Influence of glycemic control on zinc urinary excretion in patients with type 1 diabetes

Univ Fed Sao Paulo, EPM, Dept Prevent Med, BR-04023900 Sao Paulo, BrazilUniv Fed Sao Paulo, Div Endocrinol, BR-04023900 Sao Paulo, BrazilUniv Sao Paulo, Fac Pharmaceut Sci, Dept Food & Expt Nutr, Sao Paulo, BrazilUniv Fed Rio Grande Norte, Dept Publ Hlth & Nutr, BR-59072970 Natal, RN, BrazilUniv Fed Sao Paulo, EPM, Dept Prevent Med, BR-04023900 Sao Paulo, BrazilUniv Fed Sao Paulo, Div Endocrinol, BR-04023900 Sao Paulo, BrazilWeb of Scienc

Frequency of metabolic syndrome and associated factors in institutionalized elderly individuals

Marcia Cristina Sales,1 Larissa Praça Oliveira,2 Laura Camila Pereira Liberalino,3 Aline Tuane Oliveira Cunha,2 Sara Estefani Soares Sousa,4 Telma Maria Araujo Moura Lemos,5 Severina Carla Vieira Cunha Lima,6 Kenio Costa Lima,7 Karine Cavalcanti Mauricio Sena-Evangelista,6 Lucia Fatima Campos Pedrosa61Postgraduate Program of Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; 2School of Nutrition, Potiguar University (Laureate International Universities), Natal, Rio Grande do Norte, Brazil; 3Department of Medicine, State University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; 4Postgraduate Program of Nutrition, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; 5Department of Clinical and Toxicological Analysis, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; 6Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; 7Department of Dentistry, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, BrazilIntroduction: Population aging generally accompanies an increase in chronic noncommunicable diseases, such as metabolic syndrome (MS). Nursing homes have provided a solution for the decreased ability of elderly individuals for self-care and familial difficulties in meeting the health care needs of elderly individuals.Purpose: The aim of the present study was to determine the frequency of MS and its associated factors in elderly individuals living in nursing homes.Patients and methods: This cross-sectional study was conducted with 202 institutionalized elderly individuals. MS was diagnosed according to the National Cholesterol Education Program – Adult Treatment Panel III criteria. Sociodemographic, clinical, and lifestyle factors were assessed to verify their association with MS by logistic regression.Results: The MS frequency was 29.2%. The most frequent MS components were low high-density lipoprotein cholesterol level (63.9%) and abdominal obesity (42.7%). Factors associated with MS were female sex (prevalence ratio [PR]=2.16; 95% CI, 1.04–4.49), age-adjusted institutionalization time >50% (PR=2.38, 95% CI, 1.46–3.88), and high concentrations of interleukin-6 (PR=2.01; 95% CI, 1.21–3.32) and tumor necrosis factor-α (PR=1.70; 95% CI, 1.05–2.77). Moreover, it was verified that the likelihood of having MS was 1.85-fold higher (95% CI, 1.11–3.10) in the group with a diet characterized by very high energy, very low fat, and high dietary fiber.Conclusion: The occurrence of MS in institutionalized elderly individuals was higher in females, and individuals with longer age-adjusted institutionalization time, higher concentrations of immunologic biomarkers, and a dietary intake consisting of higher energy and fiber and lower total fat. The results of the study are useful for guiding health care programs aimed at institutionalized elderly individuals.Keywords: chronic noncommunicable diseases, aging, nursing home, institutionalizatio

Efeitos da suplementação e da fortificação de alimentos sobre a biodisponibilidade de minerais Effects of supplementation and food fortification on mineral bioavailability

Estratégias de prevenção e combate a algumas deficiências nutricionais, como a anemia e a osteoporose, incluem a fortificação de alimentos e o uso de suplementação com minerais em populações de risco. Entretanto, interações com outros minerais podem ocorrer e comprometer o estado de saúde do indivíduo. Este artigo teve por objetivo rever algumas das interações que podem ocorrer entre minerais quando da suplementação ou fortificação de alimentos. A suplementação de cálcio parece estar relacionada a uma diminuição da absorção do zinco, fósforo e ferro. Por sua vez, o excesso de ferro pode comprometer a absorção e utilização do zinco, especialmente quando em formulações antianêmicas. Apesar dos resultados de alguns estudos serem controversos, a suplementação de minerais ou a fortificação de alimentos devem ser cuidadosas a fim de não ocasionar outras deficiências nutricionais.<br>Strategies for the prevention and control of some nutritional deficiencies, such as anemia and osteoporosis, include food fortification and the use of mineral supplements for at-risk populations. Nevertheless, interactions among minerals may occur and jeopardize the health status of subjects. The objective of this study was to review some possible interactions among minerals when supplementation and food fortification are used. Calcium supplements seem to be related to reduce zinc, phosphorus and iron absorption. In addition, iron excess can decrease zinc absorption and utilization, especially in antianemic formulas. Although several studies have shown controversial outcomes, mineral supplementation and food fortification must be carefully monitored, in order to avoid promoting other nutritional deficiencies

Educação em diabetes: papel e resultados das colônias de férias

Improving diabetes care is essential to preserve quality of life and longevity. The achievement of this goal depends on the diabetes education. Different health care centers have developed diabetes programmes based on regional characteristics and availability of resources. Our experience with educational summer camp (SC) for type 1 diabetic subjects is presented. The UNIFESP-ADJ SC aims to promote diabetes education at leisure with the participation of a multiprofessional team who has the opportunity to improve knowledge and skills in diabetes management. Seven-hundred-ninety subjects participated in 18 camps. The 9-day camp programme included adequate diet and exercise 3 times a day. Capillary glucose is monitored with appropriate insulin closes adjustments. The same questionnaire is applied at the beginning and end of the camping period in order to evaluate knowledge improvement in diabetes; they are invited to participate in educational daily meetings. Also the multiprofessional team meets every night for cases discussion. Anthropometric measurements, blood pressure, urine an blood samples are obtained. Individual recordings are provided to the respective families and physicians at the end of the camping period. The SCs have allowed diabetic subjects to recognize the possibility of a normal life. Improvement of knowledge in diabetes was confirmed by the comparison of questionnaires scores. They experienced the benefits of an adequate diet associated with exercise for glucose control and understood its importance to prevent long-term complications. Hypoglycemia occured more frequently, but they learned how to identify symptoms and to treat them. Blood pressure, plasma glucose and lipoproteins levels were reduced. The multiprofessional team recognized the role of diabetes education and developed skills to improve effectiveness of diabetes care. The complexity of diabetes treatment required the participation of the patient and its family in order to achieve metabolic control. Short-term benefits of diabetes education are seen by patients and their families. Assuming that metabolic control is necessary to prevent diabetic chronic complications, long-term benefits should be detected by the implementation of educational SCs for diabetic youngsters. The proposed modality of diabetes education in SCs showed to be reliable and effective, contributing to improve health of diabetic people and the quality of diabetes management. We concluded that such proposal should become more widespread.É essencial atuar na atenção ao indivíduo diabético, visando sua qualidade de vida e a longevidade. O sucesso desta meta depende da educação em diabetes (DM). Características regionais e disponibilidade de recursos fizeram com que centros de atenção ao DM criassem programas específicos de educação. Mostramos a experiência de educação de jovens com DM1 através de Colônias de Férias (CF) da UNIFESP-ADJ, mediante o convívio com equipe multiprofissional de saúde, que tem a oportunidade de adquirir experiência no manejo do DM. Um total de 790 jovens já participaram das 18 CF realizadas. Oferece-se 9 dias de lazer programado, com dieta adequada e exercícios nos 3 períodos do dia. Glicemia capilar é feita sobre a qual se baseiam ajustes nas doses de insulina. Questionário de avaliação de conhecimentos é aplicado no primeiro e último dias e ocorrem seminários abordando temas diversos. Reuniões da equipe visam discutir casos e condutas. São obtidas medidas antropométricas, pressão arterial e amostras de sangue e urina e relatórios fornecidos ao final. Para o jovem as CF representam oportunidade de conscientizar-se da possibilidade de uma vida normal. A melhora dos conhecimentos teóricos é comprovada pela comparação da pontuação obtida nos questionários. Observam os benefícios da alimentação adequada associada ao exercício e assimilam a importância do bom controle na prevenção de complicações crônicas. Vivenciam hipoglicemias, mas aprendem a programar suas doses segundo o exercício a ser realizado, identificar seus sintomas e tratá-la. Melhoram os níveis pressóricos, o controle glicêmico e o perfil lipídico. A equipe multiprofissional recebe subsídios para atuar com mais eficácia na educação do jovem e melhorar o relacionamento médico-paciente. As CF permitem reconhecer a complexidade do tratamento do DM e a necessidade de trabalho integrado com o paciente e sua família para a obtenção de bom controle metabólico. Assumindo-se que o controle metabólico é importante para a prevenção das complicações crônicas do DM, também a longo prazo benefícios da educação nas CF devem ser detectados. O modelo proposto de educação em DM através de CF se mostrou viável e eficaz, contribuindo para melhora da qualidade de vida do jovem diabético e formação de profissionais nesta área. Concluímos que esta proposta, já compartilhada por outros centros no Brasil, deva ser amplamente divulgada.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamentos de Medicina, Preventiva e de EnfermagemUNIFESP, EPM, Depto.s de Medicina, Preventiva e de EnfermagemSciEL