Elderly patients on hemodialysis have worse dietary quality and higher consumption of ultraprocessed food than elderly without chronic kidney disease.

OBJECTIVES: The multiple dietary restrictions recommended to patients on hemodialysis (HD), coupled with conditions imposed by aging, may lead to poor dietary quality in these patients. The aim of this study was to investigate the dietary quality and consumption of ultraprocessed food by elderly patients on HD and those without chronic kidney disease (CKD). Additionally, diets on the day of dialysis and on nondialysis days were evaluated. METHODS: This was a cross-sectional study conducted with 153 noninstitutionalized elderly patients on HD (Elder-HD) and 47 non-CKD elderly (Elder-Healthy) aged ≥60 y. From a 3-d food record, the dietary quality was assessed using the Brazilian Healthy Eating Index Revised (BHEI-R) and the energy contribution of food-processing groups. RESULTS: Compared with the Elder-Healthy group, the Elder-HD group showed a lower total BHEI-R score (P < 0.05). On the weekdays, the Elder-HD group showed lower scores (P < 0.05) of whole fruit, dark green vegetables and legumes, meat, eggs, and legumes, whereas total cereals showed a higher score (P < 0.05). When furthering the analysis on the Elder-HD group, although the total BHEI-R score did not differ among the days assessed, the components whole fruit, dark green vegetables, and legumes had lower scores (P < 0.05) on the day of dialysis, and the opposite was observed for milk and dairy products. Moreover, the Elder-HD showed a higher (P < 0.05) contribution of processed and ultraprocessed foods and lower (P < 0.05) contribution of natural or minimally processed foods. CONCLUSION: The Elder-HD group showed poorer dietary quality and higher consumption of processed and ultraprocessed foods than the Elder-Healthy group. Moreover, when compared with the nondialysis day, these patients exhibited worse dietary quality, on the day of dialysis.

Evaluation of clinical and laboratory parameters used in the identification of index cases for genetic screening of familial hypercholesterolemia in Brazil.

BACKGROUND AND AIMS: There is controversy on the accuracy of different diagnostic criteria for familial hypercholesterolemia (FH). The aim of this study is to assess the performance of different clinical criteria used to identify individuals for FH genetic cascade screening in Brazil. METHODS: All index cases (IC) registered in the Hipercol Brasil program between 2011 and 2016 were analyzed. Inclusion criteria were age ≥18 years and elevated LDL-cholesterol (LDL-C) levels, with a conclusive result in the genetic test, whether positive or negative. Initially, we tested the multivariable association between clinical and laboratory markers and the presence of an FH causing mutation. Then, we analyzed sensitivity, specificity, positive and negative predictive values for the LDL-C quartile distribution, LDL-C as a continuous variable, as well as the performance measures for the Dutch Lipid Clinic Network (DLCN) score to identify a mutation. RESULTS: Overall, 753 ICs were included and an FH causing mutation was found in 34% (n = 257) of the subjects. After multivariable analysis, LDL-C as a continuous variable, tendon xanthomas and corneal arcus were independently associated with the presence of FH mutations. LDL-C values ≥ 230 mg/dL (5.9 mmol/L) had the best tradeoff between sensitivity and specificity to diagnose a mutation. The DLCN score presented a better performance than LDL-C to identify a mutation, area under the ROC curve were 0.744 (95% CI: 0.704-0.784) and 0.730 (95% CI: 0.687-0.774), respectively, p=0.014. CONCLUSIONS: In our population, LDL ≥230 mg/dL is a feasible criterion to indicate ICs to genetic testing.

Effectiveness of nutritional treatment assessed by the quality of the diet in patients with chronic coronary artery disease / Eficacia del tratamiento nutricional según la evaluación de calidad de la dieta en pacientes con enfermedad arterial coronaria crónica

The effectiveness of nutritional treatment is important protective factor for the prevention of recurrences of cardiovascular diseases. The goal of this study was to assess the effectiveness of nutritional treatment and to know the eating pattern and the quality of an adjuvant diet for optimized clinical treatment in patients with chronic coronary artery disease (CCAD). This is a clinical trial with a three-month duration conducted with 116 patients of both sexes with (CCAD) in secondary prevention. The patients underwent nutritional treatment and blood pressure, anthropometric, biochemical and dietetic (24-hour recall) measures were collected. The Brazilian Healthy Eating Index (BHEI-R) was calculated for assessing diet quality. The average age was 62.5 ± 7.8 years. The nutritional treatment reduced: weight -1.5 ± 2.3 kg; p < 0.01; body mass index -0.5 ± 0.9 kg/m2; p < 0.01; neck circumference -0.8 ± 0.1; p < 0.01 cm; concentrations of plasma insulin -1.3 ± 0.5mU/ mL p < 0.03, glycated hemoglobin -0.4 ± 0.1 mg/dL; p < 0.01 (- 0,004 mmol/L), and HOMA-IR (-0.8 ± 3.9; p < 0.03); and increased insulin sensitivity 6.64 ± 23,9 x10-3; p < 0.01. The nutritional treatment increased HDL-cholesterol concentrations in patients who adhered to the diet after BHEI-R control 1.7 ± 1.4 mg/dL; p = 0.04 (0,04 mmol/L). Three-month nutritional treatment promoted reduction of saturated fats consumption (-1.9 ± 0.5%; p= < 0.01), cholesterol (-67.7 ± 18.6 mg/d; p < 0.01), and sodium (815.2 ± 146.5 mg/d; p < 0.01); and 20.7% of the patients finished the study with a healthy diet. The intensive nutritional treatment was effective in reducing anthropometric measures and improving glycemic control (AU)

La eficacia del tratamiento nutricional es un factor de protección importante para la prevención de la enfermedad cardiovascular recurrente. El objetivo del estudio fue evaluar la eficacia del tratamiento nutricional y para cumplir con el estándar de la comida y la calidad de la dieta adyuvante para el tratamiento médico óptimo en pacientes con enfermedad de la arteria coronaria crónica (EACC). Esta es una prueba que dura tres meses realizado con 116 pacientes de ambos sexos (EACC) en la prevención secundaria. Los pacientes fueron sometidos a tratamiento nutricional y se recogieron la presión arterial, las mediciones antropométricas, (24 horas, recuerdo) y las medidas bioquímicas y dietéticas. Se utilizó el índice Brasileño de Calidad de la Dieta (ICD-R) para evaluar la calidad de esta. La edad media fue de 62,5 ± 7,8 años. El tratamiento nutricional baja: -1,5 ± 2,3 kg; p < 0,01; índice de masa corporal -0,5 ± 0,9 kg/m2; p < 0,01; circunferencia de la cintura -2,0 ± 0,1 cm; p < 0,01; concentraciones de insulina en plasma -1,3 ± 0.5mU/ml; p < 0,03, hemoglobina glucosilada 0,4 ± 0,1 mg/dl; p < 0,01 (-0,004 mmol/L) HOMA-IR (-0,8 ± 3,9; p < 0,03) y una mayor sensibilidad a la insulina 23,9 ± 6,64x10-3; p < 0,01. El tratamiento nutricional aumentó las concentraciones de colesterol HDL en los pacientes que se adhirieron a la dieta después de ICD-R 1,7 ± 1,4 mg/dl; p = 0,04 (0,04 mmol/L). Tres meses de tratamiento redujeron la ingesta nutricional de grasas saturadas (-1,9 ± 0,5%, p= < 0,01), colesterol (-67,7 ± 18,6 mg/d; p < 0,01) y sodio (815,2 ± 146,5 mg/d; p < 0,01); y el 20,7% de los pacientes completó el estudio con una dieta saludable. El tratamiento nutricional intensivo fue eficaz en la reducción de las medidas antropométricas y a la hora de conseguir un mejor control glucémico (AU)

EFFECTIVENESS OF NUTRITIONAL TREATMENT ASSESSED BY THE QUALITY OF THE DIET IN PATIENTS WITH CHRONIC CORONARY ARTERY DISEASE.

The effectiveness of nutritional treatment is important protective factor for the prevention of recurrences of cardiovascular diseases. The goal of this study was to assess the effectiveness of nutritional treatment and to know the eating pattern and the quality of an adjuvant diet for optimized clinical treatment in patients with chronic coronary artery disease (CCAD). This is a clinical trial with a three-month duration conducted with 116 patients of both sexes with (CCAD) in secondary prevention. The patients underwent nutritional treatment and blood pressure, anthropometric, biochemical and dietetic (24-hour recall) measures were collected. The Brazilian Healthy Eating Index (BHEI-R) was calculated for assessing diet quality. The average age was 62.5 ± 7.8 years. The nutritional treatment reduced: weight -1.5 ± 2.3 kg; p < 0.01; body mass index -0.5 ± 0.9 kg/m2; p < 0.01; waist circumference -2.0 ± 0.1cm; p < 0.01; neck circumference -0.8 ± 0.1; p < 0.01 cm; concentrations of plasma insulin -1.3 ± 0.5mU/ mL p < 0.03, glycated hemoglobin -0.4 ± 0.1 mg/dL; p < 0.01 (- 0,004 mmol/L), and HOMA-IR (-0.8 ± 3.9; p < 0.03); and increased insulin sensitivity 6.64 ± 23,9 x10-3; p < 0.01. The nutritional treatment increased HDL-cholesterol concentrations in patients who adhered to the diet after BHEI-R control 1.7 ± 1.4 mg/dL; p = 0.04 (0,04 mmol/L). Three-month nutritional treatment promoted reduction of saturated fats consumption (-1.9 ± 0.5%; p=<0.01), cholesterol (-67.7 ± 18.6 mg/d; p < 0.01), and sodium(815.2 ± 146.5 mg/d; p < 0.01); and 20.7% of the patients finished the study with a healthy diet. The intensive nutritional treatment was effective in reducing anthropometric measures and improving glycemic control.

La eficacia del tratamiento nutricional es un factor de protección importante para la prevención de la enfermedad cardiovascular recurrente. El objetivo del estudio fue evaluar la eficacia del tratamiento nutricional y para cumplir con el estándar de la comida y la calidad de la dieta adyuvante para el tratamiento médico óptimo en pacientes con enfermedad de la arteria coronaria crónica (EACC). Esta es una prueba que dura tres meses realizado con 116 pacientes de ambos sexos (EACC) en la prevención secundaria. Los pacientes fueron sometidos a tratamiento nutricional y se recogieron la presión arterial, las mediciones antropométricas, (24 horas, recuerdo) y las medidas bioquímicas y dietéticas. Se utilizó el índice Brasileño de Calidad de la Dieta (ICD-R) para evaluar la calidad de esta. La edad media fue de 62,5 ± 7,8 años. El tratamiento nutricional baja: -1,5 ± 2,3 kg; p < 0,01; índice de masa corporal -0,5 ± 0,9 kg/m2; p < 0,01; circunferencia de la cintura -2,0 ± 0,1 cm; p < 0,01; circunferencia del cuello -0,8 ± 0,1cm; p < 0,01; concentraciones de insulina en plasma -1,3 ± 0.5mU/ml; p < 0,03, hemoglobina glucosilada 0,4 ± 0,1 mg/dl; p < 0,01 (-0,004 mmol/L) HOMA-IR (-0,8 ± 3,9; p < 0,03) y una mayor sensibilidad a la insulina 23,9 ± 6,64x10-3; p < 0,01. El tratamiento nutricional aumentó las concentraciones de colesterol HDL en los pacientes que se adhirieron a la dieta después de ICD-R 1,7 ± 1,4 mg/dl; p = 0,04 (0,04 mmol/L). Tres meses de tratamiento redujeron la ingesta nutricional de grasas saturadas (-1,9 ± 0,5%, p=.

Food intake assessment of elderly patients on hemodialysis.

OBJECTIVE: To investigate whether the dietary intake of elderly patients on hemodialysis (HD) is lower than that of elderly individuals with normal renal function. In addition, we also assessed whether the dietary intake of elderly on HD is lower on the dialysis day (DD) than on nondialysis days (non-DD). DESIGN: A cross-sectional and observational study including elderly on HD and non-chronic kidney disease (non-CKD) elderly. SUBJECTS: We assessed 54 noninstitutionalized elderly patients on HD (study group) and 47 non-CKD elderly (control group) aged ≥60 years. MAIN OUTCOME MEASURES: All participants had their dietary intake assessed by 3-day food diaries. As a sensitivity analysis, we also assessed the dietary intake in the adequate reporters, which were identified when the ratio-energy intake-to-estimated basal metabolic rate-was above 1.27 (Goldberg index). RESULTS: When comparing dietary intake between the study and control groups, adjusted for sex and underreporting, it was noted that only the intake of protein (ß: -9.9; P: .01) and phosphorus (ß: -104; P: .04) were significantly lower in the study group. In addition, when furthering the analysis in the study group by comparing DD with non-DD, it was observed that energy (18 ± 7 vs. 21 ± 8 kcal/kg/day), protein (0.8 ± 0.4 vs. 1.0 ± 0.4 g/kg/day), lipids (41 ± 20 vs. 48 ± 23 g/day), potassium (1371 ± 587 vs. 1540 ± 484 mg/day), and phosphorous intake (647 ± 312 vs. 789 ± 287 mg/day), but not carbohydrate (155 ± 54 vs. 167 ± 55 g/day) and calcium (470 ± 345 vs. 518 ± 333 g/day) were significantly lower on DDs than on non-DDs, respectively. CONCLUSIONS: Except for protein and phosphorous, energy and nutrient intake of elderly patients on HD are similar to that of non-CKD elderly. In addition, the dietary intake is lower on DDs, highlighting the importance of focusing efforts to improve nutritional intake mainly during the day of dialysis treatment.

Dietary intake and nutritional status in cancer patients; comparing adults and older adults.

OBJECTIVE: Evaluate the nutrient intake and nutritional status of food in cancer patients admitted to a university hospital, with comparison of adult and older adult age category. METHODS: Cross-sectional study. This study involved cancer patients admitted to a hospital in 2010. Dietary habits were collected using a Brazilian food frequency questionnaire. Participants were divided in two groups: adults or older adults and in 4-cancer category: hematologic, lung, gastrointestinal and others. Body Mass Index evaluated nutritional status. RESULTS: A total of 86 patients with a mean age of 56.5 years, with 55% males and 42% older adults were evaluated. The older adult category had a higher frequency of being underweight (24.4% vs 16.3%, p < 0.01) and a lower frequency of being overweight (7% vs. 15.1%, p < 0.01) than adults. Both, adult and older adults had a high frequency of smoking, alcohol consumption and physical inactivity. The older adults had lower consumption of calories, intake of iron and folic acid. Inadequacy of vitamin intake was observed in both groups; respectively, 52%, 43%, 95%, 76% and 88% for Vitamin A, C, D, E and folic acid. The older adults had a higher folic acid and calcium inadequacy than the adults (97% vs 82%, p <0.01; 88% vs 72%, p < 0.01). There was no association of micronutrient intake with cancer, nor with nutritional status. CONCLUSION: The food intake, macro and micronutrients ingestion is insufficient among cancer individuals. Food intake of older adults was inferior, when compared to the adult category. There was a high prevalence of BMI excess in the adult group and a worst nutritional status in the older adult category.

Objetivo: Evaluar la ingesta de nutrientes y el estado nutricional de los alimentos en pacientes con cáncer ingresados en un hospital universitario, comparando por categoría de edad entre adulto y adulto mayor. Métodos: Estudio transversal. Este estudio incluía pacientes cancerosos ingresados en un hospital en 2010. Se recogieron los hábitos dietéticos mediante un cuestionario brasileño de frecuencia de alimentos. Se dividieron los participantes en dos grupos: adultos y adultos mayores y en 4 categorías de cáncer: hematológico, pulmonar, gastrointestinal y otros. El estado nutricional se evaluó con el índice de masa corporal. Resultados: Se evaluó a un total de 86 pacientes con una edad promedio de 56,5 años, siendo el 55 % varones y el 42 % adultos mayores. La categoría de adultos mayores tenía con mayor frecuencia peso bajo (24,4 % frente a 16,3 %, p < 0,01) y una menor frecuencia de sobrepeso (7 % frente a 15,1 %, p < 0,01) que los adultos. En ambos grupos había una frecuencia elevada de fumadores, consumo de alcohol e inactividad física. Los adultos mayores tenían un menor consumo de calorías, ingesta de hierro y ácido fólico. Se observó una ingesta inadecuada de vitaminas en ambos grupos; respectivamente, 52 %, 43 %, 95 %, 76 % y 88 % para las vitaminas A, C, D, E y el ácido fólico. Los adultos mayores tenían más ingesta inadecuada de ácido fólico y calcio que los adultos (97 % frente a 82 %, p < 0,01; 88 % frente a 72 %, p < 0,01). No hubo una asociación entre la ingesta de micronutrientes con el cáncer ni con el estado nutritivo. Conclusión: La ingesta de alimentos y de macro y micronutrientes es insuficiente en los individuos con cáncer. La ingesta de alimentos en adultos mayores fue menor en comparación con los adultos. Hubo una prevalencia elevada de IMC excesivo en el grupo de adultos y un peor estado nutricional en la categoría de adultos mayores.