Dieta habitual e fatores de risco para doenças cardiovasculares Habitual diet and cardiovascular disease risk factors

INTRODUÇÃO: Estudo descritivo por amostragem em munícípio do Estado de São Paulo, Brasil, em 1990, com objetivo de analisar, mediante entrevistas domiciliares, a dieta habitual e fatores de risco para doenças cardiovasculares em indivíduos maiores de 20 anos. METODOLOGIA: Foram entrevistados 557 indivíduos, de idade entre 20 e 88 anos, que fazem parte de subamostra de um estudo global na região. A dieta habitual, identificada pelo histórico alimentar foi comparada às recomendações da OMS e os fatores de risco estudados (obesidade, dislipidemias, diabetes melito) diagnosticados pelo Índice de Massa Corpórea e dosagens bioquímicas. RESULTADOS E CONCLUSÕES: Observou-se que 60% da população consome dieta com energia total abaixo da estimativa das necessidades e que a contribuição calórica dos carboidratos foi de 56%, dos lipídios de 29% e das proteínas de 15%. Entretanto, na análise por percentil, a contribuição calórica dos lipídios e das proteínas encontra-se muito acima dos padrões recomendados em detrimento dos carboidratos. A energia, distribuição calórica e quantidade de colesterol foi adequada em apenas 5% das dietas. Dentre os fatores de risco para doenças cardiovasculares estudados observou-se a prevalência de obesidade em 38% dos indivíduos, de dislipidemias em 26% e de diabetes melito em 5%. A atividade física leve preponderante com dieta inadequada, tanto em termos de qualitativos quanto quantitativos, agravam ainda mais esse quadro.<br>INTRODUCTION: A survey by sampling in a county of the State of S. Paulo in 1990 sought, by means of home interviews, to analyse the habitual diet and risk factors for cardiovascular disease of people over 20 years of age. METHODOLOGY: Of the sub-specimen of a comprehensive study population, 557 individuals, aged between 20 and 88, were interviewed. The habitual diet, characterized by the dietary history, was compared with the recommendations on energy and nutrients of the WHO and the risk factors (obesity, lipemic disorders and diabetes mellitus) diagnosed by the Body Mass Index and biochemical measurements. RESULTS AND CONCLUSION: It was observed that 60% of the population consume a diet with total energy below the estimated need and that the caloric contribution of carbohydrates was of 56%, of the lipids 29% and of the proteins 15%. However, by percentil analysis, the caloric contribuition of lipids and of proteins was far above the recommended levels to the detriment of the carbohydrates. Energy, caloric distribution and quantity of cholesterol were satisfactory in only 5% of diets. Among the risk factors for the cardiovascular disease studied, obesity was found to be present in 38% of individuals, lipemic disorders in 26% and diabetes mellitus in 5%. Preponderantly light physical activity together with unsatisfactory diet, both in qualitative as in quantitative terms, aggravated this scenario still further

Combination antiretroviral therapy and the risk of myocardial infarction

Background: It remains controversial whether exposure to combination antiretroviral treatment increases the risk of myocardial infarction. Methods: In this prospective observational study, we enrolled 23,468 patients from 11 previously established cohorts from December 1999 to April 2001 and collected follow-up data until February 2002. Data were collected on infection with the human immunodeficiency virus and on risk factors for and the incidence of myocardial infarction. Relative rates were calculated with Poisson regression models. Combination antiretroviral therapy was defined as any combination regimen of antiretroviral drugs that included a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor. Results: Over a period of 36,199 person-years, 126 patients had a myocardial infarction. The incidence of myocardial infarction increased with longer exposure to combination antiretroviral therapy (adjusted relative rate per year of exposure, 1.26 [95 percent confidence interval, 1.12 to 1.41]; P Conclusions: Combination antiretroviral therapy was independently associated with a 26 percent relative increase in the rate of myocardial infarction per year of exposure during the first four to six years of use. However, the absolute risk of myocardial infarction was low and must be balanced against the marked benefits from antiretroviral treatment

Association between antiretroviral exposure and renal impairment among HIV-positive persons with normal baseline renal function: the D:A:D study

BACKGROUND Several antiretroviral agents (ARVs) are associated with chronic renal impairment, but the extent of such adverse events among human immunodeficiency virus (HIV)-positive persons with initially normal renal function is unknown. METHODS D:A:D study participants with an estimated glomerular filtration rate (eGFR) of ≥ 90 mL/min after 1 January 2004 were followed until they had a confirmed eGFR of ≤ 70 mL/min (the threshold below which we hypothesized that renal interventions may begin to occur) or ≤ 60 mL/min (a value indicative of moderately severe chronic kidney disease [CKD]) or until the last eGFR measurement during follow-up. An eGFR was considered confirmed if it was detected at 2 consecutive measurements ≥ 3 months apart. Predictors and eGFR-related ARV discontinuations were identified using Poisson regression. RESULTS Of 22 603 persons, 468 (2.1%) experienced a confirmed eGFR of ≤ 70 mL/min (incidence rate, 4.78 cases/1000 person-years of follow-up [95% confidence interval {CI}, 4.35-5.22]) and 131 (0.6%) experienced CKD (incidence rate, 1.33 cases/1000 person-years of follow-up [95% CI, 1.10-1.56]) during a median follow-up duration of 4.5 years (interquartile range [IQR], 2.7-6.1 years). A current eGFR of 60-70 mL/min caused significantly higher rates of discontinuation of tenofovir (adjusted incidence rate ratio [aIRR], 1.72 [95% CI, 1.38-2.14]) but not other ARVs compared with a current eGFR of ≥ 90 mL/min. Cumulative tenofovir use (aIRR, 1.18/year [95% CI, 1.12-1.25]) and ritonavir-boosted atazanavir use (aIRR, 1.19/year [95% CI, 1.09-1.32]) were independent predictors of a confirmed eGFR of ≤ 70 but were not significant predictors of CKD whereas ritonavir-boosted lopinavir use was a significant predictor for both end points (aIRR, 1.11/year [95% CI, 1.05-1.17] and 1.22/year [95% CI, 1.16-1.28], respectively). Associations were unaffected by censoring for concomitant ARV use but diminished after discontinuation of these ARVs. CONCLUSIONS Tenofovir, ritonavir-boosted atazanavir, and ritonavir-boosted lopinavir use were independent predictors of chronic renal impairment in HIV-positive persons without preexisting renal impairment. Increased tenofovir discontinuation rates with decreasing eGFR may have prevented further deteriorations. After discontinuation, the ARV-associated incidence rates decreased