RESUMO Objetivo A taxa metabólica de repouso é uma informação importante para o monitoramento nutricional na anorexia nervosa e buscou-se investigar diferenças nas medidas da taxa metabólica de repouso por diferentes métodos entre pacientes de anorexia nervosa com baixo peso e recuperados e controles saudáveis. Métodos Os participantes foram distribuídos em grupos de anorexia nervosa ativa, anorexia nervosa recuperada e indivíduos saudáveis. A calorimetria indireta, medida padrão ouro da taxa metabólica de repouso, foi utilizada para comparar o desempenho das equações de Harris e Benedict, Shebendach, FAO/OMS e Buchholz. O índice de massa corporal e a massa livre de gordura também foram medidos. Foram comparadas médias e medianas dos métodos de avaliação da taxa metabólica de repouso e também foi empregado análise de Bland Altman e tabelas de diferenças percentuais para comparar os diferentes métodos. Resultados No grupo de anorexia nervosa ativa as equações de Buchholz, Harris e Benedict e FAO/WHO superestimaram a taxa metabólica de repouso, o que não foi observado com a equação de Schebendach. No grupo de anorexia nervosa recuperada, a equação de Schebendach subestimou a taxa metabólica de repouso, enquanto as outras equações, com exceção da FAO/OMS, não o fizeram. A análise de Bland Altman sugeriu a adequação da equação de Shedenbach na anorexia nervosa ativa. Na anorexia nervosa recuperada, os vieses proporcionais observados para as equações de Harris e Benedict, Buchholz e FAO/OMS indicaram sua inadequação para este grupo. Conclusão Em pacientes com anorexia ativa, os resultados indicam que a equação de Schebendach pode ser adequada para estimar a taxa metabólica de repouso. Nenhuma das equações mostrou adequação para estimar a taxa metabólica de repouso em pacientes recuperados. buscouse buscou se saudáveis indireta Shebendach FAOOMS FAO OMS medidos FAOWHO WHO fizeram

ABSTRACT Objective Resting metabolic rate is an important measure for nutritional monitoring in anorexia nervosa. This study aims to investigate the differences in resting metabolic rate measurements across various methods between underweight and recovered anorexia nervosa patients, as well as healthy controls. Methods Participants were categorized into three groups: active anorexia nervosa, recovered anorexia nervosa, and healthy individuals. Indirect calorimetry, the gold standard for resting metabolic rate measurement, was used to evaluate the performance of the Harris-Benedict, Schebendach, FAO/WHO, and Buchholz equations. Body mass index and fat free mass were also measured. Mean and median resting metabolic rate values across evaluation methods were compared, and Bland-Altman plots along with percent difference tables were employed to compare the different methods. Results In the active anorexia nervosa group, the Buchholz, Harris-Benedict, and FAO/WHO equations overestimated resting metabolic rate, whereas the Schebendach equation did not. In the recovered anorexia nervosa group, Schebendach’s equation underestimated resting metabolic rate, while the other equations, with the exception of FAO/WHO, did not. Bland-Altman analysis supported the adequacy of the Schebendach equation in active anorexia nervosa. In recovered anorexia nervosa, proportional biases observed for the Harris-Benedict, Buchholz, and FAO/WHO equations indicated its inadequacies for this group. Conclusion In patients with active anorexia nervosa, the results indicate that the Schebendach equation may be adequate for estimating resting metabolic rate. However, none of the equations showed adequacy for estimating resting metabolic rate in recovered patients. controls groups individuals calorimetry measurement HarrisBenedict, HarrisBenedict Harris Benedict, Benedict Harris-Benedict FAOWHO FAO WHO measured compared BlandAltman Bland Altman group not Schebendachs s However

ResumoObjetivo:Analisar o impacto do índice de massa corporal no desfecho de 101 pacientes submetidos à cirurgia revascularização do miocárdio, troca valvar ou cirurgia cardíaca combinada em um hospital privado de Belo Horizonte, Minas Gerais.Métodos:Trata-se de um estudo transversal com inclusão prospectiva de pacientes submetidos à cirurgia cardíaca no período de maio de 2009 a dezembro de 2012. Todos os pacientes foram acompanhados do primeiro dia de internação até a alta hospitalar ou óbito. Os pacientes foram divididos em três grupos definidos pelo índice de massa corporal aferido no pré-operatório: eutrófico, sobrepeso e obeso. O principal desfecho avaliado neste estudo foi a associação entre índice de massa corporal e morbimortalidade pós-operatória.Resultados:análise multivariada revelou obesidade como preditor independente de aumento nas chances de reintervenção cirúrgica por deiscência de sutura de esterno (OR 13,6; IC95% 1,1-162,9; P=0,046) e redução no risco de sangramento (OR 0,05; IC95% 0,09-0,69; P=0,025). Na análise univariada, obesidade também foi associada a maior frequência de deiscência de sutura (P=0,021). Estado nutricional não foi associado à presença de outras complicações no pós-operatório e nem de mortalidade, ainda na análise univariada. No intraoperatório não houve diferença nos tempos de circulação extracorpórea e de pinçamento aórtico. No pós-operatório, os tempos de ventilação mecânica e de internação na unidade de terapia intensiva ou hospital foram semelhantes entre os pacientes eutróficos, com sobrepeso e obesos.Conclusão:Pacientes obesos apresentam risco aumentado de reintervenção cirúrgica por deiscência de sutura e menor risco sangramento no pós-operatório de cirurgia de revascularização do miocárdio, troca valvar ou cirurgia cardíaca combinada.

AbstractObjective:This study aimed to analyze the impact of body mass index on outcomes of 101 patients undergoing coronary artery bypass grafting, valve replacement, or combined valve/ coronary artery bypass grafting surgery in a private hospital in Belo Horizonte, Brazil.Methods:This was a prospective cross-sectional study of patients undergoing cardiac surgery from May 2009 to December 2012. All patients were followed up from the first day of admission until discharge or death. Patients were divided into three groups according to BMI: normal weight, overweight, and obese. The main outcome measure was the association between BMI and postoperative morbidities and mortality.Results:Multivariate analysis identified obesity as an independent predictor of increased risk of surgical reintervention (odds ratio [OR] 13.6; 95%CI 1.1 - 162.9; P=0.046) and reduced risk of bleeding (OR 0.05; 95% CI 0.09 - 0.69; P=0.025). Univariate analysis showed that obesity was associated with increased frequency of wound dehiscence (P=0.021). There was no association between BMI and other complications or mortality in univariate analysis. There was also no association between body mass index and duration of cardiopulmonary bypass, aortic clamping, mechanical ventilation, and intensive care unit or hospital stay.Conclusion:Obese individuals undergoing coronary artery bypass grafting, valve replacement, or combined surgery have a higher postoperative risk of surgical reintervention and lower chances of bleeding.

RESUMO OBJETIVOS: A doença hepática gordurosa não alcoólica éa principal causa de patologia hepática. Essencial para seu manejo éa perda de peso. Nosso objetivo foi avaliar as respostas a aconselhamento nutricional em pacientes crônicos com esta condição. METODOS: Estudo prospectivo de coorte com inclusão consecutiva de 105 indivíduos com doenca hepática gordurosa não alcoólica que receberam dieta individualizada de baixa caloria (1400-1600kcal/dia, de acordo com o sexo) e aconselhamento a cada 3 meses, durante 24 meses. A perda de peso de 5% ou mais foi considerada como resposta terapêutica adequada. RESULTADOS: Dos 105 pacientes, 45 (42,9%) não voltaram para uma segunda avaliação. A média de idade foi de 55 ± 9 anos, 81,6% eram mulheres e o índice de massa corporal foi de 31,9 (23,8-44,9) kg/m2. O tempo de seguimento foi de 6,5 (3,2-26,9) meses e número médio de entrevistas foi de 3 (2-11). A síndrome metabólica e a hipercolesterolemia foram mais comuns em mulheres. O número de indivíduos que perderam mais de 5% em peso foi: 5/20 (25%) em 6 meses; 3/15 (33%) aos 12 meses; 3/18 (17%) e aos 18 meses 4/13 (31%) no final do seguimento. A perda de peso corporal média aos 6, 12, 18 e 24 meses diminuiu significativamente. CONCLUSÕES: A adesão ao aconselhamento nutricional épobre em pacientes com doenca hepática gordurosa não alcoólica. Apenas uma pequena proporcão de pacientes que atingiu a perda de peso corporal programada a longo prazo.

BACKGROUND: Nonalcoholic fatty liver disease is the leading cause of liver pathology. The mainstay of management is weight loss. Our aim was to evaluate responses to nutritional counseling in long-term patients with this condition. METHODS: A prospective cohort study with consecutive inclusion of 105 subjects with nonalcoholic fatty liver disease who received individualized low-calories diet counseling (1400 to 1600 kcal/day according to gender) every three months for 24 months. Weight loss of 5% or more was considered as a therapeutic response. RESULTS: Out of 105 patients, 45 (42.9%) did not return for a second evaluation. Mean age was 55 ± 9 years, 81.6% were women and mean body mass index was 31.9 (23.8-44.9) kg/m2. Follow-up time was 6.5 (3.2-26.9) months and median appointment number was 3 (2-11). Metabolic syndrome and hypercholesterolemia were more common in women. The number of subjects who lost more than 5% weight was: 5/20 (25%) at 6-months; 3/15 (33%) at 12 months; 3/18 (17%) at 18 months and 4/13 (31%) at the end of follow up. The median body weight loss at 6, 12, 18 and 24 months decreased significantly. CONCLUSIONS: Adherence to nutritional counseling is poor in patients with nonalcoholic fatty liver disease. Only a very small proportion of patients reached the targeted body loss of weight on long term.

OBJECTIVE: Recent evidence suggests that non-alcoholic fatty liver disease is associated with diet. Our aim was to investigate the dietary patterns of a Brazilian population with this condition and compare them with the recommended diet. METHODS: A cross-sectional study was conducted on 96 non-alcoholic fatty liver disease patients before any dietetic counseling. All patients underwent abdominal ultrasound, biochemical tests, dietary evaluations, and anthropometric evaluations. Their food intake was assessed by a semi-quantitative food-frequency questionnaire and 24-hour food recall. RESULTS: The median patient age was 53 years, and 77% of the individuals were women. Most (67.7%) participants were obese, and a large waist circumference was observed in 80.2% subjects. Almost 70% of the participants had metabolic syndrome, and 62.3% presented evidence of either insulin resistance or overt diabetes. Most patients (51.5, 58.5, and 61.7%, respectively) exceeded the recommendations for energy intake, as well as total and saturated fat. All patients consumed less than the amount of recommended monounsaturated fatty acids, and 52.1 and 76.6% of them consumed less polyunsaturated fatty acids and fiber, respectively, than recommended. In most patients, the calcium, sodium, potassium, pyridoxine, and vitamin C intake did not meet the recommendations, and in 10.5-15.5% of individuals, the tolerable upper limit intake for sodium was exceeded. The patients presented a significantly high intake of meats, fats, sugars, legumes (beans), and vegetables and a low consumption of cereals, fruits, and dairy products compared with the recommendations. CONCLUSIONS: Although patients with non-alcoholic fatty liver disease exhibited high energy and lipid consumption, most of them had inadequate intake of some micronutrients. The possible role of nutrient-deficient intake in the development of non-alcoholic fatty liver disease warrants investigation.