Background: Prolonged preoperative fasting may impair nutritional status of the patient and their recovery. In contrast, some studies show that fasting abbreviation can improve the response to trauma and decrease the length of hospital stay.Aim: Investigate whether the prescribed perioperative fasting time and practiced by patients is in compliance with current multimodal protocols and identify the main factors associated. Methods: Cross-sectional study with 65 patients undergoing elective surgery of the digestive tract or abdominal wall. We investigated the fasting time in the perioperative period, hunger and thirst reports, physical status, diabetes diagnosis, type of surgery and anesthesia.Results: The patients were between 19 and 87 years, mostly female (73.8%). The most performed procedure was cholecystectomy (47.69%) and general anesthesia the most used (89.23%). The most common approach was to start fasting from midnight for liquids and solids, and most of the patients received grade II (64.6%) to the physical state. The real fasting average time was 16 h (9.5-41.58) was higher than prescribed (11 h, 6.58 -26.75). The patients submitted to surgery in the afternoon were in more fasting time than those who did in the morning (p<0.001). The intensity of hunger and thirst increased in postoperative fasting period (p=0.010 and 0.027). The average period of postoperative fasting was 18.25 h (3.33-91.83) and only 23.07% restarted feeding on the same day. Conclusion: Patients were fasted for prolonged time, higher even than the prescribed time and intensity of the signs of discomfort such as hunger and thirst increased over time. To better recovery and the patient's well-being, it is necessary to establish a preoperative fasting abbreviation protocol.

RESUMENIntroducción: El paciente en diálisis debe ser evaluado por la nutrición y mantener seguimiento regular desde el inicio del tratamiento para así tener las mejores respuestas de intervenciones y dieta. Objetivo: Comparar la concordancia de la clasificación del estado nutricional de los pacientes con enfermedad renal crónica en hemodiálisis por medio de diferentes evaluaciones clínicas, antropométricas y parámetros bioquímicos. Materiales y Métodos: Estudio transversal con 90 pacientes de una clínica de diálisis, en la ciudad de Belo Horizonte, Brasil en 2010. Se recogieron los datos socioeconómicos, nutricionales, clínicos, bioquímicos y antropométricos. Resultados y Discusión: La frecuencia de desnutrición fue de 12,2% hasta 86,7% de acuerdo con diferentes parámetros de evaluación. En los análisis antropométricos, los hombres presentaran pliegues cutáneos más pequeños que las mujeres. Casi 40% de los pacientes tenían la clasificación de la desnutrición en los análisis de la circunferencia muscular del brazo, siendo aproximadamente 30% de hombres. Los valores promedios de índice de masa corporal se encontraban en el rango adecuado. Considerando la ingesta de energía y proteínas, 86,7% y 57,8% fueran clasificados como desnutridos, respectivamente. El valor promedio de albúmina fue 3,9 g / dl y la frecuencia de desnutrición varió 35,6% y 50%, según la referencia. Conclusiones: La alta frecuencia de pacientes con desnutrición de acuerdo con diferentes clasificaciones sugiere la necesidad de estandarización de indicadores, la observación cuidadosa y el seguimiento de las referencias utilizadas y también la necesidad de que los comités de evaluación en determinar nuevos puntos de corte para la mejor clasificación nutricional de esta población.

The influence of apolipoprotein E alleles and genotypes on plasma lipid levels was determined in 185 individuals of mixed ethnicity living in Ouro Preto, Brazil. DNA was obtained from blood samples and the genotypes were determined by an RFLP-PCR procedure. The *3 allele was the most frequent (72%), followed by *4 (20%) and *2 (8%); *4 frequency was higher and *2 frequency was lower in the dyslipidemic group than in the normal control group. The *2 carriers presented lower LDL and total cholesterol levels compared to the *3 and *4 carriers. All six expected genotypes were observed in the individuals genotyped: E2/2 (2.1%), E4/4 (2.7%), E2/4 (3.7%), E2/3 (8.0%), E3/3 (53.3%), E3/4 (29.9%); no difference in genotype frequencies was found between the normal and dyslipidemic groups. Compared with *2, the presence of *3 increases more than two times the risk for dyslipidemia (OR = 2.31; P = 0.025; 95% CI = 1.06-5.06) and the presence of *4 increases it three times (OR = 3.31; P = 0.006; 95% CI = 1.36-8.04). The only significant effect of genotype was an increased risk for dyslipidemia in the *4 genotype carriers (E3/4 + E4/ 4) compared with the *2 genotype carriers (E2/2 + E2/3) with OR = 3.69 (95% CI = 1.25-10.88). The present study indicates that in the Ouro Preto admixed population the presence of APOE *2 can confer a protective effect, whereas the presence of APOE *4 implies an enhanced risk for dyslipidemia.

This study aimed to assess the frequency and severity of depressive symptoms and their relationship with sociodemographic characteristics in women with gestational diabetes mellitus (GDM) who participated in the LINDA-Brazil study. We conducted cross-sectional analyses of 820 women with GDM who were receiving prenatal care in the public health system. We conducted structured interviews to obtain clinical and sociodemographic information and applied the Edinburgh Postnatal Depression Scale (EPDS) to assess depressive symptoms. We classified the presence and severity of depressive symptoms using scores of ≥12 and ≥18, respectively. We used Poisson regression to estimate prevalence ratios (PR). Most of the women lived with a partner (88%), 50% were between 30 and 39 years old, 39% had finished high school, 39% had a family income of 1-2 minimum wages, and 47% were obese before their pregnancies. The presence of depressive symptoms was observed in 31% of the women, and severe depressive symptoms were observed in 10%; 8.3% reported self-harm intent. Lower parity and higher educational levels were associated with lower EPDS score. Depressive symptoms were common and frequently severe among women with GDM, indicating the need to consider this situation when treating such women, especially those who are more socially vulnerable. This trial is registered with NCT02327286, registered on 23 December 2014.

Resumo O objetivo deste estudo foi analisar a validade e a acurácia do Índice de Massa Corporal (IMC) e da Circunferência da Cintura (CC) na avaliação de obesidade avaliada pelo excesso de gordura corporal (GC) e propor pontos de corte mais adequados para idosos. Os pontos propostos da literatura IMC (25,27 ou 30 kg/m2) e CC (≥ 102 cm-homens e ≥ 88 cm-mulheres ou ≥ 90 cm-homens e ≥ 80 cm-mulheres) foram avaliados conforme densitometria corporal total. A elevada GC foi definida por percentil > 90. Dos 132 idosos, 60,6% eram mulheres de 60-91 anos. Os pontos de corte recomendados de IMC ≥ 25 e ≥ 27kg/m2 apresentaram desempenhos similares, sendo que o IMC ≥ 30kg/m2 apresentou alta especificidade e baixa sensibilidade no sexo masculino e melhor desempenho para GC nas mulheres. Os pontos de corte convencionais de CC não apresentaram boa sensibilidade/especificidade. Foram propostos novos pontos de corte para IMC (masculino-25 kg/m2; feminino-26,6 kg/m2) e CC (masculino-98,8 cm; feminino-77,8 cm). Estes valores demonstraram sensibilidade e especificidade > 74% e acurácia > 76%. As áreas sob a curva foram > 0,86. O presente estudo propõe a utilização de pontos de corte mais acurados para diagnóstico de obesidade/GC em idosos, sendo para homens IMC 25kg/m2 e CC de 98,8cm e para mulheres IMC de 26,6kg/m2 e CC de 77,8cm, com melhores níveis de sensibilidade e especificidade.

Purpose Quality of life in colorectal cancer patients may be affected by colostomy and treatment, but relevant studies are still scarce and contradictory. The present study aimed to evaluate the association between colostomy time and treatment type with quality of life in colorectal cancer patients. Methods A prospective observational study of 41 patients with colorectal cancer was conducted on three occasions T0, T1 and T2 (0–2; 3–5 and 6–8 months after ostomy surgery, respectively). The treatments prescribed were: surgery alone, chemotherapy or radiotherapy, or chemoradiotherapy. European Organization for Research and Treatment of Cancer questionnaires were used to evaluate quality of life. Worsening clinical changes were evaluated considering difference in scores between times of surgery ≥±9 points. Results Regarding ostomy surgery, scores in physical function improved between T0 and T1 and these better scores were maintained at T1 to T2. The same was observed for urinary frequency, appetite loss and dry mouth. Chemoradiotherapy was associated with worse scores for global health status, nausea and vomiting, bloating and dry mouth. Although significant differences were not observed in some domains in the Generalized Estimating Equations analysis, patients showed noticeable changes for the worse in the pain, anxiety, weight concern, flatulence and embarrassment domains during these periods. Conclusions Colostomy improved quality of life at 3–5 months in most domains of quality of life and remained better at 6–8 months after surgery. Chemoradiotherapy had a late negative influence on quality of life. Health teams could use these results to reassure patients that this procedure will improve their quality of life in many functional and symptomatic aspects.

We compared the relationships among percentage of body fat (%BF) and physical activity with breast cancer (BC) and benign breast diseases (BBD) in low-income Brazilian women. A case-control study including 106 incident BC cases, 178 incident BBD cases, and 181 control women recruited from a public hospital-based screening center was conducted. Logistic regression models showed that sedentary women have a higher odds of developing BC in the age adjusted model [odds ratio (OR) = 2.39, 95% confidence interval (CI) 1.43-3.99]. After adjusting for hormonal-related risk factors and family history of breast cancer (OR = 2.94, 95% CI 1.50-5.79) and also for the % BF (OR = 2.71, 95% CI 1.36-5.37) the odds remained high. Independent of the adjustments made, %BF did not affect the odds for developing BC. When the same models were tested for women with BBD, we found a significant association with sedentary lifestyle in all models tested, with an OR = 3.03 (95% CI 1.69-5.42) in the fully adjusted model. In the same way, in the fully adjusted model %BF was significantly associated to risk for BBD (OR = 0.54, 95% CI 0.30-0.98). Similar to results found in other populations, our data suggest that physical activity is an important, independent protective factor for the risk of developing BC and BBD in low-income women from an admixed population.

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