Nutritional state assessed by ultrasonography, but not by bioelectric impedance, predicts 28-day mortality in critically ill patients. Prospective cohort study.

BACKGROUND & AIMS: Malnutrition is a disease associated with unfavorable outcomes and high prevalence among critically ill patients. The primary aim of the study was to correlate the nutritional status of patients recently admitted to the intensive care unit (ICU) with the 28-day mortality rate. The secondary aim was to establish cut-off values for the bioelectrical impedance analysis (BIA) and ultrasonography (USG) methods for the classification of the nutritional status of critically ill patients. METHODS: Cohort-type prospective observational study design, with the inclusion of critically ill clinical-surgical patients, ≥18 years old, mechanically ventilated. Their nutritional status was assessed by phase angle and skeletal muscle mass (using BIA), and the sectional area of the rectus femoris muscle (RFM) (using USG) within the first 48 h of ICU admission. RESULTS: Among the patients included (n = 160), the non-survivors had lower values related to the survivors for averages of the phase angle (4.4 ± 1.5° vs 4.9 ± 1.2°; p = 0.041) and sectional area of the RFM (6.1 ± 1.6 cm2/m2vs 7.4 ± 1.8 cm2/m2; p = 0.030). Cut-off values were identified using the ROC curves for phase angle (≤4.4°), skeletal muscle mass (≤19.2 kg/m2), and sectional area of the RFM (≤5.9 cm2/m2). In multivariate logistic regression analysis, the sectional area of the RFM (≤5.9 cm2/m2) was the only independent predictor of 28-day mortality (OR = 6.08; p = 0.028). In the survival analysis, greater survival at 28 days was demonstrated for patients with phase angle >4.4° (p = 0.020) and sectional area of the RFM >5.9 cm2/m2 (p = 0.001). Malnourished patients had higher mortality than nourished patients according to the phase angle (31.5% vs 15.1%, respectively; p = 0.015) and the sectional area of the RFM (38.9% vs 6.3%, respectively; p = 0.001). CONCLUSIONS: The USG of the RFM is an efficient method for both classifying the nutritional status at ICU admission and assessing the prognosis of critically ill patients.

Dietary intake, body composition and metabolic parameters in women with polycystic ovary syndrome.

BACKGROUND & AIMS: Overweight polycystic ovary syndrome (PCOS) patients present exacerbation of clinical symptoms and increased risk for chronic diseases. The effects of inadequate dietary intake have been investigated in body weight gain in PCOS women. The aim of this study was to evaluate the dietary pattern and to analyze possible associations with the metabolism and body composition in PCOS women. METHODS: A case-control study was performed with thirty-nine women diagnosed with PCOS and thirty-five control women, matched by age and body mass index. A body composition assessment was performed by Dual-energy X-ray absorptiometry (DXA) and food intake was assessed using the seven-day food record. The metabolic parameters evaluated were fasting glucose, insulin, Homeostasis Model Assessment-estimated Insulin Resistance (HOMA-IR) index and oral glucose tolerance test (OGTT). RESULTS: No significant differences were observed in dietary intake of women with or without PCOS. In the analysis of the associations between dietary intake, metabolic parameters and body composition, PCOS women showed an inverse correlation between dietetic fiber intake and HOMA-IR index (r = -0.365; p = 0.024). Also in PCOS group, dietary fiber intake presented an inverse correlation with total body fat (r = -0.401; p = 0.011), trunk fat (r = -0.388; p = 0.015), and android fat (r = -0.431; p = 0.006). PCOS women group had higher glucose 120', compared to those without PCOS (p = 0.015). CONCLUSION: These results provide evidence that the adequate intake of dietary fiber contributes to more appropriate body composition and glucose metabolism in PCOS women and possibly toward the prevention of chronic non-communicable diseases.

Association between chronotype, food intake and physical activity in medical residents.

An individual's chronotype is a trait which reflects his/her diurnal preferences for the times of rest and activities, and displays a continuum from morningness to eveningness. Studies have shown that eveningness tends to be associated with a less healthy lifestyle, including increased likelihood of developing obesity. In this study, we examined the relationship between chronotype and food intake, physical sleep and activity in 72 resident physicians (52 women and 20 men). Assessments included chronotype evaluation by the Horne and Ostberg Morningness-Eveningness questionnaire (MEQ); food intake pattern through a self-administered food diary that was kept over the course of 3 non-successive days; physical activity level, using the Baecke questionnaire (BQ); sleep quality and quantity using the Pittsburgh Sleep Quality Index (PSQI); and sleepiness, Epworth Sleepiness Scale (ESS). Linear regression analyses, after adjustments for age, sex, body mass index (BMI), hours of additional work per week ESS and total physical activity score, showed that the chronotype score was negatively associated with cholesterol (coefficient = -0.24; p = 0.04), sweets (coefficient = -0.27, p = 0.03) and vegetables (coefficient = -0.26; p = 0.04) intakes. Following the same statistical adjustments, the chronotype score was positivity associated with leisure-time index (coefficient = 0.26, p = 0.03) and BQ total score (coefficient = 0.27, p = 0.03). We concluded that most issues related to nutrition problems and unhealthy lifestyle were associated with scores indicative of eveningness. These findings emphasize the importance of assessing an individual's chronotype when examining feeding behavior.

Xenogeneic Mesenchymal Stromal Cells Improve Wound Healing and Modulate the Immune Response in an Extensive Burn Model.

Major skin burns are difficult to treat. Patients often require special care and long-term hospitalization. Besides specific complications associated with the wounds themselves, there may be impairment of the immune system and of other organs. Mesenchymal stromal cells (MSCs) are a recent therapeutic alternative to treat burns, mainly aiming to accelerate the healing process. Several MSC properties favor their use as therapeutic approach, as they promote angiogenesis, stimulate regeneration, and enhance the immunoregulatory function. Moreover, since patients with extensive burns require urgent treatment and because the expansion of autologous MSCs is a time-consuming process, in this present study we chose to evaluate the therapeutic potential of xenogeneic MSCs in the treatment of severe burns in rats. MSCs were isolated from mouse bone marrow, expanded in vitro, and intradermally injected in the periphery of burn wounds. MSC-treated rats presented higher survival rates (76.19%) than control animals treated with PBS (60.86%, p < 0.05). In addition, 60 days after the thermal injury, the MSC-treated group showed larger proportion of healed areas within the burn wounds (90.81 ± 5.05%) than the PBS-treated group (76.11 ± 3.46%, p = 0.03). We also observed that CD4(+) and CD8(+) T cells in spleens and in damaged skin, as well as the percentage of neutrophils in the burned area, were modulated by MSC treatment. Plasma cytokine (TGF-ß, IL-10, IL-6, and CINC-1) levels were also altered in the MSC-treated rats, when compared to controls. Number of injected GFP(+) MSCs progressively decreased over time, and 60 days after injection, few MSCs were still detected in the skin of treated animals. This study demonstrates the therapeutic effectiveness of intradermal application of MSCs in a rat model of deep burns, providing basis for future regenerative therapies in patients suffering from deep burn injuries.

Severe protein malnutrition in a morbidly obese patient after bariatric surgery.

The aim of this study was to describe the clinical course of a morbidly obese patient who underwent Roux-en-Y gastric bypass (RYGB) surgery and, in the late postoperative period, presented the expected loss of weight, but also presented severe protein malnutrition (PM). A patient with morbid obesity, who in March 2012, presented PM (serum albumin = 2.4 g/dL) 2 y after the completion of RYGB surgery (loss of 52.7% of usual body weight). During the hospitalization, the patient received partial volumes of commercial semi-elemental, high-protein, low-fat diet by tube feeding with gastric positioning, associated with an oral low-fat, low-sodium, and bland-consistency diet. The patient presented a temporary clinical improvement, however, outpatient monitoring identified the need for subsequent hospitalizations due to the recurrence of severe hypoalbuminemia (e.g., 1.39 g/dL), anasarca (increase of 15 kg in 79 d), and normocytic and normochromic anemia (e.g., hemoglobin 9.2 g/dL). In July 2013 the RYGB partial reversal technique was performed with a reduction of 100 cm in the Roux-en-Y arm. Seventy days after surgery, the patient was asymptomatic (albumin 3.7 g/dL), however, she presented rapid and progressive recovery of the body weight (increase of 10.3 kg in 60 d, without edema). The effective treatment of morbid obesity is still a major challenge in clinical practice. Restrictive, malabsorptive bariatric techniques are associated with nutritional deficiencies. Severe PM is rarely reported as a late postoperative complication of RYGB, however, due to the serious consequences associated with this, it requires early diagnosis and treatment.

Sleep pattern is associated with adipokine levels and nutritional markers in resident physicians.

Shift work and long hours of work are common in medical training and have been associated with a higher propensity for developing nutritional problems and obesity. Changes in leptin and ghrelin concentrations - two hormones that contribute importantly to the central regulation of food intake - are poorly described in this population. The aim of this study was to identify possible negative associations between sleep patterns, nutritional status and serum levels of adipokines. The study included 72 resident physicians (52 women and 20 men) who underwent the following assessments: nutritional assessment (3-day dietary recall evaluated by the Adapted Healthy Eating Index), anthropometric variables, fasting metabolism, physical activity level, sleep quality and sleepiness. Resident physicians with poor sleep quality reported greater weight gain after the beginning of residency (5.1 and 3.0 kg, respectively; p = 0.01) and higher frequency of abnormal waist circumference (44.2 and 17.6%, respectively; p = 0.04) than those with better sleep quality. Mean ghrelin concentration was greater in volunteers with poor sleep quality (64.6 ± 67.8 and 26.2 ± 25.0 pg/mL, respectively; p = 0.04). Women identified as having excessive daytime sleepiness had lower levels of leptin (9.57 ± 10.4 ng/mL versus 16.49 ± 11.4 ng/mL, respectively; p = 0.03) than those without excessive sleepiness. Furthermore, correlations were found between hours of additional work per week and: intake of cereals, bread and pasta (r = 0.22, p = 0.01); intake of servings of fruits (r = -0.20; p = 0.02) and beans (r = -0.21; p = 0.01); and global score for Adapted Healthy Eating Index (r = -0.23; p = 0.008; Table 3). The sleep quality total score correlated with servings of beans (r = -0.22; p = 0.01) and servings of oils (r = 0.23; p = 0.008). Significant correlations were found between mean of time of sleep and servings of cereals, bread and pasta (r = 0.20; p = 0.02), servings of meat (r = -0.29; p = 0.02) and cholesterol levels (r = 0.27; p = 0.03). These observations indicate that sleep patterns and long working hours of resident physicians are negatively associated with biological markers related to central food control, the lipid profile, cholesterol levels and eating healthy foods. These factors may predispose these shift workers to become overweight and develop metabolic disorders.

Dietary patterns, metabolic markers and subjective sleep measures in resident physicians.

Shiftwork is common in medical training and is necessary for 24-h hospital coverage. Shiftwork poses difficulties not only because of the loss of actual sleep hours but also because it can affect other factors related to lifestyle, such as food intake, physical activity level, and, therefore, metabolic patterns. However, few studies have investigated the nutritional and metabolic profiles of medical personnel receiving training who are participating in shiftwork. The aim of the present study was to identify the possible negative effects of food intake, anthropometric variables, and metabolic and sleep patterns of resident physicians and establish the differences between genders. The study included 72 resident physicians (52 women and 20 men) who underwent the following assessments: nutritional assessment (3-day dietary recall evaluated by the Adapted Healthy Eating Index), anthropometric variables (height, weight, body mass index, and waist circumference), fasting metabolism (lipids, cortisol, high-sensitivity C-reactive protein [hs-CRP], glucose, and insulin), physical activity level (Baecke questionnaire), sleep quality (Pittsburgh Sleep Quality Index; PSQI), and sleepiness (Epworth Sleepiness Scale; ESS). We observed a high frequency of residents who were overweight or obese (65% for men and 21% for women; p = 0.004). Men displayed significantly greater body mass index (BMI) values (p = 0.002) and self-reported weight gain after the beginning of residency (p = 0.008) than women. Poor diet was observed for both genders, including the low intake of vegetables and fruits and the high intake of sweets, saturated fat, cholesterol, and caffeine. The PSQI global scores indicated significant differences between genders (5.9 vs. 7.5 for women and men, respectively; p = 0.01). Women had significantly higher mean high-density lipoprotein cholesterol (HDL-C; p < 0.005), hs-CRP (p = 0.04), and cortisol (p = 0.009) values than men. The elevated prevalence of hypertriglyceridemia and abnormal values of low-density lipoprotein cholesterol (LDL-C; >100 mg/dL) were observed in most individuals. Higher than recommended hs-CRP levels were observed in 66% of the examined resident physicians. Based on current recommendations, a high prevalence of low sleep quality and excessive daytime sleepiness was identified. These observations indicate the need to monitor health status and develop actions to reassess the workload of medical residency and the need for permission to perform extra night shifts for medical residents to avoid worsening health problems in these individuals.