Interação fármaco-nutriente: uma revisão

Reduced circulating folate among older adults caused by continuous work: nested cross-sectional study conducted in a country with folic acid fortification program

Population aging is 1 of the biggest challenges facing public health today, and cognitive dysfunction is an important concern. Cognitive impairment may be associated with high folate concentrations and low vitamin B₁₂ concentrations; the latter is a common problem among elderly people. Therefore, we hypothesized there was a high circulating folate concentration among older people living in a country with a mandatory folic acid fortification program. We conducted a cross-sectional study to investigate nutritional status of folate and vitamin B₁₂ among aged people. Three dietary recalls, serum folate (sfolate), erythrocyte (red blood cell) folate (RBC folate), and serum vitamin B₁₂ and homocysteine were collected. Linear regression models were used to investigate factors associated with circulating vitamins. We interviewed 169 participants. Half reported inadequate consumption of folate. However, RBC folate deficiency was observed in 27%, 13% in the serum, and a 10% excess of sfolate. One-quarter reported inadequate consumption of B_12, but only 5% had deficiency. Factors negatively associated with circulating folate were continuous work and smoking, and positively associated with polyunsaturated fatty acid. Factor negatively associated with the circulating B₁₂ were use of a dental prosthesis and intake of saturated fatty acid. Permanent investigation of excess of sfolate and B₁₂ deficiency, especially among older adults living in countries exposed to a mandatory folic acid fortification program, is important because of the possible relation to the cognitive function.

Deficiency of vitamins C and E in women of childbearing age in Brazil: a systematic review and meta-analysis

BACKGROUND

Despite the several options available for supplements containing vitamins C and E, evidence regarding the prevalence of deficiency or insufficiency of these vitamins is weak.

OBJECTIVES

To estimate the prevalence of deficiency or insufficiency of vitamins C and E and associated factors among women of childbearing age, in Brazil.

DESIGN AND SETTING

Systematic review and meta-analysis conducted at a Brazilian public university.

METHODS

A search from index inception until May 2020 was conducted. Meta-analyses were performed using inverse variance for fixed models, with summary proportions calculation using Freeman-Tukey double arcsine (base case). Reporting and methodological quality were assessed using the Joanna Briggs Institute tool for prevalence studies.

RESULTS

Our review identified 12 studies, comprising 1,316 participants, especially breastfeeding women. There was at least one quality weakness in all studies, mainly regarding sampling method (i.e. convenience sampling) and small sample size. The prevalence of vitamin C deficiency ranged from 0% to 40%. Only vitamin E deficiency was synthetized in meta-analyses, with mean prevalences of 6% regardless of the alpha-tocopherol cutoff in plasma, and 5% and 16% for cutoffs of < 1.6-12.0 mmol/l and < 16.2 mmol/l, respectively. The cumulative meta-analysis suggested that a trend to lower prevalence of vitamin E deficiency occurred in recent studies.

CONCLUSIONS

Although the studies identified in this systematic review had poor methodological and reporting quality, mild-moderate vitamin C and E deficiencies were identified, especially in breastfeeding women. Thus, designing and implementing policies does not seem to be a priority, because the need has not been properly dimensioned among women of childbearing age in Brazil.

REGISTRATION NUMBER IN PROSPERO

CRD42020221605.

[Adequacy of the frequency and types of meals consumed by community-dwelling elderly folk in the south of Brazil]

The scope of this study was to describe the frequency and types of meals consumed by the elderly in Pelotas (Brazil) and factors associated with the adequacy of meal frequency. A cross-sectional study was carried out with ≥60 years of age individuals. They were asked about daily meals during the week prior to the interview. The adequacy of meals was defined as recommended by the Ministry of Health (at least three main meals and two small snacks per day). The independent variables were sociodemographic, health and food routine characteristics. Prevalence ratios and 95% confidence intervals were calculated using Poisson regression. Of the 1,438 elderly individuals interviewed, about 40% reported consuming four meals a day. Lunch was the most reported meal, followed by breakfast. A total of 30.6% of men and 38.6% of women had adequate frequency of meals (p=0.002). Men with edentulism (total tooth loss) were 35% more likely to eat adequately, while this probability was about 30% lower among non-white women, those without schooling and those who reported a lack of money to buy food. One in each three elderly people met the recommendation of adequate frequency of meals and some sociodemographic characteristics were negatively associated with this habit.

Usnic Acid Potassium Salt: Evaluation of the Acute Toxicity and Antinociceptive Effect in Murine Model

To obtain usnic acid potassium salt (PS-UA), the usnic acid (UA) was extracted and purified from the lichen Cladonia substellata, and modified to produce PS-UA. The structure was determined by ¹H-NMR, IR and elemental analysis, ratified through computational models, as well as identification the site of K⁺ insertion in the molecule. Antinociceptive activity was detected through contortions in mice induced by acetic acid and formalin (phases I and II) after treatments with 10 and 20 mg/kg of PS-UA, indicating interference in both non-inflammatory and inflammatory pain. After oral administration at doses of 500, 1000 and 2000 mg/kg, no deaths of mice with treatments below 2000 mg/kg were observed. Except for body weight gain, food and water consumption decreased with treatments of 1000 and 2000 mg/kg, and the number of segmented leukocytes was higher for both treatments. Regarding serum levels, cholesterol and triglycerides decreased, however, there was an increase in hepatic transaminases with both treatments. Liver and kidney histological changes were detected in treatments of 2000 mg/kg, while the spleen was preserved. The PS-UA demonstrated antinociceptive activity while the acute toxicity at the concentration of 2000 mg/kg was the only dose that presented morphological changes in the liver and kidney.

EFEITOS DA CLONIDINA E DA RILMENIDINA SOBRE OS SISTEMAS CARDIORRESPIRATÓRIO E GASTROINTESTINAL DE EQUINOS

Resumo: Clonidina e rilmenidina são fármacos utilizados em medicina humana como agentes anti-hipertensivos de ação central devido às suas ações sobre os receptores alfa2-adrenérgicos e imidazolínicos I1 no SNC. Atualmente a clonidina é também utilizada como medicação pré-anestésica e em anestesias espinhais e a rilmenidina, apesar da menor seletividade pelo receptor alfa2-adrenérgico, também tem demonstrado potencial antinociceptivo em modelos experimentais de dor. Neste estudo, seis equinos foram submetidos a quatro tratamentos: grupo R1 (0,014 mg/kg de rilmenidina); grupo R2 (0,021 mg/kg de rilmenidina); grupo Clo (0,002 mg/kg de clonidina) e um grupo controle. Foram avaliadas as frequências cardíaca e respiratória, a pressão arterial sistólica e motilidade intestinal em níveis basais e, em seguida, 60 e 120 minutos após a administração oral dos fármacos. A rilmenidina reduziu a frequência cardíaca nas duas doses testadas, o que não ocorreu com a clonidina; variações discretas na pressão arterial sistólica em todos os tratamentos e redução na frequência respiratória nos tratamentos com 0,021 mg/kg de rilmenidina e 0,002 mg/kg de clonidina também foram observadas. São ainda necessários maiores estudos com doses e vias de administração diferentes para se elucidar maiores efeitos destes fármacos na espécie equina.

Avaliação nutricional e o uso da levodopa com refeições proteicas em pacientes com doença de Parkinson do município de Macaé, Rio de Janeiro

Resumo A doença de Parkinson (DP) é caracterizada pela redução da dopamina no sistema nervoso central. Apresenta progressão gradativa e é conhecida, principalmente, por tremores e dificuldade em realizar movimentos. Estudos demonstram que há significativa alteração do estado nutricional nos pacientes com DP. O principal medicamento utilizado no tratamento dos pacientes é a levodopa e a sua administração, sem respeitar o intervalo de no mínimo 30 minutos antes ou uma hora após as refeições, pode diminuir o efeito farmacológico da substância devido à interação droga-nutriente. Este estudo objetivou identificar, no município de Macaé-RJ, pacientes com DP em risco nutricional e o consumo proteico associado ao uso da levodopa. Trata-se de um estudo transversal, quantitativo e descritivo.Os instrumentos utilizados foram a Mini Avaliação Nutricional (MAN) e o registro alimentar estimado de três dias. A análise foi descritiva. Para compor a amostra, foi realizado um levantamento do número de pacientes com diagnóstico de DP de dois programas da Secretaria de Saúde e da Associação Parkinson de Macaé. Foram avaliados 40 indivíduos, desses, 57,5% eram do sexo masculino. Apresentaram risco de desnutrição ou desnutrição pela MAN 62,5% dos pacientes, caracterizando déficit nutricional. A ingestão proteica da população foi de 1,4g/Kg/dia. A maior ingestão de proteínas foi no período do dia, considerando as refeições compreendidas entre o café da manhã e o lanche da tarde. O consumo pela população nesse período foi de 74,7% da proteína total. Dos idosos, 75,0% ingeriam seus medicamentos compostos de levodopa simultaneamente às refeições ou não, seguindo o intervalo recomendado pela ANVISA. O estudo verificou que a maioria dos indivíduos apresentou risco nutricional, a maior parte realizava uma ingestão diária total hiperproteica, sendo o conteúdo proteico mal distribuído nas refeições ao longo do dia, além do não cumprimento ao intervalo recomendado da levodopa.

Investigation of medication administration through catheters in intensive care

This study aims to identify errors in medication administration through probes and characterize the interruption or not of nutrition in the case of drugs that require relative fasting. This is an epidemiological, cross-sectional and observational study in intensive care with a sample of 350 doses of drugs administered by 56 nursing technicians. The results showed no pause between the drug administration and the infusion of enteral feeding in 116 (33.14%) doses of drugs that required relative fasting, including captopril, sodic warfarin, sodic levothyroxine, sodic digoxin and sodic phenytoin. The irrigation of probes did not occur (94.28%) in most cases. It is concluded that the serum bioavailability of the drugs mentioned may have been reduced, compromising their therapeutic efficacy; and that the lack of probe irrigation with sterile water before administering drugs shows the absence of a specific and fundamental care to prevent probe clogging.

[Research on preparation techniques for drugs administered through catheters by intensive care nursing]

The goals of the research were to assess the pharmaceutical form of medicinal preparations administered through catheters and identify the profile of errors that occur during their preparation. This is a cross-sectional study of an observational nature, conducted in an intensive care unit with a sample of 350 doses of medication prepared by 56 nursing technicians. Data collection occurred in March 2010. The results showed that 92% of the drugs were in the solid form. The errors were divided into two categories for liquid forms: dilution and mixing, and grinding was added as an error possibility for a solid form. The error rates were greater than 40% in all categories. The conclusions are that grinding can compromise the therapeutic effect of coated controlled-release tablets, not diluting syrups may contribute to the obstruction of catheters, and mixing medication during grinding may increase the risk of drug interactions.

Riscos da interação droga-nutriente em idosos de instituição de longa permanência

O objetivo do estudo foi verificar riscos da interação droga-nutriente nos idosos residentes em Instituição de Longa Permanência. Trata-se de estudo descritivo, de abordagem quantitativa, realizado em 73 idosos. A coleta dos dados ocorreu em 2008, através da análise dos prontuários, história dietética e avaliação do IMC. Os dados evidenciaram que os medicamentos mais utilizados foram do sistema nervoso e cardiovascular, totalizando 66% das prescrições. Entre 375 medicamentos prescritos, 166 fazem algum tipo de interação, 32,0% diminuem o efeito de absorção do fármaco quando há utilização de cafeína e 14,3% diminuem absorção de vitamina B12. A utilização de diversos medicamentos de uso contínuo pode acarretar prejuízo na absorção de nutrientes, aumentando o risco de desnutrição em idosos. Torna-se indispensável a ação da equipe de saúde, através da avaliação criteriosa dos medicamentos administrados, dietoterapia e a interação entre os mesmos, para beneficiar idosos com melhor aproveitamento da terapêutica e melhoria das condições nutricionais.

Identification and analysis of antinutritional factors in possible interactions between medications and food/nutrients in hospitalized patients

ABSTRACT Objective: To identify and analyze the presence of antinutritional factors in possible interactions between medications and foods/ nutrients of the diets prescribed for patients of the Hospital Regional Justino Luz, in the city of Picos (PI) in order to suggest their likely mechanisms. Methods: The sample was made up of 120 medical records of hospitalized patients. The charts were analyzed to verify the presence or absence of interactions between medications and foods/nutrients of the diets prescribed to the patients at the Hospital Regional Justino Luz, emphasizing the action of antinutritional factors in these interactions. Results: Of the 189 medications prescribed, 128 (67.7%) had a possible interaction with food, totaling up 98 possible interactions between nutrients/foods and medications. Therefore, 20 (20.4%), 12 (12.2%) and 11 (11.2%) possible interactions were identified with captopril, acetylsalicylic acid and spironolactone, respectively, representing, in this order, the greatest frequencies of possible interactions among drugs and foods. A total of nine antinutritional factors were found in seven vegetable foods prescribed to inpatients, in which five (55.6%) were capable of interacting with the medications. Phytates and tannins had the largest quantity of possible interactions with drugs, each with 4 (26.7%) in a total of 15 interactions. The medications aluminum hydroxide, digoxin, and paracetamol attained greater probability of interaction with antinutrients, with 5 (33.3%), 3 (20%) and 3 (20%) interactions, respectively. Conclusion: Due to the large quantity of antinutritional factors capable of interacting with drugs prescribed for inpatients, the involvement of a multiprofessional team is indispensable so that these possible interactions between foods, antinutritional factors and drugs might be foreseen, detected, and resolved.

Evaluation of the profile of drug therapy administered through enteral feeding tube in a general hospital in Rio de Janeiro

Enteral nutrition (EN) is the method of choice for patients that cannot adequately receive oral feeding despite good gastrointestinal tract condition. Enteral diets may be administered through tube or ostomy placed in the stomach, duodenum or jejunum. The administration of drugs via enteral feeding tube (EFT) is a common practice in hospitals due to patient clinical status, and requires special attention from professionals involved in this process. This study entailed an analysis of the profile of drug therapy through EFT based on evaluation of medical prescriptions of the Medical Clinic of the Hospital dos Servidores do Estado (HSE) of Rio de Janeiro sent to the Pharmacy Service between January and June 2007, according to standard protocols in place. Prescription of drugs via EFT outside recommended guidelines was observed, besides potential drug-nutrient incompatibilities associated with this practice. These results point to the need for improvement of enteral route access and the adoption of measures to promote safe and effective use of drugs and nutritional therapy.

Analysis of possible food/nutrient and drug interactions in hospitalized patients

ABSTRACT Objective: To evaluate the prescription in relation to the possible interactions between drugs and foods/nutrients in the diets of patients in the Hospital Regional Justino Luz in the municipality of Picos, Piauí, Brazil. Methods: The sample consisted of 60 medical records of patients admitted at the hospital. The records were analyzed according to the presence or absence of interactions between drugs and foods/nutrients of the prescribed diets. Results: Of the 82 drugs prescribed in all periods, there were 16 drugs (19.5%) with possible interaction with food, a total of 60 interactions between nutrient/food and medicine. Thus, 18 (30%), 10 (17%) and 8 (13%) possible interactions were identified with captopril (cardiovascular drug) with acetylsalicylic acid (anti-inflammatory) and spironolactone (diuretic), respectively representing the highest numbers of interactions among the classes of investigated drugs. It was also found that the total interactions between food/nutrients and drugs, 32 (53%) accounted for interactions with cardiovascular drugs, 13 (22%) with anti-inflammatory drugs, 11 (18%) with diuretic agents e 4 (7%) with drugs that act on the digestive tract. Conclusion: There was a high number of interactions between food/nutrients and medicines emphasizing the need for prior knowledge of these interactions as a way to avoid impairment in the treatment, longer hospital stays and/or damage to the nutritional status of the patients.

A rede de comércio popular de drogas psicoativas na cidade de Diadema e o seu interesse para a Saúde Pública

O comércio popular de drogas vegetais sem garantia de qualidade implica risco sanitário. O presente estudo faz uma análise da rede de comércio popular de drogas vegetais psicoativas (DVPs) na cidade de Diadema e os riscos associados ao seu consumo. São apresentados dados parciais de um projeto realizado em colaboração com outras áreas de investigação. Métodos da etnofarmacologia, tais como entrevistas informais, semiestruturadas e observação participante foram utilizados para a realização do trabalho de campo, durante o qual selecionaram-se quatro comerciantes, a fim de registrar a obtenção, manipulação, acondicionamento e uso das DVPs comercializadas (nomes populares, receitas, partes utilizadas, contraindicações e doses). Foram registradas 63 DVPs distintas, e posteriormente categorizadas de acordo com suas possíveis ações psicoativas, predominando as estimulantes (67%) e depressoras (27%). Observaram-se deficiências na manipulação e acondicionamento das drogas por parte dos comerciantes, expondo seus clientes a possíveis riscos à saúde. Os resultados obtidos nesse estudo possibilitaram observar prioridades de adequação na comercialização de drogas vegetais no comércio popular a fim de resguardar a saúde de seus usuários, bem como a necessidade de promover um diálogo entre este e o sistema formal de saúde.

Caracterização nutricional de idosos com hipertensão arterial em Teresina, PI

Resumo O objetivo do estudo foi avaliar o estado nutricional e o consumo alimentar, e caracterizar aspectos do estilo de vida de idosos hipertensos que freqüentam centros de convivência na cidade de Teresina-PI. O estudo, do tipo transversal, envolveu 125 idosos, de ambos os sexos (17 homens e 108 mulheres), avaliados por meio de questionário previamente testado para a caracterização da casuística. As variáveis nutricionais foram investigadas por antropometria, medidas de circunferência e pelo levantamento do consumo alimentar nas últimas 24 horas. Encontraram-se índices elevados de sobrepeso (45,6%) e baixo-peso (36,0%), a pressão arterial diastólica (PAD) associando-se positivamente com o sobrepeso (índice de massa corporal 27kg/m2). A distribuição da gordura central apresentou elevada prevalência (88%), indicando risco para doenças cardiovasculares. Os alimentos mais consumidos foram: feijão, leite, pães, cereais, arroz, massas e carnes. Não se observou grande adesão às medidas terapêuticas não-farmacológicas no grupo de idosos hipertensos, o que mostra a necessidade de rever as orientações propostas no Programa de Controle da Pressão Arterial para o Idoso.