Diet quality of patients with cardiovascular diseases in Pelotas in the State of Rio Grande do Sul, Brazil

Cardiovascular diseases are the leading causes of death in Brazil and worldwide. Among the main modifiable cardiovascular risk factors are poor dietary habits, such as high intake of saturated fats and sodium. Thus, it is important to analyze the quality of feeding of this population for secondary prevention of these events. The objective of this study was to evaluate the quality of the diet of individuals with cardiovascular diseases. This is a crosssectional study, nested in a multicenter national randomized clinical trial, in which 80 patients belonging to the collaborating center of Pelotas, Rio Grande do Sul, Brazil, were evaluated, aged 45 years or more. Clinical, anthropometric, biochemical and sociodemographic variables were collected. The quality of the diet was evaluated by the Diet Quality Index Revised, based on the 24h recall analysis. Statistical analysis was performed using the Stata 12.1® program. The majority of the sample was male, more than sixty years old, belonging to social class C, with education until elementary school, former smokers and were overweight. Regarding diet quality, the overall mean score was 56.70 ± 12.56 points. The components with the lowest mean contribution to the IQD-R total score were "whole grains", "dark green and orange vegetables and legumes", "whole fruits" and "total fruits". Patients who presented higher quality scores of the diet were diabetics (p = 0.014) and those who used hypoglycemic agents (p = 0.029). The results point to the need for a greater attention in the quality of the diet of individuals with cardiovascular diseases, especially with regard to the ingestion of vegetables, fruits and whole grains.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESAs doenças cardiovasculares representam a principal causa de morte no Brasil e no mundo. Dentre os fatores de risco modificáveis, os hábitos alimentares exercem forte influência sobre a saúde cardiovascular. Dessa forma, o objetivo deste estudo foi avaliar a qualidade da dieta através do Índice de Qualidade da Dieta Revisado de indivíduos com doença aterosclerótica manifesta. Trata-se de um estudo transversal, aninhado a um ensaio clínico randomizado, multicêntrico nacional, em que foram avaliados 80 pacientes pertencentes ao centro colaborador de Pelotas, Rio Grande do Sul, com idade igual ou superior a 45 anos, no momento baseline. Foram coletadas variáveis clínicas, antropométricas, bioquímicas e sociodemográficas. O consumo alimentar foi avaliado por meio de um recordatório de 24h. Para a análise estatística foi utilizado o programa Stata 12.1®. A maioria da amostra era do sexo masculino, possuíam mais de sessenta anos, pertenciam à classe social C, com escolaridade até o ensino fundamental, não fumantes e estavam acima do peso. Em relação à qualidade da dieta, a média geral do escore foi de 56,70±12,56 pontos. Os componentes com menor contribuição média para o escore total do IQD-R foram “cereais integrais”, “vegetais verde-escuros e alaranjados e leguminosas”, “frutas inteiras” e “frutas totais”. Foi verificada associação entre melhor qualidade da dieta e portadores de diabetes mellitus (p=0,014). Em relação às outras variáveis não foi verificada nenhuma associação estatisticamente significativa. Os resultados apontam para a necessidade de uma maior atenção na qualidade da dieta de indivíduos com doenças cardiovasculares, principalmente no que se refere à ingestão de vegetais, frutas e cereais integrais

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P <.01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P =.15). Secondary end points did not differ between groups after follow-up. Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death. © 2019 The Author