Publications by authors named "Daniel Magnoni"

12 Publications

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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

Risk factors for oropharyngeal dysphagia in cardiovascular diseases.

J Appl Oral Sci 2020 11;28:e20190489. Epub 2020 May 11.

Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências, Universidade Estadual Paulista, Marilia, SP, Brasil.

Some conditions consolidated as risk factors for oropharyngeal dysphagia have already been identified in other diseases, such as neurological. Studies on cardiovascular diseases concentrate in individuals in the postoperative period; thus, it is unknown if these same factors occur in individuals hospitalized for clinical or surgical treatment of these diseases. Objective to correlate predictive risk factors for oropharyngeal dysphagia in individuals with cardiovascular disease admitted at a reference cardiology hospital. Methodology This is a retrospective clinical study. Medical records of 175 individuals hospitalized for clinical and/or surgical treatment at a reference cardiology hospital from January to June 2017, attendants of the Speech-Language Pathology and Nutrition team, were analyzed. Of these, 100 records were included in the study: 41 females and 59 males (mean age 67.56 years). Deaths and individuals from 0 to 18 years were excluded. Stroke, malnutrition, age and prolonged orotracheal intubation were considered predictive risk factors for oropharyngeal dysphagia. Mann-Whitney test and Fisher's test were used for statistical analysis. Results Stroke (OR=2.93 p=0.02), malnutrition (OR=2.89 p=0.02) and prolonged orotracheal intubation (OR=3.94 p=0.02) were statistically significant predictors for oropharyngeal dysphagia within this population. Age below 80 years was not significant (p=0.06), but within octogenarians, significance was found (p=0.033). Conclusion Stroke, malnutrition, prolonged orotracheal intubation and age > 80 years are predictive risk factors for oropharyngeal dysphagia in adult population with cardiovascular diseases.
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http://dx.doi.org/10.1590/1678-7757-2019-0489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213782PMC
May 2020

Unsaturated Fatty Acids Improve Atherosclerosis Markers in Obese and Overweight Non-diabetic Elderly Patients.

Obes Surg 2017 10;27(10):2663-2671

Department of Gastroenterology, Hospital das Clínicas, São Paulo, 05403-900, Brazil.

Background: Several studies have demonstrated the benefits of replacing trans and saturated fats with unsaturated fatty acids on cardiovascular diseases. We aimed to demonstrate the effect of polyunsaturated and monounsaturated fat supplementation on the biochemical and endothelial markers of atherosclerotic disease in obese or overweight non-diabetic elderly patients.

Method: Seventy-nine patients were randomly divided into three groups: flaxseed oil, olive oil, and sunflower oil; patients in each group received 30 mL of oil for 90 days. Patients were subjected to anthropometric and bioimpedance assessments; biochemical and endothelial evaluations were performed through ultrasonography of the brachial artery and carotid artery for endothelium-dependent dilation and intima-media thickness assessment, respectively, before and after the intervention. The participants' usual diet remained unchanged.

Results: The flaxseed oil group had improved ultra-sensitive C-reactive protein levels (p = 0.074) and reduced carotid intima-media thickness (CIMT) (p = 0.028); the olive oil group exhibited an improved apolipoprotein (Apo)B/ApoA ratio (p = 0.021), reduced CIMT (p = 0.028), and improved flow-mediated vasodilation (FMV) (p = 0.054); and similarly, the sunflower oil group showed an improved ApoB/ApoA ratio (p = 0.024), reduced CIMT (p = 0.048), and improved FMV (p = 0.001).

Conclusion: Unsaturated fatty acid supplementation using the three vegetable oils attenuated pro-inflammatory properties and improved prothrombotic conditions. Therefore, introducing or replacing saturated and trans fat with unsaturated fatty acids is beneficial for cardiovascular risk reduction in obese or overweight non-diabetic elderly people. Further studies are needed to determine which unsaturated fat best prevents cardiovascular disease in elderly patients.
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http://dx.doi.org/10.1007/s11695-017-2704-8DOI Listing
October 2017

Diabetes and cardiovascular events in high-risk patients: Insights from a multicenter registry in a middle-income country.

Diabetes Res Clin Pract 2017 May 25;127:275-284. Epub 2017 Mar 25.

Research Institute of Heart Hospital (Hcor), São Paulo, Brazil.

Aims: The aim of this study was to determine the rate of major clinical events and its determinants in patients with previous cardiovascular event or not, and with or without diabetes from a middle-income country.

Methods: REACT study is a multicenter registry conducted between July 2010 and May 2013 in Brazil. Patients were eligible if they were over 45years old and high cardiovascular risk. Patients were followed for 12months; data were collected regarding adherence to evidence-based therapies and occurrence of clinical events (all-cause mortality, non-fatal cardiac arrest, myocardial infarction, or stroke).

Results: A total of 5006 subjects was included and analyzed in four groups: No diabetes and no previous cardiovascular event, n=430; diabetes and no previous cardiovascular event, n=1138; no diabetes and previous cardiovascular event, n=1747; and diabetes and previous cardiovascular event, n=1691. Major clinical events in one-year follow-up occurred in 332 patients. A previous cardiovascular event was associated with a higher risk of having another event in the follow-up (HR 2.31 95% CI 1.74-3.05, p<0.001), as did the presence of diabetes (HR 1.28 95% CI 1.10-1.73, p=0.005). In patients with diabetes,failure to reach HbA1c targetswas related topoorer event-free survival compared to patients with good metabolic control (HR 1.70 95% CI 1.01-2.84, p=0.044).

Conclusions: In Brazil, diabetes confers high risk for major clinical events, but this condition is not equivalent to having a previous cardiovascular event. Moreover, not so strict targets for HbA1c in patients with diabetes and previous cardiovascular events might be considered.
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http://dx.doi.org/10.1016/j.diabres.2017.03.021DOI Listing
May 2017

The Brazilian Cardioprotective Nutritional Program to reduce events and risk factors in secondary prevention for cardiovascular disease: study protocol (The BALANCE Program Trial).

Am Heart J 2016 Jan 15;171(1):73-81.e1-2. Epub 2015 Aug 15.

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

This article reports the rationale for the Brazilian Cardioprotective Nutritional Program (BALANCE Program) Trial. This pragmatic, multicenter, nationwide, randomized, concealed, controlled trial was designed to investigate the effects of the BALANCE Program in reducing cardiovascular events. The BALANCE Program consists of a prescribed diet guided by nutritional content recommendations from Brazilian national guidelines using a unique nutritional education strategy, which includes suggestions of affordable foods. In addition, the Program focuses on intensive follow-up through one-on-one visits, group sessions, and phone calls. In this trial, participants 45 years or older with any evidence of established cardiovascular disease will be randomized to the BALANCE or control groups. Those in the BALANCE group will receive the afore mentioned program interventions, while controls will be given generic advice on how to follow a low-fat, low-energy, low-sodium, and low-cholesterol diet, with a view to achieving Brazilian nutritional guideline recommendations. The primary outcome is a composite of death (any cause), cardiac arrest, acute myocardial infarction, stroke, myocardial revascularization, amputation for peripheral arterial disease, or hospitalization for unstable angina. A total of 2468 patients will be enrolled in 34 sites and followed up for up to 48 months. If the BALANCE Program is found to decrease cardiovascular events and reduce risk factors, this may represent an advance in the care of patients with cardiovascular disease.
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http://dx.doi.org/10.1016/j.ahj.2015.08.010DOI Listing
January 2016

Evidence-based therapy prescription in high-cardiovascular risk patients: the REACT study.

Arq Bras Cardiol 2013 Mar;100(3):212-20

Hospital do Coração, São Paulo, SP.

Background: Data on outpatient care provided to patients at high cardiovascular risk in Brazil are insufficient.

Objective: To describe the profile and document the clinical practice of outpatient care in patients at high cardiovascular risk in Brazil, regarding the prescription of evidence-based therapies.

Methods: Prospective registry that documented the ambulatory clinical practice in individuals at high cardiovascular risk, which was defined as the presence of the following factors: coronary artery disease, cerebrovascular and peripheral vascular diseases, diabetes, or those with at least three of the following factors: hypertension, smoking, dyslipidemia, age > 70 years, family history of coronary artery disease, chronic kidney disease or asymptomatic carotid artery disease. Basal characteristics were assessed and the rate of prescription of pharmacological and non-pharmacological interventions was analyzed.

Results: A total of 2364 consecutive patients were included, of which 52.2% were males, with a mean age of 66.0 years (± 10.1). Of these, 78.3% used antiplatelet agents, 77.0% used statins and of patients with a history of myocardial infarction, 58.0% received beta-blockers. Concomitant use of these three classes of drugs was 34%; 50.9% of hypertensive, 67% of diabetic and 25.7% of dyslipidemic patients did not achieve the goals recommended by guidelines. The main predictors of prescription therapies with proven benefit were centers with a cardiologist and history of coronary artery disease.

Conclusion: This national and representative registry identified important gaps in the incorporation of therapies with proven benefit, offering a realistic outlook of patients at high cardiovascular risk.
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http://dx.doi.org/10.5935/abc.20130062DOI Listing
March 2013

Is intake of vitamin D and calcium important for cardiovascular health in elderly obese patients?

Obes Surg 2012 Mar;22(3):437-44

Dante Pazzanese Institute of Cardiology, Sao Paulo, 04012-909, Brazil.

There is compelling evidence that bariatric weight loss reduces cardiovascular complications; however, these still tend to be the most common cause of late death after surgical intervention. In a prospective cohort study, correlations of dietary nutrients with indexes of vascular health were sought, with emphasis on vitamin D and calcium. Clinically stable obese outpatient subjects (>60 years old, N = 44) were interviewed about dietary macro and micronutrients. Nutritional assessment targeted anthropometric and bioimpedance analysis (BIA), hematologic counts, lipid profile, glucose homeostasis, and inflammatory markers. Carotid intima-media thickness (IMT) and brachial flow-mediated dilation (FMD), along with related vascular measurements, were documented, and results were correlated by uni- and multivariate analysis, corrected for known risk factors. IMT, FMD, and also brachial basal flow were positively influenced by vitamin D (P < 0.001). Calcium appeared beneficial for brachial basal flow only (P = 0.010). No association with IMT occurred, and a negative result for FMD was elicited. Also, vitamins A and B12 were advantageous for FMD, whereas iron was deleterious for IMT. Intake of many micronutrients including calcium and vitamin D did not meet recommendations. Vitamin D displayed a beneficial profile regarding vascular health, and more attention to this nutrient should be given, especially concerning obese patients with cardiometabolic risk. Calcium exhibited less straightforward results but deserves focus as well, along with antioxidant vitamin A as well as the B-complex which were mostly deficient in this experience.
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http://dx.doi.org/10.1007/s11695-012-0593-4DOI Listing
March 2012

Long-term use of a diabetes-specific oral nutritional supplement results in a low-postprandial glucose response in diabetes patients.

Diabetes Res Clin Pract 2008 Apr 11;80(1):75-82. Epub 2007 Dec 11.

Instituto Dante Pazzanese de Cardiologia, Rua Carlos Sampaio 304, cj 31 CEP 01333 020 São Paulo, Brazil.

Background: To determine the effect of 12 weeks supplementation with a high-MUFA, high-fibre diabetes-specific oral nutritional supplement (ONS) on postprandial glucose response in type 2 diabetic patients at risk for malnutrition.

Methods: Forty patients participated in this randomised, controlled, double-blind, parallel-group study. Subjects consumed 2 x 200 ml of diabetes-specific ONS (Diasip) or standard ONS per day in addition to their normal diet. At baseline, after 6 and 12 weeks postprandial glucose responses and secondary parameters were assessed.

Results: Postprandial glucose responses (incremental area under curve) (p<0.01) and delta postprandial peak glucose concentration (p<0.01) were significantly lower in the diabetes-specific ONS group compared with the standard ONS group at all visits. In time, iAUC glucose (p=0.074, t=0 week vs. t=12 weeks) and delta postprandial peak plasma glucose concentration (p<0.05, t=0 week vs. t=12 weeks) were decreased within the diabetes-specific ONS group, but not in the standard ONS group. No significant differences in fasting glucose, insulin, HbA1c, lipid profile, hs-CRP, oxidized LDL and malondialdehyde, laboratory safety parameters and nutritional status parameters were found between both groups at either of the visits.

Conclusions: These data demonstrate that diabetic patients at risk for malnutrition benefit from use of this diabetes-specific ONS to improve postprandial blood glucose control.
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http://dx.doi.org/10.1016/j.diabres.2007.10.027DOI Listing
April 2008
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