Muscle mass evaluation in hospitalized patients: Comparison between doubly indirect methods.

BACKGROUND: Loss of muscle mass (MM) in hospitalized patients has been associated with negative outcomes, thus, evaluating this biomarker is important to stratify risk. Although studies have been showing that calf circumference (CC) and bioelectrical impedance analysis (BIA) are valid for estimating MM in hospitalized patients, we do not know if they are associated. The aim of this study was to evaluate the associations between CC and BIA in hospitalized patients. METHODS: A cross-sectional study, in hospitalized patients' post-acute cardiac event. We collected sociodemographic, clinical, and anthropometric data. CC measurement was adjusted according to the BMI. Spearman's correlations and associations between the methods were performed for the total sample, according to sex and stage of life (older adults or not). RESULTS: We included 177 patients, mean age of 60.5 ± 12.4 years old, the majority males (75 %). Median BMI was 26.2 kg/m2 (23.8-29.2 kg/m2), most of them overweight (41.8 %). The median of CC was lower in females and older adults, and majority of the patients had low CC (87.6 %). Higher values of fat-free mass (FFM) by BIA were observed in males and younger adults, and 5.6 % presented low FFMI. We found a positive and moderate correlation between fat-free mass index (FFMI) and CC (rho = 0.532). Males had higher correlations (rho = 0.481). An increase of 1 kg in the FFM represented an increase of 1.16 cm (crude analysis) to 1.59 cm (adjusted analysis) in CC (p < 0.001). FFM explained 37 % in the variability of CC, and together with BMI, sex and age, explained 60 % in the variability. CONCLUSIONS: Raw values of FFM obtained by BIA and CC presented a weak to moderate correlation in cardiac patients. Changes in one measure impact on the other one.

Bioelectrical impedance vector analysis is different according to the comorbidity burden in post-acute myocardial infarction.

BACKGROUND: The prevalence of a high comorbidity burden in patients who suffered an acute myocardial infarction (AMI) is increasing with the aging population, and the nutrition status also may be a predictor of clinical outcomes for these patients. This study aimed to investigate the relationship between the comorbidity burden and the characteristics of the bioelectrical impedance vector analysis (BIVA) in patients post-AMI. METHODS: This prospective observational cohort study was conducted with adult patients who were hospitalized with AMI. Pre-existing comorbidities were assessed by the Charlson comorbidity index (CCI) adjusted by age, and anthropometric and BIVA characteristics were evaluated after the hemodynamic stabilization. All patients were followed-up until hospital discharge, and their length of stay was observed. RESULTS: A total of 184 patients (75% were males; mean age, 60.2 ± 12.3 years) were included. The most common comorbidities were dyslipidemia (73.9%), hypertension (62%), and type 2 diabetes (34.2%). A higher CCI (≥3) was associated with sex (P = 0.008) and age (P < 0.001). Regarding BIVA, statistically significant differences were detected between sex (P < 0.001), age (P < 0.001), and CCI (P = 0.003), with longer vectors in female, older adults, and those with CCI ≥ 3. CONCLUSION: Finding a relationship between BIVA and CCI suggests the first identified coherent differences, potentially correlated with diseases, representing a first contribution to support this type of assessment. Therefore, with BIVA, healthcare professionals may monitor abnormalities and adopt preventive nutrition care measures on patients post-AMI to improve their clinical status.

SARC-F Is a Predictor of Longer LOS and Hospital Readmission in Hospitalized Patients after a Cardiovascular Event.

It is already established that sarcopenia is associated with adverse outcomes; however, few studies have focused on patients who have suffered an acute cardiovascular event. The use of SARC-F, a 5-item sarcopenia screening questionnaire, in these patients remains to be investigated. We aimed to investigate whether SARC-F can predict adverse outcomes in patients admitted to a hospital with a suspected infarction. This is a 1-year prospective cohort study. During hospitalization, patients completed the SARC-F questionnaire (scores ≥ 4 considered positive for the risk of sarcopenia). Length of hospital stay (LOS), new hospital admission, myocardial infarction, and cardiovascular mortality were collected via medical records and phone interviews. In total, 180 patients were evaluated. The median age was 60.6 years; 72.3% of the participants were men, and half of the sample had comorbidities. The median SARC-F score was 1.0 (interquartile range, 0-3.0), and 21.1% of the participants screened positive. Risk of sarcopenia was independently associated with longer LOS (odds ratio, 2.34; 95% CI, 1.09-5.04; p = 0.030) and hospital readmission (odds ratio, 3.73; 95% CI, 1.60-8.69; p = 0.002). One-fifth of post-acute cardiovascular event patients in this cohort screened positive for sarcopenia using the SARC-F screening questionnaire. Positive scores were associated with a longer LOS and hospital readmission.

Is the standardized phase angle a predictor of short- and long-term adverse cardiovascular events in patients with acute myocardial infarction? A cohort study.

OBJECTIVES: Acute myocardial infarction (AMI) is myocardial necrosis resulting from myocardial ischemia, and its risk factors are usually a combination of the consumption of tobacco, inadequate diet, obesity, and a sedentary lifestyle, in addition to preexisting comorbidities. These risk factors may compromise cellular integrity, affecting physiologic and nutritional components. The phase angle (PhA) has been measured by bioelectrical impedance analysis (BIA) to identify the quality of the cell membrane and the distribution of body fluids. The aim of this study was to verify if the standardized PhA (SPhA) is a predictor of short- and long-term adverse cardiovascular events in patients after AMI. METHODS: This was a prospective cohort study including hospitalized adult patients with a diagnosis of AMI. Demographic, clinical, and nutritional data were collected. The PhA was calculated through the measuring of the resistance (R) and reactance (Xc) from BIA, and it was adjusted based on reference values for sex and age, presenting, therefore, the SPhA. Low SPhA was defined as that <10th percentile of distribution. Hospital length of stay (LOS) and major adverse cardiac events (MACE), such as new hospital admission for unstable angina, new MI, and cardiovascular mortality, were observed. The sample comprised 153 patients, with a mean age of 61.2 ± 12.6 y, with 57.5% being older adults. RESULTS: Fifteen patients with low SPhA (values <-3.10) had a longer LOS compared with those with normal SPhA (median 14 versus 8 d, P = 0.007), and shorter time for the occurrence of death (320 versus 354 d, P = 0.024). In the multivariate analysis, an association was observed between SPhA and longer LOS (hazard ratio, 9.25; P = 0.005), but not with mortality and MACE (P > 0.05 for all). CONCLUSION: SPhA was a predictor of longer LOS, but not of long-term adverse cardiac events in patients following AMI.

Nutritional and environmental risk factors for breast cancer: a case-control study / Fatores de risco nutricionais e ambientais para câncer de mama: estudo de casos e controles

AIMS: To investigate the associations between breast cancer diagnosis and nutritional and environmental factors in women from Northeast Brazil. METHODS: A case-control study included women evaluated in two hospitals specialized in cancer treatment. The case group was composed by women with breast cancer whose data were obtained during the hospitalization period for surgical treatment of the disease. The control group was selected in the same hospitals excluding the oncology ward. The following risk factors were investigated: household environmental sanitation, breastfeeding history, social class, smoking exposition, alcohol consumption and family history of cancer. A food frequency questionnaire was completed by the subjects and an evaluation of anthropometric nutritional status was made. Comparison for quantitative variables was performed using independent t-test or Mann-Whitney test. Chi-square or Fisher's exact test were used to compare categorical variables. The estimated risk associated with consumption of nutrients and food groups was assessed by OR, with a 95% confidence interval. In order to assess the effect of possible confounding factors such as excess weight or excessive caloric intake, a multivariate analysis was performed with the variables with p<0.15 in the food consumption analysis. The significance level for all analyses was set at p<0.05. RESULTS: The total sample consisted of 118 women, 59 in each group. Of all environmental risk factors investigated, poor sanitation (OR [odds ratio]=3.2, 95%CI 1.43-7.11) and family history for cancer (OR=3.11, 95%CI 1.42-6.78) were significantly associated with the diagnosis of breast cancer. Regarding anthropometric assessments, overweight or obesity and waist circumference >88cm were more prevalent in the case group (OR=2.70, 95%CI 1.28-5.70 and OR=3.10, 95%CI 1.46-6.56, respectively). Regular consumption of ultra-processed foods was identified as a risk factor for breast cancer (adjusted OR=2.35, 95%CI 1.08-5.12). CONCLUSIONS: Higher consumption of ultra-processed food, presence of overweight or obesity, waist circumference ≥88 cm, poor sanitation, and family history of cancer were risk factors for breast cancer in this sample of women living in Rio Grande do Norte state, Brazil.

OBJETIVOS: Investigar associações entre o diagnóstico de câncer de mama e fatores nutricionais e ambientais em mulheres do Nordeste do Brasil. MÉTODOS: Um estudo caso-controle incluiu mulheres avaliadas em dois hospitais especializados em câncer. O grupo de casos foi composto por mulheres com câncer de mama cujos dados foram obtidos durante o período de internação para tratamento cirúrgico da doença. O grupo controle foi selecionado nos mesmos hospitais, excluindo as unidades de oncologia. Os seguintes fatores de risco foram investigados: saneamento básico nas moradias, história de amamentação, classe social, exposição ao tabagismo, consumo de álcool e história familiar de câncer. Um questionário de frequência alimentar foi completado pelas participantes e foi feita uma avaliação do estado nutricional antropométrico. Foram usados o teste t independente ou o teste de Mann-Whitney para comparação entre variáveis quantitativas, e o qui-quadrado ou o teste exato de Fisher para variáveis categóricas. O risco estimado associado ao consumo de nutrientes e grupos de alimentos foi avaliado por OR, com intervalo de confiança de 95%. Para avaliar o efeito de possíveis fatores de confusão, como excesso de peso ou ingestão calórica excessiva, foi realizada uma análise multivariada com as variáveis com p<0,15 na análise do consumo de alimentos. O nível de significância para todas as análises foi definido em p<0,05. RESULTADOS: A amostra total consistiu de 118 mulheres, 59 em cada grupo. De todos os fatores de risco ambientais investigados, um saneamento deficiente (OR [odds ratio]=3,2, IC95% 1,43-7,11) e história familiar de câncer (OR=3,11, IC95% 1,42-6,78) foram significativamente associados ao diagnóstico de câncer de mama. Em relação às avaliações antropométricas, excesso de peso ou obesidade e circunferência da cintura >88 cm foram mais prevalentes no grupo de casos (OR=2,70, IC95% 1,28-5,70 e OR=3,10, IC95% 1,46-6,56, respectivamente). O consumo regular de alimentos ultraprocessados foi identificado como um fator de risco para câncer de mama (OR ajustada=2,35, IC95% 1,08-5,12). CONCLUSÕES: Maior consumo de alimentos ultraprocessados, presença de excesso de peso ou obesidade, circunferência da cintura ≥88 cm, saneamento básico deficiente e história familiar de câncer foram fatores de risco para o câncer de mama nesta amostra de mulheres que vivem no estado do Rio Grande do Norte.