Utilização da bioimpedância em pacientes cardiopatas cirúrgicos / Bioimpedance usage in cardiac surgery patients

INTRODUÇÃO: Existem diversas ferramentas que podem auxiliar na avaliação e caracterização do estado nutricional. Uma delas é a bioimpedância (BIA), que fornece parâmetros como resistência (R), reactância capacitiva (Xc) e ângulo de fase (AF). Esses parâmetros podem variar, dependendo da composição celular e de seu potencial de membrana. Dessa forma, esse instrumento apresenta cada vez mais destaque no cenário clínico atual, podendo apresentar resultados promissores. Caracterizamos o sexo e estado nutricional da população estudada através do índice de massa corpórea (IMC) e identificamos elementos da BIA por meio de parâmetros da BIA (Xc, R e AF) de pacientes cardiopatas no período pré e pós-operatório. Também associou-se o AF com o tempo de permanência na unidade de terapia intensiva (UTI) e tempo de intubação orotraqueal (IOT) no período pós-operatório, além de possíveis readmissões no hospital público IDPC (Instituto Dante Pazzanese de Cardiologia), em São Paulo, Brasil. MÉTODO: Trata-se de um estudo transversal com 51 pacientes participantes do projeto Avaliação Nutricional e Terapia Nutricional em Cirurgia Cardíaca (AVANTCCA). Os pacientes foram avaliados no período pré-operatório, entre 2016 e 2017, avaliando a composição corporal e dados da BIA. Associou-se aqueles que apresentaram intercorrências clínicas no período pós-operatório. Resultados: Em mulheres, os valores de AF foram relacionados com maior tempo de hospitalização na UTI (p=0,02) e maior readmissão hospitalar (p=0,01). Não houve relação entre AF e tempo de IOT. CONCLUSÃO: A população estudada apresentou eutrofia (homens) e obesidade (mulheres). Houve uma associação entre o valor de AF em mulheres e maior tempo de permanência na UTI. O AF proporcionou uma melhor caracterização da evolução clínica dos pacientes.

Associação entre ângulo de fase e o SCORE HFA-PEFF de pacientes com ICFEP / Association between phase angle and HFA-PEFF SCORE in patients with HFpEF

INTRODUÇÃO: A insuficiência cardíaca com fração de ejeção preservada (ICFEp), já é responsável por mais da metade de todas as internações hospitalares por insuficiência cardíaca (IC). Pesquisas mostram que na população geral com idade >60 anos, 4,9% são diagnosticados com ICFEP e espera-se um aumento à medida que as pessoas vivem mais e a obesidade e diabetes tornam-se mais comuns. Heart Failure Association (HFA) da European Society of Cardiology (ESC) publicou uma recomendação para o diagnóstico da insuficiência cardíaca com fração de ejeção preservada ICFEp, trata-se do score (HFA-PEFF).A utilização de índices prognósticos no paciente com IC permite uma avaliação quanto à gravidade e ao impacto da doença na sobrevida do seu portador, além do monitoramento adequado da evolução clínica do mesmo. Nesse contexto, o exame de bioimpedância elétrica (BIA) vem sendo adotado para a avaliação de prognóstico. A partir da BIA obtém-se o ângulo de fase (AF), que expressa o equilíbrio entre os espaços intra e extracelulares, e tem sido relacionado com o sucesso, sobrevivência e evolução da doença, possibilitando não só monitorar a resposta do paciente ao tratamento em curso, mas reprogramar o cuidado prestado com a possibilidade de modificar o prognóstico. OBJETIVO: Verificar associação entre o AF a classificação dos pacientes com ICFEp, de acordo com o score HFA-PEFF. MÉTODO: Estudo transversal com 132 pacientes que foram avaliados e classificados através do score HFA-PEFF em baixa, intermediária ou alta probabilidade de ICFEp. Foram obtidos dados antropométricos e realizaram o exame de BIA para avaliação do AF. RESULTADOS: A média etária dos avaliados foi de 63±12 anos, sendo 65,15% (n= 86) do sexo feminino. Segundo a probabilidade de ICFEP pelo score HFA-PEFF, foram classificados em Baixa (n=39), Intermediário (n=57) e Alta (n=36). Em relação ao AF, houve associação entre pacientes com alta probabilidade de ICFEP e AF significativamente menores do que aqueles com probabilidades baixa e intermediária. CONCLUSÃO: O menor AF verificado foi encontrado nos pacientes com alta probabilidade de ICFEP segundo o score HFA-PEFF, sugerindo como um potencial marcador prognóstico na evolução da ICFEp.

Orange juice intake by obese and insulin-resistant subjects lowers specific plasma triglycerides: a randomized clinical trial

BACKGROUND & AIMS: Dyslipidaemia is usually common in obesity, insulin resistance, and type 2 diabetes mellitus. Clinical trials suggest that orange juice may have a positive impact on lipid metabolism and blood lipid profiles; however conflicting results have been reported. Here, we applied a combined untargeted/targeted lipidomic analysis of plasma to examine the impact of orange (Citrus sinensis) juice intake on the lipidome profile of obese and insulin-resistant subjects. METHODS: Twenty-five participants, both sexes, aged 40-60 years, with obesity and insulin resistance (homeostasis model assessment of insulin resistance (HOMA-IR) index >2.71) ingested 400 mL of orange juice 'Pera' (C. sinensis) for 15 d. Cardiometabolic biomarkers, anthropometric parameters, blood pressure, and plasma lipidomic analysis results were assessed at the beginning and end of the intervention. RESULTS: After the 15-d intervention, a significant decrease was observed in the diastolic blood pressure and blood lipid profile. Among plasma lipidomes, 316 lipid molecules were identified, with the triglycerides (TGs) subclass being the most abundant (n = 106). Plasma lipidome profiling revealed a major signature of the intervention; with concentrations of 37 TG species decreasing after intervention. Qualitatively, oleic and linoleic acids were among the most prevalent fatty acids linked to the altered TG species, representing 50% of TG chains. Modulated TG species were positively correlated with total TG and very low-density lipoprotein levels, as well as systolic and diastolic blood pressure. A strong inter-individual trend was observed, wherein, compared with less responsive subjects, the high responsive subjects displayed the highest decrease in the concentrations of altered TG species, as as well as systolic blood pressure (decrease of 10.3 ± 6.8 mmHg) and body weight (decrease of 0.67 ± 0.71 kg). CONCLUSIONS: These findings suggest that orange juice has a positive impact on lipid metabolism, mainly regarding the composition of TG-specific fatty acid chains and cholesterol esters, protecting against insulin resistance. Furthermore, lipidomics may help clarify alterations at the molecular level after an intervention, contributing to improve the evaluation of the link between dyslipidaemia, insulin resistance, and nutrition.

Effect of qualitative and quantitative nutritional plan on gene expression in obese patients in secondary prevention for cardiovascular disease

Summary Background & aims: Diet is a modifiable risk factor, which may influence the gene expression and the concentration of inflammatory biomarkers related to obesity and atherosclerosis. In this sub study from Brazilian Cardioprotective Nutritional (BALANCE) Program, we hypothesized that a nutritional intervention based on the usual Brazilian diet modulates the expression of genes involved with atherosclerosis and inflammatory biomarkers in male patients, in the secondary prevention for cardiovascular disease. Methods: Six male patients, aged 45 years or older, obese, were selected to follow a qualitative-quantitative food plan for 6 months. Glycemia, insulinemia, lipid profile, plasma concentration of inflammatory biomarkers (interleukin (IL) -1b), IL-6, IL-8, IL-10, IL-12, tumor necrosis factor alpha, C-reactive protein and adiponectin, and expression of 84 atherosclerosis-related genes in total peripheral blood cells, were measured. Results: After nutritional intervention, the participants reduced weight (p<0.04), waist circumference(p<0.04), Homeostasis Model Assessment index for insulin resistance (p»0.046) and overall leukocyte count (p»0.046) and neutrophils (p»0.028). There was no significant modification in the plasma concentration of the inflammatory biomarkers, however, there was a significant increase in the expression of Apo A1 (p»0.011), ELN (p»0.017) and IL4 (p»0.037) genes. Conclusions: The BALANCE Program, the qualitative-quantitative food plan composed of Brazilian usual foods, did not reduce the concentration of inflammatory biomarkers, but increased in total peripheral blood cells the expression of genes involved in reducing the risk of cardiometabolic in obese patients, in secondary prevention for cardiovascular disease. The clinical trial is registered athttps://clinicaltrials.gov/and the unique identifier is NCT01620398.

Association between plasma fatty acids and inflammatory markers in patients with and without insulin resistance and in secondary prevention of cardiovascular disease, a cross-sectional study.

BACKGROUND: Proinflammatory biomarkers levels are increased among patients with cardiovascular disease, and it is known that both the presence of insulin resistance and diet may influence those levels. However, these associations are not well studied among patients with established cardiovascular disease. Our objective is to compare inflammatory biomarker levels among cardiovascular disease secondary prevention patients with and without insulin resistance, and to evaluate if there is any association between plasma fatty acid levels and inflammatory biomarker levels among them. METHODS: In this cross-sectional sub-study from the BALANCE Program Trial, we collected data from 359 patients with established cardiovascular disease. Plasma fatty acids and inflammatory biomarkers (interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12, high sensitive C-reactive protein (hs-CRP), adiponectin, and tumor necrosis factor (TNF)-alpha) were measured. Biomarkers and plasma fatty acid levels of subjects across insulin resistant and not insulin resistant groups were compared, and general linear models were used to examine the association between plasma fatty acids and inflammatory biomarkers. RESULTS: Subjects with insulin resistance had a higher concentration of hs-CRP (p = 0.002) and IL-6 (p = 0.002) than subjects without insulin resistance. Among subjects without insulin resistance there was a positive association between stearic fatty acid and IL-6 (p = 0.032), and a negative association between alpha-linolenic fatty acid and pro-inflammatory biomarkers (p < 0.05). Among those with insulin resistance there was a positive association between monounsaturated fatty acids and arachidonic fatty acid and adiponectin (p < 0.05), and a negative association between monounsaturated and polyunsaturated fatty acids and pro-inflammatory biomarkers (p < 0.05), as well as a negative association between polyunsaturated fatty acids and adiponectin (p < 0.05). Our study has not found any association between hs-CRP and plasma fatty acids. CONCLUSIONS: Subjects in secondary prevention for cardiovascular disease with insulin resistance have a higher concentration of hs-CRP and IL-6 than individuals without insulin resistance, and these inflammatory biomarkers are positively associated with saturated fatty acids and negatively associated with unsaturated fatty acids.

Association between plasma fatty acids and inflammatory markers in patients with and without insulin resistance and in secondary prevention of cardiovascular disease, a cross-sectional study

BACKGROUND: Proinflammatory biomarkers levels are increased among patients with cardiovascular disease, and it is known that both the presence of insulin resistance and diet may influence those levels. However, these associations are not well studied among patients with established cardiovascular disease. Our objective is to compare inflammatory biomarker levels among cardiovascular disease secondary prevention patients with and without insulin resistance, and to evaluate if there is any association between plasma fatty acid levels and inflammatory biomarker levels among them. METHODS: In this cross-sectional sub-study from the balance Program Trial, we collected data from 359 patients with established cardiovascular disease. Plasma fatty acids and inflammatory biomarkers (interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12, high sensitive C-reactive protein (hs-CRP), adiponectin, and tumor necrosis factor (TNF)-alpha) were measured. Biomarkers and plasma fatty acid levels of subjects across insulin resistant and not insulin resistant groups were compared, and general linear models were used to examine the association between plasma fatty acids and inflammatory biomarkers. RESULTS: Subjects with insulin resistance had a higher concentration of hs-CRP (p = 0.002) and IL-6 (p = 0.002) than subjects without insulin resistance. Among subjects without insulin resistance there was a positive association between stearic fatty acid and IL-6 (p = 0.032), and a negative association between alpha-linolenic fatty acid and pro-inflammatory biomarkers (p < 0.05). Among those with insulin resistance there was a positive association between monounsaturated fatty acids and arachidonic fatty acid and adiponectin (p < 0.05), and a negative association between monounsaturated and polyunsaturated fatty acids and pro-inflammatory biomarkers (p < 0.05), as well as a negative association between polyunsaturated fatty acids and adiponectin (p < 0.05). Our study has not found any association between hs-CRP and plasma fatty acids.

Screening tool for oropharyngeal dysphagia in stroke - Part I: evidence of validity based on the content and response processes. / Instrumento de rastreio para disfagia orofaríngea no Acidente Vascular Encefálico - Parte I: evidências de validade baseadas no conteúdo e nos processos de resposta.

PURPOSE: The aim of the present study was to identify the evidence of validity based on the content and response process of the Rastreamento de Disfagia Orofaríngea no Acidente Vascular Encefálico (RADAVE; "Screening Tool for Oropharyngeal Dysphagia in Stroke"). METHODS: The criteria used to elaborate the questions were based on a literature review. A group of judges consisting of 19 different health professionals evaluated the relevance and representativeness of the questions, and the results were analyzed using the Content Validity Index. In order to evidence validity based on the response processes, 23 health professionals administered the screening tool and analyzed the questions using a structured scale and cognitive interview. RESULTS: The RADAVE structured to be applied in two stages. The first version consisted of 18 questions in stage I and 11 questions in stage II. Eight questions in stage I and four in stage II did not reach the minimum Content Validity Index, requiring reformulation by the authors. The cognitive interview demonstrated some misconceptions. New adjustments were made and the final version was produced with 12 questions in stage I and six questions in stage II. CONCLUSION: It was possible to develop a screening tool for dysphagia in stroke with adequate evidence of validity based on content and response processes. Both validity evidences obtained so far allowed to adjust the screening tool in relation to its construct. The next studies will analyze the other evidences of validity and the measures of accuracy.

Association between polyunsaturated fatty acids and inflammatory markers in patients in secondary prevention of cardiovascular disease.

OBJECTIVE: The aim of this study was to assess the association between polyunsaturated fatty acids (PUFAs) and inflammatory biomarkers among patients in secondary prevention of cardiovascular disease (CVD). METHODS: In this cross-sectional substudy from BALANCE Program Trial, we have collected data from 364 patients with established CVD. Twenty-four-hour dietary recalls and plasma FA concentrations were analyzed to estimate the FA intake. Inflammatory biomarkers measurement consisted of interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12, C-reactive protein, adiponectin, and tumor necrosis factor-α. After log-transformation of inflammatory biomarkers, multivariate-adjusted general linear model was used to examine the effect of FA intake. The association was adjusted for body mass index, waist circumference, energy, smoking status, age, total cholesterol, low-density lipoprotein cholesterol, physical activity, and calcium channel blockers. RESULTS: PUFAs were inversely associated with C-reactive protein levels (P = 0.006) and with IL-1 ß. The increase of 1 g/1000 kcal in PUFAs, omega-3, and omega-6 reduces, on average, 6%, 48%, and 8% respectively, the mean concentration of IL-1 ß. CONCLUSION: Omega-3 and omega-6 FA intakes are inversely associated with inflammatory biomarkers among CVD patients. Additional studies on omega-3 and omega-6 intake in relation to inflammatory biomarkers in patients in secondary prevention of CVD are needed, particularly regarding dietary patterns that are rich in some sources of PUFA.

Association between polyunsaturated fatty acids and inflammatory markers in patients in secondary prevention of cardiovascular disease

OBJECTIVE: The aim of this study was to assess the association between polyunsaturated fatty acids (PUFAs) and inflammatory biomarkers among patients in secondary prevention of cardiovascular disease (CVD). METHODS: In this cross-sectional substudy from BALANCE Program Trial, we have collected data from 364 patients with established CVD. Twenty-four-hour dietary recalls and plasma FA concentrations were analyzed to estimate the FA intake. Inflammatory biomarkers measurement consisted of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12, C-reactive protein, adiponectin, and tumor necrosis factor-α. After log-transformation of inflammatory biomarkers, multivariate-adjusted general linear model was used to examine the effect of FA intake. The association was adjusted for body mass index, waist circumference, energy, smoking status, age, total cholesterol, low-density lipoprotein cholesterol, physical activity, and calcium channel blockers.RESULTS:PUFAs were inversely associated with C-reactive protein levels (P = 0.006) and with IL-1 β. The increase of 1 g/1000 kcal in PUFAs, omega-3, and omega-6 reduces, on average, 6%, 48%, and 8% respectively, the mean concentration of IL-1 β...

Instrumento de rastreio para disfagia orofaríngea no Acidente Vascular Encefálico - Parte I: evidências de validade baseadas no conteúdo e nos processos de resposta / Screening tool for oropharyngeal dysphagia in stroke - Part I: evidence of validity based on the content and response processes

RESUMO Objetivo Este estudo tem o objetivo de identificar as evidências de validade baseadas no conteúdo e nos processos de resposta de um instrumento de Rastreamento para disfagia orofaríngea no Acidente Vascular Encefálico (RADAVE). Método Os critérios para elaborar os itens do instrumento foram baseados na revisão de literatura. Um grupo de juízes com 19 profissionais distintos e da área da saúde avaliaram a relevância e representatividade das questões e o resultado foi analisado por meio do índice de validade de conteúdo (IVC). Para evidência de validade baseada nos processos de resposta, 23 profissionais da saúde aplicaram o instrumento e analisaram as questões por meio de escala estruturada e entrevista cognitiva. Resultados O RADAVE foi estruturado para ser aplicado em duas etapas. A primeira versão foi constituída por 18 questões na etapa I e 11 questões na etapa II. Oito questões da etapa I e quatro questões da etapa II não atingiram o IVC mínimo, sendo realizadas reformulações pelos autores. A entrevista cognitiva demonstrou a necessidade de novos ajustes que resultaram na versão final com 12 questões na Etapa I e seis questões na Etapa II. Conclusão Foi possível desenvolver um instrumento de rastreamento para a disfagia no Acidente Vascular Encefálico com adequadas evidências de validade baseadas no conteúdo e nos processos de resposta. As duas evidências de validade obtidas até o momento permitiram ajustar o instrumento em relação ao seu constructo. Os próximos estudos irão analisar as demais evidências de validade e as medidas de acurácia.

ABSTRACT Purpose The aim of the present study was to identify the evidence of validity based on the content and response process of the Rastreamento de Disfagia Orofaríngea no Acidente Vascular Encefálico (RADAVE; "Screening Tool for Oropharyngeal Dysphagia in Stroke"). Methods The criteria used to elaborate the questions were based on a literature review. A group of judges consisting of 19 different health professionals evaluated the relevance and representativeness of the questions, and the results were analyzed using the Content Validity Index. In order to evidence validity based on the response processes, 23 health professionals administered the screening tool and analyzed the questions using a structured scale and cognitive interview. Results The RADAVE structured to be applied in two stages. The first version consisted of 18 questions in stage I and 11 questions in stage II. Eight questions in stage I and four in stage II did not reach the minimum Content Validity Index, requiring reformulation by the authors. The cognitive interview demonstrated some misconceptions. New adjustments were made and the final version was produced with 12 questions in stage I and six questions in stage II. Conclusion It was possible to develop a screening tool for dysphagia in stroke with adequate evidence of validity based on content and response processes. Both validity evidences obtained so far allowed to adjust the screening tool in relation to its construct. The next studies will analyze the other evidences of validity and the measures of accuracy.

Perfil nutricional de crianças e adolescente com cardiopatia congênita no pré-operatório / Nutritional profile of children and adolescents with preoperative congenital heart disease

A cardiopatia congênita é a manifestação da alteração na estrutura cardiovascular normal ou da incapacidade da estrutura atingir desenvolvimento completo durante o período fetal, produ-zindo graus variáveis de disfunção circulatória, podendo afetar o crescimento e estado nutricional de crianças, sendo a desnutrição o fator de risco mais importante de morbimortalidade nesses pacientes. Objetivo: Descrever o perfil nutricional de crianças e adolescentes com cardiopatia em período pré-operatório sob regime de internação. Método: Estudo transversal com coleta de dados de crianças e adolescentes de ambos os gêneros internados na enfermaria pediátrica em um hospital de cardiologia de janeiro a março de 2012. Foram mensuradas as medidas de peso e estatura e calculados os escores-z de peso/idade, peso/estatura, estatura/idade, Índice de Massa Corporal (IMC)/idade segundo as curvas de crescimento da Organização Mundial da Saúde. A classificação do estado nutricional foi realizada de acordo com a recomendação do Sistema de Vigilância Alimentar e Nutricional - SISVAN. Resultados: Foram avaliados 60 pacientes. Segundo o índice peso/estatura, 54,3% crianças foram classificadas como eutróficas, 33,3% desnutridas e 11,9% apresentaram excesso de peso. De acordo com o IMC/idade, 51,7% dos pacientes eram eutróficos, 30% eram desnutridos e 21% com excesso de peso. Conclusão: Este grupo estudado apresentou elevada proporção de desnutrição segundo o índice peso/estatura e IMC/estatura, o que pode acarretar no aumento da morbidade e mortalidade desses pacientes. (AU)

Utilização do azeite de oliva na prevenção e no tratamento das doenças cardiovasculares / Use of olive oil in the prevention and treatment of cardiovascular diseases

O azeite de oliva é um dos principais ingridientes da Dieta do Mediterâneo, que apresenta relação inversa com a doença aterosclerótica. O efeito cardioprotetor dessa dieta tem sido atribuído em grande parte, à formulação exclusiva do azeite de oliva virgem. O alto teor de ácidos graxos monoinsaturados e de compostos fenólicos, especialemnte oleuropeína e o hidroxitirosol, está relacionado a ações antiaterogênicas, como redução da colesterolemia, redução da agregação plaquetária e diminuição da expressão de moléculas de adesão. Não existe grande variação no teor de ácidos graxos monoinsaturados no que se refere à qualidade de azeite, contudo a maior concentração de compostos fenólicos está no azeite extravirgem, obtido a partir de todo o fruto por meio da primeira prensa física a frio.

Gastrostomia endoscópica em pacientes com cardiopatia complicada / Endoscopic gastrostomy in patients with complicated heart diseases

Pacientes cardiopatas complicados com isquemia cerebral e insuficiência cardíaca necessitam terapia nutricional enteral prolongada por se apresentarem em situaçäo de risco nutricional. Complicaçöes advindas do uso prolongado da sonda nasoenteral poderiam ser evitadas com a execuçäo da gastrotonomia endoscópica. Esta é alternativa técnica para acesso ao tubo digestivo em nutriçäo enteral. O objetivo deste estudo foi avaliar o tempo de indicaçäo para gastronomia endoscópica em pacientes com nutriçäo enteral com uso de sonda nasoenteral e as principais complicaçöes do procedimento. Doze pacientes foram submetidos a gastronomia endoscópica, sendo oito do sexo masculino. A idade média foi de 62,42 + 22,10 anos. A indicaçäo principal foi síndrome isquêmica cerebral após parada cardiorespiratória por patologia clínica (sete pacientes) ou cirurgia cardiovascular complicada (cinco). O tempo médio para indicaçäo da gastronomia endoscópica foi de 35,58 + 26,79 dias após introduçäo da nutriçäo enteral. Näo houve intercorrências com o procedimento e, no período pós-operatório tardio, ocorreu infecçäo do orificio de inserçäo da gastronomia endoscópica em um caso, resolvida com cuidados locais. Em conclusäo, a gastronomia endoscópica é tecnica segura, com baixa incidência de complicaçöes. Pode ser realizada em ambulatórios, no leite do paciente, ou em centro de terapia intensiva e sua indicaçäo deveria ser mais precoce.