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OBJECTIVE: To evaluate the effects of replacing time spent in sedentary behavior (SB) with moderate to vigorous physical activity on sleep quality in young adults. METHODS: Multicenter cross-sectional study, carried out with students enrolled in undergraduate courses at universities in Brazil. Sleep quality was assessed using a question of the World Health Organization Quality of Life (WHOQOL-brief) and classified as good or poor sleep quality. SB was evaluated by self-reported total sitting time, and the level of leisure-time PA was classified according to the intensity of moderate-intensity physical activity (MPA) and vigorous-intensity physical activity (VPA), which were assessed using a self-reported questionnaire. An isotemporal replacement logistic model was used to evaluate the effects of different SB, MPA, and VPA sessions on sleep quality. RESULTS: A total of 8,059 study participants were evaluated, the majority had poor sleep quality (64.79%), were physically inactive (48.28%, defined as practicing < 150 min of MPA or < 75 min of VPA per week), and spent ≥ 9 h/day in SB (55.08%). The multivariate model showed an association between non-adherence to wake-based movement guidelines and poor sleep quality, where those with one altered behavior were 43% more likely to have poor sleep quality (OR:1.43;95%CI:1.27 to 1.60), while individuals with two altered behaviors were 97% more likely (OR:1.97;95%CI:1.73 to 2.24). In the isotemporal analysis, replacing MPA and VPA with equivalent time in SB increased the odds of poor sleep at all times assessed, with peaks of 56% for MPA and 68% for VPA. CONCLUSION: The results of the present study indicate that replacing SB with the same amount of MPA or VPA may reduce poor sleep quality.
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Ejercicio Físico , Conducta Sedentaria , Calidad del Sueño , Humanos , Masculino , Femenino , Estudios Transversales , Adulto Joven , Brasil , Factores de Tiempo , Adulto , Adolescente , Encuestas y Cuestionarios , Autoinforme , Universidades , Estudiantes/estadística & datos numéricos , Estudiantes/psicología , Calidad de VidaRESUMEN
OBJECTIVES: Muscle loss is one of the phenotypic criteria of malnutrition, is highly prevalent in patients with cirrhosis, and is associated with adverse outcomes. Mid-arm muscle circumference (MAMC) estimates the skeletal muscle mass and is especially helpful in cases of fluid overload. This study aimed to propose MAMC cutoff points for patients with cirrhosis and demonstrate its association with 1-year mortality. METHODS: This is an analysis of cohort databases from five reference centers in Brazil that included inpatients and outpatients with cirrhosis aged ≥18 y. The nutritional variables obtained were the MAMC (n = 1075) and the subjective global assessment (n = 629). We established the MAMC cutoff points stratified by sex based on the subjective global assessment as a reference standard for malnutrition diagnosis, considering the sensitivity, specificity, and Youden index. An adjusted Cox regression model was used to test the association of MAMC cutoff points and 1-year mortality. RESULTS: We included 1075 patients with cirrhosis, with a mean age of 54.8 ± 11.3 y; 70.4% (n = 757) male. Most patients had alcoholic cirrhosis (47.1%, n = 506) and were classified as Child-Pugh B (44.7%, n = 480). The MAMC cutoff points for moderate and severe depletion were ≤21.5 cm and ≤24.2 cm; ≤20.9 cm and ≤22.9 cm for women and men, respectively. According to these cutoff points, 13.8% (n = 148) and 35.1% (n = 377) of the patients had moderate or severe MAMC depletion, respectively. The 1-year mortality rate was 17.3% (n = 186). In the multivariate analysis adjusted for sex, age, MELD-Na, and Child-Pugh scores, a severe depletion in MAMC was an independent increased risk factor for 1-year mortality (HR: 1.71, 95% CI: 1.24-2.35, P < 0.001). Each increase of 1 cm in MAMC values was associated with an 11% reduction in 1-year mortality risk (HR: 0.89, 95% CI: 0.85-0.94, P < 0.001). CONCLUSIONS: Low MAMC classified according to the new cutoff points predicts mortality risk in patients with cirrhosis and could be used in clinical practice.
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Brazo , Cirrosis Hepática , Desnutrición , Músculo Esquelético , Humanos , Masculino , Femenino , Persona de Mediana Edad , Desnutrición/diagnóstico , Desnutrición/mortalidad , Cirrosis Hepática/mortalidad , Cirrosis Hepática/complicaciones , Brasil/epidemiología , Adulto , Anciano , Estado Nutricional , Evaluación Nutricional , Modelos de Riesgos Proporcionales , Estudios de Cohortes , Sarcopenia/mortalidad , Sarcopenia/diagnósticoRESUMEN
OBJECTIVE: The objective was to evaluate the psychometric properties of the Mindful Eating Questionnaire (MEQ) in Brazilian subjects with type 2 diabetes mellitus (T2DM) and validate a Brazilian version of the MEQ for adults with T2DM (MEQ-DM). METHODOLOGY: Baseline data from the multicentre Nutritional Strategy for Glycaemic Control in Patients with Type 2 Diabetes Mellitus (NUGLIC) trial were used. Construct validity was assessed using exploratory factor analysis (EFA). The root mean square error of approximation (RMSEA), comparative fit index (CFI) and TuckerâLewis index (TLI) fit indices indicated the adequacy of the model. The reliability of the questionnaire was evaluated considering the different factor loadings. Criterion validity was tested by correlating the MEQ-DM with sociodemographic variables, body mass index (BMI) and physical activity levels. RESULTS: A total of 370 participants were included, who were mostly female (60.8 %) and had a median age of 61 (54-67) years. The EFA results supported the two-factor structure of the 25-item MEQ-DM: disinhibition and awareness. The results of the fit indices (RMSEA = 0.04; CFI = 0.95 and TLI = 0.94) and composite reliability (disinhibition = 0.84 and awareness = 0.81) were consistent. The criterion validity analysis indicated a significant association between MEQ-DM scores and age, sex, civil status, education level, BMI and physical activity (p < 0.05). CONCLUSION: When explored with Brazilian adults with T2DM, the MEQ-DM presented a factorial model with two dimensions: disinhibition and awareness. This model must be confirmed in future studies with Brazilians with T2DM.
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Diabetes Mellitus Tipo 2 , Ingestión de Alimentos , Atención Plena , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Brasil , Psicometría , Reproducibilidad de los Resultados , Pueblos Sudamericanos , Encuestas y Cuestionarios , Ingestión de Alimentos/psicologíaRESUMEN
OBJECTIVES: The Global Leadership Initiative on Malnutrition (GLIM) is a framework aiming to standardize malnutrition diagnosis. However, it still needs to be validated, in particular for patients with chronic liver disease. This study aimed to validate the GLIM criteria in patients with liver cirrhosis awaiting liver transplant (LTx). METHODS: This was a retrospective observational study carried out with adult patients on the waiting list for LTx, consecutively evaluated between 2006 and 2021. The phenotypic criteria were unintentional weight loss, low body mass index, and reduced muscle mass (midarm muscle circumference [MAMC]). The etiologic criteria were high Model for End-Stage Liver Disease (MELD) and MELD adjusted for serum sodium (MELD-Na) scores, the Child-Pugh score, low serum albumin, and low food intake and/or assimilation. Forty-three GLIM combinations were tested. Sensitivity (SE), specificity (SP), positive and negative predictive values, and machine learning (ML) techniques were used. Survival analysis with Cox regression was carried out. RESULTS: A total of 419 patients with advanced liver cirrhosis were included (median age, 52.0 y [46-59 y]; 69.2% male; 68.8% malnourished according to the Subjective Global Assessment [SGA]). The prevalence of malnutrition by the GLIM criteria ranged from 3.1% to 58.2%, and five combinations had SE or SP >80%. The MAMC as a phenotypic criterion with MELD and MELD-Na as etiologic criteria were predictors of mortality. The MAMC and the presence of any phenotypic criteria associated with liver disease parameters and low food intake or assimilation were associated with malnutrition prediction in ML analysis. CONCLUSIONS: The MAMC and liver disease parameters were associated with malnutrition diagnosis by SGA and were also predictors of 1-y mortality in patients with liver cirrhosis awaiting LTx.
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Enfermedad Hepática en Estado Terminal , Trasplante de Hígado , Desnutrición , Adulto , Humanos , Masculino , Persona de Mediana Edad , Femenino , Enfermedad Hepática en Estado Terminal/complicaciones , Enfermedad Hepática en Estado Terminal/cirugía , Liderazgo , Índice de Severidad de la Enfermedad , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Desnutrición/diagnósticoRESUMEN
Understanding of the association between nutritional risk and clinical outcomes in hospitalised patients with overweight is still at an early stage. Given the lack of specific tools for the patient with overweight, the objective of this study was to compare two of the main general screening instruments for assessing nutritional risk in predicting clinical outcomes in a population of hospitalised patients with overweight. A retrospective study was carried out in a medium-sized hospital in Brazil, with patients ≥20 years old admitted between July 2017 and December 2019. Patients who were overweight and had records of Nutritional Risk Screening-2002 (NRS-2002) and Mini-Nutritional Assessment-Short Form (MNA-SF) in their medical files were included in the study. Clinical outcomes data (longer length of stay, readmission during the study period and mortality before the end of study or during hospitalisation) were obtained. The Kappa coefficient assessed agreement between both tools, and their performance for predicting outcomes was analysed using characteristic receiver operating curves (ROC). Data were collected from 643 patients. The prevalence of nutritional risk was 17.7% and 36.1% according to the NRS-2002 and MNA-SF (k = 0.390; p < 0.001), respectively. According to both tools, all clinical outcomes were significantly more common among individuals at nutritional risk (p < 0.05). Only the MNA-SF showed a significant percentage of predictions for readmission (57.2%) and death during hospitalisation (65.7%). For mortality until the end of the study, the area under the ROC curve was similar for MNA-SF (60.5%) and NRS-2002 (60.7%; p = 0.057). The MNA-SF detected a greater proportion of nutritional risk among hospitalised patients with overweight and better predicted all clinical outcomes compared to the NRS-2002 and should be used to screen patients with overweight for nutritional risk.
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Desnutrición , Evaluación Nutricional , Humanos , Adulto Joven , Adulto , Estado Nutricional , Desnutrición/diagnóstico , Estudios Retrospectivos , Sobrepeso/diagnósticoRESUMEN
BACKGROUND: The COVID 19 pandemic impacted the health and well-being of different populations around the world. The aim of this study is to investigate the changes in the daily habits of Brazilians before and during two moments of the COVID-19 pandemic. METHODS: A longitudinal study in which an online questionnaire (sleeping time, alcohol consumption, smoking, use of screen devices, physical activity, and dietary patterns) was applied at three moments. RESULTS: The frequency of alcohol consumption, smoking, and sleep hours did not change significantly at different times. For the number of alcoholic beverages, there was a reduction in consumption from T0 to T1 and an increase from T1 to T2. There was a significant increase in hours of screen device use from T0 to T1, remaining high at T2. Finally, the level of physical activity in minutes reduced from T0 to T1, returning to base levels at T2. As for eating habits, there was an increase in the frequency of consumption of instant meals, fast food, and sweets at the first moment, with a significant reduction at the second moment. The consumption of legumes, milk and dairy products, bakery products, and meats was higher at T2. CONCLUSIONS: Some habits returned to or approached T0 levels. However, other habits remained unchanged, such as screen time and frequency of consumption of some food groups, throughout the last evaluation.
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COVID-19 , Humanos , COVID-19/epidemiología , Pandemias , Estudios Longitudinales , Dieta , Conducta AlimentariaRESUMEN
Introduction and Aims: The behavioral changes that arose from quarantine due to the COVID-19 pandemic may have impacted the weight of people. This study aims to investigate the incidence and predictors of weight gain during the quarantine period. Methods: An online survey was performed five months after the social distance measures implementation. Participants recorded their current and usual weight before lockdown. A multivariate logistic regression model was performed. Results: Data on 1334 participants were evaluated (33.6y, 79.8% females), and 58.8% have gained weight (3.0 kg; 0.1 to 30.0 kg). Predictors of weight gain were increased food intake (OR = 5.40); snacking (OR = 2.86); fast food (OR = 1.11); canned products (OR = 1.08); and in physical activity (OR = 0.99) concerning the period before the pandemic; also time spent at work, including household chores (OR = 1.58); evening snack (OR = 1.54); higher frequency of alcoholic beverage intake (OR = 1.59) and dose of alcoholic beverage (OR = 1.11); uncontrolled eating (OR = 1.01), and vegetable intake (OR = 0.92) during the quarantine and physical activity before pandemic period (OR = 0.99). Conclusion: Most participants have gained weight during the pandemic because of working changes, lifestyle, eating habits changes, and uncontrolled eating behavior. These results can be useful to encourage changes during future quarantine periods to prevent weight gain.
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BACKGROUND & AIMS: Studies using the Global Leadership Initiative on Malnutrition (GLIM) criteria for patients with liver cirrhosis are limited. This study aimed to assess the impact of malnutrition according to the GLIM criteria on the outcomes of patients awaiting a liver transplant (LTx) and compare these criteria with Subjective Global Assessment (SGA). METHODS: This retrospective observational study included adult patients awaiting LTx. Patient clinical data, nutritional status according to various tools including SGA, and resting energy expenditure were assessed. The distinct phenotypic and etiologic criteria provided 36 different GLIM combinations. The GLIM criteria and SGA were compared using the kappa coefficient. The variables associated with mortality before and after the LTx and with a longer length of stay (LOS) after LTx (≥18 days) were assessed by Cox regression and logistic regression analyses, respectively. RESULTS: A total of 152 patients were included [median age 52.0 (interquartile range: 46.5-59.5) years; 66.4% men; 63.2% malnourished according to SGA]. The prevalence of malnutrition according to the GLIM criteria ranged from 0.7% to 30.9%. The majority of the GLIM combinations exhibited poor agreement with SGA. Independent predictors of mortality before and after LTx were presence of ascites or edema (p = 0.011; HR:2.58; CI95%:1.24-5.36), GLIM 32 (PA-phase angle + MELD) (p = 0.026; HR:2.08; CI95%:1.09-3.97), GLIM 33 (PA + MELD-Na≥12) (p = 0.018; HR:2.17; CI95%:1.14-4.13), and GLIM 34 (PA + Child-Pugh) (p = 0.043; HR:1.96; CI95%:1.02-3.77). Malnutrition according to GLIM 28 (handgrip strength + Child-Pugh) was independently associated with a longer LOS (p = 0.029; OR:7.21; CI95%:1.22-42.50). CONCLUSION: The majority of GLIM combinations had poor agreement with SGA, and 4 of the 36 GLIM combinations were independently associated with adverse outcomes.
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Cirrosis Hepática/fisiopatología , Desnutrición/diagnóstico , Evaluación Nutricional , Medición de Riesgo/métodos , Listas de Espera/mortalidad , Adulto , Femenino , Fuerza de la Mano , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Trasplante de Hígado/mortalidad , Masculino , Desnutrición/etiología , Persona de Mediana Edad , Estado Nutricional , Prevalencia , Pronóstico , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
OBJECTIVES: The aim of this study was to assess patients on the waiting list for liver transplant (LTx) according to bioelectrical impedance vector analysis (BIVA), as well as to verify the association between the placement of the vectors on the graph with clinical outcomes and identify the predictors to vector placement in quadrant 4 (Q4; indicating more hydration and less cellularity). METHODS: This was a retrospective observational study including 129 patients ≥20 y of age awaiting LTx. Patients' nutritional status was assessed by using different tools, including single-frequency bioelectrical impedance analysis and the Subjective Global Assessment (SGA). Clinical data were registered. The BIVA was evaluated by comparing the individual vectors plotted for all patients to the tolerance ellipses of 50%, 75%, and 95% of the reference healthy population. The quadrant of the vector for each patient was registered. RESULTS: The majority of the vectors were placed in Q1 (n = 54; 41.9%) and Q4 (n = 39; 30.2%). The presence of ascites or edema (hazard ratio [HR], 2.43; 95% confidence interval [CI], 1.15-5.12; P = 0.019) and the BIVA vector placed in Q4 in any ellipse (HR, 2.10; 95% CI, 1.07-4.09; P = 0.029) were independent predictors for mortality on the waiting list or ≤1 y after LTx. BIVA was not associated with longer hospital length of stay. The predictors of vector placement in Q4 were higher age, malnutrition according to SGA, and presence of ascites or edema. CONCLUSION: Patients on the waiting list for LTx with BIVA vectors placed in Q4, in the 50%, 75%, or 95% tolerance ellipses, presented a worse prognosis.
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Trasplante de Hígado , Desnutrición , Composición Corporal , Impedancia Eléctrica , Humanos , Desnutrición/diagnóstico , Pronóstico , Listas de EsperaRESUMEN
The study aimed to assess the eating behavior [uncontrolled eating (UE), emotional eating (EE), and cognitive restraint (CR)], the perceived stress, and independently associated factors among Brazilians during the COVID-19 pandemic. An online survey was conducted and data about 1,368 participants were evaluated. Multivariate logistic regression models were performed to identify factors independently associated (socioeconomic, lifestyle, and eating habits data) with eating behaviors and perceived stress. Working in the COVID-19 frontline (OR = 2.19), increased food delivery (OR = 1.49), increased food intake (OR = 1.48), increased number of meals (OR = 1.13), and EE (OR = 1.05) were factors independently associated with UE. Variables that were independently associated with EE were: increased food intake (OR = 2.57), graduation in a non-health-related course (OR = 1.78), perceived stress (OR = 1.08), UE (OR = 1.07), and CR (OR = 1.02). Reduced snacking (OR = 2.08), female gender (OR = 1.47), having a higher degree (OR = 1.44), increased homemade meals (OR = 1.31), the higher difference in the frequency of instant meals and snacks intake (OR = 0.91), EE (OR = 1.01), not increased alcohol dose intake (OR = 0.57), and increased physical activity (OR = 0.54) were independently associated with CR. Perceived stress was independently associated with changes in the way of working or studying (OR = 2.48), worse sleep quality (OR = 2.22), younger age (OR = 1.06), and EE (OR = 1.02). This study indicates that socioeconomic variables, lifestyle, and eating habits were independently associated with the eating behaviors of Brazilians and perceived stress during the quarantine.
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INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 has infected more than 9,834,513 Brazilians up to February 2021. Knowledge of risk factors of coronavirus disease among Brazilians remains scarce, especially in the adult population. This study verified the risk factors for intensive care unit admission and mortality for coronavirus disease among 20-59-year-old Brazilians. METHODS: A Brazilian database on respiratory illness was analyzed on October 9, 2020, to gather data on age, sex, ethnicity, education, housing area, and comorbidities (cardiovascular disease, diabetes, and obesity). Multivariate logistic regression analysis was performed to identify the risk factors for coronavirus disease. RESULTS: Overall, 1,048,575 persons were tested for coronavirus disease; among them, 43,662 were admitted to the intensive care unit, and 34,704 patients died. Male sex (odds ratio=1.235 and 1.193), obesity (odds ratio=1.941 and 1.889), living in rural areas (odds ratio=0.855 and 1.337), and peri-urban areas (odds ratio=1.253 and 1.577) were predictors of intensive care unit admission and mortality, respectively. Cardiovascular disease (odds ratio=1.552) was a risk factor for intensive care unit admission. Indigenous people had reduced chances (odds ratio=0.724) for intensive care unit admission, and black, mixed, East Asian, and indigenous ethnicity (odds ratio=1.756, 1.564, 1.679, and 1.613, respectively) were risk factors for mortality. CONCLUSIONS: Risk factors for intensive care unit admission and mortality among adult Brazilians were higher in men, obese individuals, and non-urban areas. Obesity was the strongest risk factor for intensive care unit admission and mortality.
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COVID-19 , Enfermedad Crítica , Adulto , Brasil/epidemiología , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Factores de Riesgo , SARS-CoV-2 , Adulto JovenRESUMEN
ABSTRACT Objective The objective of this study was to translate and cross-culturally adapt the NutriQoL® into Brazilian Portuguese. Methods The NutriQoL® comprises 17 questions that evaluate the quality of life of patients receiving home enteral nutrition therapy. The methodological procedures included the translation from the Spanish version into Portuguese by two translators, synthesis of the translations, back translation, evaluation by a committee of judges composed of 24 individuals in which a content validity index > 0.78 was considered acceptable, and generation of the pre-final version. A pre-test to analyze its semantic equivalence was administered to 12 patients receiving home enteral nutrition therapy. The final version of the questionnaire was then prepared. Results A summary version of the questionnaire was obtained using two versions of the translation. Both back translations were identical for 73.6% of sentences (n=25). Twenty-four volunteers were included in the committee of judges. The content validity index was 0.88±0.11, and 14.7% (n=5) of questions had a low content validity index and were thus reformulated. In the pre-test, 35.3% (n=12) of items obtained low levels of understanding and required adjustment. In the preparation of the final version, the inconsistencies of the items mentioned were corrected and/or adjusted. Conclusion After completing the methodological procedures, a Brazilian Portuguese version of the NutriQoL® questionnaire was obtained. Following the validation process, it can be used by dieticians and other health professionals to assess the quality of life of patients receiving home enteral nutrition therapy to contribute to improvements in care practices.
RESUMO Objetivo O intuito deste estudo foi realizar a tradução do NutriQoL para a língua portuguesa e a adaptação transcultural para o Brasil. Métodos O NutriQoL® é composto de 17 pares de perguntas que avaliam a qualidade de vida de pacientes em terapia nutricional enteral domiciliar. Os procedimentos metodológicos foram: tradução da versão em espanhol para a língua portuguesa por dois tradutores; síntese das traduções; retrotradução; avaliação, da versão traduzida, por um comitê de juízes composto por 24 indivíduos, na qual o índice de validade de conteúdo > 0,78 foi considerado, gerando a versão pré-final e realização de um pré-teste no qual a versão pré-final do questionário foi aplicada a 12 pacientes em uso de terapia nutricional enteral domiciliar para análise da equivalência semântica e elaboração da versão final do questionário. Resultados Observou-se que, a partir das duas versões traduzidas, foi possível obter uma versão síntese do questionário. As duas retrotraduções geradas foram idênticas em 73,6% das sentenças (n=25). O índice de validade de conteúdo foi 0,88 ± 0,11, e 14,7% (n=5) das questões tiveram baixo índice de validade de conteúdo, sendo então reformuladas. No pré-teste foi observado que 35,3% (n=12) dos itens obtiveram baixos índices de compreensão e necessitaram de ser reformulados. Na elaboração da versão final do questionário as inconsistências dos itens mencionados foram sanadas e/ou adaptadas. Conclusão Após conclusão dos procedimentos metodológicos, foi possível obter a versão brasileira do questionário NutriQoL® em língua portuguesa para que, após processo de validação, o instrumento seja utilizado pelo nutricionista ou demais profissionais de saúde para avaliação da qualidade de vida de pacientes em uso de terapia nutricional enteral domiciliar, a fim de contribuir com melhorias nas práticas assistenciais.
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Encuestas y Cuestionarios , Personas Imposibilitadas , Calidad de Vida , Terapia NutricionalRESUMEN
Abstract INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 has infected more than 9,834,513 Brazilians up to February 2021. Knowledge of risk factors of coronavirus disease among Brazilians remains scarce, especially in the adult population. This study verified the risk factors for intensive care unit admission and mortality for coronavirus disease among 20-59-year-old Brazilians. METHODS: A Brazilian database on respiratory illness was analyzed on October 9, 2020, to gather data on age, sex, ethnicity, education, housing area, and comorbidities (cardiovascular disease, diabetes, and obesity). Multivariate logistic regression analysis was performed to identify the risk factors for coronavirus disease. RESULTS: Overall, 1,048,575 persons were tested for coronavirus disease; among them, 43,662 were admitted to the intensive care unit, and 34,704 patients died. Male sex (odds ratio=1.235 and 1.193), obesity (odds ratio=1.941 and 1.889), living in rural areas (odds ratio=0.855 and 1.337), and peri-urban areas (odds ratio=1.253 and 1.577) were predictors of intensive care unit admission and mortality, respectively. Cardiovascular disease (odds ratio=1.552) was a risk factor for intensive care unit admission. Indigenous people had reduced chances (odds ratio=0.724) for intensive care unit admission, and black, mixed, East Asian, and indigenous ethnicity (odds ratio=1.756, 1.564, 1.679, and 1.613, respectively) were risk factors for mortality. CONCLUSIONS: Risk factors for intensive care unit admission and mortality among adult Brazilians were higher in men, obese individuals, and non-urban areas. Obesity was the strongest risk factor for intensive care unit admission and mortality.
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Humanos , Masculino , Adulto , Adulto Joven , Enfermedad Crítica , COVID-19 , Brasil/epidemiología , Factores de Riesgo , SARS-CoV-2 , Hospitalización , Unidades de Cuidados Intensivos , Persona de Mediana EdadRESUMEN
Resumo A Terapia Nutricional Enteral Domiciliar é um método eficaz para garantir o aporte nutricional de um indivíduo em seu domicílio. Sendo assim, o objetivo do estudo foi investigar os aspectos clínicos comumente recorrentes em pacientes pediátricos em terapia nutricional enteral domiciliar. A pesquisa de artigos foi realizada por meio das bases de dados: Scientific Eletronic Library Online (SciElo) e US National Library of Medicine National Institutes of Health (PubMed) utilizando as seguintes palavras-chaves: 'home enteral nutrition', 'home tube feeding' e 'children'. Foram selecionados 16 estudos realizados nos países: Brasil, Chile, Espanha, França, Holanda, Itália, Polônia e Monte Sinai, os quais trouxeram evidências que as principais condições clínicas relatadas para a indicação na terapia nutricional enteral domiciliar são as doenças neurológicas, neoplasias em geral e doenças do trato gastrointestinal. Apenas dois estudos abordaram os aspectos negativos da terapia domiciliar que são os episódios de engasgos, tosse, vômitos, diarreia e constipação intestinal. Deste modo, por meio das condições clínicas relatadas observa-se que a indicação da TNED é essencial para estes pacientes, podendo preveni-los da desnutrição hospitalar, diminuição do tempo de permanência, reinternações e redução dos custos hospitalares, além de trazer maior conforto para o paciente pediátrico por estar mais próximo dos familiares.
Abstract Home Enteral Nutrition is an effective method to ensure the nutritional compliance of an individual at home. The aim of this study was investigate the clinical aspects commonly recurrent in children and youth patients in home enteral nutrition. Research of articles was carried out through the databases: Scientific Electronic Library Online (SciElo) and US National Library of Medicine National Institutes of Health (PubMed) using the following keywords: 'home enteral nutrition', 'home tube feeding' and 'children'. Sixteen studies were selected in countries as Brazil, Spain, France, Netherlands, Italy, Poland and Monte Sinai, in which it was presented evidence that the main clinical conditions related to enteral nutritional therapy are neurological diseases, neoplasia in general and the upper and lower gastrointestinal tract diseases. Only two studies had reported the negative aspects of home therapy as episodes of gagging, coughing, vomiting, diarrhea, and constipation. Thus, through the clinical conditions reported, it is observed that the indication of home enteral nutrition is essential for these patients, which can prevent them from hospital malnutrition, decrease length of stay, rehospitalizations and reduce hospital costs, as well as bring greater comfort to patients by being closer to their family.
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Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Salud Infantil , Nutrición Enteral , Salud del Adolescente , Terapia Nutricional , Servicios de Atención de Salud a DomicilioRESUMEN
BACKGROUND: Sarcopenia is prevalent before liver transplantation, and it is considered to be a risk factor for morbidity/mortality. After liver transplantation, some authors suggest that sarcopenia remains, and as patients gain weight as fat, they reach sarcopenic obesity status. AIM: Prospectively to assess changes in body composition, prevalence and associated factors with respect to sarcopenia, obesity and sarcopenic obesity after transplantation. METHODS: Patients were evaluated at two different times for body composition, 4.0±3.2y and 7.6±3.1y after transplantation. Body composition data were obtained using bioelectrical impedance. The fat-free mass index and fat mass index were calculated, and the patients were classified into the following categories: sarcopenic; obesity; sarcopenic obesity. RESULTS: A total of 100 patients were evaluated (52.6±13.3years; 57.0% male). The fat-free mass index decreased (17.9±2.5 to 17.5±3.5 kg/m2), fat mass index increased (8.5±3.5 to 9.0±4.0; p<0.05), prevalence of sarcopenia (19.0 to 22.0%), obesity (32.0 to 37.0%) and sarcopenic obesity (0 to 2.0%) also increased, although not significantly. The female gender was associated with sarcopenia. CONCLUSION: The fat increased over the years after surgery and the lean mass decreased, although not significantly. Sarcopenia and obesity were present after transplantation; however, sarcopenic obesity was not a reality observed in these patients.
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Composición Corporal/fisiología , Trasplante de Hígado/efectos adversos , Obesidad/etiología , Obesidad/fisiopatología , Sarcopenia/etiología , Sarcopenia/fisiopatología , Adulto , Anciano , Índice de Masa Corporal , Brasil/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estado Nutricional/fisiología , Obesidad/epidemiología , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Sarcopenia/epidemiología , Estadísticas no Paramétricas , Factores de Tiempo , Aumento de Peso/fisiologíaRESUMEN
ABSTRACT Background: Sarcopenia is prevalent before liver transplantation, and it is considered to be a risk factor for morbidity/mortality. After liver transplantation, some authors suggest that sarcopenia remains, and as patients gain weight as fat, they reach sarcopenic obesity status. Aim: Prospectively to assess changes in body composition, prevalence and associated factors with respect to sarcopenia, obesity and sarcopenic obesity after transplantation. Methods: Patients were evaluated at two different times for body composition, 4.0±3.2y and 7.6±3.1y after transplantation. Body composition data were obtained using bioelectrical impedance. The fat-free mass index and fat mass index were calculated, and the patients were classified into the following categories: sarcopenic; obesity; sarcopenic obesity. Results: A total of 100 patients were evaluated (52.6±13.3years; 57.0% male). The fat-free mass index decreased (17.9±2.5 to 17.5±3.5 kg/m2), fat mass index increased (8.5±3.5 to 9.0±4.0; p<0.05), prevalence of sarcopenia (19.0 to 22.0%), obesity (32.0 to 37.0%) and sarcopenic obesity (0 to 2.0%) also increased, although not significantly. The female gender was associated with sarcopenia. Conclusion: The fat increased over the years after surgery and the lean mass decreased, although not significantly. Sarcopenia and obesity were present after transplantation; however, sarcopenic obesity was not a reality observed in these patients.
RESUMO Racional: A sarcopenia é prevalente antes do transplante de fígado e é considerada fator de risco para morbidade/mortalidade desses pacientes. Após o transplante hepático, alguns autores sugerem que a sarcopenia permanece, e os pacientes ganham peso na forma de gordura, atingindo o status de obesidade sarcopênica. Objetivo: Avaliar prospectivamente as mudanças na composição corporal, prevalência e fatores associados em relação à sarcopenia, obesidade e obesidade sarcopênica após o transplante. Métodos: Os pacientes foram avaliados em dois momentos diferentes para composição corporal, 4,0±3,2 e 7,6±3,1 anos e após o transplante. Os dados da composição corporal foram obtidos por meio de bioimpedância elétrica. O índice de massa livre de gordura e o índice de massa gorda foram calculados, e os pacientes foram classificados nas seguintes categorias: sarcopênico; obesidade; obesidade sarcopênica. Resultados: Foram avaliados 100 pacientes (52,6±13,3 anos; 57,0% homens). A prevalência de sarcopenia (19,0% para 22,0%), obesidade (32,0% para 37,0%) e índice de massa livre de gordura (17,9±2,5 para 17,5±3,5 kg/m2), índice de massa gorda aumentou (8,5±3,5 para 9,0±4,0 kg/m2), e obesidade sarcopênica (0 para 2,0%) também aumentaram, embora não significativamente. O gênero feminino foi associado à sarcopenia. Conclusão: Após a operação, a gordura aumentou ao longo dos anos e a massa magra diminuiu, embora não significativamente. A sarcopenia e a obesidade estavam presentes após o transplante; no entanto, a obesidade sarcopênica não foi realidade observada nesses pacientes.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Composición Corporal/fisiología , Trasplante de Hígado/efectos adversos , Sarcopenia/etiología , Sarcopenia/fisiopatología , Obesidad/etiología , Obesidad/fisiopatología , Factores de Tiempo , Brasil/epidemiología , Aumento de Peso/fisiología , Índice de Masa Corporal , Estado Nutricional/fisiología , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Sarcopenia/epidemiología , Obesidad/epidemiologíaRESUMEN
OBJECTIVE: to determine the prevalence of abnormal total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides in patients undergoing liver transplantation (LTx) and to identify predictors of these disorders. METHODS: cross-sectional study to assess the prevalence of dyslipidemia in patients undergoing LTx. Demographic, socioeconomic, clinical, anthropometric and dietetic data were collected to determine the association with dyslipidemia using univariate and multivariate statistical analysis. RESULTS: 136 patients were evaluated, 68.1% of which had at least one type of dyslipidemia. The triglyceride level was high in 32.4% of cases, with low HDL in 49.3% of patients and high LDL levels in only 8.8%. High total cholesterol was observed in 16.2% of the study population and was associated with the recommendation for transplantation due to ethanolic cirrhosis (OR = 2.7) and a greater number of hours slept per night (OR = 1.5). CONCLUSION: many patients presented dyslipidemia after transplantation, demonstrating the need for interventions in relation to modifiable factors associated with dyslipidemias that can mitigate or prevent these disorders.
Asunto(s)
Dislipidemias/epidemiología , Dislipidemias/etiología , Trasplante de Hígado/efectos adversos , Brasil/epidemiología , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Factores de Riesgo , Factores Socioeconómicos , Triglicéridos/sangreRESUMEN
Objective: to determine the prevalence of abnormal total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides in patients undergoing liver transplantation (LTx) and to identify predictors of these disorders. Methods: cross-sectional study to assess the prevalence of dyslipidemia in patients undergoing LTx. Demographic, socioeconomic, clinical, anthropometric and dietetic data were collected to determine the association with dyslipidemia using univariate and multivariate statistical analysis. Results: 136 patients were evaluated, 68.1% of which had at least one type of dyslipidemia. The triglyceride level was high in 32.4% of cases, with low HDL in 49.3% of patients and high LDL levels in only 8.8%. High total cholesterol was observed in 16.2% of the study population and was associated with the recommendation for transplantation due to ethanolic cirrhosis (OR = 2.7) and a greater number of hours slept per night (OR = 1.5). Conclusion: many patients presented dyslipidemia after transplantation, demonstrating the need for interventions in relation to modifiable factors associated with dyslipidemias that can mitigate or prevent these disorders. .
Objetivo: determinar a prevalência de anormalidades de colesterol total (CT), lipoproteína de baixa densidade (LDL) e alta densidade (HDL) e triglicérides, e identificar fatores preditivos dessas desordens em pacientes submetidos ao transplante hepático (TxH). Métodos: estudo transversal de avaliação da prevalência de dislipidemias em pacientes submetidos ao TxH. Variáveis demográficas, socioeconômicas, clínicas, antropométricas e dietéticas foram coletadas para identificar os fatores associados utilizando análises estatísticas uni e multivariadas. Resultados: foram avaliados 136 pacientes, dos quais 68,1% apresentaram pelo menos um tipo de dislipidemia. O nível de triglicérides esteve elevado em 32,4% dos casos, a HDL reduzida em 49,3% dos pacientes e os níveis de LDL elevados em apenas 8,8%. Colesterol total elevado foi observado em 16,2% da população estudada e esteve associado à indicação de transplante por cirrose etanólica (OR = 2,7) e maior número de horas dormidas por noite (OR = 1,5). Conclusão: grande parte dos pacientes apresentou dislipidemia após o transplante, demonstrando a necessidade de intervenções em relação aos fatores modificáveis associados às dislipidemias que podem atenuar ou prevenir essas desordens. .
Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Dislipidemias/epidemiología , Dislipidemias/etiología , Trasplante de Hígado/efectos adversos , Brasil/epidemiología , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Estudios Transversales , Valor Predictivo de las Pruebas , Prevalencia , Factores de Riesgo , Factores Socioeconómicos , Triglicéridos/sangreRESUMEN
OBJECTIVES: The aim of this study was to evaluate the energy balance (EB) of patients on the waiting list for liver transplantation, using total energy expenditure (TEE) assessment and total caloric intake (TCI). METHODS: We analyzed nutrient adequacy and factors associated with it. EB was obtained by subtracting the TCI (obtained by 3-d food record) from TEE, which was measured as resting energy expenditure and physical activity factor calculation. Socioeconomic and clinical data also were evaluated. Univariate and multiple linear regressions were used (P < 0.05). Seventy-three patients were included. RESULTS: The TEE was 2318.5 kcal, and the TCI was 1485.1 kcal, with 81.6% of patients presenting with negative EB. There was no significant association between TCI and socioeconomic variables, medications, and encephalopathy (P > 0.05). Women, less-educated patients, those with ascites, and those who were malnourished presented with lower TCI (P < 0.05). Severity of disease, by Child-Pugh and Model for End-Stage Liver Disease scores were associated with EB (P < 0.05). Child-Pugh remained significant after multivariate analyses. Energy inadequacy was observed in 91.8% of patients, and protein inadequacy in 72.6% of patients. Polyunsaturated fatty acid (64.4%) and monounsaturated fatty acid (91.8%) and fiber (94.5%) inadequacies also were high. The percentage of adequate intake was less than 10% for vitamins B5 and D, calcium, folic acid, and potassium, and higher percentages of adequate intake (>80%) were found for iron and vitamins B1 and B12. Moreover, 54.8% and 16.4% of the patients had excessive sodium and cholesterol intakes, respectively. CONCLUSION: Negative EB was highly prevalent among patients on the waiting list for liver transplantation, and was associated with the severity of liver disease. Negative EB was primarily affected by low food intake. The food intake data were characterized by low overall energy and protein intake and inadequate composition of the patient's diet plan, which tended to be characterized by specific nutrient deficiencies and excesses.
Asunto(s)
Ingestión de Energía , Metabolismo Energético , Trasplante de Hígado , Desnutrición/fisiopatología , Listas de Espera , Adulto , Anciano , Colesterol en la Dieta/administración & dosificación , Estudios Transversales , Registros de Dieta , Fibras de la Dieta , Ácidos Grasos Monoinsaturados/administración & dosificación , Ácidos Grasos Insaturados/administración & dosificación , Femenino , Humanos , Modelos Lineales , Masculino , Micronutrientes/administración & dosificación , Micronutrientes/deficiencia , Persona de Mediana Edad , Actividad Motora , Evaluación Nutricional , Estado Nutricional , Factores Socioeconómicos , Sodio en la Dieta/administración & dosificación , Adulto JovenRESUMEN
AIM: Metabolic disorders are widely described in patients after liver transplantation (LTx). MATERIAL AND METHODS: Arterial hypertension, diabetes mellitus and obesity incidence and risk factors were assessed in 144 post-LTx patients at least one year after transplantation (59% male; median age 54 y; median time since transplantation 4 y). Risk factors were assessed using logistic regression analysis according to demographic, socioeconomic, lifestyle, clinical, anthropometric and dietetic variables. RESULTS: The incidence of hypertension was 18.9%; diabetes, 14.0% and obesity, 15.9%. Risk factors for the incidence of hypertension were abdominal obesity (OR: 2.36; CI: 1.02-5.43), family history of hypertension (OR: 2.75; CI: 1.06-7.19) and cyclosporine use (OR: 3.92; CI: 1.05-14.70). Risk factor for incidence of diabetes were greater fasting glucose levels (mg/dL) pre-LTx (OR: 1.04; CI: 1.01-1.06) and on the diagnosis of alcoholic cirrhosis as an indication of LTx (OR: 2.54; CI: 0.84-7.72). The incidence of obesity after LTx was related to lower milk consumption (mL) (OR: 1.01; CI: 1.001-1.01; P < 0.05), greater donor BMI (kg/m(2)) (OR: 1.34; CI: 1.04-1.74; P < 0.05), greater BMI prior to liver disease (kg/m(2)) (OR: 1.79; CI: 1.36-2.36; P < 0.01) and a per capita income twice the minimum wage (OR: 5.71; CI: 4.51-6.86; P < 0.05). CONCLUSION: LTx was associated with significantly increased rates of hypertension, diabetes and obesity. Furthermore, the incidences of these disorders were related to immunosuppressive therapy and have risk factors that are common in the general population.
Objetivo: Los trastornos metabólicos han sido ampliamente descritos en los pacientes sometidos al transplante hepático (TH). Material y métodos: La incidencia de hipertensión arterial, diabetes mellitus y obesidad además de los factores de riesgo se evaluaron en 144 pacientes post-TH al menos un año después del trasplante (59% hombres, edad promedio 54 años, mediana del tiempo desde el trasplante 4 años). Los factores de riesgo se evaluaron mediante análisis de regresión logística de acuerdo con variables demográficas, socioeconómicas, estilo de vida, así como variables clínicas, antropométricas y dietéticas. Resultados: La incidencia de hipertensión fue del 18,9%, la diabetes, el 14,0% y la obesidad, el 15,9%. Los factores de riesgo para la incidencia de la hipertensión fueron la obesidad abdominal (OR: 2,36, IC: 1,02-5,43, p < 0,05), los antecedentes familiares de hipertensión arterial (OR: 2,75, IC: 1,06-7,19, p < 0,05) y el uso de la ciclosporina (OR: 3,92, IC: 1,05-14,70, p < 0,05). Los factores de riesgo para la incidencia de diabetes fueron niveles más altos de glucosa en ayuno (mg/dL) pre-TH (OR: 1,04, IC: 1,01-1,06, p < 0,05) y el diagnóstico de cirrosis alcohólica como indicación de TH (OR: 2,54, IC: 0,84-7,72, p < 0,05). La incidencia de obesidad después del TH se relacionó con el bajo consumo de la leche (mL) (OR: 1,01, IC: 1,001-10,01, p < 0,05), donante con IMC más grande (kg/m2) (OR: 1,34, IC: 1,04-1,74; p < 0,05), mayor índice de masa corporal antes de la enfermedad hepática (kg/m2) (OR: 1,79, IC: 1,36-2,36, p < 0,01) y ingreso per cápita dos veces el sueldo mínimo (OR: 5,71, IC: 4,51- 6,86, p < 0,05). Conclusión: El TH se asoció con tasas significativamente más altas de hipertensión, diabetes y obesidad. La incidencia de estos trastornos se relacionó con la terapia inmunosupresora y otros factores de riesgo que comunes en la población general.