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The prevalence of non-alcoholic fatty liver disease (NAFLD) is rising, an increase that may be associated with changes in lifestyle such as unhealthy dietary patterns. Although advanced age is a risk factor for NAFLD, no studies reporting this association in the elderly population were found. In the present study, the association between dietary patterns and NAFLD in the elderly was assessed. A study including 229 older adults was conducted. NAFLD diagnosis was defined as individuals whose ultrasound examination disclosed hepatic steatosis at any stage, in the absence of excess intake of alcoholic beverages. Dietary patterns were obtained by principal components analysis. Mean scores and standard errors of each dietary pattern were calculated for the groups with and without NAFLD, and mean scores of the two groups were compared using the Mann-Whitney U test. The prevalence ratios and 95 % CI were estimated for each tertile of the dietary pattern adherence scores using Poisson multiple regression models with robust variance. A total of 103 (45 %) elderly with NAFLD and four dietary patterns were identified: traditional, regional snacks, energy dense and healthy. Mean scores for adherence to the healthy pattern in the groups with and without NAFLD differed. NAFLD was inversely associated with greater adherence to the healthy pattern and directly associated with the regional snacks, after adjustment for confounders. In conclusion, healthy dietary pattern is inversely associated with NAFLD in elderly.

Critical illness in COVID-19 is an extreme and clinically homogeneous disease phenotype that we have previously shown1 to be highly efficient for discovery of genetic associations2. Despite the advanced stage of illness at presentation, we have shown that host genetics in patients who are critically ill with COVID-19 can identify immunomodulatory therapies with strong beneficial effects in this group3. Here we analyse 24,202 cases of COVID-19 with critical illness comprising a combination of microarray genotype and whole-genome sequencing data from cases of critical illness in the international GenOMICC (11,440 cases) study, combined with other studies recruiting hospitalized patients with a strong focus on severe and critical disease: ISARIC4C (676 cases) and the SCOURGE consortium (5,934 cases). To put these results in the context of existing work, we conduct a meta-analysis of the new GenOMICC genome-wide association study (GWAS) results with previously published data. We find 49 genome-wide significant associations, of which 16 have not been reported previously. To investigate the therapeutic implications of these findings, we infer the structural consequences of protein-coding variants, and combine our GWAS results with gene expression data using a monocyte transcriptome-wide association study (TWAS) model, as well as gene and protein expression using Mendelian randomization. We identify potentially druggable targets in multiple systems, including inflammatory signalling (JAK1), monocyte–macrophage activation and endothelial permeability (PDE4A), immunometabolism (SLC2A5 and AK5), and host factors required for viral entry and replication (TMPRSS2 and RAB2A).

Resumo O artigo tem como objetivo identificar características sociodemográficas e assistenciais de idosos dependentes, cuidadores formais e familiares em municípios de diferentes regiões brasileiras. Realizou-se um estudo transversal com amostra de 175 pessoas, sendo 64 idosos, 27 cuidadores formais e 84 cuidadores familiares. Foram realizadas entrevistas semiestruturadas, com questões específicas para cada grupo sobre a temática do cuidado e dependência. A maioria dos idosos era do sexo feminino, com idade igual ou maior a 80 anos, com baixa escolaridade e dependente há quatro anos ou mais. Os idosos relataram sentimentos de solidão, apontaram dificuldades na assistência médica e 29% tinham acesso apenas a ações da Atenção Primária à Saúde. Entre os cuidadores familiares, encontrou-se desigualdades, sobrecargas, adoecimentos e problemas sociais. Entre os formais predominou o sexo feminino, a raça negra, sem vínculo legal de trabalho, pouca ou nenhuma formação para a função e baixa remuneração; o cuidado associou-se aos afazeres domésticos. Conclui-se que perduram as desigualdades de gênero e raça no cuidado às pessoas idosas em situação de dependência. Observou-se também que a rigidez dos papeis sociais atribuídos a homens e mulheres no Brasil persistem nas dinâmicas familiares e laborais no cuidado ao idoso dependente.

Background The Paleolithic diet has been studied in the scope of prevention and control of chronic noncommunicable diseases (CNCD). The objective of this study was to analyze the influence of the Paleolithic diet on the prevention and control of CNCD in humans, specifically on anthropometric markers, through a systematic review with meta-analysis. Methods What is the effect of the Paleolithic diet on anthropometric parameters (weight, body mass index and waist circumference) compared to other control diets based on recommendations in adults? We included only randomized studies with humans that used the Paleolithic Diet in the prevention and control of CNCD published in Portuguese, English or Spanish. The search period was until March 2019, in the LILACS, PubMed, Scielo, Science Direct, Medline, Web of Science and Scopus databases. The abstracts were evaluated by two researchers. We found 1224 articles, of which 24 were selected and 11 were included in the meta-analysis. The effect of dietary use on body weight, body mass index and waist circumference was evaluated. Results The summary of the effect showed a loss of − 3.52 kg in the mean weight (CI 95%: − 5.26; − 1.79; p < 0,001; I 2 = 24%) of people who adopted the Paleolithic diet compared to diets based on recommendations. The analysis showed a positive association of adopting the Paleolithic diet in relation to weight loss. The effect was significant on weight, body mass index and waist circumference. Conclusion The Paleolithic diet may assist in controlling weight and waist circumference and in the management of chronic diseases. However, more randomized clinical studies with larger populations and duration are necessary to prove health benefits. Trial registration CRD42015027849 .

Background & aims Nutrition has become an important component in treating individuals during the COVID-19 pandemic, which is increasingly affecting the world population, and bringing with it a collapse in health services. Prolonged hospitalization, involving immobilization and catabolism, induces a decrease in body weight and muscle mass that may result in sarcopenia, a condition that impairs respiratory and cardiac function, worsening the prognosis. The present study aimed to analyze enteral nutritional support and the clinical evolution of patients admitted for COVID-19 in Brazil. Methods This was a retrospective study, carried out from March to May 2020, with patients admitted to a referral hospital in cardiology and pulmonology in Fortaleza-Ce/Brazil, 200 patients with COVID-19 were selected. Sociodemographic, clinical, and nutritional data were collected from electronic medical records, and associations between outcomes and use of prone body position with nutritional variables were analyzed by linear regression. The odds ratio and 95% confidence interval estimates for the death outcome were analyzed by logistic regression. Results Of the 112 patients who fed by the enteral route, the majority were male (n = 61, 54.5%), elderly (n = 88, 78.6%), with no current smoking habit (n = 81, 72.3%). The median hospital stay was 14 days, mostly in the intensive care units (median of 9 days). Prone body positioning impacted the nutritional therapy. In general, those patients who maintained a prone body position tested lower for kcal/kg of body weight, proteins/kg of body weight, percentage of diet adequacy, and total caloric value. In addition, patients who died had lower mean maximum kcal/kg body weight, protein/kg body weight, percentage of diet adequacy, and total caloric value compared to surviving patients. Conclusions There was an association between inadequacies in protein and energy supply with mortality was confirmed suggesting that nutritional support optimization be prescribed in such situations.

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Considering the high prevalence of low HDL-c in the population of São Paulo, GI and GL may contribute to the nutritional therapy of this dyslipidemia. However, findings should be treated with caution, considering several conflicting results between studies.