Association of insufficient practice of physical activity with demographic, anthropometric and biochemical factors in hypertensive patients / Fatores associados à atividade física em pacientes com hipertensão tratados e monitorados pelo Hiperdia

Resumo Introdução Considerando-se a magnitude da hipertensão arterial sistêmica e suas complicações, assim como a importância da atividade física regular na sua prevenção e/ou tratamento, é necessário identificar os fatores associados à prática de atividade física insuficiente. Objetivo Analisar os fatores associados à atividade física insuficiente em hipertensos atendidos na atenção primária à saúde. Método Estudo transversal realizado com amostra aleatória de 305 hipertensos em três unidades de saúde de São Luís (MA). Foi realizada análise bivariada, com estimativas de razões de prevalência, intervalos de confiança e análise multivariada por regressão de Poisson. Resultados A atividade física insuficiente foi observada em 38,7% da amostra. Atividade física insuficiente foi associada a menos de 8 anos de educação formal (razão de prevalência - RP = 1,58; intervalo de confiança de 95% - IC = 1,04-2,39), colesterol total ≥200 mg/dL (RP = 0,78; IC 95% = 0,58 -1,04), lipoproteína de baixa densidade colesterol-LDLc ≥100 mg/dL (RP = 0,79; IC 95% = 0,53-0,95) e lipoproteína de alta densidade colesterol-HDLc <40 mg / dL entre homens e <50 mg/dL entre mulheres (RP = 1,21; IC 95% = 0,90-1,64). A escolaridade <8 anos (RP = 1,50; IC 95% = 0,99-2,29) e LDLc ≥100 mg/dL (RP = 0,72; IC 95% = 0,54-0,96) também estiveram associados na regressão multivariada. Conclusão Observou-se alta prevalência de atividade física insuficiente e sua associação com baixa escolaridade e LDLc alterado em hipertensos.

Abstract Background Considering the magnitude of systemic hypertension (SH) and its complications, as well as the importance of regular physical activity in its prevention and/or treatment, there is a necessity to identify the factors associated with insufficient practice of physical activity. Objective To analyze factors associated with insufficient physical activity in hypertensive patients treated at Primary Health Care (PHC). Method This cross-sectional study was performed with a random sample of 305 hypertensive patients in three PHC units in São Luis, state of Maranhão, Brazil. A bivariate analysis was performed with estimates of prevalence ratios and confidence intervals, and multivariate analysis using Poisson regression. Results Insufficient physical activity was observed in 38.7% of the sample. Insufficient physical activity was associated with having <8 years of formal education (prevalence ratio-PR=1.58; 95% confidence interval-CI=1.04-2.39), total cholesterol ≥200 mg/dL (PR=0.78; 95% CI=0.58-1.04), low-density lipoprotein cholesterol-LDL ≥100 mg/dL (PR=0.79; 95% CI=0.53-0.95), and high-density lipoprotein cholesterol-HDL <40 mg/dL among men and <50 mg/dL among women (PR=1.21; 95% CI=0.90-1.64). Length of education <8 years (PR=1.50; 95% CI=0.99-2.29) and LDL ≥100 mg/dL (PR=0.72;95% CI=0.54-0.96) were also associated in the multivariate regression. Conclusion High prevalence of insufficient physical activity and its association with low education level and altered LDL serum levels were observed in hypertensive patients.

Sum of skinfolds measurement can be used in the estimation of total body fat in patients with chronic kidney disease undergoing hemodialysis.

INTRODUCTION: Introduction: body fat reflects important clinical impacts among hemodialysis patients; thus, simple and safe methods are required for a careful evaluation of this body compartment. Objectives: to evaluate the concordance of estimates of total body fat percentage (%BF), calculated using bioelectrical impedance analysis (BIA) and sum of four skinfolds (SSKD) measures, with those obtained using dual-energy X-ray absorptiometry (DEXA) in patients with chronic kidney disease (CKD) receiving hemodialysis. Methods: a cross-sectional study was conducted in 317 patients undergoing hemodialysis. The %BF was evaluated using BIA, SSKD measurement, and DEXA, and stratified by sex and tertiles. The Wilcoxon test for paired samples was used to compare the %BF obtained using the different methods, and Lin's concordance correlation coefficient (CCC-L) to evaluate concordance. Results: the average %BF estimated using DEXA was 29.3 ± 9.3 %, with significant differences among the three methods (p < 0.05). SSKD measurement presented a higher CCC-L concordance with DEXA, regardless of sex. After stratification of the sample in tertiles, BIA presented a higher CCC-L concordance with DEXA among the patients with CKD with a %BF above 34.4 % (third tertile). Conversely, SSKD measurement presented better concordance with DEXA for those with a %BF equal to or less than 34.4 %. Conclusions: in terms of the estimates of the %BF, SSKD measurement displayed a better concordance with DEXA.

INTRODUCCIÓN: Introducción: la grasa corporal refleja importantes impactos clínicos entre los pacientes en hemodiálisis; por lo tanto, se requieren métodos simples y seguros para una evaluación cuidadosa de este compartimiento del cuerpo. Objetivos: evaluar la concordancia de las estimaciones del porcentaje de grasa corporal total (%GC), calculadas mediante el análisis de impedancia bioeléctrica (BIA) y la suma de las medidas de cuatro pliegues cutáneos (CPC), con las obtenidas mediante absorciometría dual energética de rayos X (DEXA) en pacientes con enfermedad renal crónica (ERC) que reciben hemodiálisis. Métodos: se realizó un estudio transversal en 317 pacientes en hemodiálisis. La %GC se evaluó mediante BIA, medición de CPC y DEXA, y se estratificó por sexos y terciles. Se utilizó la prueba de Wilcoxon para muestras pareadas para comparar los %GC obtenidos con los diferentes métodos, y el coeficiente de correlación de concordancia de Lin (CCC-L) para evaluar la concordancia. Resultados: el %GC promedio estimado usando DEXA fue del 29,3 ± 9,3 %, con diferencias significativas entre los tres métodos (p < 0,05). La medición de los CPC presentó una mayor concordancia de CCC-L con DEXA, independientemente del sexo. Tras la estratificación de la muestra en terciles, la BIA presentó una mayor concordancia de CCC-L con DEXA entre los pacientes con ERC con un %GC superior al 34,4 % (tercer tercil). Por el contrario, la medición de los CPC presentó una mejor concordancia con la DEXA para aquellos con un %GC igual o inferior al 34,4 %. Conclusión: en términos de las estimaciones del %GC, la medición de los CPC mostró una mejor concordancia con la DEXA.

Prevalence of sarcopenia in kidney transplants and their association with determinant factors of muscle homeostasis.

INTRODUCTION: Sarcopenia is characterized by the involuntary loss of lean body mass associated with a progressive reduction of muscle strength. OBJECTIVE: To determine the prevalence of sarcopenia in kidney transplant recipients and its association with the determining factors that control muscle homeostasis. METHODS: We evaluated renal transplant recipients undergoing follow-up at the University Hospital of the Federal University of Maranhão from June 2017 to July 2018 and who met the inclusion criteria. Sarcopenia was defined according to the European criteria. The skeletal muscle mass index was measured by dual-energy radiological absorptiometry; the values <7,26 kg/m2 for men and <5,5 kg/m2 for women were adopted for muscle depletion. For handgrip strength, values of <30 kg for men and <20 kg for women were considered as reduced muscle strength. In both sexes, the cutoff point for walking speed was <0,8 m/s. RESULTS: We evaluated 83 renal transplant recipients with a mean age of 48.8 ± 12,1 years and predominantly males (57,8%). The prevalence of sarcopenia was 19,3%. Among individuals without sarcopenia, 17,9% had a decrease in handgrip strength and 40,3% has altered gait speed. DISCUSSION: Individuals submitted to renal transplant may develop sarcopenia while still young and already present altered muscle function and strength even before the depletion of lean body mass. CONCLUSION: Early diagnosis may allow the prevention of sarcopenia and provide a better quality of life for patients.

Prevalence of sarcopenia in kidney transplants and their association with determinant factors of muscle homeostasis

SUMMARY INTRODUCTION: Sarcopenia is characterized by the involuntary loss of lean body mass associated with a progressive reduction of muscle strength. OBJECTIVE: To determine the prevalence of sarcopenia in kidney transplant recipients and its association with the determining factors that control muscle homeostasis. METHODS: We evaluated renal transplant recipients undergoing follow-up at the University Hospital of the Federal University of Maranhão from June 2017 to July 2018 and who met the inclusion criteria. Sarcopenia was defined according to the European criteria. The skeletal muscle mass index was measured by dual-energy radiological absorptiometry; the values <7,26 kg/m2 for men and <5,5 kg/m2 for women were adopted for muscle depletion. For handgrip strength, values of <30 kg for men and <20 kg for women were considered as reduced muscle strength. In both sexes, the cutoff point for walking speed was <0,8 m/s. RESULTS: We evaluated 83 renal transplant recipients with a mean age of 48.8 ± 12,1 years and predominantly males (57,8%). The prevalence of sarcopenia was 19,3%. Among individuals without sarcopenia, 17,9% had a decrease in handgrip strength and 40,3% has altered gait speed. DISCUSSION: Individuals submitted to renal transplant may develop sarcopenia while still young and already present altered muscle function and strength even before the depletion of lean body mass. CONCLUSION: Early diagnosis may allow the prevention of sarcopenia and provide a better quality of life for patients.

RESUMO INTRODUÇÃO: A sarcopenia é caracterizada pela perda involuntária da massa magra associada à redução da força e função muscular, de modo progressivo. OBJETIVO: Determinar a prevalência de sarcopenia em transplantados renais e sua associação com os fatores determinantes que controlam a homeostase do músculo. MÉTODOS: Foram avaliados indivíduos transplantados renais em acompanhamento no Hospital Universitário da Universidade Federal do Maranhão no período de junho de 2017 a julho de 2018 e que preencheram os critérios. A sarcopenia foi definida de acordo com o critério europeu. O índice de massa muscular esquelética foi medido por meio da densitometria computadorizada por absorciometria radiológica de dupla energia; valores <7,26 kg/m2 para homens e <5,5 kg/m2 para mulheres foram adotados para depleção muscular. Para força de preensão manual, valores de <30 kg para homens e <20 kg para mulheres foram considerados como redução da força muscular. Em ambos os sexos, o ponto de corte para velocidade de marcha reduzida foi <0,8 m/s. RESULTADOS: Foram avaliados 83 transplantados renais, com média de idade de 48,8±12,1 anos e predominância de indivíduos do sexo masculino (57,8%). A prevalência de sarcopenia foi de 19,3%. Entre os indivíduos sem sarcopenia, 17,9% já tinham diminuição da força de preensão manual e 40,3%, alteração do teste de marcha. DISCUSSÃO: Indivíduos submetidos ao transplante renal podem desenvolver sarcopenia jovens e apresentar alteração da função e da força muscular mesmo antes da depleção da massa magra. CONCLUSÃO: O diagnóstico precoce pode permitir a prevenção da sarcopenia e propiciar melhor qualidade de vida aos pacientes.

Sarcopenia and inflammation in patients undergoing hemodialysis.

INTRODUCTION: Introduction: in individuals with chronic kidney disease, sarcopenia is prevalent and is associated with increased morbidity and mortality, and the occurrence of cardiovascular complications. Objective: to verify the relationship between sarcopenia and inflammation in hemodialysis patients. Methods: a cross-sectional study with 209 patients in five hemodialysis units. Demographic, socioeconomic, body composition, clinical laboratory, and functional data were collected. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People (grip strength < 27 kg for men and < 16 kg for women; DEXA muscle mass < 7.0 kg/m² for men and < 5.5 kg/m² for women). Inflammation was assessed by C-reactive protein. Results: mean age was 51.9 ± 15.0 years, with a predominance of males (59.3 %). The prevalence of sarcopenia was 29.1 % and that of inflammation was 50.2 %. A Poisson regression analysis showed that sarcopenia was associated with increased hsCRP values (PR: 1.06; 95 % CI: 1.01-1.10; p-value = 0.005); BMI (PR: 0.74; 95 % CI: 0.65-0.84; p-value < 0.001); age (PR: 1.02; 95 % CI: 1.00-1.03; p < 0.001); male (PR: 5.75; 95 % CI: 3.20-10.34; p-value < 0.001); presence of diabetes mellitus (DM) (PR: 1.87; 95 % CI: 1.27-2.74; p-value < 0.001); % body fat (PR: 1.07; 95 % CI: 1.04-1.09; p-value < 0.001). Conclusion: the prevalence of sarcopenia can be considered high in this study, as well as inflammation. Being inflamed, presence of DM, being male, increasing age, and % body fat were risk factors for sarcopenia. On the other hand, increased BMI had a protective role.

INTRODUCCIÓN: Introducción: en individuos con enfermedad renal crónica, la sarcopenia es prevalente y está asociada a un aumento de la morbilidad y la mortalidad, y a la aparición de complicaciones cardiovasculares. Objetivo: verificar la relación entre sarcopenia e inflamación en pacientes en hemodiálisis. Métodos: estudio transversal de 209 pacientes en cinco unidades de hemodiálisis. Se recopilaron datos demográficos, socioeconómicos, de composición corporal, laboratorio clínico y funcional. La sarcopenia se diagnosticó conforme al Grupo de Trabajo Europeo sobre Sarcopenia en Personas Mayores (fuerza de agarre < 27 kg para hombres y < 16 kg para mujeres; masa muscular DEXA < 7.0 kg/m² para hombres y < 5.5 kg/m² para mujeres). La inflamación se evaluó mediante la proteína C-reactiva. Resultados: la edad media fue de 51,9 ± 15,0 años, con predominio de varones (59,3 %). La prevalencia de la sarcopenia fue del 29,1 % y la de la inflamación del 50,2 %. El análisis de regresión de Poisson mostró que la sarcopenia se asociaba con un aumento de los valores de hsCRP (PR: 1,06; IC del 95 %: 1,01-1,10; valor de p = 0,005); IMC (PR: 0,74; IC del 95 %: 0,65-0,84; valor p < 0,001); edad (PR: 1,02; IC 95 %: 1,00-1,03; p < 0,001); hombre (PR: 5,75; IC 95 %: 3,20-10,34; valor p < 0,001); presencia de DM (PR: 1,87; IC 95 %: 1,27-2,74; valor p < 0,001); % de grasa corporal (PR: 1,07; IC 95 %: 1,04-1,09; valor p < 0,001). Conclusión: la prevalencia de la sarcopenia puede considerarse alta en este estudio, así como la inflamación. Tener inflamación, la presencia de DM, ser hombre, la mayor edad y el % de grasa corporal resultaron ser factores de riesgo de sarcopenia. Por otro lado, el aumento del IMC tuvo un papel protector.

Abdominal obesity and reduction of glomerular filtration.

The objective was to evaluate the association between nutritional status and the glomerular filtration rate (GFR) in remaining quilombolas. Cross-sectional study carried out on 32 remaining quilombola communities in the municipality of Alcântara-MA. The nutritional indicators (IN) used were: body mass index (BMI); Waist circumference (WC); Waist-to-hip ratio (WHR); Waist-to-height ratio (WHtR); conicity index (CI) and estimated visceral adipose tissue (VAT). GFR was estimated from the CKD-EPI creatinine-cystatin C formula. The Shapiro Wilk test was used to evaluate the normality of the quantitative variables. In order to compare the second IN sex, the chi-square test was applied. The Anova or Kruskal-Wallis tests were used to verify the association between IN and GFR. Of the 1,526 remaining quilombolas studied, 89.5% were black or brown, 51.2% were women, 88.6% belonged to economic classes D and E and 61.2% were farmers or fishermen. Clinical investigation revealed 29.2% of hypertensive patients, 8.5% of diabetics and 3.1% with reduced GFR. The BMI revealed 45.6% of the remaining quilombolas with excess weight. When compared to men, women presented a higher prevalence of overweight by BMI (56.6% vs 33.8%, p <0.001) and abdominal obesity CC (52.3% vs 4.3%), WHR (76,5% vs 5.8%), WHtR (82.3% vs 48.9%) and VAT (27.1% vs 14.5%) (p <0.001). Comparing the means of IN according to the GFR, it was observed that the higher the mean value of the IN lower the GFR (p <0.05). The GFR reduced with increasing mean values of nutritional indicators of abdominal obesity, regardless of sex.

Abdominal obesity and reduction of glomerular filtration

SUMMARY The objective was to evaluate the association between nutritional status and the glomerular filtration rate (GFR) in remaining quilombolas. Cross-sectional study carried out on 32 remaining quilombola communities in the municipality of Alcântara-MA. The nutritional indicators (IN) used were: body mass index (BMI); Waist circumference (WC); Waist-to-hip ratio (WHR); Waist-to-height ratio (WHtR); conicity index (CI) and estimated visceral adipose tissue (VAT). GFR was estimated from the CKD-EPI creatinine-cystatin C formula. The Shapiro Wilk test was used to evaluate the normality of the quantitative variables. In order to compare the second IN sex, the chi-square test was applied. The Anova or Kruskal-Wallis tests were used to verify the association between IN and GFR. Of the 1,526 remaining quilombolas studied, 89.5% were black or brown, 51.2% were women, 88.6% belonged to economic classes D and E and 61.2% were farmers or fishermen. Clinical investigation revealed 29.2% of hypertensive patients, 8.5% of diabetics and 3.1% with reduced GFR. The BMI revealed 45.6% of the remaining quilombolas with excess weight. When compared to men, women presented a higher prevalence of overweight by BMI (56.6% vs 33.8%, p <0.001) and abdominal obesity CC (52.3% vs 4.3%), WHR (76,5% vs 5.8%), WHtR (82.3% vs 48.9%) and VAT (27.1% vs 14.5%) (p <0.001). Comparing the means of IN according to the GFR, it was observed that the higher the mean value of the IN lower the GFR (p <0.05). The GFR reduced with increasing mean values of nutritional indicators of abdominal obesity, regardless of sex.

RESUMO O objetivo foi avaliar a associação entre o estado nutricional e a taxa de filtração glomerular (TFG) em remanescentes quilombolas. Estudo transversal, realizado em 32 comunidades remanescentes de quilombolas, no município de Alcântara - MA. Os indicadores nutricionais (IN) utilizados foram: índice de massa corporal (IMC); circunferência da cintura (CC); relação cintura-quadril (RCQ); relação cintura-estatura (RCEst); índice de conicidade (Índice C) e tecido adiposo visceral estimado (TAVe). A TFG foi estimada a partir da fórmula do CKD-EPI creatinina-cistatina C. O teste Shapiro Wilk foi utilizado para avaliar a normalidade das variáveis quantitativas. Para comparar os IN segundo sexo foi aplicado o teste qui-quadrado. Os testes Anova ou Kruskal-Wallis foram usados para verificar a associação entre os IN e a TFG. Dos 1.526 remanescentes quilombolas estudados, 89,5% eram da cor preta ou parda, 51,2% eram mulheres, 88,6% pertenciam às classes econômicas D e E e 61,2% eram lavradores ou pescadores. A investigação clínica revelou 29,2% de hipertensos, 8,5% de diabéticos e 3,1% com TFG reduzida. O IMC revelou 45,6% dos remanescentes quilombolas com excesso de peso. Quando comparadas aos homens, as mulheres apresentaram maior prevalência de excesso de peso pelo IMC (56,6% vs. 33,8%; p <0,001) e obesidade abdominal CC (52,3% vs. 4,3%), RCQ (76,5% vs. 5,8%), RCEst (82,3% vs. 48,9%) e TAVe (27,1% vs. 14,5%) (p<0,001). Comparando as médias dos IN segundo a TFG observou-se que, quanto maior o valor médio dos IN, menor a TFG (p<0,05). A TFG foi reduzida com o aumento dos valores médios dos indicadores nutricionais de obesidade abdominal, independentemente do sexo.

Abordagem nutricional ao paciente com Doença Renal Crônica

São abordados assuntos como: os métodos de avaliação e diagnóstico nutricional na DRC para o desenvolvimento de estratégias para a prevenção e terapia nutricional para pacientes renais e de grupos de risco; as principais estratégias nutricionais para a realização das orientações referentes a prevenção da doença renal crônica nos principais grupos de risco; as principais técnicas de aferição para avaliação e diagnóstico do estado nutricional do paciente com DRC. Este recurso educacional integra o conjunto de objetos na área temática de Nefrologia, ofertados pela UNA-SUS/UFMA. Trata-se de um recurso autoinstrucional, com carga horária sugerida de 30 horas. O curso é composto por 3 unidades educacionais com o objetivo de capacitar os profissionais da saúde que atuam ou que pretendem atuar na Atenção Básica.

Terapia nutricional para indivíduos com doença renal

Este recurso educacional integra o conjunto de objetos autoinstrucionais ofertados pela UNA-SUS/UFMA na área temática de Nefrologia. Trata-se de um e-book que visa promover a compreensão sobre as principais abordagens de terapia nutricional para indivíduos com doença renal crônica durante o tratamento conservador, diálise e transplante. No material, são apresentadas as recomendações de suporte nutricional para o paciente com lesão renal aguda. Faz-se também a identificação dos principais grupos de alimentos indicados e contraindicados para a nutrição de portadores de DRC. Além deste, há mais 31 e-books tratando sobre diversas questões relacionadas à Nefrologia. Todos eles fornecem conteúdos interessantes para a formação dos profissionais da saúde que atuam no SUS e dos acadêmicos da área.

Conhecimento de hiperfosfatemia e quelante de fósforo em hemodialíticos / Knowledge about hyperphosphatemia and phosphate binder at hemodialysis

Introdução: O controle do fósforo sérico é um desafio no tratamento de pacientes em hemodiálise. A orientação dietética e o uso adequado de quelantes são a base do tratamento e seu sucesso depende essencialmente da habilidade do paciente em entender e aderir ao plano dietético e ao uso dos quelantes. Objetivo: Avaliar o conhecimento sobre hiperfosfatemia e uso de quelantes de fósforo de pacientes em hemodiálise. Método: Estudo transversal que avaliou 74 pacientes em hemodiálise, por meio de questionário preestabelecido sobre conhecimento da hiperfosfatemia, uso de quelantes, alimentos ricos em fósforo, e aspectos relacionados ao tratamento da hiperfosfatemia. Os parâmetros laboratoriais Kt/V, níveis séricos de paratormônio (PTH), fósforo (P), cálcio (Ca) e produto cálcio/fósforo (CaxP) foram identificados. Os dados foram apresentados como porcentagens ou média e desvio padrão. Para avaliação dos fatores associados à hiperfosfatemia, utilizou-se a regressão de Poisson, adotando nível de significância adotado de 5%. Resultados: Cerca de 40,3% dos pacientes faziam uso de quelantes de fósforo, 36,6% apresentavam níveis séricos de PTH elevados, 36% de hiperfosfatemia e 28% estavam com o produto Ca x P inadequado. A maioria conhecia os efeitos da hiperfosfatemia (52%) e sua relação causal com a alimentação (82,2%), sendo capazes de identificar os alimentos ricos em fósforo (60%). O uso de quelantes junto às refeições foi apontado por 88% dos pacientes. O insucesso no tratamento da hiperfosfatemia foi atribuído ao consumo de dieta rica em fósforo por 70,9% dos pacientes. Conclusão: A maioria dos pacientes possuía conhecimento sobre a hiperfosfatemia, contudo, apresentou baixa adesão às recomendações dietéticas.(AU)

Introduction: The control of serum phosphorus is a challenge in the treatment of hemodialysis patients. Dietary guidance and the proper use of chelating agents are the mainstay of treatment, its success depends primarily on the patient's ability to understand and adhere to the dietary plan and the use of chelators. Objective: To assess the knowledge of hyperphosphatemia and use of phosphate binders in hemodialysis patients treated. Methods: A cross-sectional study evaluated 74 patients in hemodialysis, through preestablished questionnaire on knowledge of hyperphosphatemia, use of binders, phosphorus-rich foods, and aspects related to the treatment of hyperphosphatemia. The laboratory parameters Kt / V, serum levels of parathyroid hormone (PTH), phosphorus (P), calcium (Ca) and product calcium / phosphorus (Ca x P) were identified. The data were presented as percentages or means and standard deviations. To evaluate the factors associated with hyperphosphatemia were used Poisson regression, with a level of significance of 5%. Results: About 40.3% of patientes made use of phosphorus binders, 36.6% had elevated serum PTH, 36% of hyperphosphatemia and 28% had inadequate Ca x P product. Most knew the effects of hyperphosphatemia (52%) and their causal relationship with food (82.2%), being able to identify foods rich in phosphorus (60%). The use of binders with meals was reported by 88% of patients. The failure in the treatment of hyperphosphatemia has been attributed to the consumption of a diet rich in phosphorus by 70.9% of patients. Conclusion: Most patients had knowledge of hyperphosphatemia, however showed poor adherence to dietary recommendations.(AU)

Factors associated with dietary supplement use by people who exercise at gyms.

OBJECTIVE To assess the factors associated with the use of dietary supplements by people who exercise at gyms.METHODS A cross-sectional study with a sample defined by convenience, considering the number of gyms registered in the Conselho Regional de Educação Física (Regional Council of Physical Education) of Sao Luis, MA, Northeastern Brazil, from July 2011 to July 2012. The final sample comprised 723 individuals who exercise at gyms. The dependent variable was supplement use, and the explanatory variables were length of time and motivation of the physical exercises, duration, goal and self-perception of training, weekly frequency of gym attendance, sex, age, educational attainment, self-perception of body weight, smoking and self-perception of diet. The association between variables was analysed by hierarchical Poisson regression based on a theoretical model.RESULTS Supplement use was reported by 64.7% of the participants. Most of the sample was male (52.6%). The most frequent age group was 20 to 39 years (74.4%). Most participants (46.1%) had been exercising for over a year. The following variables were associated with supplement use: self-perceiving body weight as below ideal (p < 0.001), smoking (p < 0.001), exercising for 7 to 12 months (p = 0.028) or more than one year (p < 0.001), spending more than two hours at the gym (p = 0.051), and perceiving training as moderate (p = 0.024) or intense (p = 0.001).CONCLUSIONS The use of supplements lacks proper professional guidance, being motivated by individuals unsatisfied with their low body weight and who perceive their workout as intense, which raises the need for monitoring this population.

Doença renal crônica: diagnóstico e intervenção

Neste vídeo acompanhamos a rotina de consultas com enfermeira, médico e nutricionista de Maria Bárbara Costa, portadora de doença renal crônica e diabetes mellitus, e as devidas orientações para um correto diagnóstico e intervenção.

Factors associated with dietary supplement use by people who exercise at gyms / Fatores associados ao consumo de suplementos nutricionais por frequentadores de academias

OBJECTIVE To assess the factors associated with the use of dietary supplements by people who exercise at gyms.METHODS A cross-sectional study with a sample defined by convenience, considering the number of gyms registered in the Conselho Regional de Educação Física (Regional Council of Physical Education) of Sao Luis, MA, Northeastern Brazil, from July 2011 to July 2012. The final sample comprised 723 individuals who exercise at gyms. The dependent variable was supplement use, and the explanatory variables were length of time and motivation of the physical exercises, duration, goal and self-perception of training, weekly frequency of gym attendance, sex, age, educational attainment, self-perception of body weight, smoking and self-perception of diet. The association between variables was analysed by hierarchical Poisson regression based on a theoretical model.RESULTS Supplement use was reported by 64.7% of the participants. Most of the sample was male (52.6%). The most frequent age group was 20 to 39 years (74.4%). Most participants (46.1%) had been exercising for over a year. The following variables were associated with supplement use: self-perceiving body weight as below ideal (p < 0.001), smoking (p < 0.001), exercising for 7 to 12 months (p = 0.028) or more than one year (p < 0.001), spending more than two hours at the gym (p = 0.051), and perceiving training as moderate (p = 0.024) or intense (p = 0.001).CONCLUSIONS The use of supplements lacks proper professional guidance, being motivated by individuals unsatisfied with their low body weight and who perceive their workout as intense, which raises the need for monitoring this population.

OBJETIVO Analisar os fatores associados ao consumo de suplementos nutricionais por frequentadores de academias.MÉTODOS Estudo transversal, com amostra por conveniência, considerando o número de academias cadastradas no Conselho Regional de Educação Física em São Luís, MA, no período de julho de 2011 a julho de 2012, composta por 723 praticantes de exercício físico. A variável dependente foi uso de suplementos e as variáveis explanatórias foram tempo e objetivo da prática de exercícios físicos, duração, objetivo e autopercepção do treino, frequência semanal na academia, sexo, idade, escolaridade, autopercepção do peso, fumo e autopercepção da alimentação. A associação das variáveis foram analisadas por regressão Poisson hierarquizada com base em modelo teórico.RESULTADOS Relataram utilizar algum tipo de suplemento, 64,7% praticantes. A maioria da amostra foi composta por homens (52,6%). A faixa etária de 20 a 39 anos foi mais frequente (74,4%). A maioria dos entrevistados (46,1%) praticava exercício físico há mais de um ano. As seguintes variáveis apresentaram associação com consumo de suplementos: considerar seu próprio peso abaixo do ideal (p < 0,001), ser fumante (p < 0,001), praticar o exercício físico de 7 a 12 meses (p = 0,028) ou por mais de um ano (p = 0,001), permanência na academia por mais de duas horas (p = 0,051) e considerar o seu próprio treino moderado (p = 0,024) ou intenso (p = 0,001).CONCLUSÕES O uso de suplementos não tem a devida orientação profissional, sendo motivada pelo individuo insatisfeito com o baixo peso corporal e que acredita ter um treino intenso, levantando à necessidade de acompanhamento desse público.

Avaliação e terapia nutricional em crianças e adolescentes com Doença Renal Crônica

Texto que compõe a unidade 2 do módulo "Nutrição e doenças renais" do Curso de Especialização em Nefrologia Multidisciplinar, produzido pela UNA-SUS/UFMA. Aborda a avaliação e terapia nutricional em crianças e adolescentes com Doença Renal Crônica.

Terapia nutricional para indivíduos com doença renal

Texto que compõe a unidade 4 do módulo "Nutrição e doenças renais" do Curso de Especialização em Nefrologia Multidisciplinar, produzido pela UNA-SUS/UFMA. Apresenta a importância da terapia nutricional, bem como as recomendações de nutrientes para pacientes com Doença Renal Crônica e Lesão Renal Aguda. Nesta unidade o manejo nutricional será apresentado na fase pré-dialítica, hemodiálise, diálise peritoneal, lesão renal aguda e transplante renal.

Estimated visceral adipose tissue, but not body mass index, is associated with reductions in glomerular filtration rate based on cystatin C in the early stages of chronic kidney disease.

Information on the association between obesity and initial phases of chronic kidney disease (CKD) is still limited, principally those regarding the influence of visceral adipose tissue. We investigated whether the visceral adipose tissue is more associated with reductions in glomerular filtration rate (GFR) than total and abdominal obesity in hypertensive individuals with stage 1-2 CKD. A cross-sectional study was implemented which involved 241 hypertensive patients undergoing treatment at a primary health care facility. GFR was estimated using equations based on creatinine and cystatin C levels. Explanatory variables included body mass index (BMI), waist circumference (WC), and estimated visceral adipose tissue (eVAT). The mean age was 59.6 ± 9.2 years old and 75.9% were female. According to BMI, 28.2% of subjects were obese. Prevalence of increased WC and eVAT was 63.9% and 58.5%, respectively. Results from the assessment of GFR by BMI, WC, and eVAT categories showed that only women with increased eVAT (≥150 cm(2)) had a lower mean GFR by Larsson (P = 0.016), Levey 2 (P = 0.005), and Levey 3 (P = 0.008) equations. The same result was not observed when the MDRD equation was employed. No association was found between BMI, WC, eVAT, and GFR using only serum creatinine. In the early stages of CKD, increased eVAT in hypertensive women was associated with decreased GFR based on cystatin C.