The effect of oral dietary interventions on nutritional status and treatment tolerance in patients with hematologic neoplasms receiving chemotherapy: a systematic review.

CONTEXT: Adverse events from chemotherapy treatment affect food intake, nutritional status, and treatment tolerance in cancer patients. However, the effect of nutritional intervention in patients with hematologic neoplasms receiving chemotherapy remains unknown. OBJECTIVE: The aim of this systematic review was to evaluate the evidence on nutritional interventions on nutritional status, treatment tolerance, inflammatory markers, quality of life, and mortality in patients with hematologic neoplasms receiving chemotherapy. DATA SOURCES: The MEDLINE, LILACS, CINAHL, Web of Science, Embase, ICTRP, CENTRAL, and ClinicalTrials.gov databases were searched. Additional literature and the bibliographies of identified articles were also considered. DATA EXTRACTION: Randomized controlled trials in individuals with hematologic neoplasms receiving chemotherapy along with nutritional counseling and oral nutritional supplementation, and intake of supplementary food products, alone or in combination, were assessed as criteria of interest. The data were extracted independently by 2 researchers. The risk of bias was assessed through the Cochrane risk-of-bias tool (RoB 2). DATA ANALYSIS: Ten studies were included up to August 15, 2022 (updated in November of 2022). With regard to the outcomes, 4 studies assessed nutritional status and 2 studies showed a positive result of the intervention on some of the markers. Seven studies assessed certain markers of treatment tolerance and only 2 studies showed improvement in the outcome after the intervention. CONCLUSION: The studies that found positive results are quite different from each other in terms of intervention, study time, and design. More randomized controlled trials are needed to test different dietary interventions using placebo and blinding, when possible, and with reduced sample variability in individuals with hematologic neoplasms receiving chemotherapy. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42020196765.

Impact of Chemotherapy Regimens on Body Composition of Breast Cancer Women: A Multicenter Study across Four Brazilian Regions.

This study aimed to investigate the effect of chemotherapy (CT) and its different types of regimens on the anthropometry and body composition of women with breast cancer. Three-hundred-and-four women with breast cancer were enrolled in this multicenter study. The participants were evaluated before the infusion of the first cycle of CT (pre-CT), and until two weeks after CT completion (post-CT), regarding body weight, body mass index (BMI); waist circumference (WC); waist-to-height ratio (WHtR); conicity index (C-index); fat mass index (FMI); and fat-free mass index (FFMI). CT regimens were classified as anthracycline-based (AC-doxorubicin or epirubicin); anthracyclines and taxane (ACT); cyclophosphamide, methotrexate, and 5-fluorouracil (CMF); or isolated taxanes (paclitaxel or docetaxel). Women significantly increased BMI and FMI post-CT (p < 0.001 and p = 0.007, respectively). The ACT regimen increased FMI (p < 0.001), while FFMI increased after AC (p = 0.007). It is concluded that the CT negatively impacted body composition and the type of regime had a strong influence. The ACT regimen promoted an increase in FMI compared to other regimens, and the AC increased FFMI. These findings reinforce the importance of nutritional monitoring of breast cancer patients throughout the entire CT treatment.

Low to moderate adherence to 2018 diet and physical exercise recommendations of the World Cancer Research Fund/American Institute for Cancer Research is associated with prooxidant biochemical profile in women undergoing adjuvant breast cancer treatment.

Adequate adherence to the 2018 diet and exercise recommendations of the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) can possibly result in less oxidative stress, lower risk to chemo- and radiotoxicity, lower risk of relapse, and increased quality of life in breast cancer survivors. This observational study aims to investigate the influence of adherence to updated recommendations of the WCRF/AICR on oxidative stress biomarkers in women with breast cancer undergoing adjuvant treatment (AT). We hypothesized that adherence to WCRF/AICR recommendations is inversely related to oxidative damage biomarkers and directly associated with antioxidant status. Women (n = 78) were evaluated before (T0) and after AT. After collecting anthropometric, physical activity, and food consumption data, a standardized score of adherence to WCRF/AICR recommendations was applied. The sample was divided into low-medium adherence and high adherence groups. Blood samples were collected at both timepoints for oxidative stress biomarkers analysis. Multiple linear regression analyzes were applied to verify associations between WCRF/AICR score and biomarkers. We found that low-medium adherence to WCRF/AICR recommendations at T0 affected lower levels of reduced glutathione (P= .003) and higher levels of lipid hydroperoxides (P= .002) and plasma carbonylated proteins (P= .001) after AT. The WCRF/AICR score at T0 was inversely associated with changes in plasma carbonylated protein concentrations after AT (adjusted ß = -0.359; P= .01). Our findings suggest that high WCRF/AICR score before and during AT may provide greater stability of antioxidant capacity and protection against exacerbated oxidative stress.

Diet Quality Influences the Occurrence of Food Aversions in Women Undergoing Adjuvant Chemotherapy for Breast Cancer.

Food aversions in women undergoing adjuvant chemotherapy for breast cancer may be linked to oxidative stress and gastrointestinal consequences underlying it, and diet possibly plays a role in this association. This follow-up study included 73 women with breast cancer treated in Florianopolis City, Brazil. Dietary antioxidant capacity-DaC (mmol/d), diet quality-Brazilian Healthy Eating Index Revised (BHEI-R score), and oxidative stress biomarkers were accessed before the treatment, and women were asked if they developed food aversions during adjuvant chemotherapy. Red meat was the main aversion-causing food reported (37.9%, n = 9). There was no difference in DaC, BHEI-R score, or oxidative stress biomarkers between women with no food aversion occurrence and those showing food aversions. A logistic regression adjusted model showed that women exhibiting higher BHEI-R scores were 1.08 times more likely to not develop food aversions during adjuvant chemotherapy (p = 0.041). In summary, this innovative investigation showed that diet quality before adjuvant chemotherapy may influence the non-occurrence of food aversion. Considering this, the result opens new areas for early nutritional interventions, focusing on reducing the occurrence of food aversions and consequently benefiting women with breast cancer by having better outcomes in oncologic treatment.

Dietary Antioxidant Capacity Promotes a Protective Effect against Exacerbated Oxidative Stress in Women Undergoing Adjuvant Treatment for Breast Cancer in a Prospective Study.

Breast cancer (Bca) is the most common type of cancer among women worldwide, and oxidative stress caused by adjuvant treatment may be decreased by antioxidant intake. The aim of this study is to investigate the associations between Dietary antioxidant Capacity (DaC) and oxidation and antioxidant biomarkers in women undergoing adjuvant treatment (AT) for Bca. This prospective study had a sample of 70 women (52.2 ± 10.7 y). DaC (mmol/g) was calculated using nutritional data obtained from a Food Frequency Questionnaire, and blood was collected to measure the oxidation and antioxidant biomarkers at baseline (T0), and after AT (T1). Carbonylated protein levels were inversely associated with DaC at T1 (p = 0.004); women showed an increased risk of having increment on lipid hydroperoxides and thiobarbituric acid reactive substances (TBARS), and decrement on ferric reducing antioxidant power (FRAP) and reduced glutathione after AT, in response to lowered DaC (p < 0.05). Carbonylated proteins, TBARS and FRAP levels remained stable between the periods for women at the 3rd DaC tertile at T1, differentiating them from those at the 1st tertile, who showed negative changes in these biomarkers (p < 0.04). DaC may be beneficial for women undergoing AT for Bca, since it promoted a reduction in oxidative stress.

Açaí (Euterpe oleracea Mart.) and juçara (Euterpe edulis Mart.) juices improved HDL-c levels and antioxidant defense of healthy adults in a 4-week randomized cross-over study.

OBJECTIVE: To evaluate the effects of moderate-term açaí and juçara juice intake on fasting glucose, lipid profile, and oxidative stress biomarkers in healthy subjects. METHODS: A randomized cross-over study was performed with 30 healthy adults. The subjects were assigned to drink 200 mL/day of açaí or juçara juice for four weeks with a 4-week washout period. Before and after each nutritional intervention, blood samples were obtained to evaluate the outcomes: fasting glucose, total cholesterol, triglycerides, high-density lipoprotein-cholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c), small, dense LDL-c (sd-LDL-c), total antioxidant capacity (TAC), total oxidant status (TOS), oxidative stress index (OSI), uric acid, and activity of the enzymes superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx). RESULTS: After four weeks, açaí and juçara juices increased the concentrations of HDL-c by 7.7% and 11.4%, respectively (P < 0.05). In addition, açaí juice intake promoted significant increases in TAC (66.7%), CAT (275.1%), GPx (15.3%), and a decrease in OSI (55.7%) compared to baseline (P < 0.05 for all). Juçara juice intake significantly increased CAT activity (~15.0%) in relation to baseline. No significant intergroup differences were observed for any outcomes (P > 0.05). CONCLUSION: The results indicated a positive impact of regular consumption of açaí and juçara juices on the HDL-c levels, as well as on the antioxidant enzyme activities, which may contribute to cardiovascular health.

Trends in food consumption of schoolchildren from 2nd to 5th grade: a panel data analysis / Tendências no consumo alimentar de escolares do 2º ao 5º ano: uma análise de dados em painel

ABSTRACT Objective To identify trends in food consumption among schoolchildren (2nd-5th grades) from public schools in the city of Florianópolis, Brazil, in a period of three years. Methods Three cross-sectional surveys were carried out in 2013 (n=1,942), 2014 (n=1,989) and 2015 (n=2,418). Dietary intake data were obtained using the Web-Based Food Intake and Physical Activity of Schoolchildren questionnaire. Food items were aggregated to eight food groups. Kruskal-Wallis heterogeneity and trend tests were used to analyze the differences and trends among the mean intake frequency of food groups. Results There were trends to decrease the mean intake frequency of sweets in the total sample (2013: 0.72±0.91; 2014: 0.68±0.87; 2015: 0.67±0.89, p=0.03) which was determined by children between 7-9 years old (2013: 0.69±0.88; 2014: 0.64±0.85; 2015: 0.62±0.87, p=0.02), and boys (2013: 0.75±0.90; 2014: 0.70±0.86; 2015: 0.68±0.88, p=0.03). Younger children also tended to increase the mean intake frequency of fruits and vegetables (2013: 1.03±1.35; 2014: 1.16±1.45; 2015: 1.17±1.41, p=0.03) and those aged ten-12 years decreased their intake of dairy products (2013: 1.32±1.25; 2014: 1.23±1.18; 2015: 1.20±1.20, p=0.05). Conclusion The results suggest positive trends for younger children, with an increased consumption of fruits and vegetables in both sexes and decreased consumption of sweets for boys. Older children reduced their consumption of dairy products over the three-year period of this study.

RESUMO Objetivo Este estudo buscou identificar tendências no consumo alimentar de escolares do 2º ao 5º ano de escolas públicas do município de Florianópolis durante três anos. Métodos Três pesquisas transversais foram conduzidas em 2013 (n=1.942), 2014 (n=1.989) e 2015 (n=2.418). Dados de consumo alimentar foram obtidos com a aplicação do questionário de avaliação de consumo alimentar e atividade física. Os itens alimentares foram classificados em oito grupos. Utilizaram-se os testes Kruskal-Wallis de heterogeneidade e de tendência para analisar as diferenças e tendências entre as médias de frequência de consumo dos grupos alimentares. Resultados Verificou-se uma tendência de redução da média de frequência de consumo de doces para a amostra total (2013: 0,72±0,91; 2014: 0,68±0,87; 2015: 0,67±0,89, p=0,03), que foi determinada pelos escolares de 7 a 9 anos (2013: 0,69±0,88; 2014: 0,64±0,85; 2015: 0,62±0,87, p=0,02) e do sexo masculino (2013: 0,75±0,90; 2014: 0,70±0,86; 2015: 0,68±0,88, p=0,03). Escolares mais novos também tenderam a aumentar o consumo de frutas, verduras e legumes (2013: 1,03±1,35; 2014: 1,16±1,45; 2015: 1,17±1,41, p=0,03), e os de 10 a 12 anos diminuíram laticínios (2013: 1,32±1,25; 2014: 1,23±1,18; 2015: 1,20±1,20, p=0,05). Conclusão Os resultados sugerem tendências positivas para escolares mais novos, com o aumento do consumo de frutas, verduras e legumes em ambos os sexos e redução de doces para os meninos. Escolares mais velhos reduziram laticínios nos três anos de seguimento.

Validation of the Online version of the Previous Day Food Questionnaire for schoolchildren / Validação da versão Online do Questionário Alimentar do Dia Anterior para Escolares

ABSTRACT Objective To evaluate the validity of the web-based version of the Previous Day Food Questionnaire Online for schoolchildren from the 2nd to 5th grades of elementary school. Methods Participants were 312 schoolchildren aged 7 to 12 years of a public school from the city of Florianópolis, Santa Catarina, Brazil. Validity was assessed by sensitivity, specificity, as well as by agreement rates (match, omission, and intrusion rates) of food items reported by children on the Previous Day Food Questionnaire Online, using direct observation of foods/beverages eaten during school meals (mid-morning snack or afternoon snack) on the previous day as the reference. Multivariate multinomial logistic regression analysis was used to evaluate the influence of participants' characteristics on omission and intrusion rates. Results The results showed adequate sensitivity (67.7%) and specificity (95.2%). There were low omission and intrusion rates of 22.8% and 29.5%, respectively when all food items were analyzed. Pizza/hamburger showed the highest omission rate, whereas milk and milk products showed the highest intrusion rate. The participants who attended school in the afternoon shift presented a higher probability of intrusion compared to their peers who attended school in the morning. Conclusion The Previous Day Food Questionnaire Online possessed satisfactory validity for the assessment of food intake at the group level in schoolchildren from the 2nd to 5th grades of public school.

RESUMO Objetivo Avaliar a validade da versão baseada na Internet do Questionário Alimentar do Dia Anterior (Online) para escolares do segundo ao quinto ano do ensino fundamental. Métodos Participaram do estudo 312 escolares de 7 a 12 anos de uma escola pública de Florianópolis, Santa Catarina. A validade foi testada pela sensibilidade, especificidade e taxas de concordância (acertos, omissões e intrusões) dos itens alimentares relatados no Questionário Alimentar do Dia Anterior Online, usando a observação direta dos alimentos consumidos no lanche escolar do dia anterior como padrão de referência. Análise de regressão logística multivariada multinomial foi conduzida para avaliar a influência de fatores relacionados aos participantes nas taxas de omissão e intrusão. Resultados Os resultados apontaram adequada sensibilidade (67,7%) e especificidade expressiva (95,2%). As taxas de omissão e de intrusão foram baixas, 22,8% e 29,5%, respectivamente, quando considerados todos os itens alimentares. O item pizza/hambúrguer exibiu a maior taxa de omissão, enquanto os laticínios apresentaram a maior taxa de intrusão. Escolares que frequentavam a escola no turno vespertino apresentaram maior probabilidade de intrusões de itens alimentares comparados aos escolares do turno matutino. Conclusão O Questionário Alimentar do Dia Anterior Online apresentou validade satisfatória para a análise do consumo alimentar em nível de grupo de escolares do segundo ao quinto ano de escola pública.

Assessment of diet and physical activity of brazilian schoolchildren: usability testing of a web-based questionnaire.

BACKGROUND: Information and communication technology (ICT) has been used with increasing frequency for the assessment of diet and physical activity in health surveys. A number of Web-based questionnaires have been developed for children and adolescents. However, their usability characteristics have scarcely been reported, despite their potential importance for improving the feasibility and validity of ICT-based methods. OBJECTIVE: The objective of this study was to describe the usability evaluation of the Consumo Alimentar e Atividade Física de Escolares (CAAFE) questionnaire (Food Consumption and Physical Activity Questionnaire for schoolchildren), a new Web-based survey tool for the self-assessment of diet and physical activity by schoolchildren. METHODS: A total of 114 schoolchildren aged 6 to 12 years took part in questionnaire usability testing carried out in computer classrooms at five elementary schools in the city of Florianopolis, Brazil. Schoolchildren used a personal computer (PC) equipped with software for recording what is on the computer screen and the children's speech during usability testing. Quantitative and qualitative analyses took into account objective usability metrics such as error counts and time to complete a task. Data on the main difficulties in accomplishing the task and the level of satisfaction expressed by the children were assessed by the observers using a standardized form and interviews with the children. Descriptive statistics and content analysis were used to summarize both the quantitative and the qualitative aspects of the data obtained. RESULTS: The mean time for completing the questionnaire was 13.7 minutes (SD 3.68). Compared to the children in 2nd or 3rd grades, those in 4th or 5th grades spent less time completing the questionnaire (median 12.4 vs 13.3 minutes, P=.022), asked for help less frequently (median 0 vs 1.0 count, P=.005), had a lower error count (median 2.0 vs 8.0 count, P<.001), and obtained a higher overall performance score (median 73.0 vs 68.0, P=.005). Children with a PC at home spent less time completing the questionnaire (median 12.3 vs 14.9 minutes, P<.001), had a lower overall error count (median 2.0 vs 9.0 count, P=.03), and had a higher performance score (median 72.0 vs 64.0, P=.005) compared to the children without a PC at home. The most common difficulty in completing the questionnaire was in using the scroll bar. The majority of children reported a positive evaluation (liked a lot or liked) for the four design elements, which were evaluated. CONCLUSIONS: The results of the present study provided feedback to improve the final version of the CAAFE questionnaire. Quantitative data showed minor errors and system failures, while qualitative data indicated that, overall, the children enjoyed the CAAFE questionnaire. Grade levels and PC use must be taken into account in Web-based tools designed for children.

Efeito do tratamento antineoplásico adjuvante na mudança de peso corporal em mulheres com câncer de mama / Effect of adjuvant antineoplastic treatment on body weight change in women with breast cancer

Aims: To identify the effect of adjuvant antineoplastic treatment on body weight change of women with breast cancer.METHODS: A non-randomized clinical study included women with a recent surgical diagnosis of breast cancer, admitted tothe Maternidade Carmela Dutra hospital in Florianópolis, Santa Catarina, southern Brazil, between October 2006 and July2008. Food intake, weight, body mass index, hip circumference, waist circumference and other variables were measuredbefore (baseline) and after the adjuvant antineoplastic treatment (pos-treatment). A mixed effects linear regression modelwas used to estimate the longitudinal changes occurring in weight.Results: The sample comprised 53 patients. A significant increase (P<0.05) was observed in body weight (2.81 kg), bodymass index (1.08 kg/m2), hip circumference (3.62 cm) and waist circumference (1.93 cm). In relation to diet, there was asignificant increase (P<0.05) in the intake of energy (272.7 kcal), total fat (11.2 g) and polyunsaturated fatty acids (5.4 g).The final regression model for the change in body weight demonstrated that the women who were exposed to chemotherapytreatment, and to chemotherapy associated with radiotherapy, had the largest mean increase in body weight (2.47 kg and 5.21kg, respectively). Socio-economic, demographic and nutritional factors were not associated with the increase in body weight.Conclusions: Weight gain was associated with chemotherapy treatment either alone or in combination with radiotherapy.

Objetivos: Identificar o efeito do tratamento antineoplásico adjuvante sobre a mudança de peso corporal em mulheres com câncer de mama. Métodos: Um estudo clínico não randomizado incluiu mulheres com diagnóstico cirúrgico recente de câncer de mama, admitidas no hospital Maternidade Carmela Dutra em Florianópolis, Santa Catarina, entre outubro de 2006 e julho de 2008. Os dados de consumo alimentar, peso corporal, índice de massa corporal, circunferência do quadril, circunferência da cintura e outras variáveis, foram avaliados antes (basal) e depois do tratamento antineoplásico adjuvante (pós-tratamento). Um modelo de regressão linear de efeitos mistos foi utilizado para estimar as mudanças longitudinais que ocorreram no peso corporal. Resultados: A amostra foi composta por 53 pacientes. Foi observado um aumento significativo (P<0,05) no peso corporal (2,81 kg), índice de massa corporal (1,08 kg/m2), circunferência do quadril (3,62 cm) e circunferência da cintura (1,93 cm). Em relação aos aspectos dietéticos, houve um significativo aumento (P<0,05) na ingestão de energia (272,7 kcal), gorduras totais (11,2 g) e ácidos graxos poliinsaturados (5,4 g). O modelo final para a mudança no peso corporal demonstrou que as mulheres as quais foram expostas ao tratamento quimioterápico, e quimioterápico associado ao radioterápico, tiveram um maior aumento médio no peso corporal (2,47 kg e 5,21 kg, respectivamente). Os fatores socioeconômicos, demográficos e nutricionais não foram associados com o aumento no peso corporal. Conclusões: O aumento de peso esteve associado com o tratamento quimioterápico sozinho ou em combinação com o tratamento radioterápico.

Association of mate tea (Ilex paraguariensis) intake and dietary intervention and effects on oxidative stress biomarkers of dyslipidemic subjects.

OBJECTIVE: To evaluate the effect of long-term ingestion of mate tea, with or without dietary intervention, on the markers of oxidative stress in dyslipidemic individuals. METHODS: Seventy-four dyslipidemic volunteers participated in this randomized clinical trial. Subjects were divided into three treatment groups: mate tea (MT), dietary intervention (DI), and mate tea with dietary intervention (MD). Biochemical and dietary variables were assessed at the beginning of the study (baseline) and after 20, 40, 60, and 90 d of treatment. Participants in the MT and MD groups consumed 1 L/d of mate tea. Those in the DI and MD groups were instructed to increase their intake of fruit, legumes and vegetables and decrease their consumption of foods rich in cholesterol and saturated and trans-fatty acids. Biomarkers of oxidative stress such as antioxidant capacity of serum (ferric reducing antioxidant potential assay), uric acid, reduced glutathione, paraoxonase-1 enzyme, lipid hydroperoxide (LOOH), and protein carbonyl were analyzed. RESULTS: Participants in the DI group showed a significant decrease in total fat and saturated fatty acid intakes. Those in the DI and MD groups presented a significant increase in vitamin C consumption. For all groups, there was a significant increase in ferric reducing antioxidant potential and reduced glutathione concentrations but no significant changes in LOOH, protein carbonyl, and paraoxonase-1 values. The reduced glutathione concentration was positively correlated with the consumption of monounsaturated fatty acids, fiber, and vitamin C, whereas levels of LOOH were inversely correlated with intakes of vitamin C and fiber. In addition, LOOH correlated positively with low-density lipoprotein cholesterol and inversely with high-density lipoprotein cholesterol, which had a positive association with paraoxonase-1. CONCLUSION: The ingestion of mate tea independently of the dietary intervention increased plasma and blood antioxidant protection in patients with dyslipidemia.

Benefits and risks of fish consumption for the human health / Benefícios e riscos do consumo de peixes para a saúde humana

The article aimed at identifying and discussing scientific evidences on the benefits and risks of fish consumption the human health. There was a systematic survey for articles published from 2003 and May 2011, at the MedLine, Scopus, SciELO, Lilacs and Google Scholar databases. The key words used were: fish, food intake, omega-3 fatty acids, fatty fish, benefits, risk, and consumption. The search produced 12,632 articles, 25 eligible cohort studies on possible benefits, 61 on risks and 10 studies that assessed the "risk/benefit" relation. Of the 25 works, 14 suggested a preventive effect of fish consumption related to cardiovascular diseases, depression, cataract and some types of cancer. Evidences of a relation between exposure to mercury and an increase in the risk of neurological disorders, but not of cardiovascular diseases, were also found. Given the importance of fish consumption, its possible risks and the lack of Brazilian studies on the topic, it is important to conduct more longitudinal studies that assess both the benefits and risks of fish consumption for the human health. We also emphasize the need for policies to reduce exposure of fish and seafood to mercury and other contaminants.

O artigo objetivou identificar e discutir evidências científicas sobre benefícios e riscos do consumo de peixes para a saúde humana. Realizou-se uma busca de artigos publicados entre 2003 e maio de 2011, nas bases de dados MedLine, Scopus, SciELO, Lilacs e Google acadêmico. Utilizaram-se as palavras chaves: fish, food intake, omega-3 fatty acids, fatty fish, benefits, risk, consumption. Encontraram-se 12.632 artigos, sendo elegíveis 25 estudos de coorte que investigaram possíveis benefícios, 61 sobre riscos e 10 estudos que avaliam a relação "risco/benefício". Dentre os 25 trabalhos, 14 sugeriram efeito protetor do consumo de peixes, relacionado a doenças cardiovasculares, depressão, catarata e alguns tipos de câncer. Foram encontradas evidências de relação entre exposição ao mercúrio e aumento do risco de distúrbios neurológicos, mas não do risco de doenças cardiovasculares. Tendo em vista a importância do consumo de peixes e seus possíveis riscos, bem como a escassez de pesquisas nacionais sobre o tema, observa-se a relevância de se realizarem mais estudos longitudinais que aliem a avaliação dos benefícios e riscos do seu consumo para a saúde humana. Ressalta-se também a necessidade de políticas para redução da exposição de peixes e frutos do mar ao mercúrio e outros contaminantes.

Regulamentação da comercialização de alimentos no ambiente escolar: análise dos dispositivos legais brasileiros que buscam a alimentação saudável / Regulation of food commercialization in school environment: analyses of the Brazilian legal instruments to promote healthy foods

Este estudo investigou os dispositivos legais que regulamentam a comercialização de alimentos e bebidas em escolas do Brasil. Como critério para a busca, utilizou-se o levantamento em sites populares de busca eletrônica, incluindo dispositivos publicados no Brasil nos últimos dez anos (período de 2001 a 2010). Foram identificadas 19 regulamentações que dispõem sobre os itens a serem comercializados nas escolas brasileiras. Dentre essas, dez referem-se a regulamentos municipais; uma, aos municípios da região metropolitana da Grande São Paulo; uma, ao Distrito Federal; e sete versam sobre diferentes estados brasileiros. Todos os dispositivos relacionam itens com proibição de comercialização; 44%deles apresentam opções de alimentos permitidos e vedam a divulgação de propagandas dos alimentos proibidos no ambiente escolar; 50% referem à obrigatoriedade de divulgação de material informativo sobre alimentação e nutrição. Os dispositivos legais objetivam auxiliar a escola na formação de hábitos alimentares saudáveis e na prevenção da obesidade. Todavia, a eficácia dessas regulamentações precisa ser monitorada para que os objetivos propostos possam ser alcançados. Considerando-se a função pedagógica da alimentação escolar, são fundamentais ações bem estruturadas que promovam a adoção de práticas alimentares saudáveis.

[Factors associated with changes in energy intake of women after treatment for breast cancer]. / Fatores que influenciam o consumo energético de mulheres no tratamento do câncer de mama.

PURPOSE: To investigate changes in the dietary consumption as well as the influence of the general characteristics, of the sociodemographic, clinical and nutritional factors, and of the antineoplastic therapy on the changes in the energy intake of women from southern Brazil, before and after adjuvant therapy for breast cancer. METHODS: A non-randomized clinical study was conducted on 53 patients at a hospital of the public health network. Dietary information was collected with a food frequency questionnaire. A mixed-effects linear regression model was used to evaluate the factors that influenced longitudinal alterations of energy intake. RESULTS: A significant increase was observed in daily energy intake of fats, calcium, iron, copper, polyunsaturated fatty acids, omega 6 and omega 3, and a significant decrease in vitamin B2 intake. The final regression model for the change in energy intake showed an average increase of 19.2 kcal/month. Fruit and legume consumption showed the highest association with energy intake, with each 100 g consumed resulting in an average increase of 68.4 and 370.5 kcal, respectively. Women in the 51 to 60 year age range consumed 403.5 kcal less than those in the 31 to 50 year age range. CONCLUSION: There was an increase in energy intake during treatment and the increase in the ingestion of fruits and legumes was associated with significant increases in energy intake.

Alimentos comercializados nas escolas e estratégias de intervenção para promover a alimentação escolar saudável: revisão sistemática / Food sold at schools and the intervention strategies for promoting healthy nourishments at schools: a systematic review

Com o objetivo de realizar uma revisão sistemática da literatura sobre alimentos comercializados e estratégias desenvolvidas nas escolas para promover alimentação saudável, efetuaram-se buscas de artigos científicos publicados no período compreendido entre janeiro de 2002 e junho de 2011, nas bases eletrônicas Medline, Lilacs e SciELO-Br. Dentre os 26 artigos incluídos na análise, 19 indicaram alta disponibilidade de alimentos de baixo valor nutricional nas escolas e escassez na implementação e avaliação de políticas de alimentação escolar. Sete artigos relataram estratégias de intervenção positivas, visando aumentar a disponibilidade e o comércio de alimentos saudáveis nas escolas. Apesar da existência de políticas de alimentação e estratégias de intervenção nas escolas, o valor nutricional dos alimentos disponíveis para comercialização é preocupante. A implementação de políticas públicas bem estruturadas que visem à alimentação saudável é fundamental para promover a saúde de crianças e adolescentes em fase escolar. Concomitantemente, destaca-se a necessidade da fiscalização para avaliar o cumprimento de legislações específicas, bem como a realização sistemática de estudos longitudinais que acompanhem a implementação das medidas destinadas à melhoria da qualidade nutricional dos alimentos comercializados no ambiente escolar e oferecidos nos programas institucionais de alimentação escolar.

Fatores que influenciam o consumo energético de mulheres no tratamento do câncer de mama / Factors associated with changes in energy intake of women after treatment for breast cancer

RESUMO OBJETIVO: Investigar alterações no consumo dietético, bem como a influência das características gerais, dos fatores sociodemográficos, clínicos e nutricionais, e do tratamento antineoplásico sobre as mudanças do consumo energético, em mulheres do sul do Brasil, antes e após a realização de terapia adjuvante para o câncer de mama. MÉTODOS: Ensaio clínico não randomizado, conduzido em hospital da rede pública de saúde, com 53 pacientes. Informações dietéticas foram coletadas com questionário de frequência alimentar. Para avaliar os fatores que influenciaram alterações longitudinais da ingestão energética, usou-se modelo de regressão linear de efeitos mistos. RESULTADOS: Houve aumento significativo no consumo diário de energia, de gorduras, cálcio, ferro, cobre, ácidos graxos poli-insaturados, ômega 6 e ômega 3, e uma diminuição significativa da vitamina B2. O modelo final de regressão mostrou aumento médio de 19,2 kcal/mês. As maiores associações com ingestão energética foram frutas e leguminosas, sendo que cada 100 g de consumo destas, resultou um acréscimo médio de 68,4 e 370,5 kcal, respectivamente. Mulheres com idade compreendida entre 51 e 60 anos consumiram 403,5 kcal menos do que aquelas com idade de 31 a 50 anos. CONCLUSÃO: Observou-se que houve aumento na ingestão energética durante o tratamento e que o aumento na ingestão de frutas e leguminosas foi associado com aumentos significativos na ingestão de energia.

PURPOSE: To investigate changes in the dietary consumption as well as the influence of the general characteristics, of the sociodemographic, clinical and nutritional factors, and of the antineoplastic therapy on the changes in the energy intake of women from southern Brazil, before and after adjuvant therapy for breast cancer. METHODS: A non-randomized clinical study was conducted on 53 patients at a hospital of the public health network. Dietary information was collected with a food frequency questionnaire. A mixed-effects linear regression model was used to evaluate the factors that influenced longitudinal alterations of energy intake. RESULTS: A significant increase was observed in daily energy intake of fats, calcium, iron, copper, polyunsaturated fatty acids, omega 6 and omega 3, and a significant decrease in vitamin B2 intake. The final regression model for the change in energy intake showed an average increase of 19.2 kcal/month. Fruit and legume consumption showed the highest association with energy intake, with each 100 g consumed resulting in an average increase of 68.4 and 370.5 kcal, respectively. Women in the 51 to 60 year age range consumed 403.5 kcal less than those in the 31 to 50 year age range. CONCLUSION: There was an increase in energy intake during treatment and the increase in the ingestion of fruits and legumes was associated with significant increases in energy intake.

Influência da televisão no consumo alimentar e na obesidade em crianças e adolescentes: uma revisão sistemática / Television influence on food intake and obesity in children and adolescents: a systematic review

O objetivo deste trabalho foi identificar a influência da televisão no consumo alimentar e na obesidade em crianças e adolescentes. Realizou-se revisão sistemática nas bases MedLine, PubMed, SciELO-Brasil e Lilacs, capturando-se 73 artigos publicados entre 1997 e 2007. Definiu-se não analisar artigos com adultos ou pré-escolares, notas, comunicações, revisões, amostras de população específica (indígenas, por exemplo) e enferma (exceto obesidade), e estudos de intervenção, selecionando-se vinte artigos para análise. Em seis, dentre oito estudos brasileiros, observou-se associação significativa entre televisão e obesidade, e, em um destes, também se verificou associação positiva entre televisão e consumo alimentar. Nas investigações internacionais, observaram-se seis, dentre dez artigos, evidenciando associação entre televisão e obesidade, além de se identificar associação inversa entre televisão e tempo de atividade física. Em cinco artigos, do total de seis internacionais que investigaram o consumo alimentar, observou-se associação significativa entre televisão e ingestão alimentar, verificando-se que crianças e adolescentes que despendem maior tempo com a televisão tendem a ingerir menos frutas e verduras, e mais porções de salgadinhos, doces e bebidas com elevado teor de açúcar. A associação entre televisão e consumo alimentar foi evidente (85 por cento dos artigos), e a associação com obesidade apareceu em 60 por cento dos artigos. Ao identificar-se que o tempo em frente à TV associa-se à inadequação dos hábitos alimentares e à redução da atividade física, revela-se o hábito de assistir à televisão como um importante fator que pode propiciar a obesidade entre crianças e adolescentes.

The objective of this study was to identify the influence that watching television has on food intake and obesity in children and adolescents. A systematic review of the MedLine, PubMed, SciELO-Brasil and Lilacs databases was done which resulted in 73 articles published between 1997 and 2007. Articles with adults or preschoolers, notes, communications, reviews, samples of specific populations (Indians for example) or diseases (except for obesity) and intervention studies were excluded, resulting in 20 articles for analysis. In six of eight Brazilian studies, there was a significant association between watching television and obesity. In one of them, there was also a significant association between watching television and food intake. In six of ten international studies, there was a positive association between watching television and obesity and a negative association between times spent watching television and doing physical activity. In five out of six international studies that investigated food intake, there was a significant association between watching television and food intake. It was also found that children and adolescents who spend more time watching television tend to consume less fruits and vegetables and more salty snacks, sweets and sugar-rich beverages. The association between watching television and food intake was evident, found in 85 percent of the articles, and the association between watching television and obesity was found in 60 percent of the articles. Since time spent watching television is associated with unhealthy food habits and reduced levels of physical activity, it becomes an important factor in the promotion of obesity in children and adolescents.

Validação da terceira versão do Questionário Alimentar do Dia Anterior (QUADA-3) para escolares de 6 a 11 anos / Validation of the third version of the Previous Day Food Questionnaire (PDFQ-3) for 6-to-11-years-old schoolchildren

O estudo objetivou conferir validade à terceira versão do Questionário Alimentar do Dia Anterior (QUADA-3) para escolares. O QUADA-3 é um instrumento estruturado com seis refeições e 21 alimentos. Participaram 164 escolares de 6 a 11 anos de idade, de uma escola pública de período integral, em 2007. A validade foi testada pela comparação entre os itens alimentares selecionados no questionário e a observação direta de alimentos consumidos em três refeições escolares do dia anterior (lanche da manhã, almoço, lanche da tarde). Análise de regressão logística multivariada foi conduzida para avaliar a discordância entre as respostas do questionário e o registro das observações. Os resultados indicaram alta sensibilidade e especificidade para a maioria dos itens alimentares. Em média, os valores de sensibilidade e especificidade foram de 70,2 por cento e de 96,2 por cento, respectivamente, para os 12 itens alimentares nas três refeições combinadas. Os escolares de 6 a 8 anos, quando comparados aos de 9 a 11 anos, apresentam maiores taxas de discordância de respostas entre o QUADA-3 e as observações. Os resultados indicaram que o QUADA-3 pode gerar dados válidos para avaliar o consumo alimentar do dia anterior em nível de grupo de escolares.

The aim of this study was to assess the validity of the third version of the Previous Day Food Questionnaire (PDFQ-3) for schoolchildren. PDFQ-3 is a structured instrument with 6 meals and 21 foods. The study included 164 students aged 6 to 11 years in a public school with a full-day school schedule in 2007. Validity was assessed by comparing food items selected on the questionnaire and direct observations of foods eaten in three school meals on the previous day (mid-morning snack, lunch, and mid-afternoon snack). Multivariate logistic regression analysis was used to evaluate the discordance between answers from the questionnaire versus those from observations. Results indicated high sensitivity and specificity for the majority of the food items. Mean values for sensitivity and specificity were 70.5 percent and 87.1 percent, respectively, for 12 food items in three combined school meals. Schoolchildren aged 6 to 8 years showed higher discordance between PDFQ-3 and observations, compared to 9-to-11-year-olds. Based on the findings, the PDFQ-3 can generate valid data for the evaluation of previous day food consumption in groups of schoolchildren.

Comparação do valor nutricional de dez cardápios segundo quatro programas computacionais / Comparison of nutritional values of ten menus based on four computer programs

OBJETIVO:Comparar os valores de energia e os nutrientes de 10 cardápios à luz de 4 programas computacionais de análise de consumo alimentar utilizados no Brasil. MÉTODOS:Foram selecionados os programas NutWin, DietWin, DietPro e Virtual Nutri. Foram analisados o valor energético e 11 nutrientes de 101 alimentos, que compunham 10 cardápios. Para testar diferenças do valor nutricional dos 10 cardápios entre os programas, foram utilizados os testes de Kruskal-Wallis e Mann-Whitney. RESULTADOS:Os programas variaram em relação ao número de alimentos (934 a 3 815), de nutrientes (28 a 144) e das principais fontes utilizadas. Não foram encontradas diferenças significantes dos valores de energia e macronutrientes entre os 4 programas. Em relação aos demais, o programa Diet Pro apresentou menores valores de gordura saturada, gordura monoinsaturada, gordura poliinsaturada, de ferro e sódio; o programa Virtual Nutri apresentou menores valores de fibra. CONCLUSÃO: Os resultados deste estudo não permitem inferências quanto à qualidade das bases de dados e nem indicam a superioridade de quaisquer desses programas que justifique sua utilização preferencial na prática do profissional de nutrição ou do pesquisador do consumo alimentar. Os resultados encontrados apontam para a necessidade de revisão do desenho dos programas computacionais e de suas bases de dados de nutrientes - para o planejamento e a análise do consumo alimentar.

OBJECTIVE:To compare values of energy and nutrients of 10 menus based on four softwares used for food consumption analysis in Brazil. METHODS:The selected softwares were NutWin, DietWin, DietPro and Virtual Nutri. Values of energy and eleven nutrients from 101 foods were analyzed, divided into 10 menus with established portion sizes. Differences in nutritional values obtained for the ten menus were tested using Kruskal-Wallis and Mann-Whitney tests. RESULTS: The programs varied in relation to number of foods (934 - 3,815), number of nutrients (28 - 144) and main sources used. Comparing to the other three softwares, significantly lower values of saturated fat, monounsaturated fat, polyunsaturated fat, iron and sodium were found in the DietPro software; significantly lower values of fiber were found in the Virtual Nutri software. CONCLUSION: The results of this study do not allow inferences related to the quality of the databases or indicate superiority of any one of the programs, to be used in practice by the nutrition professional or in research about food consumption. Results suggest the need of design revision and the nutrient database of softwares used in planning and analyzing food consumption.