Priccila Zuchinali

Estado nutricional dos indígenas Kaingáng matriculados em escolas indígenas do Estado do Rio Grande do Sul, Brasil

The studys objective was to characterize the nutritional status of 3,254 Kaingang Indians in indigenous schools in Rio Grande do Sul State, Brazil. This was a school-based study. Weight (W), height (H), and waist circumference (WC) were measured according to World Health Organization guidelines (1995). Childrens nutritional status classification included H/A, W/A, and W/H according to the National Center for Health Statistics (WHO, 1995) and H/A, W/A, and body mass index/age (BMI/A) according to WHO (2006). Adolescents were classified for BMI/A (WHO, 1995 and 2006) and H/A (WHO, 2006). Adults were classified for BMI (WHO, 1995) and WC (WHO, 2003). Adolescents represented 56% of the sample, children 42.5%, adults 1.4%, and elderly 0.1%. Prevalence rates for stunting were 15.1% (WHO, 1983) and 15.5% (WHO, 2006) in children and 19.9% in adolescents. Prevalence rates for overweight were 11% (WHO, 1983) and 5.7% (WHO, 2006) in children, 6.7% in adolescents, and 79.2% in adults. 45.3% of adults were at increased risk of metabolic diseases. A nutritional transition was observed in the group, characterized by significant prevalence of stunting in children and adolescents and prominent overweight in all age groups.

Estado nutricional dos indígenas Kaingáng matriculados em escolas indígenas do Estado do Rio Grande do Sul, Brasil Nutritional status of Kaingáng Indians enrolled in 12 indigenous schools in the State of Rio Grande do Sul, Brazil

The studys objective was to characterize the nutritional status of 3,254 Kaingang Indians in indigenous schools in Rio Grande do Sul State, Brazil. This was a school-based study. Weight (W), height (H), and waist circumference (WC) were measured according to World Health Organization guidelines (1995). Childrens nutritional status classification included H/A, W/A, and W/H according to the National Center for Health Statistics (WHO, 1995) and H/A, W/A, and body mass index/age (BMI/A) according to WHO (2006). Adolescents were classified for BMI/A (WHO, 1995 and 2006) and H/A (WHO, 2006). Adults were classified for BMI (WHO, 1995) and WC (WHO, 2003). Adolescents represented 56% of the sample, children 42.5%, adults 1.4%, and elderly 0.1%. Prevalence rates for stunting were 15.1% (WHO, 1983) and 15.5% (WHO, 2006) in children and 19.9% in adolescents. Prevalence rates for overweight were 11% (WHO, 1983) and 5.7% (WHO, 2006) in children, 6.7% in adolescents, and 79.2% in adults. 45.3% of adults were at increased risk of metabolic diseases. A nutritional transition was observed in the group, characterized by significant prevalence of stunting in children and adolescents and prominent overweight in all age groups.

Short-term Effects of High-Dose Caffeine on Cardiac Arrhythmias in Patients With Heart Failure: A Randomized Clinical Trial

Importance The presumed proarrhythmic action of caffeine is controversial. Few studies have assessed the effect of high doses of caffeine in patients with heart failure due to left ventricular systolic dysfunction at high risk for ventricular arrhythmias. Objective To compare the effect of high-dose caffeine or placebo on the frequency of supraventricular and ventricular arrhythmias, both at rest and during a symptom-limited exercise test. Design, Setting, and Participants Double-blinded randomized clinical trial with a crossover design conducted at the heart failure and cardiac transplant clinic of a tertiary-care university hospital. The trial included patients with chronic heart failure with moderate-to-severe systolic dysfunction (left ventricular ejection fraction <45%) and New York Heart Association functional class I to III between March 5, 2013, and October 2, 2015. Interventions Caffeine (100 mg) or lactose capsules, in addition to 5 doses of 100 mL decaffeinated coffee at 1-hour intervals, for a total of 500 mg of caffeine or placebo during a 5-hour protocol. After a 1-week washout period, the protocol was repeated. Main Outcomes and Measures Number and percentage of ventricular and supraventricular premature beats assessed by continuous electrocardiographic monitoring. Results We enrolled 51 patients (37 [74%] male; mean [SD] age, 60.6 [10.9] years) with predominantly moderate-to-severe left ventricular systolic dysfunction (mean [SD] left ventricular ejection fraction, 29% [7%]); 31 [61%] had an implantable cardioverter-defibrillator device. No significant differences between the caffeine and placebo groups were observed in the number of ventricular (185 vs 239 beats, respectively; P = .47) and supraventricular premature beats (6 vs 6 beats, respectively; P = .44), as well as in couplets, bigeminal cycles, or nonsustained tachycardia during continuous electrocardiographic monitoring. Exercise test-derived variables, such as ventricular and supraventricular premature beats, duration of exercise, estimated peak oxygen consumption, and heart rate, were not influenced by caffeine ingestion. We observed no increases in ventricular premature beats (91 vs 223 vs 207 beats, respectively) in patients with higher levels of plasma caffeine concentration compared with lower plasma levels (P = .91) or with the placebo group (P = .74). Conclusions and Relevance Acute ingestion of high doses of caffeine did not induce arrhythmias in patients with systolic heart failure and at high risk for ventricular arrhythmias. Trial Registration clinicaltrials.gov Identifier: NCT02045992.

Triceps skinfold as a prognostic predictor in outpatient heart failure

Background Most reports regarding the obesity paradox have focused on body mass index (BMI) to classify obesity and the prognostic values of other indirect measurements of body composition remain poorly examined in heart failure (HF). Objective To evaluate the association between BMI and other indirect, but easily accessible, body composition measurements associated with the risk of all-cause mortality in HF. Methods Anthropometric parameters of body composition were assessed in 344 outpatients with a left ventricular ejection fraction (LVEF) of ≤50% from a prospective HF cohort that was followed-up for 30 ± 8.2 months. Survival was evaluated using the Kaplan-Meier method and Cox proportional hazard regression analysis. Results HF patients were predominantly male, of non-ischemic etiology, and had moderate to severe LV systolic dysfunction (mean LVEF = 32 ± 9%). Triceps skinfold (TSF) was the only anthropometric index that was associated with HF prognosis and had significantly lower values in patients who died (p = 0.047). A TSF ≥ 20 mm was present in 9% of patients that died and 22% of those who survived (p = 0.027). Univariate analysis showed that serum creatinine level, LVEF, and NYHA class were associated with the risk of death, while Cox proportional hazard regression analysis showed that TSF ≥ 20 was a strong independent predictor of all-cause mortality (hazard ratio = 0.36; 95% CI = 0.13-0.97, p = 0.03). Conclusion Although BMI is the most widely used anthropometric parameter in clinical practice, our results suggested that TSF is a better predictive marker of mortality in HF outpatients.

Mediterranean Diet and Other Dietary Patterns in Primary Prevention of Heart Failure and Changes in Cardiac Function Markers: A Systematic Review

Background: Heart failure (HF) is a complex syndrome and is recognized as the ultimate pathway of cardiovascular disease (CVD). Studies using nutritional strategies based on dietary patterns have proved to be effective for the prevention and treatment of CVD. Although there are studies that support the protective effect of these diets, their effects on the prevention of HF are not clear yet. Methods: We searched the Medline, Embase, and Cochrane databases for studies that examined dietary patterns, such as dietary approaches to stop hypertension (DASH diet), paleolithic, vegetarian, low-carb and low-fat diets and prevention of HF. No limitations were used during the search in the databases. Results: A total of 1119 studies were identified, 14 met the inclusion criteria. Studies regarding the Mediterranean, DASH, vegetarian, and Paleolithic diets were found. The Mediterranean and DASH diets showed a protective effect on the incidence of HF and/or worsening of cardiac function parameters, with a significant difference in relation to patients who did not adhere to these dietary patterns. Conclusions: It is observed that the adoption of Mediterranean or DASH-type dietary patterns may contribute to the prevention of HF, but these results need to be analyzed with caution due to the low quality of evidence.

Causes and Predictors of In-Hospital Mortality in Patients Admitted with or for Heart Failure at a Tertiary Hospital in Brazil

Background Although heart failure (HF) has high morbidity and mortality, studies in Latin America on causes and predictors of in-hospital mortality are scarce. We also do not know the evolution of patients with compensated HF hospitalized for other reasons. Objective To identify causes and predictors of in-hospital mortality in patients hospitalized for acute decompensated HF (ADHF), compared to those with HF and admitted to the hospital for non-HF related causes (NDHF). Methods Historical cohort of patients hospitalized in a public tertiary hospital in Brazil with a diagnosis of HF identified by the Charlson Comorbidity Index (CCI). Results A total of 2056 patients hospitalized between January 2009 and December 2010 (51% men, median age of 71 years, length of stay of 15 days) were evaluated. There were 17.6% of deaths during hospitalization, of which 58.4% were non-cardiovascular (63.6% NDHF vs 47.4% ADHF, p = 0.004). Infectious causes were responsible for most of the deaths and only 21.6% of the deaths were attributed to HF. The independent predictors of in-hospital mortality were similar between the groups and included: age, length of stay, elevated potassium, clinical comorbidities, and CCI. Renal insufficiency was the most relevant predictor in both groups. Conclusion Patients hospitalized with HF have high in-hospital mortality, regardless of the primary reason for hospitalization. Few deaths are directly attributed to HF; Age, renal function and levels of serum potassium, length of stay, comorbid burden and CCI were independent predictors of in-hospital death in a Brazilian tertiary hospital.

Características de gestão, funcionamento e cardápios do Programa Nacional de Alimentação Escolar em escolas indígenas Kaingáng, Rio Grande do Sul, Brasil (Management, operations, and menus in Kaingáng indigenous schools participating in the National School Nutrition Program in Rio Grande do Sul State, Brazil)

Few studies have focused on the National School Nutrition Program (PNAE) in indigenous schools in Brazil. The current study describes the programs operations, management, and menus in 35 Kaingáng indigenous schools in Rio Grande do Sul State, Brazil. A cross-sectional study design was used to obtain information on the program through questionnaires submitted to the Regional Educational Offices (CRE) and to the schools. The menus suggested to the schools by the regional offices were obtained. There were no Centers for Indigenous Education in the regional offices. All the assistant principals were indigenous, 26 schools (74.6%) practiced local management of the meal program, and 34 (97.1%) reported purchasing food from local markets. Most cooks (63.9%) had temporary work contracts with the schools and 65.7% were indigenous. Low offerings of veges, milk and dairy products were observed in around 60% of the menus, and legumes and fruits low in around 80%. It points out the need for more studies about the indigenous PNAE and intends to support public policies in health, food and nutrition for the national indigenous school .Hay pocos estudios sobre el Programa Nacional de Alimentacion Escolar (PNAE) en las escuelas indigenas del pais. El objetivo es describir caracteristicas de la gestion, la operatividad y los menus del PNAE de 35 escuelas Kaingang de Rio Grande do Sul, Brasil. Se trata de un estudio transversal, donde las informaciones del PNAE se obtuvieron por medio de cuestionarios aplicados a las Coordinaciones Regionales de Educacion (CRE) y a las escuelas. Fueron obtenidos los menus sugeridos por las CRE a las escuelas. No existia el Centro para la Educacion Indigena en las CRE. Todos los sub-directores eran indigenas, 26 (74,7%) escuelas tenian gestion escolarizada y 34 escuelas hacian la compra de alimentos en mercados proximos. La mayoria de los cocineros (62,9%) tenia un contrato de trabajo temporal y un 65,7% eran indigenas. Se observo una baja oferta de verduras y leche y derivados en alrededor de 60% de los menus y de leguminosas y frutas en alrededor de un 80%. Se indica la necesidad de mas estudios sobre el PNAE indigena y se pretende subvencionar politicas publicas de salud, alimentacion y nutricion para el espacio escolar indigena nacional.

Management, operations, and menus in Kaingáng indigenous schools participating in the National School Nutrition Program in Rio Grande do Sul State, Brazil

Few studies have focused on the National School Nutrition Program (PNAE) in indigenous schools in Brazil. The current study describes the programs operations, management, and menus in 35 Kaingáng indigenous schools in Rio Grande do Sul State, Brazil. A cross-sectional study design was used to obtain information on the program through questionnaires submitted to the Regional Educational Offices (CRE) and to the schools. The menus suggested to the schools by the regional offices were obtained. There were no Centers for Indigenous Education in the regional offices. All the assistant principals were indigenous, 26 schools (74.6%) practiced local management of the meal program, and 34 (97.1%) reported purchasing food from local markets. Most cooks (63.9%) had temporary work contracts with the schools and 65.7% were indigenous. Low offerings of veges, milk and dairy products were observed in around 60% of the menus, and legumes and fruits low in around 80%. It points out the need for more studies about the indigenous PNAE and intends to support public policies in health, food and nutrition for the national indigenous school .Hay pocos estudios sobre el Programa Nacional de Alimentacion Escolar (PNAE) en las escuelas indigenas del pais. El objetivo es describir caracteristicas de la gestion, la operatividad y los menus del PNAE de 35 escuelas Kaingang de Rio Grande do Sul, Brasil. Se trata de un estudio transversal, donde las informaciones del PNAE se obtuvieron por medio de cuestionarios aplicados a las Coordinaciones Regionales de Educacion (CRE) y a las escuelas. Fueron obtenidos los menus sugeridos por las CRE a las escuelas. No existia el Centro para la Educacion Indigena en las CRE. Todos los sub-directores eran indigenas, 26 (74,7%) escuelas tenian gestion escolarizada y 34 escuelas hacian la compra de alimentos en mercados proximos. La mayoria de los cocineros (62,9%) tenia un contrato de trabajo temporal y un 65,7% eran indigenas. Se observo una baja oferta de verduras y leche y derivados en alrededor de 60% de los menus y de leguminosas y frutas en alrededor de un 80%. Se indica la necesidad de mas estudios sobre el PNAE indigena y se pretende subvencionar politicas publicas de salud, alimentacion y nutricion para el espacio escolar indigena nacional.

Características de la gestión, la operatividad y los menús del Programa Nacional de Alimentación Escolar en escuelas Kaingáng de Río Grande do Sul, Brasil

Few studies have focused on the National School Nutrition Program (PNAE) in indigenous schools in Brazil. The current study describes the programs operations, management, and menus in 35 Kaingáng indigenous schools in Rio Grande do Sul State, Brazil. A cross-sectional study design was used to obtain information on the program through questionnaires submitted to the Regional Educational Offices (CRE) and to the schools. The menus suggested to the schools by the regional offices were obtained. There were no Centers for Indigenous Education in the regional offices. All the assistant principals were indigenous, 26 schools (74.6%) practiced local management of the meal program, and 34 (97.1%) reported purchasing food from local markets. Most cooks (63.9%) had temporary work contracts with the schools and 65.7% were indigenous. Low offerings of veges, milk and dairy products were observed in around 60% of the menus, and legumes and fruits low in around 80%. It points out the need for more studies about the indigenous PNAE and intends to support public policies in health, food and nutrition for the national indigenous school .Hay pocos estudios sobre el Programa Nacional de Alimentacion Escolar (PNAE) en las escuelas indigenas del pais. El objetivo es describir caracteristicas de la gestion, la operatividad y los menus del PNAE de 35 escuelas Kaingang de Rio Grande do Sul, Brasil. Se trata de un estudio transversal, donde las informaciones del PNAE se obtuvieron por medio de cuestionarios aplicados a las Coordinaciones Regionales de Educacion (CRE) y a las escuelas. Fueron obtenidos los menus sugeridos por las CRE a las escuelas. No existia el Centro para la Educacion Indigena en las CRE. Todos los sub-directores eran indigenas, 26 (74,7%) escuelas tenian gestion escolarizada y 34 escuelas hacian la compra de alimentos en mercados proximos. La mayoria de los cocineros (62,9%) tenia un contrato de trabajo temporal y un 65,7% eran indigenas. Se observo una baja oferta de verduras y leche y derivados en alrededor de 60% de los menus y de leguminosas y frutas en alrededor de un 80%. Se indica la necesidad de mas estudios sobre el PNAE indigena y se pretende subvencionar politicas publicas de salud, alimentacion y nutricion para el espacio escolar indigena nacional.

Características de gestão, funcionamento e cardápios do Programa Nacional de Alimentação Escolar em escolas Kaingáng do Rio Grande do Sul, Brasil

Few studies have focused on the National School Nutrition Program (PNAE) in indigenous schools in Brazil. The current study describes the programs operations, management, and menus in 35 Kaingáng indigenous schools in Rio Grande do Sul State, Brazil. A cross-sectional study design was used to obtain information on the program through questionnaires submitted to the Regional Educational Offices (CRE) and to the schools. The menus suggested to the schools by the regional offices were obtained. There were no Centers for Indigenous Education in the regional offices. All the assistant principals were indigenous, 26 schools (74.6%) practiced local management of the meal program, and 34 (97.1%) reported purchasing food from local markets. Most cooks (63.9%) had temporary work contracts with the schools and 65.7% were indigenous. Low offerings of veges, milk and dairy products were observed in around 60% of the menus, and legumes and fruits low in around 80%. It points out the need for more studies about the indigenous PNAE and intends to support public policies in health, food and nutrition for the national indigenous school .Hay pocos estudios sobre el Programa Nacional de Alimentacion Escolar (PNAE) en las escuelas indigenas del pais. El objetivo es describir caracteristicas de la gestion, la operatividad y los menus del PNAE de 35 escuelas Kaingang de Rio Grande do Sul, Brasil. Se trata de un estudio transversal, donde las informaciones del PNAE se obtuvieron por medio de cuestionarios aplicados a las Coordinaciones Regionales de Educacion (CRE) y a las escuelas. Fueron obtenidos los menus sugeridos por las CRE a las escuelas. No existia el Centro para la Educacion Indigena en las CRE. Todos los sub-directores eran indigenas, 26 (74,7%) escuelas tenian gestion escolarizada y 34 escuelas hacian la compra de alimentos en mercados proximos. La mayoria de los cocineros (62,9%) tenia un contrato de trabajo temporal y un 65,7% eran indigenas. Se observo una baja oferta de verduras y leche y derivados en alrededor de 60% de los menus y de leguminosas y frutas en alrededor de un 80%. Se indica la necesidad de mas estudios sobre el PNAE indigena y se pretende subvencionar politicas publicas de salud, alimentacion y nutricion para el espacio escolar indigena nacional.