Nutrição e Saúde

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http://repositorio.ufes.br/handle/10/17582

Programa de Pós-Graduação em Nutrição e Saúde

Centro: CCS
Telefone: (27) 3335 7017
URL do programa: http://www.nutricaoesaude.ufes.br/pt-br/apresenta%C3%A7%C3%A3o

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Consumo alimentar e fatores associados : um estudo em bancários
(Universidade Federal do Espírito Santo, 2017-05-04) Cattafesta, Monica; Salaroli, Luciane Bresciani; Assunção, Maria Cecília Formoso; Barbosa, Míriam Carmo Rodrigues; Paixão, Mírian Patrícia Castro Pereira; Guandalini, Valdete Regina
Food consumption and living habits of workers are relevant to productive capacity due to the possibility of reducing the incidence of diseases. However, studies evaluating food intake in these conditions are scarce in the scientific literature. Thus, the objective of this dissertation was to evaluate the food consumption of a group of bank employees, and the association with socioeconomic, behavioral, labor and health condition factors. This is an observational and cross-sectional study with employees of a banking network in Grande Vitória/ES/BR. A semiquantitative Food Frequency Questionnaire was applied, in which, the analysis of main components with varimax rotation was used to determine the dietary patterns. Three food patterns were identified: “vegetables, fruits, cereals and tubers”, “sweets and snacks” and “traditional and protein”. The first pattern was positively associated with the habit of rarely exchanging lunch for snack, to make five or more meals a day, and not consuming industrialized seasoning. It was also a protective factor for abdominal obesity, Metabolic Syndrome (MS) and elevation of the ultra-sensitive C-reactive Protein (CRP-us). On the other hand, the patterns “sweets and snacks” and “traditional and protein” showed associations inverse to those found in the healthier pattern. The “sweets and snacks” pattern was also directly associated with the habit of changing lunch for 1 to 4 times a week, eating in a restaurant 1 to 3 times a day, not using sweetener, using salt shaker at the table, using industrialized seasonings and to have higher education. The “traditional and protein” dietary pattern was associated with to have four or fewer meals a day, not using sweeteners, using industrialized seasoning and to receive high social support, besides being a risk factor for hypertriglyceridemia. It is concluded, therefore, that the food consumption of bank employees is mainly related to the life style of these individuals. In addition, a healthy diet, represented by the “vegetables, fruits, cereals and tubers” pattern, was associated with a better health condition, especially when evaluating competing metabolic complications, such as in the presence of abdominal obesity, MS, and changes in us-CRP. In contrast, the "traditional and protein" pattern, rich in processed foods, has been shown to be a risk factor for the development of hypertriglyceridemia.
Vinhos da região serrana do Espírito Santo : composição, análise sensorial e avaliação das boas práticas de elaboração
(Universidade Federal do Espírito Santo, 2017-07-05) Rodrigues, Leticia Karina; Chiaradia, Ana Cristina Nascimento; Sousa, Márcio Vinícius Ferreira de; Silva, Erika Madeira Moreira da
Wine production has expanded in the mountain region of Espírito Santo, which in 2014 was classified as a grape production zone destined for industrialization. This region is exploited by agrotourism and has as its characteristic the artisanal production of wines, whose profile meets the preference of the Brazilian consumer who seeks products of accessible value and sweet palate. The current emerging panorama of Espírito Santo in the national scenario as a grape producer, and the precariousness of data and information on the capixaba production of “table wines”, encouraged the exploration of the theme. Thus, the objectives of this work were to identify the conditions in which wines are prepared, as to the adequacy to the standard of identity and quality (PIQ) advocated by the Ministry of Agriculture, Livestock and Food Supply (MAPA); Lifting hygienic sanitary conditions of manufacturing; As well as to analyze the sensorial profile of “table wines” produced in artisanal and industrial scale. For physical-chemical and sensory parameters, 48 samples of wines made with american and / or hybrid grape varieties from harvests between 2010 and 2016 were evaluated from 19 canteens located in 05 municipalities in the mountain region of Espírito Santo which were also submitted to the evaluation of Good Manufacturing Practices (GMP). The samples were composed of red and white wine, of the soft, demi-sec and dry classes, elaborated with 10 distinct varieties of grapes in the varietal form or as an assemblage (mixtures). The results obtained in the analyzes show that 60% of the studied samples present at least one item that was disapproved in the physico-chemical analysis considering the PIQ established by the current legislation of the MAPA. The sensorial profile of the samples was quite different from each other. This variation can be related to the great diversity of products supplied spontaneously by the winemakerss according to their production line, which made it impossible to apply the comparative analyzes between products of different classes, different vintages and produced with the most varied assemblages of grapes. The assessment of compliance with GMP by means of a weighted score calculation found that 22% of the canteens were in excellent or very good hygienic conditions, 22% in good conditions, 33% in regular conditions and 22% in poor sanitary conditions. It is worth noting that the deviations found can be treated by means of the application of suitable oenological techniques, treatment of the vineyards with the use of the available technologies and with adequacy to the GMP. The present research found that the viticulture of the mountain region of Espírito Santo still has much to develop and a long way to go in search of a quality standard that meets the requirements of current legislation and with the guarantee of consumer safety. There is a need for specialized technical support in the sector, government incentive, training and awareness of the vine grower, for the success and expansion of the wine production chain in the State.
Desenvolvimento e caracterização de biscoitos elaborados com farinha mista de arroz e feijão vermelho
(Universidade Federal do Espírito Santo, 2017-07-14) Bassani, Aline Bravim Santos; Silva, Erika Madeira Moreira da; Oliveira, Daniela da Silva; Sena, Geralda Gillian Silva; São José, Jackline Freitas Brilhante de; Ascheri, Jose Luis Ramirez
Beans (Phaseolus vulgaris L.) are a legume rich in essential nutrients for humans. It is a food of significant social, economic and nutritional importance, acting as one of the main protein sources for the low income population, besides helping in the caloric intake of this social group. Rice (Oryza sativa L.) is a cereal that has a smooth taste, easy digestion, colorless appearance, important energy source due to the high concentration of starch present, offers proteins, vitamins and minerals, besides containing low sodium content and lipids. It also has hypoallergenic properties, not containing gluten in its composition. Rice and bean flour are nutritionally convenient in the manufacture of gluten-free products, and can be an alternative for the preparation of baked goods such as biscuits. The aim of the present study was to develop and characterize biscuits made with mixed rice flour and red beans flour. Bean flour, as well as the biscuits were developed in the Dietetic Technique Laboratory of the nutrition course of the Espírito Santo’s Federal University, Maruipe’s Campus. Rice flour and other ingredients were purchased in the local market. A soaking treatment was used in the grains with an intention to reduce antinutritional factors A 22 central composite rotational design was used to study the effect of different ratios of red bean (FFV) and margarine on measurements, water activity, color, texture and sensorial analysis of the cookies. Three treatments (25 g / 100 g FFV and 21 g / 100 g margarine, 85,35 g / 100 g FFV and 18 g / 100 g margarine and 50 g / 100 g and 50g/100g FFV and 22,24 g / 100 g of margarine) were selected by sensory analysis for the conduction of centesimal composition, iron, zinc, total phenolics, antioxidant activity and tannins. Moreover, were analyzed color, water activity and texture during storage of up to 60 days. Finally, the analysis of scanning electron microscopy (SEM) was conducted with the purpose of analyzing these products morphologically. The addition of margarine (up to 22,24 g / 100 g) was able to increase the cookie’s thickness measures and the expansion factor. The addition of red bean flour (up to 85,35 g / 100g) was able to reduce the cookie’s brightness, making them darker, as well as producing them tendency to less yellowish coloration. On the other hand, when added concomitantly with a margarine, it is able to produce cookies with a tendency to yellowish coloration. The addition of up to 85,35 g / 100 g of beans, singly, did not show interference in the acceptance of the cookies. On the other hand, an addition of up to 22,24 g / 100g of margarine was able to positively influence the texture values and purchase intention. The treatments containing the highest FFV content were those with the highest amount of iron and zinc. Wasn’t watched effect of the treatment applied in the flour about phenolic content and antioxidant capacity. All evaluated treatments withstand the storage of up to 60 days without presenting significant losses in their quality. By means of SEM it was observed that in all treatments the starch granules appear immersed in a matrix composed of starch and lipids, suggesting perhaps the presence of globular proteins. Considering the results and the experimental conditions applied in this study, it is possible to ensure the possibility of the preparation of biscuits using up to 85,35 g / 100g FFV, keeping good nutritional, sensorial and technological characteristics.
Avaliação dos efeitos do consumo de dieta hiperlipídica na infecção experimental pelo trypanosoma cruzi
(Universidade Federal do Espírito Santo, 2017-07-24) Domingues, Elisa Liz Belli Cassa; Viana, Mirelle Lomar; Santos, Fabiane Matos dos; Fux, Blima; Tonussi, Carlos Rogério; Haraguchi, Fabiano Kenji; Leite, Gustavo Rocha; Salaroli, Luciane Bresciani; Pedrosa, Rogério Graça
Chagas disease (DC) is a parasitic disease with the etiological agent Trypanosoma cruzi. Chagasic heart disease is an important infection of T. cruzi infection and can manifest severe cases of heart failure with evolution to sudden death. In addition to the parasitic etiology, others are also the causes that can lead to the development of cardiovascular diseases with signs of heart failure, such as consumption of the hyperlipid diet and the inflammatory process corroborated by dyslipidemias. Thus, the objective of the present study was to evaluate the effects of the hyperlipidic diet on T. cruzi experimental infection. Body weight and food intake were measured weekly. The parasitemia was monitored daily in the acute phase of infection and biochemical parameters were evaluated monthly for a period of 90 days of infection. For histopathological evaluations, fragments of adipose tissue and cardiac muscle tissue were collected after euthanasia of the animals at 90 days of infection. The experimental procedures were approved by the Ethics Committee on the Use of Animals of the Federal University of Espírito Santo (protocol no 043/2015). The hyperlipidic diet led to a reduction of parasitemia in the acute phase of infection (p <0.05), elevation of body weight mainly in the uninfected group and fed a hyperlipid diet, reduction in mean dietary intake and elevation of serum total cholesterol levels Infection (p <0.05). Increased adipose tissue hypertrophy (p <0.001) in uninfected animals fed a hyperlipidic diet, and an increase in inflammatory cells in the cardiac muscle tissue (p <0.001) following the elevated serum levels of TNF-alpha cytokine in animals Infected individuals who consumed a hyperlipidic diet. These results demonstrate that the high lipid consumption resulted in hypertrophy of adipose tissue and maintenance of the cardiac inflammatory process.
Associação entre composição corporal, estágio puberal, hábitos de vida e dislipidemia em crianças e adolescentes
(Universidade Federal do Espírito Santo, 2017-07-25) Oliosa, Polyana Romano; Barbosa, Miriam Carmo Rodrigues; Mill, José Geraldo; Faria, Carolina Perim de; Kuschnir, Maria Cristina Caetano
Objective: To analyze the lipid profile of children and adolescents in the age group of 6 to 18 years incomplete and its relation with nutritional status, body composition, life habits, puberty and to verify the impact of body fat accumulation on plasma lipids in boys and girls. Methods: We studied 854 schoolchildren of both sexes. The anthropometric variables analyzed were waist circumference (WC), height, weight, percentage of body fat (% G), body mass index (BMI) and waist circumference by height (RCE). Total cholesterol (TC), high density lipoprotein (HDLc), low density lipoprotein (LDLc) and non-HDL cholesterol (Non-HDLc) were measured in blood. Age was stratified in 6┣ 9 years, 9┣ 15 years and 15┣ 19 years, and the pubertal stages classified according to the Tanner scale in 1 (pre-pubertal), 2 to 4 (puberal) and 5 (post-puberal). Descriptive data were analyzed using the chi-square test, continuous variables presented by mean ± standard deviation and percentages. The analyzes were done by T-Student, ANOVA (followed by Tukey's test) and linear regression. The significance was set at p <0.05. Results: The sample consisted of 56% (n = 478) of boys. The prevailing age was 9 to 15 years (n = 584, 68.4%) with a mean of 11.87 ± 2.8 years. When analyzed the variables of life habits, the male practiced more physical activity, both inside and outside the "Estação Conhecimento" (p = 0.000) and had the habit of feeding with parents and / or guardians, more frequent (p = 0.002 ). There was no difference between the sexes for screen time (p = 0.270), leisure (p = 0.887) and breakfast (p = 0.286). When checking the influence of these variables on the lipid fractions, we did not obtain association (p> 0.05). Overweight was observed in 28.2% of the girls and in 20.3% of the boys (p <0.05). The boys classified in the pubertal and post-pubertal stages had lower (p <0.01) CT, LDLc and non-HDLc concentrations than pre-pubertals. Adolescents aged 15 to 19 years incomplete had lower concentrations of lipid fractions than those aged 6 to 9 years, 9 to 15 years (p <0.01). The mean levels of TC, LDLc and HDLc were higher in girls, however, with no difference between sexes when stratified by pubertal stages (p = 0.093) and age (p = 0.797). Plasma lipid levels change markedly during the pubertal stages. Obese boys had higher CT, non-HDLc and LDLc than eutrophic, whereas in non-HDLc only girls had significance (p <0.05). Boys and girls with inadequate% G and RCE had a higher concentration of LDLc and non-HDLc (p <0.001) when compared to children who had% G and an appropriate RCE. The% G and RCE were positively associated with lipid fractions (CT and non-HDLc) in both genders (p <0.001). The percentage of high body fat contributed with 21% of children or adolescents having high cholesterol (≥170 mg / dL). Conclusion: The nutritional status and excess body fat, are positively associated with the atherogenic lipid profile, impacting with more evidence in the male sex. There was no increase in cholesterol with age, but decreases as age advances as well as with pubertal stages, lipid fractions also decrease. As for the association between life habits and lipid fractions, no feasible associations were found. Thus, the data emphasize the need to control body weight, especially a monitoring of the body composition of children and adolescents aiming at the prevention of cardiovascular diseases in adult life.
Efetividade de um programa de intervenção sobre níveis pressóricos : um estudo com escolares - Vitória/ES
(Universidade Federal do Espírito Santo, 2017-07-27) Matos, Raiani Spalenza; Cunha, Diana Barbosa; Molina, Maria del Carmen Bisi; Cade, Nagela Valadão; Rocha, José Luiz Marques; Mill, Jose Geraldo; Faria, Carolina Perim de
The school environment is privileged place to promote healthy habits of life and prevention of diseases. The objective of this study is to evaluate the effectiveness of a health intervention program on the pressure levels of schoolchildren in the public school system in Vitória / ES-Brazil. This is a intervention study conducted with 237 schoolchildren aged 6 to 12 from two public schools, randomly defined as Intervention and Control school. Anthropometric, hemodynamic data, 12 - hour urine at night, and data on the practice of physical activity and eating habits of schoolchildren were collected. All the students were evaluated at the beginning and at the end of the study and the participants of the Intervention group underwent educational actions that stimulated the promotion of healthy eating practices and physical activity. To test differences between groups, chi-square or Fisher's exact test was used for categorical variables, and Student's t-test or Mann-Whitney test for continuous variables. The paired t-test or Wilcoxon was used to evaluate differences between averages of continuous variables in paired samples. Correlation tests were performed to evaluate the relationship between variables at baseline. The rate of variation of systolic blood pressure (SBP) and diastolic blood pressure (DBP) throughout the follow-up, according to the allocation group, was evaluated using linear generalized models for time-repeated measures. There was a reduction in the means of SBP (0.5 mmHg) and DBP (0.6 mmHg) in the intervention group, and a statistically significant increase of SBP (1.8 mmHg) and DBP (2.2 mmHg) in the control group (p <0.05). Significant correlations were found between the DBP and the time of exposure to the screen (p <0.01) and the quality of school feeding (p <0.05) at baseline. In conclusion, the proposed intervention was effective for prevent the increase in BP in the studied group, being feasible to be reproduced in a school environment.
Comparação entre os fatores associados à resistência à insulina no final da infância e início da adolescência
(Universidade Federal do Espírito Santo, 2017-07-28) Pani, Virgilia Oliveira; Barbosa, Miriam Carmo Rodrigues; Faria, Eliane Rodrigues de; Mill, José Geraldo; Alvim, Rafael de Oliveira
The objective of this study was to compare the risk factors associated with the development of insulin resistance (IR) at the end of childhood (8-9 years) and beginning of adolescence (10-14 years) in children and adolescents in the city of Vitória-ES. It is a cross-sectional study with 296 children and adolescents aged 8 to 14 years of public schools in Vitória / ES. Fasting plasma glucose, plasma insulin, total cholesterol and fractions (HDL and LDL), plasma triglycerides (TG), uric acid (AU), C-reactive protein and total leukocytes were determined. IR was assessed by calculating the HOMA-IR index. Measurements of weight, height, waist circumference (WC), perimeter of the neck (PN), perimeter of the hip (PH) and percentage of body fat (%BF) were obtained. Socioeconomic conditions, physical activity practice, eating habits, smoking and alcohol consumption were evaluated. We used the Shapiro Willk normality test, non-parametric tests and simple and multiple logistic regression models. The project was approved by the Human Research Ethics Committee of the Federal University of Espírito Santo (opinion n°. 1.565.490). Of the participants, 54.4% were female and 53.7% were adolescents. The female sex and the adolescence presented greater chances of inadequacy of insulin and IR. Adolescence presented a greater chance of inadequate number of meals, tablet or cellular use, screen time and alcohol consumption. All the anthropometric variables, time on the tablet or cell, time watching television (TV) and total screen time correlated positively with insulin and HOMA-IR. The IR group presented higher values of all the anthropometric variables and most of the biochemical and lifestyle variables, as well as the higher HOMA-IR quartile. Individuals who presented overweight, inadequate WC, PH, PN, Waist / Stature Relationship, excess body fat, inadequate glucose, HDL, TG, TG/HDL ratio, uric acid, insulin, metabolic syndrome, TV, longer screen time, greater family availability of sugar and individuals whose father does not work out were more likely to have IR. In the final model, the excess body fat, the TV watching time above 2h/day and the father did not work out were related to IR in the total sample. In childhood, the TG/HDL ratio ≥p90, AU ≥p90 and the TV watching time was higher than 2h/day and in adolescence the excess body fat, the TV watching time was higher than 2h/day and the family received a government appeal. It was concluded that the risk factors related to IR after 12 adjustments demonstrated different behaviors in the phases evaluated. In this way, it is extremely important to consider the phases separately when evaluating them.
Segurança dos alimentos no âmbito da alimentação escolar
(Universidade Federal do Espírito Santo, 2017-07-31) Vitória, Alyne Gomes da; São José, Jackline Freitas Brilhante de; Faria, Carolina Perim de; Oliveira, Daniela da Silva; Silva, Erika Madeira Moreira da; Bernardes, Patricia Campos
The adoption and evaluation of good practices in food handling in food services is essential to minimize the risk of foodborne diseases, especially in schools, which are responsible for serving a vulnerable public. In this context, a study was carried out in 52 school feeding units of the municipal network of Vitória-ES, in order to evaluate the safety of food production in these places. For the evaluation of knowledge, attitudes and practices related to food safety, a specific questionnaire was applied with food handlers. The hygienic and sanitary conditions of each site were diagnosed by means of a checklist of good practices and the microbiological evaluation of surfaces that come into contact with food. The results showed that the majority of the participants (74.4%) had participated in at least 4 times of training. The lowest score was obtained in the knowledge block (7.1 ± 1.22). The knowledge score was associated with the time of experience and time of accomplishment of the last training. Attitudes were significantly related to schooling and time of last training. The increase in the practice score was only influenced by the attitudes score. Through the evaluation of the checklist, 61.5% of the units had a low health risk. The most evident inadequacies were related to structural conditions, hand hygiene, absence of the manual of good practices and environmental hygiene. In the surface analyzes, high counts of aerobic mesophiles and enterobacteria were observed. Most schools obtained a low sanitary risk rating through a checklist evaluation, which indicates the presence of good behaviors in food production, but with evidences of aspects that need adequacy. It is suggested that the intervention activities focused on food safety in the units be constant covering the main aspects related to the training and corrections of observed failures.
Aplicação do ultrassom e compostos químicos na sanitização de couve (brassica Oleracea)
(Universidade Federal do Espírito Santo, 2017-07-31) Machado, Maria Clara de Moraes Motta; Bernardes, Patricia Campos; São José, Jackline Freitas Brilhante de; Chiaradia, Ana Cristina Nascimento; Silva, Erika Madeira Moreira da
Adequate sanitation procedures are essential to ensure the quality and safety of food, making it the main procedure to maintain the microbiological quality of ready-to-eat salads without causing risks to human health. The objective of the study was to evaluate the application of chemical compounds such as sodium dichloroisocyanurate, acetic acid 1000 mg/L, acetic acid 2000 mg/L, peracetic acid 20mg/L, combined or not with 60 kHz ultrasound in the inactivation of adhered Salmonella enterica Typhimurium cells The surface of cabbage butter and the effect of the treatments on the contaminating natural microbiota and on the physical-chemical characteristics of cabbage stored at 7º C for 6 days. In the evaluation of the contaminating natural microbiota the initial count of aerobic mesophiles, filamentous fungi and yeasts and coliforms at 35ºC was 6.8, 5.4 and 3.8 log CFU.g-1 , respectively. After inoculation of Salmonella enterica Typhimurium, the number of cells adhered to the cabbage surface was 6.3 log CFU.g-1. When the cabbage sanitization treatments were applied, the S. Typhimurium count was reduced from 1.6 to 3.8 log CFU.g-1 in relation to the count of non-sanitized samples. For pH, total titratable acidity, soluble solids, mass loss, determination of vitamin C and total phenolic compounds did not show significant changes (p> 0.05) shortly after sanitization and throughout storage. The antioxidant capacity presented a significant reduction throughout the storage. The scanning electron microscopy evidenced the adhesion of S. Typhimurium on the surface of the cabbage and the removal of cells from the sanitization treatments. All treatments performed were equal to or greater than sodium dichloroisocyanurate treatment, indicating that the proposed treatments associated or not with ultrasound have potential for use in the sanitization of cabbage (Brassica oleracea var. acephala).
Influência do treinamento resistido na expressão proteica do trânsito de cálcio intracelular miocárdico de ratos obesos
(Universidade Federal do Espírito Santo, 2017-11-29) Damiani, Andressa Prata Leite; Leopoldo, André Soares; Leopoldo, Ana Paula Lima; Ribeiro, Alessandra Baldotto; Ferreira, Lucas Guimarães; Leite, Richard Diego; Pedrosa, Rogério Graça
Introduction: Obesity is considered a chronic metabolic disease of multifactorial origin characterized by excessive accumulation of adipose mass that can lead to cardiac damages such as morphological and functional changes. The functional alterations are related to the homeostatic imbalance of the proteins involved in calcium handling, an important mechanism responsible for the regulation of contractility and relaxation of the heart. In an attempt to minimize and/or reverse cardiac changes observed in the pathological condition of obesity, nonpharmacological strategy such as physical exercise have been used. Resistance training (RT) has been reported for benefits in improving body composition and cardiac function. However, the relationship between obesity, RT and calcium handling still needs to be clarified and better understood. Objective: To evaluate the effect of RT on the protein expression of calcium handling in obese rats, besides analyzing the biomarkers of morbidities associated with obesity. Methods: Wistar rats were induced and exposed to the condition of obesity and later redistributed in sedentary groups and submitted to RT: Control (C, n = 10), Obese (Ob, n = 9), Control submitted to resistance training (Ctr, n = 11) and Obese submitted to resistance training (Obtr, n = 11). The control groups received standard diet and the obese groups hyperlipidic diet. The ladder RT protocol was performed for 10 weeks, with frequency of 3 days a week. The training consisted of 4 to 5 series with progressive intensities of 50%, 75%, 90% and 100% of the maximum load (ML), at the end of the 4th grade, the animal was submitted to 5th grade with 100% ML + 30g. The analysis of the nutritional, blood pressure, glycemic, lipid, and hormonal profile and determination of the water content in cardiac, pancreatic, pulmonary and hepatic tissue were performed. In addition, the total weight of the heart, left and right ventricles, atriums and their respective relationships with tibial length, as well as the cross sectional area, myocardial collagen, and protein regulatory expression of calcium handling were analyzed by Western Blot technique. Parametric data were expressed as mean ± standard deviation and the nonparametric in median ± interquartile range. The comparisons between groups C and Ob were performed by Test t. For the comparisons between groups C, Ob, Ctr and Obtr two-way ANOVA was used and complemented with Bonferroni post hoc test. The level of significance was 5%. Results: The main findings were the frequently comorbidities seen in the condition of obesity, hypertriglyceridemia and hyperleptinemia. In addition, in the process of cardiac remodeling, despite the absence of hypertrophy, obesity led to an increase in the deposition of myocardial collagen and expression of pPLBser16 and pPLB/PLB reduced. The reversals from RT were expressed by reduction of body weight and fat, adiposity index, plasmatic triglycerides and leptin. Conclusion: The RT was not able to reverse the pPLBser16 impairment in the obesity condition. However, it represented a relevant non-pharmacological treatment in the improvement of body composition and the biomarkers of obesity, expressed by the reduction of body weight and fat, adiposity index and plasma triglycerides and leptin levels.
Composição da dieta e sua associação com o fenótipo metabolicamente saudável em indivíduos da linha de base do ELSA-BRASIL
(Universidade Federal do Espírito Santo, 2017-12-14) Alves, Sara Rodrigues; Faria, Carolina Perim de; Mill, José Geraldo; Cade, Nagela Valadão; Rocha, José Luiz Marques; Molina, Maria del Carmen Bisi
INTRODUCTION: Obesity is a multifactorial disease and is considered a risk factor for the development of chronic non communicable diseases. However, there are obese individuals who do not present an unfavorable metabolic profile, denominated in the literature as metabolically healthy obese. It is believed that genetic factors and lifestyle factors among other characteristics may influence the determination of this group. Among the described lifestyle factors, food consumption should be highlighted; the use of this variable in epidemiological studies tends to be limited and, consequently, inconclusive. Thus, the objective of this research was to investigate the association between dietary intake and metabolically healthy obesity. METHODS: The research population came from the baseline of ELSA-Brasil (N = 15,105) and after exclusion criteria, the final sample was of 2,033 individuals. They were classified as obese when BMI ≥ 30 kg / m², metabolic criteria adopted by IDF and NHANES were used to define the outcome. Variables were collected using questionnaires and physical, hemodynamic and biochemical tests. The association between exposure, adjust and outcome variables was tested using chi-square and tstudent tests; those that presented significance levels below 0.10 were inserted in the adjusted model of the binary logistic regression. All analysis was performed using SPSS version 23 and significance level of 5%. RESULTS: The mean age of participants was 53.3 years and 1130 (55.6%) were women. A prevalence of 19.3% of metabolically healthy obesity was observed for this sample. The younger age, female gender, better self-perception of health, active employment status, strong physical activity levels, lower BMI and lower weight gain since 20 years of age were positively associated with the healthy phenotype. Regarding food consumption, total lipids (g) (OR 1.007), including saturated fat (g) (OR 1.017) and trans fat (g) (OR 1.119) were positively associated to the outcome even after adjustment for the socioeconomic, health and lifestyle variables. CONCLUSION: It can be concluded that nutrient intake was associated with metabolically healthy obesity in a manner different from the usual recommendations in dietary guidelines, even after adjustment; demonstrating that, even though nutritional differences are quite small, healthy individuals have poorer food behavior; such a finding suggests the existence 8 of an association between food consumption and the metabolically healthy phenotype. Also, other factors, not addressed by the present research, such as epigenetic issues or the interactions between food and nutrients (eating patterns) may improve the comprehension of the relation between metabolically healthy obesity and diet.
Caracterização de remodelação cardíaca em modelo experimental de obesidade a partir de diferentes tipos de dietas hipercalóricas
(Universidade Federal do Espírito Santo, 2017-12-18) Matias, Amanda Martins; Leopoldo, Ana Paula Lima; Leopoldo, André Soares; Santos, Leonardo dos; Ferreira, Lucas Guimarães; Padilha, Alessandra Simão; Haraguchi, Fabiano Kenji
Obesity is a worldwide epidemic and a serious public health problem. Several diseases are associated with excess of adipose tissue, and obesity is considered an independent risk factor for the development of cardiac remodeling and heart failure. The objective of the present study was the development and characterization of an obesity experimental model from hypercaloric diets, a high sucrose (HS), high fat (HF) and high fat and sucrose (HFS), which resulted in cardiac remodeling and predisposition to heart failure. The hypothesis of this investigation was that hypercaloric diets would promote cardiac remodeling, cardiovascular damage and predispose to heart failure, being this condition more evident in the high fat and sucrose model. Wistar rats (n = 60) were randomized into four groups: control (C), high sucrose (HS), high fat (HF) and high fat and sucrose (HFS). General characteristics and comorbidities were measured. The process of cardiac remodeling was evaluated through the weights of the heart, left and right ventricles, atrium, and relationships with the tibia length. The mycoyte cross sectional area and fraction of interstitial collagen of the left ventricle were evaluated. In vivo functional evaluation was determined by hemodynamic and in vitro by analysis of isolated cardiomyocyte. Heart failure was analyzed by pulmonary congestion, right ventricular hypertrophy, and hemodynamic parameters. Data were expressed by mean and standard error of the mean and were submitted to analysis of variance (ANOVA) for independent samples. HF and HFS models led to obesity by increase in adipose tissue deposition and adiposity index (C = 8.3 ± 0.2%, HF = 10.9 ± 0.5%, HFS = 10.2 ± 0.3%, p <0.05). Comorbidities were hypertension, glucose intolerance (HF and HFS) and hyperleptinemia (HF). There was no change in the morphological parameters that characterize the cardiac remodeling process. Regarding the functional analyzes, the obesity promotes reduction in time to 50% of shortening (C = 160 ± 4 ms vs. HF = 134 ± 2, p <0.05) and time to 50% of the relaxation (C: 160 ± 4 ms, HF: 134 ± 3 and HFS: 133 ± 3, p <0.05). The HS model presented contractile dysfunction visualized by reduction in the shortening (C: 8.34 ± 0.32%, HS: 6.91 ± 0.28, p <0.05) and maximal shortening velocity (C: -2, 58 ± 0.10 μm / s, HS: -2.21 ± 0.08, p <0.05). In conclusion, the experimental models proposed in this study were not promote cadiac remodeling and predisposition to heart failure under conditions of obesity or sucrose excess.
Efeito do treinamento de força sobre a morfologia do músculo esquelético de ratos obesos
(Universidade Federal do Espírito Santo, 2017-12-21) Contreiro, Catarina Denise Entringer; Ferreira, Lucas Guimarães; Leite, Richard Diego; Cunha, Márcia Regina Holanda da; Leopoldo, André Soares; Leopoldo, Ana Paula Lima
Obesity is a chronic multifactorial disease characterized by accumulation of fat in the body, causing damage to the health of the individual. The treatment of obesity varies according to the severity of the disease, however, healthy eating with caloric restriction and physical activity are strategies used in this process. The beneficial effects of regular physical activity are related to adaptations that occur in various organs of the body, including skeletal muscle. The effects of obesity on skeletal muscle hypertrophy induced by strength training are not well understood. Clarifying the interaction mechanisms is fundamental for the development of new approaches in the treatment of obesity. The objective of the present study was to evaluate the effect of obesity associated with strength training on skeletal muscle morphology. For this, 58 male Wistar rats were randomized into two groups: control, fed standard diet (C), and obese, fed a high fat diet (49.2% fat) (Ob). The experimental protocol consisted of 28 weeks, being divided into three moments: M1) induction to obesity; M2) maintenance of obesity and; M3) strength training protocol. After the maintenance of obesity period, the animals were randomized into two new groups. Thus, the study was composed of four groups: sedentary control (CS), control submitted to the strength training protocol (CTF), obese sedentary (ObS) and obese submitted to strength training protocol (ObTF). Strength training was performed on a mouse ladder 3 times a week for 10 weeks. The hyperlipid diet was efficient to induce animals to obesity in the second week of the experimental protocol, initiating the period of exposure to obesity. The weight of the soleus, tibial and FHL muscles were higher in the ObTF group compared to the CTF group, however the training protocol did not promote hypertrophy in the cross-sectional area of the FHL and plantar muscles.The training protocol used was efficient to increase the absolute strength in the trained groups, but the capacity to produce strength seems to be impaired in obesity when relative strength was evaluated. At the beginning of the training, the ObTF group already had lower relative strength compared to the ObTF group, this difference was maintained after the training protocol. The training was efficient to promote positive changes in body weight and accumulation of fat in trained animals. Body weight gain was lower in the groups submitted to strength 23 training compared to sedentary groups (ObTF vs ObS, CTF vs CS). The ObTF group presented lower total body fat and adiposity index in relation to the ObS group.
Fatores associados à insatisfação corporal no final da infância e início da adolescência
(Universidade Federal do Espírito Santo, 2018-02-27) Martins, Caroline Resende; Barbosa, Miriam Carmo Rodrigues; Faria, Eliane Rodrigues de; Alvim, Rafael de Oliveira; Mill, Jose Geraldo; Soares, Fabíola Lacerda Pires; Leopoldo, Ana Paula Lima
The objective of this study was to identify factors associated with body dissatisfaction at the end of childhood (8-9 years) and beginning of adolescence (10-14 years) in children and adolescents in the Maruípe region of the city of Vitória-ES. It is an observational, cross-sectional study with 296 children and adolescents aged 8 to 14 years of public schools in Vitória / ES. To evaluate the biochemical profile, after a 12- hour fast, 10 mL of blood was collected for the determination of fasting glycemia, plasma insulin, total cholesterol and fractions (HDL and LDL), plasma triglycerides (TGC), acid uric acid (AU), plasma insulin, C-reactive protein and total leukocytes. Insulin resistance was assessed by calculating the HOMA-IR index. Measurements of weight, height, waist circumference (WC), neck circumference (NC), hip circumference (HC) and body fat percentage (% BF) were obtained. Body dissatisfaction was assessed through the Kakeshita silhouettes scale, as well as questions from the Body Shape Questionnaire (BSQ) were used to evaluate eating behaviors. Socioeconomic conditions, physical activity, eating habits, race / color, smoking and alcohol consumption were also evaluated. Sexual maturation was assessed through the selfassessment proposed by Tanner. A subsample for the screening of eating disorders was carried out using the Edinburgh Bulimia Research Test (BITE) and Food Attitude Test (EAT) tests. We used the Shapiro Willk Normality Test, non-parametric tests and simple and multiple logistic regression models. The project was approved by the Human Research Ethics Committee of the Federal University of Espírito Santo (opinion No. 1,565,490) and the Informed Consent Form and Assent was signed by the participants and their officials. It was observed that 88.8% (n = 263) of the sample was dissatisfied with body image, with the desire to lose weight in girls (68.5%) (p <0.0001) and to gain weight in the boys (35.1%) (p <0.0001). In girls, the prevalence of high triglycerides, high fasting insulin and insulin resistance were significantly higher than in boys. No group of dissatisfied ones such as prevalence of overweight, excess body fat, high WC, elevated CRF, high fasting insulin and high waist height ratio (WHR) were greater than satisfied. In the sub-sample, it was possible to observe that the prevalence of individuals who presented positive screening for anorexia nervosa was higher than that of the unsatisfied group (p <0.05). In the simple regression it was observed that overweight, WHR, inadequate% BF, high plasma insulin and cigarette use were associated with body dissatisfaction, presenting different behaviors according to stage and sexual maturation. However, only overweight remained in the final model, in early adolescence and in the final stages of sexual maturation. It is concluded that overweight was the main factor associated with body dissatisfaction in the children and adolescents of this study, being essential the evaluation of the life stage and the degree of maturation that these are.
Consumo de potássio e relação Na/k na população adulta de Vitória/ES
(Universidade Federal do Espírito Santo, 2018-03-07) Alves, Silian Angela Avila; Molina, Maria del Carmen Bisi; Guandalini, Valdete Regina; Rocha, José Luiz Marques; Mill, Jose Geraldo; Moraes, Érica Aguiar
Lower potassium (K+ ) intake associated to high sodium (Na+ ) foods may have negative health impact. Besides K+ and Na+ isolated intake, their ratio have been strongly associated to hypertension and cardiovascular diseases. This study aimed to estimate K+ intake, Na / K rate and its associated factors from a crosssectional analysis National Health Survey substudy (PNS). Total of 272 adults, both sexes, aged 20 to 69 years, domiciled in Vitória / ES were screened to participate on it. Na+ and K+ intake estimation was performed from 24-hours urinary excretion method. Socioeconomic, health and lifestyle data were analyzed from a questionnaire. Adequate K+ intake (≥ 3.5g / day) and Na / K ratio in tertiles were analyzed as outcome variables. Appropriate statistical tests were performed to evaluate groups differences and multinomial logistic regression was used to identify factors associated to low Na / K ratio (p <0.05). K+ intake mean was 2.9 ± 1.2 g / day. Lower averages compared to recommended value was found for both sexes, in all age groups and independent of nutritional status. Almost a quarter of individuals reached K+ intake recommendation (38% of men and 14% of women). On the other hand, women showed lower Na / K ratio. Younger and less educated individuals are more likely to have higher Na / K ratio. This high Na / K ratio could be justified by the high Na+ consumption, since Na+ recommendation is farther to be reached in these population than K+ intake recommendation. Therefore, surveys are needed to significantly reduce Na+ consumption.
Fatores de risco cardiovascular : um estudo em agricultores do Espírito Santo
(Universidade Federal do Espírito Santo, 2018-04-05) Luz, Tamires Conceição da; Bezerra, Olívia Maria de Paula Alves; Salaroli, Luciane Bresciani; Pedrosa, Rogério Graça; Barbosa, Miriam Carmo Rodrigues; Zandonade, Eliana; Mill, José Geraldo
Rural populations have changed their eating and living habits over the years, leading to an increase in the occurrence of cardiovascular diseases. There are still few studies that describe how these risk factors are distributed in these populations. Therefore, this study aims to estimate the prevalence of cardiovascular risk factors in the Santa Maria de Jetibá farmers' population and the association with sociodemographic, occupational, lifestyle and anthropometric indicators. This is a cross-sectional population epidemiological study, developed in family farmers in the rural area of Santa Maria de Jetibá / ES. A questionnaire was applied and hemodynamic and anthropometric evaluations were carried out, as well as biochemical tests. Among the data collected, four cardiovascular risk factors defined in the Framingham studies (arterial hypertension, dyslipidemia, smoking, and fasting glycemia) were chosen as outcomes. Of the 790 study participants, 52,3% (n = 413) were males, 88,9% were white (n = 702), 31% were between 30 and 40 years old (n = 444) and 67,5% had between zero and four years of study. Regarding cardiovascular risk factors, hypertension was more prevalent in men (p <0.001), and dyslipidemia was more prevalent in women (p = 0,036). The number of cardiovascular risk factors was associated with age (p <0,001), schooling (p <0,001), landowner (p = 0,003), total weekly working hours (p = 0,004), working time as family farmer (p <0,000), body mass index (p <0,001), waist circumference (p = 0,005) and triceps skin fold (p = 0,001). Having more than 30 years of work as a farmer increased the chance of having two or more cardiovascular risk factors by 10,72 times (OR 2,92; CI 1,365 – 84,301); High waist circumference increased the chance in 2,43 times of having two or more cardiovascular risk factors (OR: 2,431, CI 1,526-3,874); Tricipital cut fold increased the chance of having two or more cardiovascular risk factors by 1.54 times (OR: 1,539; CI: 1,013-2,339). The results prove that family farmers are exposed to risk factors for the development of cardiovascular diseases. It is important to create public policies in SUS that meet the specific demands of this population.
Consumo de álcool e dislipidemias em participantes do estudo longitudinal de saúde do adulto ELSA-BRASIL
(Universidade Federal do Espírito Santo, 2018-04-06) Martinez, Oscar Geovanny Enriquez; Molina, Maria del Carmen Bisi; Cade, Nagela Valadão; Faria, Carolina Perim de
Dyslipidemias are defined as a change in the functioning of lipoproteins, such as Total Cholesterol (CT), HDL Cholesterol (HDL-c), LDL Cholesterol (LDL-C) and Triglycerides (TGS). Several factors are involved in its genesis, and there are still constroversias about the effect of alcohol consumption on the dyslipidemic. In Brazil, alcohol abuse increased by 3.4% in 10 years. The objective of this study was to investigate the relationship between alcohol consumption, as well as the type of alcoholic beverage, and lipid parameters in ELSA-Brasil participants. A baseline sample (2008-2010), aged 35-74, of both sexes was studied. Sociodemographic, lifestyle, biochemical and anthropometric data were collected in a standardized way in six teaching and research institutions The consumption of alcoholic beverages was estimated in dose / week and categorized in tertiles (1-7, 7-14 and> 14 doses / week) and by type of drink (beer, wine and spirits). Lipid parameters were used as continuous data. Linear regression models for each type and total of alcoholic beverages were tested. A significance level of 5% was accepted. A total of 12,179 participants were studied, 55.7% were women, 41.3% were 45-54 years old, 53.4% were superior, and 69.8% reported consuming alcoholic beverages. A significant association was found between CT, TGS and HDL-c and total alcohol consumption, but not with LDL-c. When analyzed by type of alcoholic beverage, it was observed that all lipid parameters increased with the increase in the number of doses / week of beer. It was also observed that consumption of 1-7 doses / week of wine significantly increased TC. Consumption between 1-7 and 7-14 doses / week elevated HDL-c. No association was observed with TGS and LDL-c. Consumption of spirits drinks of 1-7 and 7-14 doses / week increased CT. It was observed increased HDL-C in all categories of beverage consumption spirits. It is concluded that the total consumption of alcoholic beverages and beer increased all the biochemical parameters evaluated. Wine consumption increased all parameters, with the exception of TGS.
Desenvolvimento e caracterização de biscoitos com farinha mista extrudada de arroz integral e feijão preto
(Universidade Federal do Espírito Santo, 2018-04-12) Marques, Gleicyane de Almeida; Ascheri, Jose Luis Ramirez; Silva, Erika Madeira Moreira da; Moraes, Érica Aguiar; São José, Jackline Freitas Brilhante de; Chiaradia, Ana Cristina Nascimento
The combination of rice and beans has an important nutritional value, providing energy, vitamins and minerals, as well as the balance of essential amino acids, offering a good protein quality. Such foodstuffs can be an option as ingredients of certain products, such as cookies. In this way, it is possible to increase the offer of products processed for individuals with celiac disease (DC). This brings the need to improve processed products available in the market to increase the consumption options. This can be achieved through alternatives to conventional products that seek to satisfy the desires and demands of the consumers. The objective of the present study was to develop and characterize cookies made of extruded brown rice flour (Oryza sativa L.) and extruded black beans flour (Phaseolus vulgaris L.). The rotational central composite design was applied to study the effects of different levels of extruded black bean flour (BBF) (13,2 – 46,8 g/100 g), moisture (14,6 – 21,4 g/100 g ) and temperature (91,4 – 158,7 ° C) in the characteristics of specific mechanical energy (SME), expansion index (EI), initial viscosity (V25), maximum viscosity (Vmax), breakdown, viscosity final, setback, water solubility index (WSI), water absorption index (WAI) and color variation (ΔE) in the extruded flours. Cookies were evaluated physically (measurements, water activity (Aw), color, texture, sensory analysis and scanning electron microscopy (SEM)) and chemically (centesimal composition, total phenolic compounds, tannins, antioxidant capacity and protein integrity through SDS – PAGE). Aw, color, texture, pH and titratable total acidity (TTA) were analyzed for 60 days of storage. The BBF, moisture and temperature were able to influence significantly the results of SME, EI, viscosity, WAI and ΔE. Regarding the cookie measurement, only the thickness and the diameter were significantly influenced by the independent variables. The highest value of Aw was found in the treatment with 30 g/100 g of BBF. The darker biscuits were related to the increase of the BBF and humidity, but the increase of the temperature combined with the BBF caused less darkening. The cookie hardness was lower with the increase of moisture and temperature of the treatment of the flour. On the other hand, the increase of the BBF combined with moisture was able to increase the hardness of the biscuits. The addition of up to 30 g/100 g BBF showed a higher acceptance rate. The treatments containing the highest amount of bean flour presented higher content of ash, fiber, protein, iron and zinc. There was no effect of the heat treatment applied in the flour on the content of total phenolic compounds, antioxidant activity and tannins. Regarding protein quality, it was observed by SDS- PAGE that the extrusion process did not cause changes in the protein groups present in the flour. In cookies, it was observed that addition of 20 g/100 g of FFP allowed a higher intensity in the bands around 35.41 and 24.11 kDa. The presence of air bubbles and the amido-lipid complex were observed through SEM in all samples. All evaluated treatments maintained the quality parameters for 60 days.
Ângulo de fase e índices de prognóstico inflamatório e nutricional em mulheres submetidas à cirurgia bariátrica
(Universidade Federal do Espírito Santo, 2018-05-23) Koehler, Kymberle Betzel; Pedrosa, Rogério Graça; Haraguchi, Fabiano Kenji; Salaroli, Luciane Bresciani; Barauna, Valério Garrone
Introduction: Bariatric surgery is indicated as a treatment for severe obesity, and nutritional assessment in the first six months after surgery is imperative, given the acute weight loss that can occur in this period. Phase angle (PA) is indicated as an indicator of nutritional status and prognosis, and inflammatory and nutritional prognostic indexes have been used to evaluate patients in several clinical situations. The relationship between PA and inflammatory and nutritional prognostic indexes is poorly understood, especially in bariatric patients. The aim of this study was to evaluate PA and its correlation with inflammatory and nutritional prognostic indexes in women submitted to Roux-en-Y gastric by-pass (RYGB). Methods: The study was performed with female patients of the Bariatric Surgery Program of the Cassiano Antonio Moraes University Hospital. The patients were evaluated in three moments: approximately one month before surgery (M0), and approximately two (M1) and sixth (M2) months after surgery. The following parameters were evaluated: body weight, height, body mass index (BMI), PA, serum concentrations of prealbumin, albumin, Creactive protein (CRP), and alpha-1-acid glycoprotein (α1-AG), the CRP/Albumin Ratio and the Prognostic Inflammatory and Nutritional Index (PINI). Data were analyzed using the Shapiro-Wilk Normality Test, one-way ANOVA test for repeated measurements with Sidak post hoc, and Pearson or Spearman correlations, depending on the nature of the data. Results: Body weight and BMI decreased significantly over the evaluated periods (P <0.05). The PA had a significant reduction over the evaluated periods, with values in M1 and M2 differing from M0. Serum concentrations of pre-albumin, CRP and α1-AG were significantly reduced over time, with concentrations in M1 and M2 differing from M0 (P <0.05). The CRP/albumin ratio showed a significant reduction over time, with M1 and M2 being different from M0 (P <0.05). The PINI did not show statistically significant alterations, but indicated a change in the classification of low risk of complications for no infection / inflammation, demonstrating an improvement in the prognosis of these patients. There was a very strong correlation between PINI and the CRP/albumin ratio (r = 0.96, P <0.001). There was no significant correlation between PA and prognostic indexes, however, a direct strong correlation between PA and pre-albumin serum concentrations (r = 0.63, P <0.01) was observed, which remained moderate in M0 ( r = 0.55, P = 0.01) and M1 (r = 0.57, P <0.01), suggesting the use of AF as an indicator of nutritional status during the perioperative period of women submitted to RYGB. Conclusion: PA decreased and inflammatory and nutritional prognosis improved. PA did not correlate with improvement in the prognosis indicated by the indexes, however, the strong correlation between PA and pre-albumin serum concentrations suggests its applicability in the evaluation of nutritional risk after RYGB and reinforces its use as an alternative tool to evaluate the nutritional status.
Efeito da ingestão aguda de cafeína no desempenho de soco e respostas perceptivas em atletas de esportes de combate
(Universidade Federal do Espírito Santo, 2018-05-29) Azevedo, Arthur Persio de; Ferreira, Lucas Guimarães; Leopoldo, André Soares; Amaral, Fabian Tadeu do
The beneficial effects of caffeine intake on athletic performance, especially in prolonged exercise with aerobic predominance, are well documented in the scientific literature. In addition, there is increasing evidence of its application in short duration and high intensity exercise. Combat sports generally involve intermittent efforts, where strokes are delivered with maximum power. The effect of caffeine intake on the performance of combat athletes was, however, little explored until then. The aim of the present study was to evaluate the effect of acute caffeine intake on the intermittent performance of punches and perceptual responses combat sports athletes. 11 male combat athletes aged 18-35 years and weighing between 70kg and 95kg were selected and submitted to an intermittent punch protocol consisting of three periods of 15 seconds, with interval of 45 seconds, where they were instructed to deliver the largest number of punches with the dominant member with the greatest possible force. Performance indicators (number of punches and maximum strength and average of punches) were collected, besides subjective measures of physical and mental readiness and perception of effort. After a familiarization session and on different days, participants underwent the same protocol in two conditions, in a randomized and double-blinded fashion: 60 minutes after the ingestion of a solution containing caffeine (5 mg / kg) or placebo (flavored water) . There were no differences in the number of punches delivered in each series (p = 0.4562) or in the total number of punches (p = 0.99), as well as on the maximum force (p = 4534) and mean force of the punches (p = 0.7044). In addition, there were no differences in physical (p = 4235) or mental (p = 0.99) readiness to invest in effort and subjective perception of exertion between placebo and caffeine conditions (p = 0.2826). We can conclude that the intake of 5mg / kg of caffeine was not able to change the performance of fighters' punches when we evaluated the frequency of blows, medium and maximum strength, PSE and mental and physical readiness to invest in the effort.

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