Nutritional status and use of drugs by elders

O aumento da freqüência das doenças crônico-degenerativas associadas ao envelhecimento implica, muitas vezes, no uso contínuo de fármacos. Paralelamente, os idosos são mais propensos a alterações nutricionais, devido a distintos fatores. De acordo com a literatura, as alterações nutricionais com influência potencial no efeito de um maior número de fármacos são as mudanças na concentração de proteínas plasmáticas -hipoalbuminemia e alterações na α-glicoproteína ácida e na composição corporal. Tais alterações podem modificar os efeitos de agentes sedativos, cardiovasculares, diuréticos, entre outros. A consideração desses aspectos é fundamental para melhorar o uso de medicamentos entre idosos.The frequency increase of chronic degenerative diseases associated with elderly usually implies the continuous use of medicines. Elders are more prone to nutritional changes as a function of different factors. According to the literature, the nutritional changes with potential influence in the effect of most drugs are the modification in the concentration of plasmatic proteins -hypoalbuminemia and acid α-1-glycoprotein-, and in the body composition. Such alterations may modify the effects of sedative, cardiovascular agents, anticonvulsives, and diuretics, among others. Consideration of these aspects is a basic condition to improve the use of medicines among elderly people.Colegio de Farmacéuticos de la Provincia de Buenos Aire

Determinantes sociodemográficos, antropométricos e alimentares de dislipidemia em pré-escolares

OBJETIVO: O objetivo deste estudo foi investigar os determinantes de dislipidemia em pré-escolares. MÉTODOS: A partir de um desenho transversal, foi avaliado um total de 227 pré-escolares com 5 anos de idade residentes em uma área urbana da cidade de Diamantina, Minas Gerais, Brasil. Foram avaliados: variáveis bioquímicas, antropométricas, condição socioeconômica e comportamental, a partir de um questinário; e ingestão alimentar, a partir de um questionário de fequência de consumo de alimentos. Os padrões alimentares denominados "dieta mista", "fast food" e "não saudável" foram identificados por meio de análise de componentes principais. Os determinantes de dislipidemia foram examinados através da análise de regressão de Poisson. RESULTADOS: A prevalência de dislipidemia, neste estudo, foi de 65,19%. Os pré-escolares que consumiam com menos frequência alimentos do padrão "dieta mista" tiveram um risco maior de concentrações mais altas de lipoproteína de baixa densidade (PR = 2,30; p = 0,004), em comparação com aqueles com um consumo mais frequente do padrão "dieta mista". Os pré-escolares cujas mães apresentaram uma escolaridade mais baixa tiveram menor risco de concentrações mais altas de lipoproteína de baixa densidade (PR = 0,43; p = 0,003), e os pré-escolares que estavam com sobrepeso/obesos apresentaram maior risco de concentrações mais altas de lipoproteína de baixa densidade (PR = 2,23; p = 0,003). CONCLUSÃO: Os determinantes de dislipidemia identificados neste estudo foram o consumo menos frequente de alimentos do padrão "dieta mista", índice de massa corporal mais alto e um maior nível de escolaridade materna. Este estudo mostra que, apesar da baixa idade do grupo em estudo, já estão apresentando alta prevalência de dislipidemia, que é um fator de risco importante para doença cardiovascular

Sociodemographic, anthropometric and dietary determinants of dyslipidemia in preschoolers

Objective: To investigate the determinants of dyslipidemia in preschoolers. Methods: A total of 227 preschoolers residing in an urban area of the city of Diamantina, Minas Gerais, Brazil were evaluated at age 5 years, using a cross-sectional design. Dietary intake from a food frequency questionnaire, anthropometric/biochemical parameters, and socioeconomic/behavioral information from a questionnaire were evaluated. ‘Mixed diet’, ‘snack’, and ‘unhealthy’ dietary patterns were identified using principal component analysis. The determinants of dyslipidemia were examined using Poisson regression analysis. Results: The prevalence of dyslipidemia in this study was 65.19%. Preschoolers who less frequently consumed foods in the ‘mixed diet’ dietary pattern had a higher risk of high concentrations of low-density lipoprotein cholesterol (PR = 2.30; p = 0.004) when compared with those with more frequent consumption of the ‘mixed diet’ dietary pattern. Preschoolers whose mothers had lower levels of education presented a lower risk of high concentrations of low-density lipoprotein cholesterol (PR = 0.43; p = 0.003), and preschoolers who were overweight/obese presented with greater risk of high concentrations of low-density lipoprotein cholesterol (PR = 2.23; p = 0.003). Conclusion: The determinants of dyslipidemia identified in this study were less frequent consumption of foods in the ‘mixed diet’ dietary pattern, higher body mass index, and higher level of maternal education. This study shows that despite the young age of the group under study, they already present a high prevalence of dyslipidemia, which is an important risk factor for cardiovascular disease

Growth of preschool children was improved when fed an iron-fortified fermented milk beverage supplemented with Lactobacillus acidophilus

Food fortification is an efficient strategy applied to overcome iron deficiency anemia. This study investigated the effect of iron fortification with probiotic bacteria in a milk beverage on growth and iron status of preschool children with a usually low–bioavailable-iron diet intake. The fermented milk beverage was fortified with iron amino acid chelate (3 mg iron per 80 mL) and supplemented with Lactobacillus acidophilus (test) or not (control). The beverage was fed to 190 children aged 2 to 5 years for a duration of 101 days. Anthropometric, hematologic, and nutritional assessments were carried out before and after the intervention. The levels of red blood cells, hemoglobin, and hematocrit decreased (P < .001) in both groups (test and control) but remained within the reference range. The children fed the probiotic milk beverage exhibited higher red blood cell status and a positive correlation between iron intake and hemoglobin. An increased serum ferritin level was observed in the control group (P < .001). Nutritional status was improved after intervention in both groups by comparing the indices of weight for age and height for age. However, no difference was observed in the weight for height index in these groups. Energy and nutrient intake increased (P < .001) with intervention, and the prevalence of inadequacy was reduced. The fortified beverage contributed to improved nutrient intake and nutritional status of the preschool children. The higher demand and mobilization of nutrients to offset growth may have contributed to maintain blood parameters at borderline levels

Fatty acid composition of mature breast milk in Brazilian women

This work analyzed the fatty acid composition of mature milk samples, weekly obtained from eight Brazilian women between the 4th and 13th lactation weeks. A questionnaire was weekly applied to observe their eating habits. Saturated fatty acids constituted 39.7% of the total fatty acids. De novo fatty acids and long chain saturated fatty acids presented levels of 15.9% and 23.8%, respectively. trans-Fatty acid content was very low (2.36%). Unsaturated fatty acids constituted 50.9% of the total fatty acids, with over half being monounsaturated fatty acids (27.6%). Polyunsaturated fatty acids showed levels of 23.3%, with high linoleic and α-linolenic acid contents (20.3% and 1.43%, respectively). Arachidonic acid had a content of 0.53%, while docosahexaenoic acid content was 0.14%, values considered adequate for the needs of breast-fed infants

Avaliação dietética dos pacientes detectados com hiperglicemia na "Campanha de detecção de casos suspeitos de diabetes" no município de Viçosa, MG

Este trabalho teve como objetivo avaliar o consumo alimentar atual, qualitativo e quantitativo, de pacientes detectados com hiperglicemia na Campanha de Detecção de Casos Suspeitos de Diabetes, no município de Viçosa, MG. Dos 256 detectados com hiperglicemia em 2001, 156 (61%) foram avaliados em 2004, sendo que o restante havia falecido, mudado de endereço, não aceitou participar do estudo ou não era diabético confirmado. Aplicou-se um questionário de freqüência de consumo alimentar e um recordatório da dieta habitual, ambos testados previamente em população-piloto. Os alimentos mais consumidos diariamente foram óleo vegetal (99%), feijão (94%), arroz (90%), adoçante (80%), vegetais folhosos (63%), leite (61%) e pão francês (54%). A maior parte relatou evitar açúcar, alimentos açucarados e gorduras animais. Os maiores percentuais de inadequação de nutrientes ocorreram para energia (85%), fibras (87%), cálcio (94%), percentual de carboidratos (82%), gorduras monoinsaturadas (91%) e proteínas (58%), sendo os três últimos em relação ao Valor Energético Total ingerido. Os dados encontrados permitiram conhecer os hábitos alimentares desta população e estimar a ingestão de nutrientes, podendo ser úteis ao aconselhamento nutricional, sugerindo orientações específicas que poderão proporcionar uma alimentação mais adequada, contribuindo para melhores condições de saúde e bem-estar.The purpose of this work is to assess the current, qualitative and quantitative alimentary consumption of patients detected with hiperglycemia in the "Detection of Diabetes in Suspect Cases Campaign" in Viçosa, MG. 256 patients were detected with hiperglycemia in 2001; however, 156 (60.9%) were assessed in 2004. The remaining people were dead, had changed their address, did not accept to participate in the study or did not have diagnosed diabetes. The hiperglycemic patients answered an alimentary frequency questionnaire for assessing their dietary intake and their usual diet recall, both previously tested in pilot-population. The most daily consumed foods were vegetable oil (99%), bean (94%), rice (90%), artificial sweetener (80%), leaf vegetables (63%), milk (61%), and French bread (54%). Most of the patients said they avoid sugar, sugary foods and animal fats. The largest percentiles of nutrients inadequacy happened for energy (85%), fibers (87%), calcium (94%), carbohydrates (82%), monounsaturated fats (91%) and proteins (58%). These last three happened in relation to total energy intake values. The current data allowed us to know about the alimentary habits of these people and also to stimulate nutrition intakes, being useful to the nutritional counseling, suggesting specific orientations in order to provide a more appropriate feeding, contributing to better health conditions and well-being

Nutritional status, metabolic changes and white blood cells in adolescents

OBJECTIVE: To analyze the relationship between the peripheral blood white cells, metabolic changes, and nutritional status of adolescents with and without excess weight and body fat.METHODS: This cross-sectional study evaluated the body mass index (BMI) and percentage body fat (%BF) in 362 adolescents from 15 to 19 years of age, of both sexes. White blood cell count, platelet count, uric acid, fasting glucose, insulin, and lipid profile were measured. The inclusion criteria were agreement to participate in the study and signature of the informed consent. Exclusion criteria were: presence of chronic or infectious disease; use of medications that could cause changes in biochemical tests; pregnancy; participation in weight reduction and weight control programs; use of diuretics and laxatives; or the presence of a pacemaker. The following statistical tests were applied: Kolmogorov-Smirnov test, Student's t or Mann-Whitney test, Pearson or Spearman correlation tests, and chi-squared test, considering p<0.05.RESULTS: Overweight was observed in 20.7% of adolescents. The total cholesterol (TC) had a higher percentage of inadequacy (52.2%), followed by high-density lipoprotein (HDL) (38.4%). There was a positive correlation between white cells and serum lipids, insulin, body fat, and BMI. Monocytes were negatively correlated with BMI, and rods with BMI, body fat, and insulin.CONCLUSIONS: Nutritional status is related to an inflammatory process, and adolescents with excess weight or body fat presented higher amounts of white blood cells

Intestinal permeability parameters in obese patients are correlated with metabolic syndrome risk factors

Altered intestinal permeability has been shown to be associated with metabolic alterations in animal models of obesity, but not in humans. The aim of this study was to assess intestinal permeability in obese women and verify if there is any association with anthropometric measurements, body composition or biochemical variables. Twenty lean and twenty obese females participated in the study. Anthropometric measurements, body composition and blood pressure were assessed and biochemical analyses were performed. Administration of lactulose and mannitol followed by their quantification in urine was used to assess the intestinal permeability of volunteers. The obese group showed lower HDL (p < 0.05), higher fasting glucose, insulin, HOMA index and lactulose excretion than the lean group (p < 0.05), suggesting increased paracellular permeability. Lactulose excretion showed positive correlation (p < 0.05) with waist and abdominal circumference. Blood insulin and the HOMA index also increased with the increase in mannitol and lactulose excretion and in the L/M ratio (p < 0.05). L/M ratio presented a negative correlation with HDL concentration (p < 0.05). We demonstrated that intestinal permeability parameters in obese women are positively correlated with anthropometric measurements and metabolic variables. Therapeutic interventions focused on intestine health and the modulation of intestinal permeability should be explored in the context of obesity

A Web-Based Distance Education Course in Nutrition in Public Health: Case study

BACKGROUND: Strict work timetables, personal and professional duties or an inability to be absent from home or work can all represent major constraints for those wishing to improve their professional skills. Within this context, the World Wide Web can allow people to conveniently follow distance courses from their homes. OBJECTIVE: To present an experience in the use of the Web in the continuing education of healthcare professionals in Brazil. METHODS: A Web-based distance education course in nutrition in public health was developed. The methodology was an adaptation of both problem-based and task-based learning. At the end of the course an evaluation questionnaire which covered the course's contents, the educational methodology and resources, the duration and schedule, and the use of the Web as a tool for distance education was given to the students. RESULTS: There were 83 on line registrations from 13 states, 73 of the applicants were female, 62 had a degree in nutrition and 18 were physicians. From these; eleven students from ten states were chosen: nine female nutritionists, two female physicians, and one male physician. Seven students completed the course, took and passed the final exam. Of the other four students, two failed to follow the schedule, one had health problems, and one did not obtain the minimal score for sitting the final exam. The students had a mean age of 35, and a mean of ten years in practice. They all stated that they were unable to attend a regular course, even though they felt that they needed to improve their professional skills. Most of them studied seven days a week for between two and four hours a day. The students also felt that their professional skills had improved and each reported having made changes in their practice as a result of their participation. The students approved of the course's contents, methodology and resources, however they were divided about its duration. The Web as a tool in distance education was approved by the students. If it was not for the Web they could not have taken part in a continuing education program. All students said they would attend another virtual course, if available. Even though most of them did not have difficulty adapting to the virtual environment, they did feel that an adaptation period would be of value. CONCLUSIONS: A Web-based course may be more effective than other distance education methodologies because it is more interactive and dynamic. On-line material can be constantly reviewed and updated, and the students can have the opportunity to submit commentaries or questions directly to the teaching staff. A Web-based course also allows the students to go beyond the course content as they learn how to search and take advantage of the huge resources of information available on the Internet

The TyG index cutoff point and its association with body adiposity and lifestyle in children

Objective: To investigate the factors associated with insulin resistance in children aged 4–7 years, and to identify the cutoff point of the triglyceride‐glucose index for the prediction of insulin resistance in this population. Methods: A cross‐sectional study was conducted with 403 children from a retrospective cohort. Insulin resistance was also evaluated in a sub‐sample using the HOMA index. Four indicators of body adiposity were assessed: body mass index, waist‐to‐height ratio, and the percentages of total and central body fat. Food habits were evaluated by the identification of dietary patterns, using principal component analysis. Information was also collected on lifestyle, socioeconomic status, and breastfeeding time. Results: The median index observed in the sample was 7.77, which did not differ between the genders. The shorter the time spent in active activities, the higher the triglyceride‐glucose value; and increase in the values of body adiposity indicators was positively associated with triglyceride‐glucose. The cutoff point with the best balance between sensitivity and specificity values was 7.88 (AUC = 0.63, 95% CI: 0.51–0.74). Conclusion: The present study identified that total and central body adiposity and shorter time spent in lively activities was positively associated with insulin resistance, evaluated through the triglyceride‐glucose index. The cutoff point of 7.88 may be used in this population for insulin resistance risk screening, but caution is required when using it in other populations. Resumo: Objetivo: Investigar os fatores associados à resistência à insulina em crianças de 4 a 7 anos, e identificar o ponto de corte do índice triglicerídeos‐glicemia (TyG) para predição da RI nessa população. Métodos: Estudo transversal, com 403 crianças pertencentes a uma coorte retrospectiva. A resistência à insulina foi avaliada pelo índice triglicerídeos‐glicemia e também pelo índice HOMA, este em uma subamostra. Avaliou‐se quatro indicadores de adiposidade corporal: o índice de massa corporal, a relação cintura‐estatura e os percentuais de gordura corporal total e central. O hábito alimentar foi avaliado pela identificação dos padrões alimentares, utilizando‐se a análise de componentes principais. Foram coletadas também informações sobre estilo de vida, condição socioeconômica e tempo de aleitamento materno. Resultados: A mediana observada do índice triglicerídeos‐glicemia na amostra foi de 7,77 e não diferiu entre os sexos. Quanto menor o tempo diário em atividades ativas, maior o valor de triglicerídeos‐glicemia; e o aumento nos valores dos indicadores de adiposidade corporal associou‐se positivamente com o triglicerídeos‐glicemia. O ponto de corte com melhor equilíbrio entre os valores de sensibilidade e especificidade foi o de 7,88 (AUC = 0,63; IC 95% 0,51 ‐ 0,74). Conclusão: O presente estudo identificou que a adiposidade corporal total e central e o menor tempo diário em atividades ativas associou‐se positivamente com a resistência à insulina, avaliada pelo índice triglicerídeos‐glicemia. O ponto de corte de 7,88 pode ser utilizado nessa população para triagem do risco de resistência à insulina, mas é necessário cautela na sua utilização em outras populações. Keywords: TyG index, Adiposity, Lifestyle, Children, Palavras‐chave: Índice TyG, Adiposidade, Estilo de vida, Criança