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Pre-exercise meal on oxidation of energy substrates during maximal exercise test in non-trained individuals
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Silva, Lucas Ribeiro da

; Stefani, Giuseppe Potrick

; Dorneles, Gilson Pires

; Marcadenti, Aline

; Lago, Pedro Dal

Archives of Endocrinology and Metabolism

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2023, Volume 67 N. 5 elocation e000618

Abstract: En | Text: En | PDF: En

ABSTRACT Objective: This study aimed to compare the influence of a high carbohydrate meal versus high-fat meal on the oxidation of substrates during an exercise incremental test. Materials and methods: Ten untrained male subjects underwent two days of the protocol. Randomly, they received a high carbohydrate meal or a high-fat meal, receiving the other one in the next protocol. On both days, they performed an incremental treadmill test, with heart rate and maximal oxygen consumption to estimate the oxidation of substrates. Results: The high-fat meal showed an increase in the absolute amount of oxidized fat along with the incremental test (P < 0.05; effect size = 0.9528), and a reduction in the respiratory exchange ratio at low intensities (P < 0.05; effect size = 0.7765). Conclusions: The meals presented no difference when compared to maximum oxidation point of substrates, the oxidation rate of substrates over time, and heart rate. A pre-test high-fat meal in untrained individuals was shown to be a modulating factor of total oxidized fats throughout the exercise, although it did not exert a significant effect on the rate of this oxidation over time.

https://doi.org/10.20945/2359-3997000000618

Documentação automatizada de parâmetros vitais em enfermarias utilizando estações portáteis - Efeito no acionamento adequado do time de resposta rápida: um protocolo de um ensaio clínico randomizado em clusters
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Ribeiro, José Cesar

; Sgorbissa, Cristina

; Silva, Karla Aparecida

; Braz, Maria de Lourdes Dias

; Horak, Ana Clara Peneluppi

; Nicola, Marina Lazzari

; Gurgel, Rodrigo Magalhães

; Tokunaga, Samira Martins

; Negrelli, Karina Leal

; Murizine, Gabriela Souza

; Medrado Júnior, Fernando

; Coli, Rita de Cassia Pires

; Cavalcanti, Alexandre Biasi

; Marcadenti, Aline

Revista Brasileira de Terapia Intensiva

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jul 2022, Volume 34 N. 3 Pages 319 - 326

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Avaliar a eficácia da solução Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ em acionar o time de resposta rápida em tempo hábil, em comparação com o acionamento manual. Métodos: O estudo Hillrom é um ensaio clínico unicêntrico, aberto, de superioridade, randomizado em clusters em paralelo (taxa de alocação 1:1) realizado em um hospital terciário. Serão incluídos dois grupos de três enfermarias com 28 leitos (um grupo intervenção e um grupo controle). As enfermarias serão distribuídas aleatoriamente para utilizar a solução automatizada Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ (grupo intervenção) ou para manter a rotina habitual (grupo controle) em relação ao acionamento do time de resposta rápida. O desfecho primário será o número absoluto de ocorrências de acionamento do time de resposta rápida em tempo hábil. Como desfechos secundários, características clínicas como mortalidade, parada cardíaca, necessidade de internação em unidade de terapia intensiva e duração da hospitalização serão avaliadas de forma exploratória de acordo com os grupos. Estimou-se uma amostra de 216 acionamentos de time de resposta rápida, para identificar uma possível diferença entre os grupos. O protocolo foi aprovado pelo Comitê de Ética em Pesquisa institucional. Resultados esperados: Espera-se que a solução automatizada Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ seja mais eficaz no acionamento do sistema de chamada de enfermeiros, para acionar o time de resposta rápida em tempo hábil e de maneira adequada, em comparação com o acionamento manual (prática habitual). ClinicalTrials.gov: NCT04648579

ABSTRACT Objective: To evaluate the effectiveness of the Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ solution in activating the rapid response team in a timely manner compared to manual activation. Methods: The Hillrom study is a single-center, open-label, superiority, cluster-randomized, parallel-group (1:1 allocation ratio) clinical trial that will be conducted in a tertiary hospital. Two sets of three wards with 28 beds will be included (one as the intervention cluster and the other as the control). The wards will be randomly assigned to use the Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ automated solution (intervention cluster) or to maintain the usual routine (control cluster) regarding rapid response team activation. The primary outcome will be the absolute number of episodes of rapid response team triggering in an appropriate time; as secondary outcomes, clinical features (mortality, cardiac arrest, need for intensive care unit admission and duration of hospitalization) will be assessed according to clusters in an exploratory way. A sample size of 216 rapid response team activations was estimated to identify a possible difference between the groups. The protocol has been approved by the institutional Research Ethics Committee. Expected results: The Welch Allyn Connex® Spot Monitor/Hillrom Connecta™ automated solution is expected to be more effective in triggering the nurse call system to activate the rapid response team in a timely and adequate manner compared to manual triggering (usual practice). ClinicalTrials.gov: NCT04648579

https://doi.org/10.5935/0103-507x.20220101-pt

Antivirais para pacientes adultos hospitalizados com infecção por SARS-CoV-2: Um estudo de Fase II/III, randomizado, multicêntrico, controlado por placebo, adaptativo, com múltiplos braços e estágios. COALITION COVID-19 BRAZIL IX - REVOLUTIOn: protocolo e plano de análise estatística
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Maia, Israel Silva

; Marcadenti, Aline

; Zampieri, Fernando Godinho

; Damiani, Lucas Petri

; Santos, Renato Hideo Nakagawa

; Negrelli, Karina Leal

; Gomes, Samara Pinheiro do Carmo

; Gomes, Jaqueline Oliveira

; Carollo, Mariana Barbosa dos Santos

; Miranda, Tamiris Abait

; Santucci, Eliana

; Valeis, Nanci

; Laranjeira, Ligia Nasi

; Westphal, Glauco Adrieno

; Horta, Jacques Gabriel Alvares

; Flato, Uri Adrian Prync

; Fernandes, Camilo

; Barros, Waldemar Carlos

; Bolan, Renata S

; Gebara, Otávio Celso Eluf

; Alencar Filho, Meton Soares de

; Hamamoto, Victor Augusto

; Hernandes, Mauro Esteves

; Golin, Nicole Alberti

; Olinda, Ronald Torres de

; Machado, Flávia Ribeiro

; Rosa, Régis Goulart

; Veiga, Viviane Cordeiro

; Azevedo, Luciano César Pontes de

; Avezum, Alvaro

; Lopes, Renato Delascio

; Souza, Tiago Moreno L

; Berwanger, Otávio

; Cavalcanti, Alexandre Biasi

Revista Brasileira de Terapia Intensiva

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mar 2022, Volume 34 N. 1 Pages 44 - 55

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Os medicamentos reaproveitados são importantes em contextos de recursos limitados porque as intervenções estão mais rapidamente disponíveis, já foram testadas com segurança em outras populações e são, em geral, mais baratas. Os medicamentos reaproveitados são uma solução eficaz, especialmente para doenças emergentes, como a COVID-19. O estudo REVOLUTIOn visa avaliar três medicamentos antivirais reaproveitados: atazanavir, daclatasvir e sofosbuvir, já utilizados em pacientes infectados pelo HIV ou pelo vírus da hepatite C, em um estudo randomizado, controlado por placebo, adaptativo, multibraço e em múltiplos estágios. Os medicamentos serão testados simultaneamente em um ensaio de Fase II para primeiro identificar se algum deles, isoladamente ou em combinação, reduz a carga viral. Se reduzirem, será iniciado um estudo de Fase III para investigar se tais medicamentos são capazes de aumentar o número de dias sem suporte respiratório. Os participantes devem ser adultos hospitalizados com idade ≥ 18 anos com início dos sintomas ≤ 9 dias e saturação de oxigênio ≤ 94% em ar ambiente ou necessidade de oxigênio suplementar para manter saturação de oxigênio > 94%. O tamanho total esperado da amostra varia entre 252 e 1.005 participantes, dependendo do número de estágios que serão concluídos no estudo. Assim, o protocolo é aqui descrito em detalhes, juntamente do plano de análise estatística. Em conclusão, o estudo REVOLUTIOn foi concebido para fornecer evidências se o atazanavir, o daclatasvir ou o sofosbuvir reduzem a carga viral de SARS-CoV-2 em pacientes com COVID-19 e aumentam o número de dias em que os pacientes ficam sem suporte respiratório. Neste artigo de protocolo, descrevem-se a fundamentação, o desenho e a situação do ensaio. Identificador do ClinicalTrials.gov:NCT04468087

ABSTRACT Repurposed drugs are important in resource-limited settings because the interventions are more rapidly available, have already been tested safely in other populations and are inexpensive. Repurposed drugs are an effective solution, especially for emerging diseases such as COVID-19. The REVOLUTIOn trial has the objective of evaluating three repurposed antiviral drugs, atazanavir, daclatasvir and sofosbuvir, already used for HIV- and hepatitis C virus-infected patients in a randomized, placebo-controlled, adaptive, multiarm, multistage study. The drugs will be tested simultaneously in a Phase II trial to first identify whether any of these drugs alone or in combination reduce the viral load. If they do, a Phase III trial will be initiated to investigate if these medications are capable of increasing the number of days free respiratory support. Participants must be hospitalized adults aged ≥ 18 years with initiation of symptoms ≤ 9 days and SpO2 ≤ 94% in room air or a need for supplemental oxygen to maintain an SpO2 > 94%. The expected total sample size ranges from 252 to 1,005 participants, depending on the number of stages that will be completed in the study. Hence, the protocol is described here in detail together with the statistical analysis plan. In conclusion, the REVOLUTIOn trial is designed to provide evidence on whether atazanavir, daclatasvir or sofosbuvir decrease the SARS-CoV-2 load in patients with COVID-19 and increase the number of days patients are free of respiratory support. In this protocol paper, we describe the rationale, design, and status of the trial. ClinicalTrials.gov identifier:NCT04468087

https://doi.org/10.5935/0103-507x.20220002-pt

Association between Deep Subcutaneous Adipose Tissue Estimated by DAAT Index and Dietary Intake in Patients with Acute Coronary Syndrome
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Stein, Elana

; Barbiero, Sandra

; Lucia Portal, Vera

; Luz, Victória da

; Marcadenti, Aline

International Journal of Cardiovascular Sciences

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feb 2022, Volume 35 N. 1 Pages 39 - 45

Abstract: En | Text: En | PDF: En

Abstract Background: Abdominal obesity has been associated with cardiovascular disease and may be modulated by dietary intake. The deep abdominal subcutaneous adipose tissue (dSAT) is a body fat compartment that can be estimated by using mathematical formulas. Objectives: To evaluate the association between dSAT estimated by the Deep-Abdominal-Adipose-Tissue (DAAT) index and dietary intake in patients with acute coronary syndrome (ACS). Methods: This is a cross-sectional study conducted with patients ≥ 18 years of age admitted to a tertiary hospital. Sociodemographic, clinical, and anthropometric (body weight [kg], height [m], waist, hip and neck circumferences [cm]) data were evaluated. A food frequency questionnaire was applied to identify each patient's nutrient intake. The DAAT index was calculated according to specific formulas for men and women. Possible association between food intake and the DAAT index was evaluated by multiple linear regression. The level of significance adopted was 0.05. Results: This study evaluated 138 patients, with a mean age of 61.2±10.8 years. Prevalence of obesity was 29.4% in men and 37.7% in women. Regarding waist circumference, 83% of the women showed values considered to be very high. The DAAT index was significantly higher in men when compared to woman (P < 0.0001) and proved to be positively correlated with proteins (r= 0.22, P= 0.01) and monounsaturated fatty acid (r= 0.18, P= 0.04) intake in the entire sample. After adjustment for sex, alcohol consumption, and levels of physical activity, the DAAT index was associated with the female sex (B= −129.84, P <0.001) and a sedentary lifestyle (B= 57.99, P <0.001). Conclusion: dSAT estimated by the DAAT index was not associated with dietary intake in patients with ACS.

https://doi.org/10.36660/ijcs.20200334

Resposta para: Complementariedade do escore NUTRIC modificado com ou sem proteína C-reativa e avaliação subjetiva global na predição de mortalidade em pacientes críticos
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Oliveira, Manoela Lima

; Heyland, Daren Keith

; Silva, Flávia Moraes

; Rabito, Estela Iraci

; Rosa, Mariane

; Tarnowski, Micheli da Silva

; Fernandes, Daieni

; Marcadenti, Aline

Revista Brasileira de Terapia Intensiva

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jan 2021, Volume 33 N. 1 Pages 181 - 182

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.5935/0103-507x.20210022 124 downloads

Hospital Malnutrition, Inflammation, and Cardiovascular Diseases
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Weschenfelder, Camila

; Marcadenti, Aline

International Journal of Cardiovascular Sciences

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dec 2020, Volume 33 N. 6 Pages 635 - 636

Abstract: En | Text: En | PDF: En

https://doi.org/10.36660/ijcs.20200273 194 downloads

Nutritional status and appetite-regulating hormones in early treatment of acute lymphoblastic leukemia among children and adolescents: a cohort study
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Gomes, Camila de Carvalho

; Silva, Cassia Camila Gomes da

; Nascimento, Paulo Ricardo Porfírio do

; Lemos, Telma Maria de Araújo Moura

; Marcadenti, Aline

; Markoski, Melissa Medeiros

; Fayh, Ana Paula Trussardi

Sao Paulo Medical Journal

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mar 2020, Volume 138 N. 2 Pages 118 - 125

Abstract: En | Text: En | PDF: En

ABSTRACT BACKGROUND: Children with acute lymphoblastic leukemia are at risk of malnutrition, but few studies have described the changes in nutritional status during the different phases of chemotherapy. OBJECTIVE: To evaluate changes in nutritional status, food intake and appetite-regulating hormones among children and adolescents with acute lymphoblastic leukemia in the first phase of chemotherapy. DESIGN AND SETTING: Cohort study developed in the pediatric oncology departments of two hospitals in the city of Natal, Rio Grande do Norte, Brazil. METHODS: Fourteen children/adolescents (mean age of 7 years; 50% female) with acute lymphoblastic leukemia were monitored over the 28 days of an induction chemotherapy cycle. Anthropometric measurements, 24-hours food weight records and appetite-regulating hormone levels (ghrelin, leptin, insulin and cortisol) were obtained at three different times (before, in the middle and at the end of the induction phase). RESULTS: Most of the patients (85.7%) had normal weight at the beginning of the treatment, and this did not change significantly during the 28 days. Energy and nutrient intakes improved from the start of the treatment to the midpoint, according to the ghrelin levels (from 511.1 ± 8.3 to 519.3 ± 6.6 pg/ml; P = 0.027). Other appetite-regulating hormones did not present changes. CONCLUSION: Food consumption improves during the first phase of treatment, without alterations in anthropometric nutritional status.

https://doi.org/10.1590/1516-3180.2019.0307.r1.19112019 1086 downloads

Association between salt taste sensitivity threshold and blood pressure in healthy individuals: a cross-sectional study
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Martinelli, Jéssica

; Conde, Simara Rufatto

; Araújo, Aline Ramos de

; Marcadenti, Aline

Sao Paulo Medical Journal

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feb 2020, Volume 138 N. 1 Pages 4 - 10

Abstract: En | Text: En | PDF: En

ABSTRACT BACKGROUND: Hypertension is an important public health problem. Overweight and high salt intake are risk factors for its development. OBJECTIVE: To evaluate the association between salt taste sensitivity threshold (STST) and blood pressure (BP) in healthy adults. DESIGN AND SETTING: Cross-sectional study conducted in a private institution. METHODS: 104 healthy adults (aged 18-59 years) were evaluated. Sociodemographic, clinical and dietary data were collected. Nutritional status and BP were assessed using body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP) and diastolic blood pressure (DBP). STST was assessed using graded saline solutions with sodium chloride concentrations ranging from 0.228 to 58.44 g/l. Identification of salty taste in solutions ≥ 3.652 g/l was used as the cutoff point for high STST. RESULTS: Participants with high STST presented higher daily average intakes for energy (2017.4 ± 641.5 versus 1650.5 ± 357.7 kcal/day; P = 0.01) and sodium (3070.2 ± 1195.1 versus 2435.2 ± 963.6 mg/day; P = 0.01) and higher BMI (P = 0.008) and WC (P = 0.002). After adjustment for age, sex, sodium and potassium intake, WC and family history of hypertension, the averages for SBP and DBP in subjects with high STST were higher than in those with normal STST (SBP: 138.2 ± 1.7 versus 119.7 ± 0.9 mmHg; P < 0.001; DBP: 81.2 ± 1.9 versus 75.1 ± 1.0 mmHg; P = 0.008). CONCLUSION: High STST was associated with elevated blood pressure in healthy adults, regardless of other risk factors for hypertension.

https://doi.org/10.1590/1516-3180.2019.0166.r1.02102019 865 downloads

Complementariedade do escore NUTRIC modificado com ou sem proteína C-reativa e avaliação subjetiva global na predição de mortalidade em pacientes críticos
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Oliveira, Manoela Lima

; Heyland, Daren Keith

; Silva, Flávia Moraes

; Rabito, Estela Iraci

; Rosa, Mariane

; Tarnowski, Micheli da Silva

; Fernandes, Daieni

; Marcadenti, Aline

Revista Brasileira de Terapia Intensiva

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dec 2019, Volume 31 N. 4 Pages 490 - 496

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Avaliar a concordância entre o escore NUTRIC modificado e o escore NUTRIC com proteína C-reativa na identificação de pacientes em risco nutricional e na predição da mortalidade entre pacientes críticos. Avaliou-se também o risco de óbito com agrupamento dos pacientes segundo o risco nutricional e a desnutrição detectada pela avaliação subjetiva global. Métodos: Estudo de coorte em pacientes admitidos em uma unidade de terapia intensiva. O risco nutricional foi avaliado por meio do escore NUTRIC modificado e uma versão do escore NUTRIC com proteína C-reativa. Aplicou-se avaliação subjetiva global para diagnóstico de desnutrição. Calculou-se a estatística de Kappa e construiu-se uma curva ROC considerando o NUTRIC modificado como referência. A validade preditiva foi avaliada considerando a mortalidade em 28 dias (na unidade de terapia intensiva e após a alta) como desfecho. Resultados: Estudaram-se 130 pacientes (63,05 ± 16,46 anos, 53,8% do sexo masculino). Segundo o NUTRIC com proteína C-reativa, 34,4% foram classificados como escore alto, enquanto 28,5% dos pacientes tiveram esta classificação com utilização do NUTRIC modificado. Segundo a avaliação subjetiva global, 48,1% dos pacientes estavam desnutridos. Observou-se concordância excelente entre o NUTRIC modificado e o NUTRIC com proteína C-reativa (Kappa = 0,88; p < 0,001). A área sob a curva ROC foi igual a 0,942 (0,881 - 1,000) para o NUTRIC com proteína C-reativa. O risco de óbito em 28 dias estava aumentado nos pacientes com escores elevados pelo NUTRIC modificado (HR = 1,827; IC95% 1,029 - 3,244; p = 0,040) e pelo NUTRIC com proteína C-reativa (HR = 2,685; IC95% 1,423 - 5,064; p = 0,002). Observou-se elevado risco de óbito nos pacientes com alto risco nutricional e desnutrição, independentemente da versão do NUTRIC aplicada. Conclusão: A concordância entre o escore NUTRIC modificado e o NUTRIC com proteína C-reativa foi excelente. Além disto, a combinação da avaliação com um escore NUTRIC mais avaliação subjetiva global pode aumentar a precisão para predição de mortalidade em pacientes críticos.

ABSTRACT Objective: To evaluate the concordance between the modified NUTRIC and NUTRIC with C-reactive protein instruments in identifying nutritional risk patients and predicting mortality in critically ill patients. The risk of death in patient groups was also investigated according to nutritional risk and malnutrition detected by subjective global assessment. Methods: A cohort study of patients admitted to an intensive care unit. Nutritional risk was assessed by modified NUTRIC and a version of NUTRIC with C-reactive protein. Subjective global assessment was applied to diagnose malnutrition. Kappa statistics were calculated, and an ROC curve was constructed considering modified NUTRIC as a reference. The predictive validity was assessed considering mortality in 28 days (whether in the intensive care unit or after discharge) as the outcome. Results: A total of 130 patients were studied (63.05 ± 16.46 years, 53.8% males). According to NUTRIC with C-reactive protein, 34.4% were classified as having a high score, while 28.5% of patients had this classification with modified NUTRIC. According to SGA 48.1% of patients were malnourished. There was excellent agreement between modified NUTRIC and NUTRIC with C-reactive protein (Kappa = 0.88, p < 0.001). The area under the ROC curve was equal to 0.942 (0.881 - 1.000) for NUTRIC with C-reactive protein. The risk of death within 28 days was increased in patients with high modified NUTRIC (HR = 1.827; 95%CI 1.029 - 3.244; p = 0.040) and NUTRIC with C-reactive protein (HR = 2.685; 95%CI 1.423 - 5.064; p = 0.002) scores. A high risk of death was observed in patients with high nutritional risk and malnutrition, independent of the version of the NUTRIC score applied. Conclusion: An excellent agreement between modified NUTRIC and NUTRIC with C-reactive protein was observed. In addition, combining NUTRIC and subjective global assessment may increase the accuracy of predicting mortality in critically ill patients.

https://doi.org/10.5935/0103-507x.20190086 1169 downloads

10.

Left lateral intercostal region versus subxiphoid position for pleural drain during elective coronary artery bypass graft surgery: randomized clinical trial
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Simon, Sandra

; Coronel, Christian

; Almeida, Adriana Silveira de

; Marcadenti, Aline

Sao Paulo Medical Journal

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feb 2019, Volume 137 N. 1 Pages 66 - 74

Abstract: En | Text: En | PDF: En

ABSTRACT BACKGROUND: The pleural drain insertion site after coronary artery bypass graft (CABG) surgery may alter lung function, especially respiratory muscle strength. The main objective of this study was to compare the effectiveness and safety of use of the left lateral intercostal region versus the subxiphoid position for pleural drainage during elective CABG surgery using extracorporeal circulation (ECC). DESIGN AND SETTING: Randomized trial conducted in a tertiary-level hospital in Porto Alegre, Brazil. METHODS: 48 patients were assigned to group 1 (pleural drain in the left lateral intercostal region) or group 2 (pleural drain in the subxiphoid position). Respiratory muscle strength was measured in terms of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), in cmH2O, by means of manovacuometry preoperatively, 24 and 72 hours after drain removal and before discharge from hospital. Painand dyspnea scales, presence of infections, pleural effusion and atelectasis, duration of drain use, drainage volumes and surgical reinterventions were also evaluated. RESULTS: After adjustments, there were no significant differences between the groups at the end of the study (before discharge), in predicted percentages either for MIP (delta group 1: -17.21% versus delta group 2: -22.26%; P = 0.09) or for MEP (delta group 1: -9.38% versus delta group 2: -13.13%; P = 0.17). Therewere no differences between the groups in relation to other outcomes. CONCLUSION: There was no difference in maximal respiratory pressures in relation to the pleural drain insertion site among patients who underwent CABG surgery using ECC. TRIAL REGISTRATION: ReBEc V1111.1159.4447.

https://doi.org/10.1590/1516-3180.2018.040940119 750 downloads

11.

Enlarged waist combined with elevated triglycerides (hypertriglyceridemic waist phenotype) and HDL-cholesterol in patients with heart failure
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Weschenfelder, Camila

; Marcadenti, Aline

; Stein, Airton Tetelbom

; Gottschall, Catarina Bertaso Andreatta

Sao Paulo Medical Journal

Journal Metrics
- Sobre o periódico
- SciELO Analytics

jan 2017, Volume 135 N. 1 Pages 50 - 56

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO CONTEXTO E OBJETIVO: A associação de triglicerídeos séricos e circunferência da cintura parece ser um bom marcador de risco cardiovascular e é denominada fenótipo da cintura hipertrigliceridêmica. O objetivo do estudo foi avaliar a associação entre o fenótipo da cintura hipertrigliceridêmica e o HDL-colesterol em pacientes portadores de insuficiência cardíaca. TIPO DE ESTUDO E LOCAL: Estudo transversal em um hospital terciário no sul do Brasil. MÉTODOS: Foram incluídos indivíduos com insuficiência cardíaca com idade > 40 anos. Foram realizadas as medidas antropométricas (peso, estatura, circunferência da cintura e do quadril) e calculados índice de massa corporal e relação cintura quadril, e foi avaliado o perfil lipídico (colesterol total, LDL-colesterol, HDL-colesterol e triglicerídeos séricos). Em homens e mulheres, respectivamente, circunferência da cintura ≥ 94 cm e ≥ 80 cm e triglicerídeos ≥ 150 mg/dl foram considerados anormais e usados para identificação do fenótipo da cintura hipertrigliceridêmica. Análises de covariância foram usadas para avaliar possíveis associações entre níveis de HDL-colesterol e o fenótipo da cintura hipertrigliceridêmica de acordo com o sexo. RESULTADOS: Foram incluídos 112 participantes e 62,5% eram homens. A média de idade foi de 61,8 ± 12,3 anos e a fração de ejeção média foi 40,1 ± 14,7%. Homens e mulheres apresentaram médias de HDL-colesterol 40,5 ± 14,6 e 40,9 ± 12,7 mg/dl, respectivamente. A prevalência do fenótipo da cintura hipertrigliceridêmica na amostra foi de 25%. Observou-se diferença significativa entre as médias de HDL-colesterol entre homens com e sem o fenótipo da cintura hipertrigliceridêmica (32,8 ±14,2 versus 42,1 ± 13,7 mg/dl, P = 0,04), mesmo após ajuste para idade, índice de massa corporal, diabetes mellitus tipo 2, uso de estatinas e etiologia da insuficiência cardíaca. CONCLUSÕES: O fenótipo da cintura hipertrigliceridêmica está associado significativamente com menores níveis de HDL-colesterol em homens com insuficiência cardíaca.

ABSTRACT CONTEXT AND OBJECTIVE: The association of serum triglycerides plus waist circumference seems to be a good marker of cardiovascular risk and has been named the “hypertriglyceridemic waist” phenotype. The aim of our study was to investigate the association between the hypertriglyceridemic waist phenotype and HDL-cholesterol among patients with heart failure. DESIGN AND SETTING: Cross-sectional study in a tertiary-level hospital in southern Brazil. METHODS: We included patients with heart failure aged > 40 years. Anthropometric assessment (weight, height, waist and hip circumferences) was performed; body mass index (BMI) and waist-hip ratio were calculated and lipid measurements (serum total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides) were collected. In men and women, respectively, waist circumference ≥ 94 cm and ≥ 80 cm, and triglycerides ≥ 150 mg/dl were considered abnormal and were used to identify the hypertriglyceridemic waist phenotype. Analyses of covariance were used to evaluate possible associations between levels of HDL-cholesterol and the hypertriglyceridemic waist phenotype, according to sex. RESULTS: 112 participants were included, of whom 62.5% were men. The mean age was 61.8 ± 12.3 years and the mean ejection fraction was 40.1 ± 14.7%. Men and woman presented mean HDL-cholesterol of 40.5 ± 14.6 and 40.9 ± 12.7 mg/dl, respectively. The prevalence of the hypertriglyceridemic waist phenotype was 25%. There was a significant difference in mean HDL-cholesterol between men with and without the hypertriglyceridemic waist phenotype (32.8 ± 14.2 versus 42.1 ± 13.7 mg/dl respectively; P = 0.04), even after adjustment for age, body mass index, type 2 diabetes mellitus, use of statins and heart failure etiology. CONCLUSIONS: The hypertriglyceridemic waist phenotype is significantly associated with lower HDL-cholesterol levels in men with heart failure.

https://doi.org/10.1590/1516-3180.2016.004519102016 2102 downloads

12.

Increased ultrasensitive C-reactive protein is not associated with obesity in hospitalized heart failure patients
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Schommer, Vânia Ames

; Stein, Airton Tetelbom

; Marcadenti, Aline

; Wittke, Estefania Inez

; Galvão, André Luís Câmara

; Rosito, Guido Bernardo Aranha

einstein (São Paulo)

Journal Metrics
- Sobre o periódico
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sep 2016, Volume 14 N. 3 Pages 352 - 358

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Avaliar a associação entre obesidade e níveis de proteína c-reativa ultrassensível (PCR-us) em pacientes com insuficiência cardiac admitidos em um hospital terciário. Métodos: Estudo transversal com amostragem consecutiva de pacientes com insuficiência cardíaca hospitalizados. Foram coletados dados sociodemográficos e clínicos, e o estado nutricional foi avaliado por meio de indicadores como índice de massa corporal (em kg/m2), circunferência da cintura (em cm), razão cintura-quadril, dobra cutânea tricipital (em mm) e dobra cutânea subescapular (em mm). Circunferência do pescoço (em cm) foi aferida bem como níveis séricos de PCR-us, em mg/L. Resultados: Em 123 pacientes, a média da idade foi 61,9±12,3 anos, e 60,2% eram do sexo masculino. A mediana de PCR-us foi de 8,87mg/L (3,34 a 20,01). Detectou-se tendência à correlação inversa entre circunferência do pescoço e PCR-us (r=-0,167; p=0,069). Na análise por regressão linear múltipla, após ajustes para idade, gravidade da doença (classificação NYHA III e IV, fração de ejeção baixa, disfunção ventricular esquerda durante a diástole) e quadros infecciosos, houve associação inversa entre PCR-us e circunferência do pescoço (ß=-0,196; p=0,03) e dobra cutânea subescapular (ß=-0,005; p=0,01) na amostra total, que não se manteve após estratificação para sexo. Conclusão: O aumento dos níveis de PCR-us em pacientes hospitalizados por insuficiência cardíaca não se associou à obesidade.

ABSTRACT Objective: To evaluate the association between obesity and levels of high-sensitivity C-reactive protein (hs-CRP) in patients with heart failure admitted to a tertiary hospital. Methods: Cross-sectional study with a consecutive sampling of hospitalized patients with heart failure. Sociodemographic and clinical data were collected, and the nutritional status was assessed through indicators such as body mass index (in kg/m2), waist circumference (in cm), waist-hip ratio, triceps skinfold (in mm) and subscapularis skinfold (in mm). Neck circumference (in cm) was measured as well as serum levels of hs-CRP, in mg/L. Results: Among 123 patients, the mean age was 61.9±12.3 years and 60.2% were male. The median of hs-CRP was 8.87mg/L (3.34 to 20.01). A tendency to an inverse correlation between neck circumference and hs-CRP was detected (r=-0.167; p=0.069). In the multiple linear regression analysis, after adjustment for age, disease severity (NYHA classification III and IV, low ejection fraction, left ventricular dysfunction during diastole), and infectious conditions there was an inverse association between hs-CRP and neck circumference (ß=-0.196; p=0.03) and subscapularis skinfold (ß=-0.005; p=0.01) in the total sample, which was not maintained after the stratification by sex. Conclusion: Increased levels of hs-CRP in patients hospitalized for heart failure were not associated with obesity.

https://doi.org/10.1590/S1679-45082016AO3705 3112 downloads

13.

Visceral adiposity index and prognosis among patients with ischemic heart failure
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Vogel, Patrícia

; Stein, Airton

; Marcadenti, Aline

Sao Paulo Medical Journal

Journal Metrics
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jun 2016, Volume 134 N. 3 Pages 211 - 218

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO CONTEXTO E OBJETIVOS: O paradoxo da obesidade já está consolidado na insuficiência cardíaca, mas não se sabe qual indicador de obesidade melhor reflete esse fenômeno. Este estudo teve como objetivo avaliar a associação entre índices de obesidade e a mortalidade entre pacientes com insuficiência cardíaca. TIPO DE ESTUDO E LOCAL: Estudo de coorte realizado no Departamento de Cardiologia do Hospital Nossa Senhora da Conceição (Brasil). MÉTODOS: Foram incluídos 116 pacientes com diagnóstico de insuficiência cardíaca de 30 a 85 anos. Dados clínicos, demográficos, socioeconômicos, bioquímicos e antropométricos foram avaliados. Área de gordura do braço, índice de massa corporal, área de superfície corporal, índice de adiposidade corporal, produto da acumulação lipídica e índice de adiposidade visceral foram calculados; regressão de Cox foi usada para realizar análises de sobrevida. RESULTADOS: No início do estudo, indivíduos com insuficiência cardíaca isquêmica que se mantiveram vivos mostraram valores mais elevados de índice de adiposidade visceral (3,60 ± 3,71 contra 1,48 ± 1,58, P = 0,04) e uma tendência para produto da acumulação lipídica maior quando comparados com os indivíduos que morreram. Após acompanhamento médio de 14,3 meses, os pacientes com insuficiência cardíaca isquêmica que apresentaram índice de adiposidade visceral > 1,21 tiveram 78% menor risco de morrer (HR 0,12; IC 95% 0,02-0,67, P = 0,02) e as curvas de Kaplan-Meier para sobrevida mostraram melhor prognóstico nesses indivíduos (P = 0,005, teste log-rank). CONCLUSÃO: Nossos resultados sugerem que o índice de adiposidade visceral é um bom preditor de melhor prognóstico em pacientes com insuficiência cardíaca isquêmica.

ABSTRACT: CONTEXT AND OBJECTIVES: The obesity paradox has already been established in relation to heart failure, but it is not known which obesity indicator best reflects this phenomenon. The aim of this study was to evaluate the association between obesity indexes and mortality among patients with heart failure. DESIGN AND SETTING: Cohort study conducted in the Department of Cardiology of Hospital Nossa Senhora da Conceição (Brazil). METHODS: Clinical, demographic, socioeconomic, biochemical and anthropometric data on 116 patients aged 30 to 85 years with a diagnosis of heart failure were evaluated. Arm fat area, body mass index, body surface area, body adiposity index, lipid accumulation product (LAP) and visceral adiposity index (VAI) were calculated. Cox regression was used to perform survival analyses. RESULTS: At baseline, the individuals with ischemic heart failure who remained alive showed higher VAI (3.60 ± 3.71 versus 1.48 ± 1.58; P = 0.04) and a trend towards higher LAP, in comparison with the individuals who died. After an average follow-up of 14.3 months, ischemic heart failure patients who had VAI > 1.21 showed 78% lower risk of death (HR 0.12; 95% CI: 0.02-0.67; P = 0.02) and the Kaplan-Meier survival curves showed better prognosis for these individuals (P = 0.005; log-rank test). CONCLUSION: Our results suggest that VAI is a good predictor of better prognosis among ischemic heart failure patients.

https://doi.org/10.1590/1516-3180.2015.01452111 2247 downloads

14.

Hypertriglyceridemic waist (EWET), glycidic and lipid profile in patients with newly diagnosed heart attack
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Guattini, Veronica Lucas de Olivera

; Piovesan, Carla Haas

; Wittke, Estefânia

; Marcadenti, Aline

Nutrición Hospitalaria

Journal Metrics
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sep 2015, Volume 32 N. 3 Pages 1004 - 1008

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Introduction: hypertriglyceridemic waist phenotype (EWET) has been poorly tested in patients with established cardiovascular disease. Objectives: to evaluate a possible association between EWET, glycidic and lipid profile in patients with newly diagnosed heart attack (HA). Methods: cross-sectional study among 45 inpatients with myocardial infarction. Lipid profile (total cholesterol, HDL-c, LDL-c, serum triglycerides, TC/HDL-c ratio, non-HDL cholesterol) and glycidic profile (fasting glucose, serum insulin, glycated hemoglobin, HOMA-IR, glucose/insulin ratio) were obtained. Weight, height and waist circumferences (WC) were assessed; BMI and EWET were calculated. Analysis of Covariance Models (ANCOVA) was used to assess the objectives. Results: mean age of participants was 58.75 ± 12.41 years and 55.6% (n = 25) were men. After adjustment for age, gender and BMI, EWET was significantly associated with lower HDL-c (p = 0.02), higher TC/HDL-c ratio (p = 0.003) and a trend toward fasting glucose (p = 0.11). Conclusion: EWET phenotype seems to be associated with a worse lipidic profile in patients with newly diagnosed HA.

Introducción: el fenotipo de la cintura hipertrigliceridémica (CHT) ha sido poco estudiado en pacientes con enfermedad cardiovascular establecida. Objetivos: evaluar la posible asociación entre el CHT, el perfil glicídico y los lípidos en pacientes con nuevo diagnóstico de infarto. Métodos: estudio transversal en 45 pacientes con infarto de miocardio. Se obtuvieron los lípidos (colesterol total, HDL-c, LDL-c, triglicéridos séricos, relación CT/ HDL-c, colesterol no-HDL) y el perfil glicídico (glucosa, insulina sérica, hemoglobina glucosilada, HOMA-IR, relación glucosa/insulina). Fueron evaluados peso, talla y circunferencia de la cintura (CC); se calcularon el IMC y el CHT. Se utilizó el análisis de los modelos de covarianza (ANCOVA) para evaluar los objetivos. Resultados: la media de edad de los participantes fue de 58,75 ± 12,41 años, y el 55,6% (n = 25) eran hombres. Tras ajustar por edad, sexo y el IMC, el CHT se asoció significativamente con una menor HDL-c (p = 0,02), mayor relación CT/HDL-c (p = 0,003) y una tendencia hacia la glucosa en ayunas (p = 0,11). Conclusión: el fenotipo CHT parece estar asociado con un peor perfil lipídico en pacientes con diagnóstico reciente de infarto.

https://doi.org/10.3305/nh.2015.32.3.9309 150 downloads

15.

Association between LAP Index (lipid accumulation product) and metabolic profile in hospitalized patients
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Angelo Vieira, Bruna

; Sauer, Patrícia

; Marcadenti, Aline

; Haas Piovesan, Carla

Nutrición Hospitalaria

Journal Metrics
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jun 2015, Volume 31 N. 6 Pages 2771 - 2774

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Introduction: lipid Accumulation Product (LAP) Index correlates to cardiovascular risk factors in general population but it has not been tested in hospitalized patients. Objectives: we aimed to evaluate associations between LAP Index and metabolic profile in a tertiary hospital. Methods: Cross-sectional study with 90 inpatients. Lipid profile, fasting glucose, systolic and diastolic blood pressure measurements were obtained from electronic medical records. Weight, height and waist circumferences (WC) were assessed; Body Mass Index (BMI) and LAP Index were calculated. Data were expressed as mean ± standard deviation or percentage. Pearson's correlation and Multiple Linear Regression were used to assess the objectives. Results: mean age of participants was 55.03 ± 14.86 years and 47.8% (n = 43) were men. After adjustment for sex, age and physic activity LAP Index (log-transformed) was significantly associated with HDL-cholesterol (p < 0.001), fasting glucose (p = 0.02), systolic blood pressure (p = 0.03) and a trend toward total cholesterol (p = 0.07). Conclusion: There are independent association between LAP Index (log-transformed) and metabolic profile in hospitalized patients.

Introducción: el índice PAL (Producto de Acumulación Lipídica) se correlaciona con factores de riesgo cardiovasculares en la población general, pero no ha sido probado en pacientes hospitalizados. Objetivos: evaluar las asociaciones entre el índice PAL y el perfil metabólico en un hospital de tercer nivel. Métodos: estudio transversal con 90 pacientes hospitalizados. Se obtuvieron de los registros médicos electrónicos el perfil lipídico, la glucosa en ayunas y las mediciones de la presión arterial sistólica y diastólica. Fueron evaluados el peso, la talla y la circunferencia de la cintura (CC); se calcularon el índice de Masa Corporal (IMC) y el índice de PAL. Los datos se expresan como media ± desviación estándar o porcentaje. Para evaluar los objetivos se utilizaron la correlación de Pearson y la regresión lineal múltiple. Resultados: la edad promedio de los participantes fue de 55,03 ± 14,86 años y el 47,8% (n = 43) eran hombres. Después de ajustar por sexo, edad y actividad física, el índice PAL (transformado-log) se asoció significativamente con el HDL-colesterol (p < 0,001), la glucosa en ayunas (p=0,02), la presión arterial sistólica (p = 0,03) y una tendencia hacia el colesterol total (p = 0,07). Conclusión: en los pacientes hospitalizados existe una asociación independiente entre el índice PAL (transformado- log) y el perfil metabólico.

https://doi.org/10.3305/nh.2015.31.6.8957 308 downloads

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