Ann Kristine Jansen

Plasma zinc and hair zinc levels, anthropometric status and food intake of children in a rural area of Brazil

OBJETIVO: Investigar niveis plasmaticos de zinco, concentracao de zinco capilar, crescimento fisico, e consumo de zinco em criancas de 6 a 24 meses da regiao de Diamantina (MG), Brasil. METODOS: As concentracoes de zinco plasmatico e zinco capilar foram analisadas empregando as tecnicas de espectrometria atomica de absorcao e de ativacao neutronica, respectivamente. Peso-para-idade, peso-para-altura e altura-para-idade, expressos em escore-Z, foram medidos, de acordo as curvas de referencia da Organizacao Mundial de Saude. O zinco dietetico dos sujeitos foi avaliado a partir de tres registros alimentares, preenchidos pelas maes ou responsaveis. RESULTADOS: A deficiencia de zinco foi observada em 11,2% e em 16,8% das criancas, segundo os niveis de zinco plasmatico e zinco capilar, respectivamente. As medias em criancas com 11 meses ou menos (49) e 11 (127) meses ou mais de idade para niveis de zinco plasmatico e zinco em cabelos foram 15,4 (DP=4,2) µmol L-1 e 139,5 (DP= 72,1) µg g-1 e 16,0 (DP= 4,5) µmol L-1 e 134,3 (DP=110,3) µg g-1, respectivamente. Os resultados antropometricos mostraram que 8,0%, 6,8% e 3,4% das criancas foram classificadas com baixo peso, baixa estatura e emagrecidas, respectivamente. A media do consumo dietetico de zinco pelas criancas foi de 3,2 (DP=2,3) mg/zinco por dia, e um terco das criancas consumiam alimentos fonte de zinco abaixo do recomendado. Nao houve correlacao entre as variaveis zinco plasmatico, zinco em cabelos, antropometria e consumo de zinco. CONCLUSAO: Os resultados demonstram que a deficiencia de zinco e um problema na populacao estudada, nao somente nas criancas desnutridas. Atencao nutricional devera ser direcionada a esta populacao, com o intuito de melhorar o consumo de alimentos ricos neste mineral e monitorar a deficiencia de zinco.

Fatores associados ao desenvolvimento de úlceras de pressão: o impacto da nutrição

Objective This prospective study aimed to determine the incidence of pressure ulcers in a university hospital and investigate the nutritional factors involved in their development. Methods The clinical, sociodemographic, anthropometric and dietary data of 50 patients were collected and analyzed by the software Epi Info 3.2. Results Females aged M=66.6, SD=18.0 years prevailed. The incidence of pressure ulcers was 28.0%, resulting in roughly 1.7 pressure ulcers per patient. The most common sites were the sacral region (57.1%) and heels (35.7%). Statistical significance (p<0.05) was found for the following variables: changing position in bed, activity level, use of diaper, mental or neurological illness, anemia and use of antibiotics, anti-inflammatories and immunosuppressants. With respect to nutritional factors, positive associations were found between patients with ulcers and low arm muscle area, low calf circumference, low triceps and subscapular skinfold thicknesses, low hemoglobin level, low hematocrit, and high white blood cell count. The wounds also were associated with higher mortality rates and longer hospital stays. Conclusion There is a close association between poor nutritional status and the development of pressure ulcers. This study identified some nutritional parameters related to this event which may become important tools for the identification and treatment of patients at risk.1 Universidade Federal de Minas Gerais, Escola de Enfermagem, Curso de Nutricao. Av. Prof. Alfredo Balena, 190, Santa Efigenia, 30130-100, Belo Horizonte, MG, Brasil. Correspondencia para/Correspondence to: S.F. CAMPOS. E-mail: . 2 Nutricionista, Hospital Universitario Risoleta Tolentino Neves. Belo Horizonte, MG, Brasil. Fatores associados ao desenvolvimento de ulceras de pressao: o impacto da nutricao

Nutrient intake in neurofibromatosis type 1: A cross-sectional study

OBJECTIVES To evaluate nutrient intake among adult neurofibromatosis type 1 (NF1) patients. METHODS A cross-sectional study of 60 NF1 patients (29 men, 31 women) who were ≥18 y old and were evaluated from September 2012 to September 2013 in a neurofibromatosis outpatient reference center. Patients underwent nutritional assessment, including anthropometric and dietary data collection. Food intake was evaluated using three, non-consecutive, self-reported 24-h dietary recall surveys, and nutrient intake was analyzed according to the recommendations of the dietary reference intake document. RESULTS Forty-three patients (72%) recorded energy consumption lower than the estimated daily energy requirement (EER). Men (25/29, 86.2%) were more likely to fail to meet their target EER, compared to women (18/31, 58.1%) (P = 0.016). Inadequate intake of vitamin D, magnesium, calcium, and pyridoxine was noted between men and women, and all patients consumed excess sodium. NF1 patients did not consume adequate amounts of fiber or vitamins A and C. Excessive consumption of saturated fatty acids and lipids was also observed in both male and female patients. CONCLUSIONS In this study, NF1 patients consumed an unhealthy diet that was rich in fats and sodium and lacking in fiber, vitamins, and minerals. Further studies are needed to investigate the role of these dietary and nutritional patterns in the severity of the clinical manifestations of NF1.

Avaliação dos fatores de risco cardiovasculares em uma população rural brasileira

This cross-sectional study assessed cardiovascular health in 863 adults in rural communities in the Jequitinhonha Valley, Minas Gerais State, Brazil, focusing on seven factors, four of which behavioral (diet, physical activity, smoking, and body weight) and three biological (total cholesterol, fasting blood glucose, and arterial pressure), classified as ideal, intermediate, or poor. Men showed better results in behavioral factors (p = 0.01), with more men displaying 2 or 3 factors at ideal levels (48.5 and 25.8%, respectively), when compared to women (44.2 and 19.8%, respectively) (p = 0.01). Women presented more biological factors at ideal levels (19.1%) when compared to men (7.9%) (p < 0.001). Only three participants (0.4%) showed all seven factors at ideal levels. Prevalence of ideal indices was very low, showing the need for strategies to improve cardiovascular health in this population.Trata-se de um estudo transversal que avaliou indicadores de saude cardiovascular em 863 individuos adultos residentes em comunidades rurais do Vale do Jequitinhonha, Minas Gerais, Brasil. Foram avaliados sete fatores, quatro comportamentais (dieta, atividade fisica, tabagismo e peso corporal) e tres biologicos (colesterol total, glicemia em jejum e pressao arterial), classificados em niveis ideal, intermediario e ruim. Considerando os fatores comportamentais os homens tiveram melhor desempenho (p = 0,01), sendo observado um maior numero de homens com 2 e 3 fatores em niveis ideais (48,5 e 25,8%, respectivamente), em detrimento das mulheres (44,2 e 19,8%, respectivamente) (p = 0,01). Por outro lado, as mulheres apresentaram maior numero de fatores biologicos em niveis ideais (19,1%) quando comparadas com os homens (7,9%) (p < 0,001). Somente tres (0,4%) participantes apresentaram os sete fatores na categoria ideal. A prevalencia dos indicadores em nivel ideal foi muito baixa, demonstrando a urgencia de estrategias visando melhorar a saude cardiovascular desta populacao.

Quality of life of caregivers of overweight or obese children and adolescents

Este estudo avaliou a qualidade de vida relacionada a saude (QVRS) de cuidadores de criancas e adolescentes com sobrepeso e obesidade. Trezentos e sessenta cuidadores de criancas e adolescentes com idade entre 9 e 12 anos, com diagnostico de sobrepeso (n=96; idade media=11,1 anos), obesidade (n=62; idade media de 10,9 anos) e eutrofia (n=202; idade media de 10,7 anos), matriculadas em escolas publicas e particulares da cidade de Uberlândia (MG), foram convidados a responder o questionario The 36 item Short Form Questionnaire (SF-36). Os escores obtidos pelo questionario foram comparados segundo o indice de massa corporea (IMC) das criancas e adolescentes e nao foram encontradas diferencas significativas entre os cuidadores de criancas e adolescentes com sobrepeso, obesidade e eutrofia.Logo, os cuidadores de criancas e adolescentes com sobrepeso ou obesidade nao apresentam prejuizo na sua QVRS.This study evaluated the health-related quality of life (HRQL) of caregivers of overweight and obese children and adolescents. Three-hundred and sixty caregives of children and adolescents (ages ranging from 9 to 12 years) diagnosed with overweight (n=96; average age 11.1 years), obesity (n=62; average age 10.9 years) and eutrophy (n=202; average age 10.7 years), regular students of public and private schools in Uberlândia (Minas Gerais), were invited to answer The 36 item Short Form Questionnaire (SF-36). The scores obtained were compared according to the body mass index (BMI) of the children and adolescents, and no significant differences were found between caregivers of overweight, obese and etrophic children and adolescents. Hence, there is no harm to the HRQL of caregivers of overweight and obese children and adolescents.

Qualidade de vida de cuidadores de crianças e adolescentes com sobrepeso ou obesidade

Este estudo avaliou a qualidade de vida relacionada a saude (QVRS) de cuidadores de criancas e adolescentes com sobrepeso e obesidade. Trezentos e sessenta cuidadores de criancas e adolescentes com idade entre 9 e 12 anos, com diagnostico de sobrepeso (n=96; idade media=11,1 anos), obesidade (n=62; idade media de 10,9 anos) e eutrofia (n=202; idade media de 10,7 anos), matriculadas em escolas publicas e particulares da cidade de Uberlândia (MG), foram convidados a responder o questionario The 36 item Short Form Questionnaire (SF-36). Os escores obtidos pelo questionario foram comparados segundo o indice de massa corporea (IMC) das criancas e adolescentes e nao foram encontradas diferencas significativas entre os cuidadores de criancas e adolescentes com sobrepeso, obesidade e eutrofia.Logo, os cuidadores de criancas e adolescentes com sobrepeso ou obesidade nao apresentam prejuizo na sua QVRS.This study evaluated the health-related quality of life (HRQL) of caregivers of overweight and obese children and adolescents. Three-hundred and sixty caregives of children and adolescents (ages ranging from 9 to 12 years) diagnosed with overweight (n=96; average age 11.1 years), obesity (n=62; average age 10.9 years) and eutrophy (n=202; average age 10.7 years), regular students of public and private schools in Uberlândia (Minas Gerais), were invited to answer The 36 item Short Form Questionnaire (SF-36). The scores obtained were compared according to the body mass index (BMI) of the children and adolescents, and no significant differences were found between caregivers of overweight, obese and etrophic children and adolescents. Hence, there is no harm to the HRQL of caregivers of overweight and obese children and adolescents.

Lower fasting blood glucose in neurofibromatosis type 1

Studies indicate a lower occurrence of diabetes mellitus (DM) in patients with neurofibromatosis type 1 (NF1). Fasting blood glucose (FBG) level is the main criterion used to diagnose DM and glucose intolerance. Therefore, this study compared FBG level between adults with NF1 and non-NF1 controls. We selected clinical records of 57 out of 701 individuals attending the Neurofibromatosis Outpatient Reference Center of the Clinics Hospital of the Federal University of Minas Gerais in Brazil. The selected patients with NF1 were matched to non-NF1 controls selected from the Brazilian Longitudinal Study of Adult Health according to sex, age (range, 35–74 years) and BMI at a ratio of 1:3. In both groups, individuals with DM were excluded. Median FBG level in the NF1 group (86 mg/dl (range, 56–127 mg/dl)) was lower than that in the non-NF1 control group (102 mg/dl (range, 85–146 mg/dl)) (P<0.001). Prevalence of FBG level ≥100 mg/dl in the NF1 group (16%) was lower than that in the non-NF1 control group (63%) (P<0.05). The chance of a high FBG level was 89% lower in the NF1 group (odds ratio, 0.112; 95% CI, 0.067–0.188) (P<0.05). In conclusion, adults with NF1 showed a lower FBG level and a lower prevalence of high FBG level compared with non-NF1 controls.

Increased insulin sensitivity in individuals with neurofibromatosis type 1

Objects To compare insulin resistance (IR) and metabolic aspects of patients with neurofibromatosis type 1 (NF1) and individuals without the disease. Subjects and methods Forty patients with NF1 were matched by sex, age, and body mass index (BMI) to 40 controls from the community. Blood samples were collected for biochemical assessment. Homeostasis model assessment adiponectin (HOMA-AD), Homeostasis model assessment insulin resistance (HOMA-IR), and adiponectin/leptin ratio (ALR) were used to identify IR. Results The median HOMA-IR values were similar between the groups. However, the HOMA-AD value was significantly lower and the ALR significantly higher in the NF1 group. Fasting blood glucose (FBG), leptin, and visfatin levels of patients with NF1 were significantly lower, although adiponectin levels were significantly higher than those in the controls. Fasting insulin and blood glucose levels 2 hours after administration of 75 g of dextrose, glycated hemoglobin, and resistin showed no significant differences between groups. The HOMA-AD correlated with BMI, FBG, blood glucose levels 2 hours after administration of 75 g of dextrose, fasting insulin, glycated hemoglobin, adiponectin, leptin, visfatin, ALR, and HOMA-IR. The ALR correlated with BMI leptin, visfatin, and adiponectin. Conclusions Lower levels of FBG, leptin, visfatin, and HOMA-AD, and higher adiponectin levels and ALR may be related to increased insulin sensitivity and lower occurrence of type 2 diabetes mellitus in patients with NF1.

Saúde cardiovascular em população residente nas capitais brasileiras

Resume Objective: to estimate the prevalence of ideal cardiovascular health indicators in the Brazilian population, according to gender, age, education and region of residence. Method: cross-sectional study that used data from 41,134 participants of the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (Vigitel). The ideal cardiovascular health assessment considers four behavioral factors: not smoking; body mass index less than 25 kg/m2; practicing physical activity, eating fruits and vegetables five or more times per day; and two clinical factors (no diagnosis of diabetes or hypertension). The sum of factors at ideal levels results in a score ranging from zero (worse cardiovascular health) to six (ideal cardiovascular health). Results: considering the six factors, only 3.4% of the studied population presented ideal levels of cardiovascular health, with the majority of participants (57.6%) presenting three or four ideal factors. Women had higher prevalence of ideal cardiovascular health (3.8% versus 2.9% for men) (p < 0.0001). Conclusion: the findings of this study are consistent with the elevated risk of mortality from cardiovascular disease, observed in the Brazilian population. This may contribute to a better understanding of the scenario of cardiovascular health in the urban population of the country.Objetivo: estimar a prevalencia das metricas de saude cardiovascular ideal em nivel populacional, segundo sexo, idade, escolaridade e regiao de moradia. Metodo: estudo transversal que utilizou dados de 41.134 participantes do Sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico. A avaliacao da saude cardiovascular ideal considerou quatro fatores comportamentais: nao fumar; apresentar indice de massa corporal menor do que 25 kg/m2; realizar atividade fisica; consumir frutas e hortalicas cinco ou mais vezes por dia, e dois fatores clinicos: nao referir diagnostico de diabetes e de hipertensao arterial. A soma dos fatores resultou em um escore que variou de zero (pior saude cardiovascular) a seis (saude cardiovascular ideal) fatores em niveis ideais. Resultados: considerando os seis fatores, somente 3,4% da populacao estudada apresentou niveis ideais de saude cardiovascular e a maioria dos participantes (57,6%) apresentou tres ou quatro fatores ideais. As mulheres apresentaram maior prevalencia de saude cardiovascular ideal (3,8% vs. 2,9% dos homens) (p < 0,0001). Conclusao: os achados deste estudo sao condizentes com o elevado risco de mortalidade por doencas cardiovasculares, observado para a populacao brasileira, e podem contribuir para a melhor compreensao do cenario da saude cardiovascular na populacao urbana do pais.

Development of enteral homemade diets for elderly persons receiving home care and analysis of macro and micronutrient composition

Objetivo: Desenvolver e analisar a composicao de macro e micronutrientes de dietas enterais semiartesanais para uso domiciliar. Metodo: Foi desenvolvida uma receita de dieta enteral semiartesanal padrao, com tres concentracoes caloricas, de 1500, 1800 e 2100 Kcal. Apos o preparo e teste de viscosidade, estabilidade, odor, cor e custo as dietas tiveram a composicao quimica de macro e micronutrientes analisada. O folato e vitamina D e B12 tiveram seus valores estimados por meio de tabelas de composicao quimica. Os resultados encontrados foram comparados com as recomendacoes nutricionais para idosos. Resultado: As dietas apresentaram distribuicao normal de macronutrientes. A dieta de 1500 Kcal apresentou diversas deficiencias de minerais e vitaminas. Nos demais niveis caloricos, obteve-se valores adequados para todos os minerais exceto o magnesio. As vitaminas estavam todas adequadas no nivel calorico de 2100 Kcal e no de 1800 Kcal, a vitamina E, D e B6 nao alcancaram as recomendacoes dieteticas diarias. Conclusao: A dietas padroes desenvolvidas podem contribuir para seguranca alimentar e nutricional de idosos em terapia nutricional domiciliar, desde que todas suplementadas com magnesio, e a de 1800 Kcal com vitamina E, D e B6. A formula de 1500 Kcal nao se mostrou segura nutricionalmente no que tange aos micronutrientes.Objective: the development and analysis of the macro and micronutrient composition of homemade enteral diets. Method: A standard homemade enteral diet was developed at three caloric concentrations 1500, 1800 and 2100 Kcal. After preparation and testing of viscosity, stability, odor and color, plus evaluation of cost, the chemical composition of Palavras-chave: Atenção Domiciliar. Nutrição Enteral. Análise de Alimentos. Idoso. Segurança Alimentar e Nutricional. http://dx.doi.org/10.1590/1981-22562017020.160168