Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism associated with body fat accumulation could possibly trigger an inflammatory process by elevating homocysteine levels and increasing cytokine production, causing several diseases. This study aimed to evaluate the effects of food intervention, and not folate supplements, on the levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β) in overweight and obese women with the MTHFR C677T polymorphism. A randomized, double-blind eight-week clinical trial of 48 overweight and obese women was conducted. Participants were randomly assigned into two groups. They received 300 g of vegetables daily for eight weeks containing different doses of folate: 95 µg/day for Group 1 and 191 µg/day for Group 2. MTHFR C677T polymorphism genotyping was assessed by digestion with HinfI enzyme and on 12% polyacrylamide gels. Anthropometric measurements, 24-h dietary recall, and biochemical analysis (blood folic acid, vitamin B12, homocysteine (Hcy), TNF-α, IL-1β, and IL-6) were determined at the beginning and end of the study. Group 2 had a significant increase in folate intake (p < 0.001) and plasma folic acid (p < 0.05) for individuals with the cytosine–cytosine (CC), cytosine–thymine (CT), and thymine–thymine (TT) genotypes. However, only individuals with the TT genotype presented reduced levels of Hcy, TNF-α, IL-6, and IL-1β (p < 0.001). Group 1 showed significant differences in folate consumption (p < 0.001) and folic acid levels (p < 0.05) for individuals with the CT and TT genotypes. Food intervention with folate from vegetables increased folic acid levels and reduced interleukins, TNF-α, and Hcy levels, mainly for individuals with the TT genotype.

Studies of genes that play an important role in the development of obesity are needed, especially studies focusing on genes that regulate food intake and affect nutrient metabolism. For example, the beta-3 adrenergic receptor (ADRB3) responds to noradrenaline and mediates lipolysis in adipocytes. This was a controlled intervention study involving 40 overweight and obese adult women in which food intake, anthropometric measurements, biochemical analyses, and methylation levels of the ADRB3 gene were evaluated before and after intervention. The individuals were randomized into four groups: group 1 (G1) received 300 g of vegetables and legumes containing on average 191 μg/day of folate and 1 hazelnut oil capsule; group 2 (G2) received 300 g of vegetables and legumes containing on average 191 μg/day of folate and 1 placebo capsule; group 3 (G3) received 300 g of vegetables and legumes containing on average 90 μg/day of folate and 1 hazelnut oil capsule; and individuals in group 4 (G4) were only followed-up and maintained their regular dietary habits. Statistical analysis was performed using analysis of variance (ANOVA), Student’s t test and simple regression, using STATA 13 software. In the total sample, after the intervention, the women classified as overweight and obese did not present weight loss, and there was a reduction in the methylation levels of the ADRB3 gene and malondialdehyde, as well as an increase in high-density lipoprotein cholesterol and total antioxidant capacity. The beneficial effect of the intake of a hazelnut capsule on the methylation levels of the ADRB3 gene was demonstrated for the first time. ClinicalTrials.gov , NCT 02846025

OBJECTIVE: To evaluate the impact of the expansion of access to medicines by the Programa Farmacia Popular do Brasil (PFPB - Brazilian Popular Pharmacy Program) on the indicators of hospitalizations and deaths by hypertension and diabetes. METHODS: To estimate the impact of the Brazilian Popular Pharmacy Program, the statistical model of fixed-effect difference in differences was used, considering: the divisions Rede Propria (RP - Proprietary Network) and Rede Conveniada (RC - Partnership Network); the exposure time of the municipality to the program; intramunicipal density, measured by the number of accredited establishments; and the coverage spillover effect into patients from nonparticipating municipalities. Data from 5,566 municipalities were used, for the period from 2003 to 2016, including: (i) administrative records of the PFPB, Sistema de Informacoes sobre Mortalidade (SIM - Information System on Mortality), and Sistema de Informacoes Hospitalares (SIH - Hospital Information System); ii) other health data managed by the Departamento de Informatica do SUS (DATASUS - Department of Informatics of SUS); iii) sociodemographic data produced by the Brazilian Institute of Geography and Statistics (IBGE); and iv) data from the Relacao Anual de Informacoes Sociais (RAIS - Annual List of Social Information). RESULTS: The expansion of access to medicines for treatment of hypertension and diabetes resulted in a meaningful and statistically significant reduction (p < 0.05) of the number of hospitalizations and deaths by these diseases, in an average annual rate of 27.6% and 8.0%, respectively. The observed impacts were induced by the partnership network, highlighting the density of establishments per 100,000 inhabitants and, above all, the exposure time of the municipality to the program as relevant to the effect. Evidence of a spillover effect and of the maintenance of impacts on different age groups, especially older people, were also observed. CONCLUSIONS: The strategy to expand access to medicines through the PFPB was effective in reducing hospitalizations and deaths by hypertension and diabetes in Brazil during the investigated period. Better understanding the impacts of the program is important to improve the pharmaceutical care policy, to ensure access to cost-effective treatments.

Excess weight is a strong risk factor for the development of dysglycaemia. It has been suggested that changes in the metabolism microRNAs, small non-coding RNAs that regulate gene expression, could precede late glycaemic changes. Vitamin E in turn may exert important functions in methylation and gene expression processes. This study aimed to determine the effect of α-tocopherol on glycaemic variables and miR-9-1 and miR-9-3 promoter DNA methylation in overweight women. A randomized, double-blind, exploratory, placebo-controlled study was conducted in overweight and obese adult women (n = 44) who ingested synthetic vitamin E (all-rac-α-tocopherol), natural source vitamin E (RRR-rac-α-tocopherol) or placebo capsules and were followed up for a period of 8 weeks. Supplemented groups also received dietary guidance for an energy-restricted diet. An additional group that received no supplementation and did not follow an energy-restricted diet was also followed up. The intervention effect was evaluated by DNA methylation levels (quantitative real-time PCR assay) and anthropometric and biochemical variables (fasting plasma glucose, haemoglobin A1C, insulin, and vitamin E). Increased methylation levels of the miR-9-3 promoter region (P < 0.001) and reduced haemoglobin A1C (P < 0.05) were observed in the natural source vitamin E group after intervention. Increased fasting plasma glucose was observed in the synthetic vitamin E group, despite the significant reduction of anthropometric variables compared to the other groups. α-Tocopherol from natural sources increased methylation levels of the miR-9-3 promoter region and reduced haemoglobin A1C in overweight women following an energy-restricted diet. These results provide novel information about the influence of vitamin E on DNA methylation. ClinicalTrials.gov , NCT02922491 . Registered 4 October, 2016.

Nos últimos anos, o interesse no gasto em atenção primária à saúde (APS) cresceu em virtude de uma série de reformas realizadas na sua organização e financiamento. Dados sobre esses e outros gastos são declarados por subfunções pelos gestores da saúde por meio do Sistema de Informações sobre Orçamentos Públicos em Saúde (SIOPS). No orçamento público, as subfunções detalham em que área de despesa a ação governamental foi realizada. Contudo há problemas na informação por subfunções, sendo comum que os gastos em áreas finalísticas, como a APS, sejam subestimados, se considerados apenas os registros da subfunção específica. Assim, o objetivo deste artigo é propor um método para ajuste do gasto total de 2015 a 2020 de cada município, em atenção primária, que permita a produção de bases de dados ajustadas a serem utilizadas em estudos sobre o financiamento da APS no Brasil. Para tanto, uma investigação baseada em dados de execução orçamentário-financeira em ações e serviços públicos de saúde (ASPS) foi realizada para a produção de um quadro metodológico, sendo observadas as seguintes etapas: (i) identificação dos dados; (ii) desenvolvimento; e (iii) validação do quadro metodológico. O quadro metodológico foi produzido e testado, confirmando-se a validade do método proposto para ajuste da despesa declarada em APS no período de 2015 a 2020. Caso o ajuste não tivesse sido realizado, a despesa em APS teria sido subestimada em R$ 11,4 bilhões em 2015 e R$ 9,6 bilhões em 2020 (a preços correntes), o que corresponde a um percentual de subestimação de 19,8% e 12,6%, respectivamente.

Resumo O objetivo deste artigo é analisar a relação entre duração insuficiente do sono, sobrepeso/obesidade e o consumo de alimentos ultraprocessados em adolescentes de 10 a 14 anos. Trata-se de um estudo transversal, com avaliação de 1.384 adolescentes de escolas públicas de João Pessoa-PB, participantes do Estudo Longitudinal sobre Comportamento Sedentário, Atividade Física, Hábitos Alimentares e Saúde de Adolescentes (LONCAAFS). Foram mensuradas variáveis sociodemográficas, duração do sono, turno de aula, estado nutricional antropométrico, comportamento sedentário e consumo alimentar. Foram realizadas regressão linear e logística por meio do Software Stata 13.0. Prevalência de curta duração do sono de 29,5% (<9h/noite). Associação significativa entre a curta duração do sono e o excesso de peso somente para adolescentes <12 anos. Quanto à relação entre a duração do sono e o consumo de alimentos ultraprocessados, quanto maior a duração do sono, menor o consumo de lanches pelos adolescentes menores de 12 anos, com associação positiva para ≥12 anos apenas com ajuste pela variável atividade física. Não houve associação com os grupos “bebidas açucaradas” e “biscoitos” para nenhuma das faixas etárias analisadas.