Gluten-Free Diet Reduces Diet Quality and Increases Inflammatory Potential in Non-Celiac Healthy Women.

AIM: Gluten-free diets (GFDs) have gained popularity in the general population. Nonetheless, controlled studies are necessary before decisions can be made to promote GFDs. We aimed to evaluate the effects of gluten intake on body weight, body composition, and resting energy expenditure and observe the changes in nutrient intake caused by GFDs. METHODS: Twenty-three women were kept on a GFD for six weeks and received muffins with 20 g of gluten isolate (gluten period) or muffins without gluten (gluten-free period) in a crossover, single-blind, non-randomized trial. Gastrointestinal symptoms, food frequency questionnaires, body composition, and resting energy expenditure were assessed before the study (habitual or usual diet) and in the third and sixth weeks. Food intake was recorded daily for six weeks. RESULTS: Gastrointestinal symptoms, resting energy expenditure, and body weight and composition were similar during the gluten period and gluten-free period. When the diet of the gluten-free period was compared with the habitual diet, we found an increase in the intake of fat and sodium and a reduction in the intake of fiber and vitamins B1, B6, B12, and folate. The nutrient imbalance caused by a GFD led to an increase in the dietary inflammatory index, thus suggesting that this type of diet has high inflammatory potential. CONCLUSION: Gluten intake (20 g/day) did not alter body composition and resting energy expenditure in healthy women without caloric restriction in the diet for a short period (three weeks). However, a GFD led to changes in the composition of the diet, which worsened the quality of the diet and increased its inflammatory potential.

Factors associated with immunization against hepatitis B among primary health care professionals.

Introduction: The hepatitis B virus is the cause of one of the major public health problems worldwide. The infection may affect the entire population equally; however, health care professionals are part of a group that is more vulnerable to the disease, since they are exposed to both occupational and daily hazards. Objectives: To investigate the prevalence and factors associated with the immunization of health care professionals against the hepatitis virus type B, in the city of Montes Claros, state of Minas Gerais, Brazil. Methods: This was a cross-sectional and quantitative study, conducted with primary health care professionals. Using a random cluster sampling, 209 medical professionals, nurses, and nursing technicians who were interested in participating in the research were selected. A structured questionnaire was applied, and blood sampling was performed for the analysis of hepatitis B surface antibody titers. Finally, a descriptive and bivariate statistical analysis was conducted. Results: Data have shown that 91.8% of the professionals had complete immunization against the hepatitis B virus, that is, they had taken the three recommended doses of the vaccine. However, 13.9% of the sample, even after vaccination, was non-reactive (titers < 10 IU/mL hepatitis B surface antibody). Most of the professionals (94.3%) had direct contact with needlesticks/sharps at work and none of the participants reported a previous infection by the virus. Conclusions: Although most participants had complete immunization, the total result of individuals who did not obtain seroconversion was eminent, so the importance of the hepatitis B surface antibody test must be disseminated in the context of public health.

Introdução: O vírus da hepatite B é o causador de um dos grandes problemas de saúde pública mundial. A infecção pode acometer toda a população de igual maneira; entretanto, os profissionais de saúde são parte de um grupo mais vulnerável à doença, visto que são expostos tanto ao risco ocupacional quanto ao risco cotidiano. Objetivos: Investigar a prevalência e os fatores associados à imunização de profissionais de saúde contra o vírus da hepatite viral tipo B na cidade de Montes Claros, Minas Gerais, Brasil. Métodos: Tratou-se de um estudo transversal e quantitativo, realizado com profissionais de saúde da atenção primária. Por amostragem aleatória por conglomerado, foram selecionados 209 profissionais médicos, enfermeiros e técnicos de enfermagem que tiveram interesse em participar da pesquisa. Foi aplicado um questionário estruturado, e foi realizada coleta de sangue para análise de títulos de anticorpo contra o antígeno de superfície da hepatite B. Por fim, a análise estatística descritiva e bivariada foi efetuada. Resultados: Os dados evidenciaram que 91,8% dos profissionais tinham imunização completa contra o vírus da hepatite B - ou seja, haviam tomado as três doses preconizadas da vacina. Entretanto, 13,9% da amostra, mesmo após a vacinação, se mostrou não reagente (títulos < 10 UI/mL de anticorpo contra o antígeno de superfície da hepatite B). A maioria (94,3%) dos profissionais tinha contato direto no trabalho com materiais perfurocortantes, e nenhum participante relatou infecção prévia pelo vírus. Conclusões: Apesar do fato de que a maioria dos participantes tinha imunização completa, o resultado total de indivíduos que não obtiveram soroconversão foi eminente, de modo que há de se divulgar a valia do exame de anticorpo contra o antígeno de superfície da hepatite B no contexto de saúde pública.

A importância do técnico de enfermagem no rastreamento da tuberculose na Unidade Básica de Saúde / The importance of the nursing technician in tuberculosis screening in the Basic Health Unit

A Tuberculose é um problema de saúde mundial e entende-se que faz parte do cotidiano do técnico de enfermagem a atenção às demandas da população acometida por ela. Este trabalho discorre sobre a atuação do profissional técnico de enfermagem no atendimento de usuários sintomáticos respiratórios com características de tuberculose e na coleta de BAAR, através do relato de uma vivência ao longo do estágio curricular do curso técnico de enfermagem em uma Unidade Básica de Saúde pertencente ao Grupo Hospitalar Conceição. Com essa experiência, foi possível evidenciar a relevância do cuidado adequado desse profissional no rastreamento da tuberculose e no atendimento de sintomáticos respiratórios, bem como o valor das orientações apresentadas pela técnica de enfermagem responsável pelo atendimento. (AU)

Inconsistent effects of gluten on obesity: is there a role for the haptoglobin isoforms?

BACKGROUND AND AIMS: There is no clear evidence about the effects of gluten intake on obesity. It is known that gluten's effects on gut permeability are mediated by zonulin, a protein identified as pre-haptoglobin 2, a physiological regulator of the intestinal barrier. We investigated the obesogenic and inflammatory effects of gluten and its association with the haptoglobin genotype. METHODS: This was a single blinded, crossover study, including 40 overweight or obesity women free of celiac disease. Participants adopted a gluten-free diet (GFD) for 8 weeks and consumed a gluten-free muffin (GF-M) or a gluten-containing muffin (GLU-M, 24 g gluten) for 4 weeks, switching muffin type during the subsequent 4 weeks. During a follow-up period of 4 weeks we evaluated the usual diet (UD). Food diaries were collected to estimate the macronutrient intake and dietary inflammatory index (DII®). Bodyweight and composition, resting energy expenditure (REE), and cytokines were assessed. Haptoglobin alleles (Hp1 and Hp2) were genotyped to characterize zonulin expression. RESULTS: Energy and macronutrient intakes were similar during both periods, except for protein intake, which was higher during GLU-M. DII scores indicated a more inflammatory profile during the GF-M and GLU-M periods compared to UD. No differences were observed in body composition or REE between interventions when the Hp genotype was not considered. Nonetheless, those carrying the Hp2-2 genotype (overexpressing zonulin) presented lower REE and higher levels of IL6 and IL1beta only during gluten intake (GLU-M and UD) compared to age- and body mass index-matched Hp1-1 carrier. These results suggest an obesogenic and inflammatory action of gluten only in those overexpressing zonulin (Hp2-2). CONCLUSION: These results highlight the importance of zonulin as the mediator of gluten obesogenic and inflammatory effects. Our data suggest that in the presence of gluten, zonulin release is associated with a reduction of REE and an increase of inflammatory markers that are not seen in zonulin low producers.

Low Ankle-Brachial Index is a Simple Physical Exam Sign Predicting Intracranial Atherosclerotic Stenosis in Ischemic Stroke Patients.

BACKGROUND: The investigation of ischemic stroke etiology is commonly limited to the heart and extracranial vessels. Nevertheless, the diagnosis of intracranial stenosis may carry important therapeutic implications. The aims of this study were to determine the prevalence and clinical predictors of intracranial atherosclerotic stenosis (ICAS) in a sample of patients with ischemic stroke. METHODS: Consecutive patients admitted to a university-based outpatient stroke clinic underwent CT angiography of the intracranial and extracranial brain vessels. Clinical, demographic, and laboratory characteristics were compared between patients with increasing levels of stenosis. Ankle-brachial index (ABI) was measured to quantify peripheral arterial disease, defined as an ABI less than or equal to .9. Multivariable ordinal logistic regression was constructed to predict increasing stenosis grades (none, 1%-49%-mild, 50%-69%-moderate, 70%-100%-severe). RESULTS: We studied 106 subjects, mean age 62 ± 15 years, 54% female. ICAS was present in 38 (36%) patients: 19 (50%) mild, 7 (18%) moderate, and 12 (32%) severe. Of 74 patients where ABI was measured, low ABI was found more frequently with increasing ICAS severity (26%, 42%, 67%, and 89% of patients with none, mild, moderate, and severe ICAS, respectively). In univariable analysis, higher age, presence of diabetes, abdominal obesity, and low ABI correlated with increasing stenosis grades. In multivariable analysis, only low ABI remained independently associated with increasing stenosis grades. CONCLUSIONS: The ABI is independently associated with increasing severity of ICAS, making it a potentially useful triaging tool for more invasive test selection.