Roberta Vanacor

Câncer de mama: mortalidade crescente na Região Sul do Brasil entre 1980 e 2002

Breast cancer is the most prevalent form of cancer in the world. Breast cancer mortality rates are high in Brazil and show striking variations between geographic regions. A time-trend ecological study was performed in Southern Brazil from 1980 to 2002. Data were collected from the Mortality Information System (Ministry of Health) to assess age-standardized mortality rates. Linear regression for mortality time-trend analysis and multiple regression for mortality differences among three States were calculated. The highest mean mortality rate (14.45) was observed in Rio Grande do Sul, significantly greater (p < 0.001) than in Santa Catarina (8.93) and Paraná (9.95). An annual increase of 0.47 in the mortality rate was observed in the three States of Southern Brazil. According to these results, the South of Brazil and especially the State of Rio Grande do Sul showed a significant upward trend in breast cancer mortality. Continued efforts are needed to help explain these numbers and reverse the present situation.

Two Weeks of a Low-Iodine Diet Are Equivalent to 3 Weeks for Lowering Urinary Iodine and Increasing Thyroid Radioactive Iodine Uptake

BACKGROUND The importance of restricting iodine intake to increase thyroid uptake of ¹³¹I is well-known, but its minimum duration is not clear. The present study aimed at determining whether 3 weeks is superior to 2 weeks for a low-iodine diet (LID) as a means of increasing the thyroid uptake of ¹³¹I and reducing urinary iodine. A second goal was to evaluate the effectiveness of a questionnaire about ingestion and exposure to iodine to predict individuals in whom the LID would be less effective. METHODS Forty-six outpatients who came to the Nuclear Medicine Unit of Santa Casa de Porto Alegre, Brazil, for thyroid evaluation, were randomized to receive an LID for 2 or 3 weeks. Questionnaires regarding their exposure to iodine, the thyroid uptake of ¹³¹I, and the iodine and iodine/creatinine ratio in urine samples were administered or obtained at the beginning and end of the diet. RESULTS The questionnaire indicated exposure to exogenous iodine in five patients during their LID, all in the 3-week group. Their thyroid ¹³¹I uptake was significantly lower than patients who did not give a history of iodine exposure (p = 0.016). The comparative analysis between the 2-week and 3-week diet groups was then performed excluding the five contaminated patients. The ¹³¹I uptake increased by 43% in the 2-week group and 26.7% in the 3-week group (p = 0.105). Both diets for 2 and 3 weeks caused significant decrease in urinary iodine (p < 0.001), without a difference between the groups (63.2% in the 2-week group and 60.9% in the 3-week group, p = 0.955). There was no difference in the percentage of patients with urinary iodine ≤100 μg/L (p = 0.25) and urinary iodine ≤50 μg/L (p = 0.86) between the groups. A correlation between urinary iodine and iodine/creatinine ratio (r = 0.516; p < 0.001) was observed. CONCLUSION Two weeks of an LID are probably sufficient to augment thyroid uptake of ¹³¹I, with little or no benefit from longer periods of an LID. Questionnaires regarding exposure to iodine similar to those employed here should identify individuals in whom the LID has not been as effective in increasing the thyroid uptake of ¹³¹I.

Urinary iodine in 24 h is associated with natriuresis and is better reflected by an afternoon sample.

Aims: We aimed to assess the extent of variability in urinary iodine (UI) within a day, to determine the period of the day when UI was better associated with the UI in 24 h, and to study the relationship between UI and urinary sodium. Methods: This cross-sectional study included 60 volunteers. Four urine samples were collected from each participant (A: from breakfast to lunch; B: from lunch to dinner; C: from dinner to bedtime, and D: from bedtime to breakfast) and were compared with the 24-hour sample (calculated from samples A–D ). UI, creatinine and Na+ levels were measured in the partial samples and in the 24-hour sample. Results: The content of iodine and sodium in urine varied during the day (p < 0.001). The UI concentration from lunch to dinner was closest to the 24-hour UI concentration using the method of Bland and Altman. There were correlations between the UI content in the different periods of the day and in 24 h: A (r = 0.54; p < 0.000), B (r = 0.78; p < 0.000), C (r = 0.37; p = 0.004) and D (r = 0.77; p < 0.000). UI and urinary sodium content were strongly correlated in all periods of the day (samples A and B: r = 0.69, p < 0.000; sample C: r = 0.85, p < 0.000, and sample D: r = 0.78, p < 0.000). Conclusions: There was a within-day variation in UI content, which was strongly associated with urinary sodium content. Iodine concentration in the afternoon urine sample better reflected the 24-hour UI concentration. Therefore, urine collected in the afternoon is probably the best to evaluate iodine sufficiency in subjects with similar dietary habits.

Intra- and Interindividual Iodine Excretion in 24 Hours in Individuals in Southern Brazil: A Cross-Sectional Study

Aims: To evaluate the variability of 24-hour urinary iodine (UI) excretion intra- and interindividually on three days of a week in healthy subjects, living in southern Brazil, and the correlation among the urinary excretion of iodine and sodium. Methods: Cross-sectional study, including 47 volunteers: 18 individuals with one, 15 individuals with two and 14 individuals with three 24-hour urine samples. Iodine, creatinine and Na+ excretion in urine during 24-hour were measured. Results: Mean height, weight, BMI and 24-hour urinary excretion of creatinine were higher in men. UI and urinary sodium were correlated (n = 89, r = 0.524, p = 0.000). UI excretion varied widely, both inter- and intraindividually, on the 3 days of the week, but the mean excretion of UI was similar. In single individuals, the ratio between the maximum and minimum 24-hour UI excretion (m/m) ranged from 1.03 to 2.87, and the median coefficient of variation (CV) was 21% (P25 = 7.0% and P75 = 36.8%), with a range of 1%-51%. 24-hour UI excretion varied greatly among individuals on Sunday (CV = 47.5% and m/m = 7.75), Monday (CV = 38.7% and m/m = 4.60) and Thursday (CV = 40.4% and m/m = 4.50). UI was adequate in the group of 14 people, however, the UI excretion of two women suggested iodine intake persistently below that recommended by WHO. Conclusion: The variability of 24-hour UI excretion on different days in the same individual is lower than that observed among individuals.

Prevalence of low bone mineral density in adolescents and adults with cystic fibrosis

OBJECTIVE The aim of this cross-sectional study was to evaluate the prevalence of low bone mass density in cystic fibrosis patients as well as to evaluate the factors associated with bone mass in such patients. METHODS Bone mass density was measured by dual-photon X-ray absorptiometry of lumbar spine (L1-L4), in patients ≤19 years old, or lumbar spine and femur (total and neck) in patients ≥20 years old. Evaluations of nutritional status, biochemical parameters, and lung function were performed. Medication data were obtained from medical records. RESULTS Fifty-eight patients were included in the study (25 males/ 33 females), mean age 23.9 years (16-53 years). The prevalence of bone mass below the expected range for age at any site was 20.7%. None of the subjects had history of fracture. Lumbar spine Z-score in cystic fibrosis patients correlated positively with body mass index (r= 0.3, p=0.001), and forced expiratory volume in the first second (% predicted) (r=0.415, p=0.022). Mean lumbar spine Z-score was higher in women (p=0.001), in patients with no pancreatic insufficiency (p=0.032), and in patients with no hospitalization in the last 3 months (p=0.02). After multivariate analysis, body mass index (p= 0.001) and sex (p=0.001) were independently associated with Z-score in lumbar spine. CONCLUSION Low bone mass is a frequent problem in patients with CF, being independently associated with body mass index, and male sex.

Hypovitaminosis D in patients with cystic fibrosis: a cross-section study in South Brazil.

Cystic fibrosis (CF) patients have a susceptibility to vitamin D deficiency because of nutrient malabsorption.

Contents Vol. 57, 2010

F. Azizi, Tehran A. Berg, Freiburg F. Branca, Rome R. Brigelius-Flohé, Nuthetal P.C. Calder, Southampton N. Chang, Seoul T. Decsi, Pécs K. Eder, Halle/Saale A. El-Sohemy, Toronto, Ont. H. Goldenberg, Vienna R. Hakkak, Little Rock, Ark. H. Hauner, Munich S. Hercberg, Paris H. Heseker, Paderborn N. Houalla, Beirut A. Kafatos, Heraklion M.-H. Kang, Daejeon E.T. Kennedy, Boston, Mass. M. Krawinkel, Giessen G. Krejs, Graz A.V. Kurpad, Bangalore W. Langhans, Zurich M. Lawrence, Burwood, Vic. D. Li, Hangzhou X. Lin, Shanghai J. Linseisen, Heidelberg J.A. Martinez, Pamplona Y. Naito, Kyoto H.Y. Paik, Seoul M. Panagiotidis, Reno, Nev. J.M. Pettifor, Johannesburg L.A. Réthy, Budapest G. Rimbach, Kiel J. Sabaté, Loma Linda, Calif. W.H.M. Saris, Maastricht L. Serra-Majem, Las Palmas de Gran Canaria A.P. Simopoulos, Washington, D.C. P. Stehle, Bonn J.J. Strain, Coleraine I. Th orsdottir, Reykjavik K. Tontisirin, Nakhon Pathom R. Uauy, Santiago H. Vannucchi, Ribeirão Preto A. von Rücker, Bonn M. Wahlqvist, Clayton W. Waldhäusl, Vienna E. Wasantwisut, Salaya B. Watzl, Karlsruhe W.M. Windisch, Vienna T. Yoshikawa, Kyoto J. Zempleni, Lincoln, Nebr. A. Zittermann, Bad Oeynhausen Journal of Nutrition, Metabolic Diseases and Dietetics

Acknowledgement to the 2010 Reviewers

Andrew Ford, Crawley, W.A., Australia Gustavo Frechtel, Buenos Aires, Argentina Jeanne Freeland-Graves, Austin, Tex., USA Selma Freire, Sao Paolo, Brazil Heinz Freisling, Lyon, France Claudio Galli, Milano, Italy Reinold Gans, Groningen, The Netherlands Dieter Genser, Wien, Austria Arnab Ghosh, Sriniketan, India Hans Goldenberg, Wien, Austria Carmen Gomez-Cabrera, Valencia, Spain Toby Graham, Pittsburgh, Pa., USA Georgia Guldan, Hongkong, SAR, China James Haddow, Providence, R.I., USA Reza Hakkak, Little Rock, Ariz., USA Rainer Hampel, Rostock, Germany William Harris, Sioux Falls, S.D., USA Alexander Haslberger, Wien, Austria Anders Helander, Stockholm, Sweden Helmut Heseker, Paderborn, Germany Joanna Hlebowicz, Malmö, Sweden Michael Holick, Boston, Mass., USA Paul Holvoet, Leuven, Belgium Gerard Hornstra, Maastricht, The Netherlands Jingyu Huang, Salt Lake City, Utah, USA Yi-Chia Huang, Taichung, Taiwan Manfred Huettinger, Wien, Austria Elina Hypponen, London, UK Catherine Itsiopoulos, Canberra, A.C.T., Australia Emilio Jirillo, Bari, Italy Anthony Kafatos, Heraklion, Greece Elizabeth Kamau-Mbuthia, Njoro, Kenya Konstantinos Kantartzis, Tuebingen, Germany Christina-Maria Kastorini, Athens, Greece Aaron Kelly, Minneapolis, Minn., USA Ibrahim Khatib, Irbid, Jordan Young Cheul Kim, Amherst, Mass., USA Jörg Kotzka, Duesseldorf, Germany Michael Krawinkel, Gießen, Germany Susan Krebs-Smith, Bethesda, Md., USA Katrin Kromeyer-Hauschild, Jena, Germany Anura Kurpad, Bangalore, India William Lands, College Park, Md., USA Wolfgang Langhans, Zuerich, Switzerland Mark Lawrence, Melbourne, Vic., Australia Caroline LeBlanc, Moncton, N.B., Canada Nasser Al-Daghri, Riyadh, Saudi Arabia Omar Ali, Milwaukee, Wisc., USA Richard Anderson, Beltsville, Md., USA Giovanni Annuzzi, Napoli, Italy Christopher Ardern, York, UK Antonio Arteaga, Santiago, Chile Stephen Atkin, Hull, UK Fereidoun Azizi, Tehran, Iran William Banz, Carbondale, Ill., USA Ronald Barr, Hamilton, Ont., Canada Aloys Berg, Freiburg, Germany Roger Bouillon, Leuven, Belgium Donald Bowden, Winston-Salem, N.C., USA Ivan Brenkel, Dunfermline, UK J. Thomas Brenna, Ithaca, N.Y., USA Reinhard Bretzel, Gießen, Germany Regina Brigelius-Flohe, Nuthetal, Germany David Burns, Burlington, Mass., USA Wilfried Bursch, Wien, Austria Philip Calder, Southampton, UK Namsoo Chang, Seoul, Korea Karen Charlton, Wollongong, N.S.W., Australia Don Chisholm, Sydney, N.S.W., Australia Lech Chrostek, Bialystok, Poland Omar Dary, Washington, D.C., USA Tamás Decsi, Pécs, Hungary Benedicte Deforche, Ghent, Belgium Jacques Delarue, Brest, France Giovanni De Pergola, Bari, Italy Jeanne de Vries, Wageningen, The Netherlands Philippe De Wals, Quebec, Que., Canada Abolghasem Djazayeri, Tehran, Iran Daniel Doerge, Jefferson, Ariz., USA Leonidas Duntas, Athens, Greece Genevieve Dunton, Los Angeles, Calif., USA Klaus Eder, Gießen, Germany Eva-Charlotte Ekstroem, Uppsala, Sweden Ahmed El-Sohemy, Toronto, Ont., Canada Juan Carlos Espin de Gea, Murcia, Spain Elisabeth Fabian, Wien, Austria Mathias Fasshauer, Leipzig, Germany François Feillet, Nancy, France Reinhold Feldmann, Münster, Germany Tanis Fenton, Calgary, Alta., Canada Leopold Fezeu, Bobigny, France Marilu Fiegenbaum, Porto Alegre, Brazil