nutritional status – ABC CARDIOL

Original Article

Malnutrition in Outpatients with Heart Failure: Prevalence, Associated Factors and 6-Month Impact

Leonardo Akira Gondo et al. Lidia Ana Zytynski Moura Marcely Gimenes Bonatto Victoria Marzagao Ribeiro Pagliosa … Giovanna Voigt Machado Flavia Centenaro de Oliveira Angela Guzzo Lemke Amanda Licheski Contini Ana Karyn Ehrenfried de Freitas

Abstract

Background

Malnutrition is common in heart failure with reduced ejection fraction (HFrEF) and may negatively affect prognosis.

Objective

To determine the prevalence of malnutrition in outpatients with HFrEF, identify associated clinical factors, and evaluate its impact on mortality and clinical outcomes at 6 months.

Methods

Prospective observational cohort study including 118 outpatients with HFrEF. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and the Subjective Global Assessment (SGA). Six-month follow-up documented mortality, hospitalizations, and emergency department visits.

Results

The prevalence of malnutrition was 21.2% (25/118). Malnourished patients were older (68 ± 12 vs. 60 ± 10 years; p=0.001), had a higher prevalence of NYHA functional class III–IV (45% vs. 15%; p=0.002) and atrial fibrillation (44% vs. 25%; p=0.048), and achieved a lower percentage of target beta-blocker dose (57.9% vs. 79.8%; p=0.002). No statistically significant difference in 6-month mortality was observed between the groups, although it was numerically higher in the malnourished group (14% vs. 4%; p=0.082). No differences were observed in hospitalization rates (p=0.94) or emergency department visits (p=0.97).

Conclusion

Malnutrition is present in approximately one in five outpatients with HFrEF, more common in the elderly and those with atrial fibrillation and was associated with a trend towards higher mortality in 6 months.

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IJCS

Original Article

Interdisciplinary Group Intervention on Nutritional Profile, Quality of Life, and Stress During Cardiopulmonary Rehabilitation: A Randomized Clinical Trial

Giana de Freitas Rodrigues et al. Daniela da Rosa Vieira Patrícia Pereira Ruschel Cynthia Seelig … Christian Coronel Sandra Mari Barbiero

Abstract

Background:

Participating in therapeutic operative groups with nutritional and psychological interventions might influence the recovery of patients in cardiopulmonary rehabilitation programs.

Objective:

To evaluate the effectiveness of group interventions on the nutritional profile, stress, and quality of life of patients in cardiopulmonary rehabilitation.

Methods:

In this randomized clinical trial, adult patients of the Cardiopulmonary and Metabolic Rehabilitation (CPMR) unit were randomized into control group (CG), receiving standard follow-up assessment by the CPMR unit, and intervention group (IG), which additionally participated in 6 meetings of an interdisciplinary group with a nutritionist and a psychologist. Anthropometric data and results from a food frequency questionnaire (FFQ), Lipp’s Inventory of Stress Symptoms for Adults (ISSL), and the 12-Item Short Form Health Survey (SF-12) were analyzed. Student’s t-tests, Generalized Estimation Equations (GEE), Mann-Whitney tests, and Bonferroni tests were used for statistical analyses, with a significance level of 5%.

Results:

The sample consisted of 76 patients: 31 in the IG (64±9.2 years old) and 45 in the CG (61.4±11.8 years old). There was a significant reduction (p<0.001) in weight, body mass index, and waist circumference, and an increase (p=0.010) in the consumption of healthy food only in the IG. The consumption of unhealthy food was reduced in both groups (p<0.001), the physical aspect of quality of life improved (p=0.018), and women presented better physical (p=0.011) and mental results (p=0.008).

Conclusions:

This group intervention was effective regarding the nutritional status of patients in cardiopulmonary rehabilitation. The physical aspect of quality of life showed improvements in both groups.

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Editorial

Supplementation of Vitamin D

Marina P. Okoshi et al. Rosana M. Cortez Luana U. Pagan Paula F. Martinez Filipe W. L. Pereira

Vitamin D (Vit D) is a fat-soluble vitamin that is essential in mineral and bone metabolism. Vit D status is evaluated by measuring serum 25-hydroxyvitamin D [25(OH)D]) levels. Currently, Vit D supplementation is mainly indicated in cases of vitamin deficiency. However, there are two main issues concerning Vit D supplementation. The first is related to the definition of the lower limit of normal for serum 25(OH) D. In recent years, extensive clinical research has revealed that large percentages of global populations have low Vit D levels, i.e., serum [25(OH)D] concentrations below 20 ng/mL. However, several investigators have considered that this value is probably overestimated, therefore putting more people in need for supplementation. Several medical societies are now intensively debating on when to screen for Vit D deficiency and when to supplement Vit D.^,

The other issue concerning Vit D supplementation relates to the fact that convincing experimental and epidemiological studies have suggested that Vit D deficiency is associated with increased risk of chronic cardiovascular and immunological diseases and cancer. Therefore, Vit D has been supplemented in the general population without a specific indication. However, more recent studies have reported that Vit D supplementation for preventing or controlling chronic diseases such as cancer, diabetes mellitus, dementia or cardiovascular disease has failed to provide benefits.^– Furthermore, not only were no benefits found. In advanced heart failure, a daily Vit D supplement was associated with a greater need for mechanical circulatory support devices, which indicates caution regarding long-term supplementation.

[…]

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Original Article

Prevalence of Dyslipidemia According to the Nutritional Status in a Representative Sample of São Paulo

Marcela Riccioppo Garcez et al. Jaqueline Lopes Pereira Mariane de Mello Fontanelli Dirce Maria Lobo Marchioni Regina Mara Fisberg

Background:

Overweight is one of the major public health problems in Brazil; it is associated with dyslipidemia, which is an important risk factor for cardiovascular diseases.

Objective:

To evaluate the lipid profile of residents of the municipality of São Paulo, state of São Paulo, according to the nutritional status.

Methods:

Data from the population-based cross-sectional study ISA-Capital 2008 on a sample of residents of São Paulo were used. Participants were categorized into groups according to body mass index and age range. The levels of total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, and non-HDL cholesterol were measured. The association between lipid profile, nutricional status, and waist circumference was investigated. The data were processed using the survey mode of the Stata 11.0 software.

Results:

The prevalence of any type of dyslipidemia in the population was 59.74%, with low HDL-cholesterol dyslipidemia being the most common type. Not overweight individuals had higher mean levels of HDL-cholesterol and lower levels of LDL-cholesterol, total cholesterol, triglycerides, and non-HDL cholesterol when compared with the overweight group. The rate of inadequacy of these variables was higher in the overweight individuals, regardless of the age group, to the exception of LDL-cholesterol in the adults and elderly. A higher prevalence of isolated hypertriglyceridemia was observed in individuals with higher waist circumference among the adults and the total population.

Conclusion:

The results indicate an association between dyslipidemia and overweight in the population of the city of São Paulo. The most prevalent dyslipidemia in this population was low HDL-cholesterol.

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Artigo Original

Identification of cardiovascular risk factors in parents/caregivers of children with heart diseases

Camila Feijó Borges et al. Fernanda Michielin Busnello Lucia Campos Pellanda

BACKGROUND: Cardiovascular diseases are one of the major causes of morbidity and mortality worldwide. In Brazil, they are the major cause of death. OBJECTIVE: To identify cardiovascular risk factors in parents/caregivers of children with heart diseases by assessing their nutritional status, health conditions, and life style. METHODS: Cross-sectional study of 150 parents or caregivers of children with heart diseases who attended a cardiology outpatient clinic. Data on identification, lifestyle and health conditions were collected by means of a structured questionnaire. For the assessment of the eating habits, a questionnaire on eating frequency was used; for the assessment of the nutritional status, weight, height, and waist circumference were measured, and the body mass index (BMI) was calculated and classified. RESULTS: A total of 155 parents of children with heart diseases, predominantly of the female gender (91.6%), were evaluated; their mean age was 35.0 ± 10.6 years. The most prevalent risk factors were sedentary lifestyle (85.2%), obesity (28%) and hypertension (22.6%). As regards the eating habits, a high frequency of intake of red meat, margarine, vegetable oil, and sugar and low intake of fish were observed. Comparison between genders showed a significant difference in relation to obesity, as detected by BMI, and hypertension, both more frequent among women. Waist circumference measurement also showed a higher cardiovascular risk in women. CONCLUSION: Cardiovascular risk factors such as excess weight, sedentary lifestyle, and hypertension as well as inadequate eating habits such as a high frequency of intake of saturated fat and cholesterol and low intake of unsaturated fat were identified in the parents/caregivers assessed.

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Artigo Original

Physical fitness, age and nutritional status of military personnel

Clarissa Stefani Teixeira et al. Érico Felden Pereira

BACKGROUND: Although there is a trend toward the decrease in levels of physical fitness, the intensity of this decrease due to the aging process and the nutritional status in adult male individuals is not well-known, especially in the Brazilian population. OBJECTIVE: To analyze the levels of physical fitness according to age and the nutritional status in adult male individuals. METHODS: Aerobic and muscular endurance tests as well as flexibility tests and nutritional status assessment were carried out in 1,011 male individuals. Analyses of correlation, covariance and prevalence ratio were performed through Poisson regression. RESULTS: The individuals presented a moderate performance at the physical fitness tests. A decrease in the levels of physical performance according to the aging process was verified, considering all age ranges analyzed. The analysis of covariance corrected by age showed differences (p<0.001) for all tests comparing normal individuals and those with overweight/obesity. The prevalence ratios showed a strong trend toward the decrease in the physical fitness from 18 to 54 years. Individuals aged 41 to 54 years presented prevalences of low VO2max index that were 3.22-fold higher when compared to those aged 18 to 20 and 1.40-fold higher when compared to individuals aged 21 to 25 years. There was a decrease in the VO2max scores in the 18 to 20 age range, when compared to the 41 to 54 age range, of 11.45% in the normal group and 20.91% in the group with overweight and obesity. CONCLUSION: Age and the nutritional status have a strong influence on the decreased physical performance scores, mainly after 30 years of age.

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Artigo Original

Nutritional status and adequacy of energy and nutrient intakes among heart failure patients

Bárbara Hatzlhoffer Lourenço et al. Lis Proença Vieira Alessandra Macedo Miyoko Nakasato … Maria de Fátima Nunes Marucci Edimar Alcides Bocchi

SUMMARY: Increased knowledge about nutritional status and energy and nutrient intakes is required to improve the treatment of patients with heart failure (HF). OBJECTIVES: To verify the nutritional status and evaluate the adequacy of energy, macronutrient and micronutrient intakes in patients with HF in outpatient clinical settings. METHODS: We collected anthropometric and habitual dietary intake data of 125 patients (72% men, 52.1 ± 9.8 years, BMI 26.9 ± 4.4 kg/m2). Anthropometric variables were compared between genders, and the adequacy of energy and nutrient intakes was analyzed according to current recommendations. RESULTS: Muscle depletion or risk of depletion was present in 38.4% of patients (association with male gender, p <0.0001). In 69.6% of cases the mean energy intake was lower than the one required (p <0.0001). Among the micronutrients evaluated in this study, there was an important prevalence of inadequacy in magnesium, zinc, iron and thiamine intakes, and most patients had calcium and potassium intakes below the adequate levels, and sodium intake above the adequate levels. CONCLUSIONS: Outpatients with HF showed muscle depletion, and inadequate energy and nutrient intakes. There was no significant association between habitual dietary energy intake and nutritional status. Multidisciplinary care should be encouraged to better assess the general condition of these patients.

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Artigo Original

Influence of prior nutritional status on the development of the metabolic syndrome in adults

Renata Maria Souza Oliveira et al. Sylvia do Carmo Castro Franceschini Gilberto Paixão Rosado Silvia Eloiza Priore

BACKGROUND: The increase in the prevalence of excess weight among people of increasingly younger age groups may lead to the early development of cardiovascular risks. OBJECTIVE: To investigate the prevalence of the metabolic syndrome among young adults and the impact of birth conditions and nutritional status during adolescence on this disorder. METHODS: One hundred individuals were evaluated at three different stages of life. By consulting the database of people enlisted in the army reserve military service, data were collected on weight, height, and waist circumference of all draftees of 1996, 1997, and 1999 in order to analyze their nutritional status during adolescence. Using the same database, information was sought at the maternity on their birth conditions and the adult individuals were identified. Anthropometric and biochemical data were obtained from these adults. The Metabolic Syndrome (MS) was classified according to ATP III NCEP. Body fat percentage was assessed with bioelectrical impedance and the statistical analysis was performed using the Sigma Stat 2.0 software. RESULTS: Prevalence of the MS was detected in 13% of the individuals. The birth conditions showed no relationship with the syndrome. In adolescence, those individuals diagnosed with MS had greater values for weight (11 kg; p =<0.001), WC (8 cm; p < 0.001), and BMI (2.5 kg/m²; p= 0.002). CONCLUSION: A significant part of the risk factors for cardiovascular conditions starts during childhood and adolescence, and is likely to persist throughout life; therefore, primary prevention measures are critical in the context of cardiovascular disease.

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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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