Made available in DSpace on 2014-12-17T14:13:36Z (GMT). No. of bitstreams: 1 ClaudiaMCO_TESE.pdf: 3459363 bytes, checksum: e824874a23be9621c49f82761562b5cf (MD5) Previous issue date: 2010-12-10 / Background: Malnutrition, inflammation and comorbidities are frequent in patients with chronic renal failure in hemodialysis (HD), contributing for morbidity and mortality. Aims: To evaluate the correlation between anthropometric, laboratory parameters, bioelectrical impedance (BIA) and inflammatory markers with the morbidity and mortality of patients in HD, as well as the impact of its alterations throughout 12 months. Methods: 143 patients of a dialysis facility in Northeast Brazil were evaluated throughout 18 months. Patients with more than 3 months on dialysis, older than 18 years, without amputation of hands and feet, were included in the study. We performed a clinical (subjective global assessment - SGA), anthropometric (BMI, percent of ideal weight, MAC, MAMC, MAMA, percent of fat mass and TSF), laboratory (albumin, creatinine, lymphocyte count as nutritional markers and CRP, IL-6 and TNF-&#61537; as inflammatory markers) evaluation and BIA (reactance, phase angle and percent of body cell mass) at the beginning of study and after 3, 6 and 12 months of follow-up. The association between study variables and deaths and hospitalizations in 6 and 12 months was investigated. The variable with significance < 10% in the univariate analysis had been enclosed in a multivariate logistic regression analysis. We also investigated the risk of mortality and hospitalization associated with differences in measurements of the variables at baseline and six months later. Results: Patients were aged 52.2 ? 16.6 years on the average, 58% were male, and mean dialysis vintage was 5.27 ? 5.12 years. The prevalence of malnutrition varied from 7.7-63.6%, according to the nutritional marker. The variables associated with morbidity and mortality in 6 and 12 months had been creatinine &#8804; 9.45 mg/dl, phase angle &#8804; 4.57 degrees, BMI &#8804; 23 kg/m2, age &#8804; 64.9 years, reactance &#8804; 51.7 ohms; Charlson?s index &#8805; 4 and socioeconomic status &#8804; 7. During six months of follow up, decrease in albumin was associated with significantly higher mortality risk. Conclusions: This study detected that the best predictors of morbidity and mortality between nutritional and inflammatory markers are phase angle, reactance, creatinine and BMI and that changes in albumin values over six 107 months provide additional prognostic information. The authors believe that parameters of BIA may detect early changes in nutritional status and emphasize that longitudinal studies with larger number of patients are necessary to confirm these data and to recommend BIA as a routine nutritional evaluation in HD patients / Introdu??o: A desnutri??o proteico-cal?rica, o processo inflamat?rio sist?mico e as comorbidades s?o freq?entes em pacientes com insufici?ncia renal cr?nica em terapia dial?tica, contribuindo para a sua morbimortalidade. Objetivo: Avaliar a correla??o entre par?metros nutricionais (antropom?tricos, laboratoriais e da bioimped?ncia el?trica - BIA) e inflamat?rios e a morbimortalidade de pacientes em hemodi?lise, bem como o impacto de suas altera??es ap?s 6 meses da avalia??o inicial. Material e M?todos: Uma coorte de 143 pacientes de um ?nico centro de hemodi?lise em Fortaleza-Cear?-Brasil foi avaliada ao longo de 18 meses, sendo inclu?dos pacientes com mais de 3 meses de di?lise, idade superior a 18 anos e sem amputa??o de membros. Os pacientes foram submetidos ? avalia??o cl?nica do estado nutricional (avalia??o subjetiva global), antropom?trica (?ndice de massa corporal [IMC], percentual de peso ideal, circunfer?ncia do bra?o, circunfer?ncia muscular do bra?o, ?rea muscular do bra?o, prega cut?nea tricipital e percentual de massa gorda), laboratorial (albumina, creatinina e contagem de linf?citos como marcadores nutricionais e Prote?na C reativa, IL-6 e TNF-alfa como marcadores de inflama??o) e BIA (react?ncia, ?ngulo de fase e percentual de massa celular corporal) no in?cio do estudo e ap?s 3, 6 e 12 meses de seguimento. Foi pesquisada a associa??o entre as vari?veis do estudo e os ?bitos e as hospitaliza??es em 6 e 12 meses. As vari?veis com signific?ncia < 10% na an?lise bivariada foram inclu?das em um modelo multivariado de regress?o log?stica, que foi ajustado para idade, sexo, tempo em di?lise, classe s?cio-econ?mica (CSE) e ?ndice de comorbidade de Charlson (CCI), para identificar os fatores associados ? morbimortalidade. Foi ainda pesquisada a associa??o entre a altera??o das vari?veis entre a avalia??o inicial e a avalia??o ap?s 6 meses e os ?bitos e as hospitaliza??es nos 12 meses subseq?entes. Resultados: 58% dos pacientes eram do sexo masculino, com idade m?dia de 52,2 ? 16,6 anos e tempo m?dio em di?lise de 5,27 ? 5,12 anos. A preval?ncia de desnutri??o variou entre 7,7 a 63,6%, de acordo com o marcador nutricional. As vari?veis associadas ? morbimortalidade foram: ?bito em 6 meses: creatinina &#8804; 9,45 mg/dl, ?ngulo de fase &#8804; 4,57 graus, CCI &#8805; 4 e CSE &#8804; 7; ?bito xiii em 12 meses: idade &#8804; 64,9 anos, react?ncia &#8804; 51,7 ohms e CSE &#8804; 7; hospitaliza??o em 6 meses: ?ngulo de fase &#8804; 4,57 graus; hospitaliza??o em 12 meses: IMC &#8804; 23,0 kg/m2, ?ngulo de fase &#8804; 4,57 graus e CCI &#8805; 4. O percentual de altera??o dos marcadores nutricionais e inflamat?rios em 6 meses de seguimento, avaliado em quartis, n?o apresentou um risco de mortalidade ou de hospitaliza??o significativamente diferente para as vari?veis pesquisadas, exceto para a diferen?a da albumina inferior ao percentil 25, que associou-se ao risco de ?bito em 12 meses. Conclus?o: Na avalia??o conjunta de par?metros antropom?tricos, laboratoriais, da BIA e inflamat?rios, o ?ngulo de fase, a react?ncia, a creatinina e o IMC foram identificados como preditivos de morbimortalidade. A diminui??o nos valores de albumina s?rica em 6 meses forneceu informa??o progn?stica adicional. Os autores acreditam no potencial dos marcadores da BIA, podendo detectar altera??es precoces no estado nutricional (mesmo antes de altera??es no IMC e exames laboratoriais) e enfatizam que estudos longitudinais com maior n?mero de pacientes em diferentes popula??es sejam realizados para confirma??o destes resultados e indica??o posterior desse exame no seguimento nutricional dos pacientes em hemodi?lise

Introdução: As Mucopolissacaridoses (MPS) são doenças lisossômicas causadas pela deficiência de enzimas envolvidas na degradação dos glicoaminoglicanos. O acúmulo anormal dessa molécula compromete a função celular e orgânica, levando a um espectro de manifestações clínicas, de caráter multissistêmico e progressivo. Manifestações gastrointestinais, tais como episódios frequentes de fezes amolecidas e diarréia, têm sido frequentemente evidenciadas e relatadas por pacientes com MPS. Ainda que os sintomas gastrointestinais sejam frequentemente ofuscados pelos fenótipos neurológicos graves, eles podem afetar a qualidade de vida dos pacientes e de seus familiares. Objetivo: Avaliar as manifestações gastrointestinais em pacientes com MPS que estavam ou não recebendo Terapia de Reposição Enzimática (TRE). Adicionalmente, para melhor compreender o assunto, avaliamos a histologia da mucosa intestinal em camundongos com MPS I. Métodos: Estudo transversal com amostragem de conveniência. Foram incluídos no estudo pacientes com diagnóstico de qualquer tipo de MPS que estavam ou não em TRE. Os sujeitos foram avaliados através de inquérito alimentar, questionamentos quanto ao aparecimento de sintomas gastrointestinais e realização de uma série de exames bioquímicos. Adicionalmente, foram realizados testes de bioimpedância elétrica (para avaliação da composição corporal) e teste molecular para hipolactasia primária a partir de amostras de DNA dos pacientes, assim como análise da histologia da mucosa intestinal em um modelo de camundongo com MPS I. Resultados: Foram incluídos 27 pacientes com diferentes tipos de MPS, sendo 15 (55,6%) do sexo feminino e 12 (44,4%) do sexo masculino, com mediana de idade de 12 (1-28) anos. Os sintomas gastrointestinais mais prevalentes foram flatulência, distensão abdominal, dor abdominal e fezes amolecidas. Houve diferença significativa na prevalência de flatulência entre os tipos de MPS (p=0,004). A prevalência de flatulência e de distensão abdominal foi significativamente maior no grupo dos que não recebiam TRE, em comparação ao grupo dos que recebia TRE (p = 0,04 e 0,03, respectivamente). A maioria dos exames bioquímicos realizados para investigação e/ou exclusão de alguma patologia específica apresentaram resultados normais, sugerindo que o aparecimento de sintomas gastrointestinais nesses pacientes possa ser decorrente da própria MPS através de mecanismo fisiopatológico independente. A análise da histologia do intestino delgado de camundongos MPS I identificou células aumentadas de volume, sugerindo algum tipo de acúmulo intracelular. Em relação ao Teste Molecular para Hipolactasia, 58,8% dos pacientes apresentaram genótipo CC, o qual é compatível com intolerância à lactose. Os exames de Bioimpedância Elétrica sugerem que, os pacientes em TRE apresentam menor proporção de massa gorda (MG) em relação aos pacientes que não estavam em TRE. Conclusão: Este foi o primeiro estudo sobre manifestações gastrointestinais de pacientes brasileiros com MPS realizado em nosso meio. Inúmeros sinais e sintomas foram observados, com maior prevalência relativa nas MPS I, II, III e IV do que na MPS VI. O sintoma mais frequentemente relatado foi flatulência. Embora não tenha sido estatisticamente significativo a diferença, a proporção de pacientes com sintomas gastrointestinais foi menor nos pacientes que estavam em TRE. A Intolerância à lactose observada em maior proporção nos pacientes com MPS com manifestações gastrointestinais, a avaliação da composição corporal e as alterações observadas na mucosa intestinal do camundongo com MPS I devem ser levadas em consideração na interpretação dos resultados. Acreditamos que mais estudos, dirigidos para as manifestações gastrointestinais, devam ser realizados para comprovar esses achados e melhor compreender os mecanismos fisiopatológicos dos sintomas relacionados nos pacientes aferidos. / Introduction: The mucopolysaccharidoses (MPS) are lysosomal storage disorders characterized by a deficiency in enzymes involved in glycosaminoglycan degradation. Abnormal accumulation of this molecule compromises cellular and organic function, leading to a spectrum of progressive, multisystem clinical manifestations. Gastrointestinal manifestations, such as frequent episodes of loose stools and diarrhea, are often reported by patients with MPS. Although these gastrointestinal symptoms are often overshadowed by severe neurological phenotypes, they can have a negative impact on the quality of life of patients and their family members. Objective: To assess gastrointestinal manifestations in patients with MPS who were or not receiving enzyme replacement therapy (ERT). Furthermore, we sought to assess bowel mucosa histology in a mouse model of MPS I. Methods: Cross-sectional study with a convenience sampling strategy. The sample comprised patients with a diagnosis of MPS of any type and regardless of ERT status. Patients were assessed by means of a dietary recordatory and an interview focused on gastrointestinal symptoms, as well as a battery of biochemical tests. Bioelectrical Impedance was performed for body composition assessment.Patient DNA samples were also tested by molecular tests for primary lactase hypolactasia, and bowel mucosa specimens from MPS I mice underwent histological examination. Results: A total of 27 MPS patients were included, 15 (55.6%) female and 12 (44.4%) male, with a median age of 12 (1-28) years. The most prevalent gastrointestinal symptoms were flatulence, abdominal distension, abdominal pain, and loose stools. A significant difference in the prevalence of flatulence was observed among different MPS types (p=0.004). The prevalence of flatulence and abdominal distension was significantly higher in the non-ERT group than in the ERT group (p = 0.04 and 0.03 respectively). Most biochemical tests performed to work up and/or rule out specific conditions were within normal limits, which suggests that the development of gastrointestinal systems in these patients may be due to MPS itself through an independent pathophysiological mechanism. Histological analysis of smallbowel tissue from MPS I mice found increased cell volume indicative of some form of intracellular accumulation. On molecular testing for lactase deficiency, 58.8% of patients had the CC genotype, which is consistent with lactose intolerance. Bioelectrical Impedance analysis suggest that patients with TRE have lower proportion of fat mass (FM) compared to patients who were not on ERT. Conclusion: This was the first study to assess gastrointestinal manifestations in Brazilian patients with different MPS subtypes.Several signs and symptoms were observed with higher relative prevalence in MPS I, II, III and IV to that in MPS VI. The most frequently reported symptom was flatulence. Although was no statistical difference the proportion of patients with gastrointestinal symptoms was lower in patients on ERT.The lactose intolerance observed in a higher proportion of MPS patients with gastrointestinal manifestations, body composition assessment and observed changes in the bowel mucosa of MPS I mice should be taken into account when interpreting the results. Further studies focusing on the gastrointestinal manifestations of MPS are warranted to corroborate our findings and provide a better understanding of the pathophysiological mechanisms associated with these symptoms in affected patients.

Excessive accumulation of body fat is detrimental to people's health, so it is important to check the amount and distribution of body fat by assessing body composition. Taking into account the importance of assessing body composition and the lack of studies that indicate the most appropriate method to overweight and obesity, this study aims to examine the relationship and the agreement of different methods of assessing body composition to estimate body fat of overweight or obese. The data used in the study group were extracted Kinanthropometry Lab database (Labcine) of the Center for Physical Education and Sports (CEFD) of the Federal University of Santa Maria (UFSM), which were selected 78 overweight or obese , 49 women and 29 men between 35 and 68 years old. For the determination of body composition were used the following evaluation methods: anthropometry (weight, height, skinfold thickness and circumferences), bioelectrical impedance and dual-energy x-ray absorptiometry (DXA) (reference method). Descriptive statistics were used to characterize the study group and the normality of the data was verified by the Kolgomorov-Smirnov test. The difference between the means was verified by paired t test. We used the Pearson correlation coefficient to determine the degree of association between the evaluative methods of body composition and the Bland and Altman test to verify the agreement of the results, adopting a 5% significance level. To carry out the analysis, we used the statistical program SPSS 14.0. / O acúmulo excessivo de gordura corporal acarreta prejuízos à saúde das pessoas, por isso torna-se importante a verificação da quantidade e distribuição da gordura corporal por meio da avaliação da composição corporal. Levando em conta a importância da avaliação da composição corporal e a escassez de estudos que indiquem o método mais adequado para indivíduos com sobrepeso e obesidade, o presente estudo tem por objetivo analisar a relação e a concordância de diferentes métodos de avaliação da composição corporal para estimar a gordura corporal de indivíduos com sobrepeso ou obesidade. Os dados utilizados no grupo de estudo foram extraídos do banco de dados do Laboratório de Cineantropometria (Labcine) do Centro de Educação Física e Desportos (CEFD) da Universidade Federal de Santa Maria (UFSM), no qual foram selecionados 78 indivíduos com sobrepeso ou obesidade, sendo 49 mulheres e 29 homens, entre 35 e 68 anos de idade. Para a determinação da composição corporal foram utilizados os seguintes métodos avaliativos: antropometria (massa corporal, estatura, dobras cutâneas e perímetros), impedância bioelétrica e absorciometria de raios-X de dupla energia (DXA), sendo este o método de referência. Foi utilizada a estatística descritiva para a caracterização do grupo de estudo e a normalidade dos dados foi verificada por meio do teste de Kolgomorov-Smirnov. A diferença entre as médias foi verificada através do Teste t pareado. Utilizou-se o coeficiente de correlação de Pearson para determinar o grau de associação entre os métodos avaliativos da composição corporal e o teste de Bland e Altman para verificar a concordância dos resultados, adotando um nível de significância de 5%. Para a realização das análises, utilizou-se o programa estatístico SPSS 14.0.

Introdução: As Mucopolissacaridoses (MPS) são doenças lisossômicas causadas pela deficiência de enzimas envolvidas na degradação dos glicoaminoglicanos. O acúmulo anormal dessa molécula compromete a função celular e orgânica, levando a um espectro de manifestações clínicas, de caráter multissistêmico e progressivo. Manifestações gastrointestinais, tais como episódios frequentes de fezes amolecidas e diarréia, têm sido frequentemente evidenciadas e relatadas por pacientes com MPS. Ainda que os sintomas gastrointestinais sejam frequentemente ofuscados pelos fenótipos neurológicos graves, eles podem afetar a qualidade de vida dos pacientes e de seus familiares. Objetivo: Avaliar as manifestações gastrointestinais em pacientes com MPS que estavam ou não recebendo Terapia de Reposição Enzimática (TRE). Adicionalmente, para melhor compreender o assunto, avaliamos a histologia da mucosa intestinal em camundongos com MPS I. Métodos: Estudo transversal com amostragem de conveniência. Foram incluídos no estudo pacientes com diagnóstico de qualquer tipo de MPS que estavam ou não em TRE. Os sujeitos foram avaliados através de inquérito alimentar, questionamentos quanto ao aparecimento de sintomas gastrointestinais e realização de uma série de exames bioquímicos. Adicionalmente, foram realizados testes de bioimpedância elétrica (para avaliação da composição corporal) e teste molecular para hipolactasia primária a partir de amostras de DNA dos pacientes, assim como análise da histologia da mucosa intestinal em um modelo de camundongo com MPS I. Resultados: Foram incluídos 27 pacientes com diferentes tipos de MPS, sendo 15 (55,6%) do sexo feminino e 12 (44,4%) do sexo masculino, com mediana de idade de 12 (1-28) anos. Os sintomas gastrointestinais mais prevalentes foram flatulência, distensão abdominal, dor abdominal e fezes amolecidas. Houve diferença significativa na prevalência de flatulência entre os tipos de MPS (p=0,004). A prevalência de flatulência e de distensão abdominal foi significativamente maior no grupo dos que não recebiam TRE, em comparação ao grupo dos que recebia TRE (p = 0,04 e 0,03, respectivamente). A maioria dos exames bioquímicos realizados para investigação e/ou exclusão de alguma patologia específica apresentaram resultados normais, sugerindo que o aparecimento de sintomas gastrointestinais nesses pacientes possa ser decorrente da própria MPS através de mecanismo fisiopatológico independente. A análise da histologia do intestino delgado de camundongos MPS I identificou células aumentadas de volume, sugerindo algum tipo de acúmulo intracelular. Em relação ao Teste Molecular para Hipolactasia, 58,8% dos pacientes apresentaram genótipo CC, o qual é compatível com intolerância à lactose. Os exames de Bioimpedância Elétrica sugerem que, os pacientes em TRE apresentam menor proporção de massa gorda (MG) em relação aos pacientes que não estavam em TRE. Conclusão: Este foi o primeiro estudo sobre manifestações gastrointestinais de pacientes brasileiros com MPS realizado em nosso meio. Inúmeros sinais e sintomas foram observados, com maior prevalência relativa nas MPS I, II, III e IV do que na MPS VI. O sintoma mais frequentemente relatado foi flatulência. Embora não tenha sido estatisticamente significativo a diferença, a proporção de pacientes com sintomas gastrointestinais foi menor nos pacientes que estavam em TRE. A Intolerância à lactose observada em maior proporção nos pacientes com MPS com manifestações gastrointestinais, a avaliação da composição corporal e as alterações observadas na mucosa intestinal do camundongo com MPS I devem ser levadas em consideração na interpretação dos resultados. Acreditamos que mais estudos, dirigidos para as manifestações gastrointestinais, devam ser realizados para comprovar esses achados e melhor compreender os mecanismos fisiopatológicos dos sintomas relacionados nos pacientes aferidos. / Introduction: The mucopolysaccharidoses (MPS) are lysosomal storage disorders characterized by a deficiency in enzymes involved in glycosaminoglycan degradation. Abnormal accumulation of this molecule compromises cellular and organic function, leading to a spectrum of progressive, multisystem clinical manifestations. Gastrointestinal manifestations, such as frequent episodes of loose stools and diarrhea, are often reported by patients with MPS. Although these gastrointestinal symptoms are often overshadowed by severe neurological phenotypes, they can have a negative impact on the quality of life of patients and their family members. Objective: To assess gastrointestinal manifestations in patients with MPS who were or not receiving enzyme replacement therapy (ERT). Furthermore, we sought to assess bowel mucosa histology in a mouse model of MPS I. Methods: Cross-sectional study with a convenience sampling strategy. The sample comprised patients with a diagnosis of MPS of any type and regardless of ERT status. Patients were assessed by means of a dietary recordatory and an interview focused on gastrointestinal symptoms, as well as a battery of biochemical tests. Bioelectrical Impedance was performed for body composition assessment.Patient DNA samples were also tested by molecular tests for primary lactase hypolactasia, and bowel mucosa specimens from MPS I mice underwent histological examination. Results: A total of 27 MPS patients were included, 15 (55.6%) female and 12 (44.4%) male, with a median age of 12 (1-28) years. The most prevalent gastrointestinal symptoms were flatulence, abdominal distension, abdominal pain, and loose stools. A significant difference in the prevalence of flatulence was observed among different MPS types (p=0.004). The prevalence of flatulence and abdominal distension was significantly higher in the non-ERT group than in the ERT group (p = 0.04 and 0.03 respectively). Most biochemical tests performed to work up and/or rule out specific conditions were within normal limits, which suggests that the development of gastrointestinal systems in these patients may be due to MPS itself through an independent pathophysiological mechanism. Histological analysis of smallbowel tissue from MPS I mice found increased cell volume indicative of some form of intracellular accumulation. On molecular testing for lactase deficiency, 58.8% of patients had the CC genotype, which is consistent with lactose intolerance. Bioelectrical Impedance analysis suggest that patients with TRE have lower proportion of fat mass (FM) compared to patients who were not on ERT. Conclusion: This was the first study to assess gastrointestinal manifestations in Brazilian patients with different MPS subtypes.Several signs and symptoms were observed with higher relative prevalence in MPS I, II, III and IV to that in MPS VI. The most frequently reported symptom was flatulence. Although was no statistical difference the proportion of patients with gastrointestinal symptoms was lower in patients on ERT.The lactose intolerance observed in a higher proportion of MPS patients with gastrointestinal manifestations, body composition assessment and observed changes in the bowel mucosa of MPS I mice should be taken into account when interpreting the results. Further studies focusing on the gastrointestinal manifestations of MPS are warranted to corroborate our findings and provide a better understanding of the pathophysiological mechanisms associated with these symptoms in affected patients.

Title: The comparison of different methods of body fat measuring by ensemble of adult women devided into five groups according to the BMI level. Objectives: The aim of this thesis is to compare values of gained percentage of total body fat by descriptive method such as bioelectrical impedance analysis and skinfolds measuring in comparison with "gold standard method" DEXA and to evaluate the usability of each method of body composition measuring by five groups of women, devided according to BMI level (in range 20-47 kg/m2 ). The purpose of this thesis is to find the most useful method especially for the overweight and obese women (BMI over 30 kg/m2 ) and to estimate the equation for the whole group. The other part of this thesis is the theoretical conclusion of the matters of body composition assessing and the importance of good knowledge about this topic for physiotherapists. Methods: The study was realizing from January of 2010 to March of 2011. There were 136 women, who were clients of Fitness center of VŠTJ Medicina Praha and jointed to the group voluntarely. The criteria of choosing the subjects into the study were: age 18 - 75 years, BMI 20 ≤ 45 kg/m2 , relatively healthy without accute disease. Women with cardiostimulator, pregnant women or nursing mothers were excluded. The monitored...

Inappetenz und Gewichtsverlust sind bei Patienten, die an gastrointestinalen Tumoren erkrankt sind, häufige Symptome. Kenntnisse über Lebensmittelpräferenzen und Ernährungsgewohnheiten bei diesen Patienten sind wichtig für die Betreuung und diätetische Therapie dieser Tumorpatienten. Bei 100 Patienten, die an gastrointestinalen Tumoren (TP) erkrankt waren, untersuchten wir Ernährungsgewohnheiten, Verzehrhäufigkeiten und Lebensmittelpräferenzen mit Hilfe eines Fragebogens. Zusätzlich wurde zur Bestimmung der Körperzusammensetzung Größe, Gewicht, Body Maß Index (BMI), per Anthropometrie Armmuskelmasse (AMA) und Armfettmasse (AFA) und per Bioeletrischer Impedanzanalyse Impedanz Z, Resistanz R, Reaktanz Xc, Phasenwinkel phi und Körperzellmasse (BCM) ermittelt. Die erhobenen Daten wurden mit den Angaben einer gesunden Kontrollgruppe (KG) verglichen. Im Vergleich zur KG wurden Veränderungen zu Gunsten einer leicht verdaulichen Kost, z.B. häufiger Verzehr von Kartoffelpüree, Grießbrei und Tee bzw. Ablehnung von Schmalz, Hülsenfrüchten, Vollkornprodukten, alkoholische oder kohlensäurehaltige Getränke, angegeben. Eine Präferenz eines Lebensmittels durch TP konnte nicht ermittelt werden. TP, die eine Chemotherapie zum Zeitpunkt der Datenerhebung erhielten, bevorzugten kalorienreiche und geschmacksintensive Lebensmittel wie Sahne, Brühe, Salzgebäck und Schokolade. AFA und BCM waren in der TP Gruppe deutlich reduziert, obwohl Gewicht und BMI in TP und KG ähnlich waren. In der Betreuung von TP sollte auf Geschmacksveränderungen geachtet werden, um rechtzeitig eine reduzierte Nahrungsaufnahme zu erkennen. Untersuchungen, inwieweit Veränderungen des Geschmackssinns durch Tumorerkrankung oder Chemotherapie beeinflußt werden, stehen noch aus. / Low appetite and weight loss are frequent symptoms in patients with gastrointestinal malignancies (TP). Knowledge about food preferences and nutritional habits of TP are important for the care and treatment of these patients. Nutritional habits, food frequencies and food preferences of 100 patients with gastrointestinal malignancies were analyzed using a questionnaire. To characterize patient’s body composition body size, body weight, body mass index (BMI), arm-muscle-mass (AMA) and arm-fat-mass (AFA) was measured anthropometrically and impedance Z, resistance R, reactance Xc, phase angel phi and body cell mass (BCM) by bioelectrical impedance analysis was determined. All these data were compared to a healthy controlgroup in the same age. Compared to the controlgroup TP ate an easy digestive diet like smashed potatoes, semolina pudding and tea more frequent and avoided lard, legumes, whole-mead products, alcoholic and carbonated drinks. No food preference could be found. TP undergoing cytostatical treatment during the study preferred high caloric and intensive tasting food like cream, broth, salty pastry and chocolate. In TP AFA and BCM were clearly reduced, but no difference in body weight and BMI was detected. Tumorpatients should care for changes in their taste, to detect early symptoms of reduced food intake. Investigations of the influence of cytostatical treatments on taste sensitivity are still needed. Early symptoms of malnutrition can be found using anthropometry and bioelectrical impedance analysis.

Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2017-04-04T11:51:15Z No. of bitstreams: 1 TAMIRES BARBOSA NASCIMENTO DOS SANTOS.pdf: 5285149 bytes, checksum: d224eb611ad840d86fa9cacfe3b79d1a (MD5) / Made available in DSpace on 2017-04-04T11:51:15Z (GMT). No. of bitstreams: 1 TAMIRES BARBOSA NASCIMENTO DOS SANTOS.pdf: 5285149 bytes, checksum: d224eb611ad840d86fa9cacfe3b79d1a (MD5) Previous issue date: 2017-02-02 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / The increase of the population's average age, there was a prevalence increment on the chronic nerological disorders, degenerative such as the Alzheimer's Disease (AD). The deepening on the knowledge of the processes of lifestyle, regarding the nutritional state and its relations with the cognition are important for the guidance and conducting of the elderly people. This study aimed to analyze the nutritional status of elderly patients with AD and its relationship with the clinical aspects, neurocognitive, behavioral and lifestyle. 43 elderlies from the Clinical Neurology Ambulatory of the Celso Pierro Hospital and Maternity (PUCCampinas) were evaluated with the diagnosis of light, moderate and severe AD, according to the Clinical Dementia Rating (CDR) and 51 controls matched by age, gender, schooling and socioeconomic level, whith no history of cognitive decline. The procedures used were: clinical evaluation, mental State mini-exam, simple drawing memory, verbal fluency, clock drawing, functional ability, neuropsychiatric inventory (NPI), CDR, socioeconomic evaluation, physical and social activity (International Questionnaire of Physical Activity - IQPA short version), Mini Nutritional Assessment (MNA), Body mass Index (BMI), Waist circumference (WC), Arm Circumference (AC), Calf Circumference (CC), Triciptal Cutaneous Fold (TCF), Subscapular cutaneous fold (SCF), Muscular Arm circumference (MAC), Corrected Arm Muscle Area (CAMA), Thumb Adductor Muscle (TAM), Palmar Holding Force (PHF) and Bioelectric Impedance. Comparison were made between Alzheimer's Disease Group (ADG) and Control Group (CG) with sociodemographic aspects, lifestyle, cognitive, MNA, Nutritional indicators and nutritional indicators by gender Comparisons were made between CG and AD stages according to the CDR with nutritional variables, It were also performed correlations between PHF with anthropometric variables on the ADG and CG and between cognitive and anthropometric variables on the ADG. With suitable statistical tests the situation and level of significance of 5% in all cases. It was noticed that the ADG develops less social activity and has a smaller relationship network, less physically active, and has poor performance in Daily life activities, mostly in instrumental activities. GDA showed malnutrition with a decrease in total food intake and higher daily intake of some foods on the MNA. Among genders, woman showed diferences in most anthropometric measurements with lower values in the ADG. In the comparison between CG and fazes of ADG there were differences in some measures with lower values in the severe ADG, and higher in the CG. In the comparison between CG and ADG, CG versus light and moderate ADG versus severe ADG there was a difference for some anthropometric measurements. There were no differences between Light and Moderate stages. The Lean Mass (LM) composition measurements were lower in the ADG. No difference was seen on the WC and reactance comparison. There were correlations between PHF and anthropometric variables in the ADG but not between nutritional variables with socioeconomic aspects, behavioral, NPI, social and physical activities. The findings suggests a significant association between social and leisure activities during the eld and a lower dementia risk. In the MNA the lowest score indicates greater deterioration of mental state. As per the feeding, it was noticed that, possibly, ADG feeds with lower amount and higher quality, suggesting a better selection of food by the caregiver. The authors reports a significant difference between BMI in AD phases, with reduction in BMI at the severe stage compared to light and moderate. In the study, there was a greater presence of elderly individuals at malnutrition risk in the AD group when compared to the CG, suggesting that the malnutrition is a factor of risk to the dementia progression. The nutritionals variables were progressively more committed with the advancement of cognitive deficits, since there was a LM reduction trend with the AD progression, more evident in the transition from moderate to severe. / Com o aumento da idade m?dia da popula??o houve incremento de preval?ncia de afec??es neurol?gicas cr?nicas, degenerativas, como a Doen?a de Alzheimer (DA). O aprofundamento do conhecimento dos processos do estilo de vida no que se refere ao estado nutricional e de suas rela??es com a cogni??o s?o de import?ncia para orienta??o e conduta desses idosos. O objetivo desse trabalho foi analisar o estado nutricional de idosos com DA e sua rela??o com aspectos cl?nicos, neurocognitivos, comportamentais e de estilo de vida. Foram avaliados 43 idosos procedentes do ambulat?rio de Neurologia Cl?nica do Hospital e Maternidade Celso Pierro (PUC-Campinas) com diagn?stico de DA leve, moderado e grave, segundo o Clinical Dementia Rating (CDR) e 51 controles pareados por idade, g?nero, escolaridade e n?vel socioecon?mico, sem hist?ria de decl?nio cognitivo. Os procedimentos foram avalia??o cl?nica, Mini-Exame do estado mental, mem?ria do desenho simples, Flu?ncia Verbal, desenho do rel?gio, capacidade funcional, Invent?rio Neuropsiqui?trico (INP), CDR, avalia??o socioecon?mica, atividade f?sica (Question?rio Internacional de Atividade F?sica ? IPAQ vers?o curta) e sociais, Mini Avalia??o Nutricional (MAN), ?ndice de Massa Corp?rea (IMC), Circunfer?ncia da Cintura (CC), Circunfer?ncia do Bra?o (CB), Circunfer?ncia da Panturrilha (CP), Dobra Cut?nea Tricipital (DCT), Dobra Cut?nea Subescapular (DCSE), Circunfer?ncia Muscular do Bra?o (CMB), ?rea Muscular do Bra?o corrigida (AMBc), M?sculo Adutor do Polegar (MAP), For?a de Preens?o Palmar (FPP) e Imped?ncia Bioel?trica. Foi realizada a compara??o entre Grupo Doen?a de Alzheimer (GDA) e Grupo Controle (GC) com aspectos sociodemogr?ficos, estilo de vida, cognitivos, comportamentais, MAN, indicadores nutricionais e indicadores nutricionais por g?nero. Foram feitas compara??es entre GC e est?gios da DA de acordo com CDR com as vari?veis nutricionais, tamb?m foram realizadas correla??es entre FPP com vari?veis antropom?tricas no GDA e GC e entre vari?veis cognitivas e antropom?tricas no GDA. Com testes estat?sticos adequados a situa??o e n?vel de signific?ncia de 5% em todos os casos. Foi observado que o GDA desenvolve menos atividade social e tem rede de relacionamento menor, ? fisicamente menos ativo e tem desempenho inferior nas Atividades de Vida Di?ria, principalmente nas atividades instrumentais. O GDA apresentou desnutri??o com diminui??o da ingest?o alimentar total e maior ingest?o di?ria de alguns alimentos, na MAN. Entre os g?neros, as mulheres apresentaram diferen?a em mais medidas antropom?tricas, com valores menores no GDA. Na compara??o entre GC e fases do GDA, houve diferen?a em algumas medidas com valores menores no GDA grave e maior no GC. Na compara??o entre GC e GDA, GC versus GDA leve e moderado e GDA leve e moderado versus GDA grave houve diferen?a para algumas medidas antropom?tricas. N?o houve diferen?a entre os est?gios leve e moderado. As medidas de composi??o de Massa Magra (MM) foram menores no GDA. CC e Reat?ncia n?o apresentaram diferen?a em nenhuma compara??o. Houve correla??es entre FPP e vari?veis antropom?tricas nos GDA e n?o houve entre vari?veis nutricionais com aspectos socioecon?micos, comportamentais, INP, atividades sociais e f?sicas. Os achados da literatura sugerem uma associa??o significativa entre atividades sociais e de lazer durante a velhice e o menor risco de dem?ncia. Na MAN a menor pontua??o indica maior deteriora??o do estado mental. Quanto a alimenta??o, foi observado que possivelmente o GDA se alimenta com menor quantidade e maior qualidade, sugerindo uma melhor sele??o dos alimentos pelo cuidador. Os autores relatam diferen?a significativa entre IMC nas fases da DA, com redu??o no IMC no est?gio grave comparado ao leve e moderado. No estudo houve maior presen?a de idosos em risco de desnutri??o no grupo com DA quando comparados ao GC, sugerindo que a desnutri??o ? um fator de risco para a progress?o da dem?ncia. As vari?veis nutricionais foram progressivamente mais comprometidas com o avan?ar dos d?ficits cognitivos, pois houve uma tend?ncia a redu??o de MM com a progress?o da DA, sendo mais evidente na transi??o da fase moderada para o grave.

A avaliação do estado nutricional em pacientes com HIV é de grande importância, pois as conseqüências provocadas pelo processo patológico da doença estão associadas com perda de peso corporal, massa magra e desnutrição grave, o que prediz aumento da morbimortalidade. Os valores de linfometria CD4 também têm sido utilizados como preditores a curto e médio prazo para o desenvolvimento de infecções oportunistas, as quais são incomuns em pacientes com CD4 >200 cels/mm3. Partindo deste conhecimento, optou-se por estudar o estado nutricional de homens e mulheres HIV positivos de acordo com a contagem de células CD4. Utilizou-se como parâmetros nutricionais o índice de massa corporal (IMC), a área muscular do braço corrigida (AMBc), albumina sérica e o ângulo de fase (AF). Foram estudados 39 pacientes HIV positivos, acompanhados pelo ambulatório de doenças infectoparasitárias do Hospital Universitário Pedro Ernesto (HUPE/UERJ). Não foi observada desnutrição na população estudada, quando avaliada pelo IMC e albumina em ambos os sexos, independente do número de células CD4. Entretanto, a AMBc e o AF, tanto nos homens quanto nas mulheres, demonstraram comprometimento nos parâmetros de massa magra. Em relação à associação entre os indicadores nutricionais e o número de células CD4, foi observado correlação significante com a AMBc e a albumina no grupo estudado. A correlação de acordo com o sexo manteve-se significante em ambos os grupos para AMBc e com uma tendência positiva (p=0,06) entre o AF e CD4 no grupo dos homens. Portanto, estes resultados demonstram que para avaliar o estado nutricional, principalmente o compartimento de massa corporal magra de pacientes HIV positivos sob terapia antirretroviral, é preciso utilizar indicadores mais sensíveis, mesmo naqueles pacientes com melhor estado de controle da doença. / The assessment of nutritional status in patients with HIV is of great importance, because the consequences caused by the pathological process of the disease are associated with weight loss, lean body mass and severe malnutrition, which predicts increased morbidity and mortality. The values of CD4 linfometria have also been used as predictors of short and medium term development of opportunistic infections, which are uncommon in patients with CD4 counts > 200 cells/mm3. Based on this knowledge, we chose to study the nutritional status of HIV positive men and women according to CD4 cell count. Participants had the following nutritional parameters assessed: body mass index (BMI), corrected arm muscle area (AMA), serum albumin and the phase angle (PA). We studied 39 HIV-positive patients, under treatment in a infectious diseases clinic of the University Hospital Pedro Ernesto (HUPE). None of patients has malnutrition according BMI and albumin in both sexes, regardless of the number of CD4 cells. However, in men and women to AMA and the PA, have demonstrated reductions in parameters of lean body mass. Regarding the association between nutritional indicators and the number of CD4 cells, we observed a significant correlation with the AMA and albumin in the study group. The correlation according to gender remained significant in both groups for AMA and a positive trend (p = 0.06) between the PA and CD4 in males. Therefore these results demonstrate that to assess nutritional status, especially the compartiment of lean body mass in HIV positive patients under antirretrovirals, it is necessary to use more sensitive, even in patients with the best state of disease control.

In der klinischen Diagnostik gewinnt die Untersuchung des Ernährungszustandes zunehmend an Bedeutung. Denn die Güte des Ernährungszustandes hat einen Einfluss auf die Mortalität und Morbidität der Patienten. Zur groben Evaluierung des Ernährungszustandes dient der Body Mass Index (BMI). Eine differenzierte Beurteilung des Ernährungszustandes wird durch die Analyse der Körperzusammensetzung erreicht. Die phasensensitive bioelektrische Impedanzanalyse (BIA) ist eine schnelle, preisgünstige und nicht-invasive Methode zur Messung der Körperzusammensetzung. Insbesondere der Phasenwinkel, der ein direkter Messparameter der BIA ist, gibt einen schnellen Überblick über den Ernährungszustand der Patienten. Er spiegelt das Verhältnis von Extrazellulärmasse zu Körperzellmasse wieder, welches in vielen Studien als Indikator zur frühzeitigen Erfassung einer beginnenden Mangelernährung validiert wurde. Bei der Applikation einer Chemotherapie ist es von großer Bedeutung, dass die vorgesehene Dosis und Dosisintensität der Therapie eingehalten wird. Insbesondere unerwünschte Nebenwirkungen sind häufig für Dosisreduktionen und Verschiebungen der Chemotherapie verantwortlich. In einer prospektiven Studie wurde bei 40 Frauen, die sich aufgrund eines gynäkologischen Malignoms einer Chemotherapie unterzogen haben, die Körperzusammensetzung mit der BIA vor jedem Chemotherapiezyklus gemessen. Diese Studie zeigt, dass durch die Messung der Körperzusammensetzung ein Risikokollektiv, welches für Nebenwirkungen der Therapie anfällig ist, ermittelt werden kann. Der Body Mass Index (BMI) erwies sich als unzureichender Parameter zur Beschreibung des Ernährungszustandes der Patientinnen. Insbesondere muss mit einer erhöhten Rate von Nebenwirkungen der Chemotherapie bei einem verminderten Phasenwinkel, welcher einen reduzierten Ernährungszustand widerspiegelt, gerechnet werden. / In clinical diagnostics the nutritional status is becoming more and more of interest. The nutritional status is closely connected with morbidity and mortality. It is usually evaluated by the body mass index (BMI). An exact estimation of nutritional status can be given by the measurement of body composition. The bioelectrical impedance analysis (BIA) allows a quick and non-invasive measurement of the body composition for each patient. A main point of interest is the phase angle, which is measured directly. It gives a prompt view on the nutritional status. There is a relation between the phase angle and the ECM/BCM-Ratio, a sensitive marker for early signs of malnutrition which was validated in many studies. For patients receiving chemotherapy (CT) it is especially important that the application of the therapy is administered in the right dose and dose intensity. Adverse events often lead to a dose reduction or delay of CT administration. In a prospective clinical study we measured consecutively 40 women receiving chemotherapy for a gynaecological malignancy. BIA was performed before each course of CT. The study demonstrates that an evaluation of the nutritional status can be used to predict the risk for adverse events in patients under chemotherapy. The BMI showed not to be a reliable parameter to estimate the nutritional status. A decreased phase angle which is a parameter for a reduced nutritional status showes that a higher rate of side effects in chemotherapy can be expected .

The aim of this study was a prospective detection of postoperative lymphedema of the lower limbs in patients after the surgery for cervical and vulvar cancer using different methods of examination and their comparison and monitoring of postoperative complications and quality of life. Totally 78 women were followed after the surgery for cervical cancer and 36 for carcinoma of the vulva. Due to the radicality of the surgery the patients were divided into the conservative and radical groups. Lower limbs lymphedema were evaluated preoperatively and 3, 6 and 12 months after the surgery by the measurement of the lower limbs circumference, multifrequency bioelectrical impedance analysis (MFBIA) and subjective feeling. Quality of life using the European Organisation for Research and Treatment of Cancer (EORTC) questionnaires was evaluated before and 6 and 12 month after the surgery. 12 months after the cervical cancer surgery 35.9 % of patients reported subjective lymphedema, 37.18 % lymphedema were objectively diagnosed by the measurement of lower limb circuits and in 52.56 % of cases the increase of amount of extracellular fluid was detected by the MFBIA Ri/R0 method. The prevalence of lymphedema after the surgery for vulvar cancer reached 19.44% by the subjective assessment, 38.89 % by the measurement of...