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2.
J Clin Med ; 13(2)2024 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-38256674

RESUMO

Fluid status (FS) is a diagnostic challenge in critically ill patients with COVID-19. Here, we compared parameters related to FS derived from cumulative fluid balance (CFB), bioelectrical impedance analysis (BIA) and venous congestion assessed by ultrasound (VExUS) to predict mortality. We retrospectively reviewed the medical records of individuals with severe pneumonia due to COVID-19 between July and November 2021 in a single center. Comorbidities, demographic, clinical and laboratory data as well as results from CFB, BIA and VExUS measurements were collected on admission and weekly afterwards for two consecutive evaluations. Seventy-nine patients were included, of which eighteen (14.2%) died. Abnormalities of FS were only identified by BIA. Extracellular water/total body water ratio (ECW/TBW) > 0.394 (overhydrated) by BIA was a good predictor of mortality (AUC = 0.78, 95% CI: 0.067-0.89). Mortality risk was higher in overhydrated patients (OR: 6.2, 95% CI: 1.2-32.6, p = 0.02) and in persistently overhydrated patients (OR: 9.57, 95% CI: 1.18-77.5, p = 0.03) even after adjustment to age, serum albumin and acute kidney injury (AKI) in stages 2-3. Time to death was shorter in overhydrated patients (HR: 2.82, 95% CI: 1.05-7.5, log-rank test p = 0.03). Abnormalities in FS associated with mortality were only identified by BIA in critically ill patients with COVID-19.

3.
Front Immunol ; 14: 1244473, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37711620

RESUMO

Introduction: Our understanding of HIV-associated gut microbial dysbiosis in children perinatally-infected with HIV (CLWH) lags behind that of adults living with HIV. Childhood represents a critical window for the gut microbiota. Any disturbances, including prolonged exposure to HIV, antiretroviral drugs, and antibiotics are likely to have a significant impact on long-term health, resulting in a less resilient gut microbiome. The objective of our study was to characterize the gut microbiota in CLWH, and compare it with HIV-unexposed and -uninfected children. Methods: We enrolled 31 children aged 3 to 15 years; 15 were CLWH and 16 were HUU. We assessed dietary patterns and quality; quantified soluble and cellular markers of HIV disease progression by flow cytometry, enzyme-linked immunosorbent and multiplex-bead assays, and profiled the gut microbiota by 16S rRNA sequencing. We explored relationships between the gut microbiota, antibiotic exposure, dietary habits, soluble and cellular markers and host metadata. Results: Children had a Western-type diet, their median health eating index score was 67.06 (interquartile range 58.76-74.66). We found no discernable impact of HIV on the gut microbiota. Alpha diversity metrics did not differ between CLWH and HUU. Sex impacted the gut microbiota (R-squared= 0.052, PERMANOVA p=0.024). Male children had higher microbial richness compared with female children. Two taxa were found to discriminate female from male children independently from HIV status: Firmicutes for males, and Bacteroides for females. Markers of HIV disease progression were comparable between CLWH and HUU, except for the frequency of exhausted CD4+ T cells (PD-1+) which was increased in CLWH (p=0.0024 after adjusting for confounders). Both the frequency of exhausted CD4+ and activated CD4+ T cells (CD38+ HLADR+) correlated positively with the relative abundance of Proteobacteria (rho=0.568. false discovery rate (FDR)-adjusted p= 0.029, and rho=0.62, FDR-adjusted p=0.0126, respectively). Conclusion: The gut microbiota of CLWH appears similar to that of HUU, and most markers of HIV disease progression are normalized with long-term ART, suggesting a beneficial effect of the latter on the gut microbial ecology. The relationship between exhausted and activated CD4+ T cells and Proteobacteria suggests a connection between the gut microbiome, and premature aging in CLWH.


Assuntos
Senilidade Prematura , Infecções por HIV , Adulto , Criança , Humanos , Feminino , Masculino , RNA Ribossômico 16S/genética , Antibacterianos , Progressão da Doença
4.
Artigo em Inglês | MEDLINE | ID: mdl-37580222

RESUMO

OBJECTIVE: To describe changes in pulmonary mechanics when changing from supine position (SP) to prone position (PP) in mechanically ventilated (MV) patients with Acute Respiratory Distress Syndrome (ARDS) due to severe COVID-19. DESIGN: Retrospective cohort. SETTING: Intensive Care Unit of the National Institute of Respiratory Diseases (Mexico City). PATIENTS: COVID-19 patients on MV due to ARDS, with criteria for PP. INTERVENTION: Measurement of pulmonary mechanics in patients on SP to PP, using esophageal manometry. MAIN VARIABLES OF INTEREST: Changes in lung and thoracic wall mechanics in SP and PP RESULTS: Nineteen patients were included. Changes during first prone positioning were reported. Reductions in lung stress (10.6 vs 7.7, p=0.02), lung strain (0.74 vs 0.57, p=0.02), lung elastance (p=0.01), chest wall elastance (p=0.003) and relation of respiratory system elastances (p=0.001) were observed between patients when changing from SP to PP. No differences were observed in driving pressure (p=0.19) and transpulmonary pressure during inspiration (p=0.70). CONCLUSIONS: Changes in pulmonary mechanics were observed when patients were comparing values of supine position with measurements obtained 24h after prone positioning. Esophageal pressure monitoring may facilitate ventilator management despite patient positioning.

5.
J Nephrol ; 35(9): 2373-2375, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-35857238

RESUMO

Kidney disease in diabetes mellitus is usually explained by diabetic kidney disease, but other superimposed etiologies occur frequently. The distinction between diabetic kidney disease and non-diabetic kidney disease can only be made by performing kidney biopsy. Our objective was to evaluate the association of diabetic kidney disease, non-diabetic kidney disease, or both with renal replacement therapy initiation. This is a retrospective cohort that included patients with type 2 diabetes mellitus for whom a kidney biopsy was indicated. Subjects were followed-up for 5 years, until renal replacement therapy initiation or were lost to follow up. One hundred and forty-one patients were included, 53 (39%) had diabetic kidney disease, 13 (9%) had non-diabetic kidney disease and 75 (54%) had both. Ninety-four percent of the cohort initiated renal replacement therapy during the 5-year follow-up. Higher degree of fibrosis was associated with a trend towards higher risk of requiring renal replacement therapy. In addition, the combined diabetic kidney disease + non-diabetic kidney disease group was associated with higher need of renal replacement therapy initiation when compared to the diabetic kidney disease group.


Assuntos
Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Insuficiência Renal Crônica , Humanos , Estudos Retrospectivos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Fatores de Risco , Rim , Terapia de Substituição Renal/efeitos adversos , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/terapia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Biópsia , Taxa de Filtração Glomerular
6.
Nutr Clin Pract ; 37(1): 110-116, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34617311

RESUMO

BACKGROUND: Few studies have evaluated the prevalence of post-extubation dysphagia and associated factors in patients with coronavirus disease 2019 (COVID-19) . Our study assessed the prevalence of post-extubation dysphagia and body composition in patients with COVID-19 discharged from an intensive care unit (ICU). METHODS: A prospective cohort study was performed in post-ICU extubated patients with acute respiratory distress syndrome related to COVID-19 in two referral hospitals. A total of 112 patients were evaluated and included; swallowing assessment and bioelectrical impedance analysis (BIA) were performed after extubation and discharge from the ICU. To identify associations between dysphagia, lower phase angle (PhA) (<4.8°) and hydration (extracellular water/total body water < 0.390) logistic and linear regression analyses were conducted. RESULTS: The incidence of post-extubation dysphagia was 41% (n = 46). From these, 65% (n = 30) had severe swallowing impairment. Overhydration and PhA were significantly different in patients with dysphagia, and segmental hydration in the trunk and legs was higher than in arms. PhA <4.8° (odds ratio [OR], 12.2; 95% CI, 4.3-34.1; P < .05) and overhydration measured by BIA (OR, 9.1; 95% CI, 3.4-24.5; P < .05) were associated with post-extubation dysphagia in multivariate analysis. PhA (<4.8°) was associated with a lower rate of swallowing recovery at hospital discharge (log-rank test = 0.007). CONCLUSIONS: A high incidence of post-extubation dysphagia was found in patients with COVID-19. Low PhA and overhydration were associated with the presence of dysphagia. Lower PhA was an independent factor for swallowing recovery at discharge.


Assuntos
COVID-19 , Transtornos de Deglutição , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Humanos , Unidades de Terapia Intensiva , Alta do Paciente , Estudos Prospectivos , SARS-CoV-2
7.
Nutrition ; 94: 111515, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34844155

RESUMO

OBJECTIVES: Normal weight obesity (NWO) is defined as a condition of normal body weight, but with high body fat percentage. Clinical and immunologic implications of NWO in persons living with HIV (PLHIV) remain unknown. The aim of this study was to examine NWO prevalence and its associations with metabolic and immunologic measurements in a cohort of PLHIV on antiretroviral treatment (ART). METHODS: We enrolled 73 adult PLHIV on ART. Body composition was assessed by dual-energy x-ray absorptiometry. NWO was defined as body mass index 18.5 to 24.9 kg/m2 and body fat ≥25%. We determined triacylglycerols, total cholesterol, high-density lipoprotein, low-density lipoprotein, blood glucose, blood pressure, bone mineral density, inflammatory cytokines (interleukin [IL]-1ß, tumor necrosis factor-α and IL-6) and CD4+ and CD8+ T-cell activation. RESULTS: The prevalence of NWO was 49% (36 of 73). Participants with NWO showed lower CD4+ T-cell percentage (25 versus 27%, P = 0.03), lower CD4/CD8 ratio (0.62 versus 0.82, P = 0.02), lower muscle mass (6.84 versus 7.11 kg/m2, P = 0.01) and higher prevalence of hypercholesterolemia (26% versus 6%, P = 0.03) than individuals with normal body composition. No differences in inflammation/activation markers were observed between groups (P > 0.05 in all cases). CONCLUSION: NWO was frequent in a cohort of Mexican PLHIV on ART and was associated with lower muscle mass, hypercholesterolemia, lower CD4+ T-cell percentage, and lower CD4/CD8 ratio. The incorporation of body fat measurements in the regular physical examination of PLHIV could contribute to early identification of the NWO condition and lead to better management of possible long-term morbidity.


Assuntos
Infecções por HIV , Hipercolesterolemia , Índice de Massa Corporal , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Hipercolesterolemia/epidemiologia , Músculos/metabolismo , Obesidade/metabolismo
8.
JPEN J Parenter Enteral Nutr ; 46(4): 828-835, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34291834

RESUMO

BACKGROUND: Malnutrition status, body composition indicators, and bioelectrical impedance analysis (BIA) parameters have been associated with increased risk of death in several pathologies. The aim of this study was to describe the associations between phase angle (PhA) indicators obtained by BIA with length of hospital stay, days on mechanical ventilation, and 60-day mortality in critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: This is a prospective cohort of mechanically ventilated patients with coronavirus disease 2019 (COVID-19). We assessed nutrition risk and body composition with BIA within 48 h from intensive care unit admission. Logistic and linear regression models were used to analyze the association between variables and clinical outcomes. Survival analysis by PhA value was performed using Kaplan-Meier curves. RESULTS: Sixty-seven patients were included. PhA (odds ratio [OR], 0.36; P = .002), standardized PhA (SPA) (OR, 0.45; P = .001), and extracellular water/total body water ratio (OR, 3.25; P = .002) were significant predictors of 60-day mortality. PhA <3.85° in females and <5.25° in males showed good and fair discrimination, respectively, for mortality prediction. Using cutoff values, low PhA was associated with a significantly increased risk of 60-day mortality (hazard ratio, 3.08; 95% CI, 1.12-8.41; P = .02). No association was detected for SPA. CONCLUSION: Low PhA values could be a predictor of 60-day mortality in critically ill patients with COVID-19. This biological marker could be incorporated as part of nutrition and mortality risk assessment in this population.


Assuntos
COVID-19 , Estado Terminal , Estado Terminal/terapia , Impedância Elétrica , Feminino , Humanos , Masculino , Estudos Prospectivos , SARS-CoV-2
9.
Nutr Clin Pract ; 37(1): 146-152, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34270135

RESUMO

BACKGROUND: Phase angle (PhA), measured by bioelectrical impedance analysis (BIA) has been studied as an indicator of survival in people living with HIV (PLWH). However, it remains unclear whether PhA is associated with malnutrition or low CD4+ T-cell counts. OBJECTIVE: In this study, we assessed the discriminative capacity of PhA for malnutrition detection using Global Leadership Initiative on Malnutrition (GLIM) criteria in PLWH, aiming to propose cutoff points for this population. METHODS: This retrospective observational study included 427 adult PLWH (13% female). Participants were classified according to malnutrition status by using GLIM criteria. Body composition was assessed by using BIA. CD4+ T-cell counts were determined by flow cytometry. RESULTS: According to GLIM criteria, 30% of the participants were malnourished. Multivariate regression analysis showed that PhA (adjusted odds ratio [OR], 0.10; 95% CI, 0.05-0.18; P < 0.001), fat-mass percentage (adjusted OR, 0.86; 95% CI, 0.82-0.90; P < 0.001), and male sex (adjusted OR, 0.26; 95% CI, 0.09-0.76; P = 0.013) were independently associated with malnutrition. A PhA cutoff of 5.45° in men and 4.95° in women may predict malnutrition with sensitivity and specificity >70%. CONCLUSION: PhA could be a valid, useful, and simple predictor of malnutrition in PLWH.


Assuntos
Infecções por HIV , Desnutrição , Composição Corporal , Impedância Elétrica , Feminino , Infecções por HIV/complicações , Humanos , Masculino , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Desnutrição/etiologia , Avaliação Nutricional , Estado Nutricional , Sensibilidade e Especificidade
10.
Clin Nutr ESPEN ; 43: 495-500, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34024561

RESUMO

BACKGROUND: There is a lack of evidence about the tolerance of enteral nutrition (EN) in COVID-19 critically ill patients. However, several gastrointestinal manifestations related to COVID-19 have been described. The aims of this study were to analyze the incidence of gastrointestinal intolerance (GI) associated to EN (diarrhea, vomiting, gastroparesis and constipation) and to describe energy/protein provision along with biochemical alterations during the first week of EN. METHODS: A retrospective cohort of COVID-19 critically ill patients under mechanical ventilation. We reported daily enteral nutrition infusion and gastrointestinal manifestations within the first week of intubation and enteral nutrition initiation. RESULTS: Fifty-two patients were included; 40.3% were overweight and 46.2% were obese. During the first 7 days of EN, manifestations of GI intolerance such as vomiting, diarrhea and gastroparesis were present in 18 patients (32.4%). Hypernatremia (39%) was the most frequent electrolyte abnormality. Only Acute Kidney Injury (AKI) diagnosis was associated with a higher energy deficit on day 7. No associations between drug prescription and GI intolerance were observed. On day 4, 94.5% of patients were receiving more than 80% of energy requirements and 94.2% of protein requirements. Accumulated energy and protein deficits at day 3 were 2171.2 ± 945 kcal and 114.9 ± 49.2 g, respectively; and 2586.4 ± 1151 kcal, 133.3 ± 60.4 g at day 7. CONCLUSION: Enteral nutrition is feasible and well-tolerated in COVID-19 patients with mechanical ventilation within the first week of enteral nutrition initiation. More studies are needed to elucidate the impact of nutritional therapy on infection course and outcomes.


Assuntos
COVID-19 , Estado Terminal/terapia , Ingestão de Energia , Nutrição Enteral/efeitos adversos , Gastroenteropatias/etiologia , Necessidades Nutricionais , Respiração Artificial , Injúria Renal Aguda/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/complicações , COVID-19/terapia , Constipação Intestinal/etiologia , Diarreia/etiologia , Feminino , Gastroparesia/etiologia , Humanos , Hipernatremia/etiologia , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Estudos Retrospectivos , SARS-CoV-2 , Vômito/etiologia
11.
J Infect Dev Ctries ; 15(3): 310-319, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33839703

RESUMO

Mycobacterium tuberculosis (M.tb) is the causative agent of tuberculosis (TB), an infectious disease that leads to numerous deaths worldwide. Malnutrition, smoking, alcohol abuse, Human Immunodeficiency Virus infection, and diabetes are some of the most important risk factors associated with TB development. At present, it is necessary to conduct studies on risk factors to establish new effective strategies and combat this disease. Malnutrition has been established as a risk factor since several years ago; although there is in vitro experimental evidence that reveals the importance of micronutrients in activating the immune response against M.tb, evidence from clinical trials is controversial. Currently, nutritional assessment is recommended in all TB patients upon diagnosis. However, there is insufficient evidence to indicate micronutrient supplementation as adjuvant therapy or prophylactic to prevent micronutrient depletion. Strengthening the interaction between basic and clinical research is necessary to carry out studies that will help establish adjuvant therapies to improve outcomes in TB patients. In this review, we discuss the experimental evidence, provided by basic research, regarding micronutrients in the TB field. However, when these studies are applied to clinical trials, the data are inconsistent, indicating that still missing mechanisms are necessary to propose alternatives to the treatment of TB patients.


Assuntos
Desnutrição/complicações , Micronutrientes/imunologia , Tuberculose/etiologia , Países em Desenvolvimento/estatística & dados numéricos , Humanos , Desnutrição/epidemiologia , Desnutrição/prevenção & controle , Micronutrientes/deficiência , Mycobacterium tuberculosis/imunologia , Fatores de Risco , Tuberculose/prevenção & controle
12.
Rev Med Inst Mex Seguro Soc ; 59(4): 330-338, 2021 Aug 02.
Artigo em Espanhol | MEDLINE | ID: mdl-35015470

RESUMO

The number of patients with advanced / end-stage chronic kidney disease (ESRD) with some modality of renal replacement therapy (RRT) has been on the rise significantly. Peritoneal dialysis (PD) represents 11% of the world dialysis population. Different options for RRT have been associated with a greater risk of developing complications, such infections, metabolic alterations and nutritional complications, specifically a higher incidence of protein-energy wasting (PEW), ranging from 32 to 49% in PD patients. Peritoneal transporter type plays an important role in the development of nutritional complications, where the high transporter compared to the slow or low transporter has been associated with a higher nutritional risk by increasing the risk of volume overload, hypertension, and inflammation; as well as greater loss of proteins in the dialysate due to the greater number of replacements that characterize its prescription. Nutrition specialists needs to consider diverse aspects to achieve an individualized nutritional approach based on the characteristics of the patient, where knowing peritoneal transporter type is essential. The aim of this study is to review the evidence available to date regarding nutritional therapy in patients with peritoneal dialysis, as well as to analyze some basic aspects of dialysis therapy.


El número de pacientes con enfermedad renal crónica avanzada/terminal (ERCT) con alguna modalidad de terapia de reemplazo renal (TRR) ha ido en ascenso. A nivel mundial, la diálisis peritoneal (DP) representa el 11% del total de pacientes con TRR. Las diferentes opciones de TRR se han asociado con un mayor riesgo para desarrollar complicaciones infecciosas, metabólicas y nutricionales, reportándose cifras alarmantes de desgaste proteico energético (DPE) que oscilan entre 32-49% en pacientes en DP. El tipo de transportador peritoneal juega un rol importante en el desarrollo de complicaciones nutricionales, donde el transportador alto, en comparación con el lento o bajo, se ha asociado con un mayor riesgo nutricional al incrementar el riesgo de sobrecarga de volumen, hipertensión e inflamación; así como mayor pérdida de proteínas en el dializado por el mayor número de recambios que caracteriza su prescripción. Por tal motivo, el profesional de la nutrición debe considerar diversos aspectos para lograr un abordaje nutricional individualizado a partir de las características del paciente, en el que conocer el tipo de transportador peritoneal es fundamental. El objetivo del presente trabajo es realizar una revisión de la evidencia disponible hasta la fecha respecto a la terapia nutricional del paciente con diálisis peritoneal, así como analizar algunos aspectos básicos de la terapia dialítica.


Assuntos
Falência Renal Crônica , Diálise Peritoneal , Humanos , Falência Renal Crônica/terapia , Estado Nutricional , Diálise Peritoneal/efeitos adversos , Prescrições , Diálise Renal
13.
Clin Nutr ESPEN ; 40: 288-292, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33183552

RESUMO

BACKGROUND: Accurate measurements of resting energy expenditure (REE) are important for determining nutritional needs in HIV patients. Indirect calorimetry (IC) is a noninvasive method that reflects REE but can be costly and is frequently calculated with predictive equations. Research suggests that REE obtained by predictive equations in people living with HIV/AIDS (PLWH) is inaccurate. The aim of the study is to develop and validate a new predictive equation of REE based on a population of PLWH. METHODS: Cross-sectional study including 164 PLWH (82 to develop and 82 to validate the equation). Multiple linear regression was used to determine the relationship between variables and to develop the new predictive equation. Intraclass correlation coefficient (ICC) and Bland-Altman methods were used to evaluate agreement between the new predictive equation and indirect calorimetry. RESULTS: A new predictive equation with an accuracy of 67% when compared with IC was developed. This equation included as covariates: fat free mass, antiretroviral therapy status and age. CONCLUSION: A new equation to predict energy expenditure in PLWH was developed and validated. This formula can be used to estimate REE if IC is not available.


Assuntos
Infecções por HIV , Calorimetria Indireta , Estudos Transversais , Metabolismo Energético , Humanos , Descanso
16.
Rev Med Inst Mex Seguro Soc ; 58(2): 181-196, 2020 04 13.
Artigo em Espanhol | MEDLINE | ID: mdl-34101563

RESUMO

Body composition monitoring is important to understand the effect of diet, physical activity, illness and growth on body stores. Body composition determination by accuracy and reproducibility techniques is essential. The objective of this study was to analyze the agreement between body composition techniques in children and adolescents. Literature search was performed using the PubMed, Scielo and Google Scholar databases. Only observational studies realized in children and adolescents that analyze agreement between two or more body composition techniques were included. Thirty studies were included. Dual-energy X-ray absorptiometry, air displacement plethysmography, hydrodensitometry, deuterium dilution and four compartment model were the techniques for body composition measurement and bioelectrical impedance and anthropometry were used to estimate body composition. Agreement and correlation between methods was influenced by study populations and by technique considered as gold standard for comparisons. In conclusion, there is a low agreement between the different methods to assess body composition. Correlation and agreement interpretation are essential for body composition assessment in children and adolescents. Is recommended the use of equations developed and validated in this populations.


El monitoreo de la composición corporal (CC) permite comprender los efectos de la dieta, el ejercicio físico, la presencia de procesos patológicos y el crecimiento en las reservas corporales; de ahí la importancia de su determinación con técnicas exactas y reproducibles. El objetivo de la presente revisión es analizar la concordancia entre las distintas técnicas para evaluar la CC en población infantil y adolescente. Se realizó una búsqueda no sistemática de la literatura en las bases de datos PubMed, Scielo y Google Scholar para identificar estudios cuyo objetivo primario fuera la evaluación de la concordancia entre dos o más métodos de determinación de la CC. Se incluyeron 30 estudios para la revisión. Los métodos identificados para la medición de la CC fueron la absorciometría dual de rayos X, la pletismografía de gases (BOD-POD), la hidrodensitometría, la dilución de deuterio (D2O) y el modelo de cuatro compartimentos, utilizando bioimpedancia eléctrica y antropometría para la estimación. La concordancia y la correlación entre métodos varía según los diferentes grupos poblacionales y la técnica utilizada como método de referencia. Se concluye que existe una baja concordancia entre los distintos métodos para evaluar la composición corporal. La interpretación de la correlación y la concordancia de los diferentes métodos resulta esencial para evaluar la CC en niños y adolescentes. Se sugiere utilizar ecuaciones desarrolladas o validadas para el grupo en estudio.


Assuntos
Composição Corporal , Pletismografia , Absorciometria de Fóton , Tecido Adiposo , Adolescente , Criança , Impedância Elétrica , Humanos , Reprodutibilidade dos Testes
17.
Nutrition ; 70: 110585, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31698296

RESUMO

OBJECTIVES: Micronutrient deficiencies are common among people living with HIV (PLWHIV). The clinical and immunologic consequences of micronutrient deficiencies have been poorly explored in the context of human immunodeficiency virus (HIV) infection. The aim of this study was to determine the prevalence of zinc and selenium deficiency (dietary intake and serum concentrations) and analyze their associations with absolute CD4+ T-cell counts, inflammation markers, and metabolic disorders in a cohort of antiretroviral-experienced HIV-infected individuals. METHODS: The zinc and selenium intakes of 124 HIV-infected men were estimated using 3-d food records. In a subcohort of 45 individuals, serum zinc and selenium concentrations and proinflammatory cytokines were determined. Body composition, bone mineral density (BMD), CD4+ T-cell counts, lipid profile, glucose, and blood pressure were determined and were associated with zinc and selenium dietary intake and serum concentrations. RESULTS: Of the PLWHIV studied, 58% had suboptimal intake of zinc and 8% demonstrated suboptimal intake of selenium. Serum deficiencies for zinc and selenium were 23.9% and 65.9%, respectively. Zinc and selenium intake were correlated with increased muscle mass. Selenium intake was associated with increased BMD of the lumbar region. An inverse correlation between serum selenium concentration and several proinflammatory cytokines (interleukin-1ß, interleukin-6, and tumor necrosis factor-α) was found. CONCLUSION: Suboptimal zinc and selenium intake and serum concentration deficiencies are highly prevalent in treated HIV-positive individuals and are associated with body composition, BMD, and inflammation. Clinical trials should be designed to explore the effect of zinc and selenium supplementation on metabolic, inflammatory, and immunologic parameters on the HIV-positive population.


Assuntos
Dieta/estatística & dados numéricos , Infecções por HIV/complicações , HIV , Selênio/deficiência , Zinco/deficiência , Adulto , Antirretrovirais/uso terapêutico , Contagem de Linfócito CD4 , Citocinas/sangue , Dieta/efeitos adversos , Inquéritos sobre Dietas , Infecções por HIV/sangue , Infecções por HIV/virologia , Humanos , Mediadores da Inflamação/sangue , Masculino , México/epidemiologia , Micronutrientes/análise , Micronutrientes/deficiência , Pessoa de Meia-Idade , Estado Nutricional , Prevalência , Estudos Retrospectivos , Selênio/análise , Zinco/análise
18.
JPEN J Parenter Enteral Nutr ; 42(2): 380-386, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29187061

RESUMO

INTRODUCTION: Determination of the resting energy expenditure (REE) is essential for planning nutrition therapy in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) to help to improve their nutrition status. We aim to evaluate the agreement and accuracy of prediction equations that estimate the REE in a Mexican population with a diagnosis of HIV/AIDS with and without antiretroviral therapy (ART). METHODS: A cross-sectional study in Mexican patients with HIV/AIDS with and without ART. Weight, height, and body composition measured with dual-energy x-ray absorptiometry were evaluated. The REE was determined with indirect calorimetry and estimated using the Mifflin-St Jeor (MSJ), Harris-Benedict (HB), Schofield 1 and 2, Cunningham, Melchior 91, Melchior 93, and Batterham equations. The Bland-Altman method assessed agreement between the real and estimated values, and the percent difference between these values was used to assess the prediction accuracy. RESULTS: Sixty-five adults without ART and 102 adults with ART were included. The mean REE (kcal/kg) was 24.8 ± 2.4 and 23.8 ± 3.6 in patients without and with ART, respectively. Good agreement and reliability were observed in the HB (intraclass correlation coefficient [ICC], 0.75; P < .05), Batterham (ICC, 0.79; P < .05), Schofield 1 (ICC, 0.74; P < .05), and Schofield 2 (ICC, 0.78; P < .05) results in individuals without ART. In individuals with ART, good agreement and reliability were observed with the HB equation (ICC, 0.76; P < .05). The MSJ equation showed good agreement with poor reliability (ICC, 0.05; P < .05). CONCLUSION: The equations with the best agreement and accuracy were Schofield 2, Batterham, and HB in individuals without ART and HB and MSJ in the population with ART.


Assuntos
Antirretrovirais/uso terapêutico , Metabolismo Energético/efeitos dos fármacos , Infecções por HIV/complicações , Infecções por HIV/metabolismo , Desnutrição/complicações , Desnutrição/metabolismo , Adulto , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , México , Reprodutibilidade dos Testes
19.
Nutr Hosp ; 32(6): 2898-902, 2015 Dec 01.
Artigo em Espanhol | MEDLINE | ID: mdl-26667750

RESUMO

INTRODUCTION: weight and height measurements are important data for the nutritional assessment of elderly people and the implementation of the nutritional care process. Malnutrition is common in this population, who has high rates of disability that difficult to measurement this variables. OBJECTIVE: evaluate the validity of predictive equations for weight and height that include body circumferences created for brazilian population, in mexican elderly people. METHODS: this is a comparative, observational, prospective and cross-sectional study, 61 elderly were evaluated. Body weight, height, half span, calf, arm and abdominal circumferences were determinated. Weight and height were estimated with de predictive equations published by Rabito et al. Bland-Altman analysis and Intraclass Correlation Coefficient were used to assess the levels of agreement between the estimated and the measured values. The level of statistical significance was p < 0.05. RESULTS: the age mean was 78.7 ± 8.7 and 55.7% were females. The weight mean was 61.9 ± 14.1 kg, height mean was 155.4 ± 9.5 cm and Body Mass Index (BMI) mean corresponded to 25.5 ± 5.1 kg/m. The Bland-Altman plots indicated that the 95% confidence interval (95% IC) limits for the difference between real and estimated weight ranged from -14.3 kg to 8.1 kg, the mean of the difference or systematic error (SE) was -3.1 kg, we observed an statistically significant coefficient of 0.12 (p < 0.03). The 95% IC limits for the difference between real and estimated height ranged from -11.1 to 15.9 cm, the diffe rence mean or SE of 2.4 cm, we observed a coefficient of -0.04 (p = 0.67) . Intraclass Correlation Coefficient of 0.72 (p < 0.00) and 0.88 (p < 0.00) were obtained for weight and height, respectively. CONCLUSION: the equations developed by Rabito showed a good agreement when compared with the actual weight and height of elderly people. We observed variations in the estimated weight in obesity elderlys.


Introducción: el conocimiento del peso y la talla es fundamental en la evaluación del estado nutricional en el adulto mayor, permitiendo la implementación del proceso de cuidado nutricional. La desnutrición es común en este grupo poblacional, el cual usualmente presenta diversas situaciones clínicas que dificultan la medición de peso y talla. Objetivos: evaluar la validez de las ecuaciones para estimar peso y talla basadas en circunferencias corporales propuestas para población brasileña en adultos mayores mexicanos. Métodos: estudio comparativo, observacional, prospectivo y transversal en 61 adultos mayores. Las medidas antropométricas recolectadas fueron peso y talla, Extensión de Media Brazada (EMB), Circunferencia Abdominal (CA), Circunferencia Media de Brazo (CMB) y Circunferencia de Pantorrilla (CP). Se estimó el peso y la talla con las ecuaciones propuestas por Rabito y cols. Se utilizó el método Bland-Altman y el Coeficiente de Correlación Intraclase para evaluar la concordancia entre los valores reales y estimados. Se consideró significancia estadística un valor de p < 0,05. Resultados: la edad promedio de los participantes fue de 78,7 ± 8,7 años. El 55,7% (n = 34) fueron mujeres. La media para el peso fue de 61,9 ± 14,1 kg, para la talla de 155,4 ± 9,5 cm y para el Índice de Masa Corporal (IMC) fue de 25,5 ± 5,1 kg/m2. Mediante el método Bland-Altman los límites de intervalo de concordancia de 95% para la diferencia del peso real y el estimado fueron de -14,3 a 8,1 kg, con una media de la diferencia o error sistemático (ES) de -3,1 cm; se observó un coeficiente de 0,12 que fue estadísticamente significativo (p = 0,03). Para la talla se observa un intervalo de confianza de la diferencia entre la talla real y estimada de -11,1 a 15,9, con una media de la diferencia o ES de 2,4 cm y un coeficiente de -0,04 que no fue significativo (p = 0,67). La concordancia entre el peso real y el estimado, según el coeficiente de correlación intraclase, fue de 0,72 (p < 0,00), en el caso de la talla real, y la estimada fue de 0,88 (p < 0,00). Conclusiones: las ecuaciones propuestas por Rabito muestran una buena concordancia con los valores de peso y talla reales en adultos mayores, observando mayor variación para los valores de peso estimado en población con obesidad.


Assuntos
Algoritmos , Antropometria/métodos , Estatura , Peso Corporal , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Circunferência da Cintura
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