An adapted cardioprotective diet with or without phytosterol and/or krill oil supplement in familial hypercholesterolemia: A pilot study protocol

BACKGROUND AND AIMS: A healthy diet is one of the pillars of familial hypercholesterolemia (FH) treatment. However, the best dietary pattern and indication for specific supplementation have not been established. Our aim is to conduct a pilot study to assess the effect of an adapted cardioprotective diet with or without phytosterol and/or krill oil supplement in participants with a probable or definitive diagnosis of FH, treated with moderate/high potency statins. METHODS: A national, multicenter, factorial, and parallel placebocontrolled randomized clinical trial with a superiority design and 1:1:1:1 allocation rate will be conducted. The participants will undergo whole exome sequencing and be allocated into four treatment groups: 1) a cardioprotective diet adapted for FH (DICAFH) þ phytosterol placebo þ krill oil placebo; 2) DICA-FH þ phytosterol 2 g/day þ krill oil placebo; 3) DICA-FH þ phytosterol placebo þ krill oil 2 g/day; or 4) DICA-FH þ phytosterol 2 g/day þ krill oil 2 g/day. The primary outcomes will be low-density lipoprotein (LDL)-cholesterol and lipoprotein (a) levels and adherence to treatment after a 120-day follow-up. LDL- and high-density lipoprotein (HDL)-cholesterol subclasses, untargeted lipidomics analysis, adverse events, and protocol implementation components will also be assessed. RESULTS: A total of 58 participants were enrolled between May e August 2023. After the end of the follow-up period, the efficacy and feasibility results of this pilot study will form the basis of the design of a large-scale randomized clinical trial. CONCLUSIONS: This study's overall goal is to recommend dietary treatment strategies in the context of FH.

Oral contraceptives in adolescents: a retrospective population-based study on blood pressure and metabolic dysregulation.

PURPOSE: This study aimed to explore the relationship between oral contraceptive use and blood pressure values and in a national cohort of women adolescents and to investigate the level of coexistence of the high blood pressure levels, dyslipidemia or insulin resistance. METHODS: This is a retrospective cohort study that evaluated data form 14,299 adolescents aged 14 to 17 years. Crude and race-and age-adjusted analyses were performed using Poisson regression to estimate the prevalence ratios. Data clustering analysis was performed using machine learning approaches supported by an unsupervised neural network of self-organizing maps. RESULTS: We found that 14.5% (n = 2076) of the women adolescents use oral contraceptives. Moreover, an increased prevalence of high blood pressure, dyslipidemia, and insulin resistance (all P < 0.001) was observed among adolescents who use oral contraceptives as compared to those who do not. Our analysis also showed that 2.3% of adolescents using oral contraceptives had both high blood pressure levels and dyslipidemia, whereas 3.2% had high blood pressure levels combined with insulin resistance (all P < 0.001). The algorithmic investigative approach demonstrated that total cholesterol, LDLc, HDLc, insulin, and HOMA-IR were the most predicted variables to assist classificatory association in the context of oral contraceptive use among women adolescents with high blood pressure. CONCLUSIONS: These findings suggest that oral contraceptives were associated with an increased prevalence of high blood pressure, dyslipidemia, and insulin resistance among women adolescents. Although the indication of this therapy is adequate to avoid unintended pregnancies, their use must be based on rigorous individual evaluation and under constant control of the cardiometabolic risk factors.

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

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

Efeitos da orientação nutricional na performance e no controle glicêmico de maratonista com diabetes mellitus tipo 2 em insulinoterapia - relato de caso / Effects of nutritional counseling on performance and glycemic control of marathon runners with type 2 diabetes mellitus undergoing insulin therapy - case report

INTRODUÇÃO: A atividade física regular pode promover mudanças fisiológicas benéficas ao indivíduo com Diabetes Mellitus tipo 2 (DM2), isso por que, imediatamente após o exercício, há maior transporte de glicose no músculo esquelético por translocação do GLUT4 para a superfície da célula por mecanismos independentes de insulina. Assim, faz-se necessário, um controle eficiente da oferta de carboidratos, condizente ao nível de treinamento, principalmente entre esportistas com DM2 em insulinoterapia. OBJETIVO: Avaliar os efeitos da orientação nutricional, oferecendo suporte calórico e proteico, adequado à prática de exercício físico intenso, de paciente com DM2 em insulinoterapia. METODOLOGIA: Paciente do sexo masculino, 51 anos, com DM2 há 23 anos, praticante de corrida, deficiente visual devido descolamento da retina, eutrófico segundo o índice de massa corporal (IMC), sem risco de doenças cardiovasculares de acordo com circunferência abdominal e com bom condicionamento físico segundo o percentual de gordura corporal (17,76% de gordura corporal). Realizou quatro consultas, em perído preparatório para maratona, com prescrição dietética de 3000 kcal/dia com suplementação de módulo de carboidrato, e 2100 kcal/dia para dias de descanso. Em todos os retornos foi solicitado o preenchimento do controle glicêmico (glicemia capilar pré e pós prandial de café da manhã, almoço e jantar, e antes, durante e após o treino). RESULTADOS: Na primeira consulta, foi observado que o paciente apresentava quadros de hiperglicemia ao acordar (176 mg/dl) e hipoglicemia após o exercício (32 mg/dl), além do consumo excessivo de doces, carnes salgadas e gordurosas. Após orientação nutricional, observou-se melhora do controle glicêmico, do padrão alimentar e relato de melhora do rendimento nos treinos. Na data da prova de 21km, apresentou controles glicêmicos melhores, ao acordar (144 mg/dl), antes de iniciar a prova (192 mg/dl), com 60 minutos de prova (140 mg/dl) e ao término do exercício (103 mg/dl). CONCLUSÃO: Durante as consultas realizadas o paciente, apresentou adesão as orientações nutricionais, que, aliados ao monitoramento glicêmico adequado, proporcionou resultados satisfatórios, colaborando com a performance e contribuindo com a saúde do paciente.

Atrial Fibrillation and Use of Rivaroxaban: Performance of the Prothrombin Time / INR as a Function of Time After Blood Collection

Abstract Background Traditionally, the most effective therapy in the prevention of stroke in patients with atrial fibrillation (AF) has been oral anticoagulation with vitamin K inhibitors, particularly warfarin, whose disadvantages and adverse effects have led to their replacement by "direct oral anticoagulants", as factor X inhibitor. Objectives This study aimed to conduct a brief approach on atrial fibrillation (AF) and use of Rivaroxaban, and to comparatively evaluate the prothrombin time / International Normalized Ratio (PT/INR) in patients with AF in use of this oral anticoagulant, depending on the time elapsed between the last administration of the drug and the time of blood sample venipuncture. Methods We evaluated 34 patients with AF in use of Rivaroxaban by using PT / INR, distributed into a subgroup with blood collection time ≤ 12 hours (n = 7) and > 12 hours after the last drug intake (n = 27). Mann-Whitney test was used to compare the groups and p < 0.05 was considered significant. Results An analysis as a function of time between the Rivaroxaban intake and blood collection, revealed that PT / INR suffers the greatest effect up to 12 hours after ingestion of the drug, dropping to levels close to normal in subsequent hours before the next dose. Conclusion We concluded that, in contrast to warfarin, the knowledge of the time interval between drug intake and blood collection from patients taking Rivaroxaban is essential to properly interpret a laboratory test to assess hemostasis, particularly PT and its derivatives. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Comportamento alimentar em obesos e sua correlação com o tratamento nutricional / Eating behavior in obesity and its correlation with nutritional treatment

RESUMO Objetivo Avaliar os tipos de comportamentos alimentares em indivíduos com obesidade e correlacionar com a adesão ao tratamento proposto. Métodos Estudo transversal desenvolvido em instituição de cardiologia em indivíduos com obesidade. Os tipos de comportamentos alimentares foram analisados pela escala The Three Factor Eating Questionnaire - R21 (TFEQ-21) - versão traduzida e adaptada para brasileiros. Nela são abordadas três subescalas: restrição cognitiva (RC), alimentação emocional (AE) e descontrole alimentar (DA). A adesão ao tratamento nutricional foi verificada pelo instrumento desenvolvido pela instituição, baseado nas principais diretrizes de doenças crônicas. Resultados Analisaram-se 100 indivíduos, com maior prevalência do sexo feminino (68%). Em relação à adesão, somente 25% apresentam boa aderência (escore > 60%). Foi possível identificar a relação entre o IMC e a RC; quanto maior o IMC, menor foi a intensidade da RC (p = 0,02). Observou-se correlação positiva entre a RC e adesão ao consumo de gorduras (p = 0,02) e fibra alimentar (p = 0,004). A subescala AE apresentou correlação negativa com a adesão ao consumo de gorduras (p = 0,03) e correlação positiva com a DA (p < 0,01). Conclusões O tipo de comportamento alimentar mais frequente na amostra foi a restrição cognitiva, que não foi correlacionada com o escore total de adesão. A AE foi associada com maior consumo de gorduras, similar ao encontrado em estudos nacionais e internacionais. Nota-se uma lacuna de estudos que relacionam o comportamento alimentar com a adesão ao tratamento nutricional.

ABSTRACT Objective To analyze the types of eating behavior in individuals with obesity and correlated with adherence to the adopted treatment. Methods Cross-sectional study developed at the institution of cardiology in individuals with obesity. The types of eating behavior were analyzed using the scale The Three-Factor Eating Questionnaire - R21 (TFEQ-21) - translated and adapted for Brazilians. Three subscales are addressed: cognitive restriction (CR), emotional eating (EE), and uncontrolled eating (UE). Adherence to nutritional treatment was verified by the instrument developed by the institution, based on the main guidelines for chronic diseases. Results We analyzed 100 individuals, with a higher prevalence of females (68%). Regarding adherence, only 25% have good adherence (score > 60%). It was possible to identify the relationship between the BMI and the CR, the higher or lower the BMI was the intensity of the CR (p = 0.02) There was a positive correlation between CR and adherence to fat (p = 0.02) and dietary fiber (p = 0.004). The EE subscale showed a negative correlation with adherence to fat consumption (p = 0.03) and a positive correlation with UE (p < 0.01). Conclusions The most frequent type of eating behavior in the sample was cognitive restriction and was not correlated with the total adherence score. AE was associated with greater consumption of fats, like national and international studies. There is a gap in studies that relate to eating behavior with adherence to nutritional treatment.

Adesão ao tratamento de obesidade em um ambulatório de cardiologia do Estado de São Paulo / Adherence to obesity treatment in a cardiology clinic in the State of São Paulo

INTRODUÇÃO: Assim como as demais doenças crônicas, a obesidade, exige do paciente mudanças no estilo de vida para evitar sua progressão. A não adesão às recomendações mostra-se um problema para todos os profissionais de saúde, uma vez que para se obter sucesso no tratamento é importante que o paciente seja aderente às orientações. Considerando a escassez de estudos que avaliem a adesão aos tratamentos de obesidade, o presente trabalho buscou auxiliar no entendimento dessa temática. O OBJETIVO foi avaliar a adesão dos pacientes com obesidade ao tratamento nutricional proposto em um ambulatório de nutrição especializado em cardiologia. MÉTODOS: A amostra foi composta por 101 indivíduos, homens e mulheres, adultos e idosos de 25-84 anos, atendidos em ao menos quatro consultas na especialidade de obesidade e síndrome metabólica do ambulatório de nutrição. A adesão ao tratamento foi mensurada através de instrumento elaborado pela equipe do ambulatório de nutrição, contendo metas globais organizadas em: peso, circunferência abdominal (CA), atividade física, dieta, açúcar, sódio, gorduras saturadas/trans, fibras e proteínas. Análise Estatística: Trata-se de um estudo descritivo, observacional com a utilização de medidas de tendência central (média) e de variabilidade (desvio padrão). RESULTADOS: Considerando a média dos quatro atendimentos, a adesão às metas globais, em ordem decrescente foram: consumo de sódio (75%), gorduras saturadas/trans (65,64%), açúcar (60%), proteína (56%), dieta (49,01%), perda de peso (46,78%), fibras (43,66%), redução de CA (38,61%) e atividade física (22,44%) com menor percentual de adesão. A expectativa é de que a média de adesão total seja de no mínimo 60% para um bom resultado. A adesão total foi calculada somando-se as metas globais e dividindo pelo número de metas. A média de adesão total do primeiro ao quarto atendimento foram: 45,09%, 46,24%, 47,09% e 43,04%, respectivamente. CONCLUSÃO: O presente trabalho mostrou um baixo percentual de adesão ao modelo de acompanhamento proposto. As inúmeras variáveis relacionadas à adesão do tratamento demonstram que para a melhoria das medidas antropométricas e diminuição do risco cardiovascular é necessário um grande esforço dos nutricionistas e dos demais profissionais de saúde para a educação nutricional da população, enfatizando a importância do autocuidado e desta forma, reduzindo a progressão e/ou surgimento de doenças crônicas como a obesidade.

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial.

BACKGROUND: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. METHODS: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. RESULTS: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ±â€¯8.4 vs 24.7 ±â€¯8.6, P < .01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P = .15). Secondary end points did not differ between groups after follow-up. CONCLUSIONS: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death.

O papel da proteína como estratégia dietética no tratamento da obesidade / The role of protein as a dietary strategy in the treatment of obesity

A etiologia da obesidade é complexa e multifatorial, ocasionada pela comunicação de genes, ambiente, estilo de vida e fatores emocionais. As dietas para emagrecimento e suas proporções de macronutrientes são bastante discutidas. Alguns estudos evidenciam que dietas hiperproteicas auxiliam a perda de peso e de gordura corporal e diminuem a perda de massa corporal magra durante o emagrecimento...

Human management and hybridization shape treegourd fruits in the Brazilian Amazon Basin.

Local people's perceptions of cultivated and wild agrobiodiversity, as well as their management of hybridization are still understudied in Amazonia. Here we analyze domesticated treegourd (Crescentia cujete), whose versatile fruits have technological, symbolic, and medicinal uses. A wild relative (C. amazonica) of the cultivated species grows spontaneously in Amazonian flooded forests. We demonstrated, using whole chloroplast sequences and nuclear microsatellites, that the two species are strongly differentiated. Nonetheless, they hybridize readily throughout Amazonia and the proportions of admixture correlate with fruit size variation of cultivated trees. New morphotypes arise from hybridization, which are recognized by people and named as local varieties. Small hybrid fruits are used to make the important symbolic rattle (maracá), suggesting that management of hybrid trees is an ancient human practice in Amazonia. Effective conservation of Amazonian agrobiodiversity needs to incorporate this interaction between wild and cultivated populations that is managed by smallholder families. Beyond treegourd, our study clearly shows that hybridization plays an important role in tree crop phenotypic diversification and that the integration of molecular analyses and farmers' perceptions of diversity help disentangle crop domestication history.

Unsaturated Fatty Acids Improve Atherosclerosis Markers in Obese and Overweight Non-diabetic Elderly Patients.

BACKGROUND: Several studies have demonstrated the benefits of replacing trans and saturated fats with unsaturated fatty acids on cardiovascular diseases. We aimed to demonstrate the effect of polyunsaturated and monounsaturated fat supplementation on the biochemical and endothelial markers of atherosclerotic disease in obese or overweight non-diabetic elderly patients. METHOD: Seventy-nine patients were randomly divided into three groups: flaxseed oil, olive oil, and sunflower oil; patients in each group received 30 mL of oil for 90 days. Patients were subjected to anthropometric and bioimpedance assessments; biochemical and endothelial evaluations were performed through ultrasonography of the brachial artery and carotid artery for endothelium-dependent dilation and intima-media thickness assessment, respectively, before and after the intervention. The participants' usual diet remained unchanged. RESULTS: The flaxseed oil group had improved ultra-sensitive C-reactive protein levels (p = 0.074) and reduced carotid intima-media thickness (CIMT) (p = 0.028); the olive oil group exhibited an improved apolipoprotein (Apo)B/ApoA ratio (p = 0.021), reduced CIMT (p = 0.028), and improved flow-mediated vasodilation (FMV) (p = 0.054); and similarly, the sunflower oil group showed an improved ApoB/ApoA ratio (p = 0.024), reduced CIMT (p = 0.048), and improved FMV (p = 0.001). CONCLUSION: Unsaturated fatty acid supplementation using the three vegetable oils attenuated pro-inflammatory properties and improved prothrombotic conditions. Therefore, introducing or replacing saturated and trans fat with unsaturated fatty acids is beneficial for cardiovascular risk reduction in obese or overweight non-diabetic elderly people. Further studies are needed to determine which unsaturated fat best prevents cardiovascular disease in elderly patients.

Unsaturated fatty acids improve atherosclerosis markers in obese and overweight non-diabetic elderly patients

BACKGROUND: Several studies have demonstrated the benefits of replacing trans and saturated fats with unsaturated fatty acids on cardiovascular diseases. We aimed to demonstrate the effect of polyunsaturated and monounsaturated fat supplementation on the biochemical and endothelial markers of atherosclerotic disease in obese or overweight non-diabetic elderly patients. METHOD: Seventy-nine patients were randomly divided into three groups: flaxseed oil, olive oil, and sunflower oil; patients in each group received 30 mL of oil for 90 days. Patients were subjected to anthropometric and bioimpedance assessments; biochemical and endothelial evaluations were performed through ultrasonography of the brachial artery and carotid artery for endothelium-dependent dilation and intima-media thickness assessment, respectively, before and after the intervention. The participants' usual diet remained unchanged...

Vulnerabilidade, saúde mental e clínica-escola: uma resposta de atenção à população / Vulnerability, mental health and school-clinics: a response to attention to population

O objetivo do estudo é descrever as características da população encaminhada à clínica-escola, no momento da triagem, contemplando as possíveis condições de vulnerabilidade. Trata-se de uma pesquisa exploratória na qual foram analisadas 120 fichas de triagem, correspondentes aos atendimentos realizados no Serviço de Psicologia no ano de 2012. Foi possível identificar que o gênero masculino foi o mais frequente entre os usuários atendidos, e em relação à idade metade dos usuários tinham até dez anos de idade, sendo que, desses 50% apresentaram queixas escolares. O principal encaminhamento realizado foi a psicoterapia individual em 89,2% dos casos. A psicoterapia individual constituiu-se em uma das possibilidades de intervenção que se oferece como proteção à saúde mental diante do contexto vulnerável que se apresenta.

The objective of the study is to describe the characteristics of the population forwarded to the school clinic, at the time of screening, contemplating the possible conditions of vulnerability. This is an exploratory research with 120 sorting chips during the year of 2012. It was possible identify the most frequent profile: boys until age 10, half of them presenting schoolar difficulties. The main referral was the individual pshychotherapy . The individual psychotherapy may be understood as a possibility to approach the mental health and the contexto of vulnerability.

Chloroplast sequence of treegourd (Crescentia cujete, Bignoniaceae) to study phylogeography and domestication.

PREMISE OF THE STUDY: Crescentia cujete (Bignoniaceae) fruit rinds are traditionally used for storage vessels and handicrafts. We assembled its chloroplast genome and identified single-nucleotide polymorphisms (SNPs). METHODS AND RESULTS: Using a genome skimming approach, the whole chloroplast of C. cujete was assembled using 3,106,928 sequence reads of 150 bp. The chloroplast is 154,662 bp in length, structurally divided into a large single copy region (84,788 bp), a small single copy region (18,299 bp), and two inverted repeat regions (51,575 bp) with 88 genes annotated. By resequencing the whole chloroplast, we identified 66 SNPs in C. cujete (N = 30) and 68 SNPs in C. amazonica (N = 6). Nucleotide diversity was estimated at 1.1 × 10-3 and 3.5 × 10-3 for C. cujete and C. amazonica, respectively. CONCLUSIONS: This broadened C. cujete genetic toolkit will be important to study the origin, domestication, diversity, and phylogeography of treegourds in the Neotropics.

Anthropometric, functional capacity, and oxidative stress changes in Brazilian community-living elderly subjects. A longitudinal study.

OBJECTIVE: To examine the changes and relationships among anthropometric, functional and plasma oxidative stress markers in elderly. DESIGN: longitudinal study. SETTING: measurements in 2008 and 2010. PARTICIPANTS: 103 community-dwelling men and women aged 67-92. MEASUREMENTS: Anthropometric parameters [waist, hip, arm and calf circumferences; waist-hip ratio, triceps skinfold thickness and others], basic (ADL) and instrumental activities of daily living (IADL)] and plasma oxidative stress markers (α-tocopherol, ß-carotene and malondialdehyde) were assessed in 2008 and 2010. RESULTS: ADL, IADL, body weight, skinfold thickness and circumferences of calf and arm decreased and waist and waist-hip ratio increased from 2008 to 2010. α-Tocopherol decreased and malondialdehyde plasma levels increased during the study period. In multiple logistic regression analyses, increased age (OR=1.12; IC: 1.02-1.23; p=0.02), female gender (OR=8.43; IC: 1.23-57.58; p=0.03), hypertension (OR=0.22; IC: 0.06-0.79; p=0.02), arthritis/arthrosis (OR=0.09; IC: 0.009-0.87; p=0.04) and depression (OR=0.20; IC: 0.04-1.03; p=0.05) were independent risk factors for functional decline. CONCLUSION: Fat reduction, muscle loss, central obesity increase, functional decline and worsening of plasma oxidative stress were observed during 2-year follow-up. Some of the risk factors that were identified could be modified to help prevent functional decline in elderly. The factors deserving attention include hypertension, arthritis/arthrosis and depression.