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Background: Sarcopenia is a progressive and generalized skeletal muscle disorder with unfavorable muscle changes throughout life, which can be associated with chronic disease. Testosterone supplementation is emerging as a possible therapy; however, it is still necessary to explore its effectiveness. Objectives: This systematic review and meta-analysis aimed to evaluate and summarize the evidence related to the effect of testosterone supplementation on sarcopenia components of chronic disease patients. Methods: We performed a systematic review and meta-analysis with studies that assessed the effect of testosterone supplementation on sarcopenia components of chronic disease patients. Papers were identified using Medical Subject Heading (MeSH) terms, combining “sarcopenia”, “muscular atrophy”, and “testosterone”, searching MEDLINE, EMBASE, and Cochrane Library databases, and also hand searching. Results: The database search resulted in 1602 applicable citations that could be included. Of those, 1560 were removed at the first phase, by reading the title and abstract, and a total of 17 studies were finally included after full-text assessment and manual searches of previous review references. With regard to the effects of testosterone supplementation on sarcopenia components, when taken together, the evaluated studies presented an increase in muscle mass and/or muscle strength, but results for muscle functional capacity were inconsistent. Conclusions: Testosterone supplementation increased the muscle mass and muscle strength in chronic disease patients. However, current evidence does not indicate that those patients could benefit from testosterone supplementation in order to improve their muscle function. PRESPERO Registration ID: CRD 42019122099.

Olive culture is a recent activity in Rio Grande do Sul, Brazil with little information on its scale insects. Abundance and seasonality of armored scale insects (Hemiptera, Diaspididae) and their parasitism was evaluated in olive orchard, Olea europaea L., cultivar Arbequina, in Caçapava do Sul (30°30′43″ S, 53°29′27″ W), RS, Brazil. Samples were monthly collected from April 2012 to March 2013. At each occasion 20 trees were drawn and, from each quadrant of their canopies (northern, southern, eastern and western) two branches (20 - 30 cm - length and contained at least 20 leaves) were randomly removed, respectively from the inner part and the outer part of the canopy. We found five species of Diaspididae, Aonidiella aurantii (Maskell), Hemiberlesia cyanophylli (Signoret), Acutaspis paulista (Hempel), Aspidiotus nerii Bouché and Melanaspis obscura (Comstock). It was not found an unique pattern of abundance, indicating that these species respond differently to temperature variations between seasons. The armored scale insects were evenly distributed among quadrants. Only H. cyanophylli showed differences in abundance between the inner and outer branches. We registered parasitism in all Diaspididae species; the total parasitism rate was 9.78%. A olivicultura é uma atividade recente no Rio Grande do Sul, Brasil, com pouca informação sobre as cochonilhas associadas a esta cultura. Abundância e sazonalidade das cochonilhas-com-escudo (Hemiptera, Diaspididae) e seu parasitismo foram avaliados em olival, Olea europaea L., cultivar Arbequina, em Caçapava do Sul (30º30'43" S, 53°29'27" O), RS, Brasil. As amostras foram coletadas mensalmente, a partir de abril de 2012 a março de 2013. Em cada ocasião, 20 árvores foram sorteadas e, de cada quadrante de suas copas (norte, sul, leste e oeste) dois ramos (20 - 30 cm de comprimento e contendo pelo menos 20 folhas) foram retirados aleatoriamente, respectivamente, da parte interna e a parte externa da copa. Foram encontradas cinco espécies de Diaspididae, Aonidiella aurantii (Maskell), Hemiberlesia cyanophylli (Signoret), Acutaspis paulista (Hempel), Aspidiotus nerii Bouché e Melanaspis obscura (Comstock). Não foi encontrado um padrão único de abundância, o que indica que essas espécies respondem diferentemente a variações de temperatura entre as estações. Verificou-se que as cochonilhas se distribuem uniformemente entre os quadrantes. Apenas H. cyanophylli mostrou diferenças na abundância entre os ramos internos e externos. Foi registrado o parasitismo em todas as espécies de Diaspididae, a taxa de parasitismo total foi de 9,78%.

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

Background Despite the association between cardiovascular diseases and periodontitis, there are scarce data on the impact of oral health in the dietary intake of patients with coronary artery disease (CAD). The aim of this study was to assess the association between dietary intake with periodontitis and present teeth in individuals with stable CAD. Methods This cross-sectional study included 115 patients with stable CAD (76 males, aged 61.0 ± 8.3 years) who were under cardiovascular care in an outpatient clinic for at least 3 months. Dietary intake was recorded applying a food frequency questionnaire previously validated. Periodontal examinations were performed by two calibrated examiners in six sites per tooth from all present teeth. Blood samples were collected to determine serum levels of lipids. Multivariable logistic and linear regression models were fitted to evaluate the association between dietary outcomes and oral health variables. Results Individuals with periodontitis had significantly higher percentage of total energy intake from fried foods, sweets, and beans, and also had lower consumption of fruits than those without periodontitis. Presence of periodontitis was associated with lower percentage of individuals who reached the nutritional recommendation of monounsaturated fatty acids and higher blood concentration of triglycerides. Having a greater number of present teeth (≥20 teeth) was associated with higher intake of fibers and total calories. Conclusion In patients with stable CAD, the presence of periodontitis and tooth loss were associated with a poor dietary intake of nutrients and healthy foods, which are important for cardiovascular prevention.

Background/objectives The phase angle, expressed through bioelectrical impedance, has been studied as a prognostic marker in several health conditions. As this issue is still conflicting, the question whether this parameter correlates with mortality in the most diverse clinical situations remains. Therefore, this study aimed to evaluate the relationship between phase angle and mortality through a systematic review of the literature. Subjects/methods This research was conducted in electronic databases (Pubmed, Embase, Cochrane, Lilacs, Scielo, e Scopus), and included studies that had phase angle as a variable of interest and mortality/survival as an outcome. Data were extracted independently by two reviewers and disagreements were assessed by a third reviewer. Results Forty-eight of 455 papers were assessed and an amount of 42 showed a correlation between phase angle and mortality. Conclusions Phase angle seems to be a good indicator for mortality in many clinical situations and can be used in screening individuals prone to this outcome.

RESUMO A olivicultura é uma atividade recente no Rio Grande do Sul, com poucas informações sobre os insetos associados. A dinâmica populacional de Saissetia oleae (Oliver) e seu parasitismo natural foram avaliados em pomar de Olea europaea L., cultivar Arbequina, mantidos sob manejo convencional, situado em Caçapava do Sul (30°30'43? S, 53°29'27? O)-RS, Brasil. As amostragens foram mensais, de abril de 2012 a março de 2013. Em cada ocasião, em 20 plantas sorteadas, e dos quadrantes da copa (norte, sul, leste e oeste), foram retirados dois ramos aleatórios (20 a 30 cm de comprimento, com no mínimo 20 folhas), um interno e outro externo. A maior abundância de S. oleae foi na primavera e no verão, e a temperatura foi o fator que interferiu nesta dinâmica. Saissetia oleae distribuiu-se de forma uniforme entre os quadrantes e entre os ramos internos e externos da copa. Nas folhas, observou-se maior abundância de ninfas de primeiro e segundo instares, e nos ramos de ninfas de terceiro instar, adultos e adultos com ovos. A taxa de parasitismo foi de 3,40%. ABSTRACT Oliviculture is a recent activity in Rio Grande do Sul with little information on associated insects. The population dynamics of Saissetia oleae (Oliver) and its parasitism was evaluated in olive orchard, Olea europaea L., cultivar Arbequina, kept under traditional management, situated in Caçapava do Sul (30°30'43? S, 53°29'27? W), RS, Brazil. Samples were monthly collected from April 2012 to March 2013. At each occasion 20 trees were randomly selected and, from each quadrant of their canopies (northern, southern, eastern and western) two branches (20 - 30 cm - length and containingat least 20 leaves) were removed randomly, one inside and one outside the tree. The greater abundance of S. oleae was in the spring and summer and the temperature was the factor that interfered in this dynamic. Saissetia oleae was distributed in a uniform way between quadrant and between the internal and external branches. In the leaves were observed with greater abundance S. oleae of first and second nympal stages, while in the branches third instar nymphs, adults and adults with eggs. The parasitism rate was 3.40%.

Objective To verify the association of dietary patterns and dietary components with new-onset diabetes mellitus after transplantation (NODAT). Design Cross-sectional study. Subjects Adult kidney transplant recipients, without history of diabetes before transplantation, who received a kidney transplant and were followed up for at least 1 year. One hundred and sixteen subjects recruited between January 2013 and August 2014. Diagnosis of NODAT was established according to the American Diabetes Association criteria for type 2 diabetes. Methods Demographic, clinical, and anthropometric data were collected. Dietary intake was assessed by food frequency questionnaire, administered by a registered dietitian. Dietary patterns were identified by cluster analysis. Chi-square test was used to verify the association between dietary patterns and NODAT. Total energy, fiber, and cholesterol intake were calculated. Consumption of macronutrients, carbohydrates, proteins, and fats (total fats and saturated, monounsaturated, polyunsaturated and trans fatty acids), were expressed in percentage of total energy intake. Results Twenty-eight patients developed NODAT in the follow-up period. They presented higher body mass index and body fat percentage, as well as higher levels of triglycerides and urinary protein/creatinine ratio than the non-NODAT group. Two dietary patterns, I and II, were identified. Pattern II was characterized by higher intake of total, saturated, monounsaturated, and trans fats than pattern I. No association between the dietary patterns and NODAT was identified ( P = .905), and there was no difference in the distribution of macronutrients, dietary fiber, and dietary cholesterol between the groups with and without NODAT. Conclusion Posttransplant dietary patterns were not different between patients with and without NODAT. Further larger and prospective studies are needed to evaluate a possible relationship between dietary components and NODAT incidence in kidney transplant recipients.

BACKGROUND New-onset diabetes after transplantation (NODAT) is a well-recognized complication of kidney transplantation and is associated with poor outcomes. Both adiponectin and chemokine ligand 5 (CCL5) proteins are related to glucose metabolism and genetic variations in their genes can lead to development of NODAT. The aim of this study was to investigate the association of adiponectin and CCL5 genes polymorphisms with NODAT in a population of Caucasian kidney transplant recipients. METHODS Two hundred seventy Caucasian kidney transplant recipients (83 with NODAT and 187 without NODAT) were included in a nested case-control study. Patients with pretransplantation diabetes mellitus and multiorgan transplantation were excluded. NODAT diagnosis was determined by American Diabetes Association criteria. Subjects were genotyped for 276G/T adiponectin gene polymorphism (rs1501299) and rs2280789 and rs3817655 CCL5 gene polymorphisms by real-time polymerase chain reaction. RESULTS The TT genotype of 276G/T adiponectin gene polymorphism was significantly more frequent in NODAT than non-NODAT patients compared with GG/GT genotypes (recessive model; P=0.031). TT genotype was identified as an independent risk factor for NODAT in Caucasian kidney transplant recipients after adjusting for age at transplantation, pretransplantation body mass index, and use of tacrolimus (TT vs. GG/GT, hazard ratio=1.88, 95% confidence interval=1.03-3.45, P=0.041). There were no differences in genotype distribution and allele frequency of rs2280789 and rs3817655 CCL5 gene polymorphisms between NODAT and non-NODAT groups. CONCLUSIONS The 276G/T adiponectin gene polymorphism is associated with NODAT in Caucasian kidney transplant recipients.

Significant inter-individual variability on the effect of vitamin K to reverse overanticoagulation has been identified. Genetic polymorphisms of the vitamin K epoxide reductase complex subunit 1 (VKORC1) gene might explain in part this variability. The objective of this study was to evaluate the influence of VKORC1 -1639GA and 3730GA polymorphisms on the effect of oral vitamin K supplementation in overanticoagulated patients. We performed an interventional trial of oral vitamin K supplementation in over-anticoagulated outpatients (international normalized ratio [INR] ≥ 4). Subjects received vitamin K (2.5-5.0 mg) according to baseline INR and were genotyped by real time polymerase chain reaction (PCR). INR values were determined at 3, 6, 24 and 72 h after supplementation. We evaluated 33 outpatients, 61 % were males, with a mean age of 62 ± 12 years old. There was a significant decrease in INR values over time for both polymorphisms after oral vitamin K. At 3 h after supplementation, patients carrying the G allele for the -1639GA polymorphism had a greater decrease in INR values compared to AA patients (p 0.05 for difference among groups; p 0.001 for time variation; p = 0.001 for time × group interaction), with differences of -1.01 for GG versus AA (p = 0.003) and -0.84 for GA versus AA (p = 0.024). Mean INR value at 24 h was 1.9 ± 0.6 and at 72 h was 2.1 ± 0.7, with no differences among genotypes. No significant interaction was identified between the 3730GA polymorphism and vitamin K supplementation. Our study indicated that the VKORC1 -1639GA polymorphism plays a role in the response to acute vitamin K supplementation in over-anticoagulated patients, with faster decrease of INR value in patients carrying the G allele.

Context : Ghrelin is a hormone that stimulates weight gain and increases appetite. For these reasons, it has been used for treatment of cachexia syndrome. Objective : The aim of this systematic review was to examine the use of ghrelin in cachexia patients to better understand the most prevalent clinical outcomes, particularly since the type and dosage of hormone used and the route and duration of administration often varies. Data Sources : A search of electronic databases (MEDLINE, SciELO, Embase, Cochrane Library, and Clinical Trials.gov) was limited to original articles describing interventions in adult humans, with no limits for publication date or language. Study Selection : Articles were searched independently by 2 reviewers, from October 2013 to April 2015. Studies were eligible for inclusion if they were conducted in adult patients with a diagnosis of cachexia and provided information on type of ghrelin or analogue used, route of administration and dose administered, duration of intervention, outcomes, and clinical trial study design. Data Extraction : Data were extracted independently by 2 reviewers using a preconstructed spreadsheet. Initially, 573 references were identified. Seven articles describing 379 participants were selected for review. Results : Ghrelin was found to have a predominantly positive effect on growth hormone plasma levels, weight gain, increases in lean mass, and reductions in loss of adipose tissue. Conclusions : Although the studies reviewed here report positive results, there is still little evidence available on the use of ghrelin to treat cachexia. Further research is required to determine conclusively whether the use of ghrelin in patients with cachexia is a viable therapy.

Importance The presumed proarrhythmic action of caffeine is controversial. Few studies have assessed the effect of high doses of caffeine in patients with heart failure due to left ventricular systolic dysfunction at high risk for ventricular arrhythmias. Objective To compare the effect of high-dose caffeine or placebo on the frequency of supraventricular and ventricular arrhythmias, both at rest and during a symptom-limited exercise test. Design, Setting, and Participants Double-blinded randomized clinical trial with a crossover design conducted at the heart failure and cardiac transplant clinic of a tertiary-care university hospital. The trial included patients with chronic heart failure with moderate-to-severe systolic dysfunction (left ventricular ejection fraction Interventions Caffeine (100 mg) or lactose capsules, in addition to 5 doses of 100 mL decaffeinated coffee at 1-hour intervals, for a total of 500 mg of caffeine or placebo during a 5-hour protocol. After a 1-week washout period, the protocol was repeated. Main Outcomes and Measures Number and percentage of ventricular and supraventricular premature beats assessed by continuous electrocardiographic monitoring. Results We enrolled 51 patients (37 [74%] male; mean [SD] age, 60.6 [10.9] years) with predominantly moderate-to-severe left ventricular systolic dysfunction (mean [SD] left ventricular ejection fraction, 29% [7%]); 31 [61%] had an implantable cardioverter-defibrillator device. No significant differences between the caffeine and placebo groups were observed in the number of ventricular (185 vs 239 beats, respectively; P = .47) and supraventricular premature beats (6 vs 6 beats, respectively; P = .44), as well as in couplets, bigeminal cycles, or nonsustained tachycardia during continuous electrocardiographic monitoring. Exercise test–derived variables, such as ventricular and supraventricular premature beats, duration of exercise, estimated peak oxygen consumption, and heart rate, were not influenced by caffeine ingestion. We observed no increases in ventricular premature beats (91 vs 223 vs 207 beats, respectively) in patients with higher levels of plasma caffeine concentration compared with lower plasma levels ( P = .91) or with the placebo group ( P = .74). Conclusions and Relevance Acute ingestion of high doses of caffeine did not induce arrhythmias in patients with systolic heart failure and at high risk for ventricular arrhythmias. Trial Registration clinicaltrials.gov Identifier:NCT02045992

Metabolic syndrome (MS) has been associated with proteinuria and reduced glomerular filtration rate. Immunosuppressive agents increase the incidence of traditional risk factors for cardiovascular disease (CVD) and have known effects on MS components after kidney transplantation. The purpose of this meta-analysis was to evaluate the impact of MS on relevant outcomes after kidney transplantation. MEDLINE, EMBASE, and Cochrane Library were searched up to November 7, 2015. Papers that compared patients with and without MS and assessed one of the following outcomes, graft loss, death by cardiovascular disease, and all-cause mortality, were included. Of 585 studies identified, five studies including 1269 patients were evaluated. MS was identified as a risk factor for graft loss [relative risk, 3.06; 95% confidence interval (CI), 2.17, 4.32; I² = 0%; P heterogeneity = 0.72] and death by CVD (relative risk, 3.53; 95% CI, 1.27, 9.85; I² = 0%; P heterogeneity = 0.40). Results on the association between MS and all-cause mortality were inconclusive (relative risk, 2.61; 95% CI, 0.70, 9.81; I² = 58%; P heterogeneity = 0.09). Graft loss and death by CVD were associated with the presence of MS after transplantation. Randomized clinical trials should be conducted to define whether interventions on each MS component would result in better outcomes after transplantation.

Background and objective: Nonadherence to sodium restriction is one of the main precipitating factors of heart failure (HF) decompensation. The three-subscale Dietary Sodium Restriction Questionnaire (DSRQ) enables evaluation of factors that can interfere with adherence. The objective of this study was to assess knowledge, barriers, and attitudes of patients with decompensated HF toward dietary sodium, by comparing those hospitalized for decompensation due to dietary nonadherence (alone or with medication nonadherence) versus those admitted for decompensation due to other causes. Methods: Cross-sectional study carried out at the emergency departments of two public hospitals in Southern Brazil between 2013 and 2014. The sample included patients admitted for decompensated HF. Patients were divided into two groups: decompensation due to nonadherence to diet (alone or with medication nonadherence) and other causes. Results: A total of 225 patients were included (mean age 66 ± 12 years). Patients exhibited a high degree of knowledge about sodium restriction (up to 50\% achieved 40 of 45 points). The opinions of family and health professionals influenced adherence. The main barriers to adherence concerned palatability and dietary preferences. When compared to patients admitted for other causes, those decompensated due to nonadherence had lower ejection fraction ( p = .004) and higher Perceived Behavioral Control subscale scores ( p = .009). Conclusions: Patients have a high level of knowledge about sodium restriction. The opinion of significant others affects adherence. Nonadherent patients appeared to be more severely ill and endorsed a greater number of barriers that prevent adequate behavior. Some factors-particularly the taste of foods and patients’ dietary preferences – may justify the high prevalence of nonadherence.

Background The effects of obesity on outcomes reported after kidney transplantation have been controversial. The purpose of this systematic review and meta-analysis was to elucidate this issue. Methods MEDLINE, EMBASE, Cochrane Library, and gray literature were searched up to August 6, 2013. Studies that compared obese and nonobese patients who underwent kidney transplantation and evaluated one of these outcomes-delayed graft function (DGF), acute rejection, graft or patient survival at 1 or 5 years after transplantation, or death by cardiovascular disease (CVD)-were included. Two independent reviewers extracted the data and assessed the quality of the studies. Results From 1,973 articles retrieved, 21 studies (9,296 patients) were included. Obesity was associated with DGF (relative risk, 1.41; 95% confidence interval, 1.26-1.57; I=8%; Pheterogeneity=0.36), but not with acute rejection. Graft loss and death were associated with obesity only in the analysis of studies that evaluated patients who received a kidney graft before year 2000. No association of obesity with graft loss and death was found in the analysis of studies that evaluated patients who received a kidney graft after year 2000. Death by CVD was associated with obesity (relative risk, 2.07; 95% confidence interval, 1.17-3.64; I=0%; Pheterogeneity=0.59); however, most studies included in this analysis evaluated patients who received a kidney graft after year 2000. Conclusion In conclusion, obese patients have increased risk for DGF. In the past years, obesity was a risk factor for graft loss, death by CVD, and all-cause mortality. However, for the obese transplanted patient today, the graft and patient survival is the same as that of the nonobese patient.

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.