[Non-caloric sweeteners consumption in the adult population of Argentina]. / Consumo de edulcorantes no calóricos en la población adulta de Argentina.

INTRODUCTION: Non-caloric sweeteners (NCS) are used to replace added sugars in foods and beverages. For this replacement to be a health benefit, the intake of each NCS should not exceed its Acceptable Daily Intake (ADI). The main objective of this study is to determine the consumption of aspartame, acesulfame-K, sucralose, and saccharin in the argentine population aged 15 to 65 years and to evaluate this consumption in relation to the ADI. Other objectives are to stratify the consumption based on different sociodemographic variables and to determine the main sources of NCS consumed by the argentine population. METHODS: The sample consisted of 1266 individuals (urban population aged 15-65), stratified by region, age, sex, and socioeconomic level. Intake data was collected with two 24-hour recalls. RESULTS: In Argentina, the average consumption of saccharin, aspartame, acesulfame-K and sucralose is well below their respective ADI: 8.4%, 3.2%, 2% and 0.3% of the ADI, respectively. The maximum reported consumptions do not exceed the ADI either. There is a higher proportion of women who consume NCS. The proportion of NCS consumers increases with age. The Northeast and South regions have the lowest percentage of NCS consumers. Beverages constitute the main source of NCS, followed by tabletop sweeteners. The contribution of food to NCS consumption is negligible. DISCUSSION: In Argentina there is a good safety margin for the reformulation of sugary products aimed at reducing the excess calories and added sugars consumed by the population.

Introducción: Los edulcorantes no calóricos (ENC) se utilizan para sustituir azúcares en alimentos y bebidas. Para que este reemplazo sea beneficioso para la salud, la ingesta de cada ENC no debería superar su ingesta diaria admisible (IDA). El objetivo principal de este estudio es determinar el consumo de aspartamo, acesulfame-K, sucralosa y sacarina en la población argentina de 15 a 65 años y evaluar este consumo en relación con la IDA. Otros objetivos son estratificar el consumo en función de distintas variables sociodemográficas y determinar las principales fuentes de ENC consumidas por la población argentina. Métodos: La muestra fue de 1266 individuos (población urbana 15-65 años), estratificada por región, edad, sexo y nivel socioeconómico. Los datos de ingesta fueron recolectados con dos recordatorios de 24 horas. Resultados: En Argentina, el consumo promedio de sacarina, aspartamo, acesulfame-K y sucralosa está muy por debajo de su respectiva IDA: 8.4%, 3.2%, 2% y 0.3% de la IDA respectivamente. Los consumos máximos reportados tampoco superan la IDA. Hay una mayor proporción de mujeres consumidoras de ENC. La proporción de consumidores de ENC aumenta con la edad. Las regiones noreste y sur presentan el menor porcentaje de consumidores de ENC. Las bebidas constituyen la principal fuente de ENC, seguidas por los edulcorantes de mesa. La contribución de los alimentos al consumo de ENC es despreciable. Discusión: En Argentina existe un buen margen de seguridad para la reformulación de productos azucarados tendiente a disminuir el exceso de calorías y el consumo de azúcares añadidos.

Consumo de edulcorantes no calóricos en la población adulta de Argentina / Non-caloric sweeteners consumption in the adult population of Argentina

Resumen Introducción: Los edulcorantes no calóricos (ENC) se utilizan para sustituir azúcares en alimentos y bebidas. Para que este reemplazo sea beneficioso para la salud, la ingesta de cada ENC no de bería superar su ingesta diaria admisible (IDA). El objetivo principal de este estudio es determinar el consumo de aspartamo, acesulfame-K, sucralosa y sacarina en la población argentina de 15 a 65 años y evaluar este consumo en relación con la IDA. Otros objetivos son estratificar el consumo en función de distintas variables sociodemográficas y determinar las principales fuentes de ENC consumidas por la población argentina. Métodos: La muestra fue de 1266 individuos (población urbana 15-65 años), estratificada por región, edad, sexo y nivel socioeconómico. Los datos de ingesta fueron recolectados con dos recordatorios de 24 horas. Resultados: En Argentina, el consumo promedio de sacarina, aspartamo, acesulfame-K y sucralosa está muy por debajo de su respectiva IDA: 8.4%, 3.2%, 2% y 0.3% de la IDA respectivamente. Los consumos máximos reportados tampoco superan la IDA. Hay una mayor proporción de mujeres consumidoras de ENC. La proporción de consumidores de ENC aumenta con la edad. Las regiones noreste y sur presentan el menor porcentaje de consumidores de ENC. Las bebidas constituyen la principal fuente de ENC, seguidas por los edulcorantes de mesa. La contri bución de los alimentos al consumo de ENC es despreciable. Discusión: En Argentina existe un buen margen de seguridad para la reformulación de productos azucarados tendiente a disminuir el exceso de calorías y el consumo de azúcares añadidos.

Abstract Introduction: Non-caloric sweeteners (NCS) are used to replace added sugars in foods and bev erages. For this replacement to be a health benefit, the intake of each NCS should not exceed its Acceptable Daily Intake (ADI). The main objective of this study is to determine the consumption of aspartame, acesulfame-K, sucralose, and saccharin in the argentine population aged 15 to 65 years and to evaluate this consumption in relation to the ADI. Other objectives are to stratify the consumption based on different sociodemographic vari ables and to determine the main sources of NCS consumed by the argentine population. Methods: The sample consisted of 1266 individuals (urban population aged 15-65), stratified by region, age, sex, and socioeconomic level. Intake data was collected with two 24-hour recalls. Results: In Argentina, the average consumption of saccharin, aspartame, acesulfame-K and sucralose is well below their respective ADI: 8.4%, 3.2%, 2% and 0.3% of the ADI, respectively. The maximum reported consumptions do not exceed the ADI either. There is a higher proportion of women who consume NCS. The proportion of NCS consumers increases with age. The Northeast and South regions have the lowest percentage of NCS consumers. Beverages constitute the main source of NCS, followed by tabletop sweeteners. The contribution of food to NCS consumption is negligible. Discussion: In Argentina there is a good safety margin for the reformulation of sugary products aimed at reduc ing the excess calories and added sugars consumed by the population.

La depresión mayor en Costa Rica: aspectos epidemiológicos y psicobiológicos / Major depression disorder in Costa Rica: epidemiological and neurobiological aspects

Resumen Introducción: la depresión mayor es uno de los trastornos mentales más comunes y una de las principales causas de discapacidad en el mundo, con una prevalencia que ha aumentado en las últimas décadas. El objetivo de este ensayo es presentar datos epidemiológicos, así como revisar brevemente los mecanismos psicobiológicos de la depresión relacionados con el estrés crónico. Finalmente, discutiremos algunas estrategias para prevenirla y/o tratarla. Proposición: ciertos tratamientos alternativos complementarios a la medicación y psicoterapia podrían ser mucho más eficaces para evitar y mitigar los efectos del estrés crónico y el riesgo de padecer depresión. Argumentos para la discusión: el estrés crónico puede precipitar un episodio depresivo debido a la hiperactividad de la amígdala y del eje hipotalámico-hipofisario-suprarrenal (HHS), la falla en los mecanismos de retrocontrol negativo del HHS, la depleción de monoaminas, la disminución en los niveles de neurotrofinas, el aumento en la excitotoxicidad glutamatérgica, la reducción en la neurogénesis hipocampal, la disfunción de la corteza prefrontal y una respuesta inflamatoria excesiva. Conclusiones: la acumulación crónica de estresores psicosociales sobre los que se tiene poco control, más el sedentarismo, una mala alimentación y pocos espacios de esparcimiento le confieren a nuestro estilo de vida actual un alto potencial depresogénico. Actividades que incluyan ejercicio, interacciones sociales significativas, actividades recreativas, exposición a ambientes naturales, una dieta balanceada y rutinas saludables representarían una estrategia altamente eficaz para el manejo de la depresión y el mejoramiento de la salud integral.

Abstract Introduction: Major depression is one of the most common mental illnesses and one of the principal causes of disability worldwide, with an increasing prevalence in recent decades. The aim of this essay is to present epidemiological data, as well as to briefly review the psychobiological mechanisms of depression related to the exposure to chronic stress. Finally, we will also discuss some strategies for the prevention and/or treatment of the disease. Proposal: Alternative treatments complementing medication and psychotherapy could be much more effective in preventing and mitigating the effects of chronic stress and the risk of depression than these treatments alone. Arguments for discussion: Chronic stress can precipitate a depressive episode due to hyperactivity of the amygdala and hypothalamic-pituitary-adrenal (HPA) axis, failure of the HPA negative feedback, monoamine depletion, decreased levels of neurotrophins, increased glutamatergic excitotoxicity, reduced hippocampal neurogenesis, prefrontal cortex dysfunction, and excessive inflammatory response. Conclusions:The chronic accumulation of uncontrollable psychosocial stressors plus a sedentary lifestyle, a poor diet, and limited time or places for recreational activities underlie the high depresogenic potential of our current lifestyles. In contrast, activities that include exercise, meaningful social interactions, recreational activities, exposure to natural environments, a balanced diet, and healthy routines would represent a highly effective strategy for managing depression and improving overall health.

[Diet quality and diversity in the urban population of Argentina]. / Calidad y diversidad de la dieta en la población urbana de Argentina.

Following a varied diet is associated with a healthier diet and a greater likelihood of incorporating the necessary micronutrients. The dietary diversity index (DDI) is the indicator that measures this variety, while the diet quality index (DQI) determines how much of this diversity consists of the inclusion of healthy foods. The aim of the study was to evaluate the quality and diversity of the diet of the Argentine population by identifying differences by sex, age, socioeconomic level, nutritional status and region. The sample consisted of 1266 subjects of urban population, of both sexes, between 15 and 65 years of age and of all socioeconomic levels. Anthropometric and intake assessment was performed, through 2 24-hour recalls. The DDI was assessed following the guidelines proposed in 2016 by Food and Agriculture Organization and the development of the DQI was performed following the methodology of Imamura y col. The DQI was relatively low, with a score of 63.9%. The DDI was 4.48 out of a maximum of 10, reflecting a poorly varied diet; additionally, only 50% of the population reported a varied diet. These indicators are significantly lower in people with low SEL. The DDI and the percentage of people with a diverse diet was higher in people from the metropolitan area of Buenos Aires. This study showed that the quality of the diet in the Argentine population is low and with a limited consumption of the food groups that provide the most micronutrients.

Una dieta variada se asocia a una mayor probabilidad de incorporar micronutrientes esenciales. El índice de diversidad de dieta (IDD) es el indicador que mide esta variedad, mientras que el índice de calidad de dieta (ICD) determina cuánto de esa diversidad refleja la inclusión de alimentos saludables. El objetivo del estudio fue evaluar la calidad y diversidad de la dieta de la población argentina identificando las diferencias por sexo, edad, nivel socioeconómico, estado nutricional y región. La muestra fue de 1266 sujetos de población urbana, de ambos sexos, entre 15 y 65 años y de todos los NSE. Se realizó una evaluación antropométrica y de la ingesta, a través de 2 recordatorios de 24 horas. El IDD se evaluó siguiendo las guías propuestas en el año 2016 por la Organización de las Naciones Unidas para la Alimentación y la Agricultura y el desarrollo del ICD se realizó siguiendo la metodología de Imamura y col. El ICD fue relativamente bajo, con un puntaje de 63.9%. El IDD fue de 4.48 de un máximo de 10, lo que refleja una dieta poca variada; adicionalmente, solo el 50% de la población informó una dieta variada. Estos indicadores fueron significativamente menores en las personas con bajo NSE. El IDD y el porcentaje de personas con dieta diversa fue mayor en los habitantes del área metropolitana de Buenos Aires. Este estudio evidenció que la calidad de la dieta en la población argentina es baja y con un consumo limitado de los grupos de alimentos que más aportan micronutrientes.

Alcohol Contribution to Total Energy Intake and Its Association with Nutritional Status and Diet Quality in Eight Latina American Countries.

Alcohol consumption is a modifiable risk factor for non-communicable diseases. This study aimed to characterize alcohol consumers at the nutritional, anthropometric, and sociodemographic levels. Data from 9218 participants from Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela participating in "Latin American Health and Nutrition Study (ELANS)", a multi-country, population-based study, were used. Dietary intake was collected through two, 24 h recalls. Participants were classified into consumers (n = 1073) and non-alcohol consumers (n = 8145) using a cut-off criterium of ≥15 g/day of alcohol consumption calculated from the estimation of their usual daily intake. Among alcohol consumers, the mean alcohol consumption was 69.22 ± 2.18 grams (4.6. beverages/day), contributing to 484.62 kcal, which corresponded to 16.86% of the total energy intake. We found that the risk of alcohol consumption was higher in young and middle-aged men from low and middle socioeconomic status. Argentine, Brazil, and Chile had the highest percentage of consumers, while Ecuador showed the highest alcohol consumption. Alcohol drinkers were characterized by having higher body weight and wider neck, waist, hips circumferences. Alcohol drinkers had a higher energy intake, with macronutrients providing relatively less energy at the expense of the energy derived from alcohol. Alcohol drinkers showed lower and higher consumptions of healthy and unhealthy food groups, respectively. In addition, adequacy ratios for all micronutrients assessed were lower in alcohol consumers. All these deleterious effects of alcohol on nutritional and anthropometric parameters increased with the number of alcoholic beverages consumed daily. Altogether, these findings suggest that limiting alcohol consumption can contribute to reducing the risk of obesity, metabolic syndrome, and diet-related diseases.

Socioeconomic Status Impact on Diet Quality and Body Mass Index in Eight Latin American Countries: ELANS Study Results.

Poor health and diet quality are associated with living within a low socioeconomic status (SES). This study aimed to investigate the impact of SES on diet quality and body mass index in Latin America. Data from the "Latin American Health and Nutrition Study (ELANS)", a multi-country, population-based study of 9218 participants, were used. Dietary intake was collected through two 24 h recalls from participants of Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela. Diet quality was assessed using the dietary quality score (DQS), the dietary diversity score (DDS) and the nutrients adequacy ratio (NAR). Chi-squared and multivariate-variance analyses were used to estimate possible associations. We found that participants from the low SES consumed less fruits, vegetables, whole grains, fiber and fish and seafood and more legumes than those in the high SES. Also, the diet quality level, assessed by DQS, DDS and NAR mean, increased with SES. Women in the low SES also showed a larger prevalence of abdominal obesity and excess weight than those in the middle and high SES. Health policies and behavioral-change strategies should be addressed to reduce the impact of socioeconomic factors on diet quality and body weight, with gender as an additional level of vulnerability.

Dietary Diversity and Micronutrients Adequacy in Women of Childbearing Age: Results from ELANS Study.

Dietary diversity, an important component of diet quality, is associated with an increased probability of adequate micronutrient intake. Women of childbearing age (WCA) are particularly vulnerable to micronutrient inadequacy. The Minimum Dietary Diversity for Women (MDD-W) has been used widely as a proxy measurement of micronutrient adequacy. This study aimed to assess the association between MDD-W and nutrients adequacy among WCA of eight Latin American countries. Nutrient intakes from 3704 WCA were analyzed with two 24-hour dietary recalls. Dietary diversity was calculated based on ten food groups with a cut-off point of intake ≥5 groups. The mean dietary diversity score was 4.72 points, and 57.7% of WCA achieved MDD-W. Vitamin D and E showed a mean Nutrient Adequacy Ratio (NAR) of 0.03 and 0.38, respectively. WCA with a diverse diet (MDD-W > 5) reported a significantly higher intake of most micronutrients and healthy food groups with less consumption of red and processed meats and sugar-sweetened beverages. MDD-W was significantly associated with the mean adequacy ratio (MAR) of 18 micronutrients evaluated. Nevertheless, even those women with a diverse diet fell short of meeting the Estimated Average Requirements (EAR) for vitamins D and E. MDD-W is an appropriate tool to evaluate micronutrients adequacy in WCA from Latin America, showing that women who achieved the MDD-W reported higher adequacy ratios for most micronutrients and an overall healthier diet.

Diet Quality and Diet Diversity in Eight Latin American Countries: Results from the Latin American Study of Nutrition and Health (ELANS).

This study aimed to assess diet quality score (DQS), considering healthy and unhealthy foods and nutrients, and diet diversity score (DDS) as indicators of risk of noncommunicable diseases in eight Latin American countries, and to verify the possible differences considering country, sex, age, socioeconomic, and nutritional status. A multicenter household population-based cross-sectional survey was conducted with 9218 individuals (age range 15-65 years). Sociodemographic and anthropometric data were collected. Dietary intake was measured using two non-consecutive 24-h recalls and diet quality and diversity were assessed. In the whole sample, scores were observed from 63.0% ± 9.3% to total DQS, 65.0% ± 13.6% to healthy dietary items and 60.2% ± 13.6% to unhealthy items, and 5.6 ± 1.1 out of 9 points to DDS. Women presented lower DDS compared to men (5.5 ± 1.1 vs. 5.6 ± 1.1, p < 0.001). Healthy DQS was higher as the socio-economic level increased, and unhealthy DQS was the opposite (p < 0.05). Total DQS was significantly lower only at the low socio-economic level (p < 0.05). Chile and Venezuela showed the lowest healthy (62.2 ± 15.2 and 61.9 ± 11.7, p < 0.05) and total DQS (61.4 ± 10.3, 61.2 ± 8.7, p < 0.05). No effects were observed when considering the age and anthropometric measurements. Promoting consumption of a diverse and high-quality diet is an essential challenge to accomplish.

Assessment of trans-aortic pressure gradient using a coronary pressure wire in patients with mechanical aortic and mitral valve prostheses.

Accurate evaluation of trans-aortic valvular pressure gradients is challenging in cases where dual mechanical aortic and mitral valve prostheses are present. Non-invasive Doppler echocardiographic imaging has its limitations due to multiple geometric assumptions. Invasive measurement of trans-valvular gradients with cardiac catheterization can provide further information in patients with two mechanical valves, where simultaneous pressure measurements in the left ventricle and ascending aorta must be obtained. Obtaining access to the left ventricle via the mitral valve after a trans-septal puncture is not feasible in the case of a concomitant mechanical mitral valve, whereas left ventricular apical puncture technique is associated with high procedural risks. Retrograde crossing of a bileaflet mechanical aortic prosthesis with standard catheters is associated with the risk of catheter entrapment and acute valvular regurgitation. In these cases, the assessment of trans-valvular gradients using a 0.014˝ diameter coronary pressure wire technique has been described in a few case reports. We present the case of a 76-year-old female with rheumatic valvular heart disease who underwent mechanical aortic and mitral valve replacement in the past. She presented with decompensated heart failure and echocardiographic findings suggestive of elevated pressure gradient across the mechanical aortic valve prosthesis. The use of a high-fidelity 0.014˝ diameter coronary pressure guidewire resulted in the detection of a normal trans-valvular pressure gradient across the mechanical aortic valve. This avoided a high-risk third redo valve surgery in our patient. © 2017 Wiley Periodicals, Inc.

Bi-Atrial Compression Due to Ascending and Descending Aortic Aneurysms.

Aortic aneurysms compressing an atrium causing symptoms are uncommon. We describe a case of bi-atrial compression due to ascending and descending aneurysms leading to dyspnea.

Left Atrial Size and Heart Failure Hospitalization in Patients with Diastolic Dysfunction and Preserved Ejection Fraction.

CONTEXT: Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome associated with diastolic function abnormalities. It remains unclear which factors, if any, can predict the transition from asymptomatic diastolic dysfunction to an overt symptomatic phase. MATERIALS AND METHODS: Patients hospitalized with suspected heart failure between January 2012 and November 2014 with a transthoracic echocardiogram demonstrating preserved systolic function were screened (n = 425). Patients meeting the American College of Cardiology Foundation/American Heart Association definition for HFpEF (n = 40) were matched in a 1:1 fashion to individuals admitted for hypertensive urgency with diastolic dysfunction and neither pulmonary edema nor history of heart failure (n = 40). The clinical records and echocardiograms of all eighty patients included in this retrospective study were reviewed. RESULTS: Patients with HFpEF had higher body mass index (BMI), creatinine, beta-blocker use, and Grade 2 diastolic dysfunction when compared to the hypertensive control population. Echocardiographic analysis demonstrated higher right ventricular systolic pressures, left ventricular mass index, E/A, and E/e' in patients with HFpEF. Similarly, differences were observed in most left atrial (LA) parameters including larger LA maximum and minimum volume indices, as well as smaller LA-emptying fractions in the heart failure group. Multivariate logistic regression analysis revealed LA minimum volume index (odds ratio [OR]: 1.23 [1.09-1.38], P = 0.001) to have the strongest association with heart failure hospitalization after adjustment for creatinine (OR: 7.09 [1.43-35.07], P = 0.016) and BMI (OR: 1.11 [0.99-1.25], P = 0.074). CONCLUSION: LA minimum volume index best correlated with HFpEF in this patient cohort with diastolic dysfunction.

An example of the deleterious effects of right ventricular apical pacing.

Pacemaker implantation remains the mainstay of treatment in patients with symptomatic sinus node disease or severe heart block. Despite the dramatic benefits of this therapy, a high burden of ventricular pacing is known to have its disadvantages. Reported is the case of an 85-year-old woman with a history of sick sinus syndrome who presented with congestive heart failure after her atrioventricular sequential pacemaker defaulted to ventricular pacing mode as a result of battery depletion. After replacement of her generator and reinstitution of atrial pacing, dramatic improvements in her symptoms and echocardiographic findings were observed. Although it is difficult to predict which patients will ultimately develop cardiac decompensation as a result of ventricular pacing, closer follow-up and early recognition of these complications is essential to prevent adverse outcomes.

Accuracy of transthoracic echocardiography for the measurement of the ascending aorta: comparison with transesophageal echocardiography.

BACKGROUND: There has been a substantial increase in the number of imaging studies performed to assess thoracic aortic pathology. We sought to determine the accuracy of transthoracic echocardiography (TTE) compared to transesophageal echocardiography (TEE) for measuring ascending aortic size. HYPOTHESIS: Transthoracic echocardiography is reasonably accurate for assessing ascending aortic dimension. METHODS: Fifty-two patients with or without aortic disease underwent both TTE with nonstandard views and TEE. The ascending aorta was measured at 4 levels by 2 blinded observers for each modality. Pearson's correlation coefficients were determined and Bland-Altman plots and analyses were constructed. Inter- and intraobserver variability was determined in a random subgroup of patients. RESULTS: The mean age of the group was 65.5 years old and 15% had aortic dilation >4.0 cm. A strong positive correlation between the 2 imaging modalities was seen at all levels with the highest correlation for the maximum diameter of the ascending aorta (r = 0.936, P < 0.0001). Interobserver and intraobserver variability showed a good intraclass correlation among readers and among the same reader at all levels. CONCLUSIONS: Transthoracic echocardiography using nonstandard imaging windows is accurate in comparison to TEE for measurement of the ascending aorta at multiple levels in patients with or without aortic pathology. The findings of this study provide support for selected serial follow-up of patients with aortic disease by TTE only.

Interpolated premature ventricular contractions with postponed compensatory pauses: a misnomer?

Selected strips of a Holter recording obtained from a healthy young person with rare unifocal premature ventricular contractions (PVCs) were obtained. Occasionally, the PVCs were interpolated and showed the phenomenon originally named postponed compensatory pause by Langendorf [Am Heart J 1953;46:401]. But this is a misnomer because, by definition, interpolated PVCs do not have compensatory pauses. Thus, it follows that what does not exist cannot be postponed. In reality, the basic manifest feature is a prolongation of the first RR interval that follows the interpolated beat. However, in view of its use for more than half a century, it is probably best to continue using this terminology, but only as long as its underlying mechanism and fundamental manifestations are properly understood.

A pulmonary embolism treated with the Angiojet technique in a patient with double outlet right ventricle.

A 24-year-old man known to have a double outlet right ventricle, status post-modified Fontan procedure at age 10, taking coumadin after having a stroke one year prior, presented with a massive pulmonary embolism and hemodynamic instability. Locally delivered tPA was unsuccessful, and the pulmonary artery thrombus was finally removed with a thrombectomy catheter (Angiojet thrombectomy); the patient recovered soon thereafter. This is the first report of the successful use of a thrombectomy catheter in a patient with pulmonary emboli and an occluded Fontan conduit.

Recording undetected P waves in a case of heart transplant with a new bipolar system.

Using a new electrocardiographic lead (L-P lead), we recorded undetected P waves in a post heart-transplant patient. This case shows another application of a noninvasive method, a modification of Einthoven's bipolar leads, used to approach undetermined rhythms.