ABSTRACT
PURPOSE: Oropharyngeal dysphagia (OD) is one of the possible outcomes in patients hospitalized with COVID-19 and also in the population hospitalized for the treatment of cardiovascular disease. Thus, knowing the predictive risk factors for OD may help with referral and early intervention. This study aimed to verify the association of different factors with OD in hospitalized individuals with cardiovascular disease and COVID-19. METHODS: Cross-sectional clinical study approved by the Research Ethics Committee (4,521,771). Clinical evaluation of swallowing was carried out in 72 adult patients with cardiovascular disease and COVID-19 hospitalized from April to September 2020. Individuals under 18 years of age and without previous cardiovascular disease were excluded. The presence of general clinical and/or neurological complications, pronation, stay in the intensive care unit (ICU), orotracheal intubation (OTI), tracheostomy tube, oxygen support and age were considered as predictive risk factors for oropharyngeal dysphagia. Fisher's exact test, Mann Whitney test and logistic regression model were used for analysis. RESULTS: General clinical complications (p=0.001), pronation (p=0.003), ICU stay (p=0.043), in addition to the need for oxygen supplementation (p=0.023) and age (p= 0 .037) were statistically significant factors associated. The pronation (0.013) and age (0.038) were independently associated with dysphagia. OTI (p=0.208), tracheostomy (p=0.707) and the presence of previous cerebrovascular accidents (p=0.493) were not statistically significant. CONCLUSION: In this study, age and prone position were factors independently associated with oropharyngeal dysphagia, complications such as the need for oxygen supplementation, in addition to the need for ICU admission, were also associated factors in the population.
Subject(s)
COVID-19 , Cardiovascular Diseases , Deglutition Disorders , Humans , COVID-19/complications , Deglutition Disorders/etiology , Cross-Sectional Studies , Male , Female , Risk Factors , Middle Aged , Aged , Cardiovascular Diseases/complications , SARS-CoV-2 , Intensive Care Units , Adult , Intubation, Intratracheal , Aged, 80 and over , HospitalizationABSTRACT
BACKGROUND & AIMS: To evaluate the effect of the Brazilian Cardioprotective Diet Program (BALANCE Program) on inflammatory biomarkers, involved in the pathophysiology of the atherosclerosis, on inflammatory biomarkers, cardiovascular risk factors, and on plasma fatty acids in cardiovascular disease secondary prevention patients. METHODS: In this substudy of the BALANCE Program randomized clinical trial, a total of 369 patients aged 45 years or older, who have experienced cardiovascular disease in the previous 10 years, were included. These patients were randomized into two groups and followed up for six months: BALANCE Program group and control group (conventional nutrition advice). In the initial and six-month final visits, anthropometry (body weight, height and waist circumference), food intake evaluation by 24-h dietary recall, plasma inflammatory biomarkers (IL-6, IL-8, IL-10, IL-12, tumor necrosis factor-α, adiponectin, and C-reactive protein levels), blood pressure, glycemia, insulinemia, lipid profile, and plasma fatty acids levels were evaluated. RESULTS: The BALANCE Program group showed increased plasma alpha-linolenic acid levels (P = 0.008), reduction in waist circumference (P = 0.049) and BMI (P = 0.032). No difference was observed among plasma inflammatory biomarkers and clinical data. CONCLUSION: After six months of follow-up, BALANCE Program led to a significant reduction on BMI and waist circumference in individuals in secondary prevention for cardiovascular disease. Although plasmatic alpha-linolenic acid has increased, there was no impact on plasma inflammatory biomarkers. CLINICAL TRIAL REGISTRATION: NCT01620398.
Subject(s)
Coronary Artery Disease/diet therapy , Adiponectin/blood , Aged , Biomarkers/blood , Brazil , C-Reactive Protein/metabolism , Coronary Artery Disease/metabolism , Diet, Mediterranean , Female , Humans , Male , Middle Aged , Nutritional Physiological Phenomena , Nutritional Status , Secondary Prevention , Treatment OutcomeABSTRACT
BACKGROUND & AIMS: To evaluate the effect of the Brazilian Cardioprotective Diet Program (BALANCE Program) on inflammatory biomarkers, involved in the pathophysiology of the atherosclerosis, on inflammatory biomarkers, cardiovascular risk factors, and on plasma fatty acids in cardiovascular disease secondary prevention patients. METHODS: In this substudy of the BALANCE Program randomized clinical trial, a total of 369 patients aged 45 years or older, who have experienced cardiovascular disease in the previous 10 years, were included. These patients were randomized into two groups and followed up for six months: BALANCE Program group and control group (conventional nutrition advice). In the initial and six-month final visits, anthropometry (body weight, height and waist circumference), food intake evaluation by 24-h dietary recall, plasma inflammatory biomarkers (IL-6, IL-8, IL-10, IL-12, tumor necrosis factor-a, adiponectin, and C-reactive protein levels), blood pressure, glycemia, insulinemia, lipid profile, and plasma fatty acids levels were evaluated. RESULTS: The BALANCE Program group showed increased plasma alpha-linolenic acid levels (P » 0.008), reduction in waist circumference (P » 0.049) and BMI (P » 0.032). No difference was observed among plasma inflammatory biomarkers and clinical data. CONCLUSION: After six months of follow-up, BALANCE Program led to a significant reduction on BMI and waist circumference in individuals in secondary prevention for cardiovascular disease. Although plasmatic alpha-linolenic acid has increased, there was no impact on plasma inflammatory biomarkers. Clinical trial registration: NCT01620398.
Subject(s)
Humans , Cardiovascular Diseases , Diet , Secondary Prevention , Fatty Acids , InflammationABSTRACT
Some conditions consolidated as risk factors for oropharyngeal dysphagia have already been identified in other diseases, such as neurological. Studies on cardiovascular diseases concentrate in individuals in the postoperative period; thus, it is unknown if these same factors occur in individuals hospitalized for clinical or surgical treatment of these diseases. Objective to correlate predictive risk factors for oropharyngeal dysphagia in individuals with cardiovascular disease admitted at a reference cardiology hospital. Methodology This is a retrospective clinical study. Medical records of 175 individuals hospitalized for clinical and/or surgical treatment at a reference cardiology hospital from January to June 2017, attendants of the Speech-Language Pathology and Nutrition team, were analyzed. Of these, 100 records were included in the study: 41 females and 59 males (mean age 67.56 years). Deaths and individuals from 0 to 18 years were excluded. Stroke, malnutrition, age and prolonged orotracheal intubation were considered predictive risk factors for oropharyngeal dysphagia. Mann-Whitney test and Fisher's test were used for statistical analysis. Results Stroke (OR=2.93 p=0.02), malnutrition (OR=2.89 p=0.02) and prolonged orotracheal intubation (OR=3.94 p=0.02) were statistically significant predictors for oropharyngeal dysphagia within this population. Age below 80 years was not significant (p=0.06), but within octogenarians, significance was found (p=0.033). Conclusion Stroke, malnutrition, prolonged orotracheal intubation and age > 80 years are predictive risk factors for oropharyngeal dysphagia in adult population with cardiovascular diseases.
Subject(s)
Cardiovascular Diseases/complications , Deglutition Disorders/etiology , Intubation, Intratracheal/adverse effects , Malnutrition/complications , Stroke/complications , Adolescent , Adult , Age Factors , Aged , Female , Humans , Male , Medical Records , Middle Aged , Retrospective Studies , Risk Factors , Severity of Illness Index , Statistics, Nonparametric , Young AdultABSTRACT
ABSTRACT: Some conditions consolidated as risk factors for oropharyngeal dysphagia have already been identified in other diseases, such as neurological. Studies on cardiovascular diseases concentrate in individuals in the postoperative period; thus, it is unknown if these same factors occur in individuals hospitalized for clinical or surgical treatment of these diseases. OBJECTIVE: to correlate predictive risk factors for oropharyngeal dysphagia in individuals with cardiovascular disease admitted at a reference cardiology hospital. METHODOLOGY: This is a retrospective clinical study. Medical records of 175 individuals hospitalized for clinical and/or surgical treatment at a reference cardiology hospital from January to June 2017, attendants of the Speech-Language Pathology and Nutrition team, were analyzed. Of these, 100 records were included in the study: 41 females and 59 males (mean age 67.56 years). Deaths and individuals from 0 to 18 years were excluded. Stroke, malnutrition, age and prolonged orotracheal intubation were considered predictive risk factors for oropharyngeal dysphagia. Mann-Whitney test and Fisher's test were used for statistical analysis. RESULTS: Stroke (OR=2.93 p=0.02), malnutrition (OR=2.89 p=0.02) and prolonged orotracheal intubation (OR=3.94 p=0.02) were statistically significant predictors for oropharyngeal dysphagia within this population. Age below 80 years was not significant (p=0.06), but within octogenarians, significance was found (p=0.033). CONCLUSION: Stroke, malnutrition, prolonged orotracheal intubation and age > 80 years are predictive risk factors for oropharyngeal dysphagia in adult population with cardiovascular diseases.
Subject(s)
Cardiovascular Diseases , Deglutition Disorders , Stroke , Intubation, Intratracheal , Aging , MalnutritionABSTRACT
INTRODUÇÃO: As doenças cardiovasculares representam a principal causa de morte no mundo. Seus fatores de risco são divididos em modificáveis e não-modificáveis. Diversos estudos clínicos vêm demonstrando a influência positiva da dieta na prevenção primária e secundária de eventos cardiovasculares. Dada a importância já documentada de uma dieta equilibrada, assim como do estado nutricional adequado na manutenção da saúde cardiovascular, este estudo objetivou avaliar a adequação da dieta habitual e do estado nutricional de pacientes submetidos a cirurgia cardíaca eletiva em hospital especializado em Cardiologia. MÉTODO: Estudo de caráter descritivo e transversal, com amostra de conveniência, composta por 38 indivíduos adultos, de ambos os sexos, encaminhados para cirurgia eletiva de revascularização do miocárdio, troca de válvula ou cirurgia combinada (revascularização do miocárdio e troca de válvula). A coleta de dados ocorreu no ambulatório de Nutrição do Instituto Dante Pazzanese de Cardiologia, anteriormente à cirurgia cardíaca, sendo realizada coleta de dados demográficos, tipo de cirurgia, antecedentes clínicos, consumo alimentar e avaliação nutricional. RESULTADOS: Na amostra avaliada, 68,42% dos pacientes estavam em sobrepeso e obesidade, segundo o índice de massa corporal. O percentual de gordura corporal apresentou valores acima da normalidade em 96,87% dos pacientes, com circunferência abdominal de risco elevado e muito elevado em 75,68%. Na avaliação habitual da dieta, a adequação no consumo de macronutrientes foi de 47,37%, 2,6% e 44,74% para carboidratos, proteínas e lipídeos respectivamente. Quanto aos ácidos graxos saturados, 36,84% dos pacientes apresentaram consumo superior ao recomendado. Foi observado baixo consumo de frutas, verduras e legumes por 89,48% dos pacientes e, consequentemente, de fibras dietéticas por 97,37%. CONCLUSÃO: Conclui-se que a amostra, composta por pacientes com excesso de peso, percentual de gordura elevado, alto risco cardiovascular e submetidos à cirurgia cardíaca eletiva, apresentou um padrão alimentar com baixo consumo de frutas, verduras, legumes e fibras dietéticas, necessitando de acompanhamento nutricional individualizado. (AU)
Subject(s)
Humans , Nutritional Status , Coronary Disease , Diet , Cardiac Surgical ProceduresABSTRACT
BACKGROUND: Several studies have demonstrated the benefits of replacing trans and saturated fats with unsaturated fatty acids on cardiovascular diseases. We aimed to demonstrate the effect of polyunsaturated and monounsaturated fat supplementation on the biochemical and endothelial markers of atherosclerotic disease in obese or overweight non-diabetic elderly patients. METHOD: Seventy-nine patients were randomly divided into three groups: flaxseed oil, olive oil, and sunflower oil; patients in each group received 30 mL of oil for 90 days. Patients were subjected to anthropometric and bioimpedance assessments; biochemical and endothelial evaluations were performed through ultrasonography of the brachial artery and carotid artery for endothelium-dependent dilation and intima-media thickness assessment, respectively, before and after the intervention. The participants' usual diet remained unchanged. RESULTS: The flaxseed oil group had improved ultra-sensitive C-reactive protein levels (p = 0.074) and reduced carotid intima-media thickness (CIMT) (p = 0.028); the olive oil group exhibited an improved apolipoprotein (Apo)B/ApoA ratio (p = 0.021), reduced CIMT (p = 0.028), and improved flow-mediated vasodilation (FMV) (p = 0.054); and similarly, the sunflower oil group showed an improved ApoB/ApoA ratio (p = 0.024), reduced CIMT (p = 0.048), and improved FMV (p = 0.001). CONCLUSION: Unsaturated fatty acid supplementation using the three vegetable oils attenuated pro-inflammatory properties and improved prothrombotic conditions. Therefore, introducing or replacing saturated and trans fat with unsaturated fatty acids is beneficial for cardiovascular risk reduction in obese or overweight non-diabetic elderly people. Further studies are needed to determine which unsaturated fat best prevents cardiovascular disease in elderly patients.
Subject(s)
Atherosclerosis/diet therapy , Biomarkers/blood , Cardiovascular Diseases/prevention & control , Dietary Fats, Unsaturated/therapeutic use , Fatty Acids, Unsaturated/therapeutic use , Obesity/diet therapy , Overweight/diet therapy , Aged , Aged, 80 and over , Atherosclerosis/complications , Carotid Intima-Media Thickness , Dietary Supplements , Double-Blind Method , Female , Humans , Male , Middle Aged , Obesity/blood , Obesity/complications , Obesity/physiopathology , Overweight/blood , Overweight/complications , Overweight/physiopathology , Plant Oils/administration & dosage , Risk FactorsABSTRACT
AIMS: The aim of this study was to determine the rate of major clinical events and its determinants in patients with previous cardiovascular event or not, and with or without diabetes from a middle-income country. METHODS: REACT study is a multicenter registry conducted between July 2010 and May 2013 in Brazil. Patients were eligible if they were over 45years old and high cardiovascular risk. Patients were followed for 12months; data were collected regarding adherence to evidence-based therapies and occurrence of clinical events (all-cause mortality, non-fatal cardiac arrest, myocardial infarction, or stroke). RESULTS: A total of 5006 subjects was included and analyzed in four groups: No diabetes and no previous cardiovascular event, n=430; diabetes and no previous cardiovascular event, n=1138; no diabetes and previous cardiovascular event, n=1747; and diabetes and previous cardiovascular event, n=1691. Major clinical events in one-year follow-up occurred in 332 patients. A previous cardiovascular event was associated with a higher risk of having another event in the follow-up (HR 2.31 95% CI 1.74-3.05, p<0.001), as did the presence of diabetes (HR 1.28 95% CI 1.10-1.73, p=0.005). In patients with diabetes,failure to reach HbA1c targetswas related topoorer event-free survival compared to patients with good metabolic control (HR 1.70 95% CI 1.01-2.84, p=0.044). CONCLUSIONS: In Brazil, diabetes confers high risk for major clinical events, but this condition is not equivalent to having a previous cardiovascular event. Moreover, not so strict targets for HbA1c in patients with diabetes and previous cardiovascular events might be considered.
Subject(s)
Cardiovascular Diseases/etiology , Diabetes Mellitus, Type 2/etiology , Brazil , Cardiovascular Diseases/mortality , Cardiovascular Diseases/pathology , Diabetes Mellitus, Type 2/mortality , Diabetes Mellitus, Type 2/pathology , Female , Humans , Male , Middle Aged , Registries , Risk Factors , Social ClassABSTRACT
BACKGROUND: Several studies have demonstrated the benefits of replacing trans and saturated fats with unsaturated fatty acids on cardiovascular diseases. We aimed to demonstrate the effect of polyunsaturated and monounsaturated fat supplementation on the biochemical and endothelial markers of atherosclerotic disease in obese or overweight non-diabetic elderly patients. METHOD: Seventy-nine patients were randomly divided into three groups: flaxseed oil, olive oil, and sunflower oil; patients in each group received 30 mL of oil for 90 days. Patients were subjected to anthropometric and bioimpedance assessments; biochemical and endothelial evaluations were performed through ultrasonography of the brachial artery and carotid artery for endothelium-dependent dilation and intima-media thickness assessment, respectively, before and after the intervention. The participants' usual diet remained unchanged...
Subject(s)
Atherosclerosis , Endothelium, Vascular , Carotid Intima-Media Thickness , Aged , Inflammation , Obesity , Vascular Stiffness , Fatty Acids, UnsaturatedABSTRACT
AIMS:The aim of this study was to determine the rate of major clinical events and its determinants in patients with previous cardiovascular event or not, and with or without diabetes from a middle-income country.METHODS:REACT study is a multicenter registry conducted between July 2010 and May 2013 in Brazil. Patients were eligible if they were over 45years old and high cardiovascular risk. Patients were followed for 12months; data were collected regarding adherence to evidence-based therapies and occurrence of clinical events (all-cause mortality, non-fatal cardiac arrest, myocardial infarction, or stroke).
Subject(s)
Humans , Male , Female , Middle Aged , Diabetes Mellitus/etiology , Diabetes Mellitus/mortality , Diabetes Mellitus/pathology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/mortality , Cardiovascular Diseases/pathologyABSTRACT
Envelhecimento, sarcopenia e nutrição são áreas relacionadas à Saúde e que possuem uma grande integração clínica e científica no dia a dia de ambulatório e manuseio clínico hospitalar de pacientes em Nutrição e cuidados multidisciplinares.Os profissionais continuadamente estão recebendo um maior número de pacientes da terceira idade, identificando, inclusive, necessidades diversas dentro desse grupo. Necessidades de apoio nutricional, educação para atividade física e motivação para um estilo de vida saudável.O envelhecimento e as modificações de metabolismo, composição corporal, e a mudança dos hábitos nutricionais requerem atuações integrativas e extremamente focadas na prevenção da perda muscular, inexorável na vivência de quem atinge a terceira idade.Este livro busca, por meio de profissionais extremamente dedicados em atenção clínica e em inúmeros projetos de pesquisa, fornecer as melhores ferramentas de diagnóstico e tratamento.O conceito multiprofissional perde campo didático na medida em que neste livro estamos identificando a focalização nas características transdisciplinares da atenção à saúde e na prevenção das doenças.Na verdade, no formato inovador e adequado a uma realidade prática, o projeto editorial deve fazer parte de todo planejamento de serviços voltados à terceira idade e ser um marco nas definições estratégicas dos profissionais de saúde...