The global diet quality score as an indicator of adequate nutrient intake and dietary quality - a nation-wide representative study.

BACKGROUND: The Global Diet Quality Score (GDQS) was developed to be a simple, timely and cost-effective tool to track, simultaneously, nutritional deficiency and non-communicable disease risks from diet in diverse settings. The objective was to investigate the performance of GDQS as an indicator of adequate nutrient intake and dietary quality in a national-representative sample of the Brazilian population. METHODS: Nationally-representative data from 44,744 men and non-pregnant and non-lactating women aging ≥ 10 years, from the Brazilian National Dietary Survey were used. Dietary data were collected through two 24-h recalls (24HR). The GDQS was calculated and compared to a proxy indicator of nutrient adequate intake (the Minimum Dietary Diversity for Women-MDD-W) and to an indicator of high-risk diet for non-communicable diseases (caloric contribution from ultra-processed foods-UPF). To estimate the odds for overall nutrient inadequacy across MDD-W and GDQS quintiles, a multiple logistic regression was applied, and the two metrics' performances were compared using Wald's post-test. RESULTS: The mean GDQS for Brazilians was 14.5 (0-49 possible range), and only 1% of the population had a low-risk diet (GDQS ≥ 23). The GDQS mean was higher in women, elderly individuals and in higher-income households. An inverse correlation was found between the GDQS and UPF (rho (95% CI) = -0.20(-0.21;-0.19)). The odds for nutrient inadequacy were lower as quintiles of GDQS and MDD-W were higher (p-trend < 0.001), and MDD-W had a slightly better performance than GDQS (p-diff < 0.001). Having a low-risk GDQS (≥ 23) lowered the odds for nutrient inadequacy by 74% (95% CI:63%-81%). CONCLUSION: The GDQS is a good indicator of overall nutrient adequacy, and correlates well with UPF in a nationally representative sample of Brazil. Future studies must investigate the relationship between the GDQS and clinical endpoints, strengthening the recommendation to use this metric to surveillance dietary risks.

Gut bacterial markers involved in association of dietary inflammatory index with visceral adiposity.

OBJECTIVE: To deepen the understanding of the influence of diet on weight gain and metabolic disturbances, we examined associations between diet-related inflammation and body composition and fecal bacteria abundances in participants of the Nutritionists' Health Study. METHODS: Early-life, dietary and clinical data were obtained from 114 women aged ≤45 years. A validated food frequency questionnaire was used to calculate the energy-adjusted dietary inflammatory index (E-DII). Participants' data were compared by E-DII quartiles using ANOVA or Kruskal-Wallis. Associations of DXA-determined body composition with the E-DII were tested by multiple linear regression using DAG-oriented adjustments. Fecal microbiota was analyzed targeting the V4 region of the 16S rRNA gene. Spearman correlation coefficients were used to test linear associations; differential abundance of genera across the E-DII quartiles was assessed by pair-wise comparisons. RESULTS: E-DII score was associated with total fat (b=1.80, p<0.001), FMI (b=0.08, p<0.001) and visceral fat (b=1.19, p=0.02), independently of maternal BMI, birth type and breastfeeding. E-DII score was directly correlated to HOMA-IR (r=0.30; p=0.004), C-reactive protein (r=0.29; p=0.003) and to the abundance of Actinomyces, and inversely correlated to the abundance of Eubacterium.xylanophilum.group. Actinomyces were significantly more abundant in the highest (most proinflammatory) E-DII quartile. CONCLUSIONS: Association of E-DII with markers of insulin resistance, inflammation, body adiposity and certain gut bacteria are consistent with beneficial effects of anti-inflammatory diet on body composition and metabolic profile. Bacterial markers, such as Actinomyces, could be involved in the association between the dietary inflammation with visceral adiposity. Studies designed to explore how a pro-inflammatory diet affects both central fat deposition and gut microbiota are needed.

The Use of Herbal Medicines Among Cancer Patients.

Background and objective The use of herbal medicines has been increasing among cancer patients, as a way to control cancer and treatment-related symptoms; however, many patients are reluctant to disclose this use to their medical practitioners. The fact that oncological treatments have a narrow therapeutic margin, associated with the lack of control and clinical evidence concerning these supplements, makes medication-herbal interactions a reality. These interactions could lead to increased toxicity or a decreased effectiveness of oncological treatment. In light of this, we aimed to assess the prevalence of herbal medicine use in a patient population at a Portuguese central hospital: Centro Hospitalar Lisboa Ocidental. Materials and methods Patients with breast, prostate, or colorectal cancer diagnoses between August 2022 and July 2023 and undergoing oncological treatment were included. Data were collected through a survey during their first appointment, as well as by consulting the patients' clinical files. An interaction evaluation was carried out to assess potential medication-herbal interactions. Finally, a statistical analysis was performed to identify predictive factors for the use of herbal medicines. Results Among the 65 patients included in the study, 52% were females, and the median age of the cohort was 65 years. Breast cancer was the most prevalent diagnosis and the majority of the patients were undergoing palliative treatment. We found that 46% of patients used herbal medicines regularly: to strengthen the immune system, detoxification of the body, and treat insomnia and constipation. A medication-herbal interaction was found in 37% of the cases, the most frequent being doxorubicin-vitamin C, through an antioxidant mechanism. The univariable analysis failed to show any predictive factors associated with the use of herbal medicines. Conclusions This study sheds light on herbal medicine use among cancer patients and the reality of medication-herbal interactions. There is an urgent need for further research and evidence-based medical protocols regarding herbal medicine use, especially in complex cases such as cancer patients, to provide better and safer care.

Intra- and inter-rater reliability of muscle and fat thickness measurements obtained using portable ultrasonography in older adults.

BACKGROUND & AIMS: Ultrasonography (US) is a promising tool for assessing body composition, offering accuracy and accessibility. However, technician skills and equipment characteristics can impact measurement reliability. We aimed to evaluate the intra- and inter-rater reliability of two evaluators using A-mode Portable Ultrasound to measure muscle and fat thickness in Brazilian older adults. METHODS: Quantitative cross-sectional study carried out with 150 community-dwelling older adults of Campinas-SP-Brazil, recruited in a retirement preparation program and a geriatric outpatient care unit. Scans of nine anatomical points were performed using the portable ultrasound in A-mode (BodyMetrix Pro System BX2000; Livermore, CA), with 6 scans per location and 3 measurements taken by each evaluator. After the selection and analysis of the generated images, muscle and fat thickness were measured. Reliability estimates between measures of the same evaluator (intra-rater) and between evaluators (inter-rater) were assessed using intraclass correlation coefficients (ICC), and differences within and between technicians were assessed using one-way ANOVA. Analyses were carried out for the overall sample and stratified by sex and by nutritional status. RESULTS: Excellent ICC values (>0.90) were found for subcutaneous fat thickness in intra- and inter-rater reliability analyses. The lowest ICC values were observed for deep abdominal fat thickness measured by evaluator 1 (ICC = 0.90) and evaluator 2 (ICC = 0.87), as well as in the inter-rater analysis (ICC = 0.85). Muscle thickness measurements had satisfactory ICC values for triceps, biceps, anterior thigh, and calf, ranging from moderate to good (ICC 0.50-0.90). CONCLUSION: A portable A-mode ultrasound demonstrates excellent reliability among both intra- and inter-raters for assessing fat thickness but only moderate for muscle thickness in older adults. Hence, this could prompt inquiries regarding the sole reliance on this tool for quantifying muscle mass and examining sarcopenia in older adults. To our knowledge, this study represents the first assessment of reliability for a portable A-mode ultrasound device conducted with older adults.

Association of physical activity and sitting with metabolic syndrome and hyperglycemic clamp parameters in adolescents - BRAMS pediatric study.

Introduction: Obesity and metabolic syndrome (MetS) have immediate and long-term consequences on adolescent health and well-being. Among the available treatments for MetS in adolescents, behavioral interventions such as increasing physical activity (PA) are preferred. This study aimed to investigate the association of PA and sitting time with MetS and a complete set of metabolic health parameters. Methods: Data from the Pediatric Brazilian Metabolic Syndrome Study (BRAMS-P), a cross-sectional multicenter study conducted using a convenience sample of 448 Brazilian adolescents (10y-19y), were used. Sociodemographic and lifestyle information were collected using a standardized questionnaire. Daily PA and sitting time were estimated from the International PA Questionnaire. Anthropometric parameters, body composition, and blood pressure were measured by trained researchers. Blood lipids, uric acid, hepatic enzymes, creatinine, glycated hemoglobin, glucose, and insulin were measured in fasting blood samples, and the Homeostasis Model Assessment for Insulin Resistance was calculated. A subsample of 57 adolescents underwent the hyperglycemic clamp protocol. Results: The odds for metabolic syndrome were higher among adolescents who spent >8h sitting (OR (95%CI)=2.11 (1.02 - 4.38)), but not in those classified as active (OR (95%CI)=0.98 (0.42 - 2.26)). Adolescents who spent more time sitting had higher BMI, waist circumference, sagittal abdominal diameter, neck circumference, percentage of body fat, and worse blood lipid profile. The insulin sensitivity index was moderately and positively correlated with moderate-to-high PA in minutes per day (rho=0.29; p=0.047). Conclusion: Time spent sitting was associated with worse metabolic parameters and must be restricted in favor of adolescent health. Regular PA is associated with improved insulin sensitivity and may be encouraged not only in adolescents with obesity or metabolic disorders but also to prevent adverse metabolic outcomes in normal-weight adolescents.

Short-chain fatty acids are associated with adiposity, energy and glucose homeostasis among different metabolic phenotypes in the Nutritionists' Health Study.

BACKGROUND AND AIMS: The gut microbiome is associated with obesity, mainly mediated by bacteria-produced short-chain fatty acids (SCFAs). It is unknown how SCFA concentrations are associated with the phenotypes metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy obese/overweight (MHO), and metabolically unhealthy obese/overweight (MUO). We compared plasma and fecal SCFA concentrations among adult women categorized according to the metabolic phenotypes mentioned above and examined associations between SCFA and adiposity and components of energy and glucose homeostasis. METHODS: This was a cross-sectional study involving 111 participants. Body composition was assessed by DEXA. Energy and glycemic homeostasis were assessed by the standard mixed-meal tolerance test coupled with indirect calorimetry. SCFAs were quantified by gas chromatography and mass spectrometry. RESULTS: Only plasma propionate was increased in the MHNW phenotype compared to the MHO and MUO phenotypes [p < 0.05]. Fecal propionate and butyrate concentrations and plasma propionate concentrations were inversely associated with total and visceral adiposity [p < 0.05]. Fecal and plasma SCFA concentrations were associated with reduced glucose, insulin and HbA1c levels, increased fasting and postprandial GLP-1 levels; and more preserved beta-cell function [p < 0.05]. Fecal and plasma SCFA concentrations were positively correlated with resting energy expenditure and lipid oxidation rate and inversely correlated with the oxidation rate of carbohydrates [p < 0.05]. CONCLUSION: These findings reinforce the concept that fecal and plasma SCFA concentrations are linked to specific components of energy and glucose homeostasis; and body adiposity. However, it was not possible to discriminate the different metabolic phenotypes of adiposity based on the determination of fecal SCFA concentrations.

Her2 Status Discrepancy Between Core Needle Biopsy and Surgically Resected Mastectomy Specimen: A Clinical Case.

The biomarker concordance between core needle biopsy (CNB) and surgical specimen (SS), in breast cancer, has long been a matter of discussion because of its influence on oncologic treatment choice. Particularly, human epidermal growth factor receptor 2 (Her2) status is quite important, because of the impact on breast cancer classification and target therapy. Many factors could influence the difference in biomarker status between samples, such as the technic itself, sample procedures and intratumoral heterogeneity. Neoadjuvant chemotherapy (NAC) can also contribute to this variation and should be taken into consideration. We report a clinical case of a 33-year-old man who was diagnosed with right breast cancer, initially Her2 negative in the CNB. Therefore, the NAC was completed without anti-Her2 treatment. Later, after the mastectomy, revision of the SS was found to be positive for Her2, after the silver in situ hybridization (SISH) technique. Consequently, the patient lost the chance of doing anti-Her2 therapy in the neoadjuvant setting, reducing his possibility to achieve a complete pathologic response and later jeopardizing his clinical outcome.

The threshold value for identifying insulin resistance (HOMA-IR) in an admixed adolescent population: A hyperglycemic clamp validated study

ABSTRACT Objectives: To validate the homeostasis model assessment (HOMA) of insulin resistance (IR) as a surrogate to the hyperglycemic clamp to measure IR in both pubertal and postpubertal adolescents, and determine the HOMA-IR cutoff values for detecting IR in both pubertal stages. Subjects and methods: The study sample comprised 80 adolescents of both sexes (aged 10-18 years; 37 pubertal), in which IR was assessed with the HOMA-IR and the hyperglycemic clamp. Results: In the multivariable linear regression analysis, adjusted for sex, age, and waist circumference, the HOMA-IR was independently and negatively associated with the clamp-derived insulin sensitivity index in both pubertal (unstandardized coefficient - B = −0.087, 95% confidence interval [CI] = −0.135 to −0.040) and postpubertal (B = −0.101, 95% CI, −0.145 to −0.058) adolescents. Bland-Altman plots showed agreement between the predicted insulin sensitivity index and measured clamp-derived insulin sensitivity index in both pubertal stages (mean = −0.00 for pubertal and postpubertal); all P > 0.05. The HOMA-IR showed a good discriminatory power for detecting IR with an area under the receiver operator characteristic curve of 0.870 (95% CI, 0.718-0.957) in pubertal and 0.861 (95% CI, 0.721-0.947) in postpubertal adolescents; all P < 0.001. The optimal cutoff values of the HOMA-IR for detecting IR were > 3.22 (sensitivity, 85.7; 95% CI, 57.2-98.2; specificity, 82.6; 95% CI, 61.2-95.0) for pubertal and > 2.91 (sensitivity, 63.6; 95% CI, 30.8-89.1, specificity, 93.7; 95%CI, 79.2-99.2) for postpubertal adolescents. Conclusion: The threshold value of the HOMA-IR for identifying insulin resistance was > 3.22 for pubertal and > 2.91 for postpubertal adolescents.

Parental body mass index and maternal gestational weight gain associations with offspring body composition in young women from the Nutritionists' Health Study

ABSTRACT Objective: Intrauterine environment can induce fetal metabolic programming that predisposes to adiposity-related chronic diseases in its lifespan. We examined the associations of parental nutritional status and gestational weight gain with offspring body composition in early adulthood. Materials and methods: This is cross-sectional analysis of female participants of the NutriHS who were submitted to questionnaires, clinical examinations and body composition assessed by DXA. Association of pre-conception parental BMI and maternal gestational weight gain (exposures) with body composition measurements (outcomes) were analyzed using multiple linear models adjusted for Directed Acyclic Graphs-based covariables (maternal and paternal educational level, maternal age, and tobacco, alcohol and/or drugs use). The sample included 124 women (median 28 (24-31) years) with a mean BMI of 25.4 ± 4.7 kg/m2. Results: No association between previous paternal BMI and offspring's body composition was detected. In the fully adjusted linear regression model, maternal BMI was associated with offspring's total lean mass (β = 0.66, p = 0.001), appendicular skeletal muscle mass index (ASMI) (β = 0.11, p = 0.003) and fat mass index (FMI) (β = 0.03, p = 0.039). Gestational weight gain was associated with increased offspring's BMI (OR 1.12 [95% CI 1.02-1.20], p = 0.01). The linear regression model adjusted for maternal age and maternal and paternal education levels showed associations of gestational weight gain with offspring's ASMI (β = 0.42, p = 0.046), FMI (β = 0.22, p = 0.005) and android-to-gynoid fat ratio (β = 0.09, p = 0.035). Conclusion: Our findings suggest that preconception maternal BMI could influence lean mass and general adiposity of young adult female offspring and that gestational weight gain could be useful for predicting centrally distributed adiposity.

The threshold value for identifying insulin resistance (HOMA-IR) in an admixed adolescent population: A hyperglycemic clamp validated study.

Objective: To validate the homeostasis model assessment (HOMA) of insulin resistance (IR) as a surrogate to the hyperglycemic clamp to measure IR in both pubertal and postpubertal adolescents, and determine the HOMA-IR cutoff values for detecting IR in both pubertal stages. Subjects and methods: The study sample comprised 80 adolescents of both sexes (aged 10-18 years; 37 pubertal), in which IR was assessed with the HOMA-IR and the hyperglycemic clamp. Results: In the multivariable linear regression analysis, adjusted for sex, age, and waist circumference, the HOMA-IR was independently and negatively associated with the clamp-derived insulin sensitivity index in both pubertal (unstandardized coefficient - B = -0.087, 95% confidence interval [CI] = -0.135 to -0.040) and postpubertal (B = -0.101, 95% CI, -0.145 to -0.058) adolescents. Bland-Altman plots showed agreement between the predicted insulin sensitivity index and measured clamp-derived insulin sensitivity index in both pubertal stages (mean =-0.00 for pubertal and postpubertal); all P > 0.05. The HOMA-IR showed a good discriminatory power for detecting IR with an area under the receiver operator characteristic curve of 0.870 (95% CI, 0.718-0.957) in pubertal and 0.861 (95% CI, 0.721-0.947) in postpubertal adolescents; all P < 0.001. The optimal cutoff values of the HOMA-IR for detecting IR were > 3.22 (sensitivity, 85.7; 95% CI, 57.2-98.2; specificity, 82.6; 95% CI, 61.2-95.0) for pubertal and > 2.91 (sensitivity, 63.6; 95% CI, 30.8-89.1, specificity, 93.7; 95%CI, 79.2-99.2) for postpubertal adolescents. Conclusion: The threshold value of the HOMA-IR for identifying insulin resistance was > 3.22 for pubertal and > 2.91 for postpubertal adolescents.

Parental body mass index and maternal gestational weight gain associations with offspring body composition in young women from the Nutritionists' Health Study.

Objective: Intrauterine environment can induce fetal metabolic programming that predisposes to adiposity-related chronic diseases in its lifespan. We examined the associations of parental nutritional status and gestational weight gain with offspring body composition in early adulthood. Methods: This is cross-sectional analysis of female participants of the NutriHS who were submitted to questionnaires, clinical examinations and body composition assessed by DXA. Association of preconception parental BMI and maternal gestational weight gain (exposures) with body composition measurements (outcomes) were analyzed using multiple linear models adjusted for Directed Acyclic Graphs-based covariables (maternal and paternal educational level, maternal age, and tobacco, alcohol and/or drugs use). The sample included 124 women (median 28 (24-31) years) with a mean BMI of 25.4 ± 4.7 kg/m2. Results: No association between previous paternal BMI and offspring's body composition was detected. In the fully adjusted linear regression model, maternal BMI was associated with offspring's total lean mass (ß = 0.66, p = 0.001), appendicular skeletal muscle mass index (ASMI) (ß = 0.11, p = 0.003) and fat mass index (FMI) (ß = 0.03, p = 0.039). Gestational weight gain was associated with increased offspring's BMI (OR 1.12 [95% CI 1.02-1.20], p = 0.01). The linear regression model adjusted for maternal age and maternal and paternal education levels showed associations of gestational weight gain with offspring's ASMI (ß = 0.42, p = 0.046), FMI (ß = 0.22, p = 0.005) and android-to-gynoid fat ratio (ß = 0.09, p = 0.035). Conclusion: Our findings suggest that preconception maternal BMI could influence lean mass and general adiposity of young adult female offspring and that gestational weight gain could be useful for predicting centrally distributed adiposity.

Associations of Blautia Genus With Early-Life Events and Later Phenotype in the NutriHS.

Introduction: Early-life events are associated with the risk of obesity and comorbidities later in life. The gut microbiota-whose composition is influenced by genetics and environmental factors-could be involved. Since the microbiota affects metabolism and fat storage, early-life insults could contribute to the occurrence of obesity driven, in part, by microbiota composition. We examined associations of gut bacteria with early-life events, nutritional status, and body composition in the Nutritionist's Health Study (NutriHS). Methods: A cross-sectional study of 114 female participants examining early-life data, body composition, and biological samples was conducted. Fecal microbiota structure was determined targeting the V4 region of the 16S rRNA gene. Principal coordinates analysis (PCoA) and permutational multivariate analysis of variance (PERMANOVA) were used to test the impact of variables on microbial diversity. Profiles were identified using the Jensen-Shannon divergence matrix and Calinski-Harabasz index. Differential abundance between the categories of exclusive breastfeeding duration and nutritional status was tested using DESeq2. Results: In the sample [median age 28 years and body mass index (BMI) 24.5 kg/m2], 2 microbiota profiles driven by the Blautia or Prevotella genus were identified. An estimated 9.1% of the variation was explained by the profiles (p < 0.001), 2.1% by nutritional status (p = 0.004), and 1.8% by exclusive breastfeeding (p = 0.012). The proportion of participants with BMI <25 kg/m2 and who were breastfed for at least 6 months was higher in the Blautia profile (p < 0.05). Conclusion: Findings in a Blautia-driven profile of healthy women reinforce that early-life events play a role in defining gut microbiota composition, confirming the importance of exclusive breastfeeding for infant gut colonization in establishing a protective profile against adiposity-related outcomes in adulthood.

Leptomeningeal carcinomatosis in gastric cancer: a case report of a rare yet aggressive entity.

Leptomeningeal carcinomatosis (LMC) is exceedingly rare in gastric cancer. It is most commonly seen in breast, lung cancer and melanoma, and is associated with an extremely poor prognosis. If untreated, median overall survival is four to six weeks. No standard treatment for LMC exists and published data are scarce. We present two cases of gastric carcinoma diagnosed with LMC that exemplify how aggressive this condition is and how short the time lapse is to perform any targeted therapy. This report aims to raise awareness of this rare metastatic possibility in gastric cancer and its diagnostic and therapeutic challenges.

COVID-19 and aging: Identifying measures of severity.

INTRODUCTION: We aimed to compare clinical features of older age group and young and middle-aged patients with COVID-19 and analyze mortality predictors. METHODS: Retrospective analysis of ongoing collection of prespecified data, on a single institution, including patients hospitalized consecutively due to COVID-19 infection, from March to June 2020. RESULTS: Of 195 patients, 56.9% were ⩾65 years (older age group). Older age group had multimorbidity (p < 0.001). At admission Early Warning Score-2 (p < 0.001), C-reactive protein, D-dimer, creatinine, anemia and lymphopenia were higher in older age group, as well as median time of hospitalization (14 vs 10 days, p = 0.004). Complications were more common in older age group, but there were no significant differences in admission to intensive care. There were 18 deaths, 16 in older age group. Modified Early Warning Score at admission (odds ratio = 1.60, 95% confidence interval = 1.07-1.37, p = 0.021) and C-reactive protein >5 mg/dL (odds ratio = 2.12, 95% confidence interval = 1.13-26.26, p = 0.034) were independent predictors of inhospital mortality in older age group but not in young and middle-aged. CONCLUSION: Older age group was at higher risk for complications and inhospital mortality. Identification of specific scores of severity for this population is essential to ensure that best care is provided.

Insulin Resistance in Congenital Adrenal Hyperplasia is Compensated for by Reduced Insulin Clearance.

CONTEXT: Congenital adrenal hyperplasia (CAH) patients have potential normal longevity. However, a greater risk for cardiovascular disease has been reported. Insulin resistance and hyperinsulinemia have been described in CAH patients, whereas the prevalence of overt type 2 diabetes is not higher in CAH than in normal population. OBJECTIVE: To examine the contributions of insulin secretion and of hepatic insulin clearance to compensatory hyperinsulinemia in young insulin-resistant adults with classic CAH due to 21-hydroxylase deficiency (21-OHD). DESIGN: Cross-sectional. SETTING: University outpatient clinics. METHODS: Fifty-one participants: 21 controls, and 30 CAH (15 virilizing and 15 salt-wasting phenotypes), female/male (33/18), age (mean [SD]): 24.0 (3.6) years, body mass index: 24.6 (4.9)kg/m2 with normal glucose tolerance, were submitted to a hyperglycemic clamp study. MAIN OUTCOME MEASURES: Insulin sensitivity, beta cell function, and hepatic insulin clearance using appropriate modeling. RESULTS: We found an increased insulin resistance in 21-OHD. The systemic hyperinsulinemia (posthepatic insulin delivery) was elevated in CAH patients. No increases were observed in insulin secretory rate (beta cell function) in the first phase or during the hyperglycemic clamp. The increase in insulin concentrations was totally due to a ~33% reduction in insulin clearance. CONCLUSION: 21-OHD nonobese subjects have reduced insulin sensitivity and beta cell response unable to compensate for the insulin resistance, probably due to overexposure to glucocorticoids. Compensatory hyperinsulinemia is most related with reduced hepatic insulin clearance. The exclusive adaptation of the liver acts as a gating mechanism to regulate the access of insulin to insulin-sensitive tissues to maintain glucose homeostasis.

Maternal and paternal obesity are associated with offspring obestatin levels in the Nutritionists' Health Study.

OBJECTIVES: The aim of this study was to examine whether paternal and maternal body mass indexes (BMIs) were independently associated with obestatin and visfatin levels in adult offspring. METHODS: This cross-sectional analysis included 124 women who participated in the Nutritionists' Health Study (NutriHS) at baseline. Early life events, anthropometry, dual-energy x-ray absorptiometry-determined body composition and blood sample were obtained. Associations of parental BMI with outcomes (obestatin and visfatin) were tested by multiple linear regression, using minimal sufficient adjustments recommended by Directed Acyclic Graph. Participants' mean BMI was 25 ± 5 kg/m2 and 74% were metabolically healthy. Median obestatin and visfatin levels were 56.4 pg/mL (42-72) and 17.7 ng/mL (14-21.8), respectively. Eleven percent of mothers and 39% of fathers were overweight/obese. RESULTS: Daughters born from overweight/obese mothers had higher BMI than those born from normal weight women (P = 0.003). In adjusted regression model, offspring obestatin levels were associated with maternal BMI (ß = -0.03; P = 0.045) and paternal BMI (ß = -0.02; P = 0.048) independently of maternal and paternal education, maternal age, and maternal use of tobacco, alcohol, and/or drugs. No association was detected with visfatin levels. CONCLUSION: Inverse associations of maternal and paternal BMIs with offspring obestatin concentrations in women could suggest a utility of this biomarker of energy regulation determined in early adulthood. Whether obestatin could be an indicator of protection against obesity-related disorders in the life course requires investigation in studies designed to test such hypothesis.

FODMAP project: Development, validation and reproducibility of a short food frequency questionnaire to estimate consumption of fermentable carbohydrates.

BACKGROUND & AIMS: Irritable bowel syndrome (IBS) is a functional disorder that is characterized by gastrointestinal symptoms and that has a major impact on quality of life, resulting in direct and indirect health care costs. The majority of patients with IBS suffer from food intolerances, most commonly related to the consumption of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). This study aimed to develop and verify the validity and reproducibility of a short food frequency questionnaire (FFQ) to assess typical FODMAP consumption in adults with IBS. METHODS: The primary FFQ list consisted of source foods of FODMAPs that contributed at least 10% to the frequency of consumption among 855 adults from a population-based study in the municipality of Campinas in 2014/2015. In addition, source foods of FODMAPs (according to the Monash University Low FODMAP Diet application) and foods commonly consumed by the Brazilian population (according to the FFQ for adults validated in the city of São Paulo) were included. One hundred and five (n = 105) healthy subjects were recruited to respond to the FFQ twice and to respond the 24-h dietary recall (24HR) three times during a 3-month period. The relative validity of the proposed instrument was compared with the average of the three 24HRs, and the reproducibility of the instrument was assessed by comparing both FFQ applications. The following statistical analyses were used for validation and reproducibility: Wilcoxon's test, Spearman's correlation analysis, weighted kappa, Bland Altman's plot and index, and interclass correlation coefficient. RESULTS: The final list of items for the short FFQ included 54 different foods. The foods were organized by FODMAP groups: free fructose, lactose, total oligosaccharides and total polyols, with variations of categories of responses for consumption frequency between 0 and 10 times and the unit of time in days, weeks or months. In the validity analyses, the correlation coefficients ranged from 0.209 (polyols) to 0.652 (lactose) (p < 0.05). There was no correlation between the methods in the fructose and oligosaccharide groups. The lactose group presented good agreement, and the remaining groups had a lack of agreement, with a mean of 15.7%. The Bland-Altman index values were 4.7% (fructose), 3.8% (lactose), 5.7% (oligosaccharides) and 6.6% (polyols). Regarding reproducibility, the interclass and Spearman's correlation coefficients varied from ICC = 0.781 and r = 0.725 (oligosaccharides) to ICC = 0.913 and r = 0.807 (lactose) (p < 0.05), showing strongly reproducible results for lactose and polyols and good results for fructose and oligosaccharides. Accurate agreement between FFQ applications had a mean of 67.3%, and 3.0% showed disagreement between FFQ1 and FFQ2. The weighted kappa coefficient ranged from 0.576 (polyols) to 0.645 (lactose). CONCLUSION: The semi-quantitative short FFQ was developed to evaluate the consumption of FODMAPs in adults in São Paulo. The instrument presents good reproducibility for all groups of FODMAPs, good validity for lactose and weaker validity for fructose, polyols and oligosaccharides. As the short FFQ was carefully designed for the study population, its estimates are relatively reliable at the population group level. A future reanalysis of this questionnaire would be useful when the chemical composition data of FODMAPs are available.

NUTRITIONAL STATUS, QUALITY OF LIFE AND LIFE HABITS OF WOMEN WITH IRRITABLE BOWEL SYNDROME: A CASE-CONTROL STUDY.

BACKGROUND: Irritable bowel syndrome is a functional and chronic gastrointestinal disorder that may cause abdominal pain and altered bowel habits, affecting the nutritional status and quality of life of its carriers. Its prevalence is high, affecting about 10% to 15% of the general population in developed countries, being more prevalent in women than in men in the proportion 2:1. OBJECTIVE: The aim of our study was to compare the profile of body adiposity, life habits, and the quality of life of women with irritable bowel syndrome with a healthy control group. METHODS: Case-control study on 70 women, 34 with irritable bowel syndrome and 36 healthy. We applied the "Irritable Bowel Syndrome Quality of Life Questionnaire"to assess quality of life. Body adiposity was assessed from body mass index, waist circumference, and waist-to-hip ratio. We investigated the self-reporting of gastrointestinal symptoms with food deemed as problematic for carriers of irritable bowel syndrome and the presence of typical comorbidities. Assessment of life habits included: practice of physical activities, alcoholism, smoking, daytime sleepiness, and exclusion of foods from the feeding routine. For statistical analysis we used the IBM SPSS program, with a significance level at 5%. RESULTS: There was higher volume of central and general adiposity in the case group compared with the control group (P<0.05). Cases presented a higher chance of developing IBS-related comorbidities (P<0.05). About of 80% of patients with irritable bowel syndrome have excluded some food from the diet (P<0.01) and the total amount of troublesome foods varied from 7 to 21 (P<0.01). The case group featured worse quality of life compared with the control (P<0.05). CONCLUSION: Compared to the control group, women with irritable bowel syndrome showed greater body adiposity, higher frequency of comorbidities, greater restriction on the consumption of problematic foods and worse quality of life.

Estado nutricional, qualidade de vida e hábitos de vida em mulheres com síndrome do intestino irritável: um estudo caso-controle / Nutritional status, quality of life and life habits of women with irritable bowel syndrome: a case-control study

ABSTRACT BACKGROUND: Irritable bowel syndrome is a functional and chronic gastrointestinal disorder that may cause abdominal pain and altered bowel habits, affecting the nutritional status and quality of life of its carriers. Its prevalence is high, affecting about 10% to 15% of the general population in developed countries, being more prevalent in women than in men in the proportion 2:1. OBJECTIVE: The aim of our study was to compare the profile of body adiposity, life habits, and the quality of life of women with irritable bowel syndrome with a healthy control group. METHODS: Case-control study on 70 women, 34 with irritable bowel syndrome and 36 healthy. We applied the "Irritable Bowel Syndrome Quality of Life Questionnaire"to assess quality of life. Body adiposity was assessed from body mass index, waist circumference, and waist-to-hip ratio. We investigated the self-reporting of gastrointestinal symptoms with food deemed as problematic for carriers of irritable bowel syndrome and the presence of typical comorbidities. Assessment of life habits included: practice of physical activities, alcoholism, smoking, daytime sleepiness, and exclusion of foods from the feeding routine. For statistical analysis we used the IBM SPSS program, with a significance level at 5%. RESULTS: There was higher volume of central and general adiposity in the case group compared with the control group (P<0.05). Cases presented a higher chance of developing IBS-related comorbidities (P<0.05). About of 80% of patients with irritable bowel syndrome have excluded some food from the diet (P<0.01) and the total amount of troublesome foods varied from 7 to 21 (P<0.01). The case group featured worse quality of life compared with the control (P<0.05). CONCLUSION: Compared to the control group, women with irritable bowel syndrome showed greater body adiposity, higher frequency of comorbidities, greater restriction on the consumption of problematic foods and worse quality of life.

RESUMO CONTEXTO: A síndrome do intestino irritável é uma desordem gastrointestinal crônica e funcional que pode causar dor abdominal e alteração do hábito intestinal, afetando o estado nutricional e a qualidade de vida. Sua prevalência é alta, acomete cerca de 10% a 15% da população geral em países desenvolvidos, sendo mais prevalente em mulheres do que em homens na proporção 2:1. OBJETIVO: O objetivo deste estudo foi comparar o perfil de adiposidade corporal, os hábitos de vida e a qualidade de vida de indivíduos portadores da síndrome do intestino irritável com um grupo controle saudável. MÉTODOS: Estudo caso-controle com 70 mulheres, 34 com a síndrome do intestino irritável e 36 saudáveis. Foi aplicado o Irritable Bowel Syndrome Quality of Life Questionnaire para avaliação da qualidade de vida. A adiposidade corporal foi avaliada a partir do índice de massa corporal, circunferência da cintura e relação cintura-quadril. Foi investigado o auto-relato de sintomas gastrointestinais de alimentos considerados problemáticos para portadores da síndrome do intestino irritável e a presença de comorbidades típicas. A análise do estilo de vida incluiu a prática de atividade física, alcoolismo, tabagismo, sonolência diurna e exclusão de alimentos. Para análise estatística foi utilizado o programa IBM SPSS, com o nível de significância de 5%. RESULTADOS: Houve maior acúmulo de adiposidade central e periférica no grupo caso em comparação ao grupo controle (P<0,05). Os casos apresentaram maior chance de desenvolver comorbidades associadas à síndrome do intestino irritável (P<0,05). Cerca de 80% dos pacientes com a síndrome do intestino irritável excluíram algum alimento da dieta (P<0,01) e o total de alimentos problemáticos pode variar de 7 a 21 alimentos (P<0,01). Grupo caso apresentou pior qualidade de vida para o escore geral e para todos os domínios avaliados (P<0,05). CONCLUSÃO: Em comparação aos controles, as mulheres portadoras da síndrome do intestino irritável apresentaram maior adiposidade corporal, maior frequência de comorbidades, maior restrição ao consumo de alimentos considerados problemáticos e pior qualidade de vida.