Statistics

 array:23 [
  "pii" => "S2666275223001017"
  "issn" => "26662752"
  "doi" => "10.1016/j.abdp.2023.04.002"
  "estado" => "S300"
  "fechaPublicacion" => "2023-09-01"
  "aid" => "755"
  "copyright" => "Sociedade Brasileira de Dermatologia"
  "copyrightAnyo" => "2023"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "en" => array:18 [
      "pii" => "S0365059623000867"
      "issn" => "03650596"
      "doi" => "10.1016/j.abd.2022.08.008"
      "estado" => "S300"
      "fechaPublicacion" => "2023-09-01"
      "aid" => "755"
      "copyright" => "Sociedade Brasileira de Dermatologia"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "en" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
        "titulo" => "Intestinal microbiome characterization of adult Brazilian men with psoriasis compared to omnivore and vegetarian controls"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "635"
            "paginaFinal" => "643"
          ]
        ]
        "contieneResumen" => array:1 [
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:8 [
            "identificador" => "fig0005"
            "etiqueta" => "Figure 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1203
                "Ancho" => 3341
                "Tamanyo" => 282220
              ]
            ]
            "detalles" => array:1 [
              0 => array:3 [
                "identificador" => "at0035"
                "detalle" => "Figure "
                "rol" => "short"
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Alpha diversity&#46; Proportion distribution of the 13 most prevalent genera among the groups&#58; PSO &#40;psoriasis&#41;&#44; VEG &#40;vegetarian controls&#41;&#44; OMNI &#40;omnivore controls&#41;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Tatiana Cristina Figueira Polo, Mariana Righetto de R&#233; Lai, Luciane Donida Bartoli Miot, Giovana Fernanda Cosi Bento, M&#225;rcia Guimar&#227;es da Silva, Silvio Alencar Marques, H&#233;lio Amante Miot"
            "autores" => array:7 [
              0 => array:2 [
                "nombre" => "Tatiana Cristina Figueira"
                "apellidos" => "Polo"
              ]
              1 => array:2 [
                "nombre" => "Mariana Righetto de R&#233;"
                "apellidos" => "Lai"
              ]
              2 => array:2 [
                "nombre" => "Luciane Donida Bartoli"
                "apellidos" => "Miot"
              ]
              3 => array:2 [
                "nombre" => "Giovana Fernanda Cosi"
                "apellidos" => "Bento"
              ]
              4 => array:2 [
                "nombre" => "M&#225;rcia Guimar&#227;es da"
                "apellidos" => "Silva"
              ]
              5 => array:2 [
                "nombre" => "Silvio Alencar"
                "apellidos" => "Marques"
              ]
              6 => array:2 [
                "nombre" => "H&#233;lio Amante"
                "apellidos" => "Miot"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "pt" => array:9 [
          "pii" => "S2666275223001017"
          "doi" => "10.1016/j.abdp.2023.04.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "pt"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223001017?idApp=UINPBA00008Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000867?idApp=UINPBA00008Z"
      "url" => "/03650596/0000009800000005/v1_202307281023/S0365059623000867/v1_202307281023/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S2666275223001339"
    "issn" => "26662752"
    "doi" => "10.1016/j.abdp.2023.05.010"
    "estado" => "S300"
    "fechaPublicacion" => "2023-09-01"
    "aid" => "768"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "pt" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Artigo original</span>"
      "titulo" => "Quantifica&#231;&#227;o de pesticidas em amostras de cabelo de pacientes com p&#234;nfigo foli&#225;ceo e p&#234;nfigo vulgar no Sudeste do Brasil"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "tieneResumen" => "pt"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "644"
          "paginaFinal" => "650"
        ]
      ]
      "contieneResumen" => array:1 [
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Leonardo La Serra, Adriana Martinelli Salathiel, Rafael Lanaro, Bruno de Martinis, Ana Maria Roselino"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Leonardo"
              "apellidos" => "La Serra"
            ]
            1 => array:2 [
              "nombre" => "Adriana Martinelli"
              "apellidos" => "Salathiel"
            ]
            2 => array:2 [
              "nombre" => "Rafael"
              "apellidos" => "Lanaro"
            ]
            3 => array:2 [
              "nombre" => "Bruno"
              "apellidos" => "de Martinis"
            ]
            4 => array:2 [
              "nombre" => "Ana Maria"
              "apellidos" => "Roselino"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0365059623000995"
        "doi" => "10.1016/j.abd.2022.10.010"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000995?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223001339?idApp=UINPBA00008Z"
    "url" => "/26662752/0000009800000005/v1_202307310652/S2666275223001339/v1_202307310652/pt/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S2666275223001340"
    "issn" => "26662752"
    "doi" => "10.1016/j.abdp.2023.05.011"
    "estado" => "S300"
    "fechaPublicacion" => "2023-09-01"
    "aid" => "766"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "pt" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Artigo original</span>"
      "titulo" => "Dermatologia hospitalar&#58; an&#225;lise de consultas dermatol&#243;gicas em hospital universit&#225;rio terci&#225;rio"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => "pt"
      "tieneResumen" => "pt"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "620"
          "paginaFinal" => "634"
        ]
      ]
      "contieneResumen" => array:1 [
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "pt" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figura 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1309
              "Ancho" => 2215
              "Tamanyo" => 167774
            ]
          ]
          "descripcion" => array:1 [
            "pt" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Fluxo de encaminhamentos de consultas dermatol&#243;gicas hospitalares&#44; de agosto de 2018 a janeiro de 2020</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Iago Gon&#231;alves Ferreira, Camila Saraiva Almeida, Lucas Abascal Bulc&#227;o, Diego Gon&#231;alves Ferreira, Magda Blessmann Weber, Renan Rangel Bonamigo"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Iago Gon&#231;alves"
              "apellidos" => "Ferreira"
            ]
            1 => array:2 [
              "nombre" => "Camila Saraiva"
              "apellidos" => "Almeida"
            ]
            2 => array:2 [
              "nombre" => "Lucas Abascal"
              "apellidos" => "Bulc&#227;o"
            ]
            3 => array:2 [
              "nombre" => "Diego Gon&#231;alves"
              "apellidos" => "Ferreira"
            ]
            4 => array:2 [
              "nombre" => "Magda Blessmann"
              "apellidos" => "Weber"
            ]
            5 => array:2 [
              "nombre" => "Renan Rangel"
              "apellidos" => "Bonamigo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0365059623000971"
        "doi" => "10.1016/j.abd.2022.08.010"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059623000971?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223001340?idApp=UINPBA00008Z"
    "url" => "/26662752/0000009800000005/v1_202307310652/S2666275223001340/v1_202307310652/pt/main.assets"
  ]
  "pt" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Artigo original</span>"
    "titulo" => "Caracteriza&#231;&#227;o do microbioma intestinal de homens adultos brasileiros com psor&#237;ase em compara&#231;&#227;o com controles on&#237;voros e vegetarianos"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "635"
        "paginaFinal" => "643"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Tatiana Cristina Figueira Polo, Mariana Righetto de R&#233; Lai, Luciane Donida Bartoli Miot, Giovana Fernanda Cosi Bento, M&#225;rcia Guimar&#227;es da Silva, Silvio Alencar Marques, H&#233;lio Amante Miot"
        "autores" => array:7 [
          0 => array:4 [
            "nombre" => "Tatiana Cristina Figueira"
            "apellidos" => "Polo"
            "email" => array:1 [
              0 => "tatiana.figueira@yahoo.com.br"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Mariana Righetto de R&#233;"
            "apellidos" => "Lai"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Luciane Donida Bartoli"
            "apellidos" => "Miot"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Giovana Fernanda Cosi"
            "apellidos" => "Bento"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "M&#225;rcia Guimar&#227;es da"
            "apellidos" => "Silva"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Silvio Alencar"
            "apellidos" => "Marques"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "H&#233;lio Amante"
            "apellidos" => "Miot"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Departamento de Dermatologia&#44; Faculdade de Medicina de Botucatu&#44; Universidade Estadual Paulista&#44; Botucatu&#44; SP&#44; Brasil"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Departamento de Patologia&#44; Faculdade de Medicina&#44; Universidade Estadual Paulista&#44; Botucatu&#44; SP&#44; Brasil"
            "etiqueta" => "b"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Autor para correspond&#234;ncia&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1232
            "Ancho" => 2175
            "Tamanyo" => 158697
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Alfa&#8208;diversidade&#46; Compara&#231;&#227;o da mediana da abund&#226;ncia dos g&#234;neros que apresentaram diferen&#231;a entre os grupos &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; PSO &#40;psor&#237;ase&#41;&#44; VEG &#40;controles vegetarianos&#41; e ONI &#40;controles on&#237;voros&#41;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">Psor&#237;ase &#233; doen&#231;a cr&#244;nica inflamat&#243;ria sist&#234;mica que afeta entre 1&#37; e 2&#37; da popula&#231;&#227;o&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a> Sua patog&#234;nese &#233; multifatorial&#44; n&#227;o sendo totalmente esclarecida&#44; mas que envolve&#44; al&#233;m de uma base gen&#233;tica e est&#237;mulos ambientais&#44; a ativa&#231;&#227;o do sistema imune &#40;inato e adaptativo&#41;&#44; que desencadeia respostas inflamat&#243;rias locais na pele e articula&#231;&#245;es&#44; assim como promove inflama&#231;&#227;o sist&#234;mica de baixo grau&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Comorbidades como obesidade&#44; hipertens&#227;o arterial&#44; diabetes <span class="elsevierStyleItalic">mellitus</span>&#44; s&#237;ndrome metab&#243;lica&#44; doen&#231;a cardiovascular&#44; dislipidemia e transtornos afetivos &#40;depress&#227;o&#44; ansiedade&#41; s&#227;o frequentes em pacientes com psor&#237;ase&#44; substanciando o processo inflamat&#243;rio sist&#234;mico subjacente&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Microbioma intestinal &#40;MI&#41; consiste em flora inconstante&#44; constitu&#237;da nos primeiros anos de vida&#44; mas que varia conforme est&#237;mulos ambientais&#44; como dieta&#44; estilo de vida &#40;tabagismo&#44; consumo de &#225;lcool&#44; exerc&#237;cios f&#237;sicos&#44; estresse&#44; sono&#41;&#44; higiene&#44; terap&#234;utica com antimicrobianos&#44; localiza&#231;&#227;o geogr&#225;fica&#44; sexo&#44; idade e certas doen&#231;as&#46; Cerca de 57&#37; do MI &#233; influenciado pela dieta&#44; e apenas 12&#37; por fatores gen&#233;ticos&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> No microbioma fecal existem entre uma e 2&#46;000 esp&#233;cies de bact&#233;rias&#44; distribu&#237;das em mais de 50 filos&#46; Cerca de 90&#37; do MI s&#227;o compostos pelos filos <span class="elsevierStyleItalic">Firmicutes</span> e <span class="elsevierStyleItalic">Bacteroidetes</span>&#59; uma propor&#231;&#227;o maior de <span class="elsevierStyleItalic">Firmicutes&#47;Bacteroidetes</span> &#40;F&#47;B&#41; &#233; associada a maior est&#237;mulo inflamat&#243;rio sist&#234;mico&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A disbiose intestinal&#44; caracterizada pelo desequil&#237;brio da composi&#231;&#227;o do MI&#44; pode levar ao aumento da permeabilidade intestinal e a transloca&#231;&#227;o de mediadores inflamat&#243;rios intraluminais&#46; Portanto&#44; a caracteriza&#231;&#227;o do MI pode contribuir na compreens&#227;o sobre a patog&#234;nese de doen&#231;as inflamat&#243;rias sist&#234;micas como psor&#237;ase&#44; doen&#231;a de Crohn&#44; artrite reumatoide e obesidade&#44; pois h&#225; ind&#237;cios de que a composi&#231;&#227;o do MI esteja envolvida no curso das mesmas&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Estudos cl&#237;nicos foram conduzidos para explorar a rela&#231;&#227;o entre MI e a atividade cl&#237;nica da psor&#237;ase&#44; com resultados ainda conflitantes&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> Entretanto&#44; considera&#8208;se a modula&#231;&#227;o do MI por meio de tratamento diet&#233;tico&#44; suplementa&#231;&#245;es com probi&#243;ticos e transplante fecal&#44; com potencial de interferir&#44; al&#233;m da atividade da psor&#237;ase&#44; no curso de comorbidades&#44; al&#233;m de maximizar sua resposta terap&#234;utica&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Lipopolissacar&#237;dio &#40;LPS&#41; &#233; uma endotoxina que comp&#245;e a parede celular de bact&#233;rias gram&#8208;negativas e promove ativa&#231;&#227;o do sistema imune a partir da estimula&#231;&#227;o direta de macr&#243;fagos&#44; mon&#243;citos&#44; c&#233;lulas dendr&#237;ticas e linf&#243;citos B&#44; desencadeando febre&#44; vasodilata&#231;&#227;o &#40;&#243;xido n&#237;trico&#41; e secre&#231;&#227;o de eicosanoides&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a> A prote&#237;na de liga&#231;&#227;o de lipopolissacar&#237;dios &#40;LPB&#41; liga&#8208;se ao LPS e transfere mon&#244;meros de LPS para as c&#233;lulas inflamat&#243;rias atrav&#233;s de CD14&#46; Os n&#237;veis plasm&#225;ticos de LPB s&#227;o influenciados pelas concentra&#231;&#245;es circulantes de LPS&#44; que t&#234;m meia&#8208;vida muito curta&#46; A exposi&#231;&#227;o ao LPS induz um aumento duradouro da produ&#231;&#227;o de LPB no f&#237;gado dentro de 15 a 30 minutos&#44; com n&#237;vel s&#233;rico m&#225;ximo ocorrendo ap&#243;s 24 a 48 horas&#46; O complexo LPS&#8208;LBP&#8208;CD14&#8208;MD2 induz uma resposta pr&#243;&#8208;inflamat&#243;ria pela ativa&#231;&#227;o de NF&#8208;&#954;B mediada pelo receptor <span class="elsevierStyleItalic">Toll&#8208;like</span>&#8208;4 &#40;TLR4&#41; e&#44; como tal&#44; os n&#237;veis circulantes de LPB foram associados &#224; inflama&#231;&#227;o sist&#234;mica&#46; Al&#233;m disso&#44; n&#237;veis plasm&#225;ticos da prote&#237;na C reativa quantitativa ultrassens&#237;vel &#40;PCRqt&#41;&#44; um biomarcador s&#233;rico de inflama&#231;&#227;o sist&#234;mica sintetizado pelo f&#237;gado&#44; est&#227;o associadas ao aumento de LPS&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Na Am&#233;rica do Sul&#44; s&#227;o raros os estudos controlados que caracterizem o MI de pacientes com psor&#237;ase&#46; Assim&#44; o objetivo desta investiga&#231;&#227;o foi caracterizar o MI de homens adultos brasileiros com psor&#237;ase&#44; comparando&#8208;os com controles on&#237;voros e vegetarianos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todo</span><p id="par0040" class="elsevierStylePara elsevierViewall">Estudo transversal envolvendo 42 homens adultos &#40;21&#8208;65 anos&#41; &#8211; 21 com psor&#237;ase &#40;PSO&#41; e 21 controles sem psor&#237;ase&#44; dos quais 14 on&#237;voros &#40;ONI&#41; e sete vegetarianos &#40;VEG&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Todos os participantes inclu&#237;dos eram n&#227;o tabagistas&#44; n&#227;o etilistas&#44; n&#227;o apresentaram altera&#231;&#245;es na dieta nos &#250;ltimos tr&#234;s meses&#59; n&#227;o usaram antibi&#243;ticos&#44; laxantes&#44; anti&#8208;inflamat&#243;rios&#44; ou referiram altera&#231;&#245;es intestinais na &#250;ltima semana&#44; aus&#234;ncia de doen&#231;a inflamat&#243;ria intestinal&#44; infec&#231;&#245;es&#44; doen&#231;as autoimunes e uso de probi&#243;ticos&#46; A amostra de homens adultos do interior do estado de S&#227;o Paulo foi escolhida para reduzir a variabilidade do MI&#44; que tamb&#233;m &#233; influenciada por sexo&#44; idade e localiza&#231;&#227;o geogr&#225;fica da popula&#231;&#227;o&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">O estudo foi aprovado pelo Comit&#234; de &#201;tica em Pesquisa em Seres Humanos da Faculdade de Medicina de Botucatu &#40;FMB&#47;UNESP&#41; sob o parecer n&#176; 3&#46;743&#46;366&#46; Todos os participante assinaram o Termo de Consentimento Livre e Esclarecido&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A pesquisa foi realizada no Ambulat&#243;rio de Dermatologia da FMB&#44; no per&#237;odo de mar&#231;o de 2020 a fevereiro de 2021&#46; A popula&#231;&#227;o teve origem entre moradores da regi&#227;o de Botucatu &#40;SP&#41;&#44; pacientes com diagn&#243;stico de psor&#237;ase&#44; seus acompanhantes e convidados vegetarianos&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Foram obtidos dados cl&#237;nicos&#44; demogr&#225;ficos&#44; socioecon&#244;micos e diet&#233;ticos por meio de entrevistas presenciais&#59; as avalia&#231;&#245;es antropom&#233;trica e diet&#233;tica foram realizadas por nutricionista experiente &#40;T&#46;C&#46;F&#46;P&#46;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A avalia&#231;&#227;o diet&#233;tica foi obtida pelo Recordat&#243;rio de 24 horas &#40;R24<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; a partir do relato detalhado do consumo alimentar nas &#250;ltimas 24 horas&#44; com dados sobre os tipos de alimentos e bebidas&#44; al&#233;m do tamanho&#44; por&#231;&#245;es&#44; volume ou medidas caseiras&#46; Posteriormente&#44; os dados foram transformados em gramas&#44; valores de energia&#44; macronutrientes e micronutrientes pelo <span class="elsevierStyleItalic">software</span> NDSR &#40;<span class="elsevierStyleItalic">Nutritional Data System for Research</span>&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Para estimar a gravidade da doen&#231;a&#44; foi utilizado o escore PASI &#40;<span class="elsevierStyleItalic">Psoriasis Area and Severity Index</span>&#41;&#44; avaliado por dermatologista titulado &#40;L&#46;D&#46;B&#46;M&#46; ou M&#46;R&#46;R&#46;L&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Para avaliar o MI&#44; coletaram&#8208;se amostras de fezes para obten&#231;&#227;o do material gen&#233;tico&#46; Os indiv&#237;duos foram orientados a realizar a coleta de fezes da primeira evacua&#231;&#227;o do dia em tubo espec&#237;fico em sua resid&#234;ncia&#46; Ap&#243;s a coleta&#44; as amostras foram entregues &#224; pesquisadora respons&#225;vel &#40;T&#46;C&#46;F&#46;P&#46;&#41; e transportadas refrigeradas &#40;gelo seco&#58; &#8722;28<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; at&#233; o laborat&#243;rio Biotecnologia Pesquisa e Inova&#231;&#227;o &#40;BPI&#44; Botucatu&#8208;SP&#41;&#44; e armazenadas em freezer &#8722;80<span class="elsevierStyleHsp" style=""></span>&#176;C at&#233; o momento da extra&#231;&#227;o do DNA&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Para extra&#231;&#227;o do material gen&#233;tico&#44; foram utilizadas al&#237;quotas de 1<span class="elsevierStyleHsp" style=""></span>g e o <span class="elsevierStyleItalic">kit</span> Quick&#8208;DNA Fungal&#47;Bacterial Miniprep &#40;Zymo Research&#41;&#44; de acordo com protocolo descrito pelo fabricante&#46; Posteriormente&#44; o material passou pelo teste de qualidade por meio da quantifica&#231;&#227;o por fluoresc&#234;ncia com a utiliza&#231;&#227;o do equipamento Qubit&#174; 3&#46;0 Fluorometer &#40;Thermo Fisher Scientific&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Para as rea&#231;&#245;es de amplifica&#231;&#227;o da regi&#227;o 16S foram realizadas triplicatas de amostras&#44; tendo como volume final de 20 &#956;L&#44; contendo 10 &#956;L de GoTaq&#174; Colorless Master Mix 2<span class="elsevierStyleHsp" style=""></span>&#215; &#40;Promega&#44; USL&#41;&#44; 0&#44;3 &#956;M de oligonucleot&#237;dio <span class="elsevierStyleItalic">forward</span> e 0&#44;3 &#956;M de oligonucleot&#237;dio <span class="elsevierStyleItalic">reverse</span>&#44; 3 &#956;L de DNA gen&#244;mico e &#225;gua ultrapura est&#233;ril suficiente para completar 20 &#956;L&#46; As rea&#231;&#245;es de amplifica&#231;&#227;o foram conduzidas em termociclador Veriti<span class="elsevierStyleSup">TM</span> Thermal Cycler &#40;Applied Biosystems&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Ap&#243;s a rea&#231;&#227;o de amplifica&#231;&#227;o do DNA de cada amostra&#44; a comprova&#231;&#227;o da amplifica&#231;&#227;o foi realizada por eletroforese em gel de agarose 2&#37; corado com gel Red &#40;Uniscience&#41;&#44; aproximadamente 300 bp &#40;tamanho do <span class="elsevierStyleItalic">amplicon</span>&#41;&#46; Submeteu&#8208;se PCR para etapas de purifica&#231;&#227;o utilizando <span class="elsevierStyleItalic">bead</span> magn&#233;tica Agencourt AMPure XP &#40;Beckman Coulter&#41; para remo&#231;&#227;o de fragmentos muito pequenos da popula&#231;&#227;o total de mol&#233;culas e restos de <span class="elsevierStyleItalic">primers</span> da rea&#231;&#227;o&#46; Ap&#243;s essa etapa&#44; foi realizada a quantifica&#231;&#227;o pela metodologia de PCR em tempo real utilizando termociclador QuantStudio 3 Real Time &#40;Applied Biosystems&#41; e <span class="elsevierStyleItalic">kit</span> KAPA&#8208;KK4824 &#40;Library Quantification Kit &#8208; Illumina&#47;Universal&#41;&#44; todos de acordo com protocolo do fabricante&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Foi gerado um <span class="elsevierStyleItalic">pool</span> equimolar de DNA&#44; por meio da normaliza&#231;&#227;o de todas as amostras a 3<span class="elsevierStyleHsp" style=""></span>nM para a realiza&#231;&#227;o do sequenciamento&#44; o qual foi conduzido utilizando o sistema Illumina MiSeq de sequenciamento de nova gera&#231;&#227;o &#40;Illumina Sequencing&#41; e <span class="elsevierStyleItalic">kit</span> MiSeq Reagent Kit V2 Nano 300 ciclos &#8211; leitura de 2 &#215; 150 pb&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Utilizou&#8208;se o banco de dados Greengenes 13&#95;8 99&#37; OTUs from 515F&#47;806R region of sequences para identifica&#231;&#227;o das sequ&#234;ncias de t&#225;xons e foram consideradas apenas sequ&#234;ncias com mais de 97&#37; de analogia &#40;confiabilidade&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">A abund&#226;ncia relativa das unidades taxon&#244;micas &#40;UTN&#41; nas amostras foi explorada a partir de seus componentes extra&#237;dos pelo m&#233;todo <span class="elsevierStyleItalic">Partial Least Squares</span> &#40;PLS&#41;&#44; com dados escalonados pelos desvios&#8208;padr&#227;o&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">As principais vari&#225;veis do estudo s&#227;o a diversidade da flora intestinal identificada em cada MI avaliado&#44; segundo cada categoria de UTN&#58; abund&#226;ncia relativa dos grupos&#44; pelos &#237;ndices de diversidade de Hill &#40;riqueza&#44; Shannon e Simpson&#41;&#44; a rela&#231;&#227;o entre os filos <span class="elsevierStyleItalic">Firmicutes</span>&#47;<span class="elsevierStyleItalic">Bacteroidetes</span>&#44; abund&#226;ncia dos g&#234;neros bacterianos &#40;alfa diversidade&#41; e os componentes dos padr&#245;es PLS &#40;beta diversidade&#41; identificados para os grupos&#46; Define&#8208;se riqueza como n&#250;mero total de UTN identificadas na amostra&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Foram ainda coletadas amostras de 10<span class="elsevierStyleHsp" style=""></span>mL de sangue dos pacientes no ambulat&#243;rio de dermatologia&#44; pela m&#233;dica respons&#225;vel pelo tratamento dos pacientes &#40;M&#46;R&#46;R&#46;L&#46;&#41;&#44; para avalia&#231;&#227;o do LPB e PCRqt s&#233;ricos&#46; Ap&#243;s as coletas&#44; as amostras foram imediatamente levadas sob refrigera&#231;&#227;o para a Unidade de Pesquisa Experimental &#40;UNIPEX&#41; da FMB&#8208;Unesp&#44; para centrifuga&#231;&#227;o e extra&#231;&#227;o do soro&#46; Para a an&#225;lise do LPB&#44; foi utilizado o m&#233;todo ELISA <span class="elsevierStyleItalic">sandwich</span>&#44; conforme as orienta&#231;&#245;es do fabricante do kit &#40;<span class="elsevierStyleItalic">Human LBP DuoSet ELISA &#8208;</span> DY870&#8208;05&#44; R&#38;D Systems&#44; Inc&#46;&#44; Minneapolis&#44; MN&#44; EUA&#41;&#46; As amostras foram dilu&#237;das na fra&#231;&#227;o 1&#58;500&#46; As concentra&#231;&#245;es finais de LPB foram determinadas conforme a curva padr&#227;o&#46; As an&#225;lises do PCRqt foram realizadas pelo m&#233;todo de imunoturbidimetria&#46; Adotaram&#8208;se como valores normais de PCRqt &#8804; 3 mg&#47;dL&#44; e de LPB &#8804; 10 mg&#47;mL&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Vari&#225;veis qualitativas foram representadas pelos percentuais&#46; Vari&#225;veis quantitativas foram representadas como m&#233;dias e desvios&#8208;padr&#227;o&#44; se a normalidade for verificada pelo teste de Shapiro&#8208;Wilk&#44; ou medianas e quartis &#40;P<span class="elsevierStyleInf">25</span>&#8208;P<span class="elsevierStyleInf">75</span>&#41;&#44; se indicado&#46; As abund&#226;ncias dos g&#234;neros foram comparadas entre os grupos pelo teste de Kruskal&#8208;Wallis&#46; Os &#237;ndices de diversidade ecol&#243;gica foram comparados entre os grupos por modelos lineares generalizados&#44; ajustado pela idade dos participantes&#46; Os modelos foram ajustados para as distribui&#231;&#245;es de probabilidade mais adequadas a cada amostra &#40;p&#46; ex&#46;&#44; gama&#41;&#44; e a corre&#231;&#227;o para m&#250;ltiplas compara&#231;&#245;es foi realizada pelo procedimento de &#352;id&#225;k&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">As cargas dos componentes PLS foram correlacionadas com dados nutricionais&#44; n&#237;veis de LPB e de PCRqt pelo teste de correla&#231;&#227;o de Spearman&#44; e representado como mapa t&#233;rmico&#46; Os dados foram tabulados em Excel 2010 e analisados nos <span class="elsevierStyleItalic">softwares</span> IBM SPSS 25<span class="elsevierStyleHsp" style=""></span>v e Statistica 10<span class="elsevierStyleHsp" style=""></span>v&#46; A signific&#226;ncia estat&#237;stica foi definida como p &#8804; 0&#44;05&#59; bicaudal&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Como se trata de estudo explorat&#243;rio&#44; foi utilizada amostragem por conveni&#234;ncia a fim de se determinar o comportamento global dos grupos e fundamentar a an&#225;lise pormenorizada de amostras <span class="elsevierStyleItalic">a posteriori</span>&#46; Al&#233;m disso&#44; o m&#233;todo PLS n&#227;o exige amostragem m&#237;nima para sua execu&#231;&#227;o&#46; Para as an&#225;lises de correla&#231;&#227;o bivariada&#44; considera&#8208;se suficiente uma amostra de 41 participantes para a detec&#231;&#227;o de correla&#231;&#227;o moderada &#40;rho &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;70&#41;&#44; considerando &#945;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01 e poder de 90&#37;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0135" class="elsevierStylePara elsevierViewall">Os principais dados cl&#237;nicos&#44; demogr&#225;ficos&#44; alimentares&#44; LPB s&#233;rico e PCRqt est&#227;o dispostos na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; Idade e IMC dos grupos PSO e ONI foram maiores que do grupo VEG&#46; Do ponto de vista alimentar&#44; os grupos PSO e ONI relataram maior consumo de carboidratos e prote&#237;nas que o grupo VEG&#46; Quanto &#224;s fibras alimentares&#44; o grupo PSO relatou menor ingesta de fibras que ONI e que VEG&#46; Os n&#237;veis plasm&#225;ticos de LPB&#44; assim como os n&#237;veis de PCRqt&#44; foram maiores no grupo PSO em rela&#231;&#227;o ao VEG&#44; por&#233;m&#44; PCRqt foi maior no PSO em rela&#231;&#227;o ao ONI&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Nenhum controle VEG nem ONI eutr&#243;ficos apresentou valores elevados de LPB&#59; por&#233;m&#44; um ONI obeso&#44; um PSO eutr&#243;fico e dois PSO obesos apresentaram LPB &#62;<span class="elsevierStyleHsp" style=""></span>10 mg&#47;mL&#46; Do mesmo modo&#44; nenhum controle VEG nem ONI eutr&#243;ficos apresentou valores elevados de PCRqt&#44; por&#233;m dois ONI obesos&#44; quatro PSO eutr&#243;ficos e tr&#234;s PSO obesos apresentaram PCR<span class="elsevierStyleHsp" style=""></span>&#62; 3 mg&#47;mL&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Entre os pacientes com psor&#237;ase&#44; oito &#40;32&#37;&#41; apresentavam doen&#231;a articular&#44; seis &#40;24&#37;&#41; eram tratados exclusivamente com t&#243;picos&#44; seis &#40;24&#37;&#41; utilizavam metotrexato&#44; oito &#40;32&#37;&#41; utilizavam acitretina e cinco &#40;20&#37;&#41; utilizavam secuquinumabe&#46; O PASI variou entre 1 e 18&#44; com mediana &#40;P<span class="elsevierStyleInf">25</span>&#8208;P<span class="elsevierStyleInf">75</span>&#41; de 4 &#40;1&#8208;7&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Quanto &#224;s comorbidades&#44; entre os pacientes com psor&#237;ase encontraram&#8208;se dois &#40;17&#37;&#41; com diabetes <span class="elsevierStyleItalic">mellitus</span>&#44; tr&#234;s &#40;25&#37;&#41; com hipertens&#227;o arterial e cinco &#40;42&#37;&#41; com dislipidemia&#46; Entre os on&#237;voros&#44; dois &#40;13&#37;&#41; eram diab&#233;ticos&#44; quatro &#40;28&#37;&#41; hipertensos e seis &#40;43&#37;&#41; com dislipidemia&#46; Nenhum dos vegetarianos apresentava comorbidades&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">A an&#225;lise do MI dos participantes resultou na identifica&#231;&#227;o de 1&#46;496 diferentes UTN&#44; reunidos em 94 g&#234;neros &#40;tabela suplementar 1&#41;&#46; Os &#237;ndices de diversidade ecol&#243;gica do MI diferiram entre os grupos e est&#227;o representados na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#46; Quando ajustado pela idade e IMC&#44; o filo <span class="elsevierStyleItalic">Firmicutes</span> foi menos abundante em VEG&#44; e a rela&#231;&#227;o F&#47;B foi maior no grupo PSO que no VEG&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">Quando comparados os obesos com psor&#237;ase e controles obesos&#44; a rela&#231;&#227;o F&#47;B n&#227;o apresentou diferen&#231;a &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;078&#41;&#46; Entretanto&#44; quando s&#227;o comparados eutr&#243;ficos com psor&#237;ase e controles eutr&#243;ficos&#44; os portadores de psor&#237;ase apresentaram maiores valores m&#233;dios &#40;DP&#41; da rela&#231;&#227;o F&#47;B &#40;12&#44;1 &#91;2&#44;9&#93; <span class="elsevierStyleItalic">vs</span>&#46; 2&#44;0 &#91;1&#44;0&#93;&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o &#224; alfa&#8208;diversidade&#44; entre os 13 g&#234;neros mais prevalentes nos tr&#234;s grupos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#44; foi identificada maior propor&#231;&#227;o do g&#234;nero <span class="elsevierStyleItalic">Prevotella</span> &#40;36&#37;&#41; no grupo VEG e <span class="elsevierStyleItalic">Blautia</span> em PSO &#40;14&#37;&#41; e ONI &#40;18&#37;&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">Em rela&#231;&#227;o ao grupo PSO&#44; houve diferen&#231;a na abund&#226;ncia dos g&#234;neros <span class="elsevierStyleItalic">Prevotella</span>&#44; <span class="elsevierStyleItalic">Mogibacterium</span>&#44; <span class="elsevierStyleItalic">Dorea</span>&#44; <span class="elsevierStyleItalic">Bifidobacterium e Coprococcus</span>&#44; quando compararados com VEG<span class="elsevierStyleItalic">&#46;</span> J&#225; os g&#234;neros <span class="elsevierStyleItalic">Mogibacterium</span>&#44; <span class="elsevierStyleItalic">Collinsella</span>&#44; <span class="elsevierStyleItalic">Desulfovibrio</span> diferiram entre os grupos PSO e ONI &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">Quanto &#224; beta&#8208;diversidade&#44; dois componentes PLS representaram at&#233; 79&#44;5&#37; da vari&#226;ncia dos subgrupos&#46; A <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a> apresenta a proje&#231;&#227;o dos casos de acordo com a carga de seus componentes&#44; individualizando&#8208;os em quadrantes distintos&#46; O padr&#227;o plsPSO pode ser compreendido como os carregamentos negativos de PLS1 e 2 &#40;plsPSO<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;PLS1&#8722;PLS2&#41;&#59; inversamente&#44; o padr&#227;o plsVEG pode ser representado pelos carregamentos positivos de PLS1 e 2 &#40;plsPVEG<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>PLS1&#43;PLS2&#41;&#59; j&#225; o padr&#227;o plsONI pode ser representado pelo carregamento positivo de PS1 e negativo de PS2 &#40;plsONI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>PLS1<span class="elsevierStyleItalic">&#8208;</span>PLS2&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">Os carregamentos das UTN segundo PLS1 e PLS2 est&#227;o dispostos na <a class="elsevierStyleCrossRef" href="#sec0050">figura suplementar 1</a>&#46; Segundo os componentes plsPSO&#44; as bact&#233;rias com maior carregamento do padr&#227;o de MI do grupo PSO foram do g&#234;nero <span class="elsevierStyleItalic">Coprococcus</span>&#44; <span class="elsevierStyleItalic">Lachnospira</span>&#44; <span class="elsevierStyleItalic">Paraprevotella</span>&#44; e as esp&#233;cies <span class="elsevierStyleItalic">Faecalibacterium prausnitzii</span> sp<span class="elsevierStyleItalic">&#46;</span>&#44; <span class="elsevierStyleItalic">Prevotella stercorea</span> sp&#46;&#44; <span class="elsevierStyleItalic">Prevotella copri</span> sp&#46; e <span class="elsevierStyleItalic">Ruminococcus callidus</span> sp&#46; J&#225; as com menor carregamento foram dos g&#234;neros <span class="elsevierStyleItalic">Lactobacillus</span>&#44; <span class="elsevierStyleItalic">Streptococcus</span>&#44; <span class="elsevierStyleItalic">Dialister</span>&#44; <span class="elsevierStyleItalic">Megasphera</span>&#44; <span class="elsevierStyleItalic">Slackia</span>&#44; e as esp&#233;cies <span class="elsevierStyleItalic">Bacteroides</span><span class="elsevierStyleItalic">fragilis</span> sp<span class="elsevierStyleItalic">&#46;</span>&#44; <span class="elsevierStyleItalic">Bacteroides uniformis</span> sp<span class="elsevierStyleItalic">&#46;</span>&#44; <span class="elsevierStyleItalic">Blautia producta</span> sp<span class="elsevierStyleItalic">&#46;</span>&#44; <span class="elsevierStyleItalic">Butyricoccus pullicaerum</span> sp<span class="elsevierStyleItalic">&#46; e Parabacteroides distasonis</span> sp&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#fig0020">figura 4</a> apresenta as correla&#231;&#245;es entre os n&#237;veis de LPB&#44; PCRqt&#44; ingesta nutricional e os padr&#245;es de MI&#58; PSO&#44; ONI&#44; e VEG&#46; Os n&#237;veis de LPB se correlacionaram inversamente com a ingesta de fibras &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8208;</span>0&#44;53&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; por&#233;m&#44; positivamente com o componente do padr&#227;o de MI dos pacientes com psor&#237;ase &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;39&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46; O comportamento do PCRqt n&#227;o se associou ao componente do padr&#227;o plsPSO &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;28&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;11&#41;&#44; mas com a ingesta de carboidratos &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;41&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; e com os n&#237;veis de LPB &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;46&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Do ponto de vista alimentar&#44; o componente do padr&#227;o de MI plsPSO se correlacionou de maneira fortemente negativa com a ingesta de fibras &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#8208;</span>0&#44;71&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; assim como a menor ingesta de fibras se associou a maiores n&#237;veis de LPB e PCRqt&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0190" class="elsevierStylePara elsevierViewall">Nosso estudo indicou que caracter&#237;sticas do MI de homens adultos com psor&#237;ase diferiram dos controles on&#237;voros e vegetarianos residentes de uma mesma regi&#227;o do Brasil&#46; Aspectos et&#225;rios&#44; alimentares e de composi&#231;&#227;o corporal tamb&#233;m podem contribuir por parte dessas diferen&#231;as&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Nessa amostra&#44; o grupo PSO apresentou maior ingesta de carboidratos&#44; por&#233;m baixa ingesta de fibras&#44; mostrando ainda maior rela&#231;&#227;o F&#47;B no MI que o grupo VEG&#44; que contou com maior ingesta de fibras e menor abund&#226;ncia de <span class="elsevierStyleItalic">Firmicutes</span>&#46; Al&#233;m disso&#44; os h&#225;bitos alimentares dos pacientes com psor&#237;ase mostraram&#8208;se desequilibrados&#44; pois tamb&#233;m foram identifcados aumento de gorduras de baixa qualidade e alta densidade cal&#243;rica&#44; caracter&#237;sticas da dieta ocidental que &#233; associada &#224; disbiose intestinal e redu&#231;&#227;o de diversidade bacteriana&#46; Tais h&#225;bitos diet&#233;ticos podem se correlacionar com a gravidade da doen&#231;a e das comorbidades&#44; j&#225; que gorduras saturadas&#44; a&#231;&#250;cares&#44; carne bovina e &#225;lcool interferem no <span class="elsevierStyleItalic">status</span> inflamat&#243;rio sist&#234;mico&#44; enquanto a ingesta de fibras alimentares pode contribuir com a supress&#227;o de certas vias inflamat&#243;rias e na indu&#231;&#227;o de c&#233;lulas&#8208;T reguladoras&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">12&#8211;14</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">A disbiose intestinal tamb&#233;m atua no desequil&#237;brio dos &#225;cidos graxos de cadeia curta &#40;AGCC&#41;&#44; dos quais butirato e acetato s&#227;o os mais estudados&#44; e s&#227;o produzidos a partir da fermenta&#231;&#227;o de fibras pelas bact&#233;rias intestinais&#46; Acetato &#233; associado &#224; produ&#231;&#227;o de grelina&#44; que controla o apetite e a resist&#234;ncia &#224; insulina&#59; j&#225; o butirato &#233; fonte de energia para c&#233;lulas intestinais&#44; associado com preven&#231;&#227;o e redu&#231;&#227;o da inflama&#231;&#227;o sist&#234;mica e aumento da diversidade bacteriana&#44; favorecendo a prolifera&#231;&#227;o de bact&#233;rias do filo <span class="elsevierStyleItalic">Bacteroidetes</span>&#46; Dietas com alto teor de fibras&#44; vegetais e frutas promovem aumento de <span class="elsevierStyleItalic">Bacteroidetes</span>&#44; e por consequ&#234;ncia maior diversidade bacteriana&#46; Por outro lado&#44; dietas com excesso de frituras&#44; s&#243;dio&#44; prote&#237;na e gordura animal podem propiciar maior ativa&#231;&#227;o pr&#243;&#8208;inflamat&#243;ria sist&#234;mica e propor&#231;&#227;o F&#47;B no MI&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a> Al&#233;m disso&#44; os AGCC s&#227;o moduladores diretos da s&#237;ntese de interleucina 17 &#40;IL&#8208;17&#41; por linf&#243;citos&#8208;T&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">A disbiose intestinal pode promover o aumento intraluminal de LPS&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a> e dietas com baixa qualidade nutricional &#40;p&#46; ex&#46;&#44; dieta ocidental&#41;&#44; estresse f&#237;sico e psicol&#243;gico&#44; certos medicamentos &#40;p&#46; ex&#46;&#44; antimicrobianos&#41; s&#227;o fatores que favorecem o aumento da permeabilidade intestinal&#46; Um intestino mais perme&#225;vel propicia a transloca&#231;&#227;o de LPS para a corrente sangu&#237;nea &#40;endotoxemia metab&#243;lica&#41;&#44; favorecendo resist&#234;ncia &#224; insulina&#44; inflama&#231;&#227;o no tecido adiposo&#44; infiltra&#231;&#227;o tecidual de mon&#243;citos&#47;macr&#243;fagos&#44; que aumentam o risco de doen&#231;as como esteatose hep&#225;tica&#44; obesidade&#44; diabetes&#46; Assim&#44; parte da resposta inflamat&#243;ria sist&#234;mica pode ser atribu&#237;da &#224; composi&#231;&#227;o do MI&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">18&#44;19</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">Em modelo murino de psor&#237;ase induzida por imiquimode&#44; a administra&#231;&#227;o oral de <span class="elsevierStyleItalic">Staphylococcus aureus</span> e <span class="elsevierStyleItalic">Streptococcus danieliae</span> levou &#224; inflama&#231;&#227;o cut&#226;nea e ao aumento da express&#227;o de TNF e IL17&#44; subsidiando a hip&#243;tese de que a disbiose intestinal possa levar &#224; piora cl&#237;nica da doen&#231;a&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">Este estudo investigou&#44; de maneira original&#44; rela&#231;&#245;es entre n&#237;veis plasm&#225;ticos de LPB&#44; PCRqt&#44; e padr&#227;o alimentar em on&#237;voros&#44; vegetarianos e pacientes com psor&#237;ase&#44; demonstrando que os n&#237;veis de LPB se correlacionaram inversamente com o consumo de fibras&#46; Nessa amostra&#44; os participantes com psor&#237;ase apresentaram n&#237;veis de LPB maiores que os vegetarianos&#44; levando &#224; hip&#243;tese de que a modula&#231;&#227;o do MI &#40;p&#46; ex&#46;&#44; pode meio da dieta&#41; contribua com a redu&#231;&#227;o dos n&#237;veis de LPB s&#233;ricos&#59; portanto&#44; esses achados subsidiam que a sa&#250;de intestinal pode ser modulada por meio de escolhas alimentares&#46; Al&#233;m disso&#44; os n&#237;veis de PCRqt foram maiores em PSO&#44; associados &#224; ingesta de carboidratos e LPB&#46; Apesar de a permeabilidade intestinal n&#227;o ser avaliada de maneira direta&#44; os n&#237;veis elevados de LPB e PCRqt podem indicar maior permeabilidade intestinal em pacientes com psor&#237;ase&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Pesquisas com n&#237;veis s&#233;ricos de LPB em humanos s&#227;o escassas&#44; mas existem evid&#234;ncias de que o LPB esteja elevado em pacientes com psor&#237;ase&#44; havendo correla&#231;&#227;o com os n&#237;veis de PCRqt&#46; Desse modo&#44; LPB pode ser um indicador de inflama&#231;&#227;o sist&#234;mica e progress&#227;o para s&#237;ndrome metab&#243;lica em pacientes com psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> &#201; importante ressaltar que&#44; recentemente&#44; o LPB revelou&#8208;se um biomarcador para a permeabilidade intestinal em adultos&#44; independentemente de idade&#44; IMC e g&#234;nero&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">Em estudos controlados que analisaram o MI de pacientes com psor&#237;ase&#44; utilizando grupos populacionais diversos&#44; foram encontrados achados diferentes&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a> Em um estudo israelense que avaliou a diversidade beta em pacientes com psor&#237;ase &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41; em compara&#231;&#227;o com controles &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>46&#41; sem psor&#237;ase&#44; pareados por idade&#44; IMC e comorbidades&#44; identificou&#8208;se aumento significante em <span class="elsevierStyleItalic">Ruminoccocus gnavus</span>&#44; <span class="elsevierStyleItalic">Dorea formicigenerans</span> e <span class="elsevierStyleItalic">Collinsella aerofaciens</span> no MI da psor&#237;ase&#44; enquanto <span class="elsevierStyleItalic">Prevotella copri</span> e <span class="elsevierStyleItalic">Parabacteroides distasonis</span> foram significantemente menores em compara&#231;&#227;o com os controles<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">24</span></a> &#8211; um padr&#227;o algo diverso da estrutura de MI encontrada em nossa amostra&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Outro estudo conduzido na China evidenciou que pacientes com psor&#237;ase t&#234;m perfis de MI significantemente perturbados&#44; pois ao analisar o MI de 35 pacientes com psor&#237;ase e 27 controles&#44; mostrou diferen&#231;a nas abund&#226;ncias relativas de <span class="elsevierStyleItalic">Firmicutes</span> e <span class="elsevierStyleItalic">Bacteroidetes</span>&#44; com aumento de <span class="elsevierStyleItalic">Bacteroides</span>&#44; <span class="elsevierStyleItalic">Actinobacteria</span> e redu&#231;&#227;o de <span class="elsevierStyleItalic">Firmicutes</span>&#44; <span class="elsevierStyleItalic">Proteobacteria</span> e <span class="elsevierStyleItalic">Bifidobacterium&#46;</span><a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> Em contrapartida&#44; um estudo espanhol de pacientes com psor&#237;ase &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41;&#44; em compara&#231;&#227;o com um grupo controle saud&#225;vel &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&#44; mostrou menor diversidade bacteriana e diferente abund&#226;ncia relativa de certos t&#225;xons bacterianos em pacientes com psor&#237;ase&#44; com aumento de <span class="elsevierStyleItalic">Actinobacteria</span>&#44; <span class="elsevierStyleItalic">Firmicutes</span> e redu&#231;&#227;o de <span class="elsevierStyleItalic">Bacteroidetes</span>&#44; <span class="elsevierStyleItalic">Proteobacterias</span> e <span class="elsevierStyleItalic">Fecalibacterium</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">Em uma an&#225;lise do MI de 52 pacientes com psor&#237;ase &#40;PASI &#8805; 6&#41; em compara&#231;&#227;o com popula&#231;&#227;o saud&#225;vel &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>300&#41;&#44; evidenciou&#8208;se maior frequ&#234;ncia do padr&#227;o chamado enter&#243;tipo 2&#44; com tend&#234;ncia a apresentar transloca&#231;&#227;o bacteriana mais frequente e maior estado inflamat&#243;rio &#40;71&#37;&#41; do que outros enter&#243;tipos&#44; havendo predom&#237;nio de <span class="elsevierStyleItalic">Akkermansia</span>&#44; <span class="elsevierStyleItalic">Faecalibacterium</span>&#44; <span class="elsevierStyleItalic">Ruminococcus</span> e menor propor&#231;&#227;o de <span class="elsevierStyleItalic">Bacteroidetes</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a> Nossa amostra tamb&#233;m indicou maiores propor&#231;&#245;es de <span class="elsevierStyleItalic">Faecalibacterium</span> e <span class="elsevierStyleItalic">Ruminococcus</span>&#44; al&#233;m de menores &#237;ndices de <span class="elsevierStyleItalic">Bactroidetes</span> no perfil &#40;PLS&#41; dos pacientes com psor&#237;ase&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Recentemente&#44; um estudo conduzido na Argentina demonstrou mudan&#231;as na composi&#231;&#227;o do MI dependendo do <span class="elsevierStyleItalic">status</span> da psor&#237;ase&#44; com aumento de <span class="elsevierStyleItalic">Firmicutes</span> e deple&#231;&#227;o de <span class="elsevierStyleItalic">Bacteroidetes</span> em 55 pacientes com psor&#237;ase&#44; em compara&#231;&#227;o com 27 controles&#46; Al&#233;m disso&#44; os g&#234;neros <span class="elsevierStyleItalic">Faecalibacterium</span> e <span class="elsevierStyleItalic">Blautia</span> foram maiores em pacientes com psor&#237;ase&#44; enquanto <span class="elsevierStyleItalic">Bacteroides</span> e <span class="elsevierStyleItalic">Paraprevotella</span> foram maiores em controles sem psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> Como nossos pacientes estavam em tratamento e a maior parte com PASI &#60;<span class="elsevierStyleHsp" style=""></span>4&#44; n&#227;o foi poss&#237;vel estratificar o MI de acordo com a gravidade da doen&#231;a&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Outro estudo de caso&#8208;controle na &#193;sia Central&#44; com pacientes entre 30 e 45 anos&#44; com psor&#237;ase &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41; e controles &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&#44; pareados por idade e sexo&#44; encontrou associa&#231;&#227;o com psor&#237;ase e n&#237;veis elevados de <span class="elsevierStyleItalic">Firmicutes</span>&#44; <span class="elsevierStyleItalic">Faecalibacterium</span> e abund&#226;ncia reduzida de <span class="elsevierStyleItalic">Oscillibacter</span> e <span class="elsevierStyleItalic">Roseburia</span>&#44; mas n&#227;o houve diferen&#231;a na diversidade e rela&#231;&#227;o F&#47;B&#44; bastante alinhado com nossos resultados&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">Um estudo brasileiro mostrou menor diversidade no MI de mulheres com psor&#237;ase &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41; em compara&#231;&#227;o com controles &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&#44; identificando aumento do g&#234;nero <span class="elsevierStyleItalic">Dialister</span> e da esp&#233;cie <span class="elsevierStyleItalic">Prevotella copri</span> sp<span class="elsevierStyleItalic">&#46;</span>&#44; mas redu&#231;&#227;o nos g&#234;neros <span class="elsevierStyleItalic">Ruminococcus</span>&#44; <span class="elsevierStyleItalic">Lachnospira</span>&#44; <span class="elsevierStyleItalic">Blautia</span> e nas esp&#233;cies <span class="elsevierStyleItalic">Akkermansia muciniphila</span> sp&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">No presente estudo&#44; o perfil de MI encontrado nos homens adultos portadores de psor&#237;ase foi associado aos descritos em outras comorbidades&#44; como na s&#237;ndrome metab&#243;lica&#44; obesidade e doen&#231;as afetivas&#44; o que pode decorrer do estilo de vida ocidental&#46; Ainda de acordo com a literatura&#44; o <span class="elsevierStyleItalic">Coprococcus</span> foi associado a doen&#231;as afetivas como depress&#227;o&#44; obesidade e m&#225; qualidade do sono&#59;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a><span class="elsevierStyleItalic">Lachnospira</span> foi associado ao desenvolvimento de diabetes <span class="elsevierStyleItalic">mellitus</span>&#59;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a> e <span class="elsevierStyleItalic">Paraprevotella</span> com maior ingest&#227;o de gorduras&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a> Apesar de haver associa&#231;&#227;o com dietas vegetarianas&#44; <span class="elsevierStyleItalic">Prevotella</span> tamb&#233;m &#233; relacionada &#224; elevada ingesta de carboidratos&#44; e como apresenta alta diversidade gen&#233;tica dentro e entre esp&#233;cies&#44; podem explicar sua descri&#231;&#227;o tanto em MI saud&#225;veis como em disbi&#243;ticos&#59; uma carga elevada de <span class="elsevierStyleItalic">Prevotella</span> no MI foi associada &#224; obesidade&#44; resist&#234;ncia &#224; insulina&#44; hipertens&#227;o e doen&#231;a hep&#225;tica gordurosa n&#227;o alco&#243;lica&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">A composi&#231;&#227;o do MI de psor&#237;ase encontrado nessa amostra se op&#244;s &#224; encontrada nos vegetarianos&#44; ricos em <span class="elsevierStyleItalic">Bacteroides</span> e <span class="elsevierStyleItalic">Lactobacillus</span>&#44; associados &#224; menor permeabilidade intestinal&#46; De fato&#44; a preval&#234;ncia de psor&#237;ase em vegetarianos &#233; excepcional&#44; e a dieta vegetariana leva &#224; melhora de les&#245;es cut&#226;neas da psor&#237;ase&#44; o que sugere que a modula&#231;&#227;o do MI possa subsidiar o desenvolvimento de doen&#231;as inflamat&#243;rias como a psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">35&#44;36</span></a></p><p id="par0265" class="elsevierStylePara elsevierViewall">Estudos metagen&#244;micos do MI apresentam alta variabilidade de resultados entre as publica&#231;&#245;es&#46; Diferen&#231;as populacionais &#233;tnicas&#44; culturais e alimentares podem explicar os resultados controversos entre os estudos que caracterizaram MI em psor&#237;ase&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Assim&#44; ainda n&#227;o foi definido o que constitui um MI saud&#225;vel&#44; quando exclu&#237;das as bact&#233;rias sabidamente patog&#234;nicas&#46; Por isso&#44; &#233; essencial destacar que as esp&#233;cies comensais n&#227;o devem ser consideradas absolutamente &#8220;boas&#8221; ou &#8220;ruins&#8221;&#44; j&#225; que todas desempenham fun&#231;&#245;es no ecossistema intestinal&#46; A problem&#225;tica emerge do desequil&#237;brio&#44; ou seja&#44; a predomin&#226;ncia de grupos de esp&#233;cies comensais que promovem altera&#231;&#245;es na permeabilidade intestinal&#46; Al&#233;m disso&#44; quando se caracteriza o MI de um grupo&#44; pretende&#8208;se entender o padr&#227;o de desequil&#237;brio&#44; apesar de a composi&#231;&#227;o do MI ser &#250;nica em cada indiv&#237;duo&#44; adquirida nos primeiros anos de vida e moldada pelas caracter&#237;sticas ambientais&#44; como os h&#225;bitos alimentares&#44; ao longo da vida&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">37&#8211;39</span></a></p><p id="par0275" class="elsevierStylePara elsevierViewall">Este estudo apresenta limita&#231;&#245;es ligadas &#224; amostra modesta&#44; n&#227;o aleatorizada&#44; o que n&#227;o impediu a identifica&#231;&#227;o de padr&#245;es de MI entre os grupos&#59; al&#233;m disso&#44; a origem comum quanto ao grupo populacional maximiza a homogeneidade da amostra&#46; O efeito dos tratamentos da psor&#237;ase no MI &#233; tema a ser investigado&#44; e nossos participantes utilizaram diversos medicamentos diferentes&#59; entretanto&#44; o uso de adalimumabe n&#227;o mostrou modificar o padr&#227;o de MI em 10 pacientes&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a> Nossos participantes ainda apresentavam escores de PASI baixos&#44; decorrente do controle da doen&#231;a com a terap&#234;utica estabelecida&#46; Na verdade&#44; s&#227;o necess&#225;rios estudos de MI com pacientes com psor&#237;ase sem tratamento sist&#234;mico&#46; Outro aspecto se refere &#224; amostragem do microbioma fecal&#44; que consiste na flora transit&#243;ria do c&#243;lon&#44; em contrapartida &#224; flora permanente que &#233; ligada &#224; mucosa&#44; menos sujeita a varia&#231;&#227;o&#46; Finalmente&#44; LPB &#233; utilizado como <span class="elsevierStyleItalic">proxy</span> da medida de LPS&#44; em decorr&#234;ncia de sua labilidade&#46; As varia&#231;&#245;es alimentares podem dificultar as compara&#231;&#245;es entre os grupos&#44; visto que mesmo dentro dos grupos on&#237;voros&#44; vegetarianos e psor&#237;ase&#44; existem alimentos que podem atuar de maneira diferente no MI&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Estudos cl&#237;nicos controlados em psor&#237;ase que visem a manipula&#231;&#227;o do MI&#44; quer com transplante de fezes&#44; interven&#231;&#245;es diet&#233;ticas &#40;p&#46; ex&#46;&#44; adequa&#231;&#227;o de fibras&#41;&#44; pr&#243;&#47;pr&#233;&#8208;bi&#243;ticos ou sais biliares&#44; devem ser conduzidos para melhor compreens&#227;o do papel do MI na atividade cl&#237;nica da psor&#237;ase&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0285" class="elsevierStylePara elsevierViewall">Identificou&#8208;se diferen&#231;a no MI de homens adultos brasileiros com psor&#237;ase em rela&#231;&#227;o a on&#237;voros e vegetarianos saud&#225;veis&#46; O padr&#227;o de MI encontrado correlacionou&#8208;se com a ingesta de fibras alimentares&#44; com os n&#237;veis s&#233;ricos de LPB&#46; Mudan&#231;as nos h&#225;bitos alimentares podem remodelar o MI&#44; e por consequ&#234;ncia&#44; auxiliar no controle cl&#237;nico da psor&#237;ase&#46; Ressalta&#8208;se a necessidade de conscientiza&#231;&#227;o da import&#226;ncia nutricional no tratamento da doen&#231;a e no manejo das comorbidades&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0290" class="elsevierStylePara elsevierViewall">FUNADERM &#8208; Fundo de Apoio &#224; Dermatologia&#44; da Sociedade Brasileira de Dermatologia&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0295" class="elsevierStylePara elsevierViewall">H&#233;lio Amante Miot&#58; Concep&#231;&#227;o do estudo&#59; an&#225;lise dos resultados&#59; escrita do texto&#59; revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">Tatiana Cristina Figueira Polo&#58; Concep&#231;&#227;o do estudo&#59; coleta de dados&#59; an&#225;lise dos resultados&#59; escrita do texto&#59; revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Mariana Righetto de R&#233; Lai&#58; Concep&#231;&#227;o do estudo&#59; coleta de dados&#59; an&#225;lise dos resultados&#59; escrita do texto&#59; revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p><p id="par0310" class="elsevierStylePara elsevierViewall">Luciane Donida Bartoli Miot&#58; Coleta de dados&#59; revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">Giovana Fernanda Cosi Bento&#58; An&#225;lise dos resultados&#59; revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">M&#225;rcia Guimar&#227;es da Silva&#58; Revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">Silvio Alencar Marques&#58; Revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0330" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres1940764"
          "titulo" => "Resumo"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Fundamentos"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Objetivo"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "M&#233;todo"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Resultados"
            ]
            4 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Limita&#231;&#245;es do estudo"
            ]
            5 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Conclus&#227;o"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1672270"
          "titulo" => "Palavras&#8208;chave"
        ]
        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introdu&#231;&#227;o"
        ]
        3 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "M&#233;todo"
        ]
        4 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Resultados"
        ]
        5 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discuss&#227;o"
        ]
        6 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conclus&#227;o"
        ]
        7 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Suporte financeiro"
        ]
        8 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Contribui&#231;&#227;o dos autores"
        ]
        9 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conflito de interesses"
        ]
        10 => array:1 [
          "titulo" => "Refer&#234;ncias"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-05-02"
    "fechaAceptado" => "2022-08-09"
    "PalabrasClave" => array:1 [
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras&#8208;chave"
          "identificador" => "xpalclavsec1672270"
          "palabras" => array:7 [
            0 => "Dieta"
            1 => "Dieta ocidental"
            2 => "Dieta vegetariana"
            3 => "Microbioma gastrintestinal"
            4 => "Microbiota"
            5 => "Obesidade"
            6 => "Psor&#237;ase"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Psor&#237;ase &#233; doen&#231;a inflamat&#243;ria cr&#244;nica associada &#224; inflama&#231;&#227;o sist&#234;mica e comorbidades&#46; Altera&#231;&#245;es na composi&#231;&#227;o do microbioma intestinal est&#227;o envolvidas na patog&#234;nese de doen&#231;as inflamat&#243;rias e s&#237;ndrome metab&#243;lica&#46; Caracterizar o microbioma intestinal de pacientes com psor&#237;ase pode ser relevante no entendimento do seu curso cl&#237;nico e na preven&#231;&#227;o de comorbidades&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Caracterizar o microbioma intestinal de homens com psor&#237;ase em compara&#231;&#227;o a controles &#40;sem psor&#237;ase&#41; on&#237;voros e vegetarianos&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todo</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal envolvendo 42 homens adultos&#58; 21 com psor&#237;ase on&#237;voros&#44; 14 controles on&#237;voros e 7 controles vegetarianos&#46; A caracteriza&#231;&#227;o do microbioma intestinal foi realizada por an&#225;lise metagen&#244;mica&#46; Avaliaram&#8208;se os n&#237;veis s&#233;ricos da prote&#237;na ligadora de lipopolissacar&#237;dio &#40;LPB&#41; e prote&#237;na C reativa &#40;PCR&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Os grupos diferiram entre si quanto aos aspectos nutricionais e do microbioma&#46; Pacientes com psor&#237;ase apresentaram maior consumo de prote&#237;nas e menor de fibras&#46; N&#237;veis de LPB&#44; PCR e a rela&#231;&#227;o <span class="elsevierStyleItalic">Firmicutes&#47;Bacteroidetes</span> foram maiores no grupo com psor&#237;ase que no grupo controle vegetariano &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Os g&#234;neros <span class="elsevierStyleItalic">Prevotella<span class="elsevierStyleBold">&#44;</span> Mogibacterium</span>&#44; <span class="elsevierStyleItalic">Dorea</span>&#44; <span class="elsevierStyleItalic">Bifidobacterium</span> e <span class="elsevierStyleItalic">Coprococcus</span> diferiram no grupo com psor&#237;ase em compara&#231;&#227;o com vegetarianos&#59; j&#225; os g&#234;neros <span class="elsevierStyleItalic">Mogibacterium</span>&#44; <span class="elsevierStyleItalic">Collinsella</span> e <span class="elsevierStyleItalic">Desulfovibrio</span> diferiram dos on&#237;voros&#46; Identificou&#8208;se padr&#227;o de microbioma ligado &#224; psor&#237;ase &#40;plsPSO&#41; que se associou a maiores n&#237;veis de LPB &#40;rho &#61; 0&#44;39&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41; e menor ingesta de fibras diet&#233;ticas &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;71&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Apenas homens adultos foram avaliados&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Houve diferen&#231;a no microbioma intestinal de homens adultos com psor&#237;ase em rela&#231;&#227;o a on&#237;voros e vegetarianos saud&#225;veis&#46; O padr&#227;o de microbioma encontrado correlacionou&#8208;se com a ingesta de fibras alimentares e com os n&#237;veis s&#233;ricos de LPB&#46;</p></span>"
        "secciones" => array:6 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Fundamentos"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objetivo"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "M&#233;todo"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Limita&#231;&#245;es do estudo"
          ]
          5 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0045">Como citar este artigo&#58; Polo TCF&#44; Lai MRR&#44; Miot LDB&#44; Bento GFC&#44; Silva MG&#44; Marques SA&#44; Miot HA&#46; Intestinal microbiome characterization of adult Brazilian men with psoriasis compared to omnivore and vegetarian controls&#46; An Bras Dermatol&#46; 2023&#59;98&#58;635&#8211;43&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0050">Trabalho realizado no Departamento de Dermatologia&#44; Faculdade de Medicina de Botucatu&#44; Universidade Estadual Paulista&#44; Botucatu&#44; SP&#44; Brasil&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0340" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Material suplementar"
            "identificador" => "sec0050"
          ]
        ]
      ]
    ]
    "multimedia" => array:7 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1203
            "Ancho" => 3341
            "Tamanyo" => 271716
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Alfa&#8208;diversidade&#46; Distribui&#231;&#227;o da propor&#231;&#227;o dos 13 g&#234;neros mais prevalentes entre os grupos PSO &#40;psor&#237;ase&#41;&#44; VEG &#40;controles vegetarianos&#41; e ONI &#40;controles on&#237;voros&#41;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1232
            "Ancho" => 2175
            "Tamanyo" => 158697
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Alfa&#8208;diversidade&#46; Compara&#231;&#227;o da mediana da abund&#226;ncia dos g&#234;neros que apresentaram diferen&#231;a entre os grupos &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; PSO &#40;psor&#237;ase&#41;&#44; VEG &#40;controles vegetarianos&#41; e ONI &#40;controles on&#237;voros&#41;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1383
            "Ancho" => 1675
            "Tamanyo" => 88054
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Carregamento dos participantes segundo os componentes PLS &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41;&#46; Em destaque&#44; composi&#231;&#245;es que discriminam os grupos</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">PLS&#44; componente partial least squares&#59; ONI&#44; controles on&#237;voros&#59; VEG&#44; controles vegetarianos&#59; PSO&#44; psor&#237;ase&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figura 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1921
            "Ancho" => 2175
            "Tamanyo" => 213640
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Mapa t&#233;rmico com as correla&#231;&#245;es bivariadas entre os n&#237;veis de LPB&#44; PCR&#44; caracter&#237;sticas nutricionais da dieta e o padr&#227;o de microbioma intestinal dos pacientes com psor&#237;ase&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">LPB&#44; n&#237;vel s&#233;rico da prote&#237;na de liga&#231;&#227;o de Lipopolissacar&#237;deos&#59; PCRqt&#44; n&#237;vel s&#233;rico da prote&#237;na C reativa ultrassens&#237;vel &#40;teste quantitativo&#41;&#59; CHg&#44; carboidratos &#40;em gramas&#41;&#59; PRg&#44; prote&#237;nas &#40;em gramas&#41;&#59; LIPg&#44; lip&#237;dios &#40;em gramas&#41;&#59; FIBg&#44; fibras &#40;em gramas&#41;&#59; plsPSO&#44; componente PLS do microbioma intestinal dos participantes com psor&#237;ase</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabela 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">IMC&#44; &#237;ndice de massa corporal&#59; LPB&#44; prote&#237;na ligadora de polissacar&#237;dios&#59; PCRqt&#44; prote&#237;na C reativa ultrassens&#237;vel&#44; teste quantitativo&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Controles on&#237;voros &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Controles vegetarianos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Psor&#237;ase &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;valor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Idade &#40;anos&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#44;6 &#40;11&#44;3&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;4 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&#44;1 &#40;11&#44;1&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">IMC &#40;kg&#47;m</span><a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup"><span class="elsevierStyleBold">2</span></span></a><span class="elsevierStyleBold">&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;1 &#40;9&#44;2&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;4 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;5 &#40;6&#44;2&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Energia &#40;cal&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;859&#44;4 &#40;1297&#44;5&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;314&#44;3 &#40;129&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;058&#44;0 &#40;512&#44;0&#41;<a class="elsevierStyleCrossRefs" href="#tblfn0010"><span class="elsevierStyleSup">a&#44;b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Carboidratos &#40;g&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">539&#44;5 &#40;185&#44;7&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">362&#44;2 &#40;22&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">466&#44;9 &#40;86&#44;8&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Prote&#237;nas &#40;g&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">198&#44;9 &#40;76&#44;0&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#44;4 &#40;21&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">133&#44;4 &#40;39&#44;3&#41;<a class="elsevierStyleCrossRefs" href="#tblfn0010"><span class="elsevierStyleSup">a&#44;b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Lip&#237;dios &#40;g&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101&#44;2 &#40;45&#44;5&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#44;0 &#40;9&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#44;9 &#40;23&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Fibras &#40;g&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;1 &#40;9&#44;3&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#44;4 &#40;7&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;8 &#40;7&#44;4&#41;<a class="elsevierStyleCrossRefs" href="#tblfn0010"><span class="elsevierStyleSup">a&#44;b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">LPB &#40;mg&#47;mL&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;1 &#40;2&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;8 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;6 &#40;2&#44;9&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">PCRqt &#40;mg&#47;dL&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;6 &#40;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0 &#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;2 &#40;9&#44;2&#41;<a class="elsevierStyleCrossRefs" href="#tblfn0010"><span class="elsevierStyleSup">a&#44;b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3233293.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">M&#233;dia &#40;desvio&#8211;padr&#227;o&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">p &#8804; 0&#44;05 &#8211; comparado ao vegetariano&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">p &#8804; 0&#44;05 &#8211; comparado ao on&#237;voro&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Principais dados demogr&#225;ficos&#44; alimentares&#44; LPB e PCRqt s&#233;ricos dos participantes &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabela 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabela "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">F&#47;B&#44; Firmicutes&#47;Bacteroidetes&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Controles on&#237;voros&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Controles vegetarianos&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Psor&#237;ase&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#8208;valor<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abund&#226;ncia relativa &#40;10<span class="elsevierStyleSup">3</span>&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#44;0 &#40;12&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44;7 &#40;13&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44;6 &#40;11&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;989&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diversidade de Hill<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>q<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0 &#40;Riqueza&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">141&#44;2 &#40;53&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">136&#44;6 &#40;21&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">138&#44;5 &#40;49&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;353&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>q<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1 &#40;Shannon&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;0 &#40;18&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#44;6 &#40;15&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;4 &#40;18&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;507&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>q<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3 &#40;Simpson&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;4 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;8 &#40;7&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;5 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;813&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abund&#226;ncia segundo o filo<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Firmicutes</span> &#40;10<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#44;1 &#40;37&#44;9&#8208;46&#44;6&#41;<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;1 &#40;29&#44;6&#8208;37&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;1 &#40;33&#44;1&#8208;48&#44;8&#41;<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;049</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Bacteroidetes</span> &#40;10<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;7 &#40;6&#44;5&#8208;23&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;0 &#40;10&#44;9&#8208;40&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;1 &#40;6&#44;8&#8208;23&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;335&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rela&#231;&#227;o F&#47;B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5 &#40;1&#44;8&#8208;6&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;0 &#40;0&#44;9&#8208;3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;1 &#40;2&#44;2&#8208;5&#44;9&#41;<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;045</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3233294.png"
              ]
            ]
          ]
          "notaPie" => array:4 [
            0 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">p&#8208;valor ajustado para idade e &#237;ndice de massa corporal&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">M&#233;dia &#40;desvio&#8208;padr&#227;o&#41;&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Mediana &#40;P<span class="elsevierStyleInf">25</span>&#8208;P<span class="elsevierStyleInf">75</span>&#41;&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0035"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">p &#8804; 0&#44;05 &#8211; comparado aos vegetarianos&#59;</p> <p class="elsevierStyleNotepara" id="npar0040"><span class="elsevierStyleSup">b</span> p &#8804; 0&#44;05 &#8211; comparado aos on&#237;voros&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">&#205;ndices de diversidade ecol&#243;gica do microbioma intestinal entre os grupos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41;</p>"
        ]
      ]
      6 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc1.zip"
          "ficheroTamanyo" => 413232
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:40 [
            0 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of psoriasis in Brazil &#8208; a geographical survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Romiti"
                            1 => "M&#46; Arnone"
                            2 => "A&#46; Menter"
                            3 => "H&#46;A&#46; Miot"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Dermatol&#46;"
                        "fecha" => "2017"
                        "volumen" => "56"
                        "paginaInicial" => "167"
                        "paginaFinal" => "168"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "National&#44; regional&#44; and worldwide epidemiology of psoriasis&#58; systematic analysis and modelling study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Parisi"
                            1 => "I&#46;Y&#46;K&#46; Iskandar"
                            2 => "E&#46; Kontopantelis"
                            3 => "M&#46; Augustin"
                            4 => "C&#46;E&#46;M&#46; Griffiths"
                            5 => "D&#46;M&#46; Ashcroft"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ&#46;"
                        "fecha" => "2020"
                        "volumen" => "8247"
                        "paginaInicial" => "1590"
                        "paginaFinal" => "1605"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnostic and therapeutic guidelines for plaque psoriasis &#8208; Brazilian Society of Dermatology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Arnone"
                            1 => "M&#46;D&#46;F&#46; Takahashi"
                            2 => "A&#46;V&#46;E&#46; Carvalho"
                            3 => "W&#46;M&#46; Bernardo"
                            4 => "A&#46;L&#46; Bressan"
                            5 => "A&#46;M&#46;C&#46; Ramos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/abd1806-4841.2019940211"
                      "Revista" => array:7 [
                        "tituloSerie" => "An Bras Dermatol&#46;"
                        "fecha" => "2019"
                        "volumen" => "94"
                        "paginaInicial" => "76"
                        "paginaFinal" => "107"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31166402"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1808869416301033"
                          "estado" => "S300"
                          "issn" => "18088694"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characterization of Oral and Gut Microbiota in Patients with psoriatic diseases&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Todberg"
                            1 => "H&#46; Kaiser"
                            2 => "C&#46; Zachariae"
                            3 => "A&#46; Egeberg"
                            4 => "A&#46; Halling"
                            5 => "L&#46; Skov"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Acta Derm Venereol&#46;"
                        "fecha" => "2021"
                        "volumen" => "30"
                        "paginaInicial" => "101"
                        "paginaFinal" => "107"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The firmicutes&#47;bacteroidetes ratio&#58; a relevant marker of gut dysbiosis in obese patients&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Magne"
                            1 => "M&#46; Gotteland"
                            2 => "L&#46; Gauthier"
                            3 => "A&#46; Zazueta"
                            4 => "S&#46; Pesoa"
                            5 => "P&#46; Navarrete"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/nu12051474"
                      "Revista" => array:5 [
                        "tituloSerie" => "Nutrients&#46;"
                        "fecha" => "2020"
                        "volumen" => "12"
                        "paginaInicial" => "1474"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32438689"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gut microbiota and metabolic specificity in ulcerative colitis and crohn&#39;s disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Sankarasubramanian"
                            1 => "R&#46; Ahmad"
                            2 => "N&#46; Avuthu"
                            3 => "A&#46;B&#46; Singh"
                            4 => "C&#46; Guda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Front Med&#46;"
                        "fecha" => "2020"
                        "volumen" => "7"
                        "paginaInicial" => "606298"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic review&#58; the gut microbiome and its potential clinical application in inflammatory bowel disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Aldars-Garc&#237;a"
                            1 => "M&#46; Chaparro"
                            2 => "J&#46;P&#46; Gisbert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/microorganisms9050977"
                      "Revista" => array:5 [
                        "tituloSerie" => "Microorganisms&#46;"
                        "fecha" => "2021"
                        "volumen" => "9"
                        "paginaInicial" => "977"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33946482"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psoriasis and gut microbiome &#8211; current state of art"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Polak"
                            1 => "B&#46; Bergler-Czop"
                            2 => "M&#46; Szczepanek"
                            3 => "K&#46; Wojciechowska"
                            4 => "A&#46; Fr&#261;tczak"
                            5 => "N&#46; Kiss"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Int J Mol Sci&#46;"
                        "fecha" => "2021"
                        "volumen" => "22"
                        "paginaInicial" => "4529"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metabolic endotoxemia initiates obesity and insulin resistance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;D&#46; Cani"
                            1 => "J&#46; Amar"
                            2 => "M&#46;A&#46; Iglesias"
                            3 => "M&#46; Poggi"
                            4 => "C&#46; Knauf"
                            5 => "D&#46; Bastelica"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/db06-1491"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes&#46;"
                        "fecha" => "2007"
                        "volumen" => "56"
                        "paginaInicial" => "1761"
                        "paginaFinal" => "1772"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17456850"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "ncbi&#46;nlm &#91;Internet&#93;&#46; Gonzalez&#8208;Quintela A&#44; Alonso M&#44; Campos J&#44; Vizcaino L&#44; Loidi L&#44; Gude F&#44; et al&#46; Determinants of serum concentrations of lipopolysaccharide&#8208;binding protein &#40;LBP&#41; in the adult population&#58; the role of obesity&#46; PLoS ONE&#46; 2013&#59;8&#58;e54600&#46; &#91;citado em 20 jul&#46; 2022&#93;&#46; Dispon&#237;vel em&#58; https&#58;&#47;&#47;www&#46;ncbi&#46;nlm&#46;nih&#46;gov&#47;pmc&#47;articles&#47;PMC3551812&#47;&#35;&#58;&#8764;&#58;text<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>Serum&#37;20LBP&#37;20concentrations&#37;20increased&#37;20with&#37;20age&#46;&#44;in&#37;20these&#37;20inflammatory&#37;2C&#37;20metabolic&#37;20abnormalities&#46;"
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characterization of the intestinal microbiome in eutrophic&#44; obese omnivores&#44; and vegetarians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;C&#46;F&#46; Polo"
                            1 => "M&#46;R&#46; de R&#233; Lai"
                            2 => "H&#46;A&#46; Miot"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Nutrire&#46;"
                        "fecha" => "2022"
                        "volumen" => "47"
                        "paginaInicial" => "2"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nutrition and Psoriasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Kanda"
                            1 => "T&#46; Hoashi"
                            2 => "H&#46; Saeki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/ijms21155405"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Mol Sci&#46;"
                        "fecha" => "2020"
                        "volumen" => "21"
                        "paginaInicial" => "5405"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32751360"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1575092210000446"
                          "estado" => "S300"
                          "issn" => "15750922"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evolution of the human diet and its impact on gut microbiota&#44; immune responses&#44; and brain health"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;M&#46; Gonz&#225;lez Olmo"
                            1 => "M&#46;J&#46; Butler"
                            2 => "R&#46;M&#46; Barrientos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/nu13010196"
                      "Revista" => array:5 [
                        "tituloSerie" => "Nutrients&#46;"
                        "fecha" => "2021"
                        "volumen" => "13"
                        "paginaInicial" => "196"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33435203"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microbiota intestinal humana y dieta"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46;A&#46; Padr&#243;n Pereira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cienc Tecnol&#46;"
                        "fecha" => "2019"
                        "volumen" => "12"
                        "paginaInicial" => "31"
                        "paginaFinal" => "42"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dietary fiber intervention on gut microbiota composition in healthy adults&#58; a systematic review and meta&#8208;analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; So"
                            1 => "K&#46; Whelan"
                            2 => "M&#46; Rossi"
                            3 => "M&#46; Morrison"
                            4 => "G&#46; Holtmann"
                            5 => "J&#46;T&#46; Kelly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ajcn/nqy041"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Nutr&#46;"
                        "fecha" => "2018"
                        "volumen" => "107"
                        "paginaInicial" => "965"
                        "paginaFinal" => "983"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29757343"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gut microbiota&#8208;derived short&#8208;chain fatty acids regulate IL&#8208;17 production by mouse and human intestinal &#947;&#948; T cells"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Dupraz"
                            1 => "A&#46; Magniez"
                            2 => "N&#46; Rolhion"
                            3 => "M&#46;L&#46; Richard"
                            4 => "G&#46; Da Costa"
                            5 => "S&#46; Touch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.celrep.2021.109332"
                      "Revista" => array:5 [
                        "tituloSerie" => "Cell Rep&#46;"
                        "fecha" => "2021"
                        "volumen" => "36"
                        "paginaInicial" => "109332"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34233192"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Short&#8208;Chain fatty acids and lipopolysaccharide as mediators between gut dysbiosis and amyloid pathology in alzheimer&#39;s disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Marizzoni"
                            1 => "A&#46; Cattaneo"
                            2 => "P&#46; Mirabelli"
                            3 => "C&#46; Festari"
                            4 => "N&#46; Lopizzo"
                            5 => "V&#46; Nicolosi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3233/JAD-200306"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Alzheimers Dis&#46;"
                        "fecha" => "2020"
                        "volumen" => "78"
                        "paginaInicial" => "683"
                        "paginaFinal" => "697"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33074224"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The gut microbiome in psoriasis and psoriatic arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Myers"
                            1 => "N&#46; Brownstone"
                            2 => "V&#46; Reddy"
                            3 => "S&#46; Chan"
                            4 => "Q&#46; Thibodeaux"
                            5 => "A&#46; Truong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.berh.2020.101494"
                      "Revista" => array:5 [
                        "tituloSerie" => "Best Pract Res Clin Rheumatol&#46;"
                        "fecha" => "2019"
                        "volumen" => "33"
                        "paginaInicial" => "101494"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32360228"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Genomic alterations driving psoriasis pathogenesis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Singh"
                            1 => "D&#46; Pradhan"
                            2 => "P&#46; Puri"
                            3 => "V&#46; Ramesh"
                            4 => "S&#46; Aggarwal"
                            5 => "A&#46; Nayek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Gene&#46;"
                        "fecha" => "2019"
                        "volumen" => "683"
                        "paginaInicial" => "61"
                        "paginaFinal" => "71"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of gut microbiome in psoriasis&#58; oral administration of staphylococcus aureus and streptococcus danieliae exacerbates skin inflammation of imiquimod&#8208;induced psoriasis&#8208;like dermatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Okada"
                            1 => "Y&#46; Matsushima"
                            2 => "K&#46; Mizutani"
                            3 => "K&#46; Yamanaka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/ijms21093303"
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Mol Sci&#46;"
                        "fecha" => "2020"
                        "volumen" => "21"
                        "paginaInicial" => "3303"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32392785"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lipopolysaccharide&#8208;binding protein is increased in patients with psoriasis with metabolic syndrome and correlates with C&#8208;reactive protein&#58; lipopolysaccharide&#8208;binding protein in patients with psoriasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Roman&#237;"
                            1 => "A&#46; Caix&#224;s"
                            2 => "X&#46; Escot&#233;"
                            3 => "J&#46;M&#46; Carrascosa"
                            4 => "M&#46; Ribera"
                            5 => "M&#46; Rigla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ced.12007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp Dermatol&#46;"
                        "fecha" => "2013"
                        "volumen" => "38"
                        "paginaInicial" => "81"
                        "paginaFinal" => "84"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23082944"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Biomarkers for assessment of intestinal permeability in clinical practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Seethaler"
                            1 => "M&#46; Basrai"
                            2 => "A&#46;M&#46; Neyrinck"
                            3 => "J&#46;A&#46; Nazare"
                            4 => "J&#46; Walter"
                            5 => "N&#46;M&#46; Delzenne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Physiol&#8208;Gastrointest Liver Physiol&#46;"
                        "fecha" => "2021"
                        "volumen" => "321"
                        "paginaInicial" => "11"
                        "paginaFinal" => "17"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of gut microbiome in inflammatory skin disorders&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Widhiati"
                            1 => "D&#46; Purnomosari"
                            2 => "T&#46; Wibawa"
                            3 => "H&#46; Soebono"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Dermatol Rep&#46;"
                        "fecha" => "2021"
                        "volumen" => "14"
                        "paginaInicial" => "9188"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psoriatic patients have a distinct structural and functional fecal microbiota compared with controls"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Shapiro"
                            1 => "N&#46;A&#46; Cohen"
                            2 => "V&#46; Shalev"
                            3 => "A&#46; Uzan"
                            4 => "O&#46; Koren"
                            5 => "N&#46; Maharshak"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/1346-8138.14933"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatol&#46;"
                        "fecha" => "2019"
                        "volumen" => "46"
                        "paginaInicial" => "595"
                        "paginaFinal" => "603"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31141234"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dysbiosis of gut microbiota was closely associated with psoriasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Huang"
                            1 => "R&#46; Gao"
                            2 => "N&#46; Yu"
                            3 => "Y&#46; Zhu"
                            4 => "Y&#46; Ding"
                            5 => "H&#46; Qin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11427-018-9376-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Sci China Life Sci&#46;"
                        "fecha" => "2019"
                        "volumen" => "62"
                        "paginaInicial" => "807"
                        "paginaFinal" => "815"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30264198"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gut microbiota dysbiosis in a cohort of patients with psoriasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Hidalgo-Cantabrana"
                            1 => "J&#46; G&#243;mez"
                            2 => "S&#46; Delgado"
                            3 => "S&#46; Requena-L&#243;pez"
                            4 => "R&#46; Queiro-Silva"
                            5 => "A&#46; Margolles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Br J Dermatol&#46;"
                        "fecha" => "2019"
                        "volumen" => "181"
                        "paginaInicial" => "1287"
                        "paginaFinal" => "1295"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gut microbial composition in patients with psoriasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;M&#46; Codo&#241;er"
                            1 => "A&#46; Ram&#237;rez-Bosca"
                            2 => "E&#46; Climent"
                            3 => "M&#46; Carri&#243;n-Gutierrez"
                            4 => "M&#46; Guerrero"
                            5 => "J&#46;M&#46; P&#233;rez-Orqu&#237;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41598-018-22125-y"
                      "Revista" => array:5 [
                        "tituloSerie" => "Sci Rep&#46;"
                        "fecha" => "2018"
                        "volumen" => "8"
                        "paginaInicial" => "3812"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29491401"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metagenomic analysis of gut microbiota in non&#8208;treated plaque psoriasis patients stratified by disease severity&#58; development of a new psoriasis&#8208;microbiome index"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "I&#46; Dei-Cas"
                            1 => "F&#46; Giliberto"
                            2 => "L&#46; Luce"
                            3 => "H&#46; Dopazo"
                            4 => "A&#46; Penas-Steinhardt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41598-020-69537-3"
                      "Revista" => array:5 [
                        "tituloSerie" => "Sci Rep&#46;"
                        "fecha" => "2020"
                        "volumen" => "10"
                        "paginaInicial" => "12754"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32728075"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Psoriasis is associated with elevated gut IL&#8208;1&#945; and intestinal microbiome alterations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Yegorov"
                            1 => "D&#46; Babenko"
                            2 => "S&#46; Kozhakhmetov"
                            3 => "L&#46; Akhmaltdinova"
                            4 => "I&#46; Kadyrova"
                            5 => "A&#46; Nurgozhina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3389/fimmu.2020.571319"
                      "Revista" => array:5 [
                        "tituloSerie" => "Front Immunol&#46;"
                        "fecha" => "2020"
                        "volumen" => "11"
                        "paginaInicial" => "571319"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33117362"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The gut microbiota profile in psoriasis&#58; a Brazilian case&#8208;control study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Schade"
                            1 => "D&#46; Mesa"
                            2 => "A&#46;R&#46; Faria"
                            3 => "J&#46;R&#46; Santamaria"
                            4 => "C&#46;A&#46; Xavier"
                            5 => "D&#46; Ribeiro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/lam.13630"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lett Appl Microbiol&#46;"
                        "fecha" => "2022"
                        "volumen" => "74"
                        "paginaInicial" => "498"
                        "paginaFinal" => "504"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34897759"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0355"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gut Microbiome composition associated with major depressive disorder and sleep quality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Q&#46; Zhang"
                            1 => "Y&#46; Yun"
                            2 => "H&#46; An"
                            3 => "W&#46; Zhao"
                            4 => "T&#46; Ma"
                            5 => "Z&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3389/fpsyt.2021.645045"
                      "Revista" => array:5 [
                        "tituloSerie" => "Front Psychiatry&#46;"
                        "fecha" => "2021"
                        "volumen" => "12"
                        "paginaInicial" => "645045"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34093266"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intestinal colonization by a lachnospiraceae bacterium contributes to the development of diabetes in obese mice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46; Kameyama"
                            1 => "K&#46; Itoh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1264/jsme2.ME14054"
                      "Revista" => array:6 [
                        "tituloSerie" => "Microbes Environ&#46;"
                        "fecha" => "2014"
                        "volumen" => "29"
                        "paginaInicial" => "427"
                        "paginaFinal" => "430"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25283478"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Associations between maternal diet&#44; body composition and gut microbial ecology in pregnancy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;L&#46; Ruebel"
                            1 => "S&#46;P&#46; Gilley"
                            2 => "C&#46;R&#46; Sims"
                            3 => "Y&#46; Zhong"
                            4 => "D&#46; Turner"
                            5 => "S&#46;V&#46; Chintapalli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/nu13093295"
                      "Revista" => array:5 [
                        "tituloSerie" => "Nutrients&#46;"
                        "fecha" => "2021"
                        "volumen" => "13"
                        "paginaInicial" => "3295"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34579172"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gut Prevotella as a possible biomarker of diet and its eubiotic versus dysbiotic roles&#58; a comprehensive literature review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Precup"
                            1 => "D&#46;C&#46; Vodnar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Br J Nutr&#46;"
                        "fecha" => "2019"
                        "volumen" => "122"
                        "paginaInicial" => "131"
                        "paginaFinal" => "140"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Wolters"
                            1 => "Diet"
                            2 => "psoriasis&#58; experimental data"
                            3 => "evidence&#46; clinical"
                            4 => "J&#46; Br"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Dermatol"
                        "fecha" => "2005"
                        "volumen" => "153"
                        "paginaInicial" => "706"
                        "paginaFinal" => "714"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A fasting and vegetarian diet treatment trial on chronic inflammatory disorders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Lithell"
                            1 => "A&#46; Bruce"
                            2 => "I&#46;B&#46; Gustafsson"
                            3 => "N&#46;J&#46; H&#246;glund"
                            4 => "B&#46; Karlstr&#246;m"
                            5 => "K&#46; Ljunghall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Derm Venereol&#46;"
                        "fecha" => "1983"
                        "volumen" => "63"
                        "paginaInicial" => "397"
                        "paginaFinal" => "403"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6197838"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0385"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High&#8208;fat diet&#8211;induced colonocyte dysfunction escalates microbiota&#8208;derived trimethylamine N&#8208;oxide"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46; Yoo"
                            1 => "J&#46;K&#46; Zieba"
                            2 => "N&#46;J&#46; Foegeding"
                            3 => "T&#46;P&#46; Torres"
                            4 => "C&#46;D&#46; Shelton"
                            5 => "N&#46;G&#46; Shealy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1126/science.aba3683"
                      "Revista" => array:6 [
                        "tituloSerie" => "Science&#46;"
                        "fecha" => "2021"
                        "volumen" => "373"
                        "paginaInicial" => "813"
                        "paginaFinal" => "818"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34385401"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0390"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The crosstalk between gut bacteria and host immunity in intestinal inflammation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Q&#46; Yang"
                            1 => "Y&#46; Wang"
                            2 => "A&#46; Jia"
                            3 => "Y&#46; Wang"
                            4 => "Y&#46; Bi"
                            5 => "G&#46; Liu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/jcp.30024"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cell Physiol&#46;"
                        "fecha" => "2021"
                        "volumen" => "236"
                        "paginaInicial" => "2239"
                        "paginaFinal" => "2254"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32853458"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0395"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microbiota in health and disease &#8208; potential clinical applications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Laudes"
                            1 => "C&#46; Geisler"
                            2 => "N&#46; Rohmann"
                            3 => "J&#46; Bouwman"
                            4 => "T&#46; Pischon"
                            5 => "K&#46; Schlicht"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/nu13020386"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nutrients&#46;"
                        "fecha" => "2021"
                        "volumen" => "13"
                        "paginaInicial" => "386"
                        "paginaFinal" => "396"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33513722"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0400"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Successful treatment of psoriasis with adalimumab induced no changes in the gut microbiota"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46; Todberg"
                            1 => "A&#46; Egeberg"
                            2 => "C&#46; Zachariae"
                            3 => "N&#46; S&#248;rensen"
                            4 => "O&#46; Pedersen"
                            5 => "L&#46; Skov"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol&#46;"
                        "fecha" => "2022"
                        "volumen" => "36"
                        "paginaInicial" => "464"
                        "paginaFinal" => "467"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "pt"
  "url" => "/26662752/0000009800000005/v1_202307310652/S2666275223001017/v1_202307310652/pt/main.assets"
  "Apartado" => array:4 [
    "identificador" => "89618"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Artigo Original"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/26662752/0000009800000005/v1_202307310652/S2666275223001017/v1_202307310652/pt/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275223001017?idApp=UINPBA00008Z"
]