Educommunication in nutrition and neurodegenerative diseases: a scoping review protocol.

INTRODUCTION: Neurodegenerative diseases affect the nervous system and are characterised by the deterioration and/or death of neurons. Nutrition care is essential for maintaining an adequate nutritional status, which influences the prognosis and survival of patients with neurological diseases. Caregivers participate assiduously in the care of these patients and must be integrated into the multidisciplinary team. They often need specific training or knowledge regarding food and nutrition to perform their roles with patients. Health educommunication is a learning tool that can positively influence the appropriation of the theme and the construction of care autonomy. This scoping review (ScR) will map educommunication actions/strategies in nutrition and neurodegenerative diseases. METHODS AND ANALYSIS: This ScR will be designed based on the methodology of Arksey and O'Malley and will follow the methodological guidance for conducting a Joanna Briggs Institute ScR. The research question addressed by the scoping review will be: what actions/strategies for educommunication in nutrition and neurodegenerative diseases have been developed for patients or caregivers? Many search sites it will be used in this review, such as electronic databases (Embase, PubMed/MEDLINE, Scopus, Web of Science), Google Scholar and grey literature sources. No restrictions of date or language will be applied to the search strategy. Two reviewers will independently screen all abstracts and full-text studies for inclusion. Data, including the study design, objective, study population, neurodegenerative diseases, nutrition topics and educommunication strategies will be logically organised and tabulated in Microsoft Excel. ETHICS AND DISSEMINATION: The data used for this review are from secondary sources and available to the public; thus, no ethical approval and human consent will be required for this study. Dissemination of the results will be published in a peer-reviewed journal and presented at conferences.

Risk assessment and nutritional prognosis of clinical outcome in critically ill patients

Introduction: Nutrition assessment of critically ill patients is challenging but it should be part of the clinical nutrition routine in the hospital setting. Objective: To assess the nutritional risk and prognosis of patients admitted to the intensive care unit (ICU) of a University Hospital in Natal, Brazil. Methods: Cross-sectional study developed with adult and elderly patients between February 2017 and February 2020. The nutritional risk was detected by the modified Nutrition Risk in Critically Ill score (mNUTRIC score). The nutritional prognosis was assessed using the phase angle (PA), calculated from the resistance and reactance values provided by bioimpedance. Mann-Whitney test was used to verify the association of mNUTRIC-score and PA with the outcome (hospital discharge or death). Spearman's correlation coefficient was used to verify the correlation between mNUTRIC-score and PA. Results: A total of 55 patients were included in this study. The average value of the NUTRIC score and PA was 3.13 ± 2.35 and 4.19 ± 1.21, respectively. Most patients had low nutritional risk. Among them, 81.8% were discharged and 18.2% died. Both mNUTRIC-score (p≤0.0001) and PA (p=0.04) were associated with the clinical outcome. These two parameters were negatively correlated (r=-0.3804; p=0.0059). Conclusion: Most of the patients had a low nutritional risk determined by the mNUTRIC-score. Those with high nutritional risk had a worse outcome (death). A negative correlation was observed between the mNUTRIC score and the PA, showing that the higher the nutritional risk, the worse prognosis was found in critically ill patients.

A geographical study on amyotrophic lateral sclerosis in Rio Grande Do Norte, Brazil, from 2005 to 2018.

OBJECTIVE: amyotrophic lateral sclerosis (ALS) is a rare and fatal neurodegenerative disorder with variable incidence and prevalence worldwide. However, clinical-epidemiological studies on ALS are scarce in Brazil. Thus, this study investigated whether ALS incidence had uniform spatial distribution in population-based cluster analysis in Rio Grande do Norte state (Brazil), from 2005 to 2018. METHODS: new cases of ALS were identified in a database of the ALS multidisciplinary care center of the Onofre Lopes University Hospital in Natal (Rio Grande do Norte, Brazil). Approaches were based on incidence (empirical Bayes estimator and Moran's I analysis) and cluster analyses (Moran scatter plot and spatial correlogram). RESULTS: a total of 177 patients (59% males) participated in the study; the mean age of ALS onset was 57 years. Mean annual incidence of ALS was 0.3769 per 100,000 inhabitants (95% confidence interval of 0.0889), higher in males than in females (0.4516 per 100,000 vs. 0.3044 per 100,000). According to spatial statistics, patients were homogeneously distributed throughout the studied area. CONCLUSION: a low estimate was observed compared with other populations. Results did not indicate areas of increased risk or significant spatial geographic dependence, suggesting a random ALS incidence in Rio Grande do Norte.

Nutritional therapy in amyotrophic lateral sclerosis: protocol for a systematic review and meta-analysis.

INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is a complex neurodegenerative disease characterised by the degeneration of motor neurons. Nutritional interventions in ALS are essential and must be based on scientific evidence to provide quality of healthcare, improve the quality of life and increase survival time. Therefore, this protocol of systematic reviews and meta-analyses aims to present a synthesis of evidence-based recommendations to support adequate nutrition therapy for patients with ALS. METHODS AND ANALYSIS: The search will be performed using the following databases: PubMed, Excerpta Medica Database (Embase), Scopus, SciELO, Web of Science, LILACS, Cochrane Central Register of Controlled Trials (CENTRAL), ScienceDirect, ProQuest and Google Scholar. We will include clinical practice guidelines, treatment protocols, systematic reviews and clinical trials according to the three research questions to be answered related to nutrition therapy and interventions in patients with ALS. This protocol will be developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols. To evaluate the methodological quality of the studies, Appraisal of Guidelines, Research and Evaluation II, Cochrane Risk of Bias 2.0 and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) tools will be used. In addition, the Grading of Recommendations Assessment, Development and Evaluation will be used to assess the quality of evidence and the strength of the recommendations. The findings will be summarised and presented descriptively according to the Cochrane Collaboration Handbook and the standard statistical meta-analysis techniques. ETHICS AND DISSEMINATION: Ethical approval and human consent are not required because this is a protocol for systematic review and only secondary data will be used. Findings will be published in a peer-reviewed journal and presented at conferences. In case of any changes in this protocol, amendments will be updated in International Prospective Register of Systematic Reviews (PROSPERO) and the modifications will be explained in the final report of this review. PROSPERO REGISTRATION NUMBER: CRD42021233088.

Zinc in sickle cell disease: A narrative review.

Sickle cell disease (SCD) is an inherited disease caused by hemoglobin S mutated hemoglobin S. It is characterized by chronic hemolysis, intermittent vaso-occlusive crises followed by ischemia-reperfusion, and organ damage. These patients have an increased risk of multiple micronutrient deficiencies, such as zinc. The reduced zinc bioavailability in sickle cell patients may lead to several complications such as growth retardation, delayed wound healing, increased vaso-occlusive crises, and infections. This narrative review aims to analyze the literature concerning the zinc status in SCD and their possible consequences on the patients' clinical evolution. We found in children and adolescents a direct association between zinc insufficiencies/deficiencies with increased disease severity in SCD. Monitoring zinc status in children and adolescent SCD appears essential for reducing disease-associated morbidity and infections. Zinc supplementation is a safe therapeutic modality for treating SCD patients. New research must be carried out, especially for adults, to ensure more remarkable survival for this population.

Nutritional status, diet and viral respiratory infections: perspectives for severe acute respiratory syndrome coronavirus 2.

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was recognised by the WHO as a pandemic in 2020. Host preparation to combat the virus is an important strategy to avoid COVID-19 severity. Thus, the relationship between eating habits, nutritional status and their effects on the immune response and further implications in viral respiratory infections is an important topic discussed in this review. Malnutrition causes the most diverse alterations in the immune system, suppressing of the immune response and increasing the susceptibility to infections such as SARS-CoV-2. On the other hand, obesity induces low-grade chronic inflammation caused by excess adiposity, which increases angiotensin-converting enzyme 2. It decreases the immune response favouring SARS-CoV-2 virulence and promoting respiratory distress syndrome. The present review highlights the importance of food choices considering their inflammatory effects, consequently increasing the viral susceptibility observed in malnutrition and obesity. Healthy eating habits, micronutrients, bioactive compounds and probiotics are strategies for COVID-19 prevention. Therefore, a diversified and balanced diet can contribute to the improvement of the immune response to viral infections such as COVID-19.

Cross-validation of prediction equations for estimating body composition in ballet dancers.

INTRODUCTION: In sports related to low body weight, such as classical ballet, the assessment of body composition is important for monitoring performance and health status. This study aimed to cross-validate anthropometry and bioelectrical impedance (BIA) predictive equations for estimating body composition of non-professional classical ballet dancers, using dual-energy-X-ray absorptiometry (DXA) as a reference method. MATERIALS AND METHODS: Thirty-seven female non-professional classical dancers (median age of 19 years), at intermediate/advanced level, were evaluated in a cross-sectional study. Body composition was evaluated by DXA, anthropometry and tetrapolar BIA. Twenty different predictive equations of anthropometry (n = 8) and BIA (n = 12) were used to estimate Body Fat (BF) and Fat-Free Mass (FFM), testing their validity against DXA using the Bland-Altman statistics. RESULTS: For BF estimated by anthropometry equations, just one equation showed agreement with DXA (r = 0.852, p < 0.0005; p = 0.600 for one sample T-test). According to the Bland-Altman analysis, this equation also showed validity, with the absence of proportional bias. Regarding the predictive BIA equations tested, none were valid for our study group. CONCLUSION: Only one of the anthropometric equations, the one proposed by Durnin and Womerley (1974), but none of the BIA equations analyzed, was valid for the evaluation of body composition of the studied classical dancers. Our results emphasize the importance of previous cross-validation of existing equations or the development of specific equations for body composition assessment in specific populations.

Concordância entre ferramentas de triagem nutricional pediátrica em indivíduos com síndrome nefrótica / Concordance between pediatric nutritional screening tools in individuals with nefrotic syndrome

OBJETIVO: Avaliar a concordância entre três ferramentas de triagem nutricional validadas para pediatria entre si e a correlação com os parâmetros antropométricos de pacientes hospitalizados com síndrome nefrótica. MÉTODOS: Estudo transversal com crianças e adolescentes de ambos os sexos internados na enfermaria pediátrica de um hospital universitário, com diagnóstico de síndrome nefrótica. Foram aplicados três instrumentos de triagens nutricionais: triagem de risco para estado nutricional e crescimento (STRONGkids), pontuação pediátrica de desnutrição de Yorkhill (PYMS) e ferramenta de rastreio para a avaliação da desnutrição em pediatria (STAMP). Foram coletados dados de peso, altura e perímetro do braço. A estimativa de concordância relativa entre os instrumentos foi analisada com o teste de Kappa ponderado e as correlações com os parâmetros antropométricos foram avaliadas com o teste de correlação de Spearman. RESULTADOS: Foram avaliados 11 pacientes, com idade mínima de 2 anos e máxima de 10 anos. As ferramentas de triagem detectaram prevalência de risco nutricional moderado e elevado. Foi observada concordância moderada (k=0,47) entre a PYMS e a STAMP e não houve correlação entre as triagens e os dados antropométricos. Com relação aos parâmetros antropométricos, 100% dos participantes tinham peso adequado para idade, 63,6% dos participantes foram diagnosticados com eutrofia pelo indicador IMC/idade e 81,8% tinham estatura adequada para idade de acordo com o indicador estatura/idade. Após a análise do perímetro do braço, 27,3% estavam em risco de desnutrição. CONCLUSÕES: A despeito de não haver recomendações para uso de triagens nutricionais pediátricas específicas para cada situação clínica, duas das três triagens analisadas neste estudo apresentaram moderada concordância entre elas. Contudo, as triagens testadas não refletiram o estado nutricional antropométrico da população avaliada.

AIMS: To evaluate the concordance between three validated nutritional screening tools for pediatrics among themselves and the correlation with the anthropometric parameters of patients hospitalized with nephrotic syndrome. METHOD: Cross-sectional study with children and adolescents of both sexes hospitalized in the pediatric ward of a university hospital and diagnosed with nephrotic syndrome. Three nutritional screening instruments were applied: Screening of Risk for Nutritional Status and Growth (STRONGkids), Paediatric Yorkhill Malnutrition Score (PYMS) and Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP). Data on weight, height and upper arm perimeter was collected, and three nutritional screening tools were applied: The estimate of relative agreement between the instruments was evaluated with the weighted Kappa test and the correlations with anthropometric parameters were assessed with the Spearman's Correlation Test. RESULTS: We evaluated 11 patients, with a minimum age of 2 years and a maximum of 10 years. Screening tools detected prevalence of medium and high nutritional risk. Moderate agreement (k=0.47) was observed between PYMS and STAMP and there was no correlation between the screening tools' result and the anthropometric data. Regarding the anthropometric parameters, 100% of the participants had adequate weight for age, 63.6% of the participants were diagnosed with normal weight by the BMI/Age index and 81.8% had adequate height for age according to the index Height/Age. After analysis of the upper arm perimeter, 27.3% were at risk of malnutrition. CONCLUSIONS: Despite the fact that are no recommendations for use of pediatric nutritional screening tools specific to each clinical situation, two of the three screening tools analyzed in this study demonstrated moderate agreement between them. However, the tested tools did not reflect the anthropometric nutritional status of the evaluated population.

Phase Angle and Onodera's Prognostic Nutritional Index in critically ill patients.

INTRODUCTION: Assessing severity and nutritional prognosis in critical patients has become increasingly important in recent years, since these parameters are related to morbidity/mortality and used to guide therapeutic options. OBJECTIVE: Determine nutritional prognosis through the Phase Angle (PA) and Onodera's Prognostic Nutritional Index (OPNI) and its relationship with severity, hospitalization time and mortality of critically ill patients. METHODS: Descriptive cross-sectional study, involving adult patients hospitalized in an Intensive Care Unit (ICU). Data were collected from the patients' medical records to calculate severity indicators (APACHE II, SOFA and SAPS 3) and determine the length of hospitalization and outcome. Bioimpedance was conducted to calculate the PA, using resistance and reactance data. RESULTS: A total of 35 patients (26% men and 74% women), with mean age of 55.5 ± 16.7 years, were included. The mortality rate (17%) was similar to that expected by APACHE II and SOFA, but higher than that predicted by SAPS 3. The mean values for the PA (4.2 ± 1.0) and OPNI (38.7 ± 8.3) were lower than the reference values adopted. Individuals with PA < 5.1 exhibited significantly lower reactance and albumin and higher APACHE II and SOFA values, in addition to longer hospitalization time and higher mortality. The PA was inversely correlated with all the severity indicators under study (APACHE II, SOFA and SAPS 3), and the length of hospitalization. By contrast, there was no correlation between OPNI and these parameters, or between PA and OPNI. CONCLUSION: The PA proved to be a good tool in assessing nutritional prognosis in critically ill patients. By contrast, more studies using the OPNI with this type of patients are needed.

Protocolo diferenciado para terapia nutricional na esclerose lateral amiotrófica / Special protocol to nutritional therapy in amyotrophic lateral sclerosis

OBJETIVO: Discutir a terapia nutricional na Esclerose Lateral Amiotrófica (ELA), compartilhando um protocolo elaborado e utilizado em ambulatório especializado. MATERIAL E MÉTODOS: A fundamentação teórica desse artigo foi baseada na literatura científica publicada nas bases de dados PubMed e ISI Web of Science, utilizando os descritores "amyrotrophic lateral sclerosis" and "nutrition". RESULTADOS E DISCUSSÃO: Em síntese, a ELA é uma doença neurodegenerativa rara, com prognóstico desfavorável e tratamento paliativo. A desnutrição é bastante frequente nessa doença e aumenta o risco de morte dos pacientes. Assim, a terapia nutricional é imprescindível e deve estar integrada a uma assistência multidisciplinar. O monitoramento nutricional é recomendado pelo menos a cada três meses, incluindo avaliação nutricional e prescrição de dieta hipercalórica e hiperproteica, com adequada quantidade hídrica e de fibras. Em adição, os micronutrientes, sobretudo os antioxidantes, devem atingir a Ingestão Diária Recomendada. Modificações na consistência da dieta para tratar a disfagia são indicadas e a nutrição enteral deve ser desmistificada entre os pacientes e cuidadores. Esses pacientes são candidatos potenciais para uso da nutrição enteral, a qual deve ser indicada em casos de disfagia significativa ou prejuízo da função respiratória associada com baixa ingestão alimentar, índice de massa corporal menor que 18,5 ou 22,0 kg/m2 (para adultos e idosos, respectivamente) e/ou perda de peso acima de 10%. CONCLUSÃO: Sugere-se a padronização da terapia nutricional na ELA e a instituição de protocolo diferenciado na prática clínica. Com isso, a desnutrição pode ser evitada ou minimizada, contribuindo para melhor qualidade de vida e sobrevida desses pacientes

OBJECTIVE: To discuss the nutritional therapy in Amyotrophic Lateral Sclerosis (ALS), sharing a protocol performed and used by a specialized ambulatory care service. MATERIAL AND METHODS: The theoretical foundation of this paper was based on the literature published in both PubMed and ISI Web of Science, using "amyrotrophic lateral sclerosis" and "nutrition" as keywords. RESULTS AND DISCUSSION: In brief, ALS is a rare neurodegenerative disease with poor prognosis and palliative treatment. Malnutrition is very common in these patients and increases the risk of death among them. Nutritional therapy is essential and must be integrated into a multidisciplinary care. Nutritional monitoring is recommended at least once every three months. Nutritional assessment, high-calorie and highprotein diet with an adequate amount of water and fiber are recommended. In addition, micronutrients, especially antioxidants, must reach the Recommended Dietary Allowances. A diet texture modification for dysphagia is indicated and enteral nutrition should be demystified to patients and care givers during the follow-up care. ALS patients are potential candidates to use enteral nutrition, which should be indicated in cases of significant dysphagia or impaired respiratory function associated with low food intake, body mass index less than 18.5 or 22.0 kg/m² (for adults or elderlies, respectively), and/or body weight loss above 10%. CONCLUSION: We suggest the standardization of nutritional therapy in ALS and the establishment of a distinct protocol in clinical practice. Thus, malnutrition can be avoided or minimized, contributing to a better quality of life and survival of these patients

Oral zinc supplementation may improve cognitive function in schoolchildren.

Zinc is an important micronutrient for humans, and zinc deficiency among schoolchildren is deleterious to growth and development, immune competence, and cognitive function. However, the effect of zinc supplementation on cognitive function remains poorly understood. The purpose of our study was to evaluate the effect of oral zinc supplementation (5 mg Zn/day for 3 months) on the Full Scale Intelligence Quotient (FSIQ), Verbal Intelligence Quotient (VIQ), and Performance Intelligence Quotient (PIQ) using a Wechsler Intelligence Scale for Children (WISC-III). We studied 36 schoolchildren aged 6 to 9 years (7.8 ± 1.1) using a nonprobability sampling method. The baseline serum zinc concentrations increased significantly after zinc supplementation (p < 0.0001), with no difference between sexes. Tests were administered under basal conditions before and after zinc supplementation, and there was no difference in FSIQ according to gender or age. The results demonstrated that zinc improved the VIQ only in the Information Subtest (p = 0.009), although the supplementation effects were more significant in relation to the PIQ, as these scores improved for the Picture Completion, Picture Arrangement, Block Design, and Object Assembly Subtests (p = 0.0001, for all subtests). In conclusion, zinc supplementation improved specific cognitive abilities, thereby positively influencing the academic performance of schoolchildren, even those without marginal zinc deficiency.

Kinetics of zinc status and zinc deficiency in Berardinelli-Seip syndrome.

Berardinelli-Seip syndrome (BSS) is a very rare disorder characterized by near-complete absence of adipose tissue from birth or early infancy, hypoleptinemia, hypertriglyceridemia, insulin resistance, diabetes mellitus, and other clinical signals. It is caused by mutations in AGPAT2 or Gng3lg. We evaluated 10 BSS patients and 10 healthy subjects. A single dose of 382.43 µmol zinc was administered intravenously before and after 3 months of oral zinc supplementation. Blood samples were collected from the contralateral arm at 0, 30, 60, 90, and 120 min after zinc injection. Plasma and serum were obtained to measure hematological and biochemical parameters. Urine was collected to measure creatinine, protein, and zinc. Basal serum zinc levels were similar in controls and BSS patients. However, serum zinc profiles were significant reduced in BSS patients in comparison with controls. The change in total-body zinc clearance was more significant in BSS patients, indicating that these patients had suboptimum zinc deficiency.

Comparação de três programas computacionais utilizados na avaliação de recordatórios alimentares 24 horas / Comparison of three softwares used for evaluating of 24-hour food recall / Comparación de tres programas de ordenador usados en la evaluación de recordatorios 24 h

A avaliação do consumo alimentar tem um papel importante na área de Nutrição e Saúde. Para tanto, são necessários métodos apropriados para estimar a ingestão de alimentos e nutrientes. O mercado da informática vem desenvolvendo diversos programas computacionais especializados em nutrição clínica. No entanto, a escolha do programa mais adequado tem sido uma decisão difícil em função das características operacionais disponíveis em cada um. Este estudo objetivou comparar três programas computacionais (Dietwin® profissional, Dietpro® 5i e Avanutri® revolution) utilizados na análise química nutricional de dez Recordatórios Alimentares de 24 horas oriundos de pacientes com Esclerose Lateral Amiotrófica, atendidos no Hospital Universitário da UFRN. Não houve diferença estatística entre os programas computacionais, com relação à energia, macronutrientes e micronutrientes. Todavia, foram detectadas divergências entre as gramaturas estipuladas para medidas caseiras de alguns alimentos. Além disso, observou-se quantificação equivocada do teor de ferro e cobre em dois alimentos. Conclui-se que é preciso ter cautela na escolha de um programa computacional especializado em nutrição clínica, pois poderá superestimar ou subestimar valores de energia ou nutrientes numa dieta prescrita ou consumida. Em adição, cuidado especial deve ser dado à origem das informações que alimentam o banco de dados desses programas, devendo ser as mais fidedignas possíveis.

Food intake assessment has an important role in nutrition research and health. For this purpose, right methods are needed to estimate appropriate intake of food and nutrients. The informatics market has developed several specialized computer programs in clinical nutrition . However, choosing the most appropriate program has been a difficult decision due all of operational features available in each one. This study aimed to compare three computer programs (Dietwin ® professional DietPro ® 5i and Avanutri Revolution ®) used in chemical analysis of ten 24-hour food recall from ten Amyotrophic Lateral Sclerosis patients, attending in by specific Multidisciplinary Team at Federal University of Rio Grande do Norte. There was no statistical difference between the three computer programs related to energy, macronutrients and micronutrients. Despite this, some differences were detected like measure portion food sizes. Moreover, there was wrong quantification of iron and copper content in two foods. We conclude that care should be taken to choose a computer program in clinical nutrition, because it can overestimate or underestimate values of calories and nutrients in a specific diet. In addition, it is necessary to be especially careful in the information sources that will feed the database of these programs. They should be as reliable as possible.

La evaluación de la ingesta alimentaria tiene un papel importante en la investigación en nutrición y salud. Para evaluar la ingesta de alimentos de un individuo se requieren métodos adecuados para la estimación de la ingesta de alimentos y nutrientes. El mercado de la informática ha desarrollado varios programas informáticos especializados en nutrición clínica. Sin embargo, elegir el programa más apropiado ha sido una decisión difícil a la luz de las características disponibles operativo. Este estudio tuvo por objetivo comparar los tres programas de ordenador (Dietwin ® profesional DietPro ® 5i y Avanutri Revolución ®) utilizados en el análisis químico de de recordatorios 24 h de pacientes con Esclerosis Amiotrófica Lateral. No hubo diferencia estadística entre los programas de ordenador, con respecto a la energía, macronutrientes y micronutrientes. Sin embargo, se detectaron diferencias entre los pesos fijados para tamaños de las porciones de algunos alimentos. Además, el contenido de hierro y el cobre se equivocaron en dos alimentos. El estudio demostró que se debe tener cuidado al elegir el mejor programa en la nutrición clínica, ya que puede sobreestimar o subestimar los valores de las calorías y nutrientes de una dieta prescrita o consumido. Además, la atención especial se debe dar a la fuente de la información introducida en la base de datos de estos programas debe ser lo más fiable posible.