The impact of essential and toxic elements on cardiometabolic risk factors in adults and older people.

BACKGROUND AND AIM: Evidence suggests an association between essential and toxic elements and the worsening of cardiometabolic risk factors. This study aimed to investigate the concentrations of zinc, copper, selenium, arsenic, cadmium, and mercury and their relationship with cardiometabolic risk factors in adults and older people. METHODS: This cross-sectional study was carried out with 112 adults with a mean age of 59 (sd 14) years old and a BMI of 29.30 (sd 5.11) Kg/m2. The subject's weight and height were measured for body mass index (BMI) calculation, classified according to the cut-off points recommended by the World Health Organization (WHO). We evaluated sociodemographic, clinical, lifestyle, waist circumference - WC, visceral adiposity index - VAI, glycemic lipid profile, blood pressure, and high-sensitive C-reactive protein (hs-CRP). Cardiovascular risk was defined by The Global Risk Score (GRS) score. Plasma zinc, selenium, copper levels, urinary arsenic, cadmium, and mercury levels were measured using the inductively coupled plasma mass spectrometry technique (ICP-MS). RESULTS: There was a negative association between urinary arsenic and VAI (ß - 0.03, p < 0.01), triglycerides (ß - 1.10, p < 0.01), and VLDL cholesterol (ß - 0.14, p = 0.02). Plasma copper and copper/zinc ratio were positively associated with fasting glucose and hs-CRP (ß 0.38, p < 0.01; ß 36.02, p = 0.01, ß 0.004, p < 0.01, ß 0.68, p < 0.001, respectively). Urinary arsenic (ß - 0.14, p = 0.04) and cadmium (ß - 36.42, p = 0.04) were negatively associated with systolic blood pressure. Also, urinary cadmium was negatively associated with diastolic blood pressure (ß - 21.55, p = 0.03), and urinary mercury showed an opposite behavior (ß 1.45, p = 0.03). CONCLUSION: Essential and toxic elements in urine and plasma could be potential biomarkers for cardiovascular risk factors. A healthy lifestyle should be adopted; in addition, government policies should be developed to guarantee sustainable production and a safe environment.

NUTRITIONAL STATUS AND PERIOPERATIVE FASTING TIME VERSUS COMPLICATIONS AND HOSPITAL STAY OF SURGICAL PATIENTS.

INTRODUCTION: many factors can have a negative influence over surgical results, such as a compromised nutritional status and the extension of the perioperative fasting time. OBJECTIVE: to evaluate the influence of the nutritional status and the perioperative fasting time over the occurrence of surgical complications and over hospital stay, in patients who have undergone surgery of the gastrointestinal tract and/or abdominal wall, and who were subjected to a nutritional care protocol. METHODS: cohort study, conducted with 84 patients, from June to November 2014. Data collection was performed by applying a structured questionnaire, search over the records and medical and/or nutritional prescription. Statistical analysis was performed using STATA/SE 12.0 and significance level of 5%. RESULTS: nutritional risk was present in 26.2%, and from these 45.4% carried out preoperative nutritional therapy, having an average of 6.6 ± 2.79 days. The preoperative fasting was 4.5 (3.66; 5.50) hours and the postoperative fasting 5.1 (2.5; 20.5) hours. No associations were found between the parameters for assessing body composition and the presence of complications. A negative correlation was observed between the length of hospital stay and the BMI (p = 0.017),while a positive correlation was observed between weight loss and the length of hospital stay (p = 0.036). Patients with higher postoperative fasting time had a higher occurrence of complications (p = 0.021). CONCLUSION: the compromised nutritional status and the extension of perioperative fasting time are associated with the occurrence of surgical complications and increased length of hospital stay.

Introducción: muchos factores pueden influir negativamente en los resultados quirúrgicos, tales como el estado nutricional deteriorado y la extensión del tiempo de ayuno perioperatorio. Objetivo: evaluar la influencia del estado nutricional y el tiempo de ayuno perioperatorio en la aparición de complicaciones quirúrgicas y la duración de la estancia hospitalaria en pacientes sometidos a cirugía del tracto gastrointestinal y/o la pared abdominal, que fueron sometidos a protocolo de atención nutricional. Métodos: estudio de cohorte, realizado con 84 pacientes, de junio a noviembre de 2014. La recolección de datos se realizó mediante la aplicación de un cuestionario estructurado, búsqueda en los registros y prescripción médica y/o nutricional. Para el análisis estadístico se utilizó el programa STATA/SE 12.0 y se adoptó el nivel de significación del 5%. Resultados: el riesgo nutricional estuvo presente en el 26,2% de los casos, y de estos el 45,4% realizaron terapia nutricional preoperatoria, con una media de 6,6 ± 2,79 días. El ayuno preoperatorio fue de 4,5 (3,66; 5,50) horas y el ayuno postoperatorio fue de 5,1 (2,5; 20,5) horas. No se encontraron asociaciones entre los parámetros para evaluar la composición corporal y la presencia de complicaciones. Se observó una correlación negativa entre la duración de la estancia y el IMC (p = 0,017), y una correlación positiva entre la pérdida de peso y el tiempo de estancia hospitalaria (p = 0,036). Los pacientes con mayor tiempo de ayuno postoperatorio tuvieron una mayor incidencia de complicaciones (p = 0,021). Conclusión: el mal estado nutricional y la extensión del tiempo de ayuno perioperatorio están asociados a la aparición de complicaciones quirúrgicas y a una mayor duración de la estancia hospitalaria.

Nutritional status and perioperative fasting time versus complications and hospital stay of surgical patients / Estado nutricional y tiempo de ayuno perioperatorio versus complicaciones y tiempo de internamiento de pacientes quirúrgicos

Introduction: many factors can have a negative influence over surgical results, such as a compromised nutritional status and the extension of the perioperative fasting time. Objective: to evaluate the influence of the nutritional status and the perioperative fasting time over the occurrence of surgical complications and over hospital stay, in patients who have undergone surgery of the gastrointestinal tract and/or abdominal wall, and who were subjected to a nutritional care protocol. Methods: cohort study, conducted with 84 patients, from June to November 2014. Data collection was performed by applying a structured questionnaire, search over the records and medical and/or nutritional prescription. Statistical analysis was performed using STATA/SE 12.0 and significance level of 5%. Results: nutritional risk was present in 26.2%, and from these 45.4% carried out preoperative nutritional therapy, having an average of 6.6±2.79 days. The preoperative fasting was 4.5 (3.66; 5.50) hours and the postoperative fasting 5.1 (2.5; 20.5) hours. No associations were found between the parameters for assessing body composition and the presence of complications. A negative correlation was observed between the length of hospital stay and the BMI (p=0.017), while a positive correlation was observed between weight loss and the length of hospital stay (p=0.036). Patients with higher postoperative fasting time had a higher occurrence of complications (p=0.021). Conclusion: the compromised nutritional status and the extension of perioperative fasting time are associated with the occurrence of surgical complications and increased length of hospital stay (AU)

Introducción: muchos factores pueden influir negativamente en los resultados quirúrgicos, tales como el estado nutricional deteriorado y la extensión del tiempo de ayuno perioperatorio. Objetivo: evaluar la influencia del estado nutricional y el tiempo de ayuno perioperatorio en la aparición de complicaciones quirúrgicas y la duración de la estancia hospitalaria en pacientes sometidos a cirugía del tracto gastrointestinal y/o la pared abdominal, que fueron sometidos a protocolo de atención nutricional. Métodos: estudio de cohorte, realizado con 84 pacientes, de junio a noviembre de 2014. La recolección de datos se realizó mediante la aplicación de un cuestionario estructurado, búsqueda en los registros y prescripción médica y/o nutricional. Para el análisis estadístico se utilizó el programa STATA/SE 12.0 y se adoptó el nivel de significación del 5%. Resultados: el riesgo nutricional estuvo presente en el 26,2% de los casos, y de estos el 45,4% realizaron terapia nutricional preoperatoria, con una media de 6,6±2,79 días. El ayuno preoperatorio fue de 4,5 (3,66; 5,50) horas y el ayuno postoperatorio fue de 5,1 (2,5; 20,5) horas. No se encontraron asociaciones entre los parámetros para evaluar la composición corporal y la presencia de complicaciones. Se observó una correlación negativa entre la duración de la estancia y el IMC (p=0,017), y una correlación positiva entre la pérdida de peso y el tiempo de estancia hospitalaria (p=0,036). Los pacientes con mayor tiempo de ayuno postoperatorio tuvieron una mayor incidencia de complicaciones (p=0,021). Conclusión: el mal estado nutricional y la extensión del tiempo de ayuno perioperatorio están asociados a la aparición de complicaciones quirúrgicas y a una mayor duración de la estancia hospitalaria (AU)

Tempo de jejum perioperatório versus tempo de permanência hospitalar e complicações pós operatórias em pacientes submetidos a cirurgias do trato gastrointestinal e de parede abdominal / Fasting time perioperative versus time hospital permanence and complications after surgical patients submitted to surgery of the gastrointestinal tract and abdominal wall

Introdução: Pacientes cirúrgicos são expostos a jejum perioperatório prolongado podendo agravar a resposta metabólica ao trauma. Objetivo: identificar o tempo de jejum pré e pósoperatório e associar à incidência de complicações pós-operatórias e tempo de internamento em pacientes submetidos a cirurgias do trato gastrointestinal e de parede abdominal. Métodos: Trata-se de um estudo prospectivo observacional realizado com pacientes cirúrgicos internados no período de abril a outubro de 2013. Considerou-se o tempo de jejum pré-operatório a diferença (em horas) da última refeição realizada até o início do procedimento cirúrgico. O jejum pós-operatório foi contabilizado a partir da diferença (em horas) entre o final do procedimento cirúrgico e o reinício da dieta. As operações foram divididas em porte I (operações envolvendo parede abdominal e laparotomias sem abertura de alças e/ou manipulação de vias biliares) e porte II (operações envolvendo laparotomias com abertura de alças e/ou manipulação de vias biliares). As complicações pós-operatórias avaliadas por um período de até 30 dias após o procedimento cirúrgico. O tempo (em dias) de interna- ção pós-operatória foi calculado pela diferença entre a data da alta e a data da cirurgia. Para análise dos resultados utilizou-se o programa estatístico Sigma Stat 13.0, empregando-se o nível de confiança de 95%. Resultados: Não houve diferença nas medianas do tempo de jejum pré-operatório entre as cirurgias do porte I e II. Os pacientes que realizaram cirurgia do porte II permaneceram mais tempo em jejum pós-operatório ( p<0,001) e por mais tempo internados (p<0,001). Houve maior percentual de complicações nas cirurgias do porte II ( p= 0,001). Discussão: A nutrição tanto no pré como no pósoperatório tem papel relevante, diminuindo a resposta orgânica ao estresse e interferindo de maneira significativa na evolução dos pacientes. Conclusão: O tempo de jejum pré-operatório foi superior ao preconizado pelos protocolos multimodais de abreviação do jejum, independente do porte cirúrgico. O tempo de jejum perioperatório alargado pode favorecer ao aumento do tempo de permanência hospitalar (AU)

Introduction: Surgical patients are exposed to prolonged perioperative fasting can aggravate the metabolic response to trauma. Objective: To identify the pre fasting period and after surgery and associate the incidence of postoperative complications and length of hospital stay in patients undergoing surgery of the gastrointestinal tract and abdominal wall. Methods: This is a prospective observational study of hospitalized surgical patients from April to October 2013. It was considered the preoperative fasting time difference (in hours) of the last meal accomplished at the beginning of the surgical procedure. Postoperative fasting was recorded from the difference (in hours) between the end of the surgical procedure and the diet restart. Operations were divided into size I (operations involving abdominal wall and laparotomy without opening handles and/or manipulation of the bile ducts) and size II (operations involving laparotomy with open handles and/or manipulation of the bile ducts). Postoperative complications assessed for a period of 30 days after surgery. The time (in days) of postoperative hospital stay was calculated as the difference between the date of discharge and the date of surgery. For data analysis we used the statistical software Sigma Stat 13.0, using the confidence level of 95%. Results: There was no difference in median preoperative fasting time between the size of the surgeries I and II. Patients who underwent surgery sized II stayed longer in postoperative fasting (p< 0.001) and in hospital longer (p<0.001). There was a higher percentage of complications in the size surgeries II (p = 0.001). Discussion: Nutrition both pre and post-operative has an important role, reducing organic response to stress and interfering significantly to patient outcomes. Conclusion: Preoperative fasting time was higher than the one from multimodal protocols of fasting abbreviation, regardless of surgical size. The extended perioperative fasting time may favor the increased length of hospital stay (AU)

Nutritional status and its impact on time and relocation in postoperative complications of abdominal patients undergoing surgery / Estado nutricional y su impacto en el tiempo de la reubicación y en las complicaciones postoperatorias en pacientes sometidos a cirugía abdominal

Introduction: The nutritional state is the independent factor that most influences the post-operational results in elective surgeries. Objective: to evaluate the influence of the nutritional state on the hospitalization period and on the post-operative complications of patients submitted to abdominal surgery. Methods: prospective study with 99 surgical patients over 18 years of age, submitted to abdominal surgeries in the period from April to October of 2013, in the Instituto de Medicina Integral Professor Fernando Figueira (IMIP). All patients were submitted to anthropometric nutritional evaluations through the body mass Index (BMI), arm circumference (AC) and triceps skinfold thickness (TEST). The biochemical evaluation was carried out from the leukogram and serum albumin results. The identification of candidate patients to nutritional therapy (NT) was carried out through the nutritional risk (NR) evaluation by using the BMI, loss of weight and hypoalbuminemia. The information about post-operational complications, hospitalization period and clinical diagnosis was collected from the medical records. Program SPSS version 13.0 and significance level of 5% were used for the statistical analysis. Results: The malnutrition diagnosed by the AC showed significant positive association with the presence of post-operative complications (p=0.02) and with hospitalization period (p=0.02). The presence of NR was greater when evaluated by hypoalbuminemia (28.9%), however, only 4% of the sample carried out the NT in the pre-operational period. The hospitalization period was greater for patients with malignant neoplasia (p<0.01). Conclusion: The malnutrition diagnosis of patients submitted to abdominal surgeries is associated to greater risk of post-operational complications and longer hospitalization permanence (AU)

Introducción: El estado nutricional es el factor independiente que más influye en los resultados post-operacionales en las cirugías electivas. Objetivo: evaluar la influencia del estado nutricional en el periodo de hospitalización y en las complicaciones post-operatorias de los pacientes sometidos a cirugía abdominal. Métodos: Estudio prospectivo de 99 pacientes quirúrgicos mayores de 18 años de edad, sometidos a cirugía abdominal en el período de abril a octubre de 2013, en el Instituto de Medicina Integral Professor Fernando Figueira (IMIP). Todos los pacientes fueron sometidos a evaluaciones nutricionales antropométricos a través del índice de masa corporal (IMC), la circunferencia del brazo (CB) y el espesor del pliegue cutáneo tricipital (PCT). La evaluación bioquímica se llevó a cabo a partir de los resultados leucograma y albú- mina sérica. La identificación de los pacientes candidatos a la terapia nutricional (TN) se llevó a cabo a través de la evaluación del riesgo nutricional (RN) utilizando el IMC, la pérdida de peso y la hipoalbuminemia. La información sobre las complicaciones postoperatorias, tiempo de hospitalización y diagnóstico clínico se recogió de los registros médicos. Programa SPSS versión 13.0 y nivel de significancia de 5 % se utilizaron para el análisis estadístico. Resultados: La malnutrición diagnosticada por el CB mostraron asociación positiva significativa con la presencia de complicaciones postoperatorias (p = 0,02) y con el período de hospitalización (p = 0,02). La presencia de RN fue mayor cuando se evaluó por la hipoalbuminemia (28,9 %), sin embargo, sólo el 4 % de la muestra llevó a cabo el TN en el período pre-operacional. El período de hospitalización fue mayor para los pacientes con neoplasia maligna (p < 0,01). Conclusión: El diagnóstico desnutrición de los pacientes sometidos a cirugía abdominal se asocia a un mayor riesgo de complicaciones post-operativas y más tiempo de permanencia de hospitalización (AU)