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- Do MAFLD patients with harmful alcohol consumption have a different dietary intake?Publication . Policarpo, Sara; Carvalhana, Sofia; Craciun, Ana; Crespo, Ricardo Rios; Cortez-Pinto, HelenaThe 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.
- Effect of HCV eradication by DAAs on liver steatosis, carotid atherosclerosis, and associated metabolic comorbidities: a systematic reviewPublication . Cespiati, Annalisa; Rodrigues, Inês Coelho; Santos, Inês; Policarpo, Sara; Carvalhana, Sofia; Fracanzani, Anna Ludovica; Cortez-Pinto, HelenaBackground and Aims The beneficial effect of Hepatitis C virus (HCV) eradication by direct antiviral agents (DAAs) on liver fibrosis is well defined. Despite this, the impact of viral eradication in both hepatic and extra-hepatic metabolic features is underreached. This systematic review aimed to synthesize the evidence on the impact of HCV eradication by DAAs on liver steatosis, carotid atherosclerosis, glucidic impairment, dyslipidaemia, and weight gain. Methods A systematic search of the existing literature (up to December 2022) identified 97 original studies that fulfilled the inclusion criteria. Results Whereas total cholesterol and low-density lipoprotein (LDL) seem to increase after viral eradication, the cardiovascular damage expressed as carotid plaques and intima-media thickness seems to improve. Otherwise, the effect on liver steatosis, glucidic homeostasis, and weight seems to be strictly dependent on the presence of baseline metabolic disorders. Conclusion Despite high heterogeneity and relatively short follow-up of included studies, we can conclude that the presence of metabolic risk factors should be strictly evaluated due to their impact on liver steatosis, glucidic and lipid homeostasis, and on weight gain to better identify patients at risk of liver disease progression despite the virus eradication.
- NAFLD nutritional management: results from a multidisciplinary approachPublication . Policarpo, Sara; Machado, Mariana; Pires Barreira, David; Cortez-Pinto, HelenaIntroduction: 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.
- Cardiovascular risk in HIV-infected individuals : a comparison of three risk prediction algorithmsPublication . Policarpo, Sara; Rodrigues, Teresa; Moreira, Ana Catarina; Valadas, EmíliaIntroduction: Cardiovascular (CV) risk is known to be increased in HIV-infected individuals. Our aim was to assess CV risk in HIV-infected adults. Methods: CV risk was estimated for each patient using three different risk algorithms: SCORE, the Framingham risk score (FRS), and DAD. Patients were classified as at low, moderate or high CV risk. Clinical and anthropometric data were collected. Results: We included 571 HIV-infected individuals, mostly male (67.1%; n=383). Patients were divided into two groups according to antiretroviral therapy (ART): naïve (7.5%; n=43) or under ART (92.5%; n=528). The mean time since HIV diagnosis was 6.7±6.5 years in the naive group and 13.3±6.1 years in the ART group. Metabolic syndrome (MS) was identified in 33.9% (n=179) and 16.3% (n=7) of participants in the ART and naïve groups, respectively. MS was associated with ART (OR=2.7; p=0.018). Triglycerides ≥150 mg/dl (OR=13.643, p<0.001) was one of the major factors contributing to MS. Overall, high CV risk was found in 4.4% (n=23) of patients when the SCORE tool was used, in 20.5% (n=117) using the FRS, and in 10.3% (n=59) using the DAD score. The observed agreement between the FRS and SCORE was 55.4% (k=0.183, p<0.001), between the FRS and DAD 70.5% (k=0.465, p<0.001), and between SCORE and DAD 72.3% (k=0.347, p<0.001). Conclusion: On the basis of the three algorithms, we detected a high rate of high CV risk, particularly in patients under ART. The FRS was the algorithm that classified most patients in the high CV risk category (20.5%). In addition, a high prevalence of MS was identified in this patient group.
- Fatty liver disease : Relevance of nutritional determinants and nutritional care in the general population and in HIV patientsPublication . Policarpo, Sara; Cortez-Pinto, Helena Maria Ramos Marques Coelho; Mendes, Catarina Ferreira Murinello de Sousa Guerreiro Fragoso
- Índice inflamatório da dieta em indivíduos com sucesso na gestão do peso: associação com indicadores de comportamento alimentar e depressãoPublication . Rodrigues Paulino, Ana Catarina; Policarpo, Sara; Santos, InêsIntrodução: 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 poderá́ contribuir para o delineamento de intervenções do estilo de vida mais apropriadas.
- Telemedicine as a tool for dietary intervention in NAFLD-HIV patients during the COVID-19 lockdown: a randomized controlled trialPublication . Policarpo, Sara; Machado, Mariana; Cortez-Pinto, HelenaBackground & aims: Given reports of changes in dietary habits during covid-19 lockdown, our aim was to assess weight changes, over a 3-month Covid-19 national lockdown in a cohort of NAFLD-HIV patients on a dietary intervention trial. Methods: After NAFLD screening in an outpatient Infectious Diseases Clinic, NAFLD patients were randomly allocated to general dietary recommendations (SC group) or to a structured dietary intervention based on the Mediterranean diet (intervention group). During lockdown, follow-up consultations in the intervention group were done by video and/or phone. After 3 months of lockdown, all patients (intervention and SC group) consented to a telephone interview which aimed to characterize eating habits and lifestyle changes and evaluate stress and depression. Biochemical data when available, was compared between the peri-period of confinement. Results: One hundred and twelve patients were screened. From the 55 NAFDL identified, 27 were allocated to dietary intervention and 28 to SC and were followed before lockdown for a mean period of 5.0 ± 1.5 months in which SC group gained a median of 0.65 kg vs. a median loss of 1.5 kg in the intervention group (p < 0.001). During lockdown, 93.3% of patients in the SC group referred that "diet got worse" vs. 6.7% in the intervention group p < 0.01), and 35.3% vs. 15.7% (p = 0.014) reported increase in appetite, respectively. Both groups gained weight, SC group vs. 0.7 ± 1.7 kg in the intervention group, p < 0.001). Higher weight gain was associated with changes in the dietary pattern (3.8 ± 2.1 kg vs. 2.0 ± 1.3 kg in "no change in dietary pattern"; p = 0.002). Glucose blood levels increased after lockdown in the SC group, with a mean increase of 15 mg/dl (p = 0.023). The remaining metabolic parameters remained unchanged. Conclusion: The maintenance of dietary intervention, using telemedicine, can mitigate the adverse change in dietary habits and physical activity pattern, preventing a substantial increase in body weight.