Nutrição em rede: um relato de experiência de lives produzidas por um Grupo de Educação Tutorial durante a pandemia de covid-19 / Network nutrition: an experience report of lives produced by a Tutorial Education Group during the covid-19 pandemic / Nutrición en red: un relato de experiencia de directos producidos por un Grupo de Educación Tutorial durante la pandemia del covid-19

Devido às complexidades do período de pandemia de covid-19, houve um aumento do acesso às redes sociais para a busca de informações científicas. Este trabalho visa apresentar as adaptações de uma atividade de ensino, através de relato de experiência, promovido pelo Grupo de Educação Tutorial (GET) do Curso de Nutrição da Universidade Federal de Juiz de Fora (UFJF). Foram ciclos de palestras com atualizações científicas e vivência prática, utilizando a rede social Instagram em formato de lives, sendo o conteúdo transmitido como entrevista, em dois blocos, totalizando seis lives com aproximadamente 55 minutos cada. O público interagiu com o palestrante, ao expressar opinião e encaminhar dúvidas através do recurso de comentários. Houve sucesso na participação dos alunos, fato confirmado pelo número de visualizações, uma vez que o total foi superior quando comparado às edições presenciais. A internet viabilizou encontros de pessoas, mesmo distantes, possibilitando o acesso a profissionais de outras cidades e transmitindo informações através da rede social

Due to the complexities of the covid-19 pandemic period, there has been an increase in access to social net-works to search for scientific information. This work aims to present the adaptations of a teaching activity, through an experience report, promoted by the Tutorial Education Group, of the Nutrition Course from the Federal University of Juiz de Fora. There were lecture cycles with scientific updates and practical experience, using the social network Instagram in the format of lives, with the content being transmitted as an interview, in two blocks, totaling six lives with approximately 55 minutes each. The audience interacted with the speaker, expressing their opinion and doubts through the comment section. There was success in student participation, which can be confirmed by the number of online views, since this was higher when compared to the face-to-face editions. The internet made it possible for people to meet, even if they were far away, allowing access to professionals from other cities and transmitting information through the social network

Debido a las complejidades del período de la pandemia de covid-19, se ha incrementado el acceso a las redes sociales para buscar información científica. Este trabajo tiene como objetivo presentar las adaptaciones de una actividad docente, a través de un relato de experiencia, promovida por el Grupo de Educación Tutorial (GET) del Curso de Nutrición de la Universidad Federal de Juiz de Fora. Se realizaron ciclos de conferencias con actualización científica y experiencia práctica, utilizando la red social Instagram en formato de directos, siendo el contenido transmitido como entrevista, en dos bloques que suman seis directos con aproximada-mente 55 minutos cada una. El público interactuó con el ponente, expresando su opinión y dudas a través de la función de comentarios. Hubo éxito en la participación de los estudiantes, lo que se puede confirmar con el número de visualizaciones en línea, ya que fue mayor en comparación con las ediciones presenciales. Internet hizo posible que las personas se encontraran, aunque estuvieran lejos, permitiendo el acceso a profesionales de otras ciudades y transmitiendo información a través de la red social

Dark chocolate (70% cocoa) reduces craving in smokers with severe cardiovascular comorbidities without interference in anthropometric measures / Chocolate amargo (70% cacau) reduz fissura em tabagistas com comorbidades cardiovasculares graves sem interferir nas medidas antropométricas

ABSTRACT Objective: Analyze craving in smokers with cardiovascular comorbidities submitted to a nutritional approach. Methods: Two groups were randomized and submitted to clinical intervention (n = 32): Group 1 (G1, n = 15): ingested 40 g of chocolate containing 70% cocoa/day and behavioral intervention for smoking cessation for one month; Group 2 (G2, n = 17): control group, only behavioral intervention. Questionnaire of Smoking Urges-Brief (QSU-Brief) - Brazil version measured total craving and its factors. Anthropometric measurements verified the nutritional interference of the procedure and the serum assessment verified the interference of inflammatory processes related to smoking. The study was registered on the Brazilian Registry of Clinical Trials (ReBEC): RBR-83jr3. Results: After one month, compared to the initial evaluation, the G1 reduced the craving evaluated by the QSU-Brief and its Factors 1 and 2. Total QSU-Brief: 44.27 ± 15.82 x 27.00 ± 18.03 (p = 0.008); Factor 1: 21.90 ± 7.70 x 12.90 ± 8.87 (p = 0.006); Factor 2: 11.90 ± 6.30 x 7.00 ± 6.63 (0.007). G2 showed a reduction in total QSU-Brief and Factor 1, but not in Factor 2. QSU-Brief total 28.17 ± 17.24 x 19.52 ± 9.50 (p = 0.049); Factor 1: 14.47 ± 8.74 x 9.23 ± 6.11 (p = 0.046). Serum levels of cortisol, leptin, serotonin, C-Reactive Protein (CRP) and insulin did not show differences (p > 0.05). No anthropometric differences were found. Conclusion: The results demonstrate that daily consumption of chocolate for one month (70%) reduced craving in smokers at the beginning of treatment. Chocolate potentiated the well-known effect of behavioral counseling on Factor 1 (pleasurable drug effects) and also interfered with factor 2 (unpleasant withdrawal effects).

RESUMO Objetivo: Analisar o craving em fumantes com comorbidades cardiovasculares submetidos a uma abordagem nutricional. Métodos: Intervenção clínica (n = 32) com dois grupos randomizados: Grupo 1 (G1, n = 15): recebendo 40 g de chocolate contendo 70% de cacau/dia e intervenção comportamental para cessação do tabagismo por um mês; Grupo 2 (G2, n = 17): grupo controle, recebendo apenas intervenção comportamental pelo mesmo período. O Questionnaire of Smoking Urges-Brief (QSU-Brief) - versão Brasil foi utilizado para avaliar o craving. As medidas antropométricas verificaram a interferência nutricional do procedimento e a avaliação sérica, a interferência de processos inflamatórios relacionados ao tabagismo. O estudo foi registrado no Registro Brasileiro de Ensaios Clínicos (ReBEC), RBR-83jr3. Resultados: Um mês depois, comparado à avaliação inicial, o G1 reduziu o craving total e seus fatores (1 e 2). QSU-Brief total: 44,27 ± 15,82 x 27,00 ± 18,03 (p = 0,008); Fator 1: 21,90 ± 7,70 x 12,90 ± 8,87 (p = 0,006); Fator 2: 11,90 ± 6,30 x 7,00 ± 6,63 (0,007). G2: redução no QSU-Brief total e Fator 1, mas não no Fator 2. QSU-Brief total 28,17 ± 17,24 x 19,52 ± 9,50 (p = 0,049); Fator 1: 14,47 ± 8,74 x 9,23 ± 6,11 (p = 0,046). Níveis séricos de cortisol, leptina, serotonina, proteína C-reativa (PCR) e insulina não apresentaram diferenças (p > 0,05). Não foram encontradas diferenças antropométricas significativas. Conclusão: Os resultados demonstram que o consumo diário de chocolate por um mês (70%) reduziu o craving em fumantes no início do tratamento. O chocolate potencializou o conhecido efeito do aconselhamento comportamental sobre o Fator 1 (efeitos prazerosos da droga) e também interferiu no fator 2 (efeitos desagradáveis da abstinência).

Beneficial effects of butyrate on brain functions: A view of epigenetic.

Brain functions are influenced by the presence, activity, and metabolism of the gut microbiota through the gut-microbiota-brain (GMB) axis. The consumption of a fiber-rich diet increases the content of short-chain fatty acids (SCFAs) from bacterial fermentation in the colon. Among SCFAs, butyrate stands out because of its wide array of biological functions, such as ability to influence brain functions. Pharmacologically, sodium butyrate (NaB) regulates gene expression in the brain, where it has several beneficial effects ranging from neurodegenerative diseases to behavioral disorders through inhibitors of histone deacetylases (HDACis). In this context, we review the mechanisms of action of the two types of butyrate on brain functions, with an emphasis on the epigenetic approach. Both types of butyrate are potentially interesting for the prevention and adjuvant therapy of neurological and psychological disorders due to their neuroprotective functions. However, further studies are needed to investigate the possible neuroepigenetic effects of butyrate derived from bacterial fermentation.

Tobacco cessation in patients with multiple chronic conditions: nutritional strategies as an additional tool in treatment.

PURPOSE: Evaluate the impacts of the nutritional education intervention for patients with multiples chronic conditions during smoking cessation. METHODS: The non-probabilistic sample consisted of adult and elderly 18 individuals of both sexes, participants in a group for smoking cessation treatment. At the beginning of treatment, smoking history, degree of dependence and stage of motivation were evaluated. Craving degree was evaluated weekly during the first month. Anthropometric and biochemical evaluations were conducted at baseline, after 1 month and 3 months. Dietary intake was assessed by the "How is your diet?" questionnaire. There were three moments of nutritional intervention. The themes covered were "Energy balance and physical activity", "Healthy eating" and the importance of fruits and vegetables in the diet, respectively. Statistical analysis with Shapiro Wilk normality test, paired T-Test or Wilcoxon and U-Mann Whitney (Significance ≤0.05). RESULTS: In the intervention group, most people had a high degree of smoking dependence (55.6%), while in the control group the frequency were 22.2%. Craving degree decreased significantly after 1 month of treatment (p= 0.017). After 3 months, the groups presented mean body weight positive variation, however below 3%. In both groups the average percentage of weight gain was below 3%, reinforcing that the holding of the nutrition session and performance of the nutritionist within the protocol proposed by the INCA helped in the control of weight gain. Blood glucose and HOMA-IR in the intervention group showed a significant increase (p= 0.15 and p= 0.50, respectively). CONCLUSION: Greater proximity and more frequent action taken by the nutritionist assists and encourages healthy eating practices during smoking cessation process, which can benefit individuals control of chronic diseases in the long term.

Relationship between food consumption and improvements in circulating melatonin in humans: an integrative review.

Melatonin is an important hormone in the regulation of circadian rhythms and has great antioxidant power. Recent studies have demonstrated the benefits of its supplementation in the metabolic profile. Food sources have also been studied for complementary therapies. However, information on the bioavailability of food sources of melatonin is still scarce. Thus, the objective of this review is to gather in the literature studies that evaluate the relationship between food consumption and improvements in circulating melatonin in humans. In total, 178 studies were found, of which 11 were included in this review. The results show increases in the excretion of the melatonin metabolite (6­sulfatoxymelatonin) or circulating melatonin for foods such as cherries, grapes, bananas, pineapples, dark green vegetables, Japanese vegetables and beer. Significant increases in melatonin were observed even after ingesting cultivars with low concentrations of this hormone. It was possible to assume that other nutrients that precede their synthesis (serotonin and tryptophan) could also have led to this increase. Although consumption of the foods found is beneficial in increasing circulating melatonin, further confirmatory studies are needed.

Maternal soy protein isolate diet during lactation programs deleterious effects on hepatic lipid metabolism, atherogenic indices, and function of adrenal in adult rat offspring.

The benefits of consuming soy and its protein have been reported in many studies. However, its phytoestrogen content raises concerns about consumption during lactation and gestation We therefore examined the effects of soybean or soy protein isolate on the parameters-related cardiovascular pathophysiology in lactating mothers and their offsprings at weaning and adulthood. Lactating rats were divided: casein control (C); soy protein isolate (SPI); and soybean (S). At weaning, half of the litter received commercial ration up to 150 days. The levels of 17-ß-estradiol and superoxide dismutase were low in the S mothers. For the SPI mothers, we observed a reduction of thiobarbituric acid reactive substances (TBARS). At weaning, atherogenic indices [1 = total cholesterol (TC)/HDL; 2 = LDL/HDL; 3 = TC-HDL/HDL)] decreased in the S and SPI offsprings compared to the casein control group; TBARS and antioxidant enzymes increased in the S offspring, while reduced/oxidized glutathione ratio increased in the SPI offspring, indicating lower oxidative stress. In adulthood, the SPI offspring showed an increase in liver cholesterol and atherogenic index 1 and 3 (vs. C and S) and 2 (vs. S). In addition, we found a decrease in catecholamines in the adrenal medulla and an increase in caffeine-stimulated secretion, but tyrosine hydroxylase expression remained constant. Maternal consumption of SPI during lactation worsened atherogenic indices of the offsprings in adulthood, which was associated with increased liver cholesterol and decreased catecholamines in the adrenal medulla. Soy consumption had no consistent long-term effects on the evaluated parameters compared to casein consumption. The data suggest that the consumption of SPI during lactation should be done with caution.

Factors associated with the perceived benefits and barriers to physical activity in liver cirrhosis.

OBJECTIVE: To analyze the sociodemographic and clinical factors associated with the perceived benefits and barriers to physical activity (PA) in subjects with liver cirrhosis. METHODS: This cross-sectional study assessed 102 outpatients with liver cirrhosis regarding the clinical and sociodemographic profile and the perceived benefits and barriers to PA by the Exercise Benefits and Barriers Scale and muscle strength. A Generalized Step-Forward linear regression analysis was used to identify the factors associated. RESULTS: The participants were 59±10 years and 60.8% were men. Around 29.4% had ascites decompensation. Perceived benefits and barriers were associated with the presence of ascites (95%CI -0.079 - 0.03; p=0.06 and 95%CI 0.003 - 0.217; p=0.045, respectively). In the group with ascites, both benefits and barriers were associated with muscle strength. In the group without ascites, benefits were associated with cardiovascular risks and no association was observed with barriers to physical activity. CONCLUSIONS: Perceived benefits and barriers to physical activity are associated with intrinsic factors such as the presence of ascites and cardiovascular risk in individuals with liver cirrhosis. The results of this study highlight key elements that must be considered for increasing physical activity in this population.

Factors associated with the perceived benefits and barriers to physical activity in liver cirrhosis

SUMMARY OBJECTIVE: To analyze the sociodemographic and clinical factors associated with the perceived benefits and barriers to physical activity (PA) in subjects with liver cirrhosis. METHODS: This cross-sectional study assessed 102 outpatients with liver cirrhosis regarding the clinical and sociodemographic profile and the perceived benefits and barriers to PA by the Exercise Benefits and Barriers Scale and muscle strength. A Generalized Step-Forward linear regression analysis was used to identify the factors associated. RESULTS: The participants were 59±10 years and 60.8% were men. Around 29.4% had ascites decompensation. Perceived benefits and barriers were associated with the presence of ascites (95%CI −0.079 - 0.03; p=0.06 and 95%CI 0.003 - 0.217; p=0.045, respectively). In the group with ascites, both benefits and barriers were associated with muscle strength. In the group without ascites, benefits were associated with cardiovascular risks and no association was observed with barriers to physical activity. CONCLUSIONS: Perceived benefits and barriers to physical activity are associated with intrinsic factors such as the presence of ascites and cardiovascular risk in individuals with liver cirrhosis. The results of this study highlight key elements that must be considered for increasing physical activity in this population.

Nível de ativação e qualidade de vida relacionada à saúde de pessoas em hemodiálise / Nivel de activación y la calidad de vida relacionada com la salud de personas en hemodiálisis / Level of activation and quality of life related to the health of people in hemodialysis

Resumo Objetivo associar o nível de ativação com a qualidade de vida relacionada à saúde de pessoas que realizam o tratamento hemodialítico. Método estudo quantitativo, transversal e correlacional com 162 pessoas em tratamento hemodialítico. Os dados foram coletados por meio da aplicação de questionários para a caracterização sociodemográfica, socioeconômica e clínica do Kidney Disease Quality of Life Short Form e da escala Patient Activation Measure. Os dados secundários foram coletados por meio do prontuário médico. Para a análise dos dados, utilizaram-se a estatística descritiva e a regressão logística. Resultados a ativação do paciente em hemodiálise associou-se positivamente com os domínios sintomas, funcionamento físico, saúde geral, bem-estar emocional, energia/fadiga e o componente mental da qualidade de vida relacionada à saúde. Conclusão e implicação para a prática como a ativação apresenta relação com a qualidade de vida relacionada à saúde, na prática assistencial, essa métrica deve ser considerada ao implementar medidas que visem a aumentar a qualidade de vida relacionada à saúde das pessoas em hemodiálise.

Resumen Objetivo asociar el nivel de activación con la calidad de vida relacionada con la salud de las personas en hemodiálisis. Método estudio cuantitativo, transversal y correlacional con 162 personas en hemodiálisis. Los datos se recolectaron mediante la aplicación de cuestionarios para la caracterización sociodemográfica, socioeconómica y clínica del Kidney Disease Quality of Life Short Form y la escala Patient Activation Measure. Los datos secundarios se recopilaron a través de historias clínicas. Para el análisis de los datos se utilizó la estadística descriptiva y la regresión logística. Resultados la activación del paciente en hemodiálisis se asoció positivamente con los dominios síntomas, funcionamiento físico, salud general, bienestar emocional, energía / fatiga y el componente mental de la calidad de vida relacionada con la salud. Conclusión e implicación para la práctica dado que la activación presenta una relación con la calidad de vida relacionada con la salud, en la práctica asistencial esta métrica debe ser considerada a la hora de implementar medidas dirigidas a incrementar la calidad de vida relacionada con la salud de las personas en hemodiálisis.

Abstract Objective to associate the level of activation with the health-related quality of life of people undergoing hemodialysis. Method a quantitative, cross-sectional and correlational study with 162 people on hemodialysis treatment. Data was collected by applying questionnaires for sociodemographic, socioeconomic and clinical characterization of the Kidney Disease Quality of Life Short Form and the Patient Activation Measure scale. Secondary data were collected from medical records. For data analysis, descriptive statistics and logistic regression were used. Results hemodialysis patient activation was positively associated with the domains symptoms, physical functioning, general health, emotional well-being, energy/fatigue and the mental component of health-related quality of life. Conclusion and implication for the practice since activation is related to health-related quality of life, in care practice, this metric should be considered when implementing measures to increase the health-related quality of life of people on hemodialysis.

Conhecimento do tratamento de hiperfosfatemia e adesão às orientações nutricionais após intervenção em indivíduos em hemodiálise / Knowledge of the hyperphosphatemia treatment and adhesion to the nutritional orientations after intervention in individuals in hemodialysis

Introdução: O controle da hiperfosfatemia é um desafio no tratamento de pacientes hemodialíticos, sendo um dos principais objetivos a serem alcançados. O acompanhamento nutricional e a prática de atividades educativas contribuem para o sucesso na adesão ao tratamento. Objetivo: Descrever, em indivíduos em hemodiálise, o conhecimento do tratamento da hiperfosfatemia, bem como avaliar o possível impacto das orientações nutricionais nos níveis séricos de fósforo após intervenção nutricional em participantes do programa de HD no Hospital Universitário na cidade de Juiz de Fora, MG. Material e Métodos: Estudo quase-experimental, do tipo antes e depois com 35 pacientes em tratamento hemodialítico, com 18 anos ou mais, de ambos os sexos, em diálise há, pelo menos, dois meses e que haviam passado por, pelo menos, uma consulta com a nutricionista do setor. Foram coletados do prontuário dados sociodemográficos e clínicos e aplicados questionário de frequência alimentar adaptado e recordatório 24h para avaliação do consumo alimentar, além de questões fechadas sobre o conhecimento das causas da hiperfosfatemia, alimentos ricos em fósforo e uso de quelantes. A intervenção foi realizada mediante a utilização de cartilha educativa. Após a intervenção foram verificados os níveis séricos de fósforo, considerando hiperfosfatemia valores >5,5 mg/dL. Resultados: Na amostra, 57,1% (n=20) eram do sexo masculino, com média de idade de 61,8 ± 14,3 anos e tempo médio em diálise de 61,1 ± 68,9 meses. A prevalência de hiperfosfatemia antes da intervenção era de 60% (n=21) e ao final da intervenção houve redução para 25,7% (n=9). Houve diferença na redução dos níveis séricos de fósforo quando comparadas as médias antes e depois da intervenção [(5,9 ± 1,3 mg/dL; 4,9 ± 1,7 mg/dL; p<0,001)]. Conclusão: Os resultados mostraram que a intervenção educativa possivelmente contribuiu para melhorar a compreensão e adesão ao tratamento, tendo um papel complementar no manejo da hiperfosfatemia de pacientes dialíticos.

Introduction: Hyperphosphatemia control is a challenge in the treatment of patients in hemodialysis, which is one of the main objectives to be reached. Nutritional accompaniment and practice of educational activities contribute to the success in the adhesion to the treatment. Objective: Describe, in individuals in hemodialysis, the knowledge of the treatment of hyperphosphatemia, as well as to evaluate the possible impact of nutritional orientations on phosphorus levels after nutritional intervention in participants of the program HD at the University Hospital in the city of Juiz de Fora, MG. Material e Methods: Quasi-experimental study, of the before and after kind with 35 patients in hemodialysis treatment, with 18 years or more, of both sexes, in dialysis for, at least, two months and who have had, at least, one appointment with the nutritionist in this division. Sociodemographic and clinical data was collected from patient records and adapted reminder questionnaires of food frequency in the last 24 hours were applied for assessment of food intake, as well as multiple-choice questions about the knowledge of the causes of hyperphosphatemia, phosphorus-rich food and use of binders. The intervention was made through the use of an educational leaflet. After the intervention, phosphorus serum levels were verified, taking into consideration hyperphosphatemia values >5,5 mg/dL. Results: In the sample, 57.1% (n=20) were male, with mean age of 61.8 ± 14.3 years and mean time in dialysis of 61.1 ± 68.9 months. The prevalence of hyperphosphatemia before the intervention had been of 60% (n=21) and at the end of the intervention there was a reduction to 25.7% (n=9). There was difference in the reduction of phosphorus serum levels when compared to the medians before and after the intervention [(5.9 ± 1.3 mg/dL; 4.9 ± 1.7 mg/dL; p<0,001)]. Conclusion: The results showed that the educational intervention possibly contributed to a better understanding and treatment adherence, having a complementary role in the management of hyperphosphatemia in dialysis patients.

Caloric and protein intake in different periods of hospitalization of patients undergoing hematopoietic stem cell transplantation.

OBJECTIVE: To evaluate the nutritional status and caloric and protein intake during the hospitalization of patients undergoing hematopoietic stem cell transplantation. METHODS: A retrospective study was performed based on clinical and nutritional data of patients undergoing autologous and allogeneic hematopoietic stem cell transplantation from March 2015 to March 2017. The mean caloric and protein intake were evaluated in three different intervals (P1: from admission to the day before transplantation, P2: from the transplantation day to the day before engraftment, P3: from the engraftment day to the day of hospital discharge). Body mass index, weight loss, gastrointestinal symptoms and use of nutritional therapy were also evaluated. RESULTS: Thirty-five patients were included in this study (25 autologous and ten allogeneic). The majority (62.6%) were overweight at admission. The median and percentage weight loss were 3.2 kg and 4.6%, respectively. A nutritional supplement was provided to 33 patients for a median of nine days. The most prevalent gastrointestinal symptoms were nausea (91.4%), vomiting (88.6%) and diarrhea (80%). The mean caloric and protein intake and adequacy of patients were 1569.0 ± 443.3 Kcal (73.6 ± 22.1%) and 66 ± 22.8 g (61.9 ± 20%), respectively. The allogeneic group presented lower intake and caloric and protein adequacy throughout hospitalization, in particular in P2, compared to the autologous patients. CONCLUSION: The patients presented deterioration of nutritional status during hospitalization with the reduction in food intake being greater in patients submitted to allogeneic transplantation.

Caloric and protein intake in different periods of hospitalization of patients undergoing hematopoietic stem cell transplantation

ABSTRACT Objective: To evaluate the nutritional status and caloric and protein intake during the hospitalization of patients undergoing hematopoietic stem cell transplantation. Methods: A retrospective study was performed based on clinical and nutritional data of patients undergoing autologous and allogeneic hematopoietic stem cell transplantation from March 2015 to March 2017. The mean caloric and protein intake were evaluated in three different intervals (P1: from admission to the day before transplantation, P2: from the transplantation day to the day before engraftment, P3: from the engraftment day to the day of hospital discharge). Body mass index, weight loss, gastrointestinal symptoms and use of nutritional therapy were also evaluated. Results: Thirty-five patients were included in this study (25 autologous and ten allogeneic). The majority (62.6%) were overweight at admission. The median and percentage weight loss were 3.2 kg and 4.6%, respectively. A nutritional supplement was provided to 33 patients for a median of nine days. The most prevalent gastrointestinal symptoms were nausea (91.4%), vomiting (88.6%) and diarrhea (80%). The mean caloric and protein intake and adequacy of patients were 1569.0 ± 443.3 Kcal (73.6 ± 22.1%) and 66 ± 22.8 g (61.9 ± 20%), respectively. The allogeneic group presented lower intake and caloric and protein adequacy throughout hospitalization, in particular in P2, compared to the autologous patients. Conclusion: The patients presented deterioration of nutritional status during hospitalization with the reduction in food intake being greater in patients submitted to allogeneic transplantation.

Estudo da Atitude diante do Paciente Alcoolista e do Conhecimento sobre Alcoolismo em função do Padrão de Beber de Estudantes de Medicina / A study of the behaviour of medical students towards alcoholic patients as a result of their knowledge and self drinking patterns

RESUMO Objetivo Avaliar a atitude frente ao paciente alcoolista e o conhecimento sobre uso do álcool do estudante de Medicina em função do seu padrão de beber. Métodos Estudo transversal realizado com estudantes matriculados no terceiro, sexto e décimo primeiro período dos cursos de Medicina de três universidades federais da Região Sudeste do Brasil (UFF, UFJF e Unifesp). Foram coletados dados sociodemográficos e aplicadas escalas de avaliação da atitude médica diante do paciente alcoolista. Os dados foram complementados por uma avaliação do conteúdo científico sobre alcoolismo e pelo Audit para avaliar o padrão de ingestão de álcool dos alunos. Resultados Participaram do estudo 371 estudantes. Os consumidores de bebidas alcoólicas no padrão binge representaram 60,4% (n = 223), e 113 estudantes (30,7%) apresentaram comportamento de risco para o consumo de álcool (Audit ≥ 8). O padrão de consumo alcoólico não diferiu entre as universidades e nem entre os períodos avaliados (Kruskal Wallis, p > 0,05). Os alunos das três universidades aumentaram a pontuação na escala de conhecimentos com o progredir do curso. Entretanto, não houve correlação significativa entre conhecimento e padrão de beber (Spearman > 0,05). Quanto à atitude, foi observado que já é satisfatória no terceiro período e melhora no sexto período. Exceção foi observada entre os alunos da Unifesp, que já apresentaram atitude positiva quase máxima no terceiro período e que foi mantida até o final do curso. Conclusão Embora a atitude dos alunos melhore ao longo do curso, assim como seu conhecimento sobre adição a substâncias, o comportamento de beber permanece o mesmo, sem correlação com os conhecimentos transmitidos a respeito dos riscos de beber.

ABSTRACT Objective To evaluate the attitude toward the alcoholic patient and the knowledge about the use of alcohol by the medical student according to his drinking pattern. Method It was a cross-sectional study involving at random selected students enrolled on the third, sixth and eleventh semester in three federal universities of southeastern Brazil (UFF, UFJF and Unifesp). Method Sociodemographic data were collected and the following instruments were applied: attitude evaluation scale, knowledge of scientific information scale on alcohol and management of the alcoholic patient and Audit for evaluation of alcohol problems. Results The study included 371 students. Alcohol users in the binge pattern accounted for 60.4% (n = 223) and 113 students (30.7%) presented a risk behavior for alcohol consumption (Audit ≥ 8). The alcohol consumption pattern did not differ between the universities nor between the evaluated periods (Kruskal Wallis, p > 0.05). Students from the three universities increased the score on the knowledge scale as the course progressed. However, there was no significant correlation between knowledge and drinking pattern (Spearman > 0.05). As for the attitude, it was observed that it is already satisfactory in the third period and improvement in the sixth period. Exception was observed among the students of Unifesp, who already presented near positive attitude in the third period that was maintained until the end of the course. Conclusion Although the university increases knowledge of risk problems of drinking this does not protect students of binge drinking. On the other hand, student's positive attitude towards alcoholic patients improves over the course, regardless of drinking and the acquired scientific knowledge.

Alteration of inflammatory adipokines after four months of smoking abstinence in multidisciplinary intervention program.

BACKGROUND: many endocrine-metabolic changes are involved in smoking. OBJECTIVES: to evaluate serum concentrations of inflammatory adipokines in smokers at baseline and after four months of treatment for smoking cessation. METHODS: the serum concentrations of inflammatory cytokines were evaluated in smokers and abstinent. Nutritional assessment was based on measurements of body weight, height, and waist circumference (WC), to calculate body mass index (BMI), body adiposity index (BAI) and waist-to-height ratio (WHtR). Biochemical parameters were analyzed: total cholesterol, LDL-c, HDL-c, triglycerides, glucose, cortisol and insulin. The serum levels of leptin, adiponectin and ghrelin were determined by enzyme-linked immunosorbent assay (ELISA). The leptin/adiponectin ratio (L/A) was calculated. RESULTS: a total of 29 subjects were included in this study (22 women and seven men). The mean age of participants was 50.7 ± 10.47 years. The medium values of WHtR and BAI were above of the proposed cutoff point, indicating abdominal obesity. The biochemical parameters did not present statistically significant differences when comparing the initial and final values. At the end of treatment, the abstinent had higher levels of adiponectin when compared to those who remained smoker (p = 0.024). There was an increase in leptin levels and L/A, and a reduction in adiponectin levels after the treatment in abstinent and smokers (p < 0.05). CONCLUSION: this study has demonstrated that smoking cessation improves adiponectin levels when compared with smokers. Leptin and L/A levels increased throughout the treatment in both groups. The increased values of leptin and L/A in abstinent participants may indicate risk of metabolic events associated with smoking history that should be investigated.

Alteration of inflammatory adipokines after four months of smoking abstinence in multidisciplinary intervention program / Cambio en las adipocinas inflamatorias tras cuatro meses de abstinencia de fumar en un programa de intervención multimodal

Background: many endocrine-metabolic changes are involved in smoking. Objectives: to evaluate serum concentrations of inflammatory adipokines in smokers at baseline and after four months of treatment for smoking cessation. Methods: the serum concentrations of inflammatory cytokines were evaluated in smokers and abstinent. Nutritional assessment was based on measurements of body weight, height, and waist circumference (WC), to calculate body mass index (BMI), body adiposity index (BAI) and waist-to-height ratio (WHtR). Biochemical parameters were analyzed: total cholesterol, LDL-c, HDL-c, triglycerides, glucose, cortisol and insulin. The serum levels of leptin, adiponectin and ghrelin were determined by enzyme-linked immunosorbent assay (ELISA). The leptin/adiponectin ratio (L/A) was calculated. Results: a total of 29 subjects were included in this study (22 women and seven men). The mean age of participants was 50.7 ± 10.47 years. The medium values of WHtR and BAI were above of the proposed cutoff point, indicating abdominal obesity. The biochemical parameters did not present statistically significant differences when comparing the initial and final values. At the end of treatment, the abstinent had higher levels of adiponectin when compared to those who remained smoker (p = 0.024). There was an increase in leptin levels and L/A, and a reduction in adiponectin levels after the treatment in abstinent and smokers (p < 0.05). Conclusion: this study has demonstrated that smoking cessation improves adiponectin levels when compared with smokers. Leptin and L/A levels increased throughout the treatment in both groups. The increased values of leptin and L/A in abstinent participants may indicate risk of metabolic events associated with smoking history that should be investigated

Introducción: en el tabaquismo están involucrados un gran número de cambios endocrino-metabólicos. Objetivos: evaluar las concentraciones séricas de adipocinas inflamatorias en fumadores al inicio y después de cuatro meses de tratamiento para dejar de fumar. Métodos: se evaluaron las concentraciones séricas de citocinas inflamatorias en fumadores y no fumadores. La evaluación nutricional se basó en las mediciones del peso corporal y la altura, para calcular el índice de masa corporal (IMC), la circunferencia de la cintura (CC), el índice de adiposidad corporal (IAC) y la relación cintura/estatura (RCE). Se analizaron los parámetros bioquímicos: colesterol total, LDL-c, HDL-c, triglicéridos, glucosa, cortisol e insulina. Los niveles séricos de leptina, adiponectina y grelina se determinaron mediante ensayo de inmunoabsorción enzimática (ELISA). Se calculó la relación leptina/adiponectina (L/A). Resultados: se incluyeron un total de 29 personas (22 mujeres y siete hombres). La edad media de los participantes fue de 50,7 ± 10,47 años. Los valores medios de CC e IAC se mostraron por encima del punto de corte propuesto, indicando obesidad abdominal. Los parámetros bioquímicos no presentaron diferencias estadísticamente significativas al comparar los valores iniciales y finales. Al final del tratamiento, los abstinentes tenían niveles más altos de adiponectina cuando se comparaban con los de aquellos que seguían fumando (p = 0,024). Hubo un aumento en los niveles de leptina y L/A y reducción de los niveles de adiponectina después del tratamiento en abstinentes y fumadores (p < 0,05). Conclusiones: este estudio ha demostrado que el abandono del hábito de fumar mejora los niveles de adiponectina en comparación con los fumadores. Los niveles de leptina y L/A aumentaron a lo largo del tratamiento en ambos grupos. Los valores aumentados de leptina y L/A en abstinentes pueden indicar riesgo de eventos metabólicos asociados al historial de tabaquismo que deben ser investigados

Nutritional profile of hemodialysis patients concerning treatment time.

INTRODUCTION: The mortality of the population with chronic kidney disease (CKD) on hemodialysis (HD) is very high and the protein-energy malnutrition stands out as one of the most common consequences in relation to this condition. OBJECTIVE: To evaluate the association between time of hemodialysis and nutritional parameters of patients. METHODS: It is a cross-sectional study with secondary data, developed of the University Hospital of the Federal University of Juiz de Fora (HU/UFJF). This study was approved by the Research Ethics Committee (Nº 1.233.142), a total of 36 patients. The medical records and collected data were analyzed for anthropometric markers, biochemical and diet, considering two groups: HD time less than three and greater than or equal to three years. RESULTS: There was reduction of mass of somatic protein with increased duration of HD. In relation to food intake was observed that in patients with increased duration of dialysis, an increase in average consumption of protein / kg of weight, calories, phosphorus and potassium, with a significant difference from the mean protein intake / kg (p = 0.04) and phosphorus (p = 0.045). Increasing HD time has altered body composition of patients, indicating a decline in the nutritional status of these individuals. CONCLUSION: HD patients are a risk group for protein-energy malnutrition, where HD time interferes with the nutritional status and food profile of the patient. The group HD time greater than or equal to 3 years presented worsening nutritional status.

Nutritional profile of hemodialysis patients concerning treatment time / Análise do perfil nutricional de pacientes renais crônicos em hemodiálise em relação ao tempo de tratamento

Abstract Introduction: The mortality of the population with chronic kidney disease (CKD) on hemodialysis (HD) is very high and the protein-energy malnutrition stands out as one of the most common consequences in relation to this condition. Objective: To evaluate the association between time of hemodialysis and nutritional parameters of patients. Methods: It is a cross-sectional study with secondary data, developed of the University Hospital of the Federal University of Juiz de Fora (HU/UFJF). This study was approved by the Research Ethics Committee (Nº 1.233.142), a total of 36 patients. The medical records and collected data were analyzed for anthropometric markers, biochemical and diet, considering two groups: HD time less than three and greater than or equal to three years. Results: There was reduction of mass of somatic protein with increased duration of HD. In relation to food intake was observed that in patients with increased duration of dialysis, an increase in average consumption of protein / kg of weight, calories, phosphorus and potassium, with a significant difference from the mean protein intake / kg (p = 0.04) and phosphorus (p = 0.045). Increasing HD time has altered body composition of patients, indicating a decline in the nutritional status of these individuals. Conclusion: HD patients are a risk group for protein-energy malnutrition, where HD time interferes with the nutritional status and food profile of the patient. The group HD time greater than or equal to 3 years presented worsening nutritional status.

Resumo Introdução: Pacientes com doença renal crônica em hemodiálise (HD) apresentam risco elevado para mortalidade, sendo que a desnutrição protéico-energética se destaca como uma das causa mais comuns em relação a essa condição. Objetivo: Avaliar a associação entre o tempo de hemodiálise e parâmetros nutricionais dos pacientes. Métodos: É um estudo transversal com dados secundários, desenvolvido no Hospital Universitário Federal Universidade de Juiz de Fora (HU / UFJF). Este estudo foi aprovado pela pesquisa Comitê de Ética (nº 1.233.142), um Total de 36 pacientes. Os dados foram coletados por meio dos prontuários médicos, os quais foram analisados marcadores antropométricos, bioquímicos e dieta, considerando dois grupos: tempo HD menor do que três anos e tempo de HD maior ou igual atrês anos. Resultados: Houve redução de massa de proteína somática com aumento do tempo em HD. Em relação à avaliação alimentar, observou-se que em pacientes com maior tempo em diálise houve aumento no consumo médio de proteína/kg de peso, calorias, fósforo e Potássio, com diferença significativa da ingestão média de proteína/kg (p = 0,04) e fósforo (p = 0,045). O tempo em HD alterou a composição corporal dos pacientes, indicando um declínio doestado nutricional desses indivíduos. Conclusão: Pacientes com HD são um grupo de risco para desnutrição protéico-energética, onde o tempo em HD interfere no perfil antropométrico e alimentar do paciente.O grupo com tempo de HD superior ou igual a 3 anos apresentou piora do estado nutricional.

Pacientes em diálise peritoneal e em hemodiálise: Existe diferença em relação ao estado nutricional? / Patients in peritoneal dialysis and hemodialysis: Is there any difference in the nutritional status?

A hemodiálise (HD) e a diálise peritoneal (DP) são as terapias renais de substituição mais comumente utilizadas, sendo que o estado nutricional dos pacientes com Doença Renal Crônica (DRC) pode ser influenciado pela modalidade de diálise utilizada. Objetivo: Comparar o estado nutricional de pacientes em HD e em DP, por meio da avaliação antropométrica e bioquímica. Trata-se de um estudo transversal, realizado no setor de nefrologia do Hospital Universitário da Universidade Federal de Juiz de Fora. O estudo foi constituído por 29 pacientes em DP e 36 em HD, totalizando 65 pacientes. Os dados coletados foram: peso corporal seco, estatura, Índice de Massa Corporal (IMC), área muscular do braço (AMB), circunferência muscular do braço (CMB), prega cutânea tricipital (PCT) e circunferência do braço (CB); além dos exames bioquímicos: potássio, fósforo, uréia e albumina. Pode-se observar maior prevalência do sexo feminino na modalidade DP em relação a HD (75% X 44,4%, p = 0,01). Houve diferença nos tempos em diálise entre os grupos (DP: 41,86 ±33,2 meses X HD: 22,36 ±5,4 meses, p = 0,001). Em relação à classificação da CMB, 48,3% dos pacientes em DP e 22,2% em HD foram classificados como eutróficos (p = 0.001). Quanto à AMB, 72,5% dos pacientes em DP e 36,1% dos pacientes em HD foram classificados como eutróficos (p = 0.001). Em relação aos exames bioquímicos, somente o potássio apresentou diferença significante entre os grupos (DP: 4,9 ±0,73 mEq/L e HD: 5,64 ±0,78 mEq/L, p = 0,01). No presente estudo, os pacientes em DP apresentam melhor classificação em relação a CMB e AMB, além de melhor controle do potássio sérico, em relação aos pacientes em HD.

Hemodialysis (HD) and peritoneal dialysis (PD) are the most commonly used renal replacement therapy. The nutritional status of chronic kidney disease (CKD) patients can be influenced by the dialysis modality used. Objective: To compare the nutritional status of patients in HD and PD, through anthropometric and biochemical evaluation. This is a cross-sectional study carried out in the nephrology sector of the University Hospital of the Federal University of Juiz de Fora. The study consisted of 29 patients in PD and 36 in HD, totaling 65 patients. The data collected were: dry body weight, stature, body mass index (BMI), arm muscle area (BMA), arm muscle circumference (BMC), triceps skin fold and arm circumference. In addition, the biochemical tests: potassium, phosphorus, urea and albumin. It is possible to observe a higher prevalence of female sex in the PD modality in relation to HD (75% X 44.4%, p = 0.01). There was a difference in dialysis times between groups (SD: 41.86 ± 33.2 months X HD: 22.36 ± 5.4 months, p = 0.001). Regarding BMC classification, 48.3% of patients in PD and 22.2% in HD were classified as eutrophic (p = 0.001). As for BMA, 72.5% of patients in PD and 36.1% of patients in HD were classified as eutrophic (p = 0.001). In relation to the biochemical tests, only potassium had a significant difference between the groups (SD: 4.9 ± 0.73 mEq / L and HD: 5.64 ± 0.78 mEq / L, p = 0.01). In the present study, patients in PD present better classification in relation to BMC and BMA, in addition to better control of serum potassium, compared to patients in HD.

Perfil de indivíduos com excesso de peso metabolicamente saudáveis e metabolicamente não saudáveis / Profile of individuals with excessive weight metabolically healthy and metabolically not healthy

O presente trabalho teve como objetivo caracterizar um grupo de indivíduos adultos com excesso de peso quanto ao seu perfil metabólico, qualificando-os como obesos metabolicamente saudáveis ou obesos metabolicamente não saudáveis, segundo diferentes critérios. Trata-se de um estudo transversal, que avaliou 63 indivíduos adultos, 69,8% do sexo feminino, com sobrepeso (25,0 ­ 29,9 kg/m²) ou obesidade (≥ 30 kg/m²). Para a caracterização metabólica, foram utilizados os critérios: Índice "Homeostasis Model Assessment" (obesos metabolicamente saudáveis: dentro dos 3 menores quartis: ≤3,10; obesos metabolicamente não saudáveis: >3,10); padrões do "National Cholesterol Education Program's Adult Treatment Panel III" (obesos metabolicamente saudáveis: apresentar até 2 componentes; obesos metabolicamente não saudáveis: 3 ou mais dos cinco componentes) e a combinação destes dois. Os perfis de estilo de vida, antropométrico, bioquímico e de consumo alimentar também foram avaliados. Os resultados foram expressos como percentual ou média ± desvio padrão, conforme o tipo de variável a ser descrito. A frequência de indivíduos obesos metabolicamente saudáveis foi de 73%, pelo critério de "Homeostasis Model Assessment"; e de 49,2%, pelo "Adult Treatment Panel III". Usando os doiscritérios em conjunto, obteve-se 79,4% de obesos metabolicamente saudáveis. A qualificação dos indivíduos pode variar de acordo com o critério utilizado. De forma geral, os obesos metabolicamente saudáveis exibem menores índices de massa corporal e circunferência da cintura, e possuem menos alterações bioquímicas. Entretanto, estes indivíduos também necessitam de acompanhamento nutricional, a fim de evitar que estes parâmetros se alterem ao longo do tempo, colocando-os em risco de desenvolver doenças crônicas.

The objective of this study was to characterize a group of overweight adult individuals regarding their metabolic profile, qualifying them as metabolically healthy obese or obese metabolically unhealthy according to different criteria. This cross-sectional study evaluated 63 adult individuals, 69.8% female, overweight (25.0 - 29.9 kg / m²) or obese (≥ 30 kg / m²). For the metabolic characterization, the following criteria were used: "Homeostasis Model Assessment" index (metabolically healthy obese: within the 3 minor quartiles: ≤3.10, obese metabolically unhealthy:> 3,10); (Obese, metabolically unhealthy: 3 or more of the five components) and a combination of the two. The lifestyle, anthropometric, biochemical and food consumption profiles were also evaluated. The results were expressed as percentage or mean ± standard deviation, depending on the typeof variable to be described. The frequency of metabolically healthy obese subjects was 73%, by the criterion of "Homeostasis Model Assessment"; and 49.2% for the "Adult Treatment Panel III". Using the two criteria together, we obtained 79.4% of metabolically healthy obese subjects. The qualification of individuals may vary according to the criteria used. In general, the metabolically healthy obese exhibit lower body mass indexes and waist circumference and have fewer biochemical changes. However, these individuals also need nutritional monitoring in order to avoid that these parameters change over time, putting them at risk of developing chronic diseases.

Perfil do consumo alimentar e da relação cálcio/proteína de mulheres no climatério / Profile consumption food and ratio calcium / protein in women in climacteric

Introdução: O aumento significativo da expectativa de vida entre a população feminina nos faz observar mais claramente a importância da atenção à saúde durante a fase do climatério. Objetivo: Este estudo tem como objetivo avaliar o consumo alimentar de macronutrientes (carboidratos, proteínas e lipídeos) e micronutrientes (cálcio e vitamina D), a relação do consumo de cálcio e proteína de mulheres na fase do climatério e a correlação entre o consumo de cálcio e proteína com grau de escolaridade e nível salarial. Metodologia: Trata-se de um estudo retrospectivo que utilizou dados secundários, referentes ao período de janeiro de 2013 a janeiro de 2014, de mulheres no período do climatério. O consumo calórico e alimentar foi analisado através de registro alimentar de três dias e os dados socioeconômicos e antropométricos, através de questionários específicos aplicados como rotina do Projeto «Viver Melhor» do Hospital Universitário de Juiz de Fora, Brasil. Resultados: A população de estudo foi constituída de 43 mulheres entre 39 e 63 anos de idade, sendo a média de idade de 50,3 ± 4,7 anos. A maioria possuía o ensino médio completo (55,8%) e um nível salarial entre 1 e 2 salários mínimos (64,3%). O Índice de Massa Corporal médio foi equivalente a sobrepeso (28,9 ± 4,3kg/m²). A ingestão diária de carboidrato (259,6 ± 79,4g), proteína (72,2 ± 18,7g) e lipídio (56,5g ± 19,9g) manteve-se dentro dos valores de referência. O consumo diário de cálcio (614,2 ± 407,2 mg) e vitamina D (1,08 µg), assim como a rela- ção cálcio/proteína (8/1), foram inadequados. Não houve associação significativa entre a relação cálcio/proteína e o grau de escolaridade e entre a relação cálcio/proteína e o nível salarial, porém observou-se uma maior relação cálcio/proteína entre aquelas que possuíam renda salarial entre 2 e 5 salários-mínimos e entre as que possuíam maior escolaridade. Conclusão: Em média, as mulheres apresentam excesso de peso. O consumo calórico e de macronutrientes foi adequado, uma vez que esteve dentro da faixa de distribuição aceitável. Entretanto, o consumo de cálcio e vitamina D, não atingiu as recomendações mí- nimas preconizadas. A relação cálcio/proteína apresentou-se inadequada e sua correlação com os dados socioeconômicos não foi significativa (AU)

Introduction: The significant increase in life expectancy among women makes us look more clearly the importance of health care during the phase of menopause. Objective: This study aims to evaluate the food intake of macronutrients (carbohydrates, proteins and lipids) and micronutreintes (calcium and vitamin D), the ratio of calcium intake and women of protein in the climacteric phase and the correlation between the consumption of calcium and protein with educational level and salary level. Methods: This was a retrospective study using secondary data, for the period from January 2013 to January 2014, women in the climacteric period. The calorie and food intake was analyzed by food record three days and the socioeconomic and anthropometric data, through specific questionnaires routinely Project «Living Better» of Juiz de Fora University Hospital, Brazil. Results: The study population consisted of 43 women between 39 and 63 years old, with a mean age of 50.3 ± 4.7 years. Most had completed high school (55.8%) and a wage level between 1 and 2 minimum wages (64.3%). The mean body mass index was equivalent to overweight (28.9 ± 4,3kg / m²). The daily intake of carbohydrate (259.6 ± 79.4g), protein (72.2 ± 18.7g) and lipid (56.5 ± 19.9g) remained within the reference values. The daily calcium intake (614.2 ± 407.2 mg) and vitamin D (1.08 µg), as well as the calcium / protein ratio (8/1) were inadequate. There was no significant association between calcium / protein ratio and the degree of schooling, and the calcium / protein and salary levels, but increased the calcium was observed / protein among those who had wage income between 2 and 5 minimum wages and among those who had more education. Conclusion: On average, women are overweight. The caloric and macronutrient intake was adequate, as was within the acceptable distribution range. However, the consumption of calcium and vitamin D, did not reach the recommended minimum recommendations. The calcium / protein showed to be inadequate and its correlation with socioeconomic data was not significant (AU)