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Silva TS, Horvath JDC, Pereira MP, David CND, Vargas DF, Rigoni LDC, Sartor ITS, Kern LB, da Silva PDO, Paz AA, Daudt LE, Astigarraga CC. Impact of waitlist time on post-HSCT survival: a cohort study at a hospital in southern Brazil. Hematol Transfus Cell Ther 2023:S2531-1379(23)00088-3. [PMID: 37277257 DOI: 10.1016/j.htct.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 06/22/2022] [Accepted: 03/30/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION The time elapsed from diagnosis to hematopoietic stem cell transplantation (HSCT) is influenced by numerous factors. In Brazil, patients using the public health system are also dependent on the availability of HSCT-specific beds in the hematology ward. OBJECTIVE AND METHODS We conducted a cohort study of listed patients who underwent allogeneic HSCT at a Brazilian public hospital to investigate the impact of the waitlist time on post-HSCT survival. RESULTS The median time from diagnosis to HSCT was 19 months (IQR, 10 - 43), of which 6 months (IQR, 3 - 9) were spent on the waitlist. The time on the waitlist for HSCT appeared to influence mainly the survival of adult patients (≥ 18 years), with an increasing risk according to this time (RR, 3.53 and 95%CI, 1.81 - 6.88 for > 3 and ≤ 6 months; RR 5.86 and 95%CI, 3.26 - 10.53 for > 6 and ≤ 12 months, and; RR 4.24 and 95%CI, 2.32 - 7.75 for > 12 months). CONCLUSION Patients who remained on the waitlist for less than 3 months had the highest survival (median survival, 856 days; IQR, 131 - 1607). The risk of reduced survival was about 6-fold higher (95%CI, 2.8 - 11.5) in patients with malignancies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Liane Esteves Daudt
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (FAMED UFRGS), Porto Alegre, RS, Brazil
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Horvath JDC, Bessel M, Kops NL, Souza FMA, Pereira GM, Wendland EM. A Nationwide Evaluation of the Prevalence of Human Papillomavirus in Brazil (POP-Brazil Study): Protocol for Data Quality Assurance and Control. JMIR Res Protoc 2022; 11:e31365. [PMID: 34989680 PMCID: PMC8771346 DOI: 10.2196/31365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/04/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The credibility of a study and its internal and external validity depend crucially on the quality of the data produced. An in-depth knowledge of quality control processes is essential as large and integrative epidemiological studies are increasingly prioritized. OBJECTIVE This study aimed to describe the stages of quality control in the POP-Brazil study and to present an analysis of the quality indicators. METHODS Quality assurance and control were initiated with the planning of this nationwide, multicentric study and continued through the development of the project. All quality control protocol strategies, such as training, protocol implementation, audits, and inspection, were discussed one by one. We highlight the importance of conducting a pilot study that provides the researcher the opportunity to refine or modify the research methodology and validating the results through double data entry, test-retest, and analysis of nonresponse rates. RESULTS This cross-sectional, nationwide, multicentric study recruited 8628 sexually active young adults (16-25 years old) in 119 public health units between September 2016 and November 2017. The Human Research Ethics Committee of the Moinhos de Vento Hospital approved this project. CONCLUSIONS Quality control processes are a continuum, not restricted to a single event, and are fundamental to the success of data integrity and the minimization of bias in epidemiological studies. The quality control steps described can be used as a guide to implement evidence-based, valid, reliable, and useful procedures in most observational studies to ensure data integrity. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/31365.
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Affiliation(s)
- Jaqueline Driemeyer Correia Horvath
- Escritório de Projetos, Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Marina Bessel
- Escritório de Projetos, Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Natália Luiza Kops
- Escritório de Projetos, Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Flávia Moreno Alves Souza
- Department of Chronic Conditions Diseases and Sexually Transmitted Infections, Health Surveillance Secretariat, Ministry of Health, Brasília, Brazil
| | - Gerson Mendes Pereira
- Department of Chronic Conditions Diseases and Sexually Transmitted Infections, Health Surveillance Secretariat, Ministry of Health, Brasília, Brazil
| | - Eliana Marcia Wendland
- Escritório de Projetos, Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Department of Community Health, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Kops NL, Caierão J, Bessel M, Horvath JDC, Domingues CM, Benzaken AS, Villa LL, de Souza FMA, Pereira GFM, Wendland EM. Behavioral factors associated with multiple-type HPV genital infections: data from a cross-sectional study in young women in Brazil. Reprod Health 2021; 18:201. [PMID: 34629088 PMCID: PMC8504082 DOI: 10.1186/s12978-021-01244-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives To investigate the pattern of multiple human papillomavirus (HPV) infections and associated factors in young women who access the Brazilian public health care system to better understand the characteristics of multiple HPV infections, a critical issue in this era of multivalent vaccines. Methods This was a cross-sectional, multicenter study with sexually active unvaccinated women (16–25 years old) from 119 primary Brazilian healthcare centers between September 2016 and November 2017. Cervical samples were collected by trained health professionals, and HPV detection was performed in a central laboratory by Linear Array. Results Of the 5268 women, 33.00% (95% CI 31.07–34.92) had multiple infections. At least one type of high-risk HPV was present in 85.50% of all multiple infections. All HPV types were detected more frequently in association with other types than alone. Young individuals who were single or in a casual relationship and those who had more than one sexual partner in the past year were more likely to have multiple infections. Conclusions In this work, a high rate of multiple HPV infections among unvaccinated young adults tended to increase due to certain risk factors. Such data can provide insight for decision makers in the development of public policies regarding HPV prevention. Understanding the characteristics of multiple infections is critical in the era of HPV multivalent vaccines for the prevention of cervical carcinomas. Therefore, in this cross-sectional study, we aimed to investigate the pattern of multiple HPV infections and associated factors in 5,268 sexually active unvaccinated women (16–25 years old) who access the Brazilian public health care system. Cervical samples were collected by trained health professionals, and HPV detection was performed in a central laboratory by Linear Array. A total of 33.00% (95% CI 31.07–34.92) had multiple infections (60.43% of the HPV-positive sample). The number of HPV types in a multiple infection ranged from 2 to 14 different types. The viral types more frequently identified were HPV 16 and 52. All HPV types were detected more frequently in association with other types than alone. The incidence of multiple infections was 1.29 times higher in single than in married or cohabitating participants. Women who had two or more partners in the last year also had higher rates of multiple infections than those who had fewer than two sexual partners. In conclusion, a high prevalence of multiple infections prior to the national HPV immunization program was observed, especially with the increase in less safe behavior factors.
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Affiliation(s)
| | - Juliana Caierão
- Department of Analysis, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Adele Schwartz Benzaken
- Doctor Heitor Vieira Dourado Tropical Medicine Foundation, Molecular Biology Laboratory Manaus, Manaus, Brazil
| | - Luisa Lina Villa
- Faculdade de Medicina, and Instituto do Câncer do Estado de São Paulo (ICESP), Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Eliana Marcia Wendland
- Hospital Moinhos de Vento, Porto Alegre, Brazil. .,Graduate Program in Health Sciences and Pediatrics, Federal University of Health Science of Porto Alegre, Rua Ramiro Barcelos 910, Porto Alegre, CEP 90035-004, Brazil.
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Wendland EM, Kops NL, Comerlato J, Horvath JDC, Bessel M, Sperb D, Pimenta C, de Souza FMA, Mendes Pereira GF, Falcetta FS. STOP HPV study protocol: a nationwide case-control study of the association between oropharyngeal cancer and human papillomavirus (HPV) infection in Brazil. BMJ Open 2020; 10:e031602. [PMID: 32001492 PMCID: PMC7045017 DOI: 10.1136/bmjopen-2019-031602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/06/2019] [Accepted: 11/20/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) is the most common sexually transmitted infection and is associated with several types of cancer. The number of cases of HPV-associated head and neck squamous cell carcinomas (HNSCCs), especially oropharyngeal carcinomas, has increased significantly in recent years despite decreased tobacco smoking rates. Currently, no data concerning the risk factors and prevalence of HPV in HNSCC patients in all regions of Brazil are available, making it difficult to promote advances in this field of public health. Therefore, our goal is to determine the impact of infection by HPV, including HPVs with different genotypes, on head and neck cancer and the risk factors associated with the development of head and neck cancer in all regions of Brazil. METHODS AND ANALYSIS This is a case-control study that will include 622 patients and 622 controls from all regions of Brazil. A questionnaire will be applied to gather information on sociodemographic, behavioural and health factors. Oral, cervical or penile/scrotal, and anal specimens and serum samples will be collected from all participants. Formalin-fixed paraffin-embedded tissue from tumour biopsies will be analysed only in the case group. Molecular and serological analyses will be performed to evaluate the presence and role of HPV in the development of head and neck cancer. ETHICS AND DISSEMINATION This project was approved by the research ethical committee of the proposing institution (Hospital Moinhos de Vento, number 2.852.060). Ethical approval from the collaborators is currently under evaluation and is not yet complete. The results of this study will be presented at meetings with the Brazilian Ministry of Health through technical reports and to the scientific community at national and international events, with subsequent publication of scientific articles.
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Affiliation(s)
- Eliana Marcia Wendland
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Natalia Luiza Kops
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juliana Comerlato
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Marina Bessel
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Daniel Sperb
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cristina Pimenta
- Department of STIs, AIDS and Viral Hepatitis, Ministry of Health, Brasilia, Brazil
| | | | | | - Frederico Soares Falcetta
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
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Wendland EM, Bessel M, Comerlato J, Horvath JDC, Falcetta F, Mendes Pereira GF, de Souza FMA, Domingues C, Maranhão AGK, Kops NL. Evaluating sexual health in sex workers and men who have sex with men: the SMESH cross-sectional protocol study. BMJ Open 2019; 9:e031358. [PMID: 31748301 PMCID: PMC6886941 DOI: 10.1136/bmjopen-2019-031358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/24/2019] [Accepted: 10/30/2019] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION Human papillomavirus (HPV) infection is transmitted through skin-to-skin contact, and vaginal and anal sex are the most common transmission routes. Sex workers and men who have sex with men (MSM) are more exposed to the virus, and therefore, a higher frequency of this infection would be expected. The prevalence of HPV infection types and the forms and factors of transmission must be investigated to control infection-related outcomes. This protocol study will be the first nationwide study with a uniform methodology to evaluate HPV prevalence of and infection types among sex workers and MSM in Brazil. METHODS AND ANALYSIS This multicentre cross-sectional study will be conducted with a respondent-driven sampling method to recruit 1174 sex workers and 1198 MSM from all regions of Brazil. The study will consist of preliminary interviews to verify the eligibility criteria and characterise the network size as well as a second questionnaire to obtain sociodemographic, behavioural and sexual information. Specimens from the oral cavity and anal and cervical or penile/scrotal sites will be collected. All HPV samples will be processed in a certified central laboratory. Other sexually transmitted infections will be evaluated by interview and by rapid testing for HIV and syphilis. Strict quality control will be conducted using different procedures, including the training and certification of the health professionals responsible for acquiring data and monitoring visits. ETHICS AND DISSEMINATION The project was approved by the research ethics committee of the main institution and the corresponding ethics committees of the recruitment sites. Due to the literature gap on the sexual health of sex workers and MSM and the intense stigma surrounding these populations, a critical analysis of the study results will contribute to epidemiological knowledge and will be useful for the development of strategies against virus morbidities.
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Affiliation(s)
- Eliana Marcia Wendland
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Public Health, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marina Bessel
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juliana Comerlato
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Frederico Falcetta
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Carla Domingues
- National Immunization Program, Ministry of Health, Brasilia, DF, Brazil
| | | | - Natalia Luiza Kops
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
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Kops NL, Bessel M, Horvath JDC, Domingues C, de Souza FMA, Benzaken AS, Mendes Pereira GF, Maranhão AGK, Villa LL, Mello B, Wendland EM. Factors associated with HPV and other self-reported STI coinfections among sexually active Brazilian young adults: cross-sectional nationwide study. BMJ Open 2019; 9:e027438. [PMID: 31230011 PMCID: PMC6596954 DOI: 10.1136/bmjopen-2018-027438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To analyse factors associated with genital human papillomavirus (HPV) and other self-reported sexually transmitted infection (STI) coinfections among women and men aged 16-25 years from Brazil. DESIGN A cross-sectional, nationwide, multicentre study. SETTING 119 primary healthcare centres between September 2016 and November 2017. PARTICIPANTS 6388 sexually active young adults were enrolled by trained health professionals. PRIMARY OUTCOME MEASURE Genital HPV and other self-reported STI coinfections. RESULTS Of 3512 participants with valid data for genital HPV and (STI)-positive status, 276 (9.60%, 95% CI 7.82% to 11.36%) had HPV/STI coinfection. Among men, HPV/STI coinfection was more prevalent than HPV infection alone. Among HPV-positive participants, the percentage of subjects who reported having another STI was highest for gonorrhoea at 4.24% (95% CI 2.67% to 5.81%), followed by syphilis, herpes and HIV. Smoking, drug use and ever having a same-sex sexual experience were risk factors that were uniquely associated with HPV/STI coinfection compared with HPV infection alone. CONCLUSIONS The results identified a low prevalence of self-reported STIs, but in participants with at least one STI, the prevalence of HPV was high. These results reinforce the importance of implementing strategies to prevent risky behaviours among Brazilian young adults.
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Affiliation(s)
- Natalia Luiza Kops
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Programa de Pós Graduação Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marina Bessel
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Carla Domingues
- National Immunization Program, Ministry of Health, Brasilia, Brazil
| | | | | | | | | | - Luisa Lina Villa
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo and Cancer Institute of the São Paulo State (ICESP), São Paulo, Brazil
| | - Barbara Mello
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Eliana Marcia Wendland
- Escritório de Projetos PROADI-SUS, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Community Health, Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Wendland EM, Horvath JDC, Kops NL, Bessel M, Caierão J, Hohenberger GF, Domingues CM, Maranhão AGK, de Souza FMA, Benzaken AS. Sexual behavior across the transition to adulthood and sexually transmitted infections: Findings from the national survey of human papillomavirus prevalence (POP-Brazil). Medicine (Baltimore) 2018; 97:e11758. [PMID: 30113461 PMCID: PMC6112916 DOI: 10.1097/md.0000000000011758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 07/07/2018] [Indexed: 11/26/2022] Open
Abstract
The sexual behaviors of 15- to 24-year-olds increase the risk of this population to acquire sexually transmitted infections (STIs). The present study aimed to describe the sexual behavior in the transition to adulthood Brazilian population and its association with STI history.We analyzed cross-sectional data collected from 8562 sexually active women and men who participated in the National Survey of Human Papillomavirus Prevalence (POP-Brazil). This large-scale survey enrolled participants from 26 Brazilian capitals and the Federal District. Professionals from primary care facilities were trained to collect data utilizing a standardized questionnaire with questions on sociodemographic, sexual behavior, and drug use. We constructed a Poisson model with robust variance for both crude and adjusted analysis to investigate the associations between the variables. To adjust the distribution of the sample to the study population, we weighted the measures by the population size in each city and by gender.There were differences in several aspects from sexual behavior between genders. The majority of men reported an early sexual initiation, more sexual partners, and a different practice in sexual positions when compared with women. Women reported use of contraception more frequently than men (P < .001). The use of alcohol and drugs and the use of drugs before sexual intercourse impact in STIs equally between the genders. Exclusive for women, the presence of any STI was associated with the practice of vaginal sex and other types of intercourse (adjusted prevalence ratio [APR] 1.43, 95% CI 1.08-1.88). For men, the number of sexual partners in the last year (APR 1.02, 95% CI 1.01-1.04), not having vaginal sex (APR 3.25, 95% CI 1.78-5.92) and sexual experience with someone of the same sex (APR 4.05, 95% CI, 2.88-5.70) were associated with a higher presence of STIs.This is the first report regarding sexual behavior in a nationally representative population sample in Brazil. This study provides more valid estimates of sexual behavior and associated STIs, identifying important differences in sexual behavior and identifying predictors for referred STIs among females and males.
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Affiliation(s)
- Eliana Marcia Wendland
- Hospital Moinhos de Vento
- Federal University of Health Science of Porto Alegre, Porto Alegre, Brazil
| | | | | | | | | | | | | | | | - Flavia Moreno Alves de Souza
- Department of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis, Brazilian Ministry of Health, Brazil
| | - Adele Schwartz Benzaken
- Department of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis, Brazilian Ministry of Health, Brazil
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Correia Horvath JD, Dias de Castro ML, Kops N, Kruger Malinoski N, Friedman R. Obesity coexists with malnutrition? Adequacy of food consumption by severely obese patients to dietary reference intake recommendations. NUTR HOSP 2014; 29:292-9. [PMID: 24528344 DOI: 10.3305/nh.2014.29.2.7053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
To assess the adequacy of food intake in severely obese patients and describe their main nutritional deficiencies on the basis of Dietary Reference Intakes (DRIs). Patients on a waiting list for bariatric surgery were sequentially recruited from March 2010 to November 2011. All subjects underwent nutritional status assessment (anthropometry, dietary recall and semi-structured interview), socioeconomic evaluation (Brazilian Association of Research Companies criteria) and laboratory testing (glucose/hormone/lipid panel). A total of 77 patients were assessed, 50 of whom (76.6%) were female. Mean age was 44.48 ± 12.55 years. The most common comorbidities were hypertension (72.4%), binge eating disorder (47.4%), type 2 diabetes mellitus (32.9%), sleep apnea (30.3%) and dyslipidemia (18.4%). Macronutrient intake was largely adequate, in view of the high calorie intake. However, some micronutrient deficiencies were present. Only 19.5% of patients had an adequate intake of potassium, 26.0% of calcium, and 66.2% of iron. All subjects consumed more than the minimum recommended intake of sodium, with 98.7% reaching the upper limit. Bcomplex vitamin intake was satisfactory (adequate in >80% of subjects), but lipid-soluble vitamin (A, D, E) intake often fell short of the RDI. The diet of severely obese patients is unbalanced, with high calorie intake paralleled by insufficient micronutrient intake. When these patients are assessed and managed, qualitative dietary changes should be considered in addition to routine caloric restriction.
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Affiliation(s)
- Jaqueline Driemeyer Correia Horvath
- Graduate Program in Endocrinology. UFRGS School of Medicine. Center of Health Sciences. Program in Dietetics. UCS. Department of Endocrinology. Hospital de Clínicas de Porto Alegre..
| | - Mariana Laitano Dias de Castro
- Graduate Program in Endocrinology. UFRGS School of Medicine. Department of Endocrinology. Hospital de Clínicas de Porto Alegre..
| | - Natália Kops
- Undergraduate Program in Dietetics. UFRGS School of Medicine..
| | | | - Rogério Friedman
- Graduate Program in Endocrinology. UFRGS School of Medicine. Department of Endocrinology. Hospital de Clínicas de Porto Alegre. Department of Internal Medicine. UFRGS School of Medicine. Brazil..
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