Carlos Antonio Bruno da Silva

The Phase Angle and Mass Body Cell as Markers of Nutritional Status in Hemodialysis Patients

OBJECTIVE Bioelectrical impedance analysis (BIA) is a fast, noninvasive method for assessing body composition, and its role in the evaluation of nutritional status in haemodialysis (HD) has been studied. This study aimed to compare BIA parameters to clinical, biochemical, and anthropometric markers of nutrition in HD patients, such as subjective global assessment modified for renal disease (SGA-1), serum albumin, body mass index (BMI), percent of standard body weight (%SBW), deviation of triceps skinfold thickness (TSF), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC) from the standard value (50th percentile), anthropometry-derived fat (FM-A), and fat-free mass (FFM-A). METHODS BIA was performed 30 minutes after a HD session and the reactance (Xc), resistance (R), phase angle (PA), body cell mass (BCM), fat mass (FM-BIA), and fat-free mass (FFM-BIA) values were recorded. The prevalence of malnutrition was estimated according to PA and percent of BCM. The correlation between methods was assessed through Pearsons correlation coefficient and Bland and Altman analysis. RESULTS A total of 58 patients were studied (30 women and 28 men; mean age of 49.2 +/- 14.8 years). The mean PA was 6.19 +/- 1.33 degrees and the mean percent of BCM was 33.75 +/- 5.91%. The prevalence of malnutrition was 17.5% and 43.9% according to the PA and percent of BCM, respectively. PA had a negative correlation with age and SGA-1 score and a positive correlation with percent SBW, MAC, MAMC, FFM-A, and albumin. Percent of BCM had a negative correlation with age, MAC, MAMC and FM-A and a positive correlation with FFM-A and albumin. A significant correlation between FFM-A and FFM-BIA was observed, as well as between FM-A and FM-BIA. CONCLUSIONS BIA indexes reflected nutritional state. PA and BCM seem to be less influenced by changes in volume and can be used for nutritional assessments of dialysis patients.

Exergaming as a Strategic Tool in the Fight against Childhood Obesity: A Systematic Review

Improper use of electronic media is considered a major contributing factor to childhood obesity. However, exergames, a new generation of active games, have made it possible to combine electronic entertainment with physical exercise. The purpose of this systematic review was to analyze the use of exergaming as a strategic tool in the fight against childhood obesity. Information was retrieved from the databases SciELO, LILACS, Pubmed, Ebsco, and Science Direct, using the search words “egames,” “exergames,” “exergaming,” “new generation of video games,” “active video games,” “energy expenditure,” “body composition,” and “physical activity” in English and Portuguese, covering the period January 2008 to April 2012. Nine articles met the inclusion criteria. Exergaming was found to increase physical activity levels, energy expenditure, maximal oxygen uptake, heart rate, and percentage of physical activity engaged in and to reduce waist circumference and sedentary screen time. Thus, exergaming may be considered a highly relevant strategic tool for the adoption of an active and healthy lifestyle and may be useful in the fight against childhood obesity.

Desnutrição na insuficiência renal crônica: qual o melhor método diagnóstico na prática clínica?

INTRODUCTION: Protein-energy malnutrition, systemic inflammation, and metabolic disorders are frequent among patients with chronic kidney failure undergoing dialysis, contributing to their morbidity and mortality. MATERIAL AND METHODS: In the present study, the prevalence of malnutrition in chronic renal patients undergoing hemodialysis in one single center in the Northeastern region of Brazil was assessed according to the following: three different methods of subjective global assessment (SGA); body mass index (BMI); percent of standard body weight; adequacy to the 50th percentile of triceps skinfold (TSF) and arm muscle circumference (AMC) thicknesses; pre-dialysis albumin; phase angle; and percentage of body cell mass (%BCM). Agreement of the nutritional status diagnosis performed through SGA with anthropometric, biochemical, and bioelectrical impedance measures was assessed. RESULTS: The study assessed 58 patients [females, 30 (51.7%); mean age = 49 years]. The prevalence of malnutrition according to the different methods ranged from 12.1% to 94.8%. Conventional SGA showed a moderate agreement with patient-generated SGA (PG-SGA), BMI (cutoff point, 22.0 kg/m2), and AMC; a fair agreement with BMI (cutoff point, 18.5 kg/m2), percent of standard body weight, AC, and phase angle; and a poor agreement with SGA adapted to the renal patient, TSF, and %BCM. CONCLUSIONS: The nutritional assessment methods commonly used in clinical practice are subject to restrictions when applied to the dialysis population, considering the different percentages obtained with the different methods. Longitudinal, prospective studies on the association of nutritional markers with adverse events, such as hospitalization and mortality, should be carried out to clarify remaining issues.

Determination of urinary stone composition based on stone morphology: a prospective study of 325 consecutive patients in an emerging country.

Abstract Background: Urolithiasis is a common disease that is increasing throughout the world. This study aimed at determining the composition of urinary stones in patients with renal lithiasis in an emerging country. Methods: A morphological analysis was performed on 340 urinary stones from 325 consecutive patients from Brazil with lithiasis. Results and conclusions: Among the 340 stones analyzed, 34.7% were pure. The most frequent stone was calcium oxalate (CaOx) (59.3%), followed by uric acid (23.7%). CaOx was more frequently seen in women (p=0.024), while uric acid was more common in men (p<0.001). Among the mixed stones, CaOx (67.1%) was the most frequent major component, followed by carbapatite (11.2%) and struvite (7.9%). CaOx (p<0.001) and uric acid (p=0.014) were more frequently the major components in men, while carbapatite (p<0.001) and struvite (p=0.011) were more frequent in women. The major component of both pure and mixed stones was CaOx (65.1%), followed by uric acid (10.9%), carbapatite (10%), struvite (6.7%), ammonium urate (5.1%), cystine (1.8%) and protein (0.4%). These findings may be related to regional factors, such as weather and nutritional habits. Clin Chem Lab Med 2009;47:561–4.

Adductor Pollicis Muscle Thickness: A Promising Anthropometric Parameter for Patients With Chronic Renal Failure

INTRODUCTION Protein-calorie malnutrition is a prevalent disorder in chronic renal failure (CRF) and a major risk factor for increased mortality in hemodialysis (HD) patients. Although many methods have been used to assess malnutrition in CRF, the role of adductor pollicis muscle thickness (APMt) is not established yet. AIMS This study aimed to analyze the APMt in HD patients and to investigate the correlation between APMt and conventional anthropometric, laboratory, and bioelectrical impedance markers, as well as its association with mortality/morbidity in a period of 12 months of follow-up. SUBJECTS AND METHODS The study included 143 HD patients from a single facility. After dialysis, the dry weight, height, mid-arm circumference, triceps skinfold thickness, and APMt were measured. Subsequently, the body mass index, percentage of standard body weight, the mid-arm muscle circumference, and the mid-arm muscle area were calculated. Blood counts were performed for hemoglobin, creatinine, and albumin. Patients were also submitted to a single-frequency tetrapolar bioimpedance test for measuring resistance, reactance, phase angle, and percentage of body cell mass. The correlation between APMt and anthropometric, laboratory, and bioelectrical impedance parameters was calculated using Pearsons linear correlation. Multiple linear regression analysis was used to select independent risk factors to death and hospitalizations in 6 and 12 months of follow-up, among parameters selected by univariate analysis. RESULTS Patients were aged 52.2 ± 16.6 years (20 to 83 years) on average, 58% were men, and mean dialysis vintage was 5.27 ± 5.12 years. APMt was 11.85 ± 1.63 mm (men, 12.34 ± 1.53; women, 11.19 ± 1.51; P < .0001). APMt was positively correlated with body mass index (r = 0.37; P < .0001), mid-arm circumference (r = 0.437; P < .0001), mid-arm muscle circumference (r = 0.494; P < .0001), mid-arm muscle area (r = 0.449; P < .0001), percentage of standard body weight (r = 0.355; P = .000), creatinine (r = 0.230; P = .006), albumin (r = 0.207; P = .013), percentage of body cell mass (r = 0.293; P = .000), and phase angle (r = 0.402; P < .0001), and negatively correlated with resistance (r = -0.403; P < .0001). The APMt ≤10.6 mm was associated with a 3.3 times greater risk of hospitalization within 6 months of follow-up (OR = 3.3, 95% CI: 1.13 to 9.66; P = .029) compared with patients with an APMt >10.6 mm. The APMt was not associated with risk of death at 6 and 12 months or hospitalization within 12 months of follow-up. CONCLUSION This is the first study testing APMt as an anthropometric marker in HD patients. The parameter is easy to measure and does not seem to be significantly affected by variations in hydration status. The parameter was significantly correlated with markers reflecting the condition of the muscle compartment, but not with parameters estimating the fat mass. The determination of an APMt cutoff point for malnutrition in patients with CRF and its correlation with morbidity and mortality will require further investigation in clinical studies.

Exercise prevents cardiometabolic alterations induced by chronic use of glucocorticoids

FUNDAMENTO: Cronicamente, os glicocorticoides induzem alteracoes cardiometabolicas adversas, incluindo resistencia a insulina, diabete, dislipidemia, esteatose hepatica e hipertensao arterial. OBJETIVOS: Avaliar o efeito da pratica regular de exercicio fisico aerobio sobre as alteracoes cardiometabolicas induzidas por administracao cronica de dexametasona (Dex - 0,5 mg/kg/dia i.p) em ratos. METODOS: Ratos Wistar machos (n = 24) foram divididos em quatro grupos: Grupo controle; Grupo treinado; Grupo tratado com Dex e Grupo tratado com Dex e treinado. O treinamento fisico (iniciado 72 horas apos a primeira dose de Dex) foi realizado 3 vezes por semana, ate o final do tratamento. Ao final desse periodo, realizaram-se as seguintes avaliacoes bioquimicas: glicemia em jejum, teste de tolerância a glicose e analise do perfil lipidico no sangue que incluiu colesterol total (CT), LDL-c, HDL-c, VLDL-c e triglicerideos (TG). O peso do musculo gastrocnemio, analise histopatologica do figado e os indices cardiometabolicos (CT/HDL-c, LDL-c/HDL-c e TG/HDL-c) tambem foram avaliados. RESULTADOS: Observou-se hiperglicemia, menor tolerância a glicose, elevacao do CT, LDL-c, VLDL-c e TG, diminuicao do HDL-c, presenca de esteatose hepatica, hipotrofia muscular e elevacao dos indices CT/HDL-c, LDL-c/HDL-c e TG/HDL-c nos animais tratados com Dex. O exercicio fisico reduziu a hiperglicemia, melhorou a tolerância a glicose, reduziu a dislipidemia e preveniu a esteatose hepatica , a hipotrofia muscular e reduziu os indices CT/HDL-c, LDL-c/HDL-c e TG/HDL-c. Entretanto, nao houve efeito significante do treinamento fisico sobre o HDL-c. CONCLUSAO: O exercicio fisico aerobio tem efeito protetor contra as alteracoes cardiometabolicas induzidas pelo uso cronico de glicocorticoides.BACKGROUND Chronically, glucocorticoids induce adverse cardiometabolic alterations including insulin resistance, diabetes, dyslipidemia, liver steatosis and arterial hypertension. OBJECTIVES To evaluate the effect of regular practice of aerobic exercise on cardiometabolic alterations induced by chronic administration of dexamethasone (Dex - 0.5 mg/kg/day ip) in rats. METHODS Male Wistar rats (n = 24) were divided in four groups: Control group; Trained group; Treated with Dex group and Treated with Dex and trained group. The exercise training (initiated 72 hours after the first dose of Dex) was carried out three times a week until the end of the treatment. At the end of this period, the following biochemical assessments were performed: fasting glycemia, oral glucose tolerance test and analysis of the blood lipid profile that included total cholesterol (TC), LDL-c, HDL-c, VLDL-c and triglycerides (TG). The weight of the gastrocnemius muscle, the histopathological analysis of the liver and cardiometabolic indices (TC/HDL-c, LDL-c/HDL-c and TG/HDL-c) were also performed. RESULTS Hyperglycemia, lower glucose tolerance, increased TC, LDL-c, VLDL-c, TG, CT/HDL-c, LDL-c/HDL-c and TG/HDL-c, decreased HDL-c, presence of liver steatosis and muscular hypotrophy were observed in the animals treated with Dex. The exercise training reduced hyperglycemia, improved glucose tolerance, decreased dyslipidemia and prevented liver steatosis, muscular hypotrophy and reduced CT/HDL-c, LDL-c/HDL-c and TG/HDL-c ratios. However, there was no significant effect on HDL-c. CONCLUSION The aerobic exercise training have a protective effect against the cardiometabolic alterations induced by the chronic use of glucocorticoids.

Zinc pharmacokinetics in insulin-dependent diabetes mellitus patients after oral zinc tolerance test

Abstract Zinc is an essential micronutrient that is directly involved in the physiology of insulin, and zinc metabolism could play a role in the pathogenesis of diabetes mellitus and its complications. On the other hand, low zinc absorption and hyperzincuria in diabetic animals and humans have indicated that diabetics are more susceptible to zinc deficiency. This study was designed to compare zinc metabolism in ten insulin-dependent diabetic patients with ten healthy controls, using an oral zinc tolerance test. Pharmacokinetic parameters were performed to study intestinal zinc absorption and urinary zinc excretion. Absorption of zinc was extensive during the first two hours after administration of a single oral dose of 25 mg Zn ++ . The area under the serum zinc curve (AUC) and maximum concentration of zinc (C max ) did not differ in both control and experimental groups, p a ), elimination rate constant (K el ), absorption half-life (T 1/2a ), elimination half-life (T 1/2el ), and time of maximum concentration (T max ) were not significantly different between the diabetic patients and controls ( p > 0.05). All these kinetic parameters suggest that there is no malabsorption of zinc in diabetic patients. Conversely, zinc clearance/creatinine clearance ratio (CZn ++ /Ccr ratio) in diabetic patients differed significantly in comparison to controls, p

Chemical and morphological analysis of kidney stones: a double-blind comparative study

PURPOSE To compare chemical to morphological kidney stone composition analysis based on a sample of 50 stones retrieved from patients at a nephrology service. METHODS The chemical analysis was performed with a Bioclin® kit, while a 10-mm magnifying glass (10x; Prolabo, Paris, France) was employed in the morphological analysis. Findings obtained with the two methods were compared and classified as concordant (100% agreement), partly concordant (concordant for major components, discordant for minor components) or discordant (discordant for major components). RESULTS In the chemical analysis, the most commonly observed major component was calcium (70%), followed by oxalate (66%), ammonium (56%), urate (28%) and carbonate (24%). In the morphological analysis, the most commonly observed major components were calcium phosphate and magnesium (32% each), followed by calcium oxalate monohydrate (24%), uric acid and urates (20% each), calcium oxalate dihydrate (18%) and cystine (6%). Infectious kidney stones were identified in 34% and 24% of cases by morphological and chemical analysis, respectively. Thirty-eight percent of the samples were classified as concordant, 52% were partly concordant and 10% were discordant. CONCLUSION We suggest kidney stones be routinely submitted to both types of analysis for a better understanding of the mechanisms involved in lithogenesis.

Sensitivity of zinc kinetics and nutritional assessment of children submitted to venous zinc tolerance test.

Objective: The purposes of this study were to investigate the kinetics of zinc in schoolchildren between the ages of 6 and 9 years, of both sexes, and to verify its sensitivity in detecting alterations in body zinc status. Methods: Nutritional assessment was performed by body mass index. Food intake, venous zinc tolerance test, and zinc kinetics were carried out before and after 3-month oral zinc supplementation. Results: Of the 42 children studied, 76.2% had healthy weight. Only energy, calcium, and fiber intake were suboptimal before and after oral zinc supplementation. Serum zinc and total-body zinc clearance, although at normal levels, increased significantly after zinc supplementation. Conclusion: We concluded, therefore, that kinetics is a sensitive tool for detecting changes in body zinc status, even in children without a deficiency of this mineral. Furthermore, kinetics showed a positive response to supplementation and may be a sensitive parameter for evaluating the efficacy of this therapy.

Exercício físico previne alterações cardiometabólicas induzidas pelo uso crônico de glicocorticóides

FUNDAMENTO: Cronicamente, os glicocorticoides induzem alteracoes cardiometabolicas adversas, incluindo resistencia a insulina, diabete, dislipidemia, esteatose hepatica e hipertensao arterial. OBJETIVOS: Avaliar o efeito da pratica regular de exercicio fisico aerobio sobre as alteracoes cardiometabolicas induzidas por administracao cronica de dexametasona (Dex - 0,5 mg/kg/dia i.p) em ratos. METODOS: Ratos Wistar machos (n = 24) foram divididos em quatro grupos: Grupo controle; Grupo treinado; Grupo tratado com Dex e Grupo tratado com Dex e treinado. O treinamento fisico (iniciado 72 horas apos a primeira dose de Dex) foi realizado 3 vezes por semana, ate o final do tratamento. Ao final desse periodo, realizaram-se as seguintes avaliacoes bioquimicas: glicemia em jejum, teste de tolerância a glicose e analise do perfil lipidico no sangue que incluiu colesterol total (CT), LDL-c, HDL-c, VLDL-c e triglicerideos (TG). O peso do musculo gastrocnemio, analise histopatologica do figado e os indices cardiometabolicos (CT/HDL-c, LDL-c/HDL-c e TG/HDL-c) tambem foram avaliados. RESULTADOS: Observou-se hiperglicemia, menor tolerância a glicose, elevacao do CT, LDL-c, VLDL-c e TG, diminuicao do HDL-c, presenca de esteatose hepatica, hipotrofia muscular e elevacao dos indices CT/HDL-c, LDL-c/HDL-c e TG/HDL-c nos animais tratados com Dex. O exercicio fisico reduziu a hiperglicemia, melhorou a tolerância a glicose, reduziu a dislipidemia e preveniu a esteatose hepatica , a hipotrofia muscular e reduziu os indices CT/HDL-c, LDL-c/HDL-c e TG/HDL-c. Entretanto, nao houve efeito significante do treinamento fisico sobre o HDL-c. CONCLUSAO: O exercicio fisico aerobio tem efeito protetor contra as alteracoes cardiometabolicas induzidas pelo uso cronico de glicocorticoides.BACKGROUND Chronically, glucocorticoids induce adverse cardiometabolic alterations including insulin resistance, diabetes, dyslipidemia, liver steatosis and arterial hypertension. OBJECTIVES To evaluate the effect of regular practice of aerobic exercise on cardiometabolic alterations induced by chronic administration of dexamethasone (Dex - 0.5 mg/kg/day ip) in rats. METHODS Male Wistar rats (n = 24) were divided in four groups: Control group; Trained group; Treated with Dex group and Treated with Dex and trained group. The exercise training (initiated 72 hours after the first dose of Dex) was carried out three times a week until the end of the treatment. At the end of this period, the following biochemical assessments were performed: fasting glycemia, oral glucose tolerance test and analysis of the blood lipid profile that included total cholesterol (TC), LDL-c, HDL-c, VLDL-c and triglycerides (TG). The weight of the gastrocnemius muscle, the histopathological analysis of the liver and cardiometabolic indices (TC/HDL-c, LDL-c/HDL-c and TG/HDL-c) were also performed. RESULTS Hyperglycemia, lower glucose tolerance, increased TC, LDL-c, VLDL-c, TG, CT/HDL-c, LDL-c/HDL-c and TG/HDL-c, decreased HDL-c, presence of liver steatosis and muscular hypotrophy were observed in the animals treated with Dex. The exercise training reduced hyperglycemia, improved glucose tolerance, decreased dyslipidemia and prevented liver steatosis, muscular hypotrophy and reduced CT/HDL-c, LDL-c/HDL-c and TG/HDL-c ratios. However, there was no significant effect on HDL-c. CONCLUSION The aerobic exercise training have a protective effect against the cardiometabolic alterations induced by the chronic use of glucocorticoids.