Wrist Circumference Cutoff Points for Determining Excess Weight Levels and Predicting Cardiometabolic Risk in Adults.

(1) Background: An elevated wrist circumference may indicate excess weight and cardiometabolic risk. The present study aims to identify wrist circumference cutoff points (WrC) to determine excess weight levels and predict cardiometabolic risk in adults. (2) Methods: A cross-sectional study was conducted with adults aged 20 to 59 years old, attending the outpatient clinic at University Hospital/Federal University of Sergipe HU/UFS-EBSERH. Demographic, anthropometric, biochemical, and blood pressure (BP) data were collected. Cardiometabolic risk was assessed, according to the global risk score (ERG) and Framingham score criteria. The descriptive analysis included calculating medians and frequencies of anthropometric, demographic, biochemical, and blood pressure variables. The gender and age of adult groups were compared using the Mann-Whitney test. Spearman's correlation coefficient and multiple regression analysis were used to assess the association between wrist circumference (WrC) and the variables mentioned above. The predictive validity of WrC in identifying excess weight levels and cardiometabolic risk was analyzed using the ROC curve. The sample consisted of 1487 adults aged 20 to 59 years, 55.7% of whom were female; (3) Results: WrC correlated positively with other adiposity indicators such as waist circumference and Body Mass Index. WrC was the anthropometric indicator most significantly associated with cardiometabolic risk factors. WrC cutoff points identified by the study for determining excess weight were categorized by gender and age group. For males aged 20 to 40 years and >40 years, respectively, the cutoff points for overweight were 17.1 cm and 17.3 cm, and for obesity, 17.9 cm and 17.5 cm. For females aged 20 to 40 years and >40 years, respectively, the cutoff points for overweight were 15.6 cm and 15.4 cm, and for obesity, 16.1 cm and 16 cm (4). Conclusions: Wrist circumference showed a significant correlation with other adiposity indicators and can be used to identify adults with excess weight and predict cardiometabolic risk.

Gastrointestinal Issues in Depression, Anxiety, and Neurodegenerative Diseases: A Systematic Review on Pathways and Clinical Targets Implications.

INTRODUCTION: Multiple illnesses commonly involve both the Central Nervous System (CNS) and the Gastrointestinal Tract (GI) simultaneously. Consistent evidence suggests that neurological disorders impair GI tract function and worsen the symptomatology and pathophysiology of digestive disorders. On the other hand, it has been proposed that early functional changes in the GI tract contribute to the genesis of several CNS illnesses. Additionally, the role played by the gut in these diseases can be seen as a paradigm for how the gut and the brain interact. METHODS: We mentioned significant GI symptoms and discussed how the GI tract affects central nervous system illnesses, including depression, anxiety, Alzheimer's disease, and Parkinson's disease in this study. We also explored potential pathophysiological underpinnings and novel targets for the creation of future therapies targeted at gut-brain connections. RESULTS & DISCUSSION: In this situation, modulating the gut microbiota through the administration of fecal microbiota transplants or probiotics may represent a new therapeutic option for this population, not only to treat GI problems but also behavioral problems, given the role that dysbiosis and leaky gut play in many neurological disorders. CONCLUSION: Accurate diagnosis and treatment of co-existing illnesses also require coordination between psychiatrists, neurologists, gastroenterologists, and other specialties, as well as a thorough history and thorough physical examination.

Inflammatory Profile Associated with Secondary Infection from Bothrops atrox Snakebites in the Brazilian Amazon.

Bothrops snakebite envenomation (SBE) is consider an important health problem in Brazil, where Bothrops atrox is mainly responsible in the Brazilian Amazon. Local effects represent a relevant clinical issue, in which inflammatory signs and symptoms in the bite site represent a potential risk for short and long-term disabilities. Among local complications, secondary infections (SIs) are a common clinical finding during Bothrops atrox SBE and are described by the appearance of signs such as abscess, cellulitis or necrotizing fasciitis in the affected site. However, the influence of SI in the local events is still poorly understood. Therefore, the present study describes for the first time the impact of SBE wound infection on local manifestations and inflammatory response from patients of Bothrops atrox SBE in the Brazilian Amazon. This was an observational study carried out at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (Brazil), involving victims of Bothrops SBE. Clinical and laboratorial data were collected along with blood samples for the quantification of circulating cytokines and chemokines before antivenom administrations (T0) and 24 h (T1), 48 h (T2), 72 h (T3) and 7 days after (T4). From the 94 patients included in this study, 42 presented SI (44.7%) and 52 were without SI (NSI, 55.3%). Patients classified as moderate envenoming presented an increased risk of developing SI (OR = 2.69; CI 95% = 1.08-6.66, p = 0.033), while patients with bites in hands showed a lower risk (OR = 0.20; CI 95% = 0.04-0.96, p = 0.045). During follow-up, SI patients presented a worsening of local temperature along with a sustained profile of edema and pain, while NSI patients showed a tendency to restore and were highlighted in patients where SI was diagnosed at T2. As for laboratorial parameters, leukocytes, erythrocyte sedimentation ratio, fibrinogen and C-reactive protein were found increased in patients with SI and more frequently in patients diagnosed with SI at T3. Higher levels of circulating IL-2, IL-10, IL-6, TNF, INF-γ and CXCL-10 were observed in SI patients along with marked correlations between these mediators and IL-4 and IL-17, showing a plurality in the profile with a mix of Th1/Th2/Th17 response. The present study reports for the first time the synergistic effects of local infection and envenoming on the inflammatory response represented by local manifestations, which reflected on laboratorial parameters and inflammatory mediators and thus help improve the clinical management of SI associated to Bothrops SBE.

Two new species of Baetodes Needham & Murphy, 1924 with an updated checklist of Baetidae (Ephemeroptera) of Rondônia state, Brazil.

Baetidae is one of the most taxon-rich families in the order Ephemeroptera, and the most studied mayfly in Brazil. Despite recent advances, the vast majority of the Brazilian territory has not yet had its diversity well documented. Some of these critical gaps are in the South-Western Amazon, with emphasis on the state of Rondônia due to the high level of environmental threat (especially deforestation). In the state, only one small survey was carried out 11 years ago. Given this scenario, the objective of this study is to describe two new species and provide access to primary biodiversity data of the family Baetidae in Rondônia. As a result, two new species, Baetodes vermelho sp. nov. and Baetodes cerejeiras sp. nov., are described. Baetodes vermelho sp. nov. can be differentiated from other species by the presence of robust and pointed setae on the dorsal margin of the femora and coxal gills with medial constriction; Baetodes cerejeiras sp. nov. can be differentiated from B. liviae Polegatto & Salles, 2008 (in Salles & Polegatto, 2008) and B. capixaba Souza, Salles & Nessimian, 2011 by the absence of a tubercle on the metanotum, the presence of small blunt setae on the dorsal arc of the labrum, and less prominent tubercles on the abdomen. We have documented 50 species across 54 sites in the Rondônia. Among these, 18 species are being reported for the first time in the state, three species are recorded for the first time in the north of Brazil, and two species are new records for Brazil. Rondônia is the most speciose state in Brazil regarding the family Baetidae.

Intranasal in situ gelling liquid crystal for delivery of resveratrol ameliorates memory and neuroinflammation in Alzheimer's disease.

Alzheimer's disease (AD) is an illness that affects people aged 65 or older and affects around 6.5 million in the United States. Resveratrol is a chemical obtained from natural products and it exhibits biological activity based on inhibiting the formation, depolymerization of the amyloid, and decreasing neuroinflammation. Due to the insolubility of this compound; its incorporation in surfactant-based systems was proposed to design an intranasal formulation. A range of systems has been produced by mixing oleic acid, CETETH-20 and water. Polarised light microscopy (PLM), small angle x-ray scattering (SAXS) and transmission electron microscopy (TEM) confirm the initial liquid formulation (F) presented as microemulsion (ME). After dilution, the gelled systems were characterized as hexagonal mesophase and they showed feasibility proprieties. Pharmacological assays performed after intranasal administration showed the ability to improve learning and memory in animals, as well as remission of neuroinflammation via inhibition of interleukin.

Neuropharmacology Potential of the Hydroalcoholic Extract from the Leaves of Piper cernuum: Anxiolytic, Hypnotic, and Antidepressant-Like Effects.

Aim: The use of medicinal plants in the treatment of mental illnesses is a reality that accompanies the history of civilizations, and the Piper genus exhibits many species with pharmacologically proven central effects. Then, this study evaluated the neuropharmacological effects of the hydroalcoholic extract from Piper cernuum (HEPC) leaves to validate its uses in folk medicine. Materials and Methods: Primarily Swiss mice (female, 25-30 g) were pretreated with HEPC (50-150 mg/kg, p.o.), vehicle, or the positive control, and submitted to open-field test (OFT), inhibitory avoidance test (IAT), tail suspension test (TST), and forced swim test (FST). Also, mice were exposed to pentylenetetrazol- and strychnine-induced seizure assay, pentobarbital-induced hypnosis test, and elevated plus-maze (EPM). The GABA levels and MAO-A activity were measured in the animal's brain after 15 days of HEPC administration (150 mg/kg, p.o.). Results: Mice pretreated with HEPC (100 and 150 mg/kg) and exposed to pentobarbital presented decreased sleep latency and increased sleep duration (HEPC 150 mg/kg). In EPM, the HEPC (150 mg/kg) increased the frequency of entry and the time of exploration of mice in the open arms. The antidepressant-like properties of HEPC were demonstrated by the decrease in the mice's immobility time when tested in FST and TST. The extract did not show anticonvulsant activity, in addition to not improving the memory parameters of animals (IAT) or interfering with their locomotor activity (OFT). Besides, HEPC administration decreased the MAO-A activity and increased the GABA levels in the animal's brain. Conclusion: HEPC induces sedative-hypnotic, anxiolytic-, and antidepressant-like effects. These neuropharmacological effects of HEPC could be, at least in part, related to the modulation of the GABAergic system and/or MAO-A activity.

DYRK1A Inhibitors and Perspectives for the Treatment of Alzheimer's Disease.

BACKGROUND: Alzheimer's disease (AD) is a chronic neurodegenerative disease and the most common form of dementia, especially in the elderly. Due to the increase in life expectancy, in recent years, there has been an excessive growth in the number of people affected by this disease, causing serious problems for health systems. In recent years, research has been intensified to find new therapeutic approaches that prevent the progression of the disease. In this sense, recent studies indicate that the dual-specificity tyrosine phosphorylation regulated kinase 1A (DYRK1A) gene, which is located on chromosome 21q22.2 and overexpressed in Down syndrome (DS), may play a significant role in developmental brain disorders and early onset neurodegeneration, neuronal loss and dementia in DS and AD. Inhibiting DYRK1A may serve to stop the phenotypic effects of its overexpression and, therefore, is a potential treatment strategy for the prevention of ageassociated neurodegeneration, including Alzheimer-type pathology. OBJECTIVE: In this review, we investigate the contribution of DYRK1A inhibitors as potential anti-AD agents. METHODS: A search in the literature to compile an in vitro dataset including IC50 values involving DYRK1A was performed from 2014 to the present day. In addition, we carried out structure-activity relationship studies based on in vitro and in silico data. RESULTS: molecular modeling and enzyme kinetics studies indicate that DYRK1A may contribute to AD pathology through its proteolytic process, reducing its kinase specificity. CONCLUSION: further evaluation of DYRK1A inhibitors may contribute to new therapeutic approaches for AD.

Correction: Short Report: Early genomic detection of SARS-CoV-2 P.1 variant in Northeast Brazil.

[This corrects the article DOI: 10.1371/journal.pntd.0009591.].

Viral Hepatitis A, B and C in a Group of Transgender Women in Central Brazil.

Transgender women (TGW) have limited access to affordable viral hepatitis testing, hepatitis B vaccination, and treatment. We aimed to estimate the prevalence of viral hepatitis A, B, and C, as well as to compare the adherence and immunogenicity of two hepatitis B vaccine schedules among TGW in Central Brazil. A total of 440 TGW were interviewed and tested for hepatitis A, B, and C serological markers from 2017 to 2018. The hepatitis B vaccine was offered to 230 eligible TGW: 112 received a super accelerated hepatitis B vaccine schedule (G1) and 118 a standard schedule (G2). The antibody against the hepatitis A virus (HAV) was detected in 75.63% of the participants, and 12.3% of the TGW were exposed to the hepatitis B virus (HBV). Two (0.46%) participants were HBV carriers. Only 41.5% of the participants showed a serological profile of hepatitis B vaccination. The antibody against the hepatitis C virus (anti-HCV) was found in six participants (1.37%). Of the TGW who received the first vaccine dose, 62 (55.36%) and 49 (41.52%) in G1 and G2, respectively, received three doses (p = 0.036). The vaccine response was evaluated in 28 G1 and 22 G2 TGW; of these, 89.3% and 100% developed protective anti-hepatitis B surface-antigen titers, respectively (p = 0.113). Since one-third of younger transgender women are susceptible to HAV, hepatitis B immunization is low, and the anti-HCV rate is higher in this group than in the general population in Central Brazil, public-health attention is warranted. The super-accelerated scheme demonstrated better adhesion and good immunogenicity, suggesting that it would be a more cost-effective solution.

Adherence to secondary prevention measures after acute coronary syndrome in patients associated exclusively with the public and private healthcare systems in Brazil.

Adherence to secondary prevention measures after acute coronary syndrome (ACS) is essential to prevent disease recurrence. In Brazil, the Brazilian Unified Health System (SUS, in Portuguese), and the private healthcare system (PHCS) coexist. We aimed to evaluate the adherence to secondary prevention in patients with ACS who were assisted by either SUS or PHCS. In this longitudinal prospective study, patients with ACS were admitted to the four cardiological reference hospitals of Sergipe, three of which assisted PHCS users, and one, SUS users. We analyzed the two patient care models with multiple logistic regression models for adherence to physical activity, pharmacotherapy, and smoking cessation. We enrolled 581 volunteers in this study: 44.1 % from SUS and 55.9 % from PHCS. PHCS users showed greater adherence to pharmacotherapy at both 30 and 180 (p = 0.001) days after ACS with better results in all classes of medications (p < 0.05) than SUS users did. They also showed better adherence to physical activity (p = 0.047). There was no distinction between the groups regarding smoking cessation. The secondary prevention measures after ACS were more effective in PHCS users than in SUS users due to better adherence, especially to pharmacotherapy and regular physical activity.

Geraniol accelerates the gastric healing, minimizes ulcers recurrence, and reduces anxiolytic-like behavior in ulcerated rodents by oral or inhaled route.

BACKGROUND: Geraniol (GE) is dietary acyclic monoterpene alcohol found in essential oils from aromatic plants with therapeutic value against gastric ulcers already described. HYPOTHESIS/PURPOSE: To assess whether oral GE accelerates gastric healing or prevents ulcer recurrence, and to evaluate the hypothesis that GE promotes antiulcer effects by the inhaled route and that promotes changes in the behavior of ulcerated rodents. METHODS: Gastric healing effects, underlining mechanisms, and behavioral changes were measured in80% acetic acid-induced gastric ulcer model in rats receiving GE by oral (30 mg/kg) or inhaled route (1 mg/L of air/min); whereas the effects of GE to avoid ulcer recurrence was evaluated in mice submitted to 10% acetic acid plus IL-1ß ulcer. RESULTS: GE administered by both routes accelerates gastric healing, increasing mucin and GSH levels, CAT, and GST activities, and reducing MPO activity. Moreover, oral, and inhaled GE minimized ulcer recurrence reducing gastric TNF and IL-6 levels and preserving mucin levels. Interestingly, the inhalation or oral intake of GE promotes anxiolytic-like effects in ulcerated rats. CONCLUSION: Data altogether suggest that the GE accelerates gastric healing through the strengthening of protective factors of the gastric mucosa, promoting a quality healing that reduces the recurrence of the lesion. Besides, the anxiolytic-like effect of GE may also contribute to its gastric healing action since anxiety is recognized as one of the etiologic agents of ulcers.

Assessment of Malnutrition in Heart Failure and Its Relationship with Clinical Problems in Brazilian Health Services.

Malnutrition in heart failure (HF) is frequent and associated with a worse prognosis. Due to differences in investment and the profile of those assisted, the objective of this study was to evaluate the frequency of malnutrition in hospitalized patients with HF and its association with clinical outcomes in the public and private health systems. Methodology: A cross-sectional study, with 247 volunteers hospitalized with HF in three public hospitals and one private hospital in Aracaju, SE, Brazil. A subjective global nutritional assessment (SGA) and mini nutritional assessment (MNA) were performed. Results: Sample with 72.5% users of the public health system and 75.3% with malnutrition (public = 74.9%; private = 76.5%; p = 0.793). Regardless of the healthcare system, hospital stay (>14 days) was longer (p = 0.020) among those with malnutrition (48.4%) than well-nourished patients (29.5%). Malnutrition in the public system had higher mortality (7.5%; 5.8%; p < 0.001) and hospital transfer rate (21.1%; 0.0%; p < 0.001) than those in the private system. Death after discharge was observed only in the public system (p = 0.039). Conclusion: Malnutrition was frequent in both systems and was associated with longer hospital stays and, in the public hospital, in-hospital death and transfers.

Quality of Life among Patients with Acute Coronary Syndromes Receiving Care from Public and Private Health Care Systems in Brazil.

(1) Background: Quality of life (QOL) is used as a health indicator to assess the effectiveness and impact of therapies in certain groups of patients. This study aimed to analyze the QOL of patients with acute coronary syndrome (ACS) who received medical treatment by a public or private health care system. (2) Methods: This observational, prospective, longitudinal study was carried out in four referral hospitals providing cardiology services in Sergipe, Brazil. QoL was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey. The volunteers were divided into two groups (public or private health care group) according to the type of health care provided. Multiple linear regression models were used to evaluate QoL at 180 days after ACS. (3) Results: A total of 581 patients were eligible, including 44.1% and 55.9% for public and private health care, respectively. At 180 days after ACS, the public health care group had lower QoL scores for all domains (functional capacity, physical aspects, pain, general health status, vitality, social condition, emotional profile, and health) (p < 0.05) than the private group. The highest QoL level was associated with male sex (p < 0.05) and adherence to physical activity (p ≤ 0.003) for all assessed domains. (4) Conclusions: This shows that social factors and health status disparities influence QoL after ACS in Sergipe.

Retrospective Investigation in Horses with Encephalitis Reveals Unnoticed Circulation of West Nile Virus in Brazil.

During these past years, several studies have provided serological evidence regarding the circulation of West Nile virus (WNV) in Brazil. Despite some reports, much is still unknown regarding the genomic diversity and transmission dynamics of this virus in the country. Recently, genomic monitoring activities in horses revealed the circulation of WNV in several Brazilian regions. These findings on the paucity of genomic data reinforce the need for prompt investigation of WNV infection in horses, which may precede human cases of encephalitis in Brazil. Thus, in this study, we retrospectively screened 54 suspicious WNV samples collected between 2017 and 2020 from the spinal cord and brain of horses with encephalitis and generated three new WNV genomes from the Ceará and Bahia states, located in the northeastern region of Brazil. The Bayesian reconstruction revealed that at least two independent introduction events occurred in Brazil. The first introduction event appears to be likely related to the North American outbreak, and was estimated to have occurred in March 2013.The second introduction event appears to have occurred in September 2017 and appears to be likely related to the South American outbreak. Together, our results reinforce the importance of increasing the priority of WNV genomic monitoring in equines with encephalitis in order to track the dispersion of this emerging pathogen through the country.

Temporal trends in intraventricular hemorrhage in preterm infants: A Brazilian multicenter cohort.

BACKGROUND: Intraventricular hemorrhage (IVH) is a serious problem in preterm infants. Brazilian national data are unknown. OBJECTIVE: To evaluate the incidence and temporal trend of IVH in very low birth weight (VLBW) preterm infants of 18 centers of the Brazilian Network on Neonatal Research. STUDY DESIGN: National prospective multicenter cohort study including inborn VLBW preterm infants aged 230/7- 336/7 weeks' gestation, admitted between 2013 and 2018. The center with the mean incidence rate was used as reference. We applied two adjustments models using perinatal variables, and perinatal + neonatal diseases. RESULTS: Of 6,420 infants, 1951/30.4% (range 27.1-33.8%) had IVH and the disease showed a significant trend towards an overall increase in incidence over time (p = 0.003), especially in three centers. Severe IVH (grade III or IV) occurred in 32.2% (range 29.2-34.5%) of those affected by IVH, with a stable incidence. After adjustments for perinatal variables, the differences persisted among centers: for global IVH, 7 centers had significantly lower rates (OR ranging from 0.31 to 0.62), and 2 presented rates higher than the reference center (OR ranging from 2.00 to 12.46) for severe HIV. Considering perinatal and neonatal variables, 6 centers had significantly lower rates (OR ranging from 0.36 to 0.60) for global IVH than the reference center and 3 had statistically higher rates (OR 1.72, 1.86 and 11.78) for severe forms. CONCLUSION: The incidence rate of IVH in this Brazilian cohort was high and it revealed an increasing trend towards over time. The severe IVH rate was also worrisome.

Synchronized spread of COVID-19 in the cities of Bahia, Brazil.

The COVID-19 pandemic, caused by the highly transmissible SARS-CoV-2 virus, has overloaded health systems in many contexts Conant and Wolfe (2008). Brazil has experienced more than 345,000 deaths, as of April/2021 Conant and Wolfe (2008), with dire consequences for the country's public and private health systems. This paper aims to estimate the synchronization graph between the cities' contagion waves from public COVID-19 data records. For this purpose, the Motif-Synchronization method Magwire et al. (2011) was applied to publicly available COVID-19 data records to determine the sequential relationship of occurrence of the waves among Bahia's cities. We find synchronization between waves of infection between cities, suggesting diffusion of the disease in Bahia and a potential role for inter-city transportation Saba et al. (2018), Saba et al. (2014), Araújo et al. (2018) in the dynamics of this phenomenon McKee and Stuckler (2020), Chinazzi et al. (2020), Tizzoni et al. (2014). Our main contribution lies in the use of the Motif-Synchronization method applied to COVID-19 data records, with the results revealing a pattern of disease spread that extends beyond city boundaries.

BALANCE Dietary Index in Patients with Heart Failure, and Its Adherence in Sergipe, Brazil.

BACKGROUND: "The effective treatment of Heart Failure (HF) involves care with food intake. Recently, the Ministry of Health created the Brazilian Cardioprotective Diet and its dietary index, BALANCE, which assesses adherence to the standard's recommendations". METHODS: This observational prospective study is part of the Congestive Heart Failure Registry (VICTIM-CHF) of Aracaju/SE. Observations and data collection took place from April 2018 to February 2021. Sociodemographic and clinical aspects and food consumption were evaluated. Food intake was determined using the food frequency questionnaire. Foods were categorized using the BALANCE dietary index into green, yellow, blue and red food groups. The BALANCE dietary index was obtained using median and interquartile ranges, scores of the Mann-Whitney U test, and associations between clinical variables and the index, through linear regression. RESULTS: Participants included 240 patients with HF (61.12 ± 1.06 years), who were assisted by the Unified Health System (67.5%). Individuals with a partner showed greater adherence to the green food group recommendations (0.09; 0.00-0.17). The lowest adherence to recommendations regarding the blue food group was observed in individuals with excess weight, who had a higher consumption of foods rich in animal protein (0.54; 0.38-0.78). As for the red food group (ultra-processed foods) the highest adherence was observed by patients with diabetes mellitus (0.41; 0.05-0.77). The greatest adherence to the yellow food group, and a higher score, was observed in patients with the smallest left ventricular systolic diameter (LVSD). CONCLUSIONS: Being married was directly associated with the consumption of foods in the green group, while being overweight and having diabetes were inversely associated with adherence to the blue and red food groups, respectively. Greater adherence to the yellow food group recommendations was inversely associated with less change in the DSFVE.

A Critical Analysis of the COVID-19 Hospitalization Network in Countries with Limited Resources.

To effectively combat the COVID-19 pandemic, countries with limited resources could only allocate intensive and non-intensive care units to a low number of regions. In this work, we evaluated the actual displacement of infected patients in search of care, aiming to understand how the networks of planned and actual hospitalizations take place. To assess the flow of hospitalizations outside the place of residence, we used the concepts of complex networks. Our findings indicate that the current distribution of health facilities in Bahia, Brazil, is not sufficient to effectively reduce the distances traveled by patients with COVID-19 who require hospitalization. We believe that unnecessary trips to distant hospitals can put both the sick and the healthy involved in the transport process at risk, further delaying the stabilization of the COVID-19 pandemic in each region of the state of Bahia. From the results found, we concluded that, to mitigate this situation, the implementation of health units in countries with limited resources should be based on scientific methods, and international collaborations should be established.

Food Patterns of Hospitalized Patients with Heart Failure and Their Relationship with Demographic, Economic and Clinical Factors in Sergipe, Brazil.

Background: The high rates of hospitalization and mortality caused by Heart Failure (HF) have attracted the attention of health sectors around the world. Dietary patterns that involve food combinations and preparations with synergistic or antagonistic effects of different dietary components can influence the worsening and negative outcomes of this disease. Objectives: To describe the dietary patterns of patients hospitalized for HF decompensation and associate them with demographic, economic, and clinical factors, and the type of care provided in Sergipe. Materials and Methods: Cross-sectional study that is part of the Congestive Heart Failure Registry (VICTIM-CHF)" of Aracaju/SE. Prospective data collection took place with all patients hospitalized between April 2018 and February 2021 in cardiology referral hospitals, 2 public and 1 private. The data collected were sociodemographic, clinical, lifestyle, anthropometric and food consumption variables. Daily dietary intake was estimated by applying a semiquantitative food frequency questionnaire. The extraction of dietary patterns, by exploratory factor analysis, was performed after grouping the foods according to the nutritional value and form of preparation into 34 groups. To assess the association between the factorial scores for adherence to the standards and the variables studied, the Mann-Whitney U test was applied. Linear regressions were also performed, considering the dietary pattern (one for each pattern) as a dependent variable. Results: The study included 240 patients hospitalized for HF decompensation, most of them elderly (mean age 61.12 ± 1.06 years), male (52.08%) and attended by the Unified Health System­SUS (67.5%). Three dietary patterns were identified, labeled "traditional" (typical foods of the Brazilian northeastern population added to ultra-processed foods), "Mediterranean" (foods recommended by the Mediterranean diet) and "dual" (healthy foods combined with fast and easy-to-prepare foods like snacks, bread, sweets and desserts). Adherence to the "traditional" pattern was greater among men (p < 0.031) and non-diabetics (p < 0.003). The "Mediterranean" was more consumed by the elderly (p < 0.001), with partners (p = 0.001) and a lower income (p < 0.001), assisted by the SUS (p < 0.001) and without hypertension (p = 0,04). The "dual" diet pattern had greater adherence by the elderly (p < 0.001), self-declared non-black (p = 0.012), with higher income (p < 0.001), assisted in the private sector (p < 0.001) and with less impaired functional capacity (p = 0.037). It was also observed that being female (p = 0.031) and being older reduced the average scores of performing the "traditional" pattern (p = 0.002). Regarding the type of service, being from the public service reduced the average scores for adhering to the "dual" pattern (p = 0.008). Conclusions: Three dietary patterns representative of the population were found, called traditional, Mediterranean and dual, which were associated with demographic, economic and clinical factors. Thus, these standards must be considered in the development of nutritional strategies and recommendations in order to increase adherence to diets that are more protective against cardiovascular diseases.