Adequacy of Fatty Acids Consumption Among Individuals in Secondary Cardiovascular Prevention. / Adequação do Consumo de Ácidos Graxos entre Pacientes em Prevenção Cardiovascular Secundária.

BACKGROUND: Adhering to a diet adequate in macronutrients is crucial for the secondary prevention of cardiovascular diseases. OBJECTIVE: To assess the prevalence of adherence to recommendations for the consumption of dietary fatty acids for the prevention and treatment of cardiovascular diseases and to estimate whether the presence of certain cardiovascular risk factors would be associated with adherence. METHODS: Cross-sectional study using baseline data from 2,358 participants included in the "Brazilian Cardioprotective Nutritional Program Trial". Dietary intake and cardiovascular risk factors were assessed. Adequate intake of polyunsaturated fatty acids (PUFA) was considered as ≥10% of total daily energy intake; for monounsaturated fatty acids (MUFA), 20%; and for saturated fatty acids (SFA), <7% according to the Brazilian Society of Cardiology. A significance level of 5% was considered in the statistical analysis. RESULTS: No participant adhered to all recommendations simultaneously, and more than half (1,482 [62.9%]) did not adhere to any recommendation. Adherence exclusively to the SFA recommendation was the most prevalent, fulfilled by 659 (28%) participants, followed by adherence exclusively to the PUFA (178 [7.6%]) and MUFA (5 [0.2%]) recommendations. There was no association between the number of comorbidities and adherence to nutritional recommendations (p = 0.269). Participants from the Brazilian Northeast region showed a higher proportion of adherence to SFA consumption recommendations (38.42%) and lower adherence to PUFA intake (3.52%) (p <0.001) compared to other regions. CONCLUSIONS: Among the evaluated sample, there was low adherence to nutritional recommendations for dietary fatty acid consumption.

FUNDAMENTO: A adesão à uma alimentação adequada em macronutrientes é fundamental para a prevenção secundária de doenças cardiovasculares. OBJETIVO: Avaliar a prevalência de adesão às recomendações de consumo de ácidos graxos para prevenção e tratamento de doenças cardiovasculares, e estimar se a presença de determinados fatores de risco cardiovascular estaria associada à adesão. MÉTODOS: Estudo transversal com os dados de linha de base de 2358 participantes do estudo "Brazilian Cardioprotective Nutritional Program Trial". Dados de consumo alimentar, e fatores de risco cardiovascular foram avaliados. Foi considerada, de acordo com a Sociedade Brasileira de Cardiologia, uma ingestão adequada de ácidos graxos poli-insaturados (AGPI) ≥10% do consumo total de energia diária, para ácidos graxos monoinsaturados (AGM), 20% e para ácidos graxos saturados (AGS), <7%. Na análise estatística foi considerando nível de significância de 5%. RESULTADOS: Nenhum participante aderiu a todas as recomendações de forma simultânea e mais da metade (1482 [62,9%]) não aderiu a nenhuma recomendação. A adesão exclusivamente à recomendação de AGS foi a mais prevalente, sendo cumprida por 659 (28%) dos participantes, seguida da adesão exclusivamente à recomendação de AGP (178 [7,6%]) e de AGM (5 [0,2%]). Não houve associação entre o número de comorbidades e a adesão às recomendações nutricionais (p =0,269). Os participantes da região Nordeste do país apresentaram maior proporção de adesão às recomendações para consumo de AGS (38,42%), e menor para ingestão de AGPI (3,52%) (p <0,001) em comparação às demais. CONCLUSÕES: Na amostra avaliada, evidenciou-se baixa adesão às recomendações nutricionais para consumo de ácidos graxos.

Adequação do consumo de ácidos graxos entre pacientes em prevenção cardiovascular secundária / Adequacy of Fatty Acids Consumption Among Individuals in Secondary Cardiovascular Prevention

FUNDAMENTO: A adesão à uma alimentação adequada em macronutrientes é fundamental para a prevenção secundária de doenças cardiovasculares. OBJETIVO: Avaliar a prevalência de adesão às recomendações de consumo de ácidos graxos para prevenção e tratamento de doenças cardiovasculares, e estimar se a presença de determinados fatores de risco cardiovascular estaria associada à adesão. MÉTODOS: Estudo transversal com os dados de linha de base de 2358 participantes do estudo "Brazilian Cardioprotective Nutritional Program Trial". Dados de consumo alimentar, e fatores de risco cardiovascular foram avaliados. Foi considerada, de acordo com a Sociedade Brasileira de Cardiologia, uma ingestão adequada de ácidos graxos poli-insaturados (AGPI) ≥10% do consumo total de energia diária, para ácidos graxos monoinsaturados (AGM), 20% e para ácidos graxos saturados (AGS), <7%. Na análise estatística foi considerando nível de significância de 5%. RESULTADOS: Nenhum participante aderiu a todas as recomendações de forma simultânea e mais da metade (1482 [62,9%]) não aderiu a nenhuma recomendação. A adesão exclusivamente à recomendação de AGS foi a mais prevalente, sendo cumprida por 659 (28%) dos participantes, seguida da adesão exclusivamente à recomendação de AGP (178 [7,6%]) e de AGM (5 [0,2%]). Não houve associação entre o número de comorbidades e a adesão às recomendações nutricionais (p =0,269). Os participantes da região Nordeste do país apresentaram maior proporção de adesão às recomendações para consumo de AGS (38,42%), e menor para ingestão de AGPI (3,52%) (p <0,001) em comparação às demais. CONCLUSÕES: Na amostra avaliada, evidenciou-se baixa adesão às recomendações nutricionais para consumo de ácidos graxos.

Relationship between dietary macronutrient composition with weight loss after bariatric surgery: A systematic review.

This systematic review evaluated the relationship between macronutrient intake and weight loss after bariatric surgery (BS). The MEDLINE/Pubmed, EMBASE, COCHRANE/CENTRAL, and SCOPUS databases were accessed in August 2021 to search for eligible articles: original publications with adults undergoing BS and indicating the relationship between macronutrients and weight loss. Titles that did not meet these criteria were excluded. The review was written according to the PRISMA guide, and the risk of bias was according to the Joanna Briggs manual. Data were extracted by one reviewer and checked by another. Eight articles with 2.378 subjects were included. The studies indicated a positive relationship between weight loss and protein intake after BS. Prioritization of protein followed by carbohydrates with a lower percentage of lipids favors weight loss and increases weight stability after BS. Among the results found, a 1% increase in protein intake raises the probability of obesity remission by 6%, and high-protein diet increase 50% weight loss success. Limitations are the methods of included studies and review process. It is concluded that high-protein intake >60 g a 90 g/day may favor weight loss and maintenance after BS, but it is relevant to balance the other macronutrients.

Planos Municipais de Saúde do Estado do Tocantins: uma análise com foco no enfrentamento da obesidade / Municipal Health Plans in Tocantins, Brazil: an analysis focusing on obesity

Resumo O objetivo deste estudo foi avaliar a abrangência do enfrentamento da obesidade nos Planos Municipais de Saúde (PMS) do Estado do Tocantins, dado que, diante da crescente prevalência da obesidade no Brasil, seu enfrentamento deveria estar no foco de ação da saúde pública e previsto nos instrumentos de gestão. Trata-se de um estudo qualitativo, com análise documental, que analisou os PMS no período de vigência de 2018 a 2021 nos 139 municípios desse estado. Foram selecionados dezessete termos relacionados à obesidade e verificada a frequência e contexto nos PMS. Do total de 139 PMS, foram avaliados 129 (92,8%). Os termos "academia da saúde" e "Sisvan" foram os mais frequentes, e "obesidade" apareceu em apenas 28% dos planos, totalizando 71 citações. Destas, somente 32,4% relacionavam-se diretamente com o enfrentamento da doença, com destaque nas regiões de saúde Bico do Papagaio e Médio Norte Araguaia. Os contextos relevantes de abordagem da obesidade mais frequentes foram a caracterização da situação epidemiológica, quadros de metas de ações e indicadores. Concluiu-se que o enfrentamento da obesidade pactuado nos PMS está ausente em mais de 70% dos municípios do Tocantins, e que ações de direcionamento para inclusão dessa doença dentro dos instrumentos de gestão são urgentes.

Abstract This documentary analysis evaluated the scope of addressing obesity in the Municipal Health Plans (PMS) in the state of Tocantins, Brazil, since the growing prevalence of obesity in Brazil should put its confrontation at the center of public health action and management instruments. To analyze the PMS performance from 2018 to 2021 in the 139 municipalities of this state, 17 terms related to obesity were selected and had their frequency and context in the PMS verified. Of the existing 139 PMS, 129 (92.8%) were evaluated. "Health academy" and "SISVAN" were the most frequent terms used, whereas "obesity" appeared in only 28% of the plans, totaling 71 mentions. Of these, only 32.4% were directly related to combating the disease, mainly in the health regions of Bico do Papagaio and Médio Norte Araguaia. Relevant contexts for addressing obesity included the characterization of the epidemiological profile, tables of action goals, and indicators. PMS's role in combating obesity is absent in more than 70% of municipalities in Tocantins, which points to the urgent inclusion of this disease within the management instruments.

Dietary total antioxidant capacity is inversely associated with cardiovascular events and cardiometabolic risk factors: A cross-sectional study.

OBJECTIVES: Dietary total antioxidant capacity (dTAC) has been introduced as a useful tool to quantify the antioxidant content of a diet. However, few studies have evaluated the association of dTAC with cardiovascular disease (CVD) occurrence and cardiometabolic risk factors in people with established CVD events. Thus, we aimed to investigate the presence of an association between dTAC values, cardiovascular events, and cardiometabolic risk factors in individuals with previous CVD in a Brazilian multicenter study. METHODS: This study has a cross-sectional design. We evaluated baseline data from the Brazilian Cardioprotective Nutritional Program Trial. Sociodemographic, anthropometric, clinical, and food-consumption data were collected in face-to-face interviews. We estimated dTAC from the mean of two 24-h dietary recalls by values of ferric-reducing antioxidant power. RESULTS: We evaluated 2346 participants, most of whom were men (58.4%), older adults (64.2%), and overweight (68.6%), and had coronary artery disease (92.4%). The mean dTAC was equal to 5.6 (interquartile range, 3.9-7.8) mmol/1000 kcal. Participants in the third dTAC tertile (9.2 mmol/1000 kcal) had a 22%, 59%, and 69% lower chance, respectively, of having hypertriglyceridemic waist phenotype, abdominal aortic aneurysm, and amputation due to arterial disease in comparison to the first tertile (3.4 mmol/1000 kcal). CONCLUSIONS: The dTAC was inversely associated with hypertriglyceridemic waist phenotype, abdominal aortic aneurysm, and amputation due to arterial disease in individuals undergoing secondary care for CVD. Our results can guide strategies for the prevention of new CVD and its consequences.

Weight Loss After RYGB Is Associated with an Increase in Serum Vitamin D in a Population with Low Prevalence of Hypovitaminosis D at Low Latitude.

PURPOSE: In Brazil and worldwide, few studies have investigated vitamin D deficiency in patients with severe obesity who underwent bariatric surgery associated with latitude and level of solar radiation. The objective of this study was to investigate the prevalence of vitamin D deficiency and the predictive factors of serum level changes after 12 months of RYGB in a low latitude region. MATERIALS AND METHODS: This study included 50 patients from a low-latitude city (10° 10' 8″ S) in the north of Brazil. We collected data before surgery and after 3 and 12 months of surgery. The level of vitamin D was classified as deficiency (< 20 ng/ml), insufficiency (20-30 ng/ml), and sufficiency (≥ 30 ng/ml). RESULTS: The mean age of the patients was 38.7 ± 8.9 years, 69% were women, and percent excess weight loss (% EWL) was 83% after 1 year of surgery. The prevalence of vitamin D deficiency in the preoperative period was 14%, and after 3 and 12 months of surgery, it decreased to 4% and 6%, respectively. The variation in vitamin D after 12 months of surgery was positively associated with changes in BMI, body fat, and % EWL. CONCLUSIONS: The prevalence of vitamin D deficiency is low in patients undergoing bariatric surgery in the northern region of Brazil, which is possibly related to low latitude. Weight loss was positively associated with an increase in serum vitamin D after surgery.

Changes in oxidative stress markers and cardiometabolic risk factors among Roux-en-Y gastric bypass patients after 3- and 12-months postsurgery follow-up.

BACKGROUND: Evidence shows potential reduction in oxidative stress after Roux-en-Y gastric bypass. However, this outcome can vary, with postsurgery time, type of markers significantly altered, and possible relation with cardiometabolic risk markers, thus indicating the need for more studies. OBJECTIVE: To evaluate changes in oxidative stress and its relation with cardiometabolic risk markers in Roux-en-Y gastric bypass patients after 3 and 12 months postsurgery. SETTING: Federal University of Viçosa, Brazil. METHODS: All data were collected before surgery and after 3 and 12 months postsurgery. Biochemical data were collected, and insulin resistance was determined by homeostasis model assessment of insulin resistance, triglyceride/glucose index, and triglycerides/high-density lipoprotein cholesterol. Additionally, catalase, superoxide dismutase, ferric-reducing antioxidant power, nitric oxide, carbonylated protein, and malondialdehyde were analyzed. RESULTS: After 3 months postsurgery, excess weight loss was 46%. It increased to 82% after 12 months. We observed a significant reduction in levels of serum insulin, triglycerides, homeostasis model assessment of insulin resistance, triglyceride/glucose index, and triglycerides/high-density lipoprotein cholesterol indices and nitric oxide, throughout the entire study period. Also, reduced levels of total cholesterol, low-density lipoprotein, serum glucose, malondialdehyde, and superoxide dismutase were observed at 3 and 12 months postsurgery compared with baseline. On the other hand, reduction in ferric-reducing antioxidant power occurred only at 3 months postsurgery. We also observed that nitric oxide was positively correlated with triglycerides, percent excess weight loss, total cholesterol/high-density lipoprotein cholesterol, and triglyceride/glucose index. CONCLUSION: Roux-en-Y gastric bypass is able to reduce oxidative stress, insulin resistance, and improve lipid profile after 3 and 12 months postsurgery. Furthermore, changes in oxidative stress and cardiometabolic risk markers are correlated.

Increase in Protein Intake After 3 Months of RYGB Is an Independent Predictor for the Remission of Obesity in the First Year of Surgery.

INTRODUCTION: Although bariatric surgery promotes dietary changes, many questions regarding their effect on weight loss remain unanswered. OBJECTIVE: The aim of this study was to evaluate changes in dietary intake and predictive factors of obesity remission in the first 12 months after RYGB. METHODS: Fifty-one patients (mean 39.34 ± 9.38 years, 68.7% women) who underwent RYGB were included in this study. Dietary intake was evaluated through a 24-h dietary recall and subsequently classified by NOVA, macronutrients and calories. The predictive factors for obesity remission within 12 months after RYGB were evaluated by Cox regression. RESULTS: At baseline, 62.7% of the patients presented severe obesity; mean excess weight loss was greater than 80% after 1 year of surgery and about 70% of the patients were no longer diagnosed with obesity. An increase in percentage of calories from protein was observed at 3 and 12 months after surgery. The caloric contribution of ultra-processed foods was low at 3 months after surgery while that of unprocessed or minimally processed foods was high at 3 and 12 months after surgery. From the Cox regression analysis, preoperative BMI (HR, 0.78; 95% CI, 0.69-0.88) and age (HR, 0.94; 95% CI, 0.89-0.99) showed an inverse association with obesity remission. Also, Δ protein (at 3 months-baseline) showed a positive association with obesity remission (HR, 1.06; 95% CI, 1.01-1.12). CONCLUSION: Lower preoperative BMI, lower age, and higher protein intake at 3 months after surgery may favor remission of obesity in up to 12 months compared with baseline.

BINGE EATING DISORDER AND QUALITY OF LIFE OF CANDIDATES TO BARIATRIC SURGERY.

BACKGROUND: Obesity decreases the quality of life, which is aggravated by the association of comorbidities, and the binge eating disorder is directly related to body image and predisposes to overweight. AIM: Evaluate association between the presence and the level of binge eating disorder and the quality of life of the obese candidates for bariatric surgery. METHODS: Cross-sectional study analyzing anthropometric data (weight and height) and socioeconomics (age, sex, marital status, education and income). The application of Binge Eating Scale was held for diagnosis of Binge Eating Disorder and the Medical Outcomes Study 36-item Short-From Health Survey to assess the quality of life. RESULTS: Total sample studied was 96 patients, mean age 38.15±9.6 years, 80.2% female, 67.7% married, 41% with complete and incomplete higher education, 77.1% with lower income or equal to four the minimum salary, 59.3% with grade III obesity. Binge eating disorder was observed in 44.2% of patients (29.9% moderate and 14.3% severe), and these had the worst scores in all domains of quality of life SF36 scale; however, this difference was not statistically significant. Only the nutritional status presented significant statistically association with the presence of binge eating disorder. CONCLUSION: High prevalence of patients with binge eating disorder was found and they presented the worst scores in all domains of quality of life.

BINGE EATING DISORDER AND QUALITY OF LIFE OF CANDIDATES TO BARIATRIC SURGERY / TRANSTORNO DA COMPULSÃO ALIMENTAR PERIÓDICA E QUALIDADE DE VIDA DE PACIENTES CANDIDATOS A CIRURGIA BARIÁTRICA

Background:Obesity decreases the quality of life, which is aggravated by the association of comorbidities, and the binge eating disorder is directly related to body image and predisposes to overweight.Aim:Evaluate association between the presence and the level of binge eating disorder and the quality of life of the obese candidates for bariatric surgery.Methods:Cross-sectional study analyzing anthropometric data (weight and height) and socioeconomics (age, sex, marital status, education and income). The application of Binge Eating Scale was held for diagnosis of Binge Eating Disorder and the Medical Outcomes Study 36-item Short-From Health Survey to assess the quality of life.Results:Total sample studied was 96 patients, mean age 38.15±9.6 years, 80.2% female, 67.7% married, 41% with complete and incomplete higher education, 77.1% with lower income or equal to four the minimum salary, 59.3% with grade III obesity. Binge eating disorder was observed in 44.2% of patients (29.9% moderate and 14.3% severe), and these had the worst scores in all domains of quality of life SF36 scale; however, this difference was not statistically significant. Only the nutritional status presented significant statistically association with the presence of binge eating disorder.Conclusion:High prevalence of patients with binge eating disorder was found and they presented the worst scores in all domains of quality of life.

Racional: A obesidade diminui a qualidade de vida que se agrava com a associação de comorbidades. O transtorno da compulsão alimentar tem relação direta com a imagem corporal e predispõe ao excesso de peso.Objetivo: Avaliar a associação entre a presença e o nível do transtorno da compulsão alimentar periódica e a qualidade de vida dos pacientes obesos candidatos à cirurgia bariátrica.Métodos:Estudo ambulatorial do tipo transversal onde coletaram-se dados antropométricos (peso e altura) e socioeconômicos (idade, sexo, estado civil, escolaridade e renda). Realizou-se aplicação da Escala de Compulsão Alimentar Periódica para diagnóstico do Transtorno de Compulsão Alimentar Periódica - TCAP e o Medical Outcomes Study 36-item Short-From Health Survey para avaliar a qualidade de vida.Resultados:Amostra total estudada foi de 96 pacientes, idade média de 38,15±9,6 anos, 80,2% do sexo feminino, 67,7% casados, 41% com ensino superior completo/incompleto, 77,1% com renda ≤4 salários mínimos, 59,3% obesidade grau III. Observou-se transtorno da compulsão alimentar em 44,2% dos pacientes (29,9% moderado e 14,3% grave), e estes apresentavam os piores escores em todos os domínios de qualidade de vida da escala SF36; porém, esta diferença não foi estatisticamente significante. Somente o estado nutricional apresentou associação com a presença do transtorno.Conclusão:Constatou-se elevada prevalência de pacientes com transtorno da compulsão alimentar e eles apresentaram os piores escores em todos os domínios da qualidade de vida.

[Prevalence of pre-hypertension and arterial hypertension and evaluation of associated factors in children and adolescents in public schools in Salvador, Bahia State, Brazil]. / Prevalência de pré-hipertensão e de hipertensão arterial e avaliação de fatores associados em crianças e adolescentes de escolas públicas de Salvador, Bahia, Brasil.

This study aimed to assess pre-hypertension and hypertension-related factors in 1,125 seven- to-14-year-old subjects enrolled in the public school system in Salvador, Bahia State, Brazil. Exposure variables, namely body mass index, waist circumference, gender, age, physical activity, environmental and housing status, family income, diet, schooling, and maternal age were analyzed by polytomous logistic regression, and the outcome variable was categorized as normal, pre-hypertensive, and hypertensive. Prevalence of high blood pressure was 14.1%, including the prevalence of both hypertension (4.8%) and pre-hypertension (9.3%). An association was shown between pre-hypertension and overweight (OR: 3.13; 95%CI: 1.75-5.57). Hypertension was associated with overweight (OR: 3.02; 95%CI: 1.45-6.28), female gender (OR: 2.49; 95%CI: 1.24-4.98), and high-risk eating patterns (OR: 1.93; 95%CI: 1.04-3.56). In short, prevalence of pre-hypertension and hypertension in children and adolescents was higher among girls and individuals with overweight and inadequate diet.

Prevalência de pré-hipertensão e de hipertensão arterial e avaliação de fatores associados em crianças e adolescentes de escolas públicas de Salvador, Bahia, Brasil / Prevalence of pre-hypertension and arterial hypertension and evaluation of associated factors in children and adolescents in public schools in Salvador, Bahia State, Brazil

Trata-se de estudo para avaliar os fatores associados à hipertensão e pré-hipertensão. Participaram desta pesquisa 1.125 indivíduos com idade entre 7 e 14 anos da rede pública de ensino em Salvador, Bahia, Brasil. As variáveis de exposição foram: índice de massa corporal, circunferência da cintura, sexo, idade, atividade física, condições ambientais e de moradia, renda familiar, consumo alimentar, escolaridade e idade maternas. Os dados foram analisados utilizando-se a Regressão Logística Politômica e a variável desfecho categorizada em normotensos, pré-hipertensos e hipertensos. A prevalência de pressão arterial elevada foi de 14,1 por cento, sendo 4,8 por cento de hipertensão e 9,3 por cento pré-hipertensão. Houve associação entre pré-hipertensão e excesso de peso (OR: 3,13; IC95 por cento: 1,75-5,57). Hipertensão foi associada a excesso de peso (OR: 3,02; IC95 por cento: 1,45-6,28), sexo feminino (OR: 2,49; IC95 por cento: 1,24-4,98) e padrão alimentar de risco (OR: 1,93; IC95 por cento: 1,04-3,56). A prevalência de pré-hipertensão e hipertensão em crianças e adolescentes é maior entre aqueles com excesso de peso, do sexo feminino e com consumo alimentar inadequado.

This study aimed to assess pre-hypertension and hypertension-related factors in 1,125 seven- to-14-year-old subjects enrolled in the public school system in Salvador, Bahia State, Brazil. Exposure variables, namely body mass index, waist circumference, gender, age, physical activity, environmental and housing status, family income, diet, schooling, and maternal age were analyzed by polytomous logistic regression, and the outcome variable was categorized as normal, pre-hypertensive, and hypertensive. Prevalence of high blood pressure was 14.1 percent, including the prevalence of both hypertension (4.8 percent) and pre-hypertension (9.3 percent). An association was shown between pre-hypertension and overweight (OR: 3.13; 95 percentCI: 1.75-5.57). Hypertension was associated with overweight (OR: 3.02; 95 percentCI: 1.45-6.28), female gender (OR: 2.49; 95 percentCI: 1.24-4.98), and high-risk eating patterns (OR: 1.93; 95 percentCI: 1.04-3.56). In short, prevalence of pre-hypertension and hypertension in children and adolescents was higher among girls and individuals with overweight and inadequate diet.