Assessment of Malnutrition in Heart Failure and Its Relationship with Clinical Problems in Brazilian Health Services.

Malnutrition in heart failure (HF) is frequent and associated with a worse prognosis. Due to differences in investment and the profile of those assisted, the objective of this study was to evaluate the frequency of malnutrition in hospitalized patients with HF and its association with clinical outcomes in the public and private health systems. Methodology: A cross-sectional study, with 247 volunteers hospitalized with HF in three public hospitals and one private hospital in Aracaju, SE, Brazil. A subjective global nutritional assessment (SGA) and mini nutritional assessment (MNA) were performed. Results: Sample with 72.5% users of the public health system and 75.3% with malnutrition (public = 74.9%; private = 76.5%; p = 0.793). Regardless of the healthcare system, hospital stay (>14 days) was longer (p = 0.020) among those with malnutrition (48.4%) than well-nourished patients (29.5%). Malnutrition in the public system had higher mortality (7.5%; 5.8%; p < 0.001) and hospital transfer rate (21.1%; 0.0%; p < 0.001) than those in the private system. Death after discharge was observed only in the public system (p = 0.039). Conclusion: Malnutrition was frequent in both systems and was associated with longer hospital stays and, in the public hospital, in-hospital death and transfers.

BALANCE Dietary Index in Patients with Heart Failure, and Its Adherence in Sergipe, Brazil.

BACKGROUND: "The effective treatment of Heart Failure (HF) involves care with food intake. Recently, the Ministry of Health created the Brazilian Cardioprotective Diet and its dietary index, BALANCE, which assesses adherence to the standard's recommendations". METHODS: This observational prospective study is part of the Congestive Heart Failure Registry (VICTIM-CHF) of Aracaju/SE. Observations and data collection took place from April 2018 to February 2021. Sociodemographic and clinical aspects and food consumption were evaluated. Food intake was determined using the food frequency questionnaire. Foods were categorized using the BALANCE dietary index into green, yellow, blue and red food groups. The BALANCE dietary index was obtained using median and interquartile ranges, scores of the Mann-Whitney U test, and associations between clinical variables and the index, through linear regression. RESULTS: Participants included 240 patients with HF (61.12 ± 1.06 years), who were assisted by the Unified Health System (67.5%). Individuals with a partner showed greater adherence to the green food group recommendations (0.09; 0.00-0.17). The lowest adherence to recommendations regarding the blue food group was observed in individuals with excess weight, who had a higher consumption of foods rich in animal protein (0.54; 0.38-0.78). As for the red food group (ultra-processed foods) the highest adherence was observed by patients with diabetes mellitus (0.41; 0.05-0.77). The greatest adherence to the yellow food group, and a higher score, was observed in patients with the smallest left ventricular systolic diameter (LVSD). CONCLUSIONS: Being married was directly associated with the consumption of foods in the green group, while being overweight and having diabetes were inversely associated with adherence to the blue and red food groups, respectively. Greater adherence to the yellow food group recommendations was inversely associated with less change in the DSFVE.

Food Patterns of Hospitalized Patients with Heart Failure and Their Relationship with Demographic, Economic and Clinical Factors in Sergipe, Brazil.

Background: The high rates of hospitalization and mortality caused by Heart Failure (HF) have attracted the attention of health sectors around the world. Dietary patterns that involve food combinations and preparations with synergistic or antagonistic effects of different dietary components can influence the worsening and negative outcomes of this disease. Objectives: To describe the dietary patterns of patients hospitalized for HF decompensation and associate them with demographic, economic, and clinical factors, and the type of care provided in Sergipe. Materials and Methods: Cross-sectional study that is part of the Congestive Heart Failure Registry (VICTIM-CHF)" of Aracaju/SE. Prospective data collection took place with all patients hospitalized between April 2018 and February 2021 in cardiology referral hospitals, 2 public and 1 private. The data collected were sociodemographic, clinical, lifestyle, anthropometric and food consumption variables. Daily dietary intake was estimated by applying a semiquantitative food frequency questionnaire. The extraction of dietary patterns, by exploratory factor analysis, was performed after grouping the foods according to the nutritional value and form of preparation into 34 groups. To assess the association between the factorial scores for adherence to the standards and the variables studied, the Mann-Whitney U test was applied. Linear regressions were also performed, considering the dietary pattern (one for each pattern) as a dependent variable. Results: The study included 240 patients hospitalized for HF decompensation, most of them elderly (mean age 61.12 ± 1.06 years), male (52.08%) and attended by the Unified Health System­SUS (67.5%). Three dietary patterns were identified, labeled "traditional" (typical foods of the Brazilian northeastern population added to ultra-processed foods), "Mediterranean" (foods recommended by the Mediterranean diet) and "dual" (healthy foods combined with fast and easy-to-prepare foods like snacks, bread, sweets and desserts). Adherence to the "traditional" pattern was greater among men (p < 0.031) and non-diabetics (p < 0.003). The "Mediterranean" was more consumed by the elderly (p < 0.001), with partners (p = 0.001) and a lower income (p < 0.001), assisted by the SUS (p < 0.001) and without hypertension (p = 0,04). The "dual" diet pattern had greater adherence by the elderly (p < 0.001), self-declared non-black (p = 0.012), with higher income (p < 0.001), assisted in the private sector (p < 0.001) and with less impaired functional capacity (p = 0.037). It was also observed that being female (p = 0.031) and being older reduced the average scores of performing the "traditional" pattern (p = 0.002). Regarding the type of service, being from the public service reduced the average scores for adhering to the "dual" pattern (p = 0.008). Conclusions: Three dietary patterns representative of the population were found, called traditional, Mediterranean and dual, which were associated with demographic, economic and clinical factors. Thus, these standards must be considered in the development of nutritional strategies and recommendations in order to increase adherence to diets that are more protective against cardiovascular diseases.

Non-Targeted Self-Measurement of Blood Pressure: Association with Self-Medication, Unscheduled Emergency Visits and Anxiety.

Background and Objective: The routine practice of self-medication of blood pressure (BP) not oriented with pulse devices may not be precisely useful in the control of BP and can lead the patient to self-medicate in error. Thus, we need to evaluate the non-oriented self-assessment of BP in real-life circumstances in hypertensive patients. The objective of this study was to evaluate in hypertensive patients the association of BP self-measurement with its control, as well as the presence of anxiety disorders, the occurrence of unscheduled visits to the emergency room, and self-medication. Materials and Methods: An observational study was carried out with 1000 hypertensive volunteers (age: 61.0 ± 12.5). Using a questionnaire, sociodemographic and clinical data on BP control were collected. Anxiety was assessed by the State-Trait Anxiety Inventory (STAI). Results: The group that performed non-oriented self-measurement of BP, showed that they had higher frequencies of self-medication (57.9%, p < 0.05) and more unscheduled visits to the emergency room (68%, p < 0.05). In addition, a lower level of BP control (46.8%, p < 0.05) was associated with higher levels of anxiety (52.3%, p < 0.05) in the group that performed non-oriented self-measurements of BP. Conclusion: The practice of non-oriented self-assessment of BP was associated with negative factors such as high levels of anxiety and higher frequencies of self-medication and unscheduled emergency visits.

Consumo dos grupos alimentares em crianças usuárias da rede pública de saúde do município de Aracaju, Sergipe / Consumption of food groups among children attending the public health system of Aracaju, northeast Brazil, in Sergipe / Consumo de los grupos alimentares en niños usuarios de la red pública de salud en el municipio de Aracaju, Sergipe (Brasil)

OBJETIVO: Avaliar o consumo dos grupos alimentares em crianças usuárias da rede pública de saúde do município de Aracaju, Sergipe. MÉTODOS: Estudo transversal com crianças de 6 a 35 meses de cinco Unidades Básicas de Saúde. Para a avaliação dietética foi utilizado o recordatório alimentar de 24 horas. Os alimentos e preparações consumidos pelas crianças foram transformados em porções relacionadas aos oito grupos da Pirâmide Alimentar, e suas inadequações foram analisadas de acordo com as recomendações dos guias alimentares brasileiros. Comparou-se o consumo alimentar das faixas etárias de 6 a 11, 12 a 23 e 24 a 35 meses. Para análise das variáveis, os testes estatísticos Kruskal-Wallis e qui-quadrado foram utilizados, considerando nível de significância de 5%. RESULTADOS: Dentre as 359 crianças incluídas, observou-se consumo insuficiente de hortaliças, frutas, leite e derivados, e alto consumo de açúcares e doces. Quando comparado o consumo entre as diferentes faixas etárias, as crianças de 6 a 11 meses apresentaram menor consumo de frutas, carnes e leguminosas, e as de 24 a 35 meses tiveram maiores percentuais de ingestão excessiva de cereais, açúcares e doces, óleos e gorduras. CONCLUSÕES: O consumo alimentar das crianças apresentou inadequações nos grupos alimentares das frutas, hortaliças, leite e derivados, açúcares e doces, além de diferenças significativas no consumo entre as faixas etárias. Nesse contexto, é importante salientar a necessidade da educação alimentar e nutricional, respeitando as especificidades de cada grupo etário, visando a contribuir para a prevenção de problemas nutricionais em médio e longo prazos.

OBJECTIVE: To investigate the consumption of food groups among children attending the public health system of Aracaju, in Sergipe, Northeast Brazil. METHODS: A cross-sectional study with 359 children aged 6 to 35 months attending five Basic Health Units. Food intake was determined by 24-hour recall, and the reported foods consumed by the children were converted into portions based on the eight food groups from the Food Pyramid. Inadequacies were analyzed according to the recommendations of the Brazilian food guides. Dietary intake of children with the following age ranges were compared: 6 to 11, 12 to 23 and 24 to 35 months. Statistical analysis applied Kruskal-Wallis and chi-square tests, considering 5% as the significance level. RESULTS: Among the 359 studied children, insufficient consumption of vegetables, fruits and dairy products, and high intake of sugar and sweets were observed. When comparing consumption between the different age groups, children aged 6 to 11 months presented lower consumption of fruits, meat and vegetables, and those aged 24 to 35 months had high percentage of intake of cereals, sugar and sweets, and oil and fat. CONCLUSIONS: The dietary intake of children showed inadequacies in food groups of fruit, vegetables, dairy, and sugar and sweets, as well as significant differences between age-groups. Thus, it is important to highlight the need for nutritional education respecting age specificities, in order to contribute to medium and long-term prevention of nutritional problems.

OBJETIVO: Evaluar el consumo de los grupos alimentares en niños usuarios de la red pública de salud del municipio de Aracaju, Sergipe. MÉTODOS: Estudio transversal con niños de 6 a 35 meses de cinco Unidades Básicas de Salud. Para la evaluación dietética, se utilizó el Recordatorio Alimentar de 24 horas. Los alimentos y preparaciones consumidos por los niños fueron transformados en porciones en función de los ocho grupos de alimentos de la Pirámide Alimentar y sus inadecuaciones fueron analizadas conforme a las recomendaciones de los guías alimentares brasileños. Se comparó el consumo alimentar de las franjas de edad de 6 a 11 meses, 12 a 23 meses y 24 a 35 meses. Para análisis de las variables, se utilizaron las pruebas estadísticas Kruskal-Wallis y Chi cuadrado, considerando un nivel de significancia de 5%. RESULTADOS: Entre los 359 niños incluidos, se observó consumo insuficiente de hortalizas, frutas y leche y derivados, y alto consumo de azúcares y dulces. Cuando comparado el consumo entre las distintas franjas de edad, los niños de 6 a 11 meses presentaron menor consumo de frutas, carnes y leguminosas, y los niños de 24 a 35 meses presentaron mayores porcentajes de ingestión excesiva de cereales, azúcares y dulces, aceites y grasas. CONCLUSIÓN: El consumo alimentar de los niños presentó inadecuaciones en los grupos alimentares de las frutas, hortalizas, leche y derivados, azúcares y dulces, además de las diferencias significativas en el consumo entre las franjas de edad. En ese contexto, es importante subrayar la necesidad de la educación alimentar y nutricional, respetando las especificidades de cada grupo de edad, con el objetivo de contribuir para la prevención de problemas nutricionales en medio y largo plazos.

Fatores associados ao déficit estatural e ao sobrepeso em crianças usuárias de unidades básicas de saúde em Aracaju-SE / Factors associated with stunting and overweight in children attending Basic Health Units

The purpose of this study was to identify factors associated with short stature and overweight in children attending basic health units in Aracaju, State of Sergipe, Brazil. A cross-sectional study was carried out with 181 children aged 12 to 35 months. Nutritional status was assessed by height/ age, weight/height and BMI/age anthropometric indicators according to the World Health Organization standards (2006). A questionnaire was applied on the biological characteristics, birth conditions, morbidity and socio-demographic factors. Food consumption was investigated through 24-hour recall. The prevalence of stunting was 12,7% and overweight by weight/height and by BMI/age were 11,6% and 13,8%, respectively. The following factors were associated with short stature: morbidities in the past 15 days (runny nose and wheezing), more than two children in family, and household crowding. Energy, protein, calcium and iron intakes were higher in the overweight group compared to the eutrophic. Children with short stature presented lower carbohydrate intake and insufficient intake of iron. Moderate prevalence of stunting and overweight were observed. The insertion of nutritional education activities is necessary in order to prevent and control nutritional disorders in this population.

El objetivo de este estudio fue identificar factores asociados a la baja estatura y al exceso de peso en niños usuarios de Unidades Básicas de Salud del municipio de Aracaju, Sergipe, Brasil. Se trata de un estudio transversal observacional, realizado con 181 niños de 12 a 35 meses de edad. El estado nutricional fue evaluado por los indicado-res antropométricos estatura/edad, peso/estatura e IMC/edad, teniendo como referencia la Organización Mundial de Salud (2006). Se aplicó un formulario con preguntas sobre características biológicas, condiciones de nacimiento, morbilidades y factores socio-demográficos. El consumo alimentario fue investigado usando un Recordatorio de 24 horas. El predominio de baja estatura fue de 12,7% y de exceso de peso por el peso/estatura y por el IMC/edad fue del 11,6% y del 13,8%, respectivamente. Los factores asociados a la baja estatura fueron morbilidades en los últimos 15 días (secreción nasal y respiración sibilante), más de dos hijos y hacinamiento domiciliar. Las ingestiones energética, proteica, y de calcio y hierro fueron superiores en el grupo con exceso de peso en relación al eutrófico. Los niños con baja estatura presentaron menor ingestión de carbohidrato e ingestión insuficiente de hierro. Fueron observadas prevalencias moderadas de baja estatura y de exceso de peso. Se hace necesaria la inserción de actividades de educación nutricional en esta población, con el fin de prevenir y controlar los disturbios nutricionales.

O objetivo deste estudo foi identificar fatores associados à baixa estatura e ao excesso de peso em crianças usuárias de Unidades Básicas de Saúde de Aracaju, Sergipe. Estudo transversal observacional, realizado com 181 crianças de 12 a 35 meses de idade. O estado nutricional foi avaliado pelos indicadores antropométricos estatura/idade, peso/estatura e IMC/idade, segundo referência da Organização Mundial de Saúde (2006). Aplicou-se um formulário com questões sobre características biológicas, condições de nascimento, morbidades e fatores sociodemográficos. O consumo alimentar foi investigado pelo Recordatório de 24 horas. A prevalência de baixa estatura foi de 12,7% e de excesso de peso pelo peso/estatura e pelo IMC/idade foi de 11,6% e de 13,8%, respectivamente. Os fatores associados à baixa estatura foram morbidades nos últimos 15 dias (coriza e sibilância), número de filhos superior a dois e aglomeração no domicílio. As ingestões energética, proteica, de cálcio e de ferro foram superiores no grupo com excesso de peso em relação ao eutrófico. Crianças com baixa estatura apresentaram menor ingestão de carboidrato e ingestão insuficiente de ferro. Foram observadas prevalências moderadas de baixa estatura e de excesso de peso. Faz-se necessária a inserção de atividades de educação nutricional nesta população, a fim de prevenir e controlar os distúrbios nutricionais.