A Randomized, Open-Label, Non-inferiority Clinical Trial Assessing 7 Versus 14 Days of Antimicrobial Therapy for Severe Multidrug-Resistant Gram-Negative Bacterial Infections: The OPTIMISE Trial Protocol.

INTRODUCTION: Shorter courses of antimicrobials have been shown to be non-inferior to longer, "traditional" duration of therapies, including for some severe healthcare-associated infections, with a few exceptions. However, evidence is lacking regarding shorter regimes against severe infections by multidrug-resistant Gram-negative bacteria (MDR-GNB), which are often caused by distinct strains and commonly treated with second-line antimicrobials. In the duratiOn of theraPy in severe infecTIons by MultIdrug-reSistant gram-nEgative bacteria (OPTIMISE) trial, we aim to assess the non-inferiority of 7-day versus 14-day antimicrobial therapy in critically ill patients with severe infections caused by MDR-GNB. METHODS: This is a randomized, multicenter, open-label, parallel controlled trial to assess the non-inferiority of 7-day versus 14-day of adequate antimicrobial therapy for intensive care unit (ICU)-acquired severe infections by MDR-GNB. Adult patients with severe infections by MDR-GNB initiated after 48 h of ICU admission are screened for eligibility. Patients are eligible if they proved to be hemodynamically stable and without fever for at least 48 h on the 7th day of adequate antimicrobial therapy. After consenting, patients are 1:1 randomized to discontinue antimicrobial therapy on the 7th (± 1) day or to continue for a total of 14th (± 1) days. PLANNED OUTCOMES: The primary outcome is treatment failure, defined as death or relapse of infection within 28 days after randomization. Non-inferiority will be achieved if the upper edge of the two-tailed 95% confidence interval of the difference between the clinical failure rate in the 7-day and the 14-day group is not higher than 10%. CONCLUSION: The OPTIMISE trial is the first randomized controlled trial specifically designed to assess the duration of antimicrobial therapy in patients with severe infections by MDR-GNB. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05210387. Registered on 27 January 2022. Seven Versus 14 Days of Antibiotic Therapy for Multidrug-resistant Gram-negative Bacilli Infections (OPTIMISE).

Erratum: Evaluation of the characteristics of infection prevention and control programs and infection control committees in Brazilian hospitals: A countrywide cross-sectional study - CORRIGENDUM.

[This corrects the article DOI: 10.1017/ash.2023.136.].

Impact of waitlist time on post-HSCT survival: a cohort study at a hospital in southern Brazil.

INTRODUCTION: The time elapsed from diagnosis to hematopoietic stem cell transplantation (HSCT) is influenced by numerous factors. In Brazil, patients using the public health system are also dependent on the availability of HSCT-specific beds in the hematology ward. OBJECTIVE AND METHODS: We conducted a cohort study of listed patients who underwent allogeneic HSCT at a Brazilian public hospital to investigate the impact of the waitlist time on post-HSCT survival. RESULTS: The median time from diagnosis to HSCT was 19 months (IQR, 10 - 43), of which 6 months (IQR, 3 - 9) were spent on the waitlist. The time on the waitlist for HSCT appeared to influence mainly the survival of adult patients (≥ 18 years), with an increasing risk according to this time (RR, 3.53 and 95%CI, 1.81 - 6.88 for > 3 and ≤ 6 months; RR 5.86 and 95%CI, 3.26 - 10.53 for > 6 and ≤ 12 months, and; RR 4.24 and 95%CI, 2.32 - 7.75 for > 12 months). CONCLUSION: Patients who remained on the waitlist for less than 3 months had the highest survival (median survival, 856 days; IQR, 131 - 1607). The risk of reduced survival was about 6-fold higher (95%CI, 2.8 - 11.5) in patients with malignancies.

Evaluation of the characteristics of infection prevention and control programs and infection control committees in Brazilian hospitals: A countrywide cross-sectional study.

Objective: Data are scarce regarding hospital infection control committees and compliance with infection prevention and control (IPC) recommendations in Brazil, a country of continental dimensions. We assessed the main characteristics of infection control committees (ICCs) on healthcare-associated infections (HAIs) in Brazilian hospitals. Methods: This cross-sectional study was conducted in ICCs of public and private hospitals distributed across all Brazilian regions. Data were collected directly from the ICC staff by completing an online questionnaire and during on-site visits through face-to-face interviews. Results: In total, 53 Brazilian hospitals were evaluated from October 2019 to December 2020. All hospitals had implemented the IPC core components in their programs. All centers had protocols for the prevention and control of ventilator-associated pneumonia as well as bloodstream, surgical site, and catheter-associated urinary tract infections. Most hospitals (80%) had no budget specifically allocated to the IPC program; 34% of the laundry staff had received specific IPC training; and only 7.5% of hospitals reported occupational infections in healthcare workers. Conclusions: In this sample, most ICCs complied with the minimum requirements for IPC programs. The main limitation regarding ICCs was the lack of financial support. The findings of this survey support the development of strategic plans to improve IPCs in Brazilian hospitals.

A Nationwide Evaluation of the Prevalence of Human Papillomavirus in Brazil (POP-Brazil Study): Protocol for Data Quality Assurance and Control.

BACKGROUND: The credibility of a study and its internal and external validity depend crucially on the quality of the data produced. An in-depth knowledge of quality control processes is essential as large and integrative epidemiological studies are increasingly prioritized. OBJECTIVE: This study aimed to describe the stages of quality control in the POP-Brazil study and to present an analysis of the quality indicators. METHODS: Quality assurance and control were initiated with the planning of this nationwide, multicentric study and continued through the development of the project. All quality control protocol strategies, such as training, protocol implementation, audits, and inspection, were discussed one by one. We highlight the importance of conducting a pilot study that provides the researcher the opportunity to refine or modify the research methodology and validating the results through double data entry, test-retest, and analysis of nonresponse rates. RESULTS: This cross-sectional, nationwide, multicentric study recruited 8628 sexually active young adults (16-25 years old) in 119 public health units between September 2016 and November 2017. The Human Research Ethics Committee of the Moinhos de Vento Hospital approved this project. CONCLUSIONS: Quality control processes are a continuum, not restricted to a single event, and are fundamental to the success of data integrity and the minimization of bias in epidemiological studies. The quality control steps described can be used as a guide to implement evidence-based, valid, reliable, and useful procedures in most observational studies to ensure data integrity. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/31365.

Behavioral factors associated with multiple-type HPV genital infections: data from a cross-sectional study in young women in Brazil.

OBJECTIVES: To investigate the pattern of multiple human papillomavirus (HPV) infections and associated factors in young women who access the Brazilian public health care system to better understand the characteristics of multiple HPV infections, a critical issue in this era of multivalent vaccines. METHODS: This was a cross-sectional, multicenter study with sexually active unvaccinated women (16-25 years old) from 119 primary Brazilian healthcare centers between September 2016 and November 2017. Cervical samples were collected by trained health professionals, and HPV detection was performed in a central laboratory by Linear Array. RESULTS: Of the 5268 women, 33.00% (95% CI 31.07-34.92) had multiple infections. At least one type of high-risk HPV was present in 85.50% of all multiple infections. All HPV types were detected more frequently in association with other types than alone. Young individuals who were single or in a casual relationship and those who had more than one sexual partner in the past year were more likely to have multiple infections. CONCLUSIONS: In this work, a high rate of multiple HPV infections among unvaccinated young adults tended to increase due to certain risk factors. Such data can provide insight for decision makers in the development of public policies regarding HPV prevention.

Understanding the characteristics of multiple infections is critical in the era of HPV multivalent vaccines for the prevention of cervical carcinomas. Therefore, in this cross-sectional study, we aimed to investigate the pattern of multiple HPV infections and associated factors in 5,268 sexually active unvaccinated women (16­25 years old) who access the Brazilian public health care system. Cervical samples were collected by trained health professionals, and HPV detection was performed in a central laboratory by Linear Array. A total of 33.00% (95% CI 31.07­34.92) had multiple infections (60.43% of the HPV-positive sample). The number of HPV types in a multiple infection ranged from 2 to 14 different types. The viral types more frequently identified were HPV 16 and 52. All HPV types were detected more frequently in association with other types than alone. The incidence of multiple infections was 1.29 times higher in single than in married or cohabitating participants. Women who had two or more partners in the last year also had higher rates of multiple infections than those who had fewer than two sexual partners. In conclusion, a high prevalence of multiple infections prior to the national HPV immunization program was observed, especially with the increase in less safe behavior factors.

The use of micro-costing in an economic analysis of allogeneic HSCT in Brazil / O uso do microcusteio na análise econômica do TCTH alogênico no Brasil

Objetivo: O objetivo deste estudo foi estimar os custos do tratamento do transplante de células--tronco hematopoéticas (TCTH) em um centro de referência no Brasil. Métodos: A população do estudo foi composta por pacientes provenientes da lista de TCTH do Sistema Único de Saúde submetidos ao TCTH em um hospital do sul do Brasil, entre 2016 e 2019. A avaliação de custos foi realizada por meio de um estudo de microcusteio, baseado no Time-Driven Activity-based Costing (TDABC) adaptado para estudos econômicos em saúde e incluiu as seguintes etapas: definição da questão de pesquisa, coleta de dados estruturada e análise estatística dos resultados. Resultados: O custo total do TCTH foi de $ 155.110 ($ 92.794 ­ $ 249.146 USD). O TCTH de doador não aparentado compatível foi mais caro do que o TCTH de doador aparentado compatível. Os principais fatores de custo envolvem complicações pós-transplante, principalmente a ocorrência de infecções. Em relação à composição dos custos, exames e procedimentos representam o maior custo em TCTH (45%). Conclusão: Essas estimativas podem ser aplicáveis a novas avaliações de custo-efetividade do TCTH e ajudar os gestores na tomada de decisão em saúde, especialmente em países de média renda

Objective: The objective of this study was to estimate treatment costs of Hematopoietic stem cell transplantation (HSCT) at a reference center in Brazil. Methods: The study population consisted of patients from the Unified Health System HSCT who underwent HSCT in southern Brazil between 2016 and 2019. Costs were measured using a micro-costing approach, based on Time-Driven Activity-based Costing (TDABC) adapted for economic studies in health and included the following steps: definition of the research question, structured data collection, and statistical analysis of results. Results: The total cost of HSCT was $155,110 ($92,794 ­ $249,146 USD). Matched unrelated donor HSCT was more expensive than matched related donor HSCT. The major cost factors involve post- -transplant complications, mainly the occurrence of infections. Concerning cost composition, exams and procedures represent the largest expense in HSCT (45%). Conclusion: These estimates could be applicable to further evaluations for HSCT cost-effectiveness and help healthcare decision-makers in middle-income countries

Alimentos processados e Diabetes Mellitus: avaliação de rotulagem de alimentos industrializados indicados para diabéticos / Processed foods and Diabetes Mellitus: labeling evaluation of processed foods indicated for diabetics

O Diabetes Mellitus (DM) afeta cerca de 400 milhões de pessoas em todo o mundo. É de senso comum que esses indivíduos devem priorizar o consumo de alimentos minimamente processados e in natura. No entanto, o consumo racional de alimentos processados torna-se um desafio devido ao estilo de vida ocidental e a alta oferta desses produtos, incluindo aqueles específicos para pacientes diabéticos. Esse trabalho visa verificar a adequação dos rótulos de alimentos dietéticos industrializados. Avaliou-se rótulos de biscoitos, doces e pães destinados para diabéticos, disponíveis em supermercados, lojas de produtos naturais e lojas de suplementos alimentares. Além das informações nutricionais, foi avaliada a adequação da rotulagem segundo a Portaria nº 29, de 13 de janeiro de1998. Foram analisados 98 alimentos, sendo 57 doces, 27 biscoitos e 14 pães. Observamos que há uma grande inadequação desses produtos, bem como falta de informações acerca de importantes nutrientes. É necessária a adequação da rotulagem e a conferência de cada item, e os profissionais de saúde, principalmente os nutricionistas, devem estar atentos ao recomendar esses alimentos aos pacientes. (AU)

Diabetes Mellitus (DM) affects about 400 million people worldwide. It is common knowledge that diabetic individuals should prioritize the consumption of fresh foods or minimally processed foods. However, the rational consumption of processed foods becomes a challenge due to the western lifestyle and the high source of these products, including those specific for diabetic people. This manuscript aims to verify the label adequacy of processed dietary foods. We performed the evaluation of diabetic cookies, candy and bread labels available at supermarkets, health food stores and food supplement stores. The adequacy of the nutritional items, and the labeling was evaluated according the Brazilian current legislation. A total of 98 items were analyzed: 57 candies, 27 cookies and 14 breads. We observed that there was a great inadequacy of these products, as well as a lack of information about important nutrients. It is necessary to adapt the labeling and to perform the conference of each item, and the health professionals, especially the nutritionists, must pay close attention before recommending these foods to their patients. (AU)

Sex differences in the prevalence and determinants of HPV-related external genital lesions in young adults: a national cross-sectional survey in Brazil.

BACKGROUND: External genital lesions (EGL) are the most common sexually transmitted infections (STIs). We aimed to evaluate the prevalence, determinants and sex differences in EGL among young adults from Brazil. METHODS: Overall, 7694 participants (aged 16 to 25 years) underwent an interview, genital examination and sampling for HPV genotyping. RESULTS: The prevalence of EGL was 4.08% (234) and is more frequent in men (5.72%) than women (2.31%) (p <  0.001). Genital lesions were significantly associated with male sex, infection by high-risk and multiple HPV types, having more than two sexual partners in the last year, smoking status and the presence of other STI. While alcohol use was associated with a higher prevalence of EGL in women, same-sex sexual relationship increase the prevalence in men. In the EGL group, 67.79% (p = 0.032) were positive for HPV infection and the types HPV6 and HPV11 were the most prevalent ones. CONCLUSION: The prevalence of EGL in young adults was consistently high, and most cases were associated with genital HPV infection and STIs. Although men have a higher prevalence, both sexes share most genital lesion determinants. The promotion of sexual education and vaccination especially focus in young men, who are usually outside the targets of primary health care programmes, can prevent EGL in Brazilian young adults.

STOP HPV study protocol: a nationwide case-control study of the association between oropharyngeal cancer and human papillomavirus (HPV) infection in Brazil.

INTRODUCTION: Human papillomavirus (HPV) is the most common sexually transmitted infection and is associated with several types of cancer. The number of cases of HPV-associated head and neck squamous cell carcinomas (HNSCCs), especially oropharyngeal carcinomas, has increased significantly in recent years despite decreased tobacco smoking rates. Currently, no data concerning the risk factors and prevalence of HPV in HNSCC patients in all regions of Brazil are available, making it difficult to promote advances in this field of public health. Therefore, our goal is to determine the impact of infection by HPV, including HPVs with different genotypes, on head and neck cancer and the risk factors associated with the development of head and neck cancer in all regions of Brazil. METHODS AND ANALYSIS: This is a case-control study that will include 622 patients and 622 controls from all regions of Brazil. A questionnaire will be applied to gather information on sociodemographic, behavioural and health factors. Oral, cervical or penile/scrotal, and anal specimens and serum samples will be collected from all participants. Formalin-fixed paraffin-embedded tissue from tumour biopsies will be analysed only in the case group. Molecular and serological analyses will be performed to evaluate the presence and role of HPV in the development of head and neck cancer. ETHICS AND DISSEMINATION: This project was approved by the research ethical committee of the proposing institution (Hospital Moinhos de Vento, number 2.852.060). Ethical approval from the collaborators is currently under evaluation and is not yet complete. The results of this study will be presented at meetings with the Brazilian Ministry of Health through technical reports and to the scientific community at national and international events, with subsequent publication of scientific articles.

Evaluating sexual health in sex workers and men who have sex with men: the SMESH cross-sectional protocol study.

INTRODUCTION: Human papillomavirus (HPV) infection is transmitted through skin-to-skin contact, and vaginal and anal sex are the most common transmission routes. Sex workers and men who have sex with men (MSM) are more exposed to the virus, and therefore, a higher frequency of this infection would be expected. The prevalence of HPV infection types and the forms and factors of transmission must be investigated to control infection-related outcomes. This protocol study will be the first nationwide study with a uniform methodology to evaluate HPV prevalence of and infection types among sex workers and MSM in Brazil. METHODS AND ANALYSIS: This multicentre cross-sectional study will be conducted with a respondent-driven sampling method to recruit 1174 sex workers and 1198 MSM from all regions of Brazil. The study will consist of preliminary interviews to verify the eligibility criteria and characterise the network size as well as a second questionnaire to obtain sociodemographic, behavioural and sexual information. Specimens from the oral cavity and anal and cervical or penile/scrotal sites will be collected. All HPV samples will be processed in a certified central laboratory. Other sexually transmitted infections will be evaluated by interview and by rapid testing for HIV and syphilis. Strict quality control will be conducted using different procedures, including the training and certification of the health professionals responsible for acquiring data and monitoring visits. ETHICS AND DISSEMINATION: The project was approved by the research ethics committee of the main institution and the corresponding ethics committees of the recruitment sites. Due to the literature gap on the sexual health of sex workers and MSM and the intense stigma surrounding these populations, a critical analysis of the study results will contribute to epidemiological knowledge and will be useful for the development of strategies against virus morbidities.

Perception of Primary Health Care professionals as participants in a national survey about HPV in Brazil: an experience report. / Percepção dos profissionais da Atenção Primária à Saúde como participantes de uma pesquisa nacional sobre HPV: um relato de experiência.

OBJECTIVE: to describe the perception of data collection performed by primary health care professionals as collaborators of the national POP-Brasil survey - Epidemiological Study of National Prevalence of HPV Infection. METHODS: in all, 217 professionals from 119 primary care units participated in the POP-Brasil Study conducted in the 26 Brazilian capitals and the Federal District. RESULTS: the professionals were trained and certified locally for collecting data and biological material from 8,580 participants; participation in the study allowed professionals to recognize the importance of their work. CONCLUSION: the successful experience confirms how important it is to do research as part of work practice, as long as professionals are trained and have adequate support, given that their work routine is compatible with the execution of the research protocol.

Factors associated with HPV and other self-reported STI coinfections among sexually active Brazilian young adults: cross-sectional nationwide study.

OBJECTIVES: To analyse factors associated with genital human papillomavirus (HPV) and other self-reported sexually transmitted infection (STI) coinfections among women and men aged 16-25 years from Brazil. DESIGN: A cross-sectional, nationwide, multicentre study. SETTING: 119 primary healthcare centres between September 2016 and November 2017. PARTICIPANTS: 6388 sexually active young adults were enrolled by trained health professionals. PRIMARY OUTCOME MEASURE: Genital HPV and other self-reported STI coinfections. RESULTS: Of 3512 participants with valid data for genital HPV and (STI)-positive status, 276 (9.60%, 95% CI 7.82% to 11.36%) had HPV/STI coinfection. Among men, HPV/STI coinfection was more prevalent than HPV infection alone. Among HPV-positive participants, the percentage of subjects who reported having another STI was highest for gonorrhoea at 4.24% (95% CI 2.67% to 5.81%), followed by syphilis, herpes and HIV. Smoking, drug use and ever having a same-sex sexual experience were risk factors that were uniquely associated with HPV/STI coinfection compared with HPV infection alone. CONCLUSIONS: The results identified a low prevalence of self-reported STIs, but in participants with at least one STI, the prevalence of HPV was high. These results reinforce the importance of implementing strategies to prevent risky behaviours among Brazilian young adults.

Knowledge about HPV and vaccination among young adult men and women: Results of a national survey.

BACKGROUND: In addition to screening by Pap smears, vaccination against human papillomavirus (HPV) can dramatically reduce cervical cancers caused by the virus. The acceptance of HPV vaccination is directly related to HPV knowledge. This research aimed to evaluate knowledge about HPV and vaccination among men and women aged 16-25 years who use the public health system in Brazil. METHODS: This was a cross-sectional, multicenter study of sexually active young adults recruited from 119 primary care units between 2016 and 2017. All participants answered a face-to-face standardized questionnaire. RESULTS: Of 8581 participants, the mean percentage of correct answers about HPV and vaccination was 51.79% (95% CI 50.90-52.67), but 75.91% (95% CI 74.13-77.69) had awareness of the HPV vaccination. Women answered a higher proportion of questions correctly than men did (p = 0.0003). Lower education level was the variable that most interfered with knowledge. The best information sources for knowledge were both health professionals and the media (1.33%, 95% CI 1.03-1.70). CONCLUSIONS: The results emphasize the importance of educational programs about HPV and vaccination among young adults, especially in socially disadvantaged populations. These findings can help to increase the vaccination rate in the country and to stimulate public health policies.

Sexual behavior across the transition to adulthood and sexually transmitted infections: Findings from the national survey of human papillomavirus prevalence (POP-Brazil).

The sexual behaviors of 15- to 24-year-olds increase the risk of this population to acquire sexually transmitted infections (STIs). The present study aimed to describe the sexual behavior in the transition to adulthood Brazilian population and its association with STI history.We analyzed cross-sectional data collected from 8562 sexually active women and men who participated in the National Survey of Human Papillomavirus Prevalence (POP-Brazil). This large-scale survey enrolled participants from 26 Brazilian capitals and the Federal District. Professionals from primary care facilities were trained to collect data utilizing a standardized questionnaire with questions on sociodemographic, sexual behavior, and drug use. We constructed a Poisson model with robust variance for both crude and adjusted analysis to investigate the associations between the variables. To adjust the distribution of the sample to the study population, we weighted the measures by the population size in each city and by gender.There were differences in several aspects from sexual behavior between genders. The majority of men reported an early sexual initiation, more sexual partners, and a different practice in sexual positions when compared with women. Women reported use of contraception more frequently than men (P < .001). The use of alcohol and drugs and the use of drugs before sexual intercourse impact in STIs equally between the genders. Exclusive for women, the presence of any STI was associated with the practice of vaginal sex and other types of intercourse (adjusted prevalence ratio [APR] 1.43, 95% CI 1.08-1.88). For men, the number of sexual partners in the last year (APR 1.02, 95% CI 1.01-1.04), not having vaginal sex (APR 3.25, 95% CI 1.78-5.92) and sexual experience with someone of the same sex (APR 4.05, 95% CI, 2.88-5.70) were associated with a higher presence of STIs.This is the first report regarding sexual behavior in a nationally representative population sample in Brazil. This study provides more valid estimates of sexual behavior and associated STIs, identifying important differences in sexual behavior and identifying predictors for referred STIs among females and males.

Terapia nutricional em pacientes portadores do HIV em uso de TARV frente ao desenvolvimento de distúrbios metabólicos induzidos pela medicação / Nutrition therapy in HIV-infected patients against antiretroviral therapy-induced metabolic disorders

Embora a incidência de casos de pacientes portadores do vírus HIV ainda esteja aumentando, através da terapia antirretroviral (TARV) é possível melhorar a qualidade de vida e diminuir os agravos provocados pela patologia. No entanto, com a TARV observam-se efeitos colaterais importantes relativos ao metabolismo: resistência à insulina/intolerância à glicose, hipertensão arterial, lipodistrofia e dislipidemia. O objetivo do presente estudo foi revisar a literatura em busca de um maior entendimento acerca do efeito da terapia nutricional associada ou não às alterações nos hábitos de vida em pacientes portadores do HIV que fazem uso de TARV frente ao desenvolvimento de distúrbios metabólicos induzidos pela medicação. Foram revisados 11 estudos que preenchiam os critérios de inclusão, sendo que sete estudos demonstraram que a terapia nutricional apresenta impacto em alterações metabólicas, portanto uma adequada orientação nutricional deve ser parte integrante do tratamento de pacientes HIV positivos em terapia antirretroviral.

Although the incidence of cases of patients with HIV has increased, it is possible to improve the quality of life and reduce the complications caused by the disease through highly active antiretroviral therapy (HAART). However, HAART presents important side effects related to metabolic alterations: insulin resistance/glucose intolerance, hypertension, dyslipidemia, and lipodystrophy. The aim of the present study was to review the literature, searching for a better understanding of the effect of nutrition therapy associated or not with the alterations in lifestyle in HIV patients who use HAART, given the development of metabolic disorders induced by medication. We reviewed 11 studies that met the inclusion criteria, and seven studies showed that the nutrition therapy has impact on metabolic alterations; therefore a proper nutritional guidance should be an integral part of the treatment of HIV-positive patients on antiretroviral therapy.

Polimorfismo Ala54Thr do gene fatty acid-binding protein-2 (FABP-2): uma revisão bibliográfica / The Ala54Thr polymorphism of the fatty acid-binding protein-2 (FABP-2) gene: a literature review

O polimorfismo p.Ala54Thr (rs1799883) do gene fatty acid-binding protein-2 (FABP2) tem associação com resistência insulínica, síndrome metabólica e obesidade. A hipótese é de que o alelo mutante aumente a absorção de ácidos graxos intestinais, a concentração lipídica plasmática e a oxidação de gordura. Assim, o objetivo deste trabalho foi revisar o papel do polimorfismo p.Ala54Thr do gene FABP-2 na obesidade. A busca da literatura foi realizada na base de dados MEDLINE, através do PubMed e no Portal de Periódicos de Aperfeiçoamento de Pessoal de Nível Superior (Capes) com termos relacionados com o polimorfismo e obesidade. Parece não haver uma associação significativa da presença do alelo Thr54 com obesidade, apesar de ser uma doença complexa e que possivelmente não tenha sido captada por estudos de associação; diferente do colesterol total e lipoproteína de baixa densidade (low density level cholesterol, LDL-c), maior nos portadores do alelo Thr54. Alterações de adipocitocinas devem estar associadas a estas diferenças de perfil lipídico.

The p.Ala54Thr polymorphism (rs1799883) of the fatty acid-binding Protein-2 (FABP-2) gene has been associated with insulin resistance, metabolic syndrome and obesity. The hypothesis that the mutant allele increases the absorption of fatty acid by the bowel, plasma lipid concentration, and fat oxidation. Thus, the aim of this study was to review the role of FABP-2 Ala54Thr polymorphism in obesity. A literature search was conducted in MEDLINE database, using PubMed and Capes Portal with terms related to polymorphism and obesity. It does not seem to be a significant association between Thr54 allele and obesity, although being a complex disease and that possibly has not been captured by association studies; unlike total cholesterol and low density level cholesterol (LDL-c), which were higher in Thr54 allele carriers. Adipocytokines changes should be associated with these differences in lipid profile.

Food consumption in patients referred for bariatric surgery with and without binge eating disorder.

INTRODUCTION: The prevalence of Binge Eating Disorder (BED) is high in obese patients referred to bariatric surgery. Although the total energy intake is increased, the risk of nutritional deficiencies in these patients is unknown. This study proposes to evaluate and compare the intakes of candidate patients for bariatric surgery with and without BED, using for this purpose the Dietary Reference Intakes. METHODS: 116 patients referred for bariatric surgery were submitted to nutritional, laboratory and psychological assessments. RESULTS: Among the patients, 46.6% had BED, of these, 25.9% had the severe form. The patients with current depression (31.9%) were more compulsive than those without depression (p < 0.001). The mean age was significantly higher in patients without BED (46.94 ± 12.05 vs 42.32 ± 10.60, p = 0.030). The only difference in anthropometric parameters individuals with and without BED was the mid-upper arm circumference (P = 0.047). The percentage of energy from carbohydrates was higher in patients with BED (53.78%) than without BED (48.88%) (U = 1222, P = 0.018, r = − 0.22). The percentage from total fat (13.63% versus 12.89%, U = 1201.0, P = 0.019, r = − 0.22) and from saturated fat (9.04% versus 8.15%, U = 1074.0, P = 0.023, r = − 0.21), was higher in patients without BED. When adjusted for the body weight of patients, these differences were not significant. CONCLUSION: Patients with BED eat more carbohydrates and have larger mid-upper arm circumference in the face of similar body weight, suggesting a higher percentage of fat mass.

The role of fat mass and obesity associated gene (FTO) in satiety and binge eating disorder

Obesity is a major health problem and one of the biggest predictors of the development of chronic diseases. Variations in the Fat mass and obesity associated gene (FTO) have been shown to associate strongly with obesity. Among patients with severe obesity, there is a subpopulation that presents an eating disorder known as Binge Eating Disorder. Because of its expression in the hypothalamus, FTO could be associated with modulation of satiety and, perhaps, play a role in the genesis of BED, contributing to severe obesity. A search in PubMed was carried out with the following terms: Morbid Obesity AND FTO, FTO AND Satiety Response, Binge Eating Disorder AND FTO. No restriction on the date of publication, language or type of design was applied. Sixteen articles were found. Twelve were related to FTO and grade III obesity, and three were related to FTO and satiety. Ten studies were excluded. Thus, six articles were evaluated in this review. The scarce literature limits further conclusions about the potential impact of the associations with FTO in the treatment of obesity, but all articles included in this revision show association with at least one SNP of FTO. Further studies are required to clarify these associations, especially in relation to rs9939609 (A/T), because, up to this moment, it seems to be the one variant with greatest impact on obesity in humans...

Obesity coexists with malnutrition? Adequacy of food consumption by severely obese patients to dietary reference intake recommendations.

To assess the adequacy of food intake in severely obese patients and describe their main nutritional deficiencies on the basis of Dietary Reference Intakes (DRIs). Patients on a waiting list for bariatric surgery were sequentially recruited from March 2010 to November 2011. All subjects underwent nutritional status assessment (anthropometry, dietary recall and semi-structured interview), socioeconomic evaluation (Brazilian Association of Research Companies criteria) and laboratory testing (glucose/hormone/lipid panel). A total of 77 patients were assessed, 50 of whom (76.6%) were female. Mean age was 44.48 ± 12.55 years. The most common comorbidities were hypertension (72.4%), binge eating disorder (47.4%), type 2 diabetes mellitus (32.9%), sleep apnea (30.3%) and dyslipidemia (18.4%). Macronutrient intake was largely adequate, in view of the high calorie intake. However, some micronutrient deficiencies were present. Only 19.5% of patients had an adequate intake of potassium, 26.0% of calcium, and 66.2% of iron. All subjects consumed more than the minimum recommended intake of sodium, with 98.7% reaching the upper limit. Bcomplex vitamin intake was satisfactory (adequate in >80% of subjects), but lipid-soluble vitamin (A, D, E) intake often fell short of the RDI. The diet of severely obese patients is unbalanced, with high calorie intake paralleled by insufficient micronutrient intake. When these patients are assessed and managed, qualitative dietary changes should be considered in addition to routine caloric restriction.

Evaluar la adecuación de la dieta de los pacientes con obesidad severa y describir las principales deficiencias nutricionales a través del DRI. Los pacientes fueron seleccionados de forma secuencial, lo que indica la cirugía bariátrica en el periodo de marzo 2010 a noviembre 2011. Todos los pacientes fueron sometidos a la evaluación del estado nutricional (antropometría y la ingesta dietética) y metabólicos (perfiles de lípidos, hormonas y glucosa). Se evaluaron 77 pacientes (edad media ± DE) de 44,48 ± 12,55 años. Cincuenta pacientes (76,6% de la muestra) eran mujeres. Las comorbilidades más frecuentes fueron la hipertensión arterial (72,4%), trastorno por atracón (47,4%), diabetes mellitus (32.9%), apnea del sueño (30,3%) y la dislipemia (18,4%). El consumo de nutrientes fue generalmente adecuada, teniendo en cuenta la ingesta calórica alta. Sin embargo, se identificaron algunas deficiencias de micronutrientes. Sólo 19,5% de los pacientes alcanzar la ingesta recomendada mínima de potasio, de calcio 26,0%, y 66,2% de hierro. En cuanto a sodio, toda la muestra alcanza el mínimo recomendado, sin embargo, llegar a la UL 98,7% para el sodio. Las vitaminas del grupo B han evaluado el consumo satisfactorios, llegando a más del 80% de las necesidades, pero las vitaminas liposolubles A, D y E se consume a menudo por debajo de la ingesta diaria recomendada. La dieta del paciente obeso no está equilibrado. Un gran consumo de calorías se acompaña de una ingesta deficiente de micronutrientes. En la evaluación de estos pacientes, cambios en la dieta cualitativos deben ser considerados simultáneamente con la restricción calórica.