Obesity versus underweight: the prognostic impact of body mass phenotypes in hospitalized older patients / Obesidade versus baixo peso: o impacto prognóstico de fenótipos de massa corporal em pacientes idosos hospitalizados

Objective: To compare the frequency of underweight and obesity among previously hospitalized older adults and analyze their association with malnutrition, sarcopenia, frailty, inflammatory markers, and adverse outcomes both during hospitalization and after discharge. Methods: This secondary analysis of a prospective study, conducted at Hospital das Clínicas da Universidade Federal de Pernambuco, Brazil, included hospitalized older patients (age ≥ 60 y). Nutritional status, body composition, sarcopenia, frailty, and outcomes were assessed. Cox regression was performed to evaluate the impact of the body mass phenotypes on clinical outcomes. Results: This secondary analysis included one hundred patients. The prevalence of obesity was 22.10%, while that of underweight was 34.60%. Individuals with underweight had a higher frequency of weaker immune response, worse inflammatory profile, higher nutritional risk, higher frequency of sarcopenia and malnutrition, longer hospital stay, and a higher incidence of mortality when compared to those with obesity. Being underweight was independently associated with higher mortality rates, even after adjustment for age, sex, muscle mass, malnutrition, and diagnosis of malignancy [adjusted HR = 2.82 (95% confidence interval 1.03 ­ 7.72), p = 0.044]. Conclusion: The underweight phenotype represented a worst-case scenario in hospitalized older patients. (AU)

Avaliação do risco de sarcopenia em pacientes diabéticos tipo 2 / Assessment of the risk of sarcopenia in individuals with type 2 diabetes

Introdução: Diabéticos podem apresentar perda de força e massa muscular de forma acentuada. Assim, as triagens SARC-F e SARC-CALF são úteis na investigação do risco de sarcopenia. Objetivo: Associar o risco de sarcopenia em pacientes diabéticos com as variáveis sociodemográficas, econômicas, clínicas, antropométricas e de estilo de vida. Método: Estudo do tipo série de casos realizado com adultos diabéticos tipo 2, de ambos os sexos, com idade entre 20 e 59 anos. A avaliação do risco de sarcopenia se deu pela aplicação dos questionários SARC-F e SARC-CALF. Para caracterização da amostra e associação com o risco de sarcopenia, foram coletados dados sociodemográficos e econômicos, medidas antropométricas, condições clínicas e estilo de vida. Resultados: A amostra foi composta por 69 pacientes, com média de idade de 53±7,5 anos e maior proporção de mulheres (63,8%; IC95%: 50,7-75,4). A frequência do risco positivo para sarcopenia segundo o SARC-F e o SARC-CALF foi de 43,48% e 46,38%, respectivamente. O SARC-F não mostrou associação significativa com as variáveis estudadas; já o SARC-CALF associou-se com índice de massa corporal (p <0,001), circunferência da cintura (p <0,001) e hábito de fumar (p = 0,027). Conclusão: O risco de sarcopenia foi observado em aproximadamente metade dos pacientes avaliados. O instrumento SARC-CALF apresentou associação com as variáveis antropométricas e o hábito de fumar, podendo ser considerado satisfatório para avaliar o risco de sarcopenia e intervir de forma precoce e efetiva.

Introduction: Individuals with diabetes often experience an accentuated loss of muscle mass and strength. Thus, the SARC-F and SARC-CALF screening tools are useful for the investigation of the risk of sarcopenia. Objective: Associate the risk of sarcopenia with sociodemographic, economic, clinical, anthropometric and lifestyle variables in individuals with diabetes. Methods: A case-series study was conducted involving male and female adults with type 2 diabetes between 20 and 59 years of age. The assessment of the risk of diabetes was performed using the SARC-F and SARC-CALF instruments. Data were collected on sociodemographic-economic variables, anthropometric measures, clinical conditions and lifestyle for the characterization of the sample and to test associations with the risk of sarcopenia. Results: The sample was composed of 69 patients, with a mean age of 53 ± 7.5 years and a predominance of women (63.8%; 95%CI: 50.7-75.4). The prevalence of risk of sarcopenia was 43.48% and 46.38% based on the SARC-F and SARC-CALF, respectively. Using the SARC-F, no significant associations were found with the variables of interest. Using the SARC-CALF, however, the risk of sarcopenia was associated with body mass index (p < 0.001), waist circumference (p < 0.001) and smoking habit (p = 0.027). Conclusion: Approximately half of the individuals analyzed were at risk of sarcopenia. The SARC-CALF questionnaire was associated with anthropometric variables and the smoking habit and can be considered adequate for the assessment of the risk of sarcopenia, enabling early, effective interventions.

Central adiposity among elderly women in a gerontology-geriatric unit / Adiposidade central em idosas de uma unidade geronto-geriátrica

Abstract Objective: To evaluate central adiposity in elderly women in a gerontology-geriatric care unit of the Universidade Federal de Pernambuco (the Federal University of Pernambuco). Method: A cross-sectional study involving a sample of 182 elderly women, aged from 60 to 89 years, who received care from January to July 2011, was performed. The variables analyzed were the socio-economic and demographic conditions, lifestyle, waist circumference (WC) and body mass index (BMI) of the women, as well as the occurrence of hypertension, diabetes mellitus and high total cholesterol levels. Yates' chi-squared test and Fisher's exact test were applied. A significance rate of 5% was adopted for the rejection of the null hypothesis. Results: Of the elderly women surveyed 82.4% had a WC signifying a large waist size, 57.2% were over-weight, 78.3% presented hypercholesterolemia, 63.2% had hypertension and 23.6% had diabetes. 61.5% were aged between 60 and 69 years old; 56% received up to two minimum salaries; 63.5% had less than eight years of schooling, 74.7% stated that they did not smoke, 87.9% did not drink alcohol; and 51.4 had sedentary habits. An association was observed between BMI and central adiposity (CA) (p=0.000). CA tended to be present around 1.2 times more frequently in elderly women with excess weight than among those who were not overweight. Conclusion: The high frequency of central adiposity and overweight indicates the susceptibility of this population to these factors. While no association with cardiovascular risk factors was observed, there is a clear need for monitoring by a multidisciplinary team, so as to identify and treat this debilitating condition, thereby contributing to the quality of life of this population. AU

Resumo Objetivo: Avaliar a adiposidade central em idosas assistidas em uma unidade geronto-geriátrica da Universidade Federal de Pernambuco. Método: O estudo teve delineamento transversal envolvendo uma amostra de 182 idosas com faixa etária entre 60 a 89 anos, atendidas no período janeiro-julho de 2011. As variáveis analisadas foram: circunferência abdominal (CA), índice de massa corporal, estilo de vida, presença de Hipertensão Arterial Sistêmica (HAS), diabetes mellitus, colesterol total, condições socioeconômicas e demográficas. Aplicou-se o teste qui-quadrado e o teste exato de Fisher. Adotou-se o nível de significância de 5% para rejeição da hipótese de nulidade. Resultado: Das idosas avaliadas, 82,4% indicaram CA muito elevada, 57,2% apresentavam excesso de peso, 78,3% encontravam-se com hipercolesterolemia, 63,2% com HAS e 23,6% eram diabéticas, 61,5% encontravam-se entre 60 a 69 anos, 56% recebiam até 2 salários mínimos, 63,5% estudaram menos de 8 anos, 74,7% relataram não ser tabagista, 87,9% eram abstêmios e 51,4% sedentárias. Observou-se associação entre o Índice de Massa Corporal e AC (p=0,000). A AC tende apresentar cerca de 1,2 vezes no excesso de peso quando comparados com idosos sem AC. Conclusão: A elevada frequência de adiposidade central e o excesso de peso apontam a suscetibilidade dessa população, ainda que nenhuma associação com os fatores de risco cardiovascular tenha sido observada, impõe-se a necessidade de acompanhamento por equipe multidisciplinar para a identificação e tratamento desse agravo, contribuindo para a qualidade de vida dessa população. AU

Fatores associados à taxa de filtração glomerular em pacientes com diabetes mellitus tipo 2 atendidos em hospital universitário no nordeste do Brasil / Factors associated with glomerular filtration rate in patients with type 2 diabetes mellitus treated in university hospital, northeastern Brazil

Introdução: A função renal pode ser avaliada pela taxa de filtração glomerular (TFG), uma medida simples e de baixo custo, útil para o diagnóstico da doença renal crônica (DRC) na prática clínica. Objetivo: Avaliar a TFG e sua associação com fatores demográficos, clínicos, nutricionais, laboratoriais e do estilo de vida em pacientes com diabetes mellitus tipo 2 (DM2) acompanhados em ambulatório de hospital universitário de Pernambuco, nordeste do Brasil. Metodologia: Estudo quantitativo, descritivo, retrospectivo e documental. Os dados foram coletados, entre julho e setembro de 2014, de prontuários dos pacientes que foram atendidos no Ambulatório de Nutrição e Diabetes do Hospital das Clínicas da Universidade Federal de Pernambuco, no período entre janeiro de 2012 a dezembro de 2013. A amostra foi constituída por 146 pacientes DM2, adultos, de ambos os sexos, sem diagnóstico prévio de DRC ou em tratamento dialítico. A taxa de filtração glomerular foi avaliada pelo clearance de creatinina (ClCr ml/min) usando-se a fórmula de Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Foi considerado déficit da função renal TFG inferior a 60 ml/min. As variáveis relacionadas com a TFG foram: índice de massa corporal (IMC), sexo, idade, tempo do diabetes, presença de HAS, tabagismo, alcoolismo, glicose de jejum (GJ), hemoglobina glicada (HbA1c), colesterol total (CT) e frações, triglicerídeos (TG) e creatinina sé- rica (SCr). O IMC foi utilizado para avaliar o sobrepeso e a obesidade. Resultados: Houve diferenciação estatística entre os valores da TFG para as variáveis idade e atividade física, e na análise de correlação, a TFG se associou inversamente com as variáveis idade (r=-0,445; p<0,01), creatinina sérica (r=-0,79; p<0,01), e IMC (r=-0,197; p<0,05). O déficit da função renal ocorreu em 7% dos diabéticos. Pela classificação de estágio da DRC, a maioria estava no estágio 2. A HAS e dislipidemia foram frequentes, com 78,8% e 59,6% respectivamente. Emrelação ao IMC, a maioria dos pacientes adultos apresentou sobrepeso/obesidade (83,8%), semelhantemente predominou o excesso de peso entre os idosos (76,4%). Os valores médios da GJ e HbA1c foram 167,8 mg/dl (±74,4) e 7,6% (±1,9), respectivamente. Conclusões: A TFG foi menor nos idosos comparada aos adultos, e na presença de sedentarismo comparada aos que praticam atividade física. Três variáveis foram inversamente correlacionadas com a TFG: idade, creatinina sérica e o IMC. Foram elevadas as freqüências de obesidade, HAS e dislipidemias, isto é relevante ao se considerar a importância destes fatores na progressão da DRC e no aumento do risco cardiovascular (AU)

Introduction: Renal function can be evaluated by glomerular filtration rate (GFR), and is simple and inexpensive measurement, useful for the diagnosis of chronic renal disease in clinical practice. Objective: To evaluate the GFR and its association with demographic, clinical, nutritional, laboratory and lifestyle in patients with type 2 diabetes mellitus followed in outpatient clinic of a university hospital in Pernambuco, northeastern Brazil. Methodology: Quantitative study, descriptive, retrospective and documentary. Data were collected from medical records of patients who were treated at the Clinic Nutrition and Diabetes Hospital of the Federal University of Pernambuco, between January 2012 and December 2013. The sample consisted of 146 type 2 diabetic patients, adults of both sexes, with no previous diagnosis of CKD or on dialysis. GFR was measured by creatinine clearance (CrCl ml/min) using the formula of Chronic Kidney Disease Epidemiology Collaboration (CKD–EPI). According to the CrCl individuals were classified in stages of CKD, and was considered deficit of renal function GFR less than 60 ml/min. Variables related to GFR were: body mass index (BMI), gender, age, diabetes time, presence of hypertension (hypertension), smoking, alcohol, fasting glucose, glycated hemoglobin, total cholesterol and fractions, triglycerides and serum creatinine. BMI was used to assess overweight and obesity. Results: There was statistical difference between the values of GFR for the variables age and physical activity, and correlation analysis, GFR was inversely associated with the variables age (r =-0.445; p<0,01), serum creatinine (r =-0.79; p<0,01), and BMI (r =-0.197; p<0,05). The deficit of renal function occurred in 7% of diabetics. By CKD stage classification, most were in stage 2. Hypertension and dyslipidemia were common, 78.8%, 59.6% respectively. As to BMI, most adults were overweight/obesity (83.8%), similarly predominated overweight among the elderly (76.4%). The average values of fasting glucose and glycated hemoglobin were 167.8 (± 74.4) and 7.6 (± 1.9) respectively. Conclusions: There were high frequencies of hypertension, dyslipidemia and obesity. The GFR was lower in the elderly, and in the presence of a sedentary lifestyle. In addition, three variables were inversely correlated with GFR age, serum creatinine and BMI. This is relevant when considering the importance of these factors in the progression of CKD and increased cardiovascular risk. It is emphasized that blood glucose levels were not within the target for most diabetics (AU)