Elevated neck circumference and associated factors in adolescents

Background: Upper body subcutaneous fat, estimated by neck circumference (NC), may present greater metabolic risk than visceral fat. the aim of this study was to determine cutoff values for NC in adolescents that identify overweight and obesity, the prevalence of elevated NC, and its association with associated factors.Methods: Cross-sectional study with adolescents from public schools in São Paulo. Anthropometric variables, blood pressure and pubertal stage were collected. Cutoff values for NC were determined by Receiver Operating Characteristic curves. A binary logistic regression was used to determine relationships between NC and associated factors.Results: Among 1668 adolescents studied, 54.92% were female. the cutoff values of NC in girls and boys that identified overweight were 31.25 and 34.25 cm, and obesity, 32.65 and 37.95 cm, respectively, and the prevalence of adolescents with high NC was 32.63% in females and 37.63% among males. NC for overweight was observed that there was an association with sex, weight, body mass index, arm, waist and thigh circumferences, pubertal stages and body fat percent (BF%). NC for obesity was found association with gender, weight, arm and thigh circumferences, and BF% (p < 0.001).Conclusion: It was concluded that there is high prevalence of elevated NC and higher risks for this outcome considering overweight and obesity, sex, weight, arm and thigh circumferences, BF%, besides being an easy and simple measure for use in clinical practice.Adolescent Division, Pediatric Department, Federal University of São PauloUniversidade Federal de São Paulo, Adolescent Care & Support Ctr, Dept Pediat, Adolescent Med Sector, São Paulo, BrazilUniv Taubate, Dept Nursing & Nutr, São Paulo, BrazilCtr Phys Fitness Lab Studies Sao Caetano do Sul C, São Paulo, BrazilUniversidade Federal de São Paulo, Adolescent Care & Support Ctr, Dept Pediat, Adolescent Med Sector, São Paulo, BrazilWeb of Scienc

Prevalence of dementia subtypes in a developing country: a clinicopathological study

OBJECTIVES: To assess the distribution of dementia subtypes in Brazil using a population-based clinicopathological study. METHOD: Brains from deceased individuals aged ≥50 years old were collected after the next of kin signed an informed consent form and provided information through standardized questionnaires. Post-mortem clinical diagnoses were established in consensus meetings, and only cases with moderate or severe dementia or without cognitive impairment were included in the analysis. Immunohistochemical neuropathological examinations were performed following the universally accepted guidelines. A diagnosis of Alzheimer's disease was made when there were at least both a moderate density of neuritic plaques (Consortium to Establish a Register for Alzheimer's disease B or C) and Braak stage III for neurofibrillary tangle distribution. For the diagnosis of vascular dementia, at least three zones or strategic areas had to be affected by infarcts, lacunae, or microinfarcts. RESULTS: From 1,291 subjects, 113 cases were classified as having moderate or severe dementia, and 972 cases were free of cognitive impairment. The neuropathological diagnoses of the dementia sub-group were Alzheimer's disease (35.4%), vascular dementia (21.2%), Alzheimer's disease plus vascular dementia (13.3%), and other causes of dementia (30.1%). Small-vessel disease, which alone was not considered sufficient for a vascular dementia diagnosis, was present in 38.9% of all of the dementia cases and in 16.8% of the group without cognitive impairment (odds ratio = 2.91; 95% confidence interval, 1.53-5.51), adjusted for age, sex, and education. CONCLUSIONS: The relatively high frequencies of vascular dementia and small-vessel disease in the dementia sub-group constitute relevant findings for public health initiatives because control of vascular risk factors could decrease the prevalence of dementia in developing countries

Dementia in Latin America : paving the way towards a regional action plan

Regional challenges faced by Latin American and Caribbean countries (LACs) to fight dementia, such as heterogeneity, diversity, political instabilities, and socioeconomic disparities, can be addressed more effectively grounded in a collaborative setting based on the open exchange of knowledge. In this work, the Latin American and Caribbean Consortium on Dementia (LAC-CD) proposes an agenda for integration to deliver a Knowledge to Action Framework (KtAF). First, we summarize evidence-based strategies (epidemiology, genetics, biomarkers, clinical trials, nonpharmacological interventions, networking and translational research) and align them to current global strategies to translate regional knowledge into actions with transformative power. Then, by characterizing genetic isolates, admixture in populations, environmental factors, and barriers to effective interventions and mapping these to the above challenges, we provide the basic mosaics of knowledge that will pave the way towards a KtAF. We describe strategies supporting the knowledge creation stage that underpins the translational impact of KtAF

Capacidade preditiva de métodos indiretos para identificação precoce de desnutrição em crianças e adolescentes com neoplasias malignas

Background: Malnutrition in pediatric oncology is considered common, and this diagnosis may be underestimated according to the evaluation method. Anthropometric indicators can be useful tools for the early diagnosis of malnutrition. Objectives: The main objective of this study was to verify if calf circumference (CC), neck circumference (NC) and adductor pollicis muscle thickness (APMT) are independent predictors of malnutrition in this population and propose cutoff points to identify this nutritional status. Methods: A cross-sectional study with 2988 cases of children and adolescents with malignant neoplasms evaluated from October 2015 to April 2017. The variables collected were sex, age, weight, length / height, CC, NC, APMT, and other anthropometric variables. The nutritional status was obtained by classifying the BMI/A z-score according to the recommendations of the World Health Organization, 2006/2007. Multivariate analysis of the anthropometric indicators of interest for predictive capacity evaluation and ROC curves proposals were performed. The level of significance was p 0.05). Conclusion: It is concluded that CC is the only analyzed anthropometric indicator considered an independent predictor of malnutrition, and this outcome was not observed for NC and APMT. It was possible to propose cutoff points for CC that identify malnutrition, for the male and female sexes, and for all age groups.Introdução: A desnutrição em oncologia pediátrica é considerada comum, sendo que este diagnóstico pode estar subestimado de acordo com o método de avaliação. Indicadores antropométricos podem ser ferramentas úteis para o diagnóstico precoce de desnutrição. Objetivos: O principal objetivo deste trabalho foi verificar se a circunferência de panturrilha (CP), a circunferência do pescoço (CPesc) e a espessura do músculo adutor do polegar (EMAP) são preditores independentes de desnutrição nesta população e propor pontos de corte que identifiquem este estado nutricional. Métodos: Estudo observacional transversal com 2988 casos de crianças e adolescentes com neoplasias malignas avaliados no período de outubro de 2015 a abril de 2017. As variáveis coletadas foram sexo, idade, peso, comprimento/estatura, CP, CPesc, EMAP, dentre outras variáveis antropométricas. O estado nutricional foi obtido através da classificação do escore-z do IMC/I, de acordo com as recomendações da Organização Mundial de Saúde, 2006/2007. Foram realizadas a análise multivariada dos indicadores antropométricos de interesse para avaliação da capacidade preditiva, e propostas curvas ROC. O nível de significância foi p0,05). Conclusão: Conclui-se que a CP é o único indicador antropométrico analisado considerado preditor independente de desnutrição, não sendo observado este desfecho para CPesc e EMAP. Foi possível propor pontos de corte para CP que identificam desnutrição, para os sexos masculino e feminino, e para todas as faixas etárias.Dados abertos - Sucupira - Teses e dissertações (2019

Cutoff values for calf circumference to predict malnutrition in children and adolescents with malignant neoplasms: A new parameter for assessment?

Summary: Background &amp; Aims: Malnutrition in children and adolescents with cancer is a common finding, which tends to worsen during antineoplastic treatment. Anthropometric measurements are able to identify muscle wasting, such as calf circumference. This study aimed to propose cutoff values for calf circumference to identify malnutrition in children and adolescents with malignant neoplasms. Methods: A cross-sectional study, which included all children and adolescents, (ages 0–19 years old) with malignant neoplasms, evaluated from October 2015 to April 2017, at a Paediatric Oncology Institute's outpatient clinic. Biochemical and anthropometric parameters were collected, besides clinical data, sex and age. Receiver Operating Characteristic Curve were constructed to determine the best cutoff value for malnutrition identification, considering Body Mass Index as gold standard. The significance level was P<0.05. Results: 1794 cases (56.35% male) were selected. Cutoff values for calf circumference, in centimeters (cm) to identify undernutrition, according to the age range, in years, for males, were: 0 -1y: ≤17.2cm; 2-5y: ≤ 18.8cm; 6-9y: ≤23.9cm; 10-12y: ≤25.3 cm; 13-15y: ≤28.2cm; 16-19y: ≤32.0cm; and for females:0–1 y: ≤15.4 cm; 2-5y: ≤18.9 cm; 6–9 y: ≤ 24.1 cm; 10–12 y: ≤ 24.4cm; 13-15y: ≤ 29.1cm; 16–19 y: ≤30.2cm; (P<0,001). Malnutrition was observed in 30.14% of the sample, considering classification by calf circumference, and in 13.3%, considering the BMI z-score. There is association among malnutrition according to calf circumference, and biochemical parameters (albumin and total protein), P<0.05. Conclusion: Calf circumference is a good parameter of malnutrition in children and adolescents with cancer, besides being simple and easy to apply

Neuropsychiatric Inventory in Community-Dwelling Older Adults with Mild Cognitive Impairment and Dementia

BackgroundBehavioral and psychological symptoms (BPSD) can be a prodrome of dementia, and the Neuropsychiatric Inventory (NPI) is widely used for BPSD evaluation.ObjectiveTo compare the prevalence of BPSD according to cognitive status, and to determine NPI cutoffs that best discern individuals with mild cognitive impairment (MCI) and dementia from those without dementia.MethodsWe included 1,565 participants (mean age = 72.7±12.2 years, 48% male). BPSD and cognitive status were assessed with the NPI and the Clinical Dementia Rating (CDR). We used multivariable logistic regression models to investigate the association of BPSD with cognitive status. The area under the curve (AUC) was used to assess model discrimination, and to determine the best NPI cutoff for MCI and dementia.ResultsParticipants were cognitively normal (CDR = 0; n = 1,062), MCI (CDR = 0.5; n = 145), or dementia (CDR≥1.0, n = 358). NPI symptoms were more frequent in dementia and MCI when compared to cognitively normal. Higher odds for delusions, hallucinations, disinhibition, and psychomotor alterations were found among participants with dementia and MCI than in those who were cognitively normal. The best NPI cutoff to discern participants with dementia from those cognitively normal was 11 (AUC = 0.755). Poor discrimination (AUC = 0.563) was found for the comparison of MCI and those cognitively normal.ConclusionsWe found an increase in BPSD frequencies across the continuum of cognitive impairment. BPSD severity and frequency in MCI was more similar to individuals cognitively normal than with dementia. NPI scores≥to 11 in individuals with no diagnosis of dementia can support the decision for further investigation of dementia

Argyrophilic Grain Disease: Demographics, Clinical, and Neuropathological Features From a Large Autopsy Study.

Argyrophilic grain disease (AGD) is a frequent late-onset, 4-repeat tauopathy reported in Caucasians with high educational attainment. Little is known about AGD in non-Caucasians or in those with low educational attainment. We describe AGD demographics, clinical, and neuropathological features in a multiethnic cohort of 983 subjects ≥50 years of age from São Paulo, Brazil. Clinical data were collected through semistructured interviews with an informant and included in the Informant Questionnaire on Cognitive Decline in the Elderly, the Clinical Dementia Rating, and the Neuropsychiatric Inventory. Neuropathologic assessment relied on internationally accepted criteria. AGD was frequent (15.2%) and was the only neuropathological diagnosis in 8.9% of all cases (mean, 78.9 ± 9.4 years); it rarely occurred as an isolated neuropathological finding. AGD was associated with older age, lower socioeconomic status (SES), and appetite disorders. This is the first study of demographic, clinical, and neuropathological aspects of AGD in different ethnicities and subjects from all socioeconomic strata. The results suggest that prospective studies of AGD patients include levels of hormones related to appetite control as possible antemortem markers. Moreover, understanding the mechanisms behind higher susceptibility to AGD of low SES subjects may disclose novel environmental risk factors for AGD and other neurodegenerative diseases

Neuropathologic Correlates of Psychiatric Symptoms in Alzheimer's Disease.

Clarifying the relationships between neuropsychiatric symptoms and Alzheimer's disease (AD)-related pathology may open avenues for effective treatments. Here, we investigate the odds of developing neuropsychiatric symptoms across increasing burdens of neurofibrillary tangle and amyloid-β pathology. Participants who passed away between 2004 and 2014 underwent comprehensive neuropathologic evaluation at the Biobank for Aging Studies from the Faculty of Medicine at the University of São Paulo. Postmortem interviews with reliable informants were used to collect information regarding neuropsychiatric and cognitive status. Of 1,092 cases collected, those with any non-Alzheimer pathology were excluded, bringing the cohort to 455 cases. Braak staging was used to evaluate neurofibrillary tangle burden, and the CERAD neuropathology score was used to evaluate amyloid-β burden. The 12-item neuropsychiatric inventory was used to evaluate neuropsychiatric symptoms and CDR-SOB score was used to evaluate dementia status. In Braak I/II, significantly increased odds were detected for agitation, anxiety, appetite changes, depression, and sleep disturbances, compared to controls. Increased odds of agitation continue into Braak III/IV. Braak V/VI is associated with higher odds for delusions. No increased odds for neuropsychiatric symptoms were found to correlate with amyloid-β pathology. Increased odds of neuropsychiatric symptoms are associated with early neurofibrillary tangle pathology, suggesting that subcortical neurofibrillary tangle accumulation with minimal cortical pathology is sufficient to impact quality of life and that neuropsychiatric symptoms are a manifestation of AD biological processes

Locus coeruleus volume and cell population changes during Alzheimer's disease progression: A stereological study in human postmortem brains with potential implication for early-stage biomarker discovery.

IntroductionAlzheimer's disease (AD) progression follows a specific spreading pattern, emphasizing the need to characterize those brain areas that degenerate first. The brainstem's locus coeruleus (LC) is the first area to develop neurofibrillary changes (neurofibrillary tangles [NFTs]).MethodsThe methods include unbiased stereological analyses in human brainstems to estimate LC volume and neuronal population in controls and individuals across all AD stages.ResultsAs the Braak stage increases by 1 unit, the LC volume decreases by 8.4%. Neuronal loss started only midway through AD progression. Age-related changes spare the LC.DiscussionThe long gap between NFT accumulation and neuronal loss suggests that a second trigger may be necessary to induce neuronal death in AD. Imaging studies should determine whether LC volumetry can replicate the stage-wise atrophy observed here and how these changes are specific to AD. LC volumetry may develop into a screening biomarker for selecting high-yield candidates to undergo expensive and less accessible positron emission tomography scans and to monitor AD progression from presymptomatic stages