Estado nutricional e hábito alimentar de estudantes universitários em instituição pública do Brasil / Nutritional status and eating habits of university students in a public institution in Brazil

O objetivo desse artigo é avaliar o hábito alimentar e estado nutricional dos alunos que consomem no restaurante universitário (RU) de uma universidade pública do sul do Brasil, permitindo que um processo contínuo de vigilância nutricional fomente estratégias de promoção de saúde voltadas às principais necessidades dessa população. Estudo transversal avaliou 290 estudantes universitários, através de antropometria com IMC, perimetrias, bioimpedância elétrica para estimativa de composição corporal e questionário de hábitos alimentares. A amostra foi dividida em três grupos de frequência de consumo no RU, sendo 31,7% consumidores diários, 40,3% frequentes e 27,9% eventuais; 57,6% dos avaliados eram homens, e a média de idade foi de 23,8 ± 5,64. Constatou-se que 37,6% do total dos participantes estavam com o percentual de gordura inadequado. Foi observado sedentarismo e hábitos alimentares com padrão tradicional brasileiro composto por características preconizadas pelo Ministério da Saúde, possivelmente influenciados pelo acesso ao RU.

This article aims to evaluate the eating habits and nutritional status of students who eat at the university restaurant (UR) of a public university in the south of Brazil, with the intention that, through a continuous process of nutritional surveillance, promotion of health strategies can be focused on the main needs of this population. A cross-sectional study evaluated 290 university students, through anthropometry with BMI and Waist Circumference, electrical bioimpedance to estimate body fat percentage and eating habits questionnaire. The sample was divided in three groups of consumption frequency in the UR, 31.7 % being daily consumers, 40.3% frequent consumers and 27.9% being casual consumers. Men corresponded to 57.6% of sampling and the mean age was 23.8 ± 5.64. It was found that 37.6% of the participants had inadequate fat percentage. It was observed sedentary lifestyle and traditionally Brazilian eating habits composed of characteristics recommended by the Ministry of Health, possibly influenced by their access to the UR.

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)

Educação nutricional em universitários e estratégias para promoção de saúde institucional: revisão integrativa / Nutrition education for university students and strategies for institutional health promotion: an integrative review / Educación nutricional de universitarios y estrategias de promoción de la salud institucional: revisión integrativa

Objetivo: Refletir sobre o ambiente universitário como espaço promotor de saúde nutricional enfatizando as estratégias utilizadas. Métodos: Realizou-se uma revisão integrativa de literatura nas bases eletrônicas Scopus, MEDLINE, LILACS e SciELO utilizando os descritores: Nutrition Education, University Students, College Studens e Health Promotion. Incluiram-se os estudos publicados entre os anos de 2010 e 2015, originais, em língua portuguesa, inglesa ou espanhola, e que tivessem estratégia de intervenção nutricional em população de estudantes universitários bem definida. Dos 649 estudos revisados, após análise de títulos, resumos e texto integral, foram incluídos 18 artigos, todos realizados fora do Brasil. Resultados: Observou-se o ambiente universitário como potencial promotor de saúde no que tange ao contexto internacional, porém ainda incipiente no contexto nacional. Resultados positivos de mudança de comportamento alimentar após intervenções foram observados, embora sem avaliações a longo prazo. As principais abordagens identificadas foram intervenções práticas e teóricas com base na teoria social cognitiva e na motivacional. Conclusão: O ambiente universitário possui grande potencial para promoção de saúde nutricional e as estratégias mais efetivas foram as que apresentaram uma condução baseada na teoria social cognitiva. No entanto, esse ambiente tem sido pouco explorado em nível nacional, e, para mudar essa realidade, faz-se necessária uma ressignificação das estratégias utilizadas e das políticas públicas e ações intersetoriais que sustentem essa prática, inserindo-a na identidade social do ensino superior no Brasil.

Objective: To reflect on the university environment as a nutritional health promoting space with a focus on the strategies used. Methods: An integrative review of articles published in SCOPUS, MEDLINE (PubMed), LILACS and SciELO databases under the following descriptors: Nutrition Education, University Students, College Students, and Health Promotion. The review included original studies published between 2010 and 2015 in Portuguese, English or Spanish that reported a nutritional intervention strategy carried out with well-defined population of university students. Only 18 articles out of the 649 studies reviewed were included after the analysis of titles, abstracts and full text. All the studies were conducted outside Brazil. Results: The university environment was found to be a potential health promoting space in the international context that is still incipient in the national context. Positive changes in dietary behaviors were reported, although there were no long-term assessments. The main strategies identified were practical and theoretical interventions based on the social cognitive theory and motivation theory. Conclusion: The university environment has great potential for the promotion of nutritional health and the most effective strategies were those based on the social cognitive theory. However, this environment has been little explored in the national context. Changing this reality requires the redefinition of the strategies used and of the public policies and intersectoral actions that support such a practice so that it can be inserted in the social identity of higher education in Brazil.

Objetivo: Reflexionar sobre el ambiente de la universidad como espacio de promoción de salud nutricional con énfasis para las estrategias utilizadas. Métodos: Se realizó una revisión integrativa de la literatura en las bases de datos electrónicas Scopus, MEDLINE, LILACS y SciELO con los descriptores: Nutrition Education, University Students, College Studens y Health Promotion. Se incluyó los estudios publicados entre 2010 y 2015, originales, en el idioma portugués, inglés o español y que hubieran utilizado una estrategia de intervención nutricional en una población de estudiantes universitarios bien definida. Tras el análisis de los títulos, resúmenes y texto completo de los 649 estudios revisados, 18 artículos fueron incluidos y todos internacionales. Resultados: Se observó el ambiente de la universidad como un potencial promotor de la salud respecto el contexto internacional, aunque incipiente en el contexto nacional. Fueron observados resultados positivos de cambio de conducta alimentaria después de las intervenciones aunque sin evaluaciones a largo plazo. Los principales abordajes identificados fueron las intervenciones prácticas y teóricas basadas en la teoría social cognitiva y emocional. Conclusión: El ambiente de la universidad tiene gran potencial para la promoción de la salud nutricional y las estrategias más efectivas fueron las que presentaron una conducción basada en la teoría social cognitiva. Sin embargo, ese ambiente ha sido poco explorado a nivel nacional. Para cambiar esa realidad es necesario otra significación de las estrategias utilizadas y de las políticas públicas y acciones intersectoriales que sostengan esa práctica, incluyéndola en la identidad social de la educación superior de Brasil.

Phase angle as a prognostic marker in patients with critical illness.

BACKGROUND: Phase angle (PA) is interpreted as an indicator of cell membrane integrity and a prognostic indicator in some clinical situations. This study aims to evaluate PA as a prognostic marker in critically ill patients admitted to the intensive care unit (ICU) and associate this marker with length of hospital stay, mortality, and clinical scores. METHODS: A cohort study was conducted with 95 patients aged ≥18 years admitted to the ICU, who were assessed in terms of prognostic indexes (Acute Physiology and Chronic Health Evaluation II [APACHE II] and Sequential Organ Failure Assessment [SOFA]), clinical evolution (ICU discharge, death, and length of ICU stay), and PA. RESULTS: Patients were predominantly male (63.1%) and had a mean age of 63.7 ± 14.6 years; length of stay of 4 days (range, 3-9 days); mortality of 15.8%; mean APACHE II and SOFA scores of 17.3 ± 8.2 and 6.1 ± 3.1 points, respectively; and mean PA of 4.91 ± 1.36°. An association was observed between females and PA <5.1° (P = .035), which was the cutoff point determined from the receiver operating characteristic curve. PA was correlated with APACHE II score (r = -0.241; P = .02). This correlation became moderate only when patients without sepsis were considered (r = -0.506; P < .001). CONCLUSIONS: PA seems to be a good prognostic marker for patients without sepsis. The weak correlation between PA and APACHE II score and the lack of association with other clinical outcomes are limitations for interpreting the prognostic value of PA in the entire study sample.

Enteral nutritional therapy in septic patients in the intensive care unit: compliance with nutritional guidelines for critically ill patients.

OBJECTIVE: Evaluate the compliance of septic patients' nutritional management with enteral nutrition guidelines for critically ill patients. METHODS: Prospective cohort study with 92 septic patients, age ≥ 18 years, hospitalized in an intensive care unit, under enteral nutrition, evaluated according to enteral nutrition guidelines for critically ill patients, compliance with caloric and protein goals, and reasons for not starting enteral nutrition early or for discontinuing it. Prognostic scores, length of intensive care unit stay, clinical progression, and nutritional status were also analyzed. RESULTS: The patients had a mean age of 63.4 ± 15.1 years, were predominantly male, were diagnosed predominantly with septic shock (56.5%), had a mean intensive care unit stay of 11 (7.2 to 18.0) days, had 8.2 ± 4.2 SOFA and 24.1 ± 9.6 APACHE II scores, and had 39.1% mortality. Enteral nutrition was initiated early in 63% of patients. Approximately 50% met the caloric and protein goals on the third day of intensive care unit stay, a percentage that decreased to 30% at day 7. Reasons for the late start of enteral nutrition included gastrointestinal tract complications (35.3%) and hemodynamic instability (32.3%). Clinical procedures were the most frequent reason to discontinue enteral nutrition (44.1%). There was no association between compliance with the guidelines and nutritional status, length of intensive care unit stay, severity, or progression. CONCLUSION: Although the number of septic patients under early enteral nutrition was significant, caloric and protein goals at day 3 of intensive care unit stay were met by only half of them, a percentage that decreased at day 7.

Bioelectrical impedance phase angle in septic patients admitted to intensive care units.

OBJECTIVE: To calculate the values of the phase angle of septic patients using bioelectrical impedance analysis, correlate the values with clinical and biochemical variables, and compare them to reference values. METHODS: Cohort study conducted with 50 septic patients aged ≥ 18 years old, admitted to intensive care units, and assessed according to prognostic indexes (APACHE II and SOFA), clinical progression (mortality, severity of sepsis, length of stay in intensive care unit), biochemical parameters (albumin and C-reactive protein), and the phase angle. RESULTS: The average age of the sample was 65.6 ± 16.5 years. Most patients were male (58%) and suffering from septic shock (60%). The average APACHE II and SOFA scores were 22.98 ± 7.1 and 7.5 ± 3.4, respectively. The patients who survived stayed nine days on average (five to 13) in the intensive care unit, and the mortality rate was 30%. The average value of the phase angle was 5.4 ± 2.6° in the total sample and was smaller among the females compared with the males (p=0.01). The phase angle measures did not exhibit an association with the severity of the sepsis, mortality, gender, and age or correlate with the length of hospitalization or the biochemical parameters. The participants' phase angle values adjusted per gender and age were 1.1 to 1.9 times lower compared with the values for a normal population. CONCLUSION: The average value of the phase angle of septic patients was lower compared with the reference values for a healthy population. The phase angle measures did not exhibit association with the clinical and biochemical variables, which might be explained by the sample homogeneity.

Terapia nutricional enteral em pacientes sépticos na unidade de terapia intensiva: adequação às diretrizes nutricionais para pacientes críticos / Enteral nutritional therapy in septic patients in the intensive care unit: compliance with nutritional guidelines for critically ill patients

OBJETIVO: Avaliar a adequação do manejo nutricional do paciente séptico a diretrizes de nutrição enteral para pacientes críticos. MÉTODOS: Estudo de coorte prospectivo com 92 pacientes sépticos, idade ≥18 anos, internados em unidade de terapia intensiva, em uso de nutrição enteral, avaliados segundo diretrizes para pacientes críticos quanto à nutrição enteral precoce, adequação calórica e proteica, e motivos para não início da nutrição enteral precoce bem como de interrupção da mesma. Escores prognósticos, tempo de internação, evolução clínica e estado nutricional também foram analisados. RESULTADOS: Pacientes com idade média de 63,4±15,1 anos, predominantemente masculinos, diagnóstico de choque séptico (56,5%), tempo de internação na unidade de terapia intensiva de 11 (7,2 a 18,0) dias, escores SOFA de 8,2±4,2 e APACHE II de 24,1±9,6 e mortalidade de 39,1%. Em 63% dos pacientes, a nutrição enteral foi iniciada precocemente. Cerca de 50% atingiu as metas calóricas e proteicas no 3º dia de internação na unidade de terapia intensiva, percentual que foi reduzido para 30% no 7º dia. Motivos para início da nutrição enteral tardia foram complicações do trato gastrintestinal (35,3%) e instabilidade hemodinâmica (32,3%). Procedimentos foram o motivo mais frequente para interrupção da nutrição enteral (44,1%). Não houve associação entre a adequação às diretrizes com estado nutricional, tempo de internação, gravidade ou evolução. CONCLUSÃO: Embora expressivo o número de pacientes sépticos que iniciaram a nutrição enteral precocemente, metas calóricas e proteicas no 3º dia da internação foram atingidas apenas pela metade destes, percentual que diminui no 7º dia.

OBJECTIVE: Evaluate the compliance of septic patients' nutritional management with enteral nutrition guidelines for critically ill patients. METHODS: Prospective cohort study with 92 septic patients, age ≥18 years, hospitalized in an intensive care unit, under enteral nutrition, evaluated according to enteral nutrition guidelines for critically ill patients, compliance with caloric and protein goals, and reasons for not starting enteral nutrition early or for discontinuing it. Prognostic scores, length of intensive care unit stay, clinical progression, and nutritional status were also analyzed. RESULTS: The patients had a mean age of 63.4±15.1 years, were predominantly male, were diagnosed predominantly with septic shock (56.5%), had a mean intensive care unit stay of 11 (7.2 to 18.0) days, had 8.2±4.2 SOFA and 24.1±9.6 APACHE II scores, and had 39.1% mortality. Enteral nutrition was initiated early in 63% of patients. Approximately 50% met the caloric and protein goals on the third day of intensive care unit stay, a percentage that decreased to 30% at day 7. Reasons for the late start of enteral nutrition included gastrointestinal tract complications (35.3%) and hemodynamic instability (32.3%). Clinical procedures were the most frequent reason to discontinue enteral nutrition (44.1%). There was no association between compliance with the guidelines and nutritional status, length of intensive care unit stay, severity, or progression. CONCLUSION: Although the number of septic patients under early enteral nutrition was significant, caloric and protein goals at day 3 of intensive care unit stay were met by only half of them, a percentage that decreased at day 7.

Ângulo de fase derivado de bioimpedância elétrica em pacientes sépticos internados em unidades de terapia intensiva / Bioelectrical impedance phase angle in septic patients admitted to intensive care units

OBJETIVO: Identificar valores de ângulo de fase em pacientes sépticos, por meio de bioimpedância elétrica, buscando associação com variáveis clínicas e bioquímicas, bem como comparação com valores de ângulo de fase de referência. MÉTODOS: Estudo de coorte, com 50 pacientes sépticos, idade ≥18 anos, internados em unidade de terapia intensiva, avaliados quanto a índices prognósticos (APACHE II e SOFA), evolução clínica (mortalidade, gravidade da sepse e tempo de internação na unidade de terapia intensiva), parâmetros bioquímicos (albumina e proteína C-reativa) e ângulo de fase. RESULTADOS: A média de idade dos pacientes estudados foi de 65,6±16,5 anos, a maioria do gênero masculino (58%) e apresentando choque séptico (60%). A média dos escores APACHE II e SOFA foi de 22,98±7,1 e 7,5±3,4, respectivamente, o tempo de internação na unidade de terapia intensiva dos pacientes que sobreviveram foi de 9 dias (5 a 13) e a taxa de mortalidade foi de 30%. A média do ângulo de fase da amostra total foi de 5,4±2,6° e menor no gênero feminino (p=0,01). Não houve associação entre ângulo de fase e a gravidade da sepse, mortalidade, gênero e idade, assim como não houve correlação entre ângulo de fase, tempo de internação e parâmetros bioquímicos. Comparativamente a dados em população saudável, os valores de ângulo de fase, a depender da idade e gênero, apresentaram-se 1,1 a 1,9 vezes inferiores. CONCLUSÃO: O ângulo de fase médio de pacientes sépticos foi inferior aos valores referência para população saudável, não havendo correlação e associação com as variáveis clínicas e bioquímicas, o que poderia ser atribuído a homogeneidade da amostra.

OBJECTIVE: To calculate the values of the phase angle of septic patients using bioelectrical impedance analysis, correlate the values with clinical and biochemical variables, and compare them to reference values. METHODS: Cohort study conducted with 50 septic patients aged ≥18 years old, admitted to intensive care units, and assessed according to prognostic indexes (APACHE II and SOFA), clinical progression (mortality, severity of sepsis, length of stay in intensive care unit), biochemical parameters (albumin and C-reactive protein), and the phase angle. RESULTS: The average age of the sample was 65.6±16.5 years. Most patients were male (58%) and suffering from septic shock (60%). The average APACHE II and SOFA scores were 22.98±7.1 and 7.5±3.4, respectively. The patients who survived stayed nine days on average (five to 13) in the intensive care unit, and the mortality rate was 30%. The average value of the phase angle was 5.4±2.6° in the total sample and was smaller among the females compared with the males (p=0.01). The phase angle measures did not exhibit an association with the severity of the sepsis, mortality, gender, and age or correlate with the length of hospitalization or the biochemical parameters. The participants' phase angle values adjusted per gender and age were 1.1 to 1.9 times lower compared with the values for a normal population. CONCLUSION: The average value of the phase angle of septic patients was lower compared with the reference values for a healthy population. The phase angle measures did not exhibit association with the clinical and biochemical variables, which might be explained by the sample homogeneity.

Avaliação nutricional, consumo alimentar e risco para doenças cardiovasculares de crianças praticantes de natação / Nutritional assessment, food consumption and cardiovascular risk in child swimmers

Introdução: As doenças cardiovasculares (DCV) destacam-se, nos dias atuais, como a mais frequente causa de mortalidade, inclusive na infância. Dentre os fatores de risco para DCV estão o alto consumo de gorduras saturadas, trans, colesterol, como também o excesso de peso e gordura corporal. Objetivo: avaliar o estado nutricional e consumo alimentar de crianças praticantes de natação de um clube esportivo. Métodos: A avaliação nutricional foi realizada por meio de antropometria, utilizando-se: peso, estatura, dobra cutânea triciptal (DCT), subescapular (DCSE), circunferência abdominal (CA) e cálculo do Índice de Massa Corporal (IMC). O percentual de gordura corporal (%GC) foi determinado através da soma da DCT e da DCSE. Para avaliar o consumo alimentar utilizou-se o Questionário Simplificado para Avaliação de Risco Cardiovascular (QRC) que identifica a frequência de consumo de 9 alimentos ricos em gorduras. Resultados: Foram avaliadas 204 crianças, 59% do sexo masculino, com média de idade de 8±2 anos. Quando classificados, 30,4% apresentavam-se com excesso de peso de acordo com o IMC, 26% tinham CA aumentada e 41% apresentaram alto consumo de alimentos que aumentam o risco cardiovascular. De acordo com a classificação do %GC, 11% foram classificados como muito alto para a idade, com diferença significativa entre os sexos (P<0,05), sendo que o sexo feminino teve maior número de crianças classificadas como muito alto. Conclusão: Embora pratiquem atividade física regular, as crianças estudadas apresentaram alta prevalência de excesso de peso e alto consumo de alimentos que aumentam o risco cardiovascular.

Background: Cardiovascular diseases (CVD) stand out, today, as the most frequent cause of mortality, even in childhood. Among risk factors for CVD are high consumption of saturated and trans fat, cholesterol, as well as excess weight and body fat. Aim: Assess the nutritional status and intake of child swimmers of a sport club. Methods: The nutritional assesment was evaluated by antropometry, using: weight, height, triciptal (TS) and subscapular skinfold (SS), abdominal circumference (AC) and Body Mass Index (BMI). To assess food intake, we used the Simplified Questionnaire for Assessing Cardiovascular Risk (SCR) that identifies the frequency of consumption of 9 fat-rich foods. Results: We evaluated 204 children, 59% male, with mean age 8±2 years. When classified, 30.4% presented with excess weight according to BMI, 26% had increased waist circunference and 41% had high intake of foods that increase cardiovascular risk. According to the classification of body fat percentage (BF%), 11% were classified as having very high BF% for their age, with significant difference between sexes (P<0.05), and females had a greater number of children classified as having very high BF%. Conclusion: In spite of practicing regular physical activity, the swimmers studied showed a high prevalence of overweight and high intake of foods that increase cardiovascular risk.