Anita Sachs

Body composition in patients with chronic obstructive pulmonary disease: which method to use in clinical practice?

The objective of the present study was to compare anthropometry with bioelectrical impedance (BIA) in relation to densitometry (dual-energy X-ray absorptiometry; DEXA) as methods of nutritional assessment and body composition in out-patients with chronic pulmonary obstructive disease (COPD). We conducted a cross-sectional clinical study with sixty-one patients with COPD (forty-two men and nineteen women), mean age of 66.5 (sd 7.9) years and forced expiratory volume in 1 s of 1.3 (sd 0.6) litres (52.2 (sd 19.8) % predicted), referred to the Pulmonary Rehabilitation Center. The patients were evaluated regarding nutrition status and body composition as determined by anthropometry, BIA and DEXA. In the results, 34.4 % showed mild obstruction, 31.2 %, moderate and 34.4 %, severe obstruction. According to the BMI (mean 24.5 (sd 4.5) kg/m2), 45.9 % of the patients exhibited normal weight, while 27.9 % were underweight and 26.2 % were obese. Related to fat-free mass (FFM), anthropometry and BIA compared with DEXA presented high correlations (r 0.96 and 0.95 respectively; P < 0.001) and high reliability between the methods (alpha 0.98; P < 0.001). Agreement analysis between the methods shows that anthropometry overestimates (0.62 (sd of the difference 2.89) kg) while BIA underestimates FFM (0.61 (sd of the difference 2.82) kg) compared with DEXA. We concluded that according to the nutritional diagnosis, half of our population of patients with COPD showed normal weight, while the other half comprised equal parts obese and underweight patients. Body composition estimated by BIA and anthropometry presented good reliability and correlation with DEXA; the three methods presented satisfactory clinical accuracy despite the great disparity of the limits of agreement.

Lipid profile and cardiovascular risk factors among first-year Brazilian university students in São Paulo

BACKGROUND/AIMS The surveillance of cardiovascular risk factors has been recommended worldwide. The current study is aimed to estimate the prevalence of cardiovascular risk factors among first-year students from a public university in the city of Sao Paulo, Brazil. METHODS A cross-sectional study of 56 first-year students, of both genders, was performed. Information about demographic characteristics, family history of chronic diseases, smoking, and physical activity was obtained by means of a standardised questionnaire. Anthropometrical parameters (BMI, waist circumference, body fat percentage), metabolic parameters (glycaemia, serum lipid profile), and dietary data (total energy intake, percentage of total energy from macronutrients, cholesterol and dietary fiber) were assessed. RESULTS The risk of cardiovascular diseases was characterised by family history of cardiovascular diseases (44.6%), smoking (10.7%), physical inactivity (35.7%), borderline high total cholesterol and LDL-c levels (16.1% and 5.4, respectively), decreased HDL-c levels (8.9%), increased triglyceride levels (8.9%), and overweight and obesity (17.8% and 7.1%, respectively). The diet of the students was inadequate: it was high in fat and protein, and low in carbohydrate and dietary fibre. CONCLUSIONS The prevalence of risk factors for cardiovascular diseases in young adults draws attention to the need to adopt preventive plans in the university setting.

Nutritional and epidemiological aspects of patients with chronic renal failure undergoing hemodialysis from Brazil, 2010

INTRODUCTION The Nutrition Committee of the Brazilian Society of Nephrology (SBN) held in 2010 the first Brazilian Nutrition Census in hemodialysis patients. Multicenter data contribute to clinical development and nutritional intervention. OBJECTIVE To describe epidemiological and nutritional aspects of hemodialysis patients. METHOD Cross-sectional study in 36 dialysis clinics and 2,622 randomly selected participants. Socio-demographical, clinical, biochemical and anthropometric records were collected. RESULTS 60.45% of the patients lived in the Brazilian Southeast. 13.53% came from Northeast region, while 12.81% from South, 10.33% from Midwest and 2.86% from North regions. Approximately 58% were male and 63.1% were below 60 years old. 58.5% of patients were married or in cohabitation. Around 80% of them depended on the government Unified Health System. Smoking showed a difference between gender and age. Presumptive etiologies were Hypertensive Nephrosclerosis (26.4%), Diabetic Nephropathy (24.6%), unknown/undiagnosed causes (19.9%), Glomerulopathies (13.6%) and others (11.2%). Both Hypertension and Diabetes Mellitus affect approximately 30% of patients, especially over 60 years. Body Mass Index did not differ between genders, although it differed between age groups and when used different evaluation criteria. Men and women average waist circumference were respectively 90.5 and 88.0 cm. Lipid profile did not differ between age groups, but it did between genders. Albumin values were lower in women and in patients older than 60 years. CONCLUSION This study characterized Brazilian hemodialysis patients in 2010, and may support further studies to monitor nutrition and epidemiological transitions of the population.

Clinical value of anthropometric estimates of leg lean volume in nutritionally depleted and non-depleted patients with chronic obstructive pulmonary disease

This study aimed to investigate the clinical usefulness of an anthropometrically based method for estimating leg lean volume (LLV) in patients with chronic obstructive pulmonary disease (COPD) who presented or not with nutritional depletion. We prospectively evaluated a group of forty-eight patients (thirty-eight males) with moderate to severe COPD (Global Initiative for Chronic Obstructive Lung disease stages II-IV) who underwent a 6 min walking test and knee isokinetic dynamometry. Leg lean mass (muscle mass plus bone) was determined by dual-energy X-ray absorptiometry (DEXA) with derivation of its respective volume: these values were compared with those obtained by the truncated cones method first described by Jones and Pearson in 1969. As expected, depleted patients (n 19) had reduced exercise capacity and impaired muscle performance as compared to non-depleted subjects (P < 0.01). The mean bias of the LLV differences between anthropometry and DEXA were 0.40 litre (95 % CI - 0.59, 1.39) and 0.50 litre (95 % CI - 1.08, 2.08) for depleted and non-depleted patients, respectively. Anthropometrically and DEXA-based estimates correlated similarly with muscle functional attributes. A ROC curve analysis revealed that leg height-corrected LLV values had acceptable sensitivity and specificity to identify depleted patients (area under the curve 0.93 (range 0.86-1.00); P < 0.001). Moreover, patients with LLV <or= 9.2 litres/m (the best cut-off value according to the ROC curve) had significantly lower exercise capacity and muscle performance than their counterparts (P < 0.05). In conclusion, an anthropometrically based method of estimating LLV (Jones and Pearson method) was shown to present with clinically acceptable accuracy and external validity in depleted and non-depleted patients with stable COPD.

Peak VO2 correction for fat-free mass estimated by anthropometry and DEXA.

PURPOSE Anthropometric (ANTHRO) and dual-energy x-ray absorptiometric (DEXA) estimates of total body and leg fat-free masses (FFM) were obtained in 77 randomly selected sedentary men and women, aged 20-80: intermethod limits of agreement and their clinical significance, as inferred from the differences on peak VO2 corrected for FFMANTHRO and FFMDEXA, were determined. METHODS Limits of agreement were calculated as mean bias +/- 95% confidence intervals: peak VO2 at maximum cycle ergometry was related to FFMANTHRO and FFMDEXA by using both standard (y x x(-1)) and power function ratios (allometry). RESULTS Data distribution of the ANTHRO-DEXA differences presented significant heteroscedasticity in both sexes, i.e., differences were proportional to the mean (P < 0.05). After logarithmic transformation, the mean bias +/- 95% limits of agreement were expressed as ratios (ANTHRO x DEXA(-1) x// error ratio): these corresponded to 0.95 x// 1.11 or 0.99 x// 1.15 for total body FFM and 0.90 x// 1.10 or 1.02 x// 1.07 for leg FFM in men and women, respectively. In addition, we found different allometric exponents for FFMANTHRO and FFMDEXA: the intermethod differences, therefore, increased after power function expression (P < 0.05). CONCLUSION Discrepancies between ANTHRO and DEXA measurements of FFM depend on the magnitude of the estimate: differences are typically within 10 to 15%. Importantly, FFM-corrected peak VO2 values can vary according to the method chosen for body composition assessment, especially when allometry is used for peak VO2 correction. These results demonstrate that ANTHRO-DEXA differences in FFM estimation do have relevant practical consequences for the analysis of maximum aerobic capacity in nontrained humans.

Importância da orientação nutricional e do teor de fibras da dieta no controle glicêmico de pacientes diabéticos tipo 2 sob intervenção educacional intensiva

OBJECTIVE: To evaluate the importance of nutritional counseling within a set of multidisciplinary interventions. SUBJECTS AND METHODS: Forty-seven patients with type 2 diabetes and hyperglycemia (A1C > 8%), treated conventionally (n = 19, GC) or intensively in six weekly visits (n = 28, GI) were analyzed. We evaluated mean weekly blood glucose (MWG) at baseline and after 6 weeks in both groups. RESULTS: GI reduced caloric (p = 0.001), carbohydrate (p = 0.004), and fat (p = 0.001) intake, and increased fiber consumption, while GC reduced fiber intake (p = 0.018). Glycemic control (MWG < 150 mg/dL) occurred in 75% of GI patients and in 31.6% of CG patients (p = 0.003), with negative correlation between changes in fiber intake and MWG values (r =-0.309; P = 0.035). Results were maintained after 12 weeks. CONCLUSION: Educational short-term intensive intervention was more effective than conventional treatment to achieve glycemic control. Our results also indicate that a more appropriate fiber content in the diet contributes for better blood glucose control in these patients.

Estado nutricional e qualidade da dieta de nutrizes em amamentação exclusiva

Abstract Objective: Identifying the nutritional status, dietary intake and diet quality of nursing mothers on exclusive breastfeeding. Methods: Cross-sectional study carried out with nursing mothers on exclusive breastfeeding from day 28 postpartum. Standardized instruments were used, and body mass index, food consumption and diet quality were evaluated.Results: The nursing mothers were overweight, presented energy consumption below the recommended and adequate percentage of macronutrients, except for protein, which was elevated. The diet was classified as “needs improvement” according to the Healthy Eating Index (HEI).Conclusion: The results show that the overweight associated with a diet of poor quality indicated possible deficiencies of micronutrients. Resumo Objetivo: Identificar o estado nutricional, o consumo alimentar e a qualidade da dieta de nutrizes em amamentacao exclusiva. Metodos: Estudo transversal realizado com nutrizes em aleitamento exclusivo a partir do 28o dia pos-parto. Foram utilizados instrumentos padronizados e foram avaliados o indice de massa corporal, consumo alimentar e qualidade da dieta. Resultados: As nutrizes apresentaram sobrepeso, consumo energetico abaixo do recomendado, porcentagens de macronutrientes adequadas exceto para proteina, que foi elevada. A dieta foi classificada como “precisando de melhorias”, conforme o Indice de Alimentacao Saudavel. Conclusao: Os resultados mostraram que o sobrepeso associado a uma qualidade inadequada da dieta, indicou possiveis carencias de micronutrientes.

Desenvolvimento e pré-teste de um questionário de frequência alimentar para graduandos

Objetivo Desenvolver e aplicar em um projeto-piloto um questionario de frequencia alimentar quantitativo de autopreenchimento destinado a graduandos da area da saude. Metodos Trata-se de um estudo transversal realizado em 151 universitarios de ambos os sexos, usuarios do ambulatorio de Nutricao do Corpo Discente da Universidade Federal de Sao Paulo, Brasil. O questionario inicial foi composto a partir dos alimentos e preparacoes informados no Registro Alimentar de Tres Dias. As informacoes em medidas caseiras foram transformadas em gramas ou mililitros com o auxilio de tabelas, e os alimentos foram ordenados segundo a porcentagem de contribuicao para o valor energetico total informado. Foram selecionados 198 ali-mentos responsaveis por 95% do consumo energetico e agrupados em 77 itens alimentares de acordo com a similaridade nutricional. O tamanho das porcoes alimentares foi classificado conforme o valor do percentil 50 da distribuicao dos pesos correspondentes as medidas caseiras referidas. Definiu-se como porcao pequena, aquela cujo valor foi igual ou inferior ao percentil 25; como media, o percentil 50 e grande, o valor igual ou superior ao percentil 75. Resultados Apos o pre-teste do questionario inicial, o questionario final resultou em uma lista com 89 alimentos, agrupados em 70 itens alimentares. As instrucoes para o autopreenchimento foram refeitas, objetivando-se um melhor preenchimento. Conclusao Apos as modificacoes realizadas, o questionario de frequencia alimentar quantitativo encontra-se pronto para o estudo de validacao e calibracao.

Validation of a quantitative food frequency questionnaire developed to under graduate students

A validity test of a Food Frequency Questionnaire was carried out using 50 students of health occupation in São Paulo, Brazil. Therefore, a three day dietary record was used as reference method and variables such as energy, macronutrients and dietary fiber were analyzed. The accordance between the Food Frequency Questionnaire and average data from dietary record was tested with kappa statistics and intra-class correlation coefficients (ICC). Limits of agreement were estimated by the Bland-Altmans method. Better results were found for calories (ICC 0.43; 95%CI 0.17 - 0.63) and non-energy-adjusted nutrients, except dietary fiber (ICC 0.34; 95%CI 0.07 - 0.56). The percentage of individuals classified in the same category of consumption was nearly half (49.8%), while only 16% of them were classified in opposite categories. With the exception of lipids, other analyzed variables tended to be overestimated by the Food Frequency Questionnaire. The Food Frequency Questionnaire is recommended as a method of assessing food intake of university students in studies which focus on calorie estimates and also intend to classify groups into intake categories.

Fatores relacionados aos padrões alimentares de indivíduos com síndrome metabólica que frequentam ambulatório de nutrição em São Paulo

Objective: To identify the dietary patterns of individuals with metabolic syndrome and determine associations with sociodemographic, lifestyle, anthropometric and biochemical features. Methods: We analyzed data of individuals with metabolic syndrome attending the nutrition outpatient clinic at a public university in São Paulo, from 2008 to 2011. We assessed food intake by 24-hour dietary recall and identified the dietary patterns using principal components analysis. Multivariate multiple linear regression models were applied to investigate possible associations between dietary patterns and the independent variables. We applied Pearson’s correlations to evaluate possible associations between dietary patterns and biochemical and anthropometric variables. Results: Of the 166 outpatients enrolled, 65.7% (109) were women; 63.0% (103) were adults (21-59 years) and 37.0% were elderly (60-79 years). Most people were married, sedentary and obese, with incomplete primary education, non-smoking and non-alcoholic. We identified nine dietary patterns. There was a positive association between the “traditional Brazilian” dietary pattern (rice, beans and red meat) with men and a negative association with age, and the “prudent” (whole grains, soups) with women. There was a positive correlation between the “traditional Brazilian”, “compensatory” (snacks, sweeteners, light products) and “mixed” (refined grains, fruits, oils) patterns with fasting glucose, and negative correlation between the “healthy” (vegetables and oilseeds) and waist circumference. Conclusion: The results of this study indicate that these individuals with metabolic syndrome have dietary patterns characterized by the presence of refined foods, fats, red meat and alcohol, associated with biochemical disturbance, as impaired fasting glucose and hypertriglyceridemia.