Publications by authors named "Aline Marcadenti"

56 Publications

The effect of the a regional cardioprotective nutritional program on inflammatory biomarkers and metabolic risk factors in secondary prevention for cardiovascular disease, a randomised trial.

Clin Nutr 2021 Jun 28;40(6):3828-3835. Epub 2021 Apr 28.

Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil. Electronic address:

Background & Aims: To evaluate the effect of the Brazilian Cardioprotective Diet Program (BALANCE Program) on inflammatory biomarkers, involved in the pathophysiology of the atherosclerosis, on inflammatory biomarkers, cardiovascular risk factors, and on plasma fatty acids in cardiovascular disease secondary prevention patients.

Methods: In this substudy of the BALANCE Program randomized clinical trial, a total of 369 patients aged 45 years or older, who have experienced cardiovascular disease in the previous 10 years, were included. These patients were randomized into two groups and followed up for six months: BALANCE Program group and control group (conventional nutrition advice). In the initial and six-month final visits, anthropometry (body weight, height and waist circumference), food intake evaluation by 24-h dietary recall, plasma inflammatory biomarkers (IL-6, IL-8, IL-10, IL-12, tumor necrosis factor-α, adiponectin, and C-reactive protein levels), blood pressure, glycemia, insulinemia, lipid profile, and plasma fatty acids levels were evaluated.

Results: The BALANCE Program group showed increased plasma alpha-linolenic acid levels (P = 0.008), reduction in waist circumference (P = 0.049) and BMI (P = 0.032). No difference was observed among plasma inflammatory biomarkers and clinical data.

Conclusion: After six months of follow-up, BALANCE Program led to a significant reduction on BMI and waist circumference in individuals in secondary prevention for cardiovascular disease. Although plasmatic alpha-linolenic acid has increased, there was no impact on plasma inflammatory biomarkers.

Clinical Trial Registration: NCT01620398.
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http://dx.doi.org/10.1016/j.clnu.2021.04.035DOI Listing
June 2021

Effects of supplementing a healthy diet with pecan nuts or extra-virgin olive oil on inflammatory profile of patients with stable coronary artery disease: a randomised clinical trial.

Br J Nutr 2021 May 11:1-10. Epub 2021 May 11.

Graduate Program in Health Sciences (Cardiology), Instituto de Cardiologia/Fundação Universitária de Cardiologia do Rio Grande do Sul (IC/FUC), 395 Princesa Isabel Avenue, 90040-371 Porto Alegre, Rio Grande do Sul, Brazil.

The consumption of nuts and extra-virgin olive oil has been associated with suppression of inflammatory pathways that contribute to atherosclerosis, but its role on the modulation of the inflammatory profile in patients with established coronary artery disease (CAD) is unclear. The aim of this study was to evaluate the effects of adding pecan nuts or extra-virgin olive oil to a healthy diet on inflammatory markers in patients with stable CAD. In this randomised clinical trial, 204 patients were enrolled to three study groups: sixty seven to control group (CG: healthy diet), sixty eight to pecan nuts group (PNG: 30 g/d of pecans + healthy diet) and sixty nine to extra-virgin olive oil group (OOG: 30 ml/d of extra-virgin olive oil + healthy diet). High-sensitivity C-reactive protein (hs-CRP, in mg/l), fibrinogen (mg/dl), IL 2, 4, 6, 10 (pg/ml) and interferon-γ (IFN-γ, in pg/ml), IL-6/IL-10, IL-2/IL-4 and IFN-/γIL-4 ratios were evaluated at baseline and after the follow-up (12 weeks). As main results, after adjustment for sex, statin used and relative body weight variation, there were no differences between groups regarding inflammatory markers at the end of the study. IL-6 levels (primary outcome) were reduced in 12 weeks when compared with baseline in all study groups (CG: difference: -0·593 (se = 0·159) pg/dL; PNG: difference: -0·335 (se = 0·143) pg/dl; OOG: IL-6 difference: -0·325 (se = 0·143) pg/dl). In conclusion, there was no significant effect of including pecan nuts or extra virgin olive oil to a healthy diet on inflammatory markers in individuals with CAD.
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http://dx.doi.org/10.1017/S0007114521001513DOI Listing
May 2021

Ultra-processed foods consumption is associated with cardiovascular disease and cardiometabolic risk factors in Brazilians with established cardiovascular events.

Int J Food Sci Nutr 2021 Apr 11:1-10. Epub 2021 Apr 11.

Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil.

The consumption of ultra-processed foods (UPF) has been associated with cardiometabolic risk factors. However, there is scarce literature on the association between UPF consumption, cardiovascular events, and cardiometabolic risk factors in subjects undergoing secondary care for cardiovascular diseases (CVD). Thus, we aimed to evaluate the association between UPF consumption, CVD, and cardiometabolic risk factors in subjects with established CVD. Baseline data from 2,357 subjects participating in a Brazilian multicenter study were analysed finding a mean UPF consumption of 18.7% of their energy intake. Higher figures of UPF consumption were founded associated with an increased presence of high waist circumference, overweight, peripheral arterial disease, and with a decreased odds of the simultaneous presence of coronary arterial disease, peripheral arterial diseases, and stroke when comparing among tertiles of UPF contribution to energy intake. These associations were observed when analyzing the whole sample and women but not men. Thus, these findings should help improve strategies for CVD patients in secondary care.
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http://dx.doi.org/10.1080/09637486.2021.1908963DOI Listing
April 2021

Dietary total antioxidant capacity is inversely associated with cardiovascular events and cardiometabolic risk factors: A cross-sectional study.

Nutrition 2021 Feb 19;89:111140. Epub 2021 Feb 19.

Laboratory of Energy Metabolism and Body Composition, Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil. Electronic address:

Objectives: Dietary total antioxidant capacity (dTAC) has been introduced as a useful tool to quantify the antioxidant content of a diet. However, few studies have evaluated the association of dTAC with cardiovascular disease (CVD) occurrence and cardiometabolic risk factors in people with established CVD events. Thus, we aimed to investigate the presence of an association between dTAC values, cardiovascular events, and cardiometabolic risk factors in individuals with previous CVD in a Brazilian multicenter study.

Methods: This study has a cross-sectional design. We evaluated baseline data from the Brazilian Cardioprotective Nutritional Program Trial. Sociodemographic, anthropometric, clinical, and food-consumption data were collected in face-to-face interviews. We estimated dTAC from the mean of two 24-h dietary recalls by values of ferric-reducing antioxidant power.

Results: We evaluated 2346 participants, most of whom were men (58.4%), older adults (64.2%), and overweight (68.6%), and had coronary artery disease (92.4%). The mean dTAC was equal to 5.6 (interquartile range, 3.9-7.8) mmol/1000 kcal. Participants in the third dTAC tertile (9.2 mmol/1000 kcal) had a 22%, 59%, and 69% lower chance, respectively, of having hypertriglyceridemic waist phenotype, abdominal aortic aneurysm, and amputation due to arterial disease in comparison to the first tertile (3.4 mmol/1000 kcal).

Conclusions: The dTAC was inversely associated with hypertriglyceridemic waist phenotype, abdominal aortic aneurysm, and amputation due to arterial disease in individuals undergoing secondary care for CVD. Our results can guide strategies for the prevention of new CVD and its consequences.
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http://dx.doi.org/10.1016/j.nut.2021.111140DOI Listing
February 2021

Translation and cross-cultural adaptation of 14-item Mediterranean Diet Adherence Screener and low-fat diet adherence questionnaire.

Clin Nutr ESPEN 2020 10 22;39:180-189. Epub 2020 Jul 22.

HCor Research Institute, Heart Hospital (HCor), Brazil; Graduate Program in Health Sciences (Cardiology), Institute of Cardiology of Rio Grande do Sul/University Foundation of Cardiology (IC/FUC), Brazil. Electronic address:

Background And Aims: The Mediterranean diet and the low-fat diet are recognized as cardioprotective dietary patterns, and the use of validated instruments that quickly identify adherence to these diets is very useful in the daily practice of the nutritionist. Our aim was to translate and cross-culturally adapt the 14-point Mediterranean Diet Adherence Screener (MEDAS) and a 9-item quantitative score of compliance with the low-fat diet (low-fat diet questionnaire) to the Brazilian Portuguese language.

Methods: The process of translation and cultural adaptation was conducted in six stages: initial translation, synthesis of translations, back-translation, proof of cross-cultural equivalence, pre-final version testing, and final evaluation of the cultural adaptation process. Interviews and assessments were administered to 30 nutritionists, and to 51 healthy participants and 50 individuals at cardiovascular risk. MEDAS ranges from 0 (minimum) to 14 (maximum) points and a total score ≥ 10 points was considered for high adherence to MedDiet. Low-fat diet questionnaire ranges from 0 (minimum) to 9 (maximum) points and a total score ≥ 6 points was considered for high adherence to a diet restricted in fat.

Results: MEDAS and low-fat diet questionnaire were translated, synthetized and then back-translated, and few grammatical and/or semantic changes were required. About 24 participants suggested at least one modification in low-fat diet questionnaire's questions/terms, and 28 participants suggested at least one change in MEDAS items. The process produced a valid version of both the MEDAS and low-fat diet questionnaire in the Brazilian Portuguese language. Participants showed an average MEDAS questionnaire of 5.3 ± 2.5 points, and an average low-fat diet questionnaire of 5.9 ± 1.9 points. Nutritionists showed higher means of low-fat diet scores when compared to healthy and at high cardiovascular risk individuals (7.1 ± 1.3, 5.6 ± 2 and 5.4 ± 1.9, respectively [P < 0.0001]) but not for MEDAS questionnaire. With a cutoff of ≥10 points, 2.3% (95% CI 0.78-6.52) of the participants showed high adherence to MedDiet based on MEDAS score, and with a cutoff of ≥6 points, 58% (95% CI 49.5-66.1) of the participants showed high adherence to a diet restricted in fat based on the low-fat diet questionnaire.

Conclusions: MEDAS and low-fat diet questionnaire were successfully translated to the Portuguese language. Regarding the results from questionnaires applied to our sample, in general, poor adherence was found for both Mediterranean and low-fat diet.
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http://dx.doi.org/10.1016/j.clnesp.2020.06.018DOI Listing
October 2020

Mindfulness Practice for Glycemic Control: Could it be a New Strategy for an Old Problem? A Systematic Review and Metanalysis.

Curr Diabetes Rev 2020 08 10. Epub 2020 Aug 10.

HCor Research Institute (IP-HCor), Hospital do Coração (HCor), São Paulo. Brazil.

Background: The management of type 2 diabetes mellitus (T2DM) requires a complex and organized care that includes patient lifestyle change. Additionally, emotional well-being is an important part of self-management, and it may impair the individual's adherence. Therefore, equipping them with the necessary coping and self-care techniques may be an important step in managing diabetes.

Objective: to evaluate the effect of interventions using established based-mindfulness protocols on glycemic control of individuals T2DM.

Methods: Data sources: Two electronic databases (PubMed and EMBASE) were searched from inception to December 2019. We limited our search to published studies in the English, Spanish and Portuguese language.

Study Selection: Randomized clinical trials that assessed the effects of mindfulness in individuals with T2DM were selected.

Data Extraction: Two authors independently assessed risk of bias and extracted data from the included trials. Data were pooled using inverse-variance random-effects meta-analyses. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

Results: Four randomized trials were included. There were no differences in blood glucose change (mean difference between groups (MD) -0.73mg/dl; 95% CI, -10.49; 9.02; I2 =0%; very low quality of evidence) or glycated hemoglobin (MD 0.05%; 95%CI -0.22 to 0.32; I2 =29%; very low quality of evidence).

Conclusions: Although the quality of current evidence is very low, our findings suggest that established protocols involving mindfulness has no effect on blood glucose or glycated hemoglobin in individuals with T2DM. Indeed, largescale trials are needed to evaluate the contribution of mindfulness on glycemic control in the clinical practice.
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http://dx.doi.org/10.2174/1573399816666200810131055DOI Listing
August 2020

Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19.

N Engl J Med 2020 11 23;383(21):2041-2052. Epub 2020 Jul 23.

From HCor Research Institute (A.B.C., F.G.Z., L.P.D., A.M., L.K.-D., T.L., D.L.M.J., P.G.M.B.S., L.T., E.O.A.-S., L.N.L., I.S.M.), Brazilian Research in Intensive Care Network (A.B.C., F.G.Z., R.G.R., L.C.P.A., V.C.V., T.L., F.G.R.F., A.S.-N., F.R.M.), Hospital Sírio Libanês Research and Education Institute (L.C.P.A.), BP-A Beneficência Portuguesa de São Paulo (V.C.V.), International Research Center, Hospital Alemão Oswaldo Cruz (A.A.), Brazilian Clinical Research Institute (P.G.M.B.S., R.D.L.), Hospital São Camilo (A.T.S.), Hospital Moriah (L.S.E.), Academic Research Organization of Hospital Israelita Albert Einstein (R.H.M.F., O.B.), Hospital Israelita Albert Einstein (L.S.E., A.J.P., A.S.-N.), Hospital Sepaco (F.G.R.F.), and Hospital Santa Paula (O.C.E.G.), São Paulo, Hospital Moinhos de Vento, Porto Alegre (R.G.R., M.F.), Hospital Naval Marcílio Dias, Rio de Janeiro (V.C.S.D.), Hospital Giselda Trigueiro, Natal (E.P.M.), Instituto Tacchini de Pesquisa em Saúde, Hospital Tacchini, Bento Gonçalves (N.A.G.), Hospital Bruno Born, Lajeado (F.F.C.), Hospital Baia Sul, Florianópolis (I.S.M.), Hospital Regional Hans Dieter Schmidt, Joinville (C.R.H.F.); Angiocor Blumenau, Blumenau (A.P.M.K.), and EMS Pharma, Hortolândia (R.B.A., M.F.B.O.) - all in Brazil; and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (R.D.L.).

Background: Hydroxychloroquine and azithromycin have been used to treat patients with coronavirus disease 2019 (Covid-19). However, evidence on the safety and efficacy of these therapies is limited.

Methods: We conducted a multicenter, randomized, open-label, three-group, controlled trial involving hospitalized patients with suspected or confirmed Covid-19 who were receiving either no supplemental oxygen or a maximum of 4 liters per minute of supplemental oxygen. Patients were randomly assigned in a 1:1:1 ratio to receive standard care, standard care plus hydroxychloroquine at a dose of 400 mg twice daily, or standard care plus hydroxychloroquine at a dose of 400 mg twice daily plus azithromycin at a dose of 500 mg once daily for 7 days. The primary outcome was clinical status at 15 days as assessed with the use of a seven-level ordinal scale (with levels ranging from one to seven and higher scores indicating a worse condition) in the modified intention-to-treat population (patients with a confirmed diagnosis of Covid-19). Safety was also assessed.

Results: A total of 667 patients underwent randomization; 504 patients had confirmed Covid-19 and were included in the modified intention-to-treat analysis. As compared with standard care, the proportional odds of having a higher score on the seven-point ordinal scale at 15 days was not affected by either hydroxychloroquine alone (odds ratio, 1.21; 95% confidence interval [CI], 0.69 to 2.11; P = 1.00) or hydroxychloroquine plus azithromycin (odds ratio, 0.99; 95% CI, 0.57 to 1.73; P = 1.00). Prolongation of the corrected QT interval and elevation of liver-enzyme levels were more frequent in patients receiving hydroxychloroquine, alone or with azithromycin, than in those who were not receiving either agent.

Conclusions: Among patients hospitalized with mild-to-moderate Covid-19, the use of hydroxychloroquine, alone or with azithromycin, did not improve clinical status at 15 days as compared with standard care. (Funded by the Coalition Covid-19 Brazil and EMS Pharma; ClinicalTrials.gov number, NCT04322123.).
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http://dx.doi.org/10.1056/NEJMoa2019014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7397242PMC
November 2020

Nutritional status and appetite-regulating hormones in early treatment of acute lymphoblastic leukemia among children and adolescents: a cohort study.

Sao Paulo Med J 2020 Mar 1;138(2):118-125. Epub 2020 Jun 1.

Undergraduate Nutrition Program and Stricto Sensu Postgraduate Programs on Physical Education, Nutrition and Health Sciences, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.

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.
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http://dx.doi.org/10.1590/1516-3180.2019.0307.r1.19112019DOI Listing
March 2020

Oxidative Stress Biomarkers, Nut-Related Antioxidants, and Cardiovascular Disease.

Nutrients 2020 Mar 3;12(3). Epub 2020 Mar 3.

Graduate Program in Health Sciences (Cardiology), Institute of Cardiology of Rio Grande do Sul/University Foundation of Cardiology (IC/FUC), Princesa Isabel Avenue, 395, Porto Alegre, Rio Grande do Sul 90040-371, Brazil.

Atherosclerosis is related to fat accumulation in the arterial walls and vascular stiffening, and results in acute coronary syndrome which is commonly associated with acute myocardial infarction. Oxidative stress participates in the pathogenesis of atherosclerosis. Thus, the inclusion of food sources of dietary antioxidants, such as different kinds of nuts, may improve biomarkers related to oxidative stress, contributing to a possible reduction in atherosclerosis progression. This article has briefly highlighted the interaction between oxidative stress, atherosclerosis, and cardiovascular disease, in addition to the effect of the consumption of different nuts and related dietary antioxidants-like polyphenols and vitamin E-on biomarkers of oxidative stress in primary and secondary cardiovascular prevention. Studies suggest that nuts may exert antioxidant effects by DNA repair mechanisms, lipid peroxidation prevention, modulation of the signaling pathways, and inhibition of the MAPK pathways through the suppression of NF-κB and activation of the Nrf2 pathways. Studies conducted in animal models showed the ability of dietary nuts in improving biomarkers of oxidative stress, such as oxLDL and GPx. However, clinical trials in humans have not been conclusive, especially with regards to the secondary prevention of cardiovascular disease.
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http://dx.doi.org/10.3390/nu12030682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146201PMC
March 2020

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

Sao Paulo Med J 2020 Jan-Feb;138(1):4-10

PhD. Professor, Postgraduate Program on Health Sciences (Cardiology), Instituto de Cardiologia, Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre (RS); Professor, Postgraduate Program on Nutrition Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS); and Researcher, HCor Research Institute, Hospital do Coração (IP-HCor), São Paulo (SP), Brazil.

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.
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http://dx.doi.org/10.1590/1516-3180.2019.0166.R1.02102019DOI Listing
July 2020

Calf Circumference Is a Good Predictor of Longer Hospital Stay and Nutritional Risk in Emergency Patients: A Prospective Cohort Study.

J Am Coll Nutr 2020 Sep-Oct;39(7):645-649. Epub 2020 Feb 21.

Department of Nutrition, Postgraduate Program in Nutrition, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.

This study aimed to evaluate the validity of calf circumference (CC) in identifying malnourished patients and patients at nutritional risk and determine the association between CC and clinical outcomes of hospitalized patients. A prospective cohort study was conducted involving patients admitted to the emergency department of a tertiary hospital in the first 48 hours of admission. Nutritional risk was determined using Nutritional Risk Screening, malnutrition was diagnosed using subjective global assessment, and CC was manually measured. Brazilian cutoff points for CC were used to identify low muscle mass. The outcomes of interest were length of emergency care and hospital stay, occurrence of infection, and death, besides nutritional risk and malnutrition. In total, 528 patients (52.76 ± 16.18 years; 54.6% females) were followed up for 9.0 (3.0-19.0) days; 39.6% of them had reduced CC values. The accuracy of CC in identifying patients at nutritional risk and malnourished patients was 67.7% and 54.1%, respectively. The cutoff value of 36.5 cm was highly accurate in identifying nutritional risk [AUC-ROC curve = 0.764 (95% CI: 0.704-0.825) for men, and AUC-ROC curve = 0.716 (95% CI: 0.659-0.774) for women]. Patients with low CC had a 1.59-fold (95% CI: 1.07-2.36) greater likelihood of a long hospital stay than patients with normal CC. Low CC values have satisfactory validity in identifying nutritional risk and are associated with long hospital stay.
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http://dx.doi.org/10.1080/07315724.2020.1723452DOI Listing
February 2020

Complementarity of modified NUTRIC score with or without C-reactive protein and subjective global assessment in predicting mortality in critically ill patients.

Rev Bras Ter Intensiva 2019 Oct-Dec;31(4):490-496

Programa de Pós-Graduação em Ciências da Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil.

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.
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http://dx.doi.org/10.5935/0103-507X.20190086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008996PMC
July 2020

Adipokines and Adipose Tissue-Related Metabolites, Nuts and Cardiovascular Disease.

Metabolites 2020 Jan 11;10(1). Epub 2020 Jan 11.

Graduate Program in Health Sciences (Cardiology), Institute of Cardiology of Rio Grande do Sul/University Foundation of Cardiology (IC/FUC), Princesa Isabel Avenue, 395, Porto Alegre, Rio Grande do Sul 90040-371, Brazil.

Adipose tissue is a complex structure responsible for fat storage and releasing polypeptides (adipokines) and metabolites, with systemic actions including body weight balance, appetite regulation, glucose homeostasis, and blood pressure control. Signals sent from different tissues are generated and integrated in adipose tissue; thus, there is a close connection between this endocrine organ and different organs and systems such as the gut and the cardiovascular system. It is known that functional foods, especially different nuts, may be related to a net of molecular mechanisms contributing to cardiometabolic health. Despite being energy-dense foods, nut consumption has been associated with no weight gain, weight loss, and lower risk of becoming overweight or obese. Several studies have reported beneficial effects after nut consumption on glucose control, appetite suppression, metabolites related to adipose tissue and gut microbiota, and on adipokines due to their fatty acid profile, vegetable proteins, l-arginine, dietary fibers, vitamins, minerals, and phytosterols. The aim of this review is to briefly describe possible mechanisms implicated in weight homeostasis related to different nuts, as well as studies that have evaluated the effects of nut consumption on adipokines and metabolites related to adipose tissue and gut microbiota in animal models, healthy individuals, and primary and secondary cardiovascular prevention.
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http://dx.doi.org/10.3390/metabo10010032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7022531PMC
January 2020

Parameters of Bioelectrical Impedance Are Good Predictors of Nutrition Risk, Length of Stay, and Mortality in Critically Ill Patients: A Prospective Cohort Study.

JPEN J Parenter Enteral Nutr 2020 07 18;44(5):849-854. Epub 2019 Aug 18.

Department of Nutrition and Postgraduate Program in Nutrition, Federal University of Health Sciences, Porto Alegre, Brazil.

Background: Assessment of nutrition risk in the intensive care unit (ICU) is limited by characteristics of critically ill patients, and new methods have been investigated for their applicability and predictive validity. The aim of the present study was to evaluate the validity of bioelectrical impedance analysis (BIA) parameters as predictors of nutrition risk and clinical outcomes in critically ill patients.

Methods: This was a prospective cohort study of patients admitted to an ICU. The modified Nutrition Risk in the Critically Ill score was used for assessment of nutrition risk, and BIA was performed in the first 72 hours of admission. Phase angle (PA) measurements were obtained, and bioelectrical impedance vector analysis (BIVA) was used to classify patients by hydration status (BIVA >70%). Patients were followed until hospital discharge and evaluated for hospital mortality, ICU length of stay, length of hospitalization, and duration of mechanical ventilation.

Results: Eighty-nine patients were included (62.5 ± 14.1 years, 50.6% female). A PA <5.5 showed an accuracy of 79% (95% CI 0.59-0.83) in identifying patients at high nutrition risk and was associated with nearly 2 times greater risk for an ICU length of stay longer than 5 days (relative risk = 2.18 [95% CI 1.39-3.40]). Hyperhydration was a significant predictor of mortality (hazard ratio = 2.24 [95% CI 1.07-4.68]). Higher resistance and reactance values, adjusted for height, were found in survivors compared with nonsurvivors.

Conclusion: The predictive validity of BIA was satisfactory for the assessment of nutrition risk, ICU length of stay, and mortality in critically ill patients.
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http://dx.doi.org/10.1002/jpen.1694DOI Listing
July 2020

Correlations between Traditional and Nontraditional Indicators of Adiposity, Inflammation, and Monocyte Subtypes in Patients with Stable Coronary Artery Disease.

J Obes 2019 3;2019:3139278. Epub 2019 Jul 3.

Graduate Program in Health Sciences (Cardiology), Institute of Cardiology of Rio Grande do Sul/University Foundation of Cardiology (IC/FUC), Princesa Isabel Avenue, 395, Porto Alegre, Rio Grande do Sul 90040-371, Brazil.

Background: Recruitment of monocytes and low-grade inflammation process are both involved in obesity and in atherosclerosis. Thus, the aim of this study was to evaluate the correlation among indicators of adiposity, monocyte subtypes, and inflammatory markers in patients with stable coronary artery disease (CAD).

Methods: This was a cross-sectional study including 97 patients with stable CAD aged >40 years. Traditional anthropometric indicators of adiposity (body mass index (BMI); waist, hip, and neck circumferences; and waist-hip ratio) and nontraditional anthropometric indicators of adiposity (lipid accumulation product index (LAP), visceral adiposity index (VAI), and deep-abdominal-adipose-tissue index (DAAT)) were determined. Immunoprecipitation, turbidimetry, coagulometric method, and CBA were used for the evaluation of inflammatory markers (hs-CRP, IL-2, IL-4, IL-6, IL-10, and INF-). Monocyte subtypes were identified by flow cytometry and defined as CD14++ CD16- (Mon1), CD14++ CD16+ (Mon2), and CD14+ CD16++ (Mon3). Pearson's correlation coefficient and adjusted partial correlation were calculated.

Results: Monocyte subtypes were correlated with inflammation regardless of nutritional status according to BMI. In overweight individuals, LAP was correlated with IL-4 and fibrinogen ( < 0.01 and < 0.05, respectively) and VAI with IL-4 ( < 0.05). In obese patients, the BMI, waist, neck, and hip circumferences, and DAAT were correlated with IL-6 ( < 0.05), regardless of age and sex. The hip circumference was correlated positively with Mon1 ( = 0.40, = 0.007) and negatively with Mon3 ( = -0.35, = 0.02) in obese subjects.

Conclusion: Monocyte subtypes are correlated with inflammation in patients with stable CAD independently of BMI, whereas traditional and nontraditional indicators of adiposity are correlated differently with inflammatory markers and monocytes, according to the nutritional status.
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http://dx.doi.org/10.1155/2019/3139278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637687PMC
August 2020

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial.

Am Heart J 2019 09 21;215:187-197. Epub 2019 Jun 21.

Hospital Universitário Pedro Ernesto, Rio de Janeiro-RJ, Brazil.

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD.

Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels.

Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P < .01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P = .15). Secondary end points did not differ between groups after follow-up.

Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death.
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http://dx.doi.org/10.1016/j.ahj.2019.06.010DOI Listing
September 2019

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

Sao Paulo Med J 2019 May;137(1):66-74

PhD. Professor, Graduate Program in Health Sciences (Cardiology), Instituto de Cardiologia, Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre (RS); Professor, Postgraduate Program on Nutrition Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS); and Researcher, Instituto de Pesquisa do Hospital do Coração (HCor), São Paulo (SP), Brazil.

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.
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http://dx.doi.org/10.1590/1516-3180.2018.040940119DOI Listing
May 2019

Is cachexia associated with chemotherapy toxicities in gastrointestinal cancer patients? A prospective study.

J Cachexia Sarcopenia Muscle 2019 04 28;10(2):445-454. Epub 2019 Mar 28.

Graduate Program in Nutrition, Health Sciences Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.

Background: Chemotherapy is an effective treatment with good clinical response in patients with cancer. However, it can cause exacerbated toxicities in patients and consequently change the course of treatment. Some factors may interfere with this toxicity such as body composition, especially in gastrointestinal cancer. The aim of this study was to evaluate the effects of body composition, nutritional status, and functional capacity scale in predicting the occurrence of toxicities in gastrointestinal cancer patients during chemotherapy treatment.

Methods: This is a prospective study with gastrointestinal cancer patients at the beginning of chemotherapy treatment. Sarcopenia and muscle attenuation were assessed using the skeletal muscle index from computerized tomography by measuring cross-sectional areas of the L3 tissue (cm /m ). Cachexia was graded according to involuntary weight loss associated with sarcopenia. Nutritional status was assessed by using anthropometric evaluation and Patient-Generated Subjective Global Assessment. Functional capacity was evaluated by handgrip strength and Eastern Cooperative Oncology Group (ECOG) Performance Status scale. Haematological gastrointestinal and dose-limiting toxicities (DLTs) were defined according to National Cancer Institute Common Toxicity Criteria. The associations among sarcopenia, cachexia, nutritional status, and functional capacity with DLT were assessed by univariate and multivariate Cox regression model.

Results: A total of 60 patients were evaluated (55% male, 60.9 ± 14.0 years) and followed up for a mean of 55 days. Most patients had normal weight (44.2%) and good ECOG Performance Status (≤1) at baseline (78%). During the chemotherapy period, the most prevalent toxicities were diarrhoea, nausea, and anorexia, but the presence of DLT was similar between cycles (P > 0.05). Cachexia was associated with a higher toxicity manifested by diarrhoea (P = 0.02), nausea (P = 0.02), and anorexia (P < 0.01 and P = 0.03 at Cycles 1 and 2, respectively). Sarcopenic and cachetic individuals experienced more toxicities and DLT during chemotherapy. The only factors associated with DLT in the multivariate Cox regression analyses including the presence of metastasis and the chemotherapy protocol were cachexia and the ECOG scale (P < 0.001 for both).

Conclusions: Cachexia and ECOG score may identify patients with an increased risk for developing severe toxicity events during chemotherapy treatment for gastrointestinal cancer.
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http://dx.doi.org/10.1002/jcsm.12391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463470PMC
April 2019

Carbohydrate Mouth Rinse and Hydration Strategies on Cycling Performance in 30 Km Time Trial: A Randomized, Crossover, Controlled Trial.

J Sports Sci Med 2018 Jun 14;17(2):181-187. Epub 2018 May 14.

UFRN, Federal University of Rio Grande do Norte, Natal/RN, Brazil.

The aim of this study was to investigate whether carbohydrate mouth rinse (CMR) improves physical performance of cyclists during a 30-km time trial test and its influence on water balance compared to other strategies of fluid intake. Eleven recreationally trained male cyclists completed a 30 km time trial cycle ergometer under three experimental interventions: (a) CMR, (b) drinking to replace all weight loss (DWL), and (c) drinking "ad libitum" (DAL). Time to complete the 30 km time trial, heart rate, average power, velocity, weight loss, urine color, urine density and pH were evaluated. Statistical analysis was performed using repeated measures analysis of variance (RM-ANOVA) and generalized estimating equations (GEE) with Bonferroni adjustment (p < 0.05). Time to complete the 30 km time trial was similar among CMR 54.5 ± 2.9 min, DWL 53.6 ± 3.9 min and DAL 54.5 ± 2.5 min (p = 0.13). CMR (1.7 ± 0.4%) elicited similar water loss compared to the DAL (1.4 ± 0.6%) intervention, but it was higher than the DWL intervention (0.6 ± 0.6%) (p < 0.01). CMR did not improve the performance of recreationally trained cyclists in a 30 km time trial test compared to other fluid intake strategies. Furthermore, CMR causes higher water loss compared to DWL intervention.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5950734PMC
June 2018

The effect of carbohydrate mouth rinse on performance, biochemical and psychophysiological variables during a cycling time trial: a crossover randomized trial.

J Int Soc Sports Nutr 2018 2;15:23. Epub 2018 May 2.

1Graduate Progrtam in Physical Education, Federal University of Rio Grande do Norte, Avenida senador Salgado Filho 3000, Campus Universitário, Lagoa Nova, Natal, RN Brazil.

Background: The hypothesis of the central effect of carbohydrate mouth rinse (CMR) on performance improvement in a fed state has not been established, and its psychophysiological responses have not yet been described. The aim of this study was to evaluate the effect of CMR in athletes fed state on performance, biochemical and psychophysiological responses compared to ad libitum water intake.

Methods: Eleven trained male cyclists completed a randomized, crossover trial, which consisted of a 30 km cycle ergometer at self-selected intensity and in a fed state. Subjects were under random influence of the following interventions: CMR with a 6% unflavored maltodextrin solution; mouth rinsing with a placebo solution (PMR); drinking "ad libitum" (DAL). The time for completion of the test (min), heart rate (bpm) and power (watts), rating of perceived exertion (RPE), affective response, blood glucose (mg/dL) and lactate (mmol/DL), were evaluated before, during and immediately after the test, while insulin (uIL/mL), cortisol (μg/dL) and creatine kinase (U/L) levels were measured before, immediately after the test and 30 min after the test.

Results: Time for completion of the 30 km trial did not differ significantly among CMR, PMR and DAL interventions (means = 54.5 ± 2.9, 54.7 ± 2.9 and 54.5 ± 2.5 min, respectively;  = 0.82). RPE and affective response were higher in DAL intervention ( < 0.01). Glucose, insulin, cortisol and creatine kinase responses showed no significant difference among interventions.

Conclusions: In a fed state, CMR has not caused metabolic changes, and it has not improved physical performance compared to ad libitum water intake, but demonstrated a possible central effect. ReBec registration number: RBR-4vpwkg. Available in http://www.ensaiosclinicos.gov.br/rg/?q=RBR-4vpwkg.
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http://dx.doi.org/10.1186/s12970-018-0225-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932899PMC
July 2018

Nutritional Risk in Emergency-2017: A New Simplified Proposal for a Nutrition Screening Tool.

JPEN J Parenter Enteral Nutr 2018 Sep 13;42(7):1168-1176. Epub 2018 Mar 13.

Nutrition Department , Federal University of Health Sciences of Porto Alegre and the Health Graduate Program, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

Background: There are many nutrition screening tools currently being applied in hospitals to identify risk of malnutrition. However, multivariate statistical models are not usually employed to take into account the importance of each variable included in the instrument's development.

Objective: To develop and evaluate the concurrent and predictive validities of a new screening tool of nutrition risk.

Methods: A prospective cohort study was developed, in which 4 nutrition screening tools were applied to all patients. Length of stay in hospital and mortality were considered to test the predictive validity, and the concurrent validity was tested by comparing the Nuritional Risk in Emergency (NRE)-2017 to the other tools.

Results: A total of 748 patients were included. The final NRE-2017 score was composed of 6 questions (advanced age, metabolic stress of the disease, decreased appetite, changing of food consistency, unintentional weight loss, and muscle mass loss) with answers yes or no. The prevalence of nutrition risk was 50.7% and 38.8% considering the cutoff points 1.0 and 1.5, respectively. The NRE-2017 showed a satisfactory power to indentify risk of malnutrition (area under the curve >0.790 for all analyses). According to the NRE-2017, patients at risk of malnutrition have twice as high relative risk of a very long hospital stay. The hazard ratio for mortality was 2.78 (1.03-7.49) when the cutoff adopted by the NRE-2017 was 1.5 points.

Conclusion: NRE-2017 is a new, easy-to-apply nutrition screening tool which uses 6 bi-categoric features to detect the risk of malnutrition, and it presented a good concurrent and predictive validity.
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http://dx.doi.org/10.1002/jpen.1147DOI Listing
September 2018

The New European Society for Clinical Nutrition and Metabolism Definition of Malnutrition: Application for Nutrition Assessment and Prediction of Morbimortality in an Emergency Service.

JPEN J Parenter Enteral Nutr 2018 Mar 15;42(3):550-556. Epub 2017 Dec 15.

Departamento de Nutrição e Programa de Pós Graduação em Nutrição e Saúde, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brasil.

Background: Recently, the European Society for Clinical Nutrition and Metabolism (ESPEN) provided novel consensus criteria for malnutrition diagnosis. This study aimed to evaluate the applicability of this instrument in combination with different nutrition screening tools (1) to identify malnutrition and (2) to predict morbidity and mortality in hospitalized patients.

Materials And Methods: Observational prospective study in 750 adults admitted to the emergency service of a tertiary public hospital. Subjective Global Assessment (SGA-reference method) and the new ESPEN criteria were used to assess nutrition status of patients, who were initially screened for nutrition risk using 4 different tools. Outcome measures included length of hospital stay, occurrence of infection, and incidence of death during hospitalization, analyzed by logistic regression.

Results: There was a lack of agreement between the SGA and ESPEN definition of malnutrition, regardless of the nutrition screening tool applied previously (κ = -0.050 to 0.09). However, when Malnutrition Screening Tool and Nutritional Risk Screening-2002 (NRS-2002) were used as the screening tool, malnourished patients according to ESPEN criteria showed higher probability of infection (relative risk [RR], 1.54; 95% confidence interval [CI], 1.02-2.31 and RR, 2.06; 95% CI, 1.37-3.10, respectively), and when the NRS-2002 was used, the risk for death was 2.7 times higher (hazard ratio, 2.69; 95% CI, 1.07-6.81) in malnourished patients than in well-nourished patients.

Conclusion: Although the new ESPEN criteria had a poor diagnostic value, it seems to be a prognostic tool among hospitalized patients, especially when used in combination with the NRS-2002.
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http://dx.doi.org/10.1177/0148607117695248DOI Listing
March 2018

Red Wine, Resveratrol and Atrial Fibrillation.

Nutrients 2017 Oct 30;9(11). Epub 2017 Oct 30.

Postgraduate Program in Health Sciences: Cardiology, Institute of Cardiology/University Foundation of Cardiology (IC/FUC), Princesa Isabel Avenue, 370, Porto Alegre RS 90620-001, Brazil.

Atrial fibrillation (AF) is a common cardiac arrhythmia that is associated with increased risk for cardiovascular disease and overall mortality. Excessive alcohol intake is a well-known risk factor for AF, but this correlation is less clear with light and moderate drinking. Besides, low doses of red wine may acutely prolong repolarization and slow cardiac conduction. Resveratrol, a bioactive polyphenol found in grapes and red wine, has been linked to antiarrhythmic properties and may act as an inhibitor of both intracellular calcium release and pathological signaling cascades in AF, eliminating calcium overload and preserving the cardiomyocyte contractile function. However, there are still no clinical trials at all that prove that resveratrol supplementation leads to improved outcomes. Besides, no observational study supports a beneficial effect of light or moderate alcohol intake and a lower risk of AF. The purpose of this review is to briefly describe possible beneficial effects of red wine and resveratrol in AF, and also present studies conducted in humans regarding chronic red wine consumption, resveratrol, and AF.
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http://dx.doi.org/10.3390/nu9111190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5707662PMC
October 2017

Adiposity phenotypes are associated with type-2 diabetes: LAP index, body adiposity index, and neck circumference.

Atherosclerosis 2017 Nov 22;266:145-150. Epub 2017 Sep 22.

Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2600, CEP 90035-003, Porto Alegre, RS, Brazil. Electronic address:

Background And Aims: Adiposity phenotypes can be detected by anthropometric indexes associated with type-2 diabetes mellitus (T2DM). Besides body mass index (BMI) and waist circumference (WC), new indices seem to be able to identify T2DM. This study aimed to evaluate independent associations of T2DM with lipid accumulation product (LAP index), neck circumference (NC) and body adiposity index (BAI) in patients with hypertension.

Methods: A cross-sectional study was carried out among 430 patients with hypertension. The T2DM diagnosed was standardized. WC and NC (cm) were measured and BMI was calculated. LAP index was calculated separately for men [(WC-65) × TG] and women [(WC-58) × TG]; BAI was evaluated in percentiles according to hip (cm)/[height (m)]-18.

Results: Participants were aged 58.3 ± 11.7 years, had systolic blood pressure (SBP) 154.2 ± 24.9 mmHg, diastolic blood pressure (DBP) 89.0 ± 14.7 mmHg, and BMI 30.1 ± 6.0 kg/m. There was 145 men and 285 women, and 142 participants had T2DM. Analyses carried out separately by gender showed that among men, BAI at the 75th percentile increased about 60% the risk of T2DM, while among women, those in the upper quartile of LAP and NC had increased risk of T2DM (prevalence ratio (PR): 2.93; 95%CI: 1.62-5.28 and 3.30; 95%IC: 1.78-6.14, respectively), after adjustment for potential confounders.

Conclusions: Adiposity phenotypes such as LAP index and neck circumference were independently associated with T2DM in hypertensive women, and BAI was associated with T2DM in men.
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http://dx.doi.org/10.1016/j.atherosclerosis.2017.09.022DOI Listing
November 2017

Effects of Olive Oil Phenolic Compounds on Inflammation in the Prevention and Treatment of Coronary Artery Disease.

Nutrients 2017 Sep 30;9(10). Epub 2017 Sep 30.

Postgraduate Program in Health Sciences: Cardiology, Institute of Cardiology/University Foundation of Cardiology (IC/FUC), Princesa Isabel Avenue, 370, Porto Alegre RS 90620-001, Brazil.

Coronary artery disease (CAD) is responsible for more than 7 million deaths worldwide. In the early stages of the development of atherosclerotic plaques, cardiovascular risk factors stimulate vascular endothelial cells, initiating an inflammatory process, fundamental in the pathogenesis of CAD. The inclusion of potentially cardioprotective foods, such as olive oil, to the diet, may aid in the control of these risk factors, and in the reduction of cytokines and inflammatory markers. The present review aims to address the interaction between phenolic compounds present in olive oil, and inflammation, in the prevention and treatment of CAD. In vitro and in vivo studies suggest that phenolic compounds, such as hydroxytyrosol, tyrosol, and their secoiridoid derivatives, may reduce the expression of adhesion molecules and consequent migration of immune cells, modify the signaling cascade and the transcription network (blocking the signal and expression of the nuclear factor kappa B), inhibit the action of enzymes responsible for the production of eicosanoids, and consequently, decrease circulating levels of inflammatory markers. Daily consumption of olive oil seems to modulate cytokines and inflammatory markers related to CAD in individuals at risk for cardiovascular diseases. However, clinical studies that have evaluated the effects of olive oil and its phenolic compounds on individuals with CAD are still scarce.
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http://dx.doi.org/10.3390/nu9101087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5691704PMC
September 2017

Omega-3 Fatty Acids Supplementation Differentially Modulates the SDF-1/CXCR-4 Cell Homing Axis in Hypertensive and Normotensive Rats.

Nutrients 2017 Aug 1;9(8). Epub 2017 Aug 1.

Postgraduate Program in Health Sciences: Cardiology, Institute of Cardiology of Rio Grande do Sul/University Foundation of Cardiology (IC/FUC), Princesa Isabel Avenue, 370, Porto Alegre, RS 90620-001, Brazil.

Background: We assessed the effect of acute and chronic dietary supplementation of ω-3 on lipid metabolism and cardiac regeneration, through its influence on the Stromal Derived Factor-1 (SDF-1) and its receptor (CXCR4) axis in normotensive and hypertensive rats.

Methods: Male Wistar Kyoto (WKY) and spontaneously hypertensive rats (SHR) were allocated in eight groups (of eight animals each), which received daily orogastric administration of ω-3 (1 g) for 24 h, 72 h or 2 weeks. Blood samples were collected for the analysis of the lipid profile and SDF-1 systemic levels (ELISA). At the end of the treatment period, cardiac tissue was collected for CXCR4 expression analysis (Western blot).

Results: The use of ω-3 caused a reduction in total cholesterol levels ( = 0.044), and acutely activated the SDF-1/CXCR4 axis in normotensive animals ( = 0.037). In the presence of the ω-3, after 72 h, SDF-1 levels decreased in WKY and increased in SHR ( = 0.017), and tissue expression of the receptor CXCR4 was higher in WKY than in SHR ( = 0.001).

Conclusion: The ω-3 fatty acid supplementation differentially modulates cell homing mediators in normotensive and hypertensive animals. While WKY rats respond acutely to omega-3 supplementation, showing increased release of SDF-1 and CXCR4, SHR exhibit a weaker, delayed response.
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http://dx.doi.org/10.3390/nu9080826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579619PMC
August 2017

Height Prediction From Ulna Length of Critically Ill Patients.

Nutr Clin Pract 2018 Dec 14;33(6):887-892. Epub 2017 Dec 14.

Department of Nutrition, Federal University of Health Sciences of Porto Alegre, and Postgraduate Program in Health Sciences: Cardiology, Institute of Cardiology of the Rio Grande do Sul, Porto Alegre, Brazil.

Background: Ulna length (UL) has been used in mathematical formulas to predict the body height of healthy and sick individuals. However, the evaluation of its use with patients admitted to intensive care units (ICU) is scarce. The objective of this study was to develop a mathematical equation to estimate critically ill patients' height using the UL measure and to evaluate its agreement with measured standing height.

Methods: This cross-sectional study was performed at the ICU of a tertiary hospital in Brazil. A total of 100 patients aged ≥18 years who had their body height measured before ICU admission were enrolled. The equation was developed through multiple linear regression, and its agreement was assessed through paired Student's t test and Bland-Altman plot.

Results: The following formula was obtained: height in cm = 153.492 - (7.97 × sex [sex: male = 1, female = 2]) + (0.974 × UL [in cm]). The difference between means of measured height (MH) and height estimated from UL was not significant (166.26 ± 8.75 cm and 166.30 ± 5.29 cm, respectively, P = .96), and a significant correlation (r = 0.624, P < .001) was detected. In the Bland-Altman analysis, UL was in agreement with MH; however, there was a significant bias (P < .001) suggesting that it may be disproportional and dependent on the average's height value.

Conclusion: The mathematical equation for height estimation using UL developed in this study matched the MH of critically ill patients. However, we suggest more studies for its validation.
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http://dx.doi.org/10.1177/0884533617716432DOI Listing
December 2018

Translation and adaptation of the NUTRIC Score to identify critically ill patients who benefit the most from nutrition therapy.

Clin Nutr ESPEN 2016 08 21;14:31-36. Epub 2016 May 21.

Department of Nutrition, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Postgraduate Program in Health Sciences: Cardiology, Institute of Cardiology of the Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address:

Introduction And Objectives: Due to the scarcity of tools to assess the nutritional risk in critically ill patients, the NUTrition Risk in the Critically ill Score (NUTRIC Score) was developed and validated primarily in a limited population to quantify the risk of adverse events that may be modified by aggressive nutrition therapy. The objective of this study was to translate and adapt the NUTRIC Score into Portuguese language for further demonstrate its feasibility and clinical utility in Brazilian Intensive Care Units (ICUs).

Methods: This translation and adaptation process is part of a study for the validation of NUTRIC Score in Brazil. Translation was performed according to standardized steps: initial translation, synthesis of translations, back-translation, revision and application of the instrument by specialists and evaluation of cultural adaptation. We conducted a pilot study within 50 patients mechanically ventilated for more than 48 h in four ICUs in Southern Brazil to determine the prevalence of patients who were the most likely to benefit from aggressive nutrition therapy.

Results: The translation and adaptation process produced a valid version of NUTRIC Score in the Portuguese language. The translated version was easily introduced into four Brazilian ICUs and the prevalence of patients with high score and likely to benefit from aggressive nutritional intervention (mean age 61.4 ± 15.3 years) was 46% (23 individuals, 95%CI 0.33-0.60).

Conclusions: The NUTRIC Score has been successfully translated into Portuguese and the prevalence of nutritionally-high risk patients may be around 50% in Brazilian ICUs.
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http://dx.doi.org/10.1016/j.clnesp.2016.04.030DOI Listing
August 2016

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

Sao Paulo Med J 2017 Jan-Feb;135(1):50-56

PhD. Adjunct Professor, Department of Nutrition, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil.

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.
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http://dx.doi.org/10.1590/1516-3180.2016.004519102016DOI Listing
August 2017
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