[Telephone surveys for the study of catastrophic costs due to tuberculosis in Colombia: a novel toolPesquisas telefônicas para um estudo de custos catastróficos da tuberculose na Colômbia: uma ferramenta inovadora]. / Encuestas telefónicas para el estudio de costos catastróficos por tuberculosis en Colombia: una herramienta innovadora.

The study of catastrophic costs incurred by people affected by tuberculosis (TB), conducted in Colombia during the COVID-19 pandemic, provided the opportunity to implement telephone surveys for data collection. This constitutes a methodological innovation regarding the standards established by the World Health Organization (WHO) which, for this type of study, usually rely on face-to-face surveys of patients attending health facilities. The study design, objectives, and methodology were adapted from the WHO publication Tuberculosis patient cost surveys: a handbook. A total of 1065 people affected by tuberculosis were selected as study participants and, by telephone, were administered a standard questionnaire adapted to the Colombian context. This allowed the collection of structured data on the direct and indirect costs faced by TB patients and their families. Greater than 80% completeness was achieved for all variables of interest, with an average survey duration of 40 minutes and a rejection rate of 8%. The described survey method to determine the baseline for further study of catastrophic costs in Colombia was novel because of its telephone-based format, which adheres to the information standards required to allow internationally comparable estimates. It is a useful means of generating standardized results in contexts in which the ability to conduct face-to-face surveys is limited.

O estudo dos custos catastróficos incorridos pelas pessoas afetadas pela tuberculose realizado na Colômbia durante a pandemia de COVID-19 representou uma oportunidade de implementar pesquisas telefônicas como forma de coleta de dados. Constitui-se uma inovação metodológica dos padrões estabelecidos pela Organização Mundial da Saúde (OMS), que, para esse tipo de estudo, geralmente se baseiam no uso de pesquisas presenciais com os pacientes que frequentam estabelecimentos de saúde. O delineamento, os objetivos e a metodologia do estudo foram adaptados do manual prático da OMS para a realização de pesquisas de custos da tuberculose. Um total de 1065 pessoas afetadas pela tuberculose foram selecionadas para participar do estudo. O questionário padrão, adaptado ao contexto colombiano, foi aplicado pelo telefone. Foi possível obter dados estruturados sobre os custos diretos e indiretos enfrentados pelos pacientes com tuberculose e suas famílias. Em geral, observou-se que todas as variáveis de coleta atingiram uma completude de mais de 80%, com um tempo médio de pesquisa de 40 minutos e uma taxa de recusa de 8%. A metodologia de pesquisa telefônica desenvolvida para determinar a linha de base do estudo de custos catastróficos na Colômbia foi inovadora devido ao formato telefônico, que mantém os padrões de informação necessários para permitir estimativas comparáveis internacionalmente e é uma forma útil de gerar resultados padronizados em circunstâncias em que há limitações para a realização de pesquisas presenciais.

Monitoring financial healthcare protection in Brazil: evolution, inequalities, and associated factors.

OBJECTIVES: Although catastrophic health spending is the main measure for assessing financial healthcare protection, it varies considerably in methodological and empirical terms, which hinders comparison between studies. The aim of this study was to measure the prevalence of catastrophic health spending in Brazil in 2003, 2009, and 2018, its associated factors, and disparities in prevalence distribution according to socioeconomic status. STUDY DESIGN: This was a time series study. METHODS: Data from the Household Budget Surveys were used. Prevalence of catastrophic health spending was measured as a percentage of the budget and ability to pay, considering thresholds of 10, 25, and 40%. It was determined whether household, family, and household head characteristics influence the likelihood of incurring catastrophic health spending. Households were stratified by income deciles, consumption, and wealth score. RESULTS: There was an increase in prevalence of catastrophic health spending between 2003 and 2009 in Brazil and a slight reduction in 2018. The wealth score showed more pronounced distributional effects between the poor and the rich, with the former being the most affected by catastrophic health spending. Consumption showed greater percentage variations in the prevalence of catastrophic health spending. The prevalence of catastrophic health spending was positively associated with the presence of older adults, age and female household head, rural area, receipt of government benefits, and some degree of food insecurity. CONCLUSIONS: The poorest families are most affected by catastrophic health spending in Brazil, requiring more effective and equitable policies to mitigate financial risk.

Lifestyle and Cardiometabolic Risk Factors Associated with Impoverishment Due to Out-of-Pocket Health Expenditure in São Paulo City, Brazil.

The rise in obesity and related chronic noncommunicable diseases (NCDs) during recent decades in Brazil has been associated with increases in the financial burden and risk of impoverishment due to out-of-pocket (OOP) health expenditure. Thus, this study investigated trends and predictors associated with impoverishment due to health expenditure, in the population of São Paulo city, Brazil, between 2003 and 2015. Household data from the São Paulo Health Survey (n = 5475) were used to estimate impoverishment linked to OOP health expenses, using the three thresholds of International Poverty Lines (IPLs) defined by the World Bank at 1.90, 3.20, and 5.50 dollars per capita per day purchasing power parity (PPP) in 2011. The results indicated a high incidence of impoverishment due to OOP disbursements for health care throughout the period, predominantly concentrated among low-income individuals. Lifestyle choices referring to leisure-time physical activity (OR = 0.766 at $3.20 IPL, and OR = 0.789 at $5.50 IPL) were linked to reduction in the risk for impoverishment due to OOP health expenditures whilst there were increases in the probability of impoverishment due to cardiometabolic risk factors referring to obesity (OR = 1.588 at $3.20 IPL, and OR = 1.633 at $5.50 IPL), and diagnosis of cardiovascular diseases (OR = 2.268 at $1.90 IPL, OR = 1.967 at $3.20 IPL, and OR = 1.936 at $5.50 IPL). Diagnosis of type 2 diabetes mellitus was associated with an increase in the probability of impoverishment at only the $1.90 IPL (OR = 2.506), whilst coefficients for high blood pressure presented lack of significance in the models. Health policies should focus on interventions for prevention of obesity to ensure the financial protection of the population in São Paulo city, Brazil, especially targeting modifiable lifestyle choices like promotion of physical activity and reduction of tobacco use.

Sum of Skinfold-Corrected Girths Correlates with Resting Energy Expenditure: Development of the NRGCO Equation.

Our study aimed to validate existing equations and develop the new NRGCO equation to estimate resting energy expenditure (REE) in the Colombian population with moderate-to-high physical activity levels. Upon satisfying the inclusion criteria, a total of 86 (43F, 43M) healthy adults (mean [SD]: 27.5 [7.7] years; 67.0 [13.8] kg) were evaluated for anthropometric variables and REE by indirect calorimetry using wearable gas analyzers (COSMED K4 and K5). Significant positive correlations with REE were found for body mass (r = 0.65), body mass-to-waist (r = 0.58), arm flexed and tensed girth (r = 0.66), corrected thigh girth (r = 0.56), corrected calf girth (r = 0.61), and sum of breadths (∑3D, r = 0.59). As a novelty, this is the first time a significant correlation between REE and the sum of corrected girths (∑3CG, r = 0.63) is reported. Although existing equations such as Harris-Benedict (r = 0.63), Mifflin-St. Jeor (r = 0.67), and WHO (r = 0.64) showed moderate-to-high correlations with REE, the Bland-Altman analysis revealed significant bias (p < 0.05), indicating that these equations may not be valid for the Colombian population. Thus, participants were randomly distributed into either the equation development group (EDG, n = 71) or the validation group (VG, n = 15). A new model was created using body mass, sum of skinfolds (∑8S), corrected thigh, corrected calf, and age as predictors (r = 0.755, R2 = 0.570, RMSE = 268.41 kcal). The new NRGCO equation to estimate REE (kcal) is: 386.256 + (24.309 × BM) - (2.402 × ∑8S) - (21.346 × Corrected Thigh) + (38.629 × Corrected Calf) - (7.417 × Age). Additionally, a simpler model was identified through Bayesian analysis, including only body mass and ∑8S (r = 0.724, R2 = 0.525, RMSE = 282.16 kcal). Although external validation is needed, our validation resulted in a moderate correlation and concordance (bias = 91.5 kcal) between measured and estimated REE values using the new NRGCO equation.

The out-of-pocket cost of living with obesity: Results from a survey in Spain, South Korea, Brazil, India, Italy, and Japan.

Objectives: In many countries, obesity treatments are not fully reimbursed by healthcare systems. People living with obesity (PwO) often pay out-of-pocket (OOP) for pharmacological and non-pharmacological interventions, placing them in a position of financial risk to manage their condition. This study sought to understand the OOP expenditures and non-financial costs incurred by PwO to manage weight. Methods: A 25-min cross-sectional online survey was conducted with PwO between ages 18-60 in Italy, Japan, India, Brazil, Spain and South Korea. Respondents were recruited using proprietary vendor panels and non-probability sampling. N = 600 participants completed the survey (n = 100 per country). Results: The mean annual OOP expenditure related to weight loss/management was $7,351, accounting for nearly 17% of annual household income. Costs generally increased by BMI. Half or more of the respondents agreed that obesity affected multiple aspects of their lives (outside activities, running a household, social life, work, family life, traveling). 46% agreed that obesity limited their job prospects. Conclusion: PwO spend a notable amount of their income paying OOP expenditures related to managing their weight. Quantifying the individual economic burden of living with obesity can inform the understanding of the resources required and policy changes needed to treat obesity as a disease.

Integrative Approach of Treating Early Undernutrition with an Enriched Black Corn Chip, Study on a Murine Model.

Undernutrition (UN) increases child vulnerability to illness and mortality. Caused by a low amount and/or poor quality of food intake, it impacts physical, cognitive, and social development. Modern types of food consumption have given highly processed food a higher cultural value compared to minimally processed food. OBJECTIVE: The objective of this study was to evaluate the effect on growth, metabolism, physical activity (PA), memory, inflammation, and toxicity of an enriched black corn chip (BC) made with endemic ingredients on post-weaned UN mice. METHODS: A chip was made with a mixture of black corn, fava beans, amaranth, and nopal cactus. To probe the effects of UN, UN was induced in 3wo post-weaned male C57Bl/6j mice through a low-protein diet (LPD-50% of the regular requirement of protein) for 3w. Then, the BC was introduced to the animals' diet (17%) for 5w; murinometric parameters were measured, as were postprandial glucose response, PA, and short-term memory. Histological analysis was conducted on the liver and kidneys to measure toxicity. Gene expression related to energy balance, thermogenesis, and inflammation was measured in adipose and hypothalamic tissues. RESULTS: Treatment with the BC significantly improved mouse growth, even with a low protein intake, as evidenced by a significant increase in body weight, tail length, cerebral growth, memory improvement, physical activation, normalized energy expenditure (thermogenesis), and orexigenic peptides (AGRP and NPY). It decreased anorexigenic peptides (POMC), and there was no tissue toxicity. CONCLUSIONS: BC treatment, even with persistent low protein intake, is a promising strategy against UN, as it showed efficacy in correcting growth deficiency, cognitive impairment, and metabolic problems linked to treatment by adjusting energy expenditure, which led to the promotion of energy intake and regulation of thermogenesis, all by using low-cost, accessible, and endemic ingredients.

Comparison between Measured and Predicted Resting Metabolic Rate Equations in Cross-Training Practitioners.

This study aimed to investigate the resting metabolic rate (RMR) in cross-training practitioners (advanced and novice) using indirect calorimetry (IC) and compare it with predictive equations proposed in the scientific literature. METHODS: A cross-sectional and comparative study analyzed 65 volunteers, both sexes, practicing cross-training (CT). Anthropometry and body composition were assessed, and RMR was measured by IC (FitMate PRO®), bioimpedance (BIA-InBody 570®), and six predictive equations. Data normality was tested by the Kolgomorov-Smirnov test and expressed as mean ± standard deviation with 95% confidence intervals (CI), chi-square test was performed to verify ergogenic resources, and a Bland-Altman plot (B&A) was made to quantify the agreement between two quantitative measurements. One-way ANOVA was applied to body composition parameters, two-way ANOVA with Bonferroni post hoc was used to compare the RMR between groups, and two-way ANCOVA was used to analyze the adjusted RMR for body and skeletal muscle mass. The effect size was determined using Cohen's d considering the values adjusted by ANCOVA. If a statistical difference was found, post hoc Bonferroni was applied. The significance level was p < 0.05 for all tests. RESULTS: The main results indicated that men showed a higher RMR than women, and the most discrepant equations were Cunningham, Tinsley (b), and Johnstone compared to IC. Tinsley's (a) equation indicated greater precision in measuring the RMR in CM overestimated it by only 1.9%, and BIA and the Harris-Benedict in CW overestimated RMR by only 0.1% and 3.4%, respectively. CONCLUSIONS: The BIA and Harris-Benedict equation could be used reliably to measure the RMR of females, while Tinsley (a) is the most reliable method to measure the RMR of males when measuring with IC is unavailable. By knowing which RMR equations are closest to the gold standard, these professionals can prescribe a more assertive diet, training, or ergogenic resources. An assertive prescription increases performance and can reduce possible deleterious effects, maximizing physical sports performance.

Factors associated with financial risk due to health spending in Argentina.

This article aims to assess the association between household demographic and socioeconomic characteristics and catastrophic health expenditure (CHE) in Argentina during 2017-2018. CHE was estimated as the proportion of household consumption capacity (using both income and total consumption in separate estimations) allocated for Out-of-Pocket (OOP) health expenditure. For assessing the determinants, we estimated a generalized ordered logit model using different intensities of CHE (10%, 15%, 20% and 25%) as the ordinal dependent variable, and socioeconomic, demographic and geographical variables as explanatory factors. We found that having members older than 65 years and with long-term difficulties increased the likelihood of incurring CHE. Additionally, having an economically inactive household head was identified as a factor that increases this probability. However, the research did not yield consistent results regarding the relationship between public and private health insurance and consumption capacity. Our results, along with the robustness checks, suggest that the magnitude of the coefficients for the household head characteristics could be exaggerated in studies that overlook the attributes of other household members. In addition, these results emphasize the significance of accounting for long-term difficulties and indicate that omitting this factor could overestimate the impact of members aged over 65.

Effects of Resistance Training Techniques on Metabolic Responses in Trained Males.

This study investigated the effects of biset, drop-set and traditional resistance training (RT) techniques on metabolic responses in resistance-trained males. Fifteen trained males (age 29.7 ± 6.1 years; body mass 83.4 ± 7.6 kg; RT experience 11.4 ± 6.7 years; one-repetition maximum (1RM) barbell bench press: body mass ratio 1.4 ± 0.1 a.u.) were assigned to three experimental conditions, in a randomized crossover design. The experimental conditions were bi-set (3×10 repetitions at 70%1RM in barbell bench press followed by 10 repetitions at 60%1RM in incline bench press), drop-set (3×10 repetitions at 70%1RM followed by 10 repetitions at 50%1RM in barbell bench press) and traditional RT (3×20 at 60%1RM in barbell bench press). A portable gas analyzer was used to assess energy expenditure and maximal oxygen uptake during the experimental protocols. Blood lactate levels were assessed at baseline and 1, 3, and 5 minutes after the training session. There were no differences for total training volume (p = 0.999). Post hoc comparisons revealed that bi-set elicited higher aerobic energy expenditure (p = 0.003 vs. drop-set; p < 0.001 vs. traditional RT) and aerobic oxygen consumption (p = 0.034 vs. drop-set; p < 0.001 vs. traditional RT) than other RT schemes. There were no differences regarding anaerobic EE between-conditions (p > 0.05). There was a main effect of time and condition for blood lactate levels (p < 0.001). Post hoc comparisons revealed that drop-set training elicited higher blood lactate levels than traditional RT (p = 0.009). The results suggest that RT techniques may have a potential role in optimizing metabolic responses in resistance-trained males.

Resting Energy Expenditure, comparison of predictive formulas with bioimpedance: Peruvian population / Gasto Energético en Reposo, comparación de fórmulas predictivas con la bioimpedancia: población peruana

Introduction: In areas with limited access to healthcare systems, Resting Energy Expenditure (REE) estimation is performed using predictive equations to calculate an individual's caloric requirement. One problem is that these equations were validated in populations with different characteristics from those in Latin America, such as race, height, or body mass, leading to potential errors in the prediction of this parameter. Objective: To determine the REE using predictive formulas compared with bioimpedance in Peruvians. Materials and methods: A comparative analytical cross-sectional study with secondary database analysis of the CRONICAS cohort. Results: we worked with a total of 666 subjects. The Mjeor equation was the one with the highest rating of 0.95, a lower mean absolute percentage error (MAPE) of 4.69%, and equivalence was found with the REE values. In the multiple regression, it was observed that the Mjeor equation was the one that least overestimated the REE, increasing 0.77 Kcal/day (95% CI: 0.769-0.814; p<0.001) for each point that increased the REE determined by bioimpedance. The strength of association between Mjeor and bioimpedance was 0.9037. Furthermore, in the regression of the data (weight, height, age) in the Mjeor equation it was observed that the coefficients obtained were the same as those used in the original equation. Conclusions: The Mjeor equation seems to be the most adequate to estimate the REE in the Peruvian population. Future prospective studies should confirm the usefulness of this formula with potential utility in primary health care(AU)

Introducción: En zonas con acceso limitado a sistemas de salud, la estimación del Gasto Energético en Reposo (GER) se realiza utilizando ecuaciones predictivas para calcular el requerimiento calórico de un individuo. Uno de los problemas es que estas ecuaciones fueron validadas en poblaciones con características diferentes a las latinoamericanas, como raza, talla o masa corporal, lo que conlleva a potenciales errores en la predicción de este parámetro. Objetivo: Determinar el GER mediante fórmulas predictivas comparadas con la bioimpedancia en peruanos. Materiales y métodos: Estudio transversal analítico comparativo con análisis secundario de base de datos de la cohorte CRONICAS. Resultados: Se trabajó con un total de 666 sujetos. La ecuación de Mjeor fue la que obtuvo la puntuación más alta de 0,95, un error medio porcentual absoluto (MAPE) inferior de 4,69%, y se encontró equivalencia con los valores del GER. En la regresión múltiple, se observó que la ecuación de Mjeor fue la que menos sobreestimó el GER, aumentando 0,77 Kcal/día (IC 95%: 0,769-0,814; p<0,001) por cada punto que aumentaba el GER determinado por bioimpedancia. La fuerza de asociación entre Mjeor y bioimpedancia fue de 0,9037. Además, en la regresión de los datos (peso, talla, edad) de la ecuación de Mjeor se observó que los coeficientes obtenidos eran los mismos que los utilizados en la ecuación original. Conclusiones: La ecuación de Mjeor parece ser la más adecuada para estimar el GER en la población peruana. Futuros estudios prospectivos deberán confirmar la utilidad de esta fórmula para su potencial utilidad en la atención primaria de salud(AU)

Persistent inequities in maternal mortality in Latin America and the Caribbean, 1990-2019.

BACKGROUND: Despite the resources and personnel mobilized in Latin America and the Caribbean to reduce the maternal mortality ratio (MMR, maternal deaths per 100 000 live births) in women aged 10-54 years by 75% between 2000 and 2015, the region failed to meet the Millenium Development Goals (MDGs) due to persistent barriers to access quality reproductive, maternal, and neonatal health services. METHODS: Using 1990-2019 data from the Global Burden of Disease project, we carried out a two-stepwise analysis to (a) identify the differences in the MMR temporal patterns and (b) assess its relationship with selected indicators: government health expenditure (GHE), the GHE as percentage of gross domestic product (GDP), the availability of human resources for health (HRH), the coverage of effective interventions to reduce maternal mortality, and the level of economic development of each country. FINDINGS: In the descriptive analysis, we observed a heterogeneous overall reduction of MMR in the region between 1990 and 2019 and heterogeneous overall increases in the GHE, GHE/GDP, and HRH availability. The correlation analysis showed a close, negative, and dependent association of the economic development level between the MMR and GHE per capita, the percentage of GHE to GDP, the availability of HRH, and the coverage of SBA. We observed the lowest MMRs when GHE as a percentage of GDP was close to 3% or about US$400 GHE per capita, HRH availability of 6 doctors, nurses, and midwives per 1,000 inhabitants, and skilled birth attendance levels above 90%. CONCLUSIONS: Within the framework of the Sustainable Development Goals (SDGs) agenda, health policies aimed at the effective reduction of maternal mortality should consider allocating more resources as a necessary but not sufficient condition to achieve the goals and should prioritize the implementation of new forms of care with a gender and rights approach, as well as strengthening actions focused on vulnerable groups.

The Paradox of Alcohol and Food Affordability: Minimal Impact of Leading Beer and Cachaça Brands on Brazilian Household Income Amid Hazardous Drinking Patterns.

Alcohol consumption, associated with various cancers, mental disorders, and aggressive behavior, leads to three million deaths globally each year. In Brazil, the alcohol per capita consumption among drinkers aged 15 and over is 41.7 g of pure alcohol/day (~1 L beer/day), which falls into the risky consumption category and exceeds the global average by almost 30%. An effective way to mitigate alcohol-related harm is to increase its retail price. This study assesses the costs of consuming leading brands of beer and sugarcane spirit cachaça (Brazil's most popular alcoholic beverages) against the expenditure on staple foods. Data on food and alcoholic beverage prices were collected in João Pessoa, Brazil, for 2020 and 2021. The cost per gram of pure alcohol and food were considered to establish consumption patterns of 16.8 g/day (moderate), 41.7 g/day, and 83.4 g/day (heavy), distributed in three scenarios involving the beverages alone or combined (64% beer and 36% cachaça), and a balanced 2000 kcal/day staple diet. The study finds that all heavy consumption scenarios cost less or significantly less (cachaça alone) than a 2000 kcal/day staple diet, highlighting an urgent need for fiscal policies, such as a minimum unit pricing for alcohol, to address public health concerns.

Share of food group expenditure in Mexican households according to the gender of the head of household and size of the locality.

OBJECTIVE: To evaluate differences in the percentage of expenditure on food groups in Mexican households according to the gender of the household head and the size of the locality. DESIGN: Analysis of secondary data from the National Household Income and Expenditure Survey (ENIGH) 2018. We estimated the percentage of expenditure on fifteen food groups according to the gender of the head of household and locality size and evaluated the differences using a two-part model approach. SETTING: Mexico, 2018. PARTICIPANTS: A nationally representative sample of 74 647 Mexican households. RESULTS: Female-headed households allocated a lower share of expenditure to the purchase of sweetened beverages and alcoholic beverages and higher percentages to milk and dairy, fruits and water. In comparison with metropolitan households, households in rural and urban localities spent more on cereals and tubers, sugar and honey, oil and fat and less on food away from home. CONCLUSIONS: Households allocate different percentages of expenditure to diverse food groups according to the gender of the head of the household and the size of the locality where they are located. Future research should focus on understanding the economic and social disparities related to differences in food expenditure, including the gender perspective.

Energy imbalance gap was associated with body mass index and sex in Latin American adolescents-results from the ELANS study.

Introduction: Energy imbalance gap (EIG) is defined as the average daily difference between energy intake (EI) and energy expenditure (EE). This study aimed to examine the associations between EIG and sociodemographic and anthropometric variables in the adolescent population of eight Latin America countries. Methods: A total of 680 adolescents aged 15 to 18 were included in this study. The estimation of EI was based on two non-consecutive 24-h dietary recalls. EE was predicted from Schofield equations using physical activity level obtained through the long version of the International Physical Activity Questionnaire. Sociodemographic data and anthropometric measurements were also obtained. A descriptive analysis and multilevel linear regression models were used to examine associations between variables. Results: The mean EI, EE, and EIG were 2091.3 kcal, 2067.8 kcal, and 23.5 kcal, respectively. Argentina had the highest EI and EIG, whereas Chile had the lowest EI and EIG. Males had a higher EI (2262.4 kcal) and EE (2172.2 kcal) than females (1930.1 kcal and 2084.5 kcal), respectively (p < 0.05). Overweight subjects had a lower EIG than did underweight and normal-weight subjects (p < 0.05). Subjects with low socioeconomic status (SES) had a lower EE (2047.0 kcal) than those with a high SES (2164.2 kcal) (p < 0.05). Conclusion: Sex and BMI were associated with EIG in adolescents from Latin America.

High starch intake favours body weight control in neutered and spayed cats living in homes fed ad libitum.

Different starch-to-protein ratios were compared among neutered and spayed domiciled cats. Male and female obese and non-obese cats were fed kibble diets ad libitum for 4 months high in starch (HS (38 % crude protein (CP)): starch 32 %, protein 38 %; DM basis) or high in protein (HP (55 % CP): starch 19 %, protein 55 %) but similar in energy and fat in a crossover design. Physical activity was evaluated using an accelerometer, and body composition (BC), energy expenditure (EE) and water turnover (WT) using the doubly labelled water method. Results were compared in a 2 diet × 2 sex × 2 body condition factorial arrangement. Cats fed the HS (38 % CP) diet maintained a constant body weight, but lean mass (LM) tended to be reduced in female obese but to be increased in male non-obese (P < 0·08) and increased in female non-obese cats (P = 0·01). The HP (55 % CP) diet induced an increase in cat body weight and LM (P < 0·05) without altering BC proportion. EE tended to be higher in males (351 (se 8) kJ/kg0·67/d) than females (330 (se 8) kJ/kg0·67/d; P = 0·06), was unaffected by diet or BC, decreased as age increased (R 2 0·44; P < 0·01) and increased as physical activity increased (R 2 0·58; P < 0·01). WT was higher for the HP (55 % CP) diet (P < 0·01) and increased with EE (R 2 0·65; P < 0·01). The HS (38 % CP) diet favoured body weight control during 4 months of ad libitum feeding. Caution is necessary to balance protein in diets of female obese cats over 5 years, as they may have low energy and food intake, with LM loss.

High carbohydrate is preferable to high lipid parenteral nutrition in healthy dogs undergoing prolonged sedation.

Parenteral nutrition (PN) is commonly used in intensive care units (ICUs) and is associated with earlier hospital outcome. However, there is scarcity of information about the metabolic effects of PN caloric distribution for dogs. Considering the high tolerance of dogs to lipids and, also, that hospitalized animals usually present insulin resistance, PN formulation with high fat instead high glucose can provide metabolic benefits in this specie. This study evaluated two PN protocols, based on high lipid or high carbohydrate in 12 healthy dogs under sedation/ventilation during 24 h. For baseline data, blood samples were collected 24 h before the study beginning. After fasting, the dogs were anesthetized and put under mechanical ventilation without energy support for 12 h to obtain: daily energy expenditure (DEE), respiratory quotient (RQ), oxygen consumption (VO2), carbon dioxide production (VCO2), lactate, glucose, cholesterol, and triglycerides concentrations. After, the dogs were allocated into two groups: lipid-based energy group (LEG) and carbohydrate-based energy group (CEG). Both groups received the PN infusions at a rate of 3 mL/kg/h for 12 h. Blood tests were performed 12, 24, and 48 h after infusion's completion. VO2 increased after PN in LEG, increasing energy expenditure compared to CEG. RQ remained close to 1 in CEG, indicating carbohydrate preferential consumption. Triglycerides increased in both groups after propofol infusion, remaining higher in LEG until the end of the evaluation. Glycaemia increased in CEG compared to baseline. In conclusion, both PN protocols can be used in healthy animals undergoing prolonged sedation protocols. However, high lipid PN had higher VO2 and DEE, and resulted in higher triglycerides concentrations and lower glycaemia indexes than carbohydrate, making high carbohydrate PN preferable to high lipid PN. Therefore, for use in critically ill patients, the data obtained in this study should be extrapolated, taking into consideration the specificity of each case.

The futile creatine cycle and the synthesis of fatty acids in inguinal white adipose tissue from growing rats, submitted to a hypoprotein-hyperglycidic diet for 15 days.

The low-protein, high-carbohydrate (LPHC) diet administered to growing rats soon after weaning, for 15 days, promoted an increase in energy expenditure by uncoupling protein 1 (UCP1) in interscapular brown adipose tissue, and also due to the occurrence of the browning process in the perirenal white adipose tissue (periWAT). However, we believe that inguinal white adipose tissue (ingWAT) may also contribute to energy expenditure through other mechanisms. Therefore, the aim of this work is to investigate the presence of the futile creatine cycle, and the origin of lipids in ingWAT, since that tissue showed an increase in the lipids content in rats submitted to the LPHC diet for 15 days. We observed increases in creatine kinase and alkaline phosphatase activity in ingWAT, of the LPHC animals. The mitochondrial Nicotinamide adenine dinucleotide reduced/nicotinamide adenine dinucleotide oxidized ratio is lower in ingWAT of LPHC animals. In the LPHC animals treated with ß-guanidinopropionic acid, the extracellular uptake of creatine in ingWAT was lower, as was the rectal temperature. Regarding lipid metabolism, we observed that in ingWAT, lipolysis in vitro when stimulated with noradrenaline is lower, and there were no changes in baseline levels. In addition, increases in the activity of enzymes were also observed: malic, glucose-6-phosphate dehydrogenase, and ATP-citrate lyase, in addition to an increase in the PPARγ content. The results show the occurrence of the futile creatine cycle in ingWAT, and that the increase in the relative mass may be due to an increase in de novo fatty acid synthesis.

Comparison of pre- and posttransplant energy expenditure in patients undergoing hematopoietic stem cell transplantation and evaluation of associated factors.

OBJECTIVES: Patients undergoing hematopoietic stem cell transplantation may present with metabolic alterations that can have an effect on their energy expenditure and nutritional status. This project aimed to compare the pre- and posttransplant energy expenditures of patients undergoing hematopoietic stem cell transplantation as well as related factors. METHODS: This prospective study was conducted at a single center. Patients, undergoing autograft or allograft, were evaluated before transplantation and on the 10th and 17th d posttransplantation. Energy expenditure was measured by indirect calorimetry. Diet intake was assessed by a 24-h dietary recall. Infectious and noninfectious complications were analyzed between days 1 to 10 after transplantation and days 11 to 17 after transplantation. Paired model analyses were carried out to identify the pretransplantation and posttransplantation periods. RESULTS: Twenty patients were evaluated with a mean age of 45.6 ± 17.2 y; a majority were male sex (65%), and the most frequent diagnoses were chronic myeloid leukemia (25%) and multiple myeloma (25%). Energy expenditure increased by 15% posttransplantation, and the energy requirement per kilogram of weight was 23 kcal/kg at day 10 after transplantation. Throughout the posttransplantation period, 45% of the patients required nutritional therapy. Negative energy and negative protein balance were observed at all analyzed times. Phase angle (P = 0.018), fever (P = 0.014), mucositis grades I to II (P = 0.018), and the total number of infectious and noninfectious events (P = 0.043) were associated with an increase in energy expenditure at day 10 after transplantation. CONCLUSIONS: Energy expenditure increased after transplantation compared with pretransplantation in 50% of patients. Phase angle, fever, grades I to II mucositis, and infectious and noninfectious events were associated with increased energy expenditure at day 10 after transplantation.

Gasto catastrófico em crianças com deficiência visual: estudo transversal com cuidadores no Rio de Janeiro, Brasil / Catastrophic expenditure in children with visual impairment: a cross-sectional study with caregivers in Rio de Janeiro, Brazil / Gasto catastrófico en niños con discapacidad visual: estudio transversal con cuidadores en Río de Janeiro, Brasil

Resumo: O cuidado de um filho com deficiência visual pode vir a afetar a renda do cuidador e, por sua vez, a renda da família. Sob essa realidade, há de se considerar o gasto catastrófico consequente do aumento de despesas e da redução de renda, seja pelo desemprego, pela redução do número de horas trabalhadas ou pela dificuldade de (re)inserção no mercado de trabalho. Perante esse cenário, o objetivo principal deste estudo foi estimar o gasto catastrófico atribuído ao cuidador de crianças cegas ou com baixa visão em centros de referência em educação para cegos, oftalmologia e saúde infantil localizados no Município do Rio de Janeiro, Brasil, identificando quais fatores estão associados a uma maior ou menor prevalência desse gasto. Observou-se que 53,3% dos cuidados de crianças com cegueira comprometem 40% ou mais da renda. Entre os cuidadores de crianças com baixa visão, o gasto catastrófico é mais ameno, comprometendo no mínimo 40% da renda para 36,8% dos cuidadores. Os fatores associados à maior prevalência de gasto catastrófico foram idade do cuidador, número de moradores na residência, maior escolaridade, menor renda domiciliar, reformas na residência, plano de saúde, aquisição de empréstimos, venda de bens, quantidade de unidades de saúde que a criança recebe tratamento e parentesco do cuidador principal. A carga que recai sobre os cuidadores de crianças com deficiência visual indica uma situação de vulnerabilidade que mostra a necessidade de acesso aos mecanismos de proteção financeira e social, por meio de políticas que sejam capazes de atender esse grupo.

Abstract: Caring for a visually impaired child can affect the caregiver's income and, in turn, the family's. Catastrophic spending resulting from increased expenses and reduced income must be taken into account, whether due to unemployment, a reduction in the number of hours worked or the difficulty of entering or reentering the job market. Given this scenario, the main objective of this study was to estimate the catastrophic spending attributed to the caregiver of blind or low-vision children in reference centers for education for the blind, ophthalmology and child health located in the city of Rio de Janeiro, Brazil, identifying which factors are associated with a higher or lower prevalence of this expenditure. It was found that 53.3% of care for blind children involved 40% or more of their income. Among the caregivers of children with low vision, catastrophic spending is milder, compromising at least 40% of income for 36.8% of the caregivers. The factors associated with a higher prevalence of catastrophic spending were the caregiver's age, the number of residents in the household, higher schooling, lower household income, renovations to the home, health insurance, taking out loans, selling assets, the number of health units where the child receives treatment and the relationship of the main caregiver. The burden placed on caregivers of visually impaired children indicates a situation of vulnerability that shows the need for access to financial and social protection mechanisms, through policies that are capable of serving this group.

Resumen: El cuidado de un niño con discapacidad visual puede impactar los ingresos del cuidador y, a su vez, de la familia. En este escenario, es necesario considerar el gasto catastrófico resultante del aumento de los gastos o la reducción de los ingresos, ya sea por desempleo, reducción del número de horas trabajadas o por la dificultad de inserción o reinserción en el mercado laboral. Ante esto, el objetivo principal de este estudio fue estimar el gasto catastrófico atribuido al cuidador de niños ciegos o con baja visión en centros de referencia en educación para ciegos, oftalmología y salud infantil, ubicados en el municipio de Río de Janeiro, Brasil, con el fin de identificar qué factores se asocian con una mayor o menor prevalencia de este gasto. Se observó que el 53,3% de los cuidados de niños con discapacidad visual comprometen más del 40% de los ingresos totales. Mientras tanto, el cuidado de niños con baja visión tiene un menor gasto catastrófico, comprometiendo menos del 40% de los ingresos según el 36,8% de los cuidadores. La mayor prevalencia de gasto catastrófico estuvo asociada a los siguientes factores: edad del cuidador, número de residentes en el hogar, mayor nivel de estudios, bajos ingresos familiares, remodelaciones en el hogar, seguro de salud, adquisición de préstamos, venta de bienes, cantidad de centros de salud en las que el niño acude al tratamiento y parentesco del cuidador principal. Los cuidadores de niños con discapacidad visual enfrentan una situación de vulnerabilidad, lo que apunta a una necesidad de acceder a acciones de protección financiera y social mediante políticas dirigidas a esta población.

Encuestas telefónicas para el estudio de costos catastróficos por tuberculosis en Colombia: una herramienta innovadora / Telephone surveys for the study of catastrophic costs due to tuberculosis in Colombia: a novel tool / Pesquisas telefônicas para um estudo de custos catastróficos da tuberculose na Colômbia: uma ferramenta inovadora

RESUMEN El estudio de costos catastróficos que experimentan las personas afectadas por tuberculosis realizado en Colombia durante la pandemia de COVID-19 trajo consigo la oportunidad de implementar encuestas telefónicas como medio para la recopilación de información. Lo anterior se constituye como una innovación metodológica en los estándares establecidos por la Organización Mundial de la Salud (OMS) que, para este tipo de estudios, suelen tener base en el empleo de encuestas cara a cara con los pacientes que acuden a las instalaciones de salud. El diseño del estudio, sus objetivos y metodología fueron adaptados del manual práctico para la realización de encuestas de costos de la tuberculosis de la OMS. Se seleccionaron 1 065 personas afectadas por tuberculosis como participantes del estudio, a quienes se les administró de manera telefónica el cuestionario estándar adaptado al contexto colombiano. Fue posible obtener datos estructurados sobre los costos directos e indirectos que enfrentan los pacientes con tuberculosis y sus familias; de manera general, se observó que todas las variables de recopilación alcanzaron una completitud mayor a 80%, con un tiempo promedio de encuesta de 40 minutos y una tasa de rechazo de 8%. La metodología de encuestas telefónicas desarrollada para determinar la línea base del estudio de costos catastróficos en Colombia resultó innovadora por el formato telefónico, que mantiene los estándares de información requerida para permitir estimaciones comparables a nivel internacional, y es un medio útil en la generación de resultados estandarizados en eventos en los cuales existe limitación para la realización de encuestas cara a cara.

ABSTRACT The study of catastrophic costs incurred by people affected by tuberculosis (TB), conducted in Colombia during the COVID-19 pandemic, provided the opportunity to implement telephone surveys for data collection. This constitutes a methodological innovation regarding the standards established by the World Health Organization (WHO) which, for this type of study, usually rely on face-to-face surveys of patients attending health facilities. The study design, objectives, and methodology were adapted from the WHO publication Tuberculosis patient cost surveys: a handbook. A total of 1065 people affected by tuberculosis were selected as study participants and, by telephone, were administered a standard questionnaire adapted to the Colombian context. This allowed the collection of structured data on the direct and indirect costs faced by TB patients and their families. Greater than 80% completeness was achieved for all variables of interest, with an average survey duration of 40 minutes and a rejection rate of 8%. The described survey method to determine the baseline for further study of catastrophic costs in Colombia was novel because of its telephone-based format, which adheres to the information standards required to allow internationally comparable estimates. It is a useful means of generating standardized results in contexts in which the ability to conduct face-to-face surveys is limited.

RESUMO O estudo dos custos catastróficos incorridos pelas pessoas afetadas pela tuberculose realizado na Colômbia durante a pandemia de COVID-19 representou uma oportunidade de implementar pesquisas telefônicas como forma de coleta de dados. Constitui-se uma inovação metodológica dos padrões estabelecidos pela Organização Mundial da Saúde (OMS), que, para esse tipo de estudo, geralmente se baseiam no uso de pesquisas presenciais com os pacientes que frequentam estabelecimentos de saúde. O delineamento, os objetivos e a metodologia do estudo foram adaptados do manual prático da OMS para a realização de pesquisas de custos da tuberculose. Um total de 1065 pessoas afetadas pela tuberculose foram selecionadas para participar do estudo. O questionário padrão, adaptado ao contexto colombiano, foi aplicado pelo telefone. Foi possível obter dados estruturados sobre os custos diretos e indiretos enfrentados pelos pacientes com tuberculose e suas famílias. Em geral, observou-se que todas as variáveis de coleta atingiram uma completude de mais de 80%, com um tempo médio de pesquisa de 40 minutos e uma taxa de recusa de 8%. A metodologia de pesquisa telefônica desenvolvida para determinar a linha de base do estudo de custos catastróficos na Colômbia foi inovadora devido ao formato telefônico, que mantém os padrões de informação necessários para permitir estimativas comparáveis internacionalmente e é uma forma útil de gerar resultados padronizados em circunstâncias em que há limitações para a realização de pesquisas presenciais.