Luis Felipe Nunes de Oliveira

Introduction: Obesity is a disease that induces various changes in the body, including oxidative stress, which can contribute to the development of cancer cells in the thyroid. Objective: Evaluate whether the presence of obesity and antioxidant defense is associated with the diagnosis of malignant thyroid nodules in adult women. Methods: The cross-sectional study consisted of 109 females diagnosed with nodular thyroid disease who underwent thyroidectomy surgery, with benignity or malignancy classification previously defined by Fine Needle Aspiration Biopsy (FNAB) and the Bethesda system. The participants had anthropometric and clinical markers assessed before the surgical process. The prevalence ratio of malignant nodules with obesity and antioxidant markers was determined using Poisson regression analysis. Results: After biopsy analysis, 70 women were diagnosed with a benign nodule and 39 with a malignant nodule. A significant association was found between body mass index and nodule type (p<0.015). All but one participant had glutathione peroxidase and superoxide dismutase enzyme activity above the reference values. The prevalence of malignant nodules was significantly higher in women diagnosed with obesity (PR=1.94; 95% CI: 1.01 - 3.17; p=0.046) compared to those without obesity. Antioxidant markers showed no association with nodule malignancy. Conclusion: The prevalence of malignant thyroid nodules in adult women is higher in those who are obese, and the presence of thyroid nodules, regardless of their type, can influence the increase in antioxidant enzyme activity.

Introduction: Mental disorders, particularly depression and anxiety, represent a leading source of morbidity and disability in young adults, a group increasingly exposed to cumulative psychological processes and environmental stressors. Although evidence links healthy dietary patterns with improved mental health symptoms, the specific contribution of nut consumption (rich in anti-inflammatory, antioxidant, and neuroprotective compounds) remains insufficiently examined in this population. Current evidence also lacks robust data on the dose–response effects of nut consumption and mechanistic pathways involving biomarkers relevant to brain function and mental health. The Nuts4Brain-RCT will investigate the impact of a 6-month mixed-nut consumption intervention on mental health symptoms, cognitive functioning, sleep quality, overall well-being, health-related quality of life, and biochemical brain function mediators in young adults. Methods and analysis: A 6-month, randomized, single-blinded, three-arm, dose–response, parallel-group clinical trial will be conducted with 135 university students aged 18–24 years from the University of Castilla-La Mancha, Cuenca, Spain. The participants will be randomly assigned in a 1:1:1 ratio to one of three groups: (1) a control group maintaining their habitual diet while avoiding nut consumption; (2) a 30 g/day mixed-nut consumption group; or (3) a 60 g/day mixed-nut consumption group. The nut consumption intervention will include unsalted, unroasted walnuts, almonds, hazelnuts, and pistachios. The primary outcomes will include depressive (BDI-II) and anxiety (GAD-7) symptoms, perceived stress (PSS-10), cognitive performance (NIH Toolbox), and plasma brain-derived neurotrophic factor (BDNF). Assessments will take place at baseline and at 3 (intermediate), 6 (end of intervention) and 12 months (follow-up). Repeated-measures mixed-effects models will be applied to estimate the effects of nut consumption and dosage on mental health outcomes. Ethics and dissemination: The study adheres to the principles of the Declaration of Helsinki and the Singapore Statement on Research Integrity and obtained approval from the Clinical Research Ethics Committee of the Virgen de la Luz Hospital, Cuenca, Spain (REG: 2025/E0125). The findings will be disseminated through high-impact open-access peer-reviewed publications, presentations at scientific conferences, and social media platforms. Trial registration: ClinicalTrials.gov. Identifier: NCT07292610.

Objective: To evaluate the agreement between the overweight and obesity classifications of the World Health Organization (WHO), the International Obesity Task Force (IOTF), and the Brazilian Reference (BR) proposed by Conde and Monteiro in adolescents, and to verify the association of these classifications with cardiometabolic risk (CMR). Methods: A cross-sectional study was conducted with 823 adolescents (aged 10-19 years) from municipal schools in Fortaleza, Ceará. Nutritional status was classified according to three body mass index references. CMR was defined by the simultaneous presence of insulin resistance, identified by the waist-to-height ratio, and dyslipidemia, assessed by biochemical tests (total cholesterol, HDL-c, LDL-c, and triglycerides). Agreement between classifications was assessed using the Kappa (κ) statistic, and the association with CMR was analyzed using Poisson regression. Results: All classifications showed excellent agreement, with weighted κ values ranging from 0.85 to 0.95. The highest agreement was between WHO and IOTF references (κ=0.95; 95%CI 0.93-0.97), while the lowest was between WHO and BR (κ=0.85; 95%CI 0.82-0.88). Despite the lower agreement, the diagnosis of obesity according to the BR reference demonstrated strong clinical relevance, being associated with an 8.51-fold higher prevalence of CMR in adolescents (95%CI 6.38-11.35). Conclusions: BR showed a stronger association with CMR. The inclusion of this classification may optimize the early detection of CMR in Brazilian health services, helping to prevent cardiometabolic disorders in this population.

Objective: The aim of this study was to evaluate the role of the triglyceride-glucose (TyG) index in identifying changes in lipid profile and atherogenic risk in adolescents, according to the presence or absence of excess weight. Methods: This cross-sectional study included 823 students aged 10–18 years, classified as having or not having excess weight based on body mass index. Lipid profile was assessed and classified according to the guidelines of the Brazilian Society of Cardiology. Atherogenic risk was evaluated using the Castelli I and II indices, the Atherogenic Index of Plasma, and the atherogenic coefficient. The TyG index was assessed in tertiles. The association between TyG and lipid and atherogenic outcomes was analyzed using logistic and linear regression, stratified by excess weight status. Results: Elevated TyG was associated with altered total cholesterol (TC), high-density lipoproteincholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c), and non-HDL-c in adolescents without excess weight (p<0.001), whereas in those with excess weight, this association was found only in TC and non-HDL-c. All atherogenic indices were positively associated with elevated TyG (p<0.001). Conclusions: Adolescents without excess weight showed clearer associations between TyG and lipid profile; however, atherogenic risk was directly associated with elevated TyG, regardless of the presence or absence of excess weight.

A pré-eclâmpsia (PE) é uma complicação gestacional grave associada a desfechos adversos para a saúde materna e neonatal, mas sua interação com o estado nutricional materno sobre o baixo peso ao nascer (BPN) permanece pouco explorada. Este estudo teve como objetivo verificar a associação entre a presença de pré-eclâmpsia e o baixo peso ao nascer de acordo com o estado nutricional pré-gestacional e final da gestante. Trata-se de um estudo caso-controle realizado com 118 puérperas internadas em um hospital de referência em Ginecologia e Obstetrícia do estado do Ceará. As participantes foram divididas em dois grupos, sendo 58 do grupo caso e 60 do grupo controle. Foram avaliados dados gestacionais e condições de saúde do recém-nascido, parâmetros pressóricos e antropométricos, as informações foram coletadas através dos registros dos prontuários e do cartão de acompanhamento pré-natal da gestante. Os dados foram analisados utilizando o programa Statistical Package for the Social Sciences 22.0, considerando o nível de significância p> 0,05. Nos recém-nascidos com BPN, houve maior média de pressão arterial sistólica no terceiro trimestre de gestação e maior prevalência de PE. Não houve associação significativa entre PE e BPN quando estratificada pelo IMC pré-gestacional, entretanto, na presença de excesso de peso ao final da gestação, a PE aumentou em 113% a prevalência de BPN (RP ajustada = 2,13; p = 0,019). Conclui-se que o excesso de peso materno no final da gestação potencializa o risco de BPN em gestantes com PE, ressaltando a importância do acompanhamento nutricional durante a gravidez.

Avaliar a qualidade da dieta e a atividade física de crianças e adolescentes e sua associação com a classificação simultânea pelo índice de Massa Corporal (IMC) e Percentual de Gordura Corporal (%GC). Estudo de base escolar desenvolvido com 1027 estudantes, de 7 a 18 anos. Foram coletados dados antropométricos, como peso, estatura, circunferência da cintura e %GC através de bioimpedância. O estado nutricional foi determinado através do IMC-por-idade e uma classificação que utiliza simultaneamente o IMC e o %GC. A qualidade da dieta e o nível de atividade física foram avaliados por questionários validados. Regressão logística foi utilizada para verificar associação entre a classificação simultânea pelo IMC/I e %GC e as variáveis de exposição (qualidade da dieta e atividade física). A maioria dos estudantes era ativo ou muito ativo e quase 60% não tinham uma dieta de boa qualidade. Não houve associação entre nível de atividade física ou qualidade da dieta e a classificação simultânea segundo o IMC/I e %GC combinados. Os estudantes avaliados apresentaram um bom nível de atividade física e maior prevalência de qualidade da dieta média e baixa, entretanto essas variáveis não foram associadas a classificação simultânea utilizada.

Durante a adolescência os indivíduos exercem uma maior autonomia alimentar e são fortemente influenciados pelo ambiente no qual estão inseridos. Diante disso, os alimentos ultraprocessados (AUP) tornam-se mais presentes na rotina dos adolescentes, causando preocupação acerca de potenciais riscos à saúde e ao comprometimento da qualidade da dieta. Este estudo tem como objetivo identificar na literatura as evidências científicas mais atuais sobre a relação entre consumo de AUP e ingestão de sódio em adolescentes. Trata-se de uma revisão integrativa que partiu da seguinte pergunta norteadora: “Quais as evidências científicas sobre a relação entre consumo de AUP e ingestão de sódio em adolescentes?”. As buscas foram realizadas nas bases de dados Pubmed, Web of science e Lilacs. Em seguida, os estudos foram exportados para a plataforma Rayyan, onde ao aplicar os critérios de exclusão, foram selecionados o total de 5 estudos. Nossos achados indicaram que, à medida que a proporção de calorias provenientes de AUP na dieta aumenta, há uma elevação na ingestão total de sódio. Em adolescentes com mais de 30% das calorias diárias derivadas desses produtos, a quantidade de sódio consumida ultrapassou em até 190% o limite recomendado pela OMS. Ademais, em alguns estudos, o consumo de AUP foi associado ao aumento de risco cardiometabólico nessa faixa etária, o que se deve a composição nutricional desequilibrada desses alimentos. Portanto, concluímos que o consumo excessivo de AUP em adolescentes eleva a ingestão de sódio e o risco cardiometabólico, exigindo regulamentação através de políticas públicas ao acesso a esses produtos.

Objective: To evaluate the performance of waist-to-height ratio (WHtR) and conicity index (CIndex) as predictors of body fat percentage (BF) in children, as well as to determine the most appropriate cut-off points for this population. Methods: This school-based study assessed 314 children aged five to nine years. Body composition was evaluated using bioelectrical impedance analysis (BIA), and children were classified as having excess or normal BF according to sex. WHtR and CIndex were calculated using their respective formulas. To assess the predictive power of CIndex and WHtR, the area under the curve (AUC) of Receiver Operating Characteristic was analyzed, using excess BF by BIA as the gold standard. Results: WHtR was considered a good predictor of excess BF in both sexes, with AUC values greater than 0.8. CIndex was classified as a poor predictor (AUC0.45 for girls. Conclusions: WHtR demonstrated good performance in predicting excess BF in the children evaluated and may be included in child health surveillance as an indicator of alterations in body composition.

Background: Children and adolescents with obesity have altered serum copper (Cu) and zinc (Zn) levels, which are associated with oxidative stress, inflammation, and health outcomes. The inclusion of cashew nuts in an adequate diet may provide health benefits and help improve the mineral status of individuals with obesity. Objective: To evaluate the effects of cashew nut consumption on biomarkers of Cu and Zn status in adolescents with obesity. Methods: This was a randomized controlled trial conducted in adolescents. The participants were divided into a control group (CON) and a cashew nut group (CASN). The CASN group received 30 g/day of roasted cashew nuts for 12 weeks, and both groups received nutritional counseling during the study. Anthropometric, dietary, and biochemical parameters (Zn, Cu, and superoxide dismutase (SOD)) were assessed at the baseline and at the end of the study. Association tests, within-group and between-group mean comparisons, and analyses of variation between study periods (Δ T12-T0) were performed. Results: The sample consisted of 81 adolescents who completed the intervention period, resulting in 54 in the CASN group and 27 in the CON group. After the intervention, the CASN group presented a decrease in plasma Cu (p = 0.004) and an increase in SOD (p = 0.030). Both groups showed an increase in plasma Zn (p < 0.050) and a decrease in the Cu/Zn ratio (p < 0.001). CASN had a negative effect on the Cu concentration, which was significantly different from that of CON (p = 0.004). Conclusions: The consumption of cashew nuts for 12 weeks reduced plasma Cu levels in adolescents with obesity. Nutritional counseling may have contributed to the increase in plasma Zn levels in all the study participants.

Rationale/objective The phase angle (PhA) is a measurement obtained from the resistance and reactance found in the bioelectrical impedance examination and is useful in assessing nutritional status and in assessing cardiometabolic diseases. Therefore, the objective was to correlate the phase angle to the anthropometric variables of cardiometabolic risk (CMR) in children and adolescents. Subjects/methods Weight, height, body mass index (BMI), waist circumference (WC) and neck circumference (NC), waist-to-height ratio (WHtR), and PhA of 1231 children and adolescents aged between 5 and 18 years were assessed. PhA was assessed in tertiles and CMR was identified using the anthropometric variables BMI, WC, NC, and WHtR. Linear regression models were used to verify the association between PhA tertiles and CMR anthropometric variables, stratified by sex. Results No relationship was found between PhA and CMR variables in children. In adolescents, lower values of NC (β = -0.019, p = 0.005) and BMI (β = -0.025, p = 0.023) were found in boys, WC (β = -0.017, p = 0.020), WHtR (β = -0.017, p = 0.020), NC (β = -0.011, p = 0.027) and BMI (β = -0.026, p = 0.009) in girls when they were in tertile 1 when compared to tertile 3 of the PhA, even after adjusting for age. Conclusion The PhA was directly associated with CMR in the assessed adolescents.