Abstract Objective: Arterial hypertension (AH) is a risk factor for cardiovascular diseases (CVD). We sought to evaluate the association between two adiposity indices (visceral adiposity index [VAI] and lipid accumulation product [LAP]) with traditional markers of cardiometabolic risk in hypertensive patients. Materials and methods: This is a cross-sectional study with 1,273 subjects with hypertension treated as outpatients at a university hospital. The VAI and LAP were calculated using formulas stratified by sex. Cardiometabolic risk variables were considered: overweight, risk for waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHA), and altered biochemical test values. The predictive effect of independent variables on outcomes was assessed by multivariate linear regression analysis. There was statistical significance when p ≤ 0.05. Results: Higher cardiometabolic risk (according to BMI, WHR, WHA, and altered biochemical parameters) was associated with higher values of VAI and LAP with statistical significance (p ≤ 0.05). The regression models used explained 30.7% and 10.5% of the changes in LAP and VAI, respectively. Conclusion: LAP and VAI are associated with cardiometabolic risk parameters in the individuals evaluated, suggesting that these indices can be used to screen for CVD risk in individuals with AH.

Abstract Introduction: sarcopenia and cachexia are syndromes that result in a reduction of skeletal muscle mass, being associated with the aging process and many chronic diseases. Objective: to assess the frequency of sarcopenia as well as of cachexia and their associated factors in patients in dialysis treatment. Methodology: a cross-sectional study conducted in two dialysis treatment centers in Recife between March and September 2016. The diagnosis of sarcopenia was made according to the criteria issued by the Sarcopenia European Consensus, while that of cachexia was made in consonance with the Society for Cachexia and Wasting Disorders (SCWD). The association variables were demographic (age and sex), laboratory (C-reactive protein, serum albumin, hemoglobin, parathyroid hormone, serum creatinine), and anthropometric indicators (body mass index BMI, arm circumference AC, midarm muscular circumference MMC, triceps skinfold thickness TST). Results: the study involved 66 patients, 43.9 % men, 56.1 % women, with a mean age of 53.15 ± 15.24 years; 43.9 % were elderly subjects. Sarcopenia occurred in 59.1 % of patients; of these, 15.2 % presented with severe sarcopenia. Pre-sarcopenia was found in 4.5 %. With regard to cachexia, 15.2 % were diagnosed with this syndrome. The variables associated with sarcopenia were reduced serum albumin (p = 0.013) and cachexia (p = 0.039), and those associated with cachexia were female gender (p = 0.036) and BMI (p < 0.001). Conclusion: the main finding of the present study was the high frequency of sarcopenia found in patients on treatment with dialysis. In the patients studied, sarcopenia was significantly associated with a decrease in serum albumin. Reduced serum albumin is a predictor of mortality in patients on renal replacement therapy. A high frequency of sarcopenia has been observed among study patients. Thus, the tools currently available to assess muscle mass and muscle strength should be implemented as much as possible in clinical practice to enable the incorporation of appropriate preventive and therapeutic interventions.

Resumen Introducción: la sarcopenia y la caquexia son síndromes que producen una reducción de la masa muscular esquelética y que se asocian al proceso de envejecimiento y a muchas enfermedades crónicas. Objetivo: verificar la frecuencia de la sarcopenia, la caquexia y los factores asociados en pacientes en tratamiento dialítico. Metodología: estudio transversal realizado en dos centros de tratamiento dialítico de Recife entre marzo y septiembre de 2016. El diagnóstico de sarcopenia se realizó según el criterio del Consenso Europeo de Sarcopenia, mientras que el de caquexia se hizo por el criterio de la Society for Cachexia and Wasting Disorders (SCWD). Las variables de asociación fueron demográficas (sexo y edad), analíticas (proteína C-reactiva, albúmina sérica, hemoglobina, paratohormona y creatinina sérica) y antropométricas: índice de masa corporal (IMC), circunferencia del brazo (CB), circunferencia muscular del brazo (CMB) y pliegue cutáneo tricipital (PCT). Resultados: se estudió a 66 pacientes: el 43,9 % eran hombres y el 56,1 % mujeres, con una media de edad de 53,15 ± 15,24 años. El 43,9 % eran ancianos. La sarcopenia estuvo presente en el 59,1 % de los pacientes y, entre estos, el 15,2 % presentaban sarcopenia grave. La pre-sarcopenia se verificó en el 4,5 %. En cuanto a la caquexia, se diagnosticó en el 15,2 %. Las variables asociadas a la sarcopenia fueron la albúmina sérica reducida (p = 0,013) y la caquexia (p = 0,039); las relacionadas con la caquexia fueron el sexo femenino (p = 0,036) y el IMC (p < 0,001). Conclusión: la principal constatación es la elevada frecuencia de la sarcopenia en los pacientes que realizan terapia dialítica. En los pacientes estudiados, la sarcopenia se asoció significativamente a la disminución de la albúmina sérica. La albúmina sérica reducida es un predictor de mortandad en los pacientes en terapia renal sustitutiva. La frecuencia de la sarcopenia fue elevada en los pacientes estudiados. De este modo, las herramientas actualmente disponibles para evaluar la masa y la fuerza muscular deben aplicarse en la medida de lo posible en la práctica clínica, viabilizando la incorporación de las intervenciones preventivas y terapéuticas apropiadas.

RESUMO Objetivo: Avaliar o poder de discriminação diagnóstica da ferramenta Nutritional Risk Screening 2002. Métodos: Estudo transversal com cem participantes com idade ≥60 anos. Foram aplicados o Nutritional Risk Screening 2002 original, o Nutritional Risk Screening 2002 adaptado e o Mini Nutritional Assessment. A adaptação do Nutritional Risk Screening 2002 consistiu em diminuir o critério de idade, incluindo pontuação adicional para 60 anos de idade ou mais. Resultados: Maior risco nutricional ocorreu nos ≥70 anos quando aplicado o Nutritional Risk Screening 2002 original (p=0,009), enquanto o Nutritional Risk Screening 2002 adaptado apresentou risco nutricional semelhante em ambos os grupos (60-69 anos e ≥70 anos; p=0,117). A frequência de risco nutricional foi maior no Mini Nutritional Assessment (52,7%), seguido do Nutritional Risk Screening 2002 adaptado (35,5%) e do Nutritional Risk Screening 2002 original (29,1%). Conclusão: A adaptação do Nutritional Risk Screening 2002 mostrou-se descritivamente mais eficaz do que a original, porém mais estudos devem ser realizados para confirmar os achados.

ABSTRACT Objective: To investigate the discriminative power of Nutritional Risk Screening 2002. Methods: A cross sectional study involving one hundred participants aged ≥60 years. The original and adapted versions of Nutritional Risk Screening 2002 and the Mini Nutritional Assessment were used. Nutritional Risk Screening 2002 adaptation consisted of a lower age cutoff (60 years or older) for addition of one extra point to the final score. Results: Screening using Nutritional Risk Screening 2002 revealed higher nutritional risk among patients aged ≥70 years (p=0.009), whereas screening using the adapted version of Nutritional Risk Screening 2002 revealed similar nutritional risk in both age groups (60-69 years and ≥70 years; p=0.117). Frequency of nutritional risk was highest when the Mini Nutritional Assessment was administered (52.7%), followed by the adapted and original versions of Nutritional Risk Screening 2002 (35.5% and 29.1%, respectively). Conclusion: The adapted version of Nutritional Risk Screening 2002 was more effective than the original version. However, further studies are needed to confirm these findings.

RESUMO Objetivo: Avaliar a frequência do fenótipo cintura hipertrigliceridêmica e analisar seus fatores associados em crianças e adolescentes portadores de diabetes melito tipo 1. Métodos: Trata-se de um estudo observacional analítico com indivíduos com diabetes melito tipo 1, de cinco a 18 anos de idade, de ambos os sexos, acompanhados em um hospital universitário do Nordeste brasileiro. Foram realizadas medidas de peso, altura e circunferência da cintura, além da análise do perfil lipídico e da hemoglobina glicada. O fenótipo cintura hipertrigliceridêmica foi definido pela presença simultânea da circunferência da cintura aumentada (≥percentil 90 por idade e sexo) e dos níveis séricos de triglicerídeos elevados (≥75 mg/dL para crianças e ≥90 mg/dL para adolescentes). Investigaram-se, ainda, os antecedentes familiares para doenças cardiovasculares e diabetes, e também variáveis sociodemográficas e comportamentais. Nos testes de inferência estatística, as proporções foram comparadas pelo teste do qui-quadrado de Pearson e/ou exato de Fisher, sendo significante p<0,05. Resultados: Foram avaliados 102 pacientes, com predomínio do sexo feminino (54,9%) e de adolescentes (66,7%). A frequência de cintura hipertrigliceridêmica foi de 23,5%; a qual apresentou associação com o sexo feminino (p=0,043), excesso de peso (p=0,023), hipercolesterolemia (p=0,002), LDL elevado (p=0,001) e VLDL em valores limítrofes (<0,001). Conclusões: A frequência do fenótipo cintura hipertrigliceridêmica foi associada ao sexo feminino, ao perfil lipídico aterogênico e ao excesso ponderal, evidenciando a importância do acompanhamento nutricional dessa população, visando à redução de agravos cardiovasculares futuros.

ABSTRACT Objective: To assess the frequency of the hypertriglyceridemic waist phenotype and its associated factors in children and adolescents with type 1 diabetes mellitus. Methods: This is an observational analytical study with individuals with type 1 diabetes mellitus, aged 5 to 18 years, of both genders, followed in a university hospital in the Brazilian Northeast. Weight, height, and waist circumference were measured, and the lipid profile and glycated hemoglobin were analyzed. The hypertriglyceridemic waist phenotype was defined by the simultaneous presence of increased waist circumference (≥90th percentile for age and gender) and elevated serum triglyceride levels (≥75 mg/dL for children and ≥90 mg/dL for adolescents). We also investigated the family history of cardiovascular diseases and diabetes, as well as sociodemographic and behavioral variables. In the statistical inference tests, the proportions were compared by Pearson’s chi-square test and/or Fisher’s exact test, being significant p<0.05. Results: A total of 102 patients were evaluated, most of them females (54.9%) and adolescents (66.7%). The frequency of hypertriglyceridemic waist was 23.5%, which was associated with females (p=0.043), overweight (p=0.023), hypercholesterolemia (p=0.002), high LDL (p=0.001), and borderline VLDL (<0.001). Conclusions: The frequency of the hypertriglyceridemic waist phenotype was associated with females, atherogenic lipid profile, and overweight, indicating the importance of the nutritional monitoring of this population, aiming at reducing future cardiovascular diseases.

Abstract Background: fat-soluble vitamin deficiency may be a health problem not recognized in children and adolescents. Objective: to estimate the prevalence and factors associated with the deficiency of vitamins A, D and E among adolescent students from Northeastern Brazil. Methods: transversal study with adolescents aged 12 to 19 of both genders. A questionnaire to collect socioeconomic and lifestyle data and food intake was applied to adolescents. Then, an anthropometric evaluation and a blood sampling were performed to analyze serum concentrations of retinol, β-carotene, α -tocopherol and 25-hydroxy vitamin D (25[OH]D). Results: the intake of vitamins A (50.3%), E (94.0%) and D (99.8%), as well as α-tocopherol (88.1%), α-carotene (74.1%), 25(OH)D (50.9%) and retinol (46.6%) serum levels were mostly deficient/insufficient. An increased risk of α-tocopherol deficiency was observed in girls (PR = 1.11) and an increased risk of 25(OH)D deficiency was observed in boys (PR = 1.41). An increased likelihood of β-carotene (PR = 1.14) and 25(OH)D (PR = 1.38) insufficiency was observed in overweight individuals. Conclusions: the adolescents had a deficit in the intake and in serum levels of fat-soluble vitamins. The greatest risk of inadequacy was associated with gender and weight excess. However, the behavior of fat-soluble vitamins in adolescents needs further research.

Resumen Introducción: la deficiencia de vitaminas liposolubles puede ser un problema de salud no reconocido en niños y adolescentes. Objetivo: estimar la prevalencia y los factores asociados a la deficiencia de las vitaminas A, D y E entre adolescentes escolares del nordeste de Brasil. Métodos: estudio transversal con adolescentes de 12 a 19 años de ambos sexos. Se utilizó un cuestionario para la recolección de datos socioeconómicos, de estilo de vida y de consumo alimentario de los adolescentes. A continuación, se realizó la evaluación antropométrica y la recolección de sangre para el análisis de las concentraciones séricas de retinol, β-caroteno, α-tocoferol y 25-hidroxivitamina D (25[OH]D). Resultados: la ingesta de vitaminas A (50,3%), E (94,0%) y D (99,8%), así como los niveles séricos del α -tocoferol (88,1%), β-caroteno (74,1%), 25(OH)D (50,9%) y retinol (46,6%) se presentaron en su mayoría deficientes/insuficientes. Se observó un mayor riesgo de deficiencia del α-tocoferol en las niñas (RP = 1,11), y mayor riesgo de insuficiencia de 25(OH)D en los niños (RP = 1,41), así como mayor probabilidad de insuficiencia del β -caroteno (RP = 1,14) y 25(OH)D (RP = 1,38) en el exceso de peso. Conclusiones: los adolescentes presentaron déficit en el consumo y en los niveles séricos de las vitaminas liposolubles. El mayor riesgo de inadecuación estuvo asociado al sexo y el exceso de peso, sin embargo el comportamiento de las vitaminas liposolubles en los adolescentes necesita una mayor investigación.

OBJECTIVE: The aim of the present study was to investigate the association of the redox state via malondialdehyde (MDA) as a lipid peroxidation biomarker and hydrophilic antioxidant capacity (HAC) with dietary, anthropometric, demographic, socio-economic and clinical variables as well as the serum concentrations of vitamins in children aged 20-36 months. This cross-sectional study was conducted from May 2013 to May 2014 and included a total of 100 children. METHODS: The variables studied included anthropometric measurements, dietary intake by the Food Frequency Questionnaire (FFQ), socio-demographic features, clinical attributes, serum redox status, and serum vitamin concentrations. RESULTS: Children with a family income above the minimum wage and adequate body mass index (BMI) presented higher HAC. The MDA concentration was higher in children older than 24 months. Breastfeeding for up to 120 days provided greater antioxidant capacity. Children classified in the 2nd tertile for “fruit and vegetables” and “milk and dairy products” consumption showed lower levels of MDA. There was a positive correlation of MDA with serum vitamin A levels. These results show that among children in the 20-36 months age group, family income, breastfeeding, BMI and intake of fruits and vegetables can have an influence on the imbalance of the redox state. CONCLUSION: One strategy to prevent the imbalance between oxidants and antioxidants could be for health professionals to raise awareness among families, as such knowledge could repress/prevent the progression/initiation of several diseases in adult life.

The aim of the present study was to describe the clinical- nutritional evolution of older women submitted to Roux-en-Y gastric bypass surgery. A concurrent, retrospective study was conducted involving a sample of 16 older women with morbid obesity submitted to Rouxen- Y gastric bypass surgery between 1997 and 2010. Weight, body mass index (BMI), percentage of weight loss (%WL) and percentage of excess weight loss (%EWL) were evaluated three, six and 12 months after surgery. Preoperative comorbidities, postoperative clinical-nutritional manifestations and peri-operative mortality were also investigated. Mean age was 62.02 ± 2.02 years. A progressive reduction was found in mean body weight (116.04 ± 22.99 to 80.96 ± 21.43 Kg) and BMI (47.13 ± 8.19 to 33.42 ± 9.31 Kg/m²), with a consequent %WL of 28.60 ± 8.59% and %EWL of 64.79 ± 3.99% throughout the one-year follow-up period (p < 0.05). All patients has diseases associated with obesity, the most frequent of which were arterial hypertension (n = 16), arthropathy (n = 11), dyslipidemia (n = 9) and diabetes (n = 7). The following clinical-nutritional symptoms were reported: alopecia (n = 9), nausea/vomiting (n = 7), constipation (n = 5) and food intolerance (n = 4). One patient was diagnosed with malnutrition one year after surgery. No deaths occurred within 30 days after surgery. At the one-year evaluation, surgical success was evidenced by the significant reductions in mean weight and BMI and the more than 50% loss of excess weight.

El objetivo de este estudio fue la descripción de la evolución clinico-nutricional de mujeres mayores sometidas a cirugía de bypass gástrico en Y de Roux. Se desarrolló un estudio concurrente, retrospectivo, que incluyó una muestra de 16 mujeres mayores con obesidad mórbida sometidas a bypass gástrico en Y de Roux entre 1997 y 2010. Se evaluó el peso, índice de masa corporal (IMC), porcentaje de pérdida de peso (%WL) y porcentaje de pérdida de peso excesivo (%EWL) tres, seis y doce meses después de la cirugía. También se investigó las comorbilidades preoperatorias, manifestaciones clínico-nutricionales postoperatorias y mortalidad perioperatoria. La edad media fue 62,02 ± 2,02 años. Se detectó una reducción progresiva en el peso medio corporal (116,04 ± 22,99 a 80,96 ± 21,43 Kg) e IMC (47,13 ± 8,19 a 33,42 ± 9,31 Kg/ m²), con un consequente porcentaje de pérdida de peso (%WL) de 28,60 ± 8,59% y %EWL de 64,79 ± 3,99% a lo largo del periodo de seguimiento de un año (p < 0,05). Todas las pacientes tenían enfermedades relacionadas con obesidad, siendo la más frecuente hipertensión arterial (n = 16), artropatía (n = 11), dislipidemia (n = 9) y diabetes (n = 7). Se comunicaron los siguientes síntomas clínico-nutricionales: alopecia (n = 9), nausea/vómitos (n = 7), estreñimiento (n = 5) e intolerancia a la comida (n = 4). Una paciente fue diagnosticada de malnutrición un año después de la cirugía. No se registraron muertes tras 30 días de la cirugía. En la evaluación a un año, el éxito quirúrgico quedó constatado por las reducciones significativas en peso medio e IMC, además de más de un 50% de pérdida de peso excesivo.

Contexto Evidências sugerem um processo de transição nutricional nos pacientes com doenças inflamatórias intestinais. A obesidade, que era um distúrbio incomum nas doenças inflamatórias intestinais, cresce em paralelo com a prevalência da obesidade em toda a população, podendo aumentar o risco de doenças cardiovasculares nesta população. Objetivo Avaliar o estado nutricional e a ocorrência de fatores de risco cardiovascular em pacientes com doenças inflamatórias intestinais. Métodos Métodos – Estudo transversal, série de casos, realizado em pacientes ambulatoriais com doenças inflamatórias intestinais, adultos e de ambos os sexos. Foram obtidas variáveis demográficas, socioeconômicas, clínicas, antropométricas e os fatores de risco cardiovascular: sedentarismo, excesso de peso, obesidade abdominal, medicamentos, comorbidades, alcoolismo e tabagismo. O nível de significância foi de 5,0%. Resultados A amostra foi constituída por 80 pacientes com doenças inflamatórias intestinais, 56 (70,0%) com etocolite ulcerativa inespecífica e 24 (30,0%) com doença de Crohn, sendo a idade média 40,3±11 anos e 66,2% do sexo feminino. Elevadas frequências de excesso de peso (48,8%) e obesidade abdominal (52,5%) foram identificadas, segundo o índice de massa corporal e a circunferência da cintura, respectivamente, em ambos os grupos, e de forma mais importante na retocolite ulcerativa inespecífica. A depleção de massa muscular ocorreu em 52,5% dos pacientes segundo a circunferência muscular do braço, sendo mais depletados aqueles com (P=0,008). Dentre os fatores de risco para doenças cardiovasculares, os mais frequentes foram o sedentarismo (83,8%), o perímetro abdominal elevado (52,5%) e o excesso de peso (48,8%). Conclusão A avaliação antropométrica completa mostrou elevada frequência de déficit proteico somático ao mesmo tempo em que se encontraram elevadas frequências de excesso de peso e obesidade abdominal.

Background Evidence suggests a nutritional transition process in patients with inflammatory bowel disease. Obesity, which was once an uncommon occurrence in such patients, has grown in this population at the same prevalence rate as that found in the general population, bringing with it an increased risk of cardiovascular disease. Objective The aim of the present study was to determine the nutritional status and occurrence of cardiovascular risk factors in patients with inflammatory bowel disease. Methods A case-series cross-sectional study was conducted involving male and female adult outpatients with inflammatory bowel disease. Data were collected on demographic, socioeconomic, clinical and anthropometric variables as well as the following cardiovascular risk factors: sedentary lifestyle, excess weight, abdominal obesity, medications in use, comorbidities, alcohol intake and smoking habits. The significance level for all statistical tests was set to 5% (P< 0.05). Results The sample comprised 80 patients with inflammatory bowel disease, 56 of whom (70.0%) had ulcerative colitis and 24 of whom (30.0%) had Crohn's disease. Mean age was 40.3±11 years and the female genre accounted for 66.2% of the sample. High frequencies of excess weight (48.8%) and abdominal obesity (52.5%) were identified based on the body mass index and waist circumference, respectively, in both groups, especially among those with ulcerative colitis. Muscle depletion was found in 52.5% of the sample based on arm muscle circumference, with greater depletion among patients with Crohn’s disease (P=0.008). The most frequent risk factors for cardiovascular disease were a sedentary lifestyle (83.8%), abdominal obesity (52.5%) and excess weight (48.8%). Conclusion The results of the complete anthropometric evaluation draw one’s attention to a nutritional paradox, with high frequencies of both - muscle depletion, as well as excess weight and abdominal obesity.

OBJETIVO: avaliar a ingestão de bebidas alcoólicas nos períodos pré e pós-operatório de cirurgia bariátrica. MÉTODOS: os pacientes foram entrevistados no ambulatório de Cirurgia Geral do Hospital das Clínicas/UFPE, no período de julho/2011 a março/2012. Foram analisadas variáveis socioeconômicas, antropométricas e clínicas. A avaliação do consumo de álcool nos últimos 12 meses, foi realizada pelo questionário AUDIT C (alcohol use disorders identification test). RESULTADOS: foram estudados 119 pacientes com média de idade de 41,23+11,30 anos, com predominância do sexo feminino (83,2%), raça não branca (55%), casados ou em união estável (65,5%), com ensino médio (40,3%) e ativo ao mercado de trabalho (37%). O peso no período pré-operatório foi 128,77+25,28Kg e IMC 49,09+9,26Kg/m2, classificado em obesidade classe III, e no pós-operatório foi 87,19+19,16Kg e IMC 33,04+6,21Kg/m2, classificado em obesidade classe I, com p<0,001. A doença mais frequente no pré (66,6%) e pós operatório (36,5%) foi a hipertensão. No período pré-operatório 26,6% faziam uso de álcool, sendo 2,2% uso de alto risco e no pós-operatório 35,1%, sendo 1,4% provável dependência, não sendo encontrada diferença significativa entre os grupos de pré e pós-cirúrgico (p = 0,337). CONCLUSÃO: foi encontrada uma prevalência do uso alcoólico superior àquela detectada na população brasileira, no entanto não foi evidenciado consumo de alto risco/provável dependência, nem elevação deste consumo em período pós-operatório.

OBJECTIVE: to assess alcohol intake in the bariatric surgery pre and postoperative periods. METHODS: Patients were interviewed atSurgery Clinic of the Hospital das Clínicas da Universidade Federal de Pernambuco - HC/UFPE (Brazil) from July 2011 to March 2012. We analyzed socioeconomic, anthropometric and clinical variables. We used the Alcohol Use Disorders Identification Test (AUDIT C). RESULTS: One hundred nineteen patients were enrolled (mean age: 41.23+11.30 years), with a predominance of the female gender (83.2%), non-Caucasian race (55%), married individuals or in a stable union (65.5%), with a high school education (40.3%)and active in the job market (37%). Weight and body mass index (BMI) were 128.77+25.28Kg and 49.09+9.26Kg/m2,respectively in the preoperative period (class II obesity) and 87.19+19.16Kg and 33.04+6.21Kg/m2, respectively in the postoperative period (class I obesity) (p<0.001). Hypertension was the most frequent disease in the pre (66.6%) and postoperative (36.5%) periods. The prevalence of alcohol use was 26.6% in the preoperative period, of which 2.2% of high risk, and 35.1% in the postoperative period, of which 1.4% of probable dependence; this difference did not achieve statistical significance (p=0.337). CONCLUSION: The prevalence of abusive alcohol intake and/or probable dependence was low in both the pre and postoperative periods, with little evidence of risky consumption among the patients submitted to bariatric surgery.

OBJETIVOS: Verificar a frequência do consumo de bebidas alcoólicas e o grau de risco do hábito de etilismo em lactantes atendidas no Serviço de Puericultura do Hospital das Clínicas da Universidade Federal de Pernambuco. MÉTODOS: Estudo transversal com 157 mães lactantes matriculadas no Programa de Puericultura do hospital. Utilizou-se questionário com informações sobre variáveis demográficas, socioeconômicas, tipo e tempo de aleitamento materno, hábito de tabagismo e consumo de alimentos considerados petiscos. A avaliação do consumo de álcool nos últimos 12 meses foi realizada pelo questionário "teste de identificação de distúrbios causados pelo uso de álcool" (AUDIT C - Alcohol Use Disorders Identification Test). Para análise estatística, aplicaram-se os testes do qui-quadrado de Pearson e exato de Fisher. RESULTADOS: Verificou-se consumo de bebidas alcoólicas em 12% das lactantes; dentre estas, 100% apresentaram baixo risco para transtornos causados pelo uso do álcool. A frequência de lactantes que consumiam petiscos durante a ingestão alcoólica foi 100%, sendo os queijos os mais consumidos - 18 (95%). CONCLUSÕES: A prevalência de consumo de álcool foi baixa nas lactantes estudadas. As usuárias exibiram um consumo considerado de baixo risco e uma frequência elevada de consumo de petiscos durante a ingestão alcoólica.

OBJECTIVE: To determine the prevalence of alcohol intake and the degree of alcohol-related risk among nursing mothers attended at the Child Care Service of Hospital das Clínicas of Universidade Federal de Pernambuco, Brazil. METHODS: A cross-sectional study was carried out with 157 nursing mothers enrolled in the Child Care Program of the university hospital. A questionnaire was administered addressing demographic and socioeconomic variables, type and duration of breastfeeding, smoking habits and consumption of foods considered as appetizers. The Alcohol Use Disorders Identification Test (AUDIT C) was applied for assessing alcohol consumption in the previous 12 months. Pearson's chi-square test and Fisher's exact test were used for statistical analysis. RESULTS: Twelve percent of the nursing mothers reported consuming alcoholic beverages, 100% of whom were classified as being at low risk for alcohol use disorders. The frequency of nursing mothers who consumed appetizers during alcohol consumption was 100%, the most common of which was cheese - 18 (95%). CONCLUSIONS: The prevalence of alcohol intake was low in the nursing mothers analyzed. The users exhibited a low risk for alcohol disorders and a high frequency of the consumption of appetizers during alcohol consumption.

OBJETIVOS: Verificar la frecuencia del consumo de bebidas alcohólicas y el grado de riesgo del hábito de alcoholismo en lactantes atendidas en el Servicio de Cuidado del Niño del Hospital de Clínicas de la Universidad Federal de Pernambuco (HC/UFPE). MÉTODO: Estudio transversal con 157 madres lactantes matriculadas en el Programa de Cuidado del Niño del HC. Se utilizó cuestionario con informaciones sobre variables demográficas, socioeconómicas, tipo y tiempo de lactancia materna, hábito de tabaquismo y consumo de alimentos considerados bocados. La evaluación del consumo de alcohol en los últimos 12 meses fue realizada por el cuestionario AUDIT C (alcohol use disorders identification test). Para el análisis estadístico se utilizaron las pruebas de Chi-cuadrado de Pearson y Exacto de Fisher. RESULTADOS: El consumo de bebidas alcohólicas fue verificado en 12% de las lactantes, siendo en 100% de ellas clasificado de bajo riesgo para trastornos causados por el uso del alcohol. La frecuencia de lactantes que consumían bocados durante la ingestión alcohólica fue del 100%, siendo los quesos los más consumidos 18 (94,7%). CONCLUSIONES: La prevalencia de consumo de alcohol fue baja en las lactantes estudiadas. Las usuarias mostraron un consumo considerado de bajo riesgo y una frecuencia elevada de consumo de bocados durante la ingestión alcohólica.

OBJETIVO: A sensibilidade de indicadores antropométricos e laboratoriais, na detecção da desnutrição protéico-energética de cirróticos foi estudada em 117 adultos, com gravidades (Child-Pugh), Child A (18), B (42) e C (57). RESULTADOS: Os indicadores antropométricos mais alterados foram: a circunferência braquial 61%, a prega cutânea tricipital 55% e a prega cutânea subescapular 53%, e os laboratoriais: albumina 93% e hemoglobina 90%. Com a combinação de indicadores circunferência braquial + prega cutânea subescapular + albumina ou hemoglobina, alcançaram-se 29% de déficit, valor idêntico ao da associação apenas de circunferência braquial + prega cutânea subescapular. Essa combinação (circunferência braquial e prega cutânea subescapular) detectou 63% de desnutrição protéico-energética, com predominância das formas moderada e grave em todos os graus Child. CONCLUSÃO: A desnutrição protéico-energética na cirrose hepática é predominantemente protéica, podendo ser caracterizada por indicadores laboratoriais (mais sensíveis) ou, com maior especificidade, pela circunferência braquial, embora inespecífica à discriminação da gravidade da desnutrição protéico-energética entre os grupos Child B e C.

AIM: The prevalence and severity of protein-energy malnutrition (PEM) were investigated through the anthropometric (body mass index, triceps and subescapular skinfolds and upper arm circumferences) and blood measures in 117 cirrhotic patients. The sensitivity and specificity of single or combined PEM markers were tested among Child A (n=18), Child B (n=42) and Child C (n=57) adults (51±13y). RESULTS: Were calculated as z score and considered deficient when z<-1.28SD according to local standards. The most deficient markers where albumin (93%), hemoglobin (90%), upper arm circumference (61%), triceps (55%) and subescapular (53%) skinfolds. By combining upper arm circumference with triceps or subescapular skinfolds, PEM were detected in 63% of patients varying from 39-44% (Child A) to 64-68% (Child B or C). CONCLUSION: Thus the pattern of PEM present in cirrhosis is predominantly in their protein compartment and worsened with the severity of hepatocellular insuficiency. Upper arm circumference can be used as sensitive markers of presence and severity of PEM in cirrhotic patients but showing low specificity for discriminate PEM among Child grades (B and C) of hepatocellular dysfunctions.

Racional - A gastrectomia traz conseqüências nutricionais inevitáveis mas atenuáveis, dependendo da dietoterapia pós-operatória. Embora observada, essa desnutrição protéico-energética é pouco dimensionada, provavelmente, pela falta de consenso metodológico. Objetivo - Avaliar o grau de desnutrição protéico-energética do paciente gastrectomizado, utilizando-se de indicadores isolados ou combinados. Pacientes e Métodos - Foram estudados 71 pacientes com gastrectomia parcial (n = 53) ou total (n =18) em pós-operatório de 6 a 24 meses e 24-60 meses. Os dados dietéticos, composição corporal e bioquímicos foram analisados de acordo com o tipo de gastrectomia e tempo pós-operatório. Resultados - A cirurgia foi conseqüência de complicações de úlcera péptica (68%) ou a câncer gástrico (32%). A perda de peso foi referida por 70% dos pacientes, sendo maior no grupo gastrectomia total (16 ± 5 kg) do que no grupo gastrectomia parcial (10 ± 6 kg). Em geral, os pacientes apresentaram déficit antropométrico, albuminemia normal e baixa ingestão calórica, sugerindo deficiência energética crônica. A redução de hemoglobina, hematócrito e ferro ocorreu em maior intensidade e mais precocemente no grupo gastrectomia total. Assim, quando se associou hemoglobina aos indicadores albumina, linfócitos circunferência do braço e prega cutânea subescapular, a prevalência de desnutrição protéico-energética foi maior e em maior intensidade do que na ausência da hemoglobina. Conclusão - A gastrectomia resultou em desnutrição protéico-energética do tipo marasmática, acompanhada de anemia, mais intensa e precoce na gastrectomia total e gradativa na gastrectomia parcial, assemelhando-se à gastrectomia total no pós-operatório tardio.

Background - Gastrectomy leads to nutritional consequences that although expected, are not usually measured due to methodological limitations. Aim - To assess the protein-energy deficiency degrees estimated by isolated or combined indicators. Patients and Methods - There were studied 71 patients, who had undergone partial (n = 53) or total (n = 18) gastrectomy in the last 6-24 months (M1) or 24-60 months (M2). The dietary intake, body composition and biochemical data were estimated and compared between groups and moments. Results - The surgeries were undertaken after complications of peptic ulcer (68%) or due to gastric cancers (32%). Weight loss was referred by 70% of patients and higher (16 ± 5 x 10 ± 6 kg) in total gastrectomy group. The patients showed anthropometric deficits along with normal albumin and low energy intake, suggesting chronic-energy deficiency. Hematocrit, hemoglobin and iron showed the most prominent reductions. Anemia was installed earlier and worsened in the total gastrectomy group. Thus, when combining hemoglobin + albumin, + total lymphocyte count + arm circumference and subscapular skinfold, the protein-energy deficiency prevalence was higher and more severe than when hemoglobin was omitted. The protein-energy deficiency occurred earlier and it was more severe in total gastrectomy patients, while in partial gastrectomy the protein-energy deficiency increased in the late post-operative period. Conclusion - The protein-energy deficiency resulted from gastrectomy is more marasmus-like coarsing with anemia, both installed earlier and severer in total gastrectomy than partial gastrectomy but ending up similarly at the late postoperatory.

A doença hepática, alcoolismo e desnutrição são condições comumente associadas que interferem no metabolismo de micronutrientes. Como resultado da doença hepática pode ocorrer menor estocagem e conversão de vitaminas nas suas formas ativas, e má digestão e/ou má absorção. Há ainda o agravante do álcool diminuindo a ingestão e absorção de micronutrientes em virtude da redução da ingestão dietética e de sua associação com doença do intestino delgado ou pancreática. Outras causas de deficiências seriam: tratamento com drogas, peroxidação lipídica, déficit protéico, maior excreção urinária e aumento da necessidade e degradação de nutrientes. Como conseqüências dessas deficiências, esses pacientes apresentam usualmente anemia, esteatose hepática, estresse oxidativo e imunossupressão.

Liver disease, alcohol and malnutrition are combinations usually associated with micronutrient impairment. Chronic liver disease courses with lower storage and activation of vitamin-coenzymes related to their malabsorption. Alcohol worsens the picture by reducing food intake, increasing micronutrients utilization and decreasing their absorption secondary to either intestinal or pancreatic injuries. Other concurrent causes would be drug treatments, urinary losses, protein deficiency and oxidative stress. As consequences the clinical signs are anemia, liver steatosis, oxidative stress and immunosuppression.

A doença hepática crônica cursa, freqüentemente, com anormalidades metabólicas de macronutrientes que propiciam o desenvolvimento ou agravamento da desnutrição protéico-energética. O papel central do fígado no metabolismo dos substratos energéticos e de proteínas e aminoácidos é revisto, de modo relacionado à desnutrição protéico-energética, em pacientes com hepatopatia crônica. Aceita-se que a redução da ingestão dietética seja um dos principais componentes etiológicos da desnutrição, particularmente em pacientes alcoolistas. Acresce-se a iatrogenia pela indicação de dietas restritas e jejum prolongado aos pacientes hospitalizados. Como fatores agravantes, há má absorção intestinal de gorduras e o hipermetabolismo associado ao alcoolismo agudo. Hipoglicemia, resistência insulínica, esteatose e hipertrigliceridemia constituem achados comuns, assim como níveis elevados de alguns aminoácidos com conseqüências neurológicas. O entendimento desses mecanismos fisiopatológicos permite a intervenção nutricional apropriada reduzindo a morbidade e mortalidade desses pacientes.

Liver chronic pathologies often courses with metabolic abnormalities of macronutrients leading to or aggravating a protein-energy malnutrition status. This review raised the major pathophysiologycal mechanisms related to the protein-energy malnutrition in chronic liver patients. By large the reduced dietary intake is the most accepted cause particularly among alcoholic patients. Moreover during the treatment prevails the iatrogenic anorexia by unpalatable (restricted) diets interpolated with long-lasting fastings of hospitalyzed patients. Intestinal fat malabsorption is a common finding whereas hypermetabolism can be found associated with an acute alcoholism. Hipoglycemia or insulin resistance, hypertriglyceridemia and liver steatosis are common findings as well as lower plasma proteins along with higher levels of ammonia, aromatic and sulfer amino acids leading to neurological outcomes. The knowledge of these metabolic changes allow proper dietary interventions toward reduced morbi-mortality of those patients.