Introduction: Ascitis and undernutrition are frequent complications of cirrhosis, however ascitis volume and anthropometric assessment are not routinely documented or considered in prognostic evaluation. In a homogeneous cohort followed during two years these variables were scrutinized, aiming to ascertain relevance for longterm outcome. Methods: Population (N = 25, all males with alcoholic cirrhosis) was recruited among patients hospitalized for uncomplicated ascitis. Exclusion criteria were refractory or tense ascitis, cancer, spontaneous bacterial peritonitis, bleeding varices and critical illness. Measurements included ultrasonographically estimated ascitis volume, dry body mass index/BMI , upper arm anthropometrics, hematologic counts and liver function tests. Results: Population (age 48.3 ± 11.3 years, BMI 21.1± 3.5 kg/m², serum albumin 2.5 ± 0.8 g/dL) was mostly in the Child-Pugh C category (77.8%) but clinically stable. During the follow-up period of 22.6 ±3.8 months, additional hospitalizations numbered 1.7 ± 1.0 and more than one quarter succumbed. Admission ascitis volume corresponded to 7.1 ± 3.6 L and dry BMI to 18.3 ± 3.5 kg/m². Child Pugh index was relevant for both mortality and rehospitalization. Nevertheless, similar matches for mortality were documented with ascitis volume and dry BMI, and arm circumference below the 5th percentile was highly significantly associated with rehospitalization. Conclusions: A greater association than hitherto acknowledged, between ascitis volume and anthropometric measurements from one side, and long-term rehospitalization and mortality from the other, was demonstrated in male stable alcoholic cirrhotics. Further studies with alcoholic and other modalities of cirrhosis including women are recommended.

Introducción: Ascitis y desnutrición son complicaciones frecuentes de la cirrosis, pero el volumen ascítico y la evaluación antropométrica no son como rutina documentadas o consideradas para la evaluación del pronóstico. En un coorte homogéneo de pacientes acompañados por dos años estas variables fueron escrutinadas, con el objetivo de determinar su releváncia para los resultados clínicos de largo plazo. Métodos: La población (N = 25, todos hombres con cirrosis alcohólica) fue recrutada entre pacientes hospitalizados por ascitis no complicada. Los critérios de exclusión fueron ascitis tensa o refractária, peritonitis bacteriana espontánea, varices sangrantes y enfermedad crítica. Los métodos involucraron volumen ascítico estimado ultrasonograficamente, el índice seco de masa corporal/IMC seco, antropometria del brazo, recuentos hematológicos y pruebas de función hepática. Resultados: La población (edad 48,3 ± 11,3 años, IMC 21,1 ± 3,5 kg/m², albumina sérica 2,5 ± 0,8 g/dL) encontrabase predominantemente en la categoria Child-Pugh C (77,8%) , pero clinicamente estable. En el período de seguimiente de 22,6 ± 3,8 meses hubo 1,7 ± 1,0 hospitalizaciones adicionales por paciente, y mas de una cuarta parte sucumbió. El volumen ascítico de admisión fue de 7,1 ± 3,6 L y el IMC seco de 18,3 ± 3,5 kg/m². El indice de Child-Pugh fue relevante tanto para mortalidad como para rehospitalización. Asociaciones similares para mortalidad fueron demonstradas para volumen ascítico y para IMC seco, y la circunferencia del brazo abajo del 5º percentil fue un indicador muy significativo para rehospitalización. Conclusiones: Una asociación mas importante que lo hasta ahora publicado ocurrió entre volumen ascítico y antropometria de una parte, y mortalidad asimismo rehospitalización de otra parte, en pacientes masculinos cirróticos alcohólicos estables. Estúdios adicionales con cirrosis alcohólica y de otras modalidades incluyendo mujeres son recomendados.

Background: Risk-factors for mortality in hip fractures encompass nutritional status, nominally body mass index, but not body composition. Given the difficulty of anthropometric assessment in bedridden patients a prospective study with bioimpedance analysis was designed. Methods: Elderly patients with hip fracture were consecutively recruited. Biochemical tests, primitive bioimpedance measurements (resistance, reactance and phase angle) and follow-up till one year were targeted. Results: Patients (N = 69, 81.2 ± 8.1 years old, 72.5% females) stayed in the hospital for 15.5 ± 17.1 days, and 18.8% (13/69) required further hospitalization during the ensuing months. Mortality was 11.6% within 30 days, coinciding with hospital mortality, and an additional 11.6% till one year, thus reaching 23.2%. Anemia, hypoalbuminemia and low transferrin, along with elevated glucose and urea were frequent, suggesting undernutrition with metabolic derangements. Reactance, urea and creatinine were different in patients suffering both early and late demise. Resistance, white blood cell count and osteoporosis were risk factors for early mortality only , and anemia exclusively for late mortality. Conclusions: Primitive bioimpedance measurements, which had not been hitherto investigated , were prognostically related to early and late mortality. These markers of disease-related malnutrition and especially reactance should be further studied in patients unfit for anthropometric evaluation due to fracture and immobility.

Antecedentes: Los factores de riesgo para mortalidad en las fracturas de cadera involucran estado nutricional, nominalmente índice de masa corporal, pero no composición corporal. Considerándose la dificultad de evaluación antropométrica de pacientes acamados, un estudio prospectivo con bioimpedancia fue programado. Métodos: Pacientes de mayor edad con fractura de cadera fueron consecutivamente recrutados. Testes bioquímicos, medidas primitivas de bioimpedáncia (resisténcia, reactáncia, ángulo de fase) e seguimiento hasta un año fueron valorizados. Resultados: Los pacientes (N = 69, 81,2 ± 8,1 años, 72,5% mujeres) quedáronse en el hospital por 15,5 ± 17,1 días, y el 18,8% (13/69) necesitaron de hospitalización adicional en los meses siguientes. La mortalidad de 30 días fue 11,6%, coincidiendo con la mortalidad hospitalaria, con 11,6% adicionales hasta un año, alcanzando un total de 23,2%. Anemia, hipoalbuminemia e baja de transferrina, asimismo glucosa y urea elevadas, se observaron con frecuencia, compatibles con desnutrición e trastornos metabólicos. La reactáncia, urea y creatinina eran diferentes en pacientes con mortalidad precoz y tardía. La resistencia, recuento de leucocitos y presencia de osteoporosis indicaron mortalidad precoz solamente, y anemia solo la mortalidad de un año. Conclusiones: Las medidas primitivas de bioimpedáncia, que no habían sido hasta el momento investigadas en ese contexto, mostraronse pronosticamente relacionadas con mortalidad precoz y tardía. Estos marcadores y en especial la reactáncia merecen ser mas estudiados en pacientes donde la antropometria es difícil o imposible por razones de fractura y inmobilidad.

No nutritional protocol for poorly controlled diabetic patients receiving well-managed drug treatment is currently available. Objective: Aims were to compare dietary consumption of calcium and fibers with lipid profile and glycosilated hemoglobin HbA1c. Methodology: This was a prospective observational study. Patients with poorly controlled diabetes were consecutively recruited. A food-frequency questionnaire and tests for lipid profile, HbA1c, and C reactive protein were collected, along with clinical and anthropometric assessment. Results: Patients (N = 114, age 65.7 ± 6.5 years, 75.4% females, BMI 29.0 ± 5.3 kg/m²) were often insulin-dependent (32.5%) and with systemic inflammation (C-reactive protein 4.2 ± 3.9 mg/L). Diet was energy restricted (1,365 ± 565 kcal/day) and mostly adequate but with suboptimal fiber (15.4 ± 8.6 g/day) and very low calcium (592.4 ± 204.4 mg/day). Calcium and fiber in the diet correlated with serum lipids, whereas fiber alone displayed a protective association regarding diabetes (HBA1c, insulin use) and arterial hypertension. Conclusions: Calcium and fiber ingestion exhibited correlations with important markers of metabolic status and cardiovascular risk. Future studies should address enhancement of these ingredients by means of dietary changes and supplements.

Ningún protocolo nutricional es presentemente disponible para pacientes diabéticos mal controlados recibindo terapia farmacológica bien estructurada. Objetivo: Una comparación entre consumo dietético de cálcio y fibras, y concentraciones de lípidos y hemoglobina glicosilada HbA1c fue efectuada. Metodología: Este fue un estúdio prospectivo observacional. Pacientes con diabetes mal controlada fueron consecutivamente recrutados. Las variables fueron cuestionário de frecuéncia alimentária, evaluación clínica y antropométrica, y valores séricos de lípidos, HbA1c, proteina C reactiva (PCR). Resultados: Los pacientes (N = 114, edad 65,7 ± 6,5 años, 75,4% mujeres, IMC 29,0 ± 5,3 kg/m²) eran con moderada frecuencia insulino-dependentes (32,5%) y también sistemicamiente inflamados (PCR 4,2 ± 3,9 mg/L). La dieta era pobre en calorias (1,365 ± 565 kcal/d) pero globalmente acceptable, aún que baja en fibras (15,4 ± 8,6 g/d) y muy baja en cálcio (592,4 ± 204,4 mg/d). El cálcio e la fibra de la dieta se correlacionaran con valores lipídicos, pero solo la fibra estuvo asociada a mejor panorama de diabetes (HbA1c, uso de insulina) y de hipertensión arterial. Conclusiones: La ingestión de cálcio y fibra estuvieron correlacionadas con importantes marcadores de estado metabólico y riesgo cardiovascular. Estúdios futuros son recomendados con empleo de mayores proporciones de estes ingredientes en forma de dieta o suplementos.

Background: Botanical omega-3 fatty acid (alphalinolenic acid/ALA) has been shown to alleviate the prothrombotic and proinflammatory profile of metabolic syndrome, however clinical protocols are still scarce. Aiming to focus an obese population, a pilot study was designed. Methods: Morbidly obese candidates for bariatric surgery (n = 29, age 46.3 ± 5.2 years), 82.8% females (24/29), BMI 44.9 ± 5.2 kg/m², with C-reactive protein/CRP > 5 mg/L were recruited. Twenty were randomized and after exclusions, 16 were available for analysis. Flaxseed powder (60 g/day, 10 g ALA) and isocaloric roasted cassava powder (60 g/day, fat-free) were administered in a double-blind routine for 12 weeks. Results: During flaxseed consumption neutrophil count decreased and fibrinogen, complement C4, prothrombin time and carotid diameter remained stable, whereas placebo (cassava powder) was associated with further elevation of those measurements. Conclusions: Inflammatory and coagulatory markers tended to exhibit a better outlook in the flaxseed group. Also large-artery diameter stabilized whereas further increase was noticed in controls. These findings raise the hypothesis of a less deleterious cardiovascular course in seriously obese subjects receiving a flaxseed supplement.

Introducción: Los ácidos grasos botánicos omega-3 (ácido alfa-linolénico/ALA) se mostran convenientes para atenuar las carácterísticas protrombóticas y proinflamatórias del síndrome metabólico, pero protocolos clínicos todavía son escasos. Con el objetivo de enfocar una población obesa, un estúdio clínico fue dibujado. Métodos: Candidatos a cirugía bariátrica morbidamente obesos (n = 29, edad 46,3 ± 5,2 años), 82,8% mujeres (24/29), IMC 44,9 ± 5,2 kg/m², con proteína C reactiva/CRP > 5 mg/L fueron recrutados. Veinte fueron randomizados y após exclusiones, 16 se puderon analisar. Harina de linaza (60 g/día, 10 g ALA) y harina de casava tostada isocalórica (60 g/día, sin grasas) fueron suministradas em uma rutina doble-ciega por 12 semanas. Resultados: Mientras se recibió linaza los neutrófilos bajaron y fibrinógeno, complemento C4, tiempo de protrombina y diámetro de la carótida permanecieron estables. El uso de casava se asoció con elevación de todas estas variables. Conclusiones: Los marcadores inflamatórios y coagulatórios tuvieron un curso mas favorable con la linaza. Asimismo el diámetro arterial se quedó estable, en cambio hubo peor a en el segundo grupo. La hipótesis de una evolución cardiovascular menos deletérea en obesos graves recibiendo casava se plantea en estas circunstancias.

Low-grade inflammation adversely influences metabolism and cardiovascular prognosis, nevertheless increased intake of fruits and vegetables has rarely been studied in this context. Objective: In a prospective controlled study, the effect on C-reactive protein (CRP) levels was assessed. Methodology: Sixty consecutive women undergoing cosmetic abdominal surgery were instructed to consume six servings each of fruits and vegetables during the first postoperative month. Detailed 24h interviewer-administered dietary recall was conducted at baseline and at the end of the study, with weekly returns to monitor unscheduled dietary changes and compliance with the protocol. Variance (ANOVA) and covariance (ANCOVA) were evaluated to confirm significance and minimize confounding variables. Results: No differences concerning age (42.2 ± 5.3 vs 41.1 ± 6.0 years) or BMI (25.5± 3.1 vs 25.0± 3.0 kg/m²) occurred. Ingestion of fruits increased to approximately 5.2 vs 3.9 and of vegetables 5.9 vs 3.4 servings/ day, respectively. CRP decreased more conspicuously in the treated group (P=0.028), and correlation between vitamin C input and CRP in supplemented participants was demonstrated (P=0.014). Conclusions: Higher intake of antioxidant foods was feasible, and an antiinflammaotory effect occurred. Further studies with longer administration and follow-up period are recommended.

Inflamación subclínica influencia adversamiente el metabolismo y el pronóstico cardiovascular, pero ingestión elevada de vegetales y frutas há sido pocas veces investigada en este contexto. Objetivo: En un estúdio prospectivo y controlado, el impacto sobre la proteina C-reactiva fue determinado. Metodología: Sesenta pacientes consecutivas sometidas a cirugía cosmética abdominal fueron instruídas a consumir seis porciones diárias de frutas y mais seis de vegetales, en el primero més de postoperatório. Un recordatório alimentar detallado registrado por dietista fue conducido inicialmiente y al cabo del estúdio, con retornos semanales para monitorar aderéncia y cámbios eventuales de la dieta. Análisis de variáncia (ANOVA) y covariáncia (ANCOVA) fueron realizadas para evaluar resultados y minimizar variables de confusión. Conclusiones: Un consumo mas alto de alimientos antioxidantes fue posible, y una respuesta antiinflamatória fue documentada. Estúdios adicionales com suministración y seguimiento mas prolongados son recomendados.

Weight loss and resolution of comorbidities is well established after modern bariatric procedures, however chronology of glyco-lipidic biochemical response is still debated. Objective: Aiming to analyze this variable as well as its correlation with food amount and composition, a prospective study was designed. Methodology: Eighty consecutive patients undergoing Roux-en-Y gastric bypass were investigated every three months until one year after surgery. Females only were accepted and variables included general and nutritional course as well as glucose and lipid measurements. Energy intake was documented including percentage of macronutrients in the diet. Results: Surgery was successful with about 71% excess body weight loss at the end of the first year. Mean energy intake on the 4 postoperative quarters was respectively 519.6 ± 306.6, 836.0 ± 407.9, 702.1 ± 313.1 and 868.8 ± 342.8 kcal/day (mean ± SD). Fat intake was initially low but reached 34.1 ± 7.9% of total calories at final measurement. Blood glucose and lipid fractions tended to be borderline or abnormal preoperatively, and favorably changed by 12 months. Consumption of glucose-and lipid-lowering medication significantly diminished, but each of these was still necessary in 6.3% of the group. Correlation between body mass index and also calorie intake versus glucose and lipid measurements was highly significant (P = 0.000). Conclusions: 1) Energy intake after operation was very low; 2) Weight loss proceeded rapidly and correlated with meal pattern; 3) Improvement of glucose and lipid tests was adequate but took several quarters to normalize; 4) Decreased requirements for glucose- and lipid-lowering medication was significant but not absolute; 4) Fat percentage of total calories exceeded 30% at the end of the observation period, despite recommendations to the contrary.

Pérdida de peso y resolución de las comorbidades estan bien establecidas luego de los modernos procedimientos bariátricos, pero la cronología de la respuesta bioquímica glico-lipídica es aun debatida. Objetivo: Con el interés de analizar esta variable y sus correlaciones con la cantidad y composición de la dieta, un estudio prospectivo fue preparado. Metodología: Ochenta pacientes consecutivas sometidas a bypass gástrico en Y de Roux fueron investigadas a cada tres meses hasta el fin del primero año. Acceptaronse solamente mujeres y las variables involucraban evolución general y nutricional asimismo medidas de glucemia y lípidos. La ingestión energética fue documentada con su porcentual de macronutrientes. Resultados: La operación fue exitosa con pérdida de un promedio de 71% de exceso de peso al término de un año. Los ingresos calóricos en los 4 trimestres fueron respectivamente 519,6 ± 306,6, 836,0 ± 407,9, 702,1 ± 313,1 y 868,8 ± 342,8 kcal/día. El consumo inicial de grasas fue bajo pero alcanzó progresivamente el 34,1 ± 7,9% del total calórico. La glucemia y fracciones lipídicas quedabanse en el límite superior del normal en el preoperatório , con mejora significativa a los 12 meses. La utilización de medicación hipoglucemiante y hipolipemiante disminuyó, pero al término era aún necesária para 6,3% de la población. Las correlaciones entre índice de masa corporal y también ingestión calórica versus valores lipídicos y glucídicos fueron muy significativas (P= 0,000). Conclusiones: 1) La ingestión calórica postoperatória fue muy baja; 2) La pérdida de peso avanzó rápidamente y fue proporcional a los parámetros dietéticos; 3) La respuesta de la glucemia y hiperlipidemia fue adecuada pero solo se completó al cabo de varios trimestres; 4) El porcentaje final de grasas en la dieta fue superior al 30% pese a recomendaciones contrarias.

A gravidez acompanha-se de modificações fisiológicas bem conhecidas nos compartimentos hídricos e energéticos maternos, que se somam a hipertrofias orgânicas e ao aparecimento de um bloco feto-placentário. Conseqüentemente, a composição corporal sofre alterações, porém poucos estudos têm documentado tal fenômeno. O advento da bioimpedância favoreceu a obtenção das informações desejadas de forma prática e segura. OBJETIVOS. Foram os propósitos deste trabalho: registrar as principais variáveis antropométricas numa população de gestantes de termo; determinar as medidas de composição corpórea pela bioimpedância; comparar esses achados com os primeiros, assim como com outras metodologias relatadas na literatura. PACIENTES E MÉTODO. A população consistiu de 30 gestantes de termo admitidas no período pré-parto, sem complicações, sofrimento fetal ou gravidez múltipla, e submetidas às seguintes mensurações: Antropometria - Peso, altura, índice de massa corporal, prega cutânea do tríceps, circunferência muscular do braço; Bioimpedância - Gordura corporal, massa magra, água total, água intra e extracelular, terceiro espaço e relação sódio/potássio permutável. RESULTADOS. Observaram-se valores de peso corporal e índice de massa corporal aumentados, porém inteiramente compatíveis com a situação fisiológica das gestantes. A água corpórea total situava-se na mesma faixa percentual de mulheres não-grávidas, tal como já suspeitado por outros autores, porém com indícios de expansão do extracelular e formação de terceiro espaço. A massa gorda elevou-se, porém, também em proporções não muito diferentes do relatado anteriormente em levantamentos antropométricos. CONCLUSÕES. Nas condições do presente trabalho, em que uma equação de bioimpedância para uso geral foi aplicada, o método demonstrou resultados compatíveis com as informações clínicas disponíveis, as verificações antropométricas e os registros de outros investigadores. Conclui-se que a impedância bioelétrica é um procedimento de avaliação promissor na gravidez, justificando estudos ulteriores com esta metodologia.

BACKGROUND. Pregnancy is associated with well-known physiologic changes of maternal fluid and energy compartments, along with organ hypertrophies and the appearance of fetal and placental tissues. As a consequence, body composition is modified, but this phenomenon has not been well documented. The advent of bioimpedance has contributed to the documentation of the desired information in a safe and practical way. AIMS. The aims of this study were: To register the principal anthropometric variables in a population of pregnant women at term; To determine body composition by bioimpedance analysis; To compare these findings with the former results, as well as with other assessment procedures reported in the literature. PATIENTS AND MATHODS. The population consisted of 30 pregnant women at term admitted for delivery, without complications, fetal distress or multiple pregnancy, and submitted to the following measurements: Anthropometry - Weight, height, body mass index, triceps skinfold, arm muscle circumference; Bioimpedance analysis - Body fat, lean body mass, total water, intra and extracellular water, third space, and exchangeable Na/K ratio. RESULTS. Body weight and body mass index were increased but within the expected values for these patients. Total body water was similar to results in non-pregnant women when expressed as percentage, in accordance with other studies, but with a trend toward increase in the extracellular compartment and presence of third space fluid. Body fat was elevated, but the proportions were not much different from previous anthropometric surveys. CONCLUSIONS. In the conditions of this investigation, in which a bioimpedance equation for general use was employed, the method indicated results that were consistent with the clinical course, anthropometric documentation, and the findings of other groups. It is concluded that bioimpedance analysis compares favorably with other assessment procedures in pregnancy, and further studies with this method should be undertaken.