Changes in body composition of burn patients during the phases of response to trauma.

OBJECTIVE: To assess the changes in body composition of burn patients through electrical bioimpedance in the phases of response to trauma. METHODS: a longitudinal observational study, carried out from October 2019 to March 2020. Sociodemographic, clinical, epidemiological, anthropometric and body composition data were collected. Statistical analysis was performed with SPSS, considering a significance of 5%. The comparison between variables was performed using the paired Student's t test. RESULTS: the sample consisted of 58 adult burn patients, with a mean age of 38.2±12.5 years. The mean body surface area (BSA) with burns was 10.8±7.3%. Nutritional assessment demonstrated a depletion of body weight, Body Mass Index, fat-free mass and muscle mass in the phases of response to trauma (p<0.005). CONCLUSION: metabolic alterations in the different phases of the metabolic response to trauma led to a depletion of the nutritional status of burn patients of both sexes during hospitalization.

Visceral adiposity indices and cardiometabolic risk markers in patients with hypertension

Abstract Objective: Arterial hypertension (AH) is a risk factor for cardiovascular diseases (CVD). We sought to evaluate the association between two adiposity indices (visceral adiposity index [VAI] and lipid accumulation product [LAP]) with traditional markers of cardiometabolic risk in hypertensive patients. Materials and methods: This is a cross-sectional study with 1,273 subjects with hypertension treated as outpatients at a university hospital. The VAI and LAP were calculated using formulas stratified by sex. Cardiometabolic risk variables were considered: overweight, risk for waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHA), and altered biochemical test values. The predictive effect of independent variables on outcomes was assessed by multivariate linear regression analysis. There was statistical significance when p ≤ 0.05. Results: Higher cardiometabolic risk (according to BMI, WHR, WHA, and altered biochemical parameters) was associated with higher values of VAI and LAP with statistical significance (p ≤ 0.05). The regression models used explained 30.7% and 10.5% of the changes in LAP and VAI, respectively. Conclusion: LAP and VAI are associated with cardiometabolic risk parameters in the individuals evaluated, suggesting that these indices can be used to screen for CVD risk in individuals with AH.

Changes in body composition of burn patients during the phases of response to trauma / Alterações na composição corporal de pacientes queimados durante as fases de resposta ao trauma / Cambios en la composición corporal de pacientes quemados durante las fases de respuesta al trauma

ABSTRACT Objective: To assess the changes in body composition of burn patients through electrical bioimpedance in the phases of response to trauma. Methods: a longitudinal observational study, carried out from October 2019 to March 2020. Sociodemographic, clinical, epidemiological, anthropometric and body composition data were collected. Statistical analysis was performed with SPSS, considering a significance of 5%. The comparison between variables was performed using the paired Student's t test. Results: the sample consisted of 58 adult burn patients, with a mean age of 38.2±12.5 years. The mean body surface area (BSA) with burns was 10.8±7.3%. Nutritional assessment demonstrated a depletion of body weight, Body Mass Index, fat-free mass and muscle mass in the phases of response to trauma (p<0.005). Conclusion: metabolic alterations in the different phases of the metabolic response to trauma led to a depletion of the nutritional status of burn patients of both sexes during hospitalization.

RESUMO Objetivo: avaliar as alterações na composição corporal de pacientes queimados por meio da bioimpedância elétrica nas fases de resposta ao trauma. Métodos: estudo observacional longitudinal, realizado de outubro de 2019 a março de 2020. Foram coletados dados sociodemográficos, clínicos, epidemiológicos, antropométricos e de composição corporal. A análise estatística foi realizada com o SPSS, considerando significância de 5%. Comparação entre as variáveis foi realizada por meio do teste t de Student pareado. Resultados: a amostra foi composta por 58 pacientes adultos queimados, com média de 38,2±12,5 anos. A média da área de superfície corporal (ASC) com queimaduras foi de 10,8±7,3%. A avaliação nutricional demonstrou depleção do peso corporal, índice de massa corporal, massa magra e massa muscular nas fases de resposta ao trauma (p<0,005). Conclusão: alterações metabólicas nas diferentes fases da resposta metabólica ao trauma levaram a depleção do estado nutricional de pacientes queimados de ambos os sexos durante a internação.

RESUMEN Objetivo: evaluar alteraciones en la composición corporal de pacientes quemados mediante bioimpedancia eléctrica en las fases de respuesta al trauma. Métodos: estudio observacional longitudinal, realizado de octubre de 2019 a marzo de 2020. Se recogieron datos sociodemográficos, clínicos, epidemiológicos, antropométricos y de composición corporal. El análisis estadístico se realizó mediante SPSS, considerando una significancia del 5%. La comparación entre variables se realizó mediante la prueba de la t de Student pareada. Resultados: la muestra estuvo compuesta por 58 pacientes adultos quemados, con una edad media de 38,2±12,5 años. El área de superficie corporal media (ASC) con quemaduras fue de 10,8±7,3%. La evaluación nutricional mostró disminución del peso corporal, índice de masa corporal, masa magra y masa muscular en las fases de respuesta al trauma (p<0,005). Conclusión: los cambios metabólicos en las diferentes fases de la respuesta metabólica al trauma llevaron a la disminución del estado nutricional de los pacientes quemados de ambos sexos durante la hospitalización.

Risk of sarcopenia in older adults with type 2 diabetes mellitus: evaluation of the SARC-F and SARC-CalF as screening tools / Risco de sarcopenia em idosos com diabetes mellitus tipo 2: avaliação do SARC-F e SARC-CalF como ferramentas para rastreamento

Objective: To evaluate the diagnostic power of SARC-F and SARC-CalF as screening tools for sarcopenia risk in older adults with type 2 diabetes mellitus. Methods: This cross-sectional study of 128 patients was conducted at the endocrinology outpatient clinic of a hospital in Recife, Brazil between July 2022 and February 2023. Sarcopenia was diagnosed according to original and updated European Consensus criteria for older adults. Muscle mass was assessed with electrical bioimpedance, muscle strength was assessed with a handgrip test, and physical performance was assessed with gait speed. Sarcopenia risk was assessed using the SARC-F and SARC-CalF instruments. The sensitivity, specificity, positive and negative predictive values, receiver operating characteristic curve, and area under the curve were analyzed to determine the best diagnostic performance. Results: According to the original and updated versions of the European Consensus criteria, the prevalence of sarcopenia was 25.00% and 10.90%, respectively. Sarcopenia risk was 17.20% according to the SARC-F and 23.40% according to the SARC-CalF. The sensitivity and specificity of the SARC-F ranged from 12.55% to 36.11% and 71.87% to 92.39%, respectively, while those of the SARC-CalF ranged from 47.22% to 85.71% and 82.46% to 88.89%, respectively. The area under the curve for the SARC-F and SARC-CalF varied between 0.51 and 0.71 and 0.67 and 0.86, respectively. Conclusions: The SARC-CalF had better diagnostic performance for all analyzed diagnostic criteria. Adding calf circumference to the SARC-F was an effective screening method for sarcopenia risk in the study population

Objetivo: Avaliar o poder diagnóstico do SARC-F e SARC-CalF como ferramentas de rastreamento para o risco de sarcopenia em idosos com diabetes mellitus tipo 2. Metodologia: Estudo transversal com 128 pacientes desenvolvido no ambulatório de endocrinologia de um hospital do Recife entre julho de 2022 e fevereiro de 2023. A sarcopenia foi diagnosticada de acordo com os critérios do Consenso Europeu para sarcopenia em pessoas idosas e sua versão atualizada. Foi realizada bioimpedância elétrica para avaliar a massa muscular, teste de preensão palmar para a força muscular e teste de velocidade de marcha para a performance física. O risco para sarcopenia foi avaliado por meio do SARC-F e SARC-CalF. Realizou-se análise de sensibilidade, especificidade, valores preditivos positivos e negativos, curva Característica de Operação do Receptor (ROC) e área sob a curva (AUC) para determinar a melhor performance diagnóstica. Resultados: A prevalência de sarcopenia foi de 25,00% de acordo com a primeira versão do Consenso Europeu e 10,90% considerando a versão atualizada. O risco para sarcopenia foi de 17,20% (SARC-F) e 23,40% (SARC-CalF). A sensibilidade do SARC-F variou entre 12,55 e 36,11%, e a espec ificidade entre 71,87 e 92,39%, enquanto o SARC-CalF apresentou sensibilidade entre 47,22 e 85,71% e especificidade entre 82,46 e 88,89%. A AUC do SARC-F variou entre 0,51 e 0,71, enquanto o SARC-CalF ficou entre 0,67 e 0,86. Conclusões: O SARC-CalF apresentou melhor performance diagnóstica quando comparado a todos os critérios diagnósticos analisados. A adição da circunferência da panturrilha é um método eficaz para o rastreamento do risco de sarcopenia na população do estudo

Food consumption, anthropometry and body composition of patients diagnosed with Parkinson's disease / Consumo alimentar, antropometria e composição corporal de pacientes diagnosticados com doença de Parkinson

ABSTRACT Objective The aim of the present study was to evaluate the consumption of risk and protective foods for chronic noncommunicable diseases and to investigate associations with anthropometric parameters and body composition in individuals with Parkinson's disease. Methods A case-series study was conducted with 79 adult and elderly patients of both genders in outpatient care. Food intake was evaluated using a food frequency questionnaire for the identification of foods with greater daily consumption, stratified by gender. The consumption frequency of each food was converted into scores of two food groups characteristics: risk and protection. The conceptual model took into account sociodemographic, behavioral and anthropometric variables as well as body composition. Results A total of 72.1% of the participants in the sample had excess weight based on the body mass index and 43.5% had excess body fat. The consumption of protective foods was greater among individuals with a higher body mass index and with a greater rate of body fat. Conclusion The data indicate a situation of reverse causality and reveal the complexity of the relationship among food intake, body fat and chronic noncommunicable diseases.

RESUMO Objetivo Este estudo visou avaliar o consumo de alimentos de risco e proteção para as doenças crônicas não transmissíveis e sua associação com parâmetros antropométricos e de composição corporal em pacientes com doença de Parkinson. Métodos Estudo do tipo série de casos, com 79 pacientes adultos e idosos, de ambos os sexos, atendidos ambulatorialmente. O consumo alimentar desses pacientes foi avaliado por um questionário de frequência alimentar, sendo identificados inicialmente os alimentos com maior frequência de consumo diário por sexo e, em seguida, a frequência de consumo de cada alimento foi convertida em escores, sendo constituídos dois grupos de alimentos: risco e proteção. O modelo conceitual considerou variáveis sociodemográficas, comportamentais, antropométricas e de composição corporal. Resultados Ao todo, 72,1% dos pacientes apresentaram excesso de peso segundo o índice de massa corporal e 43,5% apresentaram excesso de gordura corporal. O consumo de alimentos protetores foi maior nos pacientes com maior índice de massa corporal e maior percentual de gordura corporal. Conclusão Os dados apontam para uma condição de causalidade reversa e revelam a complexidade envolvida na relação entre consumo alimentar, gordura corporal e doenças crônicas não transmissíveis.

Visceral adiposity indicators and cardiovascular risk in hemodialytic patients

ABSTRACT Objective: Cardiovascular diseases represent the main cause of death in chronic kidney disease (CKD). We aimed to evaluate the prevalence and association of the hypertriglyceridemia-waist phenotype (HWP) and visceral adiposity index (VAI) with cardiometabolic risk factors (CR) in patients with CKD on hemodialysis (HD). Materials and methods: The study is based on a cross-sectional design with 265 HD patients in two cities in northeastern Brazil. The VAI was calculated considering the variables body mass index (BMI), waist circumference (WC), triglycerides (TG) and high density lipoprotein cholesterol (HDL-c). HWP was defined as the concomitant elevation of WC and TG. The Poisson Regression Model with robust variance estimation was adjusted considering a hierarchical approach for explanatory variables. Prevalence ratios (PR) were also estimated. The level of significance adopted was 5%. Results: In our study HWP and VAI prevalence's were 29.82% and 58.49%, respectively. In the final model, there was an association between VAI and female gender (PR = 1.46; p < 0.0001) and high body fat (% BF) (PR = 1.33; p < 0.0019). HWP was associated with females (PR = 1.80; p = 0.002), alcohol consumption (PR = 1.58; p = 0.033), obesity (PR = 1.89; p = 0.0001), high %BF (PR = 1.76; p = 0.012) and reduced HDL-c (PR = 1.48; p = 0.035). Conclusion: The HWP stood out as the association with more CR factors, representing a promising method for tracking cardiometabolic risk in HD patients, mainly female.

Ingestão dietética e nível de atividade física como preditoresde mudanças no peso e no índice de massa corporal de universitários / Ingesta dietética y nivel de actividad física como predictores de cambios en el peso y en el índice de masa corporal de universitarios / Dietary intake and level of physical activity as predictors of changes in weight and body mass index among college student

OBJETIVO: O objetivo do presente trabalho foi investigar aingestão dietética e o nível de atividade física como preditores de mudanças no peso e no índice de massa corporal (IMC) de estudantes de uma universidade pública do Nordeste do Brasil. MÉTODOS: Tratou-se de uma coorte, onde 138 estudantes foram avaliados ao início do curso e após 1 ano de vida acadêmica. Foram coletados o peso corporal e a altura, dados sobre o nível de atividade física e sobre o consumo alimentar. O modelo conceitual também considerou variáveis sociodemográficas, comportamentais, de composição corporal e distribuição de gordura corporal. RESULTADOS: A amostra foi 76,1% do sexo feminino, com média de idade de 19,7 ± 3,3 anos no baseline. Ao final do seguimento, 50,7% dos universitários ganharam mais de 0,5Kg de peso, dentre esses, a média de ganho de peso foi 2,87 ± 2,01kg. Nos estudantes que no baseline apresentavam consumo ≤ a uma vez por semana de salada crua e ≤ a uma vez ao dia de frutas e legumes cozidos, a chance de ganho em peso foi de 3,06; 2,57 e 2,49 respectivamente. Houve uma correlação negativa entre a variação anual no peso e a variação no consumo de frutas, salada crua e legumes cozidos. Por outro lado, houve uma correlação positiva com o consumo de embutidos, salgados e doces. Comportamento similar foi observado com a variação no índice de massa corporal (IMC). CONCLUSÃO: Não foi identificado influência da prática de atividade física sobre o ganho de peso. No entanto, o padrão alimentar no baseline e o praticado durante o ano de ingresso na universidade exerceu influência sobre o peso e o IMC dos universitários

OBJETIVO: El objetivo del presente estudio fue investigar la ingesta dietética y el nivel de actividad física como predictores de cambios en el peso y el índice de masa corporal (IMC) de estudiantes de una universidad pública en el noreste de Brasil. MÉTODOS: Se trató de una cohorte, donde se evaluó a 138 estudiantes al inicio del curso y luego de 1 año de vida académica. Se recogieron el peso y la altura corporal, los datos sobre el nivel de actividad física y el consumo de alimentos. El modelo conceptual también consideró variables sociodemográficas, conductuales, de composición corporal y distribución de la grasa corporal. RESULTADOS: La muestra fue 76,1% de mujeres, con una edad media de 19,7 ± 3,3 años al inicio del estudio. Al final del seguimiento, el 50,7% de los estudiantes universitarios ganó más de 0,5 kg de peso, entre ellos, la ganancia de peso promedio fue de 2,87 ± 2,01 kg. En los estudiantes que tenían un consumo inicial ≤ una vez a la semana de ensalada cruda y ≤ una vez al día de frutas y verduras cocidas, la probabilidad de aumento de peso fue de 3,06; 2,57 y 2,49 respectivamente. Hubo una correlación negativa entre la variación anual en peso y la variación en el consumo de frutas, ensalada cruda y verduras cocidas. Por otro lado, hubo una correlación positiva con el consumo de embutidos, snacks y dulces. Se observó un comportamiento similar con la variación en el índice de masa corporal (IMC). CONCLUSIÓN: No se identificó la influencia de la actividad física en el aumento de peso. Sin embargo, el patrón dietético en la línea de base y el practicado durante el año de ingreso a la universidad influyó en el peso y el IMC de los estudiantes

OBJECTIVE: The objective of the present study was to investigate dietary intake and the level of physical activity as predictors of changes in weight and body mass index (BMI) of students at a public university in Northeast Brazil. METHODS: This was a cohort, where 138 students were assessed at the beginning of the course and after 1 year of academic life. Body weight and height, data on the level of physical activity and food consumption were collected. The conceptual model also considered sociodemographic, behavioral, body composition and body fat distribution variables. RESULTS: The sample was 76.1% female, with a mean age of 19.7 ± 3.3 years at baseline. At the end of the follow-up, 50.7% of university students gained more than 0.5 kg of weight, among them, the average weight gain was 2.87 ± 2.01 kg. In students who had a baseline consumption ≤ once a week of raw salad and ≤ once a day of cooked fruits and vegetables, the chance of weight gain was 3.06; 2.57 and 2.49 respectively. There was a negative correlation between the annual variation in weight and the variation in the consumption of fruits, raw salad and cooked vegetables. On the other hand, there was a positive correlation with the consumption of sausages, snacks and sweets. Similar behavior was observed with the variation inbody mass index (BMI). CONCLUSION: The influence of physical activity on weight gain was not identified. However, the dietary pattern in the baseline and that practiced during the year of entry into the university influenced the weight and BMI of the students

Frecuencia de la sarcopenia, la caquexia y los factores asociados en los pacientes con enfermedad renal crónica en terapia dialítica / Frequency of sarcopenia, cachexia, and associated factors in patients with chronic kidney disease in dialysis treatment

INTRODUCCIÓN: la sarcopenia y la caquexia son síndromes que producen una reducción de la masa muscular esquelética y que se asocian al proceso de envejecimiento y a muchas enfermedades crónicas. OBJETIVO: verificar la frecuencia de la sarcopenia, la caquexia y los factores asociados en pacientes en tratamiento dialítico. METODOLOGÍA: estudio transversal realizado en dos centros de tratamiento dialítico de Recife entre marzo y septiembre de 2016. El diagnóstico de sarcopenia se realizó según el criterio del Consenso Europeo de Sarcopenia, mientras que el de caquexia se hizo por el criterio de la Society for Cachexia and Wasting Disorders (SCWD). Las variables de asociación fueron demográficas (sexo y edad), analíticas (proteína C-reactiva, albúmina sérica, hemoglobina, paratohormona y creatinina sérica) y antropométricas: índice de masa corporal (IMC), circunferencia del brazo (CB), circunferencia muscular del brazo (CMB) y pliegue cutáneo tricipital (PCT). RESULTADOS: se estudió a 66 pacientes: el 43,9 % eran hombres y el 56,1 % mujeres, con una media de edad de 53,15 ± 15,24 años. El 43,9 % eran ancianos. La sarcopenia estuvo presente en el 59,1 % de los pacientes y, entre estos, el 15,2 % presentaban sarcopenia grave. La pre-sarcopenia se verificó en el 4,5 %. En cuanto a la caquexia, se diagnosticó en el 15,2 %. Las variables asociadas a la sarcopenia fueron la albúmina sérica reducida (p = 0,013) y la caquexia (p = 0,039); las relacionadas con la caquexia fueron el sexo femenino (p = 0,036) y el IMC (p < 0,001). CONCLUSIÓN: la principal constatación es la elevada frecuencia de la sarcopenia en los pacientes que realizan terapia dialítica. En los pacientes estudiados, la sarcopenia se asoció significativamente a la disminución de la albúmina sérica. La albúmina sérica reducida es un predictor de mortandad en los pacientes en terapia renal sustitutiva. La frecuencia de la sarcopenia fue elevada en los pacientes estudiados. De este modo, las herramientas actualmente disponibles para evaluar la masa y la fuerza muscular deben aplicarse en la medida de lo posible en la práctica clínica, viabilizando la incorporación de las intervenciones preventivas y terapéuticas apropiadas

INTRODUCTION: sarcopenia and cachexia are syndromes that result in a reduction of skeletal muscle mass, being associated with the aging process and many chronic diseases. OBJECTIVE: to assess the frequency of sarcopenia as well as of cachexia and their associated factors in patients in dialysis treatment. METHODOLOGY: a cross-sectional study conducted in two dialysis treatment centers in Recife between March and September 2016. The diagnosis of sarcopenia was made according to the criteria issued by the Sarcopenia European Consensus, while that of cachexia was made in consonance with the Society for Cachexia and Wasting Disorders (SCWD). The association variables were demographic (age and sex), laboratory (C-reactive protein, serum albumin, hemoglobin, parathyroid hormone, serum creatinine), and anthropometric indicators (body mass index BMI, arm circumference AC, midarm muscular circumference MMC, triceps skinfold thickness TST). RESULTS: the study involved 66 patients, 43.9 % men, 56.1 % women, with a mean age of 53.15 ± 15.24 years; 43.9 % were elderly subjects. Sarcopenia occurred in 59.1 % of patients; of these, 15.2 % presented with severe sarcopenia. Pre-sarcopenia was found in 4.5 %. With regard to cachexia, 15.2 % were diagnosed with this syndrome. The variables associated with sarcopenia were reduced serum albumin (p = 0.013) and cachexia (p = 0.039), and those associated with cachexia were female gender (p = 0.036) and BMI (p < 0.001). CONCLUSION: the main finding of the present study was the high frequency of sarcopenia found in patients on treatment with dialysis. In the patients studied, sarcopenia was significantly associated with a decrease in serum albumin. Reduced serum albumin is a predictor of mortality in patients on renal replacement therapy. A high frequency of sarcopenia has been observed among study patients. Thus, the tools currently available to assess muscle mass and muscle strength should be implemented as much as possible in clinical practice to enable the incorporation of appropriate preventive and therapeutic interventions

[Frequency of sarcopenia, cachexia, and associated factors in patients with chronic kidney disease in dialysis treatment]. / Frecuencia de la sarcopenia, la caquexia y los factores asociados en los pacientes con enfermedad renal crónica en terapia dialítica.

INTRODUCTION: Introduction: sarcopenia and cachexia are syndromes that result in a reduction of skeletal muscle mass, being associated with the aging process and many chronic diseases. Objective: to assess the frequency of sarcopenia as well as of cachexia and their associated factors in patients in dialysis treatment. Methodology: a cross-sectional study conducted in two dialysis treatment centers in Recife between March and September 2016. The diagnosis of sarcopenia was made according to the criteria issued by the Sarcopenia European Consensus, while that of cachexia was made in consonance with the Society for Cachexia and Wasting Disorders (SCWD). The association variables were demographic (age and sex), laboratory (C-reactive protein, serum albumin, hemoglobin, parathyroid hormone, serum creatinine), and anthropometric indicators (body mass index BMI, arm circumference AC, midarm muscular circumference MMC, triceps skinfold thickness TST). Results: the study involved 66 patients, 43.9 % men, 56.1 % women, with a mean age of 53.15 ± 15.24 years; 43.9 % were elderly subjects. Sarcopenia occurred in 59.1 % of patients; of these, 15.2 % presented with severe sarcopenia. Pre-sarcopenia was found in 4.5 %. With regard to cachexia, 15.2 % were diagnosed with this syndrome. The variables associated with sarcopenia were reduced serum albumin (p = 0.013) and cachexia (p = 0.039), and those associated with cachexia were female gender (p = 0.036) and BMI (p < 0.001). Conclusion: the main finding of the present study was the high frequency of sarcopenia found in patients on treatment with dialysis. In the patients studied, sarcopenia was significantly associated with a decrease in serum albumin. Reduced serum albumin is a predictor of mortality in patients on renal replacement therapy. A high frequency of sarcopenia has been observed among study patients. Thus, the tools currently available to assess muscle mass and muscle strength should be implemented as much as possible in clinical practice to enable the incorporation of appropriate preventive and therapeutic interventions.

INTRODUCCIÓN: Introducción: la sarcopenia y la caquexia son síndromes que producen una reducción de la masa muscular esquelética y que se asocian al proceso de envejecimiento y a muchas enfermedades crónicas. Objetivo: verificar la frecuencia de la sarcopenia, la caquexia y los factores asociados en pacientes en tratamiento dialítico. Metodología: estudio transversal realizado en dos centros de tratamiento dialítico de Recife entre marzo y septiembre de 2016. El diagnóstico de sarcopenia se realizó según el criterio del Consenso Europeo de Sarcopenia, mientras que el de caquexia se hizo por el criterio de la Society for Cachexia and Wasting Disorders (SCWD). Las variables de asociación fueron demográficas (sexo y edad), analíticas (proteína C-reactiva, albúmina sérica, hemoglobina, paratohormona y creatinina sérica) y antropométricas: índice de masa corporal (IMC), circunferencia del brazo (CB), circunferencia muscular del brazo (CMB) y pliegue cutáneo tricipital (PCT). Resultados: se estudió a 66 pacientes: el 43,9 % eran hombres y el 56,1 % mujeres, con una media de edad de 53,15 ± 15,24 años. El 43,9 % eran ancianos. La sarcopenia estuvo presente en el 59,1 % de los pacientes y, entre estos, el 15,2 % presentaban sarcopenia grave. La pre-sarcopenia se verificó en el 4,5 %. En cuanto a la caquexia, se diagnosticó en el 15,2 %. Las variables asociadas a la sarcopenia fueron la albúmina sérica reducida (p = 0,013) y la caquexia (p = 0,039); las relacionadas con la caquexia fueron el sexo femenino (p = 0,036) y el IMC (p < 0,001). Conclusión: la principal constatación es la elevada frecuencia de la sarcopenia en los pacientes que realizan terapia dialítica. En los pacientes estudiados, la sarcopenia se asoció significativamente a la disminución de la albúmina sérica. La albúmina sérica reducida es un predictor de mortandad en los pacientes en terapia renal sustitutiva. La frecuencia de la sarcopenia fue elevada en los pacientes estudiados. De este modo, las herramientas actualmente disponibles para evaluar la masa y la fuerza muscular deben aplicarse en la medida de lo posible en la práctica clínica, viabilizando la incorporación de las intervenciones preventivas y terapéuticas apropiadas.

HYPERTRIGLYCERIDEMIC WAIST AND ASSOCIATED FACTORS IN CHILDREN AND ADOLESCENTS WITH TYPE 1 DIABETES MELLITUS.

OBJECTIVE: To assess the frequency of the hypertriglyceridemic waist phenotype and its associated factors in children and adolescents with type 1 diabetes mellitus. METHODS: This is an observational analytical study with individuals with type 1 diabetes mellitus, aged 5 to 18 years, of both genders, followed in a university hospital in the Brazilian Northeast. Weight, height, and waist circumference were measured, and the lipid profile and glycated hemoglobin were analyzed. The hypertriglyceridemic waist phenotype was defined by the simultaneous presence of increased waist circumference (≥90th percentile for age and gender) and elevated serum triglyceride levels (≥75 mg/dL for children and ≥90 mg/dL for adolescents). We also investigated the family history of cardiovascular diseases and diabetes, as well as sociodemographic and behavioral variables. In the statistical inference tests, the proportions were compared by Pearson's chi-square test -and/-or Fisher's exact test, being significant p<0.05. RESULTS: A total of 102 patients were evaluated, most of them females (54.9%) and adolescents (66.7%). The frequency of hypertriglyceridemic waist was 23.5%, which was associated with females (p=0.043), overweight (p=0.023), hypercholesterolemia (p=0.002), high LDL (p=0.001), and borderline VLDL (<0.001). CONCLUSIONS: The frequency of the hypertriglyceridemic waist phenotype was associated with females, atherogenic lipid profile, and overweight, indicating the importance of the nutritional monitoring of this population, aiming at reducing future cardiovascular diseases.

Hypertriglyceridemic waist and associated factors in children and adolescents with type 1 diabetes mellitus / Cintura hipertrigliceridêmica e fatores associados em crianças e adolescentes portadores de diabetes melito tipo 1

ABSTRACT Objective: To assess the frequency of the hypertriglyceridemic waist phenotype and its associated factors in children and adolescents with type 1 diabetes mellitus. Methods: This is an observational analytical study with individuals with type 1 diabetes mellitus, aged 5 to 18 years, of both genders, followed in a university hospital in the Brazilian Northeast. Weight, height, and waist circumference were measured, and the lipid profile and glycated hemoglobin were analyzed. The hypertriglyceridemic waist phenotype was defined by the simultaneous presence of increased waist circumference (≥90th percentile for age and gender) and elevated serum triglyceride levels (≥75 mg/dL for children and ≥90 mg/dL for adolescents). We also investigated the family history of cardiovascular diseases and diabetes, as well as sociodemographic and behavioral variables. In the statistical inference tests, the proportions were compared by Pearson's chi-square test ­and/­or Fisher's exact test, being significant p<0.05. Results: A total of 102 patients were evaluated, most of them females (54.9%) and adolescents (66.7%). The frequency of hypertriglyceridemic waist was 23.5%, which was associated with females (p=0.043), overweight (p=0.023), hypercholesterolemia (p=0.002), high LDL (p=0.001), and borderline VLDL (<0.001). Conclusions: The frequency of the hypertriglyceridemic waist phenotype was associated with females, atherogenic lipid profile, and overweight, indicating the importance of the nutritional monitoring of this population, aiming at reducing future cardiovascular diseases.

RESUMO Objetivo: Avaliar a frequência do fenótipo cintura hipertrigliceridêmica e analisar seus fatores associados em crianças e adolescentes portadores de diabetes melito tipo 1. Métodos: Trata-se de um estudo observacional analítico com indivíduos com diabetes melito tipo 1, de cinco a 18 anos de idade, de ambos os sexos, acompanhados em um hospital universitário do Nordeste brasileiro. Foram realizadas medidas de peso, altura e circunferência da cintura, além da análise do perfil lipídico e da hemoglobina glicada. O fenótipo cintura hipertrigliceridêmica foi definido pela presença simultânea da circunferência da cintura aumentada (≥percentil 90 por idade e sexo) e dos níveis séricos de triglicerídeos elevados (≥75 mg/dL para crianças e ≥90 mg/dL para adolescentes). Investigaram-se, ainda, os antecedentes familiares para doenças cardiovasculares e diabetes, e também variáveis sociodemográficas e comportamentais. Nos testes de inferência estatística, as proporções foram comparadas pelo teste do qui-quadrado de Pearson e/ou exato de Fisher, sendo significante p<0,05. Resultados: Foram avaliados 102 pacientes, com predomínio do sexo feminino (54,9%) e de adolescentes (66,7%). A frequência de cintura hipertrigliceridêmica foi de 23,5%; a qual apresentou associação com o sexo feminino (p=0,043), excesso de peso (p=0,023), hipercolesterolemia (p=0,002), LDL elevado (p=0,001) e VLDL em valores limítrofes (<0,001). Conclusões: A frequência do fenótipo cintura hipertrigliceridêmica foi associada ao sexo feminino, ao perfil lipídico aterogênico e ao excesso ponderal, evidenciando a importância do acompanhamento nutricional dessa população, visando à redução de agravos cardiovasculares futuros.

Adiposity, inflammation and fat-soluble vitamins in adolescents / Adiposidade, inflamação e vitaminas lipossolúveis em adolescentes

Abstract Objective: Evaluate the association between inflammatory process, adiposity, and vitamins A, D, and E in adolescents, according to gender. Methods: Cross-sectional study with adolescents aged 12-19 years old of both genders attending public schools in Recife. A questionnaire was used to collect data on socioeconomic level, lifestyle, and food intake of adolescents. Then, an anthropometric evaluation and a blood sampling were performed to analyze serum concentrations of α-1-acid glycoprotein, retinol, β-carotene, α-tocopherol, and 25-hydroxy-vitamin D. Results: The levels of α-1-acid glycoprotein were higher for abdominal obesity in both genders. Male adolescents with insufficient serum α-tocopherol levels had low levels of α-1-acid glycoprotein (p = 0.03) and an increased risk of 25-hydroxy-vitamin D and β-carotene deficiency in relation to total and abdominal fat; female adolescents had an increased risk of insufficient β-carotene with abdominal obesity (PR: 1.33; 95% CI: 1.2-1.5). Conclusion: Abdominal adiposity implies a higher risk of inflammation and causes different changes to the levels of fat-soluble vitamins according to gender.

Resumo: Objetivo: Avaliar a associação entre processo inflamatório, adiposidade e as vitaminas A, D e E em adolescentes, segundo o sexo. Métodos: Estudo transversal com adolescentes de 12 a 19 anos de ambos os sexos de escolas públicas de Recife. Foi utilizado um questionário para coleta de dados socioeconômicos, de estilo de vida e de consumo alimentar dos adolescentes. Em seguida, realizou-se a avalição antropométrica e coleta de sangue para análise das concentrações séricas de α-1-glicoproteína ácida, retinol, β-caroteno, α-tocoferol e 25-hidroxivitamina D. Resultados: Os níveis de α-1-glicoproteína ácida foram maiores na obesidade abdominal de ambos os sexos. Os meninos com níveis séricos insuficientes de α-tocoferol expressaram níveis reduzidos de α-1-glicoproteína ácida (p = 0,03) e apresentaram um maior risco de deficiência de 25-hidroxivitamina D e β-caroteno na adiposidade total e abdominal, enquanto as meninas mostraram maior risco de insuficiência de β-caroteno com a obesidade abdominal (RP 1,33; IC 95% 1,2-1,5). Conclusão: A adiposidade abdominal reflete maior risco de inflamação e causa alterações distintas nas concentrações das vitaminas lipossolúveis, de acordo com o sexo.

Adiposity, inflammation and fat-soluble vitamins in adolescents.

OBJECTIVE: Evaluate the association between inflammatory process, adiposity, and vitamins A, D, and E in adolescents, according to gender. METHODS: Cross-sectional study with adolescents aged 12-19 years old of both genders attending public schools in Recife. A questionnaire was used to collect data on socioeconomic level, lifestyle, and food intake of adolescents. Then, an anthropometric evaluation and a blood sampling were performed to analyze serum concentrations of α-1-acid glycoprotein, retinol, ß-carotene, α-tocopherol, and 25-hydroxy-vitamin D. RESULTS: The levels of α-1-acid glycoprotein were higher for abdominal obesity in both genders. Male adolescents with insufficient serum α-tocopherol levels had low levels of α-1-acid glycoprotein (p=0.03) and an increased risk of 25-hydroxy-vitamin D and ß-carotene deficiency in relation to total and abdominal fat; female adolescents had an increased risk of insufficient ß-carotene with abdominal obesity (PR: 1.33; 95% CI: 1.2-1.5). CONCLUSION: Abdominal adiposity implies a higher risk of inflammation and causes different changes to the levels of fat-soluble vitamins according to gender.

CLINICAL AND NUTRITIONAL ASPECTS IN OBESE WOMEN DURING THE FIRST YEAR AFTER ROUX-EN-Y GASTRIC BYPASS / ASPECTOS CLÍNICOS E NUTRICIONAIS EM MULHERES OBESAS DURANTE O PRIMEIRO ANO APÓS BYPASS GÁSTRICO EM Y-DE-ROUX

Background:Clinic care for morbid obesity is not very effective. Bariatric surgery is being considered the best way of intervention for this kind of obesity.Aim: Evaluate the clinical and nutritional evolution during the first year of obese women submitted to Roux-en-Y gastric bypass.Method: Retrospective series non-concurrent with 61 women. The variables were weight, BMI, weight loss percentage, loss of excessive weight percentage, waist circumference, hip circumference, lipid profile, daily use of supplements, practice of physical exercise, occurrence of sickness, nausea, constipation, diarrhea, asthenia, alopecia, dry skin, cramps and brittle nails.Results: They presented significant weight and IMC reduction as well as improvement in their lipid profile, in all consultations. After one year they presented 36,6% loss of the initial weight and 75% loss of excessive weight. The waist circumference also presented a considerable reduction on all the moments, decreasing from 122,1±13,4 cm to 94,1±10,6 cm. Regarding the intercurrences, the most frequent were alopecia, asthenia, dry skin and cramps.Conclusion:The Roux-en-Y gastric bypass was effective in promoting and maintenance weight loss during the period of the first postoperative year.

Racional:O tratamento clínico para a obesidade mórbida é pouco eficaz. A cirurgia bariátrica tem sido considerada a melhor forma de intervenção para esse tipo de obesidade.Objetivo:Avaliar a evolução clínico-nutricional durante o primeiro ano de mulheres obesas submetidas ao bypass gástrico em Y-de-Roux.Métodos:Estudo retrospectivo não concorrente do tipo série de casos com 61 mulheres. As variáveis analisadas foram peso, IMC, percentual de perda de peso, percentual de perda do excesso de peso, circunferência da cintura, circunferência do quadril, perfil lipídico, uso diário de polivitamínico-mineral, prática de exercício físico, presença de vômitos, náuseas, constipação, diarréia, astenia, alopecia, pele seca, câimbras e unhas quebradiças.Resultados:As pacientes apresentaram redução significativa do peso e IMC bem como melhora do perfil lipídico, em todas as consultas avaliadas. Ao final de um ano apresentaram 36,6% de perda do peso inicial e 75% de perda do excesso de peso. A circunferência da cintura também apresentou redução significante em todos os momentos, diminuindo de 122,1±13,4 cm para 94,1±10,6 cm. No que se refere às intercorrências, as mais frequentes foram vômitos, alopecia, astenia e unhas quebradiças.Conclusão:O bypass gástrico em Y-de-Roux foi efetivo na promoção e manutenção da perda de peso no primeiro ano pós-operatório.

Disfunção renal e marcadores inflamatórios em hipertensos atendidos em hospital universitário / Renal dysfunction and inflammatory markers in hypertensive patients seen in a university hospital

FUNDAMENTO: A doença renal crônica representa hoje um grande desafio para a saúde pública no sentido de se obterem conhecimentos para subsidiar intervenções que possam alterar a velocidade de perda da função renal. OBJETIVO: Avaliar a magnitude do déficit da função renal em hipertensos adultos e sua relação com marcadores inflamatórios: proteína C reativa ultrassensível, velocidade de hemossedimentação e relação neutrófilos/linfócitos. MÉTODOS: Estudo transversal envolvendo 1.273 adultos hipertensos, de ambos os sexos, sendo 1.052 com déficit da função renal e 221 sem déficit, diagnosticados pela equação Modification of Diet in the Renal Disease. A razão de chances (OR) e a razão de prevalência (RP) foram utilizadas para determinar a probabilidade de ocorrência de atividade inflamatória na doença renal. RESULTADOS: O déficit de função renal foi diagnosticado em 82,6% dos avaliados, sendo que a maioria da amostra (70,8%) estava inserida no estágio 2 da doença renal crônica. No modelo de regressão permaneceram independentemente associadas ao déficit da função renal a síndrome metabólica (RPajustada = 1,09 [IC95%: 1,04-1,14]), a proteína C reativa ultrassensível (RPajustada = 1,54 [IC95%: 1,40-1,69]) e a velocidade de hemossedimentação (RPajustada = 1,20 [IC95%: 1,12-1,28]). No entanto, considerando os indivíduos classificados no estágio 2 do déficit da função renal, a chance de alteração dos marcadores inflamatórios foram de OR = 10,25 (IC95%: 7,00-15,05) para a proteína C reativa ultrassensível, OR = 8,50 (IC95%: 5.70-12.71) para a relação neutrófilos/linfócitos e OR = 7,18 (IC95%: 4,87-10,61) para a velocidade de hemossedimentação. CONCLUSÃO: Os resultados mostram associação da atividade inflamatória e da síndrome metabólica com o déficit da função renal.

BACKGROUND: Today, chronic kidney diseases represent a great challenge to public health as regards the acquisition of knowledge to support interventions that can slow the progression of renal function loss. OBJECTIVE: To analyze the magnitude of the renal function deficit in hypertensive adult patients and its relationship with the following inflammatory markers: high-sensitivity C reactive protein, erythrocyte sedimentation rate, and neutrophil/lymphocyte ratio. METHODS: Cross-sectional study including 1,273 adult hypertensive patients of both genders, of whom 1,052 had renal function deficit, and 221 had no deficit, as diagnosed by the Modification of Diet in Renal Disease equation. The odds ratio (OR) and the prevalence ratio (PR) were used to determine the probability of the occurrence of inflammatory activity in renal disease. RESULTS: Renal function deficit was diagnosed in 82.6% of the patients assessed, and most of the sample (70.8%) was classified as in stage 2 of chronic kidney disease. In the regression model, metabolic syndrome (PRadjusted = 1.09 [95%CI: 1.04-1.14]), high-sensitivity C reactive protein (PRadjusted = 1.54 [95%CI: 1.40-1.69]) and erythrocyte sedimentation rate (PRadjusted = 1.20 [95%CI: 1.12-1.28]) remained independently associated with the renal function deficit. However, considering the individuals classified as in stage 2 of renal function deficit, the chance of abnormalities in inflammatory markers were OR = 10.25 (95%CI: 7.00-15.05) for high-sensitivity C reactive protein, OR = 8.50 (95%CI: 5.70-12.71) for neutrophil/lymphocyte ratio, and OR = 7.18 (95%CI: 4.87-10.61) for erythrocyte sedimentation rate. CONCLUSION: The results show an association of inflammatory activity and metabolic syndrome with renal function deficit.

Renal dysfunction and inflammatory markers in hypertensive patients seen in a university hospital.

BACKGROUND: Today, chronic kidney diseases represent a great challenge to public health as regards the acquisition of knowledge to support interventions that can slow the progression of renal function loss. OBJECTIVE: To analyze the magnitude of the renal function deficit in hypertensive adult patients and its relationship with the following inflammatory markers: high-sensitivity C reactive protein, erythrocyte sedimentation rate, and neutrophil/lymphocyte ratio. METHODS: Cross-sectional study including 1,273 adult hypertensive patients of both genders, of whom 1,052 had renal function deficit, and 221 had no deficit, as diagnosed by the Modification of Diet in Renal Disease equation. The odds ratio (OR) and the prevalence ratio (PR) were used to determine the probability of the occurrence of inflammatory activity in renal disease. RESULTS: Renal function deficit was diagnosed in 82.6% of the patients assessed, and most of the sample (70.8%) was classified as in stage 2 of chronic kidney disease. In the regression model, metabolic syndrome (PR adjusted = 1.09 [95%CI: 1.04-1.14]), high-sensitivity C reactive protein (PR adjusted = 1.54 [95%CI: 1.40-1.69]) and erythrocyte sedimentation rate (PR adjusted = 1.20 [95%CI: 1.12-1.28]) remained independently associated with the renal function deficit. However, considering the individuals classified as in stage 2 of renal function deficit, the chance of abnormalities in inflammatory markers were OR = 10.25 (95%CI: 7.00-15.05) for high-sensitivity C reactive protein, OR = 8.50 (95%CI: 5.70-12.71) for neutrophil/lymphocyte ratio, and OR = 7.18 (95%CI: 4.87-10.61) for erythrocyte sedimentation rate. CONCLUSION: The results show an association of inflammatory activity and metabolic syndrome with renal function deficit.

[Anemia in students at public schools in Recife: a study of temporal trends]. / Anemia em alunos de escolas públicas no Recife: um estudo de tendências temporais.

The scope of this study was to evaluate trends in the temporal evolution of anemia in students ranging from the ages of 7 to 11 in Várzea district (Recife-PE) based on three reports concluded in 1982, 2001 and 2005. An evaluation was achieved in ten public schools in the first study and nine in the last two (one was shut down), in a sample of 305 students (1982), 684 students (2001) and 756 students (2005). Hemoglobin was determined in blood samples taken by venopunction, having two criteria to describe anemia: cut points < 12 g/dL and < 11.5 g/dL. By the first criteria, the prevalence of anemia increased from 8.8% in 1982 to 18.9% in 2001, decreasing to 13.4% in 2005. In the last evaluation, the problem of anemia practically disappeared starting from the age of 9. The evolution of anemia revealed two very different trends: marked elevation in the first phase (1982 to 2001) and a rapid decrease in the second stage (2001 to 2005).

Anemia em alunos de escolas públicas no Recife: um estudo de tendências temporais / Anemia in students at public schools in Recife: a study of temporal trends

O objetivo deste estudo foi avaliar as tendências de evolução temporal da anemia em alunos de 7 a 11 anos no bairro da Várzea (Recife-PE) com base em três inquéritos realizados em 1982, 2001 e 2005. A avaliação foi efetuada em dez escolas públicas no 1° estudo e nove nos dois últimos (uma foi desativada), em amostra de 305 alunos (1982), 684 alunos (2001) e 756 alunos (2005). A hemoglobina foi determinada em amostras de sangue colhidas por venopunção, considerando dois critérios para discriminar a anemia: pontos de corte < 12 g/dL e < 11,5 g/dL. Pelo primeiro critério, a prevalência de anemia elevou-se de 8,8 por cento em 1982 para 18,9 por cento em 2001, decaindo para 13,4 por cento em 2005. Pelo segundo critério, a ocorrência de anemia decresceu de 10,7 por cento para 3,6 por cento, entre 2001 e 2005. Na última avaliação, o problema da anemia praticamente desapareceu, a partir dos 9 anos de idade. A evolução da anemia apresentou duas tendências bem diferenciadas: elevação num primeiro momento (1982 - 2001) e rápida diminuição numa segunda etapa (2001-2005).

The scope of this study was to evaluate trends in the temporal evolution of anemia in students ranging from the ages of 7 to 11 in Várzea district (Recife-PE) based on three reports concluded in 1982, 2001 and 2005. An evaluation was achieved in ten public schools in the first study and nine in the last two (one was shut down), in a sample of 305 students (1982), 684 students (2001) and 756 students (2005). Hemoglobin was determined in blood samples taken by venopunction, having two criteria to describe anemia: cut points < 12 g/dL and < 11.5 g/dL. By the first criteria, the prevalence of anemia increased from 8.8 percent in 1982 to 18.9 percent in 2001, decreasing to 13.4 percent in 2005. In the last evaluation, the problem of anemia practically disappeared starting from the age of 9. The evolution of anemia revealed two very different trends: marked elevation in the first phase (1982 to 2001) and a rapid decrease in the second stage (2001 to 2005).

Estado nutricional e insegurança alimentar de adolescentes e adultos em duas localidades de baixo índice de desenvolvimento humano / Nutritional status and food insecurity of adolescents and adults in two cities with a low human development index

OBJETIVO: Descrever a situação da (in)segurança alimentar e sua relação com o estado nutricional de adolescentes e adultos em duas localidades, Gameleira, zona da mata de Pernambuco e São João do Tigre, zona semi-árida da Paraíba, ambas caracterizadas pelo baixo índice de desenvolvimento humano. MÉTODOS: Estudo transversal, com 501 famílias em Gameleira (PE) e 458 famílias, em São João do Tigre (PB), com 1 528 e 1 163 adolescentes e adultos, respectivamente. A (in)segurança alimentar foi determinada pelo questionário de Cornell (Estados Unidos da América), ajustado para realidade nacional (Escala Brasileira de Insegurança Alimentar), enquanto o estado nutricional foi estabelecido pelo Índice de Massa Corporal. RESULTADOS: A insegurança alimentar foi caracterizada em quase 90,0 por cento das famílias dos dois municípios, predominando as condições de insegurança moderada (40,2 por cento) em São João do Tigre (PB) e grave (36,9 por cento) em Gameleira (PE). Nas duas localidades, a insegurança alimentar prevaleceu nas famílias com adolescentes. O baixo peso para altura (proxi de desnutrição) apresentou proporções muito baixas em todos os grupos etários, enquanto a condição sobrepeso/obesidade prevaleceu entre os adultos, chegando a alcançar 58,6 por cento das observações (>40 anos, em São João do Tigre). Não foi encontrada associação estatística entre a insegurança alimentar e suas formas moderada e grave e a desnutrição. CONCLUSÃO: A escala brasileira de avaliação da (in)segurança alimentar se comporta mais como um indicador psicossocial de vulnerabilidade, não apresentando a esperada consistência com a proporção da desnutrição de adolescentes e adultos identificada por este estudo, sob o aspecto antropométrico, mesmo em populações de pobreza praticamente generalizada.

OBJECTIVE: The objective of this study was to describe the food insecurity profile and its relationship with the nutritional status of adolescents and adults of two cities in Northeast Brazil: (Gameleira (PE), located in the sugarcane area of Pernambuco and São João do Tigre (PB), located in the semiarid area of Paraíba), both characterized by a low human development index. METHODS: This is a cross-sectional study with 501 families from Gameleira (PE) and 458 families from São João do Tigre (PB), totaling 1 528 adolescents and 1 163 adults. Food insecurity was determined by Cornell's questionnaire (United States of America), localized for Brazil (Brazilian Food Insecurity Scale) while the nutritional status was determined by calculating the body mass index. RESULTS: Almost 90 percent of the families of both cities were on food insecurity. Moderate food insecurity was more common in São João do Tigre (PB) (40.2 percent) and severe food insecurity in Gameleira (PE) (36.9 percent). In the two cities, food insecurity prevailed in families with adolescents. There was a low prevalence of low weight-forheight (proxy for malnutrition) in all age groups, and a high prevalence (58.6 percent) of overweight and obesity in adults 40 years or older in São João do Tigre. There was no statistical association between moderate and severe food insecurity and malnutrition. CONCLUSION: The Brazilian scale to assess food insecurity is more of a psychosocial indicator of vulnerability. Under the anthropometric standpoint, the malnutrition rates found by this study among adolescents and adults were not consistent with their food insecurity statuses, even though poverty in these populations was widespread.

Glicemic index of tropical fruits in normal individuals, patients with type 2 diabetes and patients with impaires glucose tolerance

A proposta do estudo foi avaliar a glicemia e insulinemia após a ingestäo de frutas regionais em diabéticos tipo 2 e aqueles com intolerância à glicose. A água de coco verde, jaca, manga espada e pinha foram avaliadas com o propósito de diversificar a programaçäo alimentar do diabetico. De acordo com as respostas glicemicas, pode-se inferir que a jaca e a água de coco verde, as quais exibiam Glycemic index acima de 70, podem ser usadas com cautela na dieta do diabético, preferencialmente em refeições mistas