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Plasma Concentration of Essential and Toxic Trace Elements After Brazil Nut Intake: Results from a Randomized Controlled Trial.
Duarte, GBS, Reis, BZ, Rogero, MM, Barbosa, F, Cercato, C, Cozzolino, SMF
Biological trace element research. 2023;(3):1112-1117
Abstract
Brazil nut (BN) is a good source of essential nutrients, but little is known about the content of other components, such as toxic elements. Moreover, the high consumption of BN could probably contribute to increased levels of toxic and essential elements in the blood. Thus, this study aimed to evaluate the concentration of essential and toxic trace elements in BN and their concentration in plasma of obese women after regular intake of BN. A randomized controlled clinical trial was carried out with 55 subjects that were randomly assigned to either the Brazil nut group (BN) (n = 29) or the control group (CO) (n = 26) and followed up for 2 months. The BN group consumed one unit of Brazil nut per day, and the CO group did not receive any intervention. The concentration of essential elements (zinc, copper, manganese, and cobalt) and toxic (barium, lead, and cadmium) in BN samples and plasma of obese women (before and after the intervention) were determined by inductively coupled plasma mass spectrometry. Barium followed by copper, and manganese were the trace elements present in higher amounts in Brazil nuts. After the BN intervention period was observed an increase in plasma cadmium (p = 0.002) and a reduction of plasma manganese (p < 0.001) levels. In conclusion, our findings suggest that the regular consumption of BN from the Brazilian Amazon rainforest contributes to the intake of essential trace elements and can be considered safe regarding the content of heavy metals.
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2.
Effect of a single high dose of vitamin D3 on cytokines, chemokines, and growth factor in patients with moderate to severe COVID-19.
Fernandes, AL, Murai, IH, Reis, BZ, Sales, LP, Santos, MD, Pinto, AJ, Goessler, KF, Duran, CSC, Silva, CBR, Franco, AS, et al
The American journal of clinical nutrition. 2022;(3):790-798
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Abstract
BACKGROUND The modulating effect of vitamin D on cytokine concentrations in severe coronavirus disease 2019 (COVID-19) remains unknown. OBJECTIVES We aimed to investigate the effect of a single high dose of vitamin D3 on cytokines, chemokines, and growth factor in hospitalized patients with moderate to severe COVID-19. METHODS This is a post hoc, ancillary, and exploratory analysis from a multicenter, double-blind, placebo-controlled, randomized clinical trial. Patients with moderate to severe COVID-19 were recruited from 2 hospitals in São Paulo, Brazil. Of 240 randomly assigned patients, 200 were assessed in this study and randomly assigned to receive a single oral dose of 200,000 IU vitamin D3 (n = 101) or placebo (n = 99). The primary outcome was hospital length of stay, which has been published in our previous study. The prespecified secondary outcomes were serum concentrations of IL-1β, IL-6, IL-10, TNF-α, and 25-hydroxyvitamin D. The post hoc exploratory secondary outcomes were IL-4, IL-12p70, IL-17A, IFN-γ, granulocyte-macrophage colony-stimulating factor (GM-CSF), IL-8, IFN-inducible protein-10 (IP-10), macrophage inflammatory protein-1β (MIP-1β), monocyte chemoattractant protein-1 (MCP-1), vascular endothelial growth factor (VEGF), and leukocyte count. Generalized estimating equations for repeated measures, with Bonferroni's adjustment, were used for testing all outcomes. RESULTS The study included 200 patients with a mean ± SD age of 55.5 ± 14.3 y and BMI of 32.2 ± 7.1 kg/m2, of which 109 (54.5%) were male. GM-CSF concentrations showed a significant group-by-time interaction effect (P = 0.04), although the between-group difference at postintervention after Bonferroni's adjustment was not significant. No significant effects were observed for the other outcomes. CONCLUSIONS The findings do not support the use of a single dose of 200,000 IU vitamin D3, compared with placebo, for the improvement of cytokines, chemokines, and growth factor in hospitalized patients with moderate to severe COVID-19.This trial was registered at clinicaltrials.gov as NCT04449718.
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Effect of a Single High Dose of Vitamin D3 on Hospital Length of Stay in Patients With Moderate to Severe COVID-19: A Randomized Clinical Trial.
Murai, IH, Fernandes, AL, Sales, LP, Pinto, AJ, Goessler, KF, Duran, CSC, Silva, CBR, Franco, AS, Macedo, MB, Dalmolin, HHH, et al
JAMA. 2021;(11):1053-1060
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IMPORTANCE The efficacy of vitamin D3 supplementation in coronavirus disease 2019 (COVID-19) remains unclear. OBJECTIVE To investigate the effect of a single high dose of vitamin D3 on hospital length of stay in patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS This was a multicenter, double-blind, randomized, placebo-controlled trial conducted in 2 sites in Sao Paulo, Brazil. The study included 240 hospitalized patients with COVID-19 who were moderately to severely ill at the time of enrollment from June 2, 2020, to August 27, 2020. The final follow-up was on October 7, 2020. INTERVENTIONS Patients were randomly assigned to receive a single oral dose of 200 000 IU of vitamin D3 (n = 120) or placebo (n = 120). MAIN OUTCOMES AND MEASURES The primary outcome was length of stay, defined as the time from the date of randomization to hospital discharge. Prespecified secondary outcomes included mortality during hospitalization; the number of patients admitted to the intensive care unit; the number of patients who required mechanical ventilation and the duration of mechanical ventilation; and serum levels of 25-hydroxyvitamin D, total calcium, creatinine, and C-reactive protein. RESULTS Of 240 randomized patients, 237 were included in the primary analysis (mean [SD] age, 56.2 [14.4] years; 104 [43.9%] women; mean [SD] baseline 25-hydroxyvitamin D level, 20.9 [9.2] ng/mL). Median (interquartile range) length of stay was not significantly different between the vitamin D3 (7.0 [4.0-10.0] days) and placebo groups (7.0 [5.0-13.0] days) (log-rank P = .59; unadjusted hazard ratio for hospital discharge, 1.07 [95% CI, 0.82-1.39]; P = .62). The difference between the vitamin D3 group and the placebo group was not significant for in-hospital mortality (7.6% vs 5.1%; difference, 2.5% [95% CI, -4.1% to 9.2%]; P = .43), admission to the intensive care unit (16.0% vs 21.2%; difference, -5.2% [95% CI, -15.1% to 4.7%]; P = .30), or need for mechanical ventilation (7.6% vs 14.4%; difference, -6.8% [95% CI, -15.1% to 1.2%]; P = .09). Mean serum levels of 25-hydroxyvitamin D significantly increased after a single dose of vitamin D3 vs placebo (44.4 ng/mL vs 19.8 ng/mL; difference, 24.1 ng/mL [95% CI, 19.5-28.7]; P < .001). There were no adverse events, but an episode of vomiting was associated with the intervention. CONCLUSIONS AND RELEVANCE Among hospitalized patients with COVID-19, a single high dose of vitamin D3, compared with placebo, did not significantly reduce hospital length of stay. The findings do not support the use of a high dose of vitamin D3 for treatment of moderate to severe COVID-19. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04449718.
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No independent associations between physical activity and clinical outcomes among hospitalized patients with moderate to severe COVID-19.
Pinto, AJ, Goessler, KF, Fernandes, AL, Murai, IH, Sales, LP, Reis, BZ, Santos, MD, Roschel, H, Pereira, RMR, Gualano, B
Journal of sport and health science. 2021;(6):690-696
Abstract
BACKGROUND Regular physical activity (PA) has been postulated to improve, or at least maintain, immunity across the life span. However, the link between physical (in)activity and coronavirus disease 2019 (COVID-19) remains to be established. This small-scale prospective cohort study is nested within a randomized controlled trial aimed to investigate the possible associations between PA levels and clinical outcomes among hospitalized patients with moderate to severe COVID-19. METHODS Hospitalized patients with COVID-19 (mean age: 54.9 years) were recruited from the Clinical Hospital of the School of Medicine of the University of Sao Paulo (a quaternary referral teaching hospital) and from Ibirapuera Field Hospital, both located in Sao Paulo, Brazil. PA level was assessed using the Baecke Questionnaire of Habitual Physical Activity. The primary outcome was hospital length of stay. The secondary outcomes were mortality, admission to the intensive care unit (ICU), and mechanical ventilation requirement. RESULTS The median hospital length of stay was 7.0 ± 4.0 days, median ± IQR; 3.3% of patients died, 13.8% were admitted to the ICU, and 8.6% required mechanical ventilation. Adjusted linear regression models showed that PA indices were not associated with hospital length of stay (work index: β = -0.57 (95% confidence interval (95%CI): -1.80 to 0.65), p = 0.355; sport index: β = 0.43 (95%CI: -0.94 to 1.80), p = 0.536; leisure-time index: β = 1.18 (95%CI: -0.22 to 2.59), p = 0.099; and total activity index: β = 0.20 (95%CI: -0.48 to 0.87), p = 0.563). None of the PA indices were associated with mortality, admission to the ICU, or mechanical ventilation requirement (all p > 0.050). CONCLUSION Among hospitalized patients with COVID-19, PA did not independently associate with hospital length of stay or any other clinically relevant outcomes. These findings should be interpreted as meaning that, among already hospitalized patients with more severe forms of COVID-19, being active is a potential protective factor likely outweighed by a cluster of comorbidities (e.g., type 2 diabetes, hypertension, weight excess) and older age, suggesting that the benefit of PA against the worsening of COVID-19 may vary across stages of the disease.
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Zinc nutritional status influences ZnT1 and ZIP4 gene expression in children with a high risk of zinc deficiency.
Reis, BZ, Vieira, DADS, Maynard, DDC, Silva, DGD, Mendes-Netto, RS, Cozzolino, SMF
Journal of trace elements in medicine and biology : organ of the Society for Minerals and Trace Elements (GMS). 2020;:126537
Abstract
INTRODUCTION Subclinical deficiency of zinc is associated with impairment of immune system function, growth, and cognitive development in children. Although plasma zinc is the best available biomarker of the risk of zinc deficiency in populations, its sensitivity for early detection of deficiency is limited. Therefore, we aimed to investigate zinc deficiency among preschool children and its relationship with whole blood gene expression of zinc transporters ZIP4 and ZnT1. MATERIAL AND METHODS This cross-sectional study included 139 children aged 32-76 months enrolled in philanthropic day-care centers. We performed an anthropometric evaluation, weighed food record and dietary record for dietary assessment, blood sample collection for zinc, and whole blood gene expression analyses of ZnT1 (SLC30A1) and ZIP4 (SLC39A4). RESULTS Zinc deficiency was observed in 26.6 % of the children despite adequate zinc intake and a phytate:zinc molar ratio < 18. Usual zinc intake did not affect whole blood gene expression of zinc transporters, but zinc status influenced ZnT1 and ZIP4 whole blood mRNA. Children with zinc deficiency exhibited 37.1 % higher ZnT1 expression and 45.3 % lower ZIP4 expression than children with adequate zinc (p < 0.05). CONCLUSION Children with plasma zinc deficiency exhibited higher expression of ZnT1 and lower expression of ZIP4 in whole blood mRNA, reinforcing the existence of strong regulation of mineral homeostasis according to the nutritional status, indicating that this analysis may be useful in the evaluation of dietary interventions.
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Consumption of Brazil nuts with high selenium levels increased inflammation biomarkers in obese women: A randomized controlled trial.
Duarte, GBS, Reis, BZ, Rogero, MM, Vargas-Mendez, E, Júnior, FB, Cercato, C, Cozzolino, SMF
Nutrition (Burbank, Los Angeles County, Calif.). 2019;:162-168
Abstract
OBJECTIVE Increased inflammatory response is an important factor in the pathophysiology of obesity. The mineral selenium (Se), of which one of the main food sources is the Brazil nut, has important antioxidant and anti-inflammatory functions through the action of selenoproteins. Thus, the evaluation of the influence of this micronutrient in this context is of great relevance. The aim of this study was to evaluate the effects of Brazil nut intake with high Se concentrations on inflammatory biomarkers and its relation to Se status in obese women. METHODS A randomized controlled clinical trial was carried out with 55 women recruited at Clinical Hospital in São Paulo, Brazil. Patients were randomly assigned to either the Brazil nut group (BN) or the control group (CO) and followed up for 2 mo. The BN group consumed 1 unit/d of Brazil nuts (∼ 1261 μg/Se); the CO group did not receive any intervention. At baseline and after 2 mo, analysis of biochemical parameters related to Se status, oxidative stress, and inflammatory biomarkers were performed. RESULTS At baseline, both groups did not present Se deficiency. In the BN group, a significant increase (P < 0.05) in all Se biomarkers and in gene expression of several proinflammatory parameters (interleukin-6, tumor necrosis factor-α, and Toll-like receptors 2 and 4) were observed after the intervention period. No changes were observed for the CO group. CONCLUSION Although there were no changes in plasma inflammatory biomarkers levels, a significant increase in gene expression may be an indication of a proinflammatory stimulus in obesity, induced by the consumption of Brazil nuts with high Se levels.
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Brazil nut intake increases circulating miR-454-3p and miR-584-5p in obese women.
Reis, BZ, Duarte, GBS, Vargas-Mendez, E, Ferreira, LRP, Barbosa, F, Cercato, C, Rogero, MM, Cozzolino, SMF
Nutrition research (New York, N.Y.). 2019;:40-52
Abstract
The Brazil nut is an excellent source of selenium (Se), an essential micronutrient for human health. In this study, we hypothesized that Brazil nut intake modulates circulating microRNAs (miRNAs) in obese women and aimed to evaluate the effects of this nut intake on circulating miRNAs in women with obesity or metabolic syndrome (MetS). A randomized controlled clinical trial was conducted on 54 subjects recruited from the Clinical Hospital in São Paulo, Brazil. Patients were randomly assigned to 2 groups: a Brazil nut group (BN group, n = 29) and a control group (CO group, n = 25); both were monitored for 2 months. BN group members were instructed to consume 1 Brazil nut (approximately 1261 μg/Se) per day; CO group members were instructed not to consume any. Biochemical parameters related to Se status and 25 circulating miRNAs in plasma were evaluated in all patients both at baseline and after 2 months. Expression levels of 2 miRNAs (miR-454-3p and miR-584-5p) were significantly increased after Brazil nut intake. To investigate the effect of MetS on circulating miRNAs at baseline, we performed comparisons between women with MetS (n = 23) and women without MetS (others, n = 31). Circulating miR-375 levels were significantly lower (P = .012) in women with MetS. In conclusion, our findings suggested that a daily intake of 1 Brazil nut increased circulating miR-454-3p and miR-584-5p expression levels in obese women, and our network analysis indicated a link between Se intake, vitamin D metabolism, and calcium homeostasis.
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Erythrocyte SOD1 activity, but not SOD1 polymorphisms, is associated with ICU mortality in patients with septic shock.
Costa, NA, Cunha, NB, Gut, AL, Azevedo, PS, Polegato, BF, Zornoff, LAM, de Paiva, SAR, Reis, BZ, Fernandes, AAH, Rogero, MM, et al
Free radical biology & medicine. 2018;:199-204
Abstract
The objective of our study was to evaluate the influence of the superoxide dismutase 1 (SOD1) polymorphisms on erythrocyte SOD1 activity and the mortality of patients with septic shock. We prospectively evaluated 175 patients aged over 18 years with septic shock upon ICU admission. However, 38 patients were excluded. Thus, 137 patients were enrolled in the study. Blood samples were taken within the first 24 h of the patient's admission to determine erythrocyte SOD1 activity and nine SOD1 gene polymorphisms. The mean patient age was 63 ± 16 years, 58% were men, and ICU mortality rate was 66%. The patients who died were older and more severely ill, with higher Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, as well as higher lactate, urea, and protein carbonyl levels. In the logistic regression model, erythrocyte SOD1 activity was associated with ICU mortality. This relationship was also maintained in the highest tertile of SOD1 activity (odds ratio [OR]: 0.02; 95% confidence interval [CI]: 0.00-0.78; p = 0.037). Only SNP rs2070424 of the SOD1 gene influenced erythrocyte SOD1 activity. For patients with the AA allele, the activity of SOD1 was lower in relation to G-carriers (A/G+G/G genotype) (p = 0.019). None of the nine SOD1 SNPs were associated with ICU mortality. In conclusion, the SNP rs2070424 of the SOD1 gene interferes with erythrocyte SOD1 activity, and higher activity of SOD1 was associated with decreased mortality in patients with septic shock.
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Brazil nuts: Nutritional composition, health benefits and safety aspects.
Cardoso, BR, Duarte, GBS, Reis, BZ, Cozzolino, SMF
Food research international (Ottawa, Ont.). 2017;(Pt 2):9-18
Abstract
Brazil nuts are among the richest selenium food sources, and studies have considered this Amazonian nut as an alternative for selenium supplementation. Besides selenium, Brazil nuts present relevant content of other micronutrients such as magnesium, copper, and zinc. The nutritional composition of nuts, also characterized by adequate fatty acid profile and high content of protein and bioactive compounds, has many health benefits. In the present review, we examine the nutritional composition of Brazil nuts, comparing it with other nuts, and describe the relevance of possible contaminants and metal toxicants observed in this nut for human health. Furthermore, we report different trials available in the literature, which demonstrate positive outcomes such as modulation of the lipid serum profile, enhancement of the antioxidant system and improvement of anti-inflammatory response. These effects have been assessed under different conditions, such as cognitive impairment, dyslipidemia, cancer, and renal failure.
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[Educational nutritional intervention as an effective tool for changing eating habits and body weight among those who practice physical activities].
Teixeira, PD, Reis, BZ, Vieira, DA, Costa, Dd, Costa, JO, Raposo, OF, Wartha, ER, Netto, RS
Ciencia & saude coletiva. 2013;(2):347-56
Abstract
The scope of this study was to evaluate the effectiveness of two methods of educational nutritional intervention together with women who practice regular physical activities by fostering the adoption of healthy eating habits. The study population consisted of 52 women aged between 19 and 59 who frequented the Academia da Cidade Program in Aracaju in the State of Sergipe. The study was a randomized comparison of two intervention groups and was of the pre-test/post-test variety. The educational activities were based on two protocols - one less intensive (P1 Group) and one more intensive (P2 Group) - over a period of two months. The variables analyzed were nutritional knowledge, anthropometric measurements and changes in eating habits. The changes identified were improvement in eating habits and reduction in weight and Body Mass Index for the P2 group. The modifications identified referred mainly to increased consumption of fruit and vegetables, reduction of fat in cooking, reduction in the volume of food eaten per meal and increased meal frequency. In relation to nutritional knowledge, only 2 of the 12 questions showed significant changes. The most intensive method proved effective in changing dietary habits leading to weight loss.