Escenarios lácteos y microbiota intestinal en los primeros 1000 días / Milk scenarios and gut microbiota in the first 1000 days of life

La leche humana es el estándar de oro para la nutrición del bebé y debe iniciarse en la primera hora de vida. La leche de vaca, de otros mamíferos o las bebidas vegetales no se deben ofrecer antes del año de vida. Sin embargo, algunos niños requieren, al menos en parte, de fórmulas infantiles. Aun con las sucesivas mejoras a lo largo de la historia mediante la incorporación de oliogosacáridos, probióticos, prebióticos, sinbióticos y postbióticos, las fórmulas infantiles siguen siendo perfectibles para reducir la brecha de salud entre los bebés amamantados y aquellos alimentados con fórmula. En este sentido, se espera que la complejidad de las fórmulas siga aumentando a medida que se conozca mejor cómo modular el desarrollo de la microbiota intestinal. El objetivo de este trabajo fue realizar una revisión no sistemática del efecto de los diferentes escenarios lácteos sobre la microbiota intestinal.

Human milk is the gold standard for infant nutrition, and breastfeeding should be started within the first hour of life. Cow's milk, other mammalian milk, or plant-based beverages should not be offered before 1 year of age. However, some infants require, at least in part, infant formulas. Even with subsequent enhancements throughout history, with the addition of oligosaccharides, probiotics, prebiotics, synbiotics, and postbiotics, infant formulas still have room for improvement in reducing the health gap between breastfed and formula-fed infants. In this regard, the complexity of infant formulas is expected to continue to increase as the knowledge of how to modulate the development of the gut microbiota is better understood. The objective of this study was to perform a non-systematic review of the effect of different milk scenarios on the gut microbiota.

High-dose Vitamin C supplementation in the treatment of patients with COVID-19: A systematic review

Introduction: Vitamin C supplementation has been seen as a supportive treatment to control and prevent complications of COVID-19 by enhancing the immune response against infection. However, the effects of high doses of this vitamin are not yet fully understood. Objective: To analyze the effects of high-dose vitamin C in patients with COVID-19. Methods: This was a systematic review, using original studies published from April 2020 to November 2022 in PubMed, ScienceDirect, Scopus and Web of Science databases. The combination of descriptors registered in Medical Subject Headings (MeSH) used to search for articles were: (("vitamin C" OR "ascorbic acid") AND ("COVID-19" OR "SARS-CoV-2" OR "coronavirus")). Original articles of clinical trials conducted with patients diagnosed with COVID-19 and submitted to high-dose vitamin C supplementation were included. Results: Eligible studies included patients in intensive care units, wards, or outpatient clinics, who were given doses of vitamin C, ranging from 6,000 to 8,000 mg/day, with an average duration of 6.25 days of supplementation and mostly intravenous administration. A reduction in fever and myalgia was observed, as well as an improvement in oxygen saturation and lung impairment rate. Conclusion: The role of high-dose vitamin C in patients affected by COVID-19 requires further study, however, to date, the results have been promising for symptom reduction and improvement in lung function and oxygenation.

Introducción: La administración de suplementos de vitamina C se ha considerado un tratamiento de apoyo para controlar y prevenir las complicaciones del COVID-19 al mejorar la respuesta inmunitaria contra la infección. Sin embargo, los efectos de dosis elevadas de esta vitamina aún no se conocen en su totalidad. Objetivo: Analizar los efectos de altas dosis de vitamina C en pacientes con COVID-19. Métodos: Se trata de un estudio de revisión sistemática, utilizando artículos originales publicados desde abril de 2020 hasta noviembre de 2022 en las bases de datos PubMed, ScienceDirect, Scopus y Web of Science. Para la búsqueda de los artículos se utilizó la combinación de descriptores registrados en Medical Subject Headings (MeSH): (("vitamin C" OR "ascorbic acid") AND ("COVID-19" OR "SARS-CoV-2" OR "coronavirus")). Se incluyeron artículos originales de tipo ensayo clínico realizados con pacientes diagnosticados con COVID-19 y sometidos a suplementación con altas dosis de vitamina C. Resultados: Los estudios elegibles se realizaron con pacientes ingresados en unidades de cuidados intensivos, salas o ambulatorios, a los que se administraron dosis de vitamina C que oscilaban entre 6.000 y 8.000 mg/día, con una duración media de 6,25 días de suplementación y vía de administración mayoritariamente intravenosa. Se observó una reducción de la fiebre y las mialgias, además de una mejoría de la saturación de oxígeno y de la tasa de compromiso pulmonar. Conclusión: El papel de las dosis altas de vitamina C en pacientes afectados por COVID-19 requiere más estudios; sin embargo, hasta la fecha, los resultados han sido prometedores en cuanto a la reducción de los sintomas, y la mejora de la función pulmonar y la oxigenación.

Efectividad de la administración de hierro en forma semanal y diaria para la prevención de anemia por deficiencia de hierro en lactantes / Effectiveness of weekly and daily iron administration for the prevention of iron deficiency anemia in infants

Introducción. La deficiencia de hierro (DH) es la carencia nutricional más prevalente y la principal causa de anemia en lactantes. Existe consenso en la suplementación diaria con hierro como estrategia de prevención; también se demostró que la suplementación semanal es eficaz, pero la evidencia en lactantes es escasa. El objetivo fue comparar la efectividad de la administración diaria de hierro frente a la semanal para la prevención de la anemia por DH del lactante. Población y métodos. Ensayo clínico controlado y aleatorizado. Lactantes atendidos en un centro de salud público, sin anemia a los 3 meses de edad, aleatorizados en tres grupos: suplementación diaria (1 mg/kg/día), semanal (4 mg/kg/semana) o sin suplementación (grupo control con lactancia materna exclusiva [LME]). Se evaluó anemia y DH a los 3 y 6 meses. Se registró grado de adherencia y efectos adversos. Los datos se analizaron con el software R versión 4.0.3. Resultados. Participaron 227 lactantes. A los 6 meses el grupo de lactantes con LME sin suplementación (control) presentó prevalencias de DH y anemia por DH (ADH) mayores que los grupos intervenidos (diario y semanal). DH: 40,5 % vs. 13,5 % y 16,7 % (p = 0,002); ADH: 33,3 % vs. 7,8 % y 10 % (p < 0,001). No hubo diferencias entre los grupos diario y semanal. Tampoco hubo diferencias en el porcentaje de alta adherencia a la suplementación (50,6 % diaria vs. 57,1 % semanal), ni en los efectos adversos. Conclusiones. No se hallaron diferencias significativas en la efectividad entre la administración diaria y semanal para la prevención de ADH del lactante.

Introduction. Iron deficiency (ID) is the most prevalent nutritional deficiency and the main cause of anemia in infants. There is consensus on daily iron supplementation as a preventive strategy; and weekly iron supplementation has also been shown to be effective, but evidence in infants is scarce. The objective of this study was to compare the effectiveness of daily versus weekly iron administration for the prevention of ID anemia (IDA) in infants. Population and methods. Randomized, controlled clinical trial. Infants seen at a public health center, without anemia at 3 months of age, were randomized into 3 groups: daily supplementation (1 mg/kg/ day), weekly supplementation (4 mg/kg/week), or no supplementation (control group with exclusive breastfeeding [EB]). Anemia and ID were assessed at 3 and 6 months old. Adherence and adverse events were recorded. Data were analyzed using the R software, version 4.0.3. Results. A total of 227 infants participated. At 6 months, the group of infants with EB without supplementation(control) had a higher prevalence of ID and IDA than the intervention groups (daily and weekly). ID: 40.5% versus 13.5% and 16.7% (p = 0.002); IDA: 33.3% versus 7.8% and 10% (p < 0.001). There were no differences between the daily and weekly supplementation groups. There were also no differences in the percentage of high adherence to supplementation (50.6% daily versus 57.1% weekly) or adverse events. Conclusions. No significant differences in effectiveness were observed between daily and weekly administration for the prevention of infant IDA.

Programa Nacional de Suplementação de Ferro nos primeiros mil dias de vida em Salvador (BA) / National Iron Supplementation Program in the first thousand days of life in Salvador (BA) / Programa Nacional de Suplementación de Hierro en los primeros mil días de vida en Salvador, Bahía

Os primeiros mil dias de vida correspondem ao período desde a concepção até os primeiros dois anos após o nascimento. Durante essa fase, as necessidades nutricionais são elevadas devido às aceleradas alterações fisiológicas inerentes ao período, e o ferro está entre os micronutrientes mais requisitados. Considerando que a anemia, em especial por deficiência de ferro, é um problema de saúde pública, principalmente nessa fase da vida, foi instituído em 2005 o Programa Nacional de Suplementação de Ferro (PNSF). No entanto, há uma lacuna de estudos que analisam sua execução em municípios da Bahia. Por esse motivo, este estudo observacional descritivo objetivou avaliar a cobertura real do PNSF entre gestantes e crianças de 6 a 24 meses de vida, público-alvo do programa, no município de Salvador (BA), entre os anos de 2017 e 2022, a partir da análise de dados secundários disponibilizados pelo Ministério da Saúde. A cobertura real do PNSF ocorreu de forma insatisfatória no município, alcançando quantidades inferiores a 7% das gestantes e 1% das crianças, entre os anos de 2019 e 2021, e valores iguais a 0% para ambos os grupos nos anos de 2017, 2018 e 2022. Tais resultados podem ser motivados por diferentes fatores, como problemas operacionais na gestão/monitoramento do programa e/ou a baixa adesão da população. Destaca-se, assim, a necessidade da constante avaliação do desempenho do PNSF no intuito de identificar suas limitações e propor melhorias em sua execução.

The first thousand days of life correspond to the period from conception to the first two years after birth. During this phase, nutritional needs are high due to the accelerated physiological changes inherent to the period, and iron is among the most required micronutrients. Considering that anemia, especially due to iron deficiency, is a public health problem, especially at this stage of life, the National Iron Supplementation Program (PNSF) was instituted in 2005. However, there is a lack of studies that analyze its execution on municipalities in Bahia (BA). For this reason, this descriptive observational study aimed to evaluate the coverage of the PNSF among pregnant women and children between 6 and 24 months of life, the target audience of the program, in the municipality of Salvador (BA), between 2017 and 2022, based on the analysis of secondary data provided by the Ministry of Health. The actual coverage of the PNSF occurred unsatisfactorily in the municipality, reaching numbers below 7% of pregnant women and 1% of children, between the years 2019 and 2021, and values equal to 0% for both groups in the years 2017, 2018, and 2022. Such results can be due to different factors, such as operational problems in the management/monitoring of the program and/or the low adherence of the population. Thus, we highlight the need for constant evaluation of the PNSF performance to identify its limitations and propose improvements in its execution.

Los primeros mil días de vida corresponden al período que va desde la concepción hasta los primeros dos años después del nacimiento. Durante esta fase, las necesidades nutricionales son elevadas, debido a los cambios fisiológicos acelerados propios del período, y el hierro es uno de los micronutrientes más requeridos. Como la anemia, especialmente por deficiencia de hierro, es un problema de salud pública, especialmente en esta etapa de la vida, en 2005 se instituyó el Programa Nacional de Suplementación con Hierro (PNSF, por sus siglas en portugués). Sin embargo, faltan estudios que analicen su ejecución en municipios de Bahía (Brasil). Por esta razón, este estudio observacional descriptivo tuvo por objetivo evaluar la cobertura real del PNSF en mujeres embarazadas y en niños de entre 6 y 24 meses de vida, público objetivo del programa, en la ciudad de Salvador (Bahía), entre 2017 y 2022, con base en el análisis de datos secundarios proporcionados por el Ministerio de Salud. La cobertura real del PNSF se presentó de manera insatisfactoria en el municipio, alcanzando cifras inferiores al 7% de embarazadas y al 1% de niños, entre los años 2019 y 2021, con valores iguales al 0% para ambos grupos analizados en los años 2017, 2018 y 2022. Estos resultados pueden ser causados por diferentes factores, entre ellos, problemas operativos en la gestión/seguimiento del programa y/o baja adherencia de la población. Así, se destaca la necesidad de una evaluación constante del desempeño del Programa para identificar sus limitaciones y proponer mejoras en su ejecución.

Evaluation of usage of immunity boosters among the citizens of Pune district during the COVID-19 pandemic

Introduction: Post the coronavirus disease (COVID-19 pandemic), there was a spike in demand for immunity boosters, leading to the irrational use of supplements. To assess the usage of immunity boosters among the citizens of Pune City and correlate the side effects associated with supplements. Material and Methods: A cross-sectional study was conducted from September 2020 to May 2021 in Pune. Data, such as demographic, supplement intake (allopathic, homeopathic, and ayurvedic/home remedies), duration, frequency of supplements, and side effects associated with supplements, were collected through a personal interview and e-form circulation. The correlation of the immunity boosters with the side effects was done using Karl Pearson’s Correlation test in SPSS software version 22.0. Results: Out of 1006, the ayurvedic supplements/home remedies were preferred by 906 (98%) allopathic supplements by 599 (65%) and homeopathic supplements by 256 (28%) participants. The commonly reported side effects were acidity (37%), headache (29.6%), nausea (9%), loss of appetite (8.8%), diarrhea (7%), stomach ache (6%), cough (5.6%), and constipation (4.1%). These side effects had a weak positive linear proportionality with ayurvedic supplements such as amla (r = 0.162), Giloy Vati (r = 0.139), turmeric (r = 0.108), and Kadha (r = 0.102); also, Eupatorium perfoliatum, Vitamin C, and Vitamin D showed a linear proportionality with loss of appetite (r = 0.15), headache (r = 0.12), and cough (r = 0.12), respectively. A higher incidence of side effects such as nausea (r = 0.267), diarrhea (r = 0.243), headache (r = 0.164), and acidity (r = 0.113) was observed when supplements were taken for 6 months. Conclusion: Most participants were on immunity boosters during the COVID-19 pandemic. The study concluded that using immunity boosters in excess or for more than 6 months causes side effects, the most recurrent ones being acidity, headache, nausea, and lack of appetite.

IMPACT OF FEAR ON DEMOGRAPHY PROFILE AND EDUCATION TOWARDS THE PURCHASE OF NUTRITIONAL SUPPLEMENTS DURING COVID19 PANDEMIC

Every human being, from birth to death, is inevitably accompanied by the dominant emotion of fear. It starts when we perceive a physical or emotional threat to our life that poses a variety of risks. The customer was structurally exposed to the dread that is present in the possibility of impending infection, per the research findings at the period of "lockdown" (average score = 4.26; standard deviation = 0.865; relative standard deviation = 22.3%). Evidently, all people have a deep-seated dread of COVID-19 infection, which manifests as conscious and unconscious anxieties and phobias that influence purchases, but it can also be a helpful defence mechanism that prevents us from dying before our time. According to respondents, existential insecurity and imbalance are the root causes of fear during a pandemic (average score = 4.57, standard deviation = 1.41, and relative deviation = 21.8%). Additionally, fear was defined for the purposes of this study as an unpleasant, uncomfortable feeling related to a current or potential COVID-19 threat that increases intake in both men and women. Because the specific elements of the threat affect the emotional reaction, the perception of risk and danger, and the consumption of dietary supplements, it is crucial to consider the peculiarities of the threat of coronavirus infection. This is confirmed by the finding that 75% of respondents reported their use of dietary supplements has increased since the pandemic's beginning

Milk-Alkali Syndrome: A Century Old Cause of Resurgence of Severe Hypercalcemia Due to Excessive Use of Calcium Supplements

The milk-alkali syndrome (MAS) is characterized by a triad of elevated calcium levels, metabolic alkalosis and acute kidney injury that commonly occurs due to the combined intake of large amounts of calcium and absorbable alkali. The syndrome can have an acute onset with the rapid development of hypercalcemia and, if left untreated, may result in acute renal failure and metastatic calcification. An increased number of cases of MAS have recently been reported. This is likely due to the common use of over the counter (OTC) preparations of calcium for preventing and treating osteoporosis in postmenopausal women. Herein, we report a case of severe hypercalcemia due to prolonged intake of calcium carbonate supplements in the absence of any alkali.

Diagnosis of a Case of Hepatotoxicity Due to Drugs and Herbal Supplements in a Hospital in Pasto, Colombia

The liver is a crucial organ in metabolism, and some substances can induce toxic hepatitis with high morbidity and mortality. Chemical and drug-induced liver disease is a diagnostic and therapeutic challenge since it requires extension studies to rule out other entities. We present the case of a 51-year-old female patient without underlying comorbidities, admitted due to symptoms of two-day evolution consisting of progressive jaundice, diarrheal episodes without acholia, or any other additional manifestation. Her condition was caused by the intake of nimesulide, two tablets a day for two days, for pain secondary to a mandibular cyst diagnosed in previous days. During her admission to the emergency room, the patient described chronic consumption of Herbalife® products daily for four years. She presented with elevated transaminases, prolonged prothrombin time (PT), and direct hyperbilirubinemia. Infectious and immunological diseases were ruled out. We decided to start antibiotic and vitamin K coverage. Finally, and by exclusion, a liver biopsy suggested an inflammatory process compatible with drug-induced hepatitis. The woman evolved favorably when the medication and dietary supplement were discontinued. In conclusion, this case constitutes an initial point in advancing research into hepatotoxicity by shared mechanisms of various substances simultaneously, such as what happened to the patient with the parallel use of Herbalife® and nimesulide.

El hígado es un órgano crucial en el metabolismo y algunas sustancias pueden inducir hepatitis toxica con alta morbimortalidad. La enfermedad hepática inducida por sustancias químicas y medicamentos es un desafío tanto diagnostico como terapéutico, puesto que requiere la realización de estudios de extensión para descartar otras entidades. A continuación se presenta el caso de una paciente femenina de 51 años sin comorbilidades de base, ingresada por clínica de 2 días de evolución consistente en ictericia progresiva, episodios diarreicos sin acolia ni otra manifestación adicional. Aparentemente, su cuadro fue provocado por la administración de nimesulida, 2 tabletas al día por 2 días, contra el dolor secundario a un quiste mandibular diagnosticado en días anteriores. Durante su ingreso a urgencias la paciente describió consumo crónico, a diario desde hace 4 años, de productos de Herbalife®. Cursa con elevación de transaminasas, prolongación del tiempo de protrombina (TP) e hiperbilirrubinemia directa. Se descartan enfermedades infecciosas e inmunológicas. Se decidió iniciar el cubrimiento antibiótico y vitamina K. Finalmente y por exclusión, se realizó una biopsia hepática que sugirió un proceso inflamatorio compatible con hepatitis inducida por fármacos. La mujer evolucionó favorablemente al suspender la medicación y el suplemento dietético referido. En conclusión, el caso expuesto constituye un punto inicial en el avance hacia la investigación en hepatotoxicidad por mecanismos compartidos de diversas sustancias simultáneamente, como lo sucedido a la paciente con el uso paralelo de Herbalife® y de nimesulida.

Study of influence of anti-dementia drugs and nutritional supplements in elderly patients with mental decline

Background: Malnutrition is a common condition among elderly people with dementia and is associated with low nutrient and calorie intake. There are no data about efficacy of intervention with nutritional supplements in addition to medication in cognitive decline people. Aims and Objectives: we aimed to find out the nutritional status of patients with cognitive decline and to ascertain the effects of nutritional supplements with medication in such patients. Materials and Methods: This observational study was conducted for 12 months. All patients admitted with cognitive decline as per the mini-mental state examination score were included after informed consent. The demographic details, clinical features, treatment given, and response to treatment were noted and tabulated as mean ± and SD and analyzed statistically. Results: Maximum patients were found to be of moderate degree cognitive decline and were at risk of malnutrition. There was significant improvement in cognitive status and behavioral symptoms after 12 months of treatment with nutritional supplements and drugs in our study population. Conclusions: Addition of nutritional supplements to drug therapy does provides significant advantages in cognition and neuropsychiatric symptoms. They did add a lot in rectifying the deficiency of different nutritional parameters and thereby improving the domains such as nutritional functions and activity of daily living.

Avaliação nutricional de pacientes cirúrgicos com câncer gastrointestinal em uso de suplemento alimentar / Nutritional evaluation of surgical patients with gastrointestinal cancer using food supplements

Objetivo: Avaliar a nutrição de pacientes cirúrgicos com neoplasia no trato gastrointestinal em uso de suplemento alimentar. Método: Trata-se de uma revisão sistemática de literatura realizada nas bases de dados Google Scholar, PubMed, Scielo e Web of Science, no período de maio a junho de 2021, sem recorte temporal ou restrição de idioma, através dos descritores: "enteral nutrition e immunenutrition", "cancerpatients e gastriccancerpatients", "preoperative, perioperative e postoperative". Resultados: Foram selecionados 8 estudos, destes, a maioria identificou benefícios na utilização da suplementação em razão da diminuição de células TNF-a, do cortisol e da transferrina, diminuindo o tempo de internação e melhora no estado funcional dos participantes suplementados. Conclusão: Os achados foram positivos, no entanto, houve algumas limitações como a heterogeneidade em abordagens terapêuticas e perda de pacientes durante o estudo, apesar de apresentarem baixo risco de viés, ainda há a necessidade de mais estudos.(AU)

Objective: To evaluate the nutrition of surgical patients with neoplasia in the gastrointestinal tract using food supplements. Method: This is a systematic literature review carried out in Google Scholar, PubMed, Scielo and Web of Science databases, from May to June 2021, without time frame or language restriction, using the descriptors: "enteral nutrition and immunenutrition", "cancerpatients and gastriccancerpatients", "preoperative, perioperative and postoperative". Results: Eight studies were selected, most of which identified benefits in the use of supplementation due to the decrease in TNF-a cells, cortisol and transferrin, reducing the length of hospital stay and improving the functional status of supplemented participants. Conclusion: The findings were positive, however, there were some limitations such as heterogeneity in therapeutic approaches and loss of patients during the study, despite having a low risk of bias, there is still a need for further studies(AU)

Objetivo: Evaluar la nutrición de pacientes quirúrgicos con neoplasia en el tracto gastrointestinal utilizando suplementos alimenticios. Método: Se trata de una revisión sistemática de la literatura realizada en las bases de datos Google Scholar, PubMed, Scielo y Web of Science, de mayo a junio de 2021, sin franja horaria ni restricción de idioma, utilizando los descriptores: "nutrición enteral e inmunonutrición", "pacientes oncológicos y pacientes con cáncer gástrico", "preoperatorio, perioperatorio y postoperatorio". Resultados: Se seleccionaron ocho estudios, la mayoría de los cuales identificaron beneficios en el uso de la suplementación por la disminución de células TNF-a, cortisol y transferrina, reduciendo la estancia hospitalaria y mejorando el estado funcional de los participantes suplementados. Conclusión: Los hallazgos fueron positivos, sin embargo, hubo algunas limitaciones como la heterogeneidad en los enfoques terapéuticos y la pérdida de pacientes durante el estudio, a pesar de tener un bajo riesgo de sesgo, aún existe la necesidad de realizar más estudios(AU)

Uso de suplementos nutricionais por crianças vivendo com HIV: revisão narrativa / Use of dietary supplements by children living with HIV: narrative review / Uso de suplementos dietéticos por niños que viven con el HIV: revisión narrativa

Introdução: A suplementação nutricional em pessoas vivendo com HIV ainda é pouco difundida, sendo essencial o levantamento de evidências que apontem as terapêuticas mais eficientes para beneficiar a saúde desta população. Ao se tratar do público infantil, no qual a prevalência de carências nutricionais é elevada, o conhecimento acerca da suplementação nutricional é bastante profícuo. Objetivo: Analisar relatórios de pesquisa acerca dos efeitos do uso de suplementos nutricionais em crianças vivendo com HIV. Desenho do estudo e local: Uma revisão narrativa realizada na Universidade Federal do Maranhão, em Imperatriz, município localizado no oeste do estado do Maranhão. Método: Foi realizada uma busca nos bancos de dados Cochrane, PubMed, Scopus, WHO/OMS e biblioteca digital de teses e dissertações da USP entre setembro de 2021 a janeiro de 2022. Resultados: Foram incluídas 26 produções, as quais demonstraram que o uso de múltiplos nutrientes reduziu o tempo de hospitalização em crianças admitidas com diarreia ou pneumonia, melhorando a morbidade, concentração de hemoglobina e ganho ponderal. A oferta de ferro foi considerada satisfatória no combate à progressão da doença, vitamina A melhorou o quadro de diarreia persistente e vitamina D a habilidade motora neuromuscular. Conclusão: Os estudos sobre suplementação nutricional e a relação dos nutrientes com os diversos aspectos de saúde das crianças vivendo com HIV tem avançado. Logo, é necessário alargar as pesquisas no tema em contextos distintos, a fim de incrementar e gerar novas evidências, colaborando para uma conduta mais assertiva dos profissionais de saúde e consequente melhora no prognóstico dessas crianças.

Background: Providing nutritional supplementation to people living with human immunodeficiency virus (HIV) is a therapeutic intervention still not widespread, so it is essential to gather evidence supporting efficient therapies to benefit the health of this population. The prevalence of nutritional deficiencies is high in children; consequently, the knowledge about nutritional supplementation in this age group is quite fruitful. Objective: To analyze research reports on the effects of nutritional supplementation in children living with HIV. Design and setting: A narrative review was conducted at the Federal University of Maranhão, Imperatriz, west of the Maranhão State. Methods: The searches were performed in the Cochrane, PubMed, Scopus, and World Health Organization (WHO) databases and the São Paulo University's digital library of theses and dissertations from September 2021 to January 2022. Results: Twenty-six studies were included and showed that using multiple nutrients reduced the hospitalization time of children admitted with diarrhea or pneumonia, improving morbidity, hemoglobin concentration, and weight gain. The supply of iron was considered effective in combating the progression of the disease, vitamin A improved the condition of persistent diarrhea, and vitamin D improved neuromuscular motor skills. Conclusion: Studies have advanced on nutritional supplementation, the relationship between nutrients, and the different health aspects of children living with HIV. Therefore, it is necessary to expand research on the subject in different contexts to increase and generate new evidence, contributing to more assertive conduct of health professionals and consequent improvement in the prognosis of these children.

Antecedentes: La administración de suplementos nutricionales a las personas que viven con el virus de la inmunodeficiencia humana (VIH) es una intervención terapéutica aún poco extendida, por lo que es fundamental reunir pruebas que apoyen terapias eficaces en beneficio de la salud de esta población. La prevalencia de deficiencias nutricionales es elevada en niños, por lo que el conocimiento sobre la suplementación nutricional en este grupo de edad es bastante fructífero. Objetivo: Analizar los informes de investigación sobre los efectos de la suplementación nutricional en niños que viven con el VIH. Diseño y escenario: Se realizó una revisión narrativa en la Universidad Federal de Maranhão, Imperatriz, al oeste del Estado de Maranhão. Métodos: Las búsquedas se realizaron en las bases de datos Cochrane, PubMed, Scopus y Organización Mundial de la Salud (OMS) y en la biblioteca digital de tesis y disertaciones de la Universidad de São Paulo desde septiembre de 2021 hasta enero de 2022. Resultados: Se incluyeron 26 estudios que mostraron que el uso de múltiples nutrientes redujo el tiempo de hospitalización de los niños ingresados con diarrea o neumonía, mejorando la morbilidad, la concentración de hemoglobina y el aumento de peso. El aporte de hierro se consideró eficaz para combatir la progresión de la enfermedad, la vitamina A mejoró el cuadro de diarrea persistente y la vitamina D mejoró las habilidades motoras neuromusculares. Conclusiones: Los estudios han avanzado sobre la suplementación nutricional, la relación entre los nutrientes y los diferentes aspectos de la salud de los niños que viven con el VIH. Por lo tanto, es necesario ampliar las investigaciones sobre el tema en diferentes contextos para aumentar y generar nuevas evidencias, contribuyendo para una conducta más asertiva de los profesionales de salud y consecuente mejoría en el pronóstico de estos niños.

Avaliação nutricional de pacientes cirúrgicos com câncer gastrointestinal em uso de suplemento alimentar / Evaluación nutritional de pacientes quirúrgicos con cáncer gastrointestinal utilizando complementos alimentarios / Nutritional evaluation of surgical patients with gastrointestinal cancer using food supplements

Objetivo: Avaliar a nutrição de pacientes cirúrgicos com neoplasia no trato gastrointestinal em uso de suplemento alimentar. Método: Trata-se de uma revisão sistemática de literatura realizada nas bases de dados Google Scholar, PubMed, Scielo e Web of Science, no período de maio a junho de 2021, sem recorte temporal ou restrição de idioma, através dos descritores: "enteral nutrition e immunenutrition", "cancerpatients e gastriccancerpatients", "preoperative, perioperative e postoperative". Resultados: Foram selecionados 8 estudos, destes, a maioria identificou benefícios na utilização da suplementação em razão da diminuição de células TNF-a, do cortisol e da transferrina, diminuindo o tempo de internação e melhora no estado funcional dos participantes suplementados. Conclusão: Os achados foram positivos, no entanto, houve algumas limitações como a heterogeneidade em abordagens terapêuticas e perda de pacientes durante o estudo, apesar de apresentarem baixo risco de viés, ainda há a necessidade de mais estudos.(AU)

Objective: To evaluate the nutrition of surgical patients with neoplasia in the gastrointestinal tract using food supplements. Method: This is a systematic literature review carried out in Google Scholar, PubMed, Scielo and Web of Science databases, from May to June 2021, without time frame or language restriction, using the descriptors: "enteral nutrition and immunenutrition", "cancerpatients and gastriccancerpatients", "preoperative, perioperative and postoperative". Results: Eight studies were selected, most of which identified benefits in the use of supplementation due to the decrease in TNF-a cells, cortisol and transferrin, reducing the length of hospital stay and improving the functional status of supplemented participants. Conclusion: The findings were positive, however, there were some limitations such as heterogeneity in therapeutic approaches and loss of patients during the study, despite having a low risk of bias, there is still a need for further studies.(AU)

Objetivo: Evaluar la nutrición de pacientes quirúrgicos con neoplasia en el tracto gastrointestinal utilizando suplementos alimenticios. Método: Se trata de una revisión sistemática de la literatura realizada en las bases de datos Google Scholar, PubMed, Scielo y Web of Science, de mayo a junio de 2021, sin franja horaria ni restricción de idioma, utilizando los descriptores: "nutrición enteral e inmunonutrición", "pacientes oncológicos y pacientes con cáncer gástrico", "preoperatorio, perioperatorio y postoperatorio". Resultados: Se seleccionaron ocho estudios, la mayoría de los cuales identificaron beneficios en el uso de la suplementación por la disminución de células TNF-a, cortisol y transferrina, reduciendo la estancia hospitalaria y mejorando el estado funcional de los participantes suplementados. Conclusión: Los hallazgos fueron positivos, sin embargo, hubo algunas limitaciones como la heterogeneidad en los enfoques terapéuticos y la pérdida de pacientes durante el estudio, a pesar de tener un bajo riesgo de sesgo, aún existe la necesidad de realizar más estudios.(AU)

Construction andeffect evaluation of precise oral nutrition guidance program for postoperative patients with colorectal cancer undergoing accelerated rehabilitation / 中国实用护理杂志

Objective:To construct and evaluate the effect of precise oral nutrition guidance program for colorectal cancer patients with accelerated rehabilitation after operation.Methods:This study was a quasi experimental study. A total of 116 patients with colorectal cancer from department of Colorectal Surgery, Jiangsu Cancer Hospital from March to Deamber, 2021 were selected by convenience sampling method. They were divided into two groups according to their admission time, the experimental group (58 cases), was given precise oral nutrition guidance program after colorectal cancer surgery based. In the control group, 58 cases were treated with the conventional dietary guidance for rapid rehabilitation. The gastrointestinal tolerance rate, the compliance rate of oral nutritional supplements, the first defecation time after operation, albumin, total albumin, prealbumin and other nutritional indexes were compared between the two groups before and after intervention.Results:Finally, 111 cases were included, induding 56 in the experimental group and 55 in the control group. The compliance rate of oral nutritional supplements after intervention in the experimental group was 73.2% (41/56), higher than that in the control group 40.0%(22/55), and the difference between the two groups was statistically significant ( χ2 = 12.47, P<0.05). The first defecation time after operation in the experimental group was (29.51 ± 5.52) h, while in the control group was (61.48 ± 8.39) h, the difference between the two groups was significant ( t = -12.06, P<0.05). The postoperative enteral nutrition tolerance rate of the experimental group was 91.1% (51/56), which was higher than the 69.1%(38/55) in the control group, the difference between the two groups was statistically significant ( χ2 = 8.44, P<0.05). The serum total protein, albumin and prealbumin levels of the experimental group at discharge were (66.56 ± 5.15), (46.78 ± 7.62) g/L and (276.07 ± 53.57) mg/L, compared with the (60.27 ± 4.37), (39.12 ± 6.41) g/L and (230.14 ± 44.58) mg/L in the control group, the differences were statistically significant ( t = 6.66, 5.02, 4.91, all P<0.05). Conclusions:The implementation of precise oral nutrition guidance program is conducive to guiding the clinical practice of oral nutritional supplements in patients with colorectal cancer after surgery, improving patient compliance, reducing gastrointestinal intolerance, promoting intestinal function recovery, and improving nutritional status of patients.

Interpretation on Consensus on drug-induced liver injury by CIOMS Working Group:liver injury attributed to herbal and dietary supplements / 中国中药杂志

With the increase in the medical level, the improvement of adverse drug reaction(ADR) monitoring systems, and the enhancement of public awareness of safe medication, drug safety incidents have been frequently reported. Drug-induced liver injury(DILI), especially liver injury attributed to herbal and dietary supplements(HDS), has globally attracted high attention, bringing great threats and severe challenges to the people for drug safety management such as clinical medication and medical supervision. Consensus on drug-induced liver injury had been published by the Council for International Organizations of Medical Sciences(CIOMS) in 2020. In this consensus, liver injury attributed to HDS was included in a special chapter for the first time. The hot topics, including the definition of HDS-induced liver injury, epidemiological history, potential risk factors, collection of related risk signals, causality assessment, risk prevention, control and management were discussed from a global perspective. Based on the previous works, some experts from China were invited by CIOMS to undertake the compilation of this chapter. Meanwhile, a new causality assessment in DILI based on the integrated evidence chain(iEC) method was widely recognized by experts in China and abroad, and was recommended by this consensus. This paper briefly introduced the main contents, background, and characteristics of the Consensus on drug-induced liver injury. Significantly, a brief interpretation was illustrated to analyze the special highlights of Chapter 8, "Liver injury attributed to HDS", so as to provide practical references for the medical staff and the researchers who worked on either Chinese or Western medicine in China.

Consumo de ayudas ergogénicas nutricionales y farmacéuticas en personas que asisten a gimnasios del municipio de Cercado, Cochabamba

Dado el problema de salud pública que plantean los esteroides anabólicos, el consumo de ayudas ergogénicas está aumentando a nivel mundial, no es en Bolivia. Además, existe un consumo desmedido de suplementos nutricionales y farmacéuticos, así como efectos reversibles e irreversibles de los esteroides anabólicos. Objetivos: describir cómo se consumen las ayudas ergogénicas nutricionales y farmacéuticas y cómo los asistentes a gimnasios en el municipio Cercado de Cochabamba perciben sus efectos en su salud. Métodos: se realizó un estudio observacional transversal con 378 participantes mayores de 18 años, (estratificada) divididos en cuatro grupos; Amateur, Fitness, Deportista y en nueve gimnasios y dos grupos (NABBA-IFFB) y deportistas en general en el área metropolitana de Cercado Cochabamba. Resultados: se encontró que el 74,6% consume alguna sustancia que mejoran el rendimiento; el consumo de ayudas ergogénicas nutricionales fue del 57,1%(n=216) y farmacológicas el 17,4% (n=66). El tiempo dedicado a entrenamiento y dieta para el grupo amateur es estadísticamente significativo con un valor de (p<0,05). Los efectos percibidos y reportados por el consumo de ayudas ergogénicas farmacológicas (esteroides anabólicos androgénicos) son principalmente cambios de humor, alteración en la libido y acné. Entre los efectos secundarios irreversibles dos casos de hombres desarrollaron ginecomastia y dos mujeres desarrollaron clítoromegalia. Conclusiones: los usuarios de ejercicio en el gimnasio consumen grandes cantidades de sustancias nutricionales y/o farmacológica que mejoran el rendimiento.

Given the public health problem posed by anabolic steroids, the consumption of ergogenic aids is increasing worldwide, not indifferently in Bolivia. In addition, there is an excessive consumption of nutritional and pharmaceutical supplements, as well as reversible and irreversible effects of anabolic steroids. Objectives: to describe how nutritional and pharmaceutical ergogenic aids are consumed and how gym-goers in the Cercado municipality of Cochabamba perceive their effects on their health. Methods: a crosssectional observational study was conducted with 378 participants over 18 years of age, (stratified) divided into four groups; Amateur, Fitness, Athlete and in 9 gyms and 2 groups (NABBA-IFFB) and athletes in general in the metropolitan area of Cercado Cochabamba. Results: it was found that 74.6% consumed some performance-enhancing substance; the consumption of nutritional ergogenic aids was 57.1% (n=216) and pharmacological aids 17.4% (n=66). Time dedicated to training and diet for the amateur group is statistically significant with a value of (p<0.05). The perceived and reported effects of the consumption of pharmacological ergogenic aids (anabolic androgenic steroids) are mainly mood changes, libido alteration and acne. Among the irreversible side effects 2 cases of men developed gynecomastia and 2 women developed clitoromegaly. Conclusions: exercise users in the gym consume large amounts of nutritional and/or pharmacological performance enhancing substances.

Blood tests and use of nutritional supplements in a cohort of Brazilian children with trisomy 21

Abstract Objective: To describe the use of nutritional supplements and blood status (hemogram, lipidogram, hepatic function, inflammatory markers, minerals, and homocysteine) in a sample of Brazilian T21 children with private health support before their first consultation with a T21 expert. Method: This descriptive cross-sectional study enrolled 102 participants. Brazilian families with a T21 member under 18 years old were contacted and those that consented answered a survey regarding socio-demographics and the use of nutritional supplements and shared the blood tests that their T21 members have collected for the first consultation with a T21 expert. Results: Frequencies and percentages were used to describe the variables. The most used supplements included vitamins (A, C and D), minerals (zinc and iron), omega-3, and antioxidants (curcumin). Hypothyroidism was observed in 56.9% of the participants. Hemogram alterations (increased hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin and red cell distribution width, leukopenia, and lymphocytopenia), dyslipidemia, altered hepatic and inflammatory blood markers were frequently found. Conclusions: Nutritional supplements (mainly vitamins, minerals, omega-3 and antioxidants) are frequently used by Brazilian T21 children independently of professional counseling and/or supervision and should be a question to be raised during the clinical anamnesis since some of them may impact medical conduct. Moreover, many blood tests are altered in this population and clinicians should be aware of them in order to warrant an appropriate screening and the implementation of risk management measures as soon as possible and improve the general health of these persons.

Characterization of micronutrient supplements use by Brazilian children 6-59 months of age: Brazilian National Survey on Child Nutrition (ENANI-2019) / Caracterização do uso de suplementos de micronutrientes por crianças brasileiras de 6-59 meses de idade: Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) / Caracterización del uso de suplementos de micronutrientes por niños brasileños de 6-59 meses de edad: Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019)

This study aimed to characterize micronutrient supplements use among Brazilian children 6-59 months of age included in the Brazilian National Survey on Child Nutrition (ENANI-2019; n = 12,598). Micronutrient supplements use at the time of the interview and the 6 months prior to it was evaluated using a structured questionnaire. The following indicators were included: micronutrient supplement use; supplements containing a single micronutrient; supplements of the Brazilian National Iron Supplementation Program (PNSF); multivitamin supplements with or without minerals; multivitamin supplements with minerals; multivitamin supplements without minerals. The estimates and their respective 95% confidence intervals (95%CI) were calculated for Brazil and according to macroregion, educational level of the mother or caregiver, and type of health care service used, considering the sampling plan, weights, and calibration. In Brazil, the prevalence of micronutrient supplements use was 54.2% (95%CI: 50.5; 57.8), with the highest prevalence in the North Region (80.2%; 95%CI: 74.9; 85.6) and among children 6-23 months of age (69.5%; 95%CI: 65.7; 73.3). The prevalence of the use of supplements containing exclusively iron and exclusively vitamin A in Brazil was 14.6% (95%CI: 13.1; 16.1) and 23.3% (95%CI: 19.4; 27.1), respectively. The prevalence of the use of multivitamin with or without minerals in Brazilian children 6-59 months of age was 24.3% (95%CI: 21.4; 27.2). These results may help to understand the practice of supplements use among Brazilian children and support the proposal of national public policies for the prevention and control of micronutrient deficiencies.

O objetivo deste estudo foi caracterizar o uso de suplementos de micronutrientes entre crianças brasileiras de 6-59 meses de idade incluídas no Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019; n = 12.598). O uso de suplementos de micronutrientes no momento da entrevista e nos seis meses anteriores foi avaliado por meio de um questionário estruturado. Foram incluídos os seguintes indicadores: uso de suplemento de micronutrientes; suplementos contendo um único micronutriente; suplemento do Programa Nacional de Suplementação de Ferro (PNSF); suplementos multivitamínicos com ou sem minerais; suplementos multivitamínicos com minerais; suplementos multivitamínicos sem minerais. As estimativas pontuais e seus respectivos intervalos de 95% de confiança (IC95%) foram calculados para o Brasil e de acordo com a macrorregião, a escolaridade da mãe ou cuidadora e o tipo de serviço de saúde utilizado, considerando o plano, os pesos e a calibração amostral. No Brasil, a prevalência de uso de suplemento de micronutrientes foi de 54,2% (IC95%: 50,5; 57,8), com maior prevalência na Região Norte (80,2%; IC95%: 74,9; 85,6) e entre crianças de 6-23 meses de idade (69,5%; IC95%: 65,7; 73,3). A prevalência do uso de suplementos contendo apenas ferro e apenas vitamina A no Brasil foi de 14,6% (IC95%: 13,1; 16,1) e 23,3% (IC95%: 19,4; 27,1), respectivamente. A prevalência de uso de multivitamínicos com ou sem minerais em crianças brasileiras de 6-59 meses de idade foi de 24,3% (IC95%: 21,4; 27,2). Esses resultados podem auxiliar na compreensão da prática do uso de suplementos entre crianças brasileiras e apoiar a proposta de políticas públicas nacionais de prevenção e controle de deficiências de micronutrientes.

El objetivo de este estudio fue caracterizar el uso de suplementos de micronutrientes entre niños brasileños con edades entre 6-59 meses incluidos en el Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019; n = 12.598). El uso de suplementos de micronutrientes en el momento de la entrevista y en los seis meses anteriores se evaluó mediante un cuestionario estructurado. Se incluyeron los siguientes indicadores: uso de suplementos de micronutrientes; suplementos que contienen un solo micronutriente; suplemento del Programa Nacional de Suplementación con Hierro (PNSF); suplementos multivitamínicos con o sin minerales; suplementos multivitamínicos con minerales; suplementos multivitamínicos libres de minerales. Se calcularon las estimaciones puntuales para Brasil y sus respectivos intervalos del 95% de confianza (IC95%) de acuerdo con la macrorregión, el nivel educativo de la madre/cuidador y el tipo de servicio de salud utilizado, considerando el plan, los pesos y la calibración de la muestra. En Brasil, la prevalencia del uso de suplementos de micronutrientes fue del 54,2% (IC95%: 50,5; 57,8), con mayor prevalencia en la Región Norte (80,2%; IC95%: 74,9; 85,6) y entre niños con edades entre 6-23 meses (69,5%; IC95%: 65,7; 73,3). Las prevalencias del uso de suplementos que contienen solo hierro o solo vitamina A en Brasil fueron del 14,6% (IC95%: 13,1; 16,1) y del 23,3% (IC95%: 19,4; 27,1), respectivamente. La prevalencia de uso de multivitamínicos con o sin minerales en niños brasileños de 6-59 meses de edad fue del 24,3% (IC95%: 21,4; 27,2). Estos resultados pueden ayudar a comprender la práctica de uso de suplementos entre los niños brasileños y apoyar la propuesta de políticas públicas para la prevención y control de la carencia de micronutrientes.

Fortificación domiciliaria con polvos de micronutrientes. Lineamientos técnicos para el personal de salud

Introducción: La fortificación domiciliaria de los alimentos con polvos de micronutrientes se considera una intervención efectiva para reducir la anemia por deficiencia de hierro y otras carencias en la población infantil. Objetivo: Establecer los lineamientos técnicos para el personal de salud en el nivel primario de atención, en apoyo a la suplementación con polvos de micronutrientes a niños y niñas entre 6 y 23 meses de edad. Métodos: Se conformó el equipo técnico. Se revisaron las formulaciones utilizadas en la región y experiencia acumulada en intervenciones realizadas en provincias orientales, además, se elaboró el documento sustentado en evidencia científica con base en las recomendaciones nutricionales en esta población. Resultados: El suplemento permitió la prevención de las carencias nutricionales debido a que lograban cubrir la brecha de su requerimiento. Estuvieron disponibles los lineamientos técnicos dirigidos al personal de salud en los diferentes niveles de atención para asegurar el éxito de la consejería nutricional a la familia cubana, y el uso adecuado del suplemento. Conclusiones: Este trabajo brinda elementos y orientaciones técnicas para la capacitación del personal de salud con el fin de socializar, divulgar y brindar herramientas técnicas en el uso del suplemento como una medida costo efectiva para la prevención de las deficiencias de micronutrientes.

Introduction: Home fortification of food with micronutrient powders is considered an effective intervention to reduce iron deficiency anemia and other deficiencies in the child population. Objective: To provide technical guidelines for health personnel at the primary healthcare level to support the supplementation of children between 6 and 23 months of age with micronutrient powders. Methods: The technical team was established. The formulations used in the region and the experience gained in interventions conducted in eastern provinces were reviewed. Moreover, a document on scientific evidence was prepared based on the nutritional recommendations for this population. Results: The supplement allowed the prevention of nutritional deficiencies as it could cover the gaps in their requirement. Technical guidelines directed to health personnel at different healthcare levels were available to ensure the success of nutritional counselling to the Cuban family, and the adequate use of the supplement. Conclusions: This work provides elements and technical guidelines for the training of health personnel to socialize, disseminate and provide technical tools in the use of the supplement as a cost-effective measure for the prevention of micronutrient deficiencies.

Evaluation of Antioxidant Properties, Knowledge, Attitude and Practice (KAP) on Selected Dietary Supplements (Barley Grass, Wheatgrass and Chlorella vulgaris powders)

@#Introduction: Three selected dietary supplements (DS), barley grass (BG), wheatgrass (WG), and Chlorella vulgaris (CV), are commercially available. However, more information is needed about the antioxidant properties of the three DS and their potential health benefits on adults’ health and well-being. Thus, this study aimed to determine the antioxidant properties and adults’ knowledge, attitudes and practices (KAP) of the three selected DS. Methods: In phase 1, an experimental study was conducted on antioxidant analysis, total phenolic content (TPC) and DPPH radical scavenging activity for the three DS. For phase 2, a cross-sectional survey (n=338) was conducted for the three DS through an online platform where convenience sampling was performed. Results: In phase 1, BG (2.83±0.50mg GAE/g DW) had the highest TPC, followed by WG (2.02±0.20mg GAE/g DW) and CV (1.74±0.65mg GAE/g DW); DPPH radical scavenging activity, BG (198.23±0.15µg/mL) and WG (177.25±0.17µg/mL) had lower IC50 compared to CV (1185.84±0.28µg/mL). Significant differences (p<0.05) were found between IC50 of the three DS and standards, butylated hydroxytoluene (24.51±0.37µg/mL) and quercetin (26.04±0.55µg/mL). While in phase 2, poor knowledge (51.5%), moderate attitude (39.6%), and poor practice (43.2%) levels were observed in most of the participants. Moreover, working adults reported higher scores in knowledge (3.70±1.51) compared to students (3.33±1.63, p=0.037). Males had higher scores (29.27±2.42) in attitude compared to females (28.49±2.68, p=0.030). Besides, participants who were single and completed tertiary education with 4-6 years of working experience showed better practice scores. The overall knowledge (r=0.134, p=0.013) and attitude (r=0.273, p<0.001) scores correlated significantly with practice scores. Conclusion: Participants’ poor knowledge, moderate attitude, and inadequate practice in phase 2 caution against over-reliance on supplements, emphasizing the importance of an active lifestyle and balanced diet for optimal health and longevity.

Dietary intervention for the treatment of psoriasis / 中华皮肤科杂志

This review summarizes dietary characteristics of patients with psoriasis, discusses effects of gluten-free diet, Mediterranean diet and dietary intervention-induced weight loss on psoriasis, and analyzes the efficacy of dietary supplements in the treatment of psoriasis, such as fish oil, vitamin D, vitamin B12, selenium, and probiotics.