High-intensity functional training with an adequate and carbohydrate restricted hypocaloric diet promotes weight loss and cardiometabolic improvements

INTRODUCTION: Excess body weight and its comorbidities represent a major public health issue. Interventions based on diet and exercise have not only been shown to promote weight loss, but also improve overall health, including cardiovascular health. OBJECTIVE: This study aimed to evaluate the effects of a 12-week hypocaloric low-carbohydrate (CHO) diet coupled with high-intensity functional training (HIFT) on the cardiometabolic risk of overweight adults. METHODS: This is a randomized controlled trial. A total of 31 overweight adults participated in this study, divided into two groups based on the dietary intervention: reduced-CHO (R-CHO, ≤130 g/day; n=15) and adequate-CHO (A-CHO, >130 g/day; n=16). The cardiometabolic risk was assessed using lipidaemic, insulinemia, and glycaemic parameters. A two-way ANOVA with Bonferroni post hoc test was utilized to evaluate the effects of the intervention. A p-value < 0.05 was considered statistically significant. RESULTS: Participants from both groups displayed decreased low-density lipoprotein, very-low-density lipoprotein, total cholesterol, and triacylglycerol concentrations, as well as the number of risk factors for the metabolic disease after 12 weeks. The high-density lipoprotein (HDL) cholesterol concentration of both groups increased after 12 weeks, however, the result of the intragroup analysis revealed that a significant increase was only observed in the participants from the A-CHO group. CONCLUSION: Reduced or adequate CHO intake was both found to be effective in reducing cardiometabolic risk. However, improvements in HDL and final cardiometabolic classification risk indicated that CHO adequacy in the diet might be a better strategy associated with caloric restriction and HIFT.

Adherence to secondary prevention measures after acute coronary syndrome in patients associated exclusively with the public and private healthcare systems in Brazil.

Adherence to secondary prevention measures after acute coronary syndrome (ACS) is essential to prevent disease recurrence. In Brazil, the Brazilian Unified Health System (SUS, in Portuguese), and the private healthcare system (PHCS) coexist. We aimed to evaluate the adherence to secondary prevention in patients with ACS who were assisted by either SUS or PHCS. In this longitudinal prospective study, patients with ACS were admitted to the four cardiological reference hospitals of Sergipe, three of which assisted PHCS users, and one, SUS users. We analyzed the two patient care models with multiple logistic regression models for adherence to physical activity, pharmacotherapy, and smoking cessation. We enrolled 581 volunteers in this study: 44.1 % from SUS and 55.9 % from PHCS. PHCS users showed greater adherence to pharmacotherapy at both 30 and 180 (p = 0.001) days after ACS with better results in all classes of medications (p < 0.05) than SUS users did. They also showed better adherence to physical activity (p = 0.047). There was no distinction between the groups regarding smoking cessation. The secondary prevention measures after ACS were more effective in PHCS users than in SUS users due to better adherence, especially to pharmacotherapy and regular physical activity.

Health managers and professionals' perception on the care of child and adolescent obesity in Brazil's Unified Health System / Percepção de gestores e profissionais de saúde sobre o cuidado da obesidade infanto-juvenil no Sistema Único de Saúde

The study aimed to analyze the perception of health managers and professionals on the care of children and adolescents with overweight and obesity in the Unified Health System of Sergipe, Brazil. This is a qualitative and exploratory study with sample composed of 46 actors and semi-structured interviews as data collection method. The existing care was perceived as poor and fragmented, regardless of the health care level. The main difficulties were the professionals' work process, care management and organization, family support and insufficient resources. Potentialities related to management, teams and professionals, which could contribute to the implementation of a comprehensive care line, were also identified. However, the organization of care for child obesity still requires the connectivity of different actors' roles and tasks, with the agreement and co-responsibility between services, professionals and family. Key words: Obesity. Child. Adolescent. Comprehensive Health Care. Unified Health System.

O estudo teve como objetivo analisar a percepção de gestores e profissionais de saúde sobre o cuidado disponível para crianças e adolescentes com sobrepeso e obesidade no Sistema Único de Saúde em Sergipe, Brasil. Trata-se de um estudo qualitativo e exploratório, com amostra composta por 46 atores e coleta por meio de entrevistas semiestruturadas. O cuidado existente foi percebido como falho e fragmentado, independente do nível de atenção. As principais dificuldades abrangeram o processo de trabalho, a gestão e organização do cuidado, a adesão familiar e a insuficiência de recursos. Potencialidades relacionadas à gestão, equipes e profissionais, que poderiam contribuir para implantação de uma linha de cuidado integral, foram também identificadas. Contudo, a organização do cuidado à obesidade infantil ainda requer uma conectividade dos papéis e tarefas dos diversos atores, por meio da pactuação e corresponsabilização entre os serviços, profissionais e a família. Palavras-chave: Obesidade. Criança. Adolescente. Assistência Integral à Saúde. Sistema Único de Saúde.

Percepção de gestores e profissionais de saúde sobre o cuidado da obesidade infanto-juvenil no Sistema Único de Saúde / Health managers and professionals' perception on the care of child and adolescent obesity in Brazil's Unified Health System

Resumo O estudo teve como objetivo analisar a percepção de gestores e profissionais de saúde sobre o cuidado disponível para crianças e adolescentes com sobrepeso e obesidade no Sistema Único de Saúde em Sergipe, Brasil. Trata-se de estudo qualitativo e exploratório, com amostra composta por 46 atores e coleta de dados por meio de entrevistas semiestruturadas. O cuidado existente foi percebido como falho e fragmentado, independentemente do nível de atenção à saúde. As principais dificuldades abrangeram o processo de trabalho, a gestão e organização do cuidado, a adesão familiar e a insuficiência de recursos. Potencialidades relacionadas à gestão, equipes e profissionais, que poderiam contribuir para a implantação de uma linha de cuidado integral, foram também identificadas. Contudo, a organização do cuidado à obesidade infantil ainda requer uma conectividade dos papéis e tarefas dos diversos atores, por meio da pactuação e corresponsabilização entre os serviços, profissionais e a família.

Abstract The study aimed to analyze the perception of health managers and professionals on the care of children and adolescents with overweight and obesity in the Unified Health System of Sergipe, Brazil. This is a qualitative and exploratory study with sample composed of 46 actors and semi-structured interviews as data collection method. The existing care was perceived as poor and fragmented, regardless of the health care level. The main difficulties were the professionals' work process, care management and organization, family support and insufficient resources. Potentialities related to management, teams and professionals, which could contribute to the implementation of a comprehensive care line, were also identified. However, the organization of care for child obesity still requires the connectivity of different actors' roles and tasks, with the agreement and co-responsibility between services, professionals and family.

Influence of Factors Affecting Quality of Life on in-Hospital Cardiovascular Events of Patients with Acute Myocardial Infarction with and without ST-segment Elevation

Abstract Background Acute myocardial infarction (AMI), with and without ST-segment elevation (STEMI and NSTEMI, respectively), is the principal cause of cardiovascular morbidity and mortality in Brazil and around the world. Modifiable risk factors (RF) and quality of life (QOL) may correlate with the type of AMI. Objective To evaluate the influence of QOL and RF on the type of AMI and in-hospital cardiovascular events in STEMI and NSTEMI patients. Methods This was an observational, cross-sectional study. Patients with AMI attending four referral hospitals (three private and one public) for cardiovascular disease treatment were assessed for QOL using the Brazilian version of the 36-item short form survey. A p < 0.05 was considered statistically significant. Results We evaluated 480 volunteers; 51% were treated in one of the private hospitals. In total, 55.6% presented with STEMI, and 44.4% with NSTEMI. Patients from the public hospital were 8.56 times more likely to have STEMI compared to those from the private hospitals. There was a higher prevalence of smokers in STEMI (p < 0.028) patients. QOL was not associated with the type of AMI. A negative patient perception of the physical health and pain domains was observed. Although a significant difference between the physical and the mental health domains was not observed, individual domains were correlated with some in-hospital outcomes. Conclusion There was a higher prevalence of smokers among individuals with STEMI. Domains of QOL showed a statistically significant relationship with the occurrence of in-hospital cardiovascular events, with no difference between the types of AMI.

Low adherence to traditional dietary pattern and food preferences of low-income preschool children with food neophobia.

OBJECTIVE: To associate dietary patterns and food neophobia in low-income preschoolers. DESIGN: This was a cross-sectional study using a semi-structured questionnaire for socio-demographic data, birth conditions and breast-feeding history. Food neophobia was assessed using an adapted version of the Child Food Neophobia Scale. Children's nutritional status was assessed using BMI-for-age and height-for-age Z-scores. Dietary patterns were estimated using a semi-quantitative FFQ through exploratory factor analysis. Multiple linear regression was used to test for an association between food neophobia and dietary pattern adherence. SETTING: Philanthropic childhood education schools in Aracaju, an urban community in northeastern Brazil, between July and December 2017. PARTICIPANTS: Two hundred fourteen children aged 3-6 years and their parents. RESULTS: The percentages of low/medium and high food neophobia among preschoolers were 85·9 % and 11·2 %, respectively. Children with high food neophobia more frequently consumed ultra-processed foods rich in sugars (snacks, filled and unfilled cookies and sweets), as well as protein-rich foods (white meat, cheese and yogurt). Three dietary patterns were identified (traditional, snacks and school snacks). Children with a high level of neophobia had lower adherence to traditional dietary patterns. CONCLUSIONS: A high level of food neophobia among socially vulnerable preschoolers is an eating behaviour related to unhealthy eating and is associated with the poorest diet in typical foods.

Identification of neck circumference cut-off points for insulin resistance as a marker in adolescents / Identificação de pontos de corte da circunferência do pescoço como marcador da resistência à insulina em adolescentes

ABSTRACT Objective To identify cut-off points of neck circumference measurement to predict insulin resistance in adolescents. Methods Cross-sectional analysis with data derived from the Study of Cardiovascular Risks in Adolescents, nationwide, multicenter, school-based survey. We evaluated 901 adolescents, aged 12 to 17, from public and private schools in two cities of Sergipe state in Brazil. We measured demographic, anthropometric, and biochemical data, and insulin resistance using Homeostasis Model Assessment-Insulin Resistance. We used multiple linear regression and logistic analysis to evaluate the association between dependent variables (biochemical) and independent variables (anthropometric) controlled by body mass index, age, gender, and Tanner's stage. We used the Receiver operating characteristic curve to determine cut-off points of neck circumference that can identify insulin resistance. Results The multiple linear regression analysis showed a positive association between neck circumference measurement with fasting glycemia and glycated hemoglobin (p<0.001) and a negative association with insulin (p<0.024). Furthermore, in logistic regression, the measurement of neck circumference was the only anthropometric indicator positively correlated with homeostasis model assessment-insulin resistance. The cut-off points of neck circumference for predicting insulin resistance were: 30.55cm for female pubertal and 32.10cm for post-pubertal adolescents; 35.90cm for male pubertal adolescents and 36.65cm for post-pubertal adolescents. Conclusions The measurement of neck circumference is a simple, practical anthropometric indicator and can be used as a screening tool to identify insulin resistance in adolescents.

RESUMO Objetivo Identificar pontos de corte da medida da circunferência do pescoço que possam predizer a resistência à insulina em adolescentes. Métodos Estudo transversal com uma subamostra do Estudo de Riscos Cardiovasculares em Adolescentes, um estudo multicêntrico nacional. Avaliaram-se 901 adolescentes de 12 a 17 anos de duas cidades do estado de Sergipe, Brasil. Fatores demográficos, antropométricos e bioquímicos e a resistência à insulina pelo homeostasis model assessment-insulin resistance foram mensurados. A associação entre as variáveis dependentes (bioquímicas) e independentes (antropométricas), controladas pelo índice de massa corporal, idade, sexo e estadiamento de Tanner, foi avaliada pela análise de regressão linear múltipla e logística, e a curva característica de operação do receptor foi utilizada para determinar os pontos de corte da circunferência do pescoço na predição da resistência à insulina. Resultados A análise de regressão linear múltipla mostrou uma associação positiva entre a medida da circunferência do pescoço com a glicemia de jejum e a hemoglobina glicada (p<0,001) e negativa com a insulina (p<0,024). Na regressão logística, a medida da circunferência do pescoço foi o único indicador antropométrico que se correlacionou positivamente com o Homeostasis Model Assessment-Insulin Resistance. Os pontos de corte da circunferência do pescoço para predição da resistência à insulina em adolescentes foram: 30,55cm feminino púberes e 32,10cm feminino pós-púberes; 35,90cm masculino púberes e 36,65cm masculino pós-púberes. Conclusão A medida da circunferência do pescoço é um indicador antropométrico simples e prático e pode ser utilizada como instrumento de triagem para identificar a resistência à insulina em adolescentes.

Zinc nutritional status influences ZnT1 and ZIP4 gene expression in children with a high risk of zinc deficiency.

INTRODUCTION: Subclinical deficiency of zinc is associated with impairment of immune system function, growth, and cognitive development in children. Although plasma zinc is the best available biomarker of the risk of zinc deficiency in populations, its sensitivity for early detection of deficiency is limited. Therefore, we aimed to investigate zinc deficiency among preschool children and its relationship with whole blood gene expression of zinc transporters ZIP4 and ZnT1. MATERIAL AND METHODS: This cross-sectional study included 139 children aged 32-76 months enrolled in philanthropic day-care centers. We performed an anthropometric evaluation, weighed food record and dietary record for dietary assessment, blood sample collection for zinc, and whole blood gene expression analyses of ZnT1 (SLC30A1) and ZIP4 (SLC39A4). RESULTS: Zinc deficiency was observed in 26.6 % of the children despite adequate zinc intake and a phytate:zinc molar ratio < 18. Usual zinc intake did not affect whole blood gene expression of zinc transporters, but zinc status influenced ZnT1 and ZIP4 whole blood mRNA. Children with zinc deficiency exhibited 37.1 % higher ZnT1 expression and 45.3 % lower ZIP4 expression than children with adequate zinc (p < 0.05). CONCLUSION: Children with plasma zinc deficiency exhibited higher expression of ZnT1 and lower expression of ZIP4 in whole blood mRNA, reinforcing the existence of strong regulation of mineral homeostasis according to the nutritional status, indicating that this analysis may be useful in the evaluation of dietary interventions.

Quality of Intra-Hospital Nutritional Counseling in Patients with STEMI in the Public and Private Health Networks of Sergipe: The VICTIM Register / Qualidade da Orientação Nutricional Intra-hospitalar em Pacientes com IAMcSST das Redes Pública e Privada de Saúde em Sergipe: Registro (VICTIM)

Abstract Background: Having appropriate dietary habits is part of the recommendations after ST-Elevation Myocardial Infarction (STEMI), however, the quality of intra-hospital nutritional counselling in the different health services has been minimally explored. Objective: To evaluate the quality of intra-hospital nutritional counselling among patients with STEMI in the public and private health systems in Sergipe. Methods: A cross-sectional, with data from the Via Crucis for the Treatment of Myocardial Infarction (VICTIM) Register, conducted from April to November of 2017, with individuals aged ≥ 18 years diagnosed with STEMI, in one public health service hospital and three private hospitals. The occurrence and quality of nutritional counselling were analyzed based on current guidelines and the administration of questionnaires. A significance level of 0.05 was adopted. Results: A total of 188 patients were analyzed; 80.3% were from the public health service facility. Among the interviewees, 57.6% of the public health service, and 70.3% of the private hospital patients received intra-hospital nutritional counselling (p = 0.191). The documentation of this practice, in medical records, was lower in the public service (2.6% vs. 37.8%, p < 0.001). A predominance of restrictive orientations was found in the public and private sectors, mainly regarding salt and fat, 52.3% and 70.3% respectively (p = 0.064). Patients from the private service were more counselling to introduce of cardioprotective foods, mainly fruit, vegetable/legume consumption (48.6% vs. 13.2%, p < 0.001). Among those who received counselling, nutritional knowledge was higher in the private sector (68.2% vs. 26.3%, p < 0.001). Conclusion: The intra-hospital nutritional counselling provided to patients with STEMI, in Sergipe, still presents poor quality in both services, especially in the public health system.

Resumo Fundamento: A adequação dos hábitos alimentares faz parte das recomendações pós-infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMcSST); contudo, tem sido pouco explorada a qualidade da orientação nutricional intra-hospitalar nos diferentes serviços de saúde. Objetivo: Avaliar a qualidade da orientação nutricional intra-hospitalar entre pacientes com IAMcSST nas redes de saúde pública e privada em Sergipe. Métodos: Estudo transversal, com dados do Registro Via Crucis para o Tratamento do Infarto do Miocárdio (VICTIM), realizado de abril a novembro de 2017 com indivíduos com idade ≥ 18 anos, diagnosticados com IAMcSST em um hospital público e três privados. Analisaram-se a ocorrência de orientação nutricional e a sua qualidade com base nas diretrizes atuais e por meio de aplicação de questionários, sendo adotado nível de significância de 0,05. Resultados: Foram avaliados 188 voluntários, sendo 80,3% do serviço público. Dentre os entrevistados, 57,6% da rede pública e 70,3% da privada receberam orientação nutricional intra-hospitalar (p = 0,191). O registro dessa prática em prontuário foi menor no serviço público (2,6% versus 37,8%; p < 0,001). Verificou-se o predomínio das orientações restritivas, sobretudo de sal e gorduras, 52,3% e 70,3% no público e no privado, respectivamente (p = 0,064). Quanto à inserção de alimentos cardioprotetores, pacientes da rede privada foram mais beneficiados, principalmente quanto ao consumo de frutas e verduras/legumes (48,6% versus 13,2%, p < 0,001). Entre aqueles que receberam orientação, o conhecimento nutricional foi maior no sistema privado (68,2% versus 26,3%, p < 0,001). Conclusão: A orientação nutricional intra-hospitalar para o IAMcSST em Sergipe apresenta baixa qualidade em ambos os serviços de saúde, sobretudo no público.

Quality of Intra-Hospital Nutritional Counseling in Patients with STEMI in the Public and Private Health Networks of Sergipe: The VICTIM Register.

BACKGROUND: Having appropriate dietary habits is part of the recommendations after ST-Elevation Myocardial Infarction (STEMI), however, the quality of intra-hospital nutritional counselling in the different health services has been minimally explored. OBJECTIVE: To evaluate the quality of intra-hospital nutritional counselling among patients with STEMI in the public and private health systems in Sergipe. METHODS: A cross-sectional, with data from the Via Crucis for the Treatment of Myocardial Infarction (VICTIM) Register, conducted from April to November of 2017, with individuals aged ≥ 18 years diagnosed with STEMI, in one public health service hospital and three private hospitals. The occurrence and quality of nutritional counselling were analyzed based on current guidelines and the administration of questionnaires. A significance level of 0.05 was adopted. RESULTS: A total of 188 patients were analyzed; 80.3% were from the public health service facility. Among the interviewees, 57.6% of the public health service, and 70.3% of the private hospital patients received intra-hospital nutritional counselling (p = 0.191). The documentation of this practice, in medical records, was lower in the public service (2.6% vs. 37.8%, p < 0.001). A predominance of restrictive orientations was found in the public and private sectors, mainly regarding salt and fat, 52.3% and 70.3% respectively (p = 0.064). Patients from the private service were more counselling to introduce of cardioprotective foods, mainly fruit, vegetable/legume consumption (48.6% vs. 13.2%, p < 0.001). Among those who received counselling, nutritional knowledge was higher in the private sector (68.2% vs. 26.3%, p < 0.001). CONCLUSION: The intra-hospital nutritional counselling provided to patients with STEMI, in Sergipe, still presents poor quality in both services, especially in the public health system.

Readmission of Patients with Acute Coronary Syndrome and Determinants.

BACKGROUND: Acute coronary syndrome (ACS) is responsible for high rates of hospital admission and readmission, which are associated with increased costs for the patient and the health system, and increased in-hospital mortality rates. OBJECTIVE: To evaluate readmission in patients with ACS and its determinants. METHODS: This was a retrospective cohort study of adult and elderly patients with ACS, readmitted to public and private referral cardiology hospitals within one year after the first hospitalization for ACS. The occurrence of readmissions, the time elapsed from the first to the second admission, and the use of medications at admission were collected from the medical records. Associations between categorical variables were evaluated by the chi-square test or the Fisher's exact test. Multiple logistic regression was used to evaluate predictors for readmissions. A p < 0.05 was set as statistically significant. RESULTS: Readmission rate was 21.5% (n = 115) and mean time between admissions was 122.7 ± 112.1 days. The patients were mostly men (64.0%), mean age of 63.15 ± 12.3 years. Among readmitted patients, 7% had a prognosis of "death", and 68.7% were readmitted more than once within a one-year period. The main reasons of readmission were cardiovascular diseases including ACS. Private health care and the diagnosis of congestive heart failure were associated with multiple logistic regression. CONCLUSION: ACS was the main cause of readmission, with higher prevalence among users of supplemental health care. Readmissions were associated with previous diagnosis of congestive heart failure and the type of health care provided.

Readmission of Patients with Acute Coronary Syndrome and Determinants / Reinternação de Pacientes com Síndrome Coronariana Aguda e seus Determinantes

Abstract Background: Acute coronary syndrome (ACS) is responsible for high rates of hospital admission and readmission, which are associated with increased costs for the patient and the health system, and increased in-hospital mortality rates. Objective: To evaluate readmission in patients with ACS and its determinants. Methods: This was a retrospective cohort study of adult and elderly patients with ACS, readmitted to public and private referral cardiology hospitals within one year after the first hospitalization for ACS. The occurrence of readmissions, the time elapsed from the first to the second admission, and the use of medications at admission were collected from the medical records. Associations between categorical variables were evaluated by the chi-square test or the Fisher's exact test. Multiple logistic regression was used to evaluate predictors for readmissions. A p < 0.05 was set as statistically significant. Results: Readmission rate was 21.5% (n = 115) and mean time between admissions was 122.7 ± 112.1 days. The patients were mostly men (64.0%), mean age of 63.15 ± 12.3 years. Among readmitted patients, 7% had a prognosis of "death", and 68.7% were readmitted more than once within a one-year period. The main reasons of readmission were cardiovascular diseases including ACS. Private health care and the diagnosis of congestive heart failure were associated with multiple logistic regression. Conclusion: ACS was the main cause of readmission, with higher prevalence among users of supplemental health care. Readmissions were associated with previous diagnosis of congestive heart failure and the type of health care provided.

Resumo Fundamento: A síndrome coronariana aguda (SCA) é responsável por elevados números de admissões e readmissões hospitalares, os quais estão associados ao aumento dos custos para o paciente e para o sistema de saúde, bem como à elevação nas taxas de mortalidade hospitalar. Objetivo: Investigar a reinternação entre pacientes com SCA e seus determinantes. Métodos: Trata-se de uma coorte retrospectiva de pacientes de ambos os sexos, adultos e idosos, diagnosticados com SCA. Foram avaliados, a partir dos registros dos hospitais locais públicos e privados de referência em cardiologia, a ocorrência de reinternação em até 1 ano após internação por SCA, o tempo entre as admissões e o uso de medicamentos no momento da reinternação. As variáveis categóricas foram associadas por meio do teste qui-quadrado, ou pelo teste exato de Fisher. Regressão logística múltipla foi utilizada para avaliar as variáveis preditoras da reinternação. Adotou-se como critério de significância estatística um valor de p < 0,05. Resultados: A ocorrência de reinternações foi de 21,46% (n = 115), e o período médio entre as internações foi de 122,74 (DP 112,14) dias. Os pacientes avaliados eram, em sua maioria, do sexo masculino (64,0%), com média de idade de 63,15 anos (DP 12,26). Sete por cento apresentaram óbito como prognóstico da reinternação, e 68,7% tiveram mais de uma reinternação em 1 ano. As causas cardiovasculares, entre elas a recorrência da SCA, foram as mais prevalentes entre as reinternações hospitalares. A assistência privada e o diagnóstico de insuficiência cardíaca congestiva (ICC) foram associados a reinternação após a regressão logística múltipla. Conclusão: Conclui-se que a SCA foi a principal causa de reinternação, sendo mais prevalente entre os usuários da rede suplementar de saúde. As reinternações associaram-se ao diagnóstico prévio de ICC e ao tipo de assitência à saúde.

Plasma Total Antioxidant Capacity and Cardiometabolic Risk in Non-Obese and Clinically Healthy Young Adults / Capacidade Antioxidante Total do Plasma e Risco Cardiometabólico em Adultos Jovens, Não Obesos e Clinicamente Saudáveis

Abstract Background: The oxidative biomarkers play an important role in the genesis of cardiometabolic risk-related processes. Objective: To investigate the total antioxidant capacity of plasma and its association with cardiometabolic risk in non-obese and clinically healthy young adults. Methods: University students of the state of Sergipe, Brazil, aged between 18 and 25 years, were recruited for this study from May of 2013 and October of 2014. Anthropometric, clinical and biochemical parameters were measured and analyzed using protocols which were previously standardized and described in the literature. The measurement of plasma total antioxidant capacity was based on the ability that all the antioxidants present in the sample (plasma) have to inhibit the oxidation of the oxidizable substrate ABTS (2,2`- Azino-di-[3-ethylbenzthiazoline sulphonate]) to ABTS•+ by metmyoglobin. Results: Approximately 25% of the sample presented more than one component of cardiometabolic risk. Low HDL-cholesterol was the most prevalent component. Compared to absence of components, the subjects with at least one component presented greater body weight and waist circumference, higher levels of diastolic blood pressure and fasting glucose, greater total cholesterol/HDL-c ratio, and lower levels of HDL-c (p < 0.05). Fasting glycemia was the only parameter which was associated with total antioxidant capacity (R2 = 0.10; β = 0.17; p = 0.001). Conclusions: The plasma total antioxidant capacity was not able to predict the cardiometabolic risk components due possibly to the establishment of compensatory mechanisms that become activated in physiological conditions.

Resumo Fundamentos: Os biomarcadores oxidativos exercem um importante papel na gênese dos processos relacionados ao risco cardiometabólico. Objetivo: Investigar a capacidade antioxidante total do plasma e sua associação com risco cardiometabólico em adultos jovens, não obesos e clinicamente saudáveis. Métodos: Estudantes universitários do estado de Sergipe, Brasil, com idade entre 18 e 25 anos, foram recrutados entre maio de 2013 e outubro de 2014. Parâmetros antropométricos, clínicos e bioquímicos foram medidos e analisados usando protocolos previamente padronizados e descritos na literatura. A medida da capacidade antioxidante total do plasma baseou-se na capacidade de todos os antioxidantes presentes na amostra (plasma) em inibir a oxidação do substrato oxidável ABTS (2,2-Azino-bis-(3-etilbenzotiazolina-6-sulfonato) a ABTS•+ pela metamioglobina. Resultados: Aproximadamente 25% da amostra apresentaram mais de um componente do risco cardiometabólico. Valores baixos de HDL foram o componente mais prevalente. Em comparação à ausência de componentes, os indivíduos com pelo menos um componente apresentou valores mais altos de peso corporal, circunferência da cintura, pressão sanguínea diastólica, glicemia de jejum e razão colesterol total/HDL-c, e valores mais baixos de HDL-c (p < 0,05). A glicemia de jejum foi o único parâmetro que se associou com a capacidade antioxidante total (R2 = 0,10; β = 0,17; p = 0,001). Conclusões: A capacidade antioxidante total não foi capaz de predizer os componentes do risco cardiometabólico possivelmente devido ao estabelecimento de mecanismos compensatórios que se tornam ativados em condições fisiológicas.

Plasma Total Antioxidant Capacity and Cardiometabolic Risk in Non-Obese and Clinically Healthy Young Adults.

BACKGROUND:: The oxidative biomarkers play an important role in the genesis of cardiometabolic risk-related processes. OBJECTIVE:: To investigate the total antioxidant capacity of plasma and its association with cardiometabolic risk in non-obese and clinically healthy young adults. METHODS:: University students of the state of Sergipe, Brazil, aged between 18 and 25 years, were recruited for this study from May of 2013 and October of 2014. Anthropometric, clinical and biochemical parameters were measured and analyzed using protocols which were previously standardized and described in the literature. The measurement of plasma total antioxidant capacity was based on the ability that all the antioxidants present in the sample (plasma) have to inhibit the oxidation of the oxidizable substrate ABTS (2,2`- Azino-di-[3-ethylbenzthiazoline sulphonate]) to ABTS•+ by metmyoglobin. RESULTS:: Approximately 25% of the sample presented more than one component of cardiometabolic risk. Low HDL-cholesterol was the most prevalent component. Compared to absence of components, the subjects with at least one component presented greater body weight and waist circumference, higher levels of diastolic blood pressure and fasting glucose, greater total cholesterol/HDL-c ratio, and lower levels of HDL-c (p < 0.05). Fasting glycemia was the only parameter which was associated with total antioxidant capacity (R2 = 0.10; ß = 0.17; p = 0.001). CONCLUSIONS:: The plasma total antioxidant capacity was not able to predict the cardiometabolic risk components due possibly to the establishment of compensatory mechanisms that become activated in physiological conditions. FUNDAMENTOS:: Os biomarcadores oxidativos exercem um importante papel na gênese dos processos relacionados ao risco cardiometabólico. OBJETIVO:: Investigar a capacidade antioxidante total do plasma e sua associação com risco cardiometabólico em adultos jovens, não obesos e clinicamente saudáveis. MÉTODOS:: Estudantes universitários do estado de Sergipe, Brasil, com idade entre 18 e 25 anos, foram recrutados entre maio de 2013 e outubro de 2014. Parâmetros antropométricos, clínicos e bioquímicos foram medidos e analisados usando protocolos previamente padronizados e descritos na literatura. A medida da capacidade antioxidante total do plasma baseou-se na capacidade de todos os antioxidantes presentes na amostra (plasma) em inibir a oxidação do substrato oxidável ABTS (2,2-Azino-bis-(3-etilbenzotiazolina-6-sulfonato) a ABTS•+ pela metamioglobina. RESULTADOS:: Aproximadamente 25% da amostra apresentaram mais de um componente do risco cardiometabólico. Valores baixos de HDL foram o componente mais prevalente. Em comparação à ausência de componentes, os indivíduos com pelo menos um componente apresentou valores mais altos de peso corporal, circunferência da cintura, pressão sanguínea diastólica, glicemia de jejum e razão colesterol total/HDL-c, e valores mais baixos de HDL-c (p < 0,05). A glicemia de jejum foi o único parâmetro que se associou com a capacidade antioxidante total (R2 = 0,10; ß = 0,17; p = 0,001). CONCLUSÕES:: A capacidade antioxidante total não foi capaz de predizer os componentes do risco cardiometabólico possivelmente devido ao estabelecimento de mecanismos compensatórios que se tornam ativados em condições fisiológicas.

Fatores associados ao risco de insegurança alimentar e nutricional em famílias de assentamentos rurais / Factors associated with food insecurity risk and nutrition in rural settlements of families

Resumo A insegurança alimentar ocorre quando o direito a uma alimentação em qualidade e quantidade adequada de forma regular é desrespeitado. O objetivo deste estudo foi identificar a situação de insegurança alimentar (IAN) e suas possíveis associações com variáveis socioeconômicas e dietéticas em assentamentos rurais de Sergipe. Essa situação foi verificada através da escala brasileira de insegurança alimentar e as associações através da análise de regressão multivariada por odds ratio (OR). Foram avaliadas 179 famílias de quatro assentamentos do estado de Sergipe. Identificou-se prevalência de 88,8% de IAN, sendo 48,6% insegurança leve, 25,1% moderada e 15,1% grave. Associação estatística ajustada foi encontrada entre a IAN e as variáveis renda familiar per capita (ORa = 3,11, p = 0,008) e variedade alimentar (Ora = 2,73, p = 0,004). As famílias apresentaram alta prevalência de insegurança alimentar e nutricional, determinada nesta população, pela baixa renda familiar e pela baixa variedade da alimentação. É imprescindível políticas públicas mais efetivas, que, de fato, garantam a segurança alimentar e sejam mais completas, visando também à educação nutricional e maior possibilidade para produção de alimentos.

Abstract Food insecurity occurs when the right to food in adequate quality and quantity on a regular basis is disrespected. This study aimed to identify food and nutrition insecurity (FNI) and its possible association with socioeconomic and dietary variables in rural settlements of Sergipe. We verified food insecurity through the Brazilian of Food Insecurity Scale and associations via odds ratio multivariate regression analysis. We evaluated 179 families from four rural settlements in the state of Sergipe. An FNI prevalence of 88.8% was identified (48.6% light insecurity, 25.1% moderate and 15.1% severe). An adjusted statistical association was found between FNI and variables family income per capita (ORa = 3.11, p = 0.008) and food variety (ORa = 2.73, p = 0.004). Families showed high prevalence of food and nutritional insecurity, determined by low income and low variety of food in this population. It is essential to implement more effective and comprehensive public policies that actually ensure food security, also aiming at nutrition education and greater food production opportunities.

Inadequação nutricional na dieta de atletas adolescentes / Nutritional inadequacy in dietary intake of school athletes

INTRODUÇÃO: Os atletas adolescentes têm uma demanda energética aumentada devido à prática competitiva de exercício físico, apresentando maiores riscos de inadequações nutricionais. OBJETIVO: Avaliar a ingestão alimentar de atletas escolares envolvidos em diferentes modalidades esportivas. MÉTODOS: A amostra foi composta por 129 adolescentes, de ambos os gêneros, praticantes de tênis, natação, ginástica (artística e rítmica) e judô de equipes do município de Aracaju (SE), Brasil. Aplicou-se um questionário de frequência alimentar semiquantitativo, com auxílio de registro fotográfico, para estimar a ingestão de macro e micronutrientes e porções dos grupos alimentares. RESULTADOS: Entre os analisados, 41,2% eram do gênero feminino, com média de idade de 13,54±2,45 anos. Independente do gênero, os adolescentes mais velhos apresentaram maior ingestão energética e de macronutrientes (p<0,05), porém com semelhança na prevalência de inadequação em relação aos mais novos. Com relação aos micronutrientes, a comparação entre os gêneros mostrou maior prevalência de inadequações entre meninas mais novas para vitamina E, cálcio e ferro. Entre os meninos, apenas a inadequação do cálcio foi significativamente maior para os mais novos. Independente do gênero e da idade, observou-se baixa ingestão de lácteos e hortaliças, além do elevado consumo de doces, carnes e ovos. CONCLUSÃO: A dieta dos atletas adolescentes estudados mostrou inadequação de macro e de micronutrientes, especialmente entre as atletas mais novas. Faz-se essencial o desenvolvimento de ações de aconselhamento nutricional individual ou em grupo com vistas a adquirir hábitos alimentares adequados.

INTRODUCTION: Young athletes have an increased energy demand because of the competitive practice of physical exercise, presenting greater risks of nutritional inadequacies. OBJECTIVE: To evaluate the dietary intake of school athletes who practice different sports by gender and age. METHODS: The sample consisted of 129 adolescents of both genders, who were tennis, swimming, gymnastics (artistic and rhythmic), and judo athletes of sports teams in the city of Aracaju (SE), Brazil. A semiquantitative food frequency questionnaire was applied, which was also supported by a photographic record, to estimate the dietary intake of macro and micronutrients as well as food portions. RESULTS: Among the young athletes analyzed, 41.2% were female with a mean age of 13.54±2.45 years. Regardless of gender, older adolescents had higher energy and macronutrient intakes (p<0.05), but presented similar prevalence of inadequacy in relation to the young. Regarding micronutrients, the comparison between genders showed a higher prevalence of inadequacy among younger girls for vitamin E, calcium and iron. Among boys, only the inadequacy of calcium was significantly higher among the younger athletes. Regardless of gender and age, there was a low intake of dairy products and vegetables and a high consumption of sweets, meats and eggs. CONCLUSION: The diet of adolescent athletes studied showed inadequacy of macro and micronutrients, especially among the younger athletes. It is essential to develop individual or in group nutritional counseling, so that they may acquire proper eating habits.

Balanço energético e composição corporal entre atletas escolares / Energy balance and body composition in student athletes / Balance energético y composición corporal de atletas escolares

Objetivo: Relacionar a composição corporal e o balanço energético de atletas escolares. Métodos: Trata-se de um estudo transversal e analítico, cuja coleta de dados ocorreu entre os anos de 2010 e 2012. A amostra constituída por 134 adolescentes de 10 a 18 anos, de ambos os sexos, praticantes de cinco modalidades distintas: judô, natação, tênis, ginástica rítmica e ginástica artística. As dobras cutâneas foram utilizadas como método para avaliação da composição corporal e o balanço energético (BE) foi calculado a partir da subtração do valor energético total consumido (VET) pelo valor das necessidades energéticas estimadas (NEE). Os procedimentos estatísticos foram realizados no programa SPSS 19.0. Utilizouse o teste t de Student para a comparação dos dados entre sexos e as correlações foram realizadas pelo coeficiente de correlação de Pearson. Valores de p≤0,05 foram considerados significativos. Resultados: Os mais velhos de ambos os sexos apresentaram maiores valores de circunferência muscular do braço (CMB) e percentual de gordura (%G). Foi possível perceber uma correlação negativa e significativa entre BE e %G para o sexo masculino e uma correlação positiva, porém sem significância no sexo feminino. Observou-se também, que a maioria (51,1%) dos participantes apresentou balanço energético positivo. Conclusão: Um balanço energético positivo foi encontrado na maioria dos adolescentes avaliados e esse dado se correlacionou negativamente com a composição corporal apenas nos meninos. No entanto, no sexo feminino, não foi observada correlação entre essas variáveis.

Objective: To relate the energy balance and the body composition of student athletes. Methods: This is a cross-sectional analytical study, whose data was collected between the years 2010 and 2012. The sample consisted of 134 male and female adolescents, aged 10 to 18 years, engaged in any of five distinct activities: judo, swimming, tennis, rhythmic gymnastics and artistic gymnastics. The skinfolds were used as method for assessing body composition and the energy balance (EB) was calculated by subtracting the total energy intake (TEI) from the value of their estimated energy needs (EEN). All statistical procedures were performed using SPSS 19.0. Student's t-test was used to compare data between genders, and the correlations were performed using Pearson's correlation coefficient. Values of p≤0.05 were considered significant. Results: The older individuals in both genders showed higher values of mid-upper arm circumference (MAC) and body fat percentage (BFP). It was possible to perceive a significant negative correlation between EB and BFP for males, and a positive, but not significant, correlation in females. It was also observed that a majority of the participants (51.1%) showed a positive energy balance. Conclusion: A positive energy balance was found in a majority of the adolescents evaluated and this data was negatively correlated with body composition only in boys. Among women, however, there was no correlation between these variables.

Objetivo: Relacionar la composición corporal y el balance energético de atletas escolares. Métodos: Se trata de un estúdio transversal y analítico cuya la recogida de datos se dio entre los años de 2010 y 2012. La muestra se constituyó de 134 adolescentes entre 10 y 18 años, de ambos los sexos, practicantes de cinco modalidades distintas: judo, natación, tenis, gimnasia rítmica y gimnasia deportiva. Las pliegas cutáneas fue el método utilizado para la evaluación de la composición corporal y el cálculo del balance energético (BE) fue realizado a partir de la disminución del valor energético total consumido (VET) por el valor de las necesidades de energía estimadas (NEE). Los procedimientos estadísticos fueron realizados en el programa SPSS 19.0. El teste t de Student fue utilizado para la comparación de los datos entre los sexos y las correlaciones fueron realizadas a través del coeficiente de correlación de Pearson. Valores de p≤0,05 fueron considerados significativos. Resultados: Los mayores de ambos los sexos presentaron mayores valores de la circunferencia muscular del brazo (CMB) y del porcentaje de grasa (%G). Se percibió uma correlación negativa y significativa entre el BE y la %G para el sexo masculino y una correlación positiva pero sin significância para el sexo femenino. También se observó que la mayoría (51,1%) de los participantes presentó balance energético positivo. Conclusión: Un balance energético positivo fue encontrado en la mayoría de los adolescentes evaluados y ese dato se correlaciono de manera negativa con la composición corporal solamente para los niños. Sin embargo, para el sexo femenino, no se observo correlación entre las variables.

Frequency of healthy eating habits among students of a public university in Northeastern Brazil / Frequência de hábitos alimentares saudáveis entre estudantes de uma universidade pública do Nordeste do Brasil / Frecuencia de hábitos alimentarios saludables de Estudiantes de una universidad pública del Noreste de Brasil

Objective: The aim of this study was to measure the frequency of healthy eating habits among students of a public university in Northeastern Brazil. Methods: This is a cross-sectional population-based study. The sample was randomly composed of 933 undergraduate students of both genders aged 18-35 years. The frequency of healthy eating habits was assessed based on the adherence to the 10 Steps to Healthy Eating proposed by Brazil's Ministry of Health. The frequency of each step was measured through questions compiled from previous publications. Results: The steps to the healthy eating with the lowest frequencies of adherence were related to the practice of adding salt to prepared foods (18.6%, n=185) and to the consumption of fruits and vegetables (28.3%, n=281) and foods rich in fat (21.5%, n=213) and sugar (48.9%, n=486). However, there was an adequate consumption of beans (83.8%,n=832) and a prevalence of normal nutritional status of 69.6% (n=691) among the students. None of the interviewees followed all the steps to the healthy eating. The average adherence rate was at least 6 steps. Men and women presented different habits and food preferences. Conclusion: The university students presented a low frequency of healthy eating habits due to the high intake of food high in fat and sugar and mainly the low consumption of fruits and vegetables and the practice of adding salt to prepared foods. This may, in turn, predispose them to increased risks of morbidity and mortality from noncommunicable diseases.

Objetivo: O objetivo deste estudo foi medir a frequência de hábitos alimentares saudáveis entre estudantes de uma universidade pública do Nordeste do Brasil. Métodos: Este é um estudo transversal de base populacional. A amostra foi aleatoriamente composta por 993 graduandos, ambos os sexos e idade entre 18 e 35 anos. A frequência de hábitos alimentares saudáveis foi avaliada a partir da adesão aos 10 Passos para a Alimentação Saudável propostos pelo Ministério da Saúde do Brasil. A frequência de cada passo foi coletada por meio de perguntas compiladas a partir de publicações prévias. Resultados: Os passos da alimentação saudável, que tiveram as menores frequências de adesão, estiveram relacionados à prática de adicionar sal aos alimentos prontos (18,6%, n=185) e ao consumo de frutas e hortaliças (28,3%, n=281) e de alimentos gordurosos (21,5%, n=213) e ricos em açúcar (48,9%, n=486). No entanto, observou-se um adequado consumo de feijão (83,8%, n=832) e a prevalência de estado nutricional eutrófico de 69,6% (n=691) entre os estudantes. Nenhum dos indivíduos entrevistados aderiu a todos os passos da alimentação saudável. A taxa média de adesão foi de, pelo menos, 6 passos. Homens e mulheres apresentaram hábitos e preferências alimentares distintos. Conclusão: Os estudantes universitários apresentaram baixa frequência de hábitos alimentares saudáveis devido à alta ingestão de alimentos ricos em gordura e açúcar e devido, principalmente, ao baixo consumo de frutas e vegetais e a prática de adição de sal aos alimentos já preparados. Isto pode, por sua vez, predispô-los a um maior risco de morbidade e mortalidade por doenças não transmissíveis.

Objetivo: El objetivo del estudio fue medir la frecuencia de hábitos alimentarios saludables entre estudiantes de una universidad pública del noreste de Brasil. Métodos: Estudio transversal de base poblacional. La muestra fue randomizada y consistió de 933 estudiantes de graduación, de ambos los sexos y edades entre 18 y 35 años. La frecuencia de hábitos alimentarios saludables fue valorada a partir de la adhesión de 10 pasos para la Alimentación Saludable propuesta por el Ministerio de la Salud de Brasil.Se recogió la frecuencia de cada paso a través de cuestiones elaboradas de publicaciones anteriores. Resultados: Los pasos de la alimentación saludable los cuales tuvieron las más bajas frecuencias de adhesión estuvieron relacionadas con las practicas de la adición de sal en las comidas preparadas (18,6%, n=185) y al consumo de frutas y vegetales (28,3%, n=281) y de las comidas llenas de grasa (21,5%, n=213) y azúcar (48,9%, n=486). Sin embargo, un adecuado consumo de frijoles (83,8%, n=832) y la prevalencia del estado nutricional normal del 69,6% (n=691) fueron observados entre los estudiantes. Ninguno de los indivíduos entrevistados siguió los pasos de la alimentación saludable. La tasa media de adhesión fue de al menos 6 pasos. Hombres y mujeres han demostrado hábitos distintos y preferencias de comidas. Conclusión: Los estudiantes universitarios presentaron baja frecuencia de hábitos alimentarios saludables debido a la elevada ingesta de comidas con elevado nivel de grasa y azúcar y, principalmente, al bajo consumo de frutas y vegetables y la práctica de adicción de sal en las comidas preparadas. Eso puede contribuir a la predisposición de riesgos elevados de morbidad y mortalidad por enfermedades no comunicables.

Bariatric surgery reverses metabolic risk in patients treated in outpatient level.

BACKGROUND: The conventional treatment of obesity presents unsatisfactory results on weight loss and its long-term sustainability, therefore bariatric surgery has been suggested as an effective therapy, determining sustainable long-term weight loss, reversal of components of cardiometabolic risk and improved quality and life expectancy. AIM: To investigate the clinical component of the cardiometabolic risk in patients undergoing bariatric surgery assisted on outpatient basis. Methods : The sample consisted of 47 patients with ages between 18 and 60 years, 72% females. Diabetes mellitus, hypertension, and dyslipidemia were prospectively evaluated by using the Assessment of Obesity-Related Co-morbidities scale. RESULTS: Occurred improvement in these co-morbidities within 12 months after surgery. Co-morbidities resolved were greater than those improved. CONCLUSION: The study revealed that the Assessment of Obesity-Related Co-morbidities is a system that can be effectively used to quantify the degree of reduction of the severity of the cardiometabolic risk in response to bariatric surgery.

Bariatric surgery reverses metabolic risk in patients treated in outpatient level / Cirurgia bariatrica reverte risco metabolico em pacientes assistidos em nivel ambulatorial

Background : The conventional treatment of obesity presents unsatisfactory results on weight loss and its long-term sustainability, therefore bariatric surgery has been suggested as an effective therapy, determining sustainable long-term weight loss, reversal of components of cardiometabolic risk and improved quality and life expectancy. Aim : To investigate the clinical component of the cardiometabolic risk in patients undergoing bariatric surgery assisted on outpatient basis. Methods : The sample consisted of 47 patients with ages between 18 and 60 years, 72% females. Diabetes mellitus, hypertension, and dyslipidemia were prospectively evaluated by using the Assessment of Obesity-Related Co-morbidities scale. Results : Occurred improvement in these co-morbidities within 12 months after surgery. Co-morbidities resolved were greater than those improved. Conclusion : The study revealed that the Assessment of Obesity-Related Co-morbidities is a system that can be effectively used to quantify the degree of reduction of the severity of the cardiometabolic risk in response to bariatric surgery. .

Racional : Diante dos resultados insatisfatórios do tratamento convencional da obesidade na perda ponderal e na sua sustentabilidade em longo prazo, a cirurgia bariátrica vem sendo apontada como terapêutica eficaz, determinando perda ponderal sustentável em longo prazo, reversão de componentes do risco cardiometabólico e melhora da qualidade e expectativa de vida. Objetivo : Acompanhar a evolução clínica dos componentes do risco cardiometabólico em pacientes submetidos à cirurgia bariátrica. Métodos : A amostra constituiu-se de 47 pacientes de 18 a 60 anos de idade, 72% do sexo feminino. A evolução clínica das comorbidades diabete melito, dislipidemia e hipertensão arterial, foi quantificada, procedendo-se ao cálculo de escores relativos à Avaliação das Comorbidades Relacionadas à Obesidade. Resultados : Houve redução significativa do escore médio de todas as comorbidades relacionadas à obesidade, desde a admissão até os 12 meses seguintes. Independente do momento de assistência nutricional, o contingente de pacientes que as tiveram revertidas superou aqueles apenas melhoradas. Conclusão : O estudo revelou que a Avaliação das Comorbidades Relacionadas à Obesidade é sistema efetivo para quantificar o grau de redução da gravidade do risco cardiometabólico em resposta à cirurgia bariátrica. .