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Abstract Objective: To identify and map families' time of exposure to screens during the COVID-19 pandemic and to associate it with the frequency of children's food consumption. Methods: This is a cross-sectional study carried out with parents or guardians of children aged between 2 and 9 years through an online questionnaire. The participants answered questions about socioeconomic data, family's screen habits, and children's food consumption. Results: A total of 517 parents or guardians participated in the research. Children's median age when first exposed to screens was 6 months (interquartile range: 1-12 months). The average number of hours that children and guardians/parents were exposed to electronic devices was 3.9±2.3 and 9.0±2.9 respectively. As for food consumption, 60.9% of the guardians/parents and 54.3% of the children had the habit of having meals in front of screens. In addition, the consumption of snacks outside mealtimes, while using screens, was frequent in both groups. Conclusions: Children aged 2 to 9 years are excessively exposed to screens and the consumption of meals or snacks while using the devices is frequent. Considering the current demands of the pandemic, the necessity of using electronic devices is understandable. However, the authors emphasize the importance to educate families regarding limiting the use of screens, especially during meals, and monitoring the content of activities with electronic devices, as this exposure can influence food consumption and affect children's nutritional status and health.
RESUMO Objetivo: Identificar e mapear o tempo de exposição das famílias às telas durante a pandemia de COVID-19 e associá-lo com a frequência de consumo alimentar das crianças. Métodos: Trata-se de um estudo transversal, realizado com pais ou responsáveis de crianças de dois a nove anos de idade por meio de um questionário online. Participantes responderam a perguntas sobre dados socioeconômicos, hábitos familiares de uso de telas e consumo alimentar das crianças. Resultados: Participaram da pesquisa 517 pais ou responsáveis. A mediana de idade em que as crianças foram expostas pela primeira vez às telas foi de seis meses (intervalo interquartil: 1-12 meses). A média de horas durante as quais as crianças e os responsáveis ficavam expostos aos aparelhos eletrônicos foi de 3,9±2,3 e 9,0±2,9, respectivamente. Sobre o consumo de alimentos, 60,9% dos responsáveis e 54,3% das crianças tinham o hábito de realizar refeições em frente às telas. Além disso, o consumo de petiscos fora do horário das refeições, durante o uso de telas, foi frequente em ambos os grupos. Conclusões: Crianças de dois a nove anos estão expostas excessivamente às telas e o consumo de refeições ou petiscos durante o uso dos aparelhos é frequente. Diante das demandas atuais da pandemia, entende-se a importância do uso dos eletrônicos, porém reforça-se a necessidade de educar as famílias em relação à importância de limitar o uso de telas, especialmente durante as refeições, e de monitorar o conteúdo das atividades com telas, pois essa exposição pode influenciar a alimentação e repercutir no estado nutricional e na saúde das crianças.
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OBJECTIVE: To identify and map families' time of exposure to screens during the COVID-19 pandemic and to associate it with the frequency of children's food consumption. METHODS: This is a cross-sectional study carried out with parents or guardians of children aged between 2 and 9 years through an online questionnaire. The participants answered questions about socioeconomic data, family's screen habits, and children's food consumption. RESULTS: A total of 517 parents or guardians participated in the research. Children's median age when first exposed to screens was 6 months (interquartile range: 1-12 months). The average number of hours that children and guardians/parents were exposed to electronic devices was 3.9±2.3 and 9.0±2.9 respectively. As for food consumption, 60.9% of the guardians/parents and 54.3% of the children had the habit of having meals in front of screens. In addition, the consumption of snacks outside mealtimes, while using screens, was frequent in both groups. CONCLUSIONS: Children aged 2 to 9 years are excessively exposed to screens and the consumption of meals or snacks while using the devices is frequent. Considering the current demands of the pandemic, the necessity of using electronic devices is understandable. However, the authors emphasize the importance to educate families regarding limiting the use of screens, especially during meals, and monitoring the content of activities with electronic devices, as this exposure can influence food consumption and affect children's nutritional status and health.
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COVID-19 , Conducta Alimentaria , COVID-19/epidemiología , Niño , Preescolar , Estudios Transversales , Humanos , Lactante , Comidas , PandemiasRESUMEN
BACKGROUND: Insulin resistance, especially that induced by obesity, plays a central role in the development of non-alcoholic fatty liver disease. Although the evaluation of overweight patients is important, the nutritional assessment tools used in clinical practice have limitations. Neck circumference (NC), from this, becomes a viable and low-cost alternative, which seems to be related to the accumulation of fat in the hepatic tissue. OBJECTIVE: To evaluate the association between NC and metabolic alterations in patients with non- alcoholic fatty liver disease. METHODS: A cross-sectional study performed in 82 patients, of whom 76 underwent liver biopsy. We performed weight, height, abdominal circumference and NC measures. Values of NC ≥42 cm and ≥36 cm were considered as altered for men and women, respectively. Laboratory tests and liver biopsy result were collected in the participants' charts. We evaluated fasting blood glucose levels, insulin, glycosylated hemoglobin, triglycerides, total cholesterol, high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), ferritin, alkaline phosphatase, gamma glutamyltransferase, albumin, total bilirubin, direct bilirubin, glutamic-oxalacetic transaminase, glutamic-pyruvic transaminase and the HOMA-IR index. RESULTS: We evaluated eighty-two patients. Patients with altered NC had increased body mass index (P=0.043), abdominal circumference (P=0.007), insulin (P=0.003) and HOMA-IR (P=0.029) when compared to those with adequate NC. NC was significantly correlated with reduced levels of high-density cholesterol (HDL-C) in men (r= -042, P<0.05), increased insulin levels in men and female (rs=0.47; P<0.05 and rs=0.51; P<0.01, respectively), as well as higher HOMA-IR index both males (rs=0.49; P<0.01) and female (rs=0.30; P<0.05). There was no significant association between NC and liver outcomes (r=0.145; P=0.36). CONCLUSION: NC is associated with the HOMA-IR index in patients with non-alcoholic fatty liver disease. NC can be used in the screening of insulin resistance in these patients, considering that insulin resistance plays a key role in the progression of the disease.
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Resistencia a la Insulina/fisiología , Cuello/anatomía & histología , Enfermedad del Hígado Graso no Alcohólico/metabolismo , Adulto , Biopsia , Glucemia/análisis , Índice de Masa Corporal , HDL-Colesterol/sangre , Estudios Transversales , Femenino , Ferritinas/sangre , Homeostasis/fisiología , Humanos , Insulina/sangre , Hígado/patología , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/fisiopatología , Factores Sexuales , Circunferencia de la CinturaRESUMEN
ABSTRACT BACKGROUND: Insulin resistance, especially that induced by obesity, plays a central role in the development of non-alcoholic fatty liver disease. Although the evaluation of overweight patients is important, the nutritional assessment tools used in clinical practice have limitations. Neck circumference (NC), from this, becomes a viable and low-cost alternative, which seems to be related to the accumulation of fat in the hepatic tissue. OBJECTIVE: To evaluate the association between NC and metabolic alterations in patients with non- alcoholic fatty liver disease. METHODS: A cross-sectional study performed in 82 patients, of whom 76 underwent liver biopsy. We performed weight, height, abdominal circumference and NC measures. Values of NC ≥42 cm and ≥36 cm were considered as altered for men and women, respectively. Laboratory tests and liver biopsy result were collected in the participants' charts. We evaluated fasting blood glucose levels, insulin, glycosylated hemoglobin, triglycerides, total cholesterol, high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), ferritin, alkaline phosphatase, gamma glutamyltransferase, albumin, total bilirubin, direct bilirubin, glutamic-oxalacetic transaminase, glutamic-pyruvic transaminase and the HOMA-IR index. RESULTS: We evaluated eighty-two patients. Patients with altered NC had increased body mass index (P=0.043), abdominal circumference (P=0.007), insulin (P=0.003) and HOMA-IR (P=0.029) when compared to those with adequate NC. NC was significantly correlated with reduced levels of high-density cholesterol (HDL-C) in men (r= -042, P<0.05), increased insulin levels in men and female (rs=0.47; P<0.05 and rs=0.51; P<0.01, respectively), as well as higher HOMA-IR index both males (rs=0.49; P<0.01) and female (rs=0.30; P<0.05). There was no significant association between NC and liver outcomes (r=0.145; P=0.36). CONCLUSION: NC is associated with the HOMA-IR index in patients with non-alcoholic fatty liver disease. NC can be used in the screening of insulin resistance in these patients, considering that insulin resistance plays a key role in the progression of the disease.
RESUMO CONTEXTO: A resistência à insulina, em especial a induzida pela obesidade, desempenha papel central no desenvolvimento da doença hepática gordurosa não alcoólica (DHGNA). Embora seja importante a avaliação de pacientes com excesso de peso, as ferramentas de avaliação nutricional utilizadas na prática clínica apresentam limitações. A circunferência do pescoço, a partir disso, torna-se uma alternativa viável e de baixo custo, a qual parece estar relacionada ao acúmulo de gordura no tecido hepático. OBJETIVO: Avaliar a associação entre a circunferência do pescoço (CP) e as alterações metabólicas em pacientes com DHGNA. MÉTODOS: Estudo transversal realizado em 82 pacientes, dos quais 76 foram submetidos à biópsia hepática. Foram realizadas as medidas de peso, altura, circunferência abdominal e CP. Valores de CP ≥42 cm e ≥36 cm foram considerados alterados para homens e mulheres, respectivamente. Os exames laboratoriais e o resultado da biópsia hepática foram coletados dos prontuários dos participantes. Foram avaliados os níveis glicêmicos em jejum, insulina, hemoglobina glicosilada, triglicerídeos, colesterol total, lipoproteína de alta densidade (HDL-C), lipoproteína de baixa densidade (LDL-C), ferritina, fosfatase alcalina, gama glutamiltransferase, albumina, bilirrubina total, bilirrubina direta, transaminase glutâmico-oxalacética, transaminase glutâmico-pirúvica e o índice HOMA-IR. RESULTADOS: Foram avaliados 82 pacientes. Os pacientes com CP alterada apresentaram aumento do índice de massa corporal (P=0,043), circunferência abdominal (P=0,007), insulina (P=0,003) e HOMA-IR (P=0,029) quando comparados àqueles com CP adequada. A CP foi significativamente correlacionada com níveis reduzidos de colesterol de alta densidade (HDL-C) em homens (r= -042, P<0,05), aumento dos níveis de insulina em homens e mulheres (rs=0,47, P<0,05 e rs = 0,51; P<0,01, respectivamente), bem como maior índice HOMA-IR, tanto do sexo masculino (rs=0,49; P<0,01) quanto do feminino (rs=0,30; P<0,05). Não houve associação significativa entre CP e os desfechos hepáticos (r=0,145, P=0,36). CONCLUSÃO: A CP está associada com o índice HOMA-IR em pacientes com DHGNA. A CP pode ser utilizada no rastreamento da resistência à insulina nesses pacientes, considerando que a resistência à insulina desempenha um papel fundamental na progressão da doença.
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Humanos , Masculino , Femenino , Adulto , Resistencia a la Insulina/fisiología , Enfermedad del Hígado Graso no Alcohólico/metabolismo , Cuello/anatomía & histología , Biopsia , Glucemia/análisis , Índice de Masa Corporal , Factores Sexuales , Estudios Transversales , Circunferencia de la Cintura , Ferritinas/sangre , Enfermedad del Hígado Graso no Alcohólico/fisiopatología , Homeostasis/fisiología , Insulina/sangre , HDL-Colesterol/sangre , Hígado/patología , Persona de Mediana EdadRESUMEN
BACKGROUND: Hypertension is a public health problem and a major risk factor for cardiovascular disease. The purpose of this study is to compare the effectiveness of a multidisciplinary program based on group and individual care versus group-only care, to promote blood pressure control in hypertensive patients in primary health care. METHODS: Randomized controlled clinical trial. The study was conducted within the primary health care, in two units of the Family Health Strategy, covering 11,000 individuals, in Porto Alegre, Brazil. Two hundred and 56 patients, older than 40 years old and with uncontrolled hypertension, systolic blood pressure (BP) ≥140 mmHg and/or diastolic BP ≥90 mmHg or ≥130 mmHg and/or diastolic BP ≥80 mmHg for individuals with diabetes. Eligible patients were randomly assigned to a health care program aiming for blood pressure control, with the multidisciplinary program group or with the multidisciplinary program plus personalized care group. Primary outcome measures were reduction in systolic BP from baseline to 6 months. Secondary measures included proportion of patients with systolic or diastolic BP controlled. Student t test, Pearson's chi-squared test, Fisher's exact test, Mann-Whitney U test, Wilcoxon signed-ranks test and generalized estimating equation (GEE) model were used in the analysis. RESULTS: The baseline characteristics of participants were similar between groups. After 6 months of follow-up, systolic BP decreased markedly in both groups (Δ - 11.8 mmHg [SD, 20.2] in the multidisciplinary program group and Δ - 12.9 mmHg [SD, 19.2] in the personalized care group; p < 0.001). Similarly, we noted a significant change in diastolic BP over time in both groups (Δ - 8.1 mmHg [SD, 10.8] in the multidisciplinary program group and Δ - 7.0 mmHg [SD, 11.5] in the personalized care group; p < 0.001). CONCLUSIONS: The study demonstrates similar effectiveness of a group intervention in comparison to a personalized education program in hypertension patients to achieve BP control. These findings indicate that the intervention can be for all hypertensive patients assisted in primary health care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01696318 (May 2013).
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Hipertensión/terapia , Educación del Paciente como Asunto , Medicina de Precisión , Atención Primaria de Salud/métodos , Adulto , Anciano , Presión Sanguínea , Brasil , Femenino , Personal de Salud/educación , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente , Atención Primaria de Salud/organización & administración , Factores de RiesgoRESUMEN
BACKGROUND: In cirrhosis the production of cholesterol and lipoproteins is altered. OBJECTIVE: Evaluate the lipid profile by measuring total cholesterol, very low-density lipoprotein, low-density lipoprotein, high-density lipoprotein and triglyceride levels in patients with cirrhosis caused by alcoholism and/or hepatitis C virus infection and determine its association with Child-Pugh and MELD scores. METHODS: Cross-sectional retrospective study of patients treated at the outpatient clinic in Porto Alegre, Brazil, from 2006 to 2010. RESULTS: In total, 314 records were reviewed, and 153 (48.7%) met the inclusion criteria, of which 82 (53.6%) had cirrhosis that was due to hepatitis C virus infection, 50 (32.7%) were due to alcoholism, and 21 (13.7%) were due to alcoholism and hepatitis C virus infection. The total cholesterol levels diminished with a Child-Pugh progression (P<0.001). Child-Pugh C was significantly associated with lover levels of low-density lipoprotein (<70 mg/dL; P<0.001), high-density lipoprotein (<40 mg/dL; P<0.001) and triglyceride (<70 mg/dL; P=0.003). MELD>20 was associated with lower total cholesterol levels (<100mg/dL; P<0.001), very low-density lipoprotein (<16 mg/dL; P=0.006), and low-density lipoprotein (<70 mg/dL; P=0.003). Inverse and statistically significant correlations were observed between Child-Pugh and all the lipid fractions analyzed (P<0.001). The increase in MELD was inversely correlated with reduced levels in total cholesterol (P<0.001), high-density lipoprotein (P<0.001), low-density lipoprotein (P<0.001), very low-density lipoprotein (P=0.030) and triglyceride (P=0.003). CONCLUSION: A reduction in the lipid profile in patients with cirrhosis due to hepatitis C virus infection and/or alcoholism was significantly associated with the Child-Pugh and MELD prognostic markers. These results suggest that the lipid profile may be used as a tool to assist in evaluating liver disease.
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Lípidos/sangre , Cirrosis Hepática/sangre , Anciano , Alcoholismo/complicaciones , Brasil , Colesterol/metabolismo , Estudios Transversales , Femenino , Hepatitis C/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Triglicéridos/metabolismoRESUMEN
BackgroundIn cirrhosis the production of cholesterol and lipoproteins is altered.ObjectiveEvaluate the lipid profile by measuring total cholesterol, very low-density lipoprotein, low-density lipoprotein, high-density lipoprotein and triglyceride levels in patients with cirrhosis caused by alcoholism and/or hepatitis C virus infection and determine its association with Child-Pugh and MELD scores.MethodsCross-sectional retrospective study of patients treated at the outpatient clinic in Porto Alegre, Brazil, from 2006 to 2010.ResultsIn total, 314 records were reviewed, and 153 (48.7%) met the inclusion criteria, of which 82 (53.6%) had cirrhosis that was due to hepatitis C virus infection, 50 (32.7%) were due to alcoholism, and 21 (13.7%) were due to alcoholism and hepatitis C virus infection. The total cholesterol levels diminished with a Child-Pugh progression (P<0.001). Child-Pugh C was significantly associated with lover levels of low-density lipoprotein (<70 mg/dL; P<0.001), high-density lipoprotein (<40 mg/dL; P<0.001) and triglyceride (<70 mg/dL; P=0.003). MELD>20 was associated with lower total cholesterol levels (<100mg/dL; P<0.001), very low-density lipoprotein (<16 mg/dL; P=0.006), and low-density lipoprotein (<70 mg/dL; P=0.003). Inverse and statistically significant correlations were observed between Child-Pugh and all the lipid fractions analyzed (P<0.001). The increase in MELD was inversely correlated with reduced levels intotal cholesterol (P<0.001), high-density lipoprotein (P<0.001), low-density lipoprotein (P<0.001), very low-density lipoprotein (P=0.030) and triglyceride (P=0.003).ConclusionA reduction in the lipid profile in patients with cirrhosis due to hepatitis C virus infection and/or alcoholism was significantly associated with the Child-Pugh and MELD prognostic markers. These results suggest that the lipid profile may be used as a tool to assist in evaluating liver disease.
ContextoNa cirrose a produção de colesterol e de lipoproteínas está alterada.ObjetivoAvaliar o perfil lipídico - através da dosagem do colesterol total, lipoproteína de muito baixa densidade, lipoproteína de baixa densidade, lipoproteína de alta densidade e triglicerídeos - de pacientes com cirrose, por álcool e/ou vírus da hepatite C, e verificar sua associação com os escores Child-Pugh e MELD.MétodosEstudo transversal, retrospectivo de pacientes em acompanhamento ambulatorial no Complexo Hospitalar Santa Casa de Porto Alegre, Brasil, no período de 2006 a 2010.ResultadosForam revisados 314 prontuários, destes 153 (48,7%) preencheram os critérios de inclusão, sendo que 82 (53,6%) tinham cirrose por vírus da hepatite C, 50 (32,7%) por álcool e 21 (13,7%) por álcool e vírus da hepatite C. Os níveis de colesterol total reduziram com a progressão do Child-Pugh (P<0,001). Child-Pugh C associou-se significativamente aos níveis mais baixos de lipoproteína de baixa densidade (<70 mg/dL; P<0,001), lipoproteína de alta densidade (<40 mg/dL; P<0,001) e triglicerídeos (<70 mg/dL; P=0,003). MELD>20 esteve associado aos menores valores de colesterol total (<100 mg/dL; P<0,001), lipoproteína de muito baixa densidade (<16 mg/dL; P=0,006), lipoproteína de baixa densidade (<70 mg/dL; P=0,003). Correlações inversas e estatisticamente significativas foram observadas entre Child-Pugh e todas as frações lipídicas analisadas (P<0,001). O aumento do MELD esteve correlacionado inversamente com a redução do colesterol total (P<0,001), lipoproteína de alta densidade (P<0,001), lipoproteína de baixa densidade (P<0,001), lipoproteína de muito baixa densidade (P=0,030) e triglicerídeos (P=0,003).ConclusãoA redução do perfil lipídico, nos pacientes com cirrose por vírus da hepatite C e ou álcool, associou-se significativamente com os marcadores de prognóstico Child-Pugh e MELD. Tais resultados sugerem que o perfil lipídico poderá ser utilizado como uma ferramenta para auxiliar na avaliação da hepatopatia.
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Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Lípidos/sangre , Cirrosis Hepática/sangre , Alcoholismo/complicaciones , Brasil , Estudios Transversales , Colesterol/metabolismo , Hepatitis C/complicaciones , Pronóstico , Estudios Retrospectivos , Triglicéridos/metabolismoRESUMEN
PURPOSE: This double-blind placebo-controlled trial evaluated serum 25-hydroxyvitamin D [25(OH)D] levels after the oral intake of a single dose of cholecalciferol during one of the three meals, containing different amounts of fat or placebo. METHODS AND RESULTS: Sixty-four healthy medical residents or students of a university hospital in Porto Alegre, latitude 30° S, Brazil, were divided into four groups. Three groups received a single 50,000 IU oral dose of cholecalciferol during a meal containing 0 g (Group 1), 15 g (Group 2) or 30 g (Group 3) of fat, and one group received placebo (Group 4), according to randomization. Serum 25(OH)D, parathyroid hormone, total calcium, albumin, magnesium, and creatinine levels, and urinary calcium, magnesium, and creatinine levels were measured at baseline and after 14 days. Baseline mean serum 25(OH)D levels were low in all groups. Vitamin D given during breakfast increased the mean change of serum 25(OH)D levels, when compared to placebo. Furthermore, the intake of fat with vitamin D increased the mean change of serum 25(OH)D levels. CONCLUSION: A single oral dose of vitamin D given with food increased mean serum 25(OH)D levels, after 2 weeks, and the mean increase was larger, when the meal had at least 15 g of fat. These findings can have important implications to oral vitamin D supplementation.
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Grasas de la Dieta/administración & dosificación , Vitamina D/administración & dosificación , Vitamina D/sangre , Administración Oral , Adulto , Brasil , Desayuno , Calcio/sangre , Calcio/orina , Creatinina/sangre , Creatinina/orina , Suplementos Dietéticos , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Humanos , Magnesio/sangre , Magnesio/orina , Masculino , Hormona Paratiroidea/sangre , Albúmina Sérica/metabolismo , Adulto JovenRESUMEN
OBJECTIVE: The aim of this cross-sectional study was to evaluate the prevalence of low bone mass density in cystic fibrosis patients as well as to evaluate the factors associated with bone mass in such patients. METHODS: Bone mass density was measured by dual-photon X-ray absorptiometry of lumbar spine (L1-L4), in patients ≤19 years old, or lumbar spine and femur (total and neck) in patients ≥20 years old. Evaluations of nutritional status, biochemical parameters, and lung function were performed. Medication data were obtained from medical records. RESULTS: Fifty-eight patients were included in the study (25 males/ 33 females), mean age 23.9 years (16-53 years). The prevalence of bone mass below the expected range for age at any site was 20.7%. None of the subjects had history of fracture. Lumbar spine Z-score in cystic fibrosis patients correlated positively with body mass index (r= 0.3, p=0.001), and forced expiratory volume in the first second (% predicted) (r=0.415, p=0.022). Mean lumbar spine Z-score was higher in women (p=0.001), in patients with no pancreatic insufficiency (p=0.032), and in patients with no hospitalization in the last 3 months (p=0.02). After multivariate analysis, body mass index (p= 0.001) and sex (p=0.001) were independently associated with Z-score in lumbar spine. CONCLUSION: Low bone mass is a frequent problem in patients with CF, being independently associated with body mass index, and male sex.
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Densidad Ósea/fisiología , Enfermedades Óseas Metabólicas/epidemiología , Fibrosis Quística/complicaciones , Absorciometría de Fotón , Adolescente , Adulto , Índice de Masa Corporal , Enfermedades Óseas Metabólicas/etiología , Brasil/epidemiología , Estudios Transversales , Insuficiencia Pancreática Exocrina/complicaciones , Femenino , Fémur/diagnóstico por imagen , Volumen Espiratorio Forzado , Humanos , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estado Nutricional , Prevalencia , Factores de Riesgo , Factores Sexuales , Adulto JovenRESUMEN
Objective The aim of this cross-sectional study was to evaluate the prevalence of low bone mass density in cystic fibrosis patients as well as to evaluate the factors associated with bone mass in such patients. Methods Bone mass density was measured by dual-photon X-ray absorptiometry of lumbar spine (L1-L4), in patients ≤19 years old, or lumbar spine and femur (total and neck) in patients ≥20 years old. Evaluations of nutritional status, biochemical parameters, and lung function were performed. Medication data were obtained from medical records. Results Fifty-eight patients were included in the study (25 males/ 33 females), mean age 23.9 years (16-53years). The prevalence of bone mass below the expected range for age at any site was 20.7%. None of the subjects had history of fracture. Lumbar spine Z-score in cystic fibrosis patients correlated positively with body mass index (r= 0.3, p=0.001), and forced expiratory volume in the first second (% predicted) (r=0.415, p=0.022). Mean lumbar spine Z-score was higher in women (p=0.001), in patients with no pancreatic insufficiency (p=0.032), and in patients with no hospitalization in the last 3 months (p=0.02). After multivariate analysis, body mass index (p= 0.001) and sex (p=0.001) were independently associated with Z-score in lumbar spine. Conclusion Low bone mass is a frequent problem in patients with CF, being independently associated with body mass index, and male sex. .
Objetivo Determinar a prevalência de massa óssea baixa em pacientes adolescentes e adultos com fibrose cística e estudar os fatores potencialmente associados. Métodos Densidade mineral óssea foi determinada por absorciometria por dupla emissão de raios X na coluna lombar em pacientes ≤ 19 anos e na coluna e no fêmur em pacientes ≥ 20 anos. Avaliações nutricionais, bioquímicas e pulmonares foram realizadas. Dados referentes ao tratamento farmacológico foram coletados. Resultados 58 pacientes foram incluídos no estudo (25 homens/33 mulheres), média de idade de 23,9 anos (16-53). Massa óssea abaixo da esperada foi verificada em 20,7% dos pacientes. Não houve histórico de fratura. Z-score da coluna lombar associou-se positivamente com índice de massa corporal (r=0,3; p=0,022), volume expiratório forçado (% previsto) (r=0,415; p=0,001). A média do Z-score da coluna foi mais alta nas mulheres que nos homens (p=0,001), em pacientes que não possuíam insuficiência pancreática (p=0,02) e em pacientes que não haviam sido hospitalizados nos últimos três meses (p=0,032). Os fatores encontrados como preditores independentes de Z-score da coluna lombar foram sexo masculino (p=0,001) e índice de massa corporal (p=0,001). Conclusão Massa óssea baixa é frequente em pacientes com FC, estando associada independentemente com índice de massa corporal e sexo masculino. .
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Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Densidad Ósea/fisiología , Enfermedades Óseas Metabólicas/epidemiología , Fibrosis Quística/complicaciones , Absorciometría de Fotón , Índice de Masa Corporal , Enfermedades Óseas Metabólicas/etiología , Brasil/epidemiología , Estudios Transversales , Insuficiencia Pancreática Exocrina/complicaciones , Fémur , Volumen Espiratorio Forzado , Vértebras Lumbares , Estado Nutricional , Prevalencia , Factores de Riesgo , Factores SexualesRESUMEN
INTRODUCTION: Cystic fibrosis (CF) patients have a susceptibility to vitamin D deficiency because of nutrient malabsorption. OBJECTIVES: To evaluate the prevalence of hypovitaminosis D in CF patients and the factors associated with serum 25-hydroxyvitamin D levels. METHODS: We evaluated the prevalence of vitamin D deficiency defined as 25-hydroxyvitamin D <30 ng/mL, as suggested recently by the Cystic Fibrosis Foundation, and factors associated with its serum levels. Patients with confirmed CF were included. Nutritional status and hospital admissions were evaluated. Serum C-reactive protein, calcium, phosphate, magnesium, albumin, 25-hydroxyvitamin D and parathyroid hormone levels were measured. Lung function was evaluated by spirometry, and clinical and chest radiographic scores were assessed. Statistical significance level was set at P < 0.05. RESULTS: Fifty-nine patients were included. Prevalence of hypovitaminosis D was 61%. Patients with pancreatic insufficiency had a trend to have higher vitamin D levels. Sixteen patients had severe lung disease with percentage of forced expiratory volume in 1 s predicted below 40%. After multivariate analysis, body mass index and hospitalization in the last month remained significantly associated with serum vitamin D levels. CONCLUSIONS: Vitamin D insufficiency is still a problem in CF patients, even in those receiving supplementation.
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Fibrosis Quística/complicaciones , Deficiencia de Vitamina D/epidemiología , Adolescente , Adulto , Índice de Masa Corporal , Brasil , Estudios Transversales , Fibrosis Quística/sangre , Femenino , Hospitalización , Humanos , Masculino , Prevalencia , Factores de Riesgo , Vitamina D/análogos & derivados , Vitamina D/sangre , Deficiencia de Vitamina D/diagnóstico , Adulto JovenRESUMEN
Background/Aims. Vitamin D(3) is liposoluble, so dietary fat could increase its oral absorption. Our aim was to compare serum 25-hydroxyvitamin D [25(OH)D] after the oral intake of cholecalciferol with a high- or low-fat meal. Methods. In a single-blind, parallel clinical trial, 32 healthy physicians were divided into two groups. In the same day, they ingested 50,000 IU (1.25 mg) of vitamin D(3) with food: group 1 (G1): lipids: 25.6 g and group 2 (G2) lipids: 1.7 g. Serum 25(OH)D (0, 7, and 14 days), and parathyroid hormone (PTH), and calcium (0 and 14 days) were measured. Results. Baseline mean serum 25(OH)D levels were 42.7 ± 19.0 nmol/L in G1 and 36.4 ± 19.0 nmol/L in G2 (P = 0.38). After cholecalciferol, mean serum 25(OH)D was higher in G1 (P < 0.001): 7 days: G1 = 46.2 (38.4-53.9) nmol/L and G2 = 33.7 (25.4-40.1) nmol/L; 14 days: G1 = 53.7 (45.2-62.1) nmol/L and G2 = 33.7 (25.2-42.2) nmol/L. Serum PTH and 25(OH)D were negatively correlated before and after the intake of vitamin D(3), respectively, r = -0.42 (P = 0.02) and r = -0.52 (P = 0.003). Conclusions. A high-fat meal increased the absorption of vitamin D(3), as measured by serum 25(OH)D.
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OBJECTIVE: The objective of this study was to evaluate the presence of vitamin B12 deficiency and the factors associated with serum vitamin B12 levels in a sample of metformin-treated Brazilian diabetic patients. METHOD: Cross-sectional study. RESULTS: 144 patients were included. Serum vitamin B12 levels were low (< 125 pmol/L) in 10 patients (6.9%) and possibly low (125 - 250 pmol/L) in 53 patients (36.8%). Serum vitamin B12 levels were negatively associated with age (B = -3.17; ß= -0.171; p = 0.037) and duration of metformin use (B= -33.36; ß= -0.161; p = 0.048), and positively associated with the estimated intake of vitamin B12 (B= 67.96; ß= 0.249; p = 0.002). CONCLUSION: The present findings suggest a high prevalence of vitamin B12 deficiency in metformin-treated diabetic patients. Older patients, patients in long term treatment with metformin and low vitamin B12 intake are probably more prone to this deficiency.
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Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Metformina/uso terapéutico , Vitamina B 12/sangre , Brasil , Estudios Transversales , Diabetes Mellitus Tipo 2/sangre , Femenino , Homocisteína/sangre , Humanos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
OBJECTIVE: The objective of this study was to evaluate the presence of vitamin B12 deficiency and the factors associated with serum vitamin B12 levels in a sample of metformin-treated Brazilian diabetic patients. METHOD: Cross-sectional study. RESULTS: 144 patients were included. Serum vitamin B12 levels were low (< 125 pmol/L) in 10 patients (6.9 percent) and possibly low (125 - 250 pmol/L) in 53 patients (36.8 percent). Serum vitamin B12 levels were negatively associated with age (B = -3.17; β= -0.171; p = 0.037) and duration of metformin use (B= -33.36; β= -0.161; p = 0.048), and positively associated with the estimated intake of vitamin B12 (B= 67.96; β= 0.249; p = 0.002). CONCLUSION: The present findings suggest a high prevalence of vitamin B12 deficiency in metformin-treated diabetic patients. Older patients, patients in long term treatment with metformin and low vitamin B12 intake are probably more prone to this deficiency.
OBJETIVO: O objetivo deste estudo foi avaliar a prevalência de deficiência de vitamina B12 em pacientes diabéticos brasileiros tratados com metformina e os fatores associados aos níveis séricos de vitamina B12. MÉTODO: Corte transversal. RESULTADOS: 144 pacientes foram incluídos. Os níveis séricos de vitamina B12 foram baixos (< 125 pmol/L) em 10 pacientes (6,9 por cento) e possivelmente baixos (125 - 250pmol/L) em 53 pacientes (36,8 por cento). Os níveis séricos de vitamina B12 foram associados negativamente à idade (B = -3,17; β = -0,171; p = 0,037) e à duração do uso de metformina (B = -33,36; β= -0,161; p = 0,048) e positivamente com a ingestão estimada de vitamina B12 (B = 67,96; β = 0,249; p = 0,002). CONCLUSÃO: Estes resultados sugerem alta prevalência de deficiência de vitamina B12 em pacientes diabéticos tratados com metformina. Pacientes mais velhos, em uso de metformina há muito tempo e com ingestão baixa de vitamina B12 estão provavelmente mais predispostos a essa deficiência.
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Femenino , Humanos , Persona de Mediana Edad , /tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Metformina/uso terapéutico , /sangre , Brasil , Estudios Transversales , /sangre , Homocisteína/sangre , Factores de TiempoRESUMEN
Introdução: A baixa estatura sem causa clínica evidente pode estar relacionada com deficiências nutricionais. A vitamina D é um hormônio fundamental para o desenvolvimento ósseo, obtida através da dieta e exposição solar. Objetivo: Avaliar os níveis séricos de 25(OH)D, a variação sazonal deste metabólito e a ingestão de vitamina D em crianças e adolescentes com o déficit estatural sem causas clínicas evidentes. Métodos: Cinquenta e cinco crianças e adolescentes com baixa estatura, sem doenças crônicas, endócrinas ou genéticas, responderam a três recordatórios de 24h para estimar o consumo de vitamina D. O nível sérico de 25(OH)D foi avaliado por Cromatografia Líquida de Alta Eficiência (HPLC) no Laboratório Fleury/SP. A classificação do fototipo foi realizada através dos parâmetros de Fitzpatrick. Os dados meteorológicos foram obtidos junto ao VIII Distrito de Meteorologia de Porto Alegre, do Instituto Nacional de Meteorologia. Resultados: Verificou-se o consumo dietético de Vitamina D abaixo do recomendado em 96% (N=53) dos pacientes e níveis insuficientes de 25(OH)D (<30 ng/ml) em 60% (N=33). A concentração de 25(OH)D sérica foi mais alta nas amostras coletadas durante o outono (P<0,05), não se correlacionando com a insolação (P =0,13) ou consumo dietético de Vitamina D (P=0,32). A média de 25(OH)D sérica foi maior (P<0,05) no grupo de pacientes com fototipos I, II e III. Conclusão: A 25(OH)D sérica apresentou variação sazonal. Níveis séricos de 25(OH)D baixos reforçam a importância da vitamina D obtida através da dieta ou suplementação nos meses onde há uma menor incidência de radiação ultravioleta.
Background: Short stature without evident medical cause may be related to nutritional deficiencies. Vitamin D is an essential hormone for bone development, being obtained through diet and sun exposure. Aim: To evaluate 25(OH)D serum levels, as well as the seasonal variation of this metabolite and vitamin D intake in children and adolescents with short stature without evident clinical causes. Methods: Fifty-five short children and adolescents, without endocrine or genetic chronic diseases, completed three 24-hour dietary recalls to estimate the intake of vitamin D. 25(OH)D serum levels were evaluated using high performance liquid chromatography (HPLC) at Laboratory Fleury, state of São Paulo, Brazil. The phototype classification was performed using the Fitzpatrick parameters. Meteorological data were obtained from the VIII District of Meteorology of Porto Alegre, National Institute of Meteorology. Results: The dietary intake of vitamin D was lower than recommended in 96% (N= 53) of patients and there were insufficient levels of 25(OH)D (<30 ng/ml) in 60% (N=33). The concentration of 25(OH)D levels was higher in samples collected during the fall (P<0.05), without correlation with sunshine (P=0.13) or dietary intake of vitamin D (P=0.32). The mean 25(H)D level was higher (P<0.05) in patients with phototypes I, II and III. Conclusion: 25(OH)D levels showed seasonal variation. Low serum 25(OH)D levels reinforce the importance of vitamin D obtained from diet or supplements in the months during which there is lower incidence of ultraviolet radiation.
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Humanos , Niño , Adolescente , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/diagnóstico , Enfermedades Carenciales , Estatura , Vitamina D , HidroxicolecalciferolesRESUMEN
Introdução: Desnutrição calórico-proteica em crianças menores de cinco anos é um dos maiores problemas de saúde pública nos países em desenvolvimento. Resulta da interação entre fatores como pobreza, infecções e baixa ingestão calórica e proteica. A avaliação do estado nutricional (EN) na admissão hospitalar é fundamental para estabelecer métodos para a recuperação e/ou manutenção do EN durante a internação e identificar os fatores de risco (FR) para desnutrição. Objetivo: O objetivo deste estudo foi classificar o EN de crianças e adolescentes e seus FR para desnutrição na admissão hospitalar. Métodos: Estudo transversal realizado com 387 indivíduos de 0 a 14 anos admitidos em unidades de internação pediátrica. Na avaliação antropométrica, mensurou-se peso e estatura. Os FR para desnutrição incluíam: antropometria, jejum >2 dias, alimentação enteral ou parenteral, disfagia, perda ponderal, vômitos ou diarreia nas últimas 24 horas, febre acima de 37,5º C e risco relacionado ao diagnóstico. O EN foi classificado segundo os critérios da Organização Mundial da Saúde, 2006. Resultados: Na classificação do EN (N=363) utilizamos escore Z (N=327; 85%) e índice de massa corporal (IMC; N=36; 9%), e 23 foram avaliados através de protocolos específicos. Encontramos 48% eutróficos, 27% desnutridos, 15% em risco nutricional, 6% com sobrepeso e 4% obesos. Em relação aos FR para desnutrição, 271 (70%) indivíduos apresentavam até 2 FR; 114 (29,5%) de 3 a 5 (p<0,001) e 2 (0,5%) 6 ou mais. Conclusão: A prevalência de desnutrição e de seus fatores de risco na admissão hospitalar encontrada em crianças e adolescentes foi bastante expressiva. Esse achado é muito relevante, já que a identificação do EN permite uma intervenção nutricional adequada com a prevenção de desfechos clínicos desfavoráveis.
Background: Protein-calorie malnutrition in children under five years is a major public health problem in developing countries. Results from the interaction between factors such as poverty, infections and low energy intake and protein. The assessment of the status (NS) at hospital admission is essential to establish methods for the recovery and/or maintenance of NS during hospitalization and to identify risk factors (RF) to malnutrition. Aim: The aim of this study was to classify the NS of the children and adolescents and their RF for malnutrition at admission. Methods: Cross sectional prospective study with 387 individuals 0 to 14 years admitted to hospital pediatric units. Anthropometric evaluation, measured in weight and height. Risk factors for malnutrition included: anthropometry, fasting > 2 days, enteral or parenteral feeding, dysphagia, weight loss, vomiting or diarrhea in the last 24 hours, fever over 37.5 C and the risk of the diagnosis. NS was classified according to criteria of the World Health Organization, 2006. Results: To classify the NS (N=363) Z score (N=327, 84.5%) and body mass index (BMI, N=36, 9.3%) were used, and 23 were assessed using specific protocols. We found 48% normal weight, 27% malnourished, 15% at nutritional risk, 6% overweight and 4% obese. About RF for malnutrition, 271 (70%) subjects had up to 2 RF, 114 (29.5%) from 3 to 5 (p <0.001) and 2 (0.5%) 6 or more. Conclusion: The prevalence of malnutrition and its risk factors found in children and adolescents at hospitalar admission was very high. This finding is relevant, since the identification of NS allows an appropriate nutritional intervention, preventing unfavourable clinical outcomes.