RESUMO
OBJECTIVE: The diagnostic of protein-energy wasting should be done using a tool that can predict clinically important outcomes, besides identifying malnutrition. This study investigated which nutritional composed scoring systems best predicts all-cause mortality in maintenance hemodialysis patients. DESIGN AND METHODS: Cohort study that included prevalent patients undergoing hemodialysis for at least 1 month. To assess nutritional status, Subjective Global Assessment (SGA), Malnutrition-Inflammation Score (MIS), and diagnostic criteria for protein-energy wasting proposed by the International Society of Renal Nutrition and Metabolism (ISRNM) were used. Patients were assessed in the moment of inclusion in the study (between July 2012 and December 2012) and followed prospectively to verify the occurrence of deaths. RESULTS: A total of 163 patients were included, 54.6% were male, and mean age was 58.4 ± 15.5 years. During the follow-up period (15.5 ± 5.4 months), 29 patients died and 16 underwent kidney transplant. Kaplan-Meier survival curves and Cox proportional hazard analysis adjusted for age, gender, dialysis vintage, diabetes, and serum urea showed that SGA and MIS were predictors of all-cause mortality. CONCLUSION: Of the 3 investigated scoring systems, SGA and MIS predict mortality in a period of 15.5 ± 5.4 months of follow-up.
Assuntos
Estado Nutricional/fisiologia , Diálise Renal/mortalidade , Síndrome de Emaciação/fisiopatologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Inflamação/diagnóstico , Estimativa de Kaplan-Meier , Falência Renal Crônica/mortalidade , Falência Renal Crônica/terapia , Transplante de Rim , Masculino , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Avaliação Nutricional , Modelos de Riscos ProporcionaisRESUMO
OBJECTIVES: Peritoneal dialysis (PD) patients may suffer changes in nutritional status after starting PD. Several markers can be used to evaluate these modifications, such as body mass index (BMI), serum albumin, and serum creatinine. Fluid overload should be considered because it can overestimate or underestimate nutritional status. The objective of this study was to evaluate the BMI changes over time in incident PD patients and identify interactions among BMI, signs of fluid overload, serum albumin, and serum creatinine. DESIGN: The study included a cohort of 1,997 incident PD patients of the BRAZPD recruited from 2004 to 2007. Sociodemographic data and BMI classification were obtained at baseline. The evolutions of BMI and body weight were assessed over a period of 29 months. Changes in the evolution were analyzed when a patient presented with albumin < 3.8 g/dL, creatinine < 7.0 mg/dL, or the presence of edema. Data analysis was performed using linear mixed-effects regression models as the main statistical procedure. RESULTS: BMI increased over time (29 months) by an average of 0.05 kg/m(2) per month, and body weight increased by 0.11 kg/month for a total increase of 3.08 kg. BMI decreased by 0.12 kg/m(2) in the presence of albumin < 3.8 g/dL and by 0.38 kg/m(2) in the presence of creatinine < 7.0 mg/dL. BMI increased by 0.61 kg/m(2) in the presence of edema. BMI increased in the presence of edema and albumin < 3.8 mg/dL or edema and creatinine < 7.0 mg/dL. CONCLUSIONS: There is a mean increase in the BMI of incident PD patients over time, and these changes may be, at least partly, due to fluid overload, leading to distortions of body weight. When the patients presented with lower serum albumin or creatinine levels, the BMI values were reduced, suggesting that a reduction in lean mass and an increase in fat mass may be occurring in these patients.
Assuntos
Índice de Massa Corporal , Diálise Peritoneal/efeitos adversos , Síndrome de Emaciação/fisiopatologia , Idoso , Biomarcadores/sangue , Peso Corporal , Creatinina/sangue , Feminino , Humanos , Masculino , Estado Nutricional , Estudos Prospectivos , Análise de Regressão , Albumina Sérica/análise , Fatores SocioeconômicosRESUMO
TNFalpha is an important mediator of catabolism in cachexia. Most of its effects have been characterized in peripheral tissues, such as skeletal muscle and fat. However, by acting directly in the hypothalamus, TNFalpha can activate thermogenesis and modulate food intake. Here we show that high concentration TNFalpha in the hypothalamus leads to increased O(2) consumption/CO(2) production, increased body temperature, and reduced caloric intake, resulting in loss of body mass. Most of the thermogenic response is produced by beta 3-adrenergic signaling to the brown adipose tissue (BAT), leading to increased BAT relative mass, reduction in BAT lipid quantity, and increased BAT mitochondria density. The expression of proteins involved in BAT thermogenesis, such as beta 3-adrenergic receptor, peroxisomal proliferator-activated receptor-gamma coactivator-1 alpha, and uncoupling protein-1, are increased. In the hypothalamus, TNFalpha produces reductions in neuropeptide Y, agouti gene-related peptide, proopiomelanocortin, and melanin-concentrating hormone, and increases CRH and TRH. The activity of the AMP-activated protein kinase signaling pathway is also decreased in the hypothalamus of TNFalpha-treated rats. Upon intracerebroventricular infliximab treatment, tumor-bearing and septic rats present a significantly increased survival. In addition, the systemic inhibition of beta 3-adrenergic signaling results in a reduced body mass loss and increased survival in septic rats. These data suggest hypothalamic TNFalpha action to be important mediator of the wastage syndrome in cachexia.
Assuntos
Regulação da Temperatura Corporal/fisiologia , Caquexia/fisiopatologia , Hipotálamo/fisiologia , Fator de Necrose Tumoral alfa/fisiologia , Síndrome de Emaciação/fisiopatologia , Tecido Adiposo Marrom/inervação , Tecido Adiposo Marrom/fisiologia , Animais , Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Peso Corporal , Caquexia/tratamento farmacológico , Calorimetria Indireta , Denervação , Fármacos Gastrointestinais/uso terapêutico , Hipotálamo/efeitos dos fármacos , Hipotálamo/fisiopatologia , Infliximab , Masculino , Proteínas do Tecido Nervoso/genética , Reação em Cadeia da Polimerase , Pró-Opiomelanocortina/genética , Ratos , Ratos Wistar , Síndrome de Emaciação/tratamento farmacológicoRESUMO
AIM: To study whether adiponectin and resistin serum concentrations in children on peritoneal dialysis (PD) were related to insulin resistance (IR) and anthropometric parameters of nutritional status, 11 PD patients, 9 chronic kidney disease (CKD) patients and 10 healthy children were studied. METHODS: Glucose and insulin were measured during the oral glucose tolerance test. Levels of adiponectin and resistin were evaluated by ELISA, insulin by RIA. RESULTS: In CKD patients, higher homeostasis model assessment-insulin resistance (HOMA-IR), fasting and 2-hour serum insulin levels were shown compared to control and to PD patients. Body mass index (BMI) and body fat content were severely decreased while serum adiponectin levels were significantly higher in PD patients relative to controls. No differences among groups were shown in resistin levels. On regression modeling, inverse independent associations were observed between adiponectin with percentile BMI, weight and height z-score, and with body fat content. In contrast, no relationship was found between adiponectin and IR parameters. In multiple regression analysis, adiponectin was negatively correlated with BMI. A negative association of adiponectin and resistin with glomerular filtration rate was also shown. CONCLUSION: A role for adiponectin in terms of its association with clinical wasting parameters in PD pediatric patients might be suggested.
Assuntos
Resistência à Insulina , Falência Renal Crônica/sangue , Estado Nutricional , Diálise Peritoneal/efeitos adversos , Síndrome de Emaciação/etiologia , Adiponectina/sangue , Tecido Adiposo/patologia , Adolescente , Antropometria , Composição Corporal , Índice de Massa Corporal , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Teste de Tolerância a Glucose , Humanos , Insulina/sangue , Falência Renal Crônica/complicações , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Masculino , Desnutrição/sangue , Desnutrição/etiologia , Desnutrição/patologia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Resistina/sangue , Síndrome de Emaciação/sangue , Síndrome de Emaciação/fisiopatologiaRESUMO
The evidence for an association between poor nutrition in early life and subsequent obesity is inconclusive. In the present study, we investigated the associations between stunting, wasting and underweight at 2 and 4 years of age, and body composition in adolescence in male subjects studied since birth. The 1982 Pelotas Birth Cohort Study included all children born in maternity hospitals and living in the urban area of the city of Pelotas, Southern Brazil. All males born in 1982 were legally required to enlist in the army between January and April 2000. We were thus able to track 2250 subjects in 2000 (78.9% of the original cohort). Anthropometric measurements were collected in 1984 and 1986, and body composition was assessed in 2000. In the present analysis, we used as predictors the nutritional indices height-for-age, weight-for-height and weight-for-age presented in six categories. Outcomes included fat, lean and body mass indices and fat:lean mass ratio, derived from anthropometric and bioimpedance measurements. ANOVA and linear regression were used in the analyses to adjust for confounding. All predictors were positively associated with fat and body mass indices. Height-for-age Z score at age 2 or 4 years was not associated with lean mass index, but all other predictors were associated. Fat:lean mass ratio was associated only with weight-for-height Z score. Our results suggest that undernutrition is not a risk factor for overweight and obesity in our population and may partially protect against fatness in adolescence.
Assuntos
Composição Corporal/fisiologia , Transtornos da Nutrição Infantil/fisiopatologia , Adolescente , Peso ao Nascer/fisiologia , Estatura/fisiologia , Índice de Massa Corporal , Peso Corporal/fisiologia , Pré-Escolar , Estudos de Coortes , Transtornos do Crescimento/fisiopatologia , Humanos , Renda , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Estado Nutricional/fisiologia , Magreza/fisiopatologia , Síndrome de Emaciação/fisiopatologiaRESUMO
Descreve-se o primeiro surto de Síndrome Definhante Multissistêmica de Suínos Desmamados (SDMSD) na Região Sudeste do Brasil, no estado do Rio de Janeiro. A enfermidade que afetou principalmente suínos desmamados com idade em torno de 4 meses, levou a morte pelo menos 14 animais. A granja onde o surto ocorreu, tinha péssimas condições sanitárias e de manejo. Clinicamente, a doença caracterizou-se por má condição corporal, pouco desenvolvimento, tosse, taquipnéia, dispnéia, diarréia, ataxia, tremores após estímulo, decúbito e convulsões, com evolução aguda a subaguda. À necropsia, os achados mais importantes foram um aumento de volume de linfonodos e pulmões não-colapsados, com áreas consolidadas, principalmente nos lobos craniais e porção anterior dos lobos médios. O exame histológico revelou, com maior freqüência, infiltração linfo-histiocítica com células sinciciais em linfonodos, baço, placas de Peyer, rim, pulmão e fígado, depleção ou hiperplasia linfóide, bem como pneumonia bronco-intersticial linfo-histiocitária e áreas de broncopneumonia secundária. O diagnóstico firmou-se pela observação dos sintomas e das lesões histológicas típicas e foi confirmado por exame imunohistoquímico e PCR. O estudo teve por objetivo caracterizar os aspectos epidemiológico e clínico-patológico desse surto, já que a mesma tem causado grandes perdas econômicas, diretas ou indiretas, à suinocultura mundial.(AU)
The first outbreak of Postweaning Multisystemic Wasting Syndrome (PMWS) in swine, which occurred in southeastern Brazil, in the state of Rio de Janeiro, is described. The disease, which affects mainly weaned about 4 month-old pigs, caused the death of at least 14 animals. The property, where the outbreak occurred, had inadequate sanitary and management conditions. Clinically the disease was characterized by wasting, poor development, cough, tachypnoea, dispnoea, diarrhoea, ataxia, tremors after stimulation, decubitus and convulsions. The course of the disease was acute or subacute. The most important post-mortem findings were enlarged lymphnodes, non-collapsed lungs, with consolidated areas mainly in the cranial lobes. Histological lesions consisted mainly of lymphohistiocytic infiltration with multinucleate giant cells in lymph nodes, spleen, Peyer's patches, kidney, lung and liver, depletion or lymphoid hyperplasia, as well as lymphohistiocytic interstitial pneumonia and areas of secondary bronchopneumonia. The diagnosis was established through observations of the symptoms and typical lesions, and was confirmed by immunohistochemical examination and PCR. The objective of this study was to characterize the epidemiological, clinical and pathological aspects of the outbreak of PMWS, because of the severe direct or indirect economical losses caused by the disease to the world pig industry.(AU)
Assuntos
Animais , Circovirus/isolamento & purificação , Síndrome de Emaciação/epidemiologia , Síndrome de Emaciação/fisiopatologia , Reação em Cadeia da Polimerase/métodosRESUMO
Descreve-se o primeiro surto de Síndrome Definhante Multissistêmica de Suínos Desmamados (SDMSD) na Região Sudeste do Brasil, no estado do Rio de Janeiro. A enfermidade que afetou principalmente suínos desmamados com idade em torno de 4 meses, levou a morte pelo menos 14 animais. A granja onde o surto ocorreu, tinha péssimas condições sanitárias e de manejo. Clinicamente, a doença caracterizou-se por má condição corporal, pouco desenvolvimento, tosse, taquipnéia, dispnéia, diarréia, ataxia, tremores após estímulo, decúbito e convulsões, com evolução aguda a subaguda. A necropsia, os achados mais importantes foram um aumento de volume de linfonodos e pulmões não-colapsados, com áreas consolidadas, principalmente nos lobos craniais e porção anterior dos lobos médios. O exame histológico revelou, com maior freqüência, infiltração linfo-histiocítica com células sinciciais em linfonodos, baço, placas de Peyer, rim, pulmão e fígado, depleção ou hiperplasia linfóide, bem como pneumonia bronco-intersticial linfo-histiocitária e áreas de broncopneumonia secundária. O diagnóstico firmou-se pela observação dos sintomas e das lesões histológicas típicas e foi confirmado por exame imunohistoquímico e PCR. O estudo teve por objetivo caracterizar os aspectos epidemiológico e clínico-patológico desse surto, já que a mesma tem causado grandes perdas econômicas, diretas ou indiretas, à suinocultura mundial.
Assuntos
Animais , Circovirus/isolamento & purificação , Reação em Cadeia da Polimerase/métodos , Síndrome de Emaciação/epidemiologia , Síndrome de Emaciação/fisiopatologiaAssuntos
Infecções por Circoviridae/veterinária , Circovirus/patogenicidade , Doenças dos Suínos/epidemiologia , Síndrome de Emaciação/veterinária , Animais , Argentina , Infecções por Circoviridae/epidemiologia , Infecções por Circoviridae/fisiopatologia , Suínos , Doenças dos Suínos/fisiopatologia , Síndrome de Emaciação/epidemiologia , Síndrome de Emaciação/fisiopatologiaRESUMO
A number of population groups in Latin America show high prevalences of stunting (low height-for-age) despite very low rates of wasting (weight-for-height deficits). One possible explanation for this phenomenon is an increase in abdominal circumference, which would affect children's weights but not their heights. This study was designed to describe the abdominal circumferences of a group of poor children from Northeast Brazil, and to relate these to their weight-for-weight z-score. Children (n = 252) participating in a government growth monitoring program were studied. The prevalence of stunting (below -2 SD) was 26.2%, but only 1.2% were wasted. Abdominal circumferences increased with age up to 36 mo, followed by a slight decline after 48 mo. Abdominal circumference was the anthropometric measurement most closely associated with weight-for-height, with a coefficient of determination of 41%. Even after adjusting for arm circumference, abdominal circumference continued to explain 16% of the variation in weight-for-height. Despite slight differences in measurement techniques, the study children had consistently larger abdominal girths than a sample of North American children. These findings must be verified by replication but highlight a possible contribution of abdominal circumference in the determination of levels of wasting.