Receitas culinárias indígenas Guarani-Kaiowá e Terena na escola / Indigenous culinary recipes Guarani-Kaiowá and Terena at school

Este e-book, desenvolvido pelo Centro Colaborador em Alimentação e Nutrição Escolar (Cecane) da Universidade Federal de Mato Grosso do Sul (UFMS), apresenta receitas da culinária indígena Terena e Guarani Kaiowá, com suas respectivas Fichas Técnicas de Preparação (FTP). As receitas foram obtidas a partir de visitas e conversas informais com indígenas das etnias Guarani Kaiowá e Terena, nas Terras Indígenas Caarapó (Caarapó-MS), Limão Verde (Aquidauana-MS) e Nioaque (Nioaque-MS) e podem ser utilizadas como opções de preparações nos cardápios da alimentação escolar indígena das respectivas etnias, desde que façam parte da cultura alimentar daquela aldeia ou Terra Indígena e tenham boa aceitabilidade pelos escolares. O e-book também pode ser utilizado por indivíduos da comunidade em geral, que tenham interesse na culinária Guarani Kaiowá e Terena. A partir das visitas realizadas, por meio de conversas informais com membros das comunidades indígenas, foram registradas preparações culinárias Guarani Kaiowá e Terena. Posteriormente, as receitas obtidas nas visitas foram reproduzidas no Laboratório de Técnica Dietética e Gastronomia da UFMS e padronizadas através de Fichas Técnicas de Preparação. As fichas técnicas são instrumentos essenciais no planejamento de cardápios e se caracterizam por conter todas as informações necessárias para o desenvolvimento de uma preparação culinária, como as quantidades dos ingredientes em gramas/mililitros e também em medidas caseiras, indicadores culinários como fator de correção, rendimento da preparação, além de custo e valor nutricional. A Resolução CD/FNDE nº 06/2020, que regulamenta o PNAE, exige a Ficha Técnica de Preparação para todas as preparações do cardápio da alimentação escolar. Assim, o presente e-book traz preparações da culinária indígena Guarani Kaiowá e Terena com suas respectivas Fichas Técnicas de Preparação. O presente e-book teve por objetivo elaborar Fichas Técnicas de Preparações de receitas culinárias das etnias Guarani Kaiowá e Terena para encorajar seu uso na alimentação escolar indígena e assim buscar o pleno cumprimento do Programa Nacional de Alimentação Escolar (PNAE), o qual fortalece as políticas públicas de Segurança Alimentar e Nutricional, e assume papel fundamental para a promoção da saúde dos povos indígenas. Embora ainda existam muitos desafios no campo da nutrição a serem enfrentados no Brasil, a implementação e inserção de políticas públicas torna mais justo o acesso à alimentação adequada e saudável, combatendo todas as formas de má nutrição no país, numa abordagem focada em minimizar a problemática em saúde associada à alimentação nas comunidades vulneráveis, principalmente dos povos indígenas.

Receitas padronizadas da alimentação escolar indígena de Mato Grosso do Sul / Recettes normalisées de l'alimentation scolaire indigène du Mato Grosso do Sul

Diante das dificuldades em padronizar fichas técnicas de preparações culinárias por parte dos profissionais atuantes na alimentação escolar, o CECANE/UFMS se propôs em realizar a elaboração de um receituário padrão. Tal documento tem o objetivo de auxiliar no planejamento, organização e execução do preparo das refeições nas escolas, de modo que este receituário se constitua como um instrumento de auxílio para melhor execução do PNAE nas escolas indígenas. Acompanhando o cenário nacional, a população indígena de Mato Grosso do Sul vem sofrendo com a insegurança alimentar e nutricional devido à carência de ingestão de proteínas, vitaminas e minerais, ocasionada pela redução do consumo de alimentos in natura e pelo aumento da oferta e acesso a alimentos industrializados com alto teor de açúcares, gorduras e aditivos alimentares. Essa situação é causada pela mudança dos hábitos alimentares ocasionada pela influência da população não-indígena, pela diminuição das terras indígenas, mudanças climáticas e escassez de alimentos (CHAMORRO; COMBÈS, 2015). Nesse contexto, o suporte governamental manifesto por meio da implantação de programas sociais e políticas públicas de alimentação e nutrição são ferramentas de extrema importância para combate à fome, garantia do direito à alimentação adequada e saudável, assim como a manutenção das tradições indígenas (CHAMORRO; COMBÈS, 2015). Dentre as ferramentas governamentais existentes para promover a Segurança Alimentar e Nutricional (SAN) no âmbito escolar, o PNAE desponta como um programa federal bem consolidado que viabiliza recursos financeiros para a alimentação dos estudantes e para ações de Educação Alimentar e Nutricional (EAN) nas comunidades (BRASIL, 2020). Os ditos materiais desenvolvidos pelo CECANE/UFMS visam tratar de temas tais quais o acesso aos alimentos de forma igualitária, bem como apoiar o desenvolvimento sustentável por meio do incentivo à compra de diferentes gêneros alimentícios produzidos pela agricultura familiar e pelos empreendedores familiares rurais, principalmente aqueles das comunidades tradicionais indígenas e quilombolas. Como disposto na legislação em relação aos cardápios escolares, seu planejamento e execução devem ser feitos pelo Responsável Técnico (RT) do PNAE, priorizandose a utilização de alimentos in natura ou minimamente processados, respeitando as necessidades nutricionais das respectivas faixas etárias, os hábitos alimentares locais, e atendendo às especificidades culturais das comunidades tradicionais, além de defender a sustentabilidade, sazonalidade e diversidade agrícola da região (BRASIL, 2020).

Carbohydrate Considerations for Athletes with a Spinal Cord Injury.

The Paralympic movement is growing in popularity, resulting in increased numbers of athletes with a spinal cord injury (SCI) competing in various sport disciplines. Athletes with an SCI require specialized recommendations to promote health and to maximize performance, as evidenced by their metabolic and physiological adaptations. Nutrition is a key factor for optimal performance; however, scientifically supported nutritional recommendations are limited. This review summarizes the current knowledge regarding the importance of carbohydrates (CHO) for health and performance in athletes with an SCI. Factors possibly affecting CHO needs, such as muscle atrophy, reduced energy expenditure, and secondary complications are analyzed comprehensively. Furthermore, a model calculation for CHO requirements during an endurance event is provided. Along with assessing the effectiveness of CHO supplementation in the athletic population with SCI, the evaluation of their CHO intake from the available research supplies background to current practices. Finally, future directions are identified. In conclusion, the direct transfer of CHO guidelines from able-bodied (AB) athletes to athletes with an SCI does not seem to be reasonable. Based on the critical role of CHOs in exercise performance, establishing recommendations for athletes with an SCI should be the overall objective for prospective research.

Nutrient Requirements during Pregnancy and Lactation.

A woman's nutritional status during pregnancy and breastfeeding is not only critical for her health, but also for that of future generations. Nutritional requirements during pregnancy differ considerably from those of non-pregnant women. Thus, a personalized approach to nutritional advice is recommended. Currently, some countries recommend routine supplementation for all pregnant women, while others recommend supplements only when necessary. Maternal physiological adaptations, as well as nutritional requirements during pregnancy and lactation, will be reviewed in the literature examining the impacts of dietary changes. All of these data have been studied deeply to facilitate a discussion on dietary supplement use and the recommended doses of nutrients during pregnancy and lactation. The aim of this review is to evaluate the knowledge in the scientific literature on the current recommendations for the intake of the most common micronutrients and omega-3 fatty acids during pregnancy and lactation in the United States, Canada, and Europe. Taking into account these considerations, we examine minerals, vitamins, and omega-3 fatty acid requirements. Finally, we conclude by discussing the potential benefits of each form of supplementation.

Calcium and available phosphorus requirements of Japanese quails in early egg-laying stage.

An experiment was conducted to estimate the nutritional requirements of calcium (Ca) and available phosphorus (aP) for Japanese quails (Coturnix coturnix japonica) in the egg-laying stage (64-168 D). The experiment was an entirely randomized design, in a factorial scheme (Ca = 1.70, 2.40, 3.10, and 3.80% and aP = 0.15, 0.30, 0.45, and 0.60%), with 3 replicates and 10 quails per experimental unit. No interactions were found for quail body weight and daily feed intake (DFI) (P > 0.05). However, body weight decreased linearly (P < 0.05) as the levels of Ca increased, whereas DFI exhibited a quadratic effect (P < 0.05) for both Ca and aP. The lowest values of DFI were estimated in 2.79 and 0.36% for Ca and aP, respectively. Egg production, egg mass, and feed conversion ratio per egg dozen presented significant interaction in which all of them had a quadratic effect (P < 0.05), with estimations for maximum yield in feed containing 2.74, 2.71, 2.75, and 2.74% Ca and 0.40, 0.39, 0.39, and 0.40% aP. The concentration of Ca in the eggshell increased linearly as per the levels of Ca studied, having a quadratic effect for aP levels, with a maximum point of 0.44%. In relation to the bone parameters, there was a linear interaction for Ca and aP in bone density and bone resistance (BR) of the femur, with a quadratic effect in BD estimating 2.84 and 0.50% for Ca and aP, respectively. In BR, the estimation was 3.27% Ca, with linear increase for aP. The BR of the tibiotarso increased linearly as per the Ca levels, obtaining the same Ca concentration response in this bone. As conclusion, when considering the estimations obtained through overlapped contour plots, the best responses to the effects of Ca and aP on productive characteristics were estimated at 2.68% Ca and 0.38% aP to produce feed for egg-laying Japanese quails.

Vitamins and carotenoids in human milk delivering preterm and term infants: Implications for preterm nutrient requirements and human milk fortification strategies.

Differences in vitamin and carotenoids content of human milk (HM) produced for infants born at term and preterm is poorly understood. In this study, HM was collected weekly for four and two months post-partum for preterm and term groups, respectively. Nutrients of interest, from single full breast expressions were measured by liquid chromatography coupled with mass spectrometry. Microbiological assay was employed for vitamin B12. When compared at equivalent post-partum age, vitamins B1, B2, B6, and B9 were significantly higher in preterm than in term HM, but only during the first two weeks. No significant differences were observed for A, E, B3 and B12 between groups. Lycopene was the only carotenoid exhibiting a significant higher concentration in term than in preterm HM between weeks 1 and 4 post-partum. When compared at equivalent post-menstrual age, preterm milk was significantly higher for vitamins B1, B2, B3, B6 and B9 and lower levels of vitamins A, E, ß-carotene, ß-cryptoxanthin, lutein, zeaxanthin and lycopene compared to their term counterparts. These results suggest that preterm breastfed infants at term equivalent age may receive lower amounts of these micronutrients than breast-fed term neonates, possibly highlighting the need to supplement or fortify their nutritional intake with vitamins and carotenoids. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT #02052245.

Nutritional Considerations and Strategies to Facilitate Injury Recovery and Rehabilitation.

Nutritional interventions are not commonly a standard of care in rehabilitation interventions. A nutritional approach has the potential to be a low-cost, high-volume strategy that complements the existing standard of care. In this commentary, our aim is to provide an evidence-based, practical guide for athletes with injuries treated surgically or conservatively, along with healing and rehabilitation considerations. Injuries are a normal and expected part of exercise participation. Regardless of severity, an injury typically results in the athlete's short- or long-term removal from participation. Nutritional interventions may augment the recovery process and support optimal healing; therefore, incorporating nutritional strategies is important at each stage of the healing process. Preoperative nutrition and nutritional demands during rehabilitation are key factors to consider. The physiological response to wounds, immobilization, and traumatic brain injuries may be improved by optimizing macronutrient composition, caloric consumption, and nutrient timing and using select dietary supplements. Previous research supports practical nutrition recommendations to reduce surgical complications, minimize deficits after immobilization, and maximize the chance of safe return to play. These recommendations include identifying the individual's caloric requirements to ensure that energy needs are being met. A higher protein intake, with special attention to evenly distributed consumption throughout the day, will help to minimize loss of muscle and strength during immobilization. Dietary-supplement strategies may be useful when navigating the challenges of appropriate caloric intake and timing and a reduced appetite. The rehabilitation process also requires a strong nutritional plan to enhance recovery from injury. Athletic trainers, physical therapists, and other health care professionals should provide basic nutritional recommendations during rehabilitation, discuss the timing of meals with respect to therapy, and refer the patient to a registered dietitian if warranted. Because nutrition plays an essential role in injury recovery and rehabilitation, nutritional interventions should become a component of standard-of-care practice after injury. In this article, we address best practices for implementing nutritional strategies among patients with athletic injuries.

Modeling Possible Outcomes of Updated Daily Values on Nutrient Intakes of the United States Adult Population.

The United States (US) Food and Drug Administration has updated the Daily Values (DVs) for the Nutrition Facts Label on packaged foods. We used the National Health and Nutrition Examination Survey 2009-2012 data with the International Life Sciences Institute, North America Fortification Database, which identifies intrinsic, mandatory enriched, and fortified sources of nutrients in foods and beverages, to model the new DVs' potential impact on adult (≥19 years of age) intake. We assumed that manufacturers will adjust voluntary fortification to maintain percent DV claims. We assessed the percent of the US population whose usual intake (UI) was < the Estimated Average Requirement (EAR), and ≥ the Upper Limit (UL) based on the current DVs, and modeled estimated UI and %

How complementary feeding in infants affects allergies, chronic disease, and neurodevelopment.

Recommendations for the timing and type of complementary foods to introduce to infants have recently changed. These changes are due to increased understanding of how these foods affect the development of food allergies, risk for obesity and other chronic diseases, and infant neurodevelopment. This article brings the current recommendations and recent research together and organizes them for clinicians in pediatrics to enable them to understand and convey this information to parents of infants.

Iron intake and iron status during pregnancy and risk of congenital heart defects: A case-control study.

BACKGROUND: The relationships between iron nutritional status and congenital heart defects (CHDs) among humans are still unclear. This study aimed to explore the associations of maternal iron intake during pregnancy and maternal and neonatal iron status with CHDs. METHODS: This hospital-based case-control study analyzed 474 cases and 948 controls in Shaanxi China. Eligible women waiting for delivery in the hospital were interviewed to report their diets and characteristics during pregnancy. We conveniently collected maternal blood before delivery and neonatal cord blood to get a subgroup of 50 cases and 100 controls. Mixed logistic regression models were used to estimate ORs (95%CIs) for CHDs associated with iron intake. Mixed linear regression models were used to assess the relationships between CHDs and iron status. RESULTS: Mothers whose fetuses have CHDs were less likely to have higher intakes of total iron and heme iron during pregnancy, and the tests for linear trend were significant (all P < 0.05). Mothers whose fetuses have CHDs were less likely to take iron supplements during pregnancy (OR = 0.28, 95%CI: 0.21, 0.36) and during the first trimester (OR = 0.32, 95%CI: 0.12, 0.84). Maternal SF and Hb concentrations before delivery were lower and maternal sTfR/SF before delivery was higher among the cases than the controls. CONCLUSIONS: Mothers whose fetuses have CHDs are less likely to have higher intakes of total iron and heme iron and take iron supplements during pregnancy compared to their counterparts. Maternal iron status before delivery is low among mothers whose fetuses have CHDs.

Daily Iron Requirements in Healthy Indian Children and Adolescents.

OBJECTIVE: This study aimed to define the estimated average requirement and the recommended dietary allowance of iron for Indian children and adolescents. Methods: The Estimated average requirement was derived for children aged 1-17y, from the mean bioavailability-adjusted daily physiological iron requirement, which in turn was estimated using a factorial method. This consisted of mean daily iron losses from the body and additional iron required for tissue growth and storage, while also defining the variance of each factor to derive the Recommended dietary allowance. RESULTS: Results: The estimated average requirement of iron for children ranged from 5.6 to 11.0 mg/d in children aged 1-9y. For adolescents aged 10-17y, these ranged from 10.8 to 18.4 mg/d and 15.4 to 18.5 mg/d for adolescent boys and girls, respectively. CONCLUSIONS: New estimates of estimated average requirement for iron in Indian children are presented, and same may be used to inform iron supplementation and food fortification policies.

Composition requirements of follow-up formula for 6-12-month-old infants: recommendations of a Chinese expert group.

BACKGROUND AND OBJECTIVES: The Chinese national standard of formula for 6-12-month-old infants (GB 10767- 2010) requires review and revision because it does not correspond to current scientific knowledge and data. The aim of this paper was to summarize the formula composition recommended for 6-12-month-old infants by a Chinese expert group. METHODS AND STUDY DESIGN: Formula composition recommendations for 6-12-month-old infants were devised by a Chinese expert group based on a detailed systematic review, which included nutrient intake, nutrient content of Chinese women's breast milk, and the latest adequate intake and tolerable upper intake levels, also referencing the Codex Alimentarius recommendations and those of other countries and considering the practice in products on the market. RESULTS: Compared with current standards, it was recommended that most compositional requirements be modified, including decreasing the maximum energy density from 85 to 75 kcal/100 mL, decreasing the protein content in milk-based formula from 2.9-5.0 g/100 kcal to 1.8-3.5 g/100 kcal, increasing the minimum content of lipids from 2.9 g/100 kcal to 3.5 g/100 kcal, providing the maximum amount of vitamins and minerals (including vitamin E, vitamin K, thiamin, riboflavin, vitamin B-6, vitamin B-12, niacin, folic acid, pantothenic acid, vitamin C, biotin, magnesium, calcium, phosphorus, and iodine), and changing the content of optional components such as taurine, docosahexaenoic acid, and arachidonic acid. CONCLUSIONS: These nutrient standard modifications based on recent evidence are expected to enhance feeding practices and further guarantee the health of 6-12-month-old infants in China.

Nutritional Interventions for Elderly and Considerations for the Development of Geriatric Foods.

The process of aging is characterized by numerous changes in the body which has an overall negative effect on the health and lifestyle of elderly. Nutrition deserves special attention as an individual reaches old age. It plays a vital role in affecting the quality of life, including physical, mental and social health. The physiological decline in food intake is very common among older age and this result in nutritional deficiencies. These increased nutritional deficiencies are the major risk factors for certain chronic diseases and deteriorated age related health. Thus, the adoption of nutritional intervention can be a measure to tackle the current situation of nutritional deficiencies and promote a healthy lifestyle.

Individual participant data (IPD)-level meta-analysis of randomised controlled trials among dark-skinned populations to estimate the dietary requirement for vitamin D.

BACKGROUND: Estimation of the dietary requirements for vitamin D is crucial from a public health perspective in providing a framework for the prevention of vitamin D deficiency. It has been shown that pooling individual participant-level data (IPD) from selected randomised controlled trials (RCTs) of white children and adults facilitated the generation of more accurate estimates of the vitamin D requirement. Recent RCT data suggest the vitamin D requirement of dark-skinned, particularly black, individuals, an at-risk group of vitamin D deficiency, is greater than those of white counterparts. Thus, we wished to develop a study protocol for the conduct of an IPD-level meta-analysis of vitamin D requirements using data from appropriate vitamin D RCTs in dark-skinned population subgroups. METHODS: The study protocol details the steps needed within such an IPD meta-analysis which will include its registration, constituent systematic review to identify all appropriate RCTs on the basis of pre-specified eligibility criteria, the associated data collection, handling, and synthesis, as well as checking the integrity of the IPD, followed by implementation of a one/two-stage IPD meta-analysis and derivation of vitamin D requirement estimates. DISCUSSION: As dark-skinned population subgroups are at increased risk of vitamin D deficiency, further investigation of dietary recommendations for vitamin D in these subgroups is needed. We strongly believe that application of an IPD-based meta-analysis is a highly strategic approach by which to undertake some of this further investigation. Such IPD-based analysis, however, will need collaboration across the principal investigators of the identified RCTs meeting with the eligibility criteria, and the availability of this study protocol will be important to highlight the potential of IPD-based analysis for estimation of the dietary requirement for vitamin D for this particular population subgroup as well as for other at-risk target populations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews (registration number: CRD42018092343).

Vitamin C: should we supplement?

PURPOSE OF REVIEW: Hypovitaminosis C and vitamin C deficiency are very common in critically ill patients due to increased needs and decreased intake. Because vitamin C has pleiotropic functions, deficiency can aggravate the severity of illness and hamper recovery. RECENT FINDINGS: Vitamin C is a key circulating antioxidant with anti-inflammatory and immune-supporting effects, and a cofactor for important mono and dioxygenase enzymes. An increasing number of preclinical studies in trauma, ischemia/reperfusion, and sepsis models show that vitamin C administered at pharmacological doses attenuates oxidative stress and inflammation, and restores endothelial and organ function. Older studies showed less organ dysfunction when vitamin C was administered in repletion dose (2-3 g intravenous vitamin C/day). Recent small controlled studies using pharmacological doses (6-16 g/day) suggest that vitamin C reduces vasopressor support and organ dysfunction, and may even decrease mortality. SUMMARY: A short course of intravenous vitamin C in pharmacological dose seems a promising, well tolerated, and cheap adjuvant therapy to modulate the overwhelming oxidative stress in severe sepsis, trauma, and reperfusion after ischemia. Large randomized controlled trials are necessary to provide more evidence before wide-scale implementation can be recommended.

[Refeeding syndrome : Pathophysiology, risk factors, prevention, and treatment]. / Refeeding-Syndrom : Pathophysiologie, Risikofaktoren, Prophylaxe und Therapie.

Refeeding syndrome is a life-threatening complication that may occur after initiation of nutritional therapy in malnourished patients, as well as after periods of fasting and hunger. Refeeding syndrome can be effectively prevented and treated if its risk factors and pathophysiology are known. The initial measurement of thiamine level and serum electrolytes, including phosphate and magnesium, their supplementation if necessary, and a slow increase in nutritional intake along with close monitoring of serum electrolytes play an important role. Since refeeding syndrome is not well known and the symptoms can be extremely heterogeneous, this complication is poorly recognized, especially against the background of severe disease and multimorbidity. This overview aims to summarize the current knowledge and increase awareness about refeeding syndrome.

Estimate of choline nutritional requirements for chicks from 1 to 21 days of age.

Choline is an essential nutrient in poultry diets because it performs various important metabolic functions. The objective of this study was to re-evaluate the choline requirements of male broiler chickens from 1 to 21 days of age at two levels of methionine. Two assays using 2,160 Cobb® chickens (1,080 in each assay) were conducted. The study design was completely randomized and consisted of six treatments and six replicates, with 30 animals per experimental unit. The semipurified basal diet was formulated with corn, soya bean meal, soya protein concentrate, starch and sugar, providing 390 mg/kg choline and 0.593% digestible methionine (requirement level) in Assay 1 and a reduction of about one-quarter in the requirement level of digestible methionine (0.440%) in Assay 2. Choline chloride (62.5%) was added by a supplementation technique to both basal diets to compose crescent levels of choline supplementation (715, 1,040, 1,365, 1,690 and 2,015 mg/kg). The weight gain responses were fitted using quadratic polynomial (QP) and broken-line (BL) models. The ideal intake of choline (mg/bird.day) was estimated from the first intercept of the QP with the BL plateau (BL + QP). The results showed that the diet with the 25% reduction in digestible methionine limited the maximum weight gain by approximately 10%. The choline requirements of broilers from 1 to 7, 1 to 14 and 1 to 21 days of age were 27,013, 44,458 and 62,535 mg/bird.day, respectively, for the requirement level of digestible methionine and 26,796, 41,820 and 56,578 mg/bird.day for the broilers receiving the diet with the 25% reduction in digestible methionine.

Avaluació de les aportacions nutricionals en els lactants amb bronquiolitis aguda greu / Evaluación de los aportes nutricionales en los lactantes con bronquiolitis aguda grave / Nutritional support for infants with severa bronchiolitis

Fonament: la bronquiolitis és la causa més freqüent d'infecció de les vies respiratòries baixes en els lactants, i d'ingrés hospitalari en menors d'un any. Segons la litera-tura, entre el 3 i l'11% dels pacients haurà d'ingressar a una unitat de cures intensives pediàtriques (UCIP), i veurà compromesa la ingesta oral, tenint en compte la gravetat clínica del pacient. En la literatura s'ha demostrat que la nutrició enteral (NE) precoç és beneficiosa i que un balanç hídric i ingesta calòrica adequats en milloren l'evolució. Objectiu: conèixer el tipus d'alimentació i l'aportació calòrica que reben els pacients amb bronquiolitis aguda ingressats en una UCIP, així com el balanç de líquids. Mètode: estudi prospectiu, descriptiu i observacional dels pacients amb diagnòstic de bronquiolitis aguda que van ingressar a la UCIP, entre l'1 d'octubre de 2014 i el 15 de maig de 2015. Entre altres variables, es van analitzar el tipus d'alimentació, la via d'administració, l'aportació calòrica, les entrades i sortides de líquids, i el balanç hídric diari, durant l'ingrés de cada pacient. Resultats: es van incloure 36 pacients. Durant el primer dia d'ingrés, 21 pacients (58,3%) van restar a dieta absoluta i 12 (33,3%) van iniciar NE de forma progressiva. Posteriorment les entrades enterals i, conseqüentment, l'aportació calòrica van anar ascendent progressivament; tot i així la mediana d'aportacions calòriques va ser de 70,5 kcal/kg/dia (rang interquartílic 1,30-83,10). Conclusions: l'aportació nutricional no va ser òptima durant l'estada a la UCIP, especialment els primers dies d'ingrés. Recomanem iniciar precoçment la NE i, si les condicions clíniques no ho permeten, valorar l'administració de nutrició parentera

Fundamento. La bronquiolitis es la causa más frecuente de infección de las vías respiratorias bajas en lactantes, y de ingreso hospitalario en menores de un año. Según la literatura, entre el 3 i el 11% de pacientes tendrá que ingresar en una unidad de cuidados intensivos pediátricos (UCIP), y verá comprometida la ingesta oral, dada la gravedad clínica del paciente. En la literatura se ha demostrado que la nutrición enteral (NE) precoz es beneficiosa y que un balance hídrico e ingesta calórica adecuados mejoran su evolución. Objetivo. Conocer el tipo de alimentación y el aporte calórico que reciben los pacientes con bronquiolitis aguda ingresados en una UCIP. Método. Estudio prospectivo, descriptivo y observacional de los pacientes con diagnóstico de bronquiolitis aguda que ingresaron en la UCIP entre el 1 de octubre de 2014 y el 15 de mayo de 2015. Entre otras variables, se recogieron y analizaron el tipo de alimentación y vía de alimentación, el aporte calórico, las entradas y salidas de líquidos, y el balance hídrico diario, para cada paciente. Resultados. Se incluyeron 36 pacientes. Durante el primer día de ingreso, 21 pacientes (58,3%) estuvieron a dieta absoluta y 12 (33,3%) iniciaron NE de forma progresiva. Posteriormente, las entradas enterales y el aporte calórico fueron aumentando progresivamente; aun así, la mediana de aportes calóricos fue de 70,5 kcal/kg/día (rango intecuartílico 61,30-83,10). Conclusiones. El aporte nutricional no fue óptimo durante la estancia en la UCIP, especialmente en los primeros días de ingreso. Recomendamos iniciar precozmente la NE y, si las condiciones clínicas no lo permiten, valorar la administración de nutrición parenteral (AU)

Background. Bronchiolitis is the most frequent cause of lower respiratory tract infection and hospitalization in infants. Reports suggest that between 3% and 11% of children with bronchiolitis require admission in the pediatric critical care unit (PICU) and have severe limitations to caloric intake. The early introduction of enteral nutritional support is beneficial, and an appropriate fluid balance and caloric intake has shown to impact outcome. Objective. To investigate the type of nutrition, caloric intake, and fluid balance in patients with acute bronchiolitis admitted to a PICU. Method. Prospective, descriptive, and observational study of patients with acute bronchiolitis admitted to the PICU at our center between October 1st 2014 and May 15th 2015. Among other variables, we collected and analyzed the type and route of nutrition, the caloric intake, and the fluid balance throughout the admission of each patient. Results. 36 patients were included. During the first day of admission 21 patients (58.3%) were kept nil per os and 12 patients (33.3%) started enteral nutrition. Subsequently the enteral support increased gradually in all patients; nevertheless, the mean of caloric intake was 70.5 kcal/kg/day (interquartile range 62.3-83.1). Conclusions.The nutritional intake was not optimal during the PICU admission, especially during the first days of admission. We recommend starting early enteral nutrition and if the clinical condition contraindicates this approach, consider the administration of parenteral nutrition (AU)

Comparing nutritional requirements, provision and intakes among patients prescribed therapeutic diets in hospital: An observational study.

OBJECTIVE: Nutrition is an important part of recovery for hospitalized patients. The aim of this study was to assess the nutritional adequacy of meals provided to and consumed by patients prescribed a therapeutic diet. METHODS: Patients (N = 110) prescribed a therapeutic diet (texture-modified, low-fiber, oral fluid, or food allergy or intolerance diets) for medical or nutritional reasons were recruited from six wards of a tertiary hospital. Complete (24-h) dietary provisions and intakes were directly observed and analyzed for energy (kJ) and protein (g) content. A chart audit gathered demographic, clinical, and nutrition-related information to calculate each patient's disease-specific estimated energy and protein requirements. Provisions and intake were considered adequate if they met ≥75% of the patient's estimated requirements. RESULTS: Mean energy and protein provided to patients (5844 ± 2319 kJ, 53 ± 30 g) were significantly lower than their mean estimated requirements (8786 ± 1641 kJ, 86 ± 18 g). Consequently, mean nutrition intake (4088 ± 2423 kJ, 37 ± 28 g) were significantly lower than estimated requirements. Only 37% (41) of patients were provided with and 18% (20) consumed adequate nutrition to meet their estimated requirements. No therapeutic diet provided adequate food to meet the energy and protein requirements of all recipients. Patients on oral fluid diets had the highest estimated requirements (9497 ± 1455 kJ, 93 ± 16 g) and the lowest nutrient provision (3497 ± 1388 kJ, 25 ± 19 g) and intake (2156 ± 1394 kJ, 14 ± 14 g). CONCLUSION: Hospitalized patients prescribed therapeutic diets (particularly fluid-only diets) are at risk for malnutrition. Further research is required to determine the most effective strategies to improve nutritional provision and intake among patients prescribed therapeutic diets.

Bioenergetics-based modeling of Plasmodium falciparum metabolism reveals its essential genes, nutritional requirements, and thermodynamic bottlenecks.

Novel antimalarial therapies are urgently needed for the fight against drug-resistant parasites. The metabolism of malaria parasites in infected cells is an attractive source of drug targets but is rather complex. Computational methods can handle this complexity and allow integrative analyses of cell metabolism. In this study, we present a genome-scale metabolic model (iPfa) of the deadliest malaria parasite, Plasmodium falciparum, and its thermodynamics-based flux analysis (TFA). Using previous absolute concentration data of the intraerythrocytic parasite, we applied TFA to iPfa and predicted up to 63 essential genes and 26 essential pairs of genes. Of the 63 genes, 35 have been experimentally validated and reported in the literature, and 28 have not been experimentally tested and include previously hypothesized or novel predictions of essential metabolic capabilities. Without metabolomics data, four of the genes would have been incorrectly predicted to be non-essential. TFA also indicated that substrate channeling should exist in two metabolic pathways to ensure the thermodynamic feasibility of the flux. Finally, analysis of the metabolic capabilities of P. falciparum led to the identification of both the minimal nutritional requirements and the genes that can become indispensable upon substrate inaccessibility. This model provides novel insight into the metabolic needs and capabilities of the malaria parasite and highlights metabolites and pathways that should be measured and characterized to identify potential thermodynamic bottlenecks and substrate channeling. The hypotheses presented seek to guide experimental studies to facilitate a better understanding of the parasite metabolism and the identification of targets for more efficient intervention.