Carlos Scherr

Análise do perfil lipídico em escolares

BACKGROUND According to the World Health Organization, coronary atherosclerosis is the leading cause of death worldwide. The INTERHEART study demonstrated that dyslipidemia is one of the most important independent risk factors for AMI. OBJECTIVE To evaluate the lipid profile and blood pressure of school children attending private (paid) and public/philanthropic (free) schools. METHODS Blood samples from 343 children were tested and correlated with their lifestyle. Statistical analysis was carried out using the Students t-test for independent samples to compare the means, and the chi-square test (c2) to compare proportions. The significance level was set at 5%. RESULTS Total cholesterol and its HDL and LDL fractions, as well as the Castelli Index I, were higher among private school students, with statistical significance for both genders, except for HDL in boys. Blood pressure was higher in the same group, but without reaching statistical significance. Twenty-three percent of private school students had total cholesterol > 190 mg/d, as compared to 4% of those attending public/philanthropic institutions. When the dietary and physical activity surveys were compared and correlated with the lipid profile, a clear association was found between daily physical activity and nutritional guidance among those of lower socioeconomic status. CONCLUSION This study demonstrated the positive correlation of total cholesterol and its LDL fraction with eating habits and more intense and regular physical activity, benefiting the most needy children, compared to those enrolled in private schools.

Chemical food composition: implications for atherosclerosis prevention

OBJECTIVE To compare the fatty acid and cholesterol content in food acquired in Brazil with the composition found in the most frequently used reference tables in the country. METHODS The fatty acid and cholesterol content in 41 food items frequently used in our country and the various directions to prepare them were reviewed by using specific methodology and the information was compared to the tables adopted by Unicamp and UNIFESP. RESULTS According to Unicamp table, the cholesterol content found in parmesan cheese was 100.7 mg/100 g, while it was 68 mg/100 g in UNIFESP table, that is, a 48% (p < 0.05), higher content in the former. This study table found a cholesterol content 31% lower (94 mg/100 g vs. 123 mg/100 g, p < 0.05) for yellow cheese. For whole milk, we found a 52% difference regarding cholesterol content, while the difference for saturated fat ranged from 1.4 g/100 g in Unicamp table to 2.130 g/100 g in our study table (p < 0.05). For some food items, no statistically significant differences were found among the tables. However, when a 1,800-calorie diet was prescribed, the discrepancies among the tables and lack of information resulted in clinically relevant differences in dietary recommendations. CONCLUSION There are important differences in food fat content between the fatty acid and cholesterol content formally analyzed and the content shown on commonly used tables, and this can compromise our recommendations on preventing atherosclerosis. One possible explanation for the differences would be the fact that the UNIFESP table is American in origin.

Gorduras em laticínios, ovos, margarinas e óleos: implicações para a aterosclerose

FUNDAMENTO: Para o aconselhamento adequado de um planejamento alimentar, com vistas a prevencao da cardiopatia isquemica, e necessario o conhecimento da composicao quimica dos alimentos. ObJETIVO: Analisar a composicao de gorduras, acidos graxos e colesterol de alguns exemplos nacionais de oleos comestiveis, manteigas, margarinas, laticinios e ovos, utilizando os limites de uma dieta para prevencao de doenca arterial coronariana. METODOS: Foi analisada a composicao de oleos comestiveis, manteigas, margarinas, laticinios e ovos. Os resultados foram empregados de acordo com o recomendado pela American Heart Association para uma dieta de 1.800 calorias. RESULTADOS: Na comparacao entre os oleos comestiveis, o de canola apresentou-se como o melhor. Ja entre os leites, o desnatado e o mais recomendavel, porem nao ha vantagens em relacao ao semidesnatado. No caso do ovo, nao existiram diferencas nos tipos encontrados no mercado. Em relacao aos queijos, o tipo minas e o que apresentou o menor conteudo de colesterol e gordura saturada. Na comparacao margarina com manteiga, a primeira levou vantagem quando os niveis de gorduras trans que nao ultrapassam o recomendado. CONCLUSAO: A composicao de alimentos usados no Brasil indica que dietas com objetivo de prevencao primaria e secundaria da cardiopatia isquemica podem priorizar o uso de leite semidesnatado, oleo de girassol, margarinas com baixo teor de gorduras trans e queijo do tipo minas.

Fatty Acid and Cholesterol Concentrations in Usually Consumed Fish in Brazil

Background Several studies have demonstrated clinical benefits of fish consumption for the cardiovascular system. These effects are attributed to the increased amounts of polyunsaturated fatty acids in these foods. However, the concentrations of fatty acids may vary according to region. Objective The goal of this study was to determine the amount of,cholesterol and fatty acids in 10 Brazilian fishes and in a non-native farmed salmon usually consumed in Brazil. Methods The concentrations of cholesterol and fatty acids, especially omega-3, were determined in grilled fishes. Each fish sample was divided in 3 sub-samples (chops) and each one was extracted from the fish to minimize possible differences in muscle and fat contents. Results The largest cholesterol amount was found in white grouper (107.6 mg/100 g of fish) and the smallest in badejo (70 mg/100 g). Omega-3 amount varied from 0.01 g/100 g in badejo to 0.900 g/100 g in weakfish. Saturated fat varied from 0.687 g/100 g in seabass to 4.530 g/100 g in filhote. The salmon had the greatest concentration of polyunsaturated fats (3.29 g/100 g) and the highest content of monounsaturated was found in pescadinha (5.98 g/100 g). Whiting and boyfriend had the best omega-6/omega 3 ratios respectively 2.22 and 1.19, however these species showed very little amounts of omega-3. Conclusion All studied Brazilian fishes and imported salmon have low amounts of saturated fat and most of them also have low amounts of omega-3.

What the cardiologist should know about trans fats

Mailing address: Carlos Scherr • Avenida Visconde de Piraja, 595/1204 22410-003 – Rio de Janeiro, RJ Brazil E-mail: scherr@ali.com.br Manuscript received January 9, 2007; revised manuscript received April 4, 2007; accepted April 11, 2007. According to the World Health Organization1, 80% to 90% of people who die of coronary heart diseases have one or more risk factors directly associated with their lifestyle, eating habits, physical activities and others that could be changed. Data relative to the years 2002 and 2003 published by the Instituto Brasileiro de Geografia e Estatistica IBGE2 (Brazilian Institute of Geography and Statistics) paint a worrisome picture of Brazilian eating habits, and the risk these represent for the incidence of cardiovascular diseases, particularly coronary artery diseases. In a universe with 96 million people above 20 years of age, 41% are overweight, and out of this 10.5 million are considered obese. The publication shows that people eat very small amounts of fruits and vegetables, and that most proteins come from animal products2. High consumption of foods containing trans-isomer fats, such as margarines, ice creams, biscuits and potato chips produced in our country, which is increasing specially among young people, was also observed.

Composição química de alimentos: implicações na prevenção da aterosclerose

OBJECTIVE: To compare the fatty acid and cholesterol content in food acquired in Brazil with the composition found in the most frequently used reference tables in the country. METHODS: The fatty acid and cholesterol content in 41 food items frequently used in our country and the various directions to prepare them were reviewed by using specific methodology and the information was compared to the tables adopted by Unicamp and UNIFESP. RESULTS: According to Unicamp table, the cholesterol content found in parmesan cheese was 100.7 mg/100 g, while it was 68 mg/100 g in UNIFESP table, that is, a 48% (p < 0.05), higher content in the former. This study table found a cholesterol content 31% lower (94 mg/100 g vs. 123 mg/100 g, p < 0.05) for yellow cheese. For whole milk, we found a 52% difference regarding cholesterol content, while the difference for saturated fat ranged from 1.4 g/100 g in Unicamp table to 2.130 g/100 g in our study table (p < 0.05). For some food items, no statistically significant differences were found among the tables. However, when a 1,800-calorie diet was prescribed, the discrepancies among the tables and lack of information resulted in clinically relevant differences in dietary recommendations. CONCLUSION: There are important differences in food fat content between the fatty acid and cholesterol content formally analyzed and the content shown on commonly used tables, and this can compromise our recommendations on preventing atherosclerosis. One possible explanation for the differences would be the fact that the UNIFESP table is American in origin.

Intervenção nos Hábitos de Vida em Instituição Pública

BACKGROUND Coronary disease is the major worldwide cause of death, according to the World Health Organization (WHO) and the second in Brazil. Sudden death occurs 4 to 6 times more frequently in those who have suffered an acute myocardial infarction (AMI); within 6 years, 18% of the men and 35% of the women will have a new AMI. The secondary prevention, of which effectiveness has been previously demonstrated, is of utmost importance. OBJECTIVE To test the effectiveness of a multiprofessional program that aims at modifying risk factors for atherosclerosis in the public health system. METHODS Of the 2,337 patients with coronary artery disease undergoing outpatient treatment, 513 with a coronary angiography study agreed to participate in the present study, which used lectures on how and why to control risk factors as therapeutic tool. STATISTICAL ANALYSIS significant variation pre and post-intervention; paired Students t test or Wilcoxons test ; existence of a significant difference between the two groups; Students t test for independent samples or Mann-Whitney test. Comparison among three groups: analysis of variance (ANOVA) or Kruskal-Wallis. RESULTS Cholesterol, LDL, triglycerides, body mass index, Castelli indexes I and II and waist circumference showed a significant decrease, even in patients without hypolipemiant treatment. The assessment of the diet impact showed that 72% of the patients that did not follow a diet, started to do so. Physical activity: of the 55% sedentary patients, 71% started to exercise three or more times a week. Smoking: of the smokers, 60% (9% of the total) stopped smoking and 32% decreased the number of cigarettes. CONCLUSION These results demonstrated the effectiveness of the programs to improve life habits when applied to the units of the public health system. (Arq Bras Cardiol. 2010; [online]. ahead print, PP.0-0).

Colesterol e gorduras em alimentos brasileiros: implicações para a prevenção da aterosclerose

BACKGROUND In order to perform food surveys and prescribe diets, food composition tables have to be consulted. However, these tables are limited to the description of fatty acids and cholesterol contents and do not provide information on the different preparation methods. OBJECTIVE Based on data derived from an extensive analysis of the chemical composition of Brazilian foods, we assessed the impact of certain types of foods on diets recommended for the prevention of coronary disease. METHODS The fatty acid and cholesterol composition of some types of foods and different preparation methods were analyzed. These results were used according to the recommendations of the American Heart Association for an 1,800 calorie diet. RESULTS Cholesterol found in 100g of eggs (400mg) or fried beef liver (453mg) exceeds the amount recommended for secondary prevention, and there is no difference in cholesterol content between factory-farmed eggs and free-range eggs. The eggs had an average of 400mg of cholesterol per 100g, thus exceeding the recommended amount of up to 300mg. Each egg has 50g on average; one egg can be consumed provided that not more than 100mg of cholesterol are consumed per day. As regards saturated fat, butter (55.2g), margarine (19.4g), tilsit cheese (20.4g), Brazilian Dutch Edam cheese (19.9g), yellow (16.8g) and fresh white cheese (15.5g) exceed the 14g recommended if 100g or more are consumed. The same is true for soy oil (17.5g) and corn oil (16.1g). CONCLUSION Better knowledge on fat and cholesterol contents in foods allows the prescription of amounts not exceeding the recommended values for prevention, and this may result in better compliance to diets.FUNDAMENTO: Para realizacao de inquerito alimentar e prescricao de dieta, faz-se necessario consultar tabelas de composicao de alimentos. Entretanto, estas sao limitadas quanto a descricao do conteudo de acidos graxos e colesterol, e nao oferecem informacoes sobre as diferentes formas de preparo. OBJETIVO: A partir de dados derivados de extensa analise da composicao quimica de alimentos brasileiros, avaliamos o impacto de determinados tipos de alimentos em dietas recomendadas para prevencao da doenca coronariana. METODOS:Analisaram-se a composicao de acidos graxos e colesterol de alguns alimentos e diferentes modos de preparo. Os resultados foram empregados de acordo com o recomendado pela American Heart Association para uma dieta de 1.800 calorias. RESULTADOS:O colesterol encontrado em 100 g de ovos (400 mg) ou figado bovino frito (453 mg) ultrapassa o recomendado para prevencao secundaria, sem diferenca nesse quesito entre ovo de granja ou caipira. Os ovos apresentaram em media 400 mg de colesterol em 100 g, ultrapassando recomendacao de ate 300 mg. Cada ovo tem, em media, 50 g, um ovo pode ser consumido, desde que nao se consuma mais do que 100 g de colesterol naquele dia. Em relacao a gordura saturada, manteiga (55,2 g), margarina (19,4 g), queijos tilsit (20,4 g), prato (19,9 g), amarelo (16,8 g) e branco (15,5 g) ultrapassam os 14 g recomendados se forem consumidos 100 g ou mais, o mesmo tambem e verdadeiro para os oleos de soja (17,5 g) e de milho (16,1g). CONCLUSAO:Conhecer melhor o conteudo de gorduras e colesterol nos alimentos permite prescrever quantidades que nao ultrapassem valores recomendados para prevencao, o que pode resultar em melhor adesao a dietas.

Fat content of dairy products, eggs, margarines and oils: implications for atherosclerosis

FUNDAMENTO: Para o aconselhamento adequado de um planejamento alimentar, com vistas a prevencao da cardiopatia isquemica, e necessario o conhecimento da composicao quimica dos alimentos. ObJETIVO: Analisar a composicao de gorduras, acidos graxos e colesterol de alguns exemplos nacionais de oleos comestiveis, manteigas, margarinas, laticinios e ovos, utilizando os limites de uma dieta para prevencao de doenca arterial coronariana. METODOS: Foi analisada a composicao de oleos comestiveis, manteigas, margarinas, laticinios e ovos. Os resultados foram empregados de acordo com o recomendado pela American Heart Association para uma dieta de 1.800 calorias. RESULTADOS: Na comparacao entre os oleos comestiveis, o de canola apresentou-se como o melhor. Ja entre os leites, o desnatado e o mais recomendavel, porem nao ha vantagens em relacao ao semidesnatado. No caso do ovo, nao existiram diferencas nos tipos encontrados no mercado. Em relacao aos queijos, o tipo minas e o que apresentou o menor conteudo de colesterol e gordura saturada. Na comparacao margarina com manteiga, a primeira levou vantagem quando os niveis de gorduras trans que nao ultrapassam o recomendado. CONCLUSAO: A composicao de alimentos usados no Brasil indica que dietas com objetivo de prevencao primaria e secundaria da cardiopatia isquemica podem priorizar o uso de leite semidesnatado, oleo de girassol, margarinas com baixo teor de gorduras trans e queijo do tipo minas.

Cholesterol and fats in Brazilian foods: implications for prevention of atherosclerosis

BACKGROUND In order to perform food surveys and prescribe diets, food composition tables have to be consulted. However, these tables are limited to the description of fatty acids and cholesterol contents and do not provide information on the different preparation methods. OBJECTIVE Based on data derived from an extensive analysis of the chemical composition of Brazilian foods, we assessed the impact of certain types of foods on diets recommended for the prevention of coronary disease. METHODS The fatty acid and cholesterol composition of some types of foods and different preparation methods were analyzed. These results were used according to the recommendations of the American Heart Association for an 1,800 calorie diet. RESULTS Cholesterol found in 100g of eggs (400mg) or fried beef liver (453mg) exceeds the amount recommended for secondary prevention, and there is no difference in cholesterol content between factory-farmed eggs and free-range eggs. The eggs had an average of 400mg of cholesterol per 100g, thus exceeding the recommended amount of up to 300mg. Each egg has 50g on average; one egg can be consumed provided that not more than 100mg of cholesterol are consumed per day. As regards saturated fat, butter (55.2g), margarine (19.4g), tilsit cheese (20.4g), Brazilian Dutch Edam cheese (19.9g), yellow (16.8g) and fresh white cheese (15.5g) exceed the 14g recommended if 100g or more are consumed. The same is true for soy oil (17.5g) and corn oil (16.1g). CONCLUSION Better knowledge on fat and cholesterol contents in foods allows the prescription of amounts not exceeding the recommended values for prevention, and this may result in better compliance to diets.FUNDAMENTO: Para realizacao de inquerito alimentar e prescricao de dieta, faz-se necessario consultar tabelas de composicao de alimentos. Entretanto, estas sao limitadas quanto a descricao do conteudo de acidos graxos e colesterol, e nao oferecem informacoes sobre as diferentes formas de preparo. OBJETIVO: A partir de dados derivados de extensa analise da composicao quimica de alimentos brasileiros, avaliamos o impacto de determinados tipos de alimentos em dietas recomendadas para prevencao da doenca coronariana. METODOS:Analisaram-se a composicao de acidos graxos e colesterol de alguns alimentos e diferentes modos de preparo. Os resultados foram empregados de acordo com o recomendado pela American Heart Association para uma dieta de 1.800 calorias. RESULTADOS:O colesterol encontrado em 100 g de ovos (400 mg) ou figado bovino frito (453 mg) ultrapassa o recomendado para prevencao secundaria, sem diferenca nesse quesito entre ovo de granja ou caipira. Os ovos apresentaram em media 400 mg de colesterol em 100 g, ultrapassando recomendacao de ate 300 mg. Cada ovo tem, em media, 50 g, um ovo pode ser consumido, desde que nao se consuma mais do que 100 g de colesterol naquele dia. Em relacao a gordura saturada, manteiga (55,2 g), margarina (19,4 g), queijos tilsit (20,4 g), prato (19,9 g), amarelo (16,8 g) e branco (15,5 g) ultrapassam os 14 g recomendados se forem consumidos 100 g ou mais, o mesmo tambem e verdadeiro para os oleos de soja (17,5 g) e de milho (16,1g). CONCLUSAO:Conhecer melhor o conteudo de gorduras e colesterol nos alimentos permite prescrever quantidades que nao ultrapassem valores recomendados para prevencao, o que pode resultar em melhor adesao a dietas.