Lack of Association Between Dietary Inflammatory Index and Low Impact Fractures in the Brazilian Population: the Brazilian Osteoporosis Study (BRAZOS)

Introduction: Adequate nutrition, including intake of dietary calcium and vitamin D, is important to maintain bone health. Evidence suggests that a deficiency in micronutrients may contribute to bone loss during aging and exert generalized effects on chronic inflammation. Recently, the Dietary Inflammatory Index (DII) was developed to assess the inflammatory potential of individual diets. Our aim was to evaluate the DII in a representative sample and verify its association with low-impact fractures. Methods: Individuals from The Brazilian Osteoporosis Study (BRAZOS) database had their DII calculated. BRAZOS is an important cross-sectional epidemiological study carried out with a representative sample of men and women ≥40 years old. The research was conducted through in-home interviews administered by a trained team. Nutrition Database System for Research (NDSR) software was used to analyze data on the intake of nutrients, which were employed to calculate the DII using Statistical Analysis Software (SAS®) and Statistical Package for the Social Sciences (SPSS®) to assess its association with low-impact fractures. Results: A total of 2269 subjects had their DII score calculated using information from 24-h recall data. Males had lower DII than females (DII = 1.12 ± 1.04 vs DII = 1.24 ± 0.99, p = 0.012). Women taking statins had lower DII (DII = 0.65 ± 1.14 vs DII + 1.26 ± 0.98, p = 0.002), indicating a greater potential for diet-related anti-inflammatory effects. Conclusion: Our findings suggest that women might have a pro-inflammatory diet pattern compared to men. However, we did not find any association between DII scores and low-impact fractures

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Dietary intake and bone mineral metabolism in elderly women with sarcopenia

Introdução a redução da massa muscular esquelética relacionada à idade, denominada sarcopenia, está associada com maior incidência de quedas, fraturas e dependência funcional em idosos. Muitos são os fatores que podem contribuir para o surgimento da sarcopenia, dentre eles a deficiência de vitamina D e a inadequação do consumo alimentar, principalmente a ingestão de proteína. Objetivos investigar a relação da sarcopenia com o consumo alimentar e concentração sérica de 25(OH)D. Métodos Foram avaliadas 200 mulheres acima de 65 anos, sendo 35 com sarcopenia e 165 sem sarcopenia. Avaliou-se a densidade mineral óssea (DMO) da coluna lombar, fêmur proximal e a composição corporal (massa muscular total, massa muscular esquelética, massa adiposa, conteúdo mineral ósseo do corpo total) por meio do densitômetro de dupla emissão com fonte de raios-X (DXA), avaliação radiográfica das colunas dorsal e lombar (T4 a L4). Foi realizada também avaliação da ingestão alimentar (diário de três dias), bioquímica do metabolismo mineral e ósseo (cálcio total, fósforo, creatinina, albumina, paratormônio intacto, calcidiol) e a história clínica das pacientes. Resultados O presente estudo observou que as pacientes que apresentavam um consumo de proteína acima de 1,2g/kg/dia apresentaram massa muscular total [33,94 (4,72) vs 31,87 (3,52) kg, p=0,020], massa muscular esquelética [14,54 (2,38) vs 13,38 (1,95) kg, p=0,013], CMO do corpo total [1,945 (0,325) vs 1784 (0,265) g, p=0,005], DMO de corpo total [1,039 (0,109) vs 0,988 (0,090) g/cm2, p=0,011], DMO coluna lombar [0,983 (0,192) vs 0,903 (0,131) g/cm2, p=0,014], DMO colo de fêmur [0,813 (0,117) vs 0,760 (0,944) g/cm2, p=0,017] e DMO fêmur total [0,868 (0,135) vs 0,807 (0,116) g/cm2, p=0,026] significativamente maior quando comparado com pacientes que apresentavam consumo de proteína abaixo de 0,8g/kg/dia. Além disso, a ingestão de aminoácidos essenciais, principalmente os de cadeia ramificada como a valina [3,10 (0,89) vs 3,40 (1,04) g/dia, p=0,044] foi significantemente menor em mulheres com sarcopenia. O consumo de proteína se correlacionou positivamente com o índice de massa muscular esquelética (r=0,157; p=0,028) e a DMO do trocânter (r=0,185; p=0,010). Adicionalmente, a deficiência de vitamina D associados ao PTH elevado (> 65pg/dL), hiperparatiroidismo secundário, a prevalência de sarcopenia aumentada (77,1 vs 22,9%, p=0,032), além disso mulheres com hiperparatiroidismo secundário apresentaram massa muscular total [29,70 ( 2,99) vs 31,84 (3,65), p=0,043], índice de massa muscular esquelética [5,51 (0,55) vs 5,92 (0,78), p=0,043] significativamente menor. Alta prevalência de deficiência de vitamina D em mulheres com sarcopenia (71,4%). As mulheres com deficiência de vitamina D apresentaram massa muscular total [30,30 (2,92) vs 32,14 (3,84) kg, p=0,007], massa muscular esquelética apendicular [12,71 (1,59) vs 13,55 (0,82) kg, p=0,031]; índice de massa muscular esquelética [5,67 ( 0,60) vs 5,98 (0,82) kg/m2, p=0,030] e fêmur total BMD [0,791 (0,107) vs 0,838 (0,116) g/cm2, p=0,035] significativamente menor. Conclusões - A ingestão de proteínas acima 1,2g/kg/d, especialmente aminoácidos essenciais e suplementação de vitamina D deve ser considerada como terapia preventiva na redução da massa muscular e óssea em mulheres idosasIntroduction - Reduction of skeletal muscle mass, called sarcopenia, is associated with increased incidence of falls, fractures and functional dependence in the elderly. There are many factors that can contribute to the development of sarcopenia, among them the vitamin D deficiency and inadequate food intake, especially protein intake. Objectives - to investigate the relationship among sarcopenia, dietary intake and serum concentration of 25(OH)D. Methods - We evaluated 200 women over 65 years, 35 with sarcopenia and 165 without sarcopenia. Bone mineral density of lumbar spine, proximal femur and body composition (total muscle mass, skeletal muscle mass, fat mass, bone mineral content of the whole body) were assessed by Dual energy X-ray absorptiometry (DXA), radiological evaluation of the dorsal columns and lumbar (T4 to L4). Three-day dietary records were undertaken to estimate dietary intake and serum total albumin, calcium, phosphorus, creatinin, intact parathyroid hormone, 25(OH)D were measured. Results - Patients who presented protein intake above 1.2g/kg/day showed total muscle mass [33.94 (4.72) vs 31.87 (3.52) kg, p=0.020], muscle mass skeletal [14.54 (2.38) vs 13.38 (1.95) kg, p=0.013], total body BMC [1.945 (0.325) vs 1784 (0.265) g, p=0.005], total body BMD [1.039 (0.109) vs 0.988 (0.090) g/cm2, p=0.011], lumbar spine BMD [0.983 (0.192) vs 0.903 (0.131) g/cm2, p=0.014], femoral neck BMD [0.813 (0.117) vs 0.760 (0.944) g/cm2, p=0.017] and total femur BMD [0.868 (0.135) vs 0.807 (0.116) g/cm2, p=0.026] significantly higher when compared with patients who presented protein intake below 0.8g/kg/day. Essential amino acids intake, especially branched chain such as valine [3.10 (0.89) vs 3.40 (1.04) g/day, p=0.044] was significantly lower in women with sarcopenia. Protein intake positively correlated to skeletal muscle mass index (r=0.157, p=0.028) and trochanter BMD (r=0.185, p=0.010). Additionaly, presence of sarcopenia increases more than 20% when vitamin D deficiency is associated to PTH levels higher than 65pg/dL (77.1 vs 22.9%; p=0.032). Women with secondary hyperparathyroidism presented significantly lower total muscle mass [29.70 (2.99) vs 31.84 (3.65); p=0.043], SMMI [5.51 (0.55) vs 5.92 (0.78); p=0.043]. it was also observed high prevalence of vitamin D deficiency in women with sarcopenia (71.4%). Women with deficiency of vitamin D presented significantly lower TSMM [30.30 (2.92) vs 32.14 (3.84) kg; p=0.007], ASMM [12.71 (1.59) vs 13.55 (0.82) kg; p=0.031]; SMMI [5.67 (0.60) vs 5.98 (0.82) kg/m2; p=0.030] and total femur BMD [0.791 (0.107) vs 0.838 (0.116) g/cm2; p=0.035]. Conclusions Protein intake above 1.2g/kg/d, particularly essencial amino acids and vitamin D supplementation should be considered as preventive therapy in reducing muscle and bone mass in elderly wome

Dietary Protein Intake in Elderly Women: Association With Muscle and Bone Mass

Background: An inadequate food intake, mainly with regard to protein intake, seems to contribute to a reduction of skeletal muscle and bone mass in the elderly. This study was undertaken to evaluate differences in protein intake in women with or without sarcopenia and verify the intake level that is related to a better bone and muscle mass. Methods: Elderly women older than 65 years with sarcopenia (n = 35) and without sarcopenia (n = 165) participated in the study. Assessment of bone mineral density of the lumbar spine and femur was taken, body composition was evaluated by dual-energy x-ray absorptiometry, and an evaluation of protein intake was performed through 3-day dietary records. Results: Muscle, bone, and fat mass was significantly higher in women who had protein intake > 1.2 g/kg/d. A lower intake of essential amino acids in women with sarcopenia was also observed. Protein and energy intake were significant predictors of muscle mass. the presence of osteoporosis was a predictor of muscle strength. in conclusion, the present study demonstrated that in elderly women, an adequate protein intake in terms of quality and quantity, without need of supplementation, could have a positive impact on bone mineral density, lean mass, and skeletal muscle mass.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ São Paulo, Sch Publ Hlth, Dept Nutr, BR-01246904 São Paulo, SP, BrazilUniversidade Federal de São Paulo, Rheumatol Div, São Paulo, BrazilUniversidade Federal de São Paulo, Rheumatol Div, São Paulo, BrazilFAPESP: 03/06238-7FAPESP: 03/10314-0CNPq: 470862/2009-2Web of Scienc

Relationship between nutrient intake and vitamin D status in osteoporotic women

Vitamin D is essential for maintaining calcium homeostasis and optimizing bone health. Its inadequacy is related to many factors including dietary intake. the aim of the present study was to evaluate serum 25(OH)D and its relationship with nutrient intakes in postmenopausal Brazilian women with osteoporosis. This cross-sectional study comprised 45 free-living and assisted elderly at São Paulo Hospital. Three-day dietary records were used to assess dietary intakes. Bone mineral density was measured with a dual-energy X-ray absorptiometer (DXA). Blood and urine sample were collected for analysis of biochemical markers of bone and mineral metabolism. Insufficiency of vitamin D was observed in 24.4% of the women and optimal levels (>= 50 nmol/L) were observed in 75.6%. Parathyroid hormone was above the reference range in 51% of the participants. the mean calcium (724 mg/day) and vitamin D (4.2 mu g/day) intakes were lower than the value proposed by the Food and Nutrition Board and sodium intake was more than two-fold above the recommendation. Higher levels of serum 25(OH)D were inversely associated with sodium intake. Dietary strategies to improve serum vitamin D must focus on increasing vitamin D intake and should take a reduction of sodium intake into consideration.Univ São Paulo, Sch Publ Hlth, Dept Nutr, BR-01246904 São Paulo, BrazilUniversidade Federal de São Paulo, Div Rheumatol, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Div Rheumatol, BR-04023900 São Paulo, BrazilWeb of Scienc

O impacto da osteoporose no Brasil: dados regionais das fraturas em homens e mulheres adultos - The Brazilian Osteoporosis Study (BRAZOS)

Objectives: The BRAZOS (The Brazilian Osteoporosis Study) study is the first epidemiological and population-based study carried out in a representative sample of Brazilian men and women, 40 years or older, with the objective of identifying the prevalence and main clinical risk factors (CRF) associated with low-impact fractures. This report shows the main results according to each region of the country. Patients and Methods: A total of 2,420 subjects (70% women) from 150 different cities in five geographic regions in Brazil, and from all different socio-economical classes were included in this study. Anthropometrical data, as well life style, previous fractures, nutritional status, physical activity, falls, and quality of life were evaluated by a quantitative individual survey. Low-impact fracture was defined as that resulting from a fall no greater than standing height of an individual. A P < 0.05 was considered significant. Results: Statistically significant differences in the prevalence of fractures among the five Brazilian regions according to gender or social class were not observed. However, in women, a higher incidence of fractures was observed in metropolitan areas than in rural areas, and a tendency for a higher frequency of fractures was observed in men from Northeastern states. Statistically significant differences among men from metropolitan areas or rural areas were not observed. Conclusions: Significant differences in the prevalence of low-impact fractures among the five different regions of Brazil were not observed, as well as its frequency or relevance of risk factors.Wyeth Consumer HealthcareUniv Fed Sao Paulo EPM, Disciplina Reumatol, Sao Paulo, BrazilUniv Sao Paulo, Fac Saude Publ, Dept Nutr, BR-05508 Sao Paulo, BrazilUnifesp EPM, Ctr Paulista Econ Saude, Sao Paulo, BrazilUniv Fed Sao Paulo EPM, Disciplina Reumatol, Sao Paulo, BrazilUnifesp EPM, Ctr Paulista Econ Saude, Sao Paulo, BrazilWeb of Scienc

Effective immunotherapy against canine visceral leishmaniasis with the FML-vaccine.

The potential effect of the fucose mannose ligand (FML)-vaccine on immunotherapy of canine visceral leishmaniasis was assayed on five mongrel dogs experimentally infected withLeishmania donovani and on 21 Leishmania chagasi naturally infected dogs when seropositive to FML but completely asymptomatic. The clinical signs of the experimentally infected, symptomatic dogs only disappeared after the complete vaccination. Protection was obtained in 3/5 animals that remained asymptomatic, IDR positive and parasite free, 1 year after infection. Furthermore, the asymptomatic, FML-vaccine treated dogs showed stable anti-FML IgG1 levels, increasing IgG2 levels and 79–95% of positive DTH response, during the whole experiment. Twenty-two months after complete vaccination, no obits due to visceral leishmaniasis were recorded and 90% of these dogs were still asymptomatic, healthy and parasite free. On the other hand, 37% (17/46 dogs) kala-azar obits were recorded in a control group that received no treatment during the same period, and that was FML-seropositive and asymtpomatic at the beginning of the assay. Our results indicate that the FML-vaccine was effective in the immunotherapy against visceral leishmaniasis of asymptomatic infected dogs. Normal proportions of CD4 and CD21 lymphocytes were detected in PBMC by FACS analysis, in dogs submitted to immunotherapy, suggesting their non-infectious condition. All animals showed as well significantly increased percents of CD8 lymphocytes as expected for Quillajasaponin (QuilA) vaccine treatments

Effective immunotherapy against canine visceral leishmaniasis with the FML-vaccine.

The potential effect of the fucose mannose ligand (FML)-vaccine on immunotherapy of canine visceral leishmaniasis was assayed on five mongrel dogs experimentally infected withLeishmania donovani and on 21 Leishmania chagasi naturally infected dogs when seropositive to FML but completely asymptomatic. The clinical signs of the experimentally infected, symptomatic dogs only disappeared after the complete vaccination. Protection was obtained in 3/5 animals that remained asymptomatic, IDR positive and parasite free, 1 year after infection. Furthermore, the asymptomatic, FML-vaccine treated dogs showed stable anti-FML IgG1 levels, increasing IgG2 levels and 79?95% of positive DTH response, during the whole experiment. Twenty-two months after complete vaccination, no obits due to visceral leishmaniasis were recorded and 90% of these dogs were still asymptomatic, healthy and parasite free. On the other hand, 37% (17/46 dogs) kala-azar obits were recorded in a control group that received no treatment during the same period, and that was FML-seropositive and asymtpomatic at the beginning of the assay. Our results indicate that the FML-vaccine was effective in the immunotherapy against visceral leishmaniasis of asymptomatic infected dogs. Normal proportions of CD4 and CD21 lymphocytes were detected in PBMC by FACS analysis, in dogs submitted to immunotherapy, suggesting their non-infectious condition. All animals showed as well significantly increased percents of CD8 lymphocytes as expected for Quillajasaponin (QuilA) vaccine treatments