Diet Quality of patients with chronic Chagas disease in a tertiary hospital: a case-control study

Abstract INTRODUCTION: Nutritional status has been implicated in the modulation of the immune response, possibly augmenting the pathogenesis of Chagas disease (Cd). We evaluated diet quality and nutritional status in adults and elderly patients with chronic Cd in a tertiary hospital. METHODS: A case-control study of Cd patients was conducted, paired for gender, age, and co-morbidities with non-Cd patients. Anthropometric measurements and food frequency questionnaire was used, and diet quality was assessed by the Brazilian Healthy Eating Index-Revised (BHEI-R). The Estimated Average Requirement cut-off points were used to determine the dietary micronutrient adequacy. The Cd group was further grouped according to Los Andes classification. RESULTS: The study participants were 67 ± 10 years old, 73.6% elderly and 63% female. The prevalence of overweight/obesity and abdominal fat was high in both groups; however, Cd group showed a lower prevalence of obesity and increased risk of disease according to waist circumference classification. There was no difference in BHEI-R score between groups (p=0.145). The Cd group had sodium and saturated fat intake above recommendations and low intake of unsaturated fat, vitamin D, E, selenium, magnesium, and dairy products; but higher intake of iron. According to Los Andes classification, group III presented lower intake of whole fruit and dietary fiber. CONCLUSIONS: Patients with Cd were overweight and the quality of their diet was unsatisfactory based on the recommended diet components for age and sex.

Food consumption of children younger than 6 years according to the degree of food processing / Consumo alimentar de crianças menores de seis anos conforme o grau de processamento

Abstract: Objective: To evaluate food intake according to the degree of processing, stratified by family income and age, in a representative sample of children younger than 6 years in the city of Pelotas, RS, Brazil. Methods: Cross-sectional population-based study carried out with 770 children aged 0-72 months of age living in the urban area of Pelotas. The dietary intake of children was assessed by 24-h recall administered to mothers or guardians. The energy intake was estimated and each food item was classified according to the food processing degree. Food consumption was stratified by age (younger than 24 months; 24 months or older) and associations between quintiles of family income and relative contribution of each food to total energy were performed by linear regression. The Wald test was applied to test linear trend across groups. Results: The mean energy intake was 1725.7 kcal/day. The mean contribution of processed and ultraprocessed foods was 19.7% among children younger than 24 months and 37% in those aged 24 months or older, while the mean consumption of natural and minimally processed food was 61% and 44%, respectively. Among children aged 24 months or older, a greater consumption of canned foods, cheese and sweets was observed as family income quintiles increased, while breads were more consumed by those children belonging to the lower income quintiles. Conclusion: A high caloric contribution of ultraprocessed foods in detriment to a lower consumption of natural and minimally processed foods was observed in the diet of children younger than 6 years.

Resumo: Objetivo: Avaliar o consumo alimentar conforme o grau de processamento, segundo a renda e a faixa etária, em uma amostra representativa de crianças menores de 6 anos de Pelotas (RS), Brasil. Métodos: Estudo transversal conduzido com 770 crianças até 72 meses residentes na zona urbana de Pelotas. O consumo alimentar das crianças foi avaliado por recordatório de 24 horas, aplicado às mães ou aos responsáveis, e o consumo calórico dos alimentos foi estimado de acordo com o grau de processamento. O consumo alimentar foi estratificado por faixa etária (menos de 24 meses; 24 meses ou mais) e as associações entre renda familiar e a participação relativa dos alimentos no total de calorias diárias foram conduzidas por regressão linear simples. Fez-se o teste de Wald para avaliar tendência linear entre os grupos. Resultados: A média de consumo foi 1.725,7 Kcal/dia. A participação calórica proveniente do grupo de alimentos ultraprocessados foi de 19,7% nas crianças com menos de 24 meses e 36,1% naquelas com 24 meses ou mais, enquanto que a contribuição do grupo de alimentos in natura e minimamente processados foi de 61,2% e 44,1%%, respectivamente. Nas crianças com 24 meses ou mais observou-se maior consumo de doces conforme o aumento da renda familiar, enquanto que os pães foram mais consumidos entre as crianças pertencentes aos menores quintis de renda. Conclusão: Observou-se elevada participação calórica de alimentos ultraprocessados em detrimento do menor consumo de alimentos in natura e minimamente processados na alimentação de crianças menores de 6 anos.

Obesity and its Association with Food Consumption, Diabetes Mellitus, and Acute Myocardial Infarction in the Elderly / Obesidade em Idosos e sua Associação com Consumo Alimentar, Diabetes Mellitus e Infarto Agudo do Miocárdio

Abstract Background: Obesity affects a large part of elderly individuals worldwide and is considered a risk predictor for the development of chronic diseases such as cardiac diseases, the leading causes of death in the elderly population. Objective: To investigate the prevalence of obesity and associated factors, with emphasis on the occurrence of other diseases and on food consumption in elderly individuals treated at the Brazilian Unified Health System (Sistema Único de Saúde, SUS). Methods: Cross-sectional sampling study performed in the city of Goiânia (Brazil) including elderly individuals (≥ 60 years) receiving primary care. During home visits, we performed anthropometric measurements and applied a structured, standardized, and pre-tested questionnaire assessing socioeconomic, demographic and lifestyle conditions, occurrence of diseases, and food consumption. We performed multiple Poisson regression analysis using a hierarchical model and adopting a significance level of 5%. Results: We evaluated 418 elderly patients with a mean age of 70.7 ± 7 years. Their body mass indices had a mean value of 27.0 kg/m2 and were higher in women than in men (27.4 kg/m2 versus 26.1 kg/m2, respectively, p = 0.017). Obesity had a prevalence of 49.0%, a risk 1.87 times higher between the ages of 60-69 years and 70-79 years, and a rate 1.4 times higher among individuals with more than four morbidities. On multivariate analysis, the factors associated with obesity were age 60-69 and 70-79 years, inadequate consumption of whole-wheat grains and adequate consumption of fruit, musculoskeletal diseases, diabetes mellitus, and acute myocardial infarction. Conclusions: Obesity had a high prevalence in the evaluated elderly population and was associated with food consumption, musculoskeletal disease, diabetes mellitus, and acute myocardial infarction.

Resumo Fundamento: A obesidade atinge uma grande parcela de idosos em todo o mundo e é considerada preditora de risco para o desenvolvimento de doenças crônicas, como as doenças cardíacas, as principais causas de óbito na população idosa. Objetivo: Investigar a prevalência de obesidade e fatores associados, com ênfase na presença de outras doenças e no consumo alimentar, em idosos usuários do Sistema Único de Saúde (SUS). Métodos: Estudo transversal, por amostragem, realizado no município de Goiânia, Brasil. Foram incluídos idosos (≥ 60 anos) atendidos na rede de atenção básica. Durante visitas domiciliares, foram realizadas medidas antropométricas e aplicação de questionário estruturado, padronizado e pré-testado sobre condições socioeconômicas, demográficas, estilo de vida, presença de doenças e consumo alimentar. Realizou-se regressão de Poisson múltipla a partir de um modelo hierárquico, adotando-se um nível de significância de 5%. Resultados: Foram avaliados 418 idosos com idade média de 70,7 ± 7 anos. O índice de massa corporal apresentou um valor médio de 27,0 kg/m2 e esteve mais elevado nas mulheres do que nos homens (27,4 kg/m2 x 26,1 kg/m2, respectivamente, p = 0,017). A obesidade teve prevalência de 49,0%, risco 1,87 vezes maior entre as idades de 60-69 anos e 70-79 anos, e taxa 1,4 vezes maior nos indivíduos com mais de quatro morbidades. Em análise multivariada, os fatores associados à obesidade foram idade de 60-69 e 70-79 anos, consumo inadequado de cereais integrais e adequado de frutas, doenças osteomusculares, diabetes mellitus e infarto agudo do miocárdio. Conclusões: A obesidade teve elevada prevalência na população idosa estudada e esteve associada com consumo alimentar, doença osteomuscular, diabetes mellitus e infarto agudo do miocárdio.

Association of eating frequency with anthropometric indices and blood pressure in children and adolescents: the CASPIAN-IV Study / Associação da frequência de alimentação com índices antropométricos e pressão arterial em crianças e adolescentes: o Estudo CASPIAN-IV

Abstract Objectives: This study was conducted to explore the association of eating frequency (EF) with anthropometric indices and blood pressure (BP) in children and adolescents. Methods: This nationwide cross-sectional study was performed on a multi-stage sample of 14,880 students, aged 6–18 years, living in 30 provinces in Iran. Parents were asked to report dietary intake of children as frequency of food groups and/or items. EF was defined as the sum of the daily consumption frequency of main meals and snacks. Association of EF with weight disorders, abdominal obesity, and elevated BP was assessed using different logistic regression models adjusted for potential confounding factors. Results: Eating more frequently (≥6 vs. ≤3) was found among students who were at younger age (11.91 vs. 13.29 years) (p < 0.001). Students who reported an EF of 4 (OR: 0.67, CI: 0.57–0.79), 5 (OR: 0.74, CI: 0.62–0.87), and 6 (OR: 0.54, CI: 0.44–0.65) had lower odds of being obese compared to those who had EF ≤ 3. Having EF of 4 (OR: 0.82, CI: 0.71–0.94), 5 (OR: 0.86, CI: 0.74–0.99), and ≥6 (OR: 0.73, CI: 0.63–0.85) was related to lower prevalence of abdominal adiposity. Conclusion: Higher EF was associated with lower mean values of anthropometric and BP measures, as well as with lower prevalence of generalized and abdominal obesity in children and adolescents. Longitudinal studies are needed to assess the long-term effects of EF on body composition in the pediatric age group.

Resumo Objetivos: Este estudo foi feito para explorar a associação da frequência de alimentação (FA) com índices antropométricos e pressão arterial (PA) em crianças e adolescentes. Métodos: Este estudo transversal nacional foi feito em uma amostra de várias etapas de 14.880 estudantes entre seis e 18 anos de 30 províncias do Irã. Foi pedido que os pais relatassem o consumo alimentar das crianças, como a frequência de grupos e/ou itens alimentares. A FA foi definida como a soma da frequência de consumo diária das principais refeições e lanches. A associação entre FA e disfunções do peso, obesidade abdominal e PA elevada foi avaliada com diferentes modelos de regressão logística ajustados pelos possíveis fatores de confusão. Resultados: Foi constatada uma alimentação mais frequente (≥ 6 em comparação com ≤ 3) entre estudantes mais novos (11,91 em comparação com 3,29 anos) (P < 0,001). Estudantes que relataram quatro [razão de chance (RC): 0,67; intervalo de confiança (IC): 0,57-0,79], cinco (RC: 0,74; IC: 0,62-0,87) e seis (RC: 0,54; IC: 0,44-0.65) refeições apresentaram menores chances de se tornar obesos em comparação com os que apresentaram FAs ≤ 3. FA de quatro (RC: 0,82; IC: 0,71-0,94), cinco (RC: 0,86; IC: 0,74-0,99) e ≥ sei (RC: 0,73; IC: 0,63-0,85) foi associada a menor prevalência de adiposidade abdominal. Conclusão: A FA mais alta foi associada à redução nos valores médios das medidas antropométricas e de PA, bem como à menor prevalência de obesidade generalizada e abdominal em crianças e adolescentes. São necessários estudos longitudinais para avaliar os efeitos de longo prazo da FA sobre a composição corporal na faixa etária pediátrica.

ASSOCIATION OF THE NUTRITIONAL PROFILE WITH HISTOLOGICAL FINDINGS OF PATIENTS WITH GENOTYPE 1 CHRONIC HEPATITIS C INFECTION

Background - Different factors are responsible for the progression of hepatic fibrosis in chronic infection with hepatitis C virus, but the role of nutritional factors in the progression of the disease is not clearly defined. This study aimed to evaluate the nutritional status and dietary profile among patients with chronic hepatitis C who were candidates for treatment and its association with histopathological features. Methods - A crossectional study was conducted on treatment-naïve patients with chronic hepatitis C genotype 1, between 2011 and 2013. The following assessments were performed before treatment: liver biopsy, anthropometric measurements and qualitative/quantitative analysis of food intake. Results - Seventy patients were studied. The majority of patients was classified as obese (34%) or overweight (20%) according to body mass index [BMI] and as at risk for cardiovascular diseases by waist circumference (79%). Unhealthy food intake was presented by 59% according to qualitative parameters and several patients showed an insufficient intake of calories (59%), excessive intake of protein (36%) and of saturated fat (63%), according to quantitative analysis. With respect to histology, 68% presented activity grade ≥2, 65% had steatosis and 25% exhibited fibrosis stage >2. Comparative analysis between anthropometric parameters and histological features showed that elevated waist circumference was the only variable associated to hepatic steatosis ( P =0.05). There was no association between qualitative and quantitative food intake parameters with histological findings. Conclusion - In this study, most of the patients with hepatitis C presented inadequate qualitative food intake and excessive consumption of saturated fat; in addition, excess of abdominal fat was associated to hepatic steatosis. Therefore, nutritional guidance should be implemented prior to treatment in patients with chronic hepatitis C, in order to avoid nutritional disorders and negative impact on the management of patients.

Contexto - Diferentes fatores são responsáveis pela progressão da fibrose na infecção crônica pelo vírus da hepatite C, mas o papel dos fatores nutricionais na progressão da doença não está definido. Este estudo teve como objetivo avaliar o estado nutricional e o perfil dietético de pacientes com hepatite C crônica candidatos a tratamento e sua associação com achados histopatológicos. Métodos - Foi conduzido um estudo transversal em pacientes com hepatite C crônica genótipo 1 virgens de tratamento, entre 2011 e 2013. Foram analisados, antes do tratamento, os seguintes aspectos: biópsia hepática, medidas antropométricas e análise qualitativa e quantitativa do consumo alimentar. Resultados - Setenta pacientes foram estudados. A maioria dos pacientes apresentava obesidade (34%) ou sobrepeso (20%) de acordo com índice de massa corporal e risco para doenças cardiovasculares de acordo com a circunferência da cintura elevada (79%). Na análise qualitativa do consumo alimentar, 59% apresentavam uma dieta inadequada. Conforme análise quantitativa, 59% tinham consumo insuficiente de calorias, 36% consumo excessivo de proteínas e 63% consumo excessivo de gorduras saturadas. Com relação à histologia, 68% apresentavam grau de atividade inflamatória ≥2, 65% mostraram esteatose hepática e 25% possuíam grau de fibrose >2. Na análise comparativa entre as medidas antropométricas e achados histológicos, somente a circunferência da cintura elevada mostrou associação com esteatose hepática ( P =0,05). Não houve associação entre consumo alimentar qualitativo e quantitativo com parâmetros histológicos. Conclusão - A maioria dos pacientes apresentava consumo alimentar inadequado de acordo com parâmetros qualitativos e consumo excessivo de gordura saturada, além de excesso de gordura abdominal, que esteve associada à esteatose hepática. Portanto, aconselhamento nutricional deveria ser implementado em pacientes candidatos a tratamento para hepatite C crônica visando evitar distúrbios nutricionais que podem impactar negativamente no manejo dos pacientes.

Consumo de frutas, verduras y presión arterial: Un estudio poblacional / Fruit and vegetable intake, and blood pressure: A population research

Se ha descrito que consumir frutas y verduras disminuye la presión arterial. Sin embargo, no está clara la magnitud del efecto según la cantidad consumida. El objetivo de este estudio fue analizar la asociación entre consumo de frutas y verduras, y presión arterial. Se realizó un estudio transversal en una muestra aleatoria de 777 adultos entre 32 y 38 años de la Región de Valparaíso, Chile. Se midió presión arterial sistólica (PAS) y diastólica (PAD), y se aplicó una encuesta de tendencia de consumo cuantificada del último mes. La ingesta de frutas y verduras se dividió en tres grupos: menor a 200 g, 200 a 400 g, mayor a 400 g. Para el análisis se utilizaron modelos de regresión lineal múltiple ajustados por sexo, IMC, actividad física, nivel socioeconómico, tabaquismo e ingesta de sodio. Se observó que a medida que aumenta la ingesta de frutas y verduras disminuye la presión arterial sistólica(β=-3,37; IC 95%: -6,45 a -0,29; en consumo entre 200 y 400 g) (β=- 4,02; IC 95%: -7,06 a -0,98; en consumo mayor a 400 g), mientras que en la presión diastólica solamente se ve el efecto en los que cumplen la recomendación de la OMS de consumir más de 400 g al día (β-2,87; IC=-5,17 a -0,57). Se concluye que consumir frutas y verduras en cantidades mayores a 400 g, tiene un efecto protector en el aumento de la presión arterial tanto sistólica como diastólica.

Consuming fruits and vegetables is known to lower blood pressure. However, it is unclear how much should be consumed in order to achieve this effect. The aim of this study was to analyze the association between fruit and vegetable consumption and blood pressure. A cross-sectional study was conducted among a random sample of 777 adults between the ages of 32 and 38 from the Region of Valparaiso, Chile. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured, and a survey was carried out to quantify consumption trends over the past month. The fruit and vegetable intake was divided into three groups: less than 200 g, 200-400 g, and more than 400 g. In the analysis, multiple linear regression models were used and were adjusted for sex, BMI, physical activity, socioeconomic status, smoking, and sodium intake. It was observed that increasing intake of fruits and vegetables lowers the systolic blood pressure (β = -3.37 , 95% CI : -6.45 to -0.29; for consumption between 200 and 400 g ) (β =-4.02 , 95% CI: -7.06 to -0.98; for consumption great than 400 g), while an effect on diastolic pressure is only seen in those who meet the WHO recommendation of consuming more than 400 g per day (β -2,87, CI = -5.17 to -0.57). In conclusion, consuming fruits and vegetables in amounts larger than 400 g per day, provides a protective effect against increases in both systolic and diastolic blood pressure.

Effects of chronic stress and high-fat diet on metabolic and nutritional parameters in Wistar rats / Efeitos do estresse crônico e da dieta rica em gordura sobre os parâmetros metabólicos e nutricionais em ratos Wistar

OBJECTIVE: The aim of this study was assess the role of chronic stress on the metabolic and nutritional profile of rats exposed to a high-fat diet. MATERIALS AND METHODS: Thirty-day-old male Wistar rats (70-100 g) were distributed into four groups: normal-diet (NC), chronic stress (St), high-fat diet (HD), and chronic stress/high-fat diet (HD/St). Stress consisted at immobilization during 15 weeks, 5 times per week, 1h per day; and exposure to the high-fat diet lasted 15 weeks. Nutritional and metabolic parameters were assessed. The level of significance was 5%. RESULTS: The HD group had final body weight, total fat, as well as insulin and leptin increased, and they were insulin resistant. The St and HD/St had arterial hypertension and increased levels of corticosterone. Stress blocked the effects of the high-fat diet. CONCLUSION: Chronic stress prevented the appearance of obesity. Our results help to clarify the mechanisms involved in metabolic and nutritional dysfunction, and contribute to clinical cases linked to stress and high-fat diet.

OBJETIVO: Avaliar o papel do estresse crônico sobre parâmetros metabólicos e nutricionais de ratos expostos à dieta rica em gordura. MATERIAIS E MÉTODOS: Ratos Wistar machos (30 dias de idade/70-100 g) foram distribuídos em quatro grupos: dieta-normal (NC), estresse crônico (St), dieta rica em gordura (HD) e estresse crônico/dieta rica em gordura (HD/St). O estresse consistiu em imobilização durante 15 semanas, 5 vezes por semana 1h por dia e a dieta rica em gordura foi oferecida por 15 semanas. Parâmetros nutricionais e metabólicos foram avaliados. O nível de significância foi de 5%. RESULTADOS: HD tiveram peso corpóreo, gordura total e níveis de insulina e leptina aumentados e foram resistentes à insulina. Os grupos St e HD/St manifestaram hipertensão e níveis séricos de corticosterona elevados. O estresse bloqueou os efeitos da dieta. CONCLUSÃO: O estresse impediu o surgimento dela. Nossos resultados ajudam compreender os mecanismos envolvidos na disfunção metabólica e nutricional e contribuem para casos clínicos de estresse e dietas ricas em gorduras.

Daily consumption of foods and nutrients from institutional and home sources among young children attending two contrasting day-care centers in Guatemala City

Adequate nutrition is critical to child development and institutions such as day-care centers could potentially complement children's diets to achieve optimal daily intakes. The aim of the study was to describe the full-day diet of children, examining and contrasting the relative contribution of home-derived versus institutional energy and nutrient sources. The present comparison should be considered in the domain of a case-study format. The diets of 33, 3-6 y old children attending low-income day-care centers serving either 3 or a single meal were examined. The home-diet was assessed by means of 3 non-consecutive 24-hr recalls. Estimated energy and nutrient intakes at the centers and at home were assessed and related to Recommended Nutrient Intakes (RNI). Nutrient densities, critical densities and main sources of nutrients were computed. We observed that in children attending the day-care center serving three meals, home-foods contributed less than half the daily energy (47.7%) and between 29.9% and 53.5% of daily nutrients. In children receiving only lunch outside the home, energy contribution from the home was 83.9% and 304 kcal lower than for children receiving 3 meals. Furthermore, between 59.0% and 94.8% of daily nutrients were provided at home. Daily energy, nutrient intakes and nutrient densities were well above the nutrient requirements for this age group, and particularly high for vitamin A. The overall dietary variety was superior in the situation of greater contribution of home fare, but overall the nutrient density and adequacy of the aggregate intakes did not differ in any important manner.

Ingesta diaria de alimentos y nutrientes provenientes de la dieta institucional y del hogar en niños que asisten a dos centros de cuidado infantil contrastantes en la ciudad de Guatemala. Una adecuada nutrición es crítica para el desarrollo infantil. Los centros de cuidado infantiles (CCI) podrían jugar un papel fundamental en la complementación de la ingesta de alimentos y nutrientes. El propósito de este estudio fue describir la dieta de niños, comparando la contribución relativa de energía y nutrientes de la dieta-hogar e institucional. El presente estudio debe ser considerado como una presentación de caso. Se examinó la dieta de 33 niños de 3-6 años que asisten a dos CCI utilizados por familias de escasos recursos y con diferencias en número de comidas servidas. Se determinó la dieta-hogar utilizando 3 recordatorios de 24-horas en días no-consecutivos. Se calculó la ingesta estimada de energía y nutrientes en las instituciones y en casa y se comparó con las Ingestas Recomendadas de Nutrientes. Se determinó la densidad de nutrientes y principales fuentes. Se observó que los alimentos consumidos en el hogar contribuyeron 47.7% de la energía diaria y entre 29.9% y 53.5% de los nutrientes diarios requeridos para los niños con 3 comidas en el CCI y de 83.9%, 59.0 y 94.8%, respectivamente, para los niños que consumen únicamente el almuerzo en el CCI. La ingesta diaria de energía fue 304 kcal mayor en los niños que consumieron 3 comidas fuera del hogar. No hubo mayor variación en las dietas cuando mayor era el consumo de alimentos en el hogar, sin embargo la densidad nutricional y la adecuación de la dieta completa fue adecuada en ambos centros, y particularmente elevadas para la vitamina A.

Valor energético total e contribuição percentual de calorias por macronutrientes da alimentação de idosos domiciliados em Fortaleza - CE / Total energy value and percentage contribuition of calories from macronutrients in the diet of elderly individuals from Fortaleza, state of Ceará, Brazil

OBJETIVO: Descrever o valor energético total e contribuição percentual de calorias por macronutrientes da alimentação de idosos domiciliados em Fortaleza/CE. MÉTODOS: Este estudo é populacional, transversal e domiciliar. Participaram deste estudo 458 idosos (66,6 por cento mulheres). As variáveis avaliadas foram: valor energético total (VET) da alimentação e contribuição percentual de calorias por proteínas, carboidratos e lipídios. Os resultados são apresentados sob a forma de médias, desvios-padrão e distribuição percentilar (P5, P10, P25, P50, P75, P90, P95). Os testes t-Student e análise de variância (ANOVA de uma via) com o teste Post Hoc LSD foram utilizados para verificar a diferença estatística das médias entre dois grupos e entre três grupos ou mais, respectivamente. RESULTADOS: Ao comparar os valores médios do VET entre as categorias das variáveis socioeconômico-demográficas foi encontrada diferença estatisticamente significativa entre as mulheres para cor, anos de estudo e nível socioeconômico. Entre os homens foram encontradas diferenças para anos de estudo e nível socioeconômico. O valor energético médio da alimentação dos homens foi significativamente superior ao das mulheres. Entre as mulheres o valor médio foi 1.236,4 kcal e entre os homens foi 1.475,8 kcal. Os valores médios da contribuição percentual de calorias por proteínas, carboidratos e lipídios foram semelhantes entre homens e mulheres. CONCLUSÃO: Os idosos deste estudo apresentam diferenças significativas nas médias do valor energético da alimentação entre os sexos e entre as categorias de anos de estudo e nível socioeconómico. As mulheres apresentaram, ainda, diferenças significativas entre as categorias de cor. A contribuição relativa média dos macronutrientes no valor energético da alimentação foi semelhante entre os sexos e grupos etários.

OBJECTIVE: Describe the total energy value and percentage contribution of calories from macronutrients in the diet of elderly individuals living in Fortaleza/CE. METHODS: This is a population-based, cross-sectional domiciliary study, which included 458 elderly individuals (66.6 percent women). The variables evaluated were total energy value (TEV) and the percentage contribution of calories from proteins, carbohydrates, and lipids. The results are shown as mean, standard deviation, and percentile distribution (P5, P10, P25, P50, P75, P90, P95). The Student's t-test and analysis of variance (one-way ANOVA) with LSD post-hoc tests were used to determine the statistical significance of means between two groups and among three or more groups, respectively. RESULTS: When comparing the mean values of TEV among categories of socioeconomic and demographic variables, statistically significant differences were found between women for ethnicity, years of schooling and socioeconomic level. Among men, differences were found for years of schooling and socioeconomic level. The mean energy value of men's diet was significantly higher than that of women (1475.8 kcal and 1236.4 kcal, respectively). The mean values of calorie percentage contribution from proteins, carbohydrates, and lipids were similar between men and women. CONCLUSION: The elderly of this study showed significant differences in mean values of TEV between sexes and between the categories years of schooling and socioeconomic level. Women also showed significant differences between the ethnic categories. The mean relative contribution of macronutrients in TEV was similar between genders and age groups.

Dietary counseling on long-term weight loss in overweight hypertensive patients

OBJECTIVE: This study aimed to evaluate long-term weight loss in overweight hypertensive patients receiving dietary counseling. METHODS: Longitudinal study included overweight hypertensive patients who had an initial individual consultation with a nutritionist between January 2002 and December 2005 and were followed for four years in a hypertension clinic. Patients who had at least four consultations during the follow-up period were included in the dietary counseling group. Those who scheduled their first consultation but missed that appointment or had fewer than four consultations during the follow-up period were allocated to the control group. Target Energy intake was calculated at 20-25 kcal/kg actual body weight/day. RESULTS: The study included 102 patients aged 55 + 1 years old (58 in the dietary counseling group). As compared with the control group, patients in the dietary counseling group showed a significantly greater reduction in body weight (-3.6 + 0.8 vs. 0.8 + 0.7 kg), which remained significant after controlling for age, gender, baseline body mass index, and the use of different antihypertensive and antidiabetic drugs. Weight loss between 5.0 percent and 9.9 percent was observed in a significantly higher percentage of patients in the dietary counseling group (28 percent vs. 11 percent). A weight loss of at least 10 percent was only observed in dietary counseling group patients, who had a significantly lower odds ratio for increasing the number and/or dosage of antihypertensive agents, even after controlling for age, gender, and baseline body mass index. CONCLUSIONS: Dietary counseling may be associated with long-term weight loss in overweight hypertensive patients.

Excesso de sódio e déficit de ferro em alimentos de transição / Excess sodium and insufficient iron content in complementary foods

OBJETIVOS: Determinar, por análise química, a composição nutricional de macronutrientes, energia, sódio e ferro de alimentos preparados no domicílio para lactentes de dois estratos socioeconômicos em Belém (PA). MÉTODOS: Estudo transversal com 78 lactentes (6 a 18 meses) distribuídos em dois grupos com condição socioeconômica alta ou baixa. Foi realizada análise química de amostras de alimentos de transição preparados no domicílio para o almoço. Foi estimada a ingestão alimentar diária, com base em dois inquéritos alimentares de 24 horas. RESULTADOS: As análises químicas revelaram que parcela das amostras dos alimentos apresentava baixo teor de energia em relação ao recomendado, tanto no estrato socioeconômico baixo (29,8 por cento) como no alto (43,0 por cento; p = 0,199). Todas as amostras analisadas, em ambos os grupos, apresentaram quantidade de ferro abaixo do mínimo recomendado (6,0 mg/100 g). Por outro lado, excesso de sódio (200 mg/100 g) foi constatado em 89,2 e 31,7 por cento, respectivamente, das amostras dos grupos de baixo e alto nível socioeconômico (p = 0,027). De acordo com os inquéritos alimentares, a estimativa da ingestão energética foi maior que 120 por cento da necessidade média estimada em 86,5 por cento dos lactentes do grupo de nível socioeconômico baixo e em 92,7 por cento do alto (p = 0,483). O almoço e o jantar forneceram 35,2±14,6 e 36,4±12,0 por cento da energia, respectivamente, nos grupos de baixo e alto nível socioeconômico (p = 0,692). CONCLUSÃO: Alimentos de transição preparados no domicílio para lactentes apresentaram baixo teor de ferro. Parcela expressiva das amostras apresentou quantidade excessiva de sódio, mais frequentemente nos alimentos preparados para os lactentes de baixo nível socioeconômico.

OBJECTIVES: To determine, by chemical analysis, the macronutrient, energy, sodium, and iron contents of homemade foods prepared for infants in two socioeconomic classes in Belém, state of Pará, Brazil. METHODS: Cross-sectional study of 78 infants (aged 6 to 18 months) distributed into two groups according to socioeconomic status (high or low). Chemical analyses were performed on samples of homemade complementary foods prepared for each infant's lunch. Daily food intake was estimated on the basis of two 24-hour dietary intake recall. RESULTS: Chemical analyses showed that the energy content of some food samples was lower than recommended, both in the low socioeconomic status (SES) group (29.8 percent of samples) and in the high-SES group (43.0 percent; p = 0.199). The iron content of all samples, regardless of group, was lower than minimum recommended levels (6.0 mg/100 g). On the other hand, excessive sodium levels (200 mg/100 g) were found in 89.2 and 31.7 percent of samples in the low- and high-SES groups, respectively (p = 0.027). Dietary recalls showed that energy intake exceeded 120 percent of the Estimated Energy Requirement in 86.5 percent of infants in the low-SES group and 92.7 percent of those in the high-SES group (p = 0.483). Lunch and dinner provided 35.2±14.6 and 36.4±12.0 percent of daily energy intake in the low- and high-SES groups, respectively (p = 0.692). CONCLUSION: Homemade complementary foods for infants were found to be low in iron. A significant portion of samples had excessive sodium content, most frequently those prepared for infants in low-SES status families.

Ingestão alimentar e balanço energético da população adulta de Niterói, Rio de Janeiro, Brasil: resultados da Pesquisa de Nutrição, Atividade Física e Saúde (PNAFS) / Dietary intake and energy balance in the adult population in Niterói, Rio de Janeiro State, Brazil: the Nutrition, Physical Activity, and Health Survey (PNAFS)

Avaliou-se a ingestão alimentar de 24 horas de um dia típico, mediu-se a massa corporal e a estatura e estimou-se o gasto energético em uma amostra probabilística de adultos de Niterói, Rio de Janeiro, Brasil. Os resultados mostraram que a ingestão energética média foi de 1.570,9 (24,1) e 2.188,8 (46,1) kcal.dia-1 para mulheres e homens, respectivamente. O gasto energético foi maior nos obesos do que nos indivíduos com massa corporal normal. O balanço energético medido (ingestão energética - gasto energético) diminuiu com o aumento do índice de massa corporal, sendo negativo (-3,2; 131 kcal.dia-1) nos homens obesos. Concluiu-se que a ingestão alimentar da população adulta de Niterói encontra-se dentro do recomendado, apesar da prevalência de pré-obesidade e obesidade ser alta. Ao se estratificar a ingestão energética pelo estado nutricional nota-se menor ingestão para os indivíduos com maior massa corporal, fato mais evidente nas mulheres (possível subestimativa da ingestão energética), o que pode ser explicado, em parte, pela superestimativa no cálculo do gasto energético ou pela omissão da ingestão energética por parte dos indivíduos.

This study aimed to assess typical daily dietary intake and energy expenditure in a probabilistic sample of adults in the city of Niterói, Rio de Janeiro State, Brazil. Dietary intake was measured by 24-hour dietary recall, body mass and height were measured in the household, and energy expenditure was estimated by the Flex-heart rate method. The results showed mean energy intake of 1,570.9 (24.1) and 2,188.8 (46.1) kcal.day-1 for women and men, respectively. Energy expenditure was higher in obese women and men (1,511.5±19.5 and 2,222.3±68.8 kcal.day-1, respectively) due to their higher body mass. Measured energy balance (intake - expenditure) decreased with increasing body mass index (BMI) in both women and men and was negative (-3.2; 131 kcal.day-1) in obese men. In conclusion, energy intake among adults in Niterói falls within the recommended values, despite high prevalence of overweight and obesity in women and men. Energy intake decreased with increasing body mass, indicating possible overestimation of energy expenditure. It is important to develop better estimates of energy expenditure in this population.

Inadequação do consumo alimentar de crianças e adolescentes com artrite idiopática juvenil e lúpus eritematoso sistêmico / Inadequate dietary intake of children and adolescents with juvenile idiopathic arthritis and systemic lupus erythematosus

OBJETIVOS: Avaliar o consumo alimentar de crianças e adolescentes com artrite idiopática juvenil (AIJ) e lúpus eritematoso sistêmico (LES) por recordatório de 24 horas e relacioná-lo com características clínicas e antropométricas e com os medicamentos empregados. MÉTODOS: Em estudo transversal, avaliamos os recordatórios de 24 horas de pacientes ambulatoriais. O estado nutricional foi classificado pelo CDC, 2000. Para o cálculo da ingestão, utilizamos o software NutWin UNIFESP-EPM. Para a análise quantitativa e qualitativa, adotamos as Recommended Dietary Allowances e a pirâmide alimentar brasileira. RESULTADOS: A mediana de idade foi 12 na AIJ e 16,5 anos no LES. Na AIJ, 37,5 por cento dos pacientes estavam em atividade de doença, e, no LES, 68,2 por cento tinham Systemic Lupus Erythematosus Disease Activity Index > 4. Foi encontrada desnutrição em 8,3 e 4,5 por cento dos pacientes com AIJ e com LES, respectivamente, e obesidade, em 16,7 e 18,2 por cento. Na AIJ, o consumo excessivo de energia, proteína e lipídios foi de 12,5, 75 e 31,3 por cento, respectivamente. No LES, o consumo excessivo de energia, proteína e lipídios foi de 13,6, 86,4 e 36,4 por cento, respectivamente. Consumo deficiente de ferro, zinco e vitamina A foi observado em 29,2 e 50, 87,5 e 86,4 e 87,5 e 95,2 por cento dos pacientes com AIJ e LES, respectivamente. Não houve relação significante entre consumo, atividade da doença e estado nutricional. CONCLUSÃO: Pacientes com doenças reumáticas apresentam inadequação do consumo alimentar. Ressaltamos a ingestão excessiva de lipídios e proteínas e a ingestão insuficiente de micronutrientes.

OBJECTIVES: To evaluate the dietary intake of children and adolescents with juvenile idiopathic arthritis (JIA) and juvenile systemic lupus erythematosus (JSLE) using a 24-hour diet recall and relating it to the patients clinical and anthropometric characteristics and to the drugs used in their treatment. METHODS: By means of a cross-sectional study, we assessed the 24-hour diet recalls of outpatients. Their nutritional status was classified according to the CDC (2000). The computer program NutWin UNIFESP-EPM was used for food intake calculation. The Recommended Dietary Allowances and the Brazilian food pyramid were used for quantitative and qualitative analysis. RESULTS: Median age was 12 years for JIA patients and 16.5 years for JSLE patients. Among the JIA patients, 37.5 percent had active disease, and among the JSLE patients, 68.2 percent showed Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) > 4. Malnutrition was found in 8.3 and 4.5 percent of the JIA and JSLE patients, respectively, and obesity was present in 16.7 and 18.2 percent. For JIA patients, the excessive intake of energy, protein, and lipids was 12.5, 75, and 31.3 percent, respectively. For JSLE patients, the excessive intake of energy, protein, and lipids was 13.6, 86.4, and 36.4 percent, respectively. Low intake of iron, zinc, and vitamin A was found in 29.2 and 50, 87.5 and 86.4, and 87.5 and 95.2 percent of the JIA and JSLE patients, respectively. There was not a significant association between intake, disease activity, and nutritional status. CONCLUSION: Patients with rheumatic diseases have inadequate dietary intake. There is excessive intake of lipids and proteins and low intake of micronutrients.

Estado nutricional na doença de Alzheimer / Nutritional status in Alzheimer's disease

OBJETIVO: Descrever aspectos nutricionais de idosos com doença de Alzheimer leve a moderada em ambulatório. MÉTODOS: A amostra contou com a participação de 40 idosos de ambos os sexos, diagnosticados com doença da Alzheimer (NINCDS-ADRDA) por seleção consecutiva. Foram realizadas avaliações socioeconômicas de atividades de vida diária, antropométrica, clínica e dietética. RESULTADOS: Do total, 65 por cento eram do sexo feminino. Ao se verificar a capacidade funcional, constatou-se que mais de 70 por cento dos idosos mostraram-se independentes para a realização de suas atividades de vida diária. Com base na avaliação do estado nutricional e na gravidade da doença, os idosos encontraram-se eutróficos, com diferença estatisticamente significativa na circunferência do braço entre os graus de demência. Quanto à presença de enfermidades secundárias à doença, 52 por cento dos idosos apresentaram hipertensão arterial sistêmica, seguido de alterações do tipo artrose (17 por cento). O consumo médio de energia e de macronutrientes dos idosos classificados no estágio leve foi de 1645 kcal, distribuídos em 53,7 por cento para carboidratos, 17,5 por cento para proteínas e 28,8 por cento para lipídeos, enquanto que aqueles no estágio moderado foi de 1482 kcal, distribuídos em 59,3 por cento para carboidratos, 16,1 por cento para proteínas e 24,6 por cento para lipídeos. CONCLUSÃO: Neste estudo descritivo de uma amostra ambulatorial de idosos com DA leve e moderada a maior parte deles apresentou estado nutricional de eutrofia, com consumo dietético adequado de carboidratos, proteínas, lipídeos e vitamina C, embora com baixo consumo alimentar de vitamina E.

OBJECTIVE: To describe the nutritional status of elderly subjects with mild to moderate Alzheimer's disease. METHODS: Subjects of both genders (n=40) diagnosed with mild to moderate Alzheimer's disease according to NINCDS-ADRDA criteria, participated in the study. Socioeconomic status, activities of daily life, anthropometric, clinical and dietary profiles were surveyed. RESULTS: Of the total, 65 percent were female. More than 70 percent were capable of accomplishing daily activities by themselves. Subjects were eutrophic with a statistically significant difference of the arm circumference between the mild and moderate groups. As for illnesses secondary to Alzheimer's, 52 percent of the elderly presented hypertension, followed by arthrosis type alterations (17 percent). The mean consumption of energy and macronutrients in the elderly classified as mild dementia was of 1645 kcal, distributed in 53.7 percent of carbohydrate, 17.5 percent of proteins or 0.9 g/kg and 28.8 percent of lipids. For those classified as moderate dementia it was of 1482 kcal, distributed in 59.3 percent of carbohydrate, 16.1 percent of proteins and 24.6 percent of lipids. CONCLUSION: In this descriptive study of elderly outpatients with mild and moderate Alzheimer's disease, most presented a nutritional status of eutrophy, with adequate dietary intake of carbohydrates, proteins, lipids and vitamin C, but with low dietary intake of vitamin E.

Effect of exercise on the caloric intake of breast cancer patients undergoing treatment

The purpose of this study was to examine the effects of an exercise intervention on the total caloric intake (TCI) of breast cancer patients undergoing treatment. A secondary purpose was to determine whether or not a relationship existed between changes in TCI, body fat composition ( percentBF), and fatigue during the study, which lasted 6 months. Twenty females recently diagnosed with breast cancer, scheduled to undergo chemotherapy or radiation, were assigned randomly to an experimental (N = 10) or control group (N = 10). Outcome measures included TCI (3-day food diary), percentBF (skinfolds), and fatigue (revised Piper Fatigue Scale). Each exercise session was conducted as follows: initial cardiovascular activity (6-12 min), followed by stretching (5-10 min), resistance training (15-30 min), and a cool-down (approximately 8 min). Significant changes in TCI were observed among groups (F1,18 = 8.582; P = 0.009), at treatments 2 and 3, and at the end of the study [experimental (1973 ± 419), control (1488 ± 418); experimental (1946 ± 437), control (1436 ± 429); experimental (2315 ± 455), control (1474 ± 294), respectively]. A significant negative correlation was found (Spearman rho(18) = -0.759; P < 0.001) between TCI and percentBF and between TCI and fatigue levels (Spearman rho(18) = -0.541; P = 0.014) at the end of the study. In conclusion, the results of this study suggest that an exercise intervention administered to breast cancer patients undergoing medical treatment may assist in the mitigation of some treatment side effects, including decreased TCI, increased fatigue, and negative changes in body composition.

Análisis de la aceptabilidad, consumo y aporte nutricional del programa alimentario del adulto mayor / Assessment of the acceptability and consumption of a nutritional supplementation program for the elderly in Chile

Background: During 2005, the Chilean Ministry of Health included a fortified milk beverage to the Elderly Food Supplementation Program, to improve the compliance with the program and to increase the provision of micronutrients. This beverage was added to a soup that was distributed since 1999. Aim: To evaluate the long term acceptability, tolerance and consumption of the Milk Beverage and analyze the nutritional contribution of the products provided by the supplementation program to the usual diet of the elderly. Material and methods: One hundred twenty five elderly subjects, aged 77 ± 4 (52 males) living in Metropolitan Santiago, aged over 70 years, beneficiaries of the food supplementation program, were interviewed. The acceptability, consumption and tolerance of the Milk Beverage were evaluated by specially designed surveys. The contribution of the food suplementation products to daily nutrient intake was also analyzed by 24 hours dietary recalls. Results: The mean body mass index of the interviewed elderly subjects was 27.0 ±4.5 Kg/m². Monthly delivery of the products included in the program increased significantly after the incorporation of the Milk Beverage to the program. The milk beverage had a significantly higher daily consumption and a lower family dilution than the soup. The consumption of supplementation products increased significantly the daily intake of energy and most micronutrients. Noteworthy was the case for vitamin B12, C, E and zinc, whose intake doubled (p <0.01). Conclusions: The Milk Beverage had an excellent approval and consumption rate. The consumption of food supplementation products improved daily intake of most nutrients in elderly subjects.

Avaliação dietética dos pacientes detectados com hiperglicemia na "Campanha de Detecção de Casos Suspeitos de Diabetes" no município de Viçosa, MG / Dietary assessment of the patients detected with hiperglycemia in the "Detection of Diabetes in Suspect Cases Campaign" in Viçosa, MG / Dietary assessment of the patients detected with hiperglycemia in the \"Detection of Diabetes in Suspect Cases Campaign\" in Viçosa, MG

Este trabalho teve como objetivo avaliar o consumo alimentar atual, qualitativo e quantitativo, de pacientes detectados com hiperglicemia na Campanha de Detecção de Casos Suspeitos de Diabetes, no município de Viçosa, MG. Dos 256 detectados com hiperglicemia em 2001, 156 (61 por cento) foram avaliados em 2004, sendo que o restante havia falecido, mudado de endereço, não aceitou participar do estudo ou não era diabético confirmado. Aplicou-se um questionário de freqüência de consumo alimentar e um recordatório da dieta habitual, ambos testados previamente em população-piloto. Os alimentos mais consumidos diariamente foram óleo vegetal (99 por cento), feijão (94 por cento), arroz (90 por cento), adoçante (80 por cento), vegetais folhosos (63 por cento), leite (61 por cento) e pão francês (54 por cento). A maior parte relatou evitar açúcar, alimentos açucarados e gorduras animais. Os maiores percentuais de inadequação de nutrientes ocorreram para energia (85 por cento), fibras (87 por cento), cálcio (94 por cento), percentual de carboidratos (82 por cento), gorduras monoinsaturadas (91 por cento) e proteínas (58 por cento), sendo os três últimos em relação ao Valor Energético Total ingerido. Os dados encontrados permitiram conhecer os hábitos alimentares desta população e estimar a ingestão de nutrientes, podendo ser úteis ao aconselhamento nutricional, sugerindo orientações específicas que poderão proporcionar uma alimentação mais adequada, contribuindo para melhores condições de saúde e bem-estar.

The purpose of this work is to assess the current, qualitative and quantitative alimentary consumption of patients detected with hiperglycemia in the "Detection of Diabetes in Suspect Cases Campaign" in Viçosa, MG. 256 patients were detected with hiperglycemia in 2001; however, 156 (60.9 percent) were assessed in 2004. The remaining people were dead, had changed their address, did not accept to participate in the study or did not have diagnosed diabetes. The hiperglycemic patients answered an alimentary frequency questionnaire for assessing their dietary intake and their usual diet recall, both previously tested in pilot-population. The most daily consumed foods were vegetable oil (99 percent), bean (94 percent), rice (90 percent), artificial sweetener (80 percent), leaf vegetables (63 percent), milk (61 percent), and French bread (54 percent). Most of the patients said they avoid sugar, sugary foods and animal fats. The largest percentiles of nutrients inadequacy happened for energy (85 percent), fibers (87 percent), calcium (94 percent), carbohydrates (82 percent), monounsaturated fats (91 percent) and proteins (58 percent). These last three happened in relation to total energy intake values. The current data allowed us to know about the alimentary habits of these people and also to stimulate nutrition intakes, being useful to the nutritional counseling, suggesting specific orientations in order to provide a more appropriate feeding, contributing to better health conditions and well-being.

Dietary intake of Brazilian black and white men and its relationship to the bone mineral density of the femoral neck

CONTEXT AND OBJECTIVE: Osteoporosis and fragility fractures are an important public health problem. Although bone loss occurs with age universally, the incidence of bone loss fractures varies greatly between racial groups. The aim of this study was to examine the relationship between calcium, protein and energy intake and the bone mineral density of the femoral neck in Brazilian black and white men. DESIGN AND SETTING: This was a cross-sectional study, carried out in a teaching hospital in São Paulo. METHODS: The participants were 277 volunteer men, aged 50 years or older. The bone mineral density of the femoral neck (FNBMD) was measured by dual energy x-ray absorptiometry. The relationship between FNBMD and calcium, protein and energy intake, as assessed by a three-day food record, was analyzed using multiple linear regression models and was adjusted for age, height, physical activity and education level. The analysis was stratified by race (white and black). RESULTS: FNBMD presented similar means in the two racial groups (p = 0.538). Protein and energy intake did not show a significant correlation with FNBMD, either in the white or in the black population. Calcium intake showed a strong and independent correlation with FNBMD in the black men (partial r = 0.42). CONCLUSION: Calcium intake was a determinant of FNBMD for black men, aged 50 years or older, but not for the white ones.

CONTEXTO E OBJETIVO: Osteoporose é um importante problema de saúde pública. Embora a perda de massa óssea ocorra universalmente com a idade, a incidência de fraturas por fragilidade óssea varia largamente entre grupos raciais. O objetivo foi examinar a relação entre o consumo de cálcio, proteína e energia e a densidade mineral óssea (DMO) do colo do fêmur em uma população de homens brasileiros brancos e negros. TIPO DE ESTUDO E LOCAL: Estudo transversal, realizado em um hospital escola em São Paulo. MÉTODOS: Foram recrutados 277 homens voluntários, com 50 anos ou mais. DMO do colo do fêmur foi medida com um densitômetro de dupla emissão de raios-X. Os consumos de cálcio, proteína e energia foram avaliados pelo método de registro de três dias de consumo de alimentos. Foi analisada a relação entre DMO do colo do fêmur e os consumo de cálcio, proteína e energia, utilizando modelos de regressão linear múltipla, estratificados por raça branca e negra e ajustados por idade, altura, atividade física e escolaridade. RESULTADOS: DMO do colo do fêmur apresentou média semelhante nos dois grupos raciais (p = 0,538). Os consumos de proteína e energia não foram correlacionados com a DMO do colo do fêmur, tanto para os indivíduos da raça branca como da negra. Já o consumo de cálcio teve correlação forte e independente com a DMO do colo do fêmur nos homens negros (r parcial = 0,42). CONCLUSÃO: Concluímos que o consumo de cálcio foi um determinante da DMO do colo do fêmur destes homens negros brasileiros com idade maior ou igual a 50 anos, mas não para os homens brancos estudados.