Higher bodily adiposity, fat intake, and cholesterol serum levels are associated with higher disease activity in psoriatic arthritis patients: is there a link among fat and skin and joint involvement?

INTRODUCTION/ OBJECTIVES: Assuming that there is a link between lipid and glucose metabolism and inflammation in patients with psoriatic arthritis (PsA), our aim was to evaluate the relationships among body composition measurements, food intake, and disease activity in patients with PsA. METHODS: A total of 97 patients with PsA, according to the CASPAR criteria, were included in this cross-sectional study. Body composition measurements (whole-body DXA, GE-Lunar), food intake (3-day registry) and biochemical and inflammatory serum markers were evaluated. Skin and joint disease activity were assessed by using PASI, BSA, DAS28, and minimal disease activity (MDA). The level of significance was set as p < 0.05. RESULTS: A higher prevalence of obesity, according to the fat mass index (FMI) (92.7%), and metabolic syndrome (MetS) (54%) were found, but no significant changes regarding lean or bone mass were found. Joint disease activity was positively correlated with total body fat (r = 0.4; p < 0.001), FMI (r = 0.33; p < 0.001), body mass index (r = 0.20; p < 0.049) and waist circumference (r = 0.27; p = 0.009). In addition, joint disease activity was negatively associated with muscle mass (r = - 0.38; p < 0.001). Skin disease activity was positively correlated with total cholesterol (r = 0.3; p = 0.003) and LDL-cholesterol (r = 0.28; p = 0.006). After multiple adjustments, patients with severe joint disease activity had higher body adiposity than patients in remission or with low disease activity. Skin disease activity was associated with higher trans-fat intake and lower omega-6 consumption. CONCLUSIONS: Our data suggest a possible harmful link among fat (body adiposity, saturated fat consumption, LDL-cholesterol serum levels) and joint and skin disease activity in patients with PsA.

Lack of association between dietary inflammatory index and low impact fractures in the Brazilian population: the Brazilian Osteoporosis Study (BRAZOS)

Abstract Introduction: Adequate nutrition, including intake of dietary calcium and vitamin D, is important to maintain bone health. Evidence suggests that a deficiency in micronutrients may contribute to bone loss during aging and exert generalized effects on chronic inflammation. Recently, the Dietary Inflammatory Index (DII) was developed to assess the inflammatory potential of individual diets. Our aim was to evaluate the DII in a representative sample and verify its association with low-impact fractures. Methods: Individuals from The Brazilian Osteoporosis Study (BRAZOS) database had their DII calculated. BRAZOS is an important cross-sectional epidemiological study carried out with a representative sample of men and women ≥40 years old. The research was conducted through in-home interviews administered by a trained team. Nutrition Database System for Research (NDSR) software was used to analyze data on the intake of nutrients, which were employed to calculate the DII using Statistical Analysis Software (SAS®) and Statistical Package for the Social Sciences (SPSS®) to assess its association with low-impact fractures. Results: A total of 2269 subjects had their DII score calculated using information from 24-h recall data. Males had lower DII than females (DII = 1.12 ± 1.04 vs DII = 1.24 ± 0.99, p = 0.012). Women taking statins had lower DII (DII = 0.65 ±1.14 vs DII + 1.26 ± 0.98, p = 0.002), indicating a greater potential for diet-related anti-inflammatory effects. Conclusion: Our findings suggest that women might have a pro-inflammatory diet pattern compared to men. However, we did not find any association between DII scores and low-impact fractures.

Dietary protein intake in elderly women: association with muscle and bone mass.

BACKGROUND: An inadequate food intake, mainly with regard to protein intake, seems to contribute to a reduction of skeletal muscle and bone mass in the elderly. This study was undertaken to evaluate differences in protein intake in women with or without sarcopenia and verify the intake level that is related to a better bone and muscle mass. METHODS: Elderly women older than 65 years with sarcopenia (n = 35) and without sarcopenia (n = 165) participated in the study. Assessment of bone mineral density of the lumbar spine and femur was taken, body composition was evaluated by dual-energy x-ray absorptiometry, and an evaluation of protein intake was performed through 3-day dietary records. RESULTS: Muscle, bone, and fat mass was significantly higher in women who had protein intake >1.2 g/kg/d. A lower intake of essential amino acids in women with sarcopenia was also observed. Protein and energy intake were significant predictors of muscle mass. The presence of osteoporosis was a predictor of muscle strength. In conclusion, the present study demonstrated that in elderly women, an adequate protein intake in terms of quality and quantity, without need of supplementation, could have a positive impact on bone mineral density, lean mass, and skeletal muscle mass.

Antioxidant intake among Brazilian adults--the Brazilian Osteoporosis Study (BRAZOS): a cross-sectional study.

BACKGROUND: Antioxidant nutrient intake and the lesser formation of free radicals seem to contribute to chronic diseases. The aim of the present study was to evaluate the intake profile of the main dietary antioxidants in a representative sample of the adult Brazilian population and discuss the main consequences of a low intake of these micronutrients on overall health. METHODS: The sample comprised 2344 individuals aged 40 years or older from 150 cities and was based on a probabilistic sample from official data. The research was conducted through in-home interviews administered by a team trained for this purpose. Dietary intake information was obtained through 24-h recall. The Nutrition Data System for Research software program was used to analyze data on the intake of vitamins A, C and E, selenium and zinc, which was compared to Dietary Reference Intakes (DRIs). Differences in intake according to sex, anthropometrics, socioeconomic status and region were also evaluated. The SPSS statistical package (version 13) was used for the statistical analysis. P-values < 0.05 were considered significant. RESULTS: Higher proportions of low intake in relation to recommended values were found for vitamin E (99.7%), vitamin A (92.4%) and vitamin C (85.1%) in both genders. Intake variations were found between different regions, which may reflect cultural habits. CONCLUSION: These results should lead to the development of public health policies that encourage educational strategies for improving the intake of micronutrients, which are essential to overall health and prevention of non-communicable diseases.

Effect of protein intake on bone and muscle mass in the elderly.

The aging process is frequently characterized by an involuntary loss of muscle (sarcopenia) and bone (osteoporosis) mass. Both chronic diseases are associated with decreased metabolic rate, increased risk of falls/fracture, and, as a result, increased morbidity and loss of independence in the elderly. The quality and quantity of protein intake affects bone and muscle mass in several ways and there is evidence that increased essential amino acid or protein availability can enhance muscle protein synthesis and anabolism, as well as improve bone homeostasis in older subjects. A thorough evaluation of renal function is important, since renal function decreases with age. Finally, protein and calcium intake should be considered in the prevention or treatment of the chronic diseases osteoporosis and sarcopenia.

Consumo alimentar e metabolismo mineral e ósseo em mulheres idosas com sarcopenia / Dietary intake and bonemineral metabolism in elderly women with sarcopenia

Introdução: a redução da massa muscular esquelética relacionada à idade, denominada sarcopenia, está associada com maior incidência de quedas, fraturas e dependência funcional em idosos. Muitos são os fatores que podem contribuir para o surgimento da sarcopenia, dentre eles a deficiência de vitamina D e a inadequação do consumo alimentar, principalmente a ingestão de proteína. Objetivos: investigar a relação da sarcopenia com o consumo alimentar e concentração sérica de 25(OH)D. Métodos: foram avaliadas 200 mulheres acima de 65 anos, sendo 35 com sarcopenia e 165 sem sarcopenia. Avaliou-se a densidade mineral óssea (DMO) da coluna lombar, fêmur proximal e a composição corporal ( massa muscular total, massa muscular esquelética, massa adiposa, conteúdo mineral ósseo do corpo total) por meio do densitômetro de dupla emissão com fonte de raios-X (DXA), avaliação radiográfica das colunas dorsal e lombar (T4 a L4). Foi realizada também avaliação da ingestão alimentar ( diário de três dias), bioquímica do metabolismo mineral e ósseo (cálcio total, fósforo, creatinina, albumina, paratormônio intacto, calcidiol) e a história clínica das pacientes. Resultados: o presente estudo observou que as pacientes que apresentavam um consumo de proteína acima de 1,2g/kg/dia apresentaram massa muscular total [33,94 (4,72) VS 31,87 (3,52) kg, p=0,020], massa muscular esquelética [14,54 (2,38) vs 13,38 (1,95)kg, p=0,013], CMO do corpo total [1,945 (0,325) VS 1784 (0,265)g, p=0,005], DMO de corpo total [1,039 (0,109) vs 0,988 (0,090) g/cm²,p=0,011], DMO coluna lombar [0,983 (0,192) vs 0,903 (0,131)g/cm², p=0,014], DMO colo de fêmur [0,813 (0,117) vs 0,760 (0,944)g/cm², p=0,017] e DMO fêmur total [0,868 (0,135) vs 0,807 (0,116)g/cm², p=0,026] significativamente maior quando comparado com pacientes que apresentavam consumo de proteína abaixo de 0,8g/kg/dia. Além disso, a ingestão de aminoácidos essenciais, principalmente os de cadeina ramificada como a valina [3,10 (0,89) vs 3,40 (1,0...

[Effect of caloric restriction on longevity]. / O efeito da restrição calórica na longevidade.

Calorie restriction (CR) is the most evaluated nutritional intervention to increase lifespan in a variety of animal species, including human beings. CR has also been shown to delay the onset or reduce the incidence of many age-related diseases. The mechanism that could explain the effect of calorie intake on aging is related to the reduction of body fat and insulin signaling as well as reactive oxygen species produced during breathing. These phenomena cause oxidative damage to DNA and RNA promoting the process of aging and increasing the risk of illnesses. However, the effect of CR on longevity in human beings is not fully established and further studies are necessary in order to identify the molecular and cellular mechanisms for the therapeutic effect of RC. Moreover, it is necessary to set up the differences between the beneficial effects of caloric restriction from those related to dietary healthy habits.

O efeito da restrição calórica na longevidade: [revisão] / Effect of caloric restriction on longevity: [review]

A restrição calórica (RC) é uma das formas de intervenção nutricional mais amplamente discutida para se estender o tempo de vida em uma variedade de espécies, inclusive seres humanos. A RC parece reduzir a incidência de doenças relacionadas à idade. O mecanismo clássico que poderia explicar o efeito do consumo calórico no envelhecimento está relacionado à redução da gordura corporal e à sinalização da insulina, somada às espécies reativas de oxigênio produzidas durante a respiração que causam danos oxidativos ao DNA e ao RNA das células, promovendo o processo de envelhecimento e o aumento do risco de doenças. No entanto, o efeito da RC na longevidade em humanos ainda não está bem estabelecido e mais estudos são necessários para que os mecanismos celulares e moleculares responsáveis pelos efeitos terapêuticos da restrição calórica sejam elucidados. Além disso, é necessário diferenciar os efeitos benéficos da restrição calórica daqueles relacionados a hábitos alimentares saudáveis.

Calorie restriction (CR) is the most evaluated nutritional intervention to increase lifespan in a variety of animal species, including human beings. CR has also been shown to delay the onset or reduce the incidence of many age-related diseases. The mechanism that could explain the effect of calorie intake on aging is related to the reduction of body fat and insulin signaling as well as reactive oxygen species produced during breathing. These phenomena cause oxidative damage to DNA and RNA promoting the process of aging and increasing the risk of illnesses. However, the effect of CR on longevity in human beings is not fully established and further studies are necessary in order to identify the molecular and cellular mechanisms for the therapeutic effect of RC. Moreover, it is necessary to set up the differences between the beneficial effects of caloric restriction from those related to dietary healthy habits.

Relationship between nutrient intake and vitamin D status in osteoporotic women.

Vitamin D is essential for maintaining calcium homeostasis and optimizing bone health. Its inadequacy is related to many factors including dietary intake. The aim of the present study was to evaluate serum 25(OH)D and its relationship with nutrient intakes in postmenopausal Brazilian women with osteoporosis. This cross-sectional study comprised 45 free-living and assisted elderly at São Paulo Hospital. Three-day dietary records were used to assess dietary intakes. Bone mineral density was measured with a dual-energy X-ray absorptiometer (DXA). Blood and urine sample were collected for analysis of biochemical markers of bone and mineral metabolism. Insufficiency of vitamin D was observed in 24.4% of the women and optimal levels (> or = 50 nmol/L) were observed in 75.6%. Parathyroid hormone was above the reference range in 51% of the participants. The mean calcium (724 mg/day) and vitamin D (4.2 microg/day) intakes were lower than the value proposed by The Food and Nutrition Board and sodium intake was more than two-fold above the recommendation. Higher levels of serum 25(OH)D were inversely associated with sodium intake. Dietary strategies to improve serum vitamin D must focus on increasing vitamin D intake and should take a reduction of sodium intake into consideration.

Avaliação do consumo alimentar, composição corporal e perfil do metabolismo mineral e ósseo de mulheres na pós - menopausa com osteoporose / Evaluation of dietary intake, body composition and biochemical markers of bone metabolism in postmenopausal women weth osteoporosis

Objetivo: Sendo a osteoporose reconhecida como um importante problema de saúde pública, o objetivo deste estudo foi avaliar o consumo alimentar, a composição corporal e o perfil bioquímico de mulheres na pós-menopausa com osteoporose. Resultados: As ingestões de macronutrientes estavam adequadas, pórem a média de ingestão de cálcio 723,80 (dp=263,96) mg/dia estava abaixo do recomendado para mulheres na pós-menopausa (1200 mg/dia). Houve prevalência de 65 por cento de inadequação na ingestão de magnésio. Com relação à ingestão de cloreto de sádio, verifica-se que a maior parte das pacientes (75 por cento) tinha ingestão acima do recomendado, untrapassando a UL (Upper Limit). Quanto ao consumo de vitamina D, 100 por cento das pacientes teve consumo abaixo do recomendado. Na composição corporal observou-se a presença de 46,6 por cento de pré-obesidade, 8,9 por cento obesidade e 15,5 por cento apresentavam risco de incapacidade física decorrente do baixo índice de massa muscular esquelética. Foi detectada hipovitaminose D em 71 por cento das mulheres e 24,4 por cento de insuficiência de vitamina D. Houve correlação negativa entre a osteoprotegerina e a DMO do corpo total (r = - 0,302; p= 0,046) e a DMO da coluna lombar (r = - 0,304; p= 0,045). Os níveis de TRAP estiveram 41,4 por cento acima do parâmetro de referência e observou-se ainda que a formação óssea não esteve proeminente, pois os níveis sérico de BAP e OPG estiveram de acordo com os parâmetros de normalidade. Verificou-se ainda que as mulheres com fratura apresentavam magnésio séricosignificantemente menor. Conclusão: Os resultados enfatizam inadequação no consumo alimentar, na composição corporal e nos marcadores de reabsorção óssea e alertam para que soluções simples e viáveis para esse problema incluem melhora na qualidade da dieta e aumento da prática de atividade física.

Fatores dietéticos, atividade física e composição corporal de mulheres na pós-menopausa com osteoporose / Diet, physical activity and body composition of post-menopausal women with osteoporosis

Numerous metabolic, physiologic and functional changes take place in post-menopausal elderly women. This is due, in part, to changes in body composition, because of the loss of bone, reduction of muscle and increaseof fat tissues. The purpose of the present study was to evaluate body composition, food intake and physical activity of elderly women. Twenty four women who attend the Osteoporosis Clinic of Hospital São Paulo, averageage of 64.3±7.2 years-old, and body mass index of 25.6±3.3kg/m2, were invited to enroll in the study. Bone densitometry was used to assess body composition. The diet and physical activity were collected by means of at hree-day diary and by the Beacke questionnaire, respectively. Average caloricintake was 1293±487Kcal/day. Protein, fat, carbohydrate and phosphorusin takes were 1.09±0.5g/kg/day, 35±16g/day, 185±76g/day and 901±76mg/day, respectively, being all of them within the Dietary Recomended Intake(DRIs) guidelines. However, the mean calcium intake (663±320mg/day) was bellow the values recommended for this group (1200mg/day ­ DRI's, 1997).Analysis of body composition showed that 83% of the participants were classified as obese (mean body fat 38.0±7.8%). Assessment of physical activity showed that 75% did not engage in any activity, being considered sedentary.These results emphasize the importance of a detailed assessment of food intake,of the level of physical activity and body composition, in order to preventage-related bone metabolism co-morbidities

Mujeres en la pos-menopausia sufren alteraciones metabólicas, fisiológicas y funcionales. En parte, eso se debe a los câmbios en la composición corporal, porque hay uma perdida de masa ósea, disminución de la massa muscular y aumento de la grasa corporal. El objetivo de este estudio fue evaluar la composición corporal, ingesta alimentar y actividad física de mujeres en lesa fase de la vida.Veinticuatro mujeres frecuentadoras de la Clínicade Osteoporosis del Hospital São Paulo conpromedio de edad (64,3 ± 7,2 años) e índice de masa corporal (25,6 ± 3,3kg/m2), fueron invitadasa participar del estudio. Para evaluar lacomposición corporal fue utilizado densitometria ósea. La dieta y la actividad física fueron registradas por diario y por cuestionario dietéticode BEACKE durante tres días. La ingestión calórica media fue de 1293 ± 487Kcal/día. Laingesta de proteína, grasa, carbohidratos yfósforo fueron 1,09 ± 0,5Kcal/día, 35 ± 16g/día,185 ± 76g/día y 901 ± 76mg/día,respectivamente, todos de acuerdo con lo propuesto por las Dietary Recommended Intakes(DRI). El promedio de ingesta de calcio (663 ±320mg/día) estaba abajo de lo recomendadopara este grupo (1200mg/día ­ DRI's 1997). Elanálisis de la composición corporal demostró queel 83% de las participantes eran clasificadascomo obesas (promedio de grasa corporal 38.0± 7.8%). La evaluación física mostró que el 75%no realizaban actividad física siendo consideradas sedentarias. Esos resultados enfatizan la importancia de evaluar la alimentación y la práctica de ejercicios físicos además de una evaluación de la composición corporal para prevenir comorbidades relacionadas con el metabolismo óseo causadas por el envejecimiento

Em mulheres idosas, na pós-menopausa, ocorrem alterações metabólicas, fisiológicas e funcionais. Em parte, isso se deve as mudanças da composição corporal, pois há uma perda de massa óssea , diminuição da massa muscular e aumento da gordura corporal. O objetivo deste estudo foi avaliar a composição corporal, ingestão alimentar e atividade física de mulheres idosas. Vinte e quatro mulheres freqüentadoras do Ambulatório de Osteoporose do Hospital São Paulo, idade média (64,3 ± 7,2 anos) e índice de massa corporal (25,6 ± 3,3kg/m2), foram convidadas a participar do estudo. Para avaliar a composição corporal foi utilizada a densitometria óssea. A dieta e a atividade física foram coletadas por diário de três dias e pelo questionário de Beacke, respectivamente. A ingestão calórica média foi 1293 ± 487Kcal/dia A ingestão de proteína,gordura, carboidrato, e fósforo foram 1,09 ± 0,5g/Kg/dia, 35 ± 16g/dia, 185 ± 76g/dia e 901 ± 76mg/dia, respectivamente, todos de acordo com o proposto pela Dietary Recomended Intake (DRIs). Porém, a ingestão média de cálcio (663 ± 320 mg/d) estava abaixo do recomendado para esse grupo (1200mg/d ­ DRI's, 1997). A análise da composição corporal demonstrou que 83% das participantes foram classificadas como obesas (média de gordura corporal 38,0 ± 7,8%). A avaliação da atividade física mostrou que 75% não realizavam atividade física sendo consideradas sedentárias. Os resultados enfatizam a importância de avaliação detalhada da ingestão alimentar, do nível de atividade física,e da composição corporal, a fim de prevenir co-morbidades do metabolismo ósseo relacionadas ao envelhecimento

Vitamin A supplementation and risk of skeletal fracture.

Effects of toxic amounts of vitamin A include skeletal effects; from acute toxic exposure to chronic high-dose intake of vitamin A, these effects have led experts to speculate that long-term consumption of diets high in vitamin A (retinol) stimulates bone resorption and inhibits bone formation, and may contribute to osteoporosis and hip fractures.