Does a Gluten-free Diet Improve Metabolic Syndrome Parameters? A Systematic Review

Abstract To review scientific evidence on the effects of a gluten-free diet on body composition and improvement of clinical and biochemical parameters of metabolic syndrome. The Preferred Reporting Items for Systematic Reviews and Meta-Analyzes - PRISMA guidelines were followed. A literature search was performed in the PubMed, ScienceDirect, Trip Database, Bireme and Scielo databases, without language restriction, until March 2021. The terms "gluten-free diet", "obesity", "metabolic syndrome", and "weight loss", and Boolean operators (AND/OR) were used. The clinical hypothesis was structured according to the acronym PICOT. Randomized clinical trials with adult and elderly humans without a diagnosis of celiac disease, consuming a gluten-free diet, evaluating associations of the effects of this diet on weight loss and metabolic syndrome components were considered eligible. To assess the risk of bias, the RoB2 was used. A total of 3,198 articles were identified and, after the screening and evaluation of pre-defined eligibility criteria, four studies were included in the qualitative analysis. Weight loss was not associated with a gluten-free diet. However, individuals under a gluten-free diet had lower mean waist circumference, fat percentage (-2.3%) and serum triglyceride levels. The impact of a gluten-free diet on metabolic syndrome parameters is still controversial. In individuals without gluten sensitivity or celiac disease, the consumption of a gluten-free diet appears to provide no nutritional benefit.

Frequency and factors associated with sarcopenia prediction in adult and elderly patients hospitalized for COVID-19.

Patients with COVID-19 may develop symptoms that interfere with food intake. Systemic inflammatory response associated with physical inactivity and/or immobilization during hospital stay can induce weight and muscle loss leading to sarcopenia and worsening the clinical condition of these patients. The present study identifies the frequency and factors associated with sarcopenia prediction in adult and elderly patients hospitalized for COVID-19. It is a cohort-nested cross-sectional study on adult and elderly patients admitted to wards and intensive care units (ICUs) of 8 hospitals in a northeastern Brazilian state. The study was conducted from June 2020 to June 2021. Sociodemographic, economic, lifestyle, and current and past clinical history variables were collected. Sarcopenia prediction was determined by the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire compiled in the Remote-Malnutrition APP (R-MAPP). Patients were diagnosed with sarcopenia when the final score ≥ 4 points. The study included 214 patients with a mean age of 61.76 ± 16.91 years, of which 52.3 % were female and 57.5 % elderly. Sarcopenia prevailed in 40.7 % of the sample. Univariate analysis showed greater probability of sarcopenia in elderly individuals, nonpractitioners of physical activities, hypertensive patients, diabetic patients, and those hospitalized in the ICU. In the multivariate model, the type of hospital admission remained associated with sarcopenia prediction, where patients admitted to the ICU were 1.43 (95 % CI: 1.04; 1.97) more likely to have sarcopenia than those undergoing clinical treatment. Sarcopenia prediction was not associated with patient outcome (discharge, transfer, or death) (p = 0.332). The study highlighted an important percentage of sarcopenia prediction in patients with COVID-19, especially those admitted to the ICU. Additional investigations should be carried out to better understand and develop early diagnostic strategies to assist in the management of sarcopenic patients with COVID-19.

Association between being underweight and excess body weight before SARS coronavirus type 2 infection and clinical outcomes of coronavirus disease 2019: Multicenter study.

OBJECTIVES: The present study aimed to identify associations between extremes in body weight status (underweight and excess body weight) before a COVID-19 diagnosis and clinical outcomes in patients infected with SARS coronavirus type 2. METHODS: A multicenter cohort study was conducted in eight different states in northeastern Brazil. Demographic, clinical (previous diagnosis of comorbidities), and anthropometric (self-reported weight and height) data about individuals who tested positive for COVID-19 were collected. Outcomes included hospitalization, mechanical ventilation, and death. Multivariable logistic regression models, adjusted based on age, sex and previous comorbidities, were used to assess the effects of extremes in body weight status on clinical outcomes. RESULTS: A total of 1308 individuals were assessed (33.6% were elderly individuals). The univariable analyses showed that only hospitalization was more often observed among underweight (3.2% versus 1.2%) and overweight (68.1% versus 63.3%) individuals. In turn, cardiovascular diseases were more often observed in all clinical outcomes (hospitalization: 19.7% versus 4.8%; mechanical ventilation: 19.9% versus 13.5%; death: 21.8% versus 14.1%). Based on the multivariable analysis, body weight status was not associated with risk of hospitalization (underweight: odds ratio [OR]: 1.10; 95% confidence interval [CI] 95%, 0.50-2.41 and excess body weight: OR: 0.81; 95 CI, 0.57-1.14), mechanical ventilation (underweight: OR: 0.92; 95% CI, 0.52-1.62 and excess weight: OR: 0.90; 95% CI, 0.67-1.19), and death (underweight: OR: 0.61; 95% CI, 0.31-1.20 and excess body weight: OR 0.88; 95% CI, 0.63-1.23). CONCLUSIONS: Being underweight and excess body weight were not independently associated with clinical outcomes in patients with COVID-19 in the herein analyzed cohort. This finding indicates that the association between these variables may be confounded by both age and comorbidities.

ENERGY AND NUTRIENT INTAKE IN OSTOMY PATIENTS AND CORRELATIONS WITH ANTHROPOMETRIC VARIABLES: RESULTS FROM A REFERENCE HOSPITAL IN THE STATE OF PERNAMBUCO, BRAZIL.

BACKGROUND: Studies that assess the food intake and nutritional status of ostomy patients are scarce in the literature. However, such individuals have symptoms in the postoperative period that determine changes in the intake of calories and nutrients as well as anthropometric variables. OBJECTIVE: Estimate the energy and nutrient intake of ostomy patients and determine correlations with anthropometric variables. METHODS: A cross-sectional study was conducted with ostomy individuals in outpatient follow-up at a reference hospital for postoperative ostomy surgery in the city of Recife, Brazil. Demographic, socioeconomic, clinical, anthropometric, and dietary data were collected through interviews and from patient charts. Statistical analyses were performed with the aid of the Statistical Package for the Social Sciences, version 13.0 for Windows, with the level of significance set at 5% (P≤0.05). RESULTS: The sample was composed of 100 individuals (54% males) with a mean age of 55.1±15.4 years. Colostomy patients predominated (82%) and had a greater frequency of excess weight compared to ileostomy patients (86.36% versus 13.64%). Median intake was below the Estimated Average Requirements, especially for vitamins A, C, and E. Significant inverse correlations were found between carbohydrate intake and both arm circumference and triceps skinfold (P=0.0302 for each) and a positive correlation was found between protein intake and arm muscle circumference (P=0.0158) in male patients. CONCLUSION: The present study found significant correlations between macronutrient intake and anthropometric variables indicative of reserves of lean and adipose mass. Moreover, intake was below the recommended values according to sex and age group, especially with regards to vitamins.

Excess weight in adolescents and associated factors: data from the ERICA study

Abstract Objective: To estimate the prevalence of excessive weight and to identify associations with socioeconomic, demographic, biological, and lifestyle factors in adolescents. Methods: It is a cross-sectional school-based study, with a stratified and complex sample. The evaluated individuals were adolescents (2404), aged 12-17 years old, participating in the Study of Cardiovascular Risk Factors in Adolescents (ERICA). Demographic, socioeconomic, biological, anthropometric, and lifestyle variables were assessed. Poisson regression was used to verify the association between excess weight and independent variables. Results: The prevalence of excessive weight was 26.3% in the study population, being 16.3% for overweight and 10% for obesity. In the multivariate analysis (hierarchical model), were associated with excessive weight: private education network, a higher number of televisions in the residence, eating habits related to the breakfast consumption, snacks purchase in the canteen, snacks in front to screens consumption and consumption of carbohydrates and lipids, in addition to age group (12-14 years) and sexual maturation (post-pubertal). Conclusions: The prevalence of excessive weight among the school adolescents studied is high, with a value higher than the national average and the results of previous studies with adolescents. Its distribution is associated with different factors, which are socioeconomic, demographic, biological, and related to lifestyle, reinforcing the complexity of this condition, which deserves a broad coping approach, involving not only individual efforts but social and public ones as well.

[Perception of body weight above the ideal, anthropometric profile and lifestyle among adolescents in the city of Recife, Brazil]. / Percepção do peso corporal acima do ideal, perfil antropométrico e estilo de vida em adolescentes de Recife, PE, Brasil.

This study investigated the perception of above ideal body weight among adolescents in the city of Recife, Brazil, and its association with anthropometric profile and lifestyle. A cross-sectional study was conducted with a sample of 2480 adolescents from the "Study of Cardiovascular Risks in Adolescents." The conceptual model also assessed demographic and socioeconomic variables. Body weight perception was analyzed by asking the question: "In your opinion, your current body weight is … ?" Answers included: below ideal, ideal and above ideal body weight. Statistics were identified using Poisson Regression analysis. The mean age was 14.7 years (SD = 1.6), 53.7% were female, and 70.7% were eutrophic according to the body mass index/age (BMI/A). Perception of body weight was answered by 48.8% of the adolescents. 36.8% and 63.2% saw themselves as below and above their ideal weight, respectively. After adjustments, the variables associated with the perception of body weight above the ideal (outcome variable) were the female sex, age 12 to 14 years, mother's schooling > 8 years, BMI/A in the ideal range, being postpubescent, having breakfast and meals with parents occasionally. Demographic, anthropometric and lifestyle variables were more likely to be associated with body weight perception above the ideal.

O objetivo da pesquisa foi analisar a percepção do peso corporal acima do ideal em adolescentes de Recife/PE e sua associação com o perfil antropométrico e estilo de vida. Trata-se de um estudo transversal com 2.480 escolares participantes do Estudo de Riscos Cardiovasculares em Adolescentes (Erica). O modelo conceitual também considerou variáveis demográficas e socioeconômicas. A percepção do peso foi analisada por meio da pergunta "Na sua opinião o seu peso atual é?", sendo as respostas: "abaixo do ideal", "ideal" e "acima do ideal". As associações foram identificadas por meio da regressão de Poisson. A média da idade foi de 14,7 anos (DP = 1,6), 53,7% eram do sexo feminino e 70,7% eram eutróficos, de acordo com o índice de massa corporal/idade (IMC/I). A percepção do peso foi respondida por 48,8% dos adolescentes. Desses, 36,8% e 63,2% se percebiam com baixo peso e peso acima do ideal, respectivamente. Após os ajustes, as variáveis associadas à percepção do peso acima do ideal foram: sexo feminino, idade entre 12 e 14 anos, escolaridade materna maior que oito anos, IMC/I de eutrofia e de excesso de peso, estágio pós-púbere e realização de café da manhã e refeição com os pais ocasionalmente. Portanto, variáveis demográficas, antropométricas e do estilo de vida se associaram à maior chance de percepção do peso corporal acima do ideal.

Percepção do peso corporal acima do ideal, perfil antropométrico e estilo de vida em adolescentes de Recife, PE, Brasil / Perception of body weight above the ideal, anthropometric profile and lifestyle among adolescents in the city of Recife, Brazil

Resumo O objetivo da pesquisa foi analisar a percepção do peso corporal acima do ideal em adolescentes de Recife/PE e sua associação com o perfil antropométrico e estilo de vida. Trata-se de um estudo transversal com 2.480 escolares participantes do Estudo de Riscos Cardiovasculares em Adolescentes (Erica). O modelo conceitual também considerou variáveis demográficas e socioeconômicas. A percepção do peso foi analisada por meio da pergunta "Na sua opinião o seu peso atual é?", sendo as respostas: "abaixo do ideal", "ideal" e "acima do ideal". As associações foram identificadas por meio da regressão de Poisson. A média da idade foi de 14,7 anos (DP = 1,6), 53,7% eram do sexo feminino e 70,7% eram eutróficos, de acordo com o índice de massa corporal/idade (IMC/I). A percepção do peso foi respondida por 48,8% dos adolescentes. Desses, 36,8% e 63,2% se percebiam com baixo peso e peso acima do ideal, respectivamente. Após os ajustes, as variáveis associadas à percepção do peso acima do ideal foram: sexo feminino, idade entre 12 e 14 anos, escolaridade materna maior que oito anos, IMC/I de eutrofia e de excesso de peso, estágio pós-púbere e realização de café da manhã e refeição com os pais ocasionalmente. Portanto, variáveis demográficas, antropométricas e do estilo de vida se associaram à maior chance de percepção do peso corporal acima do ideal.

Abstract This study investigated the perception of above ideal body weight among adolescents in the city of Recife, Brazil, and its association with anthropometric profile and lifestyle. A cross-sectional study was conducted with a sample of 2480 adolescents from the "Study of Cardiovascular Risks in Adolescents." The conceptual model also assessed demographic and socioeconomic variables. Body weight perception was analyzed by asking the question: "In your opinion, your current body weight is … ?" Answers included: below ideal, ideal and above ideal body weight. Statistics were identified using Poisson Regression analysis. The mean age was 14.7 years (SD = 1.6), 53.7% were female, and 70.7% were eutrophic according to the body mass index/age (BMI/A). Perception of body weight was answered by 48.8% of the adolescents. 36.8% and 63.2% saw themselves as below and above their ideal weight, respectively. After adjustments, the variables associated with the perception of body weight above the ideal (outcome variable) were the female sex, age 12 to 14 years, mother's schooling > 8 years, BMI/A in the ideal range, being postpubescent, having breakfast and meals with parents occasionally. Demographic, anthropometric and lifestyle variables were more likely to be associated with body weight perception above the ideal.

Ingestão de energia e nutrientes em pacientes ostomizados e sua correlação com variáveis antropométricos: resultados de um hospital de referência em Pernambuco, Brasil / Energy and nutrient intake in ostomy patients and correlations with anthropometric variables: results from a reference hospital in the state of pernambuco, brazil

ABSTRACT BACKGROUND: Studies that assess the food intake and nutritional status of ostomy patients are scarce in the literature. However, such individuals have symptoms in the postoperative period that determine changes in the intake of calories and nutrients as well as anthropometric variables. OBJECTIVE: Estimate the energy and nutrient intake of ostomy patients and determine correlations with anthropometric variables. METHODS: A cross-sectional study was conducted with ostomy individuals in outpatient follow-up at a reference hospital for postoperative ostomy surgery in the city of Recife, Brazil. Demographic, socioeconomic, clinical, anthropometric, and dietary data were collected through interviews and from patient charts. Statistical analyses were performed with the aid of the Statistical Package for the Social Sciences, version 13.0 for Windows, with the level of significance set at 5% (P≤0.05). RESULTS: The sample was composed of 100 individuals (54% males) with a mean age of 55.1±15.4 years. Colostomy patients predominated (82%) and had a greater frequency of excess weight compared to ileostomy patients (86.36% versus 13.64%). Median intake was below the Estimated Average Requirements, especially for vitamins A, C, and E. Significant inverse correlations were found between carbohydrate intake and both arm circumference and triceps skinfold (P=0.0302 for each) and a positive correlation was found between protein intake and arm muscle circumference (P=0.0158) in male patients. CONCLUSION: The present study found significant correlations between macronutrient intake and anthropometric variables indicative of reserves of lean and adipose mass. Moreover, intake was below the recommended values according to sex and age group, especially with regards to vitamins.

RESUMO CONTEXTO: Estudos que avaliam o consumo alimentar e o estado nutricional de pacientes ostomizados são escassos na literatura, entretanto, sabe-se que tais indivíduos cursam com sintomatologia que determinam modificações na ingestão calórica e de nutrientes, bem como nos parâmetros antropométricos durante o pós-operatório. OBJETIVO: Estimar a ingestão de energia e nutrientes em pacientes ostomizados e verificar sua relação com variáveis antropométricas. MÉTODOS: Estudo transversal, realizado com grupo de indivíduos ostomizados em acompanhamento ambulatorial em um hospital de referência para pós-operatório de ostomias em Recife - Pernambuco. Foram obtidos dados demográficos, socioeconômicos, clínicos, antropométricos e dietéticos por meio de entrevistas e coleta direta nos prontuários. As análises estatísticas foram realizadas no software Statistical Package for the Social Sciences versão 13.0 para Windows, adotando-se o valor de 5% para verificação de significância estatística (P≤0,05). RESULTADOS: A amostra foi composta por 100 indivíduos, sendo 54% do sexo masculino, com média de idade de 55,1±15,4 anos. O grupo foi caracterizado por um predomínio de pacientes colostomizados (82%; n=82), os quais apresentaram maiores frequências de excesso de peso, quando comparados àqueles com ileostomia (86,36% vs 13,64%). Foram identificadas medianas de ingestão abaixo dos valores recomendados pelos requisitos médios estimados principalmente para as vitaminas A, C e E. Houve correlação inversa significante entre o consumo de carboidratos com a circunferência do braço e a prega cutânea tricipital (P=0,0302), e correlação positiva entre o consumo de proteínas e a circunferência muscular do braço (P=0,0158) nos pacientes do sexo masculino. CONCLUSÃO: O presente estudo encontrou relação significante entre o consumo de macronutrientes e variáveis antropométricas indicativas de reservas de massa magra e adiposa. A ingestão, principalmente de vitaminas, foi abaixo dos valores preconizados segundo o sexo e a faixa etária.

Excess weight in adolescents and associated factors: data from the ERICA study.

OBJECTIVE: To estimate the prevalence of excessive weight and to identify associations with socioeconomic, demographic, biological, and lifestyle factors in adolescents. METHODS: It is a cross-sectional school-based study, with a stratified and complex sample. The evaluated individuals were adolescents (2404), aged 12-17 years old, participating in the Study of Cardiovascular Risk Factors in Adolescents (ERICA). Demographic, socioeconomic, biological, anthropometric, and lifestyle variables were assessed. Poisson regression was used to verify the association between excess weight and independent variables. RESULTS: The prevalence of excessive weight was 26.3% in the study population, being 16.3% for overweight and 10% for obesity. In the multivariate analysis (hierarchical model), were associated with excessive weight: private education network, a higher number of televisions in the residence, eating habits related to the breakfast consumption, snacks purchase in the canteen, snacks in front to screens consumption and consumption of carbohydrates and lipids, in addition to age group (12-14 years) and sexual maturation (post-pubertal). CONCLUSIONS: The prevalence of excessive weight among the school adolescents studied is high, with a value higher than the national average and the results of previous studies with adolescents. Its distribution is associated with different factors, which are socioeconomic, demographic, biological, and related to lifestyle, reinforcing the complexity of this condition, which deserves a broad coping approach, involving not only individual efforts but social and public ones as well.

Independent predictors of insulin resistance in Brazilian adolescents: Results of the study of cardiovascular risk in adolescents-Brazil.

Considering the current changes in dietary patterns and the increasing prevalence of excess weight throughout the world, several studies have reported insulin resistance, which is a key driver of many chronic diseases, to be an important public health problem in all age groups. Therefore, the aim of the present study was to identify the prevalence and independent predictors of insulin resistance in Brazilian adolescents. A cross-sectional study was conducted with a probabilistic, representative sample of Brazilian adolescents (n = 37,023) who participated in the Study of Cardiovascular Risk in Adolescents. Data were collected on demographic, socioeconomic, lifestyle, anthropometric, and biochemical characteristics as well as antioxidant micronutrient intake (vitamins A, C, E, zinc, and selenium). Insulin resistance was determined using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and classified based on the 75th percentile of the sample distribution. Insulin resistance was detected in 27% of the adolescents and was more prevalent among those aged 12 to 14 years (PR: 1.26 [95%CI: 1.13;1.41]), those residing in the southern and south-eastern regions of the country (PR: 1.47 [95%CI: 1.27;1.70]), those who were physically inactive (PR: 1.12 [95%CI: 1.02;1.23]), and those did not consume alcohol (PR: 1.50 [95%CI: 1.13;1.99]). The prevalence of insulin resistance was 2.5-fold higher among individuals with severe obesity (PR: 2.49 [95%CI: 2.07;3.00]). Waist circumference indicative of cardiovascular risk and high serum triglyceride levels increased the likelihood of insulin resistance (PR: 1.37 [95%CI: 1.19;1.59] and 1.60 [95%CI: 1.45;1.78], respectively). The prevalence of the outcome was higher among adolescents in the lower quartiles of vitamin E intake (p<0.05). In the present study, the prevalence of insulin resistance was high among Brazilian adolescents and we identified sociodemographic, lifestyle, anthropometric, biochemical, and dietary predictors of this outcome.

Fatores associados ao risco nutricional e desfechos clínicos em pacientes cirúrgicos não-oncológicos de um hospital universitário no nordeste brasileiro / Factors associated with nutritional risk and clinical outcomes in non-oncological surgical patients at a university hospital in northeastern brazil

Objetivo: Identificar o risco nutricional, seus fatores associados e os desfechos clínicos de pacientes cirúrgicos não-oncológicos. Métodos: Estudo observacional, de natureza retrospectiva, realizado a partir de registros disponíveis em prontuários. Foram coletados dados de pacientes cirúrgicos não-oncológicos, com idade igual ou superior a 20 anos, internados em um hospital universitário de Alagoas, Brasil, de outubro a dezembro de 2019. Os pacientes foram classificados quanto ao risco nutricional através da Nutritional Risk Screening2002. Como variáveis exploratórias foram obtidos o tipo, severidade, classificação temporal da cirurgia realizada, tempo de internamento total e pós-operatório, e desfecho clínico. Adotou-se um nível de 5% (p<0,05) para constatação de significância estatística. Resultados: Foram avaliados 113 pacientes (66,4% do sexo feminino) com média de idade de 48,1±14,5 anos. O risco nutricional foi identificado em 11,5% da amostra. Indivíduos sem risco apresentaram maior frequência de excesso de peso (64% versus 30,8%) (p<0,04). Pacientes idosos tiveram maiores taxas de risco nutricional comparado aos adultos (61,54% versus 38,46%; p=0,002). Os pacientes com risco nutricional foram submetidos em maior frequência às cirurgias de maior severidade (70%), seguido por cirurgias de menor (20%) e moderada severidade (10%) (p=0,007). A classificação do risco determinou maior tempo de internamento pós-cirúrgico, com média de aproximadamente 3 dias adicionais na hospitalização (p=0,022). Dentre aqueles indivíduos com risco nutricional, 15,4% evoluíram com óbito (p=0,035). Conclusões: O risco nutricional mostrou associação com o IMC, idade, severidade da cirurgia e tempo de internamento pós-operatório. Quanto ao desfecho clínico, houve maior frequência de óbito nos pacientes classificados com risco. (AU)

Objective: Identify nutritional risk, associated factors and clinical outcomes in non-oncological surgical patients. Methods: A retrospective observational study was conducted using records available on patient charts. Data were collected from non-oncological surgical patients 20 years of age or older hospitalized at a university hospital in Alagoas, Brazil, between October and December 2019. The patients were classified regarding nutritional risk using the Nutritional Risk Screening-2002 tool. The exploratory variables were type, severity, and temporal classification of surgery, total hospital stay, postoperative hospital stay and clinical outcome. The level of statistical significance was set at 5% (p <0.05). Results: One hundred thirteen patients were evaluated; 66.4% were women and mean age was 48.1±14.5 years. Nutritional risk was identified in 11.5% of the sample. Individuals without risk had a greater frequency of excess weight (64% versus 30.8%) (p <0.04). Older people had a greater frequency of nutritional risk compared to adults (61.54% versus 38.46%; p = 0.002). Patients with nutritional risk were submitted to major surgery more often (70%), followed by minor surgery (20%) and surgery of moderate severity (10%) (p = 0.007). The classification of risk determined a longer postoperative hospital stay, with an average of three additional days (p = 0.022). Death occurred in 15.4% of the individuals at nutritional risk (p = 0.035). Conclusions: Nutritional risk was associated with body mass index, age, severity of surgery and postoperative hospital stay. Regarding clinical outcomes, death was more frequent among patients classified with nutritional risk. (AU)

Vitamin A and D deficiencies in the prognosis of respiratory tract infections: A systematic review with perspectives for COVID-19 and a critical analysis on supplementation / Vitamin A and D deficiencies: Perspectives for COVID-19

OBJECTIVE: Considering the rapid spread of COVID-19, the scientific community has been looking for ways to recognize factors that may interfere with the outcome of viral infection. Despite the lack of studies with the new coronavirus, it is known that adequate serum levels of micronutrients are essential for the organic response to infectious diseases. Thus, we aim to review the effects of vitamin A, D, iron, zinc, or folate deficiency on the prognosis of patients with respiratory infections with manifestations similar to COVID-19 and discuss about supplementation of the nutrients analyzed in this review. METHODS: The search was conducted in the databases PubMed, Lilacs, and SciELO, including observational studies published between 2010-2020, with results for individuals with respiratory tract infections with manifestations similar to COVID-19. RESULTS: Six articles met the inclusion criteria, all of which were related to deficiencies of vitamins A and D. In general, vitamin A deficiency was associated with cough, fever, and greater total respiratory resistance. Regarding vitamin D, the lack of this nutrient led to higher rates of ICU admission, the need for mechanical ventilation, and mortality. Evidence linking specific relationships between nutritional deficiencies and COVID-19 remain lacking due to the small number of studies and heterogeneities in population subgroups. CONCLUSION: In conclusion, deficiencies of vitamins A and D seem to negatively affect the prognosis of respiratory tract infections. Supplementation of these nutrients for prevention or treatment of patients diagnosed with COVID-19 should respect serum levels, nutritional status and housing conditions (e.g.,endemic location) of individuals.

Early menarche and its association with anthropometric and body composition variables in young university students / Menarquia precoz y su asociación con parámetros antropométricos y de composición corporal en jóvenes universitarias

OBJECTIVE: Evaluate the association between early menarche and anthropometric/body composition variables in young female university students. METHODS: Cross-sectional study involving female university students at a public university in northeastern Brazil. Anthropometric and body composition data were collected, along with a self-report of age at menarche. The conceptual model considered demographic, socioeconomic and lifestyle variables as well as the perception of weight in childhood and at menarche. RESULTS: Among the 162 students analyzed, 62.3% were less than 20 years of age. The frequency of underweight and overweight was 8.6% and 22.3%, respectively. The frequency of above-average body fat and obesity was 32.1% and 14.8%, respectively. Early menarche was reported in 35.2%. The frequency of self-reported excess weight in childhood and at menarche was 31.3% and 25.9%, respectively. A statistically significant association was found between early menarche and height < 1st tertile (< 1.62 m). A tendency toward an association was found between early menarche and both weight, circumference in the risk range and the perception of excess weight in childhood and at menarche. CONCLUSION: Current excess weight was more associated with excess weight in childhood and at menarche than the occurrence of early menarche.

OBJETIVO: Evaluar asociación entre menarquia precoz, parámetros antropométricos y de composición corporal en jóvenes universitarias. MÉTODOS: Estudio transversal en 162 jóvenes universitarias del Nordeste brasileño. Se recogieron datos antropométricos, de composición corporal y relato sobre la edad de la menarquia. Se consideraron, además, variables demográficas, socioeconómicas, estilo de vida e histórico del peso. RESULTADOS: De las 162 jóvenes el 62,3% tenía menos de 20 años de edad. Un 8,6% y 22,3% presentaron bajo peso, y exceso de peso respectivamente. La frecuencia de grasa corporal y obesidad por encima de la media fue de 32,1% y 14,8%, respectivamente. La menarquia temprana fue reportada en el 35,2% de los casos. El 31,3% y 25,9% repostaron tener exceso de peso en la infancia y en la menarquia respectivamente. Se verificó asociación estadísticamente significativa entre menarquia precoz y talla <1 tercil (<1,62cm). Además de una tendencia de asociación entre menarquia precoz, circunferencia de la cintura y exceso de peso, tanto en la infancia como en la edad de menarquia. CONCLUSIÓN: el exceso de peso actual está, mas asociado con el exceso de peso en la infancia y la edad de la menarquia que con la menarquia precoz.

OVERWEIGHT AND ASSOCIATED FACTORS IN CHILDREN AND ADOLESCENTS WITH PHENYLKETONURIA: A SYSTEMATIC REVIEW.

OBJECTIVE: To verify the occurrence of overweight in children and adolescents with phenylketonuria and to identify possible causal factors. DATA SOURCES: A systematic review was performed in the SciELO, PubMed and VHL databases using the descriptors "Phenylketonurias", "Overweight", "Child" and "Adolescent". Original articles conducted with children and adolescents, published between 2008 and 2018 in Portuguese, English or Spanish languages were included. DATA SYNTHESIS: A total of 16 articles were identified and, after screening procedures, 6 studies were selected for the review. Overweight in children and adolescents with phenylketonuria was a frequent occurence in the studies included in this review, ranging from 7.8 to 32.6%. The female sex was the most affected by the nutritional disorder. Furthermore, a high caloric intake combined with a lack of stimuli to practice physical activities were main factors associated with the excessive weight in the population of interest. CONCLUSIONS: Excess weight can be considered a common outcome in children and adolescents with phenylketonuria. It is mainly caused by inadequate food consumption and sedentary lifestyle. The importance of early identification of nutritional disturbances in children and adolescents with phenylketonuria should be emphasized, in order to prevent associated chronic diseases and to promote health by encouraging continued healthy eating habits and the regular practice of physical exercises.

PREVALENCE OF INSULIN RESISTANCE AND ASSOCIATION WITH METABOLIC RISK FACTORS AND FOOD CONSUMPTION IN ADOLESCENTS - RECIFE/BRAZIL.

OBJECTIVE: To identify the prevalence of insulin resistance in adolescents and its associations with metabolic factors and food intake. METHODS: Cross-sectional study conducted with a stratified, complex, school-based sample. The subjects were adolescents (n=1,081) who participated in the Study of Cardiovascular Risk in Adolescents in the city of Recife (Pernambuco, Brazil). We analyzed demographic, socioeconomic, behavioral, anthropometric, biochemical, and dietary variables. Insulin resistance was defined as HOMA-IR>75th percentile. A Poisson multivariate regression model with robust variance adjustment was used, and variables with p≤0.05 in the final model were considered statistically associated with insulin resistance. RESULTS: Median age was 14 years (interquartile range: 13-16 years), and 25.3% of the sample showed insulin resistance. The variables associated with insulin resistance in the final model were age, body mass index-for-age (BMI/A), biochemical markers (triglycerides and high-density lipoprotein cholesterol) and saturated fat intake, with insulin resistance being more prevalent in individuals whose consumption of this type of fat was below the median of the sample distribution. CONCLUSIONS: Insulin resistance was prevalent in the adolescents analyzed and was significantly associated with metabolic variables and saturated fat intake.

Prevalence of insulin resistance and association with metabolic risk factors and food consumption in adolescents - recife/brazil / Prevalência de resistência à insulina e associação com fatores de risco metabólicos e consumo alimentar de adolescentes - recife/brasil

ABSTRACT Objective: To identify the prevalence of insulin resistance in adolescents and its associations with metabolic factors and food intake. Methods: Cross-sectional study conducted with a stratified, complex, school-based sample. The subjects were adolescents (n=1,081) who participated in the Study of Cardiovascular Risk in Adolescents in the city of Recife (Pernambuco, Brazil). We analyzed demographic, socioeconomic, behavioral, anthropometric, biochemical, and dietary variables. Insulin resistance was defined as HOMA-IR>75th percentile. A Poisson multivariate regression model with robust variance adjustment was used, and variables with p≤0.05 in the final model were considered statistically associated with insulin resistance. Results: Median age was 14 years (interquartile range: 13-16 years), and 25.3% of the sample showed insulin resistance. The variables associated with insulin resistance in the final model were age, body mass index-for-age (BMI/A), biochemical markers (triglycerides and high-density lipoprotein cholesterol) and saturated fat intake, with insulin resistance being more prevalent in individuals whose consumption of this type of fat was below the median of the sample distribution. Conclusions: Insulin resistance was prevalent in the adolescents analyzed and was significantly associated with metabolic variables and saturated fat intake.

RESUMO Objetivo: Identificar a prevalência de resistência à insulina em adolescentes e verificar sua associação com variáveis metabólicas e com o consumo alimentar. Métodos: Estudo transversal, de base escolar, com amostra do tipo estratificada e complexa. Os indivíduos analisados foram adolescentes (n=1.081) participantes do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA) na cidade de Recife (Pernambuco, Brasil). Foram coletadas variáveis demográficas, socioeconômicas, comportamentais, antropométricas, bioquímicas e do consumo alimentar. A resistência à insulina foi definida como HOMA-IR>percentil 75. Análises de regressão de Poisson com ajuste robusto da variância foram empregadas, sendo identificadas associações estatisticamente significativas quando p≤0,05. Resultados: A idade mediana foi de 14 anos (intervalo interquartílico=13-16) e a resistência à insulina foi evidenciada em 25,3% da amostra. As variáveis que se associaram significativamente com a resistência à insulina no modelo final foram a faixa etária, o índice de massa corpórea por idade (IMC/I), marcadores bioquímicos (triglicerídeos e HDL-colesterol) e o consumo alimentar de gordura saturada, observando-se maior prevalência da resistência à insulina naqueles indivíduos que apresentaram a ingestão deste tipo de gordura abaixo da mediana da própria distribuição. Conclusões: A resistência à insulina foi prevalente nos adolescentes avaliados e se associou significativamente com variáveis metabólicas e com o consumo alimentar de gordura do tipo saturada.

Overweight and associated factors in children and adolescents with phenylketonuria: a systematic review / Excesso de peso e fatores associados em crianças e adolescentes com fenilcetonúria: uma revisão sistemática

ABSTRACT Objective: To verify the occurrence of overweight in children and adolescents with phenylketonuria and to identify possible causal factors. Data sources: A systematic review was performed in the SciELO, PubMed and VHL databases using the descriptors "Phenylketonurias", "Overweight", "Child" and "Adolescent". Original articles conducted with children and adolescents, published between 2008 and 2018 in Portuguese, English or Spanish languages were included. Data synthesis: A total of 16 articles were identified and, after screening procedures, 6 studies were selected for the review. Overweight in children and adolescents with phenylketonuria was a frequent occurence in the studies included in this review, ranging from 7.8 to 32.6%. The female sex was the most affected by the nutritional disorder. Furthermore, a high caloric intake combined with a lack of stimuli to practice physical activities were main factors associated with the excessive weight in the population of interest. Conclusions: Excess weight can be considered a common outcome in children and adolescents with phenylketonuria. It is mainly caused by inadequate food consumption and sedentary lifestyle. The importance of early identification of nutritional disturbances in children and adolescents with phenylketonuria should be emphasized, in order to prevent associated chronic diseases and to promote health by encouraging continued healthy eating habits and the regular practice of physical exercises.

RESUMO Objetivo: Verificar a ocorrência de excesso de peso em crianças e adolescentes com fenilcetonúria e identificar possíveis fatores causais. Fontes de dados: Revisão sistemática realizada nas bases de dados Scientific Eletronic Library Online (SciELO), Publisher Medline (PubMed) e Biblioteca Virtual em Saúde (BVS) com os descritores "Phenylketonurias", "Overweight", "Child" e "Adolescent". Foram incluídos artigos originais sobre crianças e adolescentes, publicados entre 2008 e 2018 nos idiomas português, inglês ou espanhol. Síntese dos dados: Foram identificados 16 artigos e, após aplicação dos procedimentos de seleção, 6 estudos foram selecionados para compor a revisão. O excesso de peso em crianças e adolescentes com fenilcetonúria foi evento frequente nos estudos incluídos na presente revisão, variando de 7,8 a 32,6%. Aponta-se o sexo feminino como o grupo mais acometido pelo distúrbio nutricional. O principal fator associado ao excesso de peso na população de interesse na população de interesse foi o consumo calórico elevado aliado à falta de estímulos para a prática de atividades físicas. Conclusões: O excesso de peso pode ser considerado um desfecho comum em crianças e adolescentes com fenilcetonúria, sendo ocasionado principalmente pelo consumo alimentar inadequado e pelo sedentarismo. Salienta-se a importância da identificação precoce de agravos nutricionais em crianças e adolescentes fenilcetonúricos, a fim de prevenir doenças crônicas associadas e promover a saúde, com incentivo à manutenção de hábitos alimentares saudáveis e à prática regular de exercícios físicos.

Prevalence of Systemic Arterial Hypertension and Associated Factors Among Adults from the Semi-Arid Region of Pernambuco, Brazil / Prevalência e Fatores Associados à Hipertensão Arterial Sistêmica em Adultos do Sertão de Pernambuco, Brasil

Abstract Background: Systemic arterial hypertension is a substantial public health problem responsible for millions of deaths per year worldwide. However, little is known about the epidemiology of this disease in areas distant from large urban centers in Brazil. Such information is necessary to plan health promotion strategies. Objective: To estimate the prevalence of hypertension and determine its associated factors in adults residing in the semi-arid region of the state of Pernambuco, Northeastern Brazil. Method: This is a cross-sectional study conducted with a random sample of male and female adults. Individuals with systolic blood pressure ≥ 140 mm/Hg and/or diastolic blood pressure ≥ 90 mm/Hg and those who reported being under treatment with antihypertensive drugs were considered hypertensive. We collected data on demographic, socioeconomic, behavioral, and anthropometric characteristics, as well as health and nutrition. The statistical analysis used Pearson's chi-square test, the chi-square test for trend, and multivariate Poisson regression analysis. A p-value < 0.05 in the final model was considered indicative of statistical significance. Results: The sample consisted of 416 individuals, and the prevalence of hypertension was 27.4% (95%CI 23.2 - 32.0). In the final model, the independent predictors of hypertension were age of 40 years or older (p = 0.000), low economic class (p = 0.007), smoking (p = 0.023), overweight determined by the body mass index (p = 0.003), and reduced glucose tolerance/diabetes mellitus (p = 0.012). Conclusion: The prevalence of hypertension was high and related to important risk factors. Thus, prevention and control strategies are recommended.

Resumo Fundamento: A hipertensão arterial sistêmica (HAS) constitui grande problema de saúde pública, responsável por milhões de mortes por ano no mundo. Apesar disso e frente à necessidade de informações para o delineamento de estratégias de promoção da saúde, pouco se conhece sobre a epidemiologia da doença em regiões distantes dos grandes centros urbanos brasileiros. Objetivo: Estimar a prevalência e verificar os aspectos associados à HAS em adultos do sertão de Pernambuco, Brasil. Métodos: Estudo de delineamento transversal, com uma amostra aleatória de adultos de ambos os sexos. Foram considerados hipertensos aqueles que apresentaram pressão arterial sistólica ≥ 140 mmHg e/ou diastólica ≥ 90 mmHg, além daqueles que relataram estar em tratamento com anti-hipertensivos. Informações demográficas, socioeconômicas, comportamentais, antropométricas e de saúde e nutrição foram coletadas. Foram aplicados os testes do 2 de Pearson, c2 para tendência e a regressão multivariada de Poisson. No modelo final, foi considerada significância estatística quando p < 0,05. Resultados: A amostra foi composta por 416 indivíduos e a prevalência de HAS foi de 27,4% (IC95% 23,2 - 32,0). No modelo final, foram identificados como preditores independentes da HAS a faixa etária a partir dos 40 anos (p = 0,000), classe econômica baixa (p = 0,007), tabagismo (p = 0,023), excesso de peso pelo índice de massa corporal (p = 0,003) e adultos com tolerância à glicose diminuída/diabetes mellitus (p = 0,012). Conclusão: A prevalência de HAS é elevada e se relaciona com fatores de risco importantes, logo, são recomendáveis ações de prevenção e controle.

Prevalence of Systemic Arterial Hypertension and Associated Factors Among Adults from the Semi-Arid Region of Pernambuco, Brazil.

BACKGROUND: Systemic arterial hypertension is a substantial public health problem responsible for millions of deaths per year worldwide. However, little is known about the epidemiology of this disease in areas distant from large urban centers in Brazil. Such information is necessary to plan health promotion strategies. OBJECTIVE: To estimate the prevalence of hypertension and determine its associated factors in adults residing in the semi-arid region of the state of Pernambuco, Northeastern Brazil. METHOD: This is a cross-sectional study conducted with a random sample of male and female adults. Individuals with systolic blood pressure ≥ 140 mm/Hg and/or diastolic blood pressure ≥ 90 mm/Hg and those who reported being under treatment with antihypertensive drugs were considered hypertensive. We collected data on demographic, socioeconomic, behavioral, and anthropometric characteristics, as well as health and nutrition. The statistical analysis used Pearson's chi-square test, the chi-square test for trend, and multivariate Poisson regression analysis. A p-value < 0.05 in the final model was considered indicative of statistical significance. RESULTS: The sample consisted of 416 individuals, and the prevalence of hypertension was 27.4% (95%CI 23.2 - 32.0). In the final model, the independent predictors of hypertension were age of 40 years or older (p = 0.000), low economic class (p = 0.007), smoking (p = 0.023), overweight determined by the body mass index (p = 0.003), and reduced glucose tolerance/diabetes mellitus (p = 0.012). CONCLUSION: The prevalence of hypertension was high and related to important risk factors. Thus, prevention and control strategies are recommended.

Anemia and associated factors in women at reproductive age in a Brazilian Northeastern municipality. / Anemia e fatores associados em mulheres de idade reprodutiva de um município do Nordeste brasileiro.

OBJECTIVE: To identify the prevalence of iron-deficiency anemia and associated factors in women at reproductive age in the city of Vitoria de Santo Antão, Pernambuco. METHODS: Cross-sectional study with a representative sample of 322 women aged between 15 and 49 years. Anemia was diagnosed by measuring hemoglobin below 12 g/dL. The independent variables were: demographic and socioeconomic conditions (age, race/color, education, literacy, presence of children aged < 5 years in the household, regime of residence occupation, ownership of assets, and per capita income), housing conditions (number of people in the household, number of bedrooms, and basic sanitation), food and nutrition security and women's health conditions (menarche, number of pregnancies, history of miscarriages, body mass index, and ferritin). Poisson regression was used to analyze the factors associated with anemia. RESULTS: The mean age of women surveyed was 31.1 ± 6.61 years old (standard deviation - SD) and the prevalence of anemia was 18.6% (95%CI 14.7 - 23.3). After multivariate analysis, anemia was significantly associated with age ≤ 19 years and low ferritin. CONCLUSION: The prevalence of anemia is characterized as a mild public health problem and follows the world trend in developing countries.