Tendencia de consejerías en actividad física y enfermedades cardiometabólicas en el Maule, Chile: estudio previo a pandemia por COVID-19 entre 2012 y 2019 / Trend in Physical Activity Counseling and Cardiometabolic Diseases in Maule, Chile: COVID-19 Pre-Pandemic Study between 2012 and 2019

BACKGROUND: Physical activity (PA) practice reduces the adverse effects of COVID-19. PA counseling promotes healthy lifestyles and prevents cardiometabolic diseases. AIM: To assess the trend in cases of PA counseling and the cardiometabolic disease between 2012 and 2019 (before COVID-19) in a southern Chilean region. MATERIAL AND METHODS: Records of Maule Region Health Service for 731.163 men, and 829.097 women aged < 10 to ≥ 65 years were analyzed. The average annual percentage change (AAPC) during the study period and the annual percentage change (APC) during intermediate periods, were calculated. RESULTS: There was a significant decrease in PA counseling in women in the study period (AAPC: −13.6%). In the 2012-2017 period a significant decrease in counseling for total, men and women were observed (APC: −18.1, −16.5 and −19.1%, respectively). Obesity increased significantly in total, men and women in the 2012-2019 period (AAPC: 10.1, 8.5 and 10.7%, respectively). The same trend was observed for hypertension (AAPC: 8.1, 8.5 and 7.6% respectively) and elevated blood glucose (AAPC: 10, 11.5 and 9.6%, respectively). CONCLUSIONS: In the study period PA counseling decreased along with an increase in obesity, hypertension and high blood glucose. Increasing PA counseling is a mainstay in the prevention of cardiometabolic diseases and probably to prevent contagion and complement the treatment of COVID-19.

Research progress on the application of time-restricted eating in adult obesity and related metabolic diseases / 中华预防医学杂志

The soaring prevalence of obesity and its complications presents a significant health care burden, and there is currently a lack of effective and sustainable treatment methods. Time-restricted eating (TRE) is a specific intermittent fasting (IF) protocol involving consistent fasting and eating periods within a 24-hour cycle. Time-restricted eating can restore robust circadian rhythms and improve metabolic health, providing an emerging dietary strategy for the prevention and treatment of obesity and related metabolic diseases. Previous TRE trials laid the groundwork, and indicate a need for further clinical research including large-scale controlled trials to determine TRE efficacy and the mechanisms by which it may affect humans.

Riesgo cardiometabólico del sedentarismo / Cardiometabolic risk of sedentary lifestyle

Sedentary behavior is spreading among society, especially since the rise of technology and progress. The sedentary lifestyle habits are being transmitted to young people, who increase the time they spend in sedentary activities like video games or TV. It has been demonstrated that both sedentary behavior and physical inactivity have negative cardiometabolic consequences for the health, and they become a serious problem for public health, as it has been claimed in several studies and by scientific statements. This review intent to make a call of attention to this problem that will have profound impact in the near future in many countries in Latin America. (AU)

Pharmacogenetic implications in the management of metabolic diseases in Brazilian populations

Dyslipidemia, diabetes, obesity and hypertension are common metabolic diseases. In the last decades, unhealthy lifestyle and aging have leads to an increased incidence of these diseases, increasing morbidity and mortality by cardiovascular causes. The treatment of metabolic diseases includes life-style interventions as healthy diet and physical exercise, as well as pharmacological interventions. Several drugs are available for the management of metabolic diseases including among others lipid-lowering antidiabetics and antihypertensive drugs. Variability in response to these drugs is influenced by both genetic and non-genetic factors. Polymorphisms in genes related to drug pharmacokinetics and pharmacodynamics have been shown to influence drug efficacy and safety. This review is focused on pharmacogenetic studies related to the management of metabolic diseases in samples of the Brazilian population. Associations of variants in drug metabolizing enzymes and transporters, drug target and metabolism-related genes with the efficacy and safety of lipid-lowering, antidiabetic and antihypertensive drugs are described. Most pharmacogenetic studies in Brazil have focused in pharmacological response to a small group of drugs, as statins and some antihypertensives, while there are almost no studies on antidiabetic and antiobesity drugs. Some studies reported significant associations of gene polymorphisms with drug response confirming previous data from other populations, whereas other works did not replicate, which may relay on the genetic admixture of our population. In conclusion, further studies are necessary considering larger sample sizes, new unexplored drugs and more genetic variants to obtain stronger conclusions to explore clinical applications of pharmacogenetic studies in our population.

Lipid-lowering properties of protein-rich mucuna product

BACKGROUND: The objective of this study is to evaluate the effect of protein-rich mucuna product (PRMP) on lipid parameters of hyperlipidemic rats. METHODS: Hyperlipidemia was induced in male rats for 3 weeks through high-fat diet. After induction, 30 hyperlipidemic rats were divided into five groups of six rats: control group (CG) received casein and four groups received PRMP as protein source at different proportions: 8.2, 16.4, 24.6, and 32.8 % corresponding, respectively, to 25, 50, 75, and 100 %substitution of casein in the diet for 3 weeks. Lipid and oxidative stress parameters of rats were assessed. RESULTS: There were no significant differences in food intake and body weight loss among the experimental groups. The concentrations of the serum low-density lipoprotein cholesterol, total cholesterol, and triglycerides were lower in groups fed on PRMP 50, 75, and 100 % than in the CG group (p< 0.05). Histological analysis of the liver revealed that animals fed on PRMP diets presented a lower level of steatosis than the CG group. The most significant reduction of lipid parameters was obtained when PRMP was used as unique source of protein (PRMP 100 %). PRMP also influenced oxidative stress parameters as evidenced by a decrease in malondialdehyde and an increase in catalase and superoxide dismutase. CONCLUSIONS: These findings demonstrated that PRMP exerts hypolipidemic effect; it has a metabolic effect on endogenous cholesterol metabolism and a protector effect on the development of hepatic steatosis. Our results also suggest that PRMP could manage metabolic diseases associated with oxidative stress.

Fitness cardiorrespiratorio se asocia a una mejora en marcadores metabólicos en adultos chilenos / Inverse association of cardiorespiratory fitness with cardiovascular risk factors in Chilean adults

Background: A high level of cardiorespiratory fitness (CRF) is an important protector against cardiovascular and metabolic diseases. Aim: To explore the association of CRF with several metabolic markers and estimate the variation of these parameters by an increase of 1 MET change in CRF. Material and Methods: Cross-sectional study of 447 adults (56% women) without medical history of cardiometabolic diseases. Physical activity evaluated using accelerometry, body mass index (BMI), blood pressure, blood glucose and insulin and lipid profile were measured. HOMA-IR was calculated with fasting glucose and insulin levels. The submaximal Chester Step Test was used to measure CRF. Results: CRF was significantly associated with the level and intensity of physical activity, and all metabolic markers (p-trend < 0.05), except with diastolic blood pressure. It was estimated that 1-MET increase in CRF is associated with waist circumference (β -0.32 cm), fat mass (β -0.22%), insulin (β -0.67 pmol.l-1), HOMA-IR (β -0.17) and HDL cholesterol (β +1.46 mg.dl-1). All these associations were independent of main covariates such as age, sex, education, smoking and body mass index. Conclusions: A higher level of CRF is inversely associated with several metabolic markers that are risk factors for cardiovascular disease.

Desenvolvimento e validação de métodos bioanalíticos para o monitoramento dos produtos das vias metabólicas do triptofano em linhagem celular de glioma humano / Development and validation of bioanalytical methods for monitoring the product of the metabolic pathways of tryptophan in human glioma cell line

O metabolismo do triptofano (Trp) se dá pela via das quinureninas (QUIN), pela via serotoninérgica (SER) e pela via das aminas traço. A primeira gera QUIN e uma variedade de outros metabólitos secundários. Quando conduzida pela enzima indolamina 2,3 dioxigenase (IDO) contribui para os fenômenos de tolerância e imune escape de células tumorais; e quando conduzida pela triptofano 2,3 dioxigenase (TDO) no fígado, participa na síntese da niacina e NAD. A via SER leva à formação do neurotransmissor serotonina (SER), que pode gerar o hormônio melatonina (MEL), respectivamente e outros metabólitos biologicamente ativos. Outra via menos estudada, a via das aminas traço, produz produtos neuroativos. Dada a abrangência e importância das rotas metabólicas do Trp, nós desenvolvemos e validamos uma metodologia bioanalítica robusta, seletiva e sensível por cromatografia líquida de alta eficiência (HPLC), acoplado espectrometria de massas (MS) para a determinação simultânea do Trp e seus 15 metabólitos. Para tanto, escolhemos para a avaliação das três vias, linhagens de glioma humano. A escolha por este tipo celular deveu-se ao grande interesse de estudos de metabolismo de Trp em células tumorais, no qual células de glioma tem sido modelo. Nos ensaios com as células de glioma acompanhamos os efeitos de um indutor e inibidores da primeira etapa de metabolização do Trp pela via das quinureninas, ou seja, IFN-γ (indutor da IDO), 1-metiltriptofano (1-MT; inibidor competitivo da IDO) e 680C91 (inibidor seletivo da TDO). Pudemos observar o impacto que a indução ou a inibição do primeiro passo teve sobre os metabólitos subsequentes e as diferenças no metabolismo das duas linhagens estudadas, A172 e T98G. A linhagem T98G só tem atividade de IDO, enquanto que a A172 tem tanto atividade IDO quanto TDO. A indução por IFN-γ mostrou que essa citocina não só atua na formação da via QUIN, mas possui um impacto modesto nas demais rotas. Observamos também que a inibição do 1-MT mostrou seu impacto nos metabólitos invdividualmente, do que a simples relação Trp-QUIN. Contudo, nosso resultados nos permitiu mostrar pela primeira vez a descrição completa dessas vias, em especial nessas linhagens celulares, podendo supor estratégias terapêuticas nessas rotas que estão relacionadas a progressão ou não tumoral

The tryptophan metabolism (Trp) takes place by means of kynurenine (QUIN), by the serotonin pathway (SER) and by the pathway of trace amines synthesis. The first generates QUIN and a variety of other secondary metabolites. When driven by the enzyme indoleamine 2,3 dioxygenase (IDO) contributes to the phenomena of tolerance and immune escape of tumor cells; and when conducted by tryptophan 2,3 -dioxygenase (TDO) in the liver, participates in the niacin synthesis NAD. The SER pathway leads to the serotonin neurotransmitter (SER) formation, which can generate the hormone melatonin (MEL), respectively and other biologically active metabolites. Another less studied amines trace synthesis pathway produces neuroactive products. Given the scope and importance of Trp metabolic pathways,we developed and validated a robust, sensitive and selective bioanalytical method by high performance liquid chromatography (HPLC) coupled mass spectrometry (MS) for simultaneous determination of TRP and its 16 metabolites. Therefore, we chose to evaluate the three routes, glioma cell lines. The initial choice of this type of cell was due to the great interest in Trp metabolism studies in tumor cells, which glioma cells has been a model. In assays with glioma cells, we followed the effects of an inductor and inhibitors of the first stage of Trp metabolism, via the kynurenine pathway, or IFN -γ (IDO inducer) 1- methyltryptophane (1- MT; competitive IDO inhibitor) and 680C91 (selective TDO inhibitor). We could observe the first step induction or inhibition impact had over the further metabolites and the metabolism differences between the two studied strains, A172 and T98G. The T98G glioma cell has only IDO activity, while the A172 has both IDO and TDO activity as well. The IFN-γ indution showed that this cytokine not only acts in the formation of QUIN route, but has a modest impact on the others routes. Inhibition of IDO showed that the competitive inhibitor has activity in itself than a simple Trp-QUIN relationship. However, our results allow us to show the first time the complete description of these pathways, in particular, in these cell lines that can assume therapeutic strategies in these routes that are related or not with tumor progression

Bariatric surgery reverses metabolic risk in patients treated in outpatient level / Cirurgia bariatrica reverte risco metabolico em pacientes assistidos em nivel ambulatorial

Background : The conventional treatment of obesity presents unsatisfactory results on weight loss and its long-term sustainability, therefore bariatric surgery has been suggested as an effective therapy, determining sustainable long-term weight loss, reversal of components of cardiometabolic risk and improved quality and life expectancy. Aim : To investigate the clinical component of the cardiometabolic risk in patients undergoing bariatric surgery assisted on outpatient basis. Methods : The sample consisted of 47 patients with ages between 18 and 60 years, 72% females. Diabetes mellitus, hypertension, and dyslipidemia were prospectively evaluated by using the Assessment of Obesity-Related Co-morbidities scale. Results : Occurred improvement in these co-morbidities within 12 months after surgery. Co-morbidities resolved were greater than those improved. Conclusion : The study revealed that the Assessment of Obesity-Related Co-morbidities is a system that can be effectively used to quantify the degree of reduction of the severity of the cardiometabolic risk in response to bariatric surgery. .

Racional : Diante dos resultados insatisfatórios do tratamento convencional da obesidade na perda ponderal e na sua sustentabilidade em longo prazo, a cirurgia bariátrica vem sendo apontada como terapêutica eficaz, determinando perda ponderal sustentável em longo prazo, reversão de componentes do risco cardiometabólico e melhora da qualidade e expectativa de vida. Objetivo : Acompanhar a evolução clínica dos componentes do risco cardiometabólico em pacientes submetidos à cirurgia bariátrica. Métodos : A amostra constituiu-se de 47 pacientes de 18 a 60 anos de idade, 72% do sexo feminino. A evolução clínica das comorbidades diabete melito, dislipidemia e hipertensão arterial, foi quantificada, procedendo-se ao cálculo de escores relativos à Avaliação das Comorbidades Relacionadas à Obesidade. Resultados : Houve redução significativa do escore médio de todas as comorbidades relacionadas à obesidade, desde a admissão até os 12 meses seguintes. Independente do momento de assistência nutricional, o contingente de pacientes que as tiveram revertidas superou aqueles apenas melhoradas. Conclusão : O estudo revelou que a Avaliação das Comorbidades Relacionadas à Obesidade é sistema efetivo para quantificar o grau de redução da gravidade do risco cardiometabólico em resposta à cirurgia bariátrica. .

Hábitos alimentares e prática de atividade física em escolares: relato de uma experiência de educação em saúde / Eating habits and physical activity in school children: report of a health education experience

Devido às crescentes evidências de que as alterações fisiopatológicas das doenças cardiovasculares e metabólicas estão se iniciando de forma cada vez mais precoce, ainda na infância e adolescência, ressalta-se a importância do desenvolvimento de ações de promoção da saúde e prevenção de doenças e da atuação da atenção primária neste processo. A escola torna-se, então, um cenário estratégico para estas práticas. Este trabalho trata do relato de uma experiência de educação em saúde no âmbito escolar, implementada a partir de informações sociodemográficas e de hábitos e estilo de vida relacionados à alimentação, à prática de atividades físicas, em uma turma de alunos da 5ª série de uma escola pública do município do Rio de Janeiro em 2007. Foi realizado um estudo descritivo, de corte longitudinal, com abordagem quantitativa, efetivado em duas etapas distintas. A primeira, relativa ao levantamento inicial de dados e à realização da atividade de educação em saúde; e a segunda, após 10 meses, para avaliar os possíveis impactos da mesma.. Os dados da primeira e segunda etapas foram obtidos através de questionários semiestruturados. As ações educativas foram desenvolvidas em quatro momentos e tiveram como foco prioritário de abordagem a alimentação saudável versus não saudável e suas consequências para a saúde das pessoas. Utilizou-se de metodologia participativa, centrada no aluno e nos seus hábitos alimentares, com base em técnicas de dinâmica de grupo, visando não só valorizar a participação do grupo como também buscar e ampliar o conhecimento dos estudantes, as perspectivas e possibilidades práticas de incorporação das competências trabalhadas. A maioria dos escolares avaliou positivamente a atividade. A segunda fase de coleta de dados ocorreu em 2008, cerca de 10 meses após a primeira, no mesmo grupo de alunos. Verificou-se que todos os participantes recordavam positivamente das atividades...

Because of the growing evidence of earlier onset (adolescence and even childhood) of the pathophysiological alterations due to cardiovascular and metabolic diseases, the strategic role of the school in the development of promotive, preventive and primary care strategies cannot be overemphasized. This is a report of the experience with health education of 5th grade school students of a municipal school in Rio de Janeiro, based on information about habits and lifestyles related to eating and the practice of physical exercises. The study, undertaken in two distinct phases, was descriptive, longitudinal and quantitative. The first phase, which occurred in 2007, consisted of initial data collection and the development of health education activities. The second phase, which occurred in 2008, assessed the impact of the implemented activities. Semi-structured questionnaires were used for data collection in both phases. The education activities were developed in 4 moments, and prioritized the issue of health eating X unhealthy eating, with its consequences for the individual's health. The activities developed, based on the technique of group dynamics, aimed not only to value group participation, but also identify the students' knowledge of the issue, arouse interest, and know the students' perspectives and possibilities of adoption of the competences discussed. Most students found the activities positive...

Compliance with treatment: related-issues and insights for pharmacist intervention / Adesão ao tratamento: os relacionados com questões e perspectivas para a intervenção farmacêutico

Low patient compliance with pharmacotherapy remains one of the greatest challenges for success of treatments, especially in chronic diseases, since it can negatively influence treatment effectiveness and patient quality of life, increase health expenses and decrease productivity of the patient. Compliance is an important but complex issue in clinical practice. Its complexity begins with the difficulty in adopting terminology that can express its exact meaning. Moreover, many methods to evaluate compliance have been established but no consensus exists on which method should be considered the gold standard. Additionally, socioeconomic, disease and therapy-related factors, healthcare team and system related-factors and patient-related factors can simultaneously influence compliance levels. In this highly complex scenario, pharmacist interventions have been identified as an effective strategy to enhance patient compliance with treatment. The objectives of this paper were: (1) to provide useful information for pharmacists about issues related to compliance such as terminology and definitions; methods for measuring compliance and persistence; influencing factors and the impact of low compliance; and (2) to offer insight into how these healthcare professionals can effectively contribute toward improved compliance levels.

A baixa adesão dos pacientes ao tratamento medicamentoso de doenças crônicas continua sendo um dos maiores desafios da medicina, por comprometer a efetividade do tratamento, repercutindo na qualidade de vida, aumentando os gastos com saúde e diminuindo a produtividade do indivíduo doente. O tema adesão é tão relevante para a prática clínica quanto complexo, a começar pelas tentativas de adoção de uma terminologia que expresse com exatidão o seu significado. Além disso, vários métodos para sua determinação foram estabelecidos sem, contudo, se chegar a um consenso sobre qual seria o "ótimo". Adicionalmente, as condições socioeconômicas, as características da doença, os tratamentos empregados, o sistema de saúde e seus profissionais ou o próprio paciente são alguns dos distintos fatores que influenciam, simultaneamente, o nível de adesão do paciente ao tratamento. Neste cenário de alta complexidade, intervenções realizadas pelo profissional farmacêutico têm sido apontadas como estratégias efetivas para o aumento dos níveis de adesão do paciente ao tratamento. Os objetivos deste artigo são: (1) fornecer aos farmacêuticos algumas informacões úteis relacionadas ao assunto adesão tais como: terminologia e definições, métodos para medir adesão e persistência, fatores influenciadores e impacto da baixa adesão; (2) fornecer algumas idéias a respeito de como estes profissionais de saúde podem efetivamente contribuir para a melhora dos níveis de adesão.

Efeitos de um programa de intervenção no estilo de vida sobre o perfil de risco cardiometabólico de uma população nipo-brasileira de alto risco cardiovascular / Effects of an intervention program in lifestyle on the risk profile cardiometabólico of a Japanese-Brazilian population of high cardiovascular risk

Introdução: Altas prevalências de diabetes mellitus tipo 2 e outros fatores de risco cardiovascular previamente detectadas na população nipo-brasileira motivaram a implementação de um programa de intervenção em mudança de estilo de vida. Objetivos: Avaliar os efeitos de 2 anos de intervenção comportamental sobre o perfil cardiometabólico desses indivíduos, independente da condição de tolerância à glicose no início do estudo. Métodos: A existência de dados relativos a 2000-2005 permitiu conhecer o comportamento de variáveis no período pré-intervenção. Em 2005, 728 indivíduos iniciaram o seguimento, sendo, 650 reavaliados em 2006 e 500 em 2007. Nestas ocasiões, os indivíduos foram submetidos a exames médico e laboratorial e consulta com nutricionista e educador físico. O programa constou de atendimentos individualizados e em grupo, enfocando as metas do programa: redução 5 por cento de peso corporal; prática de 150minutos/semana de exercício; ingestão de < 10 por cento de ácidos graxos saturados do valor calórico total; ingestão de 400g/dia de frutas, verduras ou legumes. Resultados: Comparado ao período pré-intervenção, o comportamento de variáveis antropométricas e metabólicas durante o programa foi significantemente mais favorável. O impacto do programa dependeu do alcance de metas em indivíduos sem diabetes. As frequências de intolerância à glicose e diabetes reduziram após um ano de intervenção (de 58,4 por cento para 35,4 por cento; p < 0,001 e de 30,1 por cento para 21,7 por cento; p < 0,001, respectivamente). Após excluir os indivíduos com diabetes no início do estudo, 71,7 por cento dos participantes mantiveram ou regrediram seu estado de tolerância à glicose ("non-progressors") no final de 2 anos de seguimento.

[Fruit and vegetable intake and the metabolic syndrome: Tehran lipid and glucose study]

While consumption of vegetable and fruit are increasingly being recommended to prevent chronic diseases in dietary guidelines, epidemiologic data on the association between vegetable and fruit intakes and the metabolic syndrome is limited. The aim of this study was to investigate the hypothesis that higher fruit and vegetable intakes reduce metabolic risk factors in Tehranian adults. In a cross-sectional study, quartiles of vegetables and fruit consumption were determined using the food frequency questionnaire, for 606 subjects, aged 18-74 years. Blood pressure was assessed according to standard methods and fasting blood samples were taken for biochemical measurements. Hypertriglyceridemia, hypercholestrolemia, high LDL, low HDL and metabolic syndrome were defined according to ATP III guidelines. Mean +/- SD consumption of starchy vegetables, vegetables and fruit intake was 50.8 +/- 49, 304 +/- 179 and 211 +/- 147 g/day, respectively. The prevalence of metabolic syndrome was higher among subjects in lower quartiles of fruits [17.2% in first vs 15.4% in fourth quartile, P<0.05]. Those in the higher quartile of vegetable intake had higher intakes of fat [31.7 +/- 8 in fourth vs 28.5 +/- 9 g/day in first quartile], cholesterol [208 +/- 13 in fourth vs 153 +/- 12 g/day in first quartile],[P<0.05]. Significant differences were seen in mean vegetable and fruit intakes across the 3 risk factor groups [0,1-2 and >/= 3 risk factors] after adjustments for fat and saturated fat intakes [310 +/- 14, 194 +/- 17 in individuals with >/= 3 risk factors vs 364 +/- 18, 248 +/- 15 g/day in individuals with no risk factors respectively, P<0.05]. There was a significant difference in mean fruit intake across the 3 risk factor groups before and after adjustments for fat and saturated fat intakes [P<0.05]. Fruit and vegetable intake is inversely associated with the risk of having metabolic syndrome

Nutrição enteral em Pediatria / Enteral nutrition in Pediatrics

O autor conceitua o que se entende por nutriçäo enteral, apresenta os diferentes tipos de dietas, fórmulas completas, modulares, artesanais e comerciais, analisa as condiçöes que requerem o uso de fórmulas lácteas especiais (prematuridade, imaturidade e inflamaçäo intestinal, alergia ao leite de vaca), as vias e a técnica de administraçäo e de passagem de sonda, cuidados com a dieta enteral e sua monitorizaçäo, particularidades do RN e complicaçöes, finalizando com estudo da interaçäo entre drogas e nutrientes