Frequency and factors associated with sarcopenia prediction in adult and elderly patients hospitalized for COVID-19.

Patients with COVID-19 may develop symptoms that interfere with food intake. Systemic inflammatory response associated with physical inactivity and/or immobilization during hospital stay can induce weight and muscle loss leading to sarcopenia and worsening the clinical condition of these patients. The present study identifies the frequency and factors associated with sarcopenia prediction in adult and elderly patients hospitalized for COVID-19. It is a cohort-nested cross-sectional study on adult and elderly patients admitted to wards and intensive care units (ICUs) of 8 hospitals in a northeastern Brazilian state. The study was conducted from June 2020 to June 2021. Sociodemographic, economic, lifestyle, and current and past clinical history variables were collected. Sarcopenia prediction was determined by the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire compiled in the Remote-Malnutrition APP (R-MAPP). Patients were diagnosed with sarcopenia when the final score ≥ 4 points. The study included 214 patients with a mean age of 61.76 ± 16.91 years, of which 52.3 % were female and 57.5 % elderly. Sarcopenia prevailed in 40.7 % of the sample. Univariate analysis showed greater probability of sarcopenia in elderly individuals, nonpractitioners of physical activities, hypertensive patients, diabetic patients, and those hospitalized in the ICU. In the multivariate model, the type of hospital admission remained associated with sarcopenia prediction, where patients admitted to the ICU were 1.43 (95 % CI: 1.04; 1.97) more likely to have sarcopenia than those undergoing clinical treatment. Sarcopenia prediction was not associated with patient outcome (discharge, transfer, or death) (p = 0.332). The study highlighted an important percentage of sarcopenia prediction in patients with COVID-19, especially those admitted to the ICU. Additional investigations should be carried out to better understand and develop early diagnostic strategies to assist in the management of sarcopenic patients with COVID-19.

Association between being underweight and excess body weight before SARS coronavirus type 2 infection and clinical outcomes of coronavirus disease 2019: Multicenter study.

OBJECTIVES: The present study aimed to identify associations between extremes in body weight status (underweight and excess body weight) before a COVID-19 diagnosis and clinical outcomes in patients infected with SARS coronavirus type 2. METHODS: A multicenter cohort study was conducted in eight different states in northeastern Brazil. Demographic, clinical (previous diagnosis of comorbidities), and anthropometric (self-reported weight and height) data about individuals who tested positive for COVID-19 were collected. Outcomes included hospitalization, mechanical ventilation, and death. Multivariable logistic regression models, adjusted based on age, sex and previous comorbidities, were used to assess the effects of extremes in body weight status on clinical outcomes. RESULTS: A total of 1308 individuals were assessed (33.6% were elderly individuals). The univariable analyses showed that only hospitalization was more often observed among underweight (3.2% versus 1.2%) and overweight (68.1% versus 63.3%) individuals. In turn, cardiovascular diseases were more often observed in all clinical outcomes (hospitalization: 19.7% versus 4.8%; mechanical ventilation: 19.9% versus 13.5%; death: 21.8% versus 14.1%). Based on the multivariable analysis, body weight status was not associated with risk of hospitalization (underweight: odds ratio [OR]: 1.10; 95% confidence interval [CI] 95%, 0.50-2.41 and excess body weight: OR: 0.81; 95 CI, 0.57-1.14), mechanical ventilation (underweight: OR: 0.92; 95% CI, 0.52-1.62 and excess weight: OR: 0.90; 95% CI, 0.67-1.19), and death (underweight: OR: 0.61; 95% CI, 0.31-1.20 and excess body weight: OR 0.88; 95% CI, 0.63-1.23). CONCLUSIONS: Being underweight and excess body weight were not independently associated with clinical outcomes in patients with COVID-19 in the herein analyzed cohort. This finding indicates that the association between these variables may be confounded by both age and comorbidities.

Prevalência de hipofosfatemia e risco de síndrome de realimentação em idosos internados em uma unidade de terapia intensiva / Prevalence of hypophosphatemia and risk of refeeding syndrome in elderly patients admitted to an intensive care unit

Introdução: A presença de hipofosfatemia é fortemente relacionada à ocorrência de síndrome de realimentação em pacientes críticos, na qual um dos principais grupos de risco é a população idosa. Objetivos: Avaliar a prevalência de hipofosfatemia e o risco de síndrome de realimentação em idosos internados em uma unidade de terapia intensiva. Métodos: Estudo observacional prospectivo, realizado numa unidade de terapia intensiva com pacientes idosos de ambos os sexos e em uso de terapia nutricional enteral. Foram coletados dados demográficos, clínicos e exames bioquímicos, e realizadas triagem e avaliação nutricional. As necessidades nutricionais foram calculadas e adotou-se o ponto de corte de 90% para estabelecer a adequação da oferta calórica. Para avaliar o risco e a ocorrência de síndrome de realimentação, foram utilizados os critérios propostos pelo grupo NICE. A análise estatística foi realizada com o auxílio do programa SPSS 13.0, com um intervalo de confiança (IC) de 95%. Resultados: Foram estudados 44 pacientes, dos quais 34,1% estavam em magreza; 86,4% dos pacientes iniciaram a terapia nutricional enteral em até 48 horas, com 43,2% de adequação calórica em até 72 horas. A hipofosfatemia foi encontrada em 9,1% dos pacientes na admissão e em 29,5% após o início da dieta. Com isso, 88,6% dos pacientes apresentaram algum risco para desenvolver síndrome de realimentação e 40,9% deles manifestaram a síndrome. Conclusão: Foi identificada elevada prevalência de hipofosfatemia após o início da terapia nutricional. Além disso, o risco de desenvolver síndrome de realimentação foi elevado e sua manifestação se assemelha aos dados encontrados na literatura. (AU)

Introduction: The presence of hypophosphatemia is strongly related to the occurrence of refeeding syndrome in critically ill patients, in which one of the main risk groups is the elderly population. Objectives: To assess the prevalence of hypophosphatemia and the risk of refeeding syndrome in elderly patients admitted to an intensive care unit. Methods: Prospective observational study carried out in an intensive care unit with elderly patients of both genders using enteral nutritional therapy. Demographic, clinical and biochemical data were collected, and nutritional screening and assessment were performed. The energy and nutrient requirements were calculated and a cutoff point of 90% was adopted to establish the adequacy of the caloric supply. To assess the risk and occurrence of refeeding syndrome, the criteria proposed by the NICE group were used. Statistical analyses were performed using the SPSS 13.0 program, with a 95% confidence interval (CI). Results: 44 patients were studied, of which 34.1% were malnourished; 86.4% of patients started enteral nutritional therapy within 48 hours, with 43.2% of caloric adequacy within 72 hours. Hypophosphatemia was found in 9.1% of patients on admission and in 29.5% after starting the diet. Thus, 88.6% of patients had some risk of developing the refeeding syndrome and 40.9% of them manifested the syndrome. Conclusion: A high prevalence of hypophosphatemia was identified after starting nutritional therapy. In addition, the risk of developing refeeding syndrome was high and its manifestation is similar to data found in the literature. (AU)

Ingestão dietética e nível de atividade física como preditoresde mudanças no peso e no índice de massa corporal de universitários / Ingesta dietética y nivel de actividad física como predictores de cambios en el peso y en el índice de masa corporal de universitarios / Dietary intake and level of physical activity as predictors of changes in weight and body mass index among college student

OBJETIVO: O objetivo do presente trabalho foi investigar aingestão dietética e o nível de atividade física como preditores de mudanças no peso e no índice de massa corporal (IMC) de estudantes de uma universidade pública do Nordeste do Brasil. MÉTODOS: Tratou-se de uma coorte, onde 138 estudantes foram avaliados ao início do curso e após 1 ano de vida acadêmica. Foram coletados o peso corporal e a altura, dados sobre o nível de atividade física e sobre o consumo alimentar. O modelo conceitual também considerou variáveis sociodemográficas, comportamentais, de composição corporal e distribuição de gordura corporal. RESULTADOS: A amostra foi 76,1% do sexo feminino, com média de idade de 19,7 ± 3,3 anos no baseline. Ao final do seguimento, 50,7% dos universitários ganharam mais de 0,5Kg de peso, dentre esses, a média de ganho de peso foi 2,87 ± 2,01kg. Nos estudantes que no baseline apresentavam consumo ≤ a uma vez por semana de salada crua e ≤ a uma vez ao dia de frutas e legumes cozidos, a chance de ganho em peso foi de 3,06; 2,57 e 2,49 respectivamente. Houve uma correlação negativa entre a variação anual no peso e a variação no consumo de frutas, salada crua e legumes cozidos. Por outro lado, houve uma correlação positiva com o consumo de embutidos, salgados e doces. Comportamento similar foi observado com a variação no índice de massa corporal (IMC). CONCLUSÃO: Não foi identificado influência da prática de atividade física sobre o ganho de peso. No entanto, o padrão alimentar no baseline e o praticado durante o ano de ingresso na universidade exerceu influência sobre o peso e o IMC dos universitários

OBJETIVO: El objetivo del presente estudio fue investigar la ingesta dietética y el nivel de actividad física como predictores de cambios en el peso y el índice de masa corporal (IMC) de estudiantes de una universidad pública en el noreste de Brasil. MÉTODOS: Se trató de una cohorte, donde se evaluó a 138 estudiantes al inicio del curso y luego de 1 año de vida académica. Se recogieron el peso y la altura corporal, los datos sobre el nivel de actividad física y el consumo de alimentos. El modelo conceptual también consideró variables sociodemográficas, conductuales, de composición corporal y distribución de la grasa corporal. RESULTADOS: La muestra fue 76,1% de mujeres, con una edad media de 19,7 ± 3,3 años al inicio del estudio. Al final del seguimiento, el 50,7% de los estudiantes universitarios ganó más de 0,5 kg de peso, entre ellos, la ganancia de peso promedio fue de 2,87 ± 2,01 kg. En los estudiantes que tenían un consumo inicial ≤ una vez a la semana de ensalada cruda y ≤ una vez al día de frutas y verduras cocidas, la probabilidad de aumento de peso fue de 3,06; 2,57 y 2,49 respectivamente. Hubo una correlación negativa entre la variación anual en peso y la variación en el consumo de frutas, ensalada cruda y verduras cocidas. Por otro lado, hubo una correlación positiva con el consumo de embutidos, snacks y dulces. Se observó un comportamiento similar con la variación en el índice de masa corporal (IMC). CONCLUSIÓN: No se identificó la influencia de la actividad física en el aumento de peso. Sin embargo, el patrón dietético en la línea de base y el practicado durante el año de ingreso a la universidad influyó en el peso y el IMC de los estudiantes

OBJECTIVE: The objective of the present study was to investigate dietary intake and the level of physical activity as predictors of changes in weight and body mass index (BMI) of students at a public university in Northeast Brazil. METHODS: This was a cohort, where 138 students were assessed at the beginning of the course and after 1 year of academic life. Body weight and height, data on the level of physical activity and food consumption were collected. The conceptual model also considered sociodemographic, behavioral, body composition and body fat distribution variables. RESULTS: The sample was 76.1% female, with a mean age of 19.7 ± 3.3 years at baseline. At the end of the follow-up, 50.7% of university students gained more than 0.5 kg of weight, among them, the average weight gain was 2.87 ± 2.01 kg. In students who had a baseline consumption ≤ once a week of raw salad and ≤ once a day of cooked fruits and vegetables, the chance of weight gain was 3.06; 2.57 and 2.49 respectively. There was a negative correlation between the annual variation in weight and the variation in the consumption of fruits, raw salad and cooked vegetables. On the other hand, there was a positive correlation with the consumption of sausages, snacks and sweets. Similar behavior was observed with the variation inbody mass index (BMI). CONCLUSION: The influence of physical activity on weight gain was not identified. However, the dietary pattern in the baseline and that practiced during the year of entry into the university influenced the weight and BMI of the students

Waist circumference measurement sites and their association with visceral and subcutaneous fat and cardiometabolic abnormalities.

OBJECTIVES: To estimate the degree of variability of the waist circumference (WC) when obtained in different anatomical sites and compare the performance of the measurement sites as predictors of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and cardiometabolic abnormalities. SUBJECTS AND METHODS: Cross-sectional study involving 119 individuals with overweight (50.3 ± 12.2 years), in which six WC measurement sites were evaluated (minimal waist, immediately below the lowest rib, midpoint between the lowest rib and the iliac crest, 2 cm above the umbilicus, immediately above the iliac crest, umbilicus level), in addition to the VAT and SAT (quantified by computed tomography) and cardiometabolic parameters. RESULTS: The differences between the measurements ranged from 0.2 ± 2.7 cm to 6.9 ± 6.7 cm for men, and from 0.1 ± 3.7 cm to 10.1 ± 4.3 cm for women. The minimum waist showed significant correlation with VAT (r = 0.70) and with a higher number of cardiometabolic parameters among men. Regarding women, the WC measurement showed high correlation with SAT and moderate correlation with VAT, not being found superiority of one measurement protocol in relation to the others when assessed the correlation with VAT and with cardiometabolic parameters. CONCLUSIONS: Greater variability between the measuring sites was observed among women. With respect to men, the minimum waist performed better as a predictor of VAT and cardiometabolic alterations.

Waist circumference measurement sites and their association with visceral and subcutaneous fat and cardiometabolic abnormalities

ABSTRACT Objectives: To estimate the degree of variability of the waist circumference (WC) when obtained in different anatomical sites and compare the performance of the measurement sites as predictors of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and cardiometabolic abnormalities. Subjects and methods: Cross-sectional study involving 119 individuals with overweight (50.3 ± 12.2 years), in which six WC measurement sites were evaluated (minimal waist, immediately below the lowest rib, midpoint between the lowest rib and the iliac crest, 2 cm above the umbilicus, immediately above the iliac crest, umbilicus level), in addition to the VAT and SAT (quantified by computed tomography) and cardiometabolic parameters. Results: The differences between the measurements ranged from 0.2 ± 2.7 cm to 6.9 ± 6.7 cm for men, and from 0.1 ± 3.7 cm to 10.1 ± 4.3 cm for women. The minimum waist showed significant correlation with VAT (r = 0.70) and with a higher number of cardiometabolic parameters among men. Regarding women, the WC measurement showed high correlation with SAT and moderate correlation with VAT, not being found superiority of one measurement protocol in relation to the others when assessed the correlation with VAT and with cardiometabolic parameters. Conclusions: Greater variability between the measuring sites was observed among women. With respect to men, the minimum waist performed better as a predictor of VAT and cardiometabolic alterations.

Hiperglicemia, evolução clínica e estado nutricional de pacientes criticamente enfermos / Hyperglycemia, clinical evolution and nutritional condition of critically ill patients

Introdução: O paciente criticamente enfermo frequentemente apresenta hipercatabolismo, caracterizado pela elevação do gasto energético e episódios de hiperglicemia. O estado hiperglicêmico está associado a fatores clínicos e nutricionais e quando mantido por um longo período, aumenta o risco de mortalidade. Objetivos: Avaliar a hiperglicemia e os parâmetros clínicos e nutricionais de pacientes em terapia nutricional enteral, internados em uma Unidade de Terapia Intensiva de um hospital Escola do Recife. Métodos: Estudo transversal realizado com pacientes internados na Unidade de Terapia Intensiva em suporte enteral por um período mínimo de 48 horas. Dados clínicos: motivo e tempo de internamento, diabetes pré-existente, uso de insulina e de drogas vasoativas, média da glicemia capilar diária, início da terapia nutricional, necessidade de ventilação mecânica, indicadores de mortalidade e desfecho clínico. Dados antropométricos: índice de massa corporal, circunferência do braço e da panturrilha. A análise estatística foi realizada pelo programa Statistical Package for Social Sciences versão 13.0. Resultados: Foram avaliados 40 pacientes, com idade média de 57,3 ± 17,87 anos. A circunferência do braço foi o parâmetro de diagnóstico nutricional com maior percentual de desnutrição (57,5%). Foi observada associação significativa da hiperglicemia com idade (p=0,049), diabetes pré-existente (p= 0,017), uso de insulina (p < 0,001), dias de ventilação mecânica (p=0,015) e Sepsis Related Organ Failure Assessment do desfecho (p=0,011). A mortalidade esteve presente em 15% da amostra. Conclusão: O monitoramento e o controle glicêmico em Unidade de Terapia Intensiva é de grande relevância, pois pode reduzir as complicações clínicas que levariam a uma menor taxa de mortalidade. A utilização de um protocolo de controle glicêmico seria uma ferramenta de grande valor nessa condição

Introduction: The critically ill patient frequently presents hypercatabolism, characterized by elevated energy expenditure and episodes of hyperglycemia. The hyperglycemic state is associated with clinical and nutritional factors and when maintained over a long period increases the risk of mortality. Objective: To evaluate hyperglycemia and the clinical and nutritional parameters of patients in enteral nutritional therapy, interned at an Intensive Therapy Unit in Recife School hospital. Methods: Transversal study conducted with in-patients at an Intensive Therapy Unit in enteral support for a minimum period of 48 hours. Clinical data: reason and time of internment, preexisting diabetes, insulin and vasoactive drugs usage, daily capillary glycemy average, start period of nutritional therapy, need for mechanical ventilation, mortality indicators and clinical outcome. Anthropometric data: body mass index, arm and calf circumference. The statistical analysis was taken by Statistical Package for Social Sciences programme version 13.0. Results: 40 evaluated patients, with an average age of 57,3 ± 17,87. Arm circumference was the nutritional diagnostic parameter with the highest percentage of malnutrition (57.5%). It has been observed significant relation between hyperglycemia and age (p=0,049), preexisting diabetes (p= 0,017), insulin usage (p < 0,001), days of mechanical ventilation (p=0,015) and Sepsis Related Organ Failure Assessment outcome (p=0,011). Mortality was present in 15% of the sample. Conclusion: Monitoring and glycemic control at the Intensive Therapy Unit is of great relevance, for it can reduce clinical complications that would lead to a minor mortality rate. The usage of glycemic control protocol would be an invaluable tool in this condition

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Predictive models for estimating visceral fat: The contribution from anthropometric parameters.

BACKGROUND: Excessive adipose visceral tissue (AVT) represents an independent risk factor for cardiometabolic alterations. The search continues for a highly valid marker for estimating visceral adiposity that is a simple and low cost tool able to screen individuals who are highly at risk of being viscerally obese. The aim of this study was to develop a predictive model for estimating AVT volume using anthropometric parameters. OBJECTIVE: Excessive adipose visceral tissue (AVT) represents an independent risk factor for cardiometabolic alterations. The search continues for a highly valid marker for estimating visceral adiposity that is a simple and low cost tool able to screen individuals who are highly at risk of being viscerally obese. The aim of this study was to develop a predictive model for estimating AVT volume using anthropometric parameters. METHODS: A cross-sectional study involving overweight individuals whose AVT was evaluated (using computed tomography-CT), along with the following anthropometric parameters: body mass index (BMI), abdominal circumference (AC), waist-to-hip ratio (WHpR), waist-to-height ratio (WHtR), sagittal diameter (SD), conicity index (CI), neck circumference (NC), neck-to-thigh ratio (NTR), waist-to-thigh ratio (WTR), and body adiposity index (BAI). RESULTS: 109 individuals with an average age of 50.3±12.2 were evaluated. The predictive equation developed to estimate AVT in men was AVT = -1647.75 +2.43(AC) +594.74(WHpR) +883.40(CI) (R2 adjusted: 64.1%). For women, the model chosen was: AVT = -634.73 +1.49(Age) +8.34(SD) + 291.51(CI) + 6.92(NC) (R2 adjusted: 40.4%). The predictive ability of the equations developed in relation to AVT volume determined by CT was 66.9% and 46.2% for males and females, respectively (p<0.001). CONCLUSIONS: A quick and precise AVT estimate, especially for men, can be obtained using only AC, WHpR, and CI for men, and age, SD, CI, and NC for women. These equations can be used as a clinical and epidemiological tool for overweight individuals.

Circunferência do pescoço como indicador de risco cardiovascular em pacientes renais crônicos em hemodiálise / Neck circumference as indicator of cardiovascular risk in patients in dialysis for chronic kidney disease

Introdução: Portadores de doença renal crônica (DRC) são frequentemente acometidos por doenças cardiovasculares (DCV). Nesse contexto, a circunferência do pescoço (CP) surge como parâmetro promissor para avaliação do risco cardiovascular (RCV) na DRC. Objetivo: Avaliar a CP como um parâmetro indicativo de RCV em pacientes renais crônicos em hemodiálise (HD), relacionando-a com variáveis antropométricas e bioquímicas associadas aos desfechos cardiometabólicos. Métodos: Estudo transversal, com pacientes adultos e idosos, de ambos os sexos, portadores de DRC em HD, cadastrados no Setor de Nefrologia do Hospital Barão de Lucena, Recife - PE. Foram obtidas variáveis demográficas, socioeconômicas, clínicas e comportamentais, além de parâmetros antropométricos e bioquímicos relacionados aos eventos cardiometabólicos. A CP identificou o RCV elevado quando ≥37cm para homens e ≥34cm para mulheres. As análises estatísticas foram conduzidas no programa Statistical Package for the Social Sciences (SPSS) versão 13.0, sendo confirmada significância estatística quando p<0,05. Resultados: A amostra foi composta por 40 indivíduos, com idade média de 54,4±14,7 anos e 72,5% (n=29) do sexo masculino. A CP evidenciou 55,0% (n=22) de pacientes com alto RCV, estando associada significativamente com o sexo masculino e com as classes econômicas B e C. Foram constatadas correlações positivas entre a CP e demais parâmetros antropométricos (índice de massa corporal, circunferência da cintura, razão cintura/estatura e razão cintura/quadril) e correlação negativa entre a CP e o HDL-Colesterol. Conclusão: A CP mostrou-se como bom método para identificação do RCV em pacientes renais crônicos em HD, correlacionando-se com variáveis antropométricas e bioquímicas associadas aos desfechos cardiometabólicos

Introduction: Individuals with chronic kidney disease are often affected by cardiovascular disease. Neck circumference (NC) is a promising variable for the evaluation of cardiovascular risk in these patients. Objective: Evaluate NC as an indicator of cardiovascular risk in patients with chronic kidney disease undergoing dialysis, relating this measure to anthropometric and biochemical variables associated with cardiometabolic outcomes. Methods: A cross-sectional study was conducted with adult patients with chronic kidney disease undergoing dialysis at the Nephrology Center of the Barão de Lucena Hospital in Recife, Brazil. Demographic, socioeconomic, clinical and behavioral characteristics were recorded, along with anthropometric and biochemical variables related to cardiometabolic events. High cardiovascular risk was identified when NC was ≥37cm in men and ≥34cm in women. Statistical analysis involved the SPSS 13.0 program, with a p-value<0.05 indicative of statistical significance. Results: Forty individuals participated (72.5% males; mean age: 54.4 ± 14.7). NC identified 55.0% (n=22) of the patients with high cardiovascular risk and was associated with the male sex as well as economic classes B and C. Positive correlations were found between NC and other anthropometric variables (body mass index, waist circumference, waist/height ratio and waist/hip ratio) and a negative correlation was found between NC and HDL cholesterol. Conclusion: NC proved to be a good method for identifying cardiovascular risk in patients undergoing dialysis for chronic kidney disease and was correlated with anthropometric and biochemical variables associated with cardiometabolic outcomes

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Proteína C-reativa como biomarcador inflamatório e fatores associados em diabéticos tipo 2 atendidos na rede pública de saúde / C-reactive protein as inflammatory biomarker and associated factors in type 2 diabetics patients treated at public health system

Introdução: O Diabetes configura-se hoje como uma epidemia mundial, traduzindo-se em grande desafio para os sistemas de saúde e favorece o risco de eventos circulatórios. Objetivo: Determinar os níveis de Proteína C-Reativa ultrassensível (PCR-us) e fatores associados em diabéticos do município de Vitória de Santo Antão, PE, Brasil. Métodos: Estudo transversal, de base populacional, realizado entre julho e outubro de 2011. Foram avaliadas variáveis sócio-demográficas, estilo de vida, clínicas, antropométricas e bioquímicas, as quais foram associadas aos níveis PCR-us. Os dados foram analisados no programa Predictive Analytics Software (PASW), versão 13.00; nível de significância de 5%. Resultados: A amostra foi constituída por 409 indivíduos, sendo 73,1% do sexo feminino. A idade variou entre 20 e 90 anos, com média de 61,00 ± 11,62 anos; com maior proporção (56,2%) de idosos. O Índice de massa corporal (IMC) mostrou 75,2% de excesso de peso. Enquanto Razão Cintura Quadril (RCQ), Razão Cintura Estatura (RCEst), Índice de Conicidade (IC) e Circunferência da Cintura (CC) revelaram 65,4%, 90,27%, 89,0% e 58,4% de obesidade central na amostra, respectivamente. Quanto à PCR-us, 53,2% dos participantes mostraram elevado nível sérico (>0,3 mg/L); e as variáveis associadas à ocorrência de inflamação foram: sexo, grau de escolaridade, Glicemia de Jejum, Lipoproteína de alta densidade (HDL-c), RCEst e CC, após ajuste para variáveis de confusão. Discussão: Os resultados sugerem que manter uma GJ abaixo de 100mg/dl, um bom nível de HDL-c e evitar a obesidade central poderia ter um efeito protetor contra a ocorrência de inflamação crônica em diabéticos. Conclusão: Os níveis de PCR-us mostraram-se elevados na maioria dos pacientes estudados e estão associados a tais níveis: o sexo feminino, a obesidade abdominal, baixos níveis de HDL-c, escolaridade e glicemia elevadas (AU)

Introduction: Diabetes is a global epidemic that increases the risk of circulatory events and constitutes a considerable challenge to healthcare services. Objective: Determine levels of high sensitivity C-reactive protein levels and associated factors in patients with diabetes in the municipality of Vitória de Santo Antão, Brazil. Methods: A population-based, cross-sectional study was conducted from July to October 2011. Socio-demographic, lifestyle, clinical, anthropometric and biochemical variables were analyzed and associations with high sensitivity C-reactive protein levels were determined. Statistical analysis was performed with the aid of the Predictive Analytics Software, version 13.00, with a 5% level of significance. Results: The sample comprised 409 individuals, 73.1% of whom were female. Age ranged from 20 to 90 years (mean: 61.00 ± 11.62 years) and older adults accounted for the largest proportion of the sample (56.2%). The body mass index demonstrated that 75.2% had excess weight. The waist-to-hip ratio, waistto-height ratio, conicity index and waist circumference revealed obesity rates of 65.4%, 90.27%, 89.0% and 58.4%, respectively. A total of 53.2% had high sensitivity C-reactive protein levels (> 0.3 mg/L). Moreover, sex, level of schooling, fasting blood sugar, high density lipoprotein cholesterol, waist-to-height ratio and waist circumference were significantly associated with inflammation after controlling for confounding variables. Discussion: The present results suggest that maintaining a fasting blood sugar level below 100 mg/dl and a good HDL-c level as well as avoiding central obesity can have a protective effect against the occurrence of chronic inflammation in patients with diabetes. Conclusion: High sensitivity C-reactive protein levels were high in the majority of patients studied and were associated with the female sex, abdominal obesity, low HDL-c levels, a low level of schooling and high blood sugar levels (AU)

Prevalência de obesidade visceral estimada por equação preditiva em mulheres jovens pernambucanas / Prevalence of visceral obesity estimated by predictive equation in young women from Pernambuco

FUNDAMENTO: O acúmulo de gordura visceral é considerado o principal fator de risco para doenças cardiovasculares e metabólicas. OBJETIVO: Determinar a prevalência de obesidade visceral e avaliar sua associação com fatores de risco cardiovasculares em mulheres jovens do Estado de Pernambuco. MÉTODOS: Estudo transversal, realizado com dados da "III Pesquisa Estadual de Saúde e Nutrição", envolvendo mulheres entre 25 e 36 anos. Avaliaram-se as variáveis: Índice de Massa Corporal (IMC), Circunferência da Cintura (CC), Razão Cintura-Estatura (RCE), Volume de Gordura Visceral (VGV) estimado por equação preditiva, Pressão Arterial Sistólica e Diastólica (PAS, PAD), Colesterol Total (CT), Triglicerídeo (TG), Glicemia de Jejum (GJ). RESULTADOS: Foram avaliadas 517 mulheres, com mediana de idade de 29 anos (27-32) e prevalência de obesidade visceral de 30,6%. Valores de IMC, PAS, PAD e TG foram superiores no grupo com obesidade visceral: IMC = 28,0 kg/m² (25,0 - 21,4) vs 23,9 kg/m² (21,5 - 26,4); PAS = 120,0 mmHg (110,0 - 130,0) vs 112,0 mmHg (100,0 - 122,0); PAD = 74 mmHg (70 - 80) vs 70 mmHg (63 - 80); TG = 156,0 mg/dL (115,0 - 203,2) vs 131,0 mg/dL (104,0 - 161,0), respectivamente, p < 0,01. Idade, PAS, PAD, TG e CT apresentaram correlação positiva e significante com o VGV: r = 0,171; 0,224; 0,163; 0,278; 0,124; respectivamente, p < 0,005. CONCLUSÃO: Verificou-se uma elevada prevalência de obesidade visceral, estando estatisticamente correlacionada a fatores de risco cardiovasculares.

BACKGROUND: The accumulation of visceral fat is considered a major risk factor for cardiovascular and metabolic diseases. OBJECTIVE: To determine the prevalence of visceral obesity and to assess its association with cardiovascular risk factors in young women from the state of Pernambuco. METHODS: Cross-sectional study carried out with data from the "III Health and Nutrition State Survey", involving women aged 25 to 36 years. The following variables were evaluated: body mass index (BMI), Waist Circumference (WC), waist-to-height ratio (WHtR), volume of visceral fat (VVF) estimated by a predictive equation, Systolic and Diastolic Blood Pressure (SBP, DBP), total cholesterol (TC), Triglycerides (TG), fasting glucose (FG). RESULTS: A total of 517 women were evaluated, with a median age of 29 years (27-32) and prevalence of visceral obesity of 30.6%. BMI, SBP, DBP and TG were higher in the group with visceral obesity: BMI = 28.0 kg/m2 (25.0 to 21.4) vs. 23.9 kg/m2 (21.5 to 26.4) , SBP = 120.0 mmHg (110.0 to 130.0) vs. 112.0 mmHg (100.0 to 122.0), DBP = 74 mmHg (70-80) vs. 70 mmHg (63-80); TG = 156.0 mg / dL (115.0 to 203.2) vs. 131.0 mg / dL (104.0 to 161.0), respectively, p < 0.01. Age, SBP, DBP, TG and TC levels were significantly and positively correlated with the VVF: r = 0.171, 0.224, 0.163, 0.278, 0.124 respectively, p < 0.005. CONCLUSION: A high prevalence of visceral obesity was observed, being statistically correlated with cardiovascular risk factors.

Prevalence of visceral obesity estimated by predictive equation in young women from Pernambuco.

BACKGROUND: The accumulation of visceral fat is considered a major risk factor for cardiovascular and metabolic diseases. OBJECTIVE: To determine the prevalence of visceral obesity and to assess its association with cardiovascular risk factors in young women from the state of Pernambuco. METHODS: Cross-sectional study carried out with data from the "III Health and Nutrition State Survey", involving women aged 25 to 36 years. The following variables were evaluated: body mass index (BMI), Waist Circumference (WC), waist-to-height ratio (WHtR), volume of visceral fat (VVF) estimated by a predictive equation, Systolic and Diastolic Blood Pressure (SBP, DBP), total cholesterol (TC), Triglycerides (TG), fasting glucose (FG). RESULTS: A total of 517 women were evaluated, with a median age of 29 years (27-32) and prevalence of visceral obesity of 30.6%. BMI, SBP, DBP and TG were higher in the group with visceral obesity: BMI = 28.0 kg/m2 (25.0 to 21.4) vs. 23.9 kg/m2 (21.5 to 26.4) , SBP = 120.0 mmHg (110.0 to 130.0) vs. 112.0 mmHg (100.0 to 122.0), DBP = 74 mmHg (70-80) vs. 70 mmHg (63-80); TG = 156.0 mg / dL (115.0 to 203.2) vs. 131.0 mg / dL (104.0 to 161.0), respectively, p < 0.01. Age, SBP, DBP, TG and TC levels were significantly and positively correlated with the VVF: r = 0.171, 0.224, 0.163, 0.278, 0.124 respectively, p < 0.005. CONCLUSION: A high prevalence of visceral obesity was observed, being statistically correlated with cardiovascular risk factors.

Desenvolvimento e validação de equação preditiva da gordura visceral em mulheres jovens / Development and validation of prediction equations for visceral fat in young women

Os métodos atualmente disponíveis para avaliação da obesidade visceral apresentam limitações, tornando-os inviáveis para avaliação em grandes grupos de indivíduos. Esse estudo teve por objetivo desenvolver e validar equação preditiva para estimar a área de tecido adiposo visceral em mulheres jovens. Foram estudadas 64 mulheres entre 19 e 36 anos. As seguintes variáveis foram avaliadas: volume de gordura visceral (VGV) (medido pela ultra-sonografia), Índice de Massa Corporal (IMC), Circunferência da Cintura, Razão Cintura-Estatura (RCE), Razão Cintura-Quadril, Índice de Conicidade, Perfil Lipídico e Glicemia de Jejum (GJ). As mulheres foram divididas em dois grupos: desenvolvimento (n=48) e validação (n=16) da equação. Foram propostas e validadas três equações para estimativa do VGV: Equação 1: VGV=-31,888+(4,044xIMC); Equação 2: VGV=-51,891+(248,018xRCE); Equação 3: VGV= -130,941 +(198,673 * RCE) + (1,185xGJ), com poder preditivo de 34%, 24% e 45%, respectivamente. Não foi observada diferença estatisticamente significante entre os valores de VGV avaliados pela ultrassonografia e estimados pelas equações preditivas no grupo de validação. As equações propostas podem ser utilizadas para cálculo do VGV de mulheres jovens, quando os exames de imagem não estiverem disponíveis, sendo uma ferramenta valiosa para estudos epidemiológicos e serviços de saúde.

The currently available methods for evaluation of visceral obesity have limitations, making them impractical for evaluating large numbers of individuals. This study aimed to develop and validate prediction equations to estimate the area of ​ ​ visceral adipose tissue in young women. The sample included 64 women aged 19 to 36 years. The following variables were evaluated: visceral fat volume (VFV) measured by ultrasound; body mass index (BMI); waist circumference; waist-to-height ratio (WHtR); waist-to-hip ratio (WHR); conicity index; lipid profile; and fasting plasma glucose (FPG). The women were divided into two groups for development (n=48) and validation (n=16) of equations. Three equations were proposed and validated to estimate VFV: Equation 1: VFV = - 31.888 + (4.044 x BMI); Equation 2: VFV = - 51.891 + (248.018 * WHtR); and Equation 3: VFV = - 130.941 + (198.673 x WHtR) + (1.185 x FPG); with a predictive power of 34%, 24%, and 45% respectively. There was no statistically significant difference between VFV values assessed by ultrasound and estimated by the prediction equations in the validation group. The proposed equations can be used to calculate VFV in young women when imaging tests are not available, providing a valuable tool for epidemiological studies and health services.

Complicações gastrointestinais e adequação calórico-protéica de pacientes em uso de nutrição enteral em uma unidade de terapia intensiva / Gastrointestinal complications and protein-calorie adequacy in intensive care unit enteral nutrition patients

OBJETIVO: Avaliar a prevalência de complicações gastrointestinais e a adequação calórico-protéica de pacientes críticos em uso de terapia de nutrição enteral. MÉTODOS: Estudo retrospectivo realizado na unidade de terapia intensiva do Hospital das Clínicas da Universidade Federal de Pernambuco, onde foram coletados, mediante análise das fichas de acompanhamento nutricional, as complicações gastrointestinais mais freqüentes durante o período de internamento do paciente, bem como a necessidade e a oferta calórico-protéica. Considerou-se como ofertado, o volume e o tipo de fórmula efetivamente recebido pelo paciente no último dia de internamento hospitalar. Foi utilizado o programa SPSS, versão 13 para análise estatística. RESULTADOS: A amostra foi composta de 77 pacientes com idade 54,7 ± 18,1 anos e predominância do sexo feminino (54,5 por cento). A dieta ofertada foi adequada e todos os pacientes apresentaram algum tipo de complicação gastrointestinal, sendo o retorno gástrico o mais prevalente (39 por cento), seguido da constipação com 36,4 por cento. CONCLUSÃO: Apesar da elevada prevalência de complicações gastrointestinais, não foi observada uma inadequação na oferta calórica-protéica. As condutas multidisciplinares frente à resolução dessas complicações necessitam ser padronizadas para que soluções precoces possam ser tomadas.

OBJECTIVE: To evaluate the prevalence of gastrointestinal complications and protein-calorie adequacy in critical patients using enteral nutrition therapy. METHODS: This was a retrospective study in the intensive care unit of the Hospital das Clinicas of the Universidade Federal de Pernambuco involving analysis of nutritional records evaluating the most frequent gastrointestinal complications during the patients' hospitalization and protein-calorie supply requirements. It was considered offered, the volume and formula effectively received by the patient on the last hospitalization day. The SPSS version 13 software was used for statistical analysis. RESULTS: The sample consisted of 77 patients aged in average 54.7 ± 18.1 years who were predominantly female (54.5 percent). The diet offered was appropriate and all patients had some type of gastrointestinal complications, being high gastric residuals the most prevalent (39 percent), followed by constipation (36.4 percent). CONCLUSION: Despite the high prevalence of gastrointestinal complications, no mismatches were observed in protein-calorie intake. Multidisciplinary approaches to these complications should be standardized in order to provide their early resolution.

Anemia, disfunção renal e desnutrição associadas à insuficiência cardíaca em pacientes valvopatas / Anemia, renal dysfunction and malnutrition associated with heart failure in patients with valvulopathy

FUNDAMENTO: A doença valvar pode cursar com insuficiência cardíaca (IC), anemia e disfunção renal (DR), aumentando o risco nutricional e piorando o prognóstico dos pacientes. OBJETIVO: Avaliar a prevalência de anemia e DR em pacientes portadores de valvopatias com ou sem IC, bem como estabelecer correlação com o estado nutricional. MÉTODOS: Foram avaliados 104 pacientes internados na enfermaria de valvopatias do PROCAPE/UPE, no período de ago-out/2008. Os dados foram obtidos das fichas de acompanhamento nutricional e dos prontuários. As variáveis coletadas foram: sexo, idade, estado nutricional segundo o índice de massa corpórea (IMC), presença de IC, anemia, DR. Considerou-se como anemia valores de hemoglobina < 13 g/dl nos homens e < 12 g/dl nas mulheres. A DR foi estabelecida de acordo com a taxa de filtração glomerular (TGF), sendo calculada pela fórmula proposta por Cockcroft e Gault. RESULTADOS: A prevalência de anemia e DR em pacientes com IC foi de 71,1 por cento e de 68,8 por cento, e nos pacientes sem IC foi de 48,1 por cento e de 60,0 por cento, respectivamente, com diferença estatisticamente significativa para anemia (p = 0,022). Dos pacientes, 48,1 por cento estavam eutróficos, 26,9 por cento com excesso de peso e 25,0 por cento com algum grau de desnutrição. Os pacientes com IC apresentaram uma frequência maior de baixo peso (p = 0,020). O estado nutricional não apresentou associação com anemia (p = 0,117), mas apresentou associação com DR, sendo a função renal diminuída mais frequente nos pacientes com baixo peso (p = 0,000). CONCLUSÃO: Houve significância estatística quando comparamos as prevalências de desnutrição, anemia e DR entre pacientes com e sem IC.

BACKGROUND: Valvular disease can course with heart failure (HF), anemia and renal dysfunction (RD), increasing the nutritional risk and worsening patient prognosis. OBJECTIVE: To evaluate the prevalence of anemia and RD in patients with valvulopathy with or without HF, as well as establish a correlation with the nutritional status. METHODS: A total of 104 patients admitted at the Clinic of Valvulopathy of PROCAPE/UPE, during the period of Aug-Oct/2008. The data were obtained from the nutritional and medical follow-up files. The collected variables were: sex, age, nutritional status according to the body mass index (BMI), presence of HF, anemia and RD. Anemia was considered when hemoglobin values were < 13 g/dl in men and < 12 g/dl in women. RD was established according to the glomerular filtration rate (GFR) and it was calculated through the formula proposed by Cockcroft and Gault. RESULTS: The prevalence of anemia and RD was 71.1 percent and 68.8 percent, and 48.1 percent and 60.0 percent, in patients with and without HF, respectively, with a statistically significant difference for anemia (p = 0.022). Of the patients, 48.1 percent were eutrophic, 26.9 percent had excess weight and 25.0 percent presented some degree of malnutrition. The patients with HF presented a higher frequency of low weight (p = 0.020). The nutritional status was not associated with anemia (p = 0.117), but it was associated with RD, with renal function being decreased more often in patients with low weight (p = 0.000). CONCLUSION: When the prevalence of malnutrition, anemia and RD was compared between patients with and without HF, it showed statistical significance.

Anemia, renal dysfunction and malnutrition associated with heart failure in patients with valvulopathy.

BACKGROUND: Valvular disease can course with heart failure (HF), anemia and renal dysfunction (RD), increasing the nutritional risk and worsening patient prognosis. OBJECTIVE: To evaluate the prevalence of anemia and RD in patients with valvulopathy with or without HF, as well as establish a correlation with the nutritional status. METHODS: A total of 104 patients admitted at the Clinic of Valvulopathy of PROCAPE/UPE, during the period of Aug-Oct/2008. The data were obtained from the nutritional and medical follow-up files. The collected variables were: sex, age, nutritional status according to the body mass index (BMI), presence of HF, anemia and RD. Anemia was considered when hemoglobin values were < 13 g/dl in men and < 12 g/dl in women. RD was established according to the glomerular filtration rate (GFR) and it was calculated through the formula proposed by Cockcroft and Gault. RESULTS: The prevalence of anemia and RD was 71.1% and 68.8%, and 48.1% and 60.0%, in patients with and without HF, respectively, with a statistically significant difference for anemia (p = 0.022). Of the patients, 48.1% were eutrophic, 26.9% had excess weight and 25.0% presented some degree of malnutrition. The patients with HF presented a higher frequency of low weight (p = 0.020). The nutritional status was not associated with anemia (p = 0.117), but it was associated with RD, with renal function being decreased more often in patients with low weight (p = 0.000). CONCLUSION: When the prevalence of malnutrition, anemia and RD was compared between patients with and without HF, it showed statistical significance.

Gastrointestinal complications and protein-calorie adequacy in intensive care unit enteral nutrition patients. / Complicações gastrointestinais e adequação calórico-protéica de pacientes em uso de nutrição enteral em uma unidade de terapia intensiva.

OBJECTIVE: To evaluate the prevalence of gastrointestinal complications and protein-calorie adequacy in critical patients using enteral nutrition therapy. METHODS: This was a retrospective study in the intensive care unit of the Hospital das Clinicas of the Universidade Federal de Pernambuco involving analysis of nutritional records evaluating the most frequent gastrointestinal complications during the patients' hospitalization and protein-calorie supply requirements. It was considered offered, the volume and formula effectively received by the patient on the last hospitalization day. The SPSS version 13 software was used for statistical analysis. RESULTS: The sample consisted of 77 patients aged in average 54.7 ± 18.1 years who were predominantly female (54.5%). The diet offered was appropriate and all patients had some type of gastrointestinal complications, being high gastric residuals the most prevalent (39%), followed by constipation (36.4%). CONCLUSION: Despite the high prevalence of gastrointestinal complications, no mismatches were observed in protein-calorie intake. Multidisciplinary approaches to these complications should be standardized in order to provide their early resolution.

Estado nutricional, consumo alimentar e risco cardiovascular: um estudo em universitários / Nutritional status, food consumption and cardiovascular risk: a study on university students

OBJETIVO: Descrever a proporção de fatores de risco para doenças cardiovasculares, dando ênfase aos fatores nutricionais, em alunos da área de saúde de uma universidade pública do Recife. MÉTODOS: Foram avaliados 250 estudantes por um questionário que abordou aspectos biossociais, dados sobre estilo de vida, história familiar para doenças cardiovasculares, variáveis antropométricas e consumo alimentar, avaliado pelo Recordatório de 24horas. RESULTADOS: Foi encontrada a seguinte freqüência para os fatores de risco analisados: tabagismo (2,8 por cento), sedentarismo (41,7 por cento), excesso de peso (35,5 por cento e 5,3 por cento nos sexos masculino e feminino, respectivamente p<0,01), história familiar de hipertensão (35,5 por cento), diabetes (11,3 por cento) e obesidade (20,2 por cento), morte antes dos 50 anos por doenças cardiovasculares nos familiares diretos (14,8 por cento). Com relação ao consumo alimentar, observou-se um elevado percentual de inadequação no consumo de energia e um baixo percentual de inadequação no consumo de proteínas e carboidratos. Quanto ao perfil lipídico da dieta, mais de 40,0 por cento dos estudantes apresentaram consumo de colesterol acima do recomendado e, em 17,9 por cento dos homens e 44,8 por cento das mulheres foi evidenciado um elevado consumo de gordura saturada (p<0,01). O consumo de ácido linoléico, ácido graxo monoinsaturado e poliinsaturado mostrou-se insuficiente em mais de 95,0 por cento dos indivíduos estudados. CONCLUSÃO: A alta proporção de fatores de risco cardiovasculares representa uma advertência, dada a juventude da população considerada, e mostra a necessidade de insistir em medidas educativas e de promoção de condutas preventivas.

OBJECTIVE: This study aimed to describe the proportion of risk factors for cardiovascular diseases, emphasizing nutritional factors, among health students from a public university in Recife, Brazil. METHODS: Two hundred and fifty students were assessed through a questionnaire that addressed biosocial aspects, lifestyle data, family history for cardiovascular diseases, anthropometric variables and food consumption determined by the 24-hour recall. RESULTS: The following rates were found for the assessed risk factors: smoking (2.8 percent), inactivity (41.7 percent), overweight (35.5 percent among men and 5.3 percent among women, p<0,01), family history of hypertension (35.5 percent), diabetes (11.3 percent), obesity (20.2 percent) and death of close relatives before age 50 due to cardiovascular diseases (14.8 percent). Regarding food consumption, a high percentage of individuals had inappropriate energy intake and a low percentage had inappropriate protein and carbohydrate intakes. Regarding the fat profile of the diet, more than 40.0 percent of the students consumed more cholesterol than the recommended levels and 17.9 percent of the men and 44.8 percent of the women consumed high amounts of saturated fat (p<0.01). The consumption of linoleic acid and monounsaturated and polyunsaturated fatty acids was inadequate in more than 95 percent of the individuals under study. CONCLUSION: The high rates of risk factors are a warning sign, given the young age of the studied population, and show the need to insist on measures to prevent primary cardiovascular disease.

Efeito benéfico da correção da acidose metabólica no estado nutricional de pacientes em hemodiálise / Beneficial effects of metabolic acidosis correction in hemodialysis patients

Objetivo: Avaliar o efeito da correção da acidose metabólica no estado nutricional de pacientes em hemodiálise. Métodos: Foram estudados, durante seis meses, 20 pacientes com acidose metabólica, definida pela média de tr~es mensurações de bicarbonato sérico pré-diálise <22 mEq/L. os pacientes dialisavam há, pelo menos, seis meses, utilizando bicarbonato de 35 mEq/L no dialisato. A correção da acidose metabólica foi feita mediante elevação do bicarbonato no dialisato para valores que não ultrapassaram 40 mEq/L, objetivando um bicarbonato sérico entre 22-26 mEq/L. Foram avaliados no início e no final do estudo: avaliação antropométrica, dietética, bioquímica e Avaliação subjetiva Global (ASG). Resultados: A avaliação nutricional na fase inicial do estudo demonstrou índice de massa corporal normal (24,23 +- 3,83 Kg/m²). A circunferência muscular do braço, a prega cutânea tricipital e a ASG classificaram homens e mulheres como desnutridos. Os consumos de calorias e proteínas foram 29,7 +- 10,1 Kcal?kg/dia e 1,31 +- 0,35 g/Kg/dia, respectivamente. A avaliação bioquímica observou albumina sérica normal e colesterol reduzido. Após correção, bicarbonato sérico e pH aumentaram de 18,2 +- 1,64 para 22 +- 1,70 (p<0,001), e de 7,32+- 0,45 para 7,37 +-0,41 (p<0,001), respectivamente. Houve melhora da ASG (21,7 +- 6,4 versus 16,8 +-6,6, p<0,0001) e aumento na ingestão calórica (1.892,61 +-454,30 versus 2.110,30 +-869,24, p<0,05). Conclusão: A suplementação de bicarbonato na solução de hemodiálise foi método efetivo para a correção da acidose metabólica, determinando aumento da ingestão calórica e melhora nos escores da ASG.

Objective: To evaluate the effect of correction of metabolic acidosis on nutritional status of hemodialysis patients. Methods: We studied for six months, 20 patients with metabolic acidosis, defined as the average of tr ~ s measurements of predialysis serum bicarbonate <22 mEq / L. patients receiving dialysis treatment for at least six months, using bicarbonate of 35 mEq / L in the dialysate. The correction of metabolic acidosis was observed in the high bicarbonate dialysate for values that exceeded 40 mEq / L, aiming for a serum bicarbonate between 22-26 mEq / L. Were assessed at baseline and at the end of the study: anthropometric, dietary, biochemical and Subjective Global Assessment (SGA). Results: The nutritional assessment in the initial phase of the study showed normal BMI (24.23 + - 3.83 kg / m²). The arm muscle circumference, triceps skinfold and the ASG men and women classified as malnourished. The intake of calories and protein were 29.7 + - 10.1 Kcal? Kg / day and 1.31 + - 0.35 g / kg / day, respectively. The biochemical evaluation showed normal serum albumin and low cholesterol. After correction, serum bicarbonate and pH increased from 18.2 + - 1.64 for 22 + - 1.70 (p <0.001), and 7.32 + - 0.45 to 7.37 + -0.41 ( p <0.001), respectively. There was improvement in ASG (21.7 + - 6.4 versus 16.8 + -6.6, p <0.0001) and increased caloric intake (1892.61 + -454.30 vs 2110.30 + -869 , 24, p <0.05). Conclusion: Supplementation of bicarbonate in the dialysis solution was an effective method for correction of metabolic acidosis, determining increased caloric intake and improvement in the scores of the ASG.

Acidose metabólica: um importante fator na etiologia da desnutrição em pacientes renais crônicos / Metabolic acidosis: an important factor in the etiology of malnutrition in chronic renal patients / La acidosis metabólica: un factor importante en la etiología de la malnutrición en los pacientes renales crónicos

A Insuficiência Renal Crônica (IRC) constitui sério problema de saúde em todo o mundo, com incidência crescente e elevada morbimortalidade, sendo que a desnutrição protéico-energética (DPE) é um importante fator que contribui para o agravamento desse quadro nosológico. Existem muitas causas que predispõem os pacientes renais crônicos à desnutrição, recentemente o papel da acidose metabólica tem sido bem-enfatizado. Desse modo, o objetivo desta revisão foi descrever os mecanismos pelos quais a acidose metabólica contribui para o catabolismo protéico nos pacientes IRC, bem como avaliar os efeitos da utilização de bicarbonato de sódio na correção da acidose e consequentemente, na redução da prevalência de desnutrição. Relatos da literatura mostram que a acidemia persistente aumenta a degradação protéica e a oxidação de aminoácidos, resultando em balanço nitrogenado negativo. Além disto, a acidose metabólica pode ocasionar resistência á insulina, supressão do hormônio do crescimento e da vitamina D, elevação do nível circulante de glicocorticóides e reduzida sensibilidade do paratormônio ao cálcio. Por outro lado, há uma escassez de estudos no que se refere aos efeitos nutricionais da correção da acidose metabólica. No entanto, as evidências encontradas demonstram que a monitoração do bicarbonato sérico e a manutenção dos seus níveis em valores superiores a 22 mmol/L (correção da acidose metabólica) deveriam ser o objetivo na conduta de pacientes renais crônicos, na tentativa de minimizar os efeitos deletéricos sobre o estado nutricional.

The Chronic Renal Failure (CRF) is a serious health problem worldwide, with increasing incidence and high mortality, and the protein-energy malnutrition (EPD) is an important contributing factor to the aggravation of this nosological. There are many causes that predispose CRF patients with malnutrition, recently the role of metabolic acidosis has been well-emphasized. Thus, the purpose of this review was to describe the mechanisms by which acidosis contributes to the protein catabolism in patients IRC, as well as evaluating the effects of using sodium bicarbonate in correcting acidosis and consequently in reducing the prevalence of malnutrition. Medical reports show that the persistent acidemia increases protein degradation and amino acid oxidation, resulting in negative nitrogen balance. Moreover, metabolic acidosis can lead to insulin resistance, suppression of growth hormone and vitamin D, elevated circulating level of glucocorticoids and reduced sensitivity of parathyroid calcium. On the other hand, there is a paucity of studies regarding the effects of nutritional correction of metabolic acidosis. However, the evidence found shows that monitoring of serum bicarbonate levels and maintenance of its values in excess of 22 mmol/L (correction of metabolic acidosis) should be the goal in treating patients with chronic renal failure in an attempt to minimize the deleterious effects on nutritional status.

La insuficiencia renal crónica (IRC) es un grave problema de salud en todo el mundo, con una incidencia y elevada mortalidad y la malnutrición proteico-energética (EPD) es un factor importante que contribuye a la agravación de esta nosológica. Hay muchas causas que predisponen a los pacientes con IRC con la desnutrición, recientemente el papel de la acidosis metabólica ha sido así-subrayó. Así, el objetivo de esta revisión fue describir los mecanismos por los que la acidosis contribuye al catabolismo proteico en los pacientes con IRC, así como la evaluación de los efectos de sodio con bicarbonato en corregir la acidosis y en consecuencia en la reducción de la prevalencia de la desnutrición. Los informes médicos muestran que la acidemia persistente aumento de la degradación de proteínas y la oxidación de aminoácidos, lo que resulta en balance negativo de nitrógeno. Por otra parte, la acidosis metabólica puede llevar a la resistencia a la insulina, la supresión de la hormona del crecimiento y la vitamina D, elevado nivel de circulación de los glucocorticoides y sensibilidad reducida de calcio paratiroides. Por otro lado, hay una escasez de estudios sobre los efectos de la corrección de la acidosis metabólica nutricional. Sin embargo, la evidencia encontrada muestra que la vigilancia de los niveles séricos de bicarbonato y el mantenimiento de sus valores por encima de 22 mmol/L (corrección de la acidosis metabólica) debería ser el objetivo en el tratamiento de pacientes con insuficiencia renal crónica en un intento de minimizar los efectos nocivos sobre el estado nutricional.