Diet – ABC CARDIOL

IJCS

Original Article

Lifestyle and Hypertension in Brazil and Spain

Giovanna Lucieri Alonso Costa et al. Jurema Correa Mota Marina Ururahy Soriano de Sousa Flavio Kapczinski … Jose Cervera-Martínez Vicent Balanzá-Martínez Raquel B. De Boni

Abstract

Background:

Hypertension is the main risk factor for cardiovascular mortality worldwide. Lifestyle medicine (LM) assesses health through seven domains (diet, physical activity, substance use, sleep, social support, stress management, and environmental exposure), which also include risk factors for hypertension.

Purpose:

To evaluate the association between lifestyle and hypertension in Brazil and Spain.

Methods:

Secondary analysis of data from two web surveys conducted in 2020 in Brazil and Spain, which assessed lifestyle through a multidimensional scale. We enrolled 5224 individuals of both genders, aged > 18 years, living in Brazil and Spain, and with Internet access. The main outcome was a self-reported hypertension diagnosis. We calculated the absolute and relative frequency of the independent variables and evaluated the factors associated with hypertension in logistic regression models.

Results:

76.2% of participants were women, 57.9% were > 42 years old, and 66.9% had finished higher education. Over the last 12 months, 19.6% of Brazilians and 9.2% of Spanish reported diagnosis/treatment of hypertension. Male and older groups living in Brazil, with lower education and worse lifestyles, were more likely to report hypertension. General lifestyle score was not associated with hypertension in Brazil, while hypertensive individuals had better scores in Spain (p < 0.001). Hypertensive individuals had worse lifestyle scores in physical activity (p < 0.05) and sleep (p < 0.05) in Brazil and better diet scores in Spain (p < 0.001). Environmental exposure was better among hypertensive individuals in both countries (p < 0.001). Our results point to cultural and socioeconomic differences between both countries.

Conclusion:

LM is an important strategy for the prevention/treatment of chronic diseases such as hypertension

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IJCS

Editorial

Ultra-Processed Foods Consumption and Cardiovascular Health

Annie Seixas Bello Moreira et al. Débora Pinto Gapanowicz

Ultra-processed foods, as defined by the NOVA classification, are industrial formulations made from substances extracted or derived from food, containing little to no whole food in their composition. These foods are typically enhanced with flavorings, colorings, emulsifiers, and other additives that alter the sensory attributes of the final product. The ingredients and processes used in the ultra- processed foods manufacture aim to create low-cost, hyper-palatable, and convenient products that have the potential to replace fresh or minimally processed foods.

Ultra-processed foods already constitute more than half of the total dietary energy consumed in high-income countries like USA, and between one-fifth and one-third in middle-income countries such as Brazil. These foods are not ‘real food’ and they are typically high in energy density, sugar, unhealthy fats, and salt, but low in dietary fiber, protein, vitamins, and minerals.

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IJCS

Editorial

The Present and Future of the Cardioprotective Food Model for the Brazilian Population

Thais de Rezende Bessa Guerra

In recent decades, researchers have found important changes in the health pattern and food consumption of the Brazilian population. These changes have been associated with chronic non-communicable diseases, especially cardiovascular disease.

The Global Burden of Disease Study (2019), which analyzed data on chronic non-communicable diseases in 204 countries and territories between 1990 and 2019, estimated that cardiovascular disease, which is attributable to modifiable risk factors such as cholesterol level, is the main health care burden worldwide. High LDL cholesterol and its associated mortality remain a major threat to public health. The report recommends that national health systems focus on new approaches that can reverse these trends, since there is an urgent need to implement effective policies and interventions to achieve a 30% reduction in premature mortality from non-communicable diseases.

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IJCS

Editorial

Diet Quality and Cardiovascular Health

Annie Seixas Bello Moreira et al. Débora Pinto Gapanowicz

The association between diet quality and cardiovascular health has been extensively investigated over the last few years. The Global Burden of Disease Study showed that, in 2017, dietary risk factors such as high intake of sodium, low intake of whole grains, and low intake of fruits were responsible for 11 million deaths across 195 countries.

Petersen et al. reviewed different ways to evaluate diet quality, which is a term used to quantify how healthy a particular dietary pattern is. It is clear that assessing and encouraging individual dietary components such as specific foods, nutrients, or bioactive compounds alone is not enough. Therefore, the totality of the diet is being increasingly assessed, since it has a greater impact on health outcomes.

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IJCS

Editorial

Abdominal Subcutaneous Adipose Tissue, Diet, and Risk of Cardiovascular Disease: What do we Know?

Camila Weschenfelder et al. Penny M. Kris-Etherton

Excess adiposity increases the risk of cardiovascular disease (CVD) due to dyslipidemia, systemic inflammation and other risk factors. The distribution of body fat depots, and central adiposity in particular, is related to cardiometabolic diseases. The different adipose tissue depots in the body, ie, epicardial adipose tissue, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), have different biochemical characteristics and produce unique biologically active molecules that affect normal and pathological processes related to CVD risk.^, Abdominal SAT is classified as superficial or deep. Deep subcutaneous adipose tissue (DSAT) has a higher ratio of saturated to monounsaturated fatty acids, and, consequently, is more saturated than superficial subcutaneous adipose tissue (SSAT). Despite being in the subcutaneous compartment, DSAT differs from VAT because of differences in gene transcription, having different metabolic functions than SSAT.

In Acute Coronary Syndrome (ACS) patients, coronary plaque instability is related to abnormal abdominal fat distribution. Analyses of the abdominal fat distribution of ACS patients have demonstrated that both VAT and SAT are positively correlated with vessel and plaque volumes, but not with plaque tissue components, the fibrous and lipid content of plaque. However, considering coronary plaque characteristics, a higher VAT/SAT ratio was independently associated with a higher percentage of plaque lipid content, with a lower percentage of fibrous volumes and a thinner fibrous cap thickness, characteristics that define greater plaque rupture vulnerability and a high risk for coronary events.

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IJCS

Original Article

Cardiac Remodeling in Obesity-Resistance Model is not Related to Collagen I and III Protein Expression

Scarlet Marques de Oliveira et al. Jéssica Leite Garcia Danielle Fernandes Vileigas Dijon Henrique Salomé de Campos … Fabiane Valentini Francisqueti-Ferron Artur Junio Togneri Ferron Danielle Cristina Tomaz da Silva-Bertani Carlos Roberto Padovani Camila Renata Corrêa Antonio Carlos Cicogna

Abstract

Background:

As some individuals present resistance to obesity development, experiments have been trying to understand their susceptibility to cardiometabolic diseases.

Objetive:

To evaluate if the cardiac remodeling was related to collagen protein expression change.

Methods:

Male Wistar rats were randomized into two experimental groups: control diet (CD, n=15) or high-fat diet (HFD, n=15) for 30 weeks. Rats fed with HFD were ranked based on their adiposity indexes and classified as obese (Ob, n = 8) or obesity-resistant (ROb, n = 6). Rats that failed to present the normal characteristic of the control group while fed with CD were excluded (Control, n = 8). Nutritional profile, comorbidities (dyslipidemia, hypertension, glucose metabolism, hyperleptinemia), cardiac remodeling, and collagen protein expression were evaluated. The groups were compared by One-Way ANOVA, together the Tukey post hoc test, with p<0.05 considered significant.

Results:

The Ob rats presented an increased adiposity index when compared to C and ROb. Both groups Ob and ROb presented increased low-density lipoprotein (LDL), insulin, homeostatic model assessment of insulin resistance (HOMA- IR) and systolic blood pressure (SBP), and low high-density lipoprotein (HDL) levels when compared to the control group. The levels of triglycerides, non-esterified fatty acid (NEFA), and leptin were lower in ROb as compared to Ob, but higher than the control group. The Ob and ROb groups presented cardiac remodeling, evidenced by echocardiographic and post-mortem analysis. The collagen protein expression did not differ among the groups.

Conclusion:

The ROb animals present cardiac remodeling that is not related to collagen type I and III protein expression change.

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IJCS

Original Article

Association between Deep Subcutaneous Adipose Tissue Estimated by DAAT Index and Dietary Intake in Patients with Acute Coronary Syndrome

Elana Stein et al. Sandra Barbiero Vera Lucia Portal Victória da Luz Aline Marcadenti

Abstract

Background:

Abdominal obesity has been associated with cardiovascular disease and may be modulated by dietary intake. The deep abdominal subcutaneous adipose tissue (dSAT) is a body fat compartment that can be estimated by using mathematical formulas.

Objectives:

To evaluate the association between dSAT estimated by the Deep-Abdominal-Adipose-Tissue (DAAT) index and dietary intake in patients with acute coronary syndrome (ACS).

Methods:

This is a cross-sectional study conducted with patients ≥ 18 years of age admitted to a tertiary hospital. Sociodemographic, clinical, and anthropometric (body weight [kg], height [m], waist, hip and neck circumferences [cm]) data were evaluated. A food frequency questionnaire was applied to identify each patient’s nutrient intake. The DAAT index was calculated according to specific formulas for men and women. Possible association between food intake and the DAAT index was evaluated by multiple linear regression. The level of significance adopted was 0.05.

Results:

This study evaluated 138 patients, with a mean age of 61.2±10.8 years. Prevalence of obesity was 29.4% in men and 37.7% in women. Regarding waist circumference, 83% of the women showed values considered to be very high. The DAAT index was significantly higher in men when compared to woman (P < 0.0001) and proved to be positively correlated with proteins (r= 0.22, P= 0.01) and monounsaturated fatty acid (r= 0.18, P= 0.04) intake in the entire sample. After adjustment for sex, alcohol consumption, and levels of physical activity, the DAAT index was associated with the female sex (B= −129.84, P <0.001) and a sedentary lifestyle (B= 57.99, P <0.001).

Conclusion:

dSAT estimated by the DAAT index was not associated with dietary intake in patients with ACS.

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Editorial

Impact of Continuing Education on the Quality of Blood Pressure Measurement

Erika Campana et al. Bruno Daniel Ferrari

Cardiovascular diseases are the leading cause of death worldwide, and a key risk factor for these diseases—hypertension—is unquestionably the most prevalent disease in the population. Cardiovascular semiology is extremely important in the setting of hypertension (HTN), since the determination of blood pressure values through established indirect measurement techniques plays an essential role in initiating further diagnostic investigation, prompting treatment, and allowing monitoring of patients with HTN. The environment in which measurement is performed; the patient’s dietary habits, use of tobacco and alcohol, and engagement in physical activity before measurement; the adequacy of cuff size in relation to the limb; and proper cuff positioning are among the several important aspects which may interfere with measurement reliability. In this context, assessing the technical knowledge of healthcare providers is critical to preventing diagnostic errors.

Differences in magnitude between office BP and mean daytime BP can be attributed both to the environment and to the technical quality of blood pressure measurement by the examiner. Beckett et al. obtained an average of three manual BP readings from 481 hypertensive patients in family practices. The average clinic BP (151/83 mmHg) was significantly (P<0.001) higher than the daytime mean BP measured by ambulatory blood pressure monitoring (ABPM) (142/80 mmHg).

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ABC

Original Article

Impact of nutritional counseling in reducing serum cholesterol in public health service patients

Maria da Conceição Rosado Batista et al. Sylvia do Carmo Castro Franceschini

OBJECTIVE: To assess the impact of nutritional attention on the lipid profile and nutritional status of hypercholesterolemic patients attended in health centers of Belo Horizonte. METHODS: Using nutritional attendance patient record cards from two health units, the evolution of the lipid profile and the nutritional state (BMI) was monitored of 96 hypercholesterolemic patients who received diet. The patients were appraised at the following moments: initial (1st consultation), after 3 months (2nd consultation) and last consultation (variable for each patient). RESULTS: On the first attendance, 44,4% of the patients presented not only high total cholesterol and LDL-c, but also hypertriglyceridemia and 70.3% were overweight or obese, but most patients (75.6%) presented adequate HDL-c levels. There was significant reduction in the BMI, total cholesterol, LDL-c values (p < 0.01) and also in the triglyceride levels (p < 0.05) in the first three months, without alteration in the HDL-c levels. A significant reduction (p < 0.01) was observed in the frequency of individuals with high cholesterol (from 89.6% down to 47.9%), high and very high LDL-c (from 82.6% down to 45.7%), as well as high and very high triglyceride (from 43.6% down to 16.7%). The observed reduction in frequency of the low HDL-c was statistically meaningless. CONCLUSION: This study evidences the effect of the nutritional attention on lipid profile in hypercholesterolemic patients, reinforcing the need for a multiprofessional team to attend them at the public health services.

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