risk of suffering a cardiovascular event within 10 years. Conclusion Although most patients with hepatitis C presented overweight, associated with high cardiovascular risk, they also have reduced functional capacity, indicative of protein-caloric commitment. Therefore, body mass index can not be considered the only method of assessment for nutritional diagnosis of patients with liver disease. Adopting methods such as hand grip strength can be important for a better understanding of nutritional status of these patients.

RESUMO Contexto A hepatite C é uma doença hepática que provoca alterações importantes no metabolismo e também tem impacto no estado nutricional. Objetivo Avaliar o estado nutricional e o risco cardiovascular em pacientes com hepatite C crônica. Métodos Este estudo transversal investigou 58 pacientes com hepatite C crônica, não cirróticos e que não estavam sob tratamento farmacológico ativo. Pacientes com consumo de álcool significativo (maior de 10 g de etanol/dia) foram excluídos. Os pacientes realizaram avaliação nutricional, através de medidas antropométricas, e avaliação funcional, através da medida da força do aperto de mão pela dinamometria. A prática de atividade física foi avaliada através do Questionário Internacional de Atividade Física. Os pacientes também passaram por avaliação clínica e laboratorial. O risco cardiovascular foi calculado pelo escore de Framingham. Resultados A média de idade dos pacientes foi 51,6±9,7 anos, 55,2% eram do sexo feminino, e 79,3% apresentavam genótipo 1. O grau de fibrose mais prevalente foi F1 (37,9%), seguido por F2 (27,6%) e F3 (1,7%). A prevalência de sobrepeso/obesidade considerando o índice de massa corporal foi de 70,7%. No entanto, 57,7% dos homens e 68,8% das mulheres foram considerados desnutridos de acordo com a força do aperto de mão. Estes pacientes também apresentaram circunferência da cintura (93,5±10,7 cm) e circunferência do pescoço (37,0±3,6 cm) elevados. Quase 60% dos pacientes foram considerados sedentários ou irregularmente ativos. Em relação ao risco cardiovascular, 50% dos pacientes apresentou elevado risco de sofrer evento cardiovascular em 10 anos. Conclusão Apesar de grande parte dos pacientes com hepatite C apresentarem excesso de peso, associado a alto risco cardiovascular, os mesmos também apresentaram diminuição da capacidade funcional, indicativa de comprometimento proteico-calórico. Portanto, o índice de massa corporal não pode ser considerado o único método de avaliação para diagnóstico nutricional de pacientes com doença hepática. Adotar métodos como a força do aperto de mão pode ser importante para uma melhor compreensão do estado nutricional destes pacientes.

Health-related quality of life of pregnant women with heartburn and regurgitation.

BACKGROUND: Heartburn and regurgitation frequently occur in the third trimester of pregnancy, but their impact on quality of life has not been thoroughly investigated. OBJECTIVE: To measure health-related quality of life of third-trimester pregnant women with heartburn and regurgitation. Methods Data on obstetric history, heartburn and regurgitation frequency and intensity, history of heartburn and regurgitation and health-related quality of life were collected of 82 third-trimester pregnant women. RESULTS: Sixty-two (76%) women had heartburn, and 58 (71%), regurgitation; 20 were asymptomatic. Mean gestational age was 33.8±3.7 weeks; 35 (43%) women had a family history of heartburn and/or regurgitation, and 57 (70%) were asymptomatic before pregnancy. The following quality of life concepts were significantly reduced: physical problems and social functioning for heartburn; physical problems and emotional functioning for regurgitation. There was agreement between heartburn in present and previous pregnancies. CONCLUSION: Heartburn and/or regurgitation affected health-related quality of life of third trimester pregnant women.

Health-related uuality of life of pregnant women with heartburn and regurgitation / Qualidade de vida em gestantes com pirose e regurgitação

Background Heartburn and regurgitation frequently occur in the third trimester of pregnancy, but their impact on quality of life has not been thoroughly investigated. Objective To measure health-related quality of life of third-trimester pregnant women with heartburn and regurgitation. Methods Data on obstetric history, heartburn and regurgitation frequency and intensity, history of heartburn and regurgitation and health-related quality of life were collected of 82 third-trimester pregnant women. Results Sixty-two (76%) women had heartburn, and 58 (71%), regurgitation; 20 were asymptomatic. Mean gestational age was 33.8±3.7 weeks; 35 (43%) women had a family history of heartburn and/or regurgitation, and 57 (70%) were asymptomatic before pregnancy. The following quality of life concepts were significantly reduced: physical problems and social functioning for heartburn; physical problems and emotional functioning for regurgitation. There was agreement between heartburn in present and previous pregnancies. Conclusion Heartburn and/or regurgitation affected health-related quality of life of third trimester pregnant women .

Contexto A pirose e a regurgitação ocorrem com frequência no terceiro trimestre de gestação, mas o seu impacto na qualidade de vida não foi completamente investigado. Objetivo Avaliar a qualidade da vida de gestantes do terceiro trimestre com pirose e regurgitação. Métodos Os dados sobre a história obstétrica, frequência, intensidade e história de pirose e regurgitação, bem como a qualidade de vida foram coletados de 82 mulheres do terceiro trimestre de gestação. Resultados Sessenta e duas (76%) mulheres tinham pirose e, 58 (71%), regurgitação; 20 eram assintomáticas. A idade gestacional média foi de 33,8 ± 3,7 semanas; 35 (43%) mulheres tinham história familiar de pirose e/ou regurgitação e 57 (70%) eram assintomáticos antes da gestação. Os seguintes domínios de qualidade de vida estavam significativamente reduzidos: limitação física e aspectos sociais pela pirose; limitação física e aspectos emocionais pela regurgitação. Houve concordância entre pirose nas gestações atuais e prévias. Conclusão A pirose e/ou regurgitação afetam a qualidade de vida de gestantes de terceiro trimestre. .

Healthier dietary pattern and lower risk of metabolic syndrome in physically active postmenopausal women.

OBJECTIVES: To investigate the relationship between habitual physical activity and dietary intake, body composition, metabolic and hormonal variables, and cardiovascular risk factors in postmenopausal women with no evidence of cardiovascular disease. METHODS: In this cross-sectional study, 105 women (mean age: 55.2 ± 4.9 years) consulting for climacteric symptoms underwent anthropometric and hormonal assessment. Usual dietary intake was assessed with a food frequency questionnaire and habitual physical activity was assessed with a digital pedometer. Participants were classified as physically inactive (<6000 steps daily) or physically active (≥6000 steps daily). RESULTS: Compared to the inactive group, active women had higher protein, total fat, cholesterol, iron, calcium, and the antioxidant micronutrients zinc and selenium intake as well as differences on food groups: higher meat, egg, and whole-dairy intake and lower intake of chips. Active participants also presented lower diastolic blood pressure (p = 0.012), ultrasensitive C-reactive protein (us-CRP; p = 0.011), fasting glucose (p = 0.003), fasting insulin (p = 0.019), and homeostasis model assessment index (p = 0.017). After adjustment for age and time since menopause, the risk for metabolic syndrome increased with physical inactivity (odds ratio [OR] = 3.55, 95% confidence interval [CI], 1.08-11.66), us-CRP (OR = 6.57, 95% CI, 2.20-19.56), and percentage body fat (OR = 5.65, 95% CI, 1.19-28.89). CONCLUSION: Both physical activity and dietary choices may have contributed toward a more favorable cardiovascular profile and lower risk of metabolic syndrome in postmenopausal women.

Dietary glycemic index is associated with less favorable anthropometric and metabolic profiles in polycystic ovary syndrome women with different phenotypes.

OBJECTIVE: To compare glycemic index (GI) in the usual diet of polycystic ovary syndrome (PCOS) and control women and to investigate whether dietary GI is associated with body composition and anthropometric and metabolic variables across PCOS phenotypes. DESIGN: Cross-sectional study. SETTING: University hospital outpatient clinic. PATIENT(S): Sixty-one women with PCOS and 44 nonhirsute women with ovulatory cycles. INTERVENTION(S): Metabolic work-up, biochemical and hormonal assays, assessment of body composition and rest metabolic rate, physical activity (pedometer), and food consumption (food frequency questionnaire). MAIN OUTCOME MEASURE(S): GI, glycemic load, dietary intake, and hormone and metabolic profile in PCOS versus control and in PCOS women stratified by tertiles of GI and PCOS phenotype. RESULT(S): Mean age was 23.7 ± 6.3 years. Participants with PCOS had higher body fat percentage, fasting insulin, insulin resistance, lipid accumulation product, and androgen levels compared with control women. PCOS and control women in the highest tertile of GI had higher body mass index and waist circumference than those in the lowest tertile. Dietary GI was higher in the classic PCOS group. Obesity and this more severe PCOS phenotype explained 28.3% of variance in dietary GI. CONCLUSION(S): Dietary GI is increased in the classic PCOS phenotype and associated with a less favorable anthropometric and metabolic profile. Obesity and classic PCOS phenotype are age-independent predictors of higher dietary GI.

Benefits of pedometer-measured habitual physical activity in healthy women.

This cross-sectional study aimed at (i) characterizing pedometer-determined physical activity and (ii) examining its associations with dietary intake and anthropometric and metabolic profile in healthy women. Anthropometric and metabolic profile was evaluated in 68 healthy women of reproductive age. Habitual physical activity was assessed using a pedometer for 6 consecutive days, including weekends. Participants were stratified into active and inactive according to the mean steps·day(-1) (≥6000 and <6000, respectively). Food consumption was evaluated by 24-h recall in a subsample of 35 participants. Thirty-eight women were defined as active and had significantly lower body mass index (BMI), fat percentage, waist circumference, sum of skinfold thickness, insulin, and HOMA than the sedentary group. Mean BMI was 27 kg·m(-2) (overweight) in active participants and 31 kg·m(-2) (class I obesity) in inactive participants. Active women consumed more carbohydrates (55.5% ± 9.4% vs. 46.3% ± 7.6%) and calories (2138 ± 679 vs. 1664 ± 558 kcal), and less protein (15.4% ± 4.2% vs. 19.9% ± 5.8%) and lipids (29.0% ± 7.2% vs. 33.8% ± 6.2%) than inactive individuals (p < 0.05). Fiber, cholesterol, and fatty acid intake was similar in both groups. The number of steps was lower on Sunday than on weekdays for the overall group. Using a pedometer for 3 days was sufficient to determine habitual physical activity (sensitivity: 94%; specificity 91% vs. 6 days of pedometer use). In the present study, nonstructured physical activity was associated with more adequate dietary consumption and contributed toward a healthier anthropometric and metabolic profile in young women, despite the high prevalence of overweight.

Nutrição enteral artesanal, semiartesanal e industrializada em unidades hospitalares do Rio Grande do Sul: inquérito telefônico / Hospital-prepared, semi-industrialized and industrialized enteral nutrition in hospitals in Rio Grande do Sul: telephone survey

Introdução: estimativas apontam frequente utilização de formulações de nutrição enteral (NE) produzidas nas próprias unidades hospitalares (UHs) brasileiras por razões econômicas, culturais e logísticas. Objetivo: caracterizar o tipo de formulação de nutrição enteral utilizado, estabelecendo associações com o cadastramento das UHs para terapia nutricional enteral e com a equipe multidisciplinar de terapia nutricional. Métodos: foi realizado estudo transversal com UHs do Rio Grande do Sul (RS). Participaram do estudo UHs que utilizam terapia nutricional enteral para adultos internados, inseridas no Cadastro Nacional de Estabelecimentos de Saúde do Ministério da Saúde, como hospitais gerais, especializados, unidades mistas, pronto socorro geral, especializado e hospitais dia.Resultados: de um universo de 419 UHs do RS, foram incluídas 375 neste estudo. Considerando as perdas, recusas e a exclusão das UHs que não faziam uso de nutrição enteral, foram obtidos dados de 278 UHs de 220 municípios, por meio de entrevista telefônica com o profissional responsável pela terapia nutricional enteral. Das instituições participantes, 29,5% (82) relataram possuir equipes multidisciplinares de terapia nutricional enteral, sendo que, destas, 74,4% (61) possuíam equipe completa, 61,2% (170) utilizavam sistema aberto de infusão e 65,7% (182) usavam fórmula industrializada. Foi observada associação entre UHs cadastradas com o uso de fórmulas industrializadas, equipe multidisciplinar de terapia nutricional enteral completa, bomba de infusão (qui-quadrado; p < 0,001) e sistema fechado (qui-quadrado; p < 0,002), em contraposição às UHs não cadastradas. Conclusão: UHs cadastradas apresentam maiores conformidades quanto às recomendações do Ministério da Saúde.

Background: estimates indicate an increasing use of enteral formulas prepared in hospital kitchens in Brazil for economic, cultural and logistical reasons. Aim: to characterize the type of enteral nutrition used in hospitals, establishing an association with the hospital’s license for enteral nutrition therapy (ENT) and the multidisciplinary team of nutrition therapy (MTNT). Methods: this cross-sectional study was conducted in hospital units (HUs) located in the State of Rio Grande Sul, Brazil. HUs that used ENT for adult inpatients and were registered in the National Registry of Health Care Institutions of the Brazilian Ministry of Health, such as general and specialized hospitals, mixed units, general and specialized emergency departments, and day hospitals, participated in the study. Results: of a total of 419 HUs selected in the state, 375 were included in the study. Considering loss, refusal and exclusion of HUs that did not use enteral diets, we collected data from 278 HUs of 220 municipalities by telephone interview with the professional responsible for ENT. Of the participating institutions, 29.5% (82) reported having MTNTs, and of these, 74.4% (61) had a full team, 61.2% (170) used an open infusion system, and 65.7% (182) used industrially manufactured formulas. There was an association of registered HUs with use of industrially manufactured formulas, full MTNT, infusion pump (chi-square; p < 0.001), and closed systems (chi-square; p < 0.002), in contrast to non-registered HUs. Conclusion: Registered HUs show higher compliance with the recommendations of the Brazilian Ministry of Health.Conclusion: Further studies should be performed to confirm these findings.