Altered serum selenium and uric acid levels and dyslipidemia in hemodialysis patients could be associated with enhanced cardiovascular risk.

In the present study, the first objective was to follow up serum selenium (Se) concentrations in 117 hemodialysis patients (HPs) during a 2-year longitudinal study, relating concentrations to biochemical indexes (n = 6; namely lipoprotein profile, uric acid, and total protein levels). It was also evaluated whether the disease is associated with an enhanced cardiovascular risk. A healthy control group (n = 50) was also studied. Mean serum Se levels were significantly lower in HPs than in the controls (p = 0.002); mean levels significantly increased from the first to third blood sampling (p < 0.001). HPs showed a marked dyslipidemia, with a significant reduction in total cholesterol, low-density lipoprotein, and high-density lipoprotein cholesterol levels and a significant increase in triglyceride levels (p < 0.001). HPs showed a marked hyperuricemia (p < 0.001). Serum selenium levels in HPs were correlated negatively with uric acid levels (inflammation biomarker; p < 0.01). In HPs, serum Se levels are reduced due to their disease (chronic renal failure). Serum Se levels rose until the third blood sampling. The marked dyslipidemia and hyperuricemia found in HPs and the negative correlation between the serum Se and uric acid levels in these patients could imply an enhanced cardiovascular risk.

Hemorragia digestiva alta: factores de riesgo para mortalidad en dos centros urbanos de América Latina / No disponible

Objetivo: presentar la experiencia con la hemorragia de vías digestivas alta (HDA) en dos hospitales centros de referencia de un país latinoamericano, las principales causas, tratamiento, pronóstico y explorar algunos factores de riesgo asociados con la mortalidad. Diseño: estudio de cohortes prospectivo. Pacientes y métodos: se incluyeron 464 pacientes mayores de 15 años de dos centros de referencia. Se estudiaron algunas variables demográficas, antecedentes, presentación clínica, tratamiento y mortalidad. Se exploraron las asociaciones de estas variables con el desenlace muerte. Resultados: el promedio de edad fue de 57,9 años, la proporción hombre: mujer fue de 1,4:1. Trescientos cincuenta y nueve pacientes (77,3%) consultaron a causa de sangrado digestivo (sangrado extrahospitalario) y 105 pacientes (22,6%) lo presen - taron en la institución (sangrado intrahospitalario). A un 71,6% de los pacientes que ingresaron con el diagnóstico de HDA se les rea lizó endoscopia digestiva alta (EDA) en las primeras 24 horas. Las causas de sangrado más frecuentes fueron úlcera péptica en 190 pacientes (41%), enfermedad erosiva en 162 (34,9%) y enfermedad variceal 47 (10,1%). La mortalidad fue del 9,5%. Los pacientes que presentan sangrado durante una hospitalización por otra causa, presentaron un riesgo de morir mayor que los pacientes cuyo motivo de consulta fue el sangrado digestivo (RR 2,4 IC 95% 1,2-4,6). La presencia de comobilidades expresada por el valor ascendente asignado por la clasificación de Rockall está asociado igualmente con mayor probabilidad de muerte (RR 2,5 IC 95% 1,1-5,4). Conclusión: el sangrado digestivo intrahospitalario y la presencia de comorbilidades son factores de riesgo para presentar un desenlace fatal. Identificar los pacientes de mayor riesgo contribuiría a mejorar el manejo de los pacientes con HDA(AU)

Objective: to describe the experience with upper gastrointestinal bleeding in two major Latin American hospitals; presenting its main causes, treatment, and prognosis, while exploring some risk factors associated with death. Design: prospective cohort study. Patients and methods: four hundred and sixty four patients were admitted into any of the 2 hospitals and were at least 15 years of age. Some variables demographics, clinics and treatment were studied. The association between those variables and the death were explored. Results: mean age was 57.9 years; the men:women ratio was 1.4:1. Three hundred and fifty nine patients (77.3%) presented as outpatients and 105 patients (22.6%) were inpatients presenting with UGIB. 71.6% of patients had an upper GI endoscopy within 24 hours. The main causes of bleeding were peptic ulcer (190 patients, 41%), erosive disease (162 patients, 34.9%) and variceal bleeding (47 patients, 10.1%). Forty four patients died (9.5%). Bleeding as an inpatient has a higher mortality risk than does bleeding as an outpatient (RR 2.4 IC 95% 1.2-4.6). An increasing number of comorbidities such as those described in the Rockall Score are also associated with a higher risk of dying (RR 2.5 IC 95% 1.1-5.4). Conclusion: UGIB as an inpatient and the presence of comorbidities should alert the clinician in identifying patients at higher risk of a fatal outcome, these patients should have a more aggressive management and be entitled to an early intervention(AU)

Dialysability of magnesium and calcium from hospital duplicate meals: influence exerted by other elements.

Total and dialysable magnesium and calcium levels and corresponding dialysabilities were measured in duplicate meals (n = 108) during 36 consecutive days. The interaction exerted by other nutrients and energy on them was also performed. Total mean magnesium and calcium fractions of 113.9 +/- 98.3 and 337.2 +/- 278.9 mg/meal respectively, were found. The Mg and Ca levels supplied by meals are positively (p < 0.05) correlated with macronutrient contents (carbohydrates and proteins). The mean dialysable Mg and Ca fractions were 56.9 +/- 36.3 and 127.4 +/- 112.3 mg/meal (50.4 +/- 13.2 and 37.8 +/- 10.7% as dialysabilities, respectively). Total Mg and Ca levels are significantly correlated with corresponding element dialysabilities (p < 0.05). For both minerals, significant correlations between their total and dialysable fractions and between their dialysable level and dialysabilities were noted (p < 0.01). The mean Mg and Ca daily dietary intakes (DDI) were 341.7 +/- 68.0 and 1,011.6 +/- 424.4 mg/day, respectively. For Ca and Mg the existence of similarities in their behaviour in meals and absorptive processes has been found. Duplicate meals with raw vegetables are good sources of bioaccessible Mg. High Ca dialysability has been found in the analysed meals. The fish and products constitute a good source of bioaccessible Ca. Mg, Ca, zinc, and chromium levels enhanced significantly the Mg dialysability. The Ca dialysability rose significantly with dialysable Ca and chromium fractions (p < 0.05).

Iron dialyzability from hospital duplicate meals: daily intake.

Both total and dialyzable iron levels and corresponding dialyzability were determined in 108 duplicate meals during 36 consecutive days. Total mean iron fraction of 5.90 +/- 4.97 mg was found in the meals. The iron supplied by the meals is directly and significantly (p < 0.05) correlated with macromicronutrient content (carbohydrates, fiber, and protein). The mean iron dialyzability (4.81 +/- 3.25%) was low and not significantly different among the three primary meals (breakfast, lunch, and dinner). Significant interactions of several minerals on iron levels were found (p < 0.05). Iron dialyzability was only statistically influenced by zinc dialyzability in meals (p < 0.05). The dialyzed iron fraction present in meals was significantly correlated with protein and ascorbic acid levels (p < 0.01). The mean iron daily dietary intake was 17.7 +/- 6.91 mg. The hospital meals provided enough iron. Foods of animal origin are primary sources of iron in diet.

Copper in foods, beverages and waters from South East Spain: influencing factors and daily dietary intake by the Andalusian population.

The copper content of 225 food, 49 beverage and twelve potable water samples were determined using atomic absorption spectrometry (AAS). Analyses of NIST and BCR reference materials demonstrated the accuracy of this technique. The highest copper levels were found in dried fruit and legumes, followed by organ meats, molluscs and crustaceans, cephalopods, cereals and sausages, respectively. In cereals, legumes and fruit, copper levels increased significantly with increasing levels of protein and decreasing carbohydrate content (p < 0.001). In meat and meat by-products, copper concentrations found in organ meats were significantly higher (p < 0.01). In fresh fish products, copper levels in shellfish were significantly higher than those measured in fish (p < 0.001). In vegetables, the copper concentrations found in mushrooms were significantly higher (p < 0.005). Mean copper concentrations analysed in cheese were statistically higher than those determined in other dairy products (p < 0.01). In beverages, copper levels determined in rum and juices were significantly higher (p < 0.001). Beverages for which a vegetable component was directly used in their manufacturing process (juices, wines and beers) had statistically higher copper levels when compared with fresh drinks. The daily dietary intake (DDI) of copper in the Andalusian diet was 1979 mug day(-1) per person. Cereals, meat, meat by-products and vegetables are the food categories that are the main source of copper in the daily diet. Taking into account the dietary reference intakes and upper levels (900 and 10, 000 mug Cu day(-1) for healthy adults, respectively), the mean copper DDI found indicate that for most of healthy adult individuals from the area, no adverse effects occur in relation to copper nutrition (deficiency or toxicity). Potable waters supplied 53 mug day(-1), which constitutes on average 0.025% of the maximum tolerable daily intake of this element set by the Joint FAO/WHO Expert Committee.

Determination of daily dietary intake of chromium by duplicate diet sampling: in vitro availability study.

Intake of chromium was estimated using a duplicate diet sampling method of 108 meals (36 breakfasts, 36 lunches and 36 dinners) from the restaurant of the Hospital of Motril (S.E. Spain), corresponding to 36 consecutive days. Total and dialyzable Cr levels were measured by a validated electro-thermal atomic absorption spectrometry (ETAAS) method. A mean Cr fraction of 26 +/- 12 microg meal (-1) was found. The Cr uptake from meals was directly and significantly (p < 0.001) correlated with their macronutrient (carbohydrates, fibre and protein) content. Cereals and cereal by-products, legumes, dry fruits, meat, potatoes, dairy products and seafood are the primary sources of Cr. The mean Cr fraction dialyzed through dialysis tubing was 1.2 +/- 1.1 microg meal(-1) (4.6 +/- 3.8% as mean Cr dialysability). Cr intake for breakfasts was significantly lower (p < 0.001). A correlation between the logarithmic data of total and dialyzable fraction of Cr in meals (p = 0.020) was found and dialysis ratio enhancement and, therefore, bioavailability increased with total Cr. The dialysed element content present in meals was significantly correlated with fibre, protein, Fe, Na, I, F, sodium, ascorbic acid and vitamin A levels (p < 0.05). At Fe contents in meals higher than congruent with7.5 mg meal(-1) the net absorption of Cr decreased significantly. The mean Cr daily dietary intake (DDI) was 77 +/- 17 microg day (-1) which indicates that no adverse effects in relation to Cr nutrition (deficiency or toxicity) should occur in individuals from the area.

Total and dialyzable levels of manganese from duplicate meals and influence of other nutrients: Estimation of daily dietary intake.

Both total and dialyzable Mn levels were determined in 108 duplicate meals during 36 consecutive days. Both mineral fractions were measured by a graphite furnace atomic absorption spectrometry (GFAAS) method previously optimized. A total mean Mn fraction of 1.03±0.49mg was found in the meals. The Mn supplied by the meals is directly and significantly (p<0.001) correlated with macronutrient content (carbohydrates, fibre and protein). The mean Mn fraction dialyzed through the dialysis membrane was 0.23±0.17mg (22.0±8.93% as bioaccessible fraction). The total and dialyzable Mn fractions found for breakfasts were significantly lower (p<0.001). Nevertheless, the Mn bioavailabilities expressed as the percentage of dialyzable element, were not significantly different among the three primary meals (breakfast, lunch and dinner). A significant correlation between the total and the dialyzable fraction of Mn in meals was found (p<0.001, r=0.78, r(2)=0.61). The dialyzed element fractions present in meals were significantly correlated mainly with carbohydrates, protein and several amino acid levels (p <0.01). Foods with higher carbohydrate and therefore energy contents, e.g. cereals, legumes, vegetables and fruits, would be primary sources of bioaccessible Mn in the diet. The bioaccessibility of Mn was only significant influenced by energy, carbohydrates and Se levels present in meals. The mean Mn daily dietary intake (DDI) was 3.05±0.61mgday(-1).

Magnesium and calcium contents in foods from SE Spain: influencing factors and estimation of daily dietary intakes.

The magnesium and calcium content (fresh weight basis) of 243 food, 69 beverages and 11 potable water samples were determined using flame atomic absorption spectrometry. Analyses of NIST and CBR-CEC reference materials demonstrated the reliability and accuracy of this technique. The highest magnesium and calcium levels corresponded to molluscs and crustacea, and dairy products, respectively. Magnesium concentrations found in different food groups were significantly and linearly related with corresponding calcium levels (P<0.001) with the exception of fish products. Significant linear relationships among magnesium and calcium concentrations, and fiber content for cereals, legumes and dry-fruits were found (P<0.001); however, total fat contents of considered foods were not related (P>0.05) with levels of elements considered. Significant linear relationships among magnesium and calcium concentrations in cereals, legumes and fruits, and protein content were found (P<0.001). In meat and by-products, magnesium concentrations found in organ meats were significantly lower (P<0.01); for calcium, levels measured in sausages were significantly higher (P<0.001) than those found in meats and organ meats. In fish products, magnesium levels in molluscs and crustacea were significantly higher than those measured in fish and cephalopoda (P<0.001); for calcium, concentrations in cephalopoda were significantly lower (P<0.001). Mean magnesium and calcium concentrations analyzed in cheese were statistically higher than those determined in other dairy products (P<0.01). In alcoholic drinks, magnesium and calcium levels measured in distilled beverages (whisky, gin, rum, brandy and alcoholic liquors) were statistically lower than those found in fermented types (wine and beer) (P<0.01). The daily intake of magnesium and calcium in the Spanish diet was 366.1 and 1266.6 mg/day per person, respectively. Results revealed that the intake of analyzed elements was similar to recommended dietary allowances.

Selenium concentrations in serum of individuals with liver diseases (cirrhosis or hepatitis): relationship with some nutritional and biochemical markers.

Serum concentrations were measured in individuals (n = 50) with liver diseases (cirrhosis and hepatitis) by hydride generation atomic absorption spectrometry in a cross-sectional study. Mean serum selenium levels determined in patients with cirrhosis (n = 12) or with hepatitis (n = 38) were significantly lower (P<0.01) than those measured in control groups mainly due to a decreased liver function. Mean serum selenium concentrations were significantly lower in cirrhotic individuals when compared with patients with hepatitis (P<0.05). Therefore, the severity of the live injury is a factor conditioning the impairment in the selenium body status observed in individuals with hepatopathies. In hepatic patients serum total cholesterol levels showed a significant correlation with serum selenium concentrations (r=0.912, P<0.05) demonstrating the important role of selenium as an antioxidant agent; similarly, gamma-glutamic-transferase levels were significantly correlated with the serum selenium levels (r=-0.803, P<0.05) indicating that when the intensity of the hepatic injury increases (enhancement in serum GGT levels) concomitantly the serum selenium levels decrease significantly. No significant relationships between serum selenium levels and sex or age of patients were observed.