RESUMO
Malnutrition is associated with morbidity and mortality in patients with heart failure (HF). Thus, it is essential to apply reliable indicators to assess the nutritional status of these individuals. Objective: To evaluate the thickness of the adductor pollicis muscle (APM) in patients with HF as an indicator of somatic protein status and correlate the obtained values with conventionally used parameters and electrical bioimpedance (EBI) markers. Methods: Cross-sectional study with patients with HF undergoing regular outpatient treatment. APM thickness was measured in the dominant arm, and the values obtained were classified according to gender and age. The anthropometric parameters assessed included the body mass index (BMI) and specific parameters to assess the muscle (arm muscle circumference [AMC] and arm muscle area [AMA]). Values of phase angle (PA), standard PA (SPA), and lean mass were obtained by EBI. Statistical analyses were performed with the software Statistical Package for the Social Sciences, version 19, using unpaired Student's t, Mann-Whitney, or one-way analysis of variance (ANOVA) tests for comparisons between groups, as appropriate. The correlation between variables of interest was performed using Pearson's or Spearman's correlation coefficient, as adequate. The level of significance was set at 5%. Results: About 70% of the 74 patients evaluated were classified as malnourished according to the APM thickness. Values of AMC, AMA, and lean mass correlated positively with APM thickness (p < 0.005). The APM thickness also correlated positively with PA and SPA (r = 0.49, p < 0.001 and r = 0.31, p = 0.008, respectively). Conclusion: Patients with HF presented a high frequency of protein malnutrition when APM thickness was used as an indicator of nutritional status. APM thickness values correlated with conventional measures of somatic protein evaluation and may be related to the prognosis of these patients, since they correlated positively with PA and SPA
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Avaliação Nutricional , Desnutrição/mortalidade , Insuficiência Cardíaca/diagnóstico , Polegar , Índice de Massa Corporal , Fatores Sexuais , Antropometria , Doença Crônica , Estudos Transversais/métodos , Análise de Variância , Fatores Etários , InflamaçãoRESUMO
The potential benefits and dangers of dietary protein restriction in chronic kidney disease (CKD) are still controversial. Thus, the aim of this study is to evaluate the effect of low protein diet (LPD) on the renal function in nondialysis CKD patients. A retrospective study was conducted from 321 nondialysis CKD patient's medical files (65.1 ± 12.7 yrs, 58.2% men). These patients received individualized dietary protein prescription (0.6-0.8 g protein/kg/day). Protein intake was evaluated by food diary and 24 h-food recall. Adherence to the LPD was considered when patients intake from 90 to 110% of the prescribed amount of protein. The patients were divided into 4 groups: (G1) adherent diabetes mellitus (DM) patients (n = 83); (G2) non-adherent DM patients (n = 106); (G3) adherent non-DM patients (n = 75); (G4) non-adherent non-DM patients (n = 57). Renal function was assessed by estimated glomerular filtration rate (eGFR). Both groups of patients (DM and non-DM) that adhered to the LPD showed significant improvement in eGFR (G1: 38.7 ± 13.2 mL/min to 51.1 ± 17.0 mL/min (p < 0.001); G3: 35.1 ± 16.8 mL/min to 46.8 ± 21.4 mL/min (p < 0.001)). In adherent patients, no differences in albumin and BMI were observed at the end of follow up. In non-adherent patients, eGFR significantly decreased in DM group (G2: 44.2 ± 18.5 mL/min to 38.2 ± 15.8 mL/min (p = 0.003)). According to multivariate analysis, annual changes in eGFR were not independent associated with age, gender, BMI, lipid profile, bicarbonate or smoking status. In summary, adherence to low protein diet could be able to improve serum creatinine and eGFR, well-known markers of renal function. However, prospective studies are needed to control confounders which affect renal function and CKD progression.
Assuntos
Creatinina/sangue , Dieta com Restrição de Proteínas , Taxa de Filtração Glomerular , Cooperação do Paciente/estatística & dados numéricos , Insuficiência Renal Crônica/dietoterapia , Idoso , Índice de Massa Corporal , Diabetes Mellitus/dietoterapia , Registros de Dieta , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Medicina de Precisão/métodos , Estudos RetrospectivosRESUMO
INTRODUCTION: Polyphenols contained in natural sources such as grapes, have been considered pharmacological agents to combat oxidative stress and inflammation, common features in Chronic Kidney Disease patients. OBJECTIVE: To evaluate the effects of grape powder supplementation on inflammatory and antioxidant biomarkers in hemodialysis (HD) patients. METHODS: The double-blind placebo-controlled randomized clinical trial evaluated non-diabetic HD patients that received grape powder (500 mg of polyphenols/day) (n = 16, 9 men, 53.0 ± 9.8 years of age, 111.6 ± 58.2 HD months) or placebo (n = 16, 9 men, 52.7 ± 13.7 years of age, 110.4 ± 93.1 HD months) for five weeks. The glutathione peroxidase (GSH-Px) activity and C-reactive protein (CRP) levels were evaluated by ELISA method. RESULTS: After the intervention period, the patients receiving grape powder showed an increase in the GSH-Px activity (16.5 (41.0) to 42.0 (43.3) nmol/min/ml) (p < 0.05) and they did not have the CRP levels increased as seen in placebo group (2.6 (0.28) to 2.8 (0.23 mg/L) (p < 0.05). CONCLUSION: The use of grape powder as phenolic source could play an important role as an antioxidant and anti-inflammatory agent in non-diabetic HD patients.
Assuntos
Proteína C-Reativa/análise , Proteína C-Reativa/efeitos dos fármacos , Suplementos Nutricionais , Glutationa Peroxidase/sangue , Glutationa Peroxidase/efeitos dos fármacos , Extratos Vegetais/farmacologia , Diálise Renal , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/terapia , Vitis , Antioxidantes/análise , Biomarcadores/sangue , Método Duplo-Cego , Feminino , Humanos , Inflamação/sangue , Masculino , Pessoa de Meia-Idade , PósRESUMO
Introduction: Polyphenols contained in natural sources such as grapes, have been considered pharmacological agents to combat oxidative stress and inflammation, common features in Chronic Kidney Disease patients. Objective: To evaluate the effects of grape powder supplementation on inflammatory and antioxidant biomarkers in hemodialysis (HD) patients. Methods: The double-blind placebo-controlled randomized clinical trial evaluated non-diabetic HD patients that received grape powder (500 mg of polyphenols/day) (n = 16, 9 men, 53.0 ± 9.8 years of age, 111.6 ± 58.2 HD months) or placebo (n = 16, 9 men, 52.7 ± 13.7 years of age, 110.4 ± 93.1 HD months) for five weeks. The glutathione peroxidase (GSH-Px) activity and C-reactive protein (CRP) levels were evaluated by ELISA method. Results: After the intervention period, the patients receiving grape powder showed an increase in the GSH-Px activity (16.5 (41.0) to 42.0 (43.3) nmol/min/ml) (p < 0.05) and they did not have the CRP levels increased as seen in placebo group (2.6 (0.28) to 2.8 (0.23 mg/L) (p < 0.05). Conclusion: The use of grape powder as phenolic source could play an important role as an antioxidant and anti-inflammatory agent in non-diabetic HD patients. .
Introdução: Polifenóis contidos em fontes naturais, como as uvas, têm sido considerados agentes farmacológicos no combate ao estresse oxidativo e inflamação, condições comuns na Doença Renal Crônica. Objetivo: Avaliar os efeitos da suplementação de farinha de uva sobre marcadores inflamatórios e antioxidantes em pacientes submetidos à hemodiálise (HD). Métodos: Estudo randomizado, duplo-cego, placebocontrolado, no qual foram avaliados pacientes não diabéticos em HD que receberam farinha de uva (500 mg de polifenóis/dia) (n = 16, 9 homens, 53,0 ± 9,8 anos, 111,6 ± 58,2 meses em HD) ou placebo (n = 16, 9 homens, 52,7 ± 13,7 anos, 110,4 ± 93,1 meses em HD) por cinco semanas. A atividade da glutationa peroxidase (GSH-Px) e os níveis plasmáticos de proteína C-reativa (PCR) foram mensurados por meio do método ELISA. Resultados: Após o período de intervenção, os pacientes que receberam farinha de uva apresentaram elevação na atividade da GSH-Px (16,5 (41,0) para 42,0 (43,3) nmol/min/ml) (p < 0,05) e não foi observada elevação nos níveis de PCR, como visto no grupo placebo (2,6 (0,28) para 2,8 (0,23) mg/L) (p < 0,05). Conclusão: O uso da farinha de uva como fonte de polifenóis pode desempenhar um importante papel anti-inflamatório e antioxidante em pacientes não diabéticos submetidos à HD. .
Assuntos
Humanos , Proteínas de Ligação a DNA , Regulação da Expressão Gênica , Mutação , Proteínas Nucleares , Transativadores/metabolismo , Fatores de Transcrição/metabolismo , Sítios de Ligação , Carcinoma Hepatocelular , DNA Viral/metabolismo , Fator 1 Nuclear de Hepatócito , Fator 1-alfa Nuclear de Hepatócito , Fator 1-beta Nuclear de Hepatócito , Vírus da Hepatite B/genética , Vírus da Hepatite B/metabolismo , Testes de Precipitina , Plasmídeos/genética , Precursores de Proteínas/genética , Precursores de Proteínas/metabolismo , Transfecção , Células Tumorais Cultivadas , Transativadores/genética , Fatores de Transcrição/genética , Proteínas do Core Viral/genética , Proteínas do Core Viral/metabolismoRESUMO
Phenolic compounds or polyphenols are bioactive compounds widely distributed in many foods such as fruits, vegetables, tea and wine. Several studies indicate the important role of these compounds in the prevention of chronic diseases such as cancer and cardiovascular diseases. Furthermore, polyphenols may be considered pharmacological agents capable of combating oxidative stress owing to reduced formation of reactive oxygen species and inflammation. The imbalance between the production of free radicals and antioxidant capacity is a common feature in patients with chronic kidney disease (CKD) and is associated with progression of disease, and is considered a risk factor for cardiovascular disease, the leading cause of mortality in these patients. Although scarce, some studies have shown the benefits of using phenolic compounds in patients with chronic kidney disease and, therefore, the present review discusses the possible applicability of phenolic compounds in this population.
Los compuestos fenólicos o polifenoles son compuestos bioactivos ampliamente distribuidos en muchos alimentos, tales como frutas, legumbres, verduras, tés y vino. Varios estudios indican el importante papel de estos compuestos en la prevención de enfermedades crónicas, tales como cáncer y enfermedades cardiovasculares. Además, debido a sus propiedades anti-inflamatorias y antioxidantes, los polifenoles pueden ser considerados agentes farmacológicos capaces de combatir el estrés oxidativo, debido a la reducción de la formación de especies reactivas del oxígeno o radicales libres. El desequilibrio entre la producción de radicales libres y la capacidad antioxidante es una característica común de los pacientes con enfermedad renal crónica (DRC) y está relacionado con la progresión de la lesión renal, además de que se considera un factor de riesgo para las enfermedades cardiovasculares, la principal causa de mortalidad en estos pacientes. Aunque sean escasos, algunos estudios han demostrado los beneficios de la utilización de compuestos fenólicos en los pacientes con DRC y, por lo tanto, la presente revisión pretende debatir la posible aplicabilidad de los compuestos fenólicos en esta población.
Os compostos fenólicos ou polifenóis são compostos bioativos amplamente distribuídos em diversos alimentos, como frutas, legumes, verduras, chás e vinho. Diversos estudos apontam o importante papel destes compostos na prevenção de doenças crônicas, como câncer e doenças cardiovasculares. Além disso, em virtude de suas habilidades anti-inflamatórias e antioxidantes, os polifenóis podem ser considerados agentes farmacológicos capazes de combater o estresse oxidativo devido à redução na formação de espécies reativas de oxigênio ou radicais livres. O desequilíbrio entre a produção de radicais livres e a capacidade antioxidante é uma característica comum nos pacientes com doença renal crônica (DRC) e está associado à progressão da lesão renal, além de ser considerado um fator de risco para doenças cardiovasculares, a principal causa de mortalidade nestes pacientes. Apesar de escassos, alguns trabalhos têm mostrado os benefícios do uso dos compostos fenólicos nos pacientes com DRC e, portanto, a presente revisão pretende discutir a possível aplicabilidade dos compostos fenólicos nesta população.
Assuntos
Compostos Fenólicos/análise , Insuficiência Renal Crônica/patologia , Antioxidantes/classificaçãoRESUMO
White adipose tissue is recognized as a dynamic endocrine organ able to produce and release several bioactive polypeptides known as adipokines. Obesity is defined as an excessive growth of adipose tissue. As such, it is likely that adipokines could play an important role in the development of diseases associated with obesity including insulin resistance, inflammation, hypertension, cardiovascular risk and metabolic disorders. This review focuses on obesity specific-adipokine profiles and the role of some adipokines in obesity-related metabolic disorders.
Assuntos
Adipocinas/metabolismo , Obesidade/metabolismo , Adipocinas/análise , Animais , HumanosRESUMO
UNLABELLED: Recent evidences suggested a possible relationship between zinc deficiency and leptin levels in pathogenesis of anorexia in chronic kidney disease. The present study addressed the relationship between zinc and leptin in hemodialysis (HD) patients. METHODS: Fifty HD patients (54.3±12.7years old, 62% men) were studied and compared to 21 healthy volunteers (50.7±15.7years old, 43% men). Biochemical data, serum zinc, plasma leptin, IL-6, TNF-α and C-Reactive Protein levels were determined. Anthropometric parameters, food intake and appetite score were also assessed. RESULTS: The leptin levels were higher in HD patients (16.1µg/mL (0.21-118.25) vs 6.0µg/mL (0.50-23.10)) in healthy volunteers (p=0.04), whereas serum zinc levels were lower (54.5±16.3µg/dL) compared to healthy volunteers (78.4±9.4µg/dL) (p=0.0001). The plasma leptin was correlated negatively with plasma zinc (r=-0.33; p=0.007), energy (r=-0.38; p=0.002) and protein intake (r=-0.34; p=0.006) and, positively correlated with BMI (r=0.54; p=0.0001), % body fat (r=0.70; p=0.0001) and conicity index (r=0.46; p=0.001). Plasma zinc was associated with hemoglobin (r=0.30; p=0.04) and negatively associated with TNF-α (r=-0.37; p=0.002) and C-Reactive Protein (r=-0.37; p=0.004). There was no correlation among Zn, leptin and appetite score in these patients. CONCLUSION: This study showed that low plasma zinc levels are negatively associated with high leptin levels in HD patients.
Assuntos
Leptina/sangue , Diálise Renal , Zinco/sangue , Adulto , Idoso , Proteína C-Reativa/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fator de Necrose Tumoral alfa/metabolismoRESUMO
Anemia is a frequent comorbidity in patients undergoing hemodialysis and is associated with reduced functional capacity. Thus, it possible to assume that anemia can also impair muscle strength in these patients. The aim of this study was to assess whether there is an association between handgrip strength and anemia in patients undergoing hemodialysis. Fifty five patients on regular hemodialysis program (aged 49.0±14.0, 38 men) were studied. Handgrip strength, assessed by manual dynamometry, was measured in the arm without vascular access functioning after the dialysis session, being considered impaired when values were lower than the 10th percentile of age and gender specific values btained from an urban population in Rio de Janeiro. Biochemical data and body composition were also evaluated. Sixty-two percent of patients presented anemia and 34.5% showed handgrip strength compromised. The handgrip strength was positively correlated with height, body weight, body mass index, waist circumference, corrected arm muscle area and fat-free mass; and negatively correlated with age and dialysis efficiency. Hemoglobin and hematocrit were not correlated with handgrip strength and they did not differ between patients with preserved handgrip strength and those with handgrip strength compromised. Thus, anemia did not exert influence on the handgrip strength in patients undergoing hemodialysis, which reinforces the use of manual dynamometry as a reliable method for the assessment of nutritional status in this population.
La anemia es una comorbilidad frecuente en pacientes sometidos a hemodiálisis y se asocia con una capacidad funcional reducida. Por lo tanto, podemos suponer que la anemia también puede comprometer la fuerza muscular en esos pacientes. El objetivo de este estudio fue evaluar si existe una asociación entre la fuerza de prensión manual y el estado de anemia en pacientes sometidos a hemodiálisis. Se estudiaron 55 pacientes en tratamiento regular de hemodiálisis (49,0±14,0 años de edad, 38 hombres). Se midió, por dinamometría, la fuerza prensil manual en un brazo sin acceso vascular funcional después de la sesión de hemodiálisis. Se consideró que la fuerza prensil se encontraba perjudicada cuando los valores fueron inferiores al 10% del valor correspondiente a sexo y edad, tomando como valores de referencia los obtenidos para la población urbana de Río de Janeiro. Se evaluaron, asimismo, los datos bioquímicos y de composición corporal. El sesenta y dos por ciento de los pacientes tenía anemia y 34,5% presentó fuerza prensil comprometida. La fuerza de prensión manual se correlacionó positivamente con la altura, el peso corporal, el índice de masa corporal, la circunferencia de la cintura, el área muscular del brazo corregida y la masa libre de grasa. Se observó correlación negativa entre la fuerza de prensil manual, la edad y la eficacia de la diálisis. La cantidad de hemoglobina y el hematocrito fueron semejantes entre los pacientes con fuerza prensil normal y comprometida pero no se correlacionaron con la misma Se concluye que la anemia no tuvo ninguna influencia en la fuerza de pensión manual en los pacientes sometidos a hemodiálisis, lo que refuerza el uso de la dinamometría manual como método confiable para la evaluación del estado nutricional de esa población.
A anemia é uma comorbidade frequente em pacientes submetidos à hemodiálise e está associada à redução da capacidade funcional. Desta forma, podemos supor que a anemia é capaz também de comprometer a força muscular destes pacientes. O objetivo deste estudo foi avaliar se há associação entre força de preensão manual e o estado de anemia em pacientes submetidos à hemodiálise. Foram estudados 55 pacientes em programa regular de hemodiálise (49,0±14,0 anos de idade, 38 homens). A força de preensão manual, avaliada através de dinamometria manual, foi aferida no braço sem acesso vascular funcionante após a sessão de hemodiálise, sendo considerada comprometida quando os valores foram inferiores ao percentil 10 correspondente, segundo gênero e idade, aos valores de referência obtidos para população urbana do RJ. Dados bioquímicos e de composição corporal também foram avaliados. Sessenta e dois por cento dos pacientes apresentaram anemia e 34,5% exibiram força de preensão manual comprometida. A força de preensão manual apresentou correlação positiva com a estatura, peso corporal, índice de massa corporal, circunferência da cintura, área muscular do braço corrigida e massa livre de gordura e correlação negativa com idade e eficiência dialítica. A hemoglobina e hematócrito não se correlacionaram com força de preensão manual e não diferiram entre os pacientes com força de preensão manual preservada e comprometida. Conclui-se que a anemia não exerceu influência sobre a força de preensão manual de pacientes submetidos à hemodiálise, o que reforça o uso da dinamometria manual como método confiável para avaliação do estado nutricional nesta população.
Assuntos
Humanos , Dinamômetro de Força Muscular/classificação , Diálise Renal/classificação , Anemia/patologiaRESUMO
A acidose metabólica é uma das complicações da doença renal crônica e está associada ao aumento do catabolismo protéico, à diminuição da síntese de proteínas e ao balanço nitrogenado negativo. A dieta tem forte influência sobre a geração de ácidos, podendo contribuir, portanto, para determinar a gravidade da acidose no paciente com doença renal crônica. Alguns pesquisadores têm observado que é possível estimar a excreção ácida renal, e que o cálculo dessa carga ácida a partir de alguns componentes da dieta, permitiria uma predição apropriada dos efeitos da dieta na acidose metabólica. Este artigo é uma comunicação sobre as bases fisiológicas, bem como as implicações clínicas da acidose em pacientes com doença renal crônica e a influência da dieta no balanço ácido-básico desses pacientes.
Metabolic acidosis is a common manifestation of chronic kidney disease and is associated with increased protein catabolism, decreased protein synthesis and negative nitrogen balance. Diet strongly influences acid generation, determining the level of acidosis in chronic kidney disease patients. Some researchers have observed that it is possible to estimate renal net acid excretion, and the analysis of the renal acid load of selected, frequently consumed foods may allow an appropriate prediction of the effects of diet on metabolic acidosis. This article discusses the physiological bases as well as the clinical implications of acidosis in patients with chronic kidney disease and the influence of the diet on the acid-base balance of these patients.