Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-01-26T13:27:51Z No. of bitstreams: 1 RAFAELA_SIVIERO_CARON_LIENERT_TES.pdf: 9419976 bytes, checksum: f123a0ee4d12fb6dd455c726f40ece4f (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2018-01-31T13:24:29Z (GMT) No. of bitstreams: 1 RAFAELA_SIVIERO_CARON_LIENERT_TES.pdf: 9419976 bytes, checksum: f123a0ee4d12fb6dd455c726f40ece4f (MD5) / Made available in DSpace on 2018-01-31T13:29:24Z (GMT). No. of bitstreams: 1 RAFAELA_SIVIERO_CARON_LIENERT_TES.pdf: 9419976 bytes, checksum: f123a0ee4d12fb6dd455c726f40ece4f (MD5) Previous issue date: 2017-11-21 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Background: During 24 hours of peritoneal dialysis (PD), it is estimated that 100 to 300g of the glucose are absorbed, which can generate metabolic changes and nutritional disorders. Objective: To study pathophysiological and clinical aspects related to nutritional status of PD patients. Materials and Methods: Observational study of PD patients evaluating body composition by bioimpedance (Body Composition Monitor; Fresenius Medical Care), examining peritoneal membrane characteristics, measuring biochemical parameters and using inductively coupled plasma mass spectrometer to measure serum concentrations of copper (63Cu), zinc (66Zn), selenium (78Se), chromium (52Cr) and nickel (58Ni). Results for each paper: Article 1: After 1y on PD, 50.6% had dry weight (DW) gain, 41.2% showed lean tissue mass (LTM) loss, and 65.9% presented fat mass (FM) gain and significant differences in DW, body mass index (BMI), adipose tissue mass (ATM), FM and fat tissue index (FTI) were disclosed. Patients with lower dialysate-to-plasma creatinine ratio showed FM gain. We observed a higher percentage of nonfast transporters in DW gain when comparing with no gain. Artigo 2: No differences were disclosed regarding body composition changes between PD modalities (CAPD and APD). Article 3: At baseline 29.9% of the patients were classified as having undernutrition (Lean Tissue Index (LTI) percentile <10th), 55.5% as obese (FTI percentile >90th), 7.9% as having fat tissue undernutrition (FTI percentile <10th) and 23.8% had LTI undernutrition and obesity in combination. The cumulative survival rates were 92%, 83%, 69%, 67% and 60% (12, 24, 36, 48 and 60 months, respectively). Kaplan-Meier survival and Cox regressions analysis showed that only PhA bellow 5? had an impact on mortality during the follow-up, even after adjusting for age, gender and diabetes. Artigo 4: Values below references were disclosed for Zn (5.8 ? 1.1 ?mol/L) in 100%; Cu (15.7 ? 5.0 ?mol/L) in 20.7%; Se (0.59 ? 0.22 ?mol/L) in 75.9%. Values above references were disclosed for Cr (0.29 ? 0.08 ?mol/L) in 86.3% and Ni (0.21 (0.17 ? 0.26) ?mol/L) in 96.6%. We observed significant positive corretations between Cu and DW (r=0.407, P=0.028), BMI (r=0.460, P=0.012) and FTI (r=0.370, P0.048). Zn was positivily correlated to albumin (r=0.527, P=0.003) and negatively correlated with OH (r=-0.394, P=0.034) and extracellular water (%ECW) (r=-0.466, P=0.014). Se had a positive correlation with serum albumin (r=0.515, P=0.005) and total cholesterol (r=0.443, P=0.021), but a negative correlation with %ECW (r=-0.404, P=0.041) and extracellular water/intracellular water (r=0.398, P0.036). Ni was negatively correlated to dry weight (r=-0.377, P0.044). Cu/Zn ratio was only correlated to BMI (r=0.376, P=0.044). Conclusions: Body composition changes over PD treatment and it does not seems to be related to the exposure of glucose or to the PD modality, however, it seems to be related to patients with slower peritoneal transports at the beginning of the treatment. Detailed analysis of body composition can generate more accurate data of nutritional status. The use of the phase angle as a marker of nutritional status is suggested and further studies are needed to better understand the association of serum microelements and body composition in this population. / Introdu??o: Durante 24 horas de Di?lise Peritoneal (DP), estima-se que cerca de 100 a 300g da glicose s?o absorvidas, o que pode gerar altera??es metab?licas e no estado nutricional. Objetivos: Estudar aspectos fisiopatol?gicos e cl?nicos relacionados ao estado nutricional de pacientes em DP. Materiais e m?todos: Estudo observacional de pacientes em DP com an?lise da composi??o corporal atrav?s da bioimped?ncia espectrosc?pica (Body Composition Monitor, Fresenius Medical Care), avalia??o da caracter?stica de transporte peritoneal, exames bioqu?micos e concentra??o s?rica de cobre (63Cu), zinco (66Zn), sel?nio (78Se), cromo (52Cr) e n?quel (58Ni) atrav?s de espectometria de massa com plasma indutivamente acoplado. Resultados por artigo: Artigo 1: Ap?s 1 ano de DP, 50,6% ganharam peso, 41,2% perderam massa magra, 65,9% aumentaram massa gorda, sendo encontrado aumento significativo para peso, ?ndice de massa corporal (IMC), tecido adiposo e ?ndice de massa gorda. Os pacientes que ganharam peso predominantemente apresentavam baixo transporte peritoneal. Artigo 2: A modifica??o da composi??o corporal encontrada n?o foi diferente entre modalidades de DP, ambulatorial cont?nua (CAPD) e automatizada (APD). Artigo 3: No in?cio da DP, os pacientes foram classificados em: 29,9% desnutridos (massa magra percentil <10), 55,5% obesos (massa gorda percentil >90) e 7,9% como desnutridos por massa gorda (massa gorda percentil <10) e 23,8% desnutri??o e obesidade em combina??o. A sobrevida cumulativa foi de 92%, 83%, 69%, 67% e 60% (12, 24, 36, 48 e 60 meses, respectivamente). O ?ngulo de fase (abaixo de 5?) possui impacto na mortalidade, inclusive ap?s ajuste para idade, sexo e diabetes. Artigo 4: Valores abaixo da refer?ncia foram observados para Zn (5,8 ? 1,1 ?mol/L) em 100%; Cu (15,7 ? 5,0 ?mol/L) em 20,7%; Se (0,59 ? 0,22 ?mol/L) em 75,9%. Valores acima do recomendado foram encontrados para Cr (0,29 ? 0,08 ?mol/L) em 86,3% e Ni (0,21 (0.17 ? 0.26) ?mol/L em 96,6%. Foi observada correla??o positiva entre Cu e peso seco (r=0,407, P=0,028), IMC (r=0,460, P=0,012) e ?ndice de massa gorda (r=0,370, P0,048). Zn apresentou correla??o positiva com albumina (r=0,527, P=0,003) e negativa com hiperhidrata??o (r=-0,394, P=0,034) e percentual de ?gua extracelular (r=-0,466, P=0,014). Se apresentou correla??o positiva com albumina (r=0,515, P=0,005) e colesterol total (r=0,443, P=0,021), mas negativa com percentual de ?gua extracelular (r=-0,404, P=0,041) e ?gua extracelular/?gua intracelular (r=0,398, P0,036). Ni correlacionou-se negativamente com peso seco (r=-0,377, P0,044). Cu/Zn apresentou correla??o com IMC (r=0,376, P=0,044). Conclus?es: A composi??o corporal de pacientes em DP se modifica ao longo do tratamento, o que n?o parece estar relacionado a exposi??o a glicose ou ? modalidade de DP, por?m, as altera??es parecem estar relacionadas ? pacientes que apresentam transportes peritoneais mais lentos no in?cio da terapia. A an?lise da composi??o corporal de forma detalhada pode gerar dados mais precisos de avalia??o nutricional. Sugere-se o uso do ?ngulo de fase como um marcador de estado nutricional e mais estudos s?o necess?rios para o melhor entendimento da associa??o de microelementos s?ricos e composi??o corporal nesta popula??o.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-07-20T21:43:09Z No. of bitstreams: 1 MarciaMariliaGomesDantasLopes_TESE.pdf: 2946604 bytes, checksum: 7c58a7a91a75997305283ee46411e977 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-07-21T19:26:11Z (GMT) No. of bitstreams: 1 MarciaMariliaGomesDantasLopes_TESE.pdf: 2946604 bytes, checksum: 7c58a7a91a75997305283ee46411e977 (MD5) / Made available in DSpace on 2016-07-21T19:26:11Z (GMT). No. of bitstreams: 1 MarciaMariliaGomesDantasLopes_TESE.pdf: 2946604 bytes, checksum: 7c58a7a91a75997305283ee46411e977 (MD5) Previous issue date: 2016-02-19 / Existem muitos m?todos de avalia??o nutricional, por?m a maioria possui limita??es, especialmente para a avalia??o de interven??o nutricional. O consumo inadequado de energia e/ou nutrientes podem ter uma influ?ncia prejudicial ? sa?de das crian?as, comprometendo significativamente o crescimento e desenvolvimento deste grupo et?rio. O zinco ? um microelemento essencial, contribuindo para o crescimento, desenvolvimento e composi??o corporal de crian?as. Diante disso, a avalia??o nutricional em crian?as ? uma ferramenta essencial na pr?tica cl?nica, pois ? importante para monitorar a sa?de e estado nutricional. Assim, esse trabalho objetivou avaliar m?todos de avalia??o nutricional para a suplementa??o oral com zinco em crian?as n?o deficientes em zinco, utilizando a antropometria, medidas bioel?tricas, consumo alimentar e dados bioqu?micos. Realizou-se um estudo controlado, randomizado, triplo-cego. As crian?as, entre 8 e 9 anos, foram divididas em um grupo controle (10% de sorbitol, n = 31) e um grupo experimental (10 mg Zn/dia, n = 31) durante 3 meses. Avalia??o antropom?trica, bioel?trica, alimentar e laboratorial foi feita no in?cio e no final do estudo em todas as crian?as. Foi utilizado o GraphPad Prism software para as an?lises estat?sticas, BIVA software 2002 para as medidas biol?tricas, NutWin software 1.5 para avalia??o diet?tica e o zinco s?rico foi medido por espectrofotometria de absor??o at?mica. Nosso estudo mostrou: (1) aumento do ?ndice de massa corporal por idade e aumento do ?ngulo de fase no grupo experimental; (2) correla??o positiva entre os par?metros de avalia??o nutricional em ambos os grupos; (3) aumento de tecido mole e, principalmente, massa livre de gordura, na composi??o corporal do grupo experimental, determinado pela an?lise do vetor de imped?ncia bioel?trico e ?ngulo de fase; (4) aumento do consumo de todos os nutrientes no grupo experimental; (5) e aumento da concentra??o de zinco no soro em ambos os grupos (p < 0.0001). A suplementa??o foi ben?fica, pois o zinco melhorou a composi??o corporal sem ganho de massa gorda, observada a partir da interpreta??o combinada de todos os m?todos. Devido a n?o exist?ncia de refer?ncia concernente ? BIVA para estudos de interven??o, s?o necess?rios dados longitudinais para investigar a migra??o de vetores durante a suplementa??o com zinco. Estes resultados refor?am a import?ncia da utiliza??o de v?rias t?cnicas para avaliar o estado nutricional das popula??es, principalmente se submetido a algum tipo de interven??o. / Background: Zinc is an essential nutrient that is required for numerous metabolic functions, and zinc deficiency results in growth retardation, cellmediated immune dysfunction, and cognitive impairment. Objective: This study evaluated nutritional assessment methods for zinc supplementation in prepubertal nonzinc- deficient children. Design: We performed a randomised, controlled, triple-blind study. The children were divided into a control group (10% sorbitol, n = 31) and an experimental group (10 mg Zn/day, n = 31) for 3 months. Anthropometric and dietary assessments as well as bioelectrical measurements were performed in all children. Results: Our study showed (1) an increased body mass index for age and an increased phase angle in the experimental group; (2) a positive correlation between nutritional assessment parameters in both groups; (3) increased soft tissue, and mainly fat-free mass, in the body composition of the experimental group, as determined using bioelectrical impedance vector analysis; (4) increased consumption of all nutrients, including zinc, in the experimental group; and (5) an increased serum zinc concentration in both groups (p < 0.0001). Conclusions: Given that a reference for body composition analysis does not exist for intervention studies, longitudinal studies are needed to investigate vector migration during zinc supplementation. These results reinforce the importance of employing multiple techniques to assess the nutritional status of populations.

Submitted by PPG Pediatria e Sa?de da Crian?a (pediatria-pg@pucrs.br) on 2018-05-21T13:54:31Z No. of bitstreams: 1 Tese_Eduardo_Mundstock Versao Final.pdf: 1978473 bytes, checksum: 4be8f1b605788a6e254263a3c448a60f (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2018-06-06T18:34:35Z (GMT) No. of bitstreams: 1 Tese_Eduardo_Mundstock Versao Final.pdf: 1978473 bytes, checksum: 4be8f1b605788a6e254263a3c448a60f (MD5) / Made available in DSpace on 2018-06-06T18:36:11Z (GMT). No. of bitstreams: 1 Tese_Eduardo_Mundstock Versao Final.pdf: 1978473 bytes, checksum: 4be8f1b605788a6e254263a3c448a60f (MD5) Previous issue date: 2018-03-15 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Introduction: The phase angle is considered an important prognostic marker because it reflects cellular health. Inadequate physical activity and sitting time are associated with a significant number of chronic noncommunicable diseases. Recent studies suggest that these two factors may be associated with phase angle values. Objective: to verify the association of phase angle with physical activity Methodology: the thesis will present two articles: a systematic review with metaanalysis and a cross-section article. Meta-analysis: We searched the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, SciELO, LILACS, SPORTDiscus, Scopus and Web of Science. Two reviewers independently assessed eligibility criteria and bias risks. The results were synthesized using random effects models. The association between physical activity and phase angle was evaluated considering the design of the study. Cross-sectional study: individuals over 11 years of age, of both sexes, who met bioimpedance assessment criteria and without diagnosis of chronic disease, were invited to participate in the study. The phase angle evaluation was performed using Ottoboni's Biospace equipment, model InBodyS10. Physical activity level and sitting time were assessed using the International Physical Activity Questionnaire (IPAQ). The association between the phase angle and the predictor variables was evaluated using a univariate and multivariate generalized linear model (GLM). All variables with a value of p <0.20 were included in the multivariate model. In the final model, only the variables with p <0.05 were included. Results: Systematic Review: Nine studies, totaling 575 participants, were included in the meta-analysis. The results of cross-sectional studies indicate that the active subjects presented a mean value of higher phase angle when compared to controls (DM = 0.70, 95% CI 0.48 to 0.92, P <0.001), with low heterogeneity (I2 = 0%, P = 0.619). In the crosssectional analysis, the differences between health status and type of physical activity evaluation were not significant (P = 0.332, P <0.253). In longitudinal studies (clinical trial and follow-up), mean values of final phase angle increased significantly compared to baseline (DM = 0.30, 95% CI 0.11 to 0.49, P <0.001), with low heterogeneity (I2 = 13%, P = 0.331). The differences were not significant in relation to the state of health and the type of longitudinal study (clinical trials or follow-up studies) (P = 0.900; 0.989). Evidence of publication bias was not observed, and the overall risk of bias was moderate to high. Cross-sectional article: 1228 subjects were included. The multivariate generalized linear model showed that both physical activity (? = 0.164, 95% CI 0.071 to 0.256, P = 0.001) and sitting time (? = 0.152, 95% CI 0.063 to 0, 242, P = 0.001) were determinant for the phase angle. As well as sex, body mass index and age, also remained associated with phase angle (? = -0.890, 95%CI -0.975 to -0.806, P <0.001; ? = 0.037, 95%CI 0.029 to 0,045, p <0.001 e; ? = -0.006, 95%CI -0.008 to -0.003 P<0.001, respectively). Conclusion: The results of the systematic review and the cross-sectional article suggest an association of phase angle with physical activity and sitting time. Among the main factors that may explain the positive effect of physical activity on the phase angle are the increase in cell membrane integrity and the change in intracellular content, these factors reflecting the cellular health and, consequently, the health of the individual. / Introdu??o: O ?ngulo de fase est? sendo considerado um importante marcador progn?stico, pois reflete a sa?de celular. A atividade f?sica inadequada e o tempo sentado est?o associados a um n?mero importante de doen?as cr?nicas n?o transmiss?veis. Estudos recentes sugerem que esses dois fatores podem estar associados com os valores do ?ngulo de fase. Objetivo: verificar a associa??o do ?ngulo de fase com a atividade f?sica. Metodologia: a tese ir? apresentar dois artigos: uma revis?o sistem?tica com metan?lise e um artigo transversal. Metan?lise: foram realizadas buscas nas seguintes bases de dados: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, SciELO, LILACS, SPORTDiscus, Scopus e Web of Science. Dois revisores avaliaram independentemente os crit?rios de elegibilidade e o risco de vi?s. Os resultados foram sintetizados mediante modelos de efeitos aleat?rios. A associa??o entre atividade f?sica e ?ngulo de fase foi avaliada considerando o desenho do estudo. Artigo transversal: os indiv?duos com mais de 11 anos de idade, de ambos os sexos, que atendiam aos crit?rios de avalia??o da bioimped?ncia e sem diagn?stico de doen?a cr?nica, foram convidados a participar do estudo. A avalia??o do ?ngulo de fase foi realizada usando o equipamento Biospace, modelo InBodyS10, da Ottoboni. O n?vel de atividade f?sica e o tempo sentado foram avaliados com o question?rio internacional de atividade f?sica (IPAQ). A associa??o entre o ?ngulo de fase e as vari?veis preditoras foram avaliadas utilizando um modelo linear generalizado univari?vel e multivari?vel (MLG). Todas as vari?veis com um valor de p <0,20 foram inclu?das no modelo multivari?vel. No modelo final, apenas as vari?veis com p <0,05 foram inclu?das. Resultados: Revis?o Sistem?tica: Nove estudos, totalizando 575 participantes, foram inclu?dos na metan?lise. Os resultados dos estudos transversais indicam que os sujeitos ativos apresentaram um valor m?dio de ?ngulo de fase superior quando comparado aos controles (DM = 0,70; IC 95%: 0,48 a 0,92, P <0,001), com baixa heterogeneidade (I2 = 0%; P = 0,619). Na an?lise transversal, as diferen?as entre o estado de sa?de e o tipo de avalia??o da atividade f?sica n?o foram significativas (P = 0,332; P <0,253). Nos estudos longitudinais (ensaio cl?nico e acompanhamento), os valores m?dios do ?ngulo de fase finais aumentaram significativamente comparando com os valores iniciais (DM = 0,30; IC 95%: 0,11 a 0,49, P <0,001), com heterogeneidade baixa (I2 = 13%, P = 0,3314). As diferen?as n?o foram significativas, em rela??o ao estado de sa?de e ao tipo de estudo longitudinal (ensaios cl?nicos ou estudos de seguimento) (P = 0,900; 0,989). N?o encontramos evid?ncia de vi?s de publica??o e o risco geral de vieses foi de moderado a alto. Artigo transversal: foram inclu?dos 1228 indiv?duos. O modelo linear generalizado multivari?vel mostrou que tanto a atividade f?sica (? = 0,164, IC95% 0,071 a 0,256, P= 0,001) como o tempo sentado (? = 0,152, IC95% 0,063 a 0,242, P= 0,001) foram determinantes para o ?ngulo de fase. Assim como o sexo, o ?ndice de massa corporal e a idade tamb?m permaneceram associados com o ?ngulo de fase (? = -0,890, IC95% -0,975 a -0,806, P <0,001; ? = 0,037, IC95% 0,029 a 0,045, p <0,001 e; ? = -0,006, IC95% - 0,008 a -0,003 P<0,001, respectivamente). Conclus?o: Os resultados da revis?o sistem?tica e do artigo transversal sugerem uma associa??o do ?ngulo de fase com a atividade f?sica e com o tempo sentado. Entre os principais fatores que podem explicar o efeito positivo da atividade f?sica sobre o ?ngulo de fase est?o o aumento da integridade da membrana celular e a mudan?a no conte?do intracelular, fatores estes que refletem a sa?de celular e, consequentemente, a sa?de do indiv?duo.