Carla Maria Avesani

The main objective of the SARC-HD study is to investigate the trajectories of sarcopenia stages and examine their potential determinants in chronic kidney disease patients undergoing dialysis regimens.

Chronic non-communicable diseases result from chronic inflammation caused by oxidative stress. Oxidative stress represents the imbalance between free radicals and antioxidants and is associated with inflammatory activity and the development and worsening of many diseases, such as neurological and cardiovascular disorders, kidney and neoplastic diseases and increased risks related to obesity. Encouraging the consumption of fresh foods with a high nutrient content, such as fruits, vegetables, sprouted grains and seed oils, is a strategy that is in accordance with the nutritional guidelines of most countries, which take into account a healthier diet. plant-based, with less ultra-processed foods and less environmental impact. These foods generally contain bioactive compounds that are substances that have plant protection characteristics, antioxidant action, and also potential benefits for the prevention and control of human diseases related to oxidative stress. The health benefits obtained through bioactive compounds are based on intake levels and the amount of these compounds that become bioaccessible and bioavailable to the body. Bioaccessibility represents the amount of a compound that is released from the food matrix into the gastrointestinal tract and becomes available for absorption, while bioavailability represents the fraction of an ingested nutrient or bioactive compound that reaches the systemic circulation and consequently specific locations. to perform its biological function. On the other hand, the microbiological quality of these foods needs to be investigated, since foods generally consumed raw can spread pathogens and are involved in several outbreaks of waterborne and foodborne diseases around the world. Therefore, studies that evaluate the levels of bioactive compounds and the antioxidant activity of in natura plant foods, as well as the bioaccessibility of these compounds through in vitro digestion methods, are fundamental for future clinical trials aimed at controlling and preventing chronic diseases not transmissible, also taking into account the microbiological quality of these foods in order to prevent food outbreaks. Therefore, this project aims to evaluate the content of bioactive compounds and the antioxidant activity of natural plant foods, as well as the in vitro bioaccessibility of these compounds and the microbiological quality of these foods.

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Life expectancy on the globe has increased significantly since 1950. It is estimated that the number of individuals aged over 65 will increase from 524 million to 1.5 billion between 2010 and 2050. prevalence of chronic noncommunicable diseases (NCDs) will also suffer a significant increase in their incidence and prevalence, since aging predisposes to the development of this group of conditions. As aging and NCDs can, independently, lead to reduced muscle mass, strength and sedentary lifestyle

the elderly individual and/or with CNCDs constitute groups highly susceptible to the development of frailty and sarcopenia. Thus, the objective of this project is to investigate the prevalence of frailty and sarcopenia in groups of individuals vulnerable to their development and to propose interventions aimed at their rehabilitation.

The growth in the number of elderly individuals is a worldwide phenomenon and is taking place at an unprecedented level in Brazil and around the world. A consequence of population aging is the development of non-communicable chronic diseases, including chronic kidney disease (CKD). This result alerts to the potential increase in the incidence and prevalence of elderly individuals on dialysis therapy in Brazil and worldwide. Thus, the health team must be prepared to meet the treatment needs that are particular to this population. In particular, it is worth mentioning the care given to the nutritional condition. Elderly individuals, regardless of whether they have CKD, often have changes in their nutritional status, with a marked reduction in muscle mass, increased body fat and decreased food intake. These alterations can be more pronounced in elderly patients with CKD on dialysis, due to the metabolic disturbances caused by the disease itself that overlap those of aging. Therefore, elderly patients on dialysis constitute a group highly susceptible to the development of protein-energy malnutrition (PEM). However, there are few studies that have investigated the nutritional status of elderly patients on hemodialysis (HD). Furthermore, there are no studies that sought to assess how the association between nutritional markers and increased mortality rates behaves in elderly patients on HD. Therefore, the objective of this study will be to identify the protein-energy malnutrition marker capable of better predicting morbidity and mortality in elderly patients with CKD undergoing HD treatment. Methods: This work has an observational, longitudinal and prospective design. We evaluated 173 elderly patients (> 60 years old) undergoing HD treatment, who will be followed up for up to 36 months for the outcome of hospitalization and mortality events. Assessment of nutritional status was performed using objective measures (anthropometry, bioelectrical impedance, handgrip strength (HGS), serum albumin, geriatric nutritional risk index and 3-day food record) and subjective measures (7-point subjective global assessment (SGA ) and Malnutrition Inflammation Score (MIS)). These variables were tested in a continuous and categorical manner, using commonly used cutoff points for patients with CKD. In addition, serum urea, creatinine, complete blood count and ultrasensitive c-reactive protein (rusCRP) were evaluated. To evaluate the survival curves, the Kaplan-Meier method will be used and the Log-rank test will be used to compare the curves. To assess the association between nutritional parameters and mortality, hazard ratios will be calculated, adjusted for covariates, and their respective 95% confidence intervals, using Cox proportional hazards models. The evaluation of the best nutritional markers will be performed using c-statistics.

This project includes studies in animal models and also patients with kidney diseases. It focuses on nutritional status as well as the effects of nutritional interventions on different aspects of kidney disease. Still, it aims to compare the different composite methods for diagnosing protein-energy malnutrition in patients with kidney disease.

This project's main objective is to evaluate the level of physical activity and energy expenditure for this component of total energy expenditure in a group of 40 patients undergoing hemodialysis treatment. For this, a biaxial accelerometer will be used.

The growth in the number of elderly is a worldwide phenomenon and is occurring at an unprecedented level. Projections indicate that by 2050 the world's elderly population will be 1.9 billion people. In Brazil, it is estimated that by 2020 this number could exceed 30 million people, accounting for nearly 13% of the population. As already shown in previous work, advancing age is associated with increased prevalence of CKD. Thus, the number of elderly individuals starting dialysis tends to increase. Added to this, it has been observed increased survival of patients on chronic dialysis program, due to improvements in dialysis and low output patients for renal transplantation in Brazil. Therefore, these results highlight the potential increase in patients on dialysis in Brazil and worldwide. Given this high prevalence of elderly on dialysis, one has to have a particular care for this population. In particular, it is worth mentioning the care spent on nutritional status. Elderly individuals, regardless of course with CKD often have reduced muscle mass and changes in nutritional status. As CKD progresses with a series of disorders that increase protein catabolism, elderly patients with CKD are a group highly susceptible to the development of protein-energy malnutrition (PEM). However, few studies evaluating the nutritional status of elderly patients on hemodialysis. Thus, the aim of this study is to evaluate the nutritional status of elderly patients with chronic kidney disease on chronic hemodialysis treatment. This study will cross-sectional design of case-control. For this, it included 50 patients on hemodialysis (HD group) and 50 elderly subjects without CKD (control group) matched for sex, age and BMI with the HD group. In both groups, included are individuals over 60 years. The assessment of nutritional status will be the evaluation of body composition (anthropometry, absorptiometry dual energy X-ray absorptiometry (DEXA and bioelectrical impedance analysis (BIA), the handgrip (dynamometer), the subjective global assessment, laboratory examination (serum albumin )

. the resting energy expenditure (indirect calorimetry) and food intake (dietary record of 3 days) Other laboratory tests are urea, serum creatinine, C-reactive protein, total cholesterol and fractions and triglycerides Only in the control group, too. creatinine clearance will be conducted to ascertain the level of renal function. To compare the HD group and control group will be used the paired Student t test or Wilcoxin test paired, depending on the distribution of the sample. In all tests, the significance level will be 5% (p ≤ 0.05). The statistical package used is the MedCalc® version 9.1.0.1.