Estado antropométrico de pacientes pediátricos com doença inflamatória intestinal

Introdução: a Doença Inflamatória Intestinal (DII) é decorrente de vários fatores que provocam alteração na homeostase do microbioma na resposta imune e no aumento da permeabilidade intestinal. O estado nutricional inadequado, principalmente em pacientes pediátricos com DII, representa prognóstico ruim e pode influenciar na resposta ao tratamento, à morbidade e à mortalidade. Objetivo: esse estudo teve objetivo de caracterizar o estado antropométrico de pacientes pediátricos atendidos em um ambulatório referência para DII. Metodologia: a amostra foi constituída por pacientes atendidos em primeira consulta no ambulatório, de junho de 2020 até fevereiro de 2021. Foram incluídos pacientes com diagnóstico clínico de Doença de Cronh e Colite Ulcerativa, de ambos sexos, com idade entre 2 a 19 anos. Resultados: dos pacientes com CU, 54,7% apresentaram adequado estado nutricional e 45,3% dos pacientes com DC. O percentual de déficit de massa muscular foi de 47,6% dos pacientes com CU e 52,4% dos pacientes com DC.A baixa estatura foi de 37,5% nos pacientes com CU e 62,5% com DC. Conclusão: a avaliação nutricional de crianças e adolescentes portadores de doenças inflamatórias intestinais deve fazer parte da rotina de atendimento, para que sejam promovidas práticas alimentares saudáveis que favoreçam o crescimento, recuperação ponderal e manutenção de massa muscula

Exposição a dieta hiperlipídica no período perinatal e pós desmame aumenta risco cardiometabólico e altera histomorfometria aórtica em ratos jovens

Introdução: Estudos sugerem forte associação da exposição intrauterina e pós-natal a dietas hiperlipídicas e complicações cardiovasculares. Objetivo: avaliar efeitos da exposição a dieta hiperlipídica no período perinatal e pós desmame sobre indicadores de risco cardiometabólico e alterações histomorfometrica aórtica em ratos. Metodologia: Ratas Wistar gestantes foram separadas em grupos: controle (n=3) e hiperlipídica (n=3). No 21º dia descendentes foram divididos em subgrupos (n=6) de acordo com a manipulação nutricional: grupo (CC) formado por animais que consumiram dieta controle, grupo (CH) formado por animais que a mãe consumiu dieta controle e após o desmame os descendentes consumiram dieta hiperlipídica, grupo (HH) formado por descendentes que consumiram apenas dieta hiperlipídica  e grupo (HC) formado por animais que a mãe consumiu dieta hiperlipídica e após o desmame os descendentes consumiram dieta controle. No 60º dia índices aterogênicos, proteína C reativa e histomorfometria da aorta dos descendentes foram avaliados. Resultados: Grupo CH apresentou maior razão colesterol total / HDL-colesterol e colesterol não-HDL / HDL-colesterol (coeficiente aterogênico) em comparação ao grupo CC (p < 0,01). Espessura da aorta dos grupos CH e HH foram maiores que CC e HC (p < 0,01). As lamelas elásticas do grupo HH apresentaram maior espessura em comparação a HC e CC (p < 0,001). A quantidade de lamelas elásticas foi maior nos grupos CH e HH em comparação a CC e HC (p < 0, 01). Conclusão: exposição a dieta hiperlipídica nos períodos perinatal e pós desmame aumentou o risco cardiometabólico e alterou a histomorfometria aórtica em ratos

Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome: ABESO 2022

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.info:eu-repo/semantics/publishedVersio

Aspectos metodológicos e desafios da Coorte On-line Comportamento Alimentar e Saúde Mental (COCASa) de docentes e discentes universitários durante a pandemia da COVID-19

O distanciamento social adotado para controle da COVID-19 obrigou Instituições de Ensino Superior (IES) a aderirem a novas estratégias para realização das atividades acadêmicas e muitas pesquisas passaram a ser realizadas em ambientes virtuais. O objetivo deste artigo é descrever os aspectos metodológicos e principais desafios enfrentados para a execução do projeto COCASa, um estudo de coorte on-line sobre comportamento alimentar e saúde mental de docentes e discentes de IES do Brasil. O estudo foi iniciado em julho de 2020 e acompanhará os participantes por dois anos. Adotou-se amostragem não probabilística estratificada proporcional com a utilização de escalas, de inquérito alimentar e de questões estruturadas elaboradas pela equipe do projeto. Entre os participantes do baseline, 4.074 discentes e 2.210 docentes iniciaram o questionário e, respectivamente, 76,8% e 85,1% finalizaram o preenchimento. Em ambos os grupos, a maior participação foi de mulheres (docentes: 66,7% e discentes: 76,2%) e residentes nas regiões Nordeste (docentes: 37% e discentes: 50,9%) e Sul (docentes: 27,1% e discentes: 22,5%) do Brasil. A pesquisa on-line amplia a possibilidade de recrutamento de participantes e alcança limites territoriais com menor demanda por financiamento. Durante a pandemia da COVID-19, o uso do ambiente virtual tornou-se uma estratégia viável e acessível para a manutenção das atividades de pesquisa, configurando-se como uma provável tendência a ser adotada pela comunidade científica

Impactos na Saúde Associados ao Uso de Psicoestimulantes: Uma Revisão Sistemática

This article conducts a systematic review of health impacts associated with the use of psychostimulants, encompassing clinical and recreational contexts. The introduction emphasizes the relevance of the topic given the prevalence of these substances and the need to understand their comprehensive effects. The methodology employed involved an extensive literature search on platforms such as PubMed and Scopus, establishing clear inclusion/exclusion criteria, and applying rigorous assessment of the quality of selected studies. In the discussion, we explore the therapeutic benefits of these psychostimulants, highlighting their efficacy in treating conditions such as Attention-Deficit/Hyperactivity Disorder (ADHD). However, the analysis also covers physical and mental risks, especially when these substances are used outside the medical context, demonstrating associations with cardiovascular complications and psychiatric disorders. The crucial differentiation between therapeutic and recreational use is emphasized, underscoring the importance of an individualized assessment to understand the risks and benefits associated with each usage context. The conclusion emphasizes the need for clarity in communication about the use of psychostimulants, a careful evaluation of long-term impacts, and the implementation of public health strategies sensitive to social and cultural influences. This work contributes to a comprehensive understanding of health impacts related to psychostimulants, providing valuable insights for healthcare professionals, researchers, and policymakers in managing these substances in different contexts.Este artigo realiza uma revisão sistemática dos impactos na saúde associados ao uso de psicoestimulantes, abrangendo contextos clínicos e recreativos. A introdução destaca a relevância do tema diante da prevalência dessas substâncias e da necessidade de compreender seus efeitos abrangentes. A metodologia adotada envolveu uma busca bibliográfica extensiva em bases como PubMed e Scopus, estabelecendo critérios claros de inclusão/exclusão e aplicando uma avaliação rigorosa da qualidade dos estudos selecionados. Na discussão, exploramos os benefícios terapêuticos desses psicoestimulantes, evidenciando sua eficácia no tratamento de condições como o Transtorno de Déficit de Atenção e Hiperatividade (TDAH). Contudo, a análise abrange também os riscos físicos e mentais, especialmente quando essas substâncias são utilizadas fora do contexto médico, evidenciando a associação com complicações cardiovasculares e transtornos psiquiátricos. A diferenciação crucial entre o uso terapêutico e o recreativo é destacada, enfatizando a importância de uma avaliação individualizada para compreender os riscos e benefícios associados a cada contexto de uso. A conclusão ressalta a necessidade de clareza na comunicação sobre o uso de psicoestimulantes, uma avaliação cuidadosa dos impactos a longo prazo e a implementação de estratégias de saúde pública sensíveis às influências sociais e culturais. Este trabalho contribui para a compreensão abrangente dos impactos na saúde relacionados a psicoestimulantes, fornecendo insights valiosos para profissionais de saúde, pesquisadores e formuladores de políticas no manejo dessas substâncias em diferentes contextos

Estimating global injuries morbidity and mortality : methods and data used in the Global Burden of Disease 2017 study

Background While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.Peer reviewe

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.

BACKGROUND: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk-outcome associations. METHODS: We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017