RESUMO
Introduction: The World Health Organization (WHO) has proposed to monitor intrinsic capacity (IC) in the older population as a public health strategy through the Integrated Care for Older People (ICOPE) program. Although the program has been developed based on solid concepts, scientific evidence on its practical applicability is still scarce. Objectives: To evaluate IC in Brazilian older adults, its progress over time, and its association with sociodemographic and health factors and outcomes. To evaluate the psychometric properties of the WHO/ICOPE screening tool. Methods: This is a prospective multicenter cohort study with a 36-month follow-up. We will recruit 3838 people aged ≥60 years, registered in the health care units included in the study by the participating centers. We will collect sociodemographic and health data and will administer tools to assess IC domains, both those provided for in the ICOPE screening tool and the sequence of confirmatory assessments provided for in the program. Participants will be reassessed every 6 months for 36 months. Expected results: To establish the profile of IC in the study population and to understand its progress and the variables associated with the clinical outcomes of interest. To reveal the diagnostic and psychometric properties of the WHO/ICOPE screening tool. The project is funded by the Brazilian National Council for Scientific and Technological Development (CNPq). Relevance: Understanding the potential use of the ICOPE public health strategy proposed by the WHO within the scope of the Brazilian Unified Health System (SUS) by integrating several research centers in the field of Geriatrics and Gerontology throughout Brazil. (AU)
Introdução: A Organização Mundial da Saúde (OMS) propõe o monitoramento da capacidade intrínseca (CI) da população idosa como estratégia de saúde pública por meio do Programa ICOPE (Integrated Care for Older People). Embora construído com base em conceitos sólidos, a evidência científica sobre a aplicabilidade prática da proposta ainda é escassa. Objetivo: Avaliar a capacidade intrínseca da população idosa brasileira, sua trajetória e sua associação com variáveis sociodemográficas, de saúde e desfechos. Avaliar as propriedades psicométricas da ferramenta de triagem da estratégia ICOPE da OMS. Metodologia: Coorte multicêntrica prospectiva com seguimento de 36 meses. Serão recrutadas 3.838 pessoas com 60 anos ou mais, cadastradas nas unidades de saúde incluídas no estudo pelos centros participantes. Serão coletados dados sociodemográficos e de saúde e aplicados instrumentos para avaliação dos domínios da CI, tanto aqueles previstos no instrumento de triagem do ICOPE quanto a sequência de avaliações confirmatórias previstas no programa. Os participantes serão acompanhados semestralmente ao longo de 36 meses. Resultados esperados: Estabelecer o perfil da CI na população estudada, entender a sua trajetória e as variáveis associadas aos desfechos clínicos avaliados. Revelar as propriedades diagnósticas e o perfil psicométrico da ferramenta de triagem do ICOPE da OMS. O projeto tem financiamento do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). Relevância: Compreensão sobre o potencial de utilização da estratégia ICOPE de saúde pública proposta pela OMS no âmbito do Sistema Único de Saúde (SUS) pela integração de diversos centros de pesquisa científica na área de Geriatria e Gerontologia de todo o Brasil. (AU)
Assuntos
Humanos , Idoso , Idoso de 80 Anos ou maisRESUMO
The increase in life expectancy can be a consequence of the world's socioeconomic, sanitary and nutritional conditions. Some studies have demonstrated that individuals with a satisfactory diet variety score present a lower risk of malnutrition and better health status. Zinc and selenium are important micronutrients that play a role in many biochemical and physiological processes of the immune system. Deficient individuals can present both innate and adaptive immunity abnormalities and increased susceptibility to infections. Primary immunodeficiency diseases, also known as inborn errors of immunity, are genetic disorders classically characterized by an increased susceptibility to infection and/or dysregulation of a specific immunologic pathway. IgA deficiency (IgAD) is the most common primary antibody deficiency. This disease is defined as serum IgA levels lower than 7 mg/dL and normal IgG and IgM levels in individuals older than four years. Although many patients are asymptomatic, selected patients suffer from different clinical complications, such as pulmonary infections, allergies, autoimmune diseases, gastrointestinal disorders and malignancy. Knowing the nutritional status as well as the risk of zinc and selenium deficiency could be helpful for the management of IgAD patients. OBJECTIVES: to investigate the anthropometric, biochemical, and nutritional profiles and the status of zinc and selenium in patients with IgAD. METHODS: in this descriptive study, we screened 16 IgAD patients for anthropometric and dietary data, biochemical evaluation and determination of plasma and erythrocyte levels of zinc and selenium. RESULTS: dietary intake of zinc and selenium was adequate in 75% and 86% of the patients, respectively. These results were consistent with the plasma levels (adequate levels of zinc in all patients and selenium in 50% of children, 25% of adolescents and 100% of adults). However, erythrocyte levels were low for both micronutrients (deficiency for both in 100% of children, 75% of adolescents and 25% of adults). CONCLUSION: our results highlight the elevated prevalence of erythrocyte zinc and selenium deficiency in patients with IgAD, and the need for investigation of these micronutrients in their follow-up.
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Deficiência de IgA , Desnutrição , Selênio , Adolescente , Adulto , Criança , Humanos , Zinco , Imunidade AdaptativaRESUMO
Iodine deficiency in pregnancy may lead to adverse maternal and fetal outcomes, including impaired child development. Sociodemographic factors and different dietary habits may be related to iodine status in pregnant women. The aim of this study was to evaluate the iodine status and its predictors among pregnant women in a city of Southeastern Brazil. This cross-sectional study was conducted with 266 pregnant women receiving prenatal care in 8 primary health care units. Sociodemographic, obstetric and health, habits of acquisition, storage and consumption of iodized salt, and dietary iodine intake data were collected through a questionnaire. The iodine content was evaluated in urinary iodine concentration (UIC), household salt and seasonings, and drinking water samples. Pregnant women were categorized into three groups according to the UIC, determined by iodine coupled plasma-mass spectrometry (ICP-MS): insufficient (< 150 µg/L), adequate (150-249 µg/L), and more than adequate iodine nutrition (≥ 250 µg/L). The median (p25-p75) UIC was 180.2 µg/L (112.8-262.7). It was found 38% and 27.8% of insufficient and more than adequate iodine nutrition, respectively. Number of gestations, KI content of supplement, alcohol consumption, salt storage, and frequency of using industrialized seasoning were associated to iodine status. Alcohol consumption (OR = 6.59; 95%CI 1.24-34.87), pack the salt in opened container (OR = 0.22; 95%CI 0.08-0.57), and use industrialized seasoning weekly (OR = 3.68; 95% CI 1.12-12.11) were predictors of iodine insufficiency. The pregnant women evaluated have adequate iodine nutrition. Household salt storage and seasoning consumption were risk factors for insufficient iodine status.
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Iodo , Gestantes , Criança , Gravidez , Feminino , Humanos , Estudos Transversais , Brasil/epidemiologia , Cloreto de Sódio na Dieta/análise , Estado NutricionalRESUMO
People living with HIV (PWH) experience an accelerated reduction in bone mineral content (BMC), and a high risk of osteopenia and osteoporosis. Anthropometry is an accurate and low-cost method that can be used to monitor changes in body composition in PWH. To date, no studies have used anthropometry to estimate BMC in PWH. To propose and validate sex-specific anthropometric models to predict BMC in PWH. This cross-sectional study enrolled 104 PWH (64 males) aged >18 years at a local university hospital. BMC was measured using dual energy X-ray absorptiometry (DXA). Anthropometric measures were collected. We used linear regression analysis to generate the models. Cross-validations were conducted using the "leave one out", from the predicted residual error sum of squares (PRESS) method. Bland-Altman plots were used to explore distributions of errors. We proposed models with high coefficient of determination and reduced standard error of estimate for males (r2 = 0.70; SEE = 199.97 g; Q2PRESS = 0.67; SEEPRESS = 208.65 g) and females (r2 = 0.65; SEE = 220.96 g; Q2PRESS = 0.62; SEEPRESS = 221.90 g). Our anthropometric predictive models for BMC are valid, practical, and a low-cost alternative to monitoring bone health in PWH.
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Densidade Óssea , Infecções por HIV , Absorciometria de Fóton/métodos , Antropometria/métodos , Composição Corporal , Estudos Transversais , Feminino , Humanos , MasculinoRESUMO
Nucleoside/nucleotide analogs such as tenofovir, have been used as long-term therapy for the treatment of hepatitis B and side effects such as the reduction in bone mineral density have been associated with their use. To determine the relationships between bone, hormonal, biochemical, and mineral parameters in patients with hepatitis B treated with nucleoside/nucleotide antiviral. A cross-sectional study was conducted with 81 adult patients with chronic hepatitis B infection. Dual-energy X-ray absorptiometry (DXA) was performed to assess bone mineral density. Biochemical analyses were performed for osteocalcin, deoxypyridinoline, parathyroid hormone, vitamin D, IGF-1, TSH, testosterone, estradiol, FSH, transaminases, urea, creatinine, calcium, serum and urinary phosphorus, magnesium, and FGF-23, body composition was performed by DXA. Participants, both gender, were divided according to the use of antiretrovirals: Group1: 27 inactive virus carriers without medication; Group2: 27 patients using tenofovir; and Group3: 27 patients using lamivudine or entecavir. DXA readings diagnosed osteopenia in the lumbar spine for 7.4% of individuals in Group1, 15% in Group2, and 3.7% in Group3. For all groups, we observed normal values in bone formation markers, osteocalcin levels as well as parathyroid hormone, insulin growth factor 1, and FGF-23. In all groups, we found increased levels of urinary deoxypyridinoline, a bone resorption marker. Increased levels in the bone resorption markers indicated a high resorptive activity of bone tissue. These data suggested high resorption activity of bone tissue in hepatitis B virus-infected patients independent of the use of antiretrovirals.
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Antirretrovirais/uso terapêutico , Reabsorção Óssea/complicações , Reabsorção Óssea/metabolismo , Hepatite B Crônica/complicações , Hepatite B Crônica/tratamento farmacológico , Osteoclastos/metabolismo , Absorciometria de Fóton , Adulto , Composição Corporal/efeitos dos fármacos , Densidade Óssea/efeitos dos fármacos , Reabsorção Óssea/diagnóstico por imagem , Reabsorção Óssea/virologia , Estudos Transversais , Feminino , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/metabolismo , Colo do Fêmur/virologia , Fator de Crescimento de Fibroblastos 23 , Guanina/análogos & derivados , Guanina/uso terapêutico , Vírus da Hepatite B/efeitos dos fármacos , Quadril/diagnóstico por imagem , Quadril/virologia , Humanos , Lamivudina/uso terapêutico , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/metabolismo , Vértebras Lombares/virologia , Masculino , Pessoa de Meia-Idade , Osteoclastos/efeitos dos fármacos , Osteoclastos/virologia , Tenofovir/uso terapêuticoRESUMO
Hepatitis B is a major public health problem worldwide and associated with significant mortality. To prevent or delay the deleterious effects of chronic infection by the hepatitis B virus, patients should be carefully followed, and antiviral therapy indicated according to specific recommendations. Currently, available drugs inhibit viral replication and slow or stop the progression of inflammation and fibrosis of the liver. However, the drugs for oral use in the treatment of hepatitis B, jointly referred to as nucleoside/nucleotide analogs, are indicated for prolonged use and have potential side effects. The reduction in bone mineral density was associated with the use of tenofovir, already evaluated in patients infected with HIV because the drug is also part of the therapeutic arsenal for this viral infection. There are few studies on the effects of tenofovir in patients with mono hepatitis B. Therefore, this literature review proposes to examine how hepatitis B acts in the body and the mechanisms by which antiretroviral drugs (especially tenofovir) can affect bone metabolism.
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Antirretrovirais/efeitos adversos , Densidade Óssea/efeitos dos fármacos , Remodelação Óssea/efeitos dos fármacos , Hepatite B Crônica/tratamento farmacológico , Antirretrovirais/administração & dosagem , Humanos , Replicação Viral/efeitos dos fármacosRESUMO
BACKGROUND: Obesity-induced inflammation is frequently associated with higher oxidative stress. In vitro and experimental studies have considered baru almonds (Dipteryx alata Vog) as a legume seed with high antioxidant capacity. The aim of this study was to evaluate whether baru almonds are capable of improving the inflammatory and antioxidant status in overweight and obese women. METHODS: In a parallel-arm, randomized placebo-controlled trial, 46 overweight and obese women (age: 40 ± 11 years; body mass index: 33.3 ± 4.3) were randomly assigned to receive advice to follow a normocaloric and isoenergetic diet with placebo (PLA, n = 22) or similar advice plus 20 g baru almonds (BARU, n = 24) for 8 wk. Malondialdehyde (MDA), adiponectin, tumor necrosis factor-α, interleukin-6, interleukin-10, antioxidant enzymes activities (catalase-CAT; glutathione peroxidase-GPx; superoxide dismutase-SOD), and minerals were analyzed in plasma samples. RESULTS: At baseline, groups were similar regarding the body composition, oxidative, and inflammatory parameters. The BARU group increased the activity of GPx (+0.08 U/mg, 95%CI + 0.05 to +0.12 vs. -0.07, 95%CI -0.12 to -0.03, p < 0.01) and plasma copper concentration (p = 0.037) when compared to the PLA group. No differences were observed between groups in CAT and SOD activity or MDA and cytokines concentrations. CONCLUSIONS: Baru almond supplementation increased the GPx activity in overweight and obese women.