Monitoring food consumption and its determinants over time is essential for defining and implementing health promotion strategies, but surveillance is scarce in Africa. The present study aimed to describe fruit and vegetable consumption in Mozambique according to sociodemographic characteristics and place of residence (urban/rural). A national representative sample (n 3323) of subjects aged 25-64 years was evaluated in 2005 following the WHO Stepwise Approach to Chronic Disease Risk Factor Surveillance, which included an assessment of usual fruit and vegetable consumption (frequency and quantity). Crude prevalence and age-, education-and family income-adjusted prevalence ratios (PR) with 95 % CI were computed. Less than 5 % of the subjects reported an intake of five or more daily servings of fruits/vegetables. Both fruits and vegetables were more often consumed by women and in rural settings. In urban areas, the prevalence of fruit intake ($ 2 servings/d) increased with education ($ 6 years v. ,1 year: women, adjusted PR ¼ 3·11, 95 % CI 1·27, 7·58; men, adjusted PR ¼ 3·63, 95 % CI 1·22, 10·81), but not with income. Conversely, vegetable consumption ($2 servings/d) was less frequent in more educated urban men ($6 years v. , 1 year: adjusted PR ¼ 0·30, 95 % CI 0·10, 0·94) and more affluent rural women ($ $801 US dollars (USD) v. $0-64: adjusted PR ¼ 0·32, 95 % CI 0·13, 0·81). The very low intake of these foods in this setting supports the need for fruit and vegetable promotion programmes that target the whole population, despite the different socio-demographic determinants of fruit and vegetable intake.Key words: Fruits: Vegetables: Africa: Mozambique Global data on consumption show that more than threequarters of the population consume less than the minimum recommendation of five daily servings of fruits and vegetables (1) . Insufficient intake of these food items is estimated to be responsible for approximately 14 % of gastrointestinal cancer, 11 % of IHD, 9 % of stroke deaths and approximately 2·9 % of overall mortality worldwide (2) . In Africa, the mortality attributable to low fruit and vegetable consumption is much smaller (0·4 % of all deaths) (3)

No abstract

sST2 provides robust prognostic information in acute heart failure with HFrEF, while this pattern was less clear in HFpEF. When sST2 was measured together with BNP, it improved prognostic accuracy in both groups, more clearly in HFrEF.

No abstract

ObjectivesPrompt diagnosis of acute coronary syndrome (ACS) remains a challenge, with presenting symptoms affecting the diagnosis algorithm and, consequently, management and outcomes. This study aimed to identify sex differences in presenting symptoms of ACS.DesignData were collected within a prospective cohort study (EPIHeart).SettingPatients with confirmed diagnosis of type 1 (primary spontaneous) ACS who were consecutively admitted to the Cardiology Department of two tertiary hospitals in Portugal between August 2013 and December 2014.ParticipantsPresenting symptoms of 873 patients (227 women) were obtained through a face-to-face interview. Outcome measures: Typical pain was defined according to the definition of cardiology societies. Clusters of symptoms other than pain were identified by latent class analysis. Logistic regression was used to quantify differences in presentation of ACS symptoms by sex.ResultsChest pain was reported by 82% of patients, with no differences in frequency or location between sexes. Women were more likely to feel pain with an intensity higher than 8/10 and this association was stronger for patients aged under 65 years (interaction P=0.028). Referred pain was also more likely in women, particularly pain referred to typical and atypical locations simultaneously. The multiple symptoms cluster, which was characterised by a high probability of presenting with all symptoms, was almost fourfold more prevalent in women (3.92, 95% CI 2.21 to 6.98). Presentation with this cluster was associated with a higher 30-day mortality rate adjusted for the GRACE V.2.0 risk score (4.9% vs 0.9% for the two other clusters, P<0.001).ConclusionsWhile there are no significant differences in the frequency or location of pain between sexes, women are more likely to feel pain of higher intensity and to present with referred pain and symptoms other than pain. Knowledge of these ACS presentation profiles is important for health policy decisions and clinical practice.

The reported obesity paradox in heart failure can only be observed in nondiabetic patients.

Introduction and objectives: Renal function impairment predicts poor survival in heart failure. Attention has recently shifted to worsening renal function, based mostly on serum creatinine and estimated glomerular filtration rate. We assessed the prognostic effect of worsening renal function in ambulatory heart failure patients. Methods: Data from 306 ambulatory patients were abstracted from medical files. Worsening renal function was based on the change in estimated glomerular filtration rate, serum creatinine and urea within 6 months of referral. Prognosis was assessed by the composite endpoint all-cause death or heart failure hospitalization, censored at 2 years. Hazard ratios were estimated for worsening renal function, adjusted for sex, age, diabetes, New York Heart Association class, left ventricular systolic dysfunction, medications and baseline renal function. Results: The agreement among definitions was fair, with kappa coefficients generally not surpassing 0.5. Worsening renal function was associated with poor outcome with adjusted hazard ratios (95% confidence interval) of 3.2 (1.8-5.9) for an increase of serum creatinine N 0.3 mg/dl; 2.2 (1.3-3.7) for an increase in serum urea N20 mg/dl and 1.9 (1.1-3.3) for a decrease in estimated glomerular filtration rate N 20%, independent of baseline renal function. The 2-year risk of death/heart failure hospitalization was approximately 50% in patients with an increase in serum creatinine or in serum urea; this positive predictive value was higher than for decreasing estimated glomerular filtration rate. Conclusions: In conclusion, worsening renal function was significantly associated with a worse outcome. Different definitions identified different patients at risk and increasing creatinine/urea performed better than decreasing estimated glomerular filtration rate.

No abstract