2024 SIAC guidelines on cardiorespiratory rehabilitation in pediatric patients with congenital heart disease.

The 2024 Interamerican Society of Cardiology (SIAC) guidelines on cardiorespiratory rehabilitation (CRR) in pediatric patients with congenital heart disease aim to gather and evaluate all relevant evidence available on the topic to unify criteria and promote the implementation of CRR programs in this population in Latin America and other parts of the world. Currently, there is no unified CRR model for the pediatric population. Consequently, our goal was to create these CRR guidelines adapted to the characteristics of congenital heart disease and the physiology of this population, as well as to the realities of Latin America. These guidelines are designed to serve as a support for health care workers involved in the care of this patient group who wish to implement a CRR program in their workplace. The guidelines include an easily reproducible program model that can be implemented in any center. The members of this Task Force were selected by the SIAC on behalf of health care workers dedicated to the care of pediatric patients with congenital heart disease. To draft the document, the selected experts performed a thorough review of the published evidence.

Muscle mass indicators as fat-free mass and lean soft tissue mass are associated with handgrip strength in HIV-diagnosed children and adolescents.

OBJECTIVE: To verify the association between fat free mass (FFM) and lean soft tissue mass (LSTM) with handgrip strength (HGS) in HIV children and adolescents, according to sex. METHOD: This cross-sectional study included 65 HIV children and adolescents, aged from 8-15 years (30 boys and 35 girls). FFM and LSTM were measured by dual-energy X-ray absorptiometry (DXA). HGS was measured with hydraulic dynamometer. Bone age was assessed by radiography of the wrist of the left carpus and moderate to vigorous physical activity was obtained through the use of accelerometers. The use of antiretroviral drugs (ART) was obtained from the medical records of each participant. RESULTS: For boys, the FFM model explained 86% the HGS variability (p < 0.001). For girls, the FFM model explained 90% the HGS variability (p < 0.001). LSTM explained 88% the HGS variability for both sexes. CONCLUSION: FFM and LSTM were directly associated with HGS. However, models with bone age, physical activity level and type of ART improved the explanatory power of LLM and LSTM in HGS.

Dyslipidemia, chronic inflammation, and subclinical atherosclerosis in children and adolescents infected with HIV: The PositHIVe Health Study.

HIV-infected children and adolescents may be at risk for cardiovascular disease due to chronic inflammation and exacerbation of risk factors. The aim of this study was as follows: 1) compare cardiovascular risk factors, chronic inflammation, and carotid intima-media thickness (IMTc) between the HIV and control groups; 2) determine the association of HIV and antiretroviral (ART) regimens with cardiovascular risk factors, chronic inflammation, and IMTc; and 3) identify variables associated with elevated IMTc. Cross-sectional analysis of 130 children and adolescents, 8-15 years of age, divided into HIV-infected (n = 65) and healthy control (n = 65) participants. Body fat, blood pressure, glycemia, insulin, and glycated hemoglobin, total cholesterol and fractions (LDL-C and HDL-C), triglycerides, C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and the IMTc were measured. The results showed HIV-infected children and adolescents had higher levels of glycemia (87.9 vs. 75.9 mg.dL-1, p< 0.001), LDL-c (94.7 vs. 79.5 mg.dL-1, p = 0.010), triglycerides (101.2 vs. 61.6 mg.dL-1, p< 0.001), CRP (1.6 vs. 1.0 mg.L-1, p = 0.007), IL-6 (1.42 vs. 0.01 pg.mL-1, p< 0.001), TNF-α (0.49 vs. 0.01 pg.mL-1, p< 0.001), mean IMTc (0.526 vs. 0.499 mm, p = 0.009), and lower HDL-c (53.7 vs. 69.4 mg.dL-1, p< 0.001) compared to controls. Systolic blood pressure (ß = 0.006, p = 0.004) and TNF-α (ß = -0.033, p = 0.029) accounted for 16% of IMTc variability in HIV-infected children and adolescents. In patients using protease inhibitors-based ART, male gender (ß = -0.186, p = 0.008), trunk body fat (ß = -0.011, p = 0.006), glucose (ß = 0.005, p = 0.046), and IL-6 (ß = 0.017, p = 0.039) accounted for 28% of IMTc variability. HIV-infected children and adolescents may be at risk for premature atherosclerosis due to chronic inflammation and dyslipidemia. Interventions with the potential to improve lipid profile, mitigate inflammation, and reduce cardiovascular risk are needed.

Validade de equações antropométricas para a estimativa da gordura corporal em idosos do sul do Brasil / Validity of anthropometric equations for the estimation of body fat in older adults individuals from southern Brazil

O objetivo do presente estudo foi analisar a validade cruzada de equações antropométricas para a estimativa do percentual de gordura corporal (%GC) em idosos brasileiros. Foram avaliados 180 idosos (120 mulheres e 60 homens) com idade entre 60 e 81 anos, a partir da medida das variáveis de estatura, massa corporal e perímetros corporais. Sete equações baseadas em medidas antropométricas foram testadas em relação aos critérios de validade cruzada sugeridos por Lohman. Utilizou-se da análise gráfica dos resíduos proposta por Bland e Altman para verificar a concordância das equações com o método critério, tendo como referência a medida de %GC estimado pela Absortometria Radiológica de Dupla Energia (DEXA). O grupo avaliado apresentou um índice de massa corporal entre 18,4 kg/m2 e 39,3kg/m2. O %GC médio foi de 23,1% nos homens e 37,3% nas mulheres, com variação de 6% a 51,4%. Os resultados apontam, para homens, as equações de Tran e Weltmann e de Deurenberg et al. não diferiram da medida da DEXA (p>0,05) e demonstraram concordância de 68,2% (r=0,78) e 72,8% (r=0,74), respectivamente. Enquanto que para as mulheres, as equações de Tran e Weltmann e de Gonçalves, não diferiram da medida da DEXA (p>0,05) e apresentam concordância de 66,0% (r=0,76) e 72,9% (r=0,75), respectivamente. Conclui-se que as equações antropométricas propostas na literatura diferem em relação à capacidade preditiva do %GC. Sugere-se cautela na utilização das equações antropométricas para a estimativa do %GC em idosos.

The objective of this study was to analyze the cross-validity of anthropometric equations for the estimation of body fat (%F) in Brazilian elderly individuals. A total of 180 elderly individuals (120 women and 60 men) ranging in age from 60 to 81 years were studied. Height, body weight and body perimeters were measured. Seven equations based on anthropometric measures were tested using the cross-validation criteria suggested by Lohman. Bland-Altman plots were used to determine the agreement of the equations with the reference method, with %F estimated by dual-energy X-ray absorptiometry (DEXA) serving as a reference. The body mass index of the group studied ranged from 18.4 to 39.3 kg/m2. Mean %F was 23.1% in men and 37.3% in women (range: 6 to 51.4%). The results showed no difference (p>0.05) between the equations of Tran and Weltmann and Deurenberg et al. and the DEXA measurement for men, with agreement of 68.2% (r=0.78) and 72.8% (r=0.74), respectively. For women, the equations of Tran and Weltmann and Gonçalves did not differ from the DEXA measurement (p>0.05), with agreement of 66.0% (r=0.76) and 72.9% (r=0.75), respectively. In conclusion, the anthropometric equations proposed in the literature differ in terms of their predictive capacity of %F. Caution in using the %F predictive anthropometric equation in elderly is advised.

[Use of bioelectrical impedance for the estimation of skeletal muscle mass in elderly men]. / Utilização da impedância bioelétrica para estimativa da massa muscular esquelética em homens idosos.

The aim of the present study was twofold: a) to determine the agreement between bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DEXA) for the estimation of skeletal muscle mass (SMM), and b) to analyze the predictive power of anthropometric variables and BIA for the prediction of SMM in the elderly. Sixty elderly men (61 to 80 years) from the southern region of Brazil were studied. Anthropometric variables (body weight and height) were measured, the resistance and hydration of fat-free tissues variables were determined by tetrapolar BIA (BF-310, Biodynamics). A whole body DEXA scan was also performed (Lunar Prodigy DF + 14319 Radiation and 7.52.002 DPX-L software). Differences between methods were analyzed using the t-test, analysis of residues and correlation coefficient. The predictive value of the anthropometric variables and BIA was evaluated by multiple linear regression. BIA overestimated SMM on average by 0.60 kg (sd = 1.59) when compared to DEXA, however, no statistical difference was observed (p > 0.05). There was a strong correlation between methods (r = 0.90; p < 0.01). Regression analysis demonstrated that the Ht2/ R variable explained 86% of the variation in SMM when adjusted for body weight and age, and this relationship did not depend on body fat, hydration of fat-free tissues or BMI. Thus, BIA as tested here is a valid method for the estimation of SMM in elderly men and its values can be best predicted using the regression model proposed, which included Ht2/R adjusted for body weight and age.