Gabriele Carra Forte

Validation of a Nutrition Screening Tool for Pediatric Patients with Cystic Fibrosis

BACKGROUND In cystic fibrosis (CF), nutrition diagnosis is of critical relevance because the early identification of nutrition-related compromise enables early, adequate intervention and, consequently, influences patient prognosis. Up to now, there has not been a validated nutrition screening tool that takes into consideration clinical variables. OBJECTIVE To validate a specific nutritional risk screening tool for patients with CF based on clinical variables, anthropometric parameters, and dietary intake. DESIGN Cross-sectional study. The nutrition screening tool was compared with a risk screening tool proposed by McDonald and the Cystic Fibrosis Foundation criteria. PARTICIPANTS/SETTING Patients aged 6 to 18 years, with a diagnosis of CF confirmed by two determinations of elevated chloride level in sweat (sweat test) and/or by identification of two CF-associated genetic mutations who were receiving follow-up care through the outpatient clinic of a Cystic Fibrosis Treatment Center. MAIN OUTCOME MEASURES Earlier identification of nutritional risk in CF patients aged 6 to 18 years when a new screening tool was applied. STATISTICAL ANALYSES PERFORMED Agreement among the tested methods was assessed by means of the kappa coefficient for categorical variables. Sensitivity, specificity, and accuracy values were calculated. The significance level was set at 5% (P<0.05). Statistical analyses were carried out in PASW Statistics for Windows version 18.0 (2009, SPSS Inc). RESULTS Eighty-two patients (49% men, aged 6 to 18 years) were enrolled in the study. The agreement between the proposed screening tool and the tool for screening nutritional risk for CF by the McDonald method was good (κ=0.804; P<0.001) and the sensitivity and specificity was 85% and 95%, respectively. Agreement with the Cystic Fibrosis Foundation criteria was lower (κ=0.418; P<0.001), and the sensitivity and specificity were both 72%. CONCLUSIONS The proposed screening tool with defined clinical variables promotes earlier identification of nutritional risk in pediatric patients with CF.

Prevalência de obesidade na asma e suas relações com gravidade e controle da asma

OBJECTIVE To determine the prevalence of obesity in asthmatic patients attending at an outpatient clinic, and to investigate its relationships with asthma severity and level of asthma control. METHODS In a cross-sectional study we recruited patients aged 11 years and older with confirmed asthma diagnosis from the outpatient asthma clinic of Hospital de Clínicas de Porto Alegre, Brazil. They underwent an evaluation by a general questionnaire, an asthma control questionnaire and by pulmonary function tests. Nutritional status was classified by body mass index (BMI). RESULTS 272 patients were included in the study. Mean age was 51.1 ± 16.5 years and there were 206 (74.9%) female patients. Mean BMI was 27.5 ± 5.3kg/m(2), and 96 (35.3%) patients were classified as normal weight, 97 (35.7%) as overweight and 79 (29%) as obesity. There was a significant higher proportion of female than male patients (34.3% vs. 13.2%, p = 0.002) in the obesity group. There were no significant differences with respect to asthma control (p = 0.741) and severity classification (p = 0.506). The FEV1% predicted was significantly higher in the obese than in the non-obese group (73.7% vs. 67.2%, p = 0.037). Logistic regression analysis identified sex (OR = 3.84, p = 0.002) as an independent factor associated with obesity. CONCLUSIONS This study showed a high prevalence of obesity in asthmatic patients. Obese and non-obese subjects were similar in regard to asthma severity and level of asthma control. Female sex was associated with obesity in this asthma population.OBJETIVO: Determinar a prevalencia de obesidade em pacientes asmaticos atendidos no ambulatorio clinico, e investigar sua relacao com a gravidade e controle da asma. METODOS: Estudo transversal, envolvendo pacientes, com idade igual ou superior a 11 anos e diagnostico de asma confirmado, do ambulatorio clinico do Hospital de Clinicas de Porto Alegre, Brasil. Os pacientes foram submetidos a avaliacao atraves de um questionario geral, questionario de controle da asma e teste de funcao pulmonar. O estado nutricional foi classificado conforme o indice de massa corporal (IMC). RESULTADOS: Foram incluidos no estudo 272 pacientes, sendo 206 (74,9%) pacientes do sexo feminino. A media de idade foi 51.1 ± 16.5 anos. O IMC medio foi 27.5 ± 5.3 kg/m2, sendo 96 (35.3%) pacientes classificados como eutroficos, 97 (35,7%) como sobrepeso e 79 (29%) como obesidade. Observou-se significativamente maior proporcao de pacientes do sexo feminino no grupo de obesidade quando comparados aos pacientes do sexo masculino (34.3% vs. 13.2%, p = 0.002). Nao houve diferenca significativaemrelacao ao controle da asma (p = 0.741) e classificacao de gravidade (p = 0.506). O FEV1% predito foi significativamente maior nos pacientes obesos quando comparados aos nao obesos (73.7% vs. 67.2%, p = 0.037). A analise de regressao logistica identificou genero como fator independente associado com a obesidade. (OR = 3.84, p = 0.002). CONCLUSAO: O presente estudo observou alta prevalencia de obesidade em pacientes asmaticos. Individuos obesos e nao obesos tiveramsimilaridade para gravidade e controle da asma. O genero feminino foi associado com obesidade nesta populacao asmatica.

Indicadores antropométricos e de ingestão alimentar como preditores da função pulmonar em pacientes com fibrose cística

Objective: To evaluate whether anthropometric and dietary intake indicators are predictors of pulmonary function in cystic fibrosis (CF) patients. Methods: This was a cross-sectional study involving 69 patients (age range, 5.4-16.5 years) diagnosed with CF under follow-up at the Hospital de Clinicas de Porto Alegre, located in the city of Porto Alegre, Brazil. Anthropometric assessment was based on body mass index (BMI), mid-arm muscle circumference (MAMC), and triceps skinfold thickness (TST). Dietary intake was assessed by using recall data, which were compared with the recommended dietary allowances. Pulmonary function was assessed by ventilatory capacity, expressed as FEV 1 . Prevalence ratios for the outcome studied (FEV 1 < 80% of predicted) were calculated by indicator. Results: In patients with MAMC and TST below the 25th percentile, the prevalence of FEV 1 < 80% of predicted was significantly higher than in those with higher MAMC and TST (p < 0.001 and p = 0.011, respectively). In comparison with other patients, those with a BMI below the 50th percentile showed a 4.43 times higher prevalence of FEV 1 < 80% of predicted (95% CI: 1.58-12.41), and that prevalence was 2.54 times higher in those colonized with methicillin-resistant Staphylococcus aureus (MRSA) than in those not so colonized (95% CI: 1.43-4.53). The association between dietary intake and the prevalence of FEV 1 < 80% of predicted was of only borderline significance (95% CI: 0.95-3.45). Conclusions: Not being colonized with MRSA and having a BMI above the 50th percentile appear to preserve pulmonary function in CF patients.

Nutrition Status Among HIV-Positive and HIV-Negative Inpatients with Pulmonary Tuberculosis

BACKGROUND The association between tuberculosis (TB) and malnutrition is well recognized. Considering the risk of mortality due to malnutrition in patients with TB, it is necessary to conduct a thorough nutrition assessment to identify individuals at nutrition risk. The study objective was to assess the nutrition status of hospitalized patients with TB, co-infected or not by human immunodeficiency virus (HIV). METHODS Patients with confirmed diagnosis of TB were included using a cross-sectional design. Nutrition assessment parameters included: body mass index (BMI), triceps skin-fold thickness (TSF), bioelectrical impedance analysis (BIA), mid-upper-arm circumference (MUAC), mid-arm muscle circumference (MAMC), food frequency questionnaire, Malnutrition Screening Tool (MST), Subjective Global Assessment (SGA), and serum levels of hemoglobin. RESULTS A total 108 patients completed the study. Forty-four patients (40.7%) were HIV positive. Considering the BMI, 36.1% of the patients met the criteria for nutrition deficiency. Body fat percentage was low in 27.8% of patients. In addition, more than half of the participants met criteria for malnutrition according to MUAC, MAMC, TSF, SGA, or MST. Malnutrition measured by MAMC was more frequent in HIV-positive patients (n=33, 75.0%) than in HIV-negative patients (n=31, 48.4%) (P = 0.010). Regarding the components of diet, selenium and vitamin C intake among HIV-positive patients was significantly lower than in HIV-negative patients. CONCLUSIONS We identified a high prevalence of malnutrition in hospitalized patients with pulmonary TB, regardless of the method used to assess nutrition status. In HIV-positive patients, malnutrition measured by MAMC was more frequent than in HIV-negative patients.

Association between anthropometric markers and asthma control, quality of life and pulmonary function in adults with asthma

BACKGROUND The role of abdominal fat and body fat (BF) in the evaluation of nutritional status in asthma has been considered recently. The present study aimed to evaluate the association between different anthropometric markers and asthma control, pulmonary function and quality of life. A secondary objective was to determine the agreement between the anthropometric markers with respect to assessing obesity in adults with asthma. METHODS This cross-sectional study enrolled adult asthma patients attending an outpatient asthma clinic in southern Brazil. Patients were evaluated regarding sociodemographic data, lung function, asthma control, nutritional status and health-related quality of life (Asthma Quality of Life Questionnaire; AQLQ). Nutritional status was classified by body mass index (BMI), waist circumference (WC) and BF. RESULTS The mean (SD) age of the 198 patients was 56.2 (14.8) years. The prevalence of uncontrolled asthma among subjects who were overweight as diagnosed by their BMI was 64.6% higher than in those who were normal weight. An increase in a measure of BMI (1 kg m-2 ) decreases approximately 44-59% of symptoms, activity limitations and emotional function domains of the AQLQ, whereas an increase in a measure in WC (1 cm) decreases approximately 24-30% of the same domains. Agreement between BMI and BF was 0.566 and that between BMI and WC was 0.597 by Kendalls Tau-b test. CONCLUSIONS The prevalence of uncontrolled asthma is greater in overweight subjects than in normal weight subjects. WC and BMI were negatively associated with symptoms, activity limitations and emotional function domains of the AQLQ. BMI appears to be sufficient to diagnose the nutritional status of subjects with asthma in this population.

Diet effects in the asthma treatment: A systematic review

ABSTRACT Introduction: Obesity in asthmatic patients has important relationships with asthma control, pulmonary function, and quality of life. The objective of this study was to conduct a systematic review of the literature on the effect of diet on asthma management in adults. Methods: We searched PubMed, Embase, and Scopus (January 1948–October 2014) for randomized clinical trials that evaluated the effects of diet in adults with asthma. Results: Of 12,215 studies identified, 21 were included. A reduction in weight of at least 7.5% from baseline as a result of caloric restriction can be beneficial for improving disease control, quality of life, and pulmonary function in obese patients with asthma. A dietary pattern rich in foods with potential antioxidant effect had an impact in improving asthma control, but with little clinical significance. Studies involving antioxidant supplementation showed improvements in asthma control with magnesium supplementation and less decline in lung function with vitamin C supplementation. Studies of fatty acid supplementation demonstrated effects on weight loss and improvement of asthma control and lung function. Studies of supplementation with propolis and caffeine reported significant increases in FEV1. Conversely, studies of high dietary salt intake reported greater declines in lung function. Conclusions: The evidence shows that, for obese adults with asthma, the best dietary intervention seems to be caloric restriction, regardless of specific dietary components.

Consumo alimentar e estado nutricional de carteiros pedestres de Porto Alegre

Introducao: O aumento da prevalencia de excesso de peso e o inadequado consumo alimentar tem sido uma preocupacao frequente entre os trabalhadores brasileiros. Portanto, o objetivo do presente estudo foi avaliar o estado nutricional e o consumo alimentar de carteiros pedestres de Porto Alegre, Rio Grande do Sul. Metodos: Estudo de carater transversal com trabalhadores dos Correios de Porto Alegre. O estado nutricional foi obtido a partir de dados de altura, peso e circunferencias da cintura e do pescoco. Foi utilizado um questionario de frequencia alimentar adaptado e dois recordatorios de 24 horas para avaliacao do consumo alimentar. Resultados: Foram entrevistados 203 carteiros, dos quais 74,5% eram homens. A media de idade foi de 41,0 ± 11,28 anos. Observou-se que a maioria dos carteiros apresentou excesso de peso (63,6%), sendo 85 (41,9%) com sobrepeso e 44 (21,7%) com obesidade. Os alimentos consumidos pelo menos tres vezes por semana pela maioria dos participantes foram carne vermelha, feijao, verduras, frutas e refrigerantes ou sucos artificiais. Por outro lado, os alimentos consumidos menos de uma vez por semana foram peixes e sucos de frutas naturais. Conclusao: Constatou-se uma alta taxa de excesso de peso entre os carteiros pedestres de Porto Alegre. Alem disso, observou-se um elevado consumo de carne vermelha, refrigerantes e sucos artificiais, e dos nutrientes sodio e cobre, e baixo consumo de peixes, dos acidos graxos omega-3 e omega-6, e dos minerais potassio e magnesio. Portanto, enfatiza-se a necessidade de promocao de atividades que visem a educacao nutricional nessa populacao. Palavras-chave: estado nutricional; consumo alimentar; excesso de peso

Avaliação nutricional dos profissionais do serviço de nutrição e dietética de um hospital terciário de Porto Alegre

Abstract This study aimed to identify anthropometric and biochemical status and to analyze the weight gain of collaborators of nutrition and dietetics services of Hospital de Clinicas de Porto Alegre (HCPA). This was a retrospective longitudinal study enrolled 190 employees. Nutritional assessment and clinical analysis was measurement. A structured questionnaire was applied all employ-ees. The prevalence of excess weight was 60.8%. Weight gain was significantly associated to length of service, working shift and physical activity. The study showed that an additional year of work was associated with weight gain around 500 g, the shift in average gain of 4 kg and physical activity with average weight loss of 3.3 kg. The association between weight gain, work-ing time and working shift in employees refers to the need to create nutrition intervention program aiming to promote healthy eating habits. Keywords: antropometry; occupational groups; weight gain. Avaliacao nutricional dos profissionais do servico de nutricao e dietetica de um hospital terciario de Porto Alegre