Sara Policarpo

INTRODUCTION: Antiretroviral therapy and the appearance of comorbidities in people living with human immunodeficiency virus contribute to an increased cardiovascular risk. OBJECTIVES: Assess the evolution of nutritional status, cardiovascular risk and mediterranean diet and physical activity level in a cohort of infected patients. METHODOLOGY: This is a longitudinal observational study based on a cohort previously evaluated and who maintained regular follow-up. Patients were reassessed after 5 years on anthropometric parameters, dietary intake (food frequency questionnaire, MedDietScore), cardiovascular risk (DAD Risk Tool). Physical Activity data was only obtained in the 5th year (International Physical Activity Questionnaire). RESULTS: The sample had an average age of 52.0±9.3years, were mostly male with a mean HIV infection time of 17.9±6.9 years. There was a percentual increase regarding baseline of 2% in type 2 diabetes, 11.4% in dyslipidemia, 0.7% in hypertension and 12.5% in metabolic syndrome. After 5 years, mediterranean diet adherence was higher (28.9±5.2 vs. 27.9±5.7); caloric intake was lower (1781±622 vs. 2173±432); 77.6% had a moderate Physical Activity level and a daily sedentary behavior of 244.4±173.9 minutes; 54.7% had a very high 5 year-CVR. CONCLUSIONS: Aging and the presence of comorbidities are a concern. Lifestyle interventions must be part of the management of the disease.

INTRODUÇÃO: A manutenção do peso perdido a longo prazo é um desafio, pelo que é essencial compreender os fatores envolvidos. OBJETIVOS: Analisar o índice inflamatório da dieta de indivíduos portugueses com sucesso na gestão do peso, explorando a sua associação com a magnitude de perda de peso e o índice de massa corporal, e com indicadores de comportamento alimentar e depressão, assim como explorar a relação destas variáveis entre si. METODOLOGIA: Foram utilizados dados do Registo Nacional de Controlo do Peso (n=205; 59,5% mulheres; 38,97 ± 10,82 anos; 25,76 ± 3,99 kg/m2). A ingestão alimentar foi avaliada através do Questionário semi-quantitativo de Frequência Alimentar, a partir do qual foi calculado o índice inflamatório da dieta; o comportamento alimentar (alimentação emocional e externa) através do Dutch Eating Behaviour Questionnaire; e o nível de depressão através do Beck Depression Index. RESULTADOS: O índice inflamatório da dieta variou de -3,67 a 3,64. Observou-se uma associação negativa entre o índice inflamatório da dieta e a magnitude de perda de peso na amostra total (r=-0,151, p=0,043) e no sexo feminino (r=-0,225, p=0,021). Relativamente ao índice de massa corporal, encontrou-se uma associação positiva com o índice de depressão (r=0,276, p<0,001) e com a alimentação emocional (r=0,284, p<0,001). Adicionalmente, o índice de depressão associou-se de forma positiva com a alimentação externa (r=0,322, p<0,001) e emocional (r=0,403, p<0,001). CONCLUSÕES: Uma alimentação anti-inflamatória parece associar-se a maior magnitude de perda de peso em mulheres com sucesso na manutenção do peso perdido, o que sugere que o índice inflamatório da dieta poderá ser um fator relevante no que diz respeito à gestão do peso nesta população em particular. À medida que o índice de massa corporal aumenta, parece aumentar também o nível de depressão e a alimentação emocional não só nestas mulheres, mas também nos homens. Uma melhor compreensão da relação entre estes e outros fatores envolvidos na gestão do peso com sucesso poderá ́contribuir para o delineamento de intervenções do estilo de vida mais apropriadas.

The term metabolic-associated fatty liver disease (MAFLD) has been proposed to define positively fatty liver disease in the form associated with metabolic risk factors. The aim of this study was to assess the dietary intake of MAFLD and explore a possible relationship between its inflammatory characteristics (assessed by Dietary Inflammatory Index—DII^®), the degree of liver fibrosis (assessed by transient elastography), and the amount of alcohol intake. MAFLD patients were included (n = 161) and were classified, according to the amount of alcoholic intake, as MAFLD without alcohol intake (n = 77) and MAFLD with alcohol intake (n = 84), with 19 presenting harmful alcoholic consumption. Dietary intake was 1868 ± 415 kcal/day and did not present differences in energy or nutrient intake based on the presence of metabolic comorbidities. Patients with MAFLD and alcohol intake consumed significantly more energy and presented a tendency for higher intake of carbohydrates and sugar. Patients with harmful alcohol intake presented a higher intake of total fat and cholesterol compared with moderate alcohol intake. There were no differences in DII^® based on fibrosis severity or the amount of alcohol consumption. This work contributes to the characterization of baseline dietary intake in MAFLD patients, paving the way to design more suited dietary interventional trials.

Introduction: Lifestyle changes are the mainstay treatment of nonalcoholic fatty liver disease (NAFLD). We aimed to assess the magnitude of weight loss in a group of NAFLD patients followed on a combined lifestyle intervention by a multidisciplinary team. Methods: Patients were assessed before and after a 12-month dietary intervention (Mediterranean diet aiming at weight loss). Patients who received a structured dietary plan along with general lifestyle recommendations were designated as the multidisciplinary treatment (MdT) group. Patients who declined follow-up still received general lifestyle recommendations and were designated as the conventional treatment group, being used as a control group. Results: From the 77 patients with documented NAFLD, 31.2% of patients were overweight and 55.8% obese; 66 patients constituted the MdT group and 11 the conventional treatment group. After 3 months, 89% of patients lost weight; at 6 months, 75.4% maintained the weight lost. At 12 months, 65% of patients still decreased their weight, with 92.2% of patients in the MdT group still maintaining a lower weight than baseline versus just 50% in the conventional group (p = 0.008). Only patients in the MdT group presented a weight loss higher than 10% (9.6%; n = 6). At 12 months patients in the MdT group presented an average reduction of 4.2 kg versus a reduction of just 0.6 kg in the conventional treatment group (p = 0.016). The MdT group, but not the conventional group, presented significant differences in liver enzymes at 12 months compared to baseline. Conclusion: Adherence to a multidisciplinary approach, compared to management solely by a hepatologist, in NAFLD patients, is effective with greater weight loss after a 12-month follow-up and a lower rate of weight gain recurrence.