Dietary acid load and the risk of events of mortality and kidney replacement therapy in people with chronic kidney disease: the Progredir Cohort Study.

BACKGROUND/OBJECTIVES: The association between dietary acid load (DAL) and chronic kidney disease (CKD) progression remains controversial. Also, there is a gap in the literature on the association between DAL and mortality. In this study, we evaluated the association between NEAP (net endogenous acid production) and PRAL (potential renal acid load) and the risk of events of all-cause mortality and kidney replacement therapy (KRT) in people with CKD. SUBJECTS/METHODS: We included 442 patients (250 diabetics) from the Progredir Cohort Study, based in São Paulo, Brazil. We estimated NEAP and PRAL from dietary intake. Events of death before KRT and KRT were ascertained after a median follow-up of 5.8 and 5.1 years, respectively. Cox proportional hazards regression, Weibull regression, and competing risk models were performed. RESULTS: Median NEAP and PRAL were 49.5 and 4.8 mEq/d. There were 200 deaths and 75 KRT events. Neither NEAP nor PRAL were associated with mortality or KRT when all participants were analyzed. After stratification for diabetes, both estimates were positively related to the risk of KRT even after adjustment for age, sex, weight status, glomerular filtration rate, serum bicarbonate, and intakes of protein, phosphorus, and energy (HR 1.31; 95% CI 1.07, 1.60 for NEAP, and HR 1.27; 95% CI 1.04, 1.57 for every 10 mEq/d increments). Competing risk analyses confirmed these findings. CONCLUSIONS: DAL estimates were associated with the risk of KRT in people with CKD and diabetes but not in non-diabetics. There was no association between all-cause mortality and DAL.

The possible role of increased consumption of ultra-processed food products in the development of frailty: a threat for healthy ageing?

Frailty, a multifactorial ageing-related syndrome characterised by reduced resistance to stressors and possibly associated with low-grade systemic inflammation, results in negative health outcomes and compromises healthy ageing. There is a growing body of evidence on the relationship between dietary habits, low-grade systemic inflammation and the risk of frailty. Consumption of dietary ultra-processed products (UPP) could negatively contribute to these conditions. In this article, we intend to (i) discuss the role that UPP might have on the development of frailty considering the inflammatory potential of this type of food and (ii) to raise awareness on deleterious effects of excess UPP intake in the development of adverse health outcomes, in particular, frailty and compromised healthy ageing. UPP are industrial formulations whose nutrient profile has been associated with inflammation and altered gut microbiota. Besides, diets with a greater presence of unprocessed foods and antioxidants have been linked to the reduction of oxidative stress and the expression of inflammatory biomarkers. Because inflammation is believed to be a contributing factor in the development of frailty, it is possible that UPP would contribute to the onset or increase of this condition. Importantly, the increasing consumption of UPP in younger populations might pose a greater risk to the development of compromised healthy ageing in the long term.

The role of the Brazilian Unified Health System in combating the global syndemic and in the development sustainable food systems. / O papel do Sistema Único de Saúde no combate à sindemia global e no desenvolvimento de sistemas alimentares sustentáveis.

The undernutrition and obesity pandemics associated with climate change are a global syndemic. They have a point of convergence, which is the unsustainable current food systems. This paper aims to discuss the role of public health policies, particularly the Brazilian Unified Health System (SUS) in the context of Primary Health Care, in combating the global syndemic and in the development of sustainable food systems. In this scenario, the National Food and Nutrition Policy is a leading intersectoral tool for an adequate and healthy diet and food and nutrition security. Also, the Dietary Guidelines for the Brazilian population is a strategic tool to support food and nutrition education. We highlight the need to articulate health, agriculture, and environmental policies to achieve sustainable development. Thus, SUS can be the arena to promote the main discussions on this topic, potentiating individual, group, and institutional actions to provide a fairer, healthy, and sustainable food system.

As pandemias de desnutrição e obesidade, em conjunto com as mudanças climáticas, constituem uma sindemia global e apresentam um importante ponto de convergência, que é a insustentabilidade dos sistemas alimentares atuais. O objetivo deste artigo é discutir o papel de políticas públicas de saúde, particularmente do Sistema Único de Saúde (SUS) no âmbito da Atenção Primária à Saúde, no combate à sindemia global e no desenvolvimento de sistemas alimentares sustentáveis. Nesse contexto, a Política Nacional de Alimentação e Nutrição se destaca como uma importante ferramenta intersetorial para a alimentação adequada e saudável e à segurança alimentar e nutricional. Além disso, o Guia Alimentar se apresenta como um instrumento estratégico de apoio às ações de educação alimentar e nutricional. De modo essencial, destaca-se a necessidade de articulação das políticas de saúde, agricultura e meio ambiente para que o desenvolvimento sustentável possa ser efetivado. Assim, o SUS tem capacidade de ser palco das principais discussões sobre essa temática, atuando como um potencializador de ações individuais, coletivas e institucionais para promover um sistema alimentar mais justo, saudável e sustentável.

O papel do Sistema Único de Saúde no combate à sindemia global e no desenvolvimento de sistemas alimentares sustentáveis / The role of the Brazilian Unified Health System in combating the global syndemic and in the development sustainable food systems

Resumo As pandemias de desnutrição e obesidade, em conjunto com as mudanças climáticas, constituem uma sindemia global e apresentam um importante ponto de convergência, que é a insustentabilidade dos sistemas alimentares atuais. O objetivo deste artigo é discutir o papel de políticas públicas de saúde, particularmente do Sistema Único de Saúde (SUS) no âmbito da Atenção Primária à Saúde, no combate à sindemia global e no desenvolvimento de sistemas alimentares sustentáveis. Nesse contexto, a Política Nacional de Alimentação e Nutrição se destaca como uma importante ferramenta intersetorial para a alimentação adequada e saudável e à segurança alimentar e nutricional. Além disso, o Guia Alimentar se apresenta como um instrumento estratégico de apoio às ações de educação alimentar e nutricional. De modo essencial, destaca-se a necessidade de articulação das políticas de saúde, agricultura e meio ambiente para que o desenvolvimento sustentável possa ser efetivado. Assim, o SUS tem capacidade de ser palco das principais discussões sobre essa temática, atuando como um potencializador de ações individuais, coletivas e institucionais para promover um sistema alimentar mais justo, saudável e sustentável.

Abstract The undernutrition and obesity pandemics associated with climate change are a global syndemic. They have a point of convergence, which is the unsustainable current food systems. This paper aims to discuss the role of public health policies, particularly the Brazilian Unified Health System (SUS) in the context of Primary Health Care, in combating the global syndemic and in the development of sustainable food systems. In this scenario, the National Food and Nutrition Policy is a leading intersectoral tool for an adequate and healthy diet and food and nutrition security. Also, the Dietary Guidelines for the Brazilian population is a strategic tool to support food and nutrition education. We highlight the need to articulate health, agriculture, and environmental policies to achieve sustainable development. Thus, SUS can be the arena to promote the main discussions on this topic, potentiating individual, group, and institutional actions to provide a fairer, healthy, and sustainable food system.

Association between Vitamins and Minerals with Antioxidant Effects and Coronary Artery Calcification in Adults and Older Adults: A Systematic Review.

BACKGROUND: Coronary Artery Calcification (CAC) is considered an important cardiovascular risk factor. There is evidence that CAC is associated with an increased risk of atherosclerosis, coronary events and cardiovascular mortality. Inflammation is one of the factors associated with CAC and despite the interest in antioxidant compounds that can prevent CAC, its association with antioxidants remains unclear. OBJECTIVE: This study aimed to systematically review the association between vitamins and minerals with antioxidant effects and CAC in adults and older adults. METHODS: We conducted a systematic review using PubMed for articles published until October 2018. We included studies conducted in subjects aged 18 years and older with no previous cardiovascular disease. Studies involving animal or in vitro experiments and the ones that did not use reference methods to assess the CAC, dietary intake or serum levels of vitamin or mineral were excluded. RESULTS: The search yielded 390 articles. After removal of duplicates, articles not related to the review, review articles, editorials, hypothesis articles and application of the inclusion and exclusion criteria, 9 articles remained. The results of the studies included in this systematic review suggest that magnesium is inversely associated with CAC and results on the association between CAC and vitamin E have been conflicting. CONCLUSION: Additional prospective studies are needed to elucidate the role of these micronutrients on CAC.

Dietary intake of non-dialysis chronic kidney disease patients: the PROGREDIR study. A cross-sectional study.

BACKGROUND: Despite evidence that diet is very important in relation to chronic kidney disease (CKD) progression, studies in this field are scarce and have focused only on some specific nutrients. We evaluated the energy, macronutrient and micronutrient intakes and dietary patterns of non-dialysis CKD participants in the PROGREDIR study. DESIGN AND SETTING: Cross-sectional study; CKD cohort, São Paulo, Brazil. METHODS: Baseline data on 454 participants in the PROGREDIR study were analyzed. Dietary intake was evaluated through a food frequency questionnaire. Dietary patterns were derived through principal component analysis. Energy and protein intakes were compared with National Kidney Foundation recommendations. Linear regression analysis was performed between energy and nutrient intakes and estimated glomerular filtration rate (eGFR), and between sociodemographic and clinical variables and dietary patterns. RESULTS: Median energy and protein intakes were 25.0 kcal/kg and 1.1 g/kg, respectively. In linear regression, protein intake (ß = -3.67; P = 0.07) was related to eGFR. Three dietary patterns (snack, mixed and traditional) were retained. The snack pattern was directly associated with male gender (ß = 0.27; P = 0.006) and inversely with diabetes (ß = -0.23; P = 0.02). The traditional pattern was directly associated with male gender (ß = 0.27; P = 0.007) and schooling (ß = 0.40; P < 0.001) and inversely with age (ß = -0.01; P = 0.001) and hypertension (ß = -0.34; P = 0.05). CONCLUSIONS: We identified low energy and high protein intake in this population. Protein intake was inversely related to eGFR. Dietary patterns were associated with age, gender, schooling level, hypertension and diabetes.

Association between Dietary Intake and Coronary Artery Calcification in Non-Dialysis Chronic Kidney Disease: The PROGREDIR Study.

Coronary artery calcification (CAC) is a widespread condition in chronic kidney disease (CKD). Diet may play an important role in CAC, but this role is not clear. This study evaluated the association between macro-and micronutrient intakes and CAC in non-dialysis CKD patients. We analyzed the baseline data from 454 participants of the PROGREDIR study. Dietary intake was evaluated by a food frequency questionnaire. CAC was measured by computed tomography. After exclusion of participants with a coronary stent, 373 people remained for the analyses. The highest tertile of CAC was directly associated with the intake of phosphorus, calcium and magnesium. There was a higher intake of pantothenic acid and potassium in the second tertile. After adjustments for confounding variables, the intake of pantothenic acid, phosphorus, calcium and potassium remained associated with CAC in the generalized linear mixed models. In order to handle the collinearity between these nutrients, we used the LASSO (least absolute shrinkage and selection operator) regression to evaluate the nutrients associated with CAC variability. In this approach, the nutrients that most explained the variance of CAC were phosphorus, calcium and potassium. Prospective studies are needed to confirm these findings and assess the role of interventions regarding these micronutrients on CAC prevention and progression.

Interactions between kidney disease and diabetes: dangerous liaisons.

BACKGROUND: Type 2 diabetes mellitus (DM) globally affects 18-20 % of adults over the age of 65 years. Diabetic kidney disease (DKD) is one of the most frequent and dangerous complications of DM2, affecting about one-third of the patients with DM2. In addition to the pancreas, adipocytes, liver, and intestines, the kidneys also play an important role in glycemic control, particularly due to renal contribution to gluconeogenesis and tubular reabsorption of glucose. METHODS: In this review article, based on a report of discussions from an interdisciplinary group of experts in the areas of endocrinology, diabetology and nephrology, we detail the relationship between diabetes and kidney disease, addressing the care in the diagnosis, the difficulties in achieving glycemic control and possible treatments that can be applied according to the different degrees of impairment. DISCUSSION: Glucose homeostasis is extremely altered in patients with DKD, who are exposed to a high risk of both hyperglycemia and hypoglycemia. Both high and low glycemic levels are associated with increased morbidity and shortened survival in this group of patients. Factors that are associated with an increased risk of hypoglycemia in DKD patients include decreased renal gluconeogenesis, deranged metabolic pathways (including altered metabolism of medications) and decreased insulin clearance. On the other hand, decrease glucose filtration and excretion, and inflammation-induce insulin resistance are predisposing factors to hyperglycemic episodes. CONCLUSION: Appropriate glycaemic monitoring and control tailored for diabetic patients is required to avoid hypoglycaemia and other glycaemic disarrays in patients with DM2 and kidney disease. Understanding the renal physiology and pathophysiology of DKD has become essential to all specialties treating diabetic patients. Disseminating this knowledge and detailing the evidence will be important to initiate breakthrough research and to encourage proper treatment of this group of patients.

Reposição de vitamina B12 reduz comportamento depressivo induzido em ratos jovens / Vitamin B12 replacement therapy reduces induced depressive behavior in young rats

OBJETIVOS: Avaliar, em modelo animal, se a depleção suave de vitamina B12, anterior ao desenvolvimento de anemia, induz à depressão; e se a suplementação com vitamina B12 em animais jovens pode atuar como medida preventiva da depressão. MÉTODOS: Foram utilizados ratos Wistar divididos em grupo controle (n=11) e grupo B12 (n=10). O grupo B12 recebeu suplementação de vitamina B12 na água de beber, ao longo de todo o estudo. Na fase 1, os animais dos dois grupos receberam por seis semanas dieta adicionada de pectina (50g/kg da ração), para induzir à depleção de vitamina B12. Após esse período, foi aplicado o Teste de Porsolt para indução e avaliação do estado depressivo. Foi realizado também um hemograma para pesquisa de anemia. Na fase 2 (com duração de quatro semanas), a pectina foi removida da ração e os mesmos testes foram aplicados novamente no final do período. RESULTADOS: Durante as duas fases do estudo o número de hemácias, o hematócrito e a concentração de hemoglobina mantiveram-se normais, ou seja, os ratos não desenvolveram anemia. Os resultados do Teste de Nado Forçado ao final da fase 1 mostram que, em relação ao grupo controle, o grupo suplementado apresentou tempo de desistência menor (0,44±0,32 vs. 0,75±0,18 minutos, p=0,024) e tempo de natação maior (4,64±0,27 vs. 4,32±0,28 minutos, p=0,013), indicando redução do estado depressivo com a reposição de vitamina B12. Na comparação entre grupos no final da fase 2 não houve diferença significativa em nenhum dos componentes do Teste de Nado Forçado. CONCLUSÕES: A depleção suave de vitamina B12 na dieta, em nível não indutor de anemia, favoreceu o estado depressivo em ratos jovens, enquanto a sua suplementação na situação de depleção reverteu esse quadro. Em condições de nutrição adequada, entretanto, a suplementação dessa vitamina não exerceu efeito sobre o estado depressivo. Estes resultados estimulam a realização de mais estudos que aprofundem a avaliação das relações entre vitamina B12 e depressão em jovens. Além disso, este estudo também abre perspectivas para um novo modelo experimental de depressão, induzida por depleção de vitamina B12.

AIMS: To assess whether mild vitamin B12 deficiency induces depression prior to the development of anemia, and whether vitamin B12 supplementation can act as a preventive measure against depression in young rats. METHODS: Wistar rats were divided into control group (n=11) and B12 group (n=10). The B12 group received vitamin B12 supplementation in drinking water throughout the study. In Phase 1, all animals received a pectin-supplemented diet (50g/kg) for six weeks to induce vitamin B12 depletion. After that, the Porsolt test was applied for induction and evaluation of depressive state and blood was collected for a complete blood count. In Phase 2, which lasted two weeks, pectin was removed from the diet and the same tests were applied again at the end. RESULTS: In both phases, erythrocyte count, hematocrit level, and hemoglobin concentration were normal, i.e., the rats did not develop anemia. The forced swim test results at the end of Phase 1 show that the B12 group exhibited shorter immobility time than the control group (0.44±0.32 vs. 0.75±0.18 minutes, p=0.024) and longer swimming time (4.64±0.27 vs. 4.32±0.28 minutes, p=0.013), indicating reduction of depressive state with vitamin B12 replacement therapy. When the groups were compared at the end of Phase 2, there was no significant difference in any of the forced swim test components. CONCLUSIONS: Mild vitamin B12 deficiency, at a level that did not induce anemia, led to depressive state in young rats where vitamin B12 supplementation reversed the effects of vitamin depletion. Under normal nutritional circumstances, however, vitamin B12 supplementation did not have any effect on depressive state. These findings encourage further studies to investigate the associations between vitamin B12 and depression in young individuals. Moreover, this study also presents perspectives for a new experimental model of depression induced by vitamin B12 depletion.

Avaliação da composição corporal e do consumo alimentar de nadadores adolescentes / Assessment of body composition and dietary intake of adolescent swimmers / Evaluación de la composición corporal y de la ingesta de alimentos de nadadores adolescentes

RESUMOIntrodução:A composição corporal e a alimentação de nadadores têm influência direta em seu desem-penho esportivo. Objetivo: Avaliar a composição corporal e o consumo alimentar de nadadores adolescentes.Métodos:Estudo transversal realizado com 15 nadadores adolescentes, de ambos os sexos, de um clube de São Paulo, Brasil. Aplicou-se um questionário de identificação e houve aferição de peso, estatura, circunferências corporais e dobras cutâneas. Para a avaliação do consumo alimentar foi aplicado um recordatório de 24 horas.Resultados:A maioria dos atletas apresentou percentual de gordura corporal adequado. Houve ingestão de suplementos alimentares por todos os nadadores. Observou-se elevado consumo de proteínas e baixa ingestão de carboidratos. As maiores prevalências de inadequação de micronutrientes foram para vitamina B9, iodo e cálcio.Conclusão:Os resultados sugerem a necessidade de intervenção nutricional nesse grupo de atletas.

ABSTRACTIntroduction:Body composition and nutritional habits of swimmers have a direct influence on their sports perfor-mance.Objective:To assess body composition and dietary intake of adolescent swimmers.Method:Cross-sectional study with 15 adolescent swimmers of both genders from a club in the city of São Paulo, Brazil. An identification questionnaire was applied, registering information on weight, height, body circumferences and skinfolds. For the assessment of dietary intake, a 24-hour recall was applied.Results:Most of the athletes presented appropriate body fat percentage. All swimmers ingested dietary supplements. Protein consumption was high and carbohydrate, low. The highest prevalence of inadequate intakes of micronutrients were vitamin B9, iodine and calcium.Conclusion:The results suggest the need for nutritional intervention in this group of athletes.

RESUMENIntroducción: La composición corporal y la alimentación de los nadadores tienen influencia directa en su rendi-miento deportivo.Objetivo:Evaluar la composición corporal y la ingesta de alimentos de nadadores adolescentes.Métodos:Estudio transversal con 15 nadadores adolescentes de ambos sexos, en un club de São Paulo, Brasil. Fue aplicado un cuestionario de identificación y fueron evaluados peso, la altura, la circunferencia del cuerpo y los plie-gues de la piel. Para la evaluación de la ingesta alimentaria se aplicó de un recordatorio de 24 horas.Resultados:La mayoría de los atletas presentó porcentaje de grasa corporal adecuada. Hubo ingesta de suplementos alimenticios por todos los nadadores. Hubo un alto consumo de proteínas y la ingesta baja en carbohidratos. Las mayores prevalencias de insuficiencia de micronutrientes fueron la vitamina B9, yodo y calcio.Conclusión:Los resultados sugieren la necesidad de intervención nutricional en este grupo de atletas.