2024 SIAC guidelines on cardiorespiratory rehabilitation in pediatric patients with congenital heart disease.

The 2024 Interamerican Society of Cardiology (SIAC) guidelines on cardiorespiratory rehabilitation (CRR) in pediatric patients with congenital heart disease aim to gather and evaluate all relevant evidence available on the topic to unify criteria and promote the implementation of CRR programs in this population in Latin America and other parts of the world. Currently, there is no unified CRR model for the pediatric population. Consequently, our goal was to create these CRR guidelines adapted to the characteristics of congenital heart disease and the physiology of this population, as well as to the realities of Latin America. These guidelines are designed to serve as a support for health care workers involved in the care of this patient group who wish to implement a CRR program in their workplace. The guidelines include an easily reproducible program model that can be implemented in any center. The members of this Task Force were selected by the SIAC on behalf of health care workers dedicated to the care of pediatric patients with congenital heart disease. To draft the document, the selected experts performed a thorough review of the published evidence.

Dietary acid load is positively associated with insulin resistance: a population-based study.

BACKGROUND & AIMS: Diabetes mellitus (DM) and cardiovascular disease (CVD) are among the biggest causes of death and health expenses worldwide. A higher dietary acid load (DAL) is associated with chronic low-grade metabolic acidosis, and may increase the risk of insulin resistance (IR), DM, hypertension, and CVD mortality. However, the association between DAL and IR still lacks population-based studies to confirm laboratory findings. METHODS: This is a population-based observational study including a sample of 545 individuals aged 25-64 years from Florianópolis (Southern Brazil) who participated in the EpiFloripa cohort study. All diet variables were obtained through two 24-h Food Recalls adjusted to obtain an estimate of habitual food consumption. DAL was measured by Potential Renal Acid Load (PRAL) and Net Endogenous Acid production (NEAP). Fasting blood samples were obtained from all participants. The primary outcome was IR, which was estimated by HOMA-IR. Secondary outcomes included HOMA-ß, glycosylated hemoglobin, and fasting blood glucose and insulin. Multiple linear regression models adjusted for sociodemographics, lifestyle, and clinical variables were used for analysis, with exposure and outcome variables standardized as Z-scores to allow comparability of the results. RESULT: The mean PRAL and NEAP in the sample were 16.9 ± 4.8 and 66.1 ± 7.1 mEq/day, respectively. The average HOMA-IR score was 2.4 ± 1.6. In adjusted analyses, PRAL was positively associated with HOMA-IR, fasting insulin, and fasting blood glucose (p-value <0.05 in all cases), but not with HOMA-ß or glycated hemoglobin. NEAP also showed a direct-trend relationship with HOMA-IR and fasting insulin, but not with fasting blood glucose or the other outcomes. The strongest association was between PRAL and HOMA-IR (ß, 0.20; 95% CI, 0.06-0.35). CONCLUSIONS: A higher DAL was consistently associated with higher IR and insulin levels but not with other glycaemic parameters. Apparently, ß-pancreatic cells function is not affected by DAL in this population. This is the first study that describes the DAL in a population-based sample of adults in Latin America and in a middle-income country population. Further longitudinal and interventional studies are required to establish a better causal effect between DAL and IR.

The independent and joint associations between muscle strength, health variables and cardiovascular disease among adults.

OBJECTIVES: We investigated the independent and joint association between muscle strength and health variables according to individual health status among adults. METHODS: Cross-sectional population-based study comprising 643 adults (39.6 ± 11.1 years, 44.9% men) from Florianópolis, Southern Brazil. Muscle strength was assessed by handgrip strength. Health variables included were systolic (SBP) and diastolic blood pressure (DBP), waist circumference (WC), carotid intima-media thickness (IMT), high-sensitivity C-reactive protein (CRP), total cholesterol (CHOL), HDL cholesterol (HDL-C), triglycerides (TRG), glycated hemoglobin (HbA1c), and insulin resistance index (HOMA-IR). Participants were grouped into three health status categories: 1) healthy (without CVD and risk for CVD); 2) at risk for CVD (obesity, high blood pressure, and hyperglycemia); 3) with CVD. Multiple linear regression adjusted for confounding factors was used. RESULTS: Muscle strength was inversely associated with IMT (ß = -0.02, SE: 0.03), CHOL (ß = -0.14, SE: 0.02) and HbA1c (ß = -0.01, SE: 0.10), and directly associated with SBP (ß = 0.16, SE: 0.06) and WC (ß = 0.02, SE: 0.03). Among adults with CVD, muscle strength was inversely associated with IMT (p < 0.05). Higher muscle strength was directly associated with SBP among healthy adults (p < 0.05). CONCLUSION: The main finding of the present study indicated that among individuals with CVD, muscle strength was associated with lower IMT values.

Association of hyperhydration evaluated by bioelectrical impedance analysis and mortality in patients with different medical conditions: Systematic review and meta-analyses.

BACKGROUND AND AIMS: Fluid retention is a risk factor for mortality in several medical conditions. However, the accurate and fast assessment of hydration status remains a challenge in the clinical practice. Bioelectrical impedance analysis (BIA) could be an alternative to assess volume status. This systematic review aimed to evaluate the use of BIA to identify hydration status in patients with different medical conditions and to verify the association of hyperhydration, assessed by BIA, with mortality. METHODS: This systematic review and meta-analyses included 29 studies conducted from 2002 to 2017 among different medical conditions in adults. Eligible studies were randomized and non-randomized clinical trials, prospective and retrospective observational studies. For quality assessment of studies, Effective Public Health Practice Project (EPHPP) was used. RESULTS: Twelve studies provided data eligible for meta-analyses. A direct association between hyperhydration and mortality was observed (Odds Ratio [OR] 4.38; Confidence interval 95% [95% CI] 2.76-6.94), even when stratified for medical condition (OR 4.37; 95% CI 1.15-6.92) and BIA device (OR 4.37; 95% CI 2.75-6.92). CONCLUSION: Hyperhydration, evaluated by BIA, was positive associated with mortality. Therefore, the prognostic impact of hyperhydration may be properly assessed by a bedside tool such as BIA.