This narrative review aims to describe the knowledge regarding nutritional evaluation and monitoring in pregnant women. We discuss care provided by non‐specialists in nutrition, regarding dietary ...information and risks during pregnancy, from a theoretical or conceptual viewpoint. A narrative review was conducted following a literature search when scientific databases were investigated, including SciELO, LILACS, Medline, PubMed, theses, government reports, books, and chapters in books. Finally, the material was fully read, categorized, and critically analyzed. National and international protocols of prenatal nutritional care were included and discussed. Different protocols describe the complexity of evaluating and monitoring nutrition among pregnant women during the prenatal period according to each country. The understanding of social conditions and eating habits has an important role in providing nutritional advice during pregnancy. The lack of dietitians in care overwhelms the healthcare workers and characterizes a missed opportunity. Therefore, it is important to consider rapid support tools that can track adverse nutritional status, and ways to recommend a diet that meets eating habit dynamics, according to the reality of each public health system.
Synopsis
Training the health team to identify maternal nutritional deficiencies with appropriate tools and guidance on better eating habits are key points for a healthy pregnancy.
Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) vary in volume and quality. We evaluated whether fat volume or attenuation (indirect measure of quality) predicts metabolic risk ...factor changes.
Framingham Heart Study Multi-detector Computed Tomography Substudy participants (n=1730, 45% women) were followed up over a mean of 6.2 years. Baseline VAT and SAT volume (in cm(3)) and attenuation (in Hounsfield units) were assessed. Outcomes included blood pressure, lipids, and glucose. We constructed multivariable regression models predicting change from baseline to follow-up. Baseline VAT was associated with metabolic risk factors at follow-up. Per 500-cm(3) increase in baseline VAT, glucose was 2.34 mg/dL higher (95% confidence interval, 1.71-2.97) and high-density lipoprotein was 1.62 mg/dL lower (95% confidence interval, 0.97-2.28) in women (P<0.0001 for both). These findings remained significant after adjustment for body mass index. Results for SAT were similar although less striking. Lower (more negative) fat attenuation was associated with more adverse metabolic profiles at follow-up. For example, per 5-unit decrease in baseline VAT Hounsfield units, log triglycerides increased by 0.08 mg/dL (95% confidence interval, 0.05-0.12; P=0.005), which remained significant after adjustment for baseline VAT. Among men, VAT and SAT Hounsfield units were associated with changes in cardiovascular disease risk factors but were mostly attenuated after baseline volume adjustment.
VAT volume and SAT volume are associated with incident metabolic risk factors beyond overall adiposity. Decreases in fat attenuation are also associated with incident risk factors. These findings suggest that both volume and quality of VAT and SAT contribute to metabolic risk.
Abstract Our objective was to adjust and validate predictive equations for appendicular skeletal muscle mass (ASM) in patients with Rheumatoid Arthritis (RA). Whole-body DXA data in 90 RA patients ...were used for measurement of ASM (kg). The prediction equation anthropometric for muscle mass proposed by Lee et al was used to generate estimates of ASM. Appendicular skeletal muscle mass index (ASMI, kg/m2) was calculated. Frequency analysis, Paired student's t-test, Linear regression, Pearson correlation, Intraclass correlation coefficients, and Bland-Altman scatter were performed. The statistical significance considered was p<0.05. Lee’s equation was overestimated by 30% when compared with ASMI by DXA. When stratified by nutritional status, Lee’s equation overestimated the ASMI by 30% in overweight patients and by 50% in obese patients when compared with DXA (p<0.05). These adjusted equations estimated values for ASMI were closer to those obtained by DXA than those estimated by the original Lee’s equation (p<0.05). This greater concordance was confirmed by the observed interclass correlation coefficients and by Bland-Altman scatter graphs. In conclusion, the prediction of muscle mass in RA patients may be performed with equations that consider the nutritional status of patients.
Resumo Nosso objetivo foi ajustar e validar equações preditivas para massa muscular esquelética apendicular (ASM) em pacientes com Artrite Reumatoide (AR). Dados de DXA de corpo inteiro em 90 pacientes com AR foram usados para medição de ASM (kg). A equação de predição antropométrica de massa muscular proposta por Lee et al foi utilizada para gerar estimativas de ASM. Índice de massa muscular esquelética apendicular (ASMI, kg / m2) foi calculada. Análise de frequência, Teste t de Student pareado, Regressão linear, Correlação de Pearson, Coeficientes de correlação intraclasse e Dispersão de Bland-Altman foram realizados. A significância estatística considerada foi p<0,05. A equação de Lee superestimou em 30% quando comparada com a ASMI da DXA. Quando estratificada por estado nutricional, a equação de Lee superestimou o ASMI em 30% em pacientes com sobrepeso e em 50% em pacientes obesos em comparação com DXA (p<0,05). Esses valores estimados de equações ajustadas para ASMI foram mais próximos daqueles obtidos por DXA do que aqueles estimados pela equação de Lee original (p<0,05). Essa maior concordância foi confirmada pelos coeficientes de correlação interclasses observados e pelos gráficos de dispersão de Bland-Altman. Em conclusão, a predição da massa muscular em pacientes com AR pode ser realizada com equações que consideram o estado nutricional dos pacientes.
Aim
To investigate functional motor performance in a large cohort of young steroid‐naïve males with Duchenne muscular dystrophy (DMD) and typically developing males, and to develop specific reference ...curves for both groups. Also, to describe associations between anthropometric values and functional motor outcomes.
Method
Cross‐sectional data of 196 steroid‐naïve males with DMD aged 4 to 8 years and 497 typically developing males aged 2 years 6 months to 8 years were included. Both groups were evaluated with the time to rise from the floor test, 10‐metre walk/run test, 6‐minute walk test, and North Star Ambulatory Assessment. Reference curves with centiles 5%, 10%, 25%, 50%, 75%, 90%, and 95% were estimated using quantile regression.
Results
Males with DMD scored significantly worse on all functional motor outcomes than age‐matched typically developing males (p < 0.001): 89% to 95% of the males with DMD scored below the 5th centile of the typically developing males. No or weak correlations exist between anthropometric values and functional motor outcomes.
Interpretation
The estimated reference curves can support consultation with families of young males with DMD and can support the evaluation of treatment for reaching motor skills and functional motor outcomes compared with typically developing males.
This study provides a detailed picture of functional motor outcomes in young steroid‐naïve males with Duchenne muscular dystrophy (DMD) compared to typically developing controls. This study was the first to establish DMD specific reference curves for functional motor outcomes: time to rise from floor (TRF), 10‐metre walk/run test, 6‐minute walk test, and North Star Ambulatory Assessment. Motor outcome reference curves clearly differ between males with DMD and typically developing controls.
This original article is commented on by Baranello on pages 557–558 of this issue.
Summary Background & aim Sarcopenia, the age-related decrease in muscle mass, strength, and function, is a main cause of reduced mobility, increased falls, fractures and nursing home admissions. ...Cross-sectional and prospective studies indicate that sarcopenia may be influenced in part by reversible factors like nutritional intake. The aim of this study was to compare functional and nutritional status, body composition, and quality of life of older adults between age and sex-matched older adults with and without sarcopenia. Methods In a multi-centre setting, non-sarcopenic older adults (n = 66, mean ± SD: 71 ± 4 y), i.e. Short Physical Performance Battery (SPPB): 11–12 and normal skeletal muscle mass index, were recruited to match 1:1 by age and sex to previously recruited adults with sarcopenia: SPPB 4–9 and low skeletal muscle mass index. Health-related quality of life, self-reported physical activity levels and dietary intakes were measured using the EQ-5D scale and index, Physical Activity Scale for the Elderly (PASE), and 3-day prospective diet records, respectively. Concentrations of 25-OH-vitamin D, α-tocopherol (adjusted for cholesterol), folate, and vitamin B-12 were assessed in serum samples. Results In addition to the defined components of sarcopenia, i.e. muscle mass, strength and function, reported physical activity levels and health-related quality of life were lower in the sarcopenic adults (p < 0.001). For similar energy intakes (mean ± SD: sarcopenic, 1710 ± 418; non-sarcopenic, 1745 ± 513, p = 0.50), the sarcopenic group consumed less protein/kg (−6%), vitamin D (−38%), vitamin B-12 (−22%), magnesium (−6%), phosphorus (−5%), and selenium (−2%) (all p < 0.05) compared to the non-sarcopenic controls. The serum concentration of vitamin B-12 was 15% lower in the sarcopenic group (p = 0.015), and all other nutrient concentrations were similar between groups. Conclusions In non-malnourished older adults with and without sarcopenia, we observed that sarcopenia substantially impacted self-reported quality of life and physical activity levels. Differences in nutrient concentrations and dietary intakes were identified, which might be related to the differences in muscle mass, strength and function between the two groups. This study provides information to help strengthen the characterization of this geriatric syndrome sarcopenia and indicates potential target areas for nutritional interventions.
Obstructive sleep apnea (OSA) is a global health issue and is associated with obesity and oropharyngeal crowding. Global data are limited on the effect of ethnicity and sex on these relationships. We ...compare associations between the apnea-hypopnea index (AHI) and these risk factors across ethnicities and sexes within sleep clinics.
This is a cross-sectional, multicenter study of patients with OSA from eight sleep centers representing the Sleep Apnea Global Interdisciplinary Consortium (SAGIC). Four distinct ethnic groups were analyzed, using a structured questionnaire: Caucasians (Australia, Iceland, Germany, United States), African Americans (United States), Asians (Taiwan), and South Americans (Brazil). Regression analyses and interaction tests were used to assess ethnic and sex differences in relationships between AHI and anthropometric measures (body mass index BMI, neck circumference, waist circumference) or Mallampati score.
Analyses included 1,585 individuals from four ethnic groups: Caucasian (60.6%), African American (17.5%), Asian (13.1%), and South American (8.9%). BMI was most strongly associated with AHI in South Americans (7.8% increase in AHI per 1 kg/m
increase in BMI;
< .0001) and most weakly in African Americans (1.9% increase in AHI per 1 kg/m
increase in BMI;
= .002). In Caucasians and South Americans, associations were stronger in males than females. Mallampati score differed between ethnicities but did not influence AHI differently across groups.
We demonstrate ethnic and sex variations in associations between obesity and OSA. For similar BMI increases, South American patients show greatest AHI increases compared to African Americans. Findings highlight the importance of considering ethnicity and sex in clinical assessments of OSA risk.
The use of smartphone applications (apps) to assist with weight management is increasingly prevalent, but the quality of these apps is not well characterized.
The goal of the study was to evaluate ...diet/nutrition and anthropometric tracking apps based on incorporation of features consistent with theories of behavior change.
A comparative, descriptive assessment was conducted of the top-rated free apps in the Health and Fitness category available in the iTunes App Store. Health and Fitness apps (N=200) were evaluated using predetermined inclusion/exclusion criteria and categorized based on commonality in functionality, features, and developer description. Four researchers then evaluated the two most popular apps in each category using two instruments: one based on traditional behavioral theory (score range: 0-100) and the other on the Fogg Behavioral Model (score range: 0-6). Data collection and analysis occurred in November 2012.
Eligible apps (n=23) were divided into five categories: (1) diet tracking; (2) healthy cooking; (3) weight/anthropometric tracking; (4) grocery decision making; and (5) restaurant decision making. The mean behavioral theory score was 8.1 (SD=4.2); the mean persuasive technology score was 1.9 (SD=1.7). The top-rated app on both scales was Lose It! by Fitnow Inc.
All apps received low overall scores for inclusion of behavioral theory-based strategies.
The popularity and professionalism of female soccer has increased markedly in recent years, with elite players now employed on either a professional or semi-professional basis. The previous review of ...the physiological demands of female soccer was undertaken two decades ago when the sport was in its relative infancy. Increased research coupled with greater training and competition demands warrants an updated review to consider the effect on physical performance and injury patterns. The physical demands of match-play along with the influence of factors such as the standard of competition, playing position and fatigue have been explored. Total distance covered for elite female players is approximately 10 km, with 1.7 km completed at high speed (>15 kmh(-1)) corrected.Elite players complete 28% more high-speed running and 24 % more sprinting than moderate-level players. Decrements in high-speed running distance have been reported between and within halves, which may indicate an inability to maintain high-intensity activity. Although the physical capacity of female players is the most thoroughly researched area, comparisons are difficult due to differing protocols. Elite players exhibit maximal oxygen uptake (VO2max) values of 49.4-57.6 mL·kg(-1)·min(-1), Yo Yo Intermittent Endurance test level 2 (YYIE2) scores of 1,774 ± 532 m mean ± standard deviation (SD) and 20 m sprint times of 3.17 ± 0.03 s (mean ± SD). Reasons for the increased prevalence of anterior cruciate ligament injuries in females (2-6 times greater than males) are discussed, with anatomical, biomechanical loading and neuromuscular activation differences being cited in the literature. This review presents an in-depth contemporary examination of the applied physiology of the female soccer player.
Abstract Background Low-grade inflammation is a marker for cardiovascular disease (CVD). The inflammatory biomarkers C-reactive protein (CRP) and soluble urokinase plasminogen activator receptor ...(suPAR) independently predict CVD. We tested the hypothesis that these biomarkers reflect different aspects of the inflammation associated with CVD. Methods We studied 2273 subjects without CVD. Log-transformed CRP and suPAR were included in general linear and logistic regression models to compare associations with measures of anthropometry and subclinical organ damage (SOD). Owing to interactions on body mass index (BMI) (P < 0.0001), the population was stratified by gender and smoking concerning anthropometry. Results In both genders, independent of smoking, log-CRP was positively associated with BMI (β: 0.28 to 0.40, P < 0.001) and waist circumference (WC) (β: 0.27 to 0.42, P < 0.001). In contrast, in smoking women and men, log-suPAR was negatively associated with BMI and WC (β: − 0.09 to − 0.19, P < 0.05). In non-smoking women, log-suPAR was positively associated with BMI and WC (β: 0.14 and 0.16, P < 0.001), whereas no associations were found in non-smoking men. No interactions were found on SOD. Adjusted for age, sex, smoking, and physical activity, log-suPAR was associated with an increased urine albumin/creatinine ratio (standardized odds ratio (95% confidence interval (CI)) for highest vs. lower quartiles: 1.36 (1.21–1.52), whereas log-CRP was not (1.10 (0.99–1.22))), and extent of atherosclerosis (standardized proportional odds ratio (95% CI) for carotid plaques 0, 1 ≤ to ≤ 3, > 3: 1.31 (1.16–1.47), whereas log-CRP was not (1.00 (0.89–1.11))). Conclusions CRP is positively associated with anthropometric measures, whereas suPAR is linked to endothelial dysfunction and atherosclerosis.
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