Assessment of the components of sarcopenia and quality of life perceived of individuals on hemodialysis.

OBJECTIVES: to evaluate the prevalence of sarcopenia in individuals aged 50 years or older on hemodialysis; to verify the association between sarcopenia and sociodemographic, clinical, anthropometric factors, components of sarcopenia and quality of life (QoL); and to correlate the components of sarcopenia with QoL. METHODS: Participated 83 individuals on hemodialysis. Sarcopenia was established according to the current European consensus. Dynamometry to determine strength, calf circumference (CC) and appendicular skeletal muscle mass index (ASMMI) to obtain muscle mass and gait speed (GS) for physical performance. For QoL used the WHOQOL-bref. RESULTS: the prevalence of sarcopenia was 32.6% (CC) and 18.1% (ASMMI). There was no association between sarcopenia and QoL. Both handgrip strength (r=0.25) and GS (r=0.36) showed a correlation with physical domain. CONCLUSIONS: sarcopenia was expressive, and the aspects of functionality determine the physical impairment in this population.

Nutrition impact symptoms, sarcopenia, and malnutrition in hospitalized patients / Sintomas de impacto nutricional, sarcopenia e desnutrição em pacientes hospitalizados

INTRODUCTION: Nutrition Impact Symptoms (NIS) are common in hospitalized patients and can be aggravated in the presence of malnutrition. OBJECTIVE: To verify the presence of NIS and its association with sociodemographic and clinical variables, sarcopenia phenotype, and nutritional status of individuals hospitalized. METHODS: This is a cross-sectional study with hospitalized patients, of both sexes and ≥50 years old. Patient-Generated Subjective Global Assessment (PG-SGA), handgrip strength (HGS), gait speed GS), and anthropometric measurements were performed up to 48 hours after admission. NIS was obtained through PG-SGA and stratified into two groups: <3 and ≥3 symptoms. The chi-square test (χ2) was performed, and a 5% significance level was adopted. RESULTS: A total of 90 patients (65.4±9.67 years) were studied, with the majority of men (56.7%), older people (70.0%), married (68.9%), low economic class (72.2%), without work activity (70.5%), with two previous diseases (60.0%), overweight by body mass index (46.7%) and adequate adductor pollicis muscle thickness (83.3%). The most prevalent NIS were "dry mouth", "anorexia", and "smells sick" respectively 31.1%, 30.0%, and 16.7%. There was an association between NIS and SARC-F score (p=0.002), handgrip strength (p=0.016), the status of sarcopenia (p=0.020), PG-SGA (p<0.001), and economic status (p=0.020). CONCLUSION: The identification of NIS is common, and may infer negative nutritional status and functional performance of patients. The use of protocols to identify NIS during hospitalization should be considered to minimize the negative impact on nutritional status.

INTRODUÇÃO: Sintomas de impacto nutricional (SIN) são comuns em pacientes hospitalizados e estes podem ser agravados na presença da desnutrição. OBJETIVO: Verificar a presença de SIN e sua associação com as variáveis sociodemográficas, clínicas, fenótipo de sarcopenia e estado nutricional de indivíduos hospitalizados. MÉTODOS: Trata-se de estudo transversal com pacientes internados, de ambos os sexos e idade ≥ 50 anos. Realizou-se Avaliação Subjetiva Global produzida pelo Paciente (ASG-PPP), força de preensão palmar (FPP), velocidade de caminhada (VC) e medidas antropométricas até 48 horas da admissão. Os SIN foram obtidos por meio da ASG-PPP e compilados em <3 ou ≥3 sintomas. Realizou-se o teste de qui-quadrado (χ2). Adotou-se nível de significância de 5%. RESULTADOS: Um total de 90 pacientes (65,4±9,67 anos), sendo a maioria homem (56,7%), idoso (70,0%), casado (68,9%), classe econômica baixa (72,2%), sem atividade de trabalho (70,5%), com uma a duas doenças pregressas (60,0%), excesso de peso ao índice de massa corporal (46,7%) e adequada espessura do músculo adutor do polegar (83,3%). Os SIN "boca seca", "anorexia" e "cheiros enjoam" foram os mais prevalentes, respectivamente 31,1%, 30,0% e 16,7%. Houve associação dos SIN com as variáveis que compõem o fenótipo de sarcopenia: o escore SARC-F (p=0,002) e FPP (p=0,016), status de sarcopenia (p=0,020), ASG-PPP (p<0,001) e classe econômica (p=0,020). CONCLUSÃO: A identificação de SIN é comum, podendo inferir negativamente no estado nutricional e desempenho funcional dos pacientes. Considerar o uso de protocolos para identificação dos SIN durante a hospitalização a fim de minimizar a repercussão negativa no estado nutricional.

Assessment of the components of sarcopenia and quality of life perceived of individuals on hemodialysis / Evaluación de componentes de sarcopenia y calidad de vida percibida de individuos en hemodiálisis / Avaliação dos componentes da sarcopenia e qualidade de vida percebida de indivíduos em hemodiálise

ABSTRACT Objectives: to evaluate the prevalence of sarcopenia in individuals aged 50 years or older on hemodialysis; to verify the association between sarcopenia and sociodemographic, clinical, anthropometric factors, components of sarcopenia and quality of life (QoL); and to correlate the components of sarcopenia with QoL. Methods: Participated 83 individuals on hemodialysis. Sarcopenia was established according to the current European consensus. Dynamometry to determine strength, calf circumference (CC) and appendicular skeletal muscle mass index (ASMMI) to obtain muscle mass and gait speed (GS) for physical performance. For QoL used the WHOQOL-bref. Results: the prevalence of sarcopenia was 32.6% (CC) and 18.1% (ASMMI). There was no association between sarcopenia and QoL. Both handgrip strength (r=0.25) and GS (r=0.36) showed a correlation with physical domain. Conclusions: sarcopenia was expressive, and the aspects of functionality determine the physical impairment in this population.

RESUMEN Objetivos: evaluar la prevalencia de sarcopenia en individuos de 50 años o más en hemodiálisis, verificar la asociación entre la sarcopenia y factores sociodemográficos, clínicos, antropométricos, componentes de la sarcopenia y la calidad de vida (CV), y para correlacionar los componentes de la sarcopenia con la CV. Métodos: Participaron 83 individuos en hemodiálisis. La sarcopenia se estableció de acuerdo con el consenso europeo vigente. Dinamometría para determinar la fuerza, la circunferencia de la pantorrilla (CP) y el índice de masa muscular esquelética apendicular (IMMEA) para obtener la masa muscular y la velocidad de la marcha (VM) para el rendimiento físico. Para CV el WHOQOL-bref. Resultados: la prevalencia de sarcopenia fue de 32,6% (CP) y 18,1% (IMMEA). No hubo asociación entre sarcopenia y CV. Tanto la fuerza de prensión manual (r=0,25) como la VM (r=0,36) se correlacionaron con el dominio físico. Conclusiones: la sarcopenia fue significativa y los aspectos de funcionalidad, determinan el deterioro físico en esta población.

RESUMO Objetivos: avaliar a prevalência de sarcopenia em indivíduos com 50 anos ou mais em hemodiálise, verificar a associação entre a sarcopenia e os fatores sociodemográficos, clínicos, antropométricos, componentes da sarcopenia e qualidade de vida (QV), e correlacionar os componentes da sarcopenia com a QV. Métodos: Participaram 83 indivíduos em hemodiálise. A sarcopenia foi estabelecida segundo consenso europeu vigente. A dinamometria para determinação da força, a circunferência da panturrilha (CP) e o índice de massa muscular esquelética apendicular (IMMEA) para a obtenção da massa muscular e a velocidade de caminhada (VC) para o desempenho físico. Para QV utilizou-se WHOQOL-bref. Resultados: a prevalência de sarcopenia foi de 32,6% (CP) e 18,1% (IMMEA). Não houve associação entre a sarcopenia e QV. Tanto a força de preensão manual (r=0,25) quanto a VC (r=0,36) apresentaram correlação com domínio físico. Conclusões: a sarcopenia foi expressiva e os aspectos da funcionalidade determinam o comprometimento físico nessa população.

Accuracy of the Global Leadership Initiative on Malnutrition to identify malnutrition in hospitalized patients / Acurácia do Global Leadership Initiative on Malnutrition para identificar a desnutrição em pacientes hospitalizados

ABSTRACT Objective: The Global Leadership Initiative on Malnutrition, introduced as a useful method in the diagnosis of malnutrition, is supported by little evidence in hospitalized individuals. Therefore, we reviewed this method with two objectives: 1) to compare the diagnostic accuracy of the Global Leadership Initiative on Malnutrition criteria with the Patient-Generated Subjective Global Assessment; 2) to determine the prevalence of malnutrition and its associated factors. Methods: Cross-sectional study, conducted with individuals hospitalized between April 2019 and July 2021. Sociodemographic, clinical and anthropometric information was investigated. Global Leadership Initiative on Malnutrition was the index test and Patient-Generated Subjective Global Assessment the standard reference to assess malnutrition. For diagnostic accuracy, measurements of sensitivity, specificity, area under the curve and kappa agreement were considered. Results: A total of 105 individuals participated (age 65.9±9.9 years). The prevalence of malnutrition in the total sample was 48.6% and 67.6% according to the Global Leadership Initiative on Malnutrition and Patient-Generated Subjective Global Assessment criteria, respectively. An association was observed between malnutrition and the variables that stand behind hospitalization, metabolic stress and anthropometric indicators (p<0.05). The comparison showed sensitivity and specificity values for the Global Leadership Initiative on Malnutrition criteria of 67.6% (95% CI: 56.1-77.3) and 91.2% (95% CI: 77.0-96.9) (total sample) and 71.7% (95% CI: 58.4-82.0) and 95.5% (95% CI: 78.2-99.2) (elderly), respectively. An agreement of 49% was observed, raising to 55% when the elderly were assessed separately. Conclusion: The Global Leadership Initiative on Malnutrition criteria presented adequate sensitivity conditions and specificity to diagnose malnutrition, moderate agreement with the reference standard and good applicability in hospitalized patients' clinical practice. Prevalence of malnutrition was high, regardless of the method used, and was associated with the reason for hospitalization, metabolic stress and anthropometric indicators.

RESUMO Objetivo: O Global Leadership Initiative on Malnutrition, apresentado como um método útil no diagnóstico de desnutrição, possui poucas evidências acerca de indivíduos hospitalizados. Portanto, exploramos esse método com dois objetivos: 1) comparar a acurácia diagnóstica dos critérios Global Leadership Initiative on Malnutrition com a Avaliação Subjetiva Global Produzida pelo Paciente; 2) determinar a prevalência de desnutrição e seus fatores associados. Métodos: Estudo transversal, realizado com indivíduos hospitalizados entre abril de 2019 a julho de 2021. Informações sociodemográficas, clínicas e antropométricas foram investigadas. Global Leadership Initiative on Malnutrition foi o index test e Avaliação Subjetiva Global Produzida pelo Paciente a referência padrão para avaliar desnutrição. Para acurácia diagnóstica considerou-se as medições de sensibilidade, especificidade e área sob a curva e concordância kappa. Resultados: Participaram 105 indivíduos (65,9±9,9 anos). A prevalência de desnutrição na amostra total foi de 48,6% e 67,6% de acordo com os critérios Global Leadership Initiative on Malnutrition e Avaliação Subjetiva Global Produzida pelo Paciente, respectivamente. Associações foram encontradas entre desnutrição e as variáveis motivo de internação, estresse metabólico e indicadores antropométricos (p<0,05). A comparação mostrou valores de sensibilidade e especificidade para os critérios Global Leadership Initiative on Malnutrition de 67,6% (IC 95%: 56,1-77,3) e 91,2% (IC 95%: 77,0-96,9) (amostra total) e 71,7% (IC 95%: 58,4-82,0) e 95,5% (IC 95%: 78,2-99,2) (idosos), respectivamente. Observou-se concordância de 49,0%, sendo 55,0% quando os idosos foram analisados separadamente. Conclusão: Os critérios Global Leadership Initiative on Malnutrition apresentaram condições adequadas de sensibilidade e especificidade para diagnosticar desnutrição, concordância moderada com o padrão de referência e boa aplicabilidade na prática clínica em hospitalizados. A prevalência de desnutrição foi elevada, independentemente do método utilizado, e apresentou relação com o motivo de internação, estresse metabólico e indicadores antropométricos.

Micronutrient supplementation in gastric bypass surgery: prospective study on inflammation and iron metabolism in premenopausal women.

BACKGROUND: Low-grade chronic inflammation in morbid obesity is associated with impaired iron metabolism. Bariatric surgery is effective in weight loss; however, it can induce specific nutritional deficiencies, such as iron, especially in premenopausal women. Alternatively, after surgery, there is an improvement in systemic inflammation, raising questions concerning the dosages of micronutrient supplementation. OBJECTIVES: This study aimed to assess the effect of two micronutrient supplementation schemes before and 6 months after a Roux-en-Y gastric bypass (RYGB) surgery on inflammation and iron metabolism in premenopausal women. METHODS: This prospective study included 45 premenopausal women (aged 20-45 years; body mass index [BMI] ≥ 35 kg/m2) divided into two supplementation schemes: group 1 (n = 34): daily supplemental dose of 1 RDA 30 days before surgery and 2 RDAs during the six months following surgery; and group 2 (n = 11): daily supplementation of 1 RDA during the 6 months postsurgery. Anthropometry, dietary intake, inflammation, and iron metabolism were monitored. RESULTS: Evident reductions in BMI, high-sensitivity C-reactive protein, and ferritin levels for both groups occurred 6 months after surgery. Additionally, anemia was 9% in both groups after surgery. However, group 1 exhibited an increased transferrin saturation index and reduced transferrin levels. Multivariate regression analysis suggested serum iron, hepcidin, and iron intake determined ferritin values before and after RYGB surgery. CONCLUSION: Six months after RYGB, systemic inflammation was reduced in both supplementation schemes. However, supplementation of 1 RDA before and 2 RDAs after surgery resulted in better improvements on iron metabolism.

Micronutrient supplementation in gastric bypass surgery: prospective study on inflammation and iron metabolism in premenopausal women / Suplementación con micronutrientes en pacientes con cirugía de bypass gástrico: estudio prospectivo sobre la inflamación y el metabolismo del hierro en mujeres premenopáusicas

Background: Low-grade chronic inflammation in morbid obesity is associated with impaired iron metabolism. Bariatric surgery is effective in weight loss; however, it can induce specific nutritional deficiencies, such as iron, especially in premenopausal women. Alternatively, after surgery, there is an improvement in systemic inflammation, raising questions concerning the dosages of micronutrient supplementation. Objectives: This study aimed to assess the effect of two micronutrient supplementation schemes before and 6 months after a Roux-en-Y gastric bypass (RYGB) surgery on inflammation and iron metabolism in premenopausal women. Methods: This prospective study included 45 premenopausal women (aged 20-45 years; body mass index [BMI] ≥ 35 kg/m2) divided into two supplementation schemes: group 1 (n = 34): daily supplemental dose of 1 RDA 30 days before surgery and 2 RDAs during the six months following surgery; and group 2 (n = 11): daily supplementation of 1 RDA during the 6 months postsurgery. Anthropometry, dietary intake, inflammation, and iron metabolism were monitored. Results: Evident reductions in BMI, high-sensitivity C-reactive protein, and ferritin levels for both groups occurred 6 months after surgery. Additionally, anemia was 9% in both groups after surgery. However, group 1 exhibited an increased transferrin saturation index and reduced transferrin levels. Multivariate regression analysis suggested serum iron, hepcidin, and iron intake determined ferritin values before and after RYGB surgery. Conclusion: Six months after RYGB, systemic inflammation was reduced in both supplementation schemes. However, supplementation of 1 RDA before and 2 RDAs after surgery resulted in better improvements on iron metabolism (AU)

Introducción: la inflamación crónica de bajo grado en la obesidad mórbida se asocia con una alteración del metabolismo del hierro. La cirugía bariátrica es eficaz en la pérdida de peso, sin embargo, puede inducir deficiencias específicas nutricionales, como es el caso del hierro, especialmente en las mujeres premenopáusicas. Por otra parte, después de la cirugía, hay una mejora en la inflamación sistémica, planteando el tema de las dosis de suplementos de micronutrientes. Objetivos: este estudio tuvo como objetivo evaluar el efecto de dos esquemas de suplementación de micronutrientes antes y 6 meses después de una cirugía de by-pass gástrico con Y de Roux (RYGB) sobre la inflamación y el metabolismo del hierro en las mujeres premenopáusicas. Métodos: estudio prospectivo que incluyó 45 mujeres premenopáusicas (edades 20-40 años, índice de masa corporal [IMC] ≥ 35 kg/m2) divididos en dos esquemas de suplementación: grupo 1 (n = 34): dosis suplementaria diaria de 1 vez las RDA 30 días antes de la cirugía y 2 veces las RDA durante los seis meses posteriores a la cirugía; y el grupo 2 (n = 11): la suplementación diaria de 1RDA durante los 6 meses después de la cirugía. Se monitorizaron las medidas antropométricas, la ingesta alimentaria, la inflamación y el metabolismo del hierro. Resultados: se observó una disminución en el IMC, la proteína C reactiva de alta sensibilidad y los niveles de ferritina en ambos grupos después de 6 meses tras la cirugía. Además, la anemia fue del 9% en ambos grupos tras de la cirugía. Sin embargo, el grupo 1 exhibió un incremento del índice de saturación de transferrina y una reducción en los niveles de transferrina. En el análisis multivariante se apreció que los niveles de hierro sérico, hepcidina y la ingesta de hierro determinaron los valores de ferritina antes y después de la cirugía. Conclusión: seis meses después de RYGB, la inflamación sistémica se redujo en ambos esquemas de suplementación. Sin embargo, la suplementación de 1 vez las RDA antes y 2 veces las RDA después de la cirugía consiguió mejorar el metabolismo del hierro (AU)

Ferritin in hypertensive and diabetic women before and after bariatric surgery / La ferritina en mujeres hipertensas y diabéticas antes y después de la cirugía bariátrica

In addition to its important role as marker of iron stores, serum ferritin is a marker of systemic inflammation, and obesity has been associated with chronic inflammation. Objective: To verify, six months after surgery, the effect of bariatric surgery on the serum ferritin of women who were hypertensive, diabetic, or comorbidity free before surgery. Sample and methods: This retrospective study included 200 women aged 20 to 45 years, with a body mass index (BMI) equal to or greater than 35 kg/m2, submitted to Roux-en-Y gastric bypass (RYGB). Seventy of these women were hypertensive, forty had type 2 diabetes (T2D), and ninety were comorbidity free (CF). They were assessed before and six months after surgery. Anthropometric, laboratory (serum ferritin and hemoglobin), and comorbidity- related data were collected from their medical records. Results: Before surgery, women with comorbidities were older, the hypertensives had higher BMI, and the diabetics had higher serum ferritin levels than the CF women. The study comorbidities had resolved in 68% of the hypertensive women and 86% of the diabetic women six months after RYGB. Also at this time, the serum ferritin of hypertensive women decreased from 110.1±86.3 to 88.7±80.5 ng/dL and of diabetic women, from 164.8±133.4 to 101.2±97.7 ng/dL (p<0.05); hemoglobin also decreased in hypertensive and CF women (p>0.05). Conclusion: High ferritin in premenopausal obese women was associated with the main obesity-related comorbidities, and these comorbidities determined the reduction of serum ferritin after bariatric surgery (AU)

Además de importante marcador de las reservas de hierro, la ferritina sérica es un marcador de la inflamación sistémica, mientras que la obesidad se ha asociado con la inflamación crónica. Objetivo: Identificar, después de 6 meses, el efecto de la cirugía bariátrica sobre los niveles de ferritina sérica en hipertensos, diabéticos o sin estas comorbilidades preoperatorias mujeres. Pacientes y métodos: Los autores realizaron un estudio retrospectivo de 200 mujeres sometidas a bypass gástrico en Y de Roux (BGYR), con edades comprendidas entre 20 y 45 años, con un índice de masa corporal (IMC) superiora 35 kg/m2, con hipertensión arterial (HA, n = 70), ladiabetes mellitus tipo 2 (DM2, n = 40) y sin comorbilidades(SC, n = 90) fueron evaluados antes y 6 meses después de BGYR. Antropométricas, de laboratorio (ferritina sérica y hemoglobina) y la información de comorbilidad se recogió de la historia clínica electrónica. Resultados: Antes de la cirugía, las mujeres con comorbilidades eran mayores, tenían mayores hipertensos IMC, niveles más altos de ferritina diabéticos en relación con el grupo SC. La resolución de las comorbilidades después de 6 meses de DGYR ocurrió en el 68 % de las mujeres con hipertensión y el 86 % de los diabéticos. 6 meses después de la cirugía, se observó una disminución de la ferritina sérica en mujeres con comorbilidades de 110,1 ± 86,3 a 88,7 ± 80,5 ng/dl en el grupo con hipertensión y 164,8 ± 133,4 a 101 2 ± 97,7 ng/dl en DM2 (p < 0,05) y la hemoglobina, excepto en los pacientes diabéticos (p > 0,05). Conclusión: El aumento de la ferritina en mujeres obesas en el periodo de premenopausia se relacionan con lasprincipales comorbilidades de la obesidad, y la presencia de estas comorbilidades fue fundamental en la reducción de la ferritina sérica después de la cirugía bariátrica (AU)

Ferritin in hypertensive and diabetic women before and after bariatric surgery.

UNLABELLED: In addition to its important role as marker of iron stores, serum ferritin is a marker of systemic inflammation, and obesity has been associated with chronic inflammation. OBJECTIVE: To verify, six months after surgery, the effect of bariatric surgery on the serum ferritin of women who were hypertensive, diabetic, or comorbidity free before surgery. SAMPLE AND METHODS: This retrospective study included 200 women aged 20 to 45 years, with a body mass index (BMI) equal to or greater than 35 kg/m2, submitted to Roux-en-Y gastric bypass (RYGB). Seventy of these women were hypertensive, forty had type 2 diabetes (T2D), and ninety were comorbidity free (CF). They were assessed before and six months after surgery. Anthropometric, laboratory (serum ferritin and hemoglobin), and comorbidity- related data were collected from their medical records. RESULTS: Before surgery, women with comorbidities were older, the hypertensives had higher BMI, and the diabetics had higher serum ferritin levels than the CF women. The study comorbidities had resolved in 68% of the hypertensive women and 86% of the diabetic women six months after RYGB. Also at this time, the serum ferritin of hypertensive women decreased from 110.1±86.3 to 88.7±80.5 ng/dL and of diabetic women, from 164.8±133.4 to 101.2±97.7 ng/dL (p0.05). CONCLUSION: High ferritin in premenopausal obese women was associated with the main obesity-related comorbidities, and these comorbidities determined the reduction of serum ferritin after bariatric surgery.

Además de importante marcador de las reservas de hierro, la ferritina sérica es un marcador de la inflamación sistémica, mientras que la obesidad se ha asociado con la inflamación crónica. Objetivo: Identificar, después de 6 meses, el efecto de la cirugía bariátrica sobre los niveles de ferritina sérica en hipertensos, diabéticos o sin estas comorbilidades preoperatorias mujeres. Pacientes y métodos: Los autores realizaron un estudio retrospectivo de 200 mujeres sometidas a bypass gástrico en Y de Roux (BGYR), con edades comprendidas entre 20 y 45 años, con un índice de masa corporal (IMC) superior a 35 kg/m2, con hipertensión arterial (HA, n = 70), la diabetes mellitus tipo 2 (DM2, n = 40) y sin comorbilidades (SC, n = 90) fueron evaluados antes y 6 meses después de BGYR. Antropométricas, de laboratorio (ferritina sérica y hemoglobina) y la información de comorbilidad se recogió de la historia clínica electrónica. Resultados: Antes de la cirugía, las mujeres con comorbilidades eran mayores, tenían mayores hipertensos IMC, niveles más altos de ferritina diabéticos en relación con el grupo SC. La resolución de las comorbilidades después de 6 meses de DGYR ocurrió en el 68 % de las mujeres con hipertensión y el 86 % de los diabéticos. 6 meses después de la cirugía, se observó una disminución de la ferritina sérica en mujeres con comorbilidades de 110,1 ± 86,3 a 88,7 ± 80,5 ng/dl en el grupo con hipertensión y 164,8 ± 133,4 a 101 2 ± 97,7 ng/dl en DM2 (p < 0,05) y la hemoglobina, excepto en los pacientes diabéticos (p > 0,05). Conclusión: El aumento de la ferritina en mujeres obesas en el periodo de premenopausia se relacionan con las principales comorbilidades de la obesidad, y la presencia de estas comorbilidades fue fundamental en la reducción de la ferritina sérica después de la cirugía bariátrica.

Food intake in women two years or more after bariatric surgery meets adequate intake requirements.

Restricted food intake after bariatric surgery can be an important factor both in the long-term control of body weight and in the onset of nutritional deficiencies. The objective of this study was to assess the adequacy of food intake in women two or more years after bariatric surgery according to the excess weight lost. A group of 141 women who underwent banded Roux-en-Y gastric bypass (RYGB) was divided according to the percentage of excess weight they lost (%EWL)<50; 50┤75; = 75. The habitual energy and nutrient intakes were determined by a 24-hour recall over two days and the probability of adequate intake was based on the Dietary Reference Intake. The mean total estimated energy requirement (EER) as well as energy, macronutrient and cholesterol intakes did not differ among the groups. Only the %EWL<50 group had an intake equal to their EER, but they presented a higher number of inadequacies, such as low levels of magnesium, folic acid and vitamins C and E. Calcium and dietary fiber intakes were extremely low in all three groups. In conclusion, weight loss after surgery is associated with food habits that favor energy intake over micronutrient intake.

Grade of esophageal cancer and nutritional status impact on postsurgery outcomes / Impacto do estágio do câncer de esôfago e do estado nutricional sobre os desfechos pós-operatórios

CONTEXT: Undernutrition is a well known underlying cause in both disease onset and outcome. OBJECTIVE: To associate disease severity with pre surgical nutritional status, the main postsurgical complications, and mortality in esophagus cancer patients. METHOD: Retrospective data from 100 patients (38-81 years old, 85 percent males) who had undergone esophagectomy (G1/n = 25) or gastro/jejunostomy (G2/n = 75) between 1995 and 2004. Data included clinical, endoscopic, histological (TNM-UICC), dietary, anthropometric, blood chemistry, and postsurgical (>30 days) complications and mortality. Surgical groups were compared by Student's test and existing associations between variables by either c² or Fisher exact tests with P = 0.05. RESULTS: The studied sample was predominantly male (85 percent), white (80 percent), smokers and alcoholics (95 percent), dysphagics (95 percent) mostly presenting body weight loss before cancer diagnosis (78 percent). TNM III and IV predominated over I and II, associated (P<0.005) with higher body mass index and hypoalbuminemia (<3.5 mg/dL) frequency. Esophagic obstructions (n = 77) were associated (P = 0.002) with lower body mass index (kg/m²). Postsurgical complications were more common in G1 (69.2 percent) than G2, predominantly with infections in G2 (80 percent) and pleura-pulmonary in G1 (61 percent). Body mass index and lower lymphocyte counts were associated with early infections and postsurgical complications in G2. Plasma albumin levels were lower in this group than G1, and were associated with postsurgical complications and mortality whereas lower lymphocyte counts was associated with mortality in G1. CONCLUSIONS: Disease severity (or late diagnosis) is associated with poor nutritional status and palliative surgery which lead to more complicated postsurgery outcome and mortality. Early diagnosis and nutritional intervention are the recommended actions.

CONTEXTO: A desnutrição protéico-energética constitui causa previsível para o desenvolvimento de complicações pós-operatórias e pior prognóstico de pacientes cirúrgicos. OBJETIVO: Estudar a associação de indicadores de estado nutricional com estádio da doença e as principais complicações e mortalidade pós-operatória de pacientes com câncer de esôfago. MÉTODO: Foram avaliados retrospectivamente 100 prontuários de pacientes com câncer de esôfago (38-81 anos) de ambos os sexos (85 por cento masculino e 15 por cento feminino) submetidos a esofagectomia (n = 25) e gastrojejunostomia (n = 75), no período de 1995 a 2004. Os dados coletados foram: história clínica, exame endoscópico, estádio (TNM-UICC), estado nutricional (índice de massa corporal, percentual de perda de peso - por centoPP, albuminemia e contagem de linfócitos total) e evolução clínica pós-operatória. Houve composição dos grupos de acordo com o porte da cirurgia (grande x pequeno). Foi realizada a associação entre as complicações pós-operatórias e a mortalidade (após pós-operatório de 30 dias). As comparações entre médias dos dois grupos foram feitas pelo teste t de Student e a existência de associações entre variáveis testadas pelos testes de χ2 ou exato de Fisher com P = 0,05. RESULTADOS: Houve predomínio dos tumores avançados (estádio III e IV), com a presença de disfagia em 95 por cento dos pacientes e perda ponderal >10 por cento, anterior ao diagnóstico, em 78 por cento. A obstrução esofágica, presente em 77 pacientes, foi associada (P = 0,0021) com o baixo índice de massa corporal (desnutrição protéico-energética). A por centoPP e a hipoalbuminemia associaram-se estatisticamente (P<0,05) com o estádio avançado da doença. As complicações pós-operatórias precoces ocorreram em 69,2 por cento e 30,7 por cento dos pacientes submetidos a esofagectomia e ostomias, respectivamente, com predomínio das infecciosas nas ostomias (80 por cento) e as pleuropulmonares nas esofagectomias (61 por cento). A albuminemia foi menor nos pacientes submetidos as ostomias, tendo sido a hipoalbuminemia associada (P<0,05) com a ocorrência de complicações pós-operatórias e mortalidade. A por centoPP e a contagem de linfócitos total associaram-se com as complicações pós-operatórias precoces e infeccionas nas ostomias e a contagem de linfócitos total, com a mortalidade operatória nas esofagectomias. CONCLUSÕES: O estado de DPE esteve associado às complicações pós-operatórias apenas nos pacientes submetidos a ostomias, sem presença destas associações nas esofagectomias.

Grade of esophageal cancer and nutritional status impact on postsurgery outcomes.

CONTEXT: Undernutrition is a well known underlying cause in both disease onset and outcome. OBJECTIVE: To associate disease severity with pre surgical nutritional status, the main postsurgical complications, and mortality in esophagus cancer patients. METHOD: Retrospective data from 100 patients (38-81 years old, 85% males) who had undergone esophagectomy (G1/n = 25) or gastro/jejunostomy (G2/n = 75) between 1995 and 2004. Data included clinical, endoscopic, histological (TNM-UICC), dietary, anthropometric, blood chemistry, and postsurgical (>30 days) complications and mortality. Surgical groups were compared by Student's test and existing associations between variables by either c² or Fisher exact tests with P = 0.05. RESULTS: The studied sample was predominantly male (85%), white (80%), smokers and alcoholics (95%), dysphagics (95%) mostly presenting body weight loss before cancer diagnosis (78%). TNM III and IV predominated over I and II, associated (P≤0.005) with higher body mass index and hypoalbuminemia (<3.5 mg/dL) frequency. Esophagic obstructions (n = 77) were associated (P = 0.002) with lower body mass index (kg/m²). Postsurgical complications were more common in G1 (69.2%) than G2, predominantly with infections in G2 (80%) and pleura-pulmonary in G1 (61%). Body mass index and lower lymphocyte counts were associated with early infections and postsurgical complications in G2. Plasma albumin levels were lower in this group than G1, and were associated with postsurgical complications and mortality whereas lower lymphocyte counts was associated with mortality in G1. CONCLUSIONS: Disease severity (or late diagnosis) is associated with poor nutritional status and palliative surgery which lead to more complicated postsurgery outcome and mortality. Early diagnosis and nutritional intervention are the recommended actions.

Alergia ao látex e a frutas em profissionais da área da saúde / Latex and fruit allergy in health care workers

INTRODUÇÃO: A alergia ao látex tornou-se um risco crescente aos indivíduos expostos, como os profissionais da área da saúde, tendo como agravo a associação com hipersensibilidade a vários alimentos, especialmente frutas. OBJETIVO: Avaliar a freqüência de sensibilização ao látex e a frutas em profissionais da área da saúde. MÉTODOS: Foram avaliados 53 profissionais da saúde, 81,9 por cento do sexo feminino, aplicando-se questionário alergológico e testes cutâneos por puntura para alérgenos inaláveis, do látex e de frutas (mamão papaia, kiwi, abacate, banana, figo, tomate, noz). RESULTADOS: Dos 53 indivíduos estudados, 15 (28,5 por cento) eram alérgicos ao látex. A sensibilidade a frutas foi diagnosticada em 14 (26,4 por cento), dos quais 10 (18,8 por cento) apresentavam teste por puntura positivo para o látex; as frutas alergênicas mais freqüentes foram papaia (80,0 por cento), kiwi (60,0 por cento) e abacate (50,0 por cento). CONCLUSÃO: Estes achados demonstram a existência da alergia látex-fruta, como descrito na literatura, sendo de suma importância uma avaliação in vivo em profissionais da área de saúde, caracterizados como potencial grupo de risco.

Alergia látex-fruta / Latex-fruit allergy

O látex está sendo considerado o alergênico do ano 2000, tendo em vista que inúmeros indivíduos, principalmente profissionais da área de saúde e pacientes submetidos a várias intervenções diagnósticas e terapêuticas, estão freqüentemente expostos aos alérgenos do látex, presentes em produtos de borracha natural. As manifestações clínicas conseqüentes às reações alérgicas de hipersensibilidade imediata vão desde rinite, urticária, conjuntivite, angioedema, asma, até anafilaxia. Estudos recentes estão demonstrando que pacientes alérgicos ao látex desenvolvem concomitantemente sensibilização a certos alimentos de origem vegetal, especialmente frutas como papaia, figo, banana, abacate, kiwi, pêssego, abacaxi, melão e castanha, acreditando-se numa provável ocorrência de reações cruzadas entre os alérgenos do látex e destas frutas. Faz-se, então, uma revisão sobre a alergia ao látex, em particular sobre os grupos de risco, incluindo a presença de reatividade cruzada entre o látex e as frutas.