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Background: Nutritional screening is defined by American Society for Parenteral and Enteral Nutrition (ASPEN) as a process to identify individuals at risk of malnutrition. Malnutrition is a prevalent condition in cirrhotic patients, and it results in important prognostic implications. Most of the commonly used instruments fail in considering the particularities of cirrhotic patients. The Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) is a nutritional screening tool developed and validated to identify malnutrition risk in patients with liver disease. Objective The study’s aim was to conduct the transcultural adaptation (translation and adaptation) of RFH-NPT tool to Portuguese (Brazil). Methods: The process of cultural translation and adaptation followed the Beaton et al. methodology. The process involved the steps of initial translation, synthesis translation, back translation pretest of the final version with 40 nutritionists and a specialists committee. The internal consistency was calculated with the Cronbach coefficient and the content validation was verified with the content validation index. Results: Forty clinical nutritionists with experience in treatment of adult patients participated in the step of cross-cultural adaptation. The alpha Cronbach coefficient was 0.84, which means high reliability. In the specialists analyzes all the tool’s questions achieved a validation content index higher than 0.8, showing high agreement. Conclusion: The NFH-NPT tool was translated and adapted to Portuguese (Brazil) and showed high reliability.

The association between dairy product consumption and cardiovascular health remains highly debated. We quantitatively synthesized prospective cohort evidence on the associations between dairy consumption and risk of hypertension (HTN), coronary heart disease (CHD), and stroke. We systematically searched PubMed, Embase, and Web of Science through August 1, 2020, to retrieve prospective cohort studies that reported on dairy consumption and risk of HTN, CHD, or stroke. We used random-effects models to calculate the pooled RR and 95% CI for the highest compared with the lowest category of intake and for a 1-serving/d increase in consumption. We rated the quality of evidence using NutriGrade. Fifty-five studies were included. Total dairy consumption was associated with a lower risk of HTN (RR for highest compared with lowest level of intake: 0.91, 95% CI: 0.86, 0.95, I(2) = 73.5%; RR for 1-serving/d increase: 0.96, 95% CI: 0.94, 0.97, I(2) = 66.5%), CHD (highest compared with lowest level of intake: 0.96, 95% CI: 0.92, 1.00, I(2) = 46.6%; 1-serving/d increase: 0.98, 95% CI: 0.95, 1.00, I(2) = 56.7%), and stroke (highest compared with lowest level of intake: 0.90, 95% CI: 0.85, 0.96, I(2) = 60.8%; 1-serving/d increase: 0.96, 95% CI: 0.93, 0.99, I(2) = 74.7%). Despite moderate to considerable heterogeneity, these associations remained consistent across multiple subgroups. Evidence on the relation between total dairy and risk of HTN and CHD was of moderate quality and of low quality for stroke. Low-fat dairy consumption was associated with lower risk of HTN and stroke and high-fat dairy with a lower risk of stroke. Milk, cheese, or yogurt consumption showed inconsistent associations with the cardiovascular outcomes in high compared with low intake and dose–response meta-analyses. Total dairy consumption was associated with a modestly lower risk of hypertension, CHD, and stroke. Moderate to considerable heterogeneity was observed in the estimates, and the overall quality of the evidence was low to moderate.

Heart failure is associated with high rates of hospitalization, which are more prevalent in frail patients, impacting the quality of life and clinical outcomes. Telemedicine is considered cost-effective for improving patient self-management and hospitalization. However, socioeconomic deprivation and frailty could hinder access to virtual care. We investigated if frailty and socioeconomic factors were associated with telemedicine access among heart failure patients. For this cross-sectional analysis of Continuum study, 35 patients were allocated to the “able to use” group (had a smart device and were able to use it) or the “not able to use” group. Socioeconomic deprivation was determined according to the deprivation index. Frailty was assessed using the Fried criteria. The mean age was 69.9 ± 9 years, 74% were in New York Heart Association class II. A total of 14 patients (39%) were physically frail. Patients considered not able to use the app were more socioeconomically deprived ( p = 0.011) and frail ( p = 0.036). There was no correlation between frailty score and socioeconomic deprivation ( r = 0.15, p = 0.411). Telemedicine use seems to be independently associated with frailty and socioeconomic deprivation in heart failure patients. More efforts should be made to foster the inclusion of vulnerable patients and improve global telemedicine access.

Summary Introduction The multidisciplinary health practitioners can facilitate adherence to treatment of hypertension. Nutritional recommendations delivered by an expert in nutrition might increase the blood pressure control through a better comprehension about how nutrition plays a role on hypertension. Objective To evaluate the effect of nutritional intervention performed by a multidisciplinary team with and without registered dietitians compared to usual care in blood pressure control of hypertensive patients. Methodology Systematic review including randomized clinical trials that assessed participants >18 years, both sexes, with blood pressure ≥140/90 mmHg or use of antihypertensive, ≥8 weeks duration and at least one nutritional planned intervention versus usual care. The search was conducted in July 2015 in MEDLINE, EMBASE, BIREME, Web of Science and LILACS without limitation to language. Outcome was defined as deltas of systolic (SBP) and diastolic blood pressure (DBP). Sub-group analysis was conducted according to the presence or not of the registered dietitians in the staff. The analyses were performed in RevMan 5.3 software, using random effects model with heterogeneity assessed by statistical I 2 . Results From 7280 identified titles, 62 studies were selected for data extraction, and 13 were included in the meta-analysis, with a total of 2050 participants. There was a greater reduction in ΔSBP −2.82 mmHg (95% CI: 4.03 to −1.62) and ΔDBP −1.37 mmHg (95% CI: −2.11 to −0.62) when diet recommendations have been delivered by multi-professional team versus usual care. In stratified analyses only the subgroup of studies with registered dietitians showed statistical significant reduction in blood pressure ΔSBP −3.21 mmHg (95% CI: −4.14 to −2.27); ΔDBP −1.46 mmHg (95% CI: −2.06 to −0.86). There were significant differences between the deltas of blood pressure according to sodium restriction (ΔSBP −3.5 mmHg (95% CI: −4.52 to −2.48), ΔDBP −1.69 mmHg (95% CI: −2.36 to −1, 02)) and caloric restriction (ΔSBP −2.83 mmHg (95% CI: −5.11 to −0.54); ΔDBP −0.92 mmHg (95% CI: −2.21 to 0.37)) only when there was a registered dietitians in the multidisciplinary team. Conclusion Nutritional recommendation made by multidisciplinary team has a statistical significant effect on blood pressure control in hypertensive patients, mainly when a registered dietitian is present in the team.

Objective: To analyze the dual interference between cardiac implantable electronic devices (CIEDs) and bioelectrical impedance analysis (BIA). Methods: Forty-three individuals admitted for CIEDs implantation were submitted to a tetrapolar BIA with an alternating current at 800 microA and 50 kHz frequency before and after the devices’ implantation. During BIA assessment, continuous telemetry was maintained between the device programmer and the CIEDs in order to look for evidence of possible electric interference in the intracavitary signal of the device. Results: BIA in patients with CIEDs was safe and not associated with any device malfunction or electrical interference in the intracardiac electrogram of any electrode. After the implantation of the devices, there were significant reductions in BIA measurements of resistance, reactance, and measurements adjusted for height resistance and reactance, reflecting an increase (+ 1 kg; P

espanolIntroduccion: la desnutricion es comun en pacientes hospitalizados y se esta convirtiendo en causa o consecuencia de enfermedades graves, asociandose a morbilidad, mortalidad y costos aumentados. Multiples factores contribuyen a un estado nutricional deficiente. La gastrostomia endoscopica percutanea (PEG) es un procedimiento minimamente invasivo para la administracion de nutricion enteral en pacientes con capacidad limitada de ingesta oral que tengan el tracto gastrointestinal intacto y funcional. El objetivo de este estudio fue determinar el perfil de pacientes sometidos a PEG en un hospital terciario del sur de Brasil. Metodos: estudio retrospectivo unicentrico de todos los pacientes sometidos a PEG del 1 de enero al 31 de diciembre de 2016 en un hospital terciario privado del sur de Brasil. Se recolectaron los datos retrospectivamente en los registros medicos, incluyendo estado nutricional, indicaciones, complicaciones y evolucion. Resultados: ciento treinta y tres pacientes se sometieron a PEG en nuestra institucion y fueron elegibles para el estudio. La edad mediana fue de 82 anos y el 57,9% eran mujeres. Las principales indicaciones para PEG fueron demencia y accidente cerebrovascular. El 68,4% fueron diagnosticados con desnutricion grave y el 23,0% presentaron complicaciones relacionadas al procedimiento. Conclusiones: se utilizan cada vez mas tubos de PEG para nutricion enteral en pacientes disfagicos o incapaces de mantener una ingesta nutricional adecuada. Nuestros hallazgos senalan la importancia del cribado para riesgo nutricional por un equipo multidisciplinario, con atencion especial al estado nutricional del paciente y a condiciones que pueden ponerlo en riesgo para disfagia y la implementacion de medidas para minimizar la desnutricion. EnglishBackground: malnutrition is a common problem in hospitalized patients, being associated with increased morbidity, mortality and costs. Multiple factors contribute to a deficient nutritional status, making malnutrition the cause or consequence of severe diseases. Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive procedure indicated for long-term administration of enteral nutrition in patients with limited ability for oral intake who have an intact, functional gastrointestinal tract. The aim of this study was to determine the profile of patients undergoing PEG in a tertiary hospital in southern Brazil. Methods: single-center retrospective study of all patients who underwent PEG from January 1st to December 31st, 2016, in a private tertiary hospital located in southern Brazil. Data were collected retrospectively from the patients’ medical records, including nutritional status, indications, complications and outcomes. Results: one hundred and thirty-three patients underwent PEG at our institution and were eligible for inclusion in the study. Median patient age was 82 years, and 57.9% were females. The main indication for PEG was dementia syndrome, followed by stroke. As much as 68.4% were diagnosed as severely malnourished and 23.0% had procedure-related complications. Conclusions: PEG tubes are being increasingly used for enteral nutrition in patients with dysphagia or inability to maintain adequate nutritional intake. The findings of the present study highlight the importance of regular nutritional risk screening by a multidisciplinary team, paying special attention to the patient’s nutritional status and conditions that may place the patient at risk of developing dysphagia, with the implementation of measures to minimize malnutrition in hospitalized patients.

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

Our aim was to develop a food frequency questionnaire (FFQ) to estimate vitamin K intake in patients receiving warfarin. We conducted a cross-sectional study. The FFQ was designed based on a literature review, and included foods containing ≥ 5 µg/100 g consumed by the study group. The correlation between the intake of vitamin K estimated by the questionnaire and habitual intake measured by two 24-hour dietary recalls was assessed, as well as correlations between FFQ, International Normalized Ratio (INR) and serum vitamin K levels. The mean intake of vitamin K, estimated by the FFQ, was 112.6± 82.7 µg/day, and the habitual dietary intake estimated by 24-hour dietary recalls was 85.1±75.5 µg/ day, with a significant correlation between both methods (r= 0.756; p< 0.001). There was no correlation between FFQ and INR (r= 0.054; p= 0.716), or between FFQ and serum vitamin K (r= -0.005; p= 0.982). The strong correlation between vitamin K intake measured by FFQ and habitual dietary intake measured by 24-hour dietary recalls suggests that the FFQ can be used to estimate vitamin K intake. RESUMEN El objetivo de este trabajo fue desarrollar un cuestionario de frecuencia de consumo (CFC) para estimar la ingesta de vitamina K en pacientes que reciben warfarina. La investigación correspondió a un estudio transversal. El CFC se basó en una revisión de la literatura e incluyó alimentos que contenían ≥ de 5 µg/100 g. Se evaluó la correlación entre la ingesta de vitamina K estimada por el CFC y la ingesta habitual medida por dos recordatorios del consumo de las últimas 24 horas (R24). También se evaluó las correlaciones entre CFC, relación normalizada internacional (RNI) y los niveles séricos de vitamina K. La ingesta media de vitamina K, estimada por el CFC, fue de 112.6±82.7 µg/día, y la ingesta dietética habitual estimada por los R24 fue de 85.1±75.5 µg/día, con una correlación significativa entre ambos métodos (r= 0.756; p< 0.001). No hubo correlación entre CFC e RNI (r= 0.054; p= 0.716), o entre CFC y vitamina K sérica (r=-0.005; p= 0.982). La fuerte correlación entre la ingesta de vitamina K medida por CFC y los dos R24 sugiere que el CFC puede usarse para estimar el consumo de vitamina K.

Aims The relationship between caffeine consumption and the occurrence of arrhythmias remains controversial. Despite this lack of scientific evidence, counselling to reduce caffeine consumption is still widely advised in clinical practice. We conducted a systematical review and meta-analysis of interventional studies of the caffeine effects on ventricular arrhythmias. Methods and results The search was performed on Pubmed, Embase, and Cochrane database, and terms related to coffee, caffeine, and cardiac arrhythmias were used. Methodological quality was assessed based on The Cochrane Collaboration recommendations and the ARRIVE guidelines. There were 2016 citations retrieved on the initial research. After full-text assessment, seven human and two animal studies were included in the meta-analysis. In animal studies, the main outcome reported was the ventricular fibrillation threshold. We observed a significant mean difference of −2.15 mA (95% CI −3.43 to −0.87; I 2 0.0%, P for heterogeneity = 0.37). The main outcome evaluated in human studies was the rate of ventricular premature beats (VPBs). The overall relative risk for occurrence of VPBs in 24 h attributed to caffeine exposure was 1.00 (95% CI 0.94–1.06; I 2 13.5%, P for heterogeneity = 0.32). Sensitivity analysis for caffeine dose, different designs, and subject profile was performed and no major differences were observed. Conclusion Our meta-analysis demonstrates that data from human interventional studies do not show a significant effect of caffeine consumption on the occurrence of VBPs. The effects observed in animal studies are most probably the result of very high caffeine doses that are not regularly consumed in a daily basis by humans.

Background: Although heart failure (HF) has high morbidity and mortality, studies in Latin America on causes and predictors of in-hospital mortality are scarce. We also do not know the evolution of patients with compensated HF hospitalized for other reasons. Objective: To identify causes and predictors of in-hospital mortality in patients hospitalized for acute decompensated HF (ADHF), compared to those with HF and admitted to the hospital for non-HF related causes (NDHF). Methods: Historical cohort of patients hospitalized in a public tertiary hospital in Brazil with a diagnosis of HF identified by the Charlson Comorbidity Index (CCI). Results: A total of 2056 patients hospitalized between January 2009 and December 2010 (51% men, median age of 71 years, length of stay of 15 days) were evaluated. There were 17.6% of deaths during hospitalization, of which 58.4% were non-cardiovascular (63.6% NDHF vs 47.4% ADHF, p = 0.004). Infectious causes were responsible for most of the deaths and only 21.6% of the deaths were attributed to HF. The independent predictors of in-hospital mortality were similar between the groups and included: age, length of stay, elevated potassium, clinical comorbidities, and CCI. Renal insufficiency was the most relevant predictor in both groups. Conclusion: Patients hospitalized with HF have high in-hospital mortality, regardless of the primary reason for hospitalization. Few deaths are directly attributed to HF; Age, renal function and levels of serum potassium, length of stay, comorbid burden and CCI were independent predictors of in-hospital death in a Brazilian tertiary hospital. Resumo Fundamento: Apesar da insuficiência cardíaca (IC) apresentar elevada morbimortalidade, são escassos os estudos na América Latina sobre causas e preditores de mortalidade intra-hospitalar. Desconhece-se, também, a evolução de pacientes com IC compensada hospitalizados por outros motivos. Objetivo: Identificar causas e preditores de mortalidade intra-hospitalar em pacientes que internam por IC aguda descompensada (ICAD), comparativamente aqueles que possuem IC e internam por outras condições (ICND). Métodos: Coorte histórica de pacientes internados em um hospital público terciário no Brasil com diagnóstico de IC identificados pelo escore de comorbidade de Charlson (ECCharlson). Resultados: Foram avaliados 2056 pacientes que internaram entre janeiro de 2009 e dezembro de 2010 (51% homens; idade mediana de 71 anos; tempo de permanência de 15 dias). Ocorreram 17,6% de óbitos durante a internação, dos quais 58,4% por causa não cardiovascular (63,6% ICND versus 47,4% ICAD, p = 0,004). As causas infecciosas foram responsáveis pela maior parte dos óbitos e apenas 21.6% das mortes foram atribuídas à IC. Os preditores independentes de mortalidade intra-hospitalar foram semelhantes entre os grupos e incluíram: idade, tempo de permanência, potássio elevado, comorbidades clínicas e ECCharlson. A insuficiência renal foi o preditor de maior relevância em ambos grupos. Conclusão: Pacientes internados com IC apresentam elevada mortalidade intra-hospitalar, independentemente do motivo primário de internação. Poucos óbitos são diretamente atribuídos à IC; Idade, alteração na função renal e níveis séricos de potássio, tempo de permanência, comorbidades e ECCharlson foram preditores independentes de morte intra-hospitalar em hospital terciário brasileiro. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Há poucos estudos sobre o Programa Nacional de Alimentação Escolar (PNAE) em escolas indígenas no país. O objetivo do presente artigo é descrever características de funcionamento, gestão e cardápios do PNAE de todas as 35 escolas Kaingáng do Rio Grande do Sul, Brasil. Em estudo transversal, as informações do PNAE foram recolhidas por meio de questionários aplicados a cada Coordenadoria Regional de Educação (CRE) e às escolas. Foram obtidos os cardápios sugeridos pelas CREs às escolas. Não existia o Núcleo de Educação Indígena nas CREs. Todos os vice-diretores eram indígenas, 26 escolas (74,6%) tinham gestão escolarizada e 34 escolas (97,1%) compravam alimentos de mercados próximos. A maioria das merendeiras (62,9%) tinha contrato de trabalho temporário e 65,7% eram indígenas. Observou-se baixa oferta de verduras/legumes e de leite e derivados em cerca de 60% dos cardápios, o mesmo ocorrendo com leguminosas e frutas em cerca de 80% destes. Aponta-se a necessidade de mais estudos sobre o PNAE indígena e pretende-se subsidiar políticas públicas de saúde, alimentação e nutrição para o espaço escolar indígena nacional. Few studies have focused on the National School Nutrition Program (PNAE) in indigenous schools in Brazil. The current study describes the program’s operations, management, and menus in 35 Kaingáng indigenous schools in Rio Grande do Sul State, Brazil. A cross-sectional study design was used to obtain information on the program through questionnaires submitted to the Regional Educational Offices (CRE) and to the schools. The menus suggested to the schools by the regional offices were obtained. There were no Centers for Indigenous Education in the regional offices. All the assistant principals were indigenous, 26 schools (74.6%) practiced local management of the meal program, and 34 (97.1%) reported purchasing food from local markets. Most cooks (63.9%) had temporary work contracts with the schools and 65.7% were indigenous. Low offerings of veges, milk and dairy products were observed in around 60% of the menus, and legumes and fruits low in around 80%. It points out the need for more studies about the indigenous PNAE and intends to support public policies in health, food and nutrition for the national indigenous school . Hay pocos estudios sobre el Programa Nacional de Alimentación Escolar (PNAE) en las escuelas indígenas del país. El objetivo es describir características de la gestión, la operatividad y los menús del PNAE de 35 escuelas Kaingáng de Río Grande do Sul, Brasil. Se trata de un estudio transversal, donde las informaciones del PNAE se obtuvieron por medio de cuestionarios aplicados a las Coordinaciones Regionales de Educación (CRE) y a las escuelas. Fueron obtenidos los menús sugeridos por las CRE a las escuelas. No existía el Centro para la Educación Indígena en las CRE. Todos los sub-directores eran indígenas, 26 (74,7%) escuelas tenían gestión escolarizada y 34 escuelas hacían la compra de alimentos en mercados próximos. La mayoría de los cocineros (62,9%) tenía un contrato de trabajo temporal y un 65,7% eran indígenas. Se observó una baja oferta de verduras y leche y derivados en alrededor de 60% de los menús y de leguminosas y frutas en alrededor de un 80%. Se indica la necesidad de más estudios sobre el PNAE indígena y se pretende subvencionar políticas públicas de salud, alimentación y nutrición para el espacio escolar indígena nacional.

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.

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

Background: Heart failure (HF) is a complex syndrome and is recognized as the ultimate pathway of cardiovascular disease (CVD). Studies using nutritional strategies based on dietary patterns have proved to be effective for the prevention and treatment of CVD. Although there are studies that support the protective effect of these diets, their effects on the prevention of HF are not clear yet. Methods: We searched the Medline, Embase, and Cochrane databases for studies that examined dietary patterns, such as dietary approaches to stop hypertension (DASH diet), paleolithic, vegetarian, low-carb and low-fat diets and prevention of HF. No limitations were used during the search in the databases. Results: A total of 1119 studies were identified, 14 met the inclusion criteria. Studies regarding the Mediterranean, DASH, vegetarian, and Paleolithic diets were found. The Mediterranean and DASH diets showed a protective effect on the incidence of HF and/or worsening of cardiac function parameters, with a significant difference in relation to patients who did not adhere to these dietary patterns. Conclusions: It is observed that the adoption of Mediterranean or DASH-type dietary patterns may contribute to the prevention of HF, but these results need to be analyzed with caution due to the low quality of evidence.

Few studies have focused on the National School Nutrition Program (PNAE) in indigenous schools in Brazil. The current study describes the program's operations, management, and menus in 35 Kaingáng indigenous schools in Rio Grande do Sul State, Brazil. A cross-sectional study design was used to obtain information on the program through questionnaires submitted to the Regional Educational Offices (CRE) and to the schools. The menus suggested to the schools by the regional offices were obtained. There were no Centers for Indigenous Education in the regional offices. All the assistant principals were indigenous, 26 schools (74.6%) practiced local management of the meal program, and 34 (97.1%) reported purchasing food from local markets. Most cooks (63.9%) had temporary work contracts with the schools and 65.7% were indigenous. Low offerings of veges, milk and dairy products were observed in around 60% of the menus, and legumes and fruits low in around 80%. It points out the need for more studies about the indigenous PNAE and intends to support public policies in health, food and nutrition for the national indigenous school .

Background Most reports regarding the obesity paradox have focused on body mass index (BMI) to classify obesity and the prognostic values of other indirect measurements of body composition remain poorly examined in heart failure (HF). Objective To evaluate the association between BMI and other indirect, but easily accessible, body composition measurements associated with the risk of all-cause mortality in HF. Methods Anthropometric parameters of body composition were assessed in 344 outpatients with a left ventricular ejection fraction (LVEF) of ≤50% from a prospective HF cohort that was followed-up for 30 ± 8.2 months. Survival was evaluated using the Kaplan-Meier method and Cox proportional hazard regression analysis. Results HF patients were predominantly male, of non-ischemic etiology, and had moderate to severe LV systolic dysfunction (mean LVEF = 32 ± 9%). Triceps skinfold (TSF) was the only anthropometric index that was associated with HF prognosis and had significantly lower values in patients who died (p = 0.047). A TSF ≥ 20 mm was present in 9% of patients that died and 22% of those who survived (p = 0.027). Univariate analysis showed that serum creatinine level, LVEF, and NYHA class were associated with the risk of death, while Cox proportional hazard regression analysis showed that TSF ≥ 20 was a strong independent predictor of all-cause mortality (hazard ratio = 0.36; 95% CI = 0.13-0.97, p = 0.03). Conclusion Although BMI is the most widely used anthropometric parameter in clinical practice, our results suggested that TSF is a better predictive marker of mortality in HF outpatients.

Caracterizar o estado nutricional de 3.254 Kaingáng de escolas indígenas de 12 terras indígenas do Rio Grande do Sul, Brasil. Transversal de base escolar. Obtidas medidas de peso (P), estatura (E) e circunferência da cintura (CC) conforme Organização Mundial da Saúde - OMS (1995). Classificação do estado nutricional: crianças: índices E/I, P/I e P/E, de acordo com o National Center for Health Statistics (WHO, 1995) e E/I, P/I e índice de massa corporal/idade (IMC/I) de acordo com OMS (2006); adolescentes: IMC/I (OMS, 1995 e 2006) e E/I (OMS, 2006); adultos: IMC (OMS, 1995) e CC (OMS, 2003). Adolescentes representaram 56% dos avaliados, crianças 42,5%, adultos 1,4% e idosos 0,1%. Deficit estatural de 15,1% (OMS, 1995) e 15,5% (OMS, 2006) entre as crianças e de 19,9% entre adolescentes. Freqüências de excesso de peso foram: crianças: 11% (OMS, 1995) e 5,7% (OMS, 2006); adolescentes: 6,7%; adultos: 79,2%. Entre adultos, 45,3% estavam em risco aumentado para doenças metabólicas. Observada a transição nutricional no segmento, caracterizada por prevalências importantes de baixa estatura na infância e adolescência e sobrepeso proeminente em todas as faixas etárias. The study's objective was to characterize the nutritional status of 3,254 Kaingáng Indians in indigenous schools in Rio Grande do Sul State, Brazil. This was a school-based study. Weight (W), height (H), and waist circumference (WC) were measured according to World Health Organization guidelines (1995). Children's nutritional status classification included H/A, W/A, and W/H according to the National Center for Health Statistics (WHO, 1995) and H/A, W/A, and body mass index/age (BMI/A) according to WHO (2006). Adolescents were classified for BMI/A (WHO, 1995 and 2006) and H/A (WHO, 2006). Adults were classified for BMI (WHO, 1995) and WC (WHO, 2003). Adolescents represented 56% of the sample, children 42.5%, adults 1.4%, and elderly 0.1%. Prevalence rates for stunting were 15.1% (WHO, 1983) and 15.5% (WHO, 2006) in children and 19.9% in adolescents. Prevalence rates for overweight were 11% (WHO, 1983) and 5.7% (WHO, 2006) in children, 6.7% in adolescents, and 79.2% in adults. 45.3% of adults were at increased risk of metabolic diseases. A nutritional transition was observed in the group, characterized by significant prevalence of stunting in children and adolescents and prominent overweight in all age groups.

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.