Sodium intake among adolescents who eat inside and outside the home. Campinas-Brazil

Background

Excessive sodium consumption (>2g/day) is one of the risk factors for the development of cardiovascular diseases, which impact the world's public health systems. Rapid urbanization, busy life, the high availability of ultra-processed foods and the short time for meals, especially inside the home, are factors that interfere in the population's food choices.

Objective

To estimate sodium intake according to the place of meal consumption and its association with demographic, socioeconomic and salt-related variables.

Methods

Cross-sectional population-based study, carried out with 901 adolescents aged 10 to 19 years, who answered the Food Consumption and Nutritional Status Survey, ISACamp-Nutri 2015. The mean sodium intake was estimated by the 24-hour recall and the association with the independent variables, using linear regression.

Results

Sodium consumption among adolescents was 3.52 g/day (95% CI 3.42-3.63). Those who consumed at least one meal away from home had an excess of 0.19 g/day (P = 0.012) of sodium, which corresponded to a 6.1% increase compared to adolescents who had eaten exclusively at home. Of the total meals eaten by adolescents, 15.9% are taken outside the home, with 6.6% eating at school and 9.3% in different places. There was a significant increase in sodium consumption among adolescents who had breakfast CR = 0.16g (p = 0.032), afternoon snack CR = 0.09g (p = 0.002) and dinner CR = 0.30g (p = 0.029) outside the home.

Conclusions

sodium consumption by adolescents exceeded the WHO recommendation. Eating at least one meal away from home was associated with a higher sodium intake among these individuals. Regulatory measures in the food industry and strategies for food and nutrition education are relevant to reduce sodium consumption in this age group.

Key messages

High sodium consumption among adolescents, exceeding WHO recommendations. Eating outside the home was associated with a higher sodium intake.

1185 Three-dimensional speckle tracking echocardiography for the global and regional assessment of myocardial deformation in breast cancer patients submitted to anthracyclines

Introduction

Serial echocardiographic assessment of 2D/3D left ventricular ejection fraction (LVEF) and 2D global longitudinal strain (GLS) is the gold standard for screening for cancer therapeutics-related cardiac dysfunction (CTRCD). Although 3D speckle tracking echocardiography (STE) has several technical advantages, is more reproducible, and has a better correlation to magnetic resonance than 2D STE, it is still not currently used in this setting. We aimed to investigate the usefulness of 3D STE in evaluating left ventricle mechanics and its relation to CTRCD.

Methods

Prospective study of female breast cancer patients submitted to anthracycline chemotherapy who underwent one transthoracic echocardiography (ETT) before and at least one ETT during/after chemotherapy. Standard ETT parameters and 3D volumetric measurements were assessed. STE was used to estimate 2D GLS – average and 18 segments – and 3D GLS, global circumferential strain (GCS), global radial strain (GRS) and global area strain (GAS) – average and 17 segments. CTRCD was defined as an absolute decrease in 2D or 3D LVEF >10% to a value <54% or a relative decrease in 2D GLS >15%.

Results

105 patients (mean age 53.8 ± 12.5 years, 52.4% immunotherapy, 77.2% radiotherapy, 2.8 echocardiograms/patient) were included. During a mean follow-up of 12.1 months, 24 patients (22.9%) developed CTRCD. During anthracycline therapy, there was a significant worsening of 2D LVEF (65.6 vs. 57.8), 3D LVEF (61.5 vs. 54.4), 2D GLS (-21.1 vs. -18.0), 3D GLS (-15.6 vs. -10.9), 3D GCS (-14.0 vs. -11.0), 3D GRS (42.0 vs. 28.5) and 3D GAS (-27.0 vs. -20.0) [all p <0.001]. More than 73% of patients presented 3D global strain values below the limits of normal during chemotherapy. On 3D strain regional analysis, impaired contractility was observed in the anterior, inferior and septal walls. Logistic regression analysis showed that 3D GRS and 3D GCS were associated with a higher incidence of CTRCD. In the multivariate model, 3D GRS remained the only independent predictor of CTRCD. The receiver operating curve analysis showed a good calibration and discrimination of 3D GCS and 3D GRS in predicting CTRCD with areas under de curve of 0.748 and 0.719, with the optimal cut-off values being 0.342 for GCS and 0.344 for GRS. These variations were observed a median of 45 days and 22.5 days before the diagnosis of CTRCD, respectively.

Conclusion

3D strain parameters worsened during anthracycline therapy, with predominant involvement of septal, anterior and inferior walls. Variations of 3D GCS and GRS were predictive of subsequent CTRCD, and thus can be considered an earlier sign of CTRCD, with added value over the currently recommended 2D/3D LVEF and 2D GLS. Routine application of this technique should be considered in order to offer targeted monitoring and timely initiation of cardioprotective treatment.

P697Regional analysis of 3D-derived speckle tracking for the assessment of myocardial deformation in breast cancer patients submitted to anthracycline chemotherapy

Introduction

Serial echocardiographic assessment of left ventricular ejection fraction (LVEF) and 2D left ventricular global longitudinal strain (GLS) is the gold standard in screening for cancer therapeutics-related cardiac dysfunction (CTRCD). Myocardial deformation assessed with 3D speckle tracking is not currently used in this setting, because of the lack of standardization and cut-off values, in spite of a potential for a greater reliability.

Methods

Prospective study of female breast cancer patients submitted to anthracycline chemotherapy with or without adjuvant immunotherapy and/or radiotherapy who underwent serial monitoring by 2D and 3D transthoracic echocardiography (ETT). Standard ETT measures and 3D-derived volumetric measures were assessed. Speckle tracking was used to estimate 2D-derived GLS – average and 18 segments – and 3D-derived GLS, global circumferential strain (GCS), global area strain (GAS) and global radial strain (GRS) – average and 17 segments. CTRCD was defined as an absolute decrease in 2D or 3D LVEF >10% to a value <54% or a relative decrease in 2D GLS >15%. Variables were compared using the t-student paired test and the Wilcoxon sign-rank test, when appropriate.

Results

106 patients (mean age 54.6±12.9 years, 33.0% immunotherapy, 16.5% radiotherapy, baseline LVEF 64.5% ± 8.5%, baseline 2D GLS −21.0±2.8) were included. During a mean follow-up of 16.5±9.6 months, an average of 3.9 echocardiographic examinations were performed per patient and 28 patients (26.4%) developed CTRCD. Overall, 3D regional longitudinal strain was determined in 88.9% of the segments analyzed, with lower success rates in the inferobasal (75.0%), the posterobasal (77.7%) and the laterobasal (82.4%) walls. When comparing variables before and during treatment, there was a significant difference in 2D-derived LVEF (64.5 vs. 57.6 p<0.001), 3D-derived LVEF (60.1 vs. 55.7 p 0.002), 2D-derived GLS (−20.6 vs. −18.2 p<0.001), 3D-derived GLS (−13.8 vs. −12.9 p 0.035), 3D-derived GRS (31.9 vs. 33.4 p 0.024), but not in GCS (−14.5 vs. −13.2 p 0.656) and GAS (−21.5 vs. −22.1 p 0.640). Figure 1 shows the segmental analysis of 2D and 3D strain parameters. In 2D GLS, 11 out of 18 segments showed decreased contractility during follow-up (mainly anterior septum and anterior, lateral and inferior walls). In 3D-derived strain parameters, only 3 out 17 for GLS, 2 out of 17 for GCS, 1 out 17 for GRS and none for GAS showed decreased contractility during follow-up.

Segmental analysis of 2D and 3D strain

Conclusion

In this population, there was worsening of 3D GLS and GRS, besides conventional values, such as LVEF and 2D GLS, during anthracycline-based cancer treatment. 3D-derived myocardial deformation parameters show promise in the setting of CTRCD, since 2D and 3D regional strain parameters might shed a light onto the mechanisms of CTRCD, such that subendocardial myocardial fibers seem to be more affected than medial and subepicardial fibers.

The HLA polymorphism of two distinctive South-American Indian tribes: the Kaingang and the Guarani

The HLA-A, B, C, DR and DQ antigens of 240 Kaingang and 98 Guarani individuals have been characterized. The most frequent antigens found among the Kaingang are A31, 2, 24; B35, 51, 39, 48; Cw4, 7, 3, 1; DR8, 4, 2; DQ blank, 3. In the Guarani, they are A2, 28, 31; B40, 62, "53G"; Cw3, 4; DR2, 4, 8, 6; DQ3, blank. B " 53G" is an unusual antigen of the B5 cross-reactive group. DQ blank possibly corresponds to DQ4, not tested in this study. The reaction patterns of B35, B40 and DR4 indicate intra-tribal (of B35 and B40), and inter-tribal (DR4, B40 and B35) heterogeneity of these antigens. 408 Kaingang and 141 Guarani haplotypes were defined by segregation analysis. Of the commonest 10 Guarani and 9 Kaingang haplotypes, only one is shared by both tribes. Significant, positive linkage disequilibrium values for HLA-A,B; HLA-A,C; HLA-B,DR and most HLA-B,C antigen pairs were also different for the two populations. Genetic distance estimates between these two and another seven South-American Indian populations, and relative to the major human races (negroids, caucasoids, and mongoloids) reveal a comparatively high degree of divergence between the Kaingang and the Guarani, which is uncommon for Amerindian populations living close one to another.

Unusual HLA-B alleles in two tribes of Brazilian Indians

The Kaingang and Guarani are culturally and linguistically distinct tribes of southern Brazil. Like all Amerindian groups they show limited HLA polymorphism, which probably reflects the small founder populations that colonized America by overland migration from Asia 11,000-40,000 years ago. We find the nucleotide sequences of HLA-B alleles from the Kaingang and Guarani to be distinct from those characterized in caucasian, oriental and other populations. By comparison, the HLA-A and C alleles are familiar. These results and those reported in the accompanying paper on the Waorani of Ecuador reveal that a marked evolution of HLA-B has occurred since humans first entered South America. New alleles have been formed through recombination between pre-existing alleles, not by point mutation, giving rise to distinctive diversification of HLA-B in different South American Indian tribes.