Zinc and selenium supplementation on treated HIV-infected individuals induces changes in body composition and on the expression of genes responsible of naïve CD8+ T cells function.

Background and aim: Deficiency of zinc and selenium is common in persons living with human immunodeficiency virus (PLWHIV) and has been associated with the development of non-AIDS related comorbidities, impaired immune system function and mortality. Micronutrient supplementation on long-term-treated PLWHIV could bring potential clinical and immunological benefits improving their health status and quality of life. The aim of the present study is to analyze the effect of zinc and selenium supplementation on body composition, bone mineral density, CD4+ T-cell counts, metabolic profile and immune system status on clinical stable PLWHIV on long-term antiretroviral therapy (ART). Methods: This is a randomized pilot clinical trial in which we recruited 60 PLWHIV on ART who were assigned to the intervention groups: zinc (30 mg of zinc gluconate), selenium (200 µg of selenium yeast), zinc + selenium (same doses and presentations) or to a control group (without nutritional supplementation) who received supplementation during 6 months. Primary outcome was defined as changes in body composition (weight, muscle and fat mass and bone mineral density) and secondary outcomes as changes in biochemical and immunological parameters (CD4+ T-cell count, cholesterol, glucose, triglycerides and seric zinc and selenium seric concentrations) before and after supplementation. Peripheral blood mononuclear cells (PBMCs) of one individual of each intervention group were analyzed for single cell transcriptomics before and after supplementation. Results: BMI (p = 0.03), fat mass (p = 0.03), and trunk fat (p = 0.01) decreased after 6 months of selenium supplementation. No changes were observed for cholesterol, glucose or triglycerides after supplementation (p > 0.05 in all cases). CD4+ T cells percentage increased after 6 months of selenium supplementation (p = 0.03). On the transcriptome analysis, zinc and selenium supplementation induced changes on de expression of genes associated with the function of naive and memory CD8+ T-cells (p < 0.05 in all cases). Conclusion: Zinc and selenium supplementation could represent a complementary intervention that may improve the health status and immune response of treated PLWHIV.

Association between longitudinal changes in phase angle and mortality rate in adults critically ill with COVID-19: A retrospective cohort study.

BACKGROUND: Phase angle (PhA) obtained by bioelectrical impedance analysis (BIA) works as a predictor of clinical outcomes. Specific cutoff values for longitudinal changes and their relationship with clinical outcomes are still undetermined for patients with critical illness. Thus, the aim of this study was to analyze the association between longitudinal changes in PhA during intensive care unit (ICU) stay and all-cause 90-day mortality in patients critically ill with COVID-19. METHODS: This was a retrospective cohort study of adults critically ill with COVID-19 undergoing invasive mechanical ventilation with a length of stay >14 days. BIA was performed at ICU admission and at days 7 and 14 of ICU stay; PhA and hydration parameters were collected. Differences between survivors and nonsurvivors were assessed. Longitudinal changes were evaluated using repeated-measures analysis of variance. A receiver operating characteristics curve for PhA declined (%) during the first 14 days, and all-cause 90-day mortality was performed. Survival probability was reported using hazard ratios (HR). RESULTS: One-hundred nine patients were included. The change in the value of PhA was close to 17.1%. Nonsurvivors had a higher prevalence of individuals with a decrease in PhA >22.2% (area under the curve = 0.65) in the first 14 days in comparison with survivors (70% vs 34.8%, P < 0.01). PhA decrease >22.2% at 14 days was a significant predictor of all-cause 90-day mortality (HR = 2.2, 95% CI 1.71-3.6, P = 0.04). CONCLUSION: Changes in PhA are associated with all-cause 90-day mortality. Future studies should be directed to interventions to prevent changes in this nutrition marker.

Fluid Status Assessment in Critically Ill Patients with COVID-19: A Retrospective Cohort Study.

Fluid status (FS) is a diagnostic challenge in critically ill patients with COVID-19. Here, we compared parameters related to FS derived from cumulative fluid balance (CFB), bioelectrical impedance analysis (BIA) and venous congestion assessed by ultrasound (VExUS) to predict mortality. We retrospectively reviewed the medical records of individuals with severe pneumonia due to COVID-19 between July and November 2021 in a single center. Comorbidities, demographic, clinical and laboratory data as well as results from CFB, BIA and VExUS measurements were collected on admission and weekly afterwards for two consecutive evaluations. Seventy-nine patients were included, of which eighteen (14.2%) died. Abnormalities of FS were only identified by BIA. Extracellular water/total body water ratio (ECW/TBW) > 0.394 (overhydrated) by BIA was a good predictor of mortality (AUC = 0.78, 95% CI: 0.067-0.89). Mortality risk was higher in overhydrated patients (OR: 6.2, 95% CI: 1.2-32.6, p = 0.02) and in persistently overhydrated patients (OR: 9.57, 95% CI: 1.18-77.5, p = 0.03) even after adjustment to age, serum albumin and acute kidney injury (AKI) in stages 2-3. Time to death was shorter in overhydrated patients (HR: 2.82, 95% CI: 1.05-7.5, log-rank test p = 0.03). Abnormalities in FS associated with mortality were only identified by BIA in critically ill patients with COVID-19.

Changes in pulmonary mechanics from supine to prone position measured through esophageal manometry in critically ill patients with COVID-19 severe acute respiratory distress syndrome.

OBJECTIVE: To describe changes in pulmonary mechanics when changing from supine position (SP) to prone position (PP) in mechanically ventilated (MV) patients with Acute Respiratory Distress Syndrome (ARDS) due to severe COVID-19. DESIGN: Retrospective cohort. SETTING: Intensive Care Unit of the National Institute of Respiratory Diseases (Mexico City). PATIENTS: COVID-19 patients on MV due to ARDS, with criteria for PP. INTERVENTION: Measurement of pulmonary mechanics in patients on SP to PP, using esophageal manometry. MAIN VARIABLES OF INTEREST: Changes in lung and thoracic wall mechanics in SP and PP RESULTS: Nineteen patients were included. Changes during first prone positioning were reported. Reductions in lung stress (10.6 vs 7.7, p=0.02), lung strain (0.74 vs 0.57, p=0.02), lung elastance (p=0.01), chest wall elastance (p=0.003) and relation of respiratory system elastances (p=0.001) were observed between patients when changing from SP to PP. No differences were observed in driving pressure (p=0.19) and transpulmonary pressure during inspiration (p=0.70). CONCLUSIONS: Changes in pulmonary mechanics were observed when patients were comparing values of supine position with measurements obtained 24h after prone positioning. Esophageal pressure monitoring may facilitate ventilator management despite patient positioning.

Association between kidney biopsy findings in CKD patients with diabetes and renal replacement therapy initiation, a perspective from a low-middle income country.

Kidney disease in diabetes mellitus is usually explained by diabetic kidney disease, but other superimposed etiologies occur frequently. The distinction between diabetic kidney disease and non-diabetic kidney disease can only be made by performing kidney biopsy. Our objective was to evaluate the association of diabetic kidney disease, non-diabetic kidney disease, or both with renal replacement therapy initiation. This is a retrospective cohort that included patients with type 2 diabetes mellitus for whom a kidney biopsy was indicated. Subjects were followed-up for 5 years, until renal replacement therapy initiation or were lost to follow up. One hundred and forty-one patients were included, 53 (39%) had diabetic kidney disease, 13 (9%) had non-diabetic kidney disease and 75 (54%) had both. Ninety-four percent of the cohort initiated renal replacement therapy during the 5-year follow-up. Higher degree of fibrosis was associated with a trend towards higher risk of requiring renal replacement therapy. In addition, the combined diabetic kidney disease + non-diabetic kidney disease group was associated with higher need of renal replacement therapy initiation when compared to the diabetic kidney disease group.

Phase angle as predictor of malnutrition in people living with HIV/AIDS.

BACKGROUND: Phase angle (PhA), measured by bioelectrical impedance analysis (BIA) has been studied as an indicator of survival in people living with HIV (PLWH). However, it remains unclear whether PhA is associated with malnutrition or low CD4+ T-cell counts. OBJECTIVE: In this study, we assessed the discriminative capacity of PhA for malnutrition detection using Global Leadership Initiative on Malnutrition (GLIM) criteria in PLWH, aiming to propose cutoff points for this population. METHODS: This retrospective observational study included 427 adult PLWH (13% female). Participants were classified according to malnutrition status by using GLIM criteria. Body composition was assessed by using BIA. CD4+ T-cell counts were determined by flow cytometry. RESULTS: According to GLIM criteria, 30% of the participants were malnourished. Multivariate regression analysis showed that PhA (adjusted odds ratio [OR], 0.10; 95% CI, 0.05-0.18; P < 0.001), fat-mass percentage (adjusted OR, 0.86; 95% CI, 0.82-0.90; P < 0.001), and male sex (adjusted OR, 0.26; 95% CI, 0.09-0.76; P = 0.013) were independently associated with malnutrition. A PhA cutoff of 5.45° in men and 4.95° in women may predict malnutrition with sensitivity and specificity >70%. CONCLUSION: PhA could be a valid, useful, and simple predictor of malnutrition in PLWH.

Low phase angle is associated with 60-day mortality in critically ill patients with COVID-19.

BACKGROUND: Malnutrition status, body composition indicators, and bioelectrical impedance analysis (BIA) parameters have been associated with increased risk of death in several pathologies. The aim of this study was to describe the associations between phase angle (PhA) indicators obtained by BIA with length of hospital stay, days on mechanical ventilation, and 60-day mortality in critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: This is a prospective cohort of mechanically ventilated patients with coronavirus disease 2019 (COVID-19). We assessed nutrition risk and body composition with BIA within 48 h from intensive care unit admission. Logistic and linear regression models were used to analyze the association between variables and clinical outcomes. Survival analysis by PhA value was performed using Kaplan-Meier curves. RESULTS: Sixty-seven patients were included. PhA (odds ratio [OR], 0.36; P = .002), standardized PhA (SPA) (OR, 0.45; P = .001), and extracellular water/total body water ratio (OR, 3.25; P = .002) were significant predictors of 60-day mortality. PhA <3.85° in females and <5.25° in males showed good and fair discrimination, respectively, for mortality prediction. Using cutoff values, low PhA was associated with a significantly increased risk of 60-day mortality (hazard ratio, 3.08; 95% CI, 1.12-8.41; P = .02). No association was detected for SPA. CONCLUSION: Low PhA values could be a predictor of 60-day mortality in critically ill patients with COVID-19. This biological marker could be incorporated as part of nutrition and mortality risk assessment in this population.

Malnutrition and tuberculosis: the gap between basic research and clinical trials.

Mycobacterium tuberculosis (M.tb) is the causative agent of tuberculosis (TB), an infectious disease that leads to numerous deaths worldwide. Malnutrition, smoking, alcohol abuse, Human Immunodeficiency Virus infection, and diabetes are some of the most important risk factors associated with TB development. At present, it is necessary to conduct studies on risk factors to establish new effective strategies and combat this disease. Malnutrition has been established as a risk factor since several years ago; although there is in vitro experimental evidence that reveals the importance of micronutrients in activating the immune response against M.tb, evidence from clinical trials is controversial. Currently, nutritional assessment is recommended in all TB patients upon diagnosis. However, there is insufficient evidence to indicate micronutrient supplementation as adjuvant therapy or prophylactic to prevent micronutrient depletion. Strengthening the interaction between basic and clinical research is necessary to carry out studies that will help establish adjuvant therapies to improve outcomes in TB patients. In this review, we discuss the experimental evidence, provided by basic research, regarding micronutrients in the TB field. However, when these studies are applied to clinical trials, the data are inconsistent, indicating that still missing mechanisms are necessary to propose alternatives to the treatment of TB patients.

[Nutrition and peritoneal dialysis: Fundaments and practical aspects for dietary prescription]. / Nutrición y diálisis peritoneal: fundamentos y aspectos prácticos para la prescripción dietética.

The number of patients with advanced / end-stage chronic kidney disease (ESRD) with some modality of renal replacement therapy (RRT) has been on the rise significantly. Peritoneal dialysis (PD) represents 11% of the world dialysis population. Different options for RRT have been associated with a greater risk of developing complications, such infections, metabolic alterations and nutritional complications, specifically a higher incidence of protein-energy wasting (PEW), ranging from 32 to 49% in PD patients. Peritoneal transporter type plays an important role in the development of nutritional complications, where the high transporter compared to the slow or low transporter has been associated with a higher nutritional risk by increasing the risk of volume overload, hypertension, and inflammation; as well as greater loss of proteins in the dialysate due to the greater number of replacements that characterize its prescription. Nutrition specialists needs to consider diverse aspects to achieve an individualized nutritional approach based on the characteristics of the patient, where knowing peritoneal transporter type is essential. The aim of this study is to review the evidence available to date regarding nutritional therapy in patients with peritoneal dialysis, as well as to analyze some basic aspects of dialysis therapy.

El número de pacientes con enfermedad renal crónica avanzada/terminal (ERCT) con alguna modalidad de terapia de reemplazo renal (TRR) ha ido en ascenso. A nivel mundial, la diálisis peritoneal (DP) representa el 11% del total de pacientes con TRR. Las diferentes opciones de TRR se han asociado con un mayor riesgo para desarrollar complicaciones infecciosas, metabólicas y nutricionales, reportándose cifras alarmantes de desgaste proteico energético (DPE) que oscilan entre 32-49% en pacientes en DP. El tipo de transportador peritoneal juega un rol importante en el desarrollo de complicaciones nutricionales, donde el transportador alto, en comparación con el lento o bajo, se ha asociado con un mayor riesgo nutricional al incrementar el riesgo de sobrecarga de volumen, hipertensión e inflamación; así como mayor pérdida de proteínas en el dializado por el mayor número de recambios que caracteriza su prescripción. Por tal motivo, el profesional de la nutrición debe considerar diversos aspectos para lograr un abordaje nutricional individualizado a partir de las características del paciente, en el que conocer el tipo de transportador peritoneal es fundamental. El objetivo del presente trabajo es realizar una revisión de la evidencia disponible hasta la fecha respecto a la terapia nutricional del paciente con diálisis peritoneal, así como analizar algunos aspectos básicos de la terapia dialítica.

Zinc and selenium indicators and their relation to immunologic and metabolic parameters in male patients with human immunodeficiency virus.

OBJECTIVES: Micronutrient deficiencies are common among people living with HIV (PLWHIV). The clinical and immunologic consequences of micronutrient deficiencies have been poorly explored in the context of human immunodeficiency virus (HIV) infection. The aim of this study was to determine the prevalence of zinc and selenium deficiency (dietary intake and serum concentrations) and analyze their associations with absolute CD4+ T-cell counts, inflammation markers, and metabolic disorders in a cohort of antiretroviral-experienced HIV-infected individuals. METHODS: The zinc and selenium intakes of 124 HIV-infected men were estimated using 3-d food records. In a subcohort of 45 individuals, serum zinc and selenium concentrations and proinflammatory cytokines were determined. Body composition, bone mineral density (BMD), CD4+ T-cell counts, lipid profile, glucose, and blood pressure were determined and were associated with zinc and selenium dietary intake and serum concentrations. RESULTS: Of the PLWHIV studied, 58% had suboptimal intake of zinc and 8% demonstrated suboptimal intake of selenium. Serum deficiencies for zinc and selenium were 23.9% and 65.9%, respectively. Zinc and selenium intake were correlated with increased muscle mass. Selenium intake was associated with increased BMD of the lumbar region. An inverse correlation between serum selenium concentration and several proinflammatory cytokines (interleukin-1ß, interleukin-6, and tumor necrosis factor-α) was found. CONCLUSION: Suboptimal zinc and selenium intake and serum concentration deficiencies are highly prevalent in treated HIV-positive individuals and are associated with body composition, BMD, and inflammation. Clinical trials should be designed to explore the effect of zinc and selenium supplementation on metabolic, inflammatory, and immunologic parameters on the HIV-positive population.

Agreement between body composition techniques in children and adolescents: narrative review of the literature. / Concordancia entre técnicas de composición corporal en niños y adolescentes: revisión narrativa de la literatura

Body composition monitoring is important to understand the effect of diet, physical activity, illness and growth on body stores. Body composition determination by accuracy and reproducibility techniques is essential. The objective of this study was to analyze the agreement between body composition techniques in children and adolescents. Literature search was performed using the PubMed, Scielo and Google Scholar databases. Only observational studies realized in children and adolescents that analyze agreement between two or more body composition techniques were included. Thirty studies were included. Dual-energy X-ray absorptiometry, air displacement plethysmography, hydrodensitometry, deuterium dilution and four compartment model were the techniques for body composition measurement and bioelectrical impedance and anthropometry were used to estimate body composition. Agreement and correlation between methods was influenced by study populations and by technique considered as gold standard for comparisons. In conclusion, there is a low agreement between the different methods to assess body composition. Correlation and agreement interpretation are essential for body composition assessment in children and adolescents. Is recommended the use of equations developed and validated in this populations.

El monitoreo de la composición corporal (CC) permite comprender los efectos de la dieta, el ejercicio físico, la presencia de procesos patológicos y el crecimiento en las reservas corporales; de ahí la importancia de su determinación con técnicas exactas y reproducibles. El objetivo de la presente revisión es analizar la concordancia entre las distintas técnicas para evaluar la CC en población infantil y adolescente. Se realizó una búsqueda no sistemática de la literatura en las bases de datos PubMed, Scielo y Google Scholar para identificar estudios cuyo objetivo primario fuera la evaluación de la concordancia entre dos o más métodos de determinación de la CC. Se incluyeron 30 estudios para la revisión. Los métodos identificados para la medición de la CC fueron la absorciometría dual de rayos X, la pletismografía de gases (BOD-POD), la hidrodensitometría, la dilución de deuterio (D2O) y el modelo de cuatro compartimentos, utilizando bioimpedancia eléctrica y antropometría para la estimación. La concordancia y la correlación entre métodos varía según los diferentes grupos poblacionales y la técnica utilizada como método de referencia. Se concluye que existe una baja concordancia entre los distintos métodos para evaluar la composición corporal. La interpretación de la correlación y la concordancia de los diferentes métodos resulta esencial para evaluar la CC en niños y adolescentes. Se sugiere utilizar ecuaciones desarrolladas o validadas para el grupo en estudio.

Accuracy of Predictive Equations for Energy Expenditure in Mexicans Living With HIV/AIDS With and Without Antiretroviral Therapy.

INTRODUCTION: Determination of the resting energy expenditure (REE) is essential for planning nutrition therapy in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) to help to improve their nutrition status. We aim to evaluate the agreement and accuracy of prediction equations that estimate the REE in a Mexican population with a diagnosis of HIV/AIDS with and without antiretroviral therapy (ART). METHODS: A cross-sectional study in Mexican patients with HIV/AIDS with and without ART. Weight, height, and body composition measured with dual-energy x-ray absorptiometry were evaluated. The REE was determined with indirect calorimetry and estimated using the Mifflin-St Jeor (MSJ), Harris-Benedict (HB), Schofield 1 and 2, Cunningham, Melchior 91, Melchior 93, and Batterham equations. The Bland-Altman method assessed agreement between the real and estimated values, and the percent difference between these values was used to assess the prediction accuracy. RESULTS: Sixty-five adults without ART and 102 adults with ART were included. The mean REE (kcal/kg) was 24.8 ± 2.4 and 23.8 ± 3.6 in patients without and with ART, respectively. Good agreement and reliability were observed in the HB (intraclass correlation coefficient [ICC], 0.75; P < .05), Batterham (ICC, 0.79; P < .05), Schofield 1 (ICC, 0.74; P < .05), and Schofield 2 (ICC, 0.78; P < .05) results in individuals without ART. In individuals with ART, good agreement and reliability were observed with the HB equation (ICC, 0.76; P < .05). The MSJ equation showed good agreement with poor reliability (ICC, 0.05; P < .05). CONCLUSION: The equations with the best agreement and accuracy were Schofield 2, Batterham, and HB in individuals without ART and HB and MSJ in the population with ART.

[VALIDATION OF PREDICTIVE EQUATIONS FOR WEIGHT AND HEIGHT USING BODY CIRCUMFERENCES IN MEXICAN ELDERLYS]. / VALIDACIÓN DE ECUACIONES DE ESTIMACIÓN DE PESO Y TALLA CON CIRCUNFERENCIAS CORPORALES EN ADULTOS MAYORES MEXICANOS.

INTRODUCTION: weight and height measurements are important data for the nutritional assessment of elderly people and the implementation of the nutritional care process. Malnutrition is common in this population, who has high rates of disability that difficult to measurement this variables. OBJECTIVE: evaluate the validity of predictive equations for weight and height that include body circumferences created for brazilian population, in mexican elderly people. METHODS: this is a comparative, observational, prospective and cross-sectional study, 61 elderly were evaluated. Body weight, height, half span, calf, arm and abdominal circumferences were determinated. Weight and height were estimated with de predictive equations published by Rabito et al. Bland-Altman analysis and Intraclass Correlation Coefficient were used to assess the levels of agreement between the estimated and the measured values. The level of statistical significance was p < 0.05. RESULTS: the age mean was 78.7 ± 8.7 and 55.7% were females. The weight mean was 61.9 ± 14.1 kg, height mean was 155.4 ± 9.5 cm and Body Mass Index (BMI) mean corresponded to 25.5 ± 5.1 kg/m. The Bland-Altman plots indicated that the 95% confidence interval (95% IC) limits for the difference between real and estimated weight ranged from -14.3 kg to 8.1 kg, the mean of the difference or systematic error (SE) was -3.1 kg, we observed an statistically significant coefficient of 0.12 (p < 0.03). The 95% IC limits for the difference between real and estimated height ranged from -11.1 to 15.9 cm, the diffe rence mean or SE of 2.4 cm, we observed a coefficient of -0.04 (p = 0.67) . Intraclass Correlation Coefficient of 0.72 (p < 0.00) and 0.88 (p < 0.00) were obtained for weight and height, respectively. CONCLUSION: the equations developed by Rabito showed a good agreement when compared with the actual weight and height of elderly people. We observed variations in the estimated weight in obesity elderlys.

Introducción: el conocimiento del peso y la talla es fundamental en la evaluación del estado nutricional en el adulto mayor, permitiendo la implementación del proceso de cuidado nutricional. La desnutrición es común en este grupo poblacional, el cual usualmente presenta diversas situaciones clínicas que dificultan la medición de peso y talla. Objetivos: evaluar la validez de las ecuaciones para estimar peso y talla basadas en circunferencias corporales propuestas para población brasileña en adultos mayores mexicanos. Métodos: estudio comparativo, observacional, prospectivo y transversal en 61 adultos mayores. Las medidas antropométricas recolectadas fueron peso y talla, Extensión de Media Brazada (EMB), Circunferencia Abdominal (CA), Circunferencia Media de Brazo (CMB) y Circunferencia de Pantorrilla (CP). Se estimó el peso y la talla con las ecuaciones propuestas por Rabito y cols. Se utilizó el método Bland-Altman y el Coeficiente de Correlación Intraclase para evaluar la concordancia entre los valores reales y estimados. Se consideró significancia estadística un valor de p < 0,05. Resultados: la edad promedio de los participantes fue de 78,7 ± 8,7 años. El 55,7% (n = 34) fueron mujeres. La media para el peso fue de 61,9 ± 14,1 kg, para la talla de 155,4 ± 9,5 cm y para el Índice de Masa Corporal (IMC) fue de 25,5 ± 5,1 kg/m2. Mediante el método Bland-Altman los límites de intervalo de concordancia de 95% para la diferencia del peso real y el estimado fueron de -14,3 a 8,1 kg, con una media de la diferencia o error sistemático (ES) de -3,1 cm; se observó un coeficiente de 0,12 que fue estadísticamente significativo (p = 0,03). Para la talla se observa un intervalo de confianza de la diferencia entre la talla real y estimada de -11,1 a 15,9, con una media de la diferencia o ES de 2,4 cm y un coeficiente de -0,04 que no fue significativo (p = 0,67). La concordancia entre el peso real y el estimado, según el coeficiente de correlación intraclase, fue de 0,72 (p < 0,00), en el caso de la talla real, y la estimada fue de 0,88 (p < 0,00). Conclusiones: las ecuaciones propuestas por Rabito muestran una buena concordancia con los valores de peso y talla reales en adultos mayores, observando mayor variación para los valores de peso estimado en población con obesidad.