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Sangali TD, Souza GC, Ribeiro ÉCT, Perry IDS. Sarcopenia: Inflammatory and Humoral Markers in Older Heart Failure Patients. Arq Bras Cardiol 2023; 120:e20220369. [PMID: 37556651 PMCID: PMC10382140 DOI: 10.36660/abc.20220369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 03/02/2023] [Accepted: 04/05/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Sarcopenia is highly prevalent in heart failure (HF) patients, and the involvement of biomarkers in its pathophysiology is suggested, but little has been studied concerning HF sarcopenic patients. OBJECTIVES To evaluate the association between inflammatory and humoral markers with sarcopenia, as well as the impact of sarcopenia on quality of life and functional capacity in older HF patients. METHODS In this cross-sectional study, 90 outpatient HF patients, aged ≥ 60 years, were evaluated for sarcopenia (EWGSOP2 diagnostic criteria), inflammation (high-sensitive C-reactive protein [hs-CRP], Interleukin-6 [IL-6], tumor necrosis factor alpha [TNF-α]) and humoral markers (total testosterone and insulin-like growth factor-1 [IGF-1]), physical activity (International Physical Activity Questionnaire), quality of life (Minnesota Living with Heart Failure Questionnaire), and functional capacity (6-minute walk test). The adopted level of significance was p<0.05. RESULTS Patients had a mean age of 69.4 ± 7.2 years, 67.8% were male, with left ventricular ejection fraction (LVEF) of 35.9 ± 11.9% and 22 (24.4%) were sarcopenic. Age (73.1 ± 8.1 and 68.3 ± 6.5 years; p= 0.006), body mass index (BMI) (23.1 ± 2.8 and 28.2 ± 4.2 kg/m2; p <0.001), and LVEF (29.9 ± 8.8 and 37.9 ± 12.1%; p= 0.005) were different between groups with and without sarcopenia, respectively. After adjusting for age, ethnicity, BMI, LVEF, and the use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers, sarcopenia was associated with higher serum levels of IL-6 and worse functional capacity. CONCLUSION In HF patients, sarcopenia was associated with IL-6 levels and functional capacity.
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Affiliation(s)
- Tamirys Delazeri Sangali
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Gabriela Corrêa Souza
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
- Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasilHospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil
| | - Édina Caroline Ternus Ribeiro
- Universidade Federal do Rio Grande do SulPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
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Bieger P, Sangali TD, Ribeiro ÉCT, Schweigert Perry ID, Souza GC. Association of phase angle values and sarcopenia in older patients with heart failure. Nutr Clin Pract 2023; 38:672-685. [PMID: 36815519 DOI: 10.1002/ncp.10956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/24/2022] [Accepted: 12/31/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Sarcopenia presents an accelerated and accentuated muscle loss in patients with heart failure (HF), leading to a worse prognosis for these patients. This study sought to assess the association of phase angle (PA) values with sarcopenia and its components, as well as to establish a PA cutoff point to predict outcomes such as hospitalization and mortality in older adult patients with HF. METHODS Sarcopenia diagnosis followed the European Working Group on Sarcopenia in Older People criteria. Anthropometric, bioelectrical impedance (PA and body composition), functional capacity and inflammatory markers were assessed. RESULTS Included patients were predominantly male (67%) and White, with a mean age of 69 ± 7 years, and a predominance of New York Heart Association I and II functional classes (82.1%) and reduced left ventricular ejection fraction (70.8%). Of the total sample, 23.6% were identified as sarcopenic. Mean PA values were lower in patients with sarcopenia (4.9 ± 0.9 and 6.0 ± 0.8°; P < 0.001). The cutoff point detected for sarcopenia in the receiver operating characteristic curve was 5.45°, which is an independent predictor for sarcopenia. PA values below this cutoff point were also associated with each of the sarcopenic components evaluated. PA proved to be an independent predictor for hospitalization (P = 0.042) in the entire sample studied. CONCLUSION PA is associated with diagnostic components of sarcopenia and the cutoff point 5.45° proved to be an independent predictor of sarcopenia and hospitalization >3 years in older adult patients with HF.
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Affiliation(s)
- Patrícia Bieger
- Graduate Program in Food, Nutrition and Health, Medical School, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Tamirys Delazeri Sangali
- Graduate Program in Food, Nutrition and Health, Medical School, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Édina Caroline Ternus Ribeiro
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Medical School, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ingrid Dalira Schweigert Perry
- Food and Nutrition Research Center, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriela Corrêa Souza
- Graduate Program in Food, Nutrition and Health, Medical School, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Food and Nutrition Research Center, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Heart Failure and Transplant Group, Nutrition Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Magenis ML, Machado AG, Bongiolo AM, Silva MAD, Castro K, Perry IDS. Dietary practices of children and adolescents with Down syndrome. J Intellect Disabil 2018; 22:125-134. [PMID: 28078918 DOI: 10.1177/1744629516686571] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this study was to assess dietary intake, breastfeeding history, weight at birth and current weight in children and adolescents with Down syndrome (DS). Therefore, a cross-sectional, controlled study with 19 DS participants and 19 controls without DS matched by gender and age was performed. Except for vitamin D, a lower or the same frequency of insufficient intake in other micronutrients was noted in participants compared with controls. The DS group had a reduced exclusive breastfeeding duration and increased carbohydrate and caloric intake. The consumption of micronutrients in both groups reinforced the current trend of excessive sodium consumption and insufficient intake of calcium, some B complex vitamins and water by children and adolescents.
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Affiliation(s)
| | | | | | | | - Kamila Castro
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Brazil; Centro de Estudos em Alimentação e Nutrição (CESAN-HCPA/UFRGS), Brasil
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Moreira MA, Lessa LS, Bortoli FR, Lopes A, Xavier EP, Ceretta RA, Sônego FGF, Tomasi CD, Pires PDS, Ceretta LB, Perry IDS, Waleska Simões P. Meta-analysis of magnetic resonance imaging accuracy for diagnosis of oral cancer. PLoS One 2017; 12:e0177462. [PMID: 28542622 PMCID: PMC5443513 DOI: 10.1371/journal.pone.0177462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/27/2017] [Indexed: 01/19/2023] Open
Abstract
Objective To establish the diagnostic accuracy of magnetic resonance imaging (MRI) as an auxiliary means for the diagnosis of oral cancer through a systematic review and meta-analysis. Methods An exhaustive search of publications from 1986 to 2016 was performed of Medline, Embase and Cochrane (and related databases), including grey literature. Primary diagnostic accuracy studies that assessed oral cancer (target condition) using MRI (index test) were included. Diagnostic threshold, sensitivity and meta-regression analyses were performed. A meta-analysis was performed using Meta-DiSc® v. 1.4 software. Results A total of 24 primary studies were assessed, comprising 1,403 oral cancer lesions. Nine studies used diffusion-weighted MRI, with a diagnostic odds ratio (DOR) of 30.7 (95% confidence interval [CI]: 12.7–74.3) and area under the curve (AUC) of 0.917 (95% CI: 0.915–0.918); seven studies used dynamic contrast-enhanced MRI, with a DOR of 48.1 (95%CI: 22.4–103.2) and AUC of 0.936 (95% CI: 0.934–0.937); and 13 studies used traditional MRI, with a DOR of 23.9 (95%CI: 13.2–43.3) and AUC of 0.894 (95% CI: 0.894–0.895). Meta-regression analysis indicated that the magnetic field strength may have influenced the heterogeneity of the results obtained (p = 0.0233) using traditional MRI. Sensitivity analysis revealed a discrete reduction of inconsistency in some subgroups. Conclusion The three types of MRI assessed exhibited satisfactory accuracy compared to biopsy. Considering the relevance of early treatment and screening and that better health care results in improved survival rates and quality of life for oral cancer patients, we suggest the use of MRI as a part of the pre-treatment and monitoring protocol at public health services.
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Affiliation(s)
- Marcelo Aldrighi Moreira
- Graduate Program in Public Health (PPGSCol), Unidade Acadêmica de Ciências da Saúde (UNASAU), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
- Laboratory of Information and Communications Technology in Health (TISaude), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Luiza Silveira Lessa
- Graduate Program in Public Health (PPGSCol), Unidade Acadêmica de Ciências da Saúde (UNASAU), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
- Dentistry Course, Unidade Acadêmica de Ciências da Saúde (UNASAU), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | | | - Abigail Lopes
- Graduate Program in Public Health (PPGSCol), Unidade Acadêmica de Ciências da Saúde (UNASAU), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
- Laboratory of Information and Communications Technology in Health (TISaude), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Eduardo Picolo Xavier
- Laboratory of Information and Communications Technology in Health (TISaude), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Renan Antonio Ceretta
- Dentistry Course, Unidade Acadêmica de Ciências da Saúde (UNASAU), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Fernanda Guglielmi Faustini Sônego
- Dentistry Course, Unidade Acadêmica de Ciências da Saúde (UNASAU), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Cristiane Damiani Tomasi
- Graduate Program in Public Health (PPGSCol), Unidade Acadêmica de Ciências da Saúde (UNASAU), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Patricia Duarte Simões Pires
- Dentistry Course, Unidade Acadêmica de Ciências da Saúde (UNASAU), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Luciane Bisognin Ceretta
- Graduate Program in Public Health (PPGSCol), Unidade Acadêmica de Ciências da Saúde (UNASAU), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
- Laboratory of Information and Communications Technology in Health (TISaude), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
- Dentistry Course, Unidade Acadêmica de Ciências da Saúde (UNASAU), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Ingrid Dalira Schweigert Perry
- Graduate Program in Public Health (PPGSCol), Unidade Acadêmica de Ciências da Saúde (UNASAU), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Priscyla Waleska Simões
- Graduate Program in Public Health (PPGSCol), Unidade Acadêmica de Ciências da Saúde (UNASAU), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
- Laboratory of Information and Communications Technology in Health (TISaude), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
- Dentistry Course, Unidade Acadêmica de Ciências da Saúde (UNASAU), Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
- Engineering, Modeling and Applied Social Sciences Center (CECS), Universidade Federal do ABC (UFABC), São Bernardo do Campo, SP, Brazil
- * E-mail:
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Berbigier MC, Pasinato VF, Rubin BDA, Moraes RB, Perry IDS. Bioelectrical impedance phase angle in septic patients admitted to intensive care units. Rev Bras Ter Intensiva 2015; 25:25-31. [PMID: 23887756 PMCID: PMC4031866 DOI: 10.1590/s0103-507x2013000100006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/14/2013] [Indexed: 12/20/2022] Open
Abstract
Objective To calculate the values of the phase angle of septic patients using bioelectrical
impedance analysis, correlate the values with clinical and biochemical variables,
and compare them to reference values. Methods Cohort study conducted with 50 septic patients aged ≥18 years old, admitted to
intensive care units, and assessed according to prognostic indexes (APACHE II and
SOFA), clinical progression (mortality, severity of sepsis, length of stay in
intensive care unit), biochemical parameters (albumin and C-reactive protein), and
the phase angle. Results The average age of the sample was 65.6±16.5 years. Most patients were male (58%)
and suffering from septic shock (60%). The average APACHE II and SOFA scores were
22.98±7.1 and 7.5±3.4, respectively. The patients who survived stayed nine days on
average (five to 13) in the intensive care unit, and the mortality rate was 30%.
The average value of the phase angle was 5.4±2.6º in the total sample and was
smaller among the females compared with the males (p=0.01). The phase angle
measures did not exhibit an association with the severity of the sepsis,
mortality, gender, and age or correlate with the length of hospitalization or the
biochemical parameters. The participants' phase angle values adjusted per gender
and age were 1.1 to 1.9 times lower compared with the values for a normal
population. Conclusion The average value of the phase angle of septic patients was lower compared with
the reference values for a healthy population. The phase angle measures did not
exhibit association with the clinical and biochemical variables, which might be
explained by the sample homogeneity.
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da Silva TK, Berbigier MC, Rubin BDA, Moraes RB, Corrêa Souza G, Schweigert Perry ID. Phase Angle as a Prognostic Marker in Patients With Critical Illness. Nutr Clin Pract 2015; 30:261-5. [DOI: 10.1177/0884533615572150] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Taís Kereski da Silva
- Multiprofessional Integrated Residency Program in Health, with emphasis on Critical Adults, Hospital de Clínicas de Porto Alegre, Brazil
- Food and Nutrition Research Center, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Marina Carvalho Berbigier
- Multiprofessional Integrated Residency Program in Health, with emphasis on Critical Adults, Hospital de Clínicas de Porto Alegre, Brazil
- Food and Nutrition Research Center, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Bibiana de Almeida Rubin
- Food and Nutrition Research Center, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
- Nutrition and Dietetics Service, Hospital de Clínicas de Porto Alegre, Brazil
| | | | - Gabriela Corrêa Souza
- Food and Nutrition Research Center, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
- Intensive Medicine Department, School of Medicine, Universidade Federal do Rio Grande do Sul, Brazil
| | - Ingrid Dalira Schweigert Perry
- Food and Nutrition Research Center, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
- Health Unit, Universidade do Extremo Sul Catarinense, Criciúma, Brazil
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Sanches Machado d'Almeida K, Dalira Schweigert Perry I, Clausell N, Corrêa Souza G. Adequacy of energy and nutrient intake in patients with heart failure. NUTR HOSP 2015; 31:500-7. [PMID: 25561152 DOI: 10.3305/nh.2015.31.1.7518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Nutritional factors have a significant influence on the prognosis of patients with heart failure (HF). OBJECTIVE The goal of the present study was to assess the food intake of stable patients with HF. METHODS Patients of both genders aged over 18 years with a confirmed diagnosis of HF were recruited and matched with healthy individuals for age, sex and BMI. Food records and weighing were used to assess participant nutritional intake. DRIs and NCEP-ATP III recommendations were used to evaluate the adequacy of nutritional intake. RESULTS Sixty-five percent of the 40 patients in the sample and 48% of the 25 control subjects were men. The mean age in both groups was 54±8 years and mean BMI was categorized as overweight. Carbohydrate, trans fatty acid and sodium intake were higher in the HF group as compared to control subjects (p=0.006, p.
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Affiliation(s)
- Karina Sanches Machado d'Almeida
- Federal University of Rio Grande do Sul - Health Sciences Graduate Program - Cardiology and Cardiovascular Sciences. Hospital de Clínicas de Porto Alegre - Cardiology Department - Heart Failure Clinic..
| | - Ingrid Dalira Schweigert Perry
- Hospital de Clínicas de Porto Alegre - Cardiology Department - Heart Failure Clinic. Food and Nutrition Research Center, Hospital de Clínicas de Porto Alegre/Federal University of Rio Grande do Sul. Federal University of Rio Grande do Sul - School of Medicine - Department of Nutrition. Brazil..
| | - Nadine Clausell
- Federal University of Rio Grande do Sul - Health Sciences Graduate Program - Cardiology and Cardiovascular Sciences. Hospital de Clínicas de Porto Alegre - Cardiology Department - Heart Failure Clinic. Federal University of Rio Grande do Sul - School of Medicine - Department of Internal Medicine..
| | - Gabriela Corrêa Souza
- Food and Nutrition Research Center, Hospital de Clínicas de Porto Alegre/Federal University of Rio Grande do Sul..
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Conzatti A, Fróes FCTDS, Schweigert Perry ID, Souza CGD. Clinical and molecular evidence of the consumption of broccoli, glucoraphanin and sulforaphane in humans. NUTR HOSP 2014; 31:559-69. [PMID: 25617536 DOI: 10.3305/nh.2015.31.2.7685] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Sulforaphane (SFN) is an isothiocyanate derived from glucoraphanin (GRA), which is found in great amounts especially in broccoli. Its consumption has been reported to be associated with a lower risk of myocardial infarction and cancer development. Additionally, its effects have been studied in neurodegenerative diseases, diabetes, and atherosclerosis, most of the times using animal models and cell cultures. OBJECTIVES Given the promising results of SFN, this review aimed to investigate evidence documented in human intervention studies with broccoli, GRA and SFN. METHODS A search was performed on PubMed and Virtual Health Library databases by two independent researchers using the descriptors "broccoli" or "glucoraphanin" or "sulforaphane", which should appear on the study's title or abstract. This review included randomized clinical trials performed in humans that were published in English and Portuguese from 2003 to 2013 and that considered clinical and molecular parameters of cell damage as outcomes of interest. RESULTS Seventeen studies were selected, and the predominant type of intervention was broccoli sprouts. More consistent results were obtained for the clinical parameters blood glucose and lipid profile and for molecular parameters of oxidative stress, indicating that there was an improvement in these parameters after intervention. Less solid evidence was found with regard to decreased inflammation, Helicobacter pylori colonization, and protection against cancer. CONCLUSION Although being relevant, the evidence for the use of broccoli, GRA and SFN in humans are limited; thus, further intervention studies are needed to evaluate outcomes more consistently and reach better grounded conclusions.
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Affiliation(s)
- Adriana Conzatti
- Departamento de Fisiologia, Universidade Federal do Rio Grande do Sul (UFRGS)..
| | | | - Ingrid Dalira Schweigert Perry
- Unidade Acadêmica da Saúde (UNASAU), Universidade do Extremo Sul Catarinense (UNESC).Centro de Estudos em Alimentação e Nutrição (CESAN)- Hospital de Clínicas de Porto Alegre (HCPA) - UFRGS..
| | - Carolina Guerini de Souza
- Centro de Estudos em Alimentação e Nutrição (CESAN)- Hospital de Clínicas de Porto Alegre (HCPA) - UFRGS. Faculdade de Medicina, Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul (UFRGS). Brazil..
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Nunes D, Eskinazi B, Camboim Rockett F, Delgado VB, Schweigert Perry ID. Estado nutricional, ingesta alimentaria y riesgo de enfermedad cardiovascular en individuos con esquizofrenia en el sur de Brasil: estudio de casos-controles. Revista de Psiquiatría y Salud Mental 2014; 7:72-9. [DOI: 10.1016/j.rpsm.2013.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/15/2013] [Accepted: 07/10/2013] [Indexed: 01/22/2023]
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Pasinato VF, Berbigier MC, Rubin BDA, Castro K, Moraes RB, Perry IDS. Enteral nutritional therapy in septic patients in the intensive care unit: compliance with nutritional guidelines for critically ill patients. Rev Bras Ter Intensiva 2013; 25:17-24. [PMID: 23887755 PMCID: PMC4031857 DOI: 10.1590/s0103-507x2013000100005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/22/2013] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Evaluate the compliance of septic patients' nutritional management with enteral nutrition guidelines for critically ill patients. METHODS Prospective cohort study with 92 septic patients, age ≥ 18 years, hospitalized in an intensive care unit, under enteral nutrition, evaluated according to enteral nutrition guidelines for critically ill patients, compliance with caloric and protein goals, and reasons for not starting enteral nutrition early or for discontinuing it. Prognostic scores, length of intensive care unit stay, clinical progression, and nutritional status were also analyzed. RESULTS The patients had a mean age of 63.4 ± 15.1 years, were predominantly male, were diagnosed predominantly with septic shock (56.5%), had a mean intensive care unit stay of 11 (7.2 to 18.0) days, had 8.2 ± 4.2 SOFA and 24.1 ± 9.6 APACHE II scores, and had 39.1% mortality. Enteral nutrition was initiated early in 63% of patients. Approximately 50% met the caloric and protein goals on the third day of intensive care unit stay, a percentage that decreased to 30% at day 7. Reasons for the late start of enteral nutrition included gastrointestinal tract complications (35.3%) and hemodynamic instability (32.3%). Clinical procedures were the most frequent reason to discontinue enteral nutrition (44.1%). There was no association between compliance with the guidelines and nutritional status, length of intensive care unit stay, severity, or progression. CONCLUSION Although the number of septic patients under early enteral nutrition was significant, caloric and protein goals at day 3 of intensive care unit stay were met by only half of them, a percentage that decreased at day 7.
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Nalin T, Perry IDS, Sitta A, Vargas CR, Saraiva-Pereira ML, Giugliani R, Blau N, Schwartz IVD. Optimized loading test to evaluate responsiveness to tetrahydrobiopterin (BH4) in Brazilian patients with phenylalanine hydroxylase deficiency. Mol Genet Metab 2011; 104 Suppl:S80-5. [PMID: 22014474 DOI: 10.1016/j.ymgme.2011.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 09/13/2011] [Accepted: 09/13/2011] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recent studies showed that phenylalanine (Phe) plasma concentrations may decrease in some patients with hyperphenylalaninemia (HPA) due to phenylalanine hydroxylase (PAH) deficiency, after the administration of tetrahydrobiopterin (BH(4)). OBJECTIVE To determine responsiveness to a single dose of BH(4) administered according to an innovative protocol using a combined Phe and BH(4) loading test in Brazilian phenylketonuria (PKU) patients. METHODS Patient age should be ≥ 4 years, and median Phe plasma concentration ≤ 600 μmol/L when following dietary restrictions. Participants received a simple Phe loading test using 100mg/kg L-Phe (Test 1) and a combined Phe+BH(4) loading test using 100mg/kg L-Phe and 20mg/kg/BH(4) (Test 2). Blood samples were collected at baseline and 3, 11 and 27 h after Phe ingestion (T0, T1, T2 and T3). Responsiveness was defined as: criterion A: plasma Phe reduction of ≥ 30% at T1 and T2 for Tests 1 and 2; criterion B: plasma Phe reduction of ≥ 30% at T1 and T3 for Tests 1 and 2; and criterion C: at least 30% difference of the areas under the Phe curve for Tests 1 and 2. RESULTS Eighteen patients (median age 12 yrs; 8 classical PKU; 10 mild PKU) participated in the study. Six patients (2 classical PKU; 4 mild PKU) were classified as responsive according to at least one of the criteria. Responsiveness was concordant when criteria A + B we compared with criterion C (kappa = 0.557; p = 0.017). Of the patients whose genotype was available (n = 16), six had data about BH(4)-responsiveness genotypes described in the literature, which were in agreement with our findings. CONCLUSION The comparison of simple Phe loading and combined Phe + BH(4) loading seems to be an optimal method to evaluate responsiveness to BH(4) in patients with good metabolic control.
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Affiliation(s)
- Tatiéle Nalin
- Post-Graduation Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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