Abstract Introduction: food type represents higher odds of having obesity (OB), especially in overweight (OW) subjects. Minimally and ultra-processed foods can be associated with the odds of having OB in OW subjects. Objective: to investigate the association of minimally and ultra-processed food consumption with OB in OW adults. Methods: we included 15,024 participants (9,618 OW [25.0-29.9 kg/m2], 5,406 OB [≥ 30 kg/m2]) with ages ranging from 18 to 59 years from the 2019 baseline survey of the Surveillance of Risk Factors and Protection for Chronic Diseases by Telephone Survey (VIGITEL, Brazil). Minimally and ultra-processed food daily consumption scores and confounding variables (age, sex, scholarly, physical activity, hypertension, and diabetes) were measured. Binary logistic regression analyzes the association of minimally and ultra-processed food consumption scores with OB (odds ratio [OR]). Results: minimally processed food consumption score quartiles (1st = 1[food-score/day]; 2nd = 6[food-score/day]; 3rd = 7[food-score/day]; 4th = 8[food-score/day]) presented higher values compared to ultra-processed food (1st = 1[food-score/day]; 2nd = 1[food-score/day]; 3rd = 2[food-score/day]; 4th = 4[food-score/day]). For each score of minimally processed food consumed, there was a -5.9 % odds of OB. Thus, the higher quartile (4th) of minimally processed food consumption score represents less odds of OB (OR: -47.2 %; p < 0.001). Each ultra-processed food score consumed presented odds of 3.7 % of OB. Therefore, higher consumption of ultra-processed food (4th quartile) shows higher odds of OB (OR: +14.8 %; p < 0.001). All associations remained significatively even after being adjusted by the confounders. Conclusion: the consumption scores of minimally processed and ultra-processed foods presented a magnitude capable of impacting OW adults' odds of OB, even when controlled by sociodemographic factors, physical activity, hypertension, and diabetes.

Resumen Introducción: el tipo de alimentación representa una mayor probabilidad de tener obesidad (OB), especialmente en sujetos con sobrepeso (SO). Los alimentos mínimamente procesados y ultraprocesados se pueden asociar con las probabilidades de tener OB en sujetos con SO. Objetivo: investigar la asociación del consumo de alimentos mínimamente procesados y ultraprocesados con la OB en adultos con SO. Métodos: se incluyeron 15.024 participantes (9.618 SO [25,0-29,9 kg/m2], 5.406 OB [≥ 30 kg/m2]) con edades entre 18 y 59 años de la encuesta basal 2019 de la Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas mediante una Encuesta Telefónica (VIGITEL, Brasil). Se midió el puntaje de consumo diario de alimentos mínimamente procesados y ultraprocesados y variables de confusión (edad, sexo, escolaridad, actividad física, hipertensión y diabetes). Mediante una regresión logística binaria se analizó la asociación de las puntuaciones de consumo de alimentos mínimamente procesados y ultraprocesados con la OB (odds ratio [OR]). Resultados: los cuartiles de puntuación de consumo de alimentos mínimamente procesados (1.º = 1[alimento-puntuación/día]; 2.º = 6[alimento-puntuación/día]; 3.º = 7[alimento-puntuación/día]; 4.º = 8[alimento-puntuación/día]) presentaron valores superiores en comparación con los alimentos ultraprocesados (1.º = 1[alimento-puntuación/día]; 2.º = 1[alimento-puntuación/día]; 3.º = 2[alimento-puntuación/día]; 4.º = 4[alimento-puntuación/día]). Por cada punto de alimentos mínimamente procesados consumidos, hubo una probabilidad de OB del -5,9 %. Por lo tanto, el cuartil más alto (4.º) de puntuación de consumo de alimentos mínimamente procesados representa menos probabilidades de OB (OR: -47,2 %; p < 0,001). Cada puntaje de alimentos ultraprocesados consumidos presentó probabilidades de 3.7 % de OB. Por lo tanto, un mayor consumo de alimentos ultraprocesados (cuartil 4.º) muestra mayores probabilidades de OB (OR: +14,8 %; p < 0,001). Todas las asociaciones se mantuvieron significativamente incluso después de ajustarlas por los factores de confusión. Conclusión: las puntuaciones de consumo de alimentos mínimamente procesados y ultraprocesados impactaron en la probabilidad de desarrollar OB en adultos con SB, incluso cuando se controló por factores sociodemográficos, actividad física, hipertensión y diabetes.

Abstract Autonomous fundamental motor skills (AFMS) are understood as movements practiced in a spontaneous, voluntary manner, without any instruction or command. The aim of the study was to compare the frequency of occurrence and the quality of performance of AFMS in children during recess and Physical Education (PE) classes. Elementary school students (n= 148) from a private school were observed during recess and PE classes, and had their AFMS classified by stages (initial; elementary-emergent; proficient). All AFMS were identified in recess and PE classes, except jump. Most skills were classified in the elementary-emergent stage and were slightly more frequent during PE classes, both in the locomotor (27 vs 23%) and manipulative (31 vs 13%) categories. The AFMS frequency of occurrence was low and the classification showed poor quality at all times observed. Recess was statistically (p< 0.05) less favorable for motor development in 60% of AFMS. The low frequency of AFMS, especially during recess, and poor classification of motor repertoire suggest the need for measures to reverse the motor deficit in the school environment. Strategies are needed to promote AFMS in the school context so that they are more diverse and challenging.

RESUMO A força muscular absoluta ou ajustada pelo índice de massa corporal (IMC) é útil para identificar a sarcopenia. No entanto, esses valores não são precisos para idosos com tamanhos corporais extremos devido à relação não linear entre força e tamanho corporal. O objetivo foi determinar os pontos de corte para identificar a sarcopenia em idosos usando coeficientes alométricos para normalizar a força de preensão manual (FPM) e teste de sentar e levantar da cadeira em 30 segundos (30-s CST) por tamanho corporal. Os expoentes alométricos foram propostos com modelos log-lineares para variáveis de tamanho corporal (massa corporal, estatura e IMC). A remoção do efeito do tamanho corporal na força muscular com normalização alométrica foi testada por correlação parcial. Os pontos de corte para baixa força muscular foram estabelecidos pela curva ROC e índice de Youden considerando a limitação funcional (teste de caminhada de seis minutos<400m). Os expoentes alométricos fornecidos para variáveis de tamanho corporal variam de -0,01 a 2,28 (FPM) e -0,27 a 0,21 (30-s CST). O efeito do tamanho corporal na força muscular foi removido com normalização alométrica (r<0,30). A precisão dos pontos de corte sempre foi adequada (AUC≥0,78; p<0,001). Em conclusão, foram propostos pontos de corte para FPM e 30-s CST normalizados alometricamente para identificar sarcopenia em idosos portugueses e a alometria manteve a precisão adequada (AUC>70%). A alometria removeu a influência do tamanho corporal na expressão da FPM e 30-s CST e permite avaliar a força muscular independentemente do tamanho corporal.

ABSTRACT Absolute muscle strength or adjusted by body mass index (BMI) are useful to identify sarcopenia. However, these values are not accurate for older adults with extreme body sizes because the nonlinear relationship between strength and body size. The purpose was to determine cut-off points for identify sarcopenia in older adults using allometric coefficients to normalise handgrip strength (HGS) and 30-sec chair stand test (30-s CST) by body size. Allometric exponents were proposed with log-linear models for body-size variables (body mass, height and BMI). The remotion of body-size effect on muscle strength with allometric normalisation was tested by partial correlation. Cut-off points for low muscle strength were established by ROC curve and Youden index considering functional limitation (six-minute walk test<400m). Allometric exponents provided for body-size variables range from -0.01 to 2.28 (HGS) and -0.27 to 0.21 (30-s CST). The effect of body size on muscle strength was removed with allometric normalisation (r<0.30). Cut-off points accuracy was always adequate (AUC≥0.78; p<0.001). In conclusion, cut-off points of HGS and 30-s CST allometrically normalised were proposed to identify sarcopenia in Portuguese older adults and allometry maintained adequate the accuracy (AUC>70%). Allometry removed influence of body size on the expression of HGS and 30-s CST and permits evaluate muscle strength regardless of body-size.

Resumo Avaliar o Estado Nutricional (EN) permite rastrear desnutrição e obesidade, condições associadas a doenças crônicas não transmissíveis. O índice de massa gorda (IMG) destaca-se em relação aos indicadores tradicionais de EN. No entanto, propostas que definem limiares para IMG não são sensíveis para discriminar casos extremos (graus de obesidade ou magreza). Apenas uma proposta (NHANES) estabeleceu oito categorias de classificação EN (IMG), mas foi determinada por densitometria corporal total (DXA). Porém, DXA é caro e nem sempre disponível. O objetivo foi testar a validade do método NHANES usando bioimpedância elétrica (BIA) e dobras cutâneas (DOCs) para classificar o EN. O IMG de 135 (69 mulheres) universitários com idade entre 18 e 30 anos foi obtido por DXA, BIA e DOCs. A concordância foi testada entre os instrumentos (Bland-Altman) e classificações de EN (Qui quadrado e índice Kappa). O teste de concordância com a DXA indicou as DOCs subestimarem o IMG (-1,9 kg/m2) para ambos os sexos e a BIA em mulheres (-2,0 kg/m2). No entanto, as BIA superestimaram o IMG (1,4 kg/m2) nos homens, embora com menos viés. Não houve concordância entre as classificações de EN (NHANES) pelo IMG entre DXA e BIA/DOCs. A exceção ocorreu entre DXA e BIA em homens que apresentaram concordância “razoável” (k = 0,214; p = 0,001). Em conclusão, DOCs e BIA não mostraram concordância suficiente para substituir DXA pela classificação de EN, dentro dos limites NHANES. As ferramentas diferem para medir IMG e classificar categorias de EN (NHANES).

Abstract Assessment of the Nutritional Status (NS) allows screening for malnutrition and obesity, conditions associated with chronic non-communicable diseases. The fat mass index (FMI) stands out concerning traditional NS indicators. However, proposals that define thresholds for FMI are not sensitive to discriminate extreme cases (degrees of obesity or thinness). Only one proposal (NHANES), determined by total body densitometry (DXA), established eight categories of NS classification (FMI). However, DXA is expensive and not always clinically available. Our study aims to test the validity of the NHANES method using electrical bioimpedance (BIA) and skinfold thickness (ST) to classify NS. The FMI of 135 (69 women) university students aged 18 to 30 years old was determined using DXA, BIA, and ST. The agreement between the instruments (Bland-Altman) and the agreement coefficient in the NS classifications (Chi-square and Kappa index) were tested. The agreement test against DXA indicated that ST underestimated the FMI (-1.9 kg/m2) for both sexes and BIA in women (-2.0 kg/m2). However, BIA overestimated FMI (1.4 kg/m2) in men, although with less bias. There was no agreement between the NS classifications (NHANES) by FMI between DXA and BIA, or DXA and ST. The exception occurred between DXA and BIA in men who showed a slightly better consensus, considered “fair” (k = 0.214; p = 0.001). In conclusion, ST and BIA did not show enough agreement to replace DXA for NS classification, within NHANES thresholds. The FMI measurement tools for the NHANES classification of the categories of NS matters.

Abstract Introduction: functional limitation is a result of sarcopenia and is associated with loss of skeletal muscle mass (SMM). Cost-effective methods are important for the identification of sarcopenia. Objective: to propose cutoff points for normalized calf circumference (CC) in order to identify low SMM in older women based on their functional limitation. Methods: in this descriptive, cross-sectional study the CC values of a young female sample (n = 78) were used to establish cutoff points (-2 SD) for low SMM in older women (n = 67). Functional limitation was identified by the six-minute walk test (≤ 400 m). CC was normalized by body mass, height, and BMI. The diagnostic accuracy of CC was calculated with a ROC curve, using functional limitation as standard. Results: cutoff points and area under the curve (AUC) were: CC (≤ 28.5; 0.62); CC·body mass-1 (≤ 0.40; 0.63); CC·height-2 (≤ 8.52; 0.55) and CC·BMI-1 (≤ 1.10; 0.73). Only CC·BMI-1 achieved a desirable accuracy (AUC > 0.7) to distinguish functional limitation. Conclusion: the accuracy attained supports the use of CC·BMI-1 to identify low SMM in older women. In the clinical context it is possible to predict the risk of sarcopenia when sophisticated methods for determining SMM are not available.

Resumen Introducción: la limitación funcional es consecuencia de la sarcopenia y se asocia con la pérdida de masa muscular esquelética (MME). Los métodos rentables son importantes para la identificación de la sarcopenia. Objetivo: proponer puntos de corte para la circunferencia de la pantorrilla (CP), normalizada para identificar un MME bajo en mujeres mayores en función de su limitación funcional. Métodos: en este estudio descriptivo de carácter transversal se utilizaron los valores de CP de una muestra de mujeres jóvenes (n = 78) para establecer los puntos de corte (-2 DS) de la MME baja en las mujeres mayores (n = 67). La limitación funcional se identificó mediante la prueba de la marcha de seis minutos (≤ 400 m). La CP se normalizó por la masa corporal, la altura y el IMC. La precisión diagnóstica de la CP se calculó con la curva ROC, utilizando como estándar la limitación funcional. Resultados: los puntos de corte y el área bajo la curva (AUC) fueron: CP (≤ 28,5; 0,62); CP·masa corporal-1 (≤ 0,40; 0,63); CP·altura-2 (≤ 8,52; 0,55) y CP·IMC-1 (≤ 1,10; 0,73). Solo el CP·IMC-1 logró la precisión deseable (AUC > 0,7) para distinguir la limitación funcional. Conclusión: la precisión alcanzada respalda el uso de CP·IMC-1 para identificar la MME baja en las mujeres mayores. En el contexto clínico es posible predecir el riesgo de sarcopenia cuando no se dispone de métodos sofisticados para determinar la MME.

Abstract Introduction: sarcopenia is a disease characterized by reduced musculoskeletal tissue and muscle strength. The estimation of appendicular lean soft tissue by DXA (ALSTDXA) is one of the criteria for the diagnosis of sarcopenia. However, this method is expensive and not readily avaiable in clinical practice. Anthropometric equations are low-cost and able to accurate predict ALST, but such equations have not been validated for male Brazilian older adults between the ages of 60 to 79 years. To this end, this study sought to validate the existing predictive anthropometric equations for ALST, and to verify its accuracy for the diagnosis of sarcopenia in male Brazilian older adults. Methods: this cross-sectional study recruited and enrolled 25 male older adults (69.3 ± 5.60 years). ALSTDXA and anthropometric measures were determined. ALST estimations with 13 equations were compared to ALSTDXA. The validity of the equations was established when: p > 0.05 (paired t-test); standard error of the estimate (SEE) < 3.5 kg; and coefficient of determination r² > 0.70. Results: two Indian equations met the criteria (Kulkarini 1: 22.19 ± 3.41 kg; p = 0.134; r² = 0.78; EPE = 1.3 kg. Kulkarini 3: 22.14 ± 3.52 kg; p = 0.135; r² = 0.82; SEE = 1.2 kg). However, these equations presented an average bias (Bland-Altman: 0.54 and 0.48 kg) and ‘false negative’ classification for the ALST index. Thus, three explanatory equations were developed. The most accurate equation demonstrated a high level of agreement (r2adj = 0.87) and validity (r²PRESS = 0.83), a low predictive error (SEEPRESS = 1.53 kg), and an adequate ALST classification. Conclusion: anthropometric models for predicting ALST are valid alternatives for the diagnosis and monitoring of sarcopenia in older adults; however, population specificity affects predictive validity, with risks of false positive/negative misclassification.

Resumen Introducción: la sarcopenia es una enfermedad caracterizada por una reducción del tejido musculoesquelético y la fuerza muscular. Uno de los criterios utilizados para su diagnóstico es la determinación de tejido blando magro apendicular por DXA (TBMADXA), método costoso que no siempre está disponible en la práctica clínica. Las ecuaciones antropométricas suponen un bajo coste y predicen bien el TBMA, pero con una validez desconocida para los varones brasileños de 60 a 79 años. Por lo tanto, nuestro objetivo fue validar las ecuaciones antropométricas existentes predictivas del TBMA y verificar su precisión para el diagnóstico de sarcopenia en varones brasileños de edad avanzada. Métodos: participaron en este estudio transversal 25 hombres de edad avanzada (69,3 ± 5,60 años). Se determinaron el TBMADXA y las medidas antropométricas. Las ecuaciones predictivas del TBMA se compararon con el TBMADXA. La validez de las ecuaciones en las comparaciones se confirmó cuando: p > 0,05 (prueba de la “t” pareada); error estándar estimado (EEE) < 3,5 kg; coeficiente de determinación r² > 0,70. Resultados: dos ecuaciones indias cumplieron los criterios (Kulkarini 1: 22,19 ± 3,41 kg; p = 0,134; r² = 0,78; EEE = 1,3 kg. Kulkarini 3: 22,14 ± 3,52 kg; p = 0,135; r² = 0,82; EEE = 1,2 kg). Sin embargo, presentaron sesgo promedio (Bland-Altman: 0,54 y 0,48 kg) y clasificación de ‘falso negativo’ para el índice de TBMA. Por lo tanto, se crearon tres ecuaciones explicativas. La ecuación más precisa mostró un alto acuerdo (r2adj = 0,87), uma alta validez (r²PRESS = 0,83), um bajo error predictivo (EEEPRESS = 1,53 kg) y uma clasificación del TBMA adecuada. Conclusión: los modelos antropométricos para predecir el TBMA son alternativas válidas para el diagnóstico y el seguimiento de la sarcopenia en los ancianos. Pero la especificidad de la población afecta a su validez predictiva, con riesgos de incorrección por clasificación falsa positiva/negativa.

Abstract Background: Hepatic congestion is a frequent finding in patients with heart failure (HF). Physical examination has limitations in quantifying systemic congestion and requires correlation with echocardiographic and laboratory data (usually B-type natriuretic peptide, BNP, or N-terminal pro-B type natriuretic peptide, NT-proBNP). Hepatic elastography evaluates liver stiffness using a transducer that transmits low-frequency vibrations (50 Hz), and the speed of shear waves propagating through the tissues is measured by ultrasound. The faster the vibrations propagate in the hepatic parenchyma, the stiffer the liver, which, in case of HF, can be correlated with hepatic congestion. Objective: In this systematic review, case-controls, cohort studies, and randomized clinical trials were searched in MEDLINE, LILACS and Cochrane Database of Systematic Review, to evaluate the use of elastography in the detection of hepatic congestion in patients with HF. Methods: From the 49 articles retrieved, seven were selected for review, according to the inclusion and exclusion criteria. The most used methods for the diagnosis and evaluation of HF were echocardiography combined with BNP and NT-proBNP measurements. Results: Elastography performed at bedside was able to establish a significant correlation between increased liver stiffness and increased venous capillary pressure. In addition, liver elastography performed at hospital discharge was able to predict rehospitalization and mortality. Conclusion: Liver elastography is a non-invasive method that can be useful in predicting prognosis and mortality of individuals with HF, contributing to the clinical management of these patients.

Abstract Introduction: appropriate appendicular lean soft tissue (ALST) parameters to identify sarcopenia in Brazil are scarce. The use of international references may lead to a false positive diagnosis. The objective was to propose cut-off points to identify sarcopenia in older men and women using DXA-derived ALST values from a young adult population. Methods: this was an observational study with a cross-sectional analysis. University students of both sexes (n = 125), aged 20 to 30 years, underwent anthropometric measurements and DXA scanning to obtain their ALST (kg). Cut-off points for sarcopenia were set at -2 standard deviations (-2SDs) away from the mean ALST of a young sample. Absolute values and index (ALST/height2, ALST/weight, and ALST/body mass index [BMI]) were considered as recommended by international consensus. Results: compared to women, men presented higher values of weight, height, BMI, bone mineral content, lean soft tissue, ALST, and ALST index (kg/m²). Only fat mass was higher in women, and age was not different between genders. The -2SD ALST index obtained were ≤ 6.56 kg/m² for men and ≤ 4.67 kg/m² for women. They were below international and national values, which tended to classify false positives. Conclusions: the -2SD ALST values proposed here are validated cut-offs for identifying low muscle in older adults and to prevent misdiagnosis with sarcopenia. In addition, they contribute to efficient monitoring and control of this disease in geriatric populations.

Resumen Introducción: los parámetros apropiados de masa muscular esquelética apendicular (MMEA) para identificar la sarcopenia en Brasil resultan escasos. Ello se debe al uso de referencias internacionales, lo cual puede conducir a un diagnóstico falso positivo. El objetivo del presente trabajo es proponer puntos de corte para determinar la sarcopenia en hombres y mujeres mayores empleando valores de MMEA derivados de las DXA de una población de adultos jóvenes. Métodos: estudio observacional con análisis transversal. Estudiantes universitarios de ambos sexos (n = 125), de 20 a 30 años de edad, se sometieron a mediciones antropométricas y DXA para obtener el MMEA (kg). Los puntos de corte de la sarcopenia se establecieron en -2 desviaciones estándar (-2SD) de la media de MMEA de una muestra joven. Se consideraron los valores absolutos e índices (MMEA/altura2, MMAE/peso y MMAE/índice de masa corporal [IMC]), según lo recomendado por el consenso internacional. Resultados: los hombres, en comparación con las mujeres, presentaron valores superiores de peso, altura, IMC, contenido mineral óseo, masa magra, MMEA e índice MMEA (kg/m²). Por otro lado, solo la masa grasa fue mayor en las mujeres, no habiendo diferencias de edad entre ambos géneros. El índice MMAE -2SD obtenido fue ≤ 6,56 kg/m² para los hombres y ≤ 4,67 kg/m² para las mujeres. Dichos resultados, al encontrarse por debajo de los valores internacionales y nacionales, tienden a clasificar los falsos positivos. Conclusiones: los MMAE -2SD propuestos aquí son valores de corte validados para identificar las cuantificaciones musculares bajas en los adultos mayores y para prevenir el diagnóstico erróneo de sarcopenia. Además, contribuyen a la monitorización y el control eficiente de esta enfermedad en las poblaciones geriátricas.

Abstract Introduction: currently, there is no consensus regarding accurate and low-cost methods for diagnosing lipodystrophy in people living with HIV/AIDS (PLWHA). The aim of this study was to propose anthropometric cutoff points for the diagnosis of lipodystrophy among PLWHA. Methods: we included 106 PLWHA (men = 65, women = 41) who are under antiretroviral therapy and have been clinically classified into either a “lipodystrophy” or “non-lipodystrophy” group. Anthropometric measurements included 19 regions of body perimeters and 6 skinfold thickness measures. The Youden index was used to establish anthropometric cutoff points for the diagnosis of lipodystrophy, using the mean values of the anthropometric data (referred to as “original”) along with the “Z index” (ZI) values, which were adjusted by the “Phantom Strategy.” The cutoff points were proposed when “original” anthropometric measurements and ZI values had a statistical significance of p < 0.01 and an area under the curve (AUC) higher than 70%. The size effect was assessed to verify the influence of lipodystrophy on each anthropometric measure. Results: our data analysis proposes sex-specific cutoff points for the diagnosis of lipodystrophy in PLWHA – 17 points using the “original” anthropometric measurements, and 20 using the ZI values (average effect size between 1.0 and 1.1, and AUC = 76.7% and 78%). Conclusions: our study proposes accurate cutoff points for the diagnosis of lipodystrophy using “original” anthropometric measurements and ZI values adjusted by the “Phantom Strategy.” Our findings support the use of anthropometric measurements as a simplified method for diagnosing lipodystrophy and monitoring body composition alterations in people living with HIV/AIDS.

Resumen Introducción: no existe consenso con respecto a métodos precisos y de bajo coste para diagnosticar la lipodistrofia en personas que viven con VIH/SIDA (PVVS). El objetivo de este estudio es proponer puntos de corte antropométricos para el diagnóstico de lipodistrofia entre las PVVS. Métodos: se incluyeron 106 PVVS (hombres = 65, mujeres = 41) en tratamiento antirretroviral que se clasificaron clínicamente en dos grupos de “lipodistrofia” o “no lipodistrofia”. Las mediciones antropométricas incluyeron 19 regiones de parámetros corporales y 6 medidas de pliegues cutáneos. El índice de Youden se utilizó para establecer puntos de corte antropométricos para el diagnóstico de lipodistrofia utilizando la media de los datos antropométricos (denominados “originales”) junto con los valores del “índice Z” (IZ), que fueron ajustados por la “estrategia Phantom”. Los puntos de corte se propusieron cuando las mediciones antropométricas “originales” y los valores de IZ fueron estadísticamente significativos con un valor p < 0,01 y un área bajo la curva (AUC) superior al 70%. Se evaluó el tamaño del efecto para verificar la influencia de la lipodistrofia en cada medida antropométrica. Resultados: se propusieron puntos de corte específicos según el sexo para el diagnóstico de lipodistrofia en PVVS: 17 puntos usando las medidas antropométricas “originales” y 20 usando los valores de IZ (tamaño del efecto promedio entre 1.0 y 1.1, y AUC = 76.7% y 78%). Conclusiones: se propusieron puntos de corte antropométricos para el diagnóstico de lipodistrofia. Las mediciones antropométricas son un método simplificado para diagnosticar y monitorear los cambios de composición corporal en las PVVS.

Resumo Ressonância magnética e tomografia computadorizada são referências para medir o tecido muscular (TM), porém apresentam custo elevado. A Absorciometria Radiológica de Dupla Energia (DXA) é segura, embora ainda dispendiosa, permite medir a Massa Isenta de Gordura e Osso apendicular (MIGOap), forte preditor do TM. Alternativamente, existem modelos antropométricos preditivos da MIGOap de atletas portugueses com baixo custo/risco, porém sem validação para outras populações. Objetivou-se validar modelos antropométricos portugueses preditivos da MIGOap em jovens atletas ou propor novos modelos, caso a validação falhe. A determinação da MIGOapDXA de 174 jovens atletas foi realizada por DXA. Dois modelos antropométricos (MIGOapmdJ1 e MIGOapmd2) de atletas portugueses foram testados para predizer MIGOap. Para validação o coeficiente de determinação, a diferença (viés) e a concordância entre valores medidos e preditos foram calculados. Finalmente, a associação entre média-e-diferença dos métodos foi calculada. A validação falhou, assim foram propostos novos modelos de regressão múltipla validados por estatística PRESS. Os modelos portugueses explicaram ~96% da variabilidade da MIGOapDJAf A diferença entre MIGOapmod1 e MIGOapDXA (-0,7kg) foi menor do que MI-GOapmod2 (-2,3kg), com limites de concordância de3,6 a -2,1 e de 6,1 a -1,5kg, respectivamente. Os novos modelos incluíram três equaçõespreditivaspara MIGOap. Somente MIGOapmd1foi válido, todavia mostrou grande tendência a vieses, conforme magnitude dos valores de MIGOap. Os novos modelos propostos mostraram validade com maior concordância (r2PRESS=0,98), menores erros de estimativa (EPEPRESS =0,91) e valores preditos mais homogêneos para casos extremos.

Abstract Magnetic resonance imaging and Computer tomography are gold standards in the measurement of muscle tissue (MT), but are expensive. Dual Energy X-Ray Absorptiometry (DXA) is also costly but safer and allows for the measurement of Appendicular Lean Soft Tissue (ALST), a strong predictor of MT. Alternatively, there are anthropometric models that predict the ALST of Portuguese athletes with low cost/risk that have not been validated in other populations. The aim of this study was to validate anthropometric Portuguese models that predict ALST in young athletes or, if the validation fails, to propose new models. The ALSTDXA of 174 young athletes was determined by DXA. Two anthropometric models (ALSTmod1 and ALSTmod2) measuring ALST among Portuguese athletes were tested. To validate the coefficient of determination, the difference (bias) and concordance correlation coefficient between predicted and actual values were computed. Finally, association between mean and difference of methods was verified. Validation failed and, for this reason, new multiple regression models were proposed and validated using PRESS statistics. The Portuguese models explained ~96% of the ALSTDXA variability. The difference between ALST (-0.7kg) was less than that found for the ALSTmod2 and ALSTDXA limits of agreement from 3.6 to -2.1 and from 6.1 to -1.5kg, respectively. The new models included three predictive equations for ALST. Only ASLTmod1was valid; however, it was prone to bias, depending on the magnitude of ALST values. The newly proposed models present validity with greater concordance (r2PRESS=0.98), lower standard error of estimate (SEEPRESS [kg]=0.91) and more homogeneous predicted extreme values.

RESUMO: Introdução: A síndrome da lipodistrofia do HIV é caracterizada por alterações no metabolismo e na composição corporal, que aumentam o risco cardiovascular de pessoas vivendo com HIV/AIDS (PVHA) em uso da terapia antirretroviral de alta potência (TARV). Objetivo: Avaliar a prevalência de lipodistrofia e de alterações do metabolismo de lipídios e glicose em PVHA em uso da TARV. Métodos: Para avaliação antropométrica foram aferidos peso, estatura e circunferência abdominal (CA). Para avaliação da lipodistrofia foi realizado o exame físico (subjetivo) e o exame (objetivo) de absortometria com raios X de dupla energia (DEXA) por meio da razão de massa gorda (RMG). Foram também realizados exames de lipidograma e glicemia de jejum e utilizados os critérios sugeridos pelo The National Cholesterol Education Program III para classificação de alterações metabólicas. Resultados: A amostra final consistiu em 262 pacientes com idade média de 44,3 ± 10,2 anos. A lipodistrofia, de acordo com o exame físico, esteve presente em 47,7% (IC95% 41,7 - 53,8) dos pacientes, enquanto pela RMG (DEXA) sua prevalência foi de 40,8% (IC95% 33,1 - 48,5). A maioria (53,0%; IC95% 47,0 - 59,1) dos pacientes apresentou aumento de adiposidade abdominal segundo a CA. As alterações metabólicas mais presentes foram o HDL reduzido (67,6%; IC95% 61,9 - 73,2) e a hipertrigliceridemia (55,7%; IC95% 49,7 - 61,7). Conclusões: A alta prevalência de lipodistrofia e alterações do metabolismo de lipídios e glicose evidenciam a importância da intervenção precoce nesse grupo de pacientes para prevenir complicações cardiovasculares.

ABSTRACT: Introduction: The HIV lipodystrophy syndrome is characterized by changes in metabolism, and body composition that increase cardiovascular risk of people living with HIV/AIDS (PLWHA) using highly active antiretroviral therapy (HAART). Objective: To assess the prevalence of lipodystrophy and changes in lipid and glucose metabolism in PLWHA in use of HAART. Methods: For the anthropometric evaluation we measured weight, height and abdominal circumference (AC). For the lipodystrophy evaluation we conducted physical examination (subjective) and the (objective) examination of absorptiometry with X-ray dual energy (DEXA) by fat mass ratio (FMR). We also conducted lipid profile tests and fasting glucose and used the criteria suggested by The National Cholesterol Education Program III for metabolic disorders classification. Results: The final sample consisted of 262 patients with a mean age of 44.3 ± 10.2 years. Lipodystrophy, according to the physical examination, was present in 47.7% (95%CI 41.7 - 53.8) of patients, while the prevalence using FMR (DEXA) was 40.8% (95%CI 33.1 - 48.5). Most (53.0%; 95%CI 47.0 - 59.1) of the patients showed increased abdominal adiposity according to AC. The most prevalent metabolic alterations were reduced HDL (67.6%; 95%CI 61.9 - 73.2) and hypertriglyceridemia (55.7%; 95%CI 49.7 - 61.7). Conclusion: The high prevalence of lipodystrophy and changes in lipid and glucose metabolism show the importance of early intervention in this group of patients to prevent cardiovascular complications.

RESUMO Introdução: A prática de atividade física constitui a base que norteia os protocolos de saúde com intuito de manutenção e preservação da saúde e, quando realizada adequadamente, pode prevenir e controlar doenças crônicas. No Brasil, há poucos estudos de base populacional ou escolar sobre atividade física em adolescentes, sendo que a prevalência é muito variada. Objetivos: Este estudo analítico teve como objetivo descrever o padrão da prática regular de atividade física de escolares do ensino fundamental da rede pública estadual de Manaus-AM, no ano de 2011. Método: Participaram 304 alunos que responderam o questionário Dia Típico de Atividade Física e Alimentação. Resultados: A média de idade foi de 9,4 anos e o desvio padrão foi 0,7 ano, com IC 95% (9,3;9,5). Entre as atividades físicas, apenas os exercícios físicos sistematizados foram estatisticamente maiores no grupo dos não ativos. O sedentarismo foi observado em 48,0% IC 95% (42,4;53,6) e a prática da atividade física de leve a moderada foi de 96,7% IC 95% (94,7;98,7) de escolares. Conclusões: O comportamento sedentário é, portanto, preocupante, sendo imprescindível o incremento de pesquisas nessa área visando evidenciar seus riscos e incentivar a inserção de prática de atividades físicas regulares e monitoradas no dia a dia de escolares para propiciar o crescimento seguro e saudável dessa população.

ABSTRACT Introduction: The practice of physical activity has been the fundamental basis for guiding health protocols in order to maintain and preserve health and, when properly performed, can prevent and control chronic diseases. In Brazil, there are few population-based or school-based studies on physical activity in adolescents, and the prevalence is very diverse. Objectives: This analytical study aimed to describe the pattern of regular physical activity of students of a public state school in Manaus-AM, in 2011. Methods: Participants were 304 students who answered the questionnaire Typical Physical Activity and Food Intake Day. Results: he mean age was 9.4 years and the standard deviation was 0.7 year, with 95% CI (9.3;9.5). Among physical activities, only systematized physical exercises were statistically higher in the non-active group. The sedentary lifestyle was observed in 48.0%, 95% CI (42.4;53.6) and the practice of mild or moderated physical activity was 96.7%, 95% CI (94.7;98.7) of school children. Conclusions: The sedentary behavior is therefore worrying, and it is imperative to increase research in this area in order to highlight its risks and encourage the insertion of regular and monitored physical activities in the daily life of school children to foster the safe and healthy growth of this population.

RESUMEN Introducción: La práctica de actividad física constituye la base que orienta los protocolos de salud con el propósito de mantener y preservar la salud y, cuando se realiza adecuadamente, puede prevenir y controlar enfermedades crónicas. En Brasil, hay pocos estudios de base poblacional o escolar sobre actividad física en adolescentes, siendo que la prevalencia es muy variada. Objetivos: Este estudio analítico tuvo como objetivo describir el patrón de la práctica regular de actividad física de escolares de la enseñanza fundamental de la red pública estadual de Manaus-AM, en el año 2011. Método: Participaron 304 alumnos que respondieron el cuestionario Día Típico de Actividad Física y Alimentación. Resultados: La edad promedio fue de 9,4 años y el la desviación estándar fue 0,7 año, con IC 95% (9,3;9,5). Entre las actividades físicas, sólo los ejercicios físicos sistematizados fueron estadísticamente mayores en el grupo de los inactivos. El sedentarismo se observó en el 48,0% IC 95% (42,4;53,6) y práctica de la actividad física de leve a moderada fue del 96,7% IC 95% (94,7;98,7) de los estudiantes. Conclusiones: El comportamiento sedentario es, por lo tanto, preocupante, siendo imprescindible el incremento de investigaciones en esa área para evidenciar sus riesgos e incentivar la inserción de la práctica de actividad física regular e monitoreada en el día a día de los escolares para propiciar el crecimiento seguro y saludable de esa población.

RESUMO: Introdução: A síndrome da lipodistrofia do HIV é caracterizada por alterações no metabolismo e na composição corporal, que aumentam o risco cardiovascular de pessoas vivendo com HIV/AIDS (PVHA) em uso da terapia antirretroviral de alta potência (TARV). Objetivo: Avaliar a prevalência de lipodistrofia e de alterações do metabolismo de lipídios e glicose em PVHA em uso da TARV. Métodos: Para avaliação antropométrica foram aferidos peso, estatura e circunferência abdominal (CA). Para avaliação da lipodistrofia foi realizado o exame físico (subjetivo) e o exame (objetivo) de absortometria com raios X de dupla energia (DEXA) por meio da razão de massa gorda (RMG). Foram também realizados exames de lipidograma e glicemia de jejum e utilizados os critérios sugeridos pelo The National Cholesterol Education Program III para classificação de alterações metabólicas. Resultados: A amostra final consistiu em 262 pacientes com idade média de 44,3 ± 10,2 anos. A lipodistrofia, de acordo com o exame físico, esteve presente em 47,7% (IC95% 41,7 - 53,8) dos pacientes, enquanto pela RMG (DEXA) sua prevalência foi de 40,8% (IC95% 33,1 - 48,5). A maioria (53,0%; IC95% 47,0 - 59,1) dos pacientes apresentou aumento de adiposidade abdominal segundo a CA. As alterações metabólicas mais presentes foram o HDL reduzido (67,6%; IC95% 61,9 - 73,2) e a hipertrigliceridemia (55,7%; IC95% 49,7 - 61,7). Conclusões: A alta prevalência de lipodistrofia e alterações do metabolismo de lipídios e glicose evidenciam a importância da intervenção precoce nesse grupo de pacientes para prevenir complicações cardiovasculares.

ABSTRACT: Introduction: The HIV lipodystrophy syndrome is characterized by changes in metabolism, and body composition that increase cardiovascular risk of people living with HIV/AIDS (PLWHA) using highly active antiretroviral therapy (HAART). Objective: To assess the prevalence of lipodystrophy and changes in lipid and glucose metabolism in PLWHA in use of HAART. Methods: For the anthropometric evaluation we measured weight, height and abdominal circumference (AC). For the lipodystrophy evaluation we conducted physical examination (subjective) and the (objective) examination of absorptiometry with X-ray dual energy (DEXA) by fat mass ratio (FMR). We also conducted lipid profile tests and fasting glucose and used the criteria suggested by The National Cholesterol Education Program III for metabolic disorders classification. Results: The final sample consisted of 262 patients with a mean age of 44.3 ± 10.2 years. Lipodystrophy, according to the physical examination, was present in 47.7% (95%CI 41.7 - 53.8) of patients, while the prevalence using FMR (DEXA) was 40.8% (95%CI 33.1 - 48.5). Most (53.0%; 95%CI 47.0 - 59.1) of the patients showed increased abdominal adiposity according to AC. The most prevalent metabolic alterations were reduced HDL (67.6%; 95%CI 61.9 - 73.2) and hypertriglyceridemia (55.7%; 95%CI 49.7 - 61.7). Conclusion: The high prevalence of lipodystrophy and changes in lipid and glucose metabolism show the importance of early intervention in this group of patients to prevent cardiovascular complications.