Abstract Background: obesity can influence vitamin D levels, which in turn might be associated with cardiometabolic risk factors. Objectives: this study assessed the association between 25-hydroxyvitamin D [25(OH)D] levels and cardiometabolic risk factors in adolescents with overweight living in a region of northeastern Brazil. Material and methods: a cross-sectional study was carried out by non-probabilistic sampling in adolescents diagnosed with overweight or obesity. The subjects were divided according to their 25(OH) D status into two groups: sufficient vitamin D and hypovitaminosis D. Biodemographic, lifestyle, cardiometabolic, and biochemical factors were evaluated. A logistic regression model was applied to determine the predictors of hypovitaminosis D. Results: we found a high frequency of hypovitaminosis D (45.6 %) in adolescents. Weekly sun exposure was negatively associated with hypovitaminosis D (OR = 0.96; 95 % CI: 0.92-0.99), while significant positive associations were observed between hypovitaminosis D and blood pressure above the 95th percentile (OR = 4.00; 95 % CI: 1.19-13.37), body weight (OR = 1.04; 95 % CI: 1.01-1.07), and fasting insulin (OR = 1.13; 95 % CI: 1.05-1.22). Conclusion: hypovitaminosis D showed a high prevalence in adolescents with overweight living in a sunny region of northeastern Brazil, and cardiometabolic risk factors such as systemic arterial hypertension, high body weight, and hyperinsulinemia are predictors of hypovitaminosis D.

Resumen Introducción: la obesidad puede influir en los niveles de vitamina D, lo que a su vez podría estar asociado con factores de riesgo cardiometabólico. Objetivos: este estudio evaluó la asociación entre los niveles de 25-hidroxivitamina D [25(OH)D] y los factores de riesgo cardiometabólico en adolescentes con sobrepeso que viven en una región del noreste de Brasil. Material y métodos: se realizó un estudio transversal mediante muestreo no probabilístico con adolescentes diagnosticados de sobrepeso u obesidad. Los sujetos se dividieron según su estado de 25(OH) D en dos grupos: suficiente vitamina D e hipovitaminosis D. Se evaluaron factores biodemográficos, de estilo de vida, cardiometabólicos y bioquímicos. Se aplicó un modelo de regresión logística para determinar los predictores de la hipovitaminosis D. Resultados: encontramos una alta frecuencia de hipovitaminosis D (45,6 %) en los adolescentes. La exposición semanal al sol se asoció negativamente a la hipovitaminosis D (OR = 0,96; IC 95 %: 0,92-0,99), mientras que se observaron asociaciones positivas significativas entre hipovitaminosis D y presión arterial por encima del percentil 95 (OR = 4,00; IC 95 %: 1,19-13,37), peso corporal (OR = 1,04; IC del 95 %: 1,01-1,07) e insulina en ayunas (OR = 1,13; IC del 95 %: 1,05-1,22). Conclusión: la hipovitaminosis D mostró una alta prevalencia entre los adolescentes con sobrepeso que viven en una región soleada del noreste de Brasil, y los factores de riesgo cardiometabólico, como hipertensión arterial sistémica, peso corporal elevado e hiperinsulinemia, son predictores de hipovitaminosis D.

Abstract Aims: hypovitaminosis D has frequently been identified in patients with heart failure (HF). However, few studies have been conducted in regions with high solar incidence. Therefore, this study aimed to evaluate vitamin D status and predictors of 25-hydroxyvitamin D (25(OH)D) levels in patients with HF living in a sunny region (5 °- 6 °S). Methods: this cross-sectional study enrolled 70 patients with HF. Biodemographic, clinical, biochemical, dietary, and sun exposure data were collected, and 25(OH)D levels were measured. Results: the mean 25(OH)D level was 40.1 (12.4) ng/mL, and 24.3 % (95 % CI: 14.2-33.8) of patients with HF had hypovitaminosis D (25(OH)D < 30 ng/mL). Female patients (p = 0.001), those with ischemic etiology (p = 0.03) and those with high parathyroid hormone levels (> 67 pg/mL) (p = 0.034) were more likely to present hypovitaminosis D. Higher 25(OH)D levels were observed in men than in women (β = 7.78, p = 0.005) and in patients with HF in New York Heart Association (NHYA) functional class I when compared to those in class III/IV (β = 8.23, p = 0.032). Conclusions: the majority of patients with HF had sufficient 25(OH)D levels. Sex and functional classification were identified as independent predictors of 25(OH)D levels. These results highlight the need for increased monitoring of vitamin D status among female patients with heart failure and those with more severe symptoms.

Resumen Objetivos: la hipovitaminosis D se ha identificado con frecuencia en pacientes con insuficiencia cardíaca (IC). Sin embargo, pocos estudios se han realizado en regiones con una alta exposición solar. Por lo tanto, este estudio tuvo como objetivo evaluar el estado de la vitamina D y los predictores de los niveles de 25-hidroxivitamina D (25(OH)D) en pacientes con IC que viven en una región soleada (5 °-6 °S). Métodos: este estudio transversal incluyó a 70 pacientes con IC. Se recopilaron datos biodemográficos, clínicos, bioquímicos, dietéticos y de exposición solar, y se midieron los niveles de 25(OH)D. Resultados: el nivel medio de 25(OH)D fue de 40,1 (,) ng/mL y el 24,3 % (IC 95 %: 14,2-33,8) de los pacientes con IC tenían hipovitaminosis D (25(OH)D < 30 ng/mL. Las pacientes mujeres (p = 0,001), aquellos con IC de etiología isquémica (p = 0,03) y aquellos otros pacientes con niveles altos de hormona paratiroidea (> 67 pg/mL) (p = 0,034) tenían más probabilidades de presentar hipovitaminosis D. Se observaron niveles más altos de 25(OH)D en los hombres que en las mujeres (β = 7,78, p = 0,005), y en los pacientes con IC de clase funcional I de la New York Heart Association (NHYA) que en los de clase III/IV (β = 8,23, p = 0,032). Conclusiones: la mayoría de los pacientes con IC tenían niveles suficientes de 25(OH)D. El sexo y la clasificación funcional se identificaron como predictores independientes de los niveles de 25(OH)D. Estos resultados destacan la necesidad de un mayor control del estado de la vitamina D entre las mujeres con insuficiencia cardíaca y los pacientes con síntomas más graves.

Abstract Background: Anabolic/catabolic disorder in heart failure (HF) favors cardiac cachexia, implying a reduction in HF survival. Objectives: To assess the accuracy and concordance of the diagnosis of protein malnutrition and excess fat among the anthropometric and body composition methods in individuals with HF. Method: A study of accuracy that included 60 individuals with HF. Body mass index (BMI), arm circumference (AC), triceps skinfold thickness (TST), adductor pollicis muscle thickness (APMT), arm muscle circumference (AMC) and corrected arm muscle area (cAMA). Fat free mass index (FFMI) and body fat percentage (BF%), obtained by electrical bioimpedance (EBI), were used to compare the diagnosis of protein malnutrition and excess fat. Accuracy was assessed by calculating sensitivity, specificity, positive and negative predictive value. The concordance of the EBI diagnosis and other methods was performed by the chi-square test and kappa (k) statistic, where p<0.05 was considered significant. Results: Higher frequencies of protein malnutrition were identified by cAMA and AMC, and excess fat by BF%. BMI presented low sensitivity (43%) and accuracy (38.5%), with moderate concordance (0.50). AMC sensitivity was 86%, accuracy 66.4%, and acceptable concordance (0.36) compared to FFMI. Similar percentages of moderate sensitivity and low accuracy were observed for TST and BMI. Conclusion: AMC may be useful to identify protein malnutrition and TST has not been adequate to diagnose adiposity. BMI was not sensitive to assess muscle and adipose reserve. EBI was more accurate.

Background: There is considerable evidence that abnormal zinc homeostasis is related to amyotrophic lateral sclerosis (ALS) pathogenesis, and malnutrition is an independent prognostic factor for worsened survival of ALS patients. Objective: To evaluate the dietary intake and zinc status in patients with ALS, treated in a specialized outpatient facility in Natal, Brazil. Methods: Twenty patients with ALS (case group) and 37 healthy subjects (control group) were included. Clinical and anthropometric assessments were carried out and dietary intake was obtained from two 24-hour recalls. Plasma and urinary zinc concentrations were determined by atomic absorption spectrophotometry. Results: Most of the participants were eutrophic. Mean energy, protein, carbohydrate and fat intake was significantly lower for the case group. There was greater prevalence of inadequate zinc intake in the case group (35%) compared to controls (27%). Mean plasma zinc was significantly lower in the case group than in controls (77.13 ± 22.21 vs 87.84 ± 17.44 µgZn/dl). Urinary zinc did not differ significantly between cases and controls. In the case group, plasma and urinary zinc concentrations were below reference values in 50.0% and 52.6% of patients, respectively. Conclusion: A large portion of patients with ALS exhibited poor dietary intake and changes in body zinc status. The zinc deficiency found in half of the ALS patients may contribute to a worsened prognosis and should be the target of nutritional intervention that aims to correct this deficiency.

Introducción: hay pruebas considerables de que los cambios en la homeostasis del zinc están relacionados con la patogénesis de la esclerosis lateral amiotrófica (ELA) y que la malnutrición es un factor pronóstico capaz de reducir la supervivencia de los pacientes con ELA. Objetivo: evaluar la ingesta dietética y el estado de zinc en pacientes con ELA, tratados en un centro de atención ambulatoria especializado en Natal, Brasil. Métodos: se incluyeron 20 pacientes con ELA (grupo de casos) y 37 sujetos sanos (grupo control). Se realizaron evaluaciones clínicas y antropométricas y se obtuvo la ingesta dietética en dos recordatorios de 24 horas. Las concentraciones plasmáticas y urinarias de zinc se determinaron por espectrofotometría de absorción atómica. Resultados: la mayoría de los participantes fueron eutróficos. El consumo medio de energía, proteínas, carbohidratos y grasas fue significativamente menor en el grupo de casos. Hubo una mayor prevalencia de ingesta inadecuada de zinc en el grupo de casos (35%) en comparación con los controles (27%). El zinc plasmático medio fue significativamente menor en el grupo de casos que en los controles (77,13 ± 22,21 frente a 87,84 ± 17,44 μgZn/dl). El zinc urinario no difirió significativamente entre los casos y los controles. En el grupo de casos, las concentraciones de zinc plasmático y urinario fueron inferiores a los valores de referencia en el 50,0% y 52,6% de los pacientes, respectivamente. Conclusión: gran parte de los pacientes con ELA exhibieron una ingesta dietética pobre y modificación en el estatus de zinc corporal. La deficiencia de zinc encontrada en la mitad de los pacientes con ELA puede contribuir a un empeoramiento del pronóstico y debe ser el objetivo de la intervención nutricional que apunta a corregir esta deficiencia.

ABSTRACT Chronic kidney disease (CKD) increases cardiovascular disease (CVD) risk development. However, the mechanisms of reduced kidney function with CVD risk are unclear. This study aimed to investigate the association between kidney function and Framingham risk score (FRS) in participants with traditional cardiovascular risk factors and normal estimated glomerular filtration rate (eGFR) > 60 mL/min/1.73 m² in an admixed population of Brazil. The participants were divided into three groups according to FRS: low risk group with 0% to <10%, moderate risk group with ≥10% to 20% and high risk group with >20%. The eGFR was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Data from participants were collected by questionnaire, and blood and urine samples were collected to analyze biochemical markers. A total of 214 subjects aged 53±10 years old was collected. There were 77 individuals in low risk group, 59 in moderate risk group and 78 in high-risk group. Mean eGFRCKD-EPI was 89.39±15.05 mL/min/1.73 m² and 90.74±16.17 mL/min/1.73 m2 when race adjustment. The results indicated that there is an increasing the cardiovascular risk with a decreased of eGFR, conforming to a significant inverse correlation observed between eGFR and FRS with Spearman correlation (R²=-0.256, p<0.001; R²=-0.224, p=0.001, when adjusted for race). There was a statistically significant difference in eGFRCKD-EPI (p<0.001) and eGFRCKD-EPI with race adjustment (p=0.002) among risk groups. The data suggests that the reduction eGFR is associated with elevated FRS among Brazilian adults without CKD. Furthermore, the results suggest that race adjustment it’s not necessary in Brazilian population.

Background: Temporal trends in dietary patterns reveal associations between food consumption and increased prevalence of non-communicable chronic diseases. Objectives: This study characterized dietary patterns in adolescents in urban area located in northeast of Brazil, relating it to the markers of a healthy diet. Methods: A cross-sectional study used two 24-hour recalls to assess dietary intake in 430 public school students from Natal-RN, Brazil. Principal component analysis was used to derive dietary patterns according to consumption of food based on weight (grams), energy (Kcal), or fiber (grams). These models resulted in a number of different main components, 7, 8 and 4, respectively (cumulative variance >70%; factor loadings >0.4). The association between independent variables and the factor scores of all components obtained was determined by the Prevalence Ratio (CI 95%). Results: The dietary patterns derived were: (1) Pure Traditional Food System, the highly representative pattern in young adolescents and the first component of the analytical models, (2) Combined and Risk Food System; extraction of total food weight and energy revealed markers of unhealthy diets based on high sugar, saturated fat, and salt consumption, and (3) Modified Traditional Food System represented by fiber; pattern 1 was observed within this model too. The associations observed, predominantly from the TFSm pattern, distinguished by sex, age and nutritional status. Conclusions: Patterns 1 and 3 are characterized by preserved regional food practices that prevent chronic disease, whereas pattern 2 is characterized by health risks. These inter-sectorial findings should be considered in the development of health care policies for children and adolescents.

Introducción: Estudios nacionales de evolución temporal encuentran que la tendencia del consumo alimentario se asocia con aumento de la prevalencia de las enfermedades crónicas. Objetivos: Caracterizar los hábitos alimentarios de los adolescentes en un área urbana del Noreste de Brasil, relacionándolos con los marcadores dietéticos saludables. Métodos: Estudio transversal con adolescentes (n=430) de las escuelas públicas de Natal-RN, Brasil. El consumo alimentario se evaluó mediante dos recordatorios 24h. La técnica de Análisis de Componentes Principales fue utilizada para derivar patrones dietéticos, de acuerdo con: alimentos en gramos (g), la energía en Kcal y la fibra en gramos, lo que resulta, respectivamente, en un número de diferentes componentes principales, 7, 8 y 4 (varianza acumulada >70%; cargas factoriales >0,4). La asociación entre las variables independientes y los escores de los factores de todos los componentes obtenidos, se determinó por la razón de prevalencia (IC 95%). Resultados: Los patrones dietéticos fueron: el (1) Sistema Alimentario Tradicional puro representó el primero componente de los modelos; el (2) Sistema Alimentario Combinado y de riesgo reveló marcadores de alimentación no saludables, debido a la alta frecuencia de azucares refinados, grasas saturadas y sal; y el (3) Sistema Alimentario Modificado fue identificado en el modelo de las fibras, el patrón 1 de nuevo fue observado en este patrón. Las asociaciones observadas, en particular del patrón SATm, distinguen por sexo, edad y estado nutricional. Conclusiones: Los patrones dietéticos 1 y 3 se caracterizaron por la preservación de las prácticas regionales de alimentos, muy saludables, desde el punto de vista de la prevención de las enfermedades crónicas, mientras que el 2 representó alerta y riesgo para la salud. Los hallazgos pueden subvencionar Políticas de Atención a la Salud para infancia y adolescencia en carácter intersectorial.

OBJETIVO: O objetivo deste estudo foi descrever as fontes de variância da dieta, determinar as razões de variâncias e o número de dias necessários para estimar a dieta habitual em adolescentes. MÉTODOS: A ingestão de energia, macronutrientes, ácidos graxos, fibra e colesterol foram estimadas por meio de dois recordatórios de 24 horas, aplicados em 366 adolescentes de escolas públicas de Natal, Rio Grande do Norte. A razão de variância foi calculada entre o componente da variância intrapessoal e interpessoal, determinada pela Análise de Variância. A definição do número de dias para a estimativa da ingestão habitual de cada nutriente foi obtida considerando a correlação hipotética de (r)>0,9, entre a verdadeira ingestão de nutrientes e a observada. RESULTADOS: As fontes de variância interpessoal foram maiores para todos os nutrientes e em ambos os sexos. As razões de variâncias foram <1 para todos os nutrientes, e mais elevadas no sexo feminino. Dois dias de recordatórios de 24 horas seriam suficientes para avaliar com precisão o consumo de energia, carboidratos, fibra, ácidos graxos saturados e monoinsaturados, exceto para proteínas, lipídeos, ácidos graxos poliinsaturados e o colesterol, que necessitariam de três dias. CONCLUSÃO: A variância interpessoal da dieta dos adolescentes foi maior do que a intrapessoal, para todos os nutrientes, repercutindo em uma razão de variância menor que 1. Para estimar a dieta habitual nesta população, uma variação de dois a três dias é necessária considerando o sexo e o nutriente avaliado.

OBJECTIVE: The aim of this study was to describe the sources of dietary variance, and determine the variance ratios and the number of days needed for estimating the habitual diet of adolescents. METHODS: Two 24 hour food recalls were used for estimating the energy, macronutrient, fatty acid, fiber and cholesterol intakes of 366 adolescents attending Public Schools in Natal, Rio Grande do Norte, Brazil. The variance ratio between the intrapersonal and interpersonal variances, determined by Analysis of Variance, was calculated. The number of days needed for estimating the habitual intake of each nutrient was given by the hypothetical correlation (r)>0.9 between the actual and observed nutrient intakes. RESULTS: Sources of interpersonal variation were higher for all nutrients and in both genders. Variance ratios were <1 for all nutrients and higher in women. Two 24 hour dietary recalls were enough to assess energy, carbohydrate, fiber and saturated and monounsaturated fatty acid intakes accurately. However, the accurate assessment of protein, lipid, polyunsaturated fatty acid and cholesterol intakes required three 24 hour recalls. CONCLUSION: Interpersonal dietary variance in adolescents was greater than intrapersonal variance for all nutrients, resulting in a variance ratio of less than 1. Two to three 24 hour recalls, depending on gender and the study nutrient, are necessary for estimating the habitual diet of this population.

INTRODUÇÃO: As doenças neuromusculares infantis são crônicas, degenerativas e determinam alterações funcionais, musculares e nutricionais. OBJETIVOS: Avaliar sistematicamente a força muscular respiratória e o perfil postural e nutricional de crianças com doenças neuromusculares em seguimento multidisciplinar institucional. MATERIAIS E MÉTODOS: Foram estudados pacientes com diferentes doenças neuromusculares por meio da verificação da força muscular respiratória, da avaliação nutricional de massa muscular, do índice de massa corpórea e da porcentagem (%) de gordura corporal, além de avaliação postural e dos padrões de movimento. RESULTADOS: Foram avaliados 41 sujeitos. As crianças do sexo masculino predominaram na população em estudo, sendo 82,9% dela (n = 34), e os outros 17,1% (n = 7) eram do sexo feminino. A média de idade encontrada foi de 9,65 ± 3,11 anos. O principal diagnóstico encontrado foi Distrofia Muscular de Duchenne, 43,9% (n = 18), seguido de Atrofia Muscular Espinhal, 9,75% (n = 4), Distrofia Congênita, 7,31% (n = 3), Distrofia Muscular de Cinturas, Polineuropatia e Miopatia Congênita, todos com 4,9% (n = 2), além de Distrofia Muscular Progressiva, Miastenia Grávis, Charcoot Marie Toot, Emery Dreifuss, encontrados em 2,43% (n = 1). Foi verificada uma diminuição da força muscular respiratória (PImáx = 81 ± 24,3 cmH2O, 91% predito e PEmáx = 70 ± 29,6 cmH2O, 72% predito), mais evidente nos músculos expiratórios. A Hiperlordose lombar foi encontrada em 26 pacientes (64%) e 9 pacientes (22%) já haviam perdido a capacidade de deambular. Em relação ao perfil nutricional, 90% dos pacientes (n = 30) mostraram uma alta incidência de perda de reserva muscular e 52% deles (n = 13) apresentaram a porcentagem de gordura corporal abaixo do aceitável. CONCLUSÃO: A avaliação multidisciplinar das doenças neuromusculares pediátricas podem auxiliar no estabelecimento de tratamento precoce da Fisioterapia para melhorar a qualidade de vida dos pacientes e cuidadores.

INTRODUCTION: Neuromuscular diseases that affect childrens are degenerative and chronic disorders that lead to functional, muscular and nutritional impairments. OBJECTIVE: Assess respiratory strength, postural and nutritional profile in childrens with neuromuscular disorder followed in on ambulatory outpatients clinics. MATERIALS AND METHODS: Patients with neuromuscular diseases were assessed in relation to respiratory muscle strength (PImax and PEmax), postural profile, walk capacity and nutrition assessment that includes body mass index, muscular mass and body fat percentage. RESULTS: Forty-one patients were included in the study. Male children's were predominant in the group, 82,9% (n = 34) of them, while female were 17,1% (n = 7). The mean age was 9,65 ± 3,11 years. The most common disorder was Duchenne Miotonic Dystrophy, found in 43.9% (n = 18) of the children, followed by Spinal Muscular Atrophy, 9,75% (n = 4), Congenital muscular dystrophy, 7,31% (n = 3), Erb's scapulohumeral Dystrophy, Polyneuropathy and Congenital Myopathy, all in 4,9% (n = 2), while Progressive Muscular Dystrophy, Myasthenia Gravis, Charcoot Marie Toot, Emery Dreifuss was found in 2,43% (n = 1) of them. We found a decrease in respiratory muscle strength (PImax = 81 ± 24,3 cmH2O, 91% predict and PEmax = 70 ± 29,6 cmH2O, 72% predict), more evident in expiratory muscles. Lumbar hyperlordosis were found in 26 (64%) of the patients, 9 patients (22%) lost their ability to walk. In relation to nutritional profile, 90% (n = 30) showed one high incidence of muscular reserve loss and 52% (n = 13) of the patient's body fat was bellow acceptable range. CONCLUSION: Multidisciplinary evaluation of children neuromuscular diseases may assist in establishing early Physical Therapy intervention to improve the quality of life of both patients and caregivers.