Fernanda Michielin Busnello

Intervenção nutricional e o impacto na adesão ao tratamento em pacientes com síndrome Metabólica

FUNDAMENTO: A sindrome metabolica representa um conjunto de fatores de risco, associados a doencas cardiovasculares e a diabete melito tipo 2. O tratamento inclui mudancas no estilo de vida, dieta, atividade fisica e medicamentos. A adesao do paciente e crucial ao tratamento da doenca. Objetivo: Avaliar dois modelos de intervencao dietoterapica e a relacao com a adesao ao tratamento e o impacto na melhora clinica de pacientes com sindrome metabolica. METODOS: Ensaio clinico randomizado, com duracao de quatro meses. Os pacientes foram randomizados em grupos intervencao e controle. Todos seguiram dieta especifica por quatro meses. O grupo Intervencao recebeu pacote de intervencao, com dieta individualizada, manual de orientacao, aconselhamento via telefone e material educativo. Foram realizadas anamnese nutricional, avaliacao antropometrica, avaliacao dietetica, orientacao dietetica individualizada e exames bioquimicos. RESULTADOS: Os pacientes que chegaram mais motivados foram aqueles que tiverem maior reducao nos valores do indice de massa corporal (p < 0,001), que reduziu de 31,7 kg/m² (DP ± 3,9) para 30,9 kg/m² (DP ± 3,8), na circunferencia abdominal a reducao foi de 108,1 cm (DP ± 9,8) para 105,9 cm (DP ± 9,5). As associacoes estatisticamente significativas se deram nas correlacoes entre indice de massa corporal, glicemia e triglicerideos, reducao do consumo de leite integral (p = 0,002), aumento no consumo de cereais integrais (p = 0,008) e de leite desnatado (p = 0,010), e entre o aumento no consumo de vegetais e a reducao dos triglicerideos. CONCLUSAO: Ambos os grupos mostraram melhora significativa nos parâmetros clinicos, que foi significativamente associada a motivacao previa. Os pacientes que chegaram mais motivados foram aqueles que responderam melhor ao tratamento.

Avaliação antropométrica em idosos: estimativas de peso e altura e concordância entre classificações de IMC

OBJECTIVE: Assessing the concordance between different classifications of body mass index (BMI) and verify if the formulas to estimate weight and height, that can be applied to the elderly population in Southern Brazil. METHOD: Cross-sectional analysis was applied to 131 elders from three long-stay institutions in Southern Brazil. They were evaluated through anthropometric assessment, considering weight, knee height, sub-scapular skin fold, as well as, calf, arm and waist circumferences and anthropometry. RESULTS: The average age of the samples was 78.9 (41.2% males and 58% females). According to the WHO scale, only two elders (1.5), were considered underweight; 63 of them (48.1) were classified as eutrophic and 66 (50.4%) were classified as being overweight, obesity degrees I and II. On the other hand, cut-off points set by Lipschitz considered 21 elders (16%) as being underweight, 69 ( 52.7%) eutrophic and 41 (31%) as overweight. By comparing standard weight and height measurement to the same estimated measures, it was clear that Rabitos formula for estimated height and weight showed no significant difference. CONCLUSION: The cut-off points showed moderate concordance. Lischitz emphasizes a higher range of risk for malnutrition. Comparing weight and height standard measurements to the estimated ones, it was concluded that just Rabitos formula can be applied to this population.

Optimism and Hope in Chronic Disease: A Systematic Review

There is a growing recognition that positive psychological functioning (which includes constructs such as optimism and hope) influences health. However, the understanding of these underlying mechanisms in relation to health is limited. Therefore, this review sought to identify what the scientific literature says about the influence of optimism and hope on chronic disease treatment. A search was conducted in the PsycINFO, Scopus, Pubmed, and Web of Science databases using the indexing terms optimism, hope, chronic diseases, randomized controlled trial, and treatment between 1998 and 2015. In the articles, we identified the most studied diseases in context, the assessment instruments used, the participant characteristics investigated, the results found, and the publication dates. From our analysis of the articles that met our inclusion criteria, it appears that the study of these constructs is recent and there is evidence that individuals with greater optimism and hope seek to engage in healthier behaviors, regardless of their clinical status, and that this contributes to chronic disease treatment. More research is needed so that targeted interventions can be carried out effectively in chronic disease treatment.

Association between low bone mass and calcium and caffeine intake among perimenopausal women in Southern Brazil: cross-sectional study

CONTEXT AND OBJECTIVE Osteoporosis is a skeletal abnormality characterized by reduction and alteration of bone microarchitecture that results in increased fragility and greater predisposition to fractures. Age and low bone mass are the main non-modifiable risk factors for osteoporotic fractures. The modifiable factors include sedentary lifestyle, inadequate calcium intake, excessive alcohol and/or caffeine consumption, smoking and low body weight. The aim here was to evaluate the association between low bone mass and calcium and caffeine intake among perimenopausal women in Southern Brazil. DESIGN AND SETTING Cross-sectional study conducted in Porto Alegre and Canoas, Rio Grande do Sul, Brazil. METHODS Women (n = 155) of mean age 53.6 ± 9.5 years were evaluated through a cross-sectional study in Southern Brazil. Food frequency questionnaires, bone mass evaluation using calcaneal ultrasound and anthropometric assessment were used. RESULTS The prevalence of overweight was 67.7%. In the bone mass screening, 30.3% had low bone mass and 4.5% had osteoporosis. The median calcium intake was 574.94 mg/day and the caffeine intake was 108.11 mg/day. No association was found between bone mass and anthropometric parameters, calcium intake or caffeine intake. It was found that 38.4% of the women had low bone mass. CONCLUSIONS No association was found between calcium and caffeine intake and bone mass. High prevalence of low bone mass was observed.

Identification of cardiovascular risk factors in parents/caregivers of children with heart diseases

BACKGROUND Cardiovascular diseases are one of the major causes of morbidity and mortality worldwide. In Brazil, they are the major cause of death. OBJECTIVE To identify cardiovascular risk factors in parents/caregivers of children with heart diseases by assessing their nutritional status, health conditions, and life style. METHODS Cross-sectional study of 150 parents or caregivers of children with heart diseases who attended a cardiology outpatient clinic. Data on identification, lifestyle and health conditions were collected by means of a structured questionnaire. For the assessment of the eating habits, a questionnaire on eating frequency was used; for the assessment of the nutritional status, weight, height, and waist circumference were measured, and the body mass index (BMI) was calculated and classified. RESULTS A total of 155 parents of children with heart diseases, predominantly of the female gender (91.6%), were evaluated; their mean age was 35.0 ± 10.6 years. The most prevalent risk factors were sedentary lifestyle (85.2%), obesity (28%) and hypertension (22.6%). As regards the eating habits, a high frequency of intake of red meat, margarine, vegetable oil, and sugar and low intake of fish were observed. Comparison between genders showed a significant difference in relation to obesity, as detected by BMI, and hypertension, both more frequent among women. Waist circumference measurement also showed a higher cardiovascular risk in women. CONCLUSION Cardiovascular risk factors such as excess weight, sedentary lifestyle, and hypertension as well as inadequate eating habits such as a high frequency of intake of saturated fat and cholesterol and low intake of unsaturated fat were identified in the parents/caregivers assessed.

Nutritional knowledge and body mass index: A cross-sectional study

OBJECTIVE To verify the knowledge about food and nutrition and its association with the nutritional status of obese patients with noncommunicable diseases (NCDs), and to identify the relationship between information sources and level of knowledge. METHOD Cross-sectional study that included 263 outpatients of a cardiology referral hospital in Porto Alegre, Rio Grande do Sul, Brazil. The participants filled out a questionnaire on socioeconomic data and knowledge about food and nutrition and had their nutritional status evaluated by body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR). RESULTS BMI showed a significant inverse association with the percentage of correct answers (p=0.002), as well as WC (p=0.000) and WHR (p<0.001). This was also true for education (p<0.001) and female gender (p=0.005) compared to males. More than 60% of patients reported using television and 23% reported using newspaper as sources of nutritional information. CONCLUSION Our study revealed a significant association between BMI and the level of knowledge about foods, showing that there is need for more information on obesity-related NCDs for greater understanding by patients.

Doença de Parkinson em idosos: ingestão alimentar e estado nutricional

OBJETIVO: Avaliar o estado nutricional e ingestao alimentar dos idosos portadores da doenca de Parkinson. METODOS: Estudo transversal, realizado com pacientes portadores da doenca de Parkinson (DP), atendidos em ambulatorio. O estado nutricional foi avaliado utilizando a mini-avaliacao nutricional (MAN), registro de consumo alimentar estimado de tres dias e antropometria. Para avaliacao da adequacao de ingestao de nutrientes e energia, utilizou-se a ingestao dietetica de referencia, considerando valores da ingestao adequada, requerimento medio estimado e ingestao dietetica recomendada. RESULTADOS: Foram avaliados 36 individuos, com idade media de 70,9±7,3 anos, sendo que 55% dos pacientes apresentaram risco de desnutricao de acordo com a MAN. Todavia, quando classificados pelo indice de massa corporal (IMC), 33% dos pacientes apresentaram sobrepeso e 39% nao apresentaram perda nos ultimos tres meses. A ingestao energetica foi de 1.632 e 1.840kcal/dia; proteinas, 71,2 e 61,9g/dia; ferro, 15,8 e 15,6mg/dia; sodio, 1.798 e 1.843mg/dia, para homens e mulheres, respectivamente, e ficaram acima das recomendacoes. Verificou-se ingestao inferior a recomendacao para fibras (13,5 e 13,6g/dia), calcio (694 e 552mg/dia) e potassio (1.637 e 1.476mg/dia). A ingestao energetica apresentou correlacao com ferro e proteina (r=0,581 e r=0,582) e a proteina apresentou correlacao com a ingestao de ferro (r=0,600). CONCLUSAO: Embora a ingestao energetica da maioria se apresente adequada, observou-se o desequilibrio dietetico, com consumo insuficiente de fibras, calcio e potassio. Alem disso, metade da populacao encontrava-se em risco nutricional, segundo a MAN.

Green Juice in Human Metabolism: A Randomized Trial

ABSTRACT Objective: Fruits and vegetables contain many compounds presenting potential antioxidant activity. The objective of this study was to evaluate the effect of a green juice recipe in adult metabolism in order to identify new preventive dietary sources. Method: This was a single-blind randomized controlled clinical trial. Recruitment and data were, respectively, made and collected at the Universidade Federal de Ciências da Saúde de Porto Alegre. Individuals who met all the inclusion criteria during the period of recruitment were included. Green juice (experimental group) or placebo (control group) were consumed from Monday to Friday between 8 and 9 am, in the amount of 300 mL for 60 days (except Saturdays and Sundays). To verify the effect of green juice on metabolism, the following were evaluated: (a) glycemia, plasma lipid profile, renal and liver functions, redox profile, and antioxidant enzymes; (b) anthropometry; and (c) well-being and anxiety. Results: This study included 14 participants in the test group (juice group) and 13 controls (placebo group), with mean ages of 31.07 and 30.15 years, respectively. We did not observe a significant difference between the treatments. Dietary properties of vegetable and fruit juices are an area of significant interest. Conclusions: Together with an analysis of previous works, we suggest that green juice did not cause an improvement in metabolic function and there is a need for further research on this issue, mainly through different interventions and other samples.

Avaliação do estado nutricional associado ao estágio de comprometimento cognitivo em pacientes com demências de um ambulatório de neurologia

Introducao: As alteracoes neurologicas de ordem cognitiva sao significativas na populacao idosa. A avaliacao do estado nutricional dos individuos com demencias e de suma importância, uma vez que norteia a definicao da conduta nutricional visando melhora da qualidade de vida. Objetivo: Avaliar o estado nutricional de idosos com demencia atendidos em um ambulatorio de neurologia de um hospital terciario, e verificar a relacao com o grau de demencia. Metodos: Foram aferidos dados antropometricos como peso, estatura, circunferencia da cintura, circunferencia da panturrilha e circunferencia do braco de 49 idosos com deficits cognitivos. Foi aplicado um questionario de Atividade de vida diaria (AVD ), a Mini Avaliacao Nutricional (MAN), bem como a aplicacao do recordatorio alimentar de 24 horas. Resultados: Encontrou-se uma prevalencia de 61,1% do sexo feminino com circunferencia do braco (CB) considerada adequada quando os valores estavam dentro do percentil 15-75 segundo idade e sexo, e 61,5% do sexo masculino apresentou desnutricao. Quanto a circunferencia abdominal (CA), ambos os sexos apresentaram valores elevados para essa medida. 61,1% das mulheres apresentaram valores muito aumentados para risco de desenvolvimento de doencas cardiovasculares (DCV), e 38,5% dos homens apresentaram valores aumentados. Pelo mini questionario do estado nutricional (MAN ) 65,4% dos pacientes com declinio cognitivo leve apresentaram risco para desnutricao e 65,2% dos com declinio cognitivo avancado apresentaram desnutricao. Conclusao: Os dados encontrados indicam o declinio do estado nutricional conforme a progressao da doenca de base, sendo necessario um acompanhamento nutricional regular e integral. Palavras-chave: estado nutricional; envelhecimento; diferencas biologicas; declinio cognitivo.

Nutritional and neuropsychological profile of the executive functions on binge eating disorder in obese adults

OBJECTIVE To examine the relationships between obese patients with and without binge eating disorder (BED) and the neuropsychological profiles of their executive functions. METHODS Data from 36 obese individuals (BMI ≥ 30 kg/m2) were divided into two groups, where one group was found to be positive for signs of BED according to the Binge Eating Scale. Two neuropsychological tests of executive function were carried out: the Go/No-go Task and the Iowa Gambling Task (IGT). Nutritional status was evaluated by measures of body weight, height and abdominal circumference, and from these, body mass indexes (BMI) were calculated. RESULTS Both groups presented similar nutritional characteristics; there were no differences when it came to the health status of individuals with or without BED. Participants found positive for signs of BED had the lowest IGT scores (p = 0.004), and Go/No-go omission scores (p = 0.015) and commission scores (p = 0.04). Further statistically significant differences were also observed here between the two groups. Statistical differences in the IGT results correlated with BED, and were associated categorically (p = 0.005). CONCLUSION Obese individuals frequently present deficits in selective attention, inhibitory control, decision-making and planning that can be directly related to binge eating and which is linked to BED. Nutritional status did not differ between the two groups studied, and did not show any connection with the disorder.