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1. Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Author

Sende O. de Jesus, Fernanda C. Amparo, Marta M. David, Sara Bobadra, Lilian P.S. Costa, Keyla L.A.L. Deucher, Juliana D Oliveira, Izabele Vian, Janaina Maiana Abreu Barbosa, Karina C.S. Missias, Alexandre Biasi Cavalcanti, Luisa P. Silva, Lannay Ferreira da Silva, Andrea P. Galante, Adriana Barros Luna, Jâniffer R. Beiersdorf, Ângela Cristine Bersch-Ferreira, Diana S. Russo, Marilia C.S. Lucas, Maria Bárbara Galdino Silva, Monique T. de Jesus, Rosângela Maria Lopes de Sousa, Délcio G.S. Junior, Raquel Milani El Kik, Sandramara Sasso, Celme B.P. de Araújo, Nathalia P. Bachettini, Maria A. Moraes, Neuma M.F.S. Leda, Cristine E. Nunes, Bruna G. Machado, Rafael M. Soares, Salvador S. Ramos, Bianca A.S. de Oliveira, Rosa Bosquetti, Cristiano P. dos Santos, Franciane Silvana Formentini, Adriana O.L. Veríssimo, Rosielle Batista Ferreira, Clenise F. Dantas, Valdiana B. Vasconcelos, Maria Renata Aragão dos Santos, Ana Paula O. de Queirós, Edite M.V.M. C. de Araújo, Luciana Pereira Pinto Dias, Francisca Eugenia Zaina Nagano, Sandra Mary Lima Vasconcelos, Elaine de Fatima Adorne, Gabriela S. Shirmann, Celma M. Martins, Aldair S. Guterres, Ana Paula Silva Caldas, Marina Berbigier, Alessandra C. Caiado, Fernanda L. Chiesa, Laís N.P. Navarro, Vera Elizabeth Closs, Raira Pagano, Cristina H. Matos, Juliane A. Rodrigues, Luciana B. Gonçalves, Raphaela Costa Ferreira, Rosana P. Costa, Isa G. Rodrigues, Emílio Hideyuki Moriguchi, Rebecca O. Maquiné, Ana P.P.F. Carvalho, Daniela O. Peçanha, Alessandra Doumid Borges Pretto, Michelle R. Santos, Mirena Boklis, Celia R. Bittencourt, Eduardo P. Trescastro, Mariana E.P. Lima, Bruna L.P. Ribas, Adriana F. Teixeira, Marina T. Asoo, Maria I.S. Taboada, Otavio Berwanger, Karen B. Ruschel, Suzi H.A. de Araujo, Nilma F. Silva, Rodrigo Necchi, Camile S. Teixeira, Vanessa C.F.O. Fagundes, Glauber B. da Silva, Carine S.A. Ribeiro, Francisco A. Costa, Sônia L. Pinto, Helen Hermana Miranda Hermsdorff, Suzana A. da Silva, Bárbara Rafaela Santos da Rocha, Rosileide S. Torres, Cíntia L. Ambrozio, Renata Torres Abib Bertacco, Rosângela C.A. Cantanhede, Annie S.B. Moreira, Camila Dourado, Aline Marcadenti, Milena P. Rodrigues, Renata A. da Silva, Daniele M.O. Carlos, Cláudia Porto Sabino Pinho, Rita C.L. Duarte, Lilian Vivian, Eliane S. Dutra, Neyla E. Silva, Luciano M. Backes, Lívia M.A.J. Silva, Letícia S. Sabino, Júlia D. Lopes, Alexsandro Ferreira dos Santos, Lúcia H.A. Gratão, Paulo Victor Gomes Modanese, Cristina T. Telles, Juliana L. Pereira, Luciana V.S. Alves, Tainah S. Souza, Lúcia Rota Borges, Maria Cristina de Oliveira Izar, Priscila Moreira, Simone Raimondi de Souza, Priscila A. Rodrigues, Jorge L. Boemo, Deborah Marotto, Eduardo Gehling Bertoldi, Priccila Zuchinali, Jéssica Schiavini, Susi B. e Lima, Claiza Barretta, Jacqueline T. da Silva, Alexandre Gastaud, Daniela Rampazzo, Vera M.S. Bortonili, Laís B. da Costa, Luciana C. Holzbach, Sabrina A. Vieira, Maria E.M. Ramos, Waldemar de Carli, Magali C.C. Kumbier, Tamirys D. Sangali, Renato Hideo Nakagawa Santos, Elisa M. Santos, Roberta Mânica Cardoso, Simone M. Fischer, Marina K. Ito, Andreza M. Penafort, Naoel H. Feres, Bruno R.B. de Ataíde, Mihaela Onofrei, José Albuquerque de Figueiredo Neto, Camila R. Honório, Enilda de Sousa Lara, Catharina C.J. Paiva, Marina Shumacher, Gabriela C. Souza, Rafael L. Rech, Viviane Aparecida Rodrigues Sant'Anna, Antônio Carlos Sobral Sousa, Laura M. da Costa, André Eduardo da Silva Júnior, Luíza M. Garlini, Cintia G.N.C. Cordeiro, Rose M. Uehara, Karina G. dos Santos, Josilene Maria Ferreira Pinheiro, Natalia de Morais Cunha, Camila Ragne Torreglosa, Luis G.S. Mota, Valéria A. Machado, Geysa Maria Nogueira Farias, Auriene L. Medeiros, Amanda G.L. Coura, Kellen C. Silva, Karine Maria Moreira Almeida, Lívia A. Pellegrini, Luana R.M. Lima, Guilherme C.M. Bragança, Joise M. Teixeira, Aline Longo, Vanessa Bertoni, Cristiane Kovacs, Fernanda Vighi Dobke, Paula Souza, Alessandra da Silva, Elza C.B. Barbosa, Clarice M. Specht, Carlos D. Magnoni, Alechandra S. Napparo, Isadora Bianco Cardoso, Mônica L.P. de los Santos, Camila V.S. Souza, Jaqueline S.O. Vieira, Viviane O.G. Nascimento, Luisa F. Reis, Andrea F.R. Cardoso, Jadson M. Morais, Helen M.S. Carvalho, Ana L. Barreto, Lais S. de Paula, Aline S. Monteiro, Josiele Kesties, Ana C.L. Andrade, Juliana T. Kato, Bernardete Weber, Tatiana M.X. de Meneses, Priscila M. Pinho, Thiago T. de Freitas, Joyce Salamoni, Moacyr M. Palmeira, Malaine M.A. Machado, Bianca M. Fracasso, Viviane Sahade, Givaldo A. Araújo, Fernando G. Zampieri, Matheus Brum Felício, Soraia Poloni, Neide M. Bruscato, Caroline Frehner, Josefina Bressan, Andreza Santos Almeida, Socorro N.A.A. Barbosa, Helyde Albuquerque Marinho, Patrícia R.T. Martins, Maiara Cantarelli, and Monica Damiani

Subjects
Male, Nutrition Education, Body Mass, National Health Programs, 030204 cardiovascular system & hematology, Vegetable, Procedures, Prescription, law.invention, 0302 clinical medicine, Cerebrovascular Accident, Randomized controlled trial, law, Risk Factors, Cardiovascular Disease, Cause of Death, Clinical endpoint, Whole Grain, Secondary Prevention, 030212 general & internal medicine, Myocardial infarction, All Cause Mortality, Amputation, Program Development, Stroke, Sex Difference, Alcohol Consumption, Incidence (epidemiology), Incidence, Unstable Angina Pectoris, Middle Aged, Clinical Trial, Hospitalization, Multicenter Study, Survival Rate, Practice Guideline, Cardiovascular Diseases, Randomized Controlled Trial, Priority Journal, Female, Public Health, Cardiology and Cardiovascular Medicine, Brazil, Human, Adult, medicine.medical_specialty, Major Clinical Study, Nutritional Status, Follow Up, 03 medical and health sciences, Age, Cause Of Death, Multicenter trial, Internal medicine, medicine, Humans, Controlled Study, Nutritional Assessment, Study Design, Unstable angina, business.industry, Brasil, Risk Factor, medicine.disease, Heart Infarction, Heart Arrest, Diet, Blood pressure, Nutrition Assessment, Fruit, Family Income, business, Cardiovascular Risk, Diet Therapy, Nutritional Counseling, Total Quality Management
Abstract

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P

Published
2019

2. Nutritional screening in hospitalized pediatric patients: a systematic review

Author

Adriana F. Teixeira and Kátia Danielle Araújo Lourenço Viana

Subjects
0301 basic medicine, SciELO, Male, medicine.medical_specialty, Pediatrics, Adolescent, Population, Alternative medicine, Scopus, MEDLINE, Nutritional Status, Desnutrição, Risk Assessment, Sensitivity and Specificity, Scientific evidence, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, medicine, Humans, 030212 general & internal medicine, Pediatrics, Perinatology, and Child Health, education, Child, education.field_of_study, 030109 nutrition & dietetics, Pediatria, business.industry, Malnutrition, lcsh:RJ1-570, Infant, Reproducibility of Results, lcsh:Pediatrics, Triagem, medicine.disease, Nutrition Surveys, Revisão sistemática, Family medicine, Child, Preschool, Pediatrics, Perinatology and Child Health, Screening, Systematic review, Female, business, Child, Hospitalized, Biomedical sciences
Abstract

Objective: This systematic review aimed to verify the available scientific evidence on the clinical performance and diagnostic accuracy of nutritional screening tools in hospitalized pediatric patients. Data source: A search was performed in the Medline (National Library of Medicine United States), LILACS (Latin American and Caribbean Health Sciences), PubMed (US National Library of Medicine National Institutes of Health), in the SCIELO (Scientific Electronic Library Online), through CAPES portal (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), bases Scopus e Web of Science. The descriptors used in accordance with the Descriptors in Health Sciences (DeCS)/Medical Subject Headings (MeSH) list were “malnutrition”, “screening”, and “pediatrics”, as well as the equivalent words in Portuguese. Summary of the findings: The authors identified 270 articles published between 2004 and 2014. After applying the selection criteria, 35 were analyzed in full and eight articles were included in the systematic review. We evaluated the methodological quality of the studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Five nutritional screening tools in pediatrics were identified. Among these, the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) showed high sensitivity, almost perfect inter-rater agreement and between the screening and the reference standard; the Screening Tool Risk on Nutritional Status and Growth (STRONGkids) showed high sensitivity, lower percentage of specificity, substantial intra-rater agreement, and ease of use in clinical practice. Conclusions: The studies included in this systematic review showed good performance of the nutritional screening tools in pediatrics, especially STRONGkids and STAMP. The authors emphasize the need to perform for more studies in this area. Only one tool was translated and adapted to the Brazilian pediatric population, and it is essential to carry out studies of tool adaptation and validation for this population. Resumo: Objetivo: Esta revisão sistemática tem por objetivo verificar as evidências científicas disponíveis sobre o desempenho clínico e acurácia diagnóstica dos instrumentos de triagem nutricional em pacientes pediátricos hospitalizados. Fonte de dados: Realizou-se busca nas bases de dados Medline (National Library of Medicine United States), LILACS (Latin American and Caribbean Health Sciences), PubMed (US National Library of Medicine National Institutes of Health), na biblioteca eletrônica SCIELO (Scientific Electronic Library Online), através do portal de periódicos da CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), bases Scopus e Web of Science. Os descritores utilizados conforme lista do DeCS (Descritores em Ciências da Saúde)/MeSH (Medical Subject Headings) foram “desnutrição”, “triagem” e “pediatria”, bem como, “malnutrition”, “screening” e “pediatrics”, respectivamente. Síntese dos dados: Identificou-se 270 artigos, publicados entre 2004 e 2014. Após aplicação dos critérios de seleção, 35 foram analisados na íntegra, sendo incluídos 8 artigos na revisão sistemática. Avaliou-se a qualidade metodológica dos estudos utilizando-se o QUADAS (Quality Assessment of Diagnostic Accuracy Studies). Verificou-se 05 instrumentos de triagem nutricional em pediatria. Dentre estes, o STAMP (Screening Tool for the Assessment of Malnutrition in Pediatrics) apresentou sensibilidade elevada, concordância quase perfeita inter-avaliador e entre a triagem e padrão de referência; o STRONGkids (Screening Tool Risk on Nutritional Status and Growth) evidenciou sensibilidade elevada, menor percentual de especificidade, concordância intra-avaliador substancial e facilidade de uso na prática clínica. Conclusões: Os estudos incluídos nesta revisão sistemática demonstraram um bom desempenho dos instrumentos de triagem nutricional em pediatria, principalmente STRONGkids e STAMP. Evidencia-se a necessidade de mais pesquisas nessa área. Apenas um instrumento foi traduzido e adaptado para a população pediátrica brasileira, sendo imprescindível a realização de estudos de adaptação e validação de instrumentos para essa população. Keywords: Screening, Malnutrition, Pediatrics, Systematic review, Palavras-chave: Triagem, Desnutrição, Pediatria, Revisão sistemática

Published
2016

3. Corrigendum to ’The Brazilian Cardioprotective Nutritional Program to reduce events and risk factors in secondary prevention for cardiovascular disease: study protocol (The BALANCE Program Trial)’ [American Heart Journal 171/1 (2016) 73–81]

Author

Bernardete Weber, Ângela C. Bersch-Ferreira, Camila R. Torreglosa, Maria B. Ross-Fernandes, Jacqueline T. da Silva, Andrea P. Galante, Enilda de Sousa Lara, Rosana P. Costa, Rafael M. Soares, Alexandre B. Cavalcanti, Emilio H. Moriguchi, Neide M. Bruscato, Josiele Kesties, Lilian Vivian, Marina Schumacher, Waldemar de Carli, Luciano M. Backes, Bruna R. Reolão, Milena P. Rodrigues, Dúnnia M.B. Baldissera, Glaucia S. Tres, Hugo R.K. Lisbôa, João B.J. Bem, Jose B.C. Reolão, Keyla L.A.L. Deucher, Maiara Cantarelli, Aline Lucion, Daniela Rampazzo, Vanessa Bertoni, Rosileide S. Torres, Adriana O.L. Verríssimo, Aldair S. Guterres, Andrea F.R. Cardos, Dalva B.S. Coutinho, Mayara G. Negrão, Mônica F.A. Alencar, Priscila M. Pinho, Socorro N.A.A. Barbosa, Ana P.P.F. Carvalho, Maria I.S. Taboada, Sheila A. Pereira, Raul V. Heyde, Francisca E.Z. Nagano, Rebecca Baumgartner, Fernanda P. Resende, Ranata Tabalipa, Ana C. Zanini, Michael J.R. Machado, Hevila Araujo, Maria L.V. Teixeira, Gabriela C. Souza, Priccila Zuchinali, Bianca M. Fracasso, Karen Ulliam, Moara Pierotto, Thamires Hilário, Daniele M.O. Carlos, Cintia G.N.C. Cordeiro, Daniele A. Carvalho, Marília S. Gonçalves, Valdiana B. Vasconcelos, Rosa Bosquetti, Raira Pagano, Marcelo L.P. Romano, César A. Jardim, Bernardo N.A. de Abreu, Aline Marcadenti, Alessandra R. Schmitt, Angela M.V. Tavares, Christiane C. Faria, Flávia M. Silva, Jaqueline S. Fink, Raquel M. El Kik, Clarice F. Prates, Cristiane S. Vieira, Elaine F. Adorne, Ellen H. Magedanz, Fernanda L. Chieza, Ingrid S. Silva, Joise M. Teixeira, Eduardo P. Trescastro, Lívia A. Pellegrini, Jéssika C. Pinto, Cristina T. Telles, Antonio C.S. Sousa, Andreza S. Almeida, Ariane A. Costa, José A.C. Carmo, Juliana T. Silva, Luciana V.S. Alves, Saulo O.C. Sales, Maria E.M. Ramos, Marilia C.S. Lucas, Monica Damiani, Patricia C. Cardoso, Salvador S. Ramos, Clenise F. Dantas, Amanda G. Lopes, Ana M.P. Cabral, Ana C.A. Lucena, Auriene L. Medeiros, Bernardino B. Terceiro, Neuma M.F.S. Leda, Sandra R.D. Baía, Josilene M.F. Pinheiro, Alexandra N. Cassiano, Andressa N.L. Melo, Anny K.O. Cavalcanti, Camila V.S. Souza, Dayanna J.M. Queiroz, Hercilla N.C.F. Farias, Larissa C.F. Souza, Letícia S. Santos, Luana R.M. Lima, Meg S. Hoffmann, Átala S. Silva Ribeiro, Daniel F. Vasconcelos, Eliane S. Dutra, Marina K. Ito, José A.F. Neto, Alexsandro F. Santos, Rosângela M.L. Sousa, Luciana Pereira P. Dias, Maria T.M.A. Lima, Victor G. Modanesi, Adriana F. Teixeira, Luciana C.N.C.D. Estrada, Paulo V.G. Modanesi, Adriana B.L. Gomes, Bárbara R.S. Rocha, Cristina Teti, Marta M. David, Bruna M. Palácio, Délcio G.S. Junior, Érica H.S. Faria, Michelle C.F. Oliveira, Rose M. Uehara, Sandramara Sasso, Annie S.B. Moreira, Ana C.A.H. Cadinha, Carla W.M. Pinto, Mariana P. Castilhos, Mariana Costa, Cristiane Kovacs, Daniel Magnoni, Quênia Silva, Michele F.C.A. Germini, Renata A. da Silva, Aline S. Monteiro, Karina G. dos Santos, Priscila Moreira, Fernanda C. Amparo, Catharina C.J. Paiva, Soraia Poloni, Diana S. Russo, Izabele V. Silveira, Maria A. Moraes, Mirena Boklis, Quinto I. Cardoso, Aline M.S. Damaceno, Elisa M. Santos, Glauber M. Dias, Cláudia P.S. Pinho, Adrilene C. Cavalcanti, Amanda S. Bezerra, Andrey V. Queiroga, Isa G. Rodrigues, Tallita V. Leal, Viviane Sahade, Daniele A. Amaral, Diana S. Souza, Givaldo A. Araújo, Karine Curvello, Manuella Heine, Marília M.S. Barretto, Nailson A. Reis, Sandra M.L. Vasconcelos, Danielly C. Vieira, Francisco A. Costa, Jessica M.S. Fontes, Juvenal G.C. Neto, Laís N.P. Navarro, Raphaela C. Ferreira, Patrícia M. Marinho, Renata Torres Abib, Aline Longo, Eduardo G. Bertoldi, Lauren S. Ferreira, Lúcia R. Borges, Norlai A. Azevedo, Celma M. Martins, Juliana T. Kato, Maria C.O. Izar, Marina T. Asoo, Mariana D. de Capitani, Valéria A. Machado, Waléria T. Fonzar, Sônia L. Pinto, Kellen C. Silva, Lúcia H.A. Gratão, Sheila D. Machado, Susane R.U. de Oliveira, Josefina Bressan, Ana P.S. Caldas, Hatanne C.F.M. Lima, Helen H.M. Hermsdorff, Tânia M. Saldanha, Sílvia E. Priore, Naoel H. Feres, Adila de Queiroz Neves, Loanda M.G. Cheim, Nilma F. Silva, Silvia R.L. Reis, Andreza M. Penafort, Ana Paula O. de Queirós, Geysa M.N. Farias, Mônica L.P. de los Santos, Cíntia L. Ambrozio, Cirília N. Camejo, Cristiano P. dos Santos, Gabriela S. Schirmann, Jorge L. Boemo, Rosane E.C. Oliveira, Súsi M.B. Lima, Vera M.S. Bortolini, Cristina H. Matos, Claiza Barretta, Clarice M. Specht, Simone R. de Souza, Cristina S. Arruda, Priscila A. Rodrigues, and Otávio Berwanger

Subjects
Secondary prevention, Protocol (science), medicine.medical_specialty, Balance (accounting), business.industry, medicine, Physical therapy, Alternative medicine, Disease, Cardiology and Cardiovascular Medicine, Intensive care medicine, business
Published
2016
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4. The Brazilian Cardioprotective Nutritional Program to reduce events and risk factors in secondary prevention for cardiovascular disease: study protocol (The BALANCE Program Trial)

Author

Bernardete Weber, Ângela C. Bersch-Ferreira, Camila R. Torreglosa, Maria B. Ross-Fernandes, Jacqueline T. da Silva, Andrea P. Galante, Enilda de Sousa Lara, Rosana P. Costa, Rafael M. Soares, Alexandre B. Cavalcanti, Emilio H. Moriguchi, Neide M. Bruscato, Josiele Kesties, Lilian Vivian, Marina Schumacher, Waldemar de Carli, Luciano M. Backes, Bruna R. Reolão, Milena P. Rodrigues, Dúnnia M.B. Baldissera, Glaucia S. Tres, Hugo R.K. Lisbôa, João B.J. Bem, Jose B.C. Reolão, Keyla L.A.L. Deucher, Maiara Cantarelli, Aline Lucion, Daniela Rampazzo, Vanessa Bertoni, Rosileide S. Torres, Adriana O.L. Verríssimo, Aldair S. Guterres, Andrea F.R. Cardos, Dalva B.S. Coutinho, Mayara G. Negrão, Mônica F.A. Alencar, Priscila M. Pinho, Socorro N.A.A. Barbosa, Ana P.P.F. Carvalho, Maria I.S. Taboada, Sheila A. Pereira, Raul V. Heyde, Francisca E.Z. Nagano, Rebecca Baumgartner, Fernanda P. Resende, Ranata Tabalipa, Ana C. Zanini, Michael J.R. Machado, Hevila Araujo, Maria L.V. Teixeira, Gabriela C. Souza, Priccila Zuchinali, Bianca M. Fracasso, Karen Ulliam, Moara Pierotto, Thamires Hilário, Daniele M.O. Carlos, Cintia G.N.C. Cordeiro, Daniele A. Carvalho, Marília S. Gonçalves, Valdiana B. Vasconcelos, Rosa Bosquetti, Raira Pagano, Marcelo L.P. Romano, César A. Jardim, Bernardo N.A. de Abreu, Aline Marcadenti, Alessandra R. Schmitt, Angela M.V. Tavares, Christiane C. Faria, Flávia M. Silva, Jaqueline S. Fink, Raquel M. El Kik, Clarice F. Prates, Cristiane S. Vieira, Elaine F. Adorne, Ellen H. Magedanz, Fernanda L. Chieza, Ingrid S. Silva, Joise M. Teixeira, Eduardo P. Trescastro, Lívia A. Pellegrini, Jéssika C. Pinto, Cristina T. Telles, Antonio C.S. Sousa, Andreza S. Almeida, Ariane A. Costa, José A.C. Carmo, Juliana T. Silva, Luciana V.S. Alves, Saulo O.C. Sales, Maria E.M. Ramos, Marilia C.S. Lucas, Monica Damiani, Patricia C. Cardoso, Salvador S. Ramos, Clenise F. Dantas, Amanda G. Lopes, Ana M.P. Cabral, Ana C.A. Lucena, Auriene L. Medeiros, Bernardino B. Terceiro, Neuma M.F.S. Leda, Sandra R.D. Baía, Josilene M.F. Pinheiro, Alexandra N. Cassiano, Andressa N.L. Melo, Anny K.O. Cavalcanti, Camila V.S. Souza, Dayanna J.M. Queiroz, Hercilla N.C.F. Farias, Larissa C.F. Souza, Letícia S. Santos, Luana R.M. Lima, Meg S. Hoffmann, Átala S. Silva Ribeiro, Daniel F. Vasconcelos, Eliane S. Dutra, Marina K. Ito, José A.F. Neto, Alexsandro F. Santos, Rosângela M.L. Sousa, Luciana Pereira P. Dias, Maria T.M.A. Lima, Victor G. Modanesi, Adriana F. Teixeira, Luciana C.N.C.D. Estrada, Paulo V.G. Modanesi, Adriana B.L. Gomes, Bárbara R.S. Rocha, Cristina Teti, Marta M. David, Bruna M. Palácio, Délcio G.S. Junior, Érica H.S. Faria, Michelle C.F. Oliveira, Rose M. Uehara, Sandramara Sasso, Annie S.B. Moreira, Ana C.A.H. Cadinha, Carla W.M. Pinto, Mariana P. Castilhos, Mariana Costa, Cristiane Kovacs, Daniel Magnoni, Quênia Silva, Michele F.C.A. Germini, Renata A. da Silva, Aline S. Monteiro, Karina G. dos Santos, Priscila Moreira, Fernanda C. Amparo, Catharina C.J. Paiva, Soraia Poloni, Diana S. Russo, Izabele V. Silveira, Maria A. Moraes, Mirena Boklis, Quinto I. Cardoso, Aline M.S. Damaceno, Elisa M. Santos, Glauber M. Dias, Cláudia P.S. Pinho, Adrilene C. Cavalcanti, Amanda S. Bezerra, Andrey V. Queiroga, Isa G. Rodrigues, Tallita V. Leal, Viviane Sahade, Daniele A. Amaral, Diana S. Souza, Givaldo A. Araújo, Karine Curvello, Manuella Heine, Marília M.S. Barretto, Nailson A. Reis, Sandra M.L. Vasconcelos, Danielly C. Vieira, Francisco A. Costa, Jessica M.S. Fontes, Juvenal G.C. Neto, Laís N.P. Navarro, Raphaela C. Ferreira, Patrícia M. Marinho, Renata Torres Abib, Aline Longo, Eduardo G. Bertoldi, Lauren S. Ferreira, Lúcia R. Borges, Norlai A. Azevedo, Celma M. Martins, Juliana T. Kato, Maria C.O. Izar, Marina T. Asoo, Mariana D. de Capitani, Valéria A. Machado, Waléria T. Fonzar, Sônia L. Pinto, Kellen C. Silva, Lúcia H.A. Gratão, Sheila D. Machado, Susane R.U. de Oliveira, Josefina Bressan, Ana P.S. Caldas, Hatanne C.F.M. Lima, Helen H.M. Hermsdorff, Tânia M. Saldanha, Sílvia E. Priore, Naoel H. Feres, Adila de Queiroz Neves, Loanda M.G. Cheim, Nilma F. Silva, Silvia R.L. Reis, Andreza M. Penafort, Ana Paula O. de Queirós, Geysa M.N. Farias, Mônica L.P. de los Santos, Cíntia L. Ambrozio, Cirília N. Camejo, Cristiano P. dos Santos, Gabriela S. Schirmann, Jorge L. Boemo, Rosane E.C. Oliveira, Súsi M.B. Lima, Vera M.S. Bortolini, Cristina H. Matos, Claiza Barretta, Clarice M. Specht, Simone R. de Souza, Cristina S. Arruda, Priscila A. Rodrigues, and Otávio Berwanger

Subjects
medicine.medical_specialty, National Health Programs, Psychological intervention, MEDLINE, Disease, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Secondary Prevention, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Intensive care medicine, Stroke, business.industry, Unstable angina, Incidence, Feeding Behavior, Guideline, medicine.disease, Diet, Survival Rate, Nutrition Assessment, Cardiovascular Diseases, Physical therapy, Cardiology and Cardiovascular Medicine, business, Brazil
Abstract

This article reports the rationale for the Brazilian Cardioprotective Nutritional Program (BALANCE Program) Trial. This pragmatic, multicenter, nationwide, randomized, concealed, controlled trial was designed to investigate the effects of the BALANCE Program in reducing cardiovascular events. The BALANCE Program consists of a prescribed diet guided by nutritional content recommendations from Brazilian national guidelines using a unique nutritional education strategy, which includes suggestions of affordable foods. In addition, the Program focuses on intensive follow-up through one-on-one visits, group sessions, and phone calls. In this trial, participants 45 years or older with any evidence of established cardiovascular disease will be randomized to the BALANCE or control groups. Those in the BALANCE group will receive the afore mentioned program interventions, while controls will be given generic advice on how to follow a low-fat, low-energy, low-sodium, and low-cholesterol diet, with a view to achieving Brazilian nutritional guideline recommendations. The primary outcome is a composite of death (any cause), cardiac arrest, acute myocardial infarction, stroke, myocardial revascularization, amputation for peripheral arterial disease, or hospitalization for unstable angina. A total of 2468 patients will be enrolled in 34 sites and followed up for up to 48 months. If the BALANCE Program is found to decrease cardiovascular events and reduce risk factors, this may represent an advance in the care of patients with cardiovascular disease.

Published
2016
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