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1.
PLoS One ; 15(7): e0235514, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645031

RESUMO

INTRODUCTION: Cardiovascular diseases (CVDs) represent the main cause of death among non-communicable diseases (NCDs) in Brazil, and they have a high economic impact on health systems. Most populations around the world, including Brazilians, consume excessive sodium, which increases blood pressure and the risk of CVDs. OBJECTIVE: To model the estimated deaths and costs associated with CVDs, which are mediated by increased blood pressure attributable to excessive sodium consumption in adults from the perspective of the Brazilian public health system in 2017. METHODS: We employed two macrosimulation methods, using top-down approaches and based on the same relative risks. The models estimated the mortality and costs-of-illness attributable to excessive sodium intake and mediated by hypertension for adults aged over 30 years in 2017. Direct healthcare cost data (inpatient care, outpatient care and medications) were extracted from the Ministry of Health information systems and official records. RESULTS: In 2017, an estimated 46,651 deaths from CVDs could have been prevented if the average sodium consumption had been reduced to 2 g/day in Brazil. Premature deaths related to excessive sodium consumption caused 575,172 Years of Life Lost and US$ 752.7 million in productivity losses to the economy. In the same year, the National Health System's costs of hospitalizations, outpatient care and medication for hypertension attributable to excessive sodium consumption totaled US$192.1 million. The main causes of death and costs associated with CVDs were coronary heart disease and stroke, followed by hypertensive disease, heart failure and aortic aneurysm. CONCLUSION: Excessive sodium consumption is estimated to account for 15% of deaths by CVDs and to 14% of the inpatient and outpatient costs associated with CVD. It also has high societal costs in terms of premature deaths. CVDs are a leading cause of disease and economic burden on the global, regional and country levels. As a largely preventable and treatable conditions, CVDs require the strengthening of cost-effective policies, supported by evidence, including modeling studies, to reduce the costs relating to illness borne by the Brazilian public health system and society.


Assuntos
Efeitos Psicossociais da Doença , Cardiopatias/epidemiologia , Modelos Teóricos , Recomendações Nutricionais , Cloreto de Sódio na Dieta/efeitos adversos , Brasil , Feminino , Fidelidade a Diretrizes , Cardiopatias/economia , Cardiopatias/etiologia , Cardiopatias/mortalidade , Humanos , Masculino , Cloreto de Sódio na Dieta/normas , Organização Mundial da Saúde
2.
Med. intensiva (Madr., Ed. impr.) ; 44(5): 294-300, jun.-jul. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-193189

RESUMO

OBJECTIVE: To compare the measurement of antimicrobial consumption by defined daily dose (DDD) versus by days of therapy (DOT). DESIGN: Retrospective analysis of clinical and administrative data from patients admitted to a polyvalent ICU. SETTING: ICU at a University Hospital in Spain. PATIENTS: All patients admitted to the ICU. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: For the DDD method, the World Health Organization (WHO)-assigned DDD was determined for the all the prescribed antimicrobials. For the DOT method, one DOT represented the administration of a single agent on a given day regardless of the number of doses administered. To express aggregate use, total DDDs and total DOTs were normalized to 100 patient-days. RESULTS: During the study period, 2393 adult patients were admitted to the ICU. Total median antimicrobial drugs measured by DDDs was 535.3 (IQR 319.8-845.5) vs. 344.0 (IQR 117.2-544.5) when measured by DOTs, p < 0.001. When antimicrobial consumption was normalized to 100 patient-days, median antimicrobial consumption was also higher when measured by DDDs [2.98/100 patient-days (IQR 1.76-5.25) vs. 1.89/100 patient-days (IQR 0.64-3.0) when measured by DOTs, p < 0.001]. CONCLUSIONS: For most antibacterial and antifungal drugs used in critically ill patients, estimates of aggregate antibiotic use by DDDs per 100 patient-days and DOTs per 100 patient-days are discordant because the administered dose is dissimilar from the WHO-assigned DDD. DOT methods should be recommended to avoid the overestimation that occurs with DDDs in adult critically ill patients


OBJETIVO: Comparar la medición del consumo de antimicrobianos por dosis diarias definidas (DDD) y por días de tratamiento (DOT). DISEÑO: Análisis retrospectivo de datos clínicos y administrativos de los pacientes ingresados en una unidad de cuidados intensivos (UCI) polivalente. Ámbito: La UCI de un hospital universitario de España. PACIENTES: Todos los pacientes ingresados en la UCI.: INTERVENCIONES: Ninguna. PRINCIPALES VARIABLES DE INTERÉS: Se determinó la DDD asignada por la Organización Mundial de la Salud (OMS) para todos los antimicrobianos prescritos. La DOT representó los días de utilización de cada antimicrobiano independientemente del número de dosis administradas cada día. Las DDD totales y los DOT totales se normalizaron por cada 100 estancias. RESULTADOS: Durante el período de estudio, 2.393 pacientes adultos ingresaron en la UCI. La mediana de los antimicrobianos medidos por DDD fue de 535,3 (RIQ: 319,8-845,5) frente a 344,0 (RIQ: 117,2-544,5) cuando se midió mediante DOT; p < 0,001. Cuando el consumo de antimicrobianos se normalizó por 100 estancias, el consumo de antimicrobianos también fue mayor cuando se midió con DDD (2,98/100 estancias [RIQ: 1,76-5,25] vs. 1,89/100 estancias [RIQ: 0,64-3,0] cuando se midió por DOT; p < 0,001). CONCLUSIONES: Para la mayoría de los antimicrobianos utilizados en la UCI, el consumo global y medido por DDD/100 estancias y DOT/100 estancias son discordantes porque la dosis administrada es diferente de la DDD asignada por la OMS. Se debe recomendar la utilización de las DOT para evitar la sobreestimación que se produce con las DDD en pacientes adultos críticamente enfermos


Assuntos
Humanos , Recomendações Nutricionais , Antibacterianos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Antifúngicos/uso terapêutico , Uso de Medicamentos/normas , Estudos Retrospectivos , Unidades de Terapia Intensiva/estatística & dados numéricos
3.
Am J Clin Nutr ; 112(1): 13-18, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32491173

RESUMO

Based on decades of research, there is strong evidence that supports ongoing dietary recommendations to decrease intakes of SFAs and, more recently, to replace SFAs with unsaturated fat, including PUFAs and MUFAs. Epidemiologic research has shown that replacement of SFAs with unsaturated fat, but not refined carbohydrate and added sugars, is associated with a reduction in coronary heart disease events and death. There is much evidence from controlled clinical studies demonstrating that SFAs increase LDL cholesterol, a major causal factor in the development of cardiovascular disease. When each (nonprotein) dietary macronutrient isocalorically replaces SFA, the greatest LDL-cholesterol-lowering effect is seen with PUFA, followed by MUFA, and then total carbohydrate. New research on full-fat dairy products high in saturated fat, particularly fermented dairy foods, demonstrates some benefits for cardiometabolic diseases. However, compared with food sources of unsaturated fats, full-fat dairy products increase LDL cholesterol. Thus, current dietary recommendations to decrease SFA and replace it with unsaturated fat should continue to the basis for healthy food-based dietary patterns.


Assuntos
Gorduras na Dieta/metabolismo , Ácidos Graxos/metabolismo , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/prevenção & controle , LDL-Colesterol/metabolismo , Ácidos Graxos/análise , Ácidos Graxos Insaturados/análise , Ácidos Graxos Insaturados/metabolismo , História do Século XXI , Humanos , Saúde Pública/história , Saúde Pública/normas , Ensaios Clínicos Controlados Aleatórios como Assunto , Recomendações Nutricionais/história
4.
PLoS One ; 15(5): e0232824, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32384114

RESUMO

Zambia is still facing undernutrition and micronutrient deficiencies despite fortification and supplementation programmes stressing the need for additional solutions. Fermented foods have the potential to improve nutrient intake and, therefore, could have an important role in food based recommendations (FBRs) to ensure adequate intake of nutrients for optimal health of populations. Secondary dietary intake data was used in Optifood, a linear programming software to develop FBRs, for children aged 1-3 and 4-5 years in Mkushi district of Zambia. Three scenarios per age group were modeled to determine FBRs based on: (1) FBRs based on local available foods (2) FBR and Mabisi, a fermented milk beverage, and (3) FBR with Munkoyo, a cereal fermented beverage. The scenarios were compared to assess whether addition of Mabisi or Munkoyo achieved a better nutrient intake. FBRs based on only locally available non-fermented foods did not meet ≥70% of recommended nutrient intake (RNI) for calcium, fat, iron and zinc, so-called problem nutrients. The addition of Munkoyo to the FBRs did not reduce the number of problem nutrients, but after adding Mabisi to the FBR's only iron (67% of RNI) in the 1-3 year age group and only zinc (67% of RNI) in the 4-5 year age group remained problem nutrients. Mabisi, a fermented milk product in combination with the local food pattern is a good additional source of nutrients for these age groups. However, additional nutrition sensitive and cost-effective measures would still be needed to improve nutrient intake, especially that of iron and zinc.


Assuntos
Grão Comestível/metabolismo , Alimentos e Bebidas Fermentados , Leite/metabolismo , Estado Nutricional , Animais , Cálcio na Dieta/metabolismo , Criança , Pré-Escolar , Dieta , Ingestão de Energia/fisiologia , Feminino , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Ferro/metabolismo , Masculino , Micronutrientes , Nutrientes/metabolismo , Necessidades Nutricionais , Recomendações Nutricionais , Zâmbia/epidemiologia
5.
Cardiovasc Ther ; 2020: 6719301, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32454893

RESUMO

Noncommunicable diseases are long-lasting and slowly progressive and are the leading causes of death and disability. They include cardiovascular diseases (CVD) and diabetes mellitus (DM) that are rising worldwide, with CVD being the leading cause of death in developed countries. Thus, there is a need to find new preventive and therapeutic approaches. Polyphenols seem to have cardioprotective properties; among them, polyphenols and/or minor polar compounds of extra virgin olive oil (EVOO) are attracting special interest. In consideration of numerous sex differences present in CVD and DM, in this narrative review, we applied "gender glasses." Globally, it emerges that olive oil and its derivatives exert some anti-inflammatory and antioxidant effects, modulate glucose metabolism, and ameliorate endothelial dysfunction. However, as in prescription drugs, also in this case there is an important gender bias because the majority of the preclinical studies are performed on male animals, and the sex of donors of cells is not often known; thus a sex/gender bias characterizes preclinical research. There are numerous clinical studies that seem to suggest the benefits of EVOO and its derivatives in CVD; however, these studies have numerous limitations, presenting also a considerable heterogeneity across the interventions. Among limitations, one of the most relevant in the era of personalized medicine, is the non-attention versus women that are few and, also when they are enrolled, sex analysis is lacking. Therefore, in our opinion, it is time to perform more long, extensive and lessheterogeneous trials enrolling both women and men.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Dieta Saudável , Saúde do Homem , Azeite de Oliva/administração & dosagem , Comportamento de Redução do Risco , Saúde da Mulher , Adolescente , Adulto , Animais , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Valor Nutritivo , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Fatores Sexuais , Adulto Jovem
6.
Nutr Metab Cardiovasc Dis ; 30(7): 1094-1105, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32451273

RESUMO

BACKGROUND AND AIMS: The relationships between dietary protein intake and risk of all-cause, cardiovascular disease (CVD), and cancer mortality are still unclear. We conducted a systematic review with meta-analysis of cohort studies to summarize the evidence. METHODS AND RESULTS: We searched PubMed and Web of Science for relevant studies through February 2020. The associations of total, animal, and plant proteins with all-cause, CVD, and cancer mortality were evaluated. Study-specific relative risks (RR) were pooled using the fixed effect model when no significant heterogeneity was detected; otherwise the random effect model was employed. Twelve cohort studies were eligible for the study. Increased total protein showed no clear association with risk of all-cause, CVD, and cancer mortality. In the stratified analysis by protein sources, higher plant protein intake was associated with a reduced risk of all-cause mortality (highest vs lowest intake: RR = 0.92; 95% CI: 0.88, 0.96; each 3% increment of intake: RR = 0.97; 95% CI: 0.94, 0.99), and may be associated with a reduced risk of CVD mortality (highest vs lowest intake: RR = 0.90; 95% CI: 0.80, 1.01; each 3% increment of intake: RR = 0.95; 95% CI: 0.91, 0.99). Moreover, higher intake of animal protein may be associated with an increased risk of CVD mortality (highest vs lowest intake: RR = 1.11; 95% CI: 1.01, 1.22; each 3% increment of intake: RR = 1.02; 95% CI: 0.98, 1.06). CONCLUSION: This study demonstrates that higher plant protein intake is associated with a reduced risk of all-cause and CVD-related mortality. Persons should be encouraged to increase their plant protein intake to potentially decrease their risk of death.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Dieta Saudável , Neoplasias/prevenção & controle , Proteínas de Vegetais Comestíveis/administração & dosagem , Comportamento de Redução do Risco , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Causas de Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/mortalidade , Valor Nutritivo , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Fatores de Tempo
7.
Rev Bras Epidemiol ; 23: e200023, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32401917

RESUMO

AIM: To verify the prevalence of recommendation of iron supplementation among children aged 12 and 24 months. METHODOLOGY: All children born in the maternities of Pelotas/RS in 2015 were eligible for the Cohort. The outcomes were the recommendation of ferrous sulphate by health professionals and its use. RESULTS: The cohort followed up 4,275 children. Approximately 64.0% of them were recommended to receive iron supplementation until 12 months of age. Among these, 68.8% used iron. From 12 to 24 months, 39.4% of the children received a prescription of iron supplementation, and among them, 26.2% actually used it. At 12 months, after adjusted analysis, higher maternal education, higher family income, lower parity, and low birth weight remained associated with the outcome. At 24 months, after adjusted analysis, we observed a higher recommendation of iron supplementation among mother with lower parity and for children with low birth weight. CONCLUSION: There was a low frequency of recommendation and low rate of use of iron among children. These findings are highly relevant given the high prevalence of anemia observed in children this year. The low recommendation of iron use among children up to 24 months of age, and the low use among those who are recommended to use it reflect the need for coordinated actions among health professionals and the expansion of knowledge among mothers to enable a wider reach of this important public policy.


Assuntos
Suplementos Nutricionais/estatística & dados numéricos , Compostos Ferrosos/uso terapêutico , Fatores Etários , Anemia Ferropriva/prevenção & controle , Brasil , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido de Baixo Peso , Masculino , Mães/estatística & dados numéricos , Recomendações Nutricionais , Fatores Socioeconômicos , Cooperação e Adesão ao Tratamento
8.
Public Health Nutr ; 23(8): 1307-1319, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32241321

RESUMO

OBJECTIVE: To determine the impacts of using a whole grain food definition on measurement of whole grain intake compared with calculation of total grams of intake irrespective of the source. DESIGN: The Australian whole grain database was expanded to identify foods that comply with the Healthgrain whole grain food definition (≥30 % whole grains on a dry weight basis, whole grain ingredients exceeds refined grain and meeting accepted standards for healthy foods based on local regulations). Secondary analysis of the National Nutrition and Physical Activity Survey (NNPAS) 2011-2012 dietary intake data included calculation of whole grain intakes based on intake from foods complying with the Healthgrain definition. These were compared with intake values where grams of whole grain in any food had been included. SETTING: Australia. PARTICIPANTS: Australians (≥2 years) who participated in the NNPAS 2011-2012 (n 12 153). RESULTS: Following expansion of the whole grain database, 214 of the 609 foods containing any amount of whole grain were compliant with the Healthgrain definition. Significant mean differences (all P < 0·05) of 2·84-6·25 g/d of whole grain intake (5·91-9·44 g/d energy adjusted) were found when applying the Healthgrain definition in comparison with values from foods containing any whole grain across all age groups. CONCLUSIONS: Application of a whole grain food definition has substantial impact on calculations of population whole grain intakes. While use of such definitions may prove beneficial in settings such as whole grain promotion, the underestimation of total intake may impact on identification of any associations between whole grain intake and health outcomes.


Assuntos
Ingestão de Energia , Terminologia como Assunto , Grãos Integrais , Adolescente , Adulto , Idoso , Austrália , Criança , Pré-Escolar , Dieta/estatística & dados numéricos , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Estado Nutricional , Recomendações Nutricionais , Adulto Jovem
9.
High Blood Press Cardiovasc Prev ; 27(3): 239-249, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32266707

RESUMO

INTRODUCTION: This study examined the prevalence of pre-hypertension (PHT) and hypertension (HT) in urban youth, and assessed the effects of sodium intake and obesity on blood pressure (BP) by ethnicity. METHODS: A convenience sample of 557 multiethnic youth, aged 11-23 years, was recruited from 12 schools and institutions in Edmonton, Alberta, Canada. Participants were divided by self-identified ethnicity into four groups (Indigenous, African and Middle Eastern (AME), Asian, and European). RESULTS: Between October 2013 and March 2014, one-on-one interviews were conducted to collect data on demographics, physical activity, diet, and Body Mass Index (BMI). BP was obtained at two different times during the interview and measured a third time in cases of high variability. The standard deviation scores (SDS) of systolic BP (SBP) and diastolic BP (DBP) were used to estimate associations with sodium intake (per 1000 mg/day). Overall, 18.2% and 5.4% of the participants had PHT and HT, respectively. Indigenous and AME participants showed the highest rates of PHT (23.1%). Indigenous and European participants showed higher rates of HT (8.3% and 5.3%, respectively) than other ethnic groups (AME = 4.4%, Asian = 3.9%). There was a positive association between 1000 mg/day increase in sodium intake and SDS of SBP by 0.041 (95% CI 0.007-0.083; p = 0.04) among pre-hypertensive participants. Over 85% of participants exceeded the recommended dietary sodium intake. Mean BMI and dietary sodium intake were higher among pre-hypertensive participants (4219 mg/day) than normotensive (3475 mg/day). CONCLUSIONS: The prevalence of HT varied by ethnicity. High dietary sodium intake was of concern. There is a need for culturally-tailored, population-based interventions to reduce sodium intake.


Assuntos
Pressão Sanguínea , Hipertensão/etnologia , Estilo de Vida/etnologia , Pré-Hipertensão/etnologia , Sódio na Dieta/efeitos adversos , Saúde da População Urbana/etnologia , Adolescente , Grupo com Ancestrais do Continente Africano , Fatores Etários , Alberta/epidemiologia , Grupo com Ancestrais do Continente Asiático , Criança , Estudos Transversais , Dieta Hipossódica/etnologia , Grupo com Ancestrais do Continente Europeu , Exercício Físico , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Inquéritos Epidemiológicos , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertensão/prevenção & controle , Índios Norte-Americanos , Masculino , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/etnologia , Pré-Hipertensão/diagnóstico , Pré-Hipertensão/fisiopatologia , Pré-Hipertensão/prevenção & controle , Prevalência , Fatores Raciais , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Adulto Jovem
10.
J Nutr ; 150(5): 1208-1213, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32140711

RESUMO

BACKGROUND: Due to a lack of research data on the protein requirements of the elderly in China, the estimated average requirement (EAR) and the recommended nutrient intake (RNI) of protein in the elderly remain the same as those in young and middle-aged people at 0.98 g/(kg·d). OBJECTIVE: The objective of this study was to determine the protein requirements of healthy Chinese adults >65y old through use of the indicator amino acid oxidation (IAAO) method. METHODS: Seven healthy adult men and 7 healthy adult women participated in the study, with protein intakes ranging from 0.3 to 1.8 g/(kg·d). The diets were isocaloric and provided energy at a 1.5 resting energy expenditure. Protein was given based on the lactalbumin. Phenylalanine and tyrosine were added to protein doses of 0.3-1.5 g/kg according to the highest dose of protein content [1.8 g/(kg·d)]. Phenylalanine and tyrosine concentrations were kept constant at each protein dose. The mean protein requirement was determined by applying a nonlinear mixed-effects model analysis to the F13CO2, which identified a breakpoint in F13CO2 in response to graded amounts of protein. This trial was registered with the Chinese clinical trial registry as ChiCTR-BOC-17010930. RESULTS: Protein EAR and RNI for healthy elderly Chinese adults were determined to be 0.91 and 1.17 g/(kg·d), respectively, based on the indicator amino acid oxidation technique. CONCLUSIONS: The estimates of protein requirements for Chinese adults >65 y in the present study are 3.4% and 19.4% higher than the current estimated requirements, 0.88 g/(kg·d) for EAR and 0.98 g/(kg·d) for RNI.


Assuntos
Proteínas na Dieta/administração & dosagem , Necessidades Nutricionais , Recomendações Nutricionais , Idoso , Envelhecimento/fisiologia , Aminoácidos/metabolismo , Peso Corporal , China , Ingestão de Energia , Metabolismo Energético , Feminino , Humanos , Masculino , Oxirredução , Fenilalanina/administração & dosagem , Fenilalanina/metabolismo , Tirosina/administração & dosagem
11.
J Stroke Cerebrovasc Dis ; 29(5): 104747, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32151478

RESUMO

OBJECTIVES: Up to 41% of intracerebral hemorrhages (ICH) are considered cryptogenic despite a thorough investigation to determine etiology. Certain over-the-counter supplements may increase proclivity to bleeding, and we hypothesize that specifically vitamin E may have an association with ICH and acutely elevated serum levels of α-tocopherol. Our aim is to report 3 cases of recently admitted patients with hypervitaminosis E and otherwise cryptogenic ICH. METHODS: At our institution between January and December 2018, 179 patients were admitted with ICH with 73 imputed to be "cryptogenic" (without clear etiology as per Structural vascular lesions, Medication, Amyloid angiopathy, Systemic disease, Hypertension, or Undetermined and Hypertension, Amyloid angiopathy, Tumor, Oral anticoagulants, vascular Malformation, Infrequent causes, and Cryptogenic criteria). Of these, we found 3 (4.1%) clearly admitted to consistent use of vitamin E supplementation for which α-tocopherol levels were checked. We describe the clinical presentation and course of these patients and their etiologic and diagnostic evaluations including neuroimaging and α-tocopherol laboratory data. RESULTS: All patients in this series were consistently consuming higher than recommended doses of vitamin E and developed acute ICH. The first 2 patients both had subcortical (thalamic) intraparenchymal hemorrhages while the third had an intraventricular hemorrhage. Serum α-tocopherol levels in patient A, B, and C were elevated at 30.8, 46.7, and 23.3 mg/L, respectively (normal range 5.7-19.9 mg/L) with a mean of 33.6 mg/L. No clear alternate etiologies to their ICH could be conclusively determined despite thorough workups. CONCLUSIONS: In patients with cryptogenic ICH, clinicians should consider hypervitaminosis E and check serum α-tocopherol level during admission. Reviewing the patient's pharmacologic history, including over-the-counter supplements such as vitamin E, may help identify its association, and its avoidance in the future may mitigate risk. With its known vitamin K antagonism, hypo-prothrombinemic effect, cytochrome p-450 interaction, and antiplatelet activity, vitamin E may not be as benign as presumed. Its consumption in nonrecommended doses may increase ICH risk, which may be underestimated and under-reported.


Assuntos
Hemorragia Cerebral/induzido quimicamente , Suplementos Nutricionais/envenenamento , Acidente Vascular Cerebral/induzido quimicamente , Vitaminas/envenenamento , alfa-Tocoferol/envenenamento , Idoso , Hemorragia Cerebral/sangue , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral Intraventricular/sangue , Hemorragia Cerebral Intraventricular/induzido quimicamente , Hemorragia Cerebral Intraventricular/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Recomendações Nutricionais , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico por imagem , Vitaminas/sangue , alfa-Tocoferol/sangue
12.
Nutr Metab Cardiovasc Dis ; 30(5): 717-729, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32127332

RESUMO

AIMS: Results regarding the association between fish intake and risk of metabolic syndrome (MetS) are ambiguous. Therefore, this study aims to evaluate whether there is an association between fish consumption and risk of MetS. DATA SYNTHESIS: A comprehensive literature search was conducted of PubMed, Embase, ScienceDirect and Google Scholar up to August 2019. A random-effects model was used to pool the risk of MetS in the highest category of fish consumption compared with the lowest one. Subgroup analysis was conducted based on country of region, gender, dietary tool, MetS definition, energy adjustment and sample size. A dose-response of analysis of fish intake and risk of MetS was also conducted. Twelve studies with a total of 16 effect sizes (10 cross-sectional and six cohort) were included. An inverse association was observed between fish intake and risk of MetS in cohort (OR = 0.80, 95% CI: 0.66, 0.96; P = 0.017, I2 = 62.9%) but not cross-sectional studies (OR = 0.80, 95% CI: 0.70, 1.02; P = 0.085, I2 = 50.1%). Subgroup analysis suggested that the results were influenced by all the included variables but sample size. A significant non-linear association was observed between fish intake levels and risk of MetS (P-value for non-linearity = 0.010). CONCLUSION: An inverse association existed between fish intake and risk of MetS when combining data from prospective cohort studies. Further studies are needed to confirm such an effect.


Assuntos
Dieta Saudável , Peixes , Síndrome Metabólica/prevenção & controle , Valor Nutritivo , Comportamento de Redução do Risco , Alimentos Marinhos , Adolescente , Adulto , Idoso , Animais , Feminino , Humanos , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Adulto Jovem
13.
Nutr Metab Cardiovasc Dis ; 30(5): 738-748, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32139253

RESUMO

BACKGROUND AND AIMS: Great discrepancies exist in results from studies examining the association between dietary patterns and cardiovascular disease (CVD) in different populations. The aim of this study is to examine the relationship between the Australian Dietary Guidelines (ADG) 2013, Mediterranean-DASH diet Intervention for Neurodegenerative Delay (MIND), Paleolithic and Okinawan dietary patterns and CVD respectively. METHODS AND RESULTS: In this cross-sectional secondary analysis of the 2011-12 Australian Health Survey, adults who self-reported physician-diagnosed CVD, completed two multiple-pass 24 h recalls and had no missing data on all confounders were analysed (weighted n = 5376; 295 CVD cases). Dietary intake was transformed to represent usual intake by the multiple source method. The score of Healthy Eating Index for Australian Adults (HEIFA-2013) was adopted for ADG 2013, while the scores of MIND, Paleolithic and Okinawan dietary patterns were constructed by separating the intake of each predefined food and nutrient into quintiles. The associations between the dietary patterns (as tertiles of scores) and CVD were examined using binary logistic regression adjusted for significant cardiovascular risk factors. Higher adherence to the Okinawan diet pattern was significantly associated with a reduced prevalence of ischemic heart disease (IHD) (OR per unit increase in dietary pattern score: 0.94, 95%CI: 0.90-0.98). Comparing its extreme tertiles, the OR was 0.49 (95%CI: 0.29-0.82; ptrend < 0.01). The associations between HEIFA-2013, MIND and Paleolithic diet patterns and CVD were insignificant. CONCLUSION: The findings suggested an inverse association between adherence to Okinawan dietary pattern and prevalence of IHD in Australian adults.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Dieta Saudável , Comportamento Alimentar , Comportamento de Redução do Risco , Adolescente , Adulto , Idoso , Austrália/epidemiologia , Restrição Calórica , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Dieta Mediterrânea , Dieta Paleolítica , Abordagens Dietéticas para Conter a Hipertensão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Valor Nutritivo , Prevalência , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Adulto Jovem
14.
Nutr Metab Cardiovasc Dis ; 30(5): 804-809, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32139254

RESUMO

BACKGROUND AND AIMS: A higher dairy product intake has been associated to higher blood concentrations of 15:0 (pentadecanoic acid), 17:0 (margaric acid), and 14:0 (myristic acid). This study investigates whether a diet high in dairy products influences cholesteryl ester fatty acid concentrations of these specific fatty acids (FA). METHODS AND RESULTS: In a randomized multiple cross-over study, 13 men and 17 women aged 22 ± 4 years with a BMI of 21.6 ± 2.2 kg/m2 received 3 isocaloric intervention diets (dairy, meat or grain) in random order. For this post-hoc analysis, FA in plasma cholesteryl esters were measured using gas chromatography. We performed a linear mixed model per centered log-ratio transformed FA, adjusting for period, and the interaction between diet and period. Consumed total fat intake per controlled intervention diet was 31.0 ± 0.9 en%/day (dairy), 31.5 ± 0.6 en%/day (meat), and 28.4 ± 1.2 en%/day (grain), respectively. The dairy diet led to higher relative concentrations of 15:0 when compared to diets high in meat and grain, (ß; 0.27, 95%CI: 0.18,0.37; p = 1.2 × 10-5, and ß: 0.15; 95%CI: 0.06,0.24; p = 1.2 × 10-2, respectively). The dairy diet also led to higher 14:0 when compared to the meat diet (ß: 0.34; 95%CI: 0.21,0.46; p = 6.0 × 10-5), but not when compared to the grain diet. 17:0 did not differ between diets. CONCLUSION: The plasma cholesteryl ester fraction after a diet high in dairy was characterized by higher 15:0 levels. Concentrations of 14:0 were only higher when comparing the FA profile after a diet high in dairy when compared to a diet high in meat. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT01314040.


Assuntos
Ésteres do Colesterol/sangue , Laticínios , Dieta , Grão Comestível , Ácidos Graxos/sangue , Comportamento Alimentar , Carne , Adolescente , Adulto , Biomarcadores/sangue , Estudos Cross-Over , Feminino , Voluntários Saudáveis , Humanos , Masculino , Miristatos/sangue , Países Baixos , Valor Nutritivo , Recomendações Nutricionais , Regulação para Cima , Adulto Jovem
15.
PLoS Med ; 17(3): e1003053, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32142510

RESUMO

BACKGROUND: Fibre is promoted as part of a healthy dietary pattern and in diabetes management. We have considered the role of high-fibre diets on mortality and increasing fibre intake on glycaemic control and other cardiometabolic risk factors of adults with prediabetes or diabetes. METHODS AND FINDINGS: We conducted a systematic review of published literature to identify prospective studies or controlled trials that have examined the effects of a higher fibre intake without additional dietary or other lifestyle modification in adults with prediabetes, gestational diabetes, type 1 diabetes, and type 2 diabetes. Meta-analyses were undertaken to determine the effects of higher fibre intake on all-cause and cardiovascular mortality and increasing fibre intake on glycaemic control and a range of cardiometabolic risk factors. For trials, meta regression analyses identified further variables that influenced the pooled findings. Dose response testing was undertaken; Grading of Recommendations Assessment, Development and Evaluation (GRADE) protocols were followed to assess the quality of evidence. Two multicountry cohorts of 8,300 adults with type 1 or type 2 diabetes followed on average for 8.8 years and 42 trials including 1,789 adults with prediabetes, type 1, or type 2 diabetes were identified. Prospective cohort data indicate an absolute reduction of 14 fewer deaths (95% confidence interval (CI) 4-19) per 1,000 participants over the study duration, when comparing a daily dietary fibre intake of 35 g with the average intake of 19 g, with a clear dose response relationship apparent. Increased fibre intakes reduced glycated haemoglobin (HbA1c; mean difference [MD] -2.00 mmol/mol, 95% CI -3.30 to -0.71 from 33 trials), fasting plasma glucose (MD -0.56 mmol/L, 95% CI -0.73 to -0.38 from 34 trials), insulin (standardised mean difference [SMD] -2.03, 95% CI -2.92 to -1.13 from 19 trials), homeostatic model assessment of insulin resistance (HOMA IR; MD -1.24 mg/dL, 95% CI -1.72 to -0.76 from 9 trials), total cholesterol (MD -0.34 mmol/L, 95% CI -0.46 to -0.22 from 27 trials), low-density lipoprotein (LDL) cholesterol (MD -0.17 mmol/L, 95% CI -0.27 to -0.08 from 21 trials), triglycerides (MD -0.16 mmol/L, 95% CI -0.23 to -0.09 from 28 trials), body weight (MD -0.56 kg, 95% CI -0.98 to -0.13 from 18 trials), Body Mass Index (BMI; MD -0.36, 95% CI -0·55 to -0·16 from 14 trials), and C-reactive protein (SMD -2.80, 95% CI -4.52 to -1.09 from 7 trials) when compared with lower fibre diets. All trial analyses were subject to high heterogeneity. Key variables beyond increasing fibre intake were the fibre intake at baseline, the global region where the trials were conducted, and participant inclusion criteria other than diabetes type. Potential limitations were the lack of prospective cohort data in non-European countries and the lack of long-term (12 months or greater) controlled trials of increasing fibre intakes in adults with diabetes. CONCLUSIONS: Higher-fibre diets are an important component of diabetes management, resulting in improvements in measures of glycaemic control, blood lipids, body weight, and inflammation, as well as a reduction in premature mortality. These benefits were not confined to any fibre type or to any type of diabetes and were apparent across the range of intakes, although greater improvements in glycaemic control were observed for those moving from low to moderate or high intakes. Based on these findings, increasing daily fibre intake by 15 g or to 35 g might be a reasonable target that would be expected to reduce risk of premature mortality in adults with diabetes.


Assuntos
Diabetes Mellitus Tipo 1/dietoterapia , Diabetes Mellitus Tipo 2/dietoterapia , Dieta para Diabéticos , Dieta Saudável , Fibras na Dieta/administração & dosagem , Valor Nutritivo , Comportamento de Redução do Risco , Grãos Integrais , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/mortalidade , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Dieta para Diabéticos/efeitos adversos , Dieta para Diabéticos/mortalidade , Dieta Saudável/efeitos adversos , Dieta Saudável/mortalidade , Fibras na Dieta/efeitos adversos , Humanos , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grãos Integrais/efeitos adversos
16.
Vasc Med ; 25(2): 184-193, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32124663

RESUMO

The rate of cardiovascular disease (CVD) mortality reduction in the United States has plateaued recently, despite the development of novel preventive pharmacotherapies, increased access to care, and healthcare spending. This is largely due to American's poor dietary patterns and practices causing increasing trends in the prevalence of obesity and type 2 diabetes mellitus. For decades, dietary guidelines on 'healthy diets' to reduce CVD risk, grounded in epidemiological research, have been nationally distributed to Americans. In this review, we highlight landmark events in modern nutrition science and how these have framed past and current understandings of diet and health. We also follow the evolution of dietary recommendations for Americans throughout the years, with an emphasis on recommendations aimed to reduce risk for CVD and mortality. Secondly, we examine how the low-fat ideology came to dominate America in the last decades of the 20th century and subsequently contributed to an excess intake of refined carbohydrates which, in the context of an increasingly sedentary lifestyle, may have fueled the obesity epidemic. We then examine the current major evidence-based dietary patterns and specific dietary approaches to reduce CVD risk, reviewing the literature surrounding nutritional components of the heart-healthy diet and discussing the dietary patterns proven most effective for CVD prevention: the Dietary Approaches to Stop Hypertension (DASH) diet, the Mediterranean diet, and the healthy vegetarian diet. Finally, we discuss emerging dietary trends, considerations for nutrition counseling, and future directions within the important field of nutrition, with the ultimate goal of improving vascular health.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Dieta Saudável , Coração/fisiopatologia , Comportamento de Redução do Risco , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/história , Doenças Cardiovasculares/fisiopatologia , Dieta Saudável/efeitos adversos , Dieta Saudável/história , Dieta Saudável/tendências , Difusão de Inovações , Comportamento Alimentar , Previsões , Nível de Saúde , História do Século XX , História do Século XXI , Humanos , Estado Nutricional , Valor Nutritivo , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco
17.
Nutr Metab Cardiovasc Dis ; 30(4): 566-573, 2020 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-32007332

RESUMO

BACKGROUND AND AIM: Olive oil consumption has been suggested to favorably impact children's health. The present study aimed to identify possible associations between exclusive olive oil consumption and metabolic indices and lifestyle factors. METHODS AND RESULTS: Cross-sectional, observational study. Population data derived from a health survey on a sample of 177 091 children aged 8-17 years. Olive oil consumption and dietary habits were evaluated using questionnaires (KIDMED index). Anthropometric and physical fitness measurements were obtained by trained investigators. Physical activity (PA) status, screen time and sleeping habits were assessed through self-completed questionnaires. Exclusive olive oil consumption decreased the odds of obesity and increased the odds of healthy cardiorespiratory fitness (CRF) by 15% (95% confidence interval (CI): 0.75-0.95) and 13% (95% CI: 1.04-1.22), respectively, after adjusting for several covariates. Moreover, exclusive olive oil consumption was associated with increased odds of having sufficient dietary habits (average/optimal adherence to the Mediterranean Diet) by almost four times (95% CI: 3.65-4.45) and decreased odds of insufficient sleep (<8-9 h/d) and increased screen time (>2 h/d) by 20% (95% CI: 0.73-0.87) and 40% (95% CI: 0.48-0.72), respectively. CONCLUSIONS: Exclusive olive oil consumption was associated with metabolic indices such as obesity and CRF and a healthy lifestyle profile. The exclusive consumption of olive oil as part of a balanced MD does seem to provide favorable health benefits and should be further promoted.


Assuntos
Comportamento do Adolescente , Comportamento Infantil , Dieta Saudável , Comportamento Alimentar , Azeite de Oliva/administração & dosagem , Obesidade Pediátrica/prevenção & controle , Adolescente , Fatores Etários , Aptidão Cardiorrespiratória , Criança , Estudos Transversais , Inquéritos sobre Dietas , Exercício Físico , Feminino , Grécia/epidemiologia , Humanos , Masculino , Valor Nutritivo , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco , Tempo de Tela , Comportamento Sedentário , Sono
18.
Nutr Metab Cardiovasc Dis ; 30(4): 574-580, 2020 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-32007333

RESUMO

BACKGROUND AND AIMS: The Mediterranean diet (MD) affects the risk of myocardial infarction and long-term prognosis after a coronary event. Limited data are available regarding the influence of MD on short-term prognosis. We assessed the impact of the MD adherence on in-hospital and short-term outcome in patients with first ST-elevation Myocardial Infarction (STEMI). METHODS AND RESULTS: As many as 533 European patients with STEMI and no previous history of coronary artery disease were included in this analysis. Previous dietary habits of each patient were collected with a food frequency questionnaire from which we calculated the FAMI Mediterranean Diet Score (FAMI MD Score), according to the MD adherence. A blood sample was drawn to each patient within 6 h of symptoms onset. Levels of high-sensitivity C-Reactive Protein (hsCRP), Interleukin-6 (IL-6) were measured. Clinical outcome at 180 days and myocardial reperfusion were assessed. Patients with higher FAMI MD Score had lower levels of hsCRP; there were no differences between IL-6 level among FAMI MD Score quintiles. There were no associations between adherence to MD and 180-day adverse events. Lower FAMI MD Score was associated with a higher risk of ineffective myocardial reperfusion after thrombolysis or percutaneous coronary intervention. Similar results were observed for daily consumption of ≥4 portions of fruit and vegetable. CONCLUSIONS: A positive effect of the Mediterranean diet, and fruit and vegetable intake was observed on hsCRP and the occurrence of effective myocardial reperfusion. These findings confirm the favorable impact of Mediterranean diet adherence not only in primary but also in secondary prevention.


Assuntos
Dieta Saudável , Dieta Mediterrânea , Comportamento Alimentar , Cooperação do Paciente , Intervenção Coronária Percutânea , Comportamento de Redução do Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Terapia Trombolítica , Idoso , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Europa (Continente) , Feminino , Frutas , Humanos , Mediadores da Inflamação/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Valor Nutritivo , Intervenção Coronária Percutânea/efeitos adversos , Estudos Prospectivos , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Verduras
19.
Environ Geochem Health ; 42(9): 2925-2941, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32062738

RESUMO

Fluoride is an essential trace element for humans, and its deficiency or excess in the environment could lead to disease. To investigate the spatial distribution and health risk assessment of fluoride (F-) in drinking water, 302 tap water samples from Chongqing urban areas, China, were collected to analyze F- using an ion chromatograph. The results showed that (1) F- concentration in drinking water ranged from 0.100 to 0.503 mg/L, with an average of 0.238 ± 0.045 mg/L. (2) The spatial autocorrelation analysis showed that high-low clusters were mostly located in Dadukou District and Beibei District, while low-low clusters were mainly in southern Banan District. (3) The fluoride average daily doses of children, teens and adults were 0.030, 0.029 and 0.031 mg/(kg day). (4) Hazard quotients of excessive fluoride (HQe) of children, teens and adults were 0.51 ± 09, 0.49 ± 0.09 and 0.52 ± 0.10, respectively (inferior to 1.00), whereas hazard quotients of inadequate fluoride (HQi) of those groups were 1.21 ± 0.26, 1.23 ± 0.26 and 1.15 ± 0.25, respectively (superior to 1.00). Therefore, average daily fluoride intake of residents with drinking water was inadequate. This could pose dental caries and osteoporosis threats for residents from Chongqing urban areas.


Assuntos
Água Potável/análise , Fluoretos/análise , Adolescente , Adulto , Criança , China , Cidades , Cárie Dentária/etiologia , Fluoretos/administração & dosagem , Humanos , Osteoporose/etiologia , Recomendações Nutricionais , Medição de Risco , Análise Espacial , Oligoelementos/administração & dosagem , Oligoelementos/análise
20.
J Nutr ; 150(5): 1230-1239, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31909790

RESUMO

BACKGROUND: Intervention strategies to reduce sodium intake and increase potassium intake may decrease blood pressure; however, most are focused on reducing sodium in processed food globally. OBJECTIVES: We attempt to fill important gaps in understanding the dynamics of these dietary determinants of hypertension in China. METHODS: We used data on 29,926 adults aged ≥20 y between 1991 and 2015 from an ongoing cohort, the China Health and Nutrition Survey. We collected detailed diet data with use of weighing methods with 3 consecutive 24-h recalls. With panel data random-effects models, we analyzed factors associated with sodium and potassium intakes and sodium to potassium (Na/K) ratios. RESULTS: Sodium intake decreased from 6.3 g/d in 1991 to 4.1 g/d in 2015, still twice the tolerable upper intake recommended by the WHO. Potassium intake was 1.7 g/d in 1991 and 1.5 g/d in 2015, below half that recommended by the WHO. The Na/K ratio decreased from 4.1 (ratios in g) in 1991 to 3.1 in 2015, 5 times the recommendation of the WHO. More than two-thirds (67%) of sodium intake was from salt added during food preparation, with 8.8% from processed foods in 2015, up from 5.0% in 1991. The most at-risk populations lived in China's central region and rural areas, were middle aged, had lower educations, or were farmers. CONCLUSIONS: Sodium intake is very high across all regions in China. As part of sodium reduction efforts, China should target people living in the central region and adults aged above 60 whose sodium intakes are much higher. Strategies to decrease sodium intake and increase potassium intake should be different from those applied in the Western world where the major source is processed food. Reduced sodium higher potassium salts should become a major policy initiative in China.


Assuntos
Potássio na Dieta/administração & dosagem , Sódio na Dieta/administração & dosagem , Adulto , Idoso , China , Estudos de Coortes , Culinária/métodos , Ingestão de Energia , Fazendeiros , Feminino , Alimentos , Manipulação de Alimentos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Recomendações Nutricionais , Reprodutibilidade dos Testes , População Rural , Cloreto de Sódio na Dieta/administração & dosagem , Organização Mundial da Saúde
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