BRUNO GUALANO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina - Líder
9 resultados
Resultados de Busca
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- Daily Leucine Intake Is Positively Associated with Lower Limb Skeletal Muscle Mass and Strength in the Elderly(2021) LIXANDRAO, Manoel E.; LONGOBARDI, Igor; LEITAO, Alice E.; MORAIS, Joao V. M.; SWINTON, Paul A.; AIHARA, Andre Y.; GOES, Paola C. K.; UGRINOWITSCH, Carlos; CANDOW, Darren G.; GUALANO, Bruno; ROSCHEL, HamiltonHigher daily protein intake, with an emphasis on leucine content, is thought to mitigate age-related anabolic resistance, potentially counteracting age-related morphological and functional declines. The present study investigated potential associations between total daily leucine intake and dependent variables, including quadriceps muscle cross-sectional area (CSA) and maximum dynamic muscle strength (1-RM) in a cohort of healthy free-living older individuals of both sexes (n = 67; 34/33 men/women). Participants performed three 24 h dietary recalls and underwent a magnetic resonance imaging exam followed by 1-RM tests. Our results demonstrate moderate associations between total daily leucine and both quadriceps CSA (r = 0.42; p = 0.004) and 1-RM (r = 0.45; p = 0.001). Furthermore, our exploratory biphasic linear regression analyses, adjusted for sex, age, and protein intake relative to body weight, revealed a plateau for daily leucine intake and muscle mass and muscle strength (~7.6-8.0 g & BULL;day(-1)) in older adults. In conclusion, we demonstrated that total daily leucine intake is associated with muscle mass and strength in healthy older individuals and this association remains after controlling for multiple factors, including overall protein intake. Furthermore, our breakpoint analysis revealed non-linearities and a potential threshold for habitual leucine intake, which may help guide future research on the effects of chronic leucine intake in age-related muscle loss.
- Association between physical activity and immunogenicity of an inactivated virus vaccine against SARS-CoV-2 in patients with autoimmune rheumatic diseases(2022) GUALANO, Bruno; LEMES, Italo R.; SILVA, Rafael P.; PINTO, Ana J.; MAZZOLANI, Bruna C.; I, Fabiana Smaira; SIECZKOWSKA, Sofia M.; AIKAWA, Nadia E.; PASOTO, Sandra G.; MEDEIROS-RIBEIRO, Ana C.; SAAD, Carla G. S.; YUKI, Emily F. N.; SILVA, Clovis A.; SWINTON, Paul; HALLAL, Pedro C.; ROSCHEL, Hamilton; BONFA, EloisaObjectives: To investigate whether physical activity is associated with enhanced immunogenicity of a SARS-CoV-2 inactivated vaccine (Coronavac) in patients with autoimmune rheumatic diseases (ARD) (n = 898) and in nonARD (n = 197) individuals without pre-existing immunogenicity to SARS-CoV-2. Methods: This was a prospective cohort study within an open-label, single-arm, phase 4 vaccination trial. Immunogenicity was assessed after vaccination by measuring seroconversion rates of total anti-SARS-CoV-2 S1/S2 IgG (SC), geometric mean titers of anti-S1/S2 IgG (GMT), factor-increase in GMT (FI-GMT), frequency of neutralizing antibody (NAb), and median neutralizing activity. Physical activity (active being defined as > 150 min/week) and sedentary behavior (>8h/day) were assessed by questionnaire. Results: Physically active ARD patients (n = 494) were younger and less frequently used prednisone/biologics than inactive patients (n = 404). After controlling for covariates, active patients exhibited greater SC (OR: 1.4 [95%CI: 1.1-2.0]), GMT (32% [95%CI: 8.8-60) and FI-GMT (33% [95%CI: 9.6-63%]) vs. inactive. Cluster analysis (physical activity/sedentary status) revealed greater GMT (43.0% [95% CI: 11.0-84.0%) and FI-GMT (48.0% [95%CI: 14.0-92.0%]) in active/non-sedentary vs. inactive/sedentary ARD patients. A dose-response was observed, with greater benefits for the group of patients performing > 350 min/week of physical activity (OR: 1.6 [95%CI: 1.1-2.4]; 41% [95%CI: 10-80%]; 35% [95%CI: 4.3-74], for SC, GMT, and FI-GMT, respectively) vs. the least active group (<= 30 min/week). Greater SC (OR: 9.9 [95%CI: 1.1-89.0]) and GMT (26% [95% CI: 2.2-56.0%]) were observed in active vs. inactive non-ARD. Conclusions: A physically active lifestyle may enhance SARS-CoV-2 vaccine immunogenicity, a finding of particular clinical relevance for immunocompromised patients.
- Physical activity and antibody persistence 6 months after the second dose of CoronaVac in immunocompromised patients(2022) GUALANO, Bruno; LEMES, Italo Ribeiro; SILVA, Rafael Pires da; PINTO, Ana Jessica; MAZZOLANI, Bruna Caruso; SMAIRA, Fabiana Infante; SIECZKOWSKA, Sofia Mendes; AIKAWA, Nadia Emi; PASOTO, Sandra; MEDEIROS-RIBEIRO, Ana Cristina; SAAD, Carla; YUK, Emily; SILVA, Clovis; SWINTON, Paul; HALLAL, Pedro Curi; ROSCHEL, Hamilton; BONFA, EloisaThis prospective cohort study within an open-label, single-arm, phase 4 vaccination trial ( #NCT04754698) aimed to investigate the association between physical activity and persistent anti-SARS-CoV-2 antibodies 6 months after two-dose schedule of CoronaVac in autoimmune rheumatic diseases (ARD) patients (n = 748). Persistent immunogenicity 6 months after the full-course vaccination was assessed using seroconversion rates of total anti-SARS-CoV-2 S1/S2 IgG, geometric mean titers of anti-S1/S2 IgG (GMT), and frequency of positive neutralizing antibodies (NAb). Physical activity was assessed trough questionnaire. Adjusted point estimates from logistic regression models indicated that physically active patients had greater odds of seroconversion rates (OR: 1.5 [95%CI: 1.1 to 2.1]) and NAb positivity (OR: 1.5 [95%CI: 1.0 to 2.1]), and approximately 43% greater GMT (42.8% [95%CI: 11.9 to 82.2]) than inactive ones. In conclusion, among immunocompromised patients, being physically active was associated with an increment in antibody persistence through 6 months after a full-course of an inactivated SARS-CoV-2 vaccine.
- No Associations Between Physical Activity and Immunogenicity in SARS-CoV-2 Seropositive Patients With Autoimmune Rheumatic Diseases Prior to and After Vaccination(2023) SMAIRA, Fabiana Infante; MAZZOLANI, Bruna Caruso; LEMES, italo Ribeiro; SILVA, Rafael Pires da; PINTO, Ana J.; SIECZKOWSKA, Sofia M.; AIKAWA, Nadia E.; PASOTO, Sandra G.; MEDEIROS-RIBEIRO, Ana C.; SAAD, Carla G. S.; YUK, Emily F. N.; SILVA, Clovis A.; SWINTON, Paul; KUPA, Leonard de Vinci Kanda; HALLAL, Pedro C.; ROSCHEL, Hamilton; GUALANO, Bruno; BONFA, EloisaAim: To investigate the association between physical activity and immunogenicity among SARS-CoV-2 seropositive patients with autoimmune rheumatic diseases prior to and following a 2-dose schedule of CoronaVac (Sinovac inactivated vaccine). Methods: This was a prospective cohort study within an open-label, single-arm, phase 4 vaccination trial conducted in Sao Paulo, Brazil. In this substudy, only SARS-CoV-2 seropositive patients were included. Immunogenicity was assessed by seroconversion rates of total anti-SARS-CoV-2 S1/S2 immunoglobulin G (IgG), geometric mean titers of anti-S1/S2 IgG, frequency of positive neutralizing antibodies, and neutralizing activity before and after vaccination. Physical activity was assessed through a questionnaire. Model-based analyses were performed controlling for age (<60 or>_60 y), sex, body mass index (<25, 25-30, and >30 kg/m2), and use of prednisone, immunosuppressants, and biologics. Results: A total of 180 seropositive autoimmune rheumatic disease patients were included. There was no association between physical activity and immunogenicity before and after vaccination. Conclusions: This study suggests that the positive association between physical activity and greater antibody responses seen in immunocompromised individuals following vaccination is overridden by previous SARS-CoV-2 infection, and does not extend to natural immunity.
- Muscle strength and muscle mass as predictors of hospital length of stay in patients with moderate to severe COVID-19: a prospective observational study(2021) GIL, Saulo; JACOB FILHO, Wilson; SHINJO, Samuel Katsuyuki; FERRIOLLI, Eduardo; BUSSE, Alexandre Leopold; AVELINO-SILVA, Thiago Junqueira; LONGOBARDI, Igor; OLIVEIRA JUNIOR, Gersiel Nascimento de; SWINTON, Paul; GUALANO, Bruno; ROSCHEL, HamiltonBackground Strength and muscle mass are predictors of relevant clinical outcomes in critically ill patients, but in hospitalized patients with COVID-19, it remains to be determined. In this prospective observational study, we investigated whether muscle strength or muscle mass are predictive of hospital length of stay (LOS) in patients with moderate to severe COVID-19 patients. Methods We evaluated prospectively 196 patients at hospital admission for muscle mass and strength. Ten patients did not test positive for SARS-CoV-2 during hospitalization and were excluded from the analyses. Results The sample comprised patients of both sexes (50% male) with a mean age (SD) of 59 (+/- 15) years, body mass index of 29.5 (+/- 6.9) kg/m(2). The prevalence of current smoking patients was 24.7%, and more prevalent coexisting conditions were hypertension (67.7%), obesity (40.9%), and type 2 diabetes (36.0%). Mean (SD) LOS was 8.6 days (7.7); 17.0% of the patients required intensive care; 3.8% used invasive mechanical ventilation; and 6.6% died during the hospitalization period. The crude hazard ratio (HR) for LOS was greatest for handgrip strength comparing the strongest versus other patients (1.47 [95% CI: 1.07-2.03; P = 0.019]). Evidence of an association between increased handgrip strength and shorter hospital stay was also identified when handgrip strength was standardized according to the sex-specific mean and standard deviation (1.23 [95% CI: 1.06-1.43; P = 0.007]). Mean LOS was shorter for the strongest patients (7.5 +/- 6.1 days) versus others (9.2 +/- 8.4 days). Evidence of associations were also present for vastus lateralis cross-sectional area. The crude HR identified shorter hospital stay for patients with greater sex-specific standardized values (1.20 [95% CI: 1.03-1.39; P = 0.016]). Evidence was also obtained associating longer hospital stays for patients with the lowest values for vastus lateralis cross-sectional area (0.63 [95% CI: 0.46-0.88; P = 0.006). Mean LOS for the patients with the lowest muscle cross-sectional area was longer (10.8 +/- 8.8 days) versus others (7.7 +/- 7.2 days). The magnitude of associations for handgrip strength and vastus lateralis cross-sectional area remained consistent and statistically significant after adjusting for other covariates. Conclusions Muscle strength and mass assessed upon hospital admission are predictors of LOS in patients with moderate to severe COVID-19, which stresses the value of muscle health in prognosis of this disease.
- Individual Participant Data Meta-Analysis Provides No Evidence of Intervention Response Variation in Individuals Supplementing With Beta-Alanine(2021) ESTEVES, Gabriel Perri; SWINTON, Paul; SALE, Craig; JAMES, Ruth M.; ARTIOLI, Guilherme Giannini; ROSCHEL, Hamilton; GUALANO, Bruno; SAUNDERS, Bryan; DOLAN, EimearCurrently, little is known about the extent of interindividual variability in response to beta-alanine (BA) supplementation, nor what proportion of said variability can be attributed to external factors or to the intervention itself (intervention response). To investigate this, individual participant data on the effect of BA supplementation on a high-intensity cycling capacity test (CCT110%) were meta-analyzed. Changes in time to exhaustion (TTE) and muscle carnosine were the primary and secondary outcomes. Multilevel distributional Bayesian models were used to estimate the mean and SD of BA and placebo group change scores. The relative sizes of group SDs were used to infer whether observed variation in change scores were due to intervention or non-intervention-related effects. Six eligible studies were identified, and individual data were obtained from four of these. Analyses showed a group effect of BA supplementation on TTE (7.7, 95% credible interval [CrI] [1.3, 14.3] s) and muscle carnosine (18.1, 95% CrI [14.5, 21.9] mmol/kg DM). A large intervention response variation was identified for muscle carnosine (sigma(IR) = 5.8, 95% CrI [4.2, 7.4] mmol/kg DM) while equivalent change score SDs were shown for TTE in both the placebo (16.1, 95% CrI [13.0, 21.3] s) and BA (15.9, 95% CrI [13.0, 20.0] s) conditions, with the probability that SD was greater in placebo being 0.64. In conclusion, the similarity in observed change score SDs between groups for TTE indicates the source of variation is common to both groups, and therefore unrelated to the supplement itself, likely originating instead from external factors such as nutritional intake, sleep patterns, or training status.
- Use of factor analysis to model relationships between bone mass and physical, dietary, and metabolic factors in frail and pre-frail older adults(2023) ESTEVES, Gabriel P.; SWINTON, Paul; SALE, Craig; GUALANO, Bruno; ROSCHEL, Hamilton; DOLAN, EimearBone mass and quality decline with age, and can culminate in osteoporosis and increased fracture risk. This investigation modeled associations between bone and physical, dietary, and metabolic factors in a group of 200 pre-frail/frail older adults using factor analysis and structural equation modeling (SEM). Exploratory (EFA) and confirmatory factor analysis (CFA) were conducted to compose factors and to assess their robustness. SEM was used to quantify associations between bone and the other factors. Factors arising from EFA and CFA were: bone (whole body, lumbar and femur bone mineral density, and trabecular bone score; good fit), body composition - lean (lean mass, body mass, vastus lateralis, and femoral cross-sectional area; good fit), body composition - fat (total fat mass, gynoid, android, and visceral fat; acceptable fit), strength (bench and leg press, handgrip, and knee extension peak torque; good fit), dietary intake (kilocalories, carbohydrate, protein, and fat; acceptable fit), and metabolic status (cortisol, insulin-like growth factor 1 (IGF-1), growth hormone (GH), and free testosterone; poor fit). SEM using isolated factors showed that body composition (lean) (13 = 0.66, P < 0.001), body composition (fat) (13 = 0.36, P < 0.001), and strength (13 = 0.74, P < 0.001) positively associated with bone. Dietary intake relative to body mass negatively associated with bone (13 = -0.28, P = 0.001), whereas in absolute terms, it showed no association (13 = 0.01, P = 0.911). In a multivariable model, only strength (13 = 0.38, P = 0.023) and body composition (lean) (13 = 0.34, P = 0.045) associated with bone. Resistance training programs that focus on improving lean mass and strength in older individuals may benefit bone in this population.
- Physical Activity: A Strategy to Improve Antibody Response to a SARS-CoV-2 Vaccine Booster Dose in Patients With Autoimmune Rheumatic Diseases(2023) GUALANO, Bruno; SIECZKOWSKA, Sofia M.; LEMES, Italo Ribeiro; SILVA, Rafael Pires da; PINTO, Ana J.; MAZZOLANI, Bruna C.; SMAIRA, Fabiana I.; AIKAWA, Nadia E.; KUPA, Leonard V. K.; PASOTO, Sandra G.; MEDEIROS-RIBEIRO, Ana C.; SAAD, Carla G. S.; YUK, Emily F. N.; SILVA, Clovis A.; SWINTON, Paul; HALLAL, Pedro C.; ROSCHEL, Hamilton; BONFA, EloisaBackground: Physical activity associates with improved immunogenicity following a 2-dose schedule of CoronaVac (Sinovac's inactivated SARS-CoV-2 vaccine) in patients with autoimmune rheumatic diseases (ARD). This study evaluates whether physical activity impacts vaccine-induced antibody responses to a booster dose in this population. Methods: This was a phase-4 trial conducted in Sao Paulo, Brazil. Patients with ARD underwent a 3-dose schedule of CoronaVac. One month after the booster, we assessed seroconversion rates of anti-SARS-CoV-2 S1/S2 IgG, geometric mean titers of anti-S1/S2 IgG, frequency of positive neutralizing antibodies, and neutralizing activity. Physical activity was assessed through questionnaire. Results: Physically active (n = 362) and inactive (n = 278) patients were comparable for most characteristics; however, physically active patients were younger (P<.01) and had a lower frequency of chronic inflammatory arthritis (P<.01). Adjusted models showed that physically active patients had -2 times odds of seroconversion rates (OR: 2.09; 95% confidence interval, 1.22 to 3.61), -22% greater geometric mean titers of anti-S1/S2 IgG (22.09%; 95% confidence interval, 3.91 to 65.60), and -7% greater neutralizing activity (6.76%; 95% confidence interval, 2.80 to 10.72) than inactive patients. Conclusions: Patients with ARD who are physically active have greater odds of experiencing better immunogenicity to a booster dose of CoronaVac. These results support the recommendation of physical activity to improve vaccination responses, particularly for immunocompromised individuals.
- Carotid intima-media thickness and flow-mediated dilation do not predict acute in-hospital outcomes in patients hospitalized with COVID-19(2022) CRISTINA-OLIVEIRA, Michelle; MEIRELES, Kamila; GIL, Saulo; ASSIS, Fabio Cavalcante; GEBER-JUNIOR, Joao Carlos; SHINJO, Samuel Katsuyuki; SOUZA, Heraldo Possolo de; SANTANA, Alfredo Nicodemos Cruz; SWINTON, Paul A.; DRAGER, Luciano F.; GUALANO, Bruno; ROSCHEL, Hamilton; PECANHA, TiagoStudies have suggested a potential role of endothelial dysfunction and atherosclerosis in the pathophysiology of COVID-19. Herein, we tested whether brachial flow-mediated dilation (FMD) and carotid intima-media thickness (cIMT) measured upon hospital admission are associated with acute in-hospital outcomes in patients hospitalized with COVID-19. A total of 211 patients hospitalized with COVID-19 were submitted to assessments of FMD and mean and maximum cIMT (cIMT(mean) and cIMT(max)) within the first 72 h of hospital admission. Study primary outcome was a composite of intensive care unit admission, mechanical ventilation, or death during the hospitalization. These outcomes were also considered independently. Thrombotic events were included as a secondary outcome. Odds ratios (ORs) and confidence intervals (CIs) were calculated using unadjusted and adjusted multivariable logistic regression models. Eighty-eight (42%) participants demonstrated at least one of the composite outcomes. cIMT(mean) and cIMT(max) were predictors of mortality and thrombotic events in the univariate analysis (cIMT(mean) and mortality: unadjusted OR 12.71 [95% CI 1.71-94.48]; P = 0.014; cIMT(mean) and thrombotic events: unadjusted OR 11.94 [95% CI 1.64-86.79]; P = 0.015; cIMT(max) and mortality: unadjusted OR 8.47 [95% CI 1.41-51.05]; P = 0.021; cIMT(max) and thrombotic events: unadjusted OR 12.19 [95% CI 2.03-73.09]; P = 0.007). However, these associations were no longer present after adjustment for potential confounders (P > 0.05). In addition, FMD% was not associated with any outcome. In conclusion, cIMT and FMD are not independent predictors of clinical outcomes in patients hospitalized with COVID-19. These results suggest that subclinical atherosclerosis and endothelial dysfunction may not be the main drivers of COVID-19 complications in patients hospitalized with COVID-19. NEW & NOTEWORTHY Studies have suggested a role of endothelial dysfunction and atherosclerosis in COVID-19 pathophysiology. In this prospective cohort study, we assessed the prognostic value of carotid intima-media thickness (IMT) and flow-mediated dilation (FMD) in patients with COVID-19. Carotid IMT and FMD were not independent predictors of major outcomes. These results suggest that other risk factors may be the main drivers of clinical outcomes in patients with COVID-19.