Ángulo de fase para el tamizaje del riesgo nutricional en pacientes cardiacos críticos

Introduction: The phase angle has been listed as a nutritional marker and its useful role in critically ill patients, but its role as a patient-to-patient tool has not yet been tested. This study sought to evaluate the phase angle as a proposal to determine nutritional risk in critically ill patients hospitalized in cardiac intensive care units. Methods: Transversal study, coupled to a prospective analysis variable (hospitalization outcome) and involving adult and elderly male and female patients in cardiac intensive care units. The nutritional risk was determined by using the NUTRICscore, the phase angle was obtained through bioelectrical impedance analysis and other data, through the clinical record. A significance level of p <0.05 was used for all statistical analysis. Results: 79 patients were included and resulted in homogeneous distribution among the sexes and an average age of 67.2 ± 13.7 years. Most of the sample had malnutrition according to the body mass index (BMI) (46.7%; CI: 36.0-57.8) and due to the adequacy of the arm circumference (40.8%; CI: 34.0-52.0). According to the NUTRIC score, 59.5% (CI: 48.5-69.3) had a high nutritional risk, and 68.4% (CI: 57.4-77.6) had a low phase angle (≤5.5 °). Correlation between the phase angle and age (p = 0.010) and BMI (p = 0.023) was verified. A good sensitivity (72%; CI: 55.6-81.9) and specificity (68%; CI: 42.5-77.5) of the low phase angle were obtained to detect nutritional risk by NUTRIC. Conclusions: The PhA had good results of sensitivity and specificity but should be used with caution to determine the nutritional risk in critically ill cardiac patients.Introducción: El ángulo de fase se ha catalogado como un marcador nutricional y su papel útil en pacientes críticos, pero aún no se ha probado su papel como herramienta de paciente a paciente. Este estudio buscó evaluar el ángulo de fase como propuesta para determinar el riesgo nutricional en pacientes críticos hospitalizados en unidades de cuidados intensivos cardíacos. Metodología: Estudio transversal, acoplado a una variable de análisis prospectivo (resultado de hospitalización);participaron pacientes adultos y adultos mayores del sexo masculino y femenino en unidades de cuidados intensivos cardíacos. El riesgo nutricional se determinó mediante el NUTRICscore, el ángulo de fase se obtuvo a través del análisis de impedancia bioeléctrica y otros datos, a través de la historia clínica. Se utilizó un nivel de significación de p <0,05 para todos los análisis estadísticos. Resultados: Se incluyeron 79 pacientes y resultó una distribución homogénea entre los sexos y una edad promedio de 67,2±13,7 años. La mayor parte de la muestra presentaba desnutrición según índice de masa corporal (IMC) (46.7%; CI: 36.0-57.8) y por adecuación del perímetro braquial (40,8%; CI: 34.0-52.0). De acuerdo con el puntaje NUTRIC, el 59,5% (CI: 48.5-69.3) tenía un riesgo nutricional alto y el 68,4% (CI: 57.4-77.6) tenía un ángulo de fase bajo (≤ 5,5°). Se verificó correlación entre el ángulo de fase y la edad (p = 0,010) y el IMC (p = 0,023). Se obtuvo una buena sensibilidad (72%; CI: 55.6-81.9) y especificidad (68%; CI: 42.5-77.5) del ángulo de fase bajo para detectar riesgo nutricional por NUTRIC. Conclusiones: El PhA tuvo buenos resultados de sensibilidad y especificidad, pero debe ser utilizado con precaución para determinar el riesgo nutricional en pacientes cardíacos críticos

PRÉ-NATAL ODONTOLÓGICO: SAÚDE BUCAL NA GESTANTE

The difficulties related to access to dental care during prenatal care have become obstacles that need to be demystified so that the question of oral health of pregnant women is prioritized, aiming to maintain a service of continuous care, focusing on health education reaffirming and improving the knowledge of both mothers and the multidisciplinary team that accompanies them. The objective of this study was to conduct this integrative review in order to understand the main factors that lead pregnant women not to adhere to treatment and the qualification of the team that provides care to pregnant women, in which the descriptors applied included: oral health, prenatal care and pregnancy. For the searches of the studies, the databases used were the Latin American and Caribbean Database on Health Sciences (LILACS), the Nursing Database (BDENF). The results were presented in tables and discussed in exhibitions of available literature related to the subject in thesis. It was found that there is a lack of dialogue between professionals, which causes failure in the care of pregnant women, from basic information about dental prenatal care to the care itself, emphasizing how much this can induce pregnant women to stop performing dental treatment during pregnancy.Las dificultades relacionadas con el acceso a la atención odontológica durante la atención prenatal se han convertido en obstáculos que necesitan ser desmitificados para priorizar la cuestión de la salud bucal de las gestantes, con el objetivo de mantener un servicio de atención continua, centrándose en la educación para la salud reafirmando y mejorando el conocimiento tanto de las madres como del equipo multidisciplinario que las acompaña. El objetivo de este estudio fue realizar esta revisión integradora con el fin de comprender los principales factores que llevan a las gestantes a no adherirse al tratamiento y la calificación del equipo que brinda atención a las embarazadas, en el que los descriptores aplicados incluyeron: salud bucal, atención prenatal y embarazo. Para las búsquedas de los estudios, las bases de datos utilizadas fueron la Base de Datos Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), la Base de Datos de Enfermería (BDENF). Los resultados fueron presentados en tablas y discutidos en exposiciones de literatura disponible relacionada con el tema en tesis. Se encontró que hay una falta de diálogo entre los profesionales, lo que causa fracaso en el cuidado de las embarazadas, desde la información básica sobre la atención prenatal dental hasta la atención propiamente dicha, enfatizando cuánto puede inducir a las gestantes a dejar de realizar el tratamiento dental durante el embarazo.As dificuldades relacionadas ao acesso a assistência odontológica durante o pré-natal tornaram-se obstáculos que necessitam ser desmitificados para que o quesito da saúde bucal da gestante seja priorizado, visando manter um serviço de atenção continuada, focando na educação em saúde reafirmando e melhorando os conhecimentos, tanto das mães como da equipe multiprofissional que a acompanha. Objetivou-se a realização desse estudo do tipo de revisão integrativa, com o intuito de compreender os principais fatores que levam as gestantes a não aderirem ao tratamento e a qualificação da equipe que presta atendimento a gestante, no qual os descritores aplicados incluíram:  saúde bucal, cuidado pré-natal e gravidez. Para as buscas dos estudos, as bases de dados utilizadas foram Base de Dados Latino-Americana e do Caribe em Ciências da saúde (LILACS), Base de Dados de Enfermagem (BDENF). Os resultados foram expostos em tabelas e discutidos em exposições de literaturas disponíveis relativas ao assunto em tese. Constatou-se haver carência na relação do diálogo entre os profissionais, o que ocasiona falha na atenção à gestante, desde as informações básicas sobre pré-natal odontológico até o atendimento em si, enfatizando o quanto isso pode induzir as gestantes a deixarem de realizar o tratamento odontológico durante a gravidez.As dificuldades relacionadas ao acesso a assistência odontológica durante o pré-natal tornaram-se obstáculos que necessitam ser desmitificados para que o quesito da saúde bucal da gestante seja priorizado, visando manter um serviço de atenção continuada, focando na educação em saúde reafirmando e melhorando os conhecimentos, tanto das mães como da equipe multiprofissional que a acompanha. Objetivou-se a realização desse estudo do tipo de revisão integrativa, com o intuito de compreender os principais fatores que levam as gestantes a não aderirem ao tratamento e a qualificação da equipe que presta atendimento a gestante, no qual os descritores aplicados incluíram:  saúde bucal, cuidado pré-natal e gravidez. Para as buscas dos estudos, as bases de dados utilizadas foram Base de Dados Latino-Americana e do Caribe em Ciências da saúde (LILACS), Base de Dados de Enfermagem (BDENF). Os resultados foram expostos em tabelas e discutidos em exposições de literaturas disponíveis relativas ao assunto em tese. Constatou-se haver carência na relação do diálogo entre os profissionais, o que ocasiona falha na atenção à gestante, desde as informações básicas sobre pré-natal odontológico até o atendimento em si, enfatizando o quanto isso pode induzir as gestantes a deixarem de realizar o tratamento odontológico durante a gravidez

Waist circumference measurement sites and their association with visceral and subcutaneous fat and cardiometabolic abnormalities

ABSTRACT Objectives: To estimate the degree of variability of the waist circumference (WC) when obtained in different anatomical sites and compare the performance of the measurement sites as predictors of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and cardiometabolic abnormalities. Subjects and methods: Cross-sectional study involving 119 individuals with overweight (50.3 ± 12.2 years), in which six WC measurement sites were evaluated (minimal waist, immediately below the lowest rib, midpoint between the lowest rib and the iliac crest, 2 cm above the umbilicus, immediately above the iliac crest, umbilicus level), in addition to the VAT and SAT (quantified by computed tomography) and cardiometabolic parameters. Results: The differences between the measurements ranged from 0.2 ± 2.7 cm to 6.9 ± 6.7 cm for men, and from 0.1 ± 3.7 cm to 10.1 ± 4.3 cm for women. The minimum waist showed significant correlation with VAT (r = 0.70) and with a higher number of cardiometabolic parameters among men. Regarding women, the WC measurement showed high correlation with SAT and moderate correlation with VAT, not being found superiority of one measurement protocol in relation to the others when assessed the correlation with VAT and with cardiometabolic parameters. Conclusions: Greater variability between the measuring sites was observed among women. With respect to men, the minimum waist performed better as a predictor of VAT and cardiometabolic alterations

Predictive models for estimating visceral fat: The contribution from anthropometric parameters

<div><p>Background</p><p>Excessive adipose visceral tissue (AVT) represents an independent risk factor for cardiometabolic alterations. The search continues for a highly valid marker for estimating visceral adiposity that is a simple and low cost tool able to screen individuals who are highly at risk of being viscerally obese. The aim of this study was to develop a predictive model for estimating AVT volume using anthropometric parameters.</p><p>Objective</p><p>Excessive adipose visceral tissue (AVT) represents an independent risk factor for cardiometabolic alterations. The search continues for a highly valid marker for estimating visceral adiposity that is a simple and low cost tool able to screen individuals who are highly at risk of being viscerally obese. The aim of this study was to develop a predictive model for estimating AVT volume using anthropometric parameters.</p><p>Methods</p><p>A cross-sectional study involving overweight individuals whose AVT was evaluated (using computed tomography–CT), along with the following anthropometric parameters: body mass index (BMI), abdominal circumference (AC), waist-to-hip ratio (WHpR), waist-to-height ratio (WHtR), sagittal diameter (SD), conicity index (CI), neck circumference (NC), neck-to-thigh ratio (NTR), waist-to-thigh ratio (WTR), and body adiposity index (BAI).</p><p>Results</p><p>109 individuals with an average age of 50.3±12.2 were evaluated. The predictive equation developed to estimate AVT in men was AVT = -1647.75 +2.43(AC) +594.74(WHpR) +883.40(CI) (R² adjusted: 64.1%). For women, the model chosen was: AVT = -634.73 +1.49(Age) +8.34(SD) + 291.51(CI) + 6.92(NC) (R² adjusted: 40.4%). The predictive ability of the equations developed in relation to AVT volume determined by CT was 66.9% and 46.2% for males and females, respectively (p<0.001).</p><p>Conclusions</p><p>A quick and precise AVT estimate, especially for men, can be obtained using only AC, WHpR, and CI for men, and age, SD, CI, and NC for women. These equations can be used as a clinical and epidemiological tool for overweight individuals.</p></div

Simple linear regression between adipose visceral tissue (AVT) volume determined by the predictive equation and AVT volume obtained using computed tomography (CT) in adult overweight women (p<0.001).

<p>Simple linear regression between adipose visceral tissue (AVT) volume determined by the predictive equation and AVT volume obtained using computed tomography (CT) in adult overweight women (p<0.001).</p

Multiple linear regression coefficients of predicative equations (eq.) for estimating adipose visceral tissue (AVT) in overweight individuals.

<p>Multiple linear regression coefficients of predicative equations (eq.) for estimating adipose visceral tissue (AVT) in overweight individuals.</p

Comparability of the characteristics of the patients included in the study in accordance with sex.

<p>Comparability of the characteristics of the patients included in the study in accordance with sex.</p

Distribution of anthropometric parameters (Mean/Standard Deviation) in accordance with sex.

<p>Distribution of anthropometric parameters (Mean/Standard Deviation) in accordance with sex.</p

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