Marcela Tatiana Watanabe
@eduvaleavare.com.br
EDUVALE DE AVARE FACULTY
Scopus Publications
Scopus Publications
Rodrigo Hagemann, Marcela Tatiana Watanabe, João Carlos Hueb, Luis Cuadrado Martín, Vanessa dos Santos Silva, and Jacqueline do Socorro Costa Teixeira Caramori
FapUNIFESP (SciELO)
Resumo Introdução: Glomerulopatias são a terceira causa de doença renal crônica (DRC) com necessidade de diálise no Brasil. Distúrbio mineral e ósseo (DMO) é uma das complicações da DRC e está presente já nos estágios iniciais. A avaliação da espessura médio-intimal de carótidas (EMIC) e da vasodilatação fluxo-mediada (VFM) são maneiras não invasivas de avaliação do risco cardiovascular. Hipótese: Pacientes com glomerulopatias primárias (GP) apresentam alta prevalência de aterosclerose e disfunção endotelial, não explicada totalmente pelos fatores de risco tradicionais, mas provavelmente influenciada pela instalação precoce do DMO. Objetivo: Avaliar os principais marcadores de aterosclerose em pacientes com GP. Método: Estudo clínico, observacional, transversal e controlado. Foram incluídos portadores de GP e excluídos menores de 18 anos, gestantes, menos de três meses de seguimento e os com glomerulopatia secundária. Também foram excluídos aqueles que, no momento da coleta, apresentavam proteinúria maior que 6 gramas/24 horas e uso de prednisona em doses superiores a 0,2 mg/kg/dia. Resultados: 95 pacientes foram incluídos, 88 colheram os exames, 1 foi excluído e 23 não realizaram a ultrassonografia. Os pacientes com GP apresentaram maior EMIC média em relação ao controle (0,66 versus 0,60), p = 0,003. Após análise multivariada, mantiveram relevância estatística a idade e os valores de pressão arterial sistólica (PAS), VFM e TFG (p = 0,02) e VFM e ácido úrico sérico (p = 0,048). Discussão e conclusão: Pacientes com GP apresentaram maior risco cardiovascular, entretanto esse risco não foi explicitado pelo DMO precoce. Estudos clínicos randomizados e multicêntricos são necessários para melhor determinação dessa hipótese.
Rodrigo Hagemann, Marcela Tatiana Watanabe, João Carlos Hueb, Luis Cuadrado Martín, Vanessa dos Santos Silva, and Jacqueline do Socorro Costa Teixeira Caramori
FapUNIFESP (SciELO)
Abstract Introduction: Glomerulonephritis are the third cause of chronic kidney disease (CKD) requiring dialysis in Brazil. Mineral and bone disorder (MBD) is one of the complications of CKD and is already present in the early stages. Assessment of carotid intima-media thickness (CIMT) and flow-mediated vasodilatation (FMV) are non-invasive ways of assessing cardiovascular risk. Hypothesis: Patients with primary glomerulonephritis (PG) have high prevalence of atherosclerosis and endothelial dysfunction, not fully explained by traditional risk factors, but probably influenced by the early onset of MBD. Objective: To evaluate the main markers of atherosclerosis in patients with PG. Method: Clinical, observational, cross-sectional and controlled study. Patients with PG were included and those under 18 years of age, pregnants, those with less than three months of follow-up and those with secondary glomerulonephritis were excluded. Those who, at the time of exams collection, had proteinuria higher than 6 grams/24 hours and using prednisone at doses higher than 0.2 mg/kg/day were also excluded. Results: 95 patients were included, 88 collected the exams, 1 was excluded and 23 did not undergo the ultrasound scan. Patients with PG had a higher mean CIMT compared to controls (0.66 versus 0.60), p = 0.003. After multivariate analysis, age and values for systolic blood pressure (SBP), FMV and GFR (p = 0.02); and FMV and serum uric acid (p = 0.048) remained statistically relevant. Discussion and conclusion: The higher cardiovascular risk in patients with PG was not explained by early MBD. Randomized and multicentric clinical studies are necessary to better assess this hypothesis.
Marcela T. Watanabe, Pasqual Barretti, and Jacqueline C.T. Caramori
Elsevier BV
THE CONTROL OF phosphatemia has been increasingly recognized as an important strategy for dialysis patients’ because hyperphosphatemia is a risk factor for cardiovascular diseases, progression of kidney disease, and mortality in chronic kidney disease (CKD) as a whole. The prevention and correction of hyperphosphatemia are important components of CKD, achieved by dietary phosphate restriction, phosphate binders administration, and adequate dialysis. In this context, we emphasize the importance of knowledge about the phosphate content in food and we developed the ‘‘phosphate traffic light’’, as a new tool for nutrition education and suggestion to improve nutrition labels. Dietary phosphate comes in an organic form (phospholipids and phosphoproteins), such as meat and dairy products, and in an inorganic form as food additives that are increasingly added to processed foods and beverages. However, estimates of dietary phosphate intake rarely considers the amount of phosphorus in mineral supplements, water, or food additives. This is extremely important because phosphate supplied in additives is more easily absorbed in the gastrointestinal tract. Protein from animal origin, such as meat, fish, and dairy products contains phosphate mainly in an organic form which is easily hydrolyzed and absorbed by the human digestive system. High-protein plant based foods, such as legumes, nuts, cereals and seeds, contain phosphate mainly in phytate, or the phytic acid form. This type is not dissolved in the human intestine due to the lack of phytase
Marcela T. Watanabe, Pasqual Barretti, and Jacqueline C.T. Caramori
Elsevier BV
PHOSPHATEMIAREPRESENTSA dynamic balance among dietetic absorption, urinary excretion and exchanges with bone tissue, soft tissues and intracellular stocks, and by regulatory hormonal mechanisms. The kidneys are the main organs that operate in the homeostasis of phosphatemia. In advanced stages of chronic kidney disease (CKD), when urinary phosphate excretion is severely limited, dietetic absorption plays a key role in phosphatemia, highlighting the importance of dietary control in the management of these patients. Thus, prevention and correction of hyperphosphatemia are important components of CKD, achieved by dietary phosphate restriction, phosphate binders administration, and adequate dialysis. In this context, we emphasize the importance of knowledge about the phosphate content in food and in nutrition labeling. Owing to the existence of phosphate in practically all living beings, it is found in most foods. Dietary phosphate comes in an organic form, such as meat and dairy products, and in an inorganic form as additives that are increasingly added to processed foods and drinks. Protein of animal origin, such as meat, fish, and dairy products contain phosphate mainly in the organic form as phosphoesters, which are easily hydrolyzed and absorbed by the human digestive system. High-protein plant based foods, such as legumes, nuts, cereals, and seeds, contain phosphate mainly in phytate, or the phytic acid form, which is not broken down in the human intestine because of the lack of phytase
Marcela T. Watanabe, Raphael M. Araujo, Barbara P. Vogt, Pasqual Barretti, and Jacqueline C.T. Caramori
Elsevier BV
BACKGROUND AND AIMS
Hyperphosphatemia is common in patients with chronic kidney disease (CKD) stages IV and V because of decreased phosphorus excretion. Phosphatemia is closely related to dietary intake. Thus, a better understanding of sources of dietary phosphate consumption, absorption and restriction, particularly inorganic phosphate found in food additives, is key to prevent consequences of this complication. Our aims were to investigate the most commonly consumed processed foods by patients with CKD on hemodialysis, to analyze phosphate and protein content of these foods using chemical analysis and to compare these processed foods with fresh foods.
METHODS
We performed a cross-sectional descriptive analytical study using food frequency questionnaires to rank the most consumed industrialized foods and beverages. Total phosphate content was determined by metavanadate colorimetry, and nitrogen content was determined by the Kjeldahl method. Protein amounts were estimated from nitrogen content. The phosphate-to-protein ratio (mg/g) was then calculated. Processed meat protein and phosphate content were compared with the nutritional composition of fresh foods using the Brazilian Food Composition Table. Phosphate measurement results were compared with data from the Food Composition Table - Support for Nutritional Decisions. An α level of 5% was considered significant.
RESULTS
Food frequency questionnaires were performed on 100 patients (mean age, 59 ± 14 years; 57% male). Phosphate additives were mentioned on 70% of the product labels analyzed. Proteins with phosphate-containing additives provided approximately twice as much phosphate per gram of protein compared with that of fresh foods (p < 0.0001).
CONCLUSIONS
Protein and phosphate content of processed foods are higher than those of fresh foods, as well as phosphate-to-protein ratio. A better understanding of phosphate content in foods, particularly processed foods, may contribute to better control of phosphatemia in patients with CKD.