Adriana Lima Mello

Perfil do nutricionista do programa nacional de alimentação escolar na região Nordeste do Brasil

OBJECTIVE: This study analyzed the profile of dieticians who work for the National School Food Program and participated in training courses offered by the Schoolchildrens Food and Nutrition Collaborator Center of the Northeastern states in 2007. METHODS: This descriptive, exploratory study used nonprobability sampling to recruit 434 dieticians. Education, work experience, work, activities performed at National School Food Program and sociodemographic variables were analyzed. Pearsons chi square test was used to investigate possible associations between time working for National School Food Program and performed activities. RESULTS: Most participants were females (97.2%) aged 20 to 30 years (42.7%) and graduated more than ten years ago (40.2%). Most were also working only part time in the program (53.3%). The income of most dieticians ranged from 2-5 minimum salaries (64.1%). Most dieticians who frequently performed the analyzed activities had been in National School Food Program for 2-5 years (p<0.05). CONCLUSION: National School Food Program dieticians take on responsibilities that overlap with other areas of knowledge, especially education and administration. In parallel, despite the professional satisfaction, the participants were not very satisfied with their work conditions.

Bioimpedância elétrica e gordura visceral: uma comparação com a tomografia computadorizada em adultos e idosos

OBJECTIVE: To evaluate the association between electrical bioimpedance analysis (BIA) and visceral fat (VF) in adult and elderly patients. SUBJECTS AND METHODS: This was a cross-sectional study, with a sample of 191 subjects (52% women, 49% elderly) stratified by sex, age and body mass. Computerized tomography (VF area) and BIA (percentage of total body fat (%TBF-BIA), phase angle, reactance and resistance) data were generated. Statistical analysis was based on Pearsons Correlation Coefficient, Anova, Pearsons Chi-square, and ROC curves. RESULTS: VF areas > 130 cm2 were more prevalent among the elderly and among men. Adult females showed a stronger correlation between GV and %TBF-BIA. The other groups showed similar results and statistically significant correlations. Correlations between GV and phase angle were weak and not statistically significant. ROC Curves analyzes showed the following %TBF-BIA, which identified excess VF: for male subjects: 21.5% (adults) and 24.25% (elderly); for female subjects: 35.05% (adults) and 38.45% (elderly) with sensitivity of 78.6%, 82.1%, 83.3%, and 66.7%, and specificity of 70.6%, 62.5%, 79.1%, and 69%, respectively. CONCLUSION: BIA was found to have satisfactory sensitivity and specificity to predict VF; however, other devices and other techniques should be investigated to improve VF prediction.

O nutricionista no programa de alimentação escolar: avaliação de uma experiência de formação a partir de grupos focais

OBJECTIVE: This study assessed a training program for dieticians, actors of the Brazilian School Food Program, in Northeast Brazil. This program was developed by a partnership between the Schoolchildrens Food and Nutrition Collaborator Center from the Federal University of Bahia and National Education Development Fund, from 2007 and 2008. METHODS: The focus group method was administered to dieticians who participated in the training program. Four focus groups were done and the data were organized into two categories: one about learning during the training program and one about the ability to make changes. RESULTS: Most participants were females aged 20 to 35 years. Their participation in the training program had been at least three months before the study. Assessment of the training program showed that the program improved their technical and scientific knowledge about themes related to professional practice and about the ethical and political dimension of their work. The program encouraged mobilization for possibly strengthening the category, incentivized partnerships among different agents and sectors and promoted the planning of new law-enforcement actions. CONCLUSION: The dialogical perspective was striking for the participants, enabling them to confront their realities and collectively reflect on the dieticians role in the field of school food.

Evaluation of plasma homocysteine level according to the C677T and A1298C polymorphism of the enzyme MTHRF in type 2 diabetic adults

OBJECTIVE To determine plasma homocysteine levels during fasting and after methionine overload, and to correlate homocysteinemia according to methylenetetrahydrofolate reductase (MTHFR) polymorphism in type 2 diabetic adults. SUBJECTS AND METHODS The study included 50 type 2 diabetic adults (DM group) and 52 healthy subjects (Control group). Anthropometric data, and information on food intake, serum levels of vitamin B12, folic acid and plasma homocysteine were obtained. The identification of C677T and A1298C polymorphisms was carried out in the MTHFR gene. RESULTS There was no significant difference in homocysteinemia between the two groups, and hyperhomocysteinemia during fasting occurred in 40% of the diabetic patients and in 23% of the controls. For the same polymorphism, there was not any significant difference in homocysteine between the groups. In the Control group, homocysteinemia was greater in those subjects with C677T and A1298C polymorphisms. Among diabetic subjects, those with the A1298C polymorphism had lower levels of homocysteine compared with individuals with C677T polymorphism. CONCLUSION The MTHFR polymorphism (C677T and A1298C) resulted in different outcomes regarding homocysteinemia among individuals of each group (diabetic and control). These data suggest that metabolic factors inherent to diabetes influence homocysteine metabolism.

Factors Associated with Anemia in the Institutionalized Elderly.

As a common problem in long-term care facilities (LTCFs), anemia affects 25–63% of the elderly. The aim of the present study was to describe the prevalence and characteristics of anemia and its associated factors in the institutionalized elderly. The cross-sectional study was carried out with three hundred thirteen individuals aged ≥ 60 years, of both genders, living in long-term care facilities for the elderly in Salvador, Bahia, Brazil. Poisson regression (PR) with robust variance estimates was used to assess the factors related to anemia. The prevalence of anemia was 38%. Mild anemia was predominant in both genders (male: 26.8%; female: 21.1%), as normocytic and normochromic anemia, with no anisocytosis (69.75%). Anemia was associated with thinness (PR: 1.68; 95% CI: 1.04–2.72) and with moderate (PR: 1.98; 95% CI: 1.07–3.63) and total (PR: 2.61; 95% CI: 1.34–5.07) dependence in the final model. Severe dependence exhibited borderline significance (PR: 1.94; 95% CI: 1.00–3.77). The prevalence of anemia was high in the institutionalized elderly in both genders, with characteristics suggesting chronic diseases as the causal factor, and the frequency of occurrence was higher in thinness elderly with moderate to total dependence.

Imaging assessment of visceral adipose tissue area and its correlations with metabolic alterations

FUNDAMENTO: A obesidade androgenica esta associada a um risco maior de disturbios metabolicos, favorecendo assim a ocorrencia de doencas cardiovasculares e outras morbidades. OBJETIVO: Verificar a influencia da area de tecido adiposo visceral (ATAV), medida pela tomografia computadorizada, sobre alteracoes metabolicas em adultos e idosos. METODOS: Tomografias computadorizadas e valores de lipoproteinas: o colesterol total e fracoes, os triglicerides, a glicemia e o acido urico foram obtidos de 194 individuos estratificados por sexo, grupo etario e massa corporal, e analisados utilizando os testes de correlacao e de media. RESULTADOS: Os idosos apresentaram maiores valores da ATAV, glicemia, acido urico e colesterol total. As maiores correlacoes foram encontradas entre a ATAV, os triglicerides e o VLDL-c (r > 0,5; p < 0,01), em ambos os grupos etarios. A media da area de tecido adiposo visceral mostrou-se sempre mais elevada quando os valores de triglicerides e de glicemia estavam alterados, em ambos os grupos etarios. CONCLUSAO: A maioria dos exames apresentou forte correlacao com a ATAV considerada de risco para alteracoes metabolicas. Em idosos, a area de tecido adiposo visceral de risco parece ser superior a de adultos.BACKGROUND Androgenic obesity is associated with a higher risk of metabolic disorders, thus favoring the occurrence of cardiovascular diseases and other morbidities. OBJECTIVE To verify the influence of the visceral adipose tissue (VAT) area, measured by computed tomography (CT), on the metabolic alterations in adult and elderly individuals. METHODS CT results and lipoprotein levels, total cholesterol and fractions, triglycerides, glycemia and uric acid levels, were obtained from 194 individuals stratified by sex, age group and body mass and analyzed using the tests of correlation and means. RESULTS The elderly individuals presented higher VAT area, glycemia, uric acid and total cholesterol levels. The most important correlations were observed between VAT area, triglycerides (TG) and VLDL-c (r > 0.5; p < 0.01), in both age groups. The mean VAT area was always higher when TG and glycemia levels were altered, in both age groups. CONCLUSION Most tests showed a strong correlation with VAT area, which was considered as risk for metabolic alterations. In elderly individuals, the risk VAT area seems to be higher than that of adult individuals.

Nutritional status of institutionalized elderly Brazilians: a study with the Mini Nutritional Assessment.

OBJECTIVE To assess the nutritional status of elderly living in nursing homes in the city of Salvador, Brazil and associated factors. METHODS Cross-sectional study performed with 359 individuals of both sexes, ages equal or over 60 years old, located in Nursing Homes in the urban area of the city of Salvador, Bahia, Brazil. RESULTS Regarding nutritional status according to Mini Nutritional Assessment (MNA), 66.3% of the evaluated elderly were malnourished and at risk of malnutrition. When comparing sexes, it has been observed that among men the prevalence of this condition (76.6%) was higher than in women (62.4%). It has been observed, as a result of the multivariate analysis, that only the variable functional capacity for Activities of Daily Living (ADL) was statistically significant. There was moderate correlation between MNA and Mini-Mental State Examination (r=0.454; p<0.0001), as well as between MNA and the ADL scale (r=0.569; p<0.0001). There was weak negative correlation between MNA total score and age (r=0.159; p=0.002). CONCLUSION Malnutrition and malnutrition risk were conditions of remarkable importance, with almost two-thirds of the elderly in this situation. ADL functional capacity must be monitored given their close relationship with the nutritional status of the elderly. An interdisciplinary approach in the context of institutionalization is needed due to the association between nutritional status and variables of different dimensions.

Avaliação por imagem da área de gordura visceral e suas correlações com alterações metabólicas

FUNDAMENTO: A obesidade androgenica esta associada a um risco maior de disturbios metabolicos, favorecendo assim a ocorrencia de doencas cardiovasculares e outras morbidades. OBJETIVO: Verificar a influencia da area de tecido adiposo visceral (ATAV), medida pela tomografia computadorizada, sobre alteracoes metabolicas em adultos e idosos. METODOS: Tomografias computadorizadas e valores de lipoproteinas: o colesterol total e fracoes, os triglicerides, a glicemia e o acido urico foram obtidos de 194 individuos estratificados por sexo, grupo etario e massa corporal, e analisados utilizando os testes de correlacao e de media. RESULTADOS: Os idosos apresentaram maiores valores da ATAV, glicemia, acido urico e colesterol total. As maiores correlacoes foram encontradas entre a ATAV, os triglicerides e o VLDL-c (r > 0,5; p < 0,01), em ambos os grupos etarios. A media da area de tecido adiposo visceral mostrou-se sempre mais elevada quando os valores de triglicerides e de glicemia estavam alterados, em ambos os grupos etarios. CONCLUSAO: A maioria dos exames apresentou forte correlacao com a ATAV considerada de risco para alteracoes metabolicas. Em idosos, a area de tecido adiposo visceral de risco parece ser superior a de adultos.BACKGROUND Androgenic obesity is associated with a higher risk of metabolic disorders, thus favoring the occurrence of cardiovascular diseases and other morbidities. OBJECTIVE To verify the influence of the visceral adipose tissue (VAT) area, measured by computed tomography (CT), on the metabolic alterations in adult and elderly individuals. METHODS CT results and lipoprotein levels, total cholesterol and fractions, triglycerides, glycemia and uric acid levels, were obtained from 194 individuals stratified by sex, age group and body mass and analyzed using the tests of correlation and means. RESULTS The elderly individuals presented higher VAT area, glycemia, uric acid and total cholesterol levels. The most important correlations were observed between VAT area, triglycerides (TG) and VLDL-c (r > 0.5; p < 0.01), in both age groups. The mean VAT area was always higher when TG and glycemia levels were altered, in both age groups. CONCLUSION Most tests showed a strong correlation with VAT area, which was considered as risk for metabolic alterations. In elderly individuals, the risk VAT area seems to be higher than that of adult individuals.

Evaluación por imagen del área de grasa visceral y sus correlaciones con alteraciones metabólicas

FUNDAMENTO: A obesidade androgenica esta associada a um risco maior de disturbios metabolicos, favorecendo assim a ocorrencia de doencas cardiovasculares e outras morbidades. OBJETIVO: Verificar a influencia da area de tecido adiposo visceral (ATAV), medida pela tomografia computadorizada, sobre alteracoes metabolicas em adultos e idosos. METODOS: Tomografias computadorizadas e valores de lipoproteinas: o colesterol total e fracoes, os triglicerides, a glicemia e o acido urico foram obtidos de 194 individuos estratificados por sexo, grupo etario e massa corporal, e analisados utilizando os testes de correlacao e de media. RESULTADOS: Os idosos apresentaram maiores valores da ATAV, glicemia, acido urico e colesterol total. As maiores correlacoes foram encontradas entre a ATAV, os triglicerides e o VLDL-c (r > 0,5; p < 0,01), em ambos os grupos etarios. A media da area de tecido adiposo visceral mostrou-se sempre mais elevada quando os valores de triglicerides e de glicemia estavam alterados, em ambos os grupos etarios. CONCLUSAO: A maioria dos exames apresentou forte correlacao com a ATAV considerada de risco para alteracoes metabolicas. Em idosos, a area de tecido adiposo visceral de risco parece ser superior a de adultos.BACKGROUND Androgenic obesity is associated with a higher risk of metabolic disorders, thus favoring the occurrence of cardiovascular diseases and other morbidities. OBJECTIVE To verify the influence of the visceral adipose tissue (VAT) area, measured by computed tomography (CT), on the metabolic alterations in adult and elderly individuals. METHODS CT results and lipoprotein levels, total cholesterol and fractions, triglycerides, glycemia and uric acid levels, were obtained from 194 individuals stratified by sex, age group and body mass and analyzed using the tests of correlation and means. RESULTS The elderly individuals presented higher VAT area, glycemia, uric acid and total cholesterol levels. The most important correlations were observed between VAT area, triglycerides (TG) and VLDL-c (r > 0.5; p < 0.01), in both age groups. The mean VAT area was always higher when TG and glycemia levels were altered, in both age groups. CONCLUSION Most tests showed a strong correlation with VAT area, which was considered as risk for metabolic alterations. In elderly individuals, the risk VAT area seems to be higher than that of adult individuals.