Serum fatty acid synthase levels and n-3 fatty acid intake in patients with breast cancer.

PURPOSE: Fatty acid synthase (FASN) is a key enzyme in fatty acid biosynthesis that is usually over-expressed in patients with breast cancer, but its relationship with the patient's dietary habit is not clear. A higher intake of n-3 polyunsaturated fatty acids is related to reduced breast carcinogenesis in vitro and in vivo. The aim of this study was to clinically investigate the association between serum FASN levels and fatty acid intake in women newly diagnosed with breast cancer. METHODS: In a case-control cross-sectional study, with 18 breast cancer patients and 29 controls, we evaluated nutritional status, dietary intake, and serum FASN levels. Statistical analyses were carried out with parametric and non-parametric tests, according to the sample's normality distribution. RESULTS: The mean age of breast cancer group (n = 18) and control group (n = 29) was 46.8 ± 9.7 y and 44.4. ± 8.6 y, respectively. Mean serum concentration of FASN in breast cancer group was significantly higher (132.51 ± 95.05 ng/mL) than in control group (36.88 ± 20.87 ng/mL) (p < 0.0001). Among breast cancer group, serum FASN levels of premenopausal women were significantly higher than those of postmenopausal women (p = 0.026). There was no significant difference between the early and late disease stages in regard to serum FASN levels in breast cancer group. Mean nutrient intake was similar and n-3 docosahexaenoic acid intake was low in both groups. We observed no association regarding fatty acid intake and serum FASN levels. CONCLUSION: These data suggest that dietary n-3 fatty acid has no association with serum FASN levels among newly diagnosed breast cancer patients.

Relation between carbohydrate intake and weight loss after bariatric surgery.

BACKGROUND: Weight loss and long-term weight maintenance in bariatric surgery patients are related to maintaining satiety. It can be related to glycemic load (GL) and carbohydrate (g CHO) intake. The aim of this study was to investigate the effect of g CHO and GL and in weight loss on patients who had undergone bariatric surgery. METHOD: The following measurements/calculations were conducted as follows: current body weight (kg), current BMI, percentage of excess weight loss (PEWL), average monthly weight loss (AMWL), energy intake (kcal per day), and GL calculation. Correlations were found among the studied variables. A multiple linear regression analysis of diet variables executed with GL and weight loss. RESULTS: The population presented 66% of EWL. The average of total energy intake (TEI) was 1220+/-480, and the calculated GL resulted in an average of 73.2. Negative correlations were found between AMWL and TEI (p=0.04), and between AMWL and GL (p=0.009); furthermore, a negative correlation was found between carbohydrate intake in grams and AMWL (p=0.003). A positive correlation (p=0.017) was found between GL and TEI. Weight loss and GL were also correlated. Among the intake variables, GL and g CHO consumed are held accountable for 62 percent of AMWL. The multiple linear regression analysis showed that GL and carbohydrate grams (g CHO) account for 62% of AMWL. CONCLUSION: The glycemic load and grams of carbohydrate are intake factors that can be useful tools in weight loss and long-term weight maintenance on patients who have undergone Roux-en-Y Gastric Bypass (RYGB).

Iron status and oxidative stress biomarkers in adults: a preliminary study.

OBJECTIVE: Although essential to many vital processes, iron catalyzes reactions that produce reactive oxygen species, which are associated with the increased risk of non-communicable chronic diseases and precocious aging. This study investigated whether ferritin, hemoglobin concentration, and dietary iron consumption are related to oxidative stress biomarkers in adults. METHODS: Data were collected from 134 allegedly healthy subjects >18 y of age who were randomly selected to participate in a cross-sectional study as part of the pilot project Prevalence of Risk Factors for Non-communicable Chronic Diseases in the Federal District, Brazil (VIVA Saúde-DF). Serum ferritin, malondialdehyde (MDA) and protein carbonyl concentrations, hemoglobin, and dietary iron consumption were analyzed. RESULTS: A weak positive correlation (r = 0.189, P = 0.032) and association (P = 0.046) was observed for serum ferritin and MDA. Hemoglobin concentrations were positively associated with serum MDA (P = 0.040). Dietary iron intake and serum protein carbonyl concentrations showed a weak positive correlation (r = 0.173, P = 0.046) for all subjects. Iron intake by women was positively associated with serum protein carbonyl (P = 0.03). A lower serum MDA concentration was found in ferritin-deficient subjects (P = 0.015) and men with anemia (P = 0.011). CONCLUSION: These results suggest that low levels of iron may reduce oxidative stress.

Perception of Hunger/Satiety and Nutrient Intake in Women Who Regain Weight in the Postoperative Period After Bariatric Surgery.

OBJECTIVE: To investigate the perception of hunger and satiety and its association with nutrient intake in women who regain weight in the postoperative period after bariatric surgery. METHODS: Cross-sectional study of adult women divided into three groups: weight regain (n = 20), stable weight (n = 20) (both at least 24 months after Roux-en-Y gastric bypass surgery), and non-operated obesity (n = 20). A visual analogue scale measured hunger/satiety perception while fasting, immediately after finishing a test meal, and 180 min after finishing the test meal. The incremental area above or under the curve was calculated. Food intake was analyzed by 3 days of food recall and adjusted for intraindividual variation. To make between-group comparisons, Mann-Whitney, ANOVA, Kruskal-Wallis, and independent-samples T tests and Pearson's correlation were used. RESULTS: There were no between-group differences in incremental areas of hunger/satiety, but protein intake was significantly lower among patients who regained weight compared with those who had stable body weight (0.99 ± 0.23 g/kg body weight vs. 1.17 ± 0.21 g/kg body weight, p = 0.047). In the group that regained weight, satiety was correlated positively with usual dietary protein density (r = 0.541; p = 0.017) and negatively with usual carbohydrate intake (r = - 0.663; p = 0.002). CONCLUSION: Women who regained weight presented similar perceptions of hunger/satiety to those of patients without weight regain and with non-operated obesity. In patients who regained weight postoperatively, satiety perception was correlated positively with usual dietary protein density and inversely with usual carbohydrate intake.

Omega 3-DHA and Delta-Tocotrienol Modulate Lipid Droplet Biogenesis and Lipophagy in Breast Cancer Cells: the Impact in Cancer Aggressiveness.

Omega 3-docosahexaenoic acid (DHA) and vitamin E Delta-tocotrienol (Delta-T3) are extensively studied as protective nutrients against cancer development. Little is known about the biological mechanisms targeted by these bioactive molecules on lipid droplet (LD) biogenesis, an important breast cancer aggressiveness marker, and the occurrence of lipophagy in breast cancer cells. The aim of this study was to investigate the effect of DHA, Delta-T3 and DHA plus Delta-T3 co-treatment in LD biogenesis and lipophagy process in triple negative breast cancer cell line MDA-MB-231. Cells were treated with 50 µM DHA and/or 5 µM Delta-T3. Our results demonstrated that DHA can trigger an increase in LD biogenesis and co-treatment with Delta-T3 was able to reduce this LD biogenesis. In addition, we showed that a higher cytoplasmic LD content is associated with a higher breast cancer cells malignance and proliferation. Reduction of cytoplasmic LD content by silencing ADRP (adipose differentiation-related protein), a structural LD protein, also decreased cell proliferation in MDA-MB-231 cells. Treatment with DHA and Delta-T3 alone or co-treatment did not reduce cell viability. Moreover, we showed here that DHA can trigger lipophagy in MDA-MB-231 cells and DHA plus Delta-T3 co-treatment was able to enhance this lipophagy process. Our findings demonstrated that co-treatment with DHA plus Delta-T3 in MDA-MB-231 cells could reduce LD biogenesis and potentiate lipophagy in these cells, possibly having a positive impact to inhibit breast cancer malignancy. Therefore, suitable doses of DHA and Delta-T3 vitamin E isoform supplementation can be a prominent tool in therapeutic treatments against breast cancer.

Omega-3 docosahexaenoic acid induces pyroptosis cell death in triple-negative breast cancer cells.

The implication of inflammation in pathophysiology of several type of cancers has been under intense investigation. Omega-3 fatty acids can modulate inflammation and present anticancer effects, promoting cancer cell death. Pyroptosis is an inflammation related cell death and so far, the function of docosahexaenoic acid (DHA) in pyroptosis cell death has not been described. This study investigated the role of DHA in triggering pyroptosis activation in breast cancer cells. MDA-MB-231 breast cancer cells were supplemented with DHA and inflammation cell death was analyzed. DHA-treated breast cancer cells triggered increased caspase-1and gasdermin D activation, enhanced IL-1ß secretion, translocated HMGB1 towards the cytoplasm, and membrane pore formation when compared to untreated cells, suggesting DHA induces pyroptosis programmed cell death in breast cancer cells. Moreover, caspase-1 inhibitor (YVAD) could protect breast cancer cells from DHA-induced pyroptotic cell death. In addition, membrane pore formation showed to be a lysosomal damage and ROS formation-depended event in breast cancer cells. DHA triggered pyroptosis cell death in MDA-MB-231by activating several pyroptosis markers in these cells. This is the first study that shows the effect of DHA triggering pyroptosis programmed cell death in breast cancer cells and it could improve the understanding of the omega-3 supplementation during breast cancer treatment.

Author Correction: Omega-3 docosahexaenoic acid induces pyroptosis cell death in triple-negative breast cancer cells.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Effect of Protein Intake on the Protein Status and Lean Mass of Post-Bariatric Surgery Patients: a Systematic Review.

BACKGROUND: Post-bariatric surgery may compromise nutritional status due to energy and protein intake restriction. METHODS: Systematic review was performed to synthesize evidence on the amount of protein intake and its association with lean mass and serum proteins during at least 6 months following Roux-en-Y gastric bypass or sleeve gastrectomy. RESULTS: Twelve studies (n = 739) were identified in the search. Protein intake below 60 g/day and significant lean mass loss were observed in majority of these studies. Of the four studies that measured association between protein intake and lean mass retention, only two supported this hypothesis. CONCLUSION: There is insufficient evidence of the effect of dietary protein on serum protein levels. Further studies are needed to better estimate the protein intake that supports a healthy nutritional status in this population.

Diet-induced thermogenesis in postoperatve Roux-en-Y gastric bypass patients with weight regain.

BACKGROUND: Bariatric surgery has been shown to be an effective treatment for obesity. Changes in energy expenditure, especially through diet-induced thermogenesis (DIT), have been identified as one of the mechanisms to explain this success. However, not all patients are able to maintain healthy postoperative weight loss. Therefore, a question arises: In the weight regain after bariatric surgery, are these changes in energy metabolism still active? OBJECTIVE: To investigate if weight regain after Roux-en-Y gastric bypass (RYGB) surgery is associated with a lower diet-induced thermogenesis in the late postoperative period. SETTING: A cross-sectional study with the participants chosen from among the patients from a private practice. METHODS: This was a cross-sectional study where 3 groups of female patients were evaluated: (1) 20 patients with a RYGB postoperative time period of at least 2 years, who kept a healthy weight after surgery (loss of at least 50% of excess weight; Healthy group); (2) 19 patients with clinically severe obesity (BMI>40 kg/m(2), without co-morbidities and>35 kg/m(2), with co-morbidities; Pre group); (3) 18 patients who experienced weight regain after RYGB (Regain group). The 3 groups were submitted to indirect calorimetry to measure resting metabolic rate (RMR), respiratory quotient (RQ), and DIT. Immediately after the RMR measurement, a mixed meal of regular consistency was offered. Ten minutes after the food intake began, energy expenditure measurements were initiated continuing throughout the following 3 postprandial hours. Body composition was evaluated using multifrequency bioelectrical impedance. In subgroups of the studied population, glucose and insulin levels were measured at baseline and at 30, 60, 90, 120, and 180 minutes after feeding. The mean area under the curve (AUC) between the 3 groups and measurements at baseline were compared using the analysis of variance (ANOVA). RESULTS: The Healthy group had the highest weight adjusted RMR value compared with both the Pre and Regain group (23.03±3.02 kcal/kg; 16.18±2.94 kcal/kg; 17.11±3.28 kcal/kg, respectively; P<.0001). The Regain and Pre groups showed no difference for this variable. The weight-adjusted DIT (AUC 0-180 min) was about 42% and 34% higher in the Healthy group compared with the Pre and Regain groups, respectively (P<.0001). Lean body mass (kg) showed a positive correlation with the AUC of weight-adjusted DIT in the 3 groups. Multiple regression revealed that lean body mass was the only variable related to weight adjusted DIT, independent of group and other selected variables. CONCLUSION: Weight-adjusted DIT in the Regain group was smaller compared with the Healthy group, and with no difference compared with the Pre group. The lean body mass seems to have a positive association with diet-induced thermogenesis.

Influences of maternal dietary intake and suckling on breast milk lipid and fatty acid composition in low-income women from Brasilia, Brazil.

Diet has a strong effect, while suckling stimulus is believed not to influence breast milk fatty acids. The effect of dietary pattern and suckling on the fatty acid composition of Brazilian women's breast milk was studied. A cross-sectional study was conducted with low-income women living in the central region of Brazil, where dietary DHA is not readily available. Fore and hind milk fatty acids were collected from 77 women on day 15+/-1 postpartum, and information on maternal characteristics and dietary habit was taken. The effect of suckling stimulus was measured by the changes between fore and hind milk. The mean body mass index (BMI) of volunteers was 23.7+/-3.2 kg/m(2), and the milk lipid concentration was 4.8+/-1.2 g/dl. A mixture of traditional and western type of dietary habit, high in fat and sugar was observed. The fatty acids of the subject's milk were 41.93+/-1.42% saturated, 33.31+/-1.67% monounsaturated and 25.03+/-5.23% polyunsaturated (wt/wt). The DHA level in the milk was 0.34+/-0.19%, similar to the values found in milk of many western societies. DHA and 18:3n-3 levels increased from fore to hind milk (p<0.05). Correlation existed mostly between dietary components and milk 16:0 and oleic acid (18:0). An analysis of classes of fatty acids in milk showed oleic acid (18:0) to present a negative correlation with all milk fatty acid classes. The results suggest that breast milk fatty acids of Brazilian women reflect a western maternal dietary pattern and are influenced by the suckling.

A prospective study on the radiation therapy associated changes in body weight and bioelectrical standardized phase angle.

BACKGROUND & AIMS: Standardized phase angle (SPA) is a value derived from bioelectrical impedance phase angle analysis and has been recognized as marker of nutritional risk and clinical status of cancer patients. This study aimed to evaluate the changes in SPA during radiation therapy of cancer patients and identify possible nutritional and clinical determinants of these changes. METHODS: Nutritional assessment was performed before the initiation and at the end of the radiotherapy. It included anthropometrics and bioelectrical impedance analysis. A generalized linear mixed model was used to evaluate the effects of selected independent variables on the changes in standardized phase angle. RESULTS: A total of 104 patients entered the study and those with complete information were included in the analysis (n = 62). Most patients (61%) were at clinical stage I and II, the most prevalent irradiation site was the pelvis (39%) and 98% were well nourished or overweight. According to the regression analysis, changes in body weight and irradiation at head and neck/upper abdomen and thorax were associated with standardized phase angle modifications during radiotherapy. Clinical stage and radiation dose were not associated with changes in standardized phase angle. Compared to baseline values, for every 1 kg weight reduction during the radiation therapy, the standardized phase angle also decreased by 0.107 (p < 0.0001). CONCLUSIONS: In well nourished or overweight patients, weight loss during radiation therapy is closely associated with decrease in standard phase angle.

Effects of a very low calorie diet in the preoperative stage of bariatric surgery: a randomized trial.

BACKGROUND: Preoperative bariatric patients can follow very low calorie diets (VLCD), reducing surgical risks. However, possible advantages of a liquid diet over one of normal consistency are controversial. This study investigated the effect of a liquid VLCD compared with one of normal consistency considering visceral fat (VF) loss and metabolic profile in preoperative clinically severe obese patients. METHODS: This was a randomized, open-labeled, controlled clinical trial. Patients were divided into 2 groups: liquid diet and normal diet. Data were collected at baseline and 7 and 14 days after intervention. Information gathered was analyzed for loss of weight and VF, biochemical data, anthropometric data, and energy intake. RESULTS: Fifty-seven patients consumed the liquid diet and 47 consumed the normal consistency diet. The liquid diet group lost significantly more weight (P<.0290) and VF (P<.0410) than the normal diet group. An inverse correlation occurred between VF loss and surgical time among the liquid diet group (r2=-.1302, P=.001). Additionally, there was a positive correlation between the percentage of excess weight loss and ketonuria (P=.0070). No between-group difference occurred regarding calorie intake. CONCLUSION: Patients that consumed a liquid diet presented a positive effect on reducing VF and greater weight loss than the normal diet group. Both VLCDs presented benefits offering a protective effect during the preoperative stage.

[Therapeutic effects of phytosterols and phytostanols in cholesterolemia]. / Efeitos terapêuticos dos fitosteróis e fitostanóis na colesterolemia.

Plant sterol and stanol esters are called "functional" compounds due to their hypocholesterolemic properties. The objective of this review is to update recent findings concerning the effect of phytosterols in the blood cholesterol, emphasizing the results from experimental and human studies. The hypocholesterolemic effect is observed with the intake of 2.5g/day of phytosterols or phytostanols. Daily intake, usually of stanols, for 4 weeks has shown to to be effective in lowering blood total- as well as LDL-cholesterol by about 10%. The mechanism of action in lowering blood cholesterol comes from their structural similarity to cholesterol, hence they act by competing with cholesterol at the luminal absorption site. The adverse effects of a high intake of phytosterols and phytostanols are the lower absorption of some liposoluble vitamins and antioxidants.

Diet-induced thermogenesis and respiratory quotient after Roux-en-Y gastric bypass surgery: a prospective study.

BACKGROUND: Studies in humans and other animals have shown that Roux-en-Y gastric bypass (RYGB) leads to increased energy expenditure (EE). We analyzed several components of EE, such as the respiratory quotient (RQ), resting metabolic rate (RMR), and diet-induced thermogenesis (DIT) among patients before and after RYGB. METHODS: In this prospective clinical study, RMR, DIT, and RQ were measured by indirect calorimetry (IC) in the same patients before and 12 months after RYGB (the preoperative and postoperative time points, respectively). Postprandial RQ and DIT were measured after patients consumed a standard ~270 kcal meal (62% carbohydrates, 12% proteins, and 26% lipids). RESULTS: The population studied consisted of 13 patients (mean age 40.8 ± 6.7 years, 85% female).At the postoperative (postop) time point, patients showed higher weight-adjusted RMR compared with the preoperative (preop) time point (P<.01). The absolute and weight-adjusted metabolic rates 20 minutes after the meal were increased postoperatively (P<.0001) but not preoperatively (P = 0.2962) (DIT); this increase in RQ was significantly higher in the postop than in the preop time point. CONCLUSION: The observed patients showed increased EE, DIT, and RQ after RYGB surgery. These data may serve as important physiologic factors contributing to the loss and maintenance of weight after RYGB.

Validation study of multi-frequency bioelectrical impedance with dual-energy X-ray absorptiometry among obese patients.

BACKGROUND: Body mass index (BMI) is the most common parameter for classifying nutritional status. However, body composition (BC) may vary considerably among individuals with identical BMIs; consequently, we need to assess BC efficiently. Bariatric surgery is the most effective method for treating obesity. To improve quality assessment of postoperative weight loss, it is essential to assess BC. Multi-frequency bioelectrical impedance analysis (BIA) is a practical assessment instrument, though limited when applied among the obese population. Despite dual-energy X-ray absorptiometry (DXA) being the current reference standard, it has physical limitations which restrict its practical application. This study, therefore, sought to correlate the results of BC assessments of same patient population using BIA and DXA. METHODS: This was a cross-sectional validation study with patients invited to undergo a multi-frequency BIA (Inbody 720®) and afterwards a DXA examination Statistical analyses were done using the intraclass correlation coefficient (ICC), paired t-test and the Bland-Altman plot analysis. RESULTS: A total of 108 patients were randomly selected, with 73 meeting the criteria for study inclusion. Most were female (89%) and had an average BMI of 40.17 ± 4.08 kg/m(2). An almost perfect correlation of fat (kg) and fat-free mass (kg) was found in results from the BIA and DXA examination (ICC = 0.832 and ICC = 0.899, respectively). A substantial correlation was also found between the percentage of body fat (%BF) and the percentage of fat-free mass (%FFM). The comparison made between the BIA and DXA using the t-test showed significant differences between all parameters. The Bland-Altman plot showed that the BIA method tends to underestimate the FM and overestimate the LM measurements when compared with DXA. CONCLUSION: BIA proved to be a safe alternative for assessing BC in clinically severely obese patients and thus provides a more accessible evaluation tool for this population. But, consideration should be given to the formula added to the BIA measurement, adjusting the values to differences observed in order to reduce errors when compared with the DXA measurements.

Metabolic syndrome in central Brazil: prevalence and correlates in the adult population.

BACKGROUND: The prevalence of metabolic syndrome (MetS) has increased in developing countries in recent decades. This syndrome, a clustering of metabolic abnormalities, has been correlated to various socioeconomic and behavioral variables. We investigated the prevalence and prevalence ratios (PR) of MetS and related factors in an adult population of the Federal District (FD) of Brazil, which is located in the central region of the country. METHODS: A cross-sectional, population-based study conducted in 2007, with 2130 adults (aged 18 years or older) in the FD of Brazil. Metabolic syndrome was defined according to the recently harmonized criteria. The prevalence of MetS and PR were estimated for each sex according to the diagnostic components and the overall contribution of the selected correlates. RESULTS: The overall prevalence of MetS was 32.0% (95%CI: 28.9-35.2), with no gender difference. The single component with the greatest contribution to the diagnosis of MetS was hypertension in men (PR 5.10, 95%CI: 3.17-8.22) and high waist circumference in women (PR 5.02, 95%CI: 3.77-6.69). The prevalence of MetS increased significantly and progressively with age and excess weight. In women, higher education was protective against MetS (PR 0.66, 95%CI: 0.49-0.89) compared to 8 or less years of education. There was no association between the prevalence of MetS and behavioral variables studied. CONCLUSIONS: This study provides comprehensive and alarming data about the prevalence of MetS among the adult population of Brazil's FD. The results suggest that reducing education inequalities may be an important public policy goal to improve health outcomes, especially among women.

Dietary protein intake and bariatric surgery patients: a review.

Bariatric surgery, a highly successful treatment for obesity, requires adherence to special dietary recommendations to insure the achievement of weight loss goals and weight maintenance. Postoperative consumption of protein is linked to satiety induction, nutritional status, and weight loss. Hence, we conducted an extensive literature review to identify studies focused on the following: protein and nutritional status; recommendations for dietary protein intake; the effects of protein-rich diets; and associations between dietary protein intake and satiety, weight loss, and body composition. We found that there have been few studies on protein intake recommendations for bariatric patients. Dietary protein ingestion among this population tends to be inadequate, potentially leading to a loss of lean body mass, reduced metabolic rates, and physiological damage. Conversely, a protein-rich diet can lead to increased satiety, enhanced weight loss, and improved body composition. The quality and composition of protein sources are also very important, particularly with respect to the quantity of leucine, which helps to maintain muscle mass, and thus is particularly important for this patient group. Randomized studies among bariatric surgery patient populations are necessary to establish the exact quantity of protein that should be prescribed to maintain their nutritional status.

Applying the triads method in the validation of dietary intake using biomarkers.

The triads method is applied in validation studies of dietary intake to evaluate the correlation between three measurements (food frequency questionnaire, reference method and biomarker) and the true intake using validity coefficients (Á). The main advantage of this technique is the inclusion of the biomarker, which presents independent errors compared with those of the traditional methods. The method assumes the linearity between the three measurements and the true intake and independence between the three measurement errors. Limitations of this technique include the occurrence of ρ > 1, known as "Heywood case", and the existence of negative correlations, which do not allow the calculation of Á. The objective of this review is to present the concept of the method, describe its application and examine the validation studies of dietary intake that use the triads method. We also conceptualize the "bootstrap" method, used to estimate the confidence intervals of the validity coefficients.

Diet quality assessment indexes / Índices de avaliação da qualidade da dieta

Various indices and scores based on admittedly healthy dietary patterns or food guides for the general population, or aiming at the prevention of diet-related diseases have been developed to assess diet quality. The four indices preferred by most studies are: the Diet Quality Index; the Healthy Eating Index; the Mediterranean Diet Score; and the Overall Nutritional Quality Index. Other instruments based on these indices have been developed and the words 'adapted', 'revised', or 'new version I, II or III' added to their names. Even validated indices usually find only modest associations between diet and risk of disease or death, raising questions about their limitations and the complexity associated with measuring the causal relationship between diet and health parameters. The objective of this review is to describe the main instruments used for assessing diet quality, and the applications and limitations related to their use and interpretation.

Para avaliação da qualidade da dieta, diferentes índices ou escores foram desenvolvidos, considerando padrões dietéticos reconhecidamente saudáveis ou baseando-se em guias alimentares para populações em geral ou para a prevenção de doenças. Dos vários índices, quatro deles servem de base para a maior parte dos estudos: Índice de Qualidade da Dieta, Índice de Alimentação Saudável, Escore da Dieta Mediterrânea e Índice Geral de Qualidade Nutricional. A partir desses modelos, alguns outros foram criados, com acréscimo do termo adaptado/revisado, ou em novas versões (I, II ou III) como referência do respectivo original. Esses índices, mesmo validados, apresentam associações geralmente modestas com o risco de mortalidade ou doenças, o que aponta suas limitações, bem como a complexidade de se medir a relação causal entre dieta e parâmetros de saúde. Esta revisão tem como objetivo descrever os principais instrumentos de avaliação da qualidade da dieta, assim como suas aplicações e limitações, relativas ao uso e interpretações.

Adesão a um programa de aconselhamento nutricional para adultos com excesso de peso e comorbidades / Adherence to a nutritional counseling program for adults with excess weight and comorbidities

OBJETIVO: Investigar adesão a programa de aconselhamento nutricional em grupo para indivíduos com excesso de peso e comorbidades. MÉTODOS: Estudo analítico de intervenção controlada e aberta. Oitenta adultos, de ambos os sexos, com índice de massa corporal entre 25 e 35kg/m², portadores de dois ou mais fatores de risco cardiovascular associados foram alocados aleatoriamente em dois grupos para acompanhamento por três meses. O grupo de intervenção com aconselhamento nutricional em grupo recebeu atendimento individual e participou de seis reuniões grupais para discussão sobre alimentação saudável e atividade física, com dinâmicas e método participativo. O grupo-controle, com atendimento padrão individual, foi assistido em três consultas ambulatoriais. Consideraram-se repercussões dietéticas antes e após a intervenção e assiduidade às reuniões como parâmetros de adesão ao tratamento. RESULTADOS: Trinta e três participantes concluíram o estudo. Do total inicial, 45,8 por cento e 40,7 por cento do grupo de intervenção com aconselhamento nutricional em grupo e do grupo-controle com atendimento padrão individual, respectiva-mente, atingiram nível ótimo de assiduidade. Os fatores mais citados como barreiras à adesão ao tratamento foram fazer refeições fora de casa (46,7 por cento - grupo-controle com atendimento padrão individual) e dificuldade em aplicar os conhecimentos na prática, principalmente em eventos sociais (33,3 por cento - grupo de intervenção com aconselhamento nutricional em grupo). Verificou-se aumento significativo do percentual médio do uso de temperos naturais e do número de refeições ao dia nos dois grupos após a intervenção. Porém, não houve diminuição significativa do consumo energético intra ou entre os grupos. CONCLUSÃO: Apesar da abrangência do conteúdo e do emprego de um método participativo no grupo de intervenção, a adesão foi insuficiente para alterar significativamente os principais parâmetros dietéticos estudados. O apro-fundamento da abordagem comportamental, continuada e multiprofissional deve ser objeto de mais investigações.

OBJECTIVE: The objective of this study was to verify adherence to a nutritional group counseling program for patients with excess weight and comorbidities. METHODS: This was an analytical, open, controlled, intervention study. Eighty adults from both genders with a body mass index ranging from 25 to 35kg/m² with two or more associated cardiovascular risk factors were randomly allocated to two groups for a three-month follow-up. The intervention group with nutritional group counseling received personalized care and participated in six group meetings to discuss healthy eating and physical activity, with group dynamics and participatory method. The control group was given standard personalized care in three outpatient visits. The parameters of adherence to treatment were the dietary repercussions before and after the intervention and attendance to the meetings. RESULTS: Thirty-three participants concluded the study. In all, 45.8 percent and 40.7 percent of intervention group and control group, respectively, had excellent attendance. The main barriers to adherence to treatment were the need of eating out (46.7 percent - control group) and the difficulty of putting their knowledge to use, especially in social occasions (33.3 percent - intervention group). There was a significant increase in the mean percentage use of natural seasonings and in the number of daily meals of both groups after the intervention. However, there was no significant decrease in energy intake within groups or between groups. CONCLUSION: Despite the breadth of the content and the use of a participatory method in the intervention group, adherence was not enough to change the main dietary parameters significantly. A deeper, continuous and multidisciplinary behavioral approach should be object of further investigations.