Reduction in Pain and Pain Intensity with Nonpharmacological Treatment in Severely Obese Patients: A Randomized Clinical Trial.

The objective of this study was to analyze the effectiveness of two nonpharmacological interventions-traditional Brazilian diet (DieTBra), and extra-virgin olive oil (EVOO)-in terms of the reduction in pain and pain intensity in individuals with severe obesity. We conducted a 12-week parallel randomized clinical trial with 149 individuals (body mass index (BMI) ≥ 35 kg/m2) who were randomized into three groups: supplementation with EVOO (n = 50), DieTBra (n = 49), and EVOO + DieTBra (n = 50). Of the total, 133 individuals with a mean BMI of 46.04 kg/m2 completed the study. By the end of the follow-up, there was a reduction in severe pain in the EVOO + DieTBra group (p = 0.003). There was a significant reduction in severe pain in the EVOO + DieTBra group (-22.7%); pain in the wrist and hand (-14.1%), upper back (-26.9%), and knees (-18.4%) in the DieTBra group; and reduction in hip pain (-11.1%) with EVOO consumption. We conclude that EVOO and DieTBra, either alone or in combination, are effective interventions to reduce pain intensity and pain in different regions in individuals with severe obesity, and have great potential for clinical application.

Serum and Dietary Vitamin D in Individuals with Class II and III Obesity: Prevalence and Association with Metabolic Syndrome.

The association between vitamin D deficiency and metabolic syndrome (MS) in severe obesity is unclear and controversial. We analyzed serum and dietary vitamin D and their association with MS in 150 adults with class II and III obesity (BMI ≥ 35 kg/m2) from the DieTBra Trial (NCT02463435). MS parameters were high fasting blood glucose, low HDL cholesterol, high triglycerides, elevated waist circumference, and hypertension. Vitamin D deficiency was considered as a level < 20 ng/mL. We performed multivariate Poisson regression adjusted for sociodemographic and lifestyle variables. The prevalence of serum vitamin D deficiency was 13.3% (mean 29.9 ± 9.4 ng/mL) and dietary vitamin D median was 51.3 IU/day. There were no significant associations between vitamin D, serum, and diet and sociodemographic variables, lifestyle, and class of obesity. Serum vitamin D deficiency was associated with age ≥ 50 years (p = 0.034). After a fully adjusted multivariate Poisson regression, MS and its parameters were not associated with serum or dietary vitamin D, except for lower HDL, which was associated with serum vitamin D deficiency (PR = 0.71, 95% CI 0.52-0.97; p = 0.029). Severe obese individuals had a low prevalence of vitamin D deficiency, which was not associated with MS.

Effect of Extra Virgin Olive Oil and Traditional Brazilian Diet on the Bone Health Parameters of Severely Obese Adults: A Randomized Controlled Trial.

Dietary interventions can stabilize and/or reverse bone mass loss. However, there are no reports on its effects on bone mineral density (BMD) in severely obese people, despite the vulnerability of this group to bone loss. We examine the effect of extra virgin olive oil supplementation and the traditional Brazilian diet (DieTBra) on BMD and levels of calcium, vitamin D, and parathyroid hormone (PTH) in severely obese adults. A randomized controlled trial followed-up with severely obese adults (n = 111, with mean body mass index 43.6 kg/m2 ± 4.5 kg/m2) for 12 weeks. Study participants received either olive oil (52 mL/day), DieTBra, or olive oil + DieTBra (52 mL/day + DieTBra). BMD was assessed by total spine and hip dual-energy X-ray absorptiometry. After interventions, BMD means for total spine (p = 0.016) and total hip (p = 0.029) were higher in the DieTBra group than in the olive oil + DieTBra group. Final mean calcium levels were higher in the olive oil group compared to the olive oil + DieTBra group (p = 0.026). Findings suggest that DieTBra and extra virgin olive oil have positive effects on bone health in severely obese adults. The major study was registered at ClinicalTrials.gov (NCT02463435).

Efeitos dos flavonoides do cacau na prevenção e no tratamento de doenças cardiovasculares: uma revisão de literatura / Flavonoids and cardiovascular diseases effects of cocoa flavonoids on prevention and treatment of cardiovascular diseases: A literature review

O objetivo deste estudo foi revisar na literatura científi ca os efeitos dos fl avonoides do cacau na prevenção e no tratamento de doenças cardiovasculares. Foi realizada uma busca sistematizada nas bases de dados PubMed, SciELO e Trip Data Base, incluindo ensaios clínicos que tiveram intervenção com fl avonoides do cacau, em adultos e idosos, realizados entre os anos de 2008 e 2018. Os descritores em saúde utilizados para a pesquisa foram: "fl avonoids", "cocoa", "dark chocolate" e/ou "cardiovascular diseases". Após análise de doze ensaios clínicos, foi observado melhora nos parâmetros antropométricos e de perfi l glicêmico; redução de colesterol total, lipoproteínas de baixa densidade, triglicerídeos, pressão arterial e de pulso; bem como aumento das lipoproteínas de alta densidade. Além disso, houve diminuição de marcadores infl amatórios, de adesão celular, de estresse oxidativo, do índice de amplifi cação, da velocidade da onda de pulso e da endotelina-1; assim como aumento da dilatação fluxo-mediada, do diâmetro da artéria braquial e do fluxo sanguíneo. Os dados encontrados suportam as alegações de que há efeito benéfico do consumo de flavonoides do cacau sobre a prevenção e o tratamento de doenças cardiovasculares

The aim of this study was to review in the scientific literature the effects of cocoa flavonoids on the prevention and treatment of cardiovascular diseases. A systematic search was carried out in the PubMed, Trip Data Base and SciELO database, including clinical trials covering interventions with cocoa flavonoids, in adults and in the elderly, between the years 2008 and 2018. The health descriptors used for the survey were: "flavonoids", "cocoa", "dark chocolate" and/or "cardiovascular diseases". After reviewing 12 clinical trials, we observed improvement in the anthropometric and glycemic profile parameters; reduction in total cholesterol, low density lipoprotein, triglycerides, blood and pulse pressure; as well as increase in high density lipoprotein. Furthermore, there was a decrease in inflammatory, cell adhesion and oxidative stress markers, augmentation index, pulse wave velocity and endothelin-1; there was also an increase of flow-mediated dilation, brachial artery diameter and blood flow. The data found support the claim that there is a beneficial effect in the consumption of cocoa flavonoids on the prevention and treatment of cardiovascular diseases.

Efeito da suplementação de ômega 3 isolado ou associado em pacientes com doença de Alzheimer: uma revisão sistemática da literatura científica / Effect of omega 3 supplementation alone or associated in patients with Alzheimer's disease: a systematic literature review

Introdução: O envelhecimento da população está associado ao aumento da incidência da doença de Alzheimer (DA), a qual causa graves complicações ao paciente. Os nutrientes imunomoduladores, como os ácidos graxos poli-insaturados (PUFAs) da série ômega 3 (w-3) podem auxiliar na melhora do quadro clínico da DA. Objetivo: Analisar o efeito da suplementação de PUFAs w-3 isolado ou associado na população idosa com DA. Material e Métodos: Trata-se de uma revisão sistemática de literatura científica nas bases de dados Pubmed e Science Direct, que englobou ensaios clínicos em idosos com provável e/ou comprovado diagnóstico de DA e suplementados com PUFAS w-3 isolado ou associado, no idioma inglês e com os seguintes descritores em saúde (DECs): brain, Alzheimer's disease, fatty docosahexaenoic acid(DHA), polyunsaturated fatty acids (PUFA), older and elderly people e termo de pesquisa: eicosapentaenoic acid (EPA). O recorte temporal das publicações foi delimitado de 2006 a 2017. Resultados: foram selecionados 10 ensaios clínicos, cuja suplementação de w-3 favoreceu menor declínio no score de miniexame de estado mental (MEEM), retardo da disfunção, melhora no domínio de agitação do inventário neuropsiquiátrico (NPI) e melhora dos sintomas depressivos pela Escala de Depressão de Montgomery-Asberg (MADRS). Foram observadas mudanças significativas como aumento de apetite, peso, índice de massa corporal (IMC), EPA e DHA, além de reduções nos níveis séricos de albumina, ácido araquidônico (AA), ácido mirístico, interleucina-6 (IL- 6), interleucina 1 ß (IL-1ß) e fator estimulante de colônias de granulócitos (G-CSF) e redução na liberação de prostaglandina F2α (PGF2α). Foram relatadas alterações positivas em alguns genes e em outros, redução de sua expressão, além de hipometilação de importantes genes. Conclusão: A suplementação de PUFAs w-3 exerceu efeito positivo em pacientes com DA grau leve a moderado.

Introduction: Aging of the population is associated with an increased incidence of Alzheimer's disease (AD), which causes severe complications to the patient. Immunomodulatory nutrients such as polyunsaturated fatty acids (PUFAs) of the omega-3 (w-3) series may help improve the clinical picture of AD. Objective: To analyze the effect of supplementation of isolated or associated w-3 PUFAs in patients with AD. Material and Methods: This is a systematic review of the scientific literature in the Pubmed and Science Direct databases, which included clinical trials in elderly people with probable and / or proven diagnosis of AD supplemented with isolated or associated PUFAS w-3, in English and with the following health descriptors (DECs): brain, Alzheimer's disease, fatty docosahexaenoic acid (DHA), polyunsaturated fatty acids (PUFA), older and elderly people and search term: eicosapentaenoic acid (EPA).The time cut of publications was delimited from 2006 to 2017. Results: a total of 10 clinical trials were selected, whose w-3 supplementation favored a smaller decline in the Mini Mental Status Examination (MMSE) score, delayed dysfunction, improved neuropsychiatric inventory (NPI) agitation, and improved depressive symptoms by the Montgomery-Asberg Depression Scale (MADRS). Significant changes were observed as increased appetite, weight, body mass index (BMI), EPA and DHA, as well as reductions in serum albumin levels, arachidonic acid (AA), myristic acid, interleukin-6 (IL-6), interleukin 1ß (IL-1ß), and granulocyte colony stimulating factor (G-CSF) and reduced clearance of prostaglandin F2α (PGF2α). Positive alterations have been reported in some genes and in others, reduction of their expression, besides hypomethylation of important genes. Conclusion: Supplementation of PUFAs w-3 had a positive effect in patients with mild to moderate AD.

Efeito da arginina isolada ou associada na cicatrização de lesões por pressão (LPP): revisando as evidências científicas / Effect of arginine alone or associated with healing of pressure ulcer (PU): Reviewing the scientific evidence

Introdução: A lesão por pressão (LPP) é um dano localizado na pele e/ou no tecido mole subjacente que ocorre normalmente em pacientes acamados, com declínio do estado nutricional e da imunidade. Portanto, tem-se, o processo de cicatrização prejudicado e o uso de alguns imunomoduladores pode melhorar esse quadro, como a arginina. Objetivo: Identificar na literatura científica o efeito e o mecanismo de ação da arginina isolada ou associada na cicatrização de LPP. Material e Métodos: Revisão sistemática da literatura científica, com pesquisas nas bases de dados PubMed, Trip Data Base, Scielo, Science Direct e Scopus entre agosto de 2018 e abril de 2019, com recorte temporal de 2008 a 2018. Foram adotados os descritores e termos de pesquisa arginina, úlcera por pressão, cicatrização e tratamento. Resultados: A busca resultou em 11 artigos que atenderam aos critérios do presente estudo. Esses evidenciaram que a suplementação de arginina, isolada ou associada a nutrientes antioxidantes, possui resultados significativos no tratamento de LPP que levam a considerável diminuição do tempo de internação e dos custos hospitalares. Conclusão: O uso de arginina isolada ou associada a nutrientes antioxidantes têm efeitos promissores na cicatrização de LPP.

Introduction: Pressure ulcer (PU) is localized damage to the skin and/or underlying soft tissue that normally occurs in hospitalized patients with declining nutritional status and immunity. Therefore, one has, the process of impaired healing and use some immunomodulators may better this picture, such as arginine. Objective: To identify in the scientific literature the effect and mechanism of action of arginine alone or associated in the healing of PU. Material and Methods: Systematic review of the scientific literature, with searches in the databases PubMed, Trip Data Base, Scielo, Science Direct and Scopus between August 2018 and April 2019, with a temporal cut from 2008 to 2018. The following descriptors and terms were adopted arginine, pressure ulcer, healing and treatment. Results: The search resulted in 11 articles that met the criteria of the present study. These evidenced that arginine supplementation, alone or associated with antioxidant nutrients, has significant results in the treatment of LPP that lead to a considerable reduction in length of stay and hospital costs. Conclusion: The use of arginine alone or associated with antioxidant nutrients has promising effects on the healing of PU.

Ganho de peso na vida adulta: preditor da hipertensão arterial? / Weight gain in adulthood: hypertension predictor?

Resumo Objetivos Avaliar o ganho de peso na idade adulta, bem como a influência sobre a prevalência da hipertensão. Métodos Estudo transversal, por meio de entrevista telefônica com indivíduos de 30-59 anos, recorte do Sistema Municipal de Monitoramento de Fatores de Risco para Doenças Crônicas Não Transmissíveis por Meio de Entrevistas Telefônicas (SIMTEL). Analisaram-se dados sociodemográficos, antropométricos e estilo de vida. O efeito independente do ganho de peso e do índice de massa corporal atual e aos 20 anos de idade na prevalência da hipertensão arterial foi analisado por meio de Regressão de Poisson. Resultados Mediana de 42 anos de idade (IC95%; 41,0-43,0). A média do ganho de peso relativo foi de 18,1 ± 11,1%. Na amostra, 7,0% tiveram ganho de peso nulo, 19,2% baixo, 34,2% médio e 39,4% alto. Na análise multivariada, o ganho de peso não se associou à hipertensão arterial, já o IMC atual teve associação significativa, sendo a prevalência 2,4 vezes maior nos obesos do que nos eutróficos, enquanto que nos obesos aos 20 anos de idade a prevalência de hipertensão foi 1,9 vezes maior. Conclusões Houve elevado ganho de peso na idade adulta, mas esse ganho não foi determinante para a hipertensão quando ajustado pelo IMC atual.

Abstract Objectives Assess weight gain in adulthood, as well as influence on the prevalence of hypertension. Methods Cross-sectional study through a telephone interview with individuals ranging from 30-59 years old, section of the Municipal Monitoring System of Risk Factors for Non-Transmitted Chronical Diseases via Telephone Interview (Sistema Municipal de Monitoramento de Fatores de Risco para Doenças Crônicas Não Transmissíveis por Meio de Entrevistas Telefônicas (SIMTEL)). We analyzed demographic data, anthropometric and lifestyle. The independent effect of weight gain and current body mass index and 20 years of age in the prevalence of hypertension was analyzed using Poisson regression. Results The median age was 42 years old (CI95%, 41.0-43.0). The average relative weight gain was 18.1 ± 11.1%. In the sample, 7.0% presented zero weight gain, 19.2% low, 34.2% average, and 39.4% high weight gain. In multivariate analysis, the weight gain was not associated to high blood pressure, since the current BMI was significantly associated, with a prevalence 2.4 times higher in obese than in normal weight, while in obese at 20 years of age, the prevalence hypertension was 1.9 times higher. Conclusions There was a high weight gain in adulthood, but this gain was not decisive for hypertension when adjusted by the current BMI.

[Low consumption of fruit, vegetables and greens: associated factors among the elderly in a Midwest Brazilian city]. / Baixo consumo de frutas, verduras e legumes: fatores associados em idosos em capital no Centro-Oeste do Brasil.

The scope of the study was to evaluate the prevalence of daily consumption of fruit, vegetables and greens by the elderly and its association with sociodemographic, lifestyle, morbidity and hospitalization variables. The study was part of the multiple-stage sampling cross-sectional research entitled the Goiânia Elderly Project (Projeto Idosos Goiânia). 416 elderly people were interviewed in their homes. Multivariate analysis was conducted using Poisson regression to analyze statistical associations. P values of <.05 were considered statistically significant. Daily consumption of fruit, vegetables and greens was 16.6%: fruit accounted for 44%, vegetables 39.7% and greens 32.5%. Factors statistically associated with daily consumption of fruits and vegetables were female sex, age between 70 and 79, higher education level, social class A/B and C, alcohol consumption, use of sweeteners, regular physical activity during leisure time, abdominal obesity and hospitalization. Public policies to promote health should develop strategies that encourage adequate intake of fruit, vegetables and greens among the elderly, since regular consumption of same can improve quality of life and prevent/control diseases.

Baixo consumo de frutas, verduras e legumes: fatores associados em idosos em capital no Centro-Oeste do Brasil / Low consumption of fruit, vegetables and greens: associated factors among the elderly in a Midwest Brazilian city

Resumo O objetivo foi avaliar a prevalência do consumo diário de frutas, verduras e legumes (FVL) em idosos e sua associação com fatores sociodemográficos, estilo de vida, presença de morbidades e hospitalização. Esta pesquisa faz parte do Projeto Idosos Goiânia, estudo transversal com amostragem em múltiplos estágios. Foram entrevistados 416 idosos em seus domicílios. Realizou-se análise multivariada por Regressão de Poisson para investigar os fatores associados ao consumo de FVL ao nível de significância de 5%. A prevalência de consumo diário de FVL foi de 16,6%, sendo de frutas 44%, verduras 39,7% e legumes 32,5%. O consumo diário de FVL foi associado a: sexo feminino, idade entre 70 e 79 anos, maior escolaridade, classe social A/B e C, consumo de bebida alcoólica, uso de adoçantes, prática regular de atividade física no lazer, obesidade abdominal e hospitalização. É importante desenvolver estratégias de promoção da alimentação saudável com ênfase na ingestão adequada de FVL na população idosa, tendo em vista seu potencial na prevenção e controle de doenças.

Abstract The scope of the study was to evaluate the prevalence of daily consumption of fruit, vegetables and greens by the elderly and its association with sociodemographic, lifestyle, morbidity and hospitalization variables. The study was part of the multiple-stage sampling cross-sectional research entitled the Goiânia Elderly Project (Projeto Idosos Goiânia). 416 elderly people were interviewed in their homes. Multivariate analysis was conducted using Poisson regression to analyze statistical associations. P values of <.05 were considered statistically significant. Daily consumption of fruit, vegetables and greens was 16.6%: fruit accounted for 44%, vegetables 39.7% and greens 32.5%. Factors statistically associated with daily consumption of fruits and vegetables were female sex, age between 70 and 79, higher education level, social class A/B and C, alcohol consumption, use of sweeteners, regular physical activity during leisure time, abdominal obesity and hospitalization. Public policies to promote health should develop strategies that encourage adequate intake of fruit, vegetables and greens among the elderly, since regular consumption of same can improve quality of life and prevent/control diseases.