Nutritional factors and pressure injury risk in hospitalised patients post-stroke.

OBJECTIVE: This study aimed to analyse the nutritional factors and pressure injury (PI) risk in hospitalised patients post-stroke. METHOD: The research employed a descriptive observational method in which patients ≥18 years of age were followed for six days. Nutritional evaluation was based on anthropometric and dietary factors. The nutritional risk was assessed via anthropometric measurements, Braden nutrition subscale and daily dietary intake. PI risk was evaluated through the Braden Scale. The Wilcoxon test, paired t-test, and Kruskal-Wallis test were applied and corrected with Bonferroni correction or analysis of variance, followed by the post hoc Tukey test. RESULTS: During their hospital stays, the participating 59 patients had an increase in sensory perception (p=0.02) and nutrition (p=0.005) scores. It was observed that patients at high risk of PI did not meet daily nutritional recommendations for calories, proteins, carbohydrates, lipids and micronutrients (zinc, selenium and copper) compared with patients at low-to-moderate risk. Weight (p<0.001), body mass index (p<0.001), calf (p=0.01) and arm (p=0.04) circumferences, and subscapular (p=0.003) and triceps (p<0.001) skinfolds decreased during the six days of hospitalisation. CONCLUSION: From the findings of this study, it was concluded that nutritional factors, such as unmet recommended daily nutritional requirements of macronutrients and micronutrients, and nutritional status are associated with a higher risk of developing a PI.

Low Food Consumption Interferes with the Nutritional Status of Surgical Patients with Neoplasia of the Gastrointestinal Tract.

Nutritional support strongly influence the nutritional status of the surgical neoplastic patients. This study aimed to evaluate the influence of food consumption on the perioperative nutritional status of hospitalized patients with neoplasia of the upper (UGIT) and lower (LGIT) gastrointestinal tract. METHOD: Observational, longitudinal, and prospective study. Data collected: food consumption, Subjective Global Assessment, anthropometry, laboratory tests. RESULTS: Eighty patients were followed up: 43 (54%) in the UGIT and 37 (46%) in the LGIT. The consumption in the perioperative period was lower than the usual consumption in the UGIT and LGIT groups, respectively, of energy (14.2 ± 6.5; 22.8 ± 11.2 Kcal/kg/d, p < 0.001; 13.6 ± 1.2; 19.0 ± 2.0 Kcal/kg/d; p = 0.014), protein (1.1 ± 0.7; 0.6 ± 0.3 g/kg/d, p < 0.001; 0.8 ± 0.1; 0.5 ± 0.1 g/kg/d; p = 0.058), selenium, zinc and copper. Most patients presented in the UGIT and LGIT groups, respectively, worsening malnutrition and muscle depletion according to the Subjective Global Assessment (61.9%; 51.4%) and hypoalbuminemia, mainly in the UGIT in the postoperative. CONCLUSION: Low food consumption during the perioperative period associated with prolongation of the postoperative fasting period worsens the nutritional status of patients undergoing surgery of the gastrointestinal tract for neoplasia, especially in the UGIT group.

Dysphagia, Immobility, and Diet Acceptance: Main Factors Associated with Increased Risk of Pressure Injury in Patients Hospitalized after Stroke.

OBJECTIVE: To determine the predisposing factors for PI in patients hospitalized after stroke. METHODS: This 7-day longitudinal study followed up with patients hospitalized after stroke. Assessments included mobility, nutrition, and the presence of dysphagia and anemia. The nutrition evaluation was based on anthropometric, biochemical, and dietary determinants. Pressure injury (PI) risk was assessed via the Braden Scale. Mann-Whitney and Kruskal-Wallis tests were applied. RESULTS: Patients who were bedridden showed a greater risk of PI development upon admission (P = .004) and 7 days later (P < .001) compared with patients who could ambulate. Patients who were not dysphagic presented a lower risk of PI development in relation to patients who were dysphagic on admission (P = .047) and 7 days later (P < .001). On admission, patients with good and average diet acceptance had a lower PI risk (P = .002; P = .034) compared with those with a low acceptance. Body mass index was lower in patients at a high risk of developing PI compared with those at moderate risk (P = .02). Hemoglobin and hematocrit were statistically lower among patients who were at high risk of PI compared with patients who were low risk. CONCLUSIONS: Predisposing factors such as immobility, dysphagia, low diet acceptance, nutrition risk, and anemia are associated with a greater risk of PI development.

Night fasting as an alternative to improve nutritional support and glycaemic control in hospitalised patients with exclusive enteral nutrition.

BACKGROUND: Enteral nutrition (EN) assists in the nutritional status of hospitalised patients unable to feed orally. The aim of this study was to determine which method-continuous EN or discontinuous EN, a diet in which the infusion is discontinued for 4h during the night,-is more effective in meeting nutrient recommendations and improving glycaemic control and biochemical parameters related to protein anabolism. METHODS: Patients were divided into two groups: discontinuous (EN administered in mL/h, 18h/day, 4-h night fasting) and continuous (EN administered in mL/h, 22h/day). All patients with EN receive the diet over a 22-h daily period, in which the diet is suspended for two hours/day for daily hospital routines such as bathing, and physiotherapy, and followed for seven days. Evaluated data: prescribed and administered volume, calories, protein, and fibre; capillary blood glucose; erythrogram; serum albumin. RESULTS: 52 patients were followed-up, with 23 (44.2%) in the discontinuous group and 29 (55.8%) in the continuous group. Compared with the continuous group, the discontinuous group received volumes closer to those prescribed, equal or higher calories, and more protein. The capillary glucose values were within the reference range in the discontinuous group, while the continuous group presented elevated values. Both groups presented hypoalbuminaemia, haemoglobin, and haematocrit below the reference values; however, in the discontinuous group, the serum albumin values improved during hospitalisation relative to the continuous. CONCLUSIONS: The method involving discontinuation of EN for 4h was more effective in meeting nutrient recommendations compared with the continuous method. Additionally, in the discontinuous group, we observed a better control of glycaemia when compared to that of the continuous group.

Plasmatic vitamin C in nontreated hepatitis C patients is negatively associated with aspartate aminotransferase.

OBJECTIVES: To evaluate the possible relationship between aminotransferases levels and markers of oxidative stress in chronic hepatitis C patients. DESIGN AND METHODS: Patients without treatment for hepatitis were divided in to group I (15-39 U/L); group II (41-76 U/L) and group III (81-311 U/L) of activity alanine aminotransferase (ALT). Blood markers of oxidative stress [catalase (CAT), glutathione peroxidase (GPx), thiobarbituric acid-reactive species (TBARS), nonprotein and protein thiol (NP-SH and P-SH) groups and vitamin C] were determined. RESULTS: P-SH and NP-SH levels, TBARS, GPx and CAT were not different between groups. Vitamin C was significantly decreased in groups II (P=0.03) and III (P=0.001) when compared with group I and correlated negatively with aspartate aminotransferase (AST; r=-0.29, P=0.042). CONCLUSION: Vitamin C levels were negatively associated with AST, suggesting that vitamin C could be an additional indicator of hepatitis C severity.

A single high dose of ascorbic acid and iron is not correlated with oxidative stress in healthy volunteers.

Fe (II) is a potential prooxidant in vivo and can induce cellular oxidative stress. Ascorbic acid (AA) is a powerful physiological antioxidant and, in the presence of free Fe (II), can exhibit prooxidant effects in vitro. However, in vivo prooxidant effects of Fe (II) and AA have not yet been indisputably demonstrated. Here we evaluate the potential toxic effect of supplementation of Fe (II) associated with AA. Nine healthy, nonsmoking male volunteers (20-31 years old) participated in the crossover study design. The volunteers were supplemented with either a dose of 2 g of AA, 150 mg of iron carbonyl or 2 g of AA plus 150 mg of iron carbonyl with a washout period of 15 days between each treatment. AA, iron, ferritin, thiobarbituric acid-reactive substances, catalase, delta-aminolevulinic dehydratase and SH thiol groups were measured in the blood of the volunteers. Plasma AA levels were increased at 2, 5 and 24 h after AA or AA plus iron ingestion. Plasma Fe levels were increased at 2 and 5 h in the AA plus iron group. Erythrocyte malondialdehyde levels decreased at 5 and 24 h after AA and 5 h after AA plus iron ingestion. Catalase activity from erythrocytes was increased 5 h after supplementation with AA plus iron. There was no significant difference between groups in the other biochemical parameters evaluated. Thus, the present study does not support the hypothesis that the combination of high plasma concentrations of AA and iron, or iron alone, could cause in vivo oxidative damage after a single supplementation dose.

Association of anemia and malnutrition in hospitalized patients with exclusive enteral nutrition.

INTRODUCTION: enteral nutrition therapy maintains and/or regains the nutritional status of the common patient in hospital settings, where anemia and malnutrition are food related and are very common diseases. OBJECTIVE: to determine and associate the presence of anemia and malnutrition in hospitalized patients with exclusive enteral nutrition. METHODS: a prospective, cross-sectional study with patients receiving exclusive enteral nutrition up to 72 hours after hospitalization. A nutritional evaluation was performed, consisting of anthropometric data, such as weight, circumferences, and skinfolds; dietary evaluation (data were collected through an electronic medical record) and biochemistry data (hemogram, albumin, C-reactive protein, capillary glucose monitoring). RESULTS: the population consists of 77 individuals. As the patients presented greater severity of anemia, corrected arm muscle area, calf circumference and serum albumin levels were reduced while C-reactive protein increased significantly (p < 0.05). In relation to the low weight classification according to the body mass index (BMI), it was observed that the anthropometric parameters such as corrected arm muscle area (R = 0.74, p < 0.001), adductor pollicis muscle thickness (R = 0.23, p = 0.046) and calf circumference (R = 0.81, p < 0.001) decreased as did biochemical parameters albumin (R = 0.26; p = 0.048) and capillary blood glucose (R = 0.34, p = 0.018). CONCLUSION: anemia has an important relation with anthropometric markers that evaluate the depletion of lean mass; the BMI has a strong association with all the anthropometric parameters evaluated, as well as the albumin and capillary blood glucose, except with the values of hemoglobin.

Fatores associados com a presença de anemia em pacientes hospitalizados / Factors associated with the presence of anemia in hospitalized patients

Introdução: Anemia é definida pela diminuição da concentração de hemoglobina circulante no sangue, podendo ser desencadeada por mecanismos fisiopatológicos e deficiências alimentares. Objetivou-se avaliar fatores associados à presença e ao tipo de anemia em pacientes hospitalizados. Métodos: Estudo retrospectivo, quantitativo realizado em hospital municipal da região central do Rio Grande do Sul. Fizeram parte do estudo pacientes hospitalizados em diferentes clínicas, com idade superior a 18 anos. Os dados foram coletados de fichas preenchidas pelos acadêmicos do curso de Nutrição durante o estágio curricular. As fichas eram compostas pelos seguintes dados: diagnóstico médico, doenças associadas, dados antropométricos como Índice de Massa Corporal (IMC) e exames laboratoriais como o hemograma. Resultados: A amostra foi composta por 100 indivíduos hospitalizados, 39% adultos e 61% idosos; 76% dos pacientes apresentaram anemia, sendo 35,4% (n= 34) anemia leve, 29% (n=28) moderada e 11,6% (n=11) grave. Percebeu-se que os idosos estão mais anêmicos em relação aos adultos. Doenças hematológicas, infecciosas, gastroenterológicas e pneumológicas tiveram maiores associações com a presença de anemia nos pacientes. Parâmetros como volume corpuscular médio e amplitude de distribuição dos eritrócitos encontraram-se normais nos pacientes. Além disso, observou-se relação inversamente proporcional da gravidade de anemia com o estado nutricional dos pacientes. Conclusão: A maioria dos pacientes hospitalizados estava anêmica, principalmente idosos. Alterações observadas no eritrograma foram semelhantes às encontradas na anemia por doença crônica. O baixo IMC e doenças associadas com alterações na eritropoiese, perda sanguínea e estimulação do sistema imunológico tiveram maiores associações com a presença de anemia nesses pacientes.

Introduction: Anemia is defined as a decreased concentration of circulating blood hemoglobin, and it can be triggered by pathophysiological mechanisms and nutritional deficiencies. We aimed to evaluate factors associated with the presence and type of anemia in hospitalized patients. Methods: This is a retrospective, quantitative study performed in a municipal hospital in central Rio Grande do Sul. The study participants were patients hospitalized at different healthcare institutions and aged 18 years or older. Data were collected through forms filled out by undergraduate nutrition students at their academic internship period. The forms included the following data: medical diagnosis, associated diseases, anthropometric data such as body mass index (BMI), and laboratory examinations such as blood counts. Results: The sample comprised 100 hospitalized individuals, of which 39% were adults and 61% were older adults; 76% of the patients presented anemia, where 35.4% (n=34) had mild anemia, 29% (n=28) had moderate anemia, and 11.6% (n = 11) had severe anemia. We noticed that older adults were more severely anemic than adults. Blood disorders and infectious, gastrointestinal, and respiratory diseases were more strongly associated with the presence of anemia in these patients. Parameters such as mean corpuscular volume and red cell distribution width were normal. Moreover, we observed an inversely proportional relationship between anemia severity and the patients' nutritional status. Conclusion: Most hospitalized patients were anemic, especially the older adults. Alterations seen in the erythrogram were similar to those found in anemia of chronic disease. Low BMI and diseases linked to changes in erythropoiesis, blood loss, and stimulation of the immune system were more strongly associated with the presence of anemia in these patients.

Comportamento da variabilidade glicêmica em pacientes hospitalizados com Diabetes Mellitus 2 / Behavior of glycemic variability in hospitalized type 2 Diabetes Mellitus patients / Comportamiento de la variable glucémica en pacientes Hospitalizados con Diabetes Mellitus 2

Introdução: A hiperglicemia pode estar presente em até 38% dos pacientes hospitalizados.O controle glicêmico está associado a melhores desfechos clínicos. Objetivo: avaliar o comportamento da variabilidade glicêmica em pacientes hospitalizados com Diabetes Mellitus 2. Metodologia: Estudo transversal, composto por pacientes hospi-talizados com e sem diabetes, adultos e idosos, de ambos os gêneros, em terapia nutricional enteral. As glicemias foram medidas por testes de glicemia capilar e classificadas como normoglicemia, hiperglicemia e variabilidade glicêmica, avaliados a partir do desvio-padrão glicêmico e coeficiente de variação glicêmico. Foram avaliados dados bioquímicos como Proteína C-reativa. A análise de variância de duas vias (ANOVA) foi utilizada para comparar os grupos, além da correlação de Spearman. Resultados: Participaram 85 indivíduos, com diabetes mellitus 2 (20%; n= 17), e sem diabetes mellitus (80%; n = 68), sendo 34% (n = 29) adultos e 66% (n=56) idosos. Adultos e idosos com diabetes mellitus apresentaram hiperglicemia em relação aos pacientes não diabéticos (p<0,01), valores supe-riores de desvio-padrão glicêmico (p<0,01) e coeficiente de variação glicêmica em relação aos pacientes sem dia-betes (p= 0,03), no entanto, não foram classificados com variabilidade glicêmica. Os valores da Proteína C-reativa foram correlacionados com o desvio-padrão glicêmico (R= 0,29; p= 0,0065), no entanto, a quantidade de carboi-dratos infundida na dieta enteral não se correlacionou estatisticamente com as glicemias nem com a variabilidade glicêmica dos pacientes (p>0,05). Conclusão: pacientes hospitalizados com ou sem diabetes mellitus 2 não apre-sentaram variabilidade glicêmica, demonstrando um controle glicêmico na hospitalização. (AU)

Introduction: Hyperglycemia may be present in up to 38% of hospitalized patients. Glycemic control is associated with better clinical outcomes. Objective: assess the behavior of glycemic variability in hospitalized patients with Diabetes Mellitus 2. Methodology: Cross-sectional study composed of hospitalized patients with and without diabetes, adults and elderly, of both genders, undergoing enteral nutritional therapy. Blood glucose was measured by capillary blood glucose tests and classified as normoglycemia, hyperglycemia, and glycemic variability, assessed from the glycemic standard deviation and glycemic variation coefficient. Biochemical data such as C-reactive protein were assessed. Two-way analysis of variance (ANOVA) was used to compare the groups, in addition to Spearman's correlation. Results: Eighty-five individuals with diabetes mellitus 2 (20%; n=17) and without diabetes mellitus (80%; n=68) participated in the study; 34% (n=29) were adults, and 66% (n=56) were elderly. Adults and elderly people with diabetes mellitus presented hyperglycemia concerning non-diabetic patients (p<0.01), higher values of glycemic standard deviation (p<0.01), and glycemic variation coefficient concerning patients without diabetes (p= 0.03); however, they were not classified with glycemic variability. The C-reactive protein values were correlated with the glycemic standard deviation (R= 0.29; p= 0.0065); however, the amount of carbohydrates infused in the enteral diet was not statistically correlated with glycemia or with the glycemic variability of patients (p>0.05). Conclusion: hospitalized patients with or without diabetes mellitus 2 did not show glycemic variability, demonstrating glycemic control during hospitalization. (AU)

Introducción: La hiperglucemia puede estar presente hasta en un 38% de los pacientes hospitalizados. El con-trol glucémico se asocia con mejores resultados clínicos. Objetivo: evaluar el comportamiento de la variación glucémica en pacientes con Diabetes Mellitus 2. Metodología: Estudio transversal, compuesto por pacientes hos-pitalizados con y sin diabetes, adultos y ancianos, con terapia nutricional enteral. Las glucemias fueron medidas por exámenes de glucemia capilar y clasificadas como normo glucemia, hiperglucemia y variación glucémica, evaluados a partir de la desviación estándar y coeficiente de variación glucémico. Fueron evaluados datos bioquí-micos como Proteína C-reactiva. El análisis de la variación de las dos vías (ANOVA) fue utilizada para comparar los grupos, junto a la correlación de Spearman. Resultados: Participaron 85 individuos, con diabetes mellitus 2 (20%; n+17), y sin diabetes mellitus (80%; n = 68). Adultos 34% (n=29) y ancianos 66% (n=56). Pacientes con diabetes mellitus presentaron hiperglucemia en relación a los pacientes nodiabéticos (p< 0,01), valores superiores de desviación estándar glucémico (p< 0,01) y coeficiente de variación glucémica en relación a los pacientes sin dia-betes (p= 0,03), sin embargo, no fueron clasificados con variación glucémica. Los valores de la Proteína C-reactiva fueron correlacionados con la desviación estándar glucémica (R = 0,29; P= 0,0065), la cantidad de carbohidratos administrada, no se correlacionó estadísticamente con las glucemias ni con la variación glucémica de los pacientes (p>0,05). Conclusión: pacientes hospitalizados con o sin diabetes mellitus 2 no presentaron variación glucémica, demostrando control glucémico en la hospitalización. (AU)

Relation of micronutrients with antioxidant properties in patients with chronic diseases and exclusive enteral nutrition

ABSTRACT Objective: To evaluate the intake of micronutrients with antioxidant properties through exclusive enteral nutrition therapy (ENT) in hospitalized patients with chronic diseases compared to the estimated average requirement (EAR). Methods: This prospective, longitudinal, descriptive, observational study was performed in a public hospital, with adult and elderly patients. The adequacy of the volume of ENT prescribed and offered was considered satisfactory when >80%. The adequacy of micronutrients with antioxidant properties was performed according to the estimated average need (EAR). Data were considered statistically significant when p<0.05. Results: Of the 53 included patients, 58.5% were male. Most of patients (45.3%) were in the neurology clinic, and the main cause was cerebral vascular accident (18.9%). The volume administered was less than the prescribed volume of ENT in both male and female patients. However, recommendations for micronutrients with antioxidant properties, such as vitamin A, vitamin C, vitamin E, zinc, selenium, copper and iron, are according to EAR and did not exceed the tolerable intake limit (upper limit, UL), (p<0.05). The present study shows a very large variability in the concentration of micronutrients in each enteral diet. It is necessary to consider the pathologies that affect the patient, as some health conditions may be able to require specific amounts of micronutrients. Conclusions: Patients received a lower volume of enteral nutrition therapy compared to the prescribed volume. The micronutrient concentrations were consistent with daily EAR recommendations and did not exceed the tolerable intake limit (UL) for healthy individuals.

RESUMEN Objetivo: Evaluar la ingesta de micronutrientes con propiedades antioxidantes a través de la terapia de nutrición enteral exclusiva (ENT) en pacientes hospitalizados con enfermedades crónicas en comparación con el requerimiento promedio estimado (RPE). Métodos: Prospectivo, longitudinal, descriptivo y de observación, se realizó en un hospital público con pacientes adultos y ancianos. La adecuación del volumen de ENT prescrito y ofrecido se consideró satisfactoria cuando fue >80%. La adecuación de micronutrientes con propiedades antioxidantes se realizó de acuerdo con la RPE. Se consideraron estadísticamente significativos p<0,05. Resultados: De los 53 pacientes incluidos, 58,5% eran hombres. La mayoría de los pacientes (45,3%) se encontraban en la consulta de neurología y la principal causa fue el accidente vascular cerebral (18,9%). El volumen administrado fue menor que el volumen prescrito de ENT tanto en pacientes masculinos como femeninos. Sin embargo, las recomendaciones de micronutrientes con propiedades antioxidantes, como vitamina A, vitamina C, vitamina E, zinc, selenio, cobre y hierro, están de acuerdo con la RPE y no superan el límite de ingesta tolerable (UL), (p<0,05). El presente estudio muestra una variabilidad muy grande en la concentración de micronutrientes en cada dieta enteral. Es necesario considerar las patologías que afectan al paciente, ya que algunas condiciones de salud pueden requerir cantidades específicas de micronutrientes. Conclusiones: Los pacientes recibieron un volumen menor de ENT en comparación con el volumen prescrito. Las concentraciones de micronutrientes fueron consistentes con las recomendaciones diarias de la RPE y no excedieron el límite de ingesta tolerable (UL) para individuos sanos.

Increased postoperative fasting time aggravates the nutritional status in patients with gastrointestinal tract neoplasia

ABSTRACT Surgical patients with gastrointestinal cancer often suffer from malnutrition. This study aimed to evaluate the influence of fasting time on the nutritional status of patients hospitalized with preoperative and postoperative gastrointestinal tract neoplasms. Observational, longitudinal, and prospective study conducted in the surgical unit at a public-school hospital. The patients were divided into groups: upper (UGIT) and lower (LGIT) gastrointestinal tract. Follow-up started within 72 h of hospitalization with reassessment 72 h after surgery. Data collected: sex, age, type and duration of surgery, preoperative (compared with 8 h) and postoperative (compared with 24 h) fasting time, food acceptance, Subjective Global Assessment, anthropometry, and laboratory tests. Analyses: Student t, Wilcoxon, and chi-square tests. Fifty-one patients were followed up, 29 (57%) UGIT and 22 (43%) LGIT. The preoperative fasting time was 8.2±2.8 h in UGIT and 8.1±2.2 h in LGIT groups, respectively; however, postoperative fasting times in UGIT (60.4±40.7 h) and LGIT groups (57.6±38.2 h) were longer than 24 h (P<0.001). Although eutrophic in the preoperative period, in the postoperative most patients in the UGIT and LGIT groups presented, respectively, malnutrition (71%; 59%; P<0.001), severe weight loss (79%; 80%), a significant correlation between triceps skinfold and postoperative fasting time (r= -0.306; P= 0.03), and hemoglobin and albumin values (r= 0.633; P<0.001), additionally low dietary acceptance, especially in the UGIT group. Prolonging postoperative fasting time worsened the nutritional status of surgical patients, especially in the UGIT group.

RESUMEN Los pacientes quirúrgicos con cáncer gastrointestinal a menudo sufren desnutrición. El objetivo de este estudio fue evaluar la influencia del tiempo de ayuno en estado nutricional de pacientes hospitalizados con neoplasias del tracto gastrointestinal preoperatorio y posoperatorio. Estudio observacional, longitudinal y prospectivo realizado en unidad quirúrgica de un hospital escolar público. Los pacientes fueron divididos en grupos: tracto gastrointestinal superior (UGIT) y inferior (LGIT). El seguimiento se inició dentro del 72 h de la hospitalización con reevaluación 72 h después de la cirugía. Datos recolectados: sexo, edad, tipo y duración de la cirugía, tiempo de ayuno preoperatorio (comparado con 8 h) y postoperatorio (comparado con 24 h), aceptación de dieta, Evaluación Subjetiva Global, antropometría y pruebas de laboratorio. Análisis: pruebas de T, Wilcoxon y chi-cuadrado. Se siguió 51 pacientes, 29 (57%) en UGIT y 22 (43%) en LGIT. El tiempo de ayuno preoperatorio fue 8,2±2,8 h (UGIT) y 8,1±2,2 h (LGIT); sin embargo, los tiempos de ayuno posoperatorio en UGIT (60,4±40,7 h) y LGIT (57,6±38,2 h) fueron superiores a 24 h (P<0,001). Aunque eutróficos en preoperatorio, en postoperatorio la mayoría de los pacientes (UGIT y LGIT, respectivamente) presentaron desnutrición (71%; 59%; P<0,001), pérdida de peso severa (79%; 80%), correlación significativa entre pliegue cutáneo del tríceps y tiempo de ayuno posoperatorio (r= -0.306; P= 0.03), valores de hemoglobina y albúmina (r= 0,633; P<0,001), y baja aceptación de dieta, especialmente del UGIT. La prolongación del ayuno postoperatorio empeoró el estado nutricional de los pacientes quirúrgicos, especialmente del UGIT.

[Prevalence and severity of asthma among adolescents and their relationship with the body mass index]. / Prevalência e gravidade da asma em adolescentes e sua relação com índice de massa corporal.

OBJECTIVE: To investigate the relationship between the increase of body mass index and the prevalence and severity of asthma in adolescents from Santa Maria, in southern Brazil, and surrounding regions. METHOD: A cross-sectional, observational, population-based study was carried out with 4,010 schoolchildren aged 13 and 14 years, without any gender restrictions, who answered the written questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC) phase III. Body mass index was used (kg/m2) as recommended by the World Health Organization for the assessment of nutritional status: below the fifth percentile (underweight), at or above the fifth percentile and below the 85th percentile (normal weight), at or above the 85th percentile and below the 95th percentile (overweight), and at or above the 95th percentile (obesity). The relationship between body mass index and the prevalence and severity of asthma was analyzed using the chi-square test for trend (statistical significance: p < or = 0.05). RESULTS: There was a significant statistical association between the increase in body mass index and the prevalence of "wheezing ever" (p = 0.036), and "wheezing with exercise" (p = 0.008). When stratified by sex, there was a positive association just for "wheezing ever" (p = 0.028) for boys and "wheezing with exercise" (p = 0.03) for girls. CONCLUSION: The increase in body mass index was associated with the increase in the prevalence of wheezing ever, but not with the increase in the prevalence and severity of asthma among adolescents.

PROFILE OF PATIENTS WHO SEEK THE BARIATRIC SURGERY.

BACKGROUND: Nowadays obesity is a chronic disease considered one of the greatest problems in public healthy. Showing to be effective in a short and long term, the bariatric surgery has emerged as an optional treatment for morbid obesity. AIM: Identify the profile of patients seeking bariatric surgery. METHODS: Were interviewed 100 patients in preoperative nutritional monitoring of bariatric surgery. The study was conducted by applying a questionnaire prepared according to the research objectives. RESULTS: From the individuals that were seeking bariatric surgery, 78% were female, 62% were married and 69% reported physical activity. The average age of those surveyed was 37±10.83 years and mean body mass index (BMI) was 43.51± 6.25 kg/m². The comorbidity more prevalent in this group was high blood pressure (51%). In previous treatments for weight reduction, 92% have already done hypocaloric diet followed by anorectic drug (83%). The success of these treatments was reported by 92% of patients; however, the weight lost was recovered in less than one year of 75%. Patients with diabetes mellitus and dyslipidemia had higher BMI values. The patients with comorbidities showed lower levels of BMI. CONCLUSION: The profile of patients who sought surgical treatment for their obesity were predominantly women with a family background of obesity and obesity-related comorbidities, especially hypertension and diabetes mellitus.

EFFECT OF ANTIOXIDANT POTENTIAL ON SEVERITY OF CIRRHOSIS IN HUMANS.

BACKGROUND/AIMS: to examine the relationship between the antioxidant potential and severity parameters of cirrhosis in humans. METHODS: fifteen patients with hepatic cirrhosis (nine subjects - Child group B, and six subjects - Child group C) and nine control subjects were enrolled in the study. The main criteria taken into account to characterize the diagnosis of cirrhosis and its complications were the AST: ALT ratio, AST to platelet ratio index, Bonacini score, Meld score and Child classification. Those parameters were determined based on laboratory results and patient's clinical records. Se, Zn, ascorbic acid (AA) levels and oxidative stress parameters were measured in blood samples of cirrhotic patients. RESULTS: the analysis of plasma levels of Se and AA showed low concentrations in cirrhotic patients compared with control subjects (P < 0.05). Though, there was a positive correlation between plasma of Se and severity parameters of cirrhosis in patients of Child group B and C. In the activity of the antioxidant enzymes only catalase was lower in patients of Child group C compared with control group. CONCLUSION: we found low plasma levels of Se and AA among cirrhotic patients. However, is not clear why selenium levels tend to increase with the severity of liver cirrhosis.

Introducción/Objetivos: examinar la relación entre los potenciales antioxidantes y los parámetros de gravedad de la cirrosis en los seres humanos. Métodos: quince pacientes con cirrosis hepática (nueve sujetos - grupo Child B, y seis sujetos - grupo Child C) y nueve sujetos control fueron incluidos en el estudio. Los principales criterios que se tuvieron en cuenta para caracterizar el diagnóstico de la cirrosis y sus complicaciones fueron la AST: relación de ALT, AST índice de la relación de plaquetas, clasificación Bonacini, clasificación MELD y clasificación de Child. Estos parámetros fueron determinados con base en los resultados de laboratorio y los registros clínicos del paciente. Se midieron los niveles de Zn, ácido ascórbico (AA) y los parámetros de estrés oxidativo en muestras de sangre de pacientes cirróticos. Resultados: el análisis de los niveles plasmáticos de Se y AA mostraron bajas concentraciones en los pacientes cirróticos en comparación con los sujetos control (P < 0,05); sin embargo, hubo una correlación positiva entre el plasma de Se y los parámetros de gravedad de la cirrosis en pacientes del grupo Child B y C. En la actividad de las enzimas antioxidantes catalasa solamente fue menor en los pacientes del grupo Child C, en comparación con el grupo control. Conclusión: se encontraron niveles bajos en plasma de Se y AA en pacientes cirróticos. Sin embargo, no está claro por qué los niveles de selenio tienden a aumentar con la gravedad de la cirrosis hepática.

Nutritional care in peptic ulcer.

INTRODUCTION: Peptic ulcer is a lesion of the mucosal lining of the upper gastrointestinal tract characterized by an imbalance between aggressive and protective factors of the mucosa, having H. pylori as the main etiologic factor. Dietotherapy is important in the prevention and treatment of this disease. AIM: To update nutritional therapy in adults' peptic ulcer. METHODS: Exploratory review without restrictions with primary sources indexed in Scielo, PubMed, Medline, ISI, and Scopus databases. RESULTS: Dietotherapy, as well as caloric distribution, should be adjusted to the patient's needs aiming to normalize the nutritional status and promote healing. Recommended nutrients can be different in the acute phase and in the recovery phase, and there is a greater need of protein and some micronutrients, such as vitamin A, zinc, selenium, and vitamin C in the recovery phase. In addition, some studies have shown that vitamin C has a beneficial effect in eradication of H. pylori. Fibers and probiotics also play a important role in the treatment of peptic ulcer, because they reduce the side effects of antibiotics and help reduce treatment time. CONCLUSION: A balanced diet is vital in the treatment of peptic ulcer, once food can prevent, treat or even alleviate the symptoms involving this pathology. However, there are few papers that innovate dietotherapy; so additional studies addressing more specifically the dietotherapy for treatment of peptic ulcer are necessary.

Antioxidant effects of Phyllanthus niruri tea on healthy subjects.

OBJECTIVE: To investigate the potential antioxidant effects of Phyllanthus niruri (P. niruri, Euphorbiaceae) tea on healthy subjects. METHODS: Five non-smoking, male healthy volunteers, 20 to 31 years old, were enrolled. Each subject was treated twice, following a randomized crossover fashion regarding the ingestion of P. niruri infusion (5 g/750 mL) (tea group) or 750 mL of water (control group). Fasting venous blood samples were collected prior to and at 1, 2 and 4 h after infusion drinking. Samples were tested for plasmatic gallic acid and ascorbic acid levels, erythrocytic catalase and superoxide dismutase activities, and intracellular DCFH fluorescence in granulocytes, monocytes and lymphocytes. RESULTS: Catalase and superoxide dismutase activities were not altered by tea ingestion. Plasma levels of gallic acid were significantly increased at 1, 2 and 4 h after P. niruri ingestion and plasma ascorbic acid at 1 h after P. niruri ingestion. CONCLUSIONS: Ingestion of P. niruri tea is associated with a slight increase in antioxidant markers in human blood (ascorbic acid and gallic acid), which may contribute to its pharmacological effects.

Brazilian nut consumption by healthy volunteers improves inflammatory parameters.

OBJECTIVE: The aim of this study was to investigate the effect of a single dose of Brazil nuts on the inflammatory markers of healthy individuals. METHOD: A randomized crossover study was conducted with 10 healthy individuals (mean age 24.7 ± 3.4 y). Each individual was tested four times regarding intake of different portions of Brazil nuts: 0, 5, 20 and 50 g. At each testing period, peripheral blood was collected before and at 1, 3, 6, 9, 24, and 48 h after intake of nuts, as well as at 5 and 30 d after intake of various Brazil nut portions. Blood samples were tested for high-sensitivity to C-reactive protein, interleukin (IL)-1, IL-6, IL-10, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ, aspartate and alanine aminotransferases, albumin, total protein, alkaline phosphatase, gamma-glutamyltransferase, urea, and creatinine. RESULTS: Consumption of nuts did not affect biochemical parameters for liver and kidney function, indicating absence of hepatic and renal toxicity. A single intake of Brazil nuts (20 or 50 g) caused a significant decrease in serum IL-1, IL-6, TNF-α, and IFN-γ levels (P < 0.05), whereas serum levels of IL-10 were significantly increased (P < 0.05). CONCLUSION: The results indicate a long-term decrease in inflammatory markers after a single intake of large portions of Brazil nuts in healthy volunteers. Therefore, the long-term effect of regular Brazil nut consumption on inflammatory markers should be better investigated.

Effect of Uncaria tomentosa Extract on Apoptosis Triggered by Oxaliplatin Exposure on HT29 Cells.

Background/Aim. The use of herbal products as a supplement to minimize the effects of chemotherapy for cancer treatment requires further attention with respect to the activity and toxicity of chemotherapy. Uncaria tomentosa extract, which contains oxindole alkaloids, is one of these herbal products. The objective of this study was to evaluate whether Uncaria tomentosa extract modulates apoptosis induced by chemotherapy exposure. Materials and Methods. Colorectal adenocarcinoma cells (HT29 cells) were grown in the presence of oxaliplatin and/or Uncaria tomentosa extract. Results. The hydroalcoholic extract of Uncaria tomentosa enhanced chemotherapy-induced apoptosis, with an increase in the percentage of Annexin positive cells, an increase in caspase activities, and an increase of DNA fragments in culture of the neoplastic cells. Moreover, antioxidant activity may be related to apoptosis. Conclusion. Uncaria tomentosa extract has a role for cancer patients as a complementary therapy. Further studies evaluating these beneficial effects with other chemotherapy drugs are recommended.

A single consumption of high amounts of the Brazil nuts improves lipid profile of healthy volunteers.

Background. This study investigates the effects of Brazil nut ingestion on serum lipid profile in healthy volunteers. Methods. Ten healthy subjects were enrolled in the study. Each subject was tested 4 times in a randomized crossover in relation to the ingestion of different serving sizes of the Brazil nut: 0, 5, 20, or 50 g. At each treatment point, peripheral blood was drawn before and at 1, 3, 6, 9, 24, and 48 hours and 5 and 30 days. Blood samples were tested for total cholesterol, high- and low-density lipoprotein cholesterol (HDL-c and LDL-c, resp.), triglycerides, selenium, aspartate and alanine aminotransferases, albumin, total protein, alkaline phosphatase, gamma GT, urea, creatinine, and C-reactive protein. Results. A significant increase of the plasma selenium levels was observed at 6 hours within the groups receiving the nuts. Serum LDL-c was significantly lower, whereas HDL-c was significantly higher 9 hours after the ingestion of 20 or 50 g of nuts. The biochemical parameters of liver and kidney function were not modified by ingestion of nuts. Conclusions. This study shows that the ingestion of a single serving of Brazil nut can acutely improve the serum lipid profile of healthy volunteers.

Factors associated with chronic gastritis in patients with presence and absence of Helicobacter pylori.

BACKGROUND: Chronic gastritis is an inflammation of the stomach mucosa, which is considered its main etiological factor the Helicobacter pylori. AIM: To observe the differences in patients with chronic gastritis as well as the presence and absence of H. pylori, to obtain a better understanding of the etiological factors, clinical, dietary and lifestyle habits and associated diseases. METHODS: This was a descriptive study, retrospective medical records of patients with chronic gastritis treated as outpatients. Endoscopy and research of H. pylori was used in the diagnosis of chronic gastritis. The survey was conducted through a questionnaire to ascertain the risk factors for chronic gastritis and the clinical manifestations of disease, dietary and lifestyle habits, family history of the disease, weight changes and medications. For statistical analysis was used Spearman coefficient. Data were considered statistically significant p<0.05. RESULTS: Of the 94 patients evaluated were symptomatic with heartburn, belching, epigastric pain, fullness and nausea. In 56.6% (n = 54) of individuals was detected the presence of bacteria and in 43.6% (n = 40) was not found any specific etiologic factor. Was performed chi-square statistical test of clinical manifestations and factors such as stress and anxiety, leading to positive correlation. It became evident that the risk factors for disease are diverse, including the use of drugs, alcoholism, eating quickly, talking during meals, with significant relation to abdominal distension and reflux. The patients with the bacteria, had a higher risk of experiencing these symptoms. CONCLUSION: Various etiological factors in eating habits and lifestyle, as smoking, alcoholism, anxiety, stress, associated diseases and inadequate nutrition, interact to the onset of clinical manifestations, and the presence and absence of H. pylori did not show significant changes in patient clinical status.