Acuracy and concordance of anthropometric indicators and body composition in heart failure / Precisão e concordância de indicadores antropométricos e composição corporal na insuficiência cardíaca

Background: Anabolic/catabolic disorder in heart failure (HF) favors cardiac cachexia, implying a reduction in HF survival. Objectives: To assess the accuracy and concordance of the diagnosis of protein malnutrition and excess fat among the anthropometric and body composition methods in individuals with HF. Method: A study of accuracy that included 60 individuals with HF. Body mass index (BMI), arm circumference (AC), triceps skinfold thickness (TST), adductor pollicis muscle thickness (APMT), arm muscle circumference (AMC) and corrected arm muscle area (cAMA). Fat free mass index (FFMI) and body fat percentage (BF%), obtained by electrical bioimpedance (EBI), were used to compare the diagnosis of protein malnutrition and excess fat. Accuracy was assessed by calculating sensitivity, specificity, positive and negative predictive value. The concordance of the EBI diagnosis and other methods was performed by the chi-square test and kappa (k) statistic, where p<0.05 was considered significant.Results: Higher frequencies of protein malnutrition were identified by cAMA and AMC, and excess fat by BF%. BMI presented low sensitivity (43%) and accuracy (38.5%), with moderate concordance (0.50). AMC sensitivity was 86%, accuracy 66.4%, and acceptable concordance (0.36) compared to FFMI. Similar percentages of moderate sensitivity and low accuracy were observed for TST and BMI.Conclusion: AMC may be useful to identify protein malnutrition and TST has not been adequate to diagnose adiposity. BMI was not sensitive to assess muscle and adipose reserve. EBI was more accurate

Effect of maternal supplementation with vitamin E on the concentration of α-tocopherol in colostrum / Efeito da suplementação materna com vitamina E sobre a concentração de α-tocopherolol no colostro

Abstract: Objective: To evaluate the effect of maternal supplementation with vitamin E on the concentration of α-tocopherol in colostrum and its supply to the newborn. Method: This randomized clinical trial enrolled 99 healthy adult pregnant women; of these, 39 were assigned to the control group and 60 to the supplemented group. After an overnight fast, 5 mL of blood and 2 mL of colostrum were collected. After the first sampling (0 h milk), the supplemented group received 400 IU of supplementary vitamin E. Another 2 mL milk aliquot was collected in both groups 24 h after supplementation (24 h milk). The samples were analyzed by high-performance liquid chromatography. The α-tocopherol content provided by colostrum was calculated by considering a daily intake of 396 mL of milk and comparing the resulting value to the recommended daily intake for infants aged 0-6 months (4 mg/day). Results: The initial mean concentration of α-tocopherol in colostrum was 1509.3 ± 793.7 µg/dL in the control group and 1452.9 ± 808.6 µg/dL in the supplemented group. After 24 h, the mean α-tocopherol concentration was 1650.6 ± 968.7 µg/dL in the control group (p > 0.05) and 2346.9 ± 1203.2 µg/dL in the supplemented group (p < 0.001), increasing the vitamin E supply to the newborn to 9.3 mg/day. Initially, 18 women in the supplemented group provided colostrum α-tocopherol contents below 4 mg/day; after supplementation only six continued to provide less than the recommended amount. Conclusion: Maternal vitamin E supplementation increases the supply of the vitamin to the infant by providing more than twice the Recommended Daily Intake.

Resumo: Objetivo: Avaliar o efeito da suplementação materna com vitamina E sobre a concentração de α-tocoferol no colostro e o fornecimento dessa para o recém-nascido. Método: O estudo clínico randomizado foi feito com 99 parturientes adultas e saudáveis, 39 alocadas no grupo controle e 60 no grupo suplementado. Após jejum noturno, foram coletados 5 mL de sangue e 2 mL de colostro das parturientes. Após a primeira coleta (leite 0 h), o grupo suplementado recebeu suplementação com 400 UI de vitamina E. Foi feita nova coleta de 2 mL de colostro, em ambos os grupos, 24 h após a suplementação (leite 24 h). As amostras foram analisadas por cromatografia líquida de alta eficiência. A quantidade de α-tocoferol fornecida pelo colostro foi considerada para uma ingestão diária de 396 mL de leite e comparada com a ingestão diária recomendada para crianças de 0 a 6 meses (4 mg/dia). Resultados: A concentração média inicial de α-tocoferol no colostro foi de 1.509,3 ± 793,7 µg/dL no grupo controle e 1.452,9 ± 808,6 µg/dL no grupo suplementado. Após 24 horas a concentração média de α-tocoferol no grupo controle foi de 1.650,6 ± 968,7 µg/dL (p > 0,05) e de 2.346,9 ± 1203,2 µg/dL (p < 0,001) no grupo suplementado. Aumentou-se assim a oferta de vitamina E para o recém-nascido para 9,3 mg/dia. Inicialmente 18 mulheres do grupo suplementado forneciam valores inferiores a 4 mg/dia de α-tocoferol em seu colostro, após suplementação apenas seis continuaram a fornecer quantidade inferior ao recomendado. Conclusão: A suplementação materna com vitamina E promove o aumento do fornecimento da vitamina para o recém-nascido e fornece mais do que o dobro da ingestão diária recomendada.

Effect of maternal supplementation with vitamin E on the concentration of α-tocopherol in colostrum.

OBJECTIVE: To evaluate the effect of maternal supplementation with vitamin E on the concentration of α-tocopherol in colostrum and its supply to the newborn. METHOD: This randomized clinical trial enrolled 99 healthy adult pregnant women; of these, 39 were assigned to the control group and 60 to the supplemented group. After an overnight fast, 5mL of blood and 2mL of colostrum were collected. After the first sampling (0h milk), the supplemented group received 400IU of supplementary vitamin E. Another 2mL milk aliquot was collected in both groups 24h after supplementation (24h milk). The samples were analyzed by high-performance liquid chromatography. The α-tocopherol content provided by colostrum was calculated by considering a daily intake of 396mL of milk and comparing the resulting value to the recommended daily intake for infants aged 0-6 months (4mg/day). RESULTS: The initial mean concentration of α-tocopherol in colostrum was 1509.3±793.7µg/dL in the control group and 1452.9±808.6µg/dL in the supplemented group. After 24h, the mean α-tocopherol concentration was 1650.6±968.7µg/dL in the control group (p>0.05) and 2346.9±1203.2µg/dL in the supplemented group (p<0.001), increasing the vitamin E supply to the newborn to 9.3mg/day. Initially, 18 women in the supplemented group provided colostrum α-tocopherol contents below 4mg/day; after supplementation only six continued to provide less than the recommended amount. CONCLUSION: Maternal vitamin E supplementation increases the supply of the vitamin to the infant by providing more than twice the Recommended Daily Intake.

α-Tocopherol in breast milk of women with preterm delivery after a single postpartum oral dose of vitamin E.

We evaluated the effect of maternal vitamin E supplementation on the α-tocopherol concentrations of colostrum, transitional milk and mature milk of women who had given birth prematurely. This longitudinal randomised-controlled trial divided eighty-nine women into two groups: a control group and a supplemented group. Blood and breast milk were collected from all the participants after delivery. Next, each woman in the supplemented group received 400 IU of RRR-α-tocopheryl acetate. Further breast milk samples were collected 24 h after the first collection, as well as 7 and 30 d after delivery. α-Tocopherol concentrations were determined by HPLC. The baseline α-tocopherol concentrations in the maternal serum of the two groups were similar: 1159·8 (sd 292·4) µg/dl (27·0 (SD 6·8) µmol/l) for the control group and 1128·3 (sd 407·2) µg/dl (26·2 (SD 9·5) µmol/l) for the supplemented group. None of the women was vitamin E deficient. Breast milk α-tocopherol concentrations increased by 60 % 24 h after supplementation in the intervention group and did not increase at all in the control group. α-Tocopherol concentration of the transitional milk in the supplemented group was 35 % higher compared with the control group. α-Tocopherol concentrations of the mature milk in both groups were similar. Maternal supplementation with 400 IU of RRR-α-tocopherol increased the vitamin E concentrations of the colostrum and transitional milk, but not of the mature milk. This study presents relevant information for the design of strategies to prevent and combat vitamin E deficiency in the risk group of preterm infants.

Association between maternal vitamin E status and alpha-tocopherol levels in the newborn and colostrum.

Vitamin E is important because of its antioxidant activity in situations of oxidative stress, especially postnatally. Hence, the objective was to verify whether maternal alpha-tocopherol level is associated with the alpha-tocopherol levels of the newborn and colostrum. This is a cross-sectional study of 58 women and their term newborns from a public hospital. Blood and colostrum were collected to measure alpha-tocopherol levels by high-performance liquid chromatography. Mothers with serum alpha-tocopherol levels <16.2 mmol L(-1) and newborns <11.6 mmol L(-1) were indicative of deficiency or low levels. Mothers were divided into two groups: <16.2 mmol L(-1) and those with levels ≥16.2 mmol L(-1) . The mean (95% confidence interval) serum alpha-tocopherol levels of mothers, umbilical cords and colostrum were 28 (24-32), 6 (5-8) and 39 mmol L(-1) (32-45), respectively (P < 0.001); 19% of the women and 90% of the newborns had low alpha-tocopherol levels. Maternal alpha-tocopherol level was associated with that of the umbilical cord. Newborns from mothers at risk of deficiency had low alpha-tocopherol levels (P < 0.001). Colostrum levels of vitamin E were not influenced by maternal serum. Maternal deficiency influenced the vitamin E level of the umbilical cord but does not in the colostrum, evidencing distinct transfer mechanisms via the mammary gland.