Baixa ingestão de proteínas está associada à mortalidade em idosos brasileiros

Resumo Objetivo Estimar a associação entre baixa ingestão de proteínas e mortalidade em pessoas idosas. Métodos Estudo prospectivo realizado com 621 pessoas idosas da cidade de Viçosa (Minas Gerais), município de médio porte no Brasil. A ingestão de proteínas foi avaliada na linha de base (2009) pelo recordatório de ingestão habitual e foi utilizada a classificação de ingestão de proteínas proposta pela Sociedade Brasileira de Nutrição Parenteral e Enteral. Os dados de mortalidade foram coletados no período de acompanhamento (2009 a 2018) através do Sistema de Informações sobre Mortalidade. Modelos de regressão de Cox foram aplicados para estimar a associação independente entre ingestão total de proteínas e mortalidade, e estimativas de hazard ratio e seus respectivos intervalos de confiança de 95% foram calculados. Resultados Entre os 621 participantes do estudo, 52,7% eram do sexo feminino e a prevalência de baixa ingestão proteica foi de 60,9%. Ao longo dos 9 anos de acompanhamento ocorreram 154 óbitos (23,3%). No modelo ajustado, pessoas idosas com baixa ingestão de proteínas apresentaram maior risco de morte [HR: 1,72; IC 95%: 1,05 - 2.82]. Conclusão A baixa ingestão de proteínas pode aumentar o risco de morte em pessoas idosas

High anti-SARS-CoV-2 antibody seroconversion rates before the second wave in Manaus, Brazil, and the protective effect of social behaviour measures: results from the prospective DETECTCoV-19 cohort

Background: The city of Manaus, Brazil, has seen two collapses of the health system due to the COVID-19 pandemic. We report anti-SARS-CoV-2 nucleocapsid IgG antibody seroconversion rates and associated risk factors in Manaus residents before the second wave of the epidemic in Brazil. Methods: A convenience sample of adult (aged ≥18 years) residents of Manaus was recruited through online and university website advertising into the DETECTCoV-19 study cohort. The current analysis of seroconversion included a subgroup of DETECTCoV-19 participants who had at least two serum sample collections separated by at least 4 weeks between Aug 19 and Oct 2, 2020 (visit 1), and Oct 19 and Nov 27, 2020 (visit 2). Those who reported (or had no data on) having a COVID-19 diagnosis before visit 1, and who were positive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at visit 1 were excluded. Using an in-house ELISA, the reactivity index (RI; calculated as the optical density ratio of the sample to the negative control) for serum anti-SARS-CoV-2 nucleocapsid IgG antibodies was measured at both visits. We calculated the incidence of seroconversion (defined as RI values ≤1·5 at visit 1 and ≥1·5 at visit 2, and a ratio >2 between the visit 2 and visit 1 RI values) during the study period, as well as incidence rate ratios (IRRs) through cluster-corrected and adjusted Poisson regression models to analyse associations between seroconversion and variables related to sociodemographic characteristics, health access, comorbidities, COVID-19 exposure, protective behaviours, and symptoms. Findings: 2496 DETECTCoV-19 cohort participants returned for a follow-up visit between Oct 19 and Nov 27, 2020, of whom 204 reported having COVID-19 before the first visit and 24 had no data regarding previous disease status. 559 participants were seropositive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at baseline. Of the remaining 1709 participants who were seronegative at baseline, 71 did not meet the criteria for seroconversion and were excluded from the analyses. Among the remaining 1638 participants who were seronegative at baseline, 214 showed seroconversion at visit 2. The seroconversion incidence was 13·06% (95% CI 11·52–14·79) overall and 6·78% (5·61–8·10) for symptomatic seroconversion, over a median follow-up period of 57 days (IQR 54–61). 48·1% of seroconversion events were estimated to be asymptomatic. The sample had higher proportions of affluent and higher-educated people than those reported for the Manaus city population. In the fully adjusted and corrected model, risk factors for seroconversion before visit 2 were having a COVID-19 case in the household (IRR 1·49 [95% CI 1·21–1·83]), not wearing a mask during contact with a person with COVID-19 (1·25 [1·09–1·45]), relaxation of physical distancing (1·31 [1·05–1·64]), and having flu-like symptoms (1·79 [1·23–2·59]) or a COVID-19 diagnosis (3·57 [2·27–5·63]) between the first and second visits, whereas working remotely was associated with lower incidence (0·74 [0·56–0·97]). Interpretation: An intense infection transmission period preceded the second wave of COVID-19 in Manaus. Several modifiable behaviours increased the risk of seroconversion, including non-compliance with non-pharmaceutical interventions measures such as not wearing a mask during contact, relaxation of protective measures, and non-remote working. Increased testing in high-transmission areas is needed to provide timely information about ongoing transmission and aid appropriate implementation of transmission mitigation measures. Funding: Ministry of Education, Brazil; Fundação de Amparo à Pesquisa do Estado do Amazonas; Pan American Health Organization (PAHO)/WHO.World Health OrganizationRevisión por pare

PROJETO ESCUTA SOLIDÁRIA: UNIVERSIDADES NO APOIO ÀS PESSOAS IDOSAS NO CONTEXTO DA COVID-19

O relato refere-se a uma ação extensionista de escuta solidária a pessoas idosas durante a pandemia da COVID-19.  Os idosos são acompanhados por ligações telefônicas, mensagens e ligações pelo Whatsapp, por estudantes universitários, nos municípios de Viçosa (MG), Palmas (TO) e Campinas (SP). A escuta e o acolhimento à pessoa idosa contribuem sobremaneira para fortalecer a autoconfiança, a percepção da transitoriedade do momento, o compartilhamento de enfrentamentos e construção positiva e otimista de que dias melhores virão. The report refers to a solidarity extension action for the older adults during a COVID-19 pandemic. The older adults are accompanied by telephone contacts, messages and contacts via WhatsApp, by university students, in the cities of Viçosa (MG), Palmas (TO) and Campinas (SP). Listening to and welcoming the older adults contributes greatly to strengthening self-confidence, the perception of the transience of the moment, the sharing of confrontations and the positive and optimistic construction of better days. El informe se refiere a una acción de extensión solidaria para los ancianos durante una pandemia de COVID-19. Los ancianos están acompañados por contactos telefónicos, mensajes y contactos a través de WhatsApp, por estudiantes universitarios, en los municipios de Viçosa (MG), Palmas (TO) y Campinas (SP). Escuchar y dar la bienvenida a los ancianos contribuye en gran medida a fortalecer la autoconfianza, la percepción de la fugacidad del momento, el intercambio de confrontaciones y la construcción positiva y optimista de días mejores

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Diet quality and associated factors in elderly in Viçosa, Minas Gerais, Brasil: A population-based study

Objetivou-se neste estudo avaliar a qualidade da dieta e os fatores associados em idosos do município de Viçosa (MG). Trata-se de um estudo transversal, de base populacional, realizado com idosos não institucionalizados residentes nas zonas rural e urbana do município. As informações de consumo alimentar foram obtidas por meio de um recordatório de ingestão habitual e a partir destas, foi avaliada a qualidade da dieta por meio do Índice de Alimentação Saudável revisado e validado para a população brasileira (IAS-R). A variável dependente analisada neste estudo foi o IAS-R. As variáveis independentes foram socioeconômicas, condições de saúde, estilo de vida e consumo alimentar. A análise estatística envolveu medidas descritivas, análise univariada e multivariada. Para identificar associações entre os tercis do IAS-R total e as variáveis independentes foi utilizado o modelo de regressão logística multinomial, com estimativas de Odds Ratio e respectivos intervalos de confiança de 95%. Foram estudados 620 idosos e a média de pontuação obtida para o IAS-R total foi de 64,28. Os componentes consumidos com piores pontuações foram os Cereais integrais, Leite e derivados, Sódio, Frutas totais e Frutas integrais. Cerca de 82% e 67% dos idosos tiveram escore zero para Cereais integrais e Sódio, respectivamente. Considerando a pontuação do IAS-R total observou-se que 75% dos idosos obtiveram pontuação menor que 72,92 e entre os sexos, os homens apresentaram pontuação significantemente menor. As mulheres apresentaram percentual de pontuação máxima, significantemente maior para Frutas totais, Frutas integrais, Cereais integrais, Leite e derivados e significantemente menor para Gordura saturada. O IAS-R foi classificado em tercis, considerando-se o primeiro tercil como “Pior qualidade da dieta”, o segundo “Qualidade intermediária da dieta” e o terceiro “Melhor qualidade da dieta”. Nos resultados da análise múltipla, os fatores que se mantiveram independentemente associados à “Qualidade intermediária da dieta”, foram ser do sexo feminino e ter perímetro da cintura entre 89,70 e 100,70cm. Já os fatores independentemente associados à “Melhor qualidade da dieta” foram sexo feminino, maior escolaridade, história de uma a cinco consultas médicas no último ano, histórico de diabetes mellitus, dislipidemia e estar em uso de polifarmácia. A maioria dos idosos necessita de melhorias na alimentação, com ênfase no aumento da ingestão de cereais integrais, frutas, leite e derivados e redução do consumo de alimentos ricos em sódio. Idosos do sexo masculino, com nenhuma ou com baixa escolaridade e os que não procuram serviços de saúde constituem o grupo que necessita de maior atenção no tocante a medidas para melhoria da qualidade da dieta.The aim of this study was to measure the quality of the diet and associated factors in older people of Viçosa (MG). It was a cross-sectional study, population-based, realized with non- institutionalized elderly resident in rural and urban areas of the city. Information about food consumption was obtained through a recall of habitual consumption. From these information, it was evaluated the quality of diet through Healthy Eating Index reviewed and validated for the brasilian population (HEI-R). The dependent variable analyzed in this study was the HEI- R. The independent variables were socioeconomic, health status, lifestyle and food consumption. The statistical analysis involves descriptive measures, univariate and multivariate analysis. To identify associations between tertiles of full HEI-R and independent variables was used the multinomial logistic regression model, with estimates of Odds Ratios and 95% confidence intervals. It was studied 620 elderly patients with mean score of total HEI-R of 64.28. The worst components consumed score were whole grains, milk and derivatives, sodium, total fruits and whole fruits. Approximately 82% and 67% of seniors had zero score for whole grains and sodium, respectively. Considering the score of the full HEI-R it was observed that 75% of the elderly had lower scores than 72.92 and between the sexes, men had significantly lower scores. Women had maximum percentage score significantly higher for total fruits, whole fruits, whole grains, milk and derivatives and significantly lower in saturated fat. The HEI-R was classified into tertiles, considering the first tertile as "Poor quality of diet," the second "intermediate diet quality" and the third "Best quality of the diet." In the results of the multivariate analysis the factors that remained independently associated with "intermediate diet quality," were being female and having waist circumference between 89.70 and 100,70cm. The factors independently associated with "Best diet quality" were female, higher education, history of one to five medical appointments in the last year, history of diabetes mellitus, dyslipidemia and be using several medicines. Most seniors need of improvements in nutrition, with an emphasis on increased intake of whole grains, fruits, dairy products and reduce consumption of foods with high sodium. Elderly men with no or low education and those who do not seek health services constitute the group that need more attention concerning measures to improve the quality of the diet.Coordenação de Aperfeiçoamento de Pessoal de Nível Superio

Nutritional status, functional disability and mortality among older adults in Viçosa, MG.

O envelhecimento acarreta modificações que podem interferir negativamente no estado nutricional, e esse tem relação com a modulação das doenças crônicas. A cronicidade dessas doenças aumenta o risco de incapacidade funcional, que por sua vez, está associada ao aumento da mortalidade em idosos. Objetivou-se neste estudo avaliar as inter-relações entre o estado nutricional, a incapacidade funcional e a mortalidade entre idosos de Viçosa (MG). Realizou-se um estudo prospectivo, com amostra aleatória simples de 796 idosos, não institucionalizados, de Viçosa (MG). Na linha de base (2009/2010), coletou-se os dados atráves de entrevistas domiciliares aplicando questionário semi-estruturado para obtenção de informações sociodemográficas, de saúde, hábitos de vida, consumo alimentar e estado nutricional. Para obtenção dos dados de óbitos ocorridos entre 2009 e 2018, consultou-se o banco de dados do Sistema de Informação sobre Mortalidade (SIM). Nos casos em que os idosos não foram registrados no SIM, realizou-se ligações telefônicas e visitas domiciliares aos familiares/responsáveis dos idosos falecidos para obtenção de informações do óbito. Foram realizadas análises descritivas dos dados, comparação entre grupos por meio dos testes t de Student, Mann-Whitney, Qui-quadrado de Pearson e de tendência linear. Foram utilizados modelos aditivos generalizados (GAM) para a identificação de pontos de corte do índice de massa corporal (IMC), perímetro da cintura (PC), perímetro da perna (PP) e relação cintura- estatura (RCE). Foi realizada análise de sobrevida a partir de curvas de sobrevida estimadas pelo método de Kaplan-Meier, para comparação das curvas, os testes Log-rank e Peto e modelos de regressão de Cox para avaliar a associação independente entre alterações nutricionais e mortalidade. Foi utilizada modelagem de equações estruturais para avaliar as inter-relações entre incapacidade funcional e estado nutricional na mortalidade. No período de acompanhamento (2009 a 2018) ocorreram 197 óbitos (24,7%). As principais causas de óbito foram as doenças do aparelho circulatório (31,2%). A probabilidade de sobreviver foi maior para idososcom valores aumentados de RCE. Os idosos com maior risco de morte, segundo os pontos de corte estimados a partir do GAM, foram aqueles com RCE < 0,52 e ≥ 0,63, com PC < 83 cm e ≥ 101 cm e com PP e IMC respectivamente, < 34,5 cm e < 24,5 Kg/m². Observou-se aumento de risco de morte nos idosos com elevada adisposidade, representada por PC elevado (HR: 2,03 IC95%: 1,20-3,41) e RCE elevada (HR: 1,51 IC95%: 1,01-2,26). Observou-se, ainda, maior risco de morte em idosos com baixo peso e baixa reserva muscular: IMC < 18,5 Kg/m² (HR: 2,57, IC95%: 1,23-5,35) e PP < 34,5 cm (HR: 1,72, IC95%: 1,27-2,33 e < 31 cm (HR: 2,11, IC95%: 1,44-3,10), respectivamente. Observou-se efeitos indiretos do IMC sobre a mortalidade mediados pela incapacidade funcional e número de doenças. Diante do exposto, atenção deve ser dada aos pontos de corte identificados para os indicadores antropométricos de baixo peso, baixa reserva muscular e adiposidade, de forma a se propor antecipadamente intervenções necessárias à promoção da saúde dos idosos. Além disso, a manutenção de um estado nutricional adequado é fundamental para prevenção da incapacidade funcional e, consequentemente, da mortalidade precoce. Palavras-chave: Idoso. Estado nutricional. Incapacidade funcional. Mortalidade.Aging causes changes that can negatively affect nutritional status, and this is related to modulation of chronic diseases. The chronicity of these diseases increases risk of functional disability, which therefore is associated with increased mortality in the older adults. The aim of this study was to evaluate the interrelationship among nutritional status, functional disability and mortality in the older adults in Viçosa (MG). A prospective study was carried out, with a simple random sample of 796 non- institutionalized older adults living in Viçosa (MG). In the baseline (2009/2010), data were collected through home interviews using a semi-structured questionnaire to obtain sociodemographic, health, lifestyle, food consumption and nutritional status information. To obtain data on deaths that occurred between 2009 and 2018, database on the Mortality Information System (SIM) was consulted. In cases where the older adults were not registered in the SIM, telephone calls and home visits were made to the family members/ guardians of the deceased subjects to obtain death information through consultation with the Death Declaration/ Certificate. Descriptive analyses of data were performed and comparison between groups using Student's t- test, Mann-Whitney, Pearson's chi-square and linear trend tests. Generalized additive models (GAM) were used to identify cutoff points for body mass index (BMI), waist perimeter (WP), calf perimeter (CP) and waist-height ratio (WHR). Survival analysis was performed using survival curves estimated by the Kaplan-Meier method and the Log-rank and Peto tests to compare the curves, and Cox regression models to assess the independent association between nutritional changes and mortality. Structural equation modeling was used to assess the interrelationships between functional disability and nutritional status in mortality. In the follow-up period (2009 to 2018), there were 197 deaths (24.7%). The probability of surviving was higher for the older adults with increased values of WHR. Main cause of death was circulatory system diseases (31.2%). The older adults with an increased risk of death, according to the cutoff points estimated from the GAM, were those with WHR <0.52 and ≥ 0.63, with WP <83 cm and ≥ 101 cm and with PP and BMI respectively, <34.5 cm and <24.5 Kg / m². An increased risk of death was observed in the older adults with highWP (HR: 2.03 95% CI: 1.20-3.41), high WHR (HR: 1.51 95% CI: 1.01-2.26 ), BMI <18.5 Kg / m² (HR: 2.57, 95% CI: 1.23-5.35) and CP <34.5 cm and <31 cm (HR: 1.72, 95% CI: 1 , 27-2.33; HR: 2.11, 95% CI: 1.44-3.10, respectively). There was no direct effect of nutritional status on mortality, but an indirect effect mediated by functional disability. Considering the results found, attention should be given to the cutoff points identified for the anthropometric indicators of low muscle reserve and adiposity, in order to propose in advance interventions necessary to promote the health of older adults. In addition, it is necessary to maintain an adequate nutritional status to prevent functional disability and, consequently, early mortality. Keywords: Older adults. Nutritional status. Functional disability. Mortality

Calf circumference is an independent predictor of mortality in older adults: an approach with generalized additive models

Background:There is a wide variation in the cutoff points of body mass index (BMI) and calf circumference (CC) , and it is necessary to assess their adequacy in predicting mortality, especially in the older adults in the community. This study aimed to investigate the association of low muscle mass and underweight with mortality in older adults, comparing different cutoff points. Methods: This was a prospective study that included 796 older adults, not institutionalized, from a Brazilian city. Generalized additive models (GAMs) were used to identify cutoff points for CC and BMI, which were compared with values available in the literature. Survival analysis using Cox regression models was used to assess the independent association between these nutrition indicators and mortality. Results: Over the 9 years of follow-up, 197 deaths (24.7%) occurred. Cutoff points established for CC and BMI as predictors of mortality were, respectively, <34.5 cm and <24.5. In the adjusted Cox models, older adults with a BMI <18.5 showed a significant increase in the risk of death (hazard ratio [HR], 2.57; 95% CI, 1.23-5.35). Higher mortality was observed among older adults with CC <34.5 cm (HR, 1.72; 95% CI, 1.27-2.33) and CC <31 cm (HR, 2.11; 95% CI, 1.44-3.10). Conclusion: CC was an independent predictor of mortality, and the cutoff point identified by GAMs was higher than recommended by literature (31 cm). This study suggests a review of cutoff points for CC currently adopted to assess low muscle mass in older adults

Systematic review of healthy eating indexes in adults and elderly: applicability and validity

The Healthy Eating Index (HEI) assesses a combination of different types of foods, nutrients and dietary components. It has been adapted in some countries, considering the local dietary habits. In this article, the Healthy Eating Indexes published to date were identified by means of a systematic review. Besides, issues relating to their validity, applicability and limitations were discussed. An electronic search was performed in the PUBMED, SCIENCE DIRECT, BVS and SciELO data base containing studies on the adaptation, review, update or validation of the HEI. The descriptors Healthy Eating Index, Index of Diet Quality, Quality of diet, Diet surveys were used, in different combinations. A total of 11 studies were described and critically analyzed. One of the studies dealt with the development of the index; six proposed adjustments; two assessed validity and reliability of the index, and the other two proposed revision and update. The Healthy Eating Indexes reveal the actual quality of the diet, but the absence of a methodological standard hinders the comparison of the results found in different populations.Los índices de alimentación saludable evalúan la combinación de diferentes tipos de alimentos, nutrientes y componentes de la dieta. Estos indicadores han sido adaptados en algunos países considerando las directrices dietéticas locales. Esta revisión sistemática identifica todos los índices de alimentación saludable publicados hasta el momento; así mismo, discute la validez, aplicabilidad y limitaciones de los mismos. Para ello se realizó una búsqueda electrónica en PubMed, Science Direct, BVS y SciELO utilizando los siguientes términos: Healthy Eating Index, Index of Diet Quality, Quality of diet y Diet surveys con diferentes combinaciones e idiomas. Un total de 11 estudios fueron seleccionados y analizados críticamente: entre ellos, un estudio que desarrolla el primer índice, seis estudios en los que se proponen ajustes en la metodología utilizada, dos estudios que evaluan la validez y la fiabilidade, así como dos de revisión y actualización. Los datos muestran que los índices de alimentación saludable son buenas herramientas para valorar la calidad de la dieta, pero la falta de estandarización en la metodología hace difícil la comparación entre los resultados de las diferentes poblaciones