Mindful eating questionnaire: Validation and reliability in Brazilian adults with type 2 diabetes mellitus.

OBJECTIVE: The objective was to evaluate the psychometric properties of the Mindful Eating Questionnaire (MEQ) in Brazilian subjects with type 2 diabetes mellitus (T2DM) and validate a Brazilian version of the MEQ for adults with T2DM (MEQ-DM). METHODOLOGY: Baseline data from the multicentre Nutritional Strategy for Glycaemic Control in Patients with Type 2 Diabetes Mellitus (NUGLIC) trial were used. Construct validity was assessed using exploratory factor analysis (EFA). The root mean square error of approximation (RMSEA), comparative fit index (CFI) and Tucker‒Lewis index (TLI) fit indices indicated the adequacy of the model. The reliability of the questionnaire was evaluated considering the different factor loadings. Criterion validity was tested by correlating the MEQ-DM with sociodemographic variables, body mass index (BMI) and physical activity levels. RESULTS: A total of 370 participants were included, who were mostly female (60.8 %) and had a median age of 61 (54-67) years. The EFA results supported the two-factor structure of the 25-item MEQ-DM: disinhibition and awareness. The results of the fit indices (RMSEA = 0.04; CFI = 0.95 and TLI = 0.94) and composite reliability (disinhibition = 0.84 and awareness = 0.81) were consistent. The criterion validity analysis indicated a significant association between MEQ-DM scores and age, sex, civil status, education level, BMI and physical activity (p < 0.05). CONCLUSION: When explored with Brazilian adults with T2DM, the MEQ-DM presented a factorial model with two dimensions: disinhibition and awareness. This model must be confirmed in future studies with Brazilians with T2DM.

Relação entre o uso de terapia nutricional enteral e o controle glicêmico em pacientes críticos / Relationship between the use of enteral nutritional therapy and glycemic control in critically ill patients

Introdução: O controle glicêmico está relacionado com a diminuição da mortalidade segundo estudos randomizados que avaliam terapia insulínica e terapia nutricional em pacientes críticos. Existem poucos estudos que abordam estratégias eficazes na terapia nutricional enteral (TNE) para o controle glicêmico. Sabendo que a TNE é um fator que influi no controle da glicemia de pacientes críticos, a dieta efetivamente ofertada ao paciente pode ser avaliada como potencializadora de efeitos positivos ou negativos na glicemia. Objetivos: Avaliar o controle glicêmico e a relação com a oferta da nutrição enteral em pacientes internados em uma Unidade de Terapia Intensiva. Métodos: Estudo de coorte histórico com 201 pacientes internados em uma unidade de terapia intensiva no Sul do Brasil no período de janeiro a dezembro de 2014 que receberam a nutrição enteral por pelo menos 72 horas após a internação. Foram extraídos dados de prontuário eletrônico. Para avaliar o controle glicêmico, foram coletados dados de glicemia da internação, 24 horas após o início da dieta e uma semana após o início da dieta. Houve estratificação de grupo de diabéticos e não-diabéticos. O estado nutricional dos pacientes foi classificado pelo IMC (n=76). A adequação da dieta foi avaliada em percentual. O tipo de dieta foi classificado de acordo com as características das fórmulas. Foram avaliados tempo de internação na UTI e evolução clínica. Resultados: A média de idade dos pacientes foi 63,6 anos (± 15,4), maioria sexo masculino (55,7%). Diabéticos foram 27,4% da população. Uma redução média de 18,4 mg/dL na glicemia depois de uma semana de dieta foi vista no grupo de pacientes diabéticos, porém não significativa (p =0,075). O percentual de adequação da dieta foi semelhante entre os grupos e no total, tanto para valor energético total (97,2%±20,5), quanto para proteínas (84,3%±23,1). O tempo de internação na UTI em mediana foi de 17 dias, maior em pacientes diabéticos (21 dias), porém não significativo. No grupo de pacientes não diabéticos a glicemia de uma semana após o início da dieta foi significativamente maior nos que foram à óbito quando comparados com pacientes não diabéticos que evoluíram para alta (p=0,033). Não houveram associações significativas entre glicemia e IMC, percentual de adequação de energia e proteínas, tempo de UTI, tipo de dieta e uso de módulos proteicos, tanto para o grupo de diabéticos quanto para o grupo de não-diabéticos (p>0,10). Discussão: A glicemia tende a reduzir mais naqueles pacientes em TNE com fórmulas de baixo carboidrato. O controle glicêmico mostra relação com a evolução clínica de pacientes críticos, dispondo maior sobrevida em pacientes com valores de glicemia seguros. Conclusões: O controle glicêmico de pacientes internados em uma unidade de terapia intensiva tende a ser efetivo após uma semana de TNE em pacientes diabéticos e a hiperglicemia após uma semana de TNE aumenta a prevalência de óbitos em pacientes não diabéticos (AU)

Introduction: According to random studies that evaluate insulin therapy and nutritional therapy in critically ill patients, glycemic control is related to the decreasing of mortality. There are only a few studies that address effective strategies in enteral nutritional therapy for glycemic control. Knowing that ENT is a factor that influences the glycemic control in critically ill patients, the diet actually offered to the patient can be evaluated as a potentiator for positive or negative effects on blood glucose. Objective: Evaluate the glycemic control and its relation with the supply of enteral nutrition for patients admitted to an Intensive Care Unit. Methods: A cohort historic study of 201 patients admitted to an ICU in Southern Brazil, from January to December of 2014, who received enteral nutrition for at least 72 hours after admission. Data from electronic medical records were extracted. To evaluate the glycemic control, blood glucose data were collected at the admission, 24 hours after the beginning of the treatment and one week after the diet’s initiation. Diabetic and non-diabetic patients were separated in two groups. The patients’ nutritional status was classified by the BMI (n = 76). The adequacy of the diet was evaluated as a percentage. The type of diet was classified according to the characteristics of the formulas. The patient’s time in ICU and their clinical outcome were also evaluated. Results: The patients’ average age was 63.6 years (± 15,4), most of them were men (55.7%). Diabetics were 27.4% of the population. An average reduction of 18.4 mg/dL in blood glucose after a week of diet was observed in the group of diabetic patients but it was not significant (p = 0.075). The diet adequacy percentage was similar in both groups, for both total energy (97.2% ± 20.5) and protein (84.3% ± 23.1). The average time that patients stayed in the ICU was 17 days. This period was a little longer for diabetic patients (21 days), but it’s not a significant difference. In the non-diabetic group, glucose levels one week after the initiation of the diet were significantly higher in patients who died, compared to the ones that left the intensive care unit (p = 0.033). There were no significant associations with blood glucose and BMI, adequate energy percentage and protein, ICU time, type of diet and use of protein modules, for both the diabetic and non-diabetic groups (p> 0.10). Discussion: Blood glucose tends to further reduce in those patients submitted to ENT with low carbohydrate formulas. The glycemic control relates to the clinical advancements in critically ill patients, providing longer survivability in patients with safe blood glucose levels. Conclusions: The glycemic control in patients admitted to an ICU tends to be effective after a week of ENT in diabetic patients and the hyperglycemia, after a week of ENT, increases the prevalence of deaths in non-diabetic patients (AU)

Intervenção nutricional e o impacto na adesão ao tratamento em pacientes com síndrome Metabólica / Nutritional intervention and the impact on adherence to treatment in patients with metabolic syndrome

FUNDAMENTO: A síndrome metabólica representa um conjunto de fatores de risco, associados a doenças cardiovasculares e a diabete melito tipo 2. O tratamento inclui mudanças no estilo de vida, dieta, atividade física e medicamentos. A adesão do paciente é crucial ao tratamento da doença. Objetivo: Avaliar dois modelos de intervenção dietoterápica e a relação com a adesão ao tratamento e o impacto na melhora clínica de pacientes com síndrome metabólica. MÉTODOS: Ensaio clínico randomizado, com duração de quatro meses. Os pacientes foram randomizados em grupos intervenção e controle. Todos seguiram dieta específica por quatro meses. O grupo Intervenção recebeu pacote de intervenção, com dieta individualizada, manual de orientação, aconselhamento via telefone e material educativo. Foram realizadas anamnese nutricional, avaliação antropométrica, avaliação dietética, orientação dietética individualizada e exames bioquímicos. RESULTADOS: Os pacientes que chegaram mais motivados foram aqueles que tiverem maior redução nos valores do índice de massa corporal (p < 0,001), que reduziu de 31,7 kg/m² (DP ± 3,9) para 30,9 kg/m² (DP ± 3,8), na circunferência abdominal a redução foi de 108,1 cm (DP ± 9,8) para 105,9 cm (DP ± 9,5). As associações estatisticamente significativas se deram nas correlações entre índice de massa corporal, glicemia e triglicerídeos, redução do consumo de leite integral (p = 0,002), aumento no consumo de cereais integrais (p = 0,008) e de leite desnatado (p = 0,010), e entre o aumento no consumo de vegetais e a redução dos triglicerídeos. CONCLUSÃO: Ambos os grupos mostraram melhora significativa nos parâmetros clínicos, que foi significativamente associada a motivação prévia. Os pacientes que chegaram mais motivados foram aqueles que responderam melhor ao tratamento.

BACKGROUND: Metabolic syndrome is associated with increased risk of cardiovascular events disease and type 2 diabetes. Treatment includes modifications on life style, diet and physical activity. Treatment adherence plays a crucial role in the successful treatment of this disease. OBJECTIVE: To evaluate two models of dietary intervention, and the relationship with adherence to treatment and impact on clinical improvement of patients with metabolic syndrome. METHODS: Randomized clinical trial, lasting four months. Participants were randomized assigned to the intervention or control group. Both groups were instructed to follow a diet for 4 months. Subjects in the intervention group additionally received an intervention package, with metabolic syndrome manual book, telephone counseling and nutrition education leaflets. In both groups nutritional anamnesis, anthropometric assessment, dietary assessment, individualized dietary and biochemical tests were done. RESULTS: Patients who arrived more motivated were those who has the greatest reduction in the values of body mass index, which decreased from 31.7 kg/m² (SD ± 3.9) to 30.9 kg/m² (SD ± 3.8), reduction in waist circumference was 108.1 cm (SD ± 9.8) to 105.9 cm (SD ± 9.5). The statistically significant associations were in the correlation between body mass index, blood glucose and triglycerides, reducing the consumption of whole milk, increased consumption of whole grains and skimmed milk and between the increase in vegetable intake and reducing triglycerides. CONCLUSION: Both groups showed significant improvement in all clinical parameters that was significantly associated with the previous motivation. Patients who arrived more motivated were those who responded better to treatment.

Nutritional intervention and the impact on adherence to treatment in patients with metabolic syndrome.

BACKGROUND: Metabolic syndrome is associated with increased risk of cardiovascular events disease and type 2 diabetes. Treatment includes modifications on life style, diet and physical activity. Treatment adherence plays a crucial role in the successful treatment of this disease. OBJECTIVE: To evaluate two models of dietary intervention, and the relationship with adherence to treatment and impact on clinical improvement of patients with metabolic syndrome. METHODS: Randomized clinical trial, lasting four months. Participants were randomized assigned to the intervention or control group. Both groups were instructed to follow a diet for 4 months. Subjects in the intervention group additionally received an intervention package, with metabolic syndrome manual book, telephone counseling and nutrition education leaflets. In both groups nutritional anamnesis, anthropometric assessment, dietary assessment, individualized dietary and biochemical tests were done. RESULTS: Patients who arrived more motivated were those who has the greatest reduction in the values of body mass index, which decreased from 31.7 kg/m² (SD ± 3.9) to 30.9 kg/m² (SD ± 3.8), reduction in waist circumference was 108.1 cm (SD ± 9.8) to 105.9 cm (SD ± 9.5). The statistically significant associations were in the correlation between body mass index, blood glucose and triglycerides, reducing the consumption of whole milk, increased consumption of whole grains and skimmed milk and between the increase in vegetable intake and reducing triglycerides. CONCLUSION: Both groups showed significant improvement in all clinical parameters that was significantly associated with the previous motivation. Patients who arrived more motivated were those who responded better to treatment.