Percorrer por autor "Regalo, Simone Cecílio Hallak"
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- Assessing frailty in the older : the role of bite force as an independent indicatorPublication . Ferreira, Luciano Maia Alves; Brito, José; Silva, Josie Resende Torres da; Silva, Marcelo Lourenço da; Andrade, Maia e Maia Fischel e; Júdice, André; Mendes, José João; Machado, Vanessa; Botelho, João; Regalo, Simone Cecílio HallakBackground: This study investigates the relationship between bite force and grip strength as indicators of frailty in older adults. Frailty syndrome, characterized by increased vulnerability to adverse health outcomes, poses significant challenges in geriatric care. Objectives: This research builds on previous findings linking oral health to frailty risk, emphasizing the need for targeted interventions. Methods: A total of 59 older participants, aged 60 years and older, were enrolled in this cross-sectional study conducted at the Egas Moniz School of Health and Science. The participants underwent assessments of bite force using an electric dynamometer and grip strength using a specialized device. Body composition was also measured using bioelectrical impedance analysis (BIA). Results: Statistical analysis revealed a significant positive correlation between bite force and grip strength, even after adjusting for age and body mass index (BMI). Age was significantly correlated with bite and grip force (p < 0.05), while BMI was correlated only with handgrip force but not with bite force (coefficient = −0.047, p = 0.737). Notably, bite force was found to be independent of BMI, unlike grip strength, which is generally influenced by body composition. This independence highlights the potential of bite force as a reliable and distinct marker for frailty that is not confounded by BMI-related factors. This study highlights the importance of oral health in maintaining overall well-being in older adults. Reduced bite force may indicate an increased risk of frailty, which can lead to malnutrition and decreased quality of life. These findings suggest that integrating bite force measurements into clinical assessments may improve the assessment of frailty and inform interventions aimed at improving health outcomes in the older population. Conclusions: This research provides new insights into the association between bite force and grip strength, emphasizing the unique value of bite force as an independent marker of frailty. It advocates for further studies to explore its role in geriatric care strategies.
- Breastfeeding as a strategic driver for One Health : a narrative reviewPublication . Machado, Vanessa; Regalo, Simone Cecílio Hallak; Ferreira, Luciano Maia Alves; Martinelli, Roberta Lopes de Castro; Trawitzki, Luciana Vitaliano Voi; Siéssere, Selma; Mendes, José João; Botelho, JoãoBreastfeeding is a renewable biological system that simultaneously advances human, environmental, and societal health. Human milk provides unparalleled nutrition and immunological protection, improving infant survival, neurodevelopment, and long-term metabolic outcomes, while reducing maternal risk of breast and ovarian cancer. However, and despite decades of evidence, only 48% of infants under six months are exclusively breastfed worldwide, and breastfeeding remains absent from most sustainability and One Health strategies. This narrative review synthesizes evidence demonstrating that breastfeeding functions as a low-carbon, zero-waste food system that avoids greenhouse gas emissions, land conversion, water consumption, and biodiversity loss linked to commercial milk formula production. At the societal level, breastfeeding reduces health-system costs, strengthens emergency resilience when supply chains fail, and generates long-term economic returns. By integrating evidence across human health, environmental impact and social determinants, this review positions breastfeeding as a strategic One Health intervention and a high-value investment for achieving multiple Sustainable Development Goals. Strengthening policy support—including protection against formula marketing, workplace accommodations, and expansion of baby-friendly systems—is essential to unlock breastfeeding’s potential for planetary and public health.
- Lip pressure, bite force and denture use as predictors of oral frailty in physically active older adults : a cross-sectional studyPublication . Colaço, Catarina; Caetano-Santos, Inês; Brito, José; Machado, Vanessa; Lobito, Angel; Mendes, José João; Siessere, Selma; Regalo, Simone Cecílio Hallak; Ferreira, Luciano Maia AlvesBackground: Oral frailty is an emerging determinant of late-life disability. While objective functional measures have been proposed as key indicators, their combined role in predicting frailty among physically active older adults remains unclear. Therefore, this study aimed to investigate the association between the presence of oral frailty and lip pressure, bite force, and denture use. Methods: This cross-sectional study included 192 participants aged 60 years or older from Brazil (n = 131) and Portugal (n = 61), all physically active and with ≥20 natural or rehabilitated teeth. Data were collected through a questionnaire on sociodemographic data and the Oral Frailty Index-8. The clinical assessment included lip pressure, bite force, and denture use. Multiple logistic regression identified independent predictors; model fit and discrimination were examined using the Hosmer–Lemeshow test and ROC curve. Results: Participants were mainly female (83.3%), mean age ≈72 years; 76% used dentures and frailty prevalence was ≈49%. Higher lip pressure (OR = 0.986, 95% CI = [0.973–0.999]) and higher bite force (OR = 0.925, 95% CI = [0.885–0.967) were independently protective, whereas denture use (OR = 6.898, 95% CI = [2.994–15.895]) markedly increased oral frailty odds. The model showed good discrimination (AUC 0.779). Conclusions: Even small increases in lip pressure and bite force reduced the likelihood of frailty, while denture use identified individuals at substantially higher risk. These findings highlight orofacial muscle strength and masticatory capacity as core components of oral frailty and support incorporating lip pressure and bite force testing into multidimensional frailty assessment and targeted rehabilitation.
- Multidimensional frailty assessment integrating physical, mental and oral health : a multicentric studyPublication . Ferreira, Luciano Maia Alves; Brito, José; Chaló, Paulo Alexandre Ferreira; Oliveira, Carlos Borges; Andrade, Maia e Maia Fischel e; Botelho, João; Mendes, José João; Fiocco, Evandro Marianeti; Regalo, Simone Cecílio HallakAim: Frailty is a complex and multidimensional condition commonly observed in older adults and associated with increased risks of falls, hospitalization, disability, and mortality. Traditionally, frailty assessments have focused primarily on physical performance and biomedical parameters. However, emerging evidence highlights the importance of psychological, social, and oral health domains, which are often excluded from standard assessment models. These omissions may limit the accuracy and clinical utility of frailty screening, particularly in diverse aging populations. Methods: To evaluate the effectiveness of an extended frailty assessment model with up to 10 predictive variables, including Bite force and the Oral Frailty Index (OFI-8/PT), in distinguishing between levels of frailty (non-frail, pre-frail, and frail), and to compare its performance with traditional models. Results: The sample included 499 community-dwelling older adults (295 from Brazil and 204 from Portugal), aged ≥ 60 years, with at least 20 functional teeth and no cognitive or neurological impairments. Participants underwent functional tests (Timed Up and Go, Sit-to-Stand, handgrip strength), body composition measurements (BMI, body fat percentage, waist-to-hip ratio), psychological assessment (CES-D for depression), physical activity evaluation (IPAQ), Bite force testing (dynamometry), and oral health screening (OFI-8/PT). Discriminant analysis was used to identify which variables best differentiated the frailty groups. Results: In the model with 8 predictors, the main discriminators were the Sit-to-Stand test (STS), handgrip strength, and CES-D depression scores. Discriminant Function 1 (DF1) effectively separated non-frail and frail individuals, while Function 2 (DF2) helped distinguish pre-frail participants. The classification performance of the extended model with 10 variables—adding Bite force and OFI-8/PT—showed no statistically meaningful deterioration, justifying the use of the model with additional predictors of clinical interest. Bite force showed a positive correlation with handgrip strength and a negative correlation with oral frailty scores, indicating its value as an independent functional marker. Conclusion: Including mental and oral health markers significantly enhances frailty assessment models, supporting a more comprehensive and sensitive approach. The 10-variable model proved effective in identifying distinct frailty profiles, highlighting depression and masticatory function as crucial components. These findings emphasize the need for adaptable, integrative assessment tools in geriatric practice, enabling early, individualized interventions and guiding public health strategies to promote healthy aging across diverse cultural settings.