Association between being underweight and excess body weight before SARS coronavirus type 2 infection and clinical outcomes of coronavirus disease 2019: Multicenter study.

OBJECTIVES: The present study aimed to identify associations between extremes in body weight status (underweight and excess body weight) before a COVID-19 diagnosis and clinical outcomes in patients infected with SARS coronavirus type 2. METHODS: A multicenter cohort study was conducted in eight different states in northeastern Brazil. Demographic, clinical (previous diagnosis of comorbidities), and anthropometric (self-reported weight and height) data about individuals who tested positive for COVID-19 were collected. Outcomes included hospitalization, mechanical ventilation, and death. Multivariable logistic regression models, adjusted based on age, sex and previous comorbidities, were used to assess the effects of extremes in body weight status on clinical outcomes. RESULTS: A total of 1308 individuals were assessed (33.6% were elderly individuals). The univariable analyses showed that only hospitalization was more often observed among underweight (3.2% versus 1.2%) and overweight (68.1% versus 63.3%) individuals. In turn, cardiovascular diseases were more often observed in all clinical outcomes (hospitalization: 19.7% versus 4.8%; mechanical ventilation: 19.9% versus 13.5%; death: 21.8% versus 14.1%). Based on the multivariable analysis, body weight status was not associated with risk of hospitalization (underweight: odds ratio [OR]: 1.10; 95% confidence interval [CI] 95%, 0.50-2.41 and excess body weight: OR: 0.81; 95 CI, 0.57-1.14), mechanical ventilation (underweight: OR: 0.92; 95% CI, 0.52-1.62 and excess weight: OR: 0.90; 95% CI, 0.67-1.19), and death (underweight: OR: 0.61; 95% CI, 0.31-1.20 and excess body weight: OR 0.88; 95% CI, 0.63-1.23). CONCLUSIONS: Being underweight and excess body weight were not independently associated with clinical outcomes in patients with COVID-19 in the herein analyzed cohort. This finding indicates that the association between these variables may be confounded by both age and comorbidities.

Visceral adiposity indicators and cardiovascular risk in hemodialytic patients.

OBJECTIVE: Cardiovascular diseases represent the main cause of death in chronic kidney disease (CKD). We aimed to evaluate the prevalence and association of the hypertriglyceridemia-waist phenotype (HWP) and visceral adiposity index (VAI) with cardiometabolic risk factors (CR) in patients with CKD on hemodialysis (HD). METHODS: The study is based on a cross-sectional design with 265 HD patients in two cities in northeastern Brazil. The VAI was calculated considering the variables body mass index (BMI), waist circumference (WC), triglycerides (TG) and high density lipoprotein cholesterol (HDL-c). HWP was defined as the concomitant elevation of WC and TG. The Poisson Regression Model with robust variance estimation was adjusted considering a hierarchical approach for explanatory variables. Prevalence ratios (PR) were also estimated. The level of significance adopted was 5%. RESULTS: In our study HWP and VAI prevalence's were 29.82% and 58.49%, respectively. In the final model, there was an association between VAI and female gender (PR = 1.46; p < 0.0001) and high body fat (% BF) (PR = 1.33; p < 0.0019). HWP was associated with females (PR = 1.80; p = 0.002), alcohol consumption (PR = 1.58; p = 0.033), obesity (PR = 1.89; p = 0.0001), high %BF (PR = 1.76; p = 0.012) and reduced HDL-c (PR = 1.48; p = 0.035). CONCLUSION: The HWP stood out as the association with more CR factors, representing a promising method for tracking cardiometabolic risk in HD patients, mainly female.

Association between socioeconomic factors and fruit and vegetable consumption in Brazilians aged ≥ 50 years: ELSI-Brazil data / Associação entre consumo de frutas, legumes e verduras e fatores socioeconômicos em brasileiros com 50 anos ou mais: dados do ELSI-Brasil

OBJECTIVE: Daily fruit and vegetable consumption is a critical factor in health, especially aging. This study aimed to evaluate the association between socioeconomic factors and daily fruit and vegetable consumption in men and women aged ≥ 50 years. METHODS: This cross-sectional study used 2015-2016 data from the Brazilian longitudinal study of aging (ELSI-Brazil), which included 8665 individuals aged ≥ 50 years. Daily fruit and vegetable consumption was the dependent variable, and income, education, sex, age, and race were the independent variables. Associations between fruit and vegetable consumption and the independent variables were determined using Poisson regression. RESULTS: Individuals who had completed higher education (OR 2.40; 95% CI 2.07-2.78), whose income was > 3 times the minimum wage (OR 2.42; 95% CI 2.18-2.68), and those aged > 80 years (OR 1.44; 95% CI 1.27-1.63) were more likely to consume fruits and vegetables. However, men (OR 0.63; 95% CI 0.58-0.67), Blacks (OR 0.74; 95% CI 0.65-0.84), and people of mixed race (OR 0.68; 95% CI 0.63-0.73), were less likely to consume fruits and vegetables. CONCLUSIONS: The results show inequality in fruit and vegetable consumption among people aged ≥ 50 years, which was lower among men, people of Black or mixed race, people with low income and education, and those with younger age. Interventions are needed to promote fruit and vegetable consumption, and thus healthy aging, among these groups

OBJETIVO: O consumo diário de frutas, legumes e verduras (FLV) é um fator primordial à saúde, especialmente no envelhecimento. Este estudo teve o objetivo de avaliar a associação entre fatores socioeconômicos e o consumo diário de FLV em pessoas com idade de ≥ 50 anos, de ambos os sexos. METODOLOGIA: Trata-se de um estudo transversal, com dados do ELSI-Brasil 2015 - 2016, realizado com 8.665 indivíduos com idade acima de 50 anos. O consumo diário de FLV foi a variável dependente e renda, escolaridade, sexo, idade e cor de pele foram as variáveis independentes. A regressão de Poisson foi usada para verificar a associação entre o consumo de FVL e as variáveis independentes. RESULTADOS: Indivíduos que possuíam ensino superior (odds ratio ­ OR 2,40; intervalo de confiança ­ IC95% 2,07 - 2,78), que recebiam mais que três salários-mínimos (OR 2,42; IC95% 2,18 - 2,68) e com idade superior a 80 anos (OR 1,44; IC95% 1,27 - 1,63) tinham maior probabilidade de consumir FLV. Por outro lado, homens (OR 0,63; IC95% 0,58 - 0,67) de cor de pele parda (OR 0,68; IC95% 0,63 - 0,73) e preta (OR 0,74; IC95% 0,65 - 0,84) tiveram menor chance de consumo de FVL. CONCLUSÕES: Os resultados revelam desigualdades no consumo de FLV entre pessoas com idade acima de 50 anos, com maior magnitude entre os com baixa renda, baixa escolaridade, menor idade, sexo masculino e cor de pele parda e preta, demonstrando, assim, a necessidade de estratégias de intervenção para aumentar o consumo desses alimentos, buscando a promoção do envelhecimento saudável

Visceral adiposity indicators and cardiovascular risk in hemodialytic patients

ABSTRACT Objective: Cardiovascular diseases represent the main cause of death in chronic kidney disease (CKD). We aimed to evaluate the prevalence and association of the hypertriglyceridemia-waist phenotype (HWP) and visceral adiposity index (VAI) with cardiometabolic risk factors (CR) in patients with CKD on hemodialysis (HD). Materials and methods: The study is based on a cross-sectional design with 265 HD patients in two cities in northeastern Brazil. The VAI was calculated considering the variables body mass index (BMI), waist circumference (WC), triglycerides (TG) and high density lipoprotein cholesterol (HDL-c). HWP was defined as the concomitant elevation of WC and TG. The Poisson Regression Model with robust variance estimation was adjusted considering a hierarchical approach for explanatory variables. Prevalence ratios (PR) were also estimated. The level of significance adopted was 5%. Results: In our study HWP and VAI prevalence's were 29.82% and 58.49%, respectively. In the final model, there was an association between VAI and female gender (PR = 1.46; p < 0.0001) and high body fat (% BF) (PR = 1.33; p < 0.0019). HWP was associated with females (PR = 1.80; p = 0.002), alcohol consumption (PR = 1.58; p = 0.033), obesity (PR = 1.89; p = 0.0001), high %BF (PR = 1.76; p = 0.012) and reduced HDL-c (PR = 1.48; p = 0.035). Conclusion: The HWP stood out as the association with more CR factors, representing a promising method for tracking cardiometabolic risk in HD patients, mainly female.

Sum of skinfolds measurement can be used in the estimation of total body fat in patients with chronic kidney disease undergoing hemodialysis / La medición de la suma de los pliegues cutáneos puede utilizarse en la estimación de la grasa corporal total en los pacientes con nefropatía crónica sometidos a hemodiálisis

INTRODUCTION: body fat reflects important clinical impacts among hemodialysis patients; thus, simple and safe methods are required for a careful evaluation of this body compartment. OBJECTIVES: to evaluate the concordance of estimates of total body fat percentage (%BF), calculated using bioelectrical impedance analysis (BIA) and sum of four skinfolds (SSKD) measures, with those obtained using dual-energy X-ray absorptiometry (DEXA) in patients with chronic kidney disease (CKD) receiving hemodialysis. METHODS: a cross-sectional study was conducted in 317 patients undergoing hemodialysis. The %BF was evaluated using BIA, SSKD measurement, and DEXA, and stratified by sex and tertiles. The Wilcoxon test for paired samples was used to compare the %BF obtained using the different methods, and Lin's concordance correlation coefficient (CCC-L) to evaluate concordance. RESULTS: the average %BF estimated using DEXA was 29.3 ± 9.3 %, with significant differences among the three methods (p < 0.05). SSKD measurement presented a higher CCC-L concordance with DEXA, regardless of sex. After stratification of the sample in tertiles, BIA presented a higher CCC-L concordance with DEXA among the patients with CKD with a %BF above 34.4 % (third tertile). Conversely, SSKD measurement presented better concordance with DEXA for those with a %BF equal to or less than 34.4 %. CONCLUSIONS: in terms of the estimates of the %BF, SSKD measurement displayed a better concordance with DEXA

INTRODUCCIÓN: la grasa corporal refleja importantes impactos clínicos entre los pacientes en hemodiálisis; por lo tanto, se requieren métodos simples y seguros para una evaluación cuidadosa de este compartimiento del cuerpo. OBJETIVOS: evaluar la concordancia de las estimaciones del porcentaje de grasa corporal total (%GC), calculadas mediante el análisis de impedancia bioeléctrica (BIA) y la suma de las medidas de cuatro pliegues cutáneos (CPC), con las obtenidas mediante absorciometría dual energética de rayos X (DEXA) en pacientes con enfermedad renal crónica (ERC) que reciben hemodiálisis. MÉTODOS: se realizó un estudio transversal en 317 pacientes en hemodiálisis. La %GC se evaluó mediante BIA, medición de CPC y DEXA, y se estratificó por sexos y terciles. Se utilizó la prueba de Wilcoxon para muestras pareadas para comparar los %GC obtenidos con los diferentes métodos, y el coeficiente de correlación de concordancia de Lin (CCC-L) para evaluar la concordancia. RESULTADOS: el %GC promedio estimado usando DEXA fue del 29,3 ± 9,3 %, con diferencias significativas entre los tres métodos (p < 0,05). La medición de los CPC presentó una mayor concordancia de CCC-L con DEXA, independientemente del sexo. Tras la estratificación de la muestra en terciles, la BIA presentó una mayor concordancia de CCC-L con DEXA entre los pacientes con ERC con un %GC superior al 34,4 % (tercer tercil). Por el contrario, la medición de los CPC presentó una mejor concordancia con la DEXA para aquellos con un %GC igual o inferior al 34,4 %. CONCLUSIÓN: en términos de las estimaciones del %GC, la medición de los CPC mostró una mejor concordancia con la DEXA

Sarcopenia and inflammation in patients undergoing hemodialysis / Sarcopenia e inflamación en pacientes sometidos a hemodiálisis

INTRODUCTION: in individuals with chronic kidney disease, sarcopenia is prevalent and is associated with increased morbidity and mortality, and the occurrence of cardiovascular complications. OBJECTIVE: to verify the relationship between sarcopenia and inflammation in hemodialysis patients. METHODS: a cross-sectional study with 209 patients in five hemodialysis units. Demographic, socioeconomic, body composition, clinical laboratory, and functional data were collected. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People (grip strength < 27 kg for men and < 16 kg for women; DEXA muscle mass < 7.0 kg/m² for men and < 5.5 kg/m² for women). Inflammation was assessed by C-reactive protein. RESULTS: mean age was 51.9 ± 15.0 years, with a predominance of males (59.3 %). The prevalence of sarcopenia was 29.1 % and that of inflammation was 50.2 %. A Poisson regression analysis showed that sarcopenia was associated with increased hsCRP values (PR: 1.06; 95 % CI: 1.01-1.10; p-value = 0.005); BMI (PR: 0.74; 95 % CI: 0.65-0.84; p-value < 0.001); age (PR: 1.02; 95 % CI: 1.00-1.03; p < 0.001); male (PR: 5.75; 95 % CI: 3.20-10.34; p-value < 0.001); presence of diabetes mellitus (DM) (PR: 1.87; 95 % CI: 1.27-2.74; p-value < 0.001); % body fat (PR: 1.07; 95 % CI: 1.04-1.09; p-value < 0.001). CONCLUSION: the prevalence of sarcopenia can be considered high in this study, as well as inflammation. Being inflamed, presence of DM, being male, increasing age, and % body fat were risk factors for sarcopenia. On the other hand, increased BMI had a protective role

INTRODUCCIÓN: en individuos con enfermedad renal crónica, la sarcopenia es prevalente y está asociada a un aumento de la morbilidad y la mortalidad, y a la aparición de complicaciones cardiovasculares. OBJETIVO: verificar la relación entre sarcopenia e inflamación en pacientes en hemodiálisis. MÉTODOS: estudio transversal de 209 pacientes en cinco unidades de hemodiálisis. Se recopilaron datos demográficos, socioeconómicos, de composición corporal, laboratorio clínico y funcional. La sarcopenia se diagnosticó conforme al Grupo de Trabajo Europeo sobre Sarcopenia en Personas Mayores (fuerza de agarre < 27 kg para hombres y < 16 kg para mujeres; masa muscular DEXA < 7.0 kg/m² para hombres y < 5.5 kg/m² para mujeres). La inflamación se evaluó mediante la proteína C-reactiva. RESULTADOS: la edad media fue de 51,9 ± 15,0 años, con predominio de varones (59,3 %). La prevalencia de la sarcopenia fue del 29,1 % y la de la inflamación del 50,2 %. El análisis de regresión de Poisson mostró que la sarcopenia se asociaba con un aumento de los valores de hsCRP (PR: 1,06; IC del 95 %: 1,01-1,10; valor de p = 0,005); IMC (PR: 0,74; IC del 95 %: 0,65-0,84; valor p < 0,001); edad (PR: 1,02; IC 95 %: 1,00-1,03; p < 0,001); hombre (PR: 5,75; IC 95 %: 3,20-10,34; valor p < 0,001); presencia de diabetes mellitus (DM) (PR: 1,87; IC 95 %: 1,27-2,74; valor p < 0,001); % de grasa corporal (PR: 1,07; IC 95 %: 1,04-1,09; valor p < 0,001). CONCLUSIÓN: la prevalencia de la sarcopenia puede considerarse alta en este estudio, así como la inflamación. Tener inflamación, la presencia de DM, ser hombre, la mayor edad y el % de grasa corporal resultaron ser factores de riesgo de sarcopenia. Por otro lado, el aumento del IMC tuvo un papel protector