RCAAP Repository

RESUMO Objetivo: Analisar a influência de intervenções educativas nos perfis antropométricos, clínicos e bioquímicos, bem como na percepção de saúde e doença de portadores de hipertensão arterial sistêmica no contexto da Estratégia de Saúde da Família. Métodos: Estudo longitudinal, de intervenção e comparativo, realizado com portadores de hipertensão arterial sistêmica cadastrados e acompanhados pela Estratégia de Saúde da Família do município de Porto Firme, Minas Gerais, Brasil. Realizaram-se intervenções educativas, com duração de 12 meses, nas unidades de Estratégia de Saúde da Família e durante visitas domiciliárias. Analisaram-se dados socioeconômicos, hábitos de vida, cuidados de saúde, nível de apreensão e conhecimento sobre a hipertensão arterial sistêmica, percepção de saúde e doença, além das variáveis antropométricas, bioquímicas e clínicas, antes e após as intervenções. Resultados: Ainda que de forma discreta, foi possível perceber melhorias nas avaliações clínicas, bioquímicas e antropométricas. As variáveis índice de massa corporal (p=0,001), circunferência da cintura (p<0,001), glicose (p=0,011), colesterol total (p<0,001), lipoproteínas de alta densidade colesterol (p<0,001) e triglicerídeos (p=0,019) apresentaram diferenças estatisticamente significativas antes e após as intervenções. Os entrevistados mostraram incorporação de novos conhecimentos ao significado da hipertensão arterial sistêmica e a percepção de saúde e doença relacionou-se de forma mais importante com aspectos subjetivos da experiência vivencial e com a qualidade de vida em detrimento das questões biológicas e médicas. Conclusão: As intervenções educativas demonstraram importante potencial no enfrentamento da hipertensão arterial sistêmica ao promoverem alterações positivas nos perfis analisados; contudo, seu efeito tem forte relação com a continuidade das ações.

ABSTRACT Objective: To compare the effects of either a carbohydrate-restrictive diets or a conventional hypoenergetic diet combined with resistance training. Methods: Twenty-one overweight and obese adults participated in an eight-week program consisting of progressive resistance training combined with carbohydrate-restrictive diets (initially set at <30 g carbohydrate; n=12) or conventional hypoenergetic diet (30% energetic restriction; carbohydrate/protein/lipid: 51/18/31% of total energy consumption; n=9). It was hypothesized that the carbohydrate-restrictive diets would induce greater weight loss but that both diets would elicit similar effects on selected health markers. Body mass, and body composition, blood variables and flow-mediated brachial artery dilation (flow-mediated brachial artery dilation; by ultrasound) were used to assess changes due to the interventions. Results: Significant within-group reductions in body mass (-5.4±3.5%; p=0.001 versus -3.7±3.0%; p=0.015) and body fat (body fat; -10.2±7.0%; p=0.005 versus -9.6±8.8%; p=0.017) were identified for carbohydrate-restrictive diets and conventional hypoenergetic diet, respectively, but there were no significant differences between groups as the result of the interventions. Fat free mass, blood variables and flow-mediated brachial artery dilation did not significantly change, except for the total cholesterol/high-density lipoprotein ratio, which was reduced 10.4±16.9% in carbohydrate-restrictive diets (p=0.037) and 0.5±11.3% in conventional hypoenergetic diet (p=0.398). Conclusion: Carbohydrate-restrictive diets associated with resistance training was as effective as conventional hypoenergetic diet in decreasing body mass and body fat, as well as maintaining fat free mass, blood variables and flow-mediated brachial artery dilation, however it was more effective at lowering the total cholesterol/low density lipoprotein ratio.

ABSTRACT Objective: To assess the dietary intake and overall diet quality of female soccer players before the competitive games. Methods: This descriptive and cross-sectional study included 21 women aged 20.8±4.5 years from a professional soccer team. Their nutritional status and dietary adequacy during the training period, before competition season, were assessed. Dietary intake was assessed by three 24-hour recalls, one food frequency questionnaire, and the Healthy Eating Index, an overall diet quality index based on food group intake. Results: The athletes have shown proper nutritional status, but a diet deficient in energy due largely to low carbohydrate intake. On the other hand, the intakes of protein, fatty acids, and sodium were above the recommended intakes, even for athletes. Diet quality assessment by the Healthy Eating Index - 2010 resulted in a mean score of 54.6 points of a maximum of 100, indicating a need of improving the overall diet quality. Conclusion: The study found that the dietary patterns of female football players were both quantitatively and qualitatively inappropriate. A nutritional intervention is indicated to improve diet quality, with the inclusion of various foods, such as whole grains, fruits, vegetables, dairy products, and better protein quality, along with a reduction in saturated fats, sodium, and added sugar.

ABSTRACT Objective: To evaluate the impact of an Interdisciplinary Food, Nutrition and Health Education Program on nutrition knowledge, intention to change eating behavior, and body dissatisfaction of adolescent volleyball players. Methods: The sample consisted of 10 female volleyball players from the juvenile category of the city of Santos, São Paulo, Brazil, who participated in a program with eight monthly meetings (one discussion group followed by six educational activities and one final discussion group for evaluation). Results: Nutrition knowledge, body perception, intention to change eating behavior, eating attitudes and practices were investigated using questionnaires and discussion groups before and after the athletes' participation in ludic activities designed to address nutrition strategies for athletic performance and healthy eating, and how to deal with pressure for results and self-image. Nutrition knowledge improved from 57.0%±9.9 to 63.0%±11.8 (p=0.03) of correct answers. The mean body distortion score did not change (70.0±14.9 versus 76.5±22.4, p=0.235). Six athletes advanced in their intention to change eating behavior. Positive food practices were reported during the program and the identified discourses indicated the intention of changing the daily eating habits in the future. Conclusion: The program had a positive impact on nutrition knowledge and intention of changing eating behavior; however, for other issues, especially involving emotional aspects, further interventions should be planned.

RESUMO Objetivo: Investigar os efeitos da vitamina C sobre níveis de peroxidação lipídica e glutationa reduzida em tecido hepático de camundongos imunossuprimidos por ciclofosfamida. Métodos: O estudo foi realizado em camundongos Swiss, fêmeas, com 45 dias de idade, separados em quatro grupos com oito animais cada. Grupos: controle (água destilada), vitamina C (50 mg/kg), ciclofosfamida (100 + 150 mg/kg) e tratamento (vitamina C 50 mg/kg + ciclofosfamida 100 +150 mg/kg). Todas as aplicações foram via intraperitoneal. O ensaio biológico teve duração de seis dias, sendo o sétimo a eutanásia dos animais. As análises bioquímicas de peroxidação lipídica (quantificação de substâncias reativas ao ácido tiobarbitúrico) e glutationa reduzida (estimativa de tiois não proteicos) foram realizadas em tecido hepático. Resultados: A ciclofosfamida causou aumento significativo (p<0,0001) nos níveis de peroxidação lipídica. Não foram observadas alterações significativas nos grupos tratados com vitamina C. A ciclofosfamida por si só, não alterou níveis de glutationa reduzida. A vitamina C causou a redução do nível de glutationa reduzida em relação ao controle tanto nos animais que receberam ciclofosfamida quanto nos que não receberam. No entanto, nos grupos tratados com o quimioterápico houve uma interação entre a droga e a vitamina, ou seja, o quimioterápico intensificou a diminuição da glutationa reduzida provocada pela vitamina C. Conclusão: A ciclofosfamida, na dose e período utilizados, foi capaz de induzir o dano oxidativo verificado pelo aumento da peroxidação lipídica. A vitamina C, na dose de 50 mg/kg de peso, não apresentou potencial para proteger contra o dano oxidativo provocado pelo quimioterápico.

ABSTRACT Objective: This study was carried out to determine the nutritional status of shift-working female nurses at a university hospital in Ankara, Turkey. Methods: A total of 110 volunteer female nurses (n=56 control group, n=54 study group) were included in the study. A questionnaire with a three day food record collected the study data. Results: The mean daily energy intake of the study group was higher than that of the control group (1756±659 kcal versus 1694±431 kcal, p>0.05). While the carbohydrate intake (196.3±85.5 g versus 185.9±54.7 g) and fat intake (79.5±29.5 g versus 77.1±22.6 g) were higher in the study group, the protein intake was higher in the control group (59.4±17.6 g versus 57.6±21.6 g). The mean iron intake was statistically higher in the control group (10.6±2.9 mg versus 10.0±4.0 mg, p<0.05). Conclusion: To improve night shift workers' performance and nutritional status it is important to provide accessible, healthy, and quality food services.

ABSTRACT Objective: To investigate the frequency of consumption of obesogenic foods among adolescents and its association with sociodemographic, family, behavioral, and environmental variables. Methods: Secondary data from the National School-Based Student Health Hurvey were analyzed from a representative sample of 9th grade Brazilian students (high school). A self-administered questionnaire, organized into thematic blocks, was used. The dependent variables were the consumption of deep fried snacks, packaged snacks, sugar candies, and soft drinks; consumption frequency for the seven days preceding the study was analyzed. Bivariate analysis was carried out to determine the empirical relationship between the regular consumption of these foods (≥3 days/week) with sociodemographic, family, behavioral, and school structural variables. p-value <0.20 was used as the criterion for initial inclusion in the multivariate logistic analysis, which was conducted using the "Enter" method, and the results were expressed as adjusted odds ratios with 95% confidence interval and p<0.05 indicating a statistically significance. Results: Regular food consumption ranged from 27.17% to 65.96%. The variables female gender, mobile phone ownership, Internet access at home, tobacco use, alcohol consumption, regular physical activity, eating while watching television or studying, watching television for at least 2 hours a day, and not willing to lose weight were associated in the final logistic models of all foods analyzed. Conclusion: It was concluded that fried snacks, packaged snacks, sugar candies, and soft drinks are regularly consumed by adolescents and that such consumption was associated with the sociodemographic, family, behavioral, and school structural variables.

ABSTRACT Objective: To investigate whether there is a relationship between nutritional status and limitations in activities of daily living in patients with chronic obstructive pulmonary disease. Methods: A cross sectional study was conducted from July to December 2011 in Santa Catarina. Seventeen chronic obstructive pulmonary disease patients [age (years) = 67±8; forced expiratory volume in one second (% of the predicted value) = 38.6±16.1; body mass index (kg/m2) = 24.7±5.4] underwent the assessments: pulmonary function (spirometry); functional status (London Chest Activity of Daily Living scale, physical activities in daily life, and Glittre ADL-Test; nutritional status (anthropometry and dual-energy X-Ray absorptiometry). Results: The total score of the London Chest Activity of Daily Living scale correlated with fat-free mass (r=-0.50; p=0.04) and lean mass (r=-0.50; p=0.04). The lying time in physical activities in daily life correlated with bone mineral content (r=-0.50; p=0.04). Nutricional status was not correlated with time spent on Glittre ADL-test. Conclusion: Variables that reflect muscle mass depletion are related to variables of self-reported limitation in activities of daily living. Bone mineral content is correlated with time patients spend lying, reflecting the impact of inactive postures on the nutritional status of these patients.

RESUMO Objetivo: Investigar a adequação calórico-proteica de pacientes em terapia nutricional enteral exclusiva internados nas Unidades de Terapia Intensiva de um hospital universitário. Métodos: Estudo longitudinal realizado entre abril e novembro de 2014 nas Unidades de Terapia Intensiva de um hospital universitário. Foram avaliados no período de 14 dias: percentual de adequação calórico-proteica, calculada pelas médias dos valores prescritos e administrados; condições clínicas (unidade e diagnóstico de internação, escore prognóstico Acute Physiology and Chronic Health Evaluation II, estado nutricional, tempo de internação); complicações gastrointestinais; e motivo de interrupção da dieta. Valores inferiores a 80% de adequação calórica e proteica foram considerados inadequados. Realizou-se análise multivariada por Regressão de Poisson com nível de significância de 5%. Resultados: O estudo contou com uma amostra de 38 pacientes, sendo 52,63% desnutridos. As médias de adequação calórica e proteica foram de 76,47% e 69,11%, respectivamente. A prevalência de inadequação calórica foi de 55,26% e de proteica, 68,42%. O jejum para procedimentos foi a causa mais frequente de interrupção da dieta. O volume residual gástrico e a diarreia foram as complicações gastrointestinais mais comuns. A inadequação calórica associou-se ao tempo de permanência ≤14 dias e ao volume residual elevado. A inadequação proteica associou-se ao tempo de permanência ≤14 dias, ao volume residual gástrico elevado e à saída ou obstrução da sonda. Conclusão: A prevalência de inadequação calórica e proteica ocorreu em mais da metade dos pacientes avaliados. Estratégias como a elaboração de protocolos por equipe multiprofissional devem ser implantadas para minimizar interrupções da dieta administrada, estabelecer medidas de controle para complicações gastrointestinais e, assim, garantir um aporte nutricional adequado durante o período de internação.

ABSTRACT Objective: To investigate the association between serum level of 25-hydroxy vitamin D and the Vitamin D Receptos gene BsmI polymorphism in the blood profile of community-dwelling older adults. Methods: This cross-sectional study included 142 older males and females. A questionnaire collected socio demographic information, medical history, and factors associated with sun exposure. Weight, height, and waist circumference were measured. Biological material was collected to analyze biochemical parameters 25-hydroxy vitamin D, parathormone, serum calcium, urea, creatinine, liver enzymes, and blood profile) and to verify the presence of the vitamin D receptos gene BsmI polymorphism. Results: Most participants were female (80.3%). The mean levels of 25-hydroxy vitamin D, hemoglobin, and hematocrit were 32.1±7.3 ng/dL, 13.5±1.5 d/dL, and 40.0±4.4%, respectively. Fifty-eight (40.8%) participants had vitamin D insufficiency/deficiency (25.7±3.3 ng/mL), and 18 (12.6%) had anemia. Serum vitamin D was associated with hemoglobin (p=0.030) and hematocrit (p=0.032). However, when subjects were categorized as anemic or not anemic, said association was not maintained (p=0.270). Moreover, the BsmI polymorphism was not associated with hemoglobin and hematocrit levels, regardless of vitamin D status. Conclusion: The serum level of vitamin D is associated with hematocrit and hemoglobin levels in older adults. However, these blood parameters were not associated with the vitamin D receptor gene BsmI polymorphism.

RESUMO Objetivo: Correlacionar os perfis metabólico e nutricional com a presença e gravidade da síndrome da apneia obstrutiva do sono. Métodos: Estudo transversal com pacientes adultos e idosos, de ambos os sexos, atendidos no Laboratório do Sono e Coração do Pronto Socorro Cardiológico Universitário de Pernambuco, entre junho e setembro de 2014. Os pacientes se submeteram à polissonografia, à bioimpedância elétrica e a aferições antropométricas. Foram verificadas a presença da síndrome metabólica e outras morbidades. Resultados: A amostra total foi constituída por 50 pacientes, com idade média de 57,52±9,80 anos, sendo que 94% receberam diagnóstico de síndrome da apneia obstrutiva do sono e 74% possuíam síndrome metabólica. As seguintes médias foram obtidas: índice de massa corporal (31,54±5,82 kg/m2); circunferência do pescoço (39,14±4,33 cm); circunferência da cintura (106,72±11,22 cm); diâmetro abdominal sagital (23,00 cm [21,00-24,00]). O índice de massa corporal, a circunferência da cintura e o diâmetro abdominal sagital apresentaram valores mais elevados (p<0,05) entre os pacientes com síndrome da apneia obstrutiva do sono grave, quando comparados aqueles com a forma leve. O diâmetro abdominal sagital apresentou moderada correlação com o índice de apneia e hipopneia e a gordura corporal apresentou fraca correlação. Conclusão: A obesidade, a circunferência do pescoço, o diâmetro abdominal sagital e a síndrome metabólica tiveram associação positiva com a gravidade da síndrome da apneia obstrutiva do sono. Dentre os parâmetros antropométricos avaliados, o diâmetro abdominal sagital mostrou ser o mais adequado preditor para avaliar a presença e gravidade da síndrome da apneia obstrutiva do sono.

RESUMO Objetivo: Determinar a prevalência do excesso de peso e fatores associados em mulheres em idade reprodutiva no município de Vitória de Santo Antão, Pernambuco. Métodos: Estudo transversal com 322 mulheres, conduzido entre os meses de janeiro e abril de 2013 através de busca ativa nos domicílios. O estado nutricional foi classificado pelo índice de massa corporal para as maiores de 18 anos e pelo índice de massa corporal/idade para as adolescentes. A variável dependente foi o excesso de peso (sobrepeso/obesidade) e os fatores associados (variáveis independentes) foram: as condições socioeconômicas e demográficas (idade, escolaridade, alfabetização, trabalho remunerado, classe econômica, condição de segurança alimentar e nutricional, número de pessoas no domicílio, condições de saneamento básico, piso, teto, número de cômodos e de dormitórios), comportamental (prática de atividade física) e história reprodutiva (menarca, número de gestações e método contraceptivo). A regressão de Poisson foi utilizada para a análise dos fatores associados ao excesso de peso. Resultados: A prevalência de excesso de peso nas mulheres foi de 60,9%. O modelo regressão mostrou que a idade (20-39 anos: razões de prevalências 1,84 intervalo de confiança 95% 1,04-3,24; ≥40 anos: razões de prevalências 2,20; intervalo de confiança 95% 1,18-4,08) e a idade da menarca (≤13anos: razões de prevalências 1,37; intervalo de confiança 95% 1,03-1,82) se associaram ao excesso de peso. Conclusão: A prevalência de excesso de peso representou quase dois terços da população estudada e esteve associada com a maior idade cronológica e a menor idade da menarca, o que corrobora outros resultados da literatura científica.

ABSTRACT Objective: This study evaluated the effect of carbohydrate intake on time to exhaustion and anaerobic contribution during supramaximal exercise on a cycle ergometer. Methods: The sample comprised ten participants with a mean age of 23.9±2.5 years, mean body mass of 75.1±12.3 kg, mean height of 170.0±1.0 cm, and mean body fat of 11.3±5.2%. The participants underwent an incremental test to determine maximal oxygen uptake and maximum power output, and two supramaximal tests with a constant load of 110% of the maximum power output to exhaustion. Thirty minutes before the supramaximal tests the participants consumed carbohydrates (2 g.kg-1) or placebo. Results: The times to exhaustion of carbohydrate and placebo did not differ (carbohydrate: 170.7±44.6s; placebo: 156.1±26.7s, p=0.17; effect size=0.39). Similarly, the anaerobic contributions of the two treatments did not differ (carbohydrate: 3.0±0.9 L; placebo: 2.7±1.1 L, p=0.23; effect size=0.29). Conclusion: Carbohydrate intake was not capable of increasing time to exhaustion and anaerobic contribution in physically active men cycling at 110% of maximum power output.

ABSTRACT Objective: To analyze the prevalence of malnutrition, overweight, and obesity in schoolchildren aged 7-10 years from public and private schools of Cascavel, Paraná, Brazil. Methods: Demographic information (sex, age, and type of school) and anthropometric measurements (body mass and height) were collected from 2,180 students (1,693 from public schools and 487 from private schools). The nutritional status of the children was classified according to their body mass index Z-score. Results: The prevalences of malnutrition, overweight, and obesity were 6.1%, 9.8% and 11.1%, respectively. Girls were 15.9% more likely to be malnourished than boys. As for overweight, 10-year-olds were 1.53 times more likely to be overweight than 7-year-olds. Children from private schools were 1.63 times more likely to be overweight and 2.88 times more likely to be obese than their public school peers. Conclusion: The prevalence of malnutrition and excess weight (overweight and obesity) were high, and girls were more likely to be malnourished. Ten-year-olds and children from private schools were the most affected by overweight and obesity.

RESUMO Objetivo: Este trabalho avaliou a modulação da microbiota gastrointestinal, do perfil de ácidos orgânicos e de lipídeos em ratas Wistar ovariectomizadas, sendo que algumas receberam dieta suplementada com 6% de fruto-oligossacarídeos e inulina, a partir do produto a base de yacon, e outras não. Métodos: Analisou-se o peso do ceco, pH e ácidos orgânicos, microbiota do conteúdo cecal, colesterol total e frações. Resultados: No grupo que recebeu a dieta suplementada durante todo o experimento ocorreu modulação benéfica da microbiota intestinal em função da fermentação dos fruto-oligossacarídeos/inulina, bem como aumento do perfil de lactato (p<0,05) e do nível de lipoproteina alta densidade (p<0,05). Conclusão: Isso sugere que o hábito de consumo contínuo do yacon tem potencial para modular a microbiota intestinal, o perfil de ácidos orgânicos e para diminuir as dislipidemias.

ABSTRACT Objective: This study examined food product advertisements directed to children and aired on closed television channels in Brazil, according to the types of foods and beverages advertised and the advertising content. Methods: A descriptive study was conducted on the adequacy of food commercials directed to children and aired by six pay-television broadcasters according to two parameters: "The Food Guide for the Brazilian Population, 2014", and the National Council on Children's and Adolescents' Rights Resolution nº 163 of 2014 about food advertising. The advertisements were recorded in July 2015, at different times and days of the week. Results: One hundred and sixty-two hours were recorded, registering 3,468 commercials: 1,850 were related to internal programming and 1,618 advertised toys (22.15%), food and beverages (5.61%), applications for electronic devices (5.58%), and entertainment/events (5.56%). The Fisher exact test showed fewer number of food commercials compared to other types of commercials (p<0.001). The main food items advertised by all television stations were ultraprocessed foods and no advertisements of fresh food were observed (p<0.001). Most of the food commercials (64.30%) used children's language and characters; 43.00% used songs in children's voices, and 21.40% linked gift distribution to food. Conclusion: The number of food commercials observed was lower than in previous national studies. However, the advertisements did not follow current legislation, indicating the abuse of marketing communication to children. More effective public policies and the respect and enforcement of legislation on child advertising could protect children from high consumption of ultraprocessed foods.

RESUMO Objetivo: Traduzir e adaptar transculturalmente um instrumento que avalia a intenção de amamentação exclusiva e os processos utilizados pela mulher para a mudança de comportamento, bem como testar propriedades psicométricas do mesmo. Métodos: A tradução e adaptação transcultural, realizadas no município de Viçosa, Minas Gerais, seguiram seis etapas as quais compreenderam a tradução e a adaptação da linguagem ao contexto sociocultural da população de interesse por meio da avaliação da equivalência transcultural. A validade de conteúdo foi verificada pelo índice de validade de conteúdo e avaliação da consistência interna pelo Alfa de Cronbach. Resultados: Os domínios do instrumento foram representativos para a avaliação da intenção de amamentar exclusivamente e para avaliação dos processos de mudança. O índice de validade de conteúdo foi de 0,84 e os valores do Alfa de Cronbach foram 0,81 e 0,77 para os estágios de mudança e processos de mudança, respectivamente. Esses valores são aceitáveis em uma adaptação de instrumento. Conclusão: Concebeu-se a preliminar de um instrumento para a promoção da amamentação exclusiva nos serviços públicos de saúde brasileiros e nos estudos de comportamento. Recomendam-se mais estudos em outros contextos populacionais que avaliem as propriedades psicométricas desse instrumento, a fim de que ele se concretize como parâmetro para a promoção da mudança de comportamento frente à amamentação exclusiva.

ABSTRACT Objective: This study aimed to analyze serving sizes declared on food labels with respect to their conformity to Brazilian law, variability among similar foods, and relationship to energy values. Methods: Food label information from 24 groups of processed foods was collected in one supermarket in southern Brazil. Declared serving sizes were classified into five groups according to their level of compliance with those recommended by law: <70% and >130% inadequate and 70-99%, 100% and 101-130% adequate. Descriptive analyses, Spearman correlations, and Kruskal-Wallis tests were applied. Results: A total of 1,953 food products were analyzed, of which 72% reported serving sizes exactly equal to those recommended, and 14% fell within the acceptable 60% range established by law. Even though most foods complied with the law, there was a variation in declared serving sizes among similar foods, with the largest ranges observed for hamburger and meatballs (364 g). In addition, declared serving sizes were significantly and positively correlated to energy value in most food groups, revealing that smaller serving sizes may be used to report lower energy value. Conclusion: The 60% acceptable serving size range established by law may lead to a lack of serving size standardization and significant variability in declared energy values on labels. This can potentially make labels confusing when comparing similar products and thus affect food choices. It is necessary to revise Brazilian law so that serving sizes are standardized among similar foods in order to facilitate healthy food choices.

RESUMEN Objetivo: La celiaquía como enfermedad crónica tiene una alta prevalencia en nuestra sociedad. El artículo analiza los aspectos psicosociales de la enfermedad celíaca en los diferentes entornos, valorando el impacto de la implantación de una dieta estricta libre de gluten. Métodos: Estudio cualitativo entre los meses de Enero del 2013 a Abril del 2013 en el cual, a través de la teoría fundamentada y el análisis de contenido, se ha profundizado en el análisis de las entrevistas semiestructuradas a personas con enfermedad celíaca en España. Se realizaron llamamientos a traves de las redes sociales y grupos de celíacos hasta llegar a la saturación teórica, que determinó el tamaño final de la muestra de 24 personas. Resultados: Educación Sanitaria, Aislamiento social, soledad y desconocimiento social emergieron como categorías centrales en la experiencia de adopción de la dieta libre de gluten a partir del diagnóstico de celiaquía. Conclusión: Los profesionales deben promover y apoyar estrategias de apoyo social basadas en una comprensión íntegra de las experiencias de desarraigo y marginación que los pacientes celíacos experimentan en sus relaciones sociales a través de la comida. Se requiere un aumento de la educación sanitaria para entender e integrar el impacto psicosocial del diagnóstico de celiaquía y la dieta libre de gluten.

ABSTRACT Objective: The aim of this study was to investigate the acute effect of a single dose of dark chocolate (70% cocoa) on blood pressure and heart rate variability. Methods: Thirty-one healthy subjects (aged 18-25 years; both sexes) were divided into two groups: 10 subjects in the white chocolate (7.4 g) group and 21 in the dark chocolate (10 g) group; measurements were performed at the university's physiology lab. An electrocardiogram measured the sympathovagal balance by spectral and symbolic analysis. Results: A single dose of dark chocolate significantly reduced systolic blood pressure and heart rate. After consuming 10 g of dark chocolate, significant increases were observed for heart rate variability, standard deviation of RR intervals standard deviation of all NN intervals, square root of the mean squared differences between adjacent normal RR intervals root mean square of successive differences, and an increase in the high frequency component in absolute values, representing the parasympathetic modulation. Conclusion: In conclusion the importance of our results lies in the magnitude of the response provoked by a single dose of cocoa. Just 10 g of cocoa triggered a significant increase in parasympathetic modulation and heart rate variability. These combined effects can potentially increase life expectancy because a reduction in heart rate variability is associated with several cardiovascular diseases and higher mortality.