Longitudinal growth of infants born to HIV-1-infected mothers in Belo Horizonte, Brazil.

OBJECTIVE: To prospectively evaluate growth parameters assessed by weight and length in infected and uninfected infants born to HIV-1-infected mothers and followed from birth to 18 months. METHODS: A cohort consisting of ninety-seven uninfected and forty-two infected infants born to HIV-infected mothers enrolled from 1995 to 2004, and admitted during their first 3 months of life at a referral Pediatric AIDS Clinic in Belo Horizonte, Brazil. Infants were followed until 18 months of age. Data were analysed using mixed-effects linear regression models for weight and length fitted by restricted maximum likelihood. RESULTS: Infected infants contributed to 466 weight and 411 recumbent length measurements. Uninfected infants provided 924 weight and 907 length measurements. Mean birth weight and length were similar in both groups, 3.1 (sd 0.4) and 3.0 (sd 0.5) kg, and 48.7 (sd 1.4) and 48.8 (sd 2.9) cm for uninfected and infected infants, respectively. However, HIV-1 infection had an early impact in growth impairment: at 6 months of age, HIV-infected children were 1 kg lighter and 2 cm shorter than the uninfected. CONCLUSIONS: Growth faltering in weight, but not length, in HIV-infected children in Brazil is more marked than that reported in a European cohort, probably reflecting background nutritional deficiencies and concomitant infections. In these settings, early and aggressive nutritional management in HIV-1-infected infants should be a priority intervention associated with the antiretroviral therapy.

[Mixed linear regression model for longitudinal data: application to an unbalanced anthropometric data set]. / O modelo de regressão linear misto para dados longitudinais: uma aplicação na análise de dados antropométricos desbalanceados.

A longitudinal data set is characterized by a time sequence of two or more observations from each individual. In cohort studies, these data are usually not balanced. A data set related to longitudinal height measurements in children of HIV-infected mothers was recorded at the university hospital of the Federal University in Minas Gerais, Brazil. The objective was to assess the application of the mixed effect model to this unbalanced data set. At six months of age, on average boys were 1.8 cm taller than girls, and seroreverter infants were 2.9 cm taller than their HIV+ peers. At 12 months of age, on average boys were 2.4 cm taller than girls and seroreverter children were 3.5 cm taller than HIV+ ones. In addition to describing longitudinal height behavior, this model also includes the growth rate estimation for this infant population by gender and group.

Prevalence of hypoalbuminemia in outpatients with HIV/AIDS.

INTRODUCTION: Hypoalbuminemia may predict progression of disease and mortality in patients with human immunodeficiency virus (HIV) infection/acquired immune deficiency syndrome (AIDS). This study was conducted to investigate the risk factors associated with hypoalbuminemia in outpatients with HIV/AIDS. METHODS: A cross-sectional study was performed in 196 outpatients with HIV/AIDS. RESULTS: The prevalence of hypoalbuminemia was 11.7%. The only risk factor associated with hypoalbuminemia was current antiretroviral therapy (no exposure: odds ratio=3.46, 95% confidence interval=1.20-10.02). CONCLUSIONS: The monitoring of plasma albumin is key to determine when antiretroviral therapy should be initiated in individuals not exposed to antiretroviral medicines.

Loss to follow-up in a cohort of HIV-negative men who have sex with men: Project Horizonte.

OBJECTIVE: The objective of this study is to estimate the attrition rates and evaluate factors associated with loss to follow-up between 1994 and 2011 in an open cohort of HIV-negative men who have sex with men. METHODS: The Project Horizonte is an open cohort study that aimed to assess the incidence of HIV infection, evaluate the impact of educational interventions, and identify potential volunteers for HIV vaccine trials. The rates of losses to follow-up were estimated for three periods (1994-1999, 2000-2005, and 2006-2011). The variables analyzed were collected in a psychosocial questionnaire. Volunteers who dropped out were compared with the ones who remained in the study using a Cox regression model. RESULTS: A total of 1,197 volunteers were recruited. The median follow-up time in the study (n = 626) was 4.2 years. The median follow-up time for the volunteers who dropped out of the study (n = 571) was 1.46 years. The overall rate of loss to follow-up was 11.6/100 person-years. Attrition rates by period were: 12.60 (1994-1999), 11.80 (2000-2005), and 9.00 (2006-2011) per 100 person-years. Factors associated with losses to follow-up were: age group of 21-30 years old, monthly per capita income of more than six or less than one Brazilian minimum wage, having more than two dependents, report of bisexual practice, and inconsistent use of condoms for receptive anal sex. CONCLUSIONS: A slight decrease of the loss to follow-up was observed over time. Higher attrition rates happened in the first three years of follow-up. It is possible that the link of the volunteers were not yet well established. Those who reported inconsistent condom use in receptive anal sex were more likely to leave the study, suggesting an underestimation of the incidence of HIV infection in a cohort population. For greater effectiveness, retention strategies must be reassessed considering the connection between the characteristics of homosexual and bisexual behavior and the motivations to engage in health research.

Determinants of Iron Deficiency Anemia in a Cohort of Children Aged 6-71 Months Living in the Northeast of Minas Gerais, Brazil.

Iron deficiency anemia is one of the most common nutritional disorders worldwide. The aim was to identify the prevalence and incidence of anemia in children and to identify predictors of this condition, including intestinal parasites, social, nutritional and environmental factors, and comorbidities. A population-based cohort study was conducted in a sample of 414 children aged 6-71 months living in Novo Cruzeiro in the Minas Gerais State. Data were collected in 2008 and 2009 by interview and included socio-economic and demographic information about the children and their families. Blood samples were collected for testing of hemoglobin, ferritin and C-reactive protein. Anthropometric measurements and parasitological analyses of fecal samples were performed. To identify risk factors associated with anemia multivariate analyses were performed using the generalized estimating equations (GEE). In 2008 and 2009, respectively, the prevalence rates of anemia were 35.9% (95%CI 31.2-40.8) and 9.8% (95%CI 7.2-12.9), the prevalence rates of iron deficiency were 18.4% (95%CI 14.7-22.6) and 21.8% (95%CI 17.8-26.2), and the incidence rates of anemia and iron deficiency were 3.2% and 21.8%. The following risk factors associated with anemia were: iron deficiency (OR = 3.2; 95%CI 2.0-.5.3), parasitic infections (OR = 1.9; 95%CI 1.2-2.8), being of risk of or being a low length/height-for-age (OR = 2.1; 95%CI 1.4-3.2), and lower retinol intake (OR = 1.7; 95%CI 1.1-2.7), adjusted over time. Nutritional factors, parasitic infections and chronic malnutrition were identified as risk factors for anemia. These factors can be verified in a chronic process and have been classically described as risk factors for these conditions.

Risk factors associated with HIV infection among male homosexuals and bisexuals followed in an open cohort study: Project Horizonte, Brazil (1994-2010).

BACKGROUND: There has recently been an increase in HIV infection rates among men who have sex with men (MSM). This study aimed at investigating risk factors associated with incident HIV infection in a MSM cohort-Project Horizonte, Belo Horizonte, Minas Gerais, Brazil. METHODOLOGY: This is a nested case-control study in an ongoing open cohort of homosexual and bisexual men, carried out in 1994-2010, during which 1,085 volunteers were enrolled. Each HIV seroconverted volunteer (case) was compared with three randomly selected HIV negative controls, matched by admission date and age (±3 years). During follow-up, 93 volunteers seroconverted and were compared with 279 controls. PRINCIPAL FINDINGS: The risk factors associated with HIV seroconversion were: contact with partner's blood during sexual relations (OR 3.7; 95% CI 1.2-11.6), attendance at gay saunas in search for sexual partners (OR 2.6; 95% CI 1.3-5.4), occasional intake of alcohol when flirting and engaging in sexual activity (OR 2.5; 95% CI 1.3-5.1), inconsistent use of condoms in receptive anal sex (OR 2.4; 95% CI 1.1-5.4), little interest to look up information about AIDS (OR 2.6; 95% CI 1.0-6.7) particularly in newspapers (OR 3.4; 95% CI 1.4-8.1). CONCLUSIONS: This study shows that MSM are still engaging in risk behavior, such as unprotected anal intercourse, despite taking part in a cohort study on various preventive measures. New preventive strategies in touch with the epidemic's development and the specificities of this particular population are needed.

Prevalence of hypoalbuminemia in outpatients with HIV/AIDS

Abstract INTRODUCTION: Hypoalbuminemia may predict progression of disease and mortality in patients with human immunodeficiency virus (HIV) infection/acquired immune deficiency syndrome (AIDS). This study was conducted to investigate the risk factors associated with hypoalbuminemia in outpatients with HIV/AIDS. METHODS: A cross-sectional study was performed in 196 outpatients with HIV/AIDS. RESULTS: The prevalence of hypoalbuminemia was 11.7%. The only risk factor associated with hypoalbuminemia was current antiretroviral therapy (no exposure: odds ratio=3.46, 95% confidence interval=1.20-10.02). CONCLUSIONS: The monitoring of plasma albumin is key to determine when antiretroviral therapy should be initiated in individuals not exposed to antiretroviral medicines.

Risk factors for seroconversion by Leishmania infantum in a cohort of dogs from an endemic area of Brazil.

Visceral leishmaniasis (VL) has recently emerged in various urban and peri-urban areas of Brazil and other countries. Understanding the urbanization of VL requires identification of risk factors associated with human and canine infection. To determine the predictors of risk for canine VL, a survey was conducted of 1,443 dogs, from which a cohort was selected (n = 455) and evaluated for approximately 26 months. Serology was conducted with two enzyme-linked immunosorbent assays (ELISA): one conducted in the Laboratory of Zoonosis of the Belo Horizonte Health Department (LZOON) and the other in the Laboratory of Immunopathology of the Federal University of Ouro Preto (LIMP). A molecular diagnostic method (PCR-restriction fragment length polymorphism) and a structured questionnaire were also used. To identify the factors associated with seroconversion, two time-dependent Cox regression models were performed with different sensitivities (model 1, seroconversion by ELISA/LZOON; model 2, seroconversion by ELISA/LIMP). The overall incidences of seroconversion were 6.5/1000 dogs-months and 11.2/1000 dogs-months for ELISA/LZOON and ELISA/LIMP, respectively. Increased risk of seroconversion was associated with short fur (model 1: hazard ratio [HR] 1.9), the presence of dry leaves (model 1: HR 2.8) or manure (model 1: HR 3.5) in the backyard, dogs sleeping predominantly in the backyard (model 2: HR 2.1), the presence of symptoms (model 2: HR 2.0), and positive molecular results during follow-up (model 2: HR 1.5). Decreased risk was associated with insecticide spraying in the house (model 2: HR 0.5). These results indicate that more-vulnerable domiciles, certain dog behaviors, lack of vector control measures, and positive molecular results were associated with the occurrence of canine VL. Furthermore, it is important to emphasize that PCR-positive dogs should be monitored, owing to the possibility of seroconversion. Identifying risk factors for seroconversion in dogs is crucial for developing adequate strategies for VL prevention and control.

Dietary patterns in Brazilian patients with nonalcoholic fatty liver disease: a cross-sectional study.

OBJECTIVE: Recent evidence suggests that non-alcoholic fatty liver disease is associated with diet. Our aim was to investigate the dietary patterns of a Brazilian population with this condition and compare them with the recommended diet. METHODS: A cross-sectional study was conducted on 96 non-alcoholic fatty liver disease patients before any dietetic counseling. All patients underwent abdominal ultrasound, biochemical tests, dietary evaluations, and anthropometric evaluations. Their food intake was assessed by a semi-quantitative food-frequency questionnaire and 24-hour food recall. RESULTS: The median patient age was 53 years, and 77% of the individuals were women. Most (67.7%) participants were obese, and a large waist circumference was observed in 80.2% subjects. Almost 70% of the participants had metabolic syndrome, and 62.3% presented evidence of either insulin resistance or overt diabetes. Most patients (51.5, 58.5, and 61.7%, respectively) exceeded the recommendations for energy intake, as well as total and saturated fat. All patients consumed less than the amount of recommended monounsaturated fatty acids, and 52.1 and 76.6% of them consumed less polyunsaturated fatty acids and fiber, respectively, than recommended. In most patients, the calcium, sodium, potassium, pyridoxine, and vitamin C intake did not meet the recommendations, and in 10.5-15.5% of individuals, the tolerable upper limit intake for sodium was exceeded. The patients presented a significantly high intake of meats, fats, sugars, legumes (beans), and vegetables and a low consumption of cereals, fruits, and dairy products compared with the recommendations. CONCLUSIONS: Although patients with non-alcoholic fatty liver disease exhibited high energy and lipid consumption, most of them had inadequate intake of some micronutrients. The possible role of nutrient-deficient intake in the development of non-alcoholic fatty liver disease warrants investigation.

Loss to follow-up in a cohort of HIV-negative men who have sex with men: Project Horizonte

ABSTRACT OBJECTIVE The objective of this study is to estimate the attrition rates and evaluate factors associated with loss to follow-up between 1994 and 2011 in an open cohort of HIV-negative men who have sex with men. METHODS The Project Horizonte is an open cohort study that aimed to assess the incidence of HIV infection, evaluate the impact of educational interventions, and identify potential volunteers for HIV vaccine trials. The rates of losses to follow-up were estimated for three periods (1994-1999, 2000-2005, and 2006-2011). The variables analyzed were collected in a psychosocial questionnaire. Volunteers who dropped out were compared with the ones who remained in the study using a Cox regression model. RESULTS A total of 1,197 volunteers were recruited. The median follow-up time in the study (n = 626) was 4.2 years. The median follow-up time for the volunteers who dropped out of the study (n = 571) was 1.46 years. The overall rate of loss to follow-up was 11.6/100 person-years. Attrition rates by period were: 12.60 (1994-1999), 11.80 (2000-2005), and 9.00 (2006-2011) per 100 person-years. Factors associated with losses to follow-up were: age group of 21-30 years old, monthly per capita income of more than six or less than one Brazilian minimum wage, having more than two dependents, report of bisexual practice, and inconsistent use of condoms for receptive anal sex. CONCLUSIONS A slight decrease of the loss to follow-up was observed over time. Higher attrition rates happened in the first three years of follow-up. It is possible that the link of the volunteers were not yet well established. Those who reported inconsistent condom use in receptive anal sex were more likely to leave the study, suggesting an underestimation of the incidence of HIV infection in a cohort population. For greater effectiveness, retention strategies must be reassessed considering the connection between the characteristics of homosexual and bisexual behavior and the motivations to engage in health research.

Concordância entre métodos de estimativa de gasto energético basal em portadores de câncer de próstata / Concordance between basal energy expenditure estimation methods in patients with prostate cancer: relationship with the excess weight

Introdução: A desnutrição pode acometer de 45 a 60% dos pacientes com câncer de próstata o que torna fundamental estimar corretamente o Gasto Energético Basal (GEB) a fim de propiciar o atendimento mais apropriado das necessidades nutricionais dos mesmos. O método para estimativa do GEB considerado padrão-ouro é a Calorimetria Indireta (CI), mas por suas limitações de ordem operacional e financeira, a impedância bioelétrica (BIA) e as fórmulas preditivas são os métodos mais usados, embora estas possam apresentar limitações quanto à confiabilidade. Objetivo: O objetivo deste estudo foi comparar estimativas de GEB obtidas por meio de fórmulas e BIA em um grupo de portadores de câncer de próstata. Métodos: Analisou-se 50 pacientes portadores de câncer de próstata. O GEB foi estimado por bioimpedância elétrica (GEBm) e calculado a partir da aplicação da fórmula constante na Dietary Reference Intake (GEBc). A análise estatística foi efetuada através do teste t de Student para comparação de médias, da Correlação de Pearson e do modelo Bland-Altman para análise de concordância, adotando-se p < 0,05 como nível de significância. Resultados: Houve diferença significante nas médias entre GEBc e GEBm, independente do estado nutricional, com melhor correlação e concordância nos indivíduos sem excesso ponderal. Conclusão: Verifica-se a importância da utilização de fórmulas de predição que levem em consideração o estado nutricional dos pacientes. Assim, são necessários maiores estudos a fim de se determinar o melhor método de estimativa do GEB, para que seja ofertado o correto aporte nutricional a estes pacientes

Introduction: The mal nutrition can affect 45 to 60% of patients with prostate cancer becoming essential to estimate correctly the Basal Energy Expenditure (BEE) with the objective of propitiate the most appropriate attendance for their nutritional needs. The method to estimate the BEE considered gold standard is the indirect calorimetry, but for his limitations operational and financial, the bioelectrical impedance (BIA) and the predictive formulations are the most used methods, although these methods can present limitations in relation their reliability. Objective: The objective of this study was to compare estimates of BEE obtained by means of formulations and BIA in a groupe of patients with prostate cancer. The BEE was estimated by bioelectrical impedance (BEEm) and calculated from the application of constant formulation in the Dietary Reference Intake (BEEc). The statistical analysis was made through Student t test to comparison of averages, of Pearson correlation and the model Bland-Altman to analysis of agreement, adopting p< 0,05 as significance level. Results: There was significant difference in the averages between GEBc and GEBm, independent of nutritional status, with best correlation and agreement in the individuals without weight excess. Conclusion: It can be observed the importance of the use of prediction formulations that consider the nutritional status of patients. Thus, are necessary studies to determinate the best estimate method of BEE, to be offer the correct nutritional intake for these patients

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Anthropometric Risk Factors for Metabolic Syndrome in HIV patients / Fatores de risco antropométricos para síndrome metabólica em pacientes com HIV

OBJECTIVE: Metabolic syndrome, which affects the general population in epidemic proportions, is associated with a set of cardiovascular disease risk factors. The aims of this cross-sectional study were to determine the prevalence and investigate the risk factors associated with metabolic syndrome in outpatients living with HIV/AIDS using anthropometric and clinical evaluations. METHOD: The study was carried out on 253 HIV infected outpatients. Metabolic syndrome was classified according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII) and the International Diabetes Federation (IDF) criteria. Logistic regression was used to identify factors associated with the metabolic syndrome. RESULTS: The prevalence of metabolic syndrome varied from 19.4% to 26.4%, according to the criterion used. The factors associated with it in the two classifications used, when adjusted by sex and BMI, were age (≥ 40years) and subscapular skinfold (> 12 mm). In the final model, using the NCEP/ATPIII criterion the risk factors associated with metabolic syndrome were age ≥ 40 years (OR = 3.18; CI95% = 1.42; 7.14) and subscapular skinfold > 12 mm (OR = 2.85, CI95% = 1.13; 7.17). In the final model, using the IDF criterion the risk factors associated with metabolic syndrome were age (OR = 3.38, CI95% = 1.61; 7.10) and subscapular skinfold > 12 mm (OR = 4.37, CI95% = 1.84; 10.39). CONCLUSION: In clinical practice, the regular monitoring of subscapular skinfold can help in the identification of HIV infected individuals in risk of MS.

OBJETIVO: A síndrome metabólica afeta a população em geral em proporções epidêmicas e está associada a um conjunto de fatores de risco de doenças cardiovasculares. Os objetivos deste estudo transversal foram determinar a prevalência e investigar os fatores de risco associados à síndrome metabólica em pacientes ambulatoriais afetados por HIV/AIDS usando avaliações antropométricas e clínicas. MÉTODO: O estudo foi realizado em 253 pacientes ambulatoriais infectados pelo HIV. A síndrome metabólica foi classificada de acordo com o National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATPIII) e os critérios da International Diabetes Federation (IDF). A regressão logística foi utilizada para identificar os fatores associados à síndrome metabólica. RESULTADOS: A prevalência de síndrome metabólica variou entre 19,4% e 26,4%, de acordo com o critério utilizado. Os fatores associados nas duas classificações utilizadas, quando ajustados por sexo e IMC, foram: idade (≥ 40 anos) e subescapular (> 12 mm). No modelo final, utilizando o critério do NCEP/ATPIII os fatores de risco associados à síndrome metabólica foram idade ≥ 40 anos (OR = 3,18; IC95% = 1,42; 7,14) e dobra cutânea subescapular > 12 mm (OR = 2,85, IC95% = 1,13; 7,17). No modelo final, utilizando o critério IDF os fatores de risco associados à síndrome metabólica foram idade (OR = 3,38, IC95% = 1,61; 7,10) e dobra cutânea subescapular > 12 mm (OR = 4,37, IC95% = 1,84; 10,39). CONCLUSÃO: Na prática clínica, o acompanhamento regular da dobra cutânea subescapular pode ajudar na identificação de indivíduos infectados pelo HIV em risco de MS.

Prevalência de excesso de peso, obesidade central e risco de comorbidades metabólicas em adultos com HIV/AIDS sem terapia antirretroviral / Prevalence of overweight, central obesity and metabolic comorbidities risk in adults living with HIV/AIDS / Prevalencia del exceso de peso, obesidad central y riesgo de comorbidades metabólicas en adultos con VIH/AIDS sin terapia antirretroviral

Objetivo: Descrever a prevalência de excesso de peso, obesidade central e risco de comorbidades metabólicas em adultos com HIV/AIDS, sem terapia antirretroviral (ARV). Métodos: Estudo observacional, transversal, descritivo realizado em um Centro de Tratamento e Referência em Doenças Infecto-Parasitarias de Belo Horizonte, MG, com adultos com HIV/AIDS que não iniciaram o tratamento antirretroviral. Foram coletadas informações sobre o peso, altura, Índice de Massa Corporal (IMC) e circunferência abdominal (CA). A ingestão alimentar foi investigada por meio da aplicação de recordatório alimentar de 24 horas. Além disso, um questionário foi usado para coleta dos dados socioeconômicos. Resultados: Dos 100 voluntários, 76% eram homens com idade média igual a 37,1 anos. Aproximadamente um terço apresentou CD4 ≤ 200 e 64% denominaram-se como sedentários. Homens apresentaram maiores médias de peso (71,6 Kg versus 59,9 Kg) e altura (1,72 m versus 1,60 m) em comparação às mulheres. As prevalências de excesso de peso e obesidade central foram iguais a 4,1% e 35,7%, respectivamente. Risco de comorbidades metabólicas aumentado substancialmente esteve presente em 20,4% dos indivíduos. Metade da amostra consumia grande quantidade de alimentos industrializados e baixo consumo de frutas, verduras e legumes. Conclusão: Antes de iniciar a terapia ARV, os indivíduos com HIV/AIDS já apresentavam excesso de peso, obesidade central e consequente risco de comorbidades metabólicas. Portanto, são necessárias intervenções de educação em saúde pregressa à terapia com ARV, para prevenção primária de problemas metabólicos futuros.

Objetive: To describe the prevalence of overweight, central obesity and risk of metabolic comorbidities in people living with HIV/AIDS, without antiretroviral (ARV) therapy. Methods: Observational, cross-sectional, descriptive study held in an Infectious and Parasitic Diseases Referral Treatment Center of Belo Horizonte, MG, with adults with HIV/AIDS, who had not initiated ARV therapy. The study collected information on weight, height, Body Mass Index (BMI) and waist circumference (WC). Food intake was investigated through the application of 24-hour dietary recall. Additionally, a questionnaire was used to collect socioeconomic data. Results: Of the 100 volunteers, 76% were men with average age of 37.1 years. Approximately one third had CD4 ≤ 200 and 64% were classified as sedentary. Men had higher mean weight (71.6 kg against 59.9 kg) and height (1.72m against 1.60m) compared to women. Weight excess and central obesity prevalences of were 4.1% and 35.7%, respectively. Substantially increased metabolic comorbidities risk was present in 20.4% of the subjects. Half of the sample consumed large amounts of processed foods and registered low consumption of fruits and vegetables. Conclusion: Before initiating the ARV therapy, the individuals with HIV/AIDS already presented overweight, central obesity, and consequent risk of metabolic comorbidities. Therefore, health education interventions prior to the ARV therapy are necessary for primary prevention of future metabolic problems.

Objetivo: Describir la prevalencia del exceso de peso, la obesidad central y el riesgo de comorbidades metabólicas en adultos com VIH/AIDS sin terapia antirretroviral (ARV). Métodos: Estudio observacional, transversal y descriptivo realizado en un Centro de Tratamiento y Referencia en Enfermedades Infecciosas y Parasitarias de Belo Horizonte, MG, con adultos con VIH/ AIDS que no habían iniciado el tratamiento antirretroviral. Se recogieron informaciones sobre el peso, la altura, el Índice de Masa Corporal (IMC) y la circunferencia abdominal (CA). La ingesta alimentaria fue investigada a través de la aplicación de un recordatorio de 24 horas. Además, se utilizó una encuesta para recoger datos socioeconómicos. Resultados: De los 100 voluntarios, el 76% eran hombres con una media de edad igual a 37,1 años. Aproximadamente un tercio presentó CD4 ≤ 200 y el 64% se presentaron como sedentarios. Los hombres presentaron mayores medias de peso (71,6 Kg versus 59,9 Kg) y altura (1,72 m versus 1,60 m) en comparación a las mujeres. Las prevalências del exceso de peso y obesidad central fueron iguales al 4,1% y al 35,7%, respectivamente. El riesgo de comorbidades metabólicas se presentó muy elevado en el 20,4% de los individuos. La mitad de la muestra consumía gran cantidad de alimentos industrializados y bajo consumo de frutas, verduras y legumbres. Conclusión: Antes del inicio de la terapia ARV, los individuos con VIH/AIDS ya presentaban exceso de peso, obesidad central y consecuente riesgo de comorbidades metabólicas. Por lo tanto, son necesarias intervenciones de educación en salud antes de la terapia com ARV para la prevención primaria de problemas metabólicos em el futuro.

Longitudinal anthropometric assessment of infants born to HIV-1-infected mothers, Belo Horizonte, Southeastern Brazil.

OBJECTIVE: To evaluate the growth parameters in infants who were born to HIV-1-infected mothers. METHODS: The study was a longitudinal evaluation of the z-scores for the weight-for-age (WAZ), weight-for-length (WLZ) and length-for-age (LAZ) data collected from a cohort. A total of 97 non-infected and 33 HIV-infected infants born to HIV-1-infected mothers in Belo Horizonte, Southeastern Brazil, between 1995 and 2003 was studied. The average follow-up period for the infected and non-infected children was 15.8 months (variation: 6.8 to 18.0 months) and 14.3 months (variation: 6.3 to 18.6 months), respectively. A mixed-effects linear regression model was used and was fitted using a restricted maximum likelihood. RESULTS: There was an observed decrease over time in the WAZ, LAZ and WLZ among the infected infants. At six months of age, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.02, 0.59, and 0.63 standard deviations, respectively. At 12 months, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.15, 1.01, and 0.87 standard deviations, respectively. CONCLUSIONS: The precocious and increasing deterioration of the HIV-infected infants' anthropometric indicators demonstrates the importance of the early identification of HIV-infected infants who are at nutritional risk and the importance of the continuous assessment of nutritional interventions for these infants.

[Factors associated with changes in energy intake of women after treatment for breast cancer]. / Fatores que influenciam o consumo energético de mulheres no tratamento do câncer de mama.

PURPOSE: To investigate changes in the dietary consumption as well as the influence of the general characteristics, of the sociodemographic, clinical and nutritional factors, and of the antineoplastic therapy on the changes in the energy intake of women from southern Brazil, before and after adjuvant therapy for breast cancer. METHODS: A non-randomized clinical study was conducted on 53 patients at a hospital of the public health network. Dietary information was collected with a food frequency questionnaire. A mixed-effects linear regression model was used to evaluate the factors that influenced longitudinal alterations of energy intake. RESULTS: A significant increase was observed in daily energy intake of fats, calcium, iron, copper, polyunsaturated fatty acids, omega 6 and omega 3, and a significant decrease in vitamin B2 intake. The final regression model for the change in energy intake showed an average increase of 19.2 kcal/month. Fruit and legume consumption showed the highest association with energy intake, with each 100 g consumed resulting in an average increase of 68.4 and 370.5 kcal, respectively. Women in the 51 to 60 year age range consumed 403.5 kcal less than those in the 31 to 50 year age range. CONCLUSION: There was an increase in energy intake during treatment and the increase in the ingestion of fruits and legumes was associated with significant increases in energy intake.

Prevalência e motivos para recusar participação em pesquisa clínica / Prevalence and reasons for refusal to participate in clinical research / Prevalencia y motivos de la negación a participar en investigaciones clínicas

As informações fornecidas sobre prevalência e os motivos da recusa de voluntários a participar em pesquisa científica são escassas. Este artigo objetiva descrever esses dados em coorte voltada a avaliar morbimortalidade de pessoas vivendo com HIV/aids (PVHA) a partir de estudo transversal realizado no Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias. Foram obtidas as informações: origem, data de nascimento, idade, sexo e motivo do não consentimento, quando aplicável. Falta de tempo para se dedicar a pesquisa foi o principal motivo alegado para o não consentimento (63%), seguido por medo de falta de sigilo (17%). Não houve diferença estatística entre os que aceitaram ou não participar por sexo, idade ou origem do serviço. Consideraram-se elevados os percentuais de recusa de PVHA (40,7%), bem como de falta de tempo disponível para participação (63%).

The information provided regarding the prevalence and reasons why volunteers refuse to participate in scientific research is sparse. This article aims to describe the prevalence and reasons for refusing to voluntarily participate in the cohort study whose objective is to evaluate morbidity and mortality amongst people living with HIV/AIDS (PLWHA), through a cross-sectional study conducted at the Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias (Training and Referral Center for Infectious and Parasitic Diseases). The following information was obtained: origin, date of birth, age, gender, and reason for not consenting, when applicable. The lack of time to devote to the research was the main reason given (63%), followed by fear of lack of confidentiality (17%). There was no statistical difference among those who accepted or not to participate in terms of gender, age or origin of the service. The percentage of PLWHA who refused to participate in the study (40.7%) and lack of time available for their participation (63%) were considered high.

Las informaciones disponibles respecto a la prevalencia y a los motivos de la negación de voluntarios para participar de investigaciones científicas son escasas. Este artículo tiene como objetivo describir la prevalencia y los motivos de la negación a participar voluntariamente en una cohorte dedicada a evaluar la morbilidad y la mortalidad de personas que viven con VIH/SIDA, a partir de un estudio transversal realizado en el Centro de Capacitación y Referencia en Enfermedades Infecciosas y Parasitarias. Se obtuvieron las siguientes informaciones: origen, fecha de nacimiento, edad, sexo y motivo del no consentimiento, cuando correspondiera. La falta de tiempo para dedicarse a la investigación fue el principal motivo alegado para el no consentimiento (63%), seguido por el temor a la no confidencialidad (17%). No hubo diferencias estadísticas entre los que aceptaron participar o no de acuerdo a sexo, edad u origen del servicio. Se consideraron elevados los porcentajes en la negación de las personas que viven con VIH/SIDA a participar de la investigación (40,7%), así como la falta de tiempo disponible para esta participación (63%).

Nonalcoholic fatty liver disease: a cohort study focusing on treatment response to nutritional counseling / A doença hepática gordurosa não-alcoólica: um estudo de coorte com foco na resposta ao tratamento com orientação nutricional

BACKGROUND: Nonalcoholic fatty liver disease is the leading cause of liver pathology. The mainstay of management is weight loss. Our aim was to evaluate responses to nutritional counseling in long-term patients with this condition. METHODS: A prospective cohort study with consecutive inclusion of 105 subjects with nonalcoholic fatty liver disease who received individualized low-calories diet counseling (1400 to 1600 kcal/day according to gender) every three months for 24 months. Weight loss of 5% or more was considered as a therapeutic response. RESULTS: Out of 105 patients, 45 (42.9%) did not return for a second evaluation. Mean age was 55 ± 9 years, 81.6% were women and mean body mass index was 31.9 (23.8-44.9) kg/m2. Follow-up time was 6.5 (3.2-26.9) months and median appointment number was 3 (2-11). Metabolic syndrome and hypercholesterolemia were more common in women. The number of subjects who lost more than 5% weight was: 5/20 (25%) at 6-months; 3/15 (33%) at 12 months; 3/18 (17%) at 18 months and 4/13 (31%) at the end of follow up. The median body weight loss at 6, 12, 18 and 24 months decreased significantly. CONCLUSIONS: Adherence to nutritional counseling is poor in patients with nonalcoholic fatty liver disease. Only a very small proportion of patients reached the targeted body loss of weight on long term.

RESUMO OBJETIVOS: A doença hepática gordurosa não alcoólica éa principal causa de patologia hepática. Essencial para seu manejo éa perda de peso. Nosso objetivo foi avaliar as respostas a aconselhamento nutricional em pacientes crônicos com esta condição. METODOS: Estudo prospectivo de coorte com inclusão consecutiva de 105 indivíduos com doenca hepática gordurosa não alcoólica que receberam dieta individualizada de baixa caloria (1400-1600kcal/dia, de acordo com o sexo) e aconselhamento a cada 3 meses, durante 24 meses. A perda de peso de 5% ou mais foi considerada como resposta terapêutica adequada. RESULTADOS: Dos 105 pacientes, 45 (42,9%) não voltaram para uma segunda avaliação. A média de idade foi de 55 ± 9 anos, 81,6% eram mulheres e o índice de massa corporal foi de 31,9 (23,8-44,9) kg/m2. O tempo de seguimento foi de 6,5 (3,2-26,9) meses e número médio de entrevistas foi de 3 (2-11). A síndrome metabólica e a hipercolesterolemia foram mais comuns em mulheres. O número de indivíduos que perderam mais de 5% em peso foi: 5/20 (25%) em 6 meses; 3/15 (33%) aos 12 meses; 3/18 (17%) e aos 18 meses 4/13 (31%) no final do seguimento. A perda de peso corporal média aos 6, 12, 18 e 24 meses diminuiu significativamente. CONCLUSÕES: A adesão ao aconselhamento nutricional épobre em pacientes com doenca hepática gordurosa não alcoólica. Apenas uma pequena proporcão de pacientes que atingiu a perda de peso corporal programada a longo prazo.

Pattern of alcoholic beverage consumption and academic performance among college students / Padrão de consumo de bebidas alcoólicas e desempenho acadêmico entre universitários

BACKGROUND: Alcoholic beverages are widely available in the university environment, particularly at the parties. There are few studies addressing the relationship between alcohol consumption and academic performance among college students.OBJECTIVE: This study evaluated the behavior of college students regarding the profile of alcohol consumption and its academic consequences.METHODS: The volunteers (343 students) answered a questionnaire about their pattern of alcohol consumption and possible related behaviors, especially academic performance. Participants were classified as "non-drinkers" (ND), "non-binge drinkers" (nBD), "binge drinkers" (BD) and "heavy drinkers" (HD).RESULTS: 88.1% of the students reported ingesting alcoholic beverages, 44% as BD. Most of the drinker students (75.5% - nBD, BD or HD) stated getting intoxicated at least once a month. Binge drinking was the predominant pattern (66.2% of those who drank). HD students presented a risk 9.2 times higher of not being in the ideal period of the course.DISCUSSION: The college students evaluated presented high rates of alcohol abuse. Binge drinking might have interfered in their academic performance. Organic, social and behavioral consequences were also reported.

CONTEXTO: Bebidas alcoólicas estão amplamente disponíveis no ambiente universitário, principalmente nas festas. Há poucos estudos abordando a relação entre o consumo de bebidas alcoólicas e o desempenho acadêmico entre estudantes universitários.OBJETIVO: Este trabalho avaliou o comportamento de estudantes universitários quanto ao padrão de consumo de bebidas alcoólicas e sua consequência acadêmica.MÉTODOS: Os voluntários (343 estudantes) responderam a um questionário sobre o padrão de consumo de álcool e possível comportamento relacionado a esse consumo, especialmente sobre o desempenho acadêmico. Os participantes foram classificados como não bebedores (ND), bebedores não em binge (nBD), bebedores em binge (BD) e bebedores pesados (HD).RESULTADOS: 88,1% dos estudantes relataram ingerir bebidas alcoólicas, sendo 44% bebedores em binge. A maioria dos bebedores (75,5% - nBD, BD ou HD) ficou embriagada pelo menos uma vez por mês. O padrão predominante de consumo foi em binge (66,2% dos que relataram beber). Estudantes HD apresentaram risco 9,2 vezes maior de não estarem no período ideal do curso.CONCLUSÃO: Os universitários avaliados apresentaram maiores taxas de abuso de álcool. O beber em binge pode ter interferido no seu desempenho acadêmico. Consequências orgânicas, sociais e comportamentais foram também relatadas.

Dietary patterns in Brazilian patients with nonalcoholic fatty liver disease: a cross-sectional study

OBJECTIVE: Recent evidence suggests that non-alcoholic fatty liver disease is associated with diet. Our aim was to investigate the dietary patterns of a Brazilian population with this condition and compare them with the recommended diet. METHODS: A cross-sectional study was conducted on 96 non-alcoholic fatty liver disease patients before any dietetic counseling. All patients underwent abdominal ultrasound, biochemical tests, dietary evaluations, and anthropometric evaluations. Their food intake was assessed by a semi-quantitative food-frequency questionnaire and 24-hour food recall. RESULTS: The median patient age was 53 years, and 77% of the individuals were women. Most (67.7%) participants were obese, and a large waist circumference was observed in 80.2% subjects. Almost 70% of the participants had metabolic syndrome, and 62.3% presented evidence of either insulin resistance or overt diabetes. Most patients (51.5, 58.5, and 61.7%, respectively) exceeded the recommendations for energy intake, as well as total and saturated fat. All patients consumed less than the amount of recommended monounsaturated fatty acids, and 52.1 and 76.6% of them consumed less polyunsaturated fatty acids and fiber, respectively, than recommended. In most patients, the calcium, sodium, potassium, pyridoxine, and vitamin C intake did not meet the recommendations, and in 10.5-15.5% of individuals, the tolerable upper limit intake for sodium was exceeded. The patients presented a significantly high intake of meats, fats, sugars, legumes (beans), and vegetables and a low consumption of cereals, fruits, and dairy products compared with the recommendations. CONCLUSIONS: Although patients with non-alcoholic fatty liver disease exhibited high energy and lipid consumption, most of them had inadequate intake of some micronutrients. The possible role of nutrient-deficient intake in the development of non-alcoholic fatty liver disease warrants investigation.

Efeito do tratamento antineoplásico adjuvante na mudança de peso corporal em mulheres com câncer de mama / Effect of adjuvant antineoplastic treatment on body weight change in women with breast cancer

Aims: To identify the effect of adjuvant antineoplastic treatment on body weight change of women with breast cancer.METHODS: A non-randomized clinical study included women with a recent surgical diagnosis of breast cancer, admitted tothe Maternidade Carmela Dutra hospital in Florianópolis, Santa Catarina, southern Brazil, between October 2006 and July2008. Food intake, weight, body mass index, hip circumference, waist circumference and other variables were measuredbefore (baseline) and after the adjuvant antineoplastic treatment (pos-treatment). A mixed effects linear regression modelwas used to estimate the longitudinal changes occurring in weight.Results: The sample comprised 53 patients. A significant increase (P<0.05) was observed in body weight (2.81 kg), bodymass index (1.08 kg/m2), hip circumference (3.62 cm) and waist circumference (1.93 cm). In relation to diet, there was asignificant increase (P<0.05) in the intake of energy (272.7 kcal), total fat (11.2 g) and polyunsaturated fatty acids (5.4 g).The final regression model for the change in body weight demonstrated that the women who were exposed to chemotherapytreatment, and to chemotherapy associated with radiotherapy, had the largest mean increase in body weight (2.47 kg and 5.21kg, respectively). Socio-economic, demographic and nutritional factors were not associated with the increase in body weight.Conclusions: Weight gain was associated with chemotherapy treatment either alone or in combination with radiotherapy.

Objetivos: Identificar o efeito do tratamento antineoplásico adjuvante sobre a mudança de peso corporal em mulheres com câncer de mama. Métodos: Um estudo clínico não randomizado incluiu mulheres com diagnóstico cirúrgico recente de câncer de mama, admitidas no hospital Maternidade Carmela Dutra em Florianópolis, Santa Catarina, entre outubro de 2006 e julho de 2008. Os dados de consumo alimentar, peso corporal, índice de massa corporal, circunferência do quadril, circunferência da cintura e outras variáveis, foram avaliados antes (basal) e depois do tratamento antineoplásico adjuvante (pós-tratamento). Um modelo de regressão linear de efeitos mistos foi utilizado para estimar as mudanças longitudinais que ocorreram no peso corporal. Resultados: A amostra foi composta por 53 pacientes. Foi observado um aumento significativo (P<0,05) no peso corporal (2,81 kg), índice de massa corporal (1,08 kg/m2), circunferência do quadril (3,62 cm) e circunferência da cintura (1,93 cm). Em relação aos aspectos dietéticos, houve um significativo aumento (P<0,05) na ingestão de energia (272,7 kcal), gorduras totais (11,2 g) e ácidos graxos poliinsaturados (5,4 g). O modelo final para a mudança no peso corporal demonstrou que as mulheres as quais foram expostas ao tratamento quimioterápico, e quimioterápico associado ao radioterápico, tiveram um maior aumento médio no peso corporal (2,47 kg e 5,21 kg, respectivamente). Os fatores socioeconômicos, demográficos e nutricionais não foram associados com o aumento no peso corporal. Conclusões: O aumento de peso esteve associado com o tratamento quimioterápico sozinho ou em combinação com o tratamento radioterápico.