High-dose Vitamin C supplementation in the treatment of patients with COVID-19: A systematic review

Introduction: Vitamin C supplementation has been seen as a supportive treatment to control and prevent complications of COVID-19 by enhancing the immune response against infection. However, the effects of high doses of this vitamin are not yet fully understood. Objective: To analyze the effects of high-dose vitamin C in patients with COVID-19. Methods: This was a systematic review, using original studies published from April 2020 to November 2022 in PubMed, ScienceDirect, Scopus and Web of Science databases. The combination of descriptors registered in Medical Subject Headings (MeSH) used to search for articles were: (("vitamin C" OR "ascorbic acid") AND ("COVID-19" OR "SARS-CoV-2" OR "coronavirus")). Original articles of clinical trials conducted with patients diagnosed with COVID-19 and submitted to high-dose vitamin C supplementation were included. Results: Eligible studies included patients in intensive care units, wards, or outpatient clinics, who were given doses of vitamin C, ranging from 6,000 to 8,000 mg/day, with an average duration of 6.25 days of supplementation and mostly intravenous administration. A reduction in fever and myalgia was observed, as well as an improvement in oxygen saturation and lung impairment rate. Conclusion: The role of high-dose vitamin C in patients affected by COVID-19 requires further study, however, to date, the results have been promising for symptom reduction and improvement in lung function and oxygenation.

Introducción: La administración de suplementos de vitamina C se ha considerado un tratamiento de apoyo para controlar y prevenir las complicaciones del COVID-19 al mejorar la respuesta inmunitaria contra la infección. Sin embargo, los efectos de dosis elevadas de esta vitamina aún no se conocen en su totalidad. Objetivo: Analizar los efectos de altas dosis de vitamina C en pacientes con COVID-19. Métodos: Se trata de un estudio de revisión sistemática, utilizando artículos originales publicados desde abril de 2020 hasta noviembre de 2022 en las bases de datos PubMed, ScienceDirect, Scopus y Web of Science. Para la búsqueda de los artículos se utilizó la combinación de descriptores registrados en Medical Subject Headings (MeSH): (("vitamin C" OR "ascorbic acid") AND ("COVID-19" OR "SARS-CoV-2" OR "coronavirus")). Se incluyeron artículos originales de tipo ensayo clínico realizados con pacientes diagnosticados con COVID-19 y sometidos a suplementación con altas dosis de vitamina C. Resultados: Los estudios elegibles se realizaron con pacientes ingresados en unidades de cuidados intensivos, salas o ambulatorios, a los que se administraron dosis de vitamina C que oscilaban entre 6.000 y 8.000 mg/día, con una duración media de 6,25 días de suplementación y vía de administración mayoritariamente intravenosa. Se observó una reducción de la fiebre y las mialgias, además de una mejoría de la saturación de oxígeno y de la tasa de compromiso pulmonar. Conclusión: El papel de las dosis altas de vitamina C en pacientes afectados por COVID-19 requiere más estudios; sin embargo, hasta la fecha, los resultados han sido prometedores en cuanto a la reducción de los sintomas, y la mejora de la función pulmonar y la oxigenación.

Consumption of ultra-processed products is associated with vitamin D deficiency in Brazilian adults and elderly.

Although studies show that the intake of ultra-processed products (UPP) has a negative impact on health, diet quality and dietary vitamin D, its influence on serum concentrations of this vitamin remains unknown; therefore, it is essential to verify the association between the UPP consumption and vitamin D deficiency. This is a cross-sectional, household, population-based study, carried out with 229 individuals aged 20 years or older, residents of the city of Teresina, Piauí, Brazil. Socio-demographic, lifestyle, food consumption and anthropometric data were collected. Food consumption was obtained using a 24-h food recall, and foods were grouped according to the NOVA classification. Plasma concentrations of calcidiol-25 (OH) D3 were determined by HPLC. Crude and adjusted binary logistic regression was applied to estimate the association between UPP consumption and vitamin D deficiency. Most individuals aged 20-39 years were vitamin D deficient (52·1 %). UPP contributed 19·9 % to the energetic intake of the participant's diet. This contribution was higher for individuals with vitamin D deficiency (22·5 %, P = 0·04). In addition, a high intake of UPP was associated with twice the risk of vitamin D deficiency in comparison with low consumption of UPP (OR: 2·05; CI 1·06, 4·50; P: 0·04). Our results suggest that the consumption of UPP may have a negative impact on serum concentrations of vitamin D; more studies are needed.

Neck circumference as a predictor of cardiometabolic risk and truncal obesity in people living with HIV.

Introduction: Introduction: recent studies have suggested the use of neck circumference as a parameter capable of identifying risks of cardiometabolic complications and the accumulation of truncal fat caused by both antiretroviral therapy and the lifestyle of people with the human immunodeficiency virus (HIV). Objective: to investigate the relationship between neck circumference and anthropometric indicators and to assess cardiometabolic risk and truncal obesity through proposed cut-off points. Methods: cross-sectional study including 233 people with HIV. Demographic, socioeconomic, lifestyle and clinical data were collected using a structured questionnaire. The anthropometric evaluation included: weight, height, body mass index (BMI) measurements; waist (WC), neck (NC), arm and arm muscle circumferences; triceps and subscapular skinfolds and their sum. ROC curves were constructed to determine the accuracy of NC in predicting cardiometabolic risk in people living with HIV. Results: the sample was 57.5 % male, with a mean age of 38.4 years (95 %CI: 37.2-39.7 years). NC showed a positive and significant correlation with all anthropometric variables analyzed (p < 0.05), and a higher correlation strength with WC and BMI. The NC cut-off point selected as a predictor of risk of cardiac metabolic complications and truncal obesity in women was ≥ 32.4 cm, considering both WC and BMI. For men, the NC cut-off points were different when considering WC (≥ 39.6 cm) and BMI (≥ 38.1 cm) as a reference. It is worth noting that NC performed well in ROC curve analysis for men, while in women it was a poor performance. Conclusion: NC proved to be a promising indicator in the assessment of nutrition and health of people living with HIV, especially in men.

Introducción: Introducción: estudios recientes han sugerido el uso de la circunferencia del cuello como parámetro capaz de identificar los riesgos de complicaciones cardiometabólicas y la acumulación de grasa troncal causados tanto por la terapia antirretroviral como por el estilo de vida de las personas con el virus de la inmunodeficiencia humana (VIH). Objetivo: investigar la relación entre la circunferencia del cuello y los indicadores antropométricos y evaluar el riesgo cardiometabólico y la obesidad troncal a través de los puntos de corte propuestos. Métodos: estudio transversal que incluyó a 233 personas con VIH. Se recogieron datos demográficos, socioeconómicos, de estilo de vida y clínicos mediante un cuestionario estructurado. La evaluación antropométrica incluyó: medidas de peso, altura, índice de masa corporal (IMC); circunferencias de cintura (CC), cuello (CN), brazo (CA) y músculo del brazo (MCB); pliegues cutáneos del tríceps y subescapular y su suma. Se construyeron curvas ROC para determinar la precisión de la CN en la predicción del riesgo cardiometabólico en personas que viven con el VIH. Resultados: el 57,5 % de la muestra eran varones, con una edad media de 38,4 años (IC 95 %: 37,2-39,7 años). La CN mostró una correlación positiva y significativa (p < 0,05) con todas las variables antropométricas analizadas, y una mayor fuerza de correlación con la CC y el IMC. El punto de corte de la CN seleccionado como predictor de riesgo de complicaciones metabólicas cardiacas y obesidad troncular en mujeres fue ≥ 32,4 cm, considerando tanto la CC como el IMC. En el caso de los hombres, los puntos de corte de la CN fueron diferentes al considerar como referencia la CC (≥ 39,6 cm) y el IMC (≥ 38,1 cm). Cabe destacar que la CN obtuvo buenos resultados en el análisis de la curva ROC en el caso de los hombres, mientras que en el de las mujeres fue deficiente. Conclusión: la CN demostró ser un indicador prometedor en la evaluación de la nutrición y la salud de las personas que viven con el VIH, especialmente en los hombres.

Consumption and supplementation of vitamin E in breast cancer risk, treatment, and outcomes: A systematic review with meta-analysis.

BACKGROUND: Robust evidence have shown diet or dietary components in playing a direct role on cancer chemoprevention such as breast cancer (BC), and also prevention against cancer therapy side effects. In this context, vitamin E isoforms have been associated with tumor suppression pathways, mainly related to proliferation, invasion, metastasis, tumor metabolism and chemoresistance. OBJECTIVE: Therefore, we performed a systematic review with meta-analysis to assess the effects of vitamin E consumption and/or supplementation on breast cancer risk, treatment, and outcomes. METHODS: The studies were selected in the electronic databases PubMed, Science Direct, Scopus and Web of Science. RESULTS: A total of 22 articles were selected, which nine manuscripts we perform the meta-analysis. The summary effect estimate did not indicate any significant association between consumption versus non-consumption of total vitamin E and breast cancer risk. After assessing the effects of vitamin E supplementation on breast cancer risk, only two had data for comparison and vitamin E supplementation presented no impact on breast cancer risk. However, the summary effect estimate from the included studies indicated that vitamin E consumption was inversely associated with breast cancer recurrence in the control group. There are no significant results regarding dietary or supplemental vitamin E intake and BC risk reduction. CONCLUSION: Finally, regarding recurrence, survival, and mortality, the results indicated that vitamin E consumption was inversely associated with breast cancer recurrence, although no association was found for breast cancer mortality.

Prevalence of prediabetes in adults and its association with sociodemographic, nutritional, metabolic and mental disorders factors: Home Health Survey, Piauí, Brazil / Prevalência de pré-diabetes em adultos e sua associação com fatores sociodemográficos, nutricionais, metabólicos e transtornos mentais: Inquérito de Saúde Domiciliar, Piauí, Brasil

ABSTRACT Objective To estimate prevalence of prediabetes and to investigate its associated factors in adults living in Teresina, Piauí, Brazil Methods Cross-sectional, home-based study, with both genders adults in Teresina, Piauí. The prevalence of prediabetes was estimated using the fasting glucose test, and was classified according to the American Diabetes Association standards (≥100mg/dL; <126mg/dL). The associations between prediabetes and the variables: sociodemographic, anthropometric, food consumption, blood pressure levels, triglycerides and common mental disorders were tested. In addition, a variable was created to verify the association of the simultaneous presence of risk factors in the same individual. Data were reviewed using Pearson's chi-square test and Poisson regression for crude and adjusted prevalence ratios, considering a significance level of 5%. Results A total of 224 adults participated in the study, of which 154 (68.7%) were female, aged between 20 and 39 years (53.1%). An 8.04% prevalence of prediabetes was observed. A statistically significant association (p<0.05) was found between lower education (0 to 8 years of study; 17.3%) and increased triglycerides levels (≥150mg/dL; 13.7%). Higher gross prevalence (PR: 2.53; CI 95%: 1.05-6.05) prediabetes ratios were observed with 5 or more simultaneous risk factors when compared to individuals who had up to 4 simultaneous risk factors. Conclusion Low schooling, hypertriglyceridemia and the presence of five or more simultaneous risk factors were associated with prediabetes; however, these risk factors are subject to intervention. Therefore, this study points to the need for changes in lifestyle habits as a strategy for glycemic control and diabetes prevention.

RESUMO Objetivo Estimar a prevalência de pré-diabetes e investigar os fatores associados em adultos residentes em Teresina, Piauí, Brasil. Métodos Estudo transversal de base domiciliar com adultos de ambos os sexos em Teresina, Piauí. A prevalência de pré-diabetes foi estimada pelo teste de glicemia em jejum, e classificado de acordo com a Associação Americana de Diabetes (≥100mg/dL; <126mg/dL). Foram testadas as associações entre pré-diabetes e as variáveis: sociodemográficas, antropométricas, consumo alimentar, níveis pressóricos, triglicerídeos e transtornos mentais comuns. Além disso, foi criada uma variável para verificar a associação da presença simultânea dos fatores de risco no mesmo indivíduo. Os dados foram analisados com o teste do qui-quadrado de Pearson e regressão de Poisson para razões de prevalência bruta e ajustada, considerando nível de significância de 5%. Resultados Participaram do estudo 224 adultos, sendo 154 (68,7%) do sexo feminino, entre 20 e 39 anos (53,1%). Verificou-se prevalência de pré-diabetes de 8,04%, com associação significativa (p<0,05) com a menor escolaridade (17,3%), e triglicerídeos elevados (13,7%). Observou-se maior razão de prevalência bruta (RP: 2,53; IC 95%: 1,05-6,05) de pré-diabetes nos indivíduos com 5 ou mais fatores de risco simultâneos quando comparados àqueles com até 4 fatores simultâneos. Conclusão A baixa escolaridade, a hipertrigliceridemia e a presença de cinco ou mais fatores de risco simultâneos apresentaram-se associados ao pré-diabetes. Entretanto, os fatores de risco encontrados são passíveis de intervenção. Este estudo aponta a necessidade de mudanças de hábitos de vida comportamentais como estratégia para o controle da glicemia e prevenção do diabetes.

Sampling plan and methodological aspects: a household healthcare survey in Piauí.

OBJECTIVE: To describe the methodological aspects of the Piauí home healthcare survey (ISAD-PI) and assess the relation between sampling plan, precision, and design effects, assuming that population health surveys are relevant instruments for health monitoring. METHODS: ISAD-PI was a population-based cross-sectional study that analyzed the living conditions and health status of the population residing in urban areas in the municipalities of Teresina and Picos, in Piauí. Sampling was carried out by conglomerates in two stages: Primary Sampling Units and households. To calculate the sample size, we considered the stratification of the population in both cities, according to the age of the individuals. We evaluated the "non-response" rate (NRR) and estimated the proportions according to sex and age, as well as the prevalence of social determinants of health in order to assess the compliance of the sampling plan. Analyses related to the precision according to the coefficient of proportion variation of the standard error (Cv-pˆ) and the design effect (deff). Cv-pˆ less than 20% and deff less than 1.5 were considered adequate. The total NRR of households was 38.2% in Teresina and 38.3% in Picos. We carried out twenty-four proportion estimates in relation to age and sex and 48 prevalence of social and health determinants estimates, totaling 72 estimates. Among them, 71 had Cv-pˆ less than 20% and 61 had deff less than or equal to 1.5. CONCLUSION: Data generated from the ISAD-PI may contribute to the assessment of health and morbidity conditions in the population. Furthermore, methodological aspects employed in this research may serve as a basis for studies carried out in other cities in Brazil.

Nutritional status and vitamin A and zinc levels in patients with kala-azar in Piauí, Brazil.

INTRODUCTION: Malnutrition and kala-azar (or visceral leishmaniasis) are significant public health problems in different parts of the world. Immunity and susceptibility to infectious and parasitic diseases are directly linked to the host's nutritional state, but little is known about the interaction between nutrition and kala-azar. This study aimed to evaluate nutritional status with kala-azar and correlate these findings with the clinical and laboratory manifestations of the disease, and zinc and retinol levels. METHODS: This was a cross-sectional study of 139 patients with kala-azar. Nutritional status classification was performed according to international recommendations. Parametric or nonparametric tests were applied whenever indicated in a two-sided test with a 5% significance level. RESULTS: Weight loss and malnutrition were more frequent in adults. Body mass index-for-age, fat area of the arm, and upper arm muscle area were significantly associated with probability of death. The presence of human immunodeficiency virus, hepatomegaly, and splenomegaly was correlated with nutritional assessment. Blood leukocyte and lymphocyte, serum creatine, and vitamin A levels were significantly higher in adult men. Vitamin A levels were highly associated with the level of hemoglobin and C-reactive protein (CRP) in multivariate analysis. All patients had reduced plasma zinc levels, but this finding had no association with the outcome variables. CONCLUSIONS: Malnutrition was correlated with severe disease and was more prevalent in older people with kala-azar. Vitamin A deficiency was associated with hemoglobin and CRP. Zinc levels were reduced in patients with kala-azar.

Effects of vitamin D supplementation on the glycemic control of pre-diabetic individuals: a systematic review / Efectos de la suplementación con vitamina D sobre el control glucémico en pacientes prediabéticos: una revisión sistemática

INTRODUCTION: research shows the potential effect of vitamin D supplementation with an improvement in the glycemic profile of pre-diabetic patients. OBJECTIVE: this study evaluates the effects of vitamin D supplementation on glycemic control markers in pre-diabetic individuals. METHODS: we analyzed studies published over the last ten years, and indexed in the Science Direct, PubMed, and LILACS databases. We searched studies using health descriptors related to vitamin D, pre-diabetes, and glycemic control markers. We considered randomized controlled trials eligible for inclusion. All phases of selection, data extraction, and risk of bias assessment were carried out by two independent evaluators. RESULTS: we identified 309 articles, of which 4 met the inclusion criteria. Of these, 3 studies have shown that vitamin D supplementation does not alter glycemic control markers in pre-diabetic individuals. Only one study showed a positive effect after supplementation with 60,000 IU/month of vitamin D3 for 12 months, with a significant reduction in the concentrations of glycated hemoglobin, fasting glucose, and two-hour postprandial glucose. CONCLUSION: there is insufficient scientific evidence to confirm the beneficial effects of vitamin D supplementation on glycemic control markers in pre-diabetic individuals

INTRODUCCIÓN: las investigaciones muestran el efecto potencial de la suplementación con vitamina D con una mejora del perfil glucémico de los pacientes prediabéticos. OBJETIVO: este estudio evalúa los efectos de la suplementación con vitamina D sobre los marcadores de control glucémico en personas prediabéticas. MÉTODOS: analizamos los estudios publicados en los últimos diez años e indexados en las bases de datos Science Direct, PubMed y LILACS. Se realizaron búsquedas de estudios mediante descriptores de salud relacionados con la vitamina D, la prediabetes y los marcadores de control glucémico. Los ensayos controlados y aleatorizados se consideraron elegibles para su inclusión. Todas las fases de selección, extracción de datos y evaluación del riesgo de sesgos fueron realizadas por dos evaluadores independientes. RESULTADOS: identificamos 309 artículos, de los que 4 cumplieron los criterios de inclusión. De estos, 3 estudios demostraron que la suplementación con vitamina D no altera los marcadores de control glucémico en las personas prediabéticas. Solo un estudio mostró un efecto positivo después de la suplementación de 60.000 UI/mes de vitamina D3 durante 12 meses, con una reducción significativa de las concentraciones de hemoglobina glucosilada, glucosa en ayunas y glucosa posprandial a las dos horas. CONCLUSIÓN: no hay evidencia científica suficiente para confirmar los efectos beneficiosos de la suplementación de vitamina D sobre los marcadores de control glucémico en las personas prediabéticas

Effects of vitamin D supplementation on the glycemic control of pre-diabetic individuals: a systematic review.

INTRODUCTION: Introduction: research shows the potential effect of vitamin D supplementation with an improvement in the glycemic profile of pre-diabetic patients. Objective: this study evaluates the effects of vitamin D supplementation on glycemic control markers in pre-diabetic individuals. Methods: we analyzed studies published over the last ten years, and indexed in the Science Direct, PubMed, and LILACS databases. We searched studies using health descriptors related to vitamin D, pre-diabetes, and glycemic control markers. We considered randomized controlled trials eligible for inclusion. All phases of selection, data extraction, and risk of bias assessment were carried out by two independent evaluators. Results: we identified 309 articles, of which 4 met the inclusion criteria. Of these, 3 studies have shown that vitamin D supplementation does not alter glycemic control markers in pre-diabetic individuals. Only one study showed a positive effect after supplementation with 60,000 IU/month of vitamin D3 for 12 months, with a significant reduction in the concentrations of glycated hemoglobin, fasting glucose, and two-hour postprandial glucose. Conclusion: there is insufficient scientific evidence to confirm the beneficial effects of vitamin D supplementation on glycemic control markers in pre-diabetic individuals.

INTRODUCCIÓN: Introducción: las investigaciones muestran el efecto potencial de la suplementación con vitamina D con una mejora del perfil glucémico de los pacientes prediabéticos. Objetivo: este estudio evalúa los efectos de la suplementación con vitamina D sobre los marcadores de control glucémico en personas prediabéticas. Métodos: analizamos los estudios publicados en los últimos diez años e indexados en las bases de datos Science Direct, PubMed y LILACS. Se realizaron búsquedas de estudios mediante descriptores de salud relacionados con la vitamina D, la prediabetes y los marcadores de control glucémico. Los ensayos controlados y aleatorizados se consideraron elegibles para su inclusión. Todas las fases de selección, extracción de datos y evaluación del riesgo de sesgos fueron realizadas por dos evaluadores independientes. Resultados: identificamos 309 artículos, de los que 4 cumplieron los criterios de inclusión. De estos, 3 estudios demostraron que la suplementación con vitamina D no altera los marcadores de control glucémico en las personas prediabéticas. Solo un estudio mostró un efecto positivo después de la suplementación de 60.000 UI/mes de vitamina D3 durante 12 meses, con una reducción significativa de las concentraciones de hemoglobina glucosilada, glucosa en ayunas y glucosa posprandial a las dos horas. Conclusión: no hay evidencia científica suficiente para confirmar los efectos beneficiosos de la suplementación de vitamina D sobre los marcadores de control glucémico en las personas prediabéticas.

Sampling plan and methodological aspects: a household healthcare survey in Piauí / Plano de amostragem e aspectos metodológicos: inquérito de saúde domiciliar no Piauí

ABSTRACT OBJECTIVE To describe the methodological aspects of the Piauí home healthcare survey (ISAD-PI) and assess the relation between sampling plan, precision, and design effects, assuming that population health surveys are relevant instruments for health monitoring. METHODS ISAD-PI was a population-based cross-sectional study that analyzed the living conditions and health status of the population residing in urban areas in the municipalities of Teresina and Picos, in Piauí. Sampling was carried out by conglomerates in two stages: Primary Sampling Units and households. To calculate the sample size, we considered the stratification of the population in both cities, according to the age of the individuals. We evaluated the "non-response" rate (NRR) and estimated the proportions according to sex and age, as well as the prevalence of social determinants of health in order to assess the compliance of the sampling plan. Analyses related to the precision according to the coefficient of proportion variation of the standard error (Cv-pˆ) and the design effect (deff). Cv-pˆ less than 20% and deff less than 1.5 were considered adequate. The total NRR of households was 38.2% in Teresina and 38.3% in Picos. We carried out twenty-four proportion estimates in relation to age and sex and 48 prevalence of social and health determinants estimates, totaling 72 estimates. Among them, 71 had Cv-pˆ less than 20% and 61 had deff less than or equal to 1.5. CONCLUSION Data generated from the ISAD-PI may contribute to the assessment of health and morbidity conditions in the population. Furthermore, methodological aspects employed in this research may serve as a basis for studies carried out in other cities in Brazil.

RESUMO OBJETIVO Descrever os aspectos metodológicos do Inquérito de Saúde Domiciliar no Piauí (ISAD-PI), bem como avaliar a conformidade do plano amostral em relação à precisão e aos efeitos do desenho, dado que os inquéritos populacionais de saúde constituem instrumentos importantes para o monitoramento da situação de saúde da população. MÉTODOS O ISAD-PI foi um estudo de base populacional, transversal, que analisou as condições de vida e situação de saúde da população residente nas áreas urbanas dos municípios de Teresina e Picos, no Piauí. A amostragem foi realizada por conglomerados, em dois estágios: Unidades Primárias de Amostragem e domicílios. Para o cálculo do tamanho da amostra, considerou-se a estratificação da população de ambas as cidades, de acordo com a idade dos indivíduos, para ambos os sexos. Para avaliação da conformidade do plano amostral, foi avaliada a taxa de "não-resposta" (TNR) e, além disso, as estimativas de proporções segundo sexo e idade, bem como as prevalências de determinantes sociais de saúde, que foram analisadas em relação à precisão por meio do coeficiente de variação da proporção do erro padrão (Cv-pˆ) e do efeito do delineamento (deff). Foram considerados adequados Cv-pˆ menores que 20%, e deff menores que 1,5. A TNR-Total dos domicílios foi de 38,2% em Teresina e de 38,3% em Picos. Foram realizadas 24 estimativas de proporção em relação à idade e ao sexo e 48 estimativas de prevalência de determinantes sociais e de saúde, totalizando 72 estimativas, das quais 71 apresentaram Cv-pˆ menor que 20% e 61 apresentaram deff menor ou igual a 1,5. CONCLUSÃO Dados gerados a partir do ISAD-PI poderão contribuir para a avaliação das condições de saúde e morbidade na população. Ademais, aspectos metodológicos empregados nesta pesquisa poderão servir de base para estudos realizados em outras cidades do Brasil.

Nutritional status and vitamin A and zinc levels in patients with kala-azar in Piauí, Brazil

Abstract INTRODUCTION: Malnutrition and kala-azar (or visceral leishmaniasis) are significant public health problems in different parts of the world. Immunity and susceptibility to infectious and parasitic diseases are directly linked to the host's nutritional state, but little is known about the interaction between nutrition and kala-azar. This study aimed to evaluate nutritional status with kala-azar and correlate these findings with the clinical and laboratory manifestations of the disease, and zinc and retinol levels. METHODS: This was a cross-sectional study of 139 patients with kala-azar. Nutritional status classification was performed according to international recommendations. Parametric or nonparametric tests were applied whenever indicated in a two-sided test with a 5% significance level. RESULTS: Weight loss and malnutrition were more frequent in adults. Body mass index-for-age, fat area of the arm, and upper arm muscle area were significantly associated with probability of death. The presence of human immunodeficiency virus, hepatomegaly, and splenomegaly was correlated with nutritional assessment. Blood leukocyte and lymphocyte, serum creatine, and vitamin A levels were significantly higher in adult men. Vitamin A levels were highly associated with the level of hemoglobin and C-reactive protein (CRP) in multivariate analysis. All patients had reduced plasma zinc levels, but this finding had no association with the outcome variables. CONCLUSIONS: Malnutrition was correlated with severe disease and was more prevalent in older people with kala-azar. Vitamin A deficiency was associated with hemoglobin and CRP. Zinc levels were reduced in patients with kala-azar.

Sampling plan and methodological aspects: a household healthcare survey in Piauí / Plano de amostragem e aspectos metodológicos: inquérito de saúde domiciliar no Piauí

ABSTRACT OBJECTIVE To describe the methodological aspects of the Piauí home healthcare survey (ISAD-PI) and assess the relation between sampling plan, precision, and design effects, assuming that population health surveys are relevant instruments for health monitoring. METHODS ISAD-PI was a population-based cross-sectional study that analyzed the living conditions and health status of the population residing in urban areas in the municipalities of Teresina and Picos, in Piauí. Sampling was carried out by conglomerates in two stages: Primary Sampling Units and households. To calculate the sample size, we considered the stratification of the population in both cities, according to the age of the individuals. We evaluated the "non-response" rate (NRR) and estimated the proportions according to sex and age, as well as the prevalence of social determinants of health in order to assess the compliance of the sampling plan. Analyses related to the precision according to the coefficient of proportion variation of the standard error (Cv-pˆ) and the design effect (deff). Cv-pˆ less than 20% and deff less than 1.5 were considered adequate. The total NRR of households was 38.2% in Teresina and 38.3% in Picos. We carried out twenty-four proportion estimates in relation to age and sex and 48 prevalence of social and health determinants estimates, totaling 72 estimates. Among them, 71 had Cv-pˆ less than 20% and 61 had deff less than or equal to 1.5. CONCLUSION Data generated from the ISAD-PI may contribute to the assessment of health and morbidity conditions in the population. Furthermore, methodological aspects employed in this research may serve as a basis for studies carried out in other cities in Brazil.

RESUMO OBJETIVO Descrever os aspectos metodológicos do Inquérito de Saúde Domiciliar no Piauí (ISAD-PI), bem como avaliar a conformidade do plano amostral em relação à precisão e aos efeitos do desenho, dado que os inquéritos populacionais de saúde constituem instrumentos importantes para o monitoramento da situação de saúde da população. MÉTODOS O ISAD-PI foi um estudo de base populacional, transversal, que analisou as condições de vida e situação de saúde da população residente nas áreas urbanas dos municípios de Teresina e Picos, no Piauí. A amostragem foi realizada por conglomerados, em dois estágios: Unidades Primárias de Amostragem e domicílios. Para o cálculo do tamanho da amostra, considerou-se a estratificação da população de ambas as cidades, de acordo com a idade dos indivíduos, para ambos os sexos. Para avaliação da conformidade do plano amostral, foi avaliada a taxa de "não-resposta" (TNR) e, além disso, as estimativas de proporções segundo sexo e idade, bem como as prevalências de determinantes sociais de saúde, que foram analisadas em relação à precisão por meio do coeficiente de variação da proporção do erro padrão (Cv-pˆ) e do efeito do delineamento (deff). Foram considerados adequados Cv-pˆ menores que 20%, e deff menores que 1,5. A TNR-Total dos domicílios foi de 38,2% em Teresina e de 38,3% em Picos. Foram realizadas 24 estimativas de proporção em relação à idade e ao sexo e 48 estimativas de prevalência de determinantes sociais e de saúde, totalizando 72 estimativas, das quais 71 apresentaram Cv-pˆ menor que 20% e 61 apresentaram deff menor ou igual a 1,5. CONCLUSÃO Dados gerados a partir do ISAD-PI poderão contribuir para a avaliação das condições de saúde e morbidade na população. Ademais, aspectos metodológicos empregados nesta pesquisa poderão servir de base para estudos realizados em outras cidades do Brasil.

Prevalence of arterial hypertension and associated factors: a population-based study.

OBJECTIVE To estimate the prevalence of hypertension in adults and analyze its association with socioeconomic, demographic, and lifestyle risk factors. METHODS Home-based cross-sectional epidemiological study conducted with adults of both sexes living in the cities of Teresina and Picos (PI). The prevalence of hypertension was estimated by self-reported diagnosis. The associations between hypertension and the following variables were tested: age, gender, skin color, education, family income, marital status, alcohol and cigarette consumption, physical activity, and nutritional status. RESULTS A total of 1,057 adult individuals with a mean age of 38.6 ± 11.5 years participated in the study, of which 62.3% were female. The prevalence of hypertension in the population was 16.4%. In the crude analysis, a significant association was observed between the prevalence of hypertension and factors such as older age, lower education, single marital status, brown skin color, smoking, and overweight (p < 0.05). However, after adjustments, only the associations with older age, brown skin color, sedentary lifestyle and overweight remained significant. CONCLUSION Older age, brown skin color, sedentary lifestyle, and the presence of overweight or obesity were significantly associated with hypertension. Among the modifiable risk factors, a sedentary lifestyle and overweight stand out as important for the genesis of hypertension, subject to intervention measures.

Feelings reported by adolescents after food ingestion: a comparative study / Sentimentos relatados por adolescentes após a ingestão alimentar: um estudo comparativo

INTRODUCTION: Food is closely linked with emotions in a complex relationship. The imaginary and symbolic meaning attributed to food has been little studied and the act of eating needs to be better understood. OBJECTIVE: To analyze the association of adolescents´ feelings to selected foods. METHODS: Cross-sectional study with 995 adolescents from public and private schools in Teresina, PI, Brazil. It was a Supplementary Project to the Brazilian national survey ERICA (Estudo de Riscos Cardiovasculares em Adolescentes). Adolescents had to choose one of the following feelings to selected food: well-being/satisfaction, malaise, no feeling, aversion. For the option aversion, the participant had to indicate if it was related to smell, color, appearance, or taste. Adolescents´ feelings to foods were analyzed by type of school, sex, and age range, using Pearson's chi-square (χ²) or Fisher's exact tests. RESULTS: There was significant differences regarding the type of school for the feeling to chocolate (p=0.015); vegetables (p=0.003); leafy greens (p=0.005); healthy sandwich/natural fruit juice (p≤0.001); high fat red meat (p=0.046); fruit/natural fruit juice (p≤0.001). For sex, there was significant difrerences for healthy sandwich/natural fruit juice (p=0.001); beans and rice (p=0.021) and high fat red meat (p=0.005). There was significant differences between age groups for sandwich, chips, soda and ice cream (p=0.018); pasta (p=0.047) and high fat red meat (p=0.021). Well-being predominated in almost all foods and aversion was poorly reported. CONCLUSION: The results suggest that adolescents' feelings are not directed to specific foods.

INTRODUÇÃO: O alimento está intimamente ligado com as emoções em uma relação complexa. O sentido imaginário e simbólico atribuído à alimentação tem sido pouco estudado e o ato de comer precisa ser melhor compreendido. OBJETIVO: Avaliar a associação de sentimentos dos adolescentes relacionados a alimentos selecionados. MÉTODO: Estudo transversal com 995 adolescentes de escolas públicas e privadas de Teresina, PI, Brasil. Os dados foram provenientes do Projeto Suplementar ao levantamento nacional brasileiro ERICA (Estudo de Riscos Cardiovasculares em Adolescentes). O adolescente teve que escolher um dos seguintes sentimentos para o alimento selecionado: bem-estar/satisfação, desconforto, nenhum sentimento ou aversão. Para a opção aversão, o participante deveria indicar se ela estava relacionada ao cheiro, cor, aparência ou sabor. Os sentimentos dos adolescentes em relação aos alimentos foram analisados ​​por tipo de escola, sexo e faixa etária, por meio do teste qui-quadrado de Pearson (c²) ou teste exato de Fisher. RESULTADOS: Houve diferenças significativas entre os tipos de escola para o sentimento em relação ao chocolate (p=0,015); legumes/verduras (p=0,003); folhosos (p=0,005); sanduiche/suco natural (p≤0,001); carne vermelha gordurosa (p=0,046); fruta/suco natural (p≤0,001). Para o sexo, houve diferença significativa para sanduiche/suco natural (p=0,001); arroz com feijão (p=0,021) e carne vermelha gordurosa (p=0,005). Para a faixa etária, houve diferença significativa para sanduíche, batata frita, refrigerante e sorvete (p=0,018); macarrão (p=0,047) e carne vermelha gordurosa (p=0,021). O bem-estar predominou em quase todos os alimentos e a aversão foi pouco relatada. CONCLUSÃO: Os resultados sugerem que os sentimentos dos adolescentes não estão direcionados a um alimento específico.

Impact of intermittent fasting on body weight in overweight and obese individuals.

OBJECTIVE: To verify the relationship of intermittent fasting in the bodyweight of overweight and obese individuals through a systematic literature review. METHODS: This is a systematic review based on randomized controlled trials. The articles were consulted in the databases: Science Direct, PubMed e BVS. This review was evaluated through the PRISMA recommendation. RESULTS: After the selection process, four articles were included in this review, comparing intermittent fasting (IF) with calorie restriction diet (CRD) as a control group. In 2 studies using similar protocols, there was no significant reduction in body weight of overweight or obese subjects. In the other two studies using different protocols, weight loss was significant in the IF group compared to the CRD group. CONCLUSIONS: Results did not provide evidence of the effect of intermittent fasting on weight loss in overweight or obese individuals.

Influence of Polymorphism of Vitamin D Receptor (Fok I) on Hypertension

Abstract Evidence suggests that polymorphisms in the gene encoding a vitamin D receptor might affect blood pressure. The objective of this systematic review was to investigate the association between hypertension and vitamin D receptor (Fok I) gene polymorphism. A literature search was performed according to the PRISMA guidelines using the MEDLINE®/PubMed, Scopus, Cochrane Library CENTRAL, SciELO, and LILACS databases. The quality of case-control or cohort studies and studies based on cross-sectional methodology was evaluated using the Newcastle-Ottawa Scale and the protocol of Loney and coauthors [25], respectively. In this systematic literature search, 215 publications were identified, of which 10 were analyzed, including seven case-control studies, two cross-sectional studies, and one cohort study. The association between Fok I polymorphism and hypertension was reported in 60% of the publications and the risk for hypertension was shown to be related to FF and ff genotypes. In addition, Fok I polymorphism was shown to increase plasma renin activity, which plays an important role in regulating blood pressure. However, no association was observed between Fok I polymorphism and serum vitamin D levels. In conclusion, Fok I polymorphism plays an important role in hypertension.

Prevalence of arterial hypertension and associated factors: a population-based study

SUMMARY OBJECTIVE To estimate the prevalence of hypertension in adults and analyze its association with socioeconomic, demographic, and lifestyle risk factors. METHODS Home-based cross-sectional epidemiological study conducted with adults of both sexes living in the cities of Teresina and Picos (PI). The prevalence of hypertension was estimated by self-reported diagnosis. The associations between hypertension and the following variables were tested: age, gender, skin color, education, family income, marital status, alcohol and cigarette consumption, physical activity, and nutritional status. RESULTS A total of 1,057 adult individuals with a mean age of 38.6 ± 11.5 years participated in the study, of which 62.3% were female. The prevalence of hypertension in the population was 16.4%. In the crude analysis, a significant association was observed between the prevalence of hypertension and factors such as older age, lower education, single marital status, brown skin color, smoking, and overweight (p < 0.05). However, after adjustments, only the associations with older age, brown skin color, sedentary lifestyle and overweight remained significant. CONCLUSION Older age, brown skin color, sedentary lifestyle, and the presence of overweight or obesity were significantly associated with hypertension. Among the modifiable risk factors, a sedentary lifestyle and overweight stand out as important for the genesis of hypertension, subject to intervention measures.

RESUMO OBJETIVO Estimar a prevalência de hipertensão arterial em adultos e analisar sua associação com fatores de risco socioeconômicos, demográficos e de estilo de vida. MÉTODOS Estudo epidemiológico transversal, de base domiciliar, realizado com adultos de ambos os sexos residentes nas cidades de Teresina e Picos (PI). A prevalência de hipertensão arterial foi estimada por meio de diagnóstico autorreferido. Foram testadas as associações entre a hipertensão arterial e as variáveis: idade, sexo, cor da pele, escolaridade, renda familiar, situação conjugal, consumo de álcool e cigarro, prática de atividade física e estado nutricional. RESULTADOS Participaram do estudo 1.057 indivíduos adultos com média de idade de 38,6 ± 11,5 anos, sendo 62,3% do sexo feminino. A prevalência de hipertensão arterial na população foi de 16,4%. Na análise bruta, observou-se associação significativa entre a prevalência de hipertensão e fatores como maior idade, menor escolaridade, estado civil solteiro, cor da pele parda, tabagismo e excesso de peso (p<0,05). Entretanto, após ajustes, apenas as associações com a maior idade, cor da pele parda, estilo de vida sedentário e excesso de peso mantiveram-se significativas. CONCLUSÃO A idade mais avançada, cor da pele parda, sedentarismo e a presença de sobrepeso ou obesidade apresentaram-se significativamente associados à hipertensão. Dentre os fatores de risco modificáveis, destaca-se o sedentarismo e o excesso de peso como importantes para a gênese de hipertensão e passíveis de medidas de intervenção.

An approach on food choice determinants: a study in the restaurants of a public market in Northeastern Brazil / Abordagem sobre determinantes de escolha alimentar: um estudo nos restaurantes de um mercado público do Nordeste do Brasil

ABSTRACT Objective To identify the main determinants of food consumption among adult users of a public market in a capital of Northeastern Brazil. Methods A total of 198 diners in a public market, constituting a sample comprising 149 males and 49 females over 19 years of age, was interviewed using a pre-tested questionnaires from August 2018 to January 2019. Sociodemographic variables such as gender, age, place of origin, education and income, in addition to the determinants of food choices were evaluated. The analysis was performed using the Wilcoxon test (nonparametric) that compared the means of the dimensions involved in these choices according to gender and income. Results Sensory appeal, price and health were the main determinants of food choices. When compared by gender and income, there were significant differences regarding the attributes reviewed. Conclusion The factors that influenced food choice were: sensory appeal, price and health. Ethical issues were the ones that least interfered with food choice. Thus, such aspects must be taken into account for the development of public policies in the area of collective eating and environmental education. The factors that influenced food choice were: sensory appeal, price and health. Ethical issues were the ones that least interfered with food choice. Thus, such aspects must be taken into account for the development of public policies in the area of collective eating and environmental education.

RESUMO Objetivo Identificar os principais determinantes do consumo alimentar entre adultos usuários de um mercado público de uma capital do nordeste brasileiro. Métodos Foram entrevistados, por intermédio de questionários pré-testados, nos meses de agosto de 2018 até janeiro de 2019, uma amostra de 198 comensais de um mercado público, constituída por 149 indivíduos do sexo masculino e 49 do sexo feminino maiores de 19 anos. Foram avaliadas variáveis sociodemográficas como sexo, idade, local de origem, escolaridade e renda, além dos determinantes das escolhas alimentares. A análise foi feita utilizando o teste de Wilcoxon (não paramétrico), que comparou as médias das dimensões envolvidas nessas escolhas conforme sexo e renda. Resultados Apelo sensorial, preço e saúde foram os principais determinantes das escolhas alimentares. Quando comparados por sexo e renda, houve diferenças significativas quanto aos atributos analisados. Conclusão Os fatores que influenciaram a escolha alimentar foram: apelo sensorial, preço e saúde. Já as questões éticas foram as que menos interferiram na escolha alimentar. Desse modo, tais aspectos devem ser levados em consideração para o desenvolvimento de políticas públicas na área de alimentação coletiva e educação ambiental.

Associação entre aleitamento materno e excesso de peso em pré-escolares / Relación entre la lactancia materna y el exceso de peso en niños preescolares / Association between breastfeeding and overweight in preschoolers

Resumo Objetivo Analisar associação entre aleitamento materno e excesso de peso em pré-escolares. Métodos Estudo transversal com 448 pré-escolares de 10 Centros Municipais de Educação Infantil do município de Teresina-PI. Realizou-se reunião com os pais, momento em que foi aplicado o questionário estruturado com questões relativas aos dados sociodemográficos e alimentação pregressa das crianças. Posteriormente, foram obtidas as medidas antropométricas das crianças (peso e altura). Foi considerado excesso de peso (sobrepeso + obesidade) quando o resultado do escore-z foi maior que ou igual a +2, e os menores que +2 foram classificados como sem excesso de peso. A análise da associação entre o aleitamento materno exclusivo até seis meses, aleitamento exclusivo até quatro meses e o aleitamento materno com o estado nutricional da criança foi feita utilizando-se o teste qui-quadrado de Pearson (c2), enquanto a razão de prevalência (RP) foi estimada para quantificar as associações entre o aleitamento materno e o estado nutricional controlado pelas variáveis sociodemográficas. Todas as estimativas e os intervalos de confiança de 95% foram calculados utilizando o modelo de regressão de Poisson com variância robusta. Resultados A prevalência do excesso de peso e a proporção das crianças que receberam o aleitamento materno exclusivo até os 6 meses de idade foi de 11,16% e 41,9%, respectivamente. O excesso de peso foi 2,5 vezes mais elevado entre as crianças não amamentadas (IC 95%: 1,09; 5,83); e, após o controle das variáveis sociodemográficas, verificou-se que as crianças maiores de 48 meses tiveram risco elevado para o excesso de peso (RP: 1,69; IC 95%: 1,01; 2,85) em relação aos menores de 48 meses de idade (p = 0,04). Conclusão O presente estudo demonstrou que as crianças que receberam aleitamento materno foram protegidas contra o excesso de peso.

Resumen Objetivo Analizar la elación entre la lactancia materna y el exceso de peso en niños preescolares. Métodos Estudio transversal con 448 niños preescolares de 10 Centros Municipales de Educación Infantil del municipio de Teresina, estado de Piauí. Se realizó una reunión con los padres, momento en que se aplicó el cuestionario estructurado con preguntas relativas a datos sociodemográficos y alimentación anterior de los niños. Posteriormente, se obtuvieron las medidas antropométricas de los niños (peso y estatura). Se consideró exceso de peso (sobrepeso + obesidad) cuando el resultado de la puntuación z fue mayor o igual a +2; y los menores a +2 se clasificaron como sin exceso de peso. El análisis de la relación entre lactancia materna exclusiva hasta los seis meses, lactancia exclusiva hasta los cuatro meses y lactancia materna con el estado nutricional del niño se realizó mediante la prueba c2 de Pearson . Para cuantificar las relaciones entre la lactancia materna y el estado nutricional controlado por las variables sociodemográficas se calculó la a razón de prevalencia (RP). Todas las estimaciones y los intervalos de confianza de 95% se calcularon utilizando el modelo de regresión de Poisson con varianza robusta. Resultados La prevalencia del exceso de peso y la proporción de los niños que recibieron lactancia materna exclusiva hasta los 6 meses de edad fue de 11,16% y 41,9%, respectivamente. El exceso de peso fue 2,5 veces más elevado en niños no amamantados (IC 95%: 1,09; 5,83). Luego del control de las variables sociodemográficas, se verificó que los niños mayores de 48 meses tuvieron un riesgo elevado de exceso de peso (RP: 1,69; IC 95%: 1,01; 2,85) con relación a los menores de 48 meses de edad (p = 0,04). Conclusión El presente estudio demostró que los niños que recibieron lactancia materna fueron protegidos contra el exceso de peso.

Abstract Objective To analyze association between breastfeeding and overweight in preschoolers. Methods A cross-sectional study with 448 preschoolers from 10 Municipal Centers of Early Childhood Education in the city of Teresina, state of Piauí. A meeting was held with the parents, at which time the structured questionnaire with questions related to sociodemographic data and past feeding of the children was applied. Subsequently, the anthropometric measurements of the children (weight and height). Overweight (overweight + obesity) was considered when the z-score result was greater than or equal to +2. Children younger than +2 were classified as not overweight. The association between exclusive breastfeeding up to six months, exclusive breastfeeding up to four months and breastfeeding with the child's nutritional status was analyzed using Pearson's chi-square test (c2), while the prevalence ratio (PR) was estimated to quantify the associations between breastfeeding and nutritional status controlled by sociodemographic variables. All estimates and 95% confidence intervals were calculated using the robust variance Poisson regression model. Results The prevalence of overweight and the proportion of children who received exclusive breastfeeding until 6 months of age were 11.16% and 41.9%, respectively. Overweight was 2.5 times higher among non-breastfed children (95% CI: 1.09; 5.83). After controlling for sociodemographic variables, it was found that children older than 48 months were at high risk for overweight (PR: 1.69; 95% CI: 1.01; 2.85) compared to children younger than 48 months. months old (p = 0.04). Conclusion The present study demonstrated that breastfed newborns were protected against overweight.

Effect of vitamin D3 supplementation on HIV-infected adults: a systematic reviewVitamin D? Supplementation on HIV-Infected Adults: A Systematic Review / Efecto de la suplementación con vitamina D3 en adultos infectados por el VIH: una revisión sistemática

Introduction: much evidence confirms that vitamin D may be associated with an improvement in CD4 cell counts in HIV-infected individuals, where antiretroviral therapy (ART) is used and associated with decreased 25(OH)D levels. Objective: to carry out a systematic review on the effect of vitamin D supplementation on HIV-infected adult patients. Methods: the research was conducted in the databases Science Direct, PubMed, BVS, Scielo Cochrane and Periods, from February to April 2018, with publication limit from 2000 to 2018, without restriction of gender, ethnicity and involving individuals with age older than 18 years. To evaluate the quality of the studies, we used the protocol Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) and the Jadad scale. Results: the search initially resulted in 198 articles. After the selection process 5 articles were identified as eligible, where they highlight that vitamin D supplementation may be an associated and effective intervention to reduce hypovitaminosis. ART reduces vitamin D3 levels and changes its metabolism, being associated with the risk of mortality. However, adequate levels of 25(OH)D are positively associated with the number of CD4 + cells and the reduction of infection levels. Conclusion: vitamin D supplementation promotes immune recovery. However, the cases analysed were few, insufficient to fully confirm the benefits and recommend supplementation. Therefore, intervention studies are needed to elucidate the role of vitamin D in human protection against HIV infections

Introducción: muchas evidencias ratifican que la vitamina D puede estar asociada con la mejora de los niveles de células CD4 en individuos infectados por el VIH, tratados con terapia antirretroviral (ART) que se asocia a la disminución de los niveles de 25(OH)D. Objetivo: realizar una revisión sistemática sobre el efecto de la suplementación de vitamina D en pacientes adultos infectados con VIH. Métodos: la investigación fue realizada en las bases de datos Science Direct, PubMed, BVS, Scielo Cochrane y periódicos, de febrero a abril de 2018, con límite de publicación de 2000 a 2018, sin restricción de género, etnicidad y que involucra a individuos con edad mayores de 18 años. Para la evaluación de la calidad de los estudios, se utilizó el protocolo Preferred Reporting Items for Systematic Reviews y Meta-Analyzes (PRISMA) y la escala de Jadad. Resultados: la encuesta inicialmente resultó en 198 artículos. Después del proceso de selección, 5 artículos fueron identificados como elegibles, donde ponen de manifiesto que la suplementación con vitamina D puede ser una intervención asociada y eficaz para reducir la hipovitaminosis. La ART reduce niveles de la vitamina D3 y altera su metabolismo, estando asociada al riesgo de mortalidad. Sin embargo, los niveles adecuados de 25(OH)D están asociados positivamente al número de células CD4 + y la reducción de los niveles de infecciones. Conclusión: la suplementación de vitamina D promueve la recuperación inmunológica. Sin embargo, los casos analizados fueron pocos, insuficientes para confirmar totalmente los beneficios y recomendar la suplementación. Por lo tanto, estudios de intervención son necesarios para elucidar la actuación de la vitamina D en la protección humana contra las infecciones por el VIH