Elevada prevalência de inadequação do consumo de fibras alimentares em idosos e fatores associados: um estudo de base populacional

Dietary Adequacy of Individuals with Cardiovascular Disease According to Clinical Guidelines in the Brazilian Cardioprotective Nutritional (BALANCE)

BACKGROUND

Achieving nutritional goals established by scientific societies is a constant challenge and not always achieved.

OBJECTIVE

To investigate the dietary adequacy of individuals with cardiovascular disease (CVD), participants in the Cardioprotective Brazilian Food Program residing in the Northeast region of Brazil, according to the recommendations of the Brazilian Society of Cardiology (SBC).

METHODS

Cross-sectional analysis with data from the study implementing the Brazilian Cardioprotective Diet (DICA BR), which evaluated individuals with CVD treated in specialized cardiovascular health centers in eight states in the Northeast region. Food consumption was obtained by 24-hour dietary records and dietary adequacy followed SBC recommendations. Values of p < 0.05 were considered significant.

RESULTS

647 patients were studied, with a mean (standard deviation) age of 63.1 (9.4) years, 50.2% of whom were female. When evaluating food intake, a low adequacy of carbohydrates (52.3%), proteins (70.9%), lipids (38.8%), and fiber (22.4%) was observed. It was observed that the majority of women consumed a low-protein diet (59.2%) and the elderly had a greater inadequacy in carbohydrate consumption (52.6%). Regarding sodium intake, men had a higher intake (72.9%), while the elderly showed a 13% reduction. Furthermore, it was shown that men ate more fiber (28.1%) and individuals with higher education had a high consumption of saturated fatty acids (70.5%).

CONCLUSIONS

Most individuals did not achieve the recommended dietary therapy goals for secondary cardiovascular prevention. The findings of the present study reinforce the need to implement structured strategies to encourage healthy eating habits in these individuals.

Risk of Malnutrition and Insufficient Protein Intake among Older People Living at Home: Baseline Findings of the Power Meals Study

This study aimed to investigate the nutritional status, nutrient intake and associated factors among older home care clients, caregivers and care recipients (≥65 years) living at home. There were a total of 78 participants, with a mean age of 78 ± 7.4 years. Nutritional status was assessed with the Mini Nutritional Assessment (MNA), nutrient intake with a three-day food record, sarcopenia with a Simple Questionnaire to Rapidly Diagnose Sarcopenia (SARC) and depression with The Geriatric Depression Scale (GDS-15). Almost one-third (32.1%) were at risk of malnutrition and 2.6% suffered from malnutrition. Impaired nutritional status was associated with depressive symptoms (β = -0.277, p = 0.015) and risk of sarcopenia (SARC points) (β = -0.401, p = 0.001). Mean protein intake was 0.9 ± 0.3 g/adjusted body weight/day. Intakes of protein and multiple vitamins and minerals were lower than recommended. In conclusion, a third of older people living at home were at risk of malnutrition or malnourished. Multiple physical, psychological and social factors in older adults were associated with nutritional status and protein intake.

Inclusion of Potentially Inappropriate Medicines for the Older Adults in the Brazilian Consensus in Accordance with International Criteria

AIM

The use of potentially inappropriate medications (PIM) can impair the safety and effectiveness of pharmacotherapy in the older adults. Thus, several countries have lists and criteria to indicate these drugs, in order to promote the safety of prescription and the rational use of drugs in geriatric practice.

OBJECTIVE

This study sought to contribute to the inclusion of PIM for the older adults in the Brazilian criterion (BCPIM/2016) - current list used in Brazil and reference in Latin American countries - through expert approval, comparing convergences with international AGS lists BEERS/2019, STOPP/START/2015, PRISCUS/2010 and EU (7)-PIM List/2015.

METHODS

This is a critical analysis of potentially inappropriate medications for use in the older adults present in the list of Brazilian criteria, together with their absence of some drugs that are on international lists (BEERS/2019; Priscus/2010; Stopp/Start/2015; EU7-PIM list/2015). This study was subdivided in 6 stages: selection of national criteria, classification of drugs according to Anatomic Therapeutic Chemical, comparison between BCPIM/2016 with international lists, selection of drugs not included in the Brazilian list, selection of experts for evaluation and suggestions about drugs not included in the Brazilian list and the synthesis of the analysis carried out by the specialists.

RESULTS

We cataloged 66 drugs marketed in Brazil that are on international lists, but not in the Brazilian consensus, of which 24 were validated by experts as necessary for inclusion in this consensus, considering the risks and benefits in health care for the older adults. However, the lists have divergences and similarities between them. We observed that eight drugs were common to all criteria studied, mainly related to the nervous system.

CONCLUSION

The results suggest the need for periodic validation of PIM against research clinics, new drugs and the inclusion of this agenda by the Ministry of Health in the revision of the National List of Essential Drugs and other Clinical Protocols and Therapeutic Prescription Guidelines for the older adults.

Dietary Fiber and All-Cause and Cardiovascular Mortality in Older Adults with Hypertension: A Cohort Study Of NHANES

OBJECTIVES

Several studies have documented that dietary fiber was inversely associated with a variety of diseases, but the association of dietary fiber with the prognosis of older adults with hypertension is unknown. The aim was to assess the association of dietary fiber with all-cause and cardiovascular mortality in older adults with hypertension.

METHODS

This study enrolled 4906 participants (51.6% were female) aged 65 years or older with hypertension in the National Health and Nutrition Examination Survey (NHANES) 2003-2014 and ascertained mortality through December 31, 2015. Dietary fiber intake data were assessed by using a 24-h recall survey. Participants were grouped by dietary fiber intake quartiles: Q1(fiber < 10.20, g/day), Q2 (10.20 ≤ fiber < 14.45, g/day), Q3 (14.45 ≤ fiber < 19.85, g/day), and Q4 (19.85 ≤ fiber, g/day). Multivariate Cox proportional hazard models were used to evaluate the associations of dietary fiber intake with all-cause and cardiovascular mortality. Kaplan-Meier survival curves and restricted cubic spline models were applied to reveal the relationship between dietary fiber intake and mortality.

RESULTS

Over the median follow-up duration of 70 months (interquartile range: 38-100 months), 1369 participants were determined as all-cause mortality (27.9%) and 270 participants were identified as cardiovascular mortality (5.5%). In the fully adjusted model, the higher dietary fiber intake group was associated with relatively lower all-cause (Q4 vs Q1: 0.68 (0.58, 0.80); P for trend <0.001) and cardiovascular mortality (Q4 vs Q1: 0.64 (0.45, 0.92); P for trend =0.010). The non-linear relationship was not observed between dietary fiber intake and all-cause or cardiovascular mortality.

CONCLUSIONS

Higher dietary fiber intake was significantly associated with decreased all-cause and cardiovascular mortality in older adults with hypertension. Increasing dietary fiber intake may improve the prognosis of older adults with hypertension.

Opportunities for diet quality improvement: the potential role of staple grain foods

OBJECTIVE

Given the high disease burden associated with the low intake of whole grains, modelling studies that estimate the impact of dietary strategies to increase more healthful grain foods consumption are essential to inform evidence-based and culturally specific policies. The current study investigated the potential nutritional impact of replacing staple grain foods with more healthful options.

DESIGN

Based on the 2015 Health Survey of São Paulo, a cross-sectional, population-based study, we modelled the substitution of white rice and white bread with brown rice and whole-wheat bread. Outcomes included changes in more healthful grain foods, energy and nutrient intakes.

SETTING

Urban area of São Paulo, Brazil.

PARTICIPANTS

Participants aged over 12 years who completed a semi-structured questionnaire and one 24-h recall (n 1741).

RESULTS

The substitution of all white rice and white bread with brown rice and whole-wheat bread, respectively, would result in more than 5 % increases in Zn (+9·1 %), Ca (+9·3 %), vitamin E (+18·8 %), dietary fibre (+27·0 %) and Mg (+52·9 %) intake, while more than a 5 % decrease would be seen for total carbohydrate (-6·1 %), folate (-6·6 %), available carbohydrate (-8·5 %), Fe (-8·6 %), vitamin B6 (-12·5 %), vitamin B2 (-17·4 %), and vitamin B1 (-20·7 %). A substantial increase in the amount of more healthful grain foods consumed would be seen (10 g/d to 220 g/d, or from 4 % to 69 % of total grain intake).

CONCLUSIONS

Replacing white rice and white bread with their whole-grain versions has the potential to improve diet quality, suggesting they are prime targets for policy actions aiming at increasing intake of more healthful grain foods.

[Low intake of dietary fibers among the elderly: 2014/2015 ISACAMP population-based study]

The scope of this article is to evaluate the prevalence of inadequate dietary fiber intake and associated factors among elderly adults. A cross-sectional population-based study evaluating participants from the Health Survey of the City of Campinas (ISACAMP) was conducted in 2014/2015, with 1,074 elderly individuals (≥60 years). Dietary fiber intake was obtained using a 24-hour recall, and the prevalence of inadequate fibers was estimated according to the cut-off point of the Institute of Medicine (30 g/day for men and 21 g/day for women). The factors evaluated were sociodemographic conditions (sex, age, schooling, income, marital status), health (number of reported diseases) and lifestyle (physical activity, smoking and alcohol consumption). The prevalence of inadequate dietary fiber intake was 86.6%, being higher in men (RP=1.10), single or divorced (RP=1.09) and physically inactive (PR=1.07). Elderly adults with higher incomes and who reported having 1 to 2 chronic non-communicable diseases had a higher intake of fibers. The high prevalence of inadequate dietary fiber intake in the elderly adults indicates that health and nutrition actions should be developed to ensure adequate dietary intake of these compounds.