Anthropometric indicators in identification ofinsulin resistance in elderly men / Indicadores antropométricos na identificação de resistência à insulina emhomens idosos

Insulin resistance (IR) increases with advancing age, yet the underlying mechanism is not well established. Anthropometricand body composition indicators are alternative tools for assessing insulin resistance in a fast, non-invasive and inexpensiveway. This study aimed to evaluate the association between anthropometric indicators and insulin resistance in older men.This cross-sectional study included 62 men aged between 60 and 92 years. We evaluated waist circumference (WC), sagittalabdominal diameter (SAD), body mass index (BMI), sagittal index (SI), conicity index (CI), body fat percentage (BF%),waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and waist-to-thigh ratio (WTR). IR was determined by homeostasismodel assessment (HOMA-IR). Statistical analysis consisted of correlation coefficient. All anthropometric indicators correlatedwith HOMA-IR, highlighting the SAD (r = 0.680), BF% (r = 0.651) and WC (r = 0.591), which showed the highestcorrelations with the index. All measurements showed significant differences and progressive increase with increasingHOMA-IR. The differences between quartiles of HOMA-IR were even more pronounced for WC, SAD and BF%. BF% wasa significant predictor for insulin resistance. Thus, obesity indicators correlated with the HOMA-IR index. We emphasizethe stronger relationship between measures of central adiposity and insulin resistance, suggesting the usefulness of SADin evaluating elderly subjects.

A resistência à insulina (RI) aumenta com o avanço da idade, no entanto os mecanismos não estão bem estabelecidos.Os indicadores antropométricos e de composição corporal são instrumentos alternativos para a avaliação da resistênciaà insulina de maneira rápida, não-invasiva e de baixo custo. O objetivo deste estudo foi avaliar a associação entre osindicadores antropométricos e a resistência à insulina em homens idosos. Estudo transversal com 62 homens com idadeentre 60 e 92 anos. Foram avaliados perímetro da cintura (PC), diâmetro abdominal sagital (DAS), índice de massa corporal(IMC), índice sagital (IS), índice de conicidade (ICO), percentual de gordura corporal (%GC) e as relações cintura-quadril(RCQ), cintura-estatura (RCE) e cintura-coxa (RCC). RI foi determinada pelo índice de resistência à insulina (HOMA-IR).Análises estatísticas consistiram de análises de correlação e regressão linear. Todos os indicadores antropométricos avaliadoscorrelacionaram-se com o HOMA-IR, destacando-se o DAS (r = 0,680), o %GC (r = 0,651) e o PC (r = 0,591), queapresentaram as maiores correlações com o índice. Todos os indicadores apresentaram aumento progressivo e diferençassignificativas com o aumento do HOMA-IR, sendo que para o PC, DAS e %GC as diferenças entre os quartis do HOMA‑IRforam ainda mais acentuadas. %PC foi preditor significativo para resistência à insulina. Portanto, os indicadores de obesidadecorrelacionaram com o índice HOMA-IR. Ressalta-se a relação mais forte das medidas de adiposidade central comresistência à insulina, sugerindo a utilidade do diâmetro abdominal sagital na avaliação de idosos.

[Depression, cognitive deficit and factors associated with malnutrition in elderly people with cancer]. / Depressão, déficit cognitivo e fatores associados à desnutrição em idosos com câncer.

The study sought to analyze the presence of depression, cognitive function, nutritional status and factors associated with malnutrition in the elderly undergoing treatment for cancer. A cross-sectional study was conducted in a cancer clinic in Minas Gerais, which included the application of a sociodemographic and health questionnaire, assessment of depressive symptoms, cognitive function and nutritional status. 96 elderly people were evaluated, 50% of which were female and the mean age was 70.6 years. Cognitive impairment was identified in 39.6% and the presence of depression in 17.7%, with a higher number of depressive symptoms in females (p = 0,017). Moderate malnutrition or suspected malnutrition was diagnosed in 29.2%, severe malnutrition in 14.6% and 47.9% had a critical need for nutritional intervention. In multivariate analysis, functional impairment was independently associated with malnutrition (PR: 3.40; CI: 1.23-9.45), the presence of two or more symptoms of nutritional impact (PR: 3.22; CI: 10.03-10.10) and current treatment by chemotherapy (PR: 2.96; CI: 1.16-7.56). The elderly with cancer showed a high prevalence of malnutrition and a need for nutritional intervention. The assessment of depression and cognitive impairment should also be an integral part in addressing this group.

Depressão, déficit cognitivo e fatores associados à desnutrição em idosos com câncer / Depression, cognitive deficit and factors associated with malnutrition in elderly people with cancer

Objetiva-se analisar a presença de depressão, a função cognitiva, o estado nutricional e os fatores associados à desnutrição em idosos em tratamento para o câncer. Foi realizado um estudo transversal em um centro oncológico em Minas Gerais que incluiu a aplicação de um questionário sociodemográfico e de saúde, a avaliação de sintomas depressivos, da função cognitiva e do estado nutricional. Foram avaliados 96 idosos, 50% do sexo feminino e com idade média de 70,6 anos. O déficit cognitivo foi identificado em 39,6% e a presença de depressão em 17,7% dos avaliados, com um maior número de sintomas depressivos sexo feminino (p = 0,017). Foi diagnosticada desnutrição moderada ou suspeita de desnutrição em 29,2% dos avaliados, desnutrição grave em 14,6% e 47,9% apresentou necessidade de intervenção nutricional crítica. Na análise multivariada foram condições independentemente associadas à desnutrição o déficit funcional (RP: 3,40; IC: 1,23-9,45), a presença de dois ou mais sintomas de impacto nutricional (RP: 3,22; IC: 1,03-10,10) e o tratamento atual por quimioterapia (RP: 2,96; IC: 1,16-7,56). Idosos com câncer apresentaram elevada prevalência de desnutrição e de necessidade de intervenção nutricional. A avaliação da depressão e do déficit cognitivo também devem ser partes integrantes na abordagem deste grupo.

The study sought to analyze the presence of depression, cognitive function, nutritional status and factors associated with malnutrition in the elderly undergoing treatment for cancer. A cross-sectional study was conducted in a cancer clinic in Minas Gerais, which included the application of a sociodemographic and health questionnaire, assessment of depressive symptoms, cognitive function and nutritional status. 96 elderly people were evaluated, 50% of which were female and the mean age was 70.6 years. Cognitive impairment was identified in 39.6% and the presence of depression in 17.7%, with a higher number of depressive symptoms in females (p = 0,017). Moderate malnutrition or suspected malnutrition was diagnosed in 29.2%, severe malnutrition in 14.6% and 47.9% had a critical need for nutritional intervention. In multivariate analysis, functional impairment was independently associated with malnutrition (PR: 3.40; CI: 1.23-9.45), the presence of two or more symptoms of nutritional impact (PR: 3.22; CI: 10.03-10.10) and current treatment by chemotherapy (PR: 2.96; CI: 1.16-7.56). The elderly with cancer showed a high prevalence of malnutrition and a need for nutritional intervention. The assessment of depression and cognitive impairment should also be an integral part in addressing this group.

Patient-Generated Subjective Global Assessment and classic anthropometry: comparison between the methods in detection of malnutrition among elderly with cancer / Valoración subjetiva global generada por el paciente y la antropometría clásica: comparación entre los métodos en la detección de desnutrición en ancianos con cáncer

Introduction: A comparative study of the various methods of nutritional assessment currently available in oncology are necessary to identify the most appropriate one, as well as the relationships that exist among the different instruments. Objective: To compare the nutritional diagnosis obtained by the Patient-Generated Subjective Global Assessment (PG-SGA) with the objective anthropometric measurements in the elderly undergoing oncology treatment and to assess the concordance between the methods used in detecting malnutrition. Methods: A cross-sectional study of the elderly, older than or equal to 60 years in age undergoing oncology treatment. The PG-SGA was performed and the anthropometric parameters including weight, height, Body Mass Index (BMI), arm circumference, arm muscle circumference, corrected arm muscle area, arm fat area, calf circumference, waist circumference, hip circumference, waist-hip ratio and triceps skinfold were evaluated. From a 24-hour recall the energy and macronutrient intakes were estimated. Results: A total of 96 elderly patients were evaluated. The PG-SGA identified 29.2% with moderate malnutrition or suspected malnutrition and 14.6% with severe malnutrition. From among the elderly evaluated, 47.9% required critical nutritional intervention. The anthropometric parameters and the consumption of energy and macronutrients revealed significant differences based on the subjective PG-SGA classification. The prevalence of malnutrition ranged from 43.8% to 61.4%, depending upon the instrument used. The method most consistent with the diagnosis of malnutrition provided by the PGSGA was the BMI (kappa = 0.54; CI: 0.347-0.648). Conclusions: The PG-SGA showed a significant correlation with the anthropometric measurements and with food consumption for both the categorical classification, as well as for the scoring system. Diagnosis of malnutrition showed variable prevalence depending upon the method used, and none were found equivalent to the PG-SGA (AU)

Introducción: Los estudios comparativos entre los métodos de evaluación nutricional en oncología son necesarios para identificar los medios más adecuados y las relaciones entre los diferentes instrumentos. Objetivos: Comparar el diagnóstico nutricional obtenido por la Valoración Subjetiva Global-Generada por el Paciente (PG-SGA) con mediciones antropométricas objetivas en el tratamiento oncológico sometido ancianos y evaluar la concordancia entre los métodos de detección de la desnutrición. Métodos: Estudio transversal de los ancianos con edad mayor o igual a 60 en tratamiento oncológico. El PG-SGA se realizó y evaluó los parámetros antropométricos: peso, talla, Índice de Masa Corporal (IMC), circunferencia del brazo, circunferencia muscular del brazo, área muscular del brazo corregida, brazo área de grasa, circunferencia de la pantorrilla, circunferencia de la cintura, circunferencia de la cadera, la cinturacadera y pliegue tricipital. Desde un recordatorio de 24 horas se estimaron los consumos de energía y macronutrientes. Resultados: Se evaluaron un total de 96 ancianos. El PG-SGA identificó 29,2% con desnutrición moderada o sospecha de la desnutrición y el 14,6% con desnutrición severa. De las personas mayores evaluados, el 47,9% necesitó una intervención nutricional crítico. Parámetros antropométricos y el consumo de energía y macronutrientes mostraron diferencias significativas en función de la clasificación subjetiva de la PG-SGA. Prevalencia de la desnutrición varió de 43,8% a 61,4%, en función del instrumento utilizado. El método más consistente con el diagnóstico de desnutrición proporcionada por el PG--SGA fue el índice de masa corporal (kappa = 0,54, IC: 0,347 hasta 0,648). Conclusiones: El PG-SGA mostró una correlación significativa con las mediciones antropométricas y con el consumo de alimentos tanto para la clasificación catgórica, así como para el sistema e puntuación. El diagnóstico de la malnutrición mostró prevalencia variable en función del método, y ninguno era equivalente a la PG-SGA (AU)

Relationship between waist circumference and sagittal abdominal diameter measured at different anatomical sites and inflammatory biomarkers in apparently health men / Relación entre la circunferencia de la cintura y el diámetro abdominal sagital medido en diferentes sitios anatómicos y biomarcadores del estado inflamatorio en hombres adultos sanos

Introduction: Visceral fat accumulation is associated with several changes, such as, increased production of inflammatory biomarkers, especially, C-reactive protein (CRP) and fibrinogen. Anthropometric measurements for central adiposity evaluation, such as, waist circumference (WC) and sagittal abdominal diameter (SAD) have been highlighted. However, there is no consensus on the best anatomical site for measurement. Objective: To evaluate the reliability of different measurements of WC and SAD and verify their capacity to discriminate changes in inflammatory biomarkers. Method: 130 men (20-59 years) were assessed, having measurements of weight, height, WC and SAD. It was considered as the cutoff point for high-sensitivity CRP (hs-CRP) values ≥ 0.12 mg/dL and for fibrinogen the 50th percentile of the evaluated sample. Results: All measurements presented an intraclass correlation coefficient between 0.998 and 0.999. WC measured at the umbilical level (AUC=0.693±0.049) and the smallest circumference between the thorax and the hips (AUC=0.607±0.050) had greater ability to discriminate changes in concentrations of hs-CRP and fibrinogen, respectively. SAD (umbilical level) showed the better ability to detect changes in concentrations of hs-CRP (AUC=0.698± 0.049) and fibrinogen (AUC=0.625±0.049), according to the ROC analysis (p<0.05). Conclusion: WC (smallest circumference between the thorax and the hips) and SAD (umbilical level) are the anatomic sites of measurement for use in predicting the inflammatory risk in apparently health men (AU)

Introducción: La acumulación de grasa visceral se asocia con varios cambios, tales como, aumento de la producción de los biomarcadores inflamatorios, en especial, la proteína C-reactiva (PCR) y fibrinógeno. Las medidas antropométricas para la evaluación de la adiposidad central, como la circunferencia de la cintura (CC) y el diámetro abdominal sagital (DAS) se han destacado. Sin embargo, no hay consenso sobre el mejor sitio anatómico para la medición. Objetivos: Evaluar la fiabilidad de diferentes mediciones de CC y DAS y verificar su capacidad para discriminar los cambios en biomarcadores inflamatorios. Métodos: Se evaluaron 130 hombres (20-59 años). Se midió peso, estatura, circunferencia de la cintura (CC) y diámetro abdominal sagital (DAS). Se consideró como punto de corte para los valores de PCR ultrasensible (PCR-us) ≥ 0,12 mg/dL y para el fibrinógeno se utilizó el percentil 50 de la muestra evaluada. Resultados: Todas las mediciones presentaron un coeficiente de correlación intraclase entre 0.998 y 0.999. CC medida a nivel umbilical (AUC=0,693±0,049) y la circunferencia más pequeña entre el tórax y las caderas (AUC=0,607±0,050) tuvieron una mayor capacidad para discriminar los cambios en las concentraciones de PCRus y fibrinógeno, respectivamente. DAS (nivel umbilical) mostró la mejor capacidad para detectar cambios en las concentraciones de PCR-us (AUC=0,698±0,049) y fibrinógeno (AUC=0,625±0,049), de acuerdo con el análisis ROC (p<0,05). Conclusiones: CC (circunferencia más pequeña entre el tórax y las caderas) y DAS (nivel umbilical) son los sitios anatómicos de elección para su uso en la predicción del riesgo inflamatorio en hombres adultos sanos (AU)

Cognitive capacity in individuals with chronic kidney disease: relation to demographic and clinical characteristics.

INTRODUCTION: The life expectancy of individuals with Chronic Kidney Disease (CKD) on hemodialysis has increased, however, with over years in treatment, there is impairment of cognitive function that affect adherence to therapy and dialysis. OBJECTIVE: To evaluate the cognitive ability of individuals on hemodialysis through the Mini Mental State Examination (MMSE) and the relation to sociodemographic and clinical characteristics of these individuals. METHODS: We obtained demographic and clinical information of 75 individuals. To assess memory and cognition MMSE was applied, which was analyzed according to the different cutoff points proposed in the literature. After classifying the participants according to proposal of different studies, the causes of CKD and sociodemographic characteristics, individuals were divided into groups with and without cognitive impairment in an attempt to identify differences between them. RESULTS: Most participants were men with a mean age of 59.2 years. The mean MMSE score was 24.16 points and there was no difference (p < 0.05) in MMSE results between the different causes of CKD. MMSE scores were correlated (p < 0.05) positively with years of schooling and income and inversely with age. According to the different cutoff points, six to 34 participants showed cognitive impairment and memory, and only three of these were classified with cognitive impairment for all cutoff points evaluated. CONCLUSION: The average MMSE score declined with increasing age and increased with years of schooling and income per capita. No relationships were found to justify the harmful effects of dialysis process on cognition and memory.

Influência do gênero e do tipo de tratamento nos parâmetros nutricionais de idosos em Oncologia / Elderly influence of gender and type of treatment on nutritional parameters in oncology

Introdução: A avaliação dos fatores que exercem influência nos parâmetros nutricionais é um importante aspecto a ser considerado em indivíduos com câncer. Objetivo: Analisar o perfil clínico, sociodemográfico e nutricional de idosos em tratamento oncológico, com ênfase nas diferenças nos indicadores nutricionais relacionados ao tipo de tratamento e ao gênero. Método: Estudo transversal com 96 idosos em tratamento oncológico, que incluiu a aplicação de um questionário sociodemográfico e de saúde, avaliação do estado nutricional pela Avaliação Subjetiva Global Produzida pelo Paciente (ASG-PPP) e pelo Índice de Massa Corporal (IMC), avaliação do consumo alimentar e aferição demedidas antropométricas. Resultados: A amostra apresentou idade média de 70,6 anos e predomínio da doença emestágio avançado. A ASG-PPP identificou desnutrição moderada ou grave em 43,8% dos avaliados. Segundo o IMC, 29,1% estavam com baixo peso e 35,4% com excesso de peso. Idosos em quimioterapia, quando comparados aos em hormonioterapia, apresentaram valores inferiores para a quase totalidade parâmetros antropométricos e maior pontuação na ASG-PPP. Foram identificados valores de medidas antropométricas inferiores no gênero masculino, independente do tipo de tratamento. Conclusão: O tipo de tratamento e o gênero parecem exercer influência nas medidas antropométricas, sugerindo-se, em idosos, maior depleção nutricional no tratamento por quimioterapia, especialmente entre os homens. O excesso de peso foi observado na mesma frequência que a eutrofia e esteve igualmente distribuído entre os tipos de tratamento. A identificação de desvios nutricionais é parte essencial na abordagem dopaciente idoso com câncer.

Introduction: The evaluation of the factors that influence on nutritional parameters is an important aspect to beconsidered in individuals with cancer. Objective: To analyze the clinical, sociodemographic and nutritional status ofelderly undergoing cancer treatment, with emphasis on differences in the nutritional indicators, related to the type oftreatment and gender. Method: We performed a cross-sectional study with 96 elderly undergoing cancer treatment,which included the application of a sociodemographic and health questionnaire, assessment of nutritional statusby Patient-Generated Subjective Global Assessment (PG-SGA) and the Body Mass Index (BMI), assessment foodconsumption and anthropometric measures. Results: The sample had a mean age of 70,6 years and a predominanceof advanced stage disease. The PG-SGA identified moderate or severe malnutrition in 43,8%. According to BMI,29,1% were underweight and 35,4% overweight. Elderly undergoing chemotherapy compared to those in hormonetherapy, showed lower values for almost all anthropometric parameters and higher scores on the PG-SGA. Quantitativevalues of anthropometric measurements were lower in males, regardless of type of treatment. Conclusion: The typeof treatment and gender seem to exert influence on anthropometric measurements, suggesting, in the elderly, highernutritional depletion in chemotherapy, especially among men. Overweight was observed in the same frequency asnormal weight and was equally distributed between treatment types. The identification of nutritional problems is anessential part in addressing the elderly cancer patient.

Serum uric acid can predict higher C-reactive protein levels in apparently healthy men / Ácido úrico sérico puede predecir mayores niveles de proteína c-reactiva en hombres adultos sanos

Introduction: Epidemiological studies have shown an association between coronary heart disease and emerging cardiovascular risk factors, such as, levels of fibrinogen and high-sensitivity C-reactive protein (hs-CRP). Objectives: To verify the ability of biochemical indicators in discriminating changes in the levels of hs-CRP and fibrinogen, in apparently healthy adult men. Methods: Were evaluated 130 apparently healthy men (20-59 years), having measurement of weight and height. Biochemical measurements (lipid profile, fasting glucose, uric acid, hs-CRP and fibrinogen) were performed. Body mass index, total cholesterol/HDL-c and LDL-c/HDL-c ratios were calculated. It was considered as the cutoff point for hs-CRP values ≥ 0.12 mg/dL and for fibrinogen the 50th percentile of the evaluated sample. Results: The uric acid showed the best correlation (r = 0.325) and the higher area under the ROC curve (0.704 ± 0.054), showing greater ability to discriminate higher levels of hs-CRP (p < 0.01). The total cholesterol/HDL-c ratio (r = 0.222) and the LDL-c/HDL-c ratio (r = 0.235) showed the best correlations and the higher areas under the ROC curves (0.624 ± 0.049 and 0.624 ± 0.049) in identify higher levels of fibrinogen (p < 0.05). Conclusion: The uric acid and the total choles - terol/HDL-c and the LDL-c/HDL-c ratios showed greater ability to identify changes in the levels of hs-CRP and fibrinogen, respectively. It was suggested the use of biochemical markers in the clinical practice, in order to establish preventive action for cardiovascular disease in apparently healthy adult men (AU)

Introducción: Los estudios epidemiológicos han demostrado una asociación entre la enfermedad coronaria y nuevos factores de riesgo cardiovascular, como, los niveles de proteína C-reactiva ultrasensible (PCR-us) y fibrinógeno. Objetivos: Evaluar la capacidad de los indicadores bioquímicos en discriminar cambios en los niveles de PCRus y fibrinógeno, en hombres adultos sanos. Métodos: Se evaluaron 130 hombres (20-59 años). Se midió peso y talla. Se realizó mediciones bioquímicas (perfil lipídico, glucosa en ayunas, ácido úrico, PCR-us y fibrinógeno). Se calculó el índice de masa corporal, la relación colesterol total/HDL-c y la relación LDL-c/HDL-c. Se consideró como punto de corte para los valores de PCR-us ≥ 0,12 mg/dL y para el fibrinógeno se utilizó el percentil 50 de la muestra evaluada. Resultados: El ácido úrico mostró la mejor correlación (r = 0,325) y el área más alta bajo la curva ROC (0,704 ± 0,054), mostrando una mayor capacidad predictiva para detectar niveles más altos de PCR-us (p < 0,01). La relación colesterol total/HDL-c (r = 0,222) y la relación LDLc/HDL-c (r = 0,235) mostraron una mejor correlación y el área más alta bajo la curva ROC (0,624 ± 0,049 y 0,624 ± 0,049) en la identificación de niveles más altos de fibrinógeno (p < 0,05). Conclusiones: El ácido úrico y la relación colesterol total/HDL-c y la relación LDL-c/HDL-c mostraron una mayor capacidad predictiva para detectar cambios en los niveles de PCR-us y fibrinógeno, respectivamente. Se sugirió el uso de marcadores bioquímicos en la práctica clínica, a fin de establecer medidas preventivas para la enfermedad cardiovascular en hombres adultos sanos (AU)

Capacidade cognitiva de indivíduos com doença renal crônica: relação com características demográficas e clínicas / Cognitive capacity in individuals with chronic kidney disease: relation to demographic and clinical characteristics

Introdução: O comprometimento da cognição e memória (CM) é comum em indivíduos com Doença Renal Crônica (DRC) em hemodiálise, o que prejudica a aderência ao tratamento. Objetivo: Avaliar a capacidade cognitiva de indivíduos renais crônicos em hemodiálise por meio do Miniexame do Estado Mental (MEEM) e a relação com as características sociodemográficas e clínicas desses indivíduos. Métodos: Foram obtidas informações clínicas e sociodemográficas de 75 indivíduos. Para avaliação da MC, foi aplicado o MEEM, o qual foi analisado segundo os diversos pontos de corte propostos na literatura. Após classificar os participantes de acordo com as diferentes propostas e pelas causas da DRC, os indivíduos foram alocados em grupos com e sem comprometimento da CM, na tentativa de identificar diferenças entre eles. Resultados: A maioria dos participantes eram homens, com idade média de 59,2 anos. O escore médio do MEEM foi 24,16 pontos e não houve diferença (p < 0,05) quanto às diferentes causas da DRC. Os escores do MEEM se correlacionaram (p < 0,05) positivamente com os anos de escolaridade e renda per capita e inversamente com a idade. Segundo os diversos pontos de corte, seis a 34 participantes apresentaram comprometimento da CM e apenas três desses foram classificados com déficit de CM por todas as propostas avaliadas. Conclusão: O escore do MEEM reduziu com o aumento da idade e se elevou com os anos de estudo e com a renda per capita. Não foram encontradas relações que justificassem efeitos prejudiciais do processo dialítico sobre a CM. .

Introduction: The life expectancy of individuals with Chronic Kidney Disease (CKD) on hemodialysis has increased, however, with over years in treatment, there is impairment of cognitive function that affect adherence to therapy and dialysis. Objective: To evaluate the cognitive ability of individuals on hemodialysis through the Mini Mental State Examination (MMSE) and the relation to sociodemographic and clinical characteristics of these individuals. Methods: We obtained demographic and clinical information of 75 individuals. To assess memory and cognition MMSE was applied, which was analyzed according to the different cutoff points proposed in the literature. After classifying the participants according to proposal of different studies, the causes of CKD and sociodemographic characteristics, individuals were divided into groups with and without cognitive impairment in an attempt to identify differences between them. Results: Most participants were men with a mean age of 59.2 years. The mean MMSE score was 24.16 points and there was no difference (p < 0.05) in MMSE results between the different causes of CKD. MMSE scores were correlated (p < 0.05) positively with years of schooling and income and inversely with age. According to the different cutoff points, six to 34 participants showed cognitive impairment and memory, and only three of these were classified with cognitive impairment for all cutoff points evaluated. Conclusion: The average MMSE score declined with increasing age and increased with years of schooling and income per capita. No relationships were found to justify the harmful effects of dialysis process on cognition and memory. .

[Analysis of the mainstreaming of the perspective of the Human Right to Adequate Food in the institutional design of the National School Nutrition Program]. / Análise da incorporação da perspectiva do Direito Humano à Alimentação Adequada no desenho institucional do Programa Nacional de Alimentação Escolar.

Being a signatory to international agreements that recognize the Human Right to Adequate Food (HRAF) and having enshrined this right into its Constitution, the Brazilian state imposes a duty to provide, protect and promote the HRAF. For this it is necessary to incorporate the principles of the HRAF into the process of planning and executing the actions of Food and Nutrition Security (FNS). The objective was to analyze the process of mainstreaming of the HRAF in the new institutional design of the National School Nutrition Program (NSNP). This is in line with the principles laid down in General Comment No 12 of the Guide for Policy Analysis and Public Programs and nutritional Food Security under the Perspective of Human Rights and the Organic Law on Food and Nutrition Security (OLFNS). The results show that the new regulatory framework of the NSNP indicates a paradigm shift that is characterized by a gradual decline in the perception of NSNP as policy of a welfare nature. Concomitantly, there is an increase in the concept of the benefit of school food as a right, with the caveat that the construction of a new regulatory framework, although essential, is not sufficient for full implementation of the HRAF.

Analise da incorporacao da perspectiva do direito humano a alimentacao adequada no desenho institucional do programa nacional de alimentacao escolar / Analysis of the mainstreaming of the perspective of the Human Right to Adequate Food in the institutional design of the National School Nutrition Program

O fato de ser signatário de acordos internacionais que reconhecem o Direito Humano à Alimentação Adequada (DHAA) e de ter inserido este direito na sua Constituição Federal, impõem ao estado brasileiro o dever de prover, proteger e promover o DHAA. Para tal, faz-se necessária a incorporação dos princípios do DHAA no processo de planejamento e execução das ações de Segurança Alimentar e Nutricional (SAN). Objetivou-se analisar o processo de incorporação da perspectiva do DHAA no novo desenho institucional do Programa Nacional de Alimentação Escolar (PNAE) tomando como referência os princípios presentes no Comentário Geral No12, no Guia para Análise de Políticas e Programas Públicos de Segurança Alimentar e Nutricional sob a Perspectiva dos Direitos Humanos e na Lei Orgânica de Segurança Alimentar e Nutricional (LOSAN). Os resultados expressam que o novo marco regulatório do PNAE sinaliza para um processo de mudança de paradigma que se caracteriza por gradativo declínio da percepção do PNAE como política de caráter assistencialista e pelo incremento da concepção do benefício da alimentação escolar como um direito, com a ressalva de que a construção de um novo marco regulatório, embora condição essencial, não é suficiente para a plena realização do DHAA. .

Being a signatory to international agreements that recognize the Human Right to Adequate Food (HRAF) and having enshrined this right into its Constitution, the Brazilian state imposes a duty to provide, protect and promote the HRAF. For this it is necessary to incorporate the principles of the HRAF into the process of planning and executing the actions of Food and Nutrition Security (FNS). The objective was to analyze the process of mainstreaming of the HRAF in the new institutional design of the National School Nutrition Program (NSNP). This is in line with the principles laid down in General Comment No 12 of the Guide for Policy Analysis and Public Programs and nutritional Food Security under the Perspective of Human Rights and the Organic Law on Food and Nutrition Security (OLFNS). The results show that the new regulatory framework of the NSNP indicates a paradigm shift that is characterized by a gradual decline in the perception of NSNP as policy of a welfare nature. Concomitantly, there is an increase in the concept of the benefit of school food as a right, with the caveat that the construction of a new regulatory framework, although essential, is not sufficient for full implementation of the HRAF. .

Predictive ability of the anthropometric and body composition indicatorsfor detecting changes in inflammatory biomarkers / Capacidad predictiva de los indicadores antropométricos y de composición corporal para detectar cambios en los biomarcadores del estado inflamatorio

Introduction: Obesity has been considered a chronic subclinical inflammation. High sensitivity C-reactive protein (hs-CRP) and fibrinogen are increasingly associated with cardiovascular risk. Objectives: To evaluate the ability of anthropometric and body composition indicators in discriminating higher levels of hs-CRP and fibrinogen. Methods: 130 men (20-59 years) were assessed, having measurement of weight, height, waist circumference (WC), hip and thigh circumferences, sagittal abdominal diameter (SAD), coronal diameter (CD) and body composition. Conicity index, waist/height ratio, body mass index, waist/hip ratio, waist/thigh ratio and sagittal index were calculated. It was considered as the cutoff point for hs-CRP values ≥ 0.12 mg/dL and for fibrinogen the 50th percentile of the evaluated sample. Results: Sagittal index (r = 0.280), waist/thigh ratio (r = 0.233) and waist/height ratio (r = 0.233) showed the best correlation with hs-CRP (p < 0.01). Conicity index (r = 0.305) and waist/height ratio (r = 0.279) showed the best correlation with fibrinogen (p < 0.01). In ROC analysis, the SAD (0.698 ± 0.049) and the conicity index (0.658 ± 0.048) had greater ability to discriminate cardiovascular risk through higher levels of hs-CRP and fibrinogen, respectively (p < 0.01). The cutoff points of 30 cm, 89.9 cm and 20.5 cm were the ones that reached largest sum between sensitivity and specificity values for the CD, WC and SAD, respectively. Conclusions: The SAD and the conicity index demonstrated a greater ability to detect higher levels of hs-CRP and fibrinogen, respectively, in apparently healthy adult men (AU)

Introducción: La obesidad ha sido considerada como una inflamación crónica subclínica. La proteína C-reactiva ultrasensible (PCR-us) y el fibrinógeno se han asociado cada vez más con el riesgo cardiovascular. Objetivos: Evaluar la capacidad, de los indicadores antropométricos y de composición corporal, en discriminar mayores niveles séricos de PCR-us y fibrinógeno. Métodos: Se evaluaron 130 hombres (20-59 años). Se midió peso, estatura, circunferencia de la cintura, de la cadera y del muslo, diámetro abdominal sagital (DAS), diámetro coronal (DC) y composición corporal. Se calculó el índice de conicidad, la relación cintura/estatura, el índice de masa corporal, la relación cintura/cadera, la relación cintura/muslo y el índice sagital. Se consideró como punto de corte para los valores de PCR-us ≥ 0,12 mg/dl y para el fibrinógeno se utilizó el percentil 50 de la muestra evaluada. Resultados: El índice sagital (r = 0,280), la relación cintura/muslo (r = 0,233) y la relación cintura/estatura (r = 0,233) mostraron una mejor correlación con la PCR-us (p < 0,01). El índice de conicidad (r = 0,305) y la relación cintura/estatura (r = 0,279) mostraron una mejor correlación con el fibrinógeno (p < 0,01). En el análisis ROC, el DAS (0,698 ± 0,049) y el índice de conicidad (0,658 ± 0,048) mostraron una mayor capacidad predictiva de riesgo cardiovascular determinado a través de mayores niveles de PCR-us y fibrinógeno, respectivamente (p < 0,01). Los puntos de corte de 30 cm, 89,9 cm y 20,5 fueron los que alcanzaron mayor sumatorio entre los valores de sensibilidad y especificidad para el DC, circunferencia de la cintura y DAS, respectivamente. Conclusiones: En hombres adultos sanos, el DAS y el índice de conicidad mostraron una mayor capacidad predictiva para detectar niveles más altos de PCR-us y fibrinógeno respectivamente.

Tratamento conservador: influência sobreparâmetros clínicos de indivíduos emhemodiálise / Conservative treatment: influence on clinical parameters ofsubjects on hemodialysis

O diagnóstico precoce da Doença Renal Crônica (DRC) possibilita a implementação de medidas que adiam a entrada emhemodiálise (HD) e melhoram parâmetros clínicos. O objetivo deste estudo foi analisar as características epidemiológicase clínicas dos indivíduos com DRC em HD que realizaram ou não tratamento conservador (TC). Foram coletados dadosde prontuários médicos de 65 participantes, os quais foram entrevistados sobre diagnóstico e tratamento da DRC. Paraanálise dos dados, os indivíduos foram divididos entre os que realizaram TC ou não e, quanto ao tempo de TC, menor,igual ou maior que seis meses. A hipertensão arterial e o diabetes mellitus foram as principais causas da DRC, a qual foidiagnosticada, na maioria dos casos, por um nefrologista. A maior parte dos indivíduos que não realizaram tratamentoconservador teve diagnóstico da DRC realizado em um hospital. Indivíduos que realizaram TC apresentaram melhoresparâmetros bioquímicos, especialmente aqueles que o fizeram por mais de seis meses. O TC, sobretudo, realizado porequipes multidisciplinares, pode contribuir para melhoria dos desfechos da DRC tanto no período pré-dialítico quantodurante o tratamento de HD.

Early diagnosis of Chronic Kidney Disease (CKD) leads to the implementation of measures that are delaying undergoinghemodialysis (HD) and improve clinical parameters. The aim of this study was to analyze the epidemiological and clinicalcharacteristics of individuals with CKD who underwent HD or not conservative treatment (CT). Data were collected frommedical records of 65 participants who were interviewed about the diagnosis and treatment of CKD. For data analysis,subjects were divided between those who underwent CT or not and as to the time of CT less than, equal to or greater thansix months. Hypertension and diabetes mellitus were the main causes of CRD, which were diagnosed, in most cases, by anephrologist. Most individuals which did not receive a conservative treatment were diagnosed as having CRD in a hospitalsettting. Individuals who underwent CT showed better biochemical parameters, especially those who did so for more thansix months. The TC mainly conducted by multidisciplinary teams, can contribute to improving the outcomes of CKD inboth pre-dialysis and during HD treatment.

Alimentação na primeira infância no Brasil / Feeding in early childhood in brazil

A alimentação, desde o nascimento até aos dois primeiros anos de vida, tem repercussões ao longo de toda a existência do indivíduo. Neste sentido, objetivou-se realizar uma revisão atualizada sobre alimentação infantil, abordando: o direito à saúde e nutrição; a importância da nutrição e alimentação no crescimento e desenvolvimento; aleitamento materno; alimentação complementar e alimentação no segundo ano de vida. Esta revisão teve o intuito de contribuir e orientar o planejamento, o monitoramento e a avaliação de programas governamentais para a promoção de saúde, nesta faixa etária. Acredita-se que alcançar a alimentação adequada, para as crianças menores de dois anos de idade, deve ser um componente essencial da estratégia global, para assegurar a alimentação de uma população. Embora seja atribuição dos profissionais de saúde a sua promoção e das mães a sua execução, o sucesso final da ação, também depende, principalmente, da definição de políticas públicas adequadas e da participação da sociedade.

Feeding from birth up to two years of age carries repercussions throughout a person?s lifetime. Accordingly, this paper aimed at doing an up-to-date review on infant feeding covering: the right to health and nutrition; the importance of nutrition and feeding while growing and developing; breastfeeding; complementary feeding; and feeding during the second year of life. The purpose was to contribute to and guide the planning, monitoring, and evaluation of government programs to promote health for this age group. It is believed that the goal of appropriate feeding of children under two years old must be an essential element of the overall strategy to ensure a population?s nourishment. Although it?s the health professional?s job to promote this action and the mother?s to carry it out, its final success also depends mainly on defining appropriate public policy, as well as on society?s participation.

Classic anthropometric and body composition indicators can predict risk of metabolic syndrome in elderly.

BACKGROUND/AIMS: Although a variety of classical body measurements have been used to assess adiposity, it is still uncertain which is the best indicator to predict effects arising from the accumulation of body fat (BF) in the elderly. The objective of this study was to analyze different classical anthropometric and body composition measurements and their potential for predicting metabolic syndrome (MS) in elderly women. METHODS: There were 113 women (60-83 years old) participating in the study, all of whom had their anthropometric, biochemical, hemodynamic and health conditions evaluated. Statistical analysis consisted of correlation coefficient and receiver operating characteristic (ROC) curves, and calculation of the area under the curve. RESULTS: The waist-hip ratio (WHR) and waist circumference correlated with three (hyperglycemia, hypertriglyceridemia and low concentrations of high density lipoprotein-cholesterol) of the seven cardiometabolic risk factors studied. Body mass index, BF, percentage of BF, and the sum of skinfolds were less related to metabolic risk factors. Among the indicators used to characterize central adiposity, WHR was the index that showed the greatest area under the ROC curve. CONCLUSIONS: It is suggested that the WHR, an indicator of abdominal adiposity, should be incorporated into the identification of risk of MS in elderly women.

Mortalidade infantil, segundo critérios de evitabilidade e componentes - Viçosa - MG, 1998-2010 / Infant mortality according to preventable causes and components - Viçosa - MG, 1998-2010

Objetivo: Analisar a evolução dos indicadores da mortalidade infantil, segundo seus componentes e por causas evitáveis, no município de Viçosa, Minas Gerais, comparando-os com o Estado de Minas Gerais e o Brasil. Métodos: Estudo ecológico e descritivo de séries temporais, realizado com dados secundários relativos à mortalidade infantil, segundo grupos de causas e componentes, no município de Viçosa, no período de 1998 a 2010. Os dados de óbitos infantis ocorridos no município de Viçosa, no período de estudo, foram categorizados de acordo com a Classificação Internacional de Doenças, 10ª revisão ou CID-10, nas categorias de dois dígitos, seus componentes ? neonatal precoce, neonatal tardio e pós-neonatal ? e também de acordo com os critérios de evitabilidade, por meio da Classificação de Óbitos Evitáveis da Fundação Sistema Estadual de Análise de Dados (Fundação SEADE) do governo do Estado de São Paulo ou Classificação de Ortiz (2000). Resultados: Apesar de um declínio ao longo dos anos do coeficiente de mortalidade infantil, mantém-se um predomínio do componente neonatal à custa dos óbitos neonatais precoces, sem redução das causas evitáveis (ou reduzíveis) de óbitos nos períodos neonatal e pós-neonatal, as quais vêm mantendo-se em percentuais superiores às causas de óbitos não evitáveis ou maldefinidas. Conclusões: Grande parte da mortalidade infantil poderia ser evitada ou reduzida por meio de adequado controle da gravidez, adequada atenção ao parto e por ações de prevenção, diagnóstico e tratamento precoces e parcerias com outros setores. Por outro lado, as causas maldefinidas ainda estão em valores bem elevados, ressaltando-se a necessidade de registros de óbitos de melhor qualidade.

Nutritional status and epidemiological profile of elderly people.

We intended to identify and evaluate the association between the socio-demographic and epidemiological characteristics of elderly people with their nutritional characteristics. This is a transversal study PMTI (from the Portuguese name of "Programa Municipal da Terceira Idade"), conducted at Viçosa, MG, Brazil. We analyzed 93 records of elderly people registered since 2006 and who underwent nutritional care. After having analyzed the questionnaire, we performed the descriptive and association analyses in the Epi Info (version 6.04) and Minitab softwares. Of the 93 analyzed records, most elderly people were women (80.4%), with an average of 72 years of age, of which 13.0% were long-lived people. The mean body mass index (BMI) was 27.4 kg/m(2), and 50.5% were overweight. We have found 26.8% elderly patients with hypertension, and 31.6% took antihypertensives. Elderly patients who were overweight are 4.54 times more likely to have arterial hypertension (odds ratio (OR)=4.54; 95% confidence interval (CI)=1.2-2.45). Only 7.5% smoked, 30.1% were alcoholics and 60.2% made physical activities. Inadequacies were found regarding the servings of fruits, dairy products, vegetables and sugars consumed. However, the servings of cereals, leguminous, meat and fat consumed were appropriate. This study showed that the nutritional diagnosis and the epidemiological and socio-demographic studies are critical tools to understand this population group, in addition to being important to the planning of health actions.

Quantificação e análise do custo da sobra limpa em unidades de alimentação e nutrição de uma empresa de grande porte / Quantification and analysis of the cost of food wastage in the cafeterias of a large company

OBJETIVO:O propósito deste estudo foi quantificar e avaliar o custo da sobra limpa em oito unidades de alimentação e nutrição de uma empresa siderúrgica de grande porte. MÉTODOS: Foram avaliadas oito unidades de alimentação e nutrição durante cinco meses. A quantificação da sobra limpa considerou as sobras e o número de refeições planejadas e servidas diariamente. As preparações foram divididas em grupos, sendo os custos obtidos a partir do valor médio dos alimentos adquiridos no mês. RESULTADOS: Cinquenta por cento das unidades de alimentação e nutrição não atingiram valores inferiores ou iguais a 30g, meta per capita de sobra limpa determinada pela empresa. Os per capitas totais de sobra limpa variaram entre 24g e 60g, equivalentes a 176kg-1.213kg de alimentos desperdiçados mensalmente. As saladas apresentaram as maiores porcentagens de desperdício na maioria das unidades. O custo mensal com as sobras atingiu de 2,2 por cento a 3 por cento do valor gasto mensalmente com alimentos, representando um custo elevado para a empresa (entre 80 a 108 salários-mínimos). Diante dos resultados obtidos, foram propostas medidas de intervenção, tais como planejamento e elaboração adequada das preparações, caracterização dos clientes e ações para educação nutricional. CONCLUSÃO: As unidades de alimentação e nutrição apresentaram considerável perda de alimentos com a sobra limpa. A implementação das intervenções propostas poderá minimizar essa perda. O valor gasto com esse desperdício poderia ser revertido em melhorias nos processos produtivos.

OBJECTIVE: The purpose of this study was to quantify and assess the cost of food wastage in eight cafeterias of a big steel mill. METHODS: Eight cafeterias were followed during five months. Quantification of food wastage was done considering the leftovers and the number of meals planned and served daily. For determining the cost, preparations were divided into groups, and the cost was obtained from the average price of foodstuffs purchased during the month. RESULTS: Fifty percent of the cafeterias did not achieve wastage less or equal to 30g (the per capita food wastage goal set by the company). The total per capita food wastage ranged from 24g to 60g, equivalent to 176-1213kg of food wasted monthly. Salads were wasted more often in most foodservices. The monthly cost of food wastage reached 2.2 percent to 3.0 percent of the amount spent monthly on food. It represented a high expense for the foodservice (approximately 80-108 minimum wages). The results allowed the proposal of intervention measures such as planning and development of appropriate preparations, identification of customers, and nutrition education actions. CONCLUSION: The cafeterias presented considerable food wastage, hence money loss. Implementation of interventions can minimize these losses. Savings from reducing wasteful spending could be used for improving production processes.

[The influence of sociosanitary conditions on the quality of life of the elderly in a municipality in the Southeast of Brazil]. / Influência de fatores sociossanitários na qualidade de vida dos idosos de um município do Sudeste do Brasil.

This study sought to evaluate sociosanitary conditions and their impact on the quality of life of the elderly living in the Teixeiras Municipality in the Southeast Region (MG) of Brazil. Two questionnaires were used: one created specifically to characterize the population in terms of sociosanitary conditions, and WHOQOL-bref, to evaluate quality of life. The correlation between the sociosanitary conditions and quality of life scores were analyzed by logistic regression analysis. Among the variables with a strong correlation with quality of life scores the following stand out: use of medication, need of medical care, lack of private health insurance, comorbidities, sleep problems, and retirement. The results of this study indicate that sociosanitary conditions are high risk factors for low quality of life scores in the elderly. This must be taken into consideration to establish health strategies and policies for this age group.

Práticas de aleitamento materno: lacuna entre o conhecimento e a incorporação do saber / Practices of breastfeeding: A gap between knowledge and knowledge application

Introdução: a Organização Mundial da Saúde recomenda a prática de aleitamento materno exclusivo por seis meses e a partir dessa idade introduzir alimentos complementares até os dois anos. Objetivo: avaliar o nível de conhecimento e incorporação do saber sobre aleitamento materno de gestantes e nutrizes usuárias da Estratégia Saúde da Família, Teixeiras-MG. Casuística e método: foi realizado estudo transversal descritivo cuja coleta de dados se deu por meio de entrevistas individuais utilizando-se questionário semiestruturado, nas Unidades de Atenção Primária de Saúde, antes das consultas pré-natais e puericulturas e em visitas domiciliares. Resultados: a duração de aleitamento materno exclusivo relatado foi de quatro meses. Destaca-se que 66% das entrevistadas já haviam recebido algum tipo de orientação, 34% por meio de consultas pré-natais e 31% por palestras realizadas pela equipe de Nutrição da Universidade Federal de Viçosa. Observou-se que as mulheres que receberam orientação acerca do aleitamento materno apresentaram 99,93% menos de chance de responder que o leite é fraco, obtendo resultado estatisticamente significante. Conclusão: ressalta-se a importância das informações sobre aleitamento materno serem transmitidas à população de modo eficaz, estimulando a prática do aleitamento em todas as classes sociais.

Introduction: The World Health Organization recommends exclusive breastfeeding over the six months after birth, and complementary food should be provided after this period until age of 2 years. Objective: To assess breastfeeding knowledge and knowledge application among women assisted by the Family Health Strategy in Teixeiras, State of Minas Gerais, Brazil. Casuistics and method: A descriptive cross-sectional study of data collected by means of individual semi-structured interviews carried out before prenatal and childcare appointments at Primary Health Care Units as well as in domiciliary visits. Results: Exclusive breastfeeding was reported to take place for four months. Among the interviewees, 66% had had some orientation: 34% at prenatal appointments, and 31% at lectures organized by the Nutrition team of the Federal University of Viþosa. Women that had had breastfeeding orientation were 99,93% less likely to report that breast milk is weak ? a figure that is statistically significant. Conclusion: It is important that information on breastfeeding be given to population efficiently in order to encourage breastfeeding among all the social classes.