Ângulo de Fase como Indicador de Prognóstico em Doentes Críticos com Sépsis

Dissertação de mestrado em Nutrição Clínica apresentada à Faculdade de Ciências da Nutrição e Alimentação da Universidade do PortoResumo da tese: A sépsis, considerada uma situação clínica complexa e um grave problema de saúde pública mundial, é uma causa comum de admissão no Serviço de Medicina Intensiva (SMI) e a principal causa de morte dos doentes críticos. O ângulo de fase (AF), determinado pela análise da Bioimpedância eléctrica (BIE) consiste numa medida directa da estabilidade das células e reflecte a contribuição de fluídos e membranas celulares do corpo humano, sendo interpretado como indicador de integridade da membrana e preditor de massa celular corporal. A aplicação do AF tem-se revelado de grande eficácia na aferição dos compartimentos corporais em diversas situações clínicas, nomeadamente em neoplasias, pré e pós-operatórios, traumatismos, doenças hepáticas, insuficiência renal, SIDA e sépsis. Nestas condições, tem sido sugerido como indicador de prognóstico e factor preditivo de sobrevivência. Alguns estudos clínicos demonstram que, baixos AF estão associados ao agravamento da doença e um pior prognóstico clínico, com consequente aumento da mortalidade em doentes críticos. Objectivos: i) Aferir a capacidade de prognóstico do AF, obtido por análise da BIE, em doentes críticos com sépsis, enquando indicador fiável e precoce de mortalidade; ii) Analisar a relação entre o AF e os índices clínicos (SAPS ll e SOFA) em doentes sépticos críticos, associando estes indicadores com a gravidade da sépsis; iii) Relacionar os valores do AF dos doentes internados no SMI, com o grau de falência orgânica, o tempo de internamento e a evolução clínica dos mesmos; iv) Avaliar a associação entre a AF e parâmetros bioquímicos, tradicionalmente utilizados na avaliação de risco nutricional, como a albumina plasmática e a proteína C-reactiva (PCR); v) Averiguar a sensibilidade e utilidade do AF para monitorizar alterações no estado nutricional, avaliando assim a efectividade da terapia nutricional (...).Thesis abstract: Introduction: Sepsis is a complex clinical situation, a serious public health problem, a common cause of admission to the Unit of Intensive Care Unit (ICU) and the leading cause of death in critically ill patients. Phase angle (PA) determined by the Bioelectrical Impedance Analysis (BIA), is a direct measure of cell stability and reflects the human body contribution of fluid and cellular membranes, thus being interpreted as a membrane integrity indicator and body cell mass predictor. The PA application has been demonstrated large efficiency in body compartments gauging in several clinical settings, such as cancer, pre and post-operative trauma, liver disease, kidney failure, AIDS and sepsis. In these conditions, has been suggested as a prognostic indicator and predictor of survival. Some clínical studies show that low PA is associated with worsening disease and a worse clinical outcome with consequent increase in morbidity and mortality in critically ill patients. Objectives i) Assess the ability of phase angle prediction, determined by the BIA, in critical patients with sepsis, while reliable and early indicator of mortality; ii) Analyze the relationship between the phase angle and the clinical indicators (SAPS ll and SOFA) in critically patients, linking them with the severity of sepsis; iii) List the values of the PA of patients in the ICU, the degree of organ failure, length of stay and clinical outcome of same; iv) Evaluate the association between PA and biochemical parameters traditionally used in the assessment of nutritional risk, such as albumin and plasma C-reactive protein (CRP); v) Establishing the sensitivity and usefulness of the PA to monitor changes in nutritional status, thus evaluating the effectiveness of nutritional therapy(...)

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Epidemiological study of coffee consumption, its contribution to the intake of polyphenols and their potential effects in cardiovascular risk factors, considering individual genetic variations

Introdução: O café é uma das bebidas mais consumidas no Brasil e no mundo Ocidental, o que explica o grande interesse por parte dos pesquisadores. Dentre as diversas substâncias presentes na composição química do café, destacam-se os polifenóis. Alguns estudos têm verificado os efeitos fisiológicos destas substâncias bioativas na saúde humana, nomeadamente nas doenças cardiovasculares. Contudo, os resultados são ainda conflitantes e inconclusivos. Objetivos: Estimar a prevalência do consumo de café e sua contribuição na ingestão de polifenóis; investigar a associação do café com fatores de risco cardiovascular, e analisar a interação entre as variações genéticas e o consumo de café nos níveis de pressão arterial (PA), em amostra representativa de adultos e idosos residentes no município de São Paulo. Métodos: Utilizaram-se dados procedentes do estudo transversal de base populacional ISA-Capital 2008 e do banco de dados de polifenóis Phenol-Explorer versão 3.5. Para o presente estudo, foram incluídos indivíduos com 20 anos ou mais, de ambos os sexos, residentes na área urbana do município de São Paulo. O consumo alimentar foi avaliado por meio de dois recordatórios de 24 horas e utilizou-se um questionário estruturado para obter informações socioeconômicas, demográficas e de estilo de vida. Aferiu-se a PA, realizaram-se medições antropométricas e coletaram-se amostras de sangue em jejum de 12 horas para as análises bioquímicas. Os analitos séricos avaliados foram: homocisteína, glicose em jejum, triacilgliceróis, colesterol total e frações plasmáticas (LDL-c e HDL-c). A genotipagem dos polimorfismos foi realizada utilizando a técnica PCR-alelo específico. Foram avaliados os polimorfismos envolvidos no metabolismo da cafeína, consumo de café e relacionados à PA. A partir de estudos de associação ampla do genoma (GWAS) previamente descritos na literatura, selecionaram-se os polimorfismos candidatos associados com a PA: CYP1A1/CYP1A2 (rs2470893), CYP1A1/CYP1A2 (rs2472297), CPLX3/ULK3 (rs6495122), MTHFR (rs17367504). Posteriormente, foi calculado um escore genético de risco (do inglês GRS) para a PA baseado nestes polimorfismos, o qual variou de zero a oito pontos, de acordo com o número de alelos de risco. As análises estatísticas foram efetuadas por modelos de regressão logística múltipla, no software STATA®, sendo considerado um nível de significância de 0,05. Resultados: Verificou-se que o consumo médio de café nos residentes no Município de São Paulo foi de aproximadamente 140 mL/dia, e que esta bebida contribuiu com 70,5 por cento da ingestão total de polifenóis. Após análises de regressão logística múltipla, encontrou-se uma associação inversa entre o consumo moderado de café e alguns dos fatores de risco cardiovascular (FRCV). Observou-se que, os indivíduos que consumiam diariamente de 1 a 3 xícaras de café, reduziram a chance de ter PA sistólica elevada (OR= 0,45; IC 95 por cento = 0,26-0,78); PA diastólica elevada (OR= 0,44; IC 95 por cento = 0,20-0,98) e concentrações plasmáticas elevadas de homocisteína (OR= 0,32; IC 95 por cento = 0,11-0,93), quando comparados aos indivíduos que tomavam menos de 1 xícara por dia. Além disso, constatou-se que o consumo de café pode interagir com a predisposição genética individual, influenciando a PA. Há medida que aumentou a pontuação no GRS, verificou-se uma maior chance dos indivíduos apresentarem níveis de PA elavada, principalmente naqueles com um alto consumo de café (superior a 3 xícaras por dia) (OR= 5,09; IC 95 por cento = 1,32-19,7). Conclusões: Este estudo sugere que a prevalência do consumo de café por indivíduos adultos e idosos residentes em São Paulo é alta, o que contribui para a maior parte da ingestão de polifenóis da alimentação. Por ser uma bebida rica nestes compostos bioativos, o seu consumo moderado, parece exercer um efeito protetor em FRCV, nomeadamente na regulação da PA elevada e nas concentrações plasmáticas de homocisteina. Além disso, verifica-se uma interação entre o consumo de café e os polimorfismos genéticos nos níveis de PA, sublinhando a importância de reduzir o seu consumo para doses inferiores a 3 xícaras diárias, nos indivíduos geneticamente predispostos a este fator de risco cardiovascularIntroduction: Coffee is one of the most consumed non-alcoholic beverages in Brazil and the Western world, which explains the great interest of the researchers. Among the various substances present in the coffee composition, polyphenols are noteworthy. Some studies have verified the physiological effects of these bioactive substances on human health, especially in cardiovascular diseases. However, the results are still conflicting and inconclusive. Objectives: To estimate the prevalence of coffee consumption and its contribution in the intake of polyphenols, to investigate the association of coffee consumption with cardiovascular risk factors, and to analyze the interaction between genetic polymorphisms and coffee in blood pressure (BP), in a representative sample of adult and older adults of the city of São Paulo. Methods: Data come from the cross-sectional population-based study ISA-Capital 2008 and the polyphenol database Phenol-Explorer version 3.5. For the present study, we included adults and older adultas, of both sexes, living in the urban area of the São Paulo city. Dietary intake was estimated by two 24-hour dietary recalls. Socioeconomic, demographic and lifestyle data were obtained through a structured questionnaire. Blood samples were collected after a 12-hour fasting for biochemical analysis and blood pressure (BP), weight, height were measured. The analytes analysed were plasma homocysteine, triglycerides, total cholesterol, and plasma fractions (HDL-c and LDL-c). Genotyping was performed using the PCR-allele-specific technique. Genetic polymorphisms involved in caffeine metabolism, coffee consumption and BP-related were identified. The following polymorphisms associated with BP [CYP1A1/CYP1A2 (rs2470893), CYP1A1/CYP1A2 (rs2472297), CPLX3/ULK3 (rs6495122), MTHFR (rs17367504)], were selected and obtained from the genome wide association studies (GWAS). Subsequently, a genetic risk score (GRS) for BP was calculated based on these polymorphisms, which ranged from zero to eight points, according to the number of risk alleles. All analyses were performed with Stata® and a p-value < 0.05 was considered statistically significant. Results: The coffee consumption mean in the residents of São Paulo city was approximately 140 mL/day, and this beverage contributed with 70.5 per cent of the total polyphenol intake. After multiple logistic regression analysis, an inverse association between moderate coffee consumption and some of the cardiovascular risk factors (CVRF) was observed. The individuals who drank 13 cups of coffee/day reduced the odds of elevated systolic blood pressure (SBP) (OR= 0.45; 95 per cent CI= 0.26, 0.78), elevated diastolic blood pressure (DBP) (OR= 0.44; 95 per cent CI= 0.20, 0.98), and hyperhomocysteinemia (OR= 0.32; 95 per cent CI= 0.11, 0.93), when compared to subjects who consumed less than 1 cup/day. Furthermore, coffee consumption may interact with individual genetic predisposition, influencing BP. Individuals with a higher genetic risk score (GRS) appear to have high BP levels (OR= 5.09; 95 per cent CI= 1.32-19.7), related to higher coffee consumption (greater than 3 cups/day). Conclusions: This study suggests that the prevalence of coffee consumption by adult and older adults living in São Paulo is high, which contributes to the majority of the polyphenol intake from the diet. The moderate consumption of this beverage seems to exert a protective effect on CVRF, principally in the regulation of high BP and hyperhomocysteinemia. In addition, there is an interaction between the consumption of this beverage and the GRS for high BP, highlighting the importance of reduce coffee consumption to doses below 3 cups/day, in individuals genetically predisposed to this CV risk facto

Impacto da intervenção nutricional em doentes gastrectomizados : monografia

Contém um relatório de estágio curricular realizado na empresa Catering Linhas Aéreas SA, aeroporto Francisco Sá Carneiro, Porto, e no Serviço de Cirurgia Geral do Hospital de São João, Porto, no âmbito da licenciatura em Ciências da Nutrição pela Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto. O exemplar do relatório de estágio existe apenas em formato papel e está disponível para consulta na Biblioteca da FCNAUPTese de licenciatura em Ciências da Nutrição apresentada à Faculdade de Ciências da Nutrição e Alimentação da Universidade do PortoResumo da tese:O Carcinoma Gástrico, permanece actualmente como um dos mais frequentes em Portugal, sendo responsável por uma elevada taxa de mortalidade e morbilidade. A ressecção total ou parcial do estômago resulta em consequências nutricionais agudas ou crónicas, com intensidade e duração variáveis e inevitáveis, contudo, atenuáveis mediante uma adequada terapia nutricional. A desnutrição é uma das consequências comuns em doentes gastrectomizados e a sua detecção precoce pode ser decisiva para a sobrevida dos mesmos. Existem diversos métodos de avaliação do estado nutricional, os quais visam estabelecer atitudes de intervenção. No entanto, deve eleger-se na prática clínica hospitalar um instrumento que contemple os aspectos subjectivos e objectivos, que seja prático, sensível, reprodutível e aplicável o mais precocemente possível. De acordo com estudos realizados constata-se que os doentes gastrectomizados apresentam boa evolução clínica no período pós-operatório, verificando-se que os que são submetidos a gastrectomia parcial apresentam melhores resultados clínicos e melhor estado nutricional, a longo prazo. Assim, um acompanhamento cuidadoso e personalizado, de incidência eficaz nos aspectos nutricionais, clínicos e sociais tem uma influência significativa na melhoria da qualidade de vida destes doentes.Thesis abstract:The Gastric carcinoma remains today as one of the most frequent in Portugal, accounting for a high rate of mortality and morbidity. The total or partial ressection of the stomach resultes in acute or chronic nutritional consequences, with different intensity and duration and inevitable, however they can be reduced through a proper nutritional support. Malnutrition is a common consequence in patient’s gastrectomy and its early detection can be decisive for survival. There are various methods for assessing nutritional status, which aim to establish attitudes of intervention. However, we should elect an instrument that addresses the subjective and objective issues in clinical practice, which is practical, sensitive, reproducible and apply as early as possible. According to studies it appears that patient`s gastrectomy have good clinical outcome in the postoperative period, there are those who are subjected to partial gastrectomy and have better clinical results and better nutritional status in the long term. Thus, a careful monitoring and custom, focusing on nutrition, clinical and social has a significant influence on improving the quality of life of these patients

The traditional lunch pattern is inversely correlated with body mass index in a population-based study in Brazil

Abstract\ud \ud Background\ud The association of obesity and dietary patterns has been well documented in scientific literature; however, information on the impact of meal patterns on obesity is scarce. The objective of this study was to investigate the association of adherence to lunch patterns and body mass index (BMI) in a representative sample of individuals aged 20 years or older in Sao Paulo.\ud \ud \ud Methods\ud Data for 933 participants were retrieved from the Health Survey of São Paulo (ISA-Capital 2008), a cross-sectional population-based survey. The usual dietary intake of individuals with at least one 24-h recall was estimated by the Multiple Source Method. The definition of lunch was self-reported by the participant. Five lunch patterns were derived from twenty-two food groups by exploratory factor analysis: Traditional, Western, Sweetened juice, Salad, and Meats. To estimate the effect of lunch patterns on BMI, we used a generalized linear model with link identity and inverse Gaussian distribution. Analyses were adjusted by age, gender, household income per capita, physical activity levels, smoking status, alcohol consumption, total energy intake, and misreporting status.\ud \ud \ud Results\ud The greater adherence to the traditional pattern at the lunch meal was associated with lower BMI, only in insufficiently active individuals (ß = −0.78; 95% CI -1.57; −0.02).\ud \ud \ud Conclusions\ud The traditional Brazilian lunch pattern might protect the insufficiently active individuals against obesity.This research was supported by the Health Department of the City of Sao\ud Paulo, São Paulo Research Foundation (FAPESP process no. no 2009/15831–\ud 0), and the National Council for Scientific and Technological Development\ud (CNPq process no. proceeding no 473100/2009–6). ROS received a graduate\ud student stipend from the Coordination for improvement of Higher Education\ud Table 2 Regression coefficients for the association of the\ud dietary patterns with body mass index in the study population\ud Lunch Patterns\ud Crude model β 95% CI\ud Traditional Pattern (ref. 1st tertile)\ud 2nd tertile −0.27 −1.01; 0.48\ud 3rd tertile −1.07 −1.80;-0.34\ud Western Pattern (ref. 1st tertile)\ud 2nd tertile 0.01 −0.74; 0.75\ud 3rd tertile −0.38 −1.11; 0.35\ud Sweetened juice Pattern (ref. 1st tertile)\ud 2nd tertile 0.22 −0.53; 0.97\ud 3rd tertile −0.56 −1.29; 0.17\ud Salads Pattern (ref. 1st tertile)\ud 2nd tertile 0.78 0.04; 1.52\ud 3rd tertile 0.46 −0.27; 1.19\ud Meats Pattern (ref. 1st tertile)\ud 2nd tertile 0.22 −0.52; 0.96\ud 3rd tertile −0.16 −0.90; 0.56\ud Model adjusteda β 95% CI\ud Traditional Insufficiently active Pattern (ref. 1st tertile)\ud 2nd tertile −0.50 −1.23, 0.24\ud 3rd tertile −0.78 −1.57, −0.02\ud Sufficiently active 2nd tertile 1.99 −0.99, 5.05\ud 3rd tertile 0.84 −2.09, 3.82\ud Western Pattern (ref. 1st tertile)\ud 2nd tertile −0.07 −0.77, 0.63\ud 3rd tertile 0.14 −0.58, 0.85\ud Sweetened juice Pattern (ref. 1st tertile)\ud 2nd tertile 0.17 −0.54, 0.87\ud 3rd tertile −0.29 −0.99, 0,40\ud Salads Pattern (ref. 1st tertile)\ud 2nd tertile 0.37 −0.33, 1.07\ud 3rd tertile 0.06 −0.62, 0.75\ud Meats Pattern (ref. 1st tertile)\ud 2nd tertile 0.01 −0.68, 0.70\ud 3rd tertile −0.29 −0.98, 0.39\ud a\ud Adjusted for age, sex, household per capita income, physical activity levels,\ud smoking status, alcohol consumption, total energy intake, misreporting status\ud and lunch patterns\ud ISA-Capital 2008. Sao Paulo. Brazil\ud de Oliveira Santos et al. BMC Public Health (2018) 18:33 Page 5 of 7\ud Personnel (CAPES). DASV and AAMM received a graduate student stipend\ud from the FAPESP

The traditional lunch pattern is inversely correlated with body mass index in a population-based study in Brazil

Abstract Background The association of obesity and dietary patterns has been well documented in scientific literature; however, information on the impact of meal patterns on obesity is scarce. The objective of this study was to investigate the association of adherence to lunch patterns and body mass index (BMI) in a representative sample of individuals aged 20 years or older in Sao Paulo. Methods Data for 933 participants were retrieved from the Health Survey of São Paulo (ISA-Capital 2008), a cross-sectional population-based survey. The usual dietary intake of individuals with at least one 24-h recall was estimated by the Multiple Source Method. The definition of lunch was self-reported by the participant. Five lunch patterns were derived from twenty-two food groups by exploratory factor analysis: Traditional, Western, Sweetened juice, Salad, and Meats. To estimate the effect of lunch patterns on BMI, we used a generalized linear model with link identity and inverse Gaussian distribution. Analyses were adjusted by age, gender, household income per capita, physical activity levels, smoking status, alcohol consumption, total energy intake, and misreporting status. Results The greater adherence to the traditional pattern at the lunch meal was associated with lower BMI, only in insufficiently active individuals (ß = −0.78; 95% CI -1.57; −0.02). Conclusions The traditional Brazilian lunch pattern might protect the insufficiently active individuals against obesity