Selenium Status and Hemolysis in Sickle Cell Disease Patients.

Sickle cell disease (SCD) is a genetic hemoglobinopathy characterized by chronic hemolysis. Chronic hemolysis is promoted by increased oxidative stress. Our hypothesis was that some antioxidant micronutrients (retinol, tocopherol, selenium, and zinc) would be determinant factors of the degree of hemolysis in SCD patients. We aimed to investigate the nutritional adequacy of these antioxidants and their relationships to hemolysis. The study included 51 adult SCD patients regularly assisted in two reference centers for hematology in the State of Rio de Janeiro, Brazil. Serum concentrations of retinol, alpha-tocopherol, selenium, and zinc were determined by high-performance liquid chromatography or atomic absorption spectrometry. Hematological parameters (complete blood count, reticulocyte count, hemoglobin, direct and indirect bilirubin, total bilirubin, lactate dehydrogenase) and inflammation markers (leukocytes and ultra-sensitive C-reactive protein) were analyzed. A linear regression model was used to test the associations between the variables. Most patients presented selenium deficiency and low selenium consumption. Linear regression analysis showed that selenium is the main determinant of hemolysis among the antioxidant nutrients analyzed. Thus, data from this study suggest that the nutritional care protocols for patients with SCD should include dietary sources of selenium in order to reduce the risk of hemolysis.

Nutritional Status, Nutrient Intake, and Food Diversity Among Children With Sickle Cell Anemia.

Children with sickle cell anemia (SCA) often exhibit nutritional deficiencies and are at high risk of dying before the age of 5 years. Ensuring adequate nutrition is a critical part of health care for such children. This study aimed to investigate the association between nutritional status, nutrient intake, and food diversity in children with SCA. A descriptive cross-sectional study was conducted on 74 children with SCA, between 24 and 71 months of age. Anthropometric measurements, food and nutrients consumption were determined. The prevalence of low weight, stunting, and overweight/obesity were 16.2%, 35.1%, and 16.2%, respectively. Mean folic acid intake was low (49.05%±51.22%), whereas the intakes of protein (426.71%±171.93%), retinol (292.97%±403.88%), phosphorus (204.55%±151.35%), magnesium (233.02%±151.14%), iron (250.76%±165.81%), and zinc (243.21%±148.40%) were high. The dietary phosphorus/protein ratio was high for 31.1% of the children, and 44.6% of the children had low dietary diversity score. No correlation was found between food diversity, nutrient adequacy, and nutritional status. Despite the adequacy of the intake of most micronutrients, diet quality was inadequate, constituting mainly ultraprocessed foods. Knowing the food consumption pattern of these children enables a more resolute nutritional intervention.

Sensitivity and Specificity of Body Mass Index as a Marker of Obesity in Elderly Patients on Hemodialysis.

OBJECTIVES: Diagnosing obesity by body mass index (BMI) may not be reliable in elderly individuals due to the changes in body composition. We aimed to analyze the accuracy of BMI thresholds by World Health Organization (WHO) and Nutrition Screening Initiative (NSI) to diagnose obesity in elderly patients on hemodialysis (HD). DESIGN: Multicenter cross-sectional study. SETTING: Six dialysis facilities. SUBJECTS: 169 elderly on chronic HD (70.4 ± 7.1 years; 63.9% men). MAIN OUTCOME VARIABLE: Total body fat percentage (BF%) was assessed by the sum of skinfold thicknesses and abdominal fat by waist circumference (WC). Both were used as reference to test the specificity and sensitivity of BMI thresholds (WHO: ≥30 kg/m(2); NSI: >27 kg/m(2)). RESULTS: The prevalence of obesity according to NSI-BMI, WHO-BMI, BF%, and WC thresholds were 31%, 13%, 27%, and 29.6% in men, respectively, and 36%, 15%, 13%, and 75% in women. Compared to BF%, the sensitivity of NSI-BMI was moderate (65.5%) for men and high (100%) for women, whereas that of WHO-BMI was low (31%) for men and high (87.5%) for women. Compared with WC, NSI-BMI had good (75%) sensitivity for men and moderate (47.8%) for women, whereas WHO-BMI had moderate (43.8%) sensitivity for men and low (19.6%) for women. The best agreement with BF% was observed for NSI-BMI in men (kappa = 0.46) and for WHO-BMI in women (kappa = 0.80). For WC, the best agreement was for WHO-BMI for men (kappa = 0.63) and NSI-BMI for women (kappa = 0.31). CONCLUSIONS: BMI thresholds do not accurately diagnose adiposity in elderly on HD. Therefore, using BMI may lead to misclassifications in this segment population.

Food intake assessment of elderly patients on hemodialysis.

OBJECTIVE: To investigate whether the dietary intake of elderly patients on hemodialysis (HD) is lower than that of elderly individuals with normal renal function. In addition, we also assessed whether the dietary intake of elderly on HD is lower on the dialysis day (DD) than on nondialysis days (non-DD). DESIGN: A cross-sectional and observational study including elderly on HD and non-chronic kidney disease (non-CKD) elderly. SUBJECTS: We assessed 54 noninstitutionalized elderly patients on HD (study group) and 47 non-CKD elderly (control group) aged ≥60 years. MAIN OUTCOME MEASURES: All participants had their dietary intake assessed by 3-day food diaries. As a sensitivity analysis, we also assessed the dietary intake in the adequate reporters, which were identified when the ratio-energy intake-to-estimated basal metabolic rate-was above 1.27 (Goldberg index). RESULTS: When comparing dietary intake between the study and control groups, adjusted for sex and underreporting, it was noted that only the intake of protein (ß: -9.9; P: .01) and phosphorus (ß: -104; P: .04) were significantly lower in the study group. In addition, when furthering the analysis in the study group by comparing DD with non-DD, it was observed that energy (18 ± 7 vs. 21 ± 8 kcal/kg/day), protein (0.8 ± 0.4 vs. 1.0 ± 0.4 g/kg/day), lipids (41 ± 20 vs. 48 ± 23 g/day), potassium (1371 ± 587 vs. 1540 ± 484 mg/day), and phosphorous intake (647 ± 312 vs. 789 ± 287 mg/day), but not carbohydrate (155 ± 54 vs. 167 ± 55 g/day) and calcium (470 ± 345 vs. 518 ± 333 g/day) were significantly lower on DDs than on non-DDs, respectively. CONCLUSIONS: Except for protein and phosphorous, energy and nutrient intake of elderly patients on HD are similar to that of non-CKD elderly. In addition, the dietary intake is lower on DDs, highlighting the importance of focusing efforts to improve nutritional intake mainly during the day of dialysis treatment.

Mixed dietary pattern is associated with a slower decline of body weight change during postpartum in a cohort of Brazilian women.

OBJECTIVE: The aim was to assess the effect of dietary patterns on postpartum body weight change (BWC). METHODS: A Food Frequency Questionnaire (FFQ) with 81 items was applied in 278 women having the first six months after delivery as the time frame. Body weight (BW) was measured at 15 days (baseline) and at 2.6 and 9 months postpartum. Principal components analysis was used to extract the dietary patterns. Linear mixed models were performed having BWC as the outcome and the dietary patterns as independent variables. RESULTS: Two major dietary patterns were identified: healthy and mixed. Energy intake was 2,838 kcal (DP = 624) and 2,233 kcal (DP = 455), for women classified in the highest quartiles of mixed and healthy dietary patterns, respectively. Mean BWC declined -0.151 kg/ month (SE = 0.02) independently of the dietary pattern. Predicted values of BWC among women that have adhered to mixed dietary pattern indicated a lower BWC of 0.830 kg/month (SE = 0.24; p < 0.001) at 6 months and 0.938 kg/month (SE = 0.24; p < 0.001) at 9 months postpartum. CONCLUSION: The mixed dietary pattern was associated with a slower rate of BWC during postpartum, compared the healthy dietary pattern.

Objetivo: El propósito de este estudio fue evaluar el efecto del patrón dietético sobre el cambio de peso corporal (CPC) en el puerperio. Métodos: Se aplicó una Cuestionario de frecuencia de alimentos (CFA) con 81 ítemes a 278 mujeres en el marco temporal de los siguientes 6 meses después del parto. El peso corporal (PC) se midió a los 15 días (basal) y a los 2,6 y 9 meses posparto. Se utilizó el análisis de los componentes principales para extraer los patrones dietéticos. Se realizaron modelos lineares mixtos, siendo el CPC el resultado y los patrones dietéticos las variables independientes. Resultados: Se identificaron dos patrones dietéticos principales: saludable y mixto. El consumo de energía fue de 2.838 kcal (DP = 624) y 2.233 kcal (DP = 455), para las mujeres clasificadas en los cuartiles más altos de los patrones dietéticos mixto y saludable, respectivamente. El decremento promedio del CPC fue de -0,151 kg/mes (EE = 0,02) independientemente del patrón dietético. Los valores predictivos del CPC en las mujeres con un patrón dietético mixto indicaron un menor CPC de 0,830 kg/mes (EE = 0,24; p < 0,001) a los 6 meses y de 0,938 kg/mes (EE = 0,24; p < 0,001) a los 9 meses posparto. Conclusión: El patrón dietético mixto se asoció con un ritmo de pérdida de peso más lento durante el puerperio en comparación con el patrón dietético saludable.