The Perception of Vitamins and Their Prevalence in Fortified Food and Supplements in Japan.

Most vitamins are primarily ingested from foods. However, it has been reported that intakes of some vitamins do not meet the nutrition reference values even in high-income countries. In this case, vitamin-fortified foods and/or vitamin supplements are helpful to fix insufficient/deficient status. However, it is not clear whether consumers are aware of their nutritional status or whether they use these products efficiently. To address this issue, we conducted an online cross-sectional questionnaire survey among 14,741 Japanese adults (over 20 years old, 7489 males and 7252 females) concerning the perceptions and prevalence of vitamin-fortified food and/or vitamin supplements. Differences in distribution among groups were compared using the chi-squared test. According to dietary habits, 33.2% of the participants consumed a well-balanced diet every day, but 25.5% could not because of time (41.6%) or money (36.9%) constraints. The perception of each vitamin varied: the highest was for vitamin C (93.2%) and the lowest was for biotin (41.9%). In addition, only a portion of the participants believed that they took sufficient amounts of each vitamin; the highest was vitamin C (22.3%) and the lowest was biotin (5.2%). Despite this situation, most did not use vitamin-fortified food and/or vitamin supplements due to economic reasons. Among vitamin-fortified food and/or vitamin supplement users, the purposes for the usage of these products were varied, such as maintaining health (80.5%), supplementation of nutrients (47.8%), beauty-related purposes (27.5%), and to prevent infectious disease (23.2%). To remedy nutritional status in individuals, it is important to improve not only consumer awareness but also the environment, which can lead consumers to use acceptable vitamin products without any burden.

Awareness, perceptions and practices regarding cancer-related malnutrition and sarcopenia: a survey of cancer clinicians.

PURPOSE: Cancer-related malnutrition and sarcopenia have severe negative consequences including reduced survival and reduced ability to complete treatment. This study aimed to determine the awareness, perceptions and practices of Australian oncology clinicians regarding malnutrition and sarcopenia in people with cancer. METHODS: A national cross-sectional survey of Australian cancer clinicians was undertaken between November 2018 and January 2019. The 30-item online purpose-designed survey was circulated through professional organizations and health services. RESULTS: The 111 participants represented dietetic (38%), nursing (34%), medical (14%) and other allied health (14%) clinicians. Overall, 86% and 88% clinicians were aware of accepted definitions of malnutrition and sarcopenia, respectively. Perception of responsibility for identification of these conditions varied across participants, although 93% agreed this was a component of their role. However, 21% and 43% of clinicians had limited or no confidence in their ability to identify malnutrition and sarcopenia, respectively. Common barriers to the identification and management of malnutrition were access to the tools or skills required and a lack of services to manage malnourished patients. Common barriers to identification of sarcopenia were lack of confidence and lack of services to manage sarcopenic patients. Enablers for identification and management of malnutrition and sarcopenia were variable; however, training and protocols for management ranked highly. CONCLUSION: While awareness of the importance of cancer-related malnutrition and sarcopenia are high, participants identified substantial barriers to delivering optimal nutrition care. Guidance at a national level is recommended to strengthen the approach to management of cancer-related malnutrition and sarcopenia.

Ready-Made Oral Nutritional Supplements Improve Nutritional Outcomes and Reduce Health Care Use-A Randomised Trial in Older Malnourished People in Primary Care.

Large trials assessing oral nutritional supplements (ONS) and dietary advice (DA) in primary care are lacking. This study examined effects of ONS + DA versus DA on intake, weight, QoL, healthcare use and satisfaction in malnourished free-living older people. Three hundred and eight people (71.5 ± 10.7y) were randomised to receive ONS + DA (n154) or DA (n154) for 12 weeks. At baseline, 4, 8, 12 weeks, intake, weight, QoL, healthcare use and satisfaction were measured. ONS + DA group (mean daily intake ONS 480 kcal; 21 g protein; 80% compliance) had significantly greater total energy and protein intakes (+401 kcal/d, p < 0.001; +15 g/d, p < 0.001) and weight gain (+0.8 kg; p < 0.001) compared to DA. QoL improved in both groups over time with a significant improvement in index with ONS + DA (p = 0.009). Significantly more participants found ONS + DA made a difference for them (p = 0.011), but no differences were found between groups using Euroqol. Compared to DA, healthcare use reduced with ONS + DA, (HCP visits by 34%, emergency admissions 50%, LOS 62%). Acceptability of both interventions was high (ONS 96%, DA 95%), with significantly more participants satisfied with ONS (89%) than DA (73%) (p = 0.009). This trial in primary care indicates that ONS are acceptable, make a difference to patients, significantly improve intake and weight, and reduce health care use with potential savings.

Cancer-related malnutrition management: A survey among Italian Oncology Units and Patients' Associations.

Attitudes toward cancer-related malnutrition vary considerably among oncologists and nutritional support is often not handled according to the available guidelines. The Italian Association of Medical Oncology (AIOM), Italian Society of Artificial Nutrition and Metabolism (SINPE), Italian Federation of Volunteer-based Cancer Organizations (FAVO), and Fondazione AIOM Working Group conducted a national web-based survey addressed to all Italian Oncology Units referees and Italian Cancer Patients Associations. The aim was to investigate the current management of malnutrition and views on nutritional care among oncologists and patients. One hundred and seventy-one (51.6%) of the 331 registered Italian Oncology Units and 75 (38.5%) of the 195 FAVO local communities participated in the survey. Nutritional assessment and support were integrated into patient care from diagnosis for 35% of Oncology Unit referees and 15% of FAVO associates. According to 42% of oncologists, nutritional assessment was carried out only after patients requested it, while it was not performed at all for 45% of FAVO associates. Almost 60% of patient affiliates were not aware of clinical referrals for home artificial nutrition management. However, for almost all responders, the evaluation of nutritional status was considered crucial in predicting tolerance to anticancer treatment. Although malnutrition was considered a limiting factor in oncology treatments by both oncologists and patients, nutritional care practices still appear largely inappropriate. Attitudes differ between oncologists and patients, the latter reporting a more dissatisfied picture. Improving nutritional care in oncology remains a challenging task.

Evidence of gut enteropathy and factors associated with undernutrition among slum-dwelling adults in Bangladesh.

BACKGROUND: Adult undernutrition (BMI <18.5 kg/m2) is responsible for immune deficits, increased risk of disease burden, and higher rates of mortality. The prevalence of adult undernutrition in Bangladesh is substantial, but there have been few studies on the etiology of this condition for the inhabitants of urban slums. OBJECTIVE: The aim of this study was to identify the factors associated with undernutrition among slum-dwelling adults in Bangladesh. METHODS: A case-control study was conducted in the Bauniabadh area of Dhaka, Bangladesh. 270 adult participants (135 cases with a BMI <18.5 and 135 controls with a BMI between 18.5 and 24.9) aged 18-45 y were enrolled between October 2018 and January 2019. Sociodemographic variables, dietary diversity, micronutrient deficiencies, psychological symptoms, infection, and biomarkers of gut health were assessed to identify the factors associated with undernutrition using multivariable logistic regression analysis. RESULTS: A higher number of siblings [adjusted odds ratio (aOR): 1.39; 95% CI: 1.11, 1.77], increased self-reporting questionnaire-20 score (an instrument to screen mental health disorders and detect psychological symptoms) (aOR: 1.12; 95% CI: 1.04, 1.23), elevated fecal concentration of α-1 antitrypsin (aOR: 4.82; 95% CI: 1.01, 25.29), and anemia (aOR: 3.63; 95% CI: 1.62, 8.58) were positively associated with undernutrition in adults. Age (aOR: 0.90; 95% CI: 0.84, 0.96), dietary diversity score (aOR: 0.75; 95% CI: 0.56, 0.99), C-reactive protein (aOR: 0.82; 95% CI: 0.73, 0.92), Helicobacter pylori infection (aOR: 0.11; 95% CI: 0.05, 0.23), and always washing hands before eating or preparing foods (aOR: 0.33; 95% CI: 0.12, 0.87) were associated with reduced odds of undernutrition among the study population. CONCLUSIONS: Our results indicate that undernutrition in slum-dwelling adults in Bangladesh is associated with numerous physiological and sociodemographic factors, including evidence of gastrointestinal inflammation and altered intestinal permeability.

Role of astaxanthin in the modulation of brain-derived neurotrophic factor and spatial learning behavior in perinatally undernourished Wistar rats.

Objective: Maternal health and nutrition during the perinatal period is the predominant factor influencing the functional development of the brain. Maternal malnutrition during the perinatal period causes retardation of brain development. The current study investigates the role of Astaxanthin (AsX) in spatial learning and memory and BDNF in perinatally undernourished Wistar rats.Methods: The albino wistar rats were perinatally undernourished and administered with different dosages of AsX. The spatial learning and memory performance and BDNF level were assessed. Data were collected and analysed.Results: The % Correct choice during the acquisition phase, performance at the end of the acquisition phase and the mean BDNF level at the Hippocampus, Cerebellum, and Cerebral cortex showed significant decline (P<0.001) in the PUN group and significantly high (P<0.001) in the PUNA2 group compared to the control. However, the mean RME and mean WME during different days of the acquisition phase were significantly high (P<0.001) in the PUN group and insignificant (P>0.05) in PUNA2 compared to the control.Discussion: The results showed that AsX effectively modulated the cognitive deficit that occurred in perinatally undernourished rats. This can be attributed to BDNF upregulation as evidenced by the significant increase of the BDNF level.

Bayesian Methods for Exposure Misclassification Adjustment in a Mediation Analysis: Hemoglobin and Malnutrition in the Association Between Ascaris and IQ.

BACKGROUND: Soil-transmitted helminth infections have been found to be associated with child development. The objective was to investigate hemoglobin levels and malnutrition as mediators of the association between Ascaris infection and intelligence quotient (IQ) scores in children. METHODS: We conducted a longitudinal cohort study in Iquitos, Peru, between September 2011 and July 2016. A total of 1760 children were recruited at 1 year of age and followed up annually to 5 years. We measured Ascaris infection and malnutrition at each study visit, and hemoglobin levels were measured as of age 3. The exposure was defined as the number of detected Ascaris infections between age 1 and 5. We measured IQ scores at age 5 and used Bayesian models to correct exposure misclassification. RESULTS: We included a sample of 781 children in the analysis. In results adjusted for Ascaris misclassification, mean hemoglobin levels mediated the association between Ascaris infection and IQ scores. The natural direct effects (not mediated by hemoglobin) (95% CrI) and natural indirect effects (mediated by hemoglobin) (95% CrI) were compared with no or one infection: -0.9 (-4.6, 2.8) and -4.3 (-6.9, -1.6) for the effect of two infections; -1.4 (-3.8, 1.0) and -1.2 (-2.0, -0.4) for three infections; and -0.4 (-3.2, 2.4) and -2.7 (-4.3, -1.0) for four or five infections. CONCLUSION: Our results are consistent with the hypothesis that hemoglobin levels mediate the association between Ascaris infection and IQ scores. Additional research investigating the effect of including iron supplements in STH control programs is warranted.

A Combined Dietary and Cognitive Intervention in 3⁻5-Year-Old Children in Indonesia: A Randomized Controlled Trial.

Early childhood nutritional interventions typically combine nutritional and psychosocial stimulation. Such combined interventions result in long-lasting improvements of cognitive abilities in children who are malnourished. Here, we investigated potential cognitive abilities in normally developing children in Indonesia who were, however, at risk for suboptimal cognitive development due to little psychosocial stimulation in their home environment. In a randomized controlled intervention, children of the experimental group received nutritional supplementation combined with cognitive stimulation. Pre- and post-intervention measurements included cognitive development and functioning, behavior, and mother⁻child interaction. The experimental and control group received nutritional supplementation in the form of a fortified or unfortified milk powder, respectively. Additionally, the children and parents of the experimental group jointly engaged in daily learning activities at home and performed iPad-based tasks designed to foster cognitive abilities. The experimental group compared to the control group displayed a significantly higher increase in intelligence quotient as well as a significantly larger reduction in attentional problems after the intervention. These results indicate that low-level cognitive stimulation in combination with nutritional supplementation during early childhood can be an effective intervention that improves global cognitive functioning in healthy developing children. ClinicalTrials.gov Identifier: NCT02359669.

Prenatal undernutrition decreases the anorectic response to septic doses of lipopolysaccharides in adulthood in male rats.

Prenatal undernutrition affects some physiological functions after birth, and such changes are associated with the pathogenesis of various diseases. Recently, we have reported that prenatally undernourished male rats exhibited stronger febrile and anorectic responses to immune stress induced by moderate-dose lipopolysaccharide (LPS) treatment in adulthood. In the present study, we evaluated the effects of prenatal undernutrition on stress responses to the administration of a septic dose (3 mg/kg) of LPS in later life, mainly focusing on changes in hypothalamic proinflammatory cytokine expression. We also evaluated the expression of hypothalamic and peripheral reproductive factors because it has been suggested that the stress responses of reproductive functions are affected by prenatal and neonatal stress and nutritional conditions. As a result, we found that prenatal undernutrition attenuated the anorectic response to septic-dose LPS treatment in adulthood in male rats. In addition, it attenuated the LPS-induced suppression of serum testosterone levels and the changes in hypothalamic proinflammatory cytokine (interleukin (IL)-1ß, tumor necrosis factor-α, and IL-6) expression induced by septic-dose LPS treatment in adulthood. These results suggest that prenatal undernutrition attenuates stress and reproductive responses under severe immune stress conditions. The downregulation of hypothalamic stress-related factor expression might be involved in such attenuated stress responses, which could be one of the protective mechanisms used to prevent excessive immune responses and aid survival.

Targeting the pains of food insecurity and malnutrition among internally displaced persons with nutrient synergy and analgesics in organ meat.

Living with pain is one of the distressing effects of food insecurity and malnutrition among millions of internally displaced persons (IDPs) worldwide. Vulnerability to emotional pain, metabolic imbalance, chronic illnesses and non-communicable diseases by IDPs are associated with stressed livelihood and restricted access to balanced diets in their camps. Tackling the complexity of issues related to internal displacement is challenging as 45% are globally trapped in protracted conditions. In this review, a diet-based intervention is proposed considering the potential benefits of nutrient synergy and analgesic constituents in organ meat. Providing an affordable, value added and well packaged nutrient dense diet is suggested to meet daily protein and micronutrient requirements from organ meat. Also, unlocking health-promoting bioactive substances and analgesics in restructured organ meat product is proposed as personalized dietary remedy to exert opioid bioactivity in food matrix. Exploiting the nutrient synergy of this animal by-product will not only improve the nutritional status or wellbeing but also raise the composite score of dietary diversity or food security index among IDPs by 2030.

Nutritional Problems Affecting Older Adults.

Nutritional problems, such as malnutrition, dehydration, and electrolyte imbalance, are multifaceted and complex issues for older adults. This article describes these potential nutritional problems and then discusses evidence-based assessment strategies and treatment modalities that target these problems. Micronutrient deficiency is explored and evidence-based supplementation discussed. Many factors contribute to weight loss and malnutrition in older adults. These factors are classified as social, psychological, and/or biological. Addressing these issues and the influence of oral health on food intake are imperative to enhancing the overall quality of life for older adults.

The everyday food practices of community-dwelling Lesbian, Gay, Bisexual, and Transgender (LGBT) older adults.

Malnutrition during old age is a significant public health issue. Prevailing behavioral and structural senior malnutrition interventions have had marginal success, largely failing to reflect the realities of people's daily lives. This novel study employed Social Practice Theory (SPT) to explore the food practices of an under-researched, yet highly vulnerable, segment of the older adult population-Lesbian, Gay, Bisexual, and Transgender (LGBT) seniors. Four focus groups were conducted with 31 older adult clients and volunteers at a national LGBT social service and advocacy organization. Findings revealed that food practices-far from being mere expressions of individuals' choices or immutable habits-are entities composed of meanings, materials, and competences that are structured as they are performed repeatedly in a social context. Gaining insight into how and why diverse older adults perform food practices in light of obstacles common to aging has important implications for senior nutrition program and policy development.

Psychosocial factors influencing preferences for food and nutritional supplements among people living with HIV in Bangkok, Thailand.

Malnutrition and HIV are often coincident and may lead to wasting, a strong predictor of mortality. However; ready to use therapeutic foods (RUTF) are showing promising results in restoring the nutritional status of adult people living with HIV (PLHIV) in resource constrained settings but, its acceptability seems low. This study aimed to identify the psychosocial factors influencing general preferences for food and responses to five potential nutritional supplements to guide the development of novel products to treat malnutrition among PLHIV. This is a qualitative research based on Grounded Theory. In-depth interviews (IDIs) with a triangulation of data from different participants (i.e. PLHIV and Peer Counselors (PCs) were used as methods for data collection. During February-March 2013, 27 IDIs were conducted in the Anonymous Clinic of the Thai Red Cross and AIDS Research Center in Bangkok, Thailand. Five themes emerged: 1) local food culture is an important motive underlying the nutritional supplements choice by PLHIV; 2) food and drinks should have self-perceptible positive impact on health status and should be perceived convenient; 3) a soft and easy to swallow texture, softer scents and flavors are the major sensory characteristics guiding food and beverages choice; 4) food packaging characteristics affect nutritional supplement preference; 5) PCs may support nutritional supplement consumption. Similar findings emerged among PLHIV and PCs. This study highlights the need to develop a nutritional supplement considering the Thai culture and PLHIV's sensory preferences. A slightly thick liquid supplement, packed in small containers may be well-accepted. A combination of sensory studies and formative research should accompany the development of an alternative nutritional supplement for PLHIV. Results of this study might be transferable to similar sociocultural contexts.

Hyperglycemia and subsequent torsades de pointes with marked QT prolongation during refeeding.

OBJECTIVE: A fatal cardiac complication can occasionally present in malnourished patients during refeeding; this is known as refeeding syndrome. However, to our knowledge, hyperglycemia preceding torsades de pointes with QT prolongation during refeeding has not been reported. In the present study, we present a case in which hyperglycemia preceded torsades de pointes with QT prolongation during refeeding. The aim of this study was to determine the possible mechanism underlying QT prolongation during refeeding and indicate how to prevent it. METHODS: A 32-y-old severely malnourished woman (body mass index 14.57 kg/m2) was admitted to the intensive care unit of our institution after resuscitation from cardiopulmonary arrest due to ventricular fibrillation. She was diagnosed with anorexia nervosa. Although no obvious electrolyte abnormalities were observed, her blood glucose level was 11 mg/dL. A 12-lead electrocardiogram at admission showed sinus rhythm with normal QT interval (QTc 0.448). RESULTS: Forty mL of 50% glucose (containing 20 g of glucose) was intravenously injected, followed by a drip infusion of glucose to maintain blood glucose level within normal range. After 9 h, the patient's blood glucose level increased to 569 mg/dL. However, after 38 h, an episode of marked QT prolongation (QTc 0.931) followed by torsades de pointes developed. CONCLUSIONS: Hyperglycemia during refeeding can present with QT prolongation; consequently, monitoring blood glucose levels may be useful in avoiding hyperglycemia, which can result in QT prolongation. Furthermore, additional monitoring of QT intervals using a 12-lead electrocardiogram should allow the early detection of QT prolongation when glucose solution is administered to a malnourished patient with (severe) hypoglycemia.

Fibromyalgia and nutrition: what news?

Fibromyalgia syndrome (FM) is a chronic, generalised pain condition usually accompanied by several associated symptoms, such as fatigue, sleep disturbance, headache, irritable bowel syndrome and mood disorders. Different medical treatments are used to treat fibromyalgia and the recent guidelines suggest that the optimal treatment consists in a multidisciplinary approach with a combination of pharmacological and non-pharmacological treatment modalities. Among non-pharmacological treatment, nutrition is a promising tool for FM patients. The aim of this review is to update the present knowledge about fibromyalgia and nutrition by means of a systematic search performed on Medline from January 2000 to December 2014. Nutritional deficiencies have been described in FM patients and the benefits of specific diet and nutritional supplementation are shown. Obesity and overweight, often present in FM patients, are related to the severity of FM worsening the quality of life in terms of higher pain, fatigue, worsened sleep quality and higher incidence of mood disorders. Weight control is thus an effective tool to improve the symptoms. Moreover, it seems reasonable to eliminate some foods from the diet of FM patients, for example excitotoxins. Non-coeliac gluten sensitivity is increasingly recognised as a frequent condition with similar manifestations which overlap with those of FM. The elimination of gluten from the diet of FM patients is recently becoming a potential dietary intervention for clinical improvement. In summary, this review reveals the potential benefit of specific dietary interventions as non-pharmacological tools as part of a multidisciplinary treatment for FM patients.

Effect of a food supplementation and psychosocial stimulation trial for severely malnourished children on the level of maternal depressive symptoms in Bangladesh.

BACKGROUND: Maternal depression is associated with poor child development and growth in low-income countries. This paper evaluates the effect of a community-based trial providing psychosocial stimulation and food supplements to severely malnourished children on maternal depressive symptoms in Bangladesh. METHODS: Severely underweight (weight-for-age Z-score < -3) hospitalized children aged 6-24 months (n = 507), were randomly assigned to: psychosocial stimulation (PS), food supplementation (FS), PS+FS, clinic control (CC) and hospital control (CH) at discharge. PS included play sessions with children and parental counselling to mothers during fortnightly follow-up visit at community clinics, conducted by trained play leaders for 6 months. FS involved cereal-based supplements (150-300 kcal/day) for 3 months. All groups received medical care, micronutrient supplements and growth monitoring. We used Bayley scales, Home Observation for Measurement of Environment (HOME) inventory and a parenting questionnaire to assess child development, home stimulation and mothers' child-rearing practices, respectively. We assessed mothers' depressive symptoms using a modified version of Centre for Epidemiologic Studies Depression Scale at baseline and at 6 months post intervention. RESULTS: Maternal depressive symptoms were significantly lower in the CH group at baseline (P = 0.014). After 6 months of intervention there was no significant effect of intervention after adjusting for baseline scores and all possible confounders. Maternal depressive symptoms were higher among poorer (P = 0.06), older (P = 0.057) and less educated (P = 0.019) mothers, who were housewives (P = 0.053), and whose husbands had more unstable jobs (P = 0.058). At 6 months post intervention, children's cognitive (P = 0.045) and motor (P = 0.075) development, HOME (P = 0.012) and mother's parenting score (P = 0.057) were higher among mothers with lower depressive symptoms. CONCLUSION: The study did not show a significant effect of the intervention on the level of maternal depressive symptoms. Interventions with higher intensity and/or of longer duration focusing directly on maternal psychosocial functioning are probably needed to reduce maternal depressive symptoms.

[Nutritional knowledge and perception on dialysis: influence on adhesion and transgression; initial study]. / Conocimiento y percepción nutricional en diálisis: su influencia en la transgresión y adherencia; estudio inicial.

BACKGROUND: The dialysis patients have problems in maintaining proper conduct and adherence to the diet prescribed in liquid nephrology consultation. Indicate the interdialytic weight gain, serum potassium and phosphorus along with self-report instruments, markers that have been used as indicators of non-adherence to the diet. Most of the time is not counted in dialysis units with dietitians-nutritionists. Nephrologists and nurses lack the time and / or sufficient to establish and monitor adherence to an individualized diet knowledge. OBJECTIVES: The main objective is to determine adherence to dietary guidelines and hemodialysis fluids by DDFQ questionnaire and establish its relationship with the dietary habits of the patients, assessed by test dietary habits and cooking procedures. Secondary objectives are to measure adherence by DDFQ and relate the results to biochemical markers of intake and interdialytic weight gain (GID). Linking monitoring liquid diet and reported by the patient, biochemical markers of intake, interdialytic weight gain and the outcome of DDFQ. Determine membership based on sex, time on hemodialysis, have diabetes or have been transplanted once. And linking dietary habits reported by patients in the test of dietary habits and cooking procedures with patients' knowledge of the guidelines prescribed by nephrologists in consultation. METHODOLOGY: Cross-sectional pilot study. Sociodemographic variables: age and sex. Clinical variables: diabetic transplant patient ever, time on dialysis, dry weight and GID. Biochemical markers: serum potassium and phosphorus. Variables adherence to diet questionnaire measures DDFQ. STATISTICAL ANALYSIS: SPSS 20 Descriptive, Spearman correlation test, Student t test, Mann-Whitney U test and contingency table. RESULTS: 42 patients; 59.5% male, 40.5% female. Age 63.64 ± 16.17 years. Diabetics 11.9%. GID 1.96 ± 0.70 kg. Potassium 5.08 ± 0.86 meq / l phosphorus 4.71 ± 1.63 mg / dl. DDFQ Measured with 50% of patients not adhering to the diet in 2 days 14 days and 50% have no adherence to liquid in 1 day 14 days. There are correlations between adherence to diet and phosphorus (ρ= 0.304) and adherence to fluid and GID (ρ= 0.413). CONCLUSIONS: There is a lack of adherence to dietary guidelines in dialysis patients, in contrast to the accession referred by them. The review of dietary and fluid patterns is necessary in patients with CKD on dialysis. Hence the importance of training and support for nurses using simple tools to detect breaches and act with greater dietary education.

Antecedentes: Los pacientes dializados presentan problemas a la hora de mantener una conducta correcta de adherencia a la dieta y a los líquidos prescritos en la consulta nefrológica. Lo indican la ganancia de peso interdiálisis, el potasio y fósforo sérico junto con instrumentos de autoinforme, marcadores que se han utilizado como indicadores de no adherencia a la dieta. La mayor parte de las veces no se cuenta en las unidades de diálisis con dietistas-nutricionistas. Nefrólogos y enfermeros no disponen del tiempo y/o conocimientos suficientes para establecer y supervisar la adherencia a una dieta individualizada. Objetivos: El objetivo principal es determinar la adhesión a las pautas dietéticas y de fluidos en hemodiálisis mediante el cuestionario DDFQ y establecer su relación con el hábito dietético de los pacientes, valorado mediante test de hábitos dietéticos y procedimientos culinarios. Los objetivos secundarios son medir la adherencia mediante el DDFQ y relacionar los resultados con marcadores bioquímicos de ingesta y con ganancia de peso interdiálisis (GID). Establecer relaciones entre el seguimiento de la dieta y los líquidos referidos por el paciente, los marcadores bioquímicos de ingesta, la ganancia de peso interdiálisis y el resultado del DDFQ. Determinar la adhesión en base al sexo, tiempo en hemodiálisis, ser diabético o haber sido trasplantado alguna vez. Y relacionar los hábitos dietéticos manifestados por los pacientes en el test de hábitos dietéticos y procedimientos culinarios con el conocimiento de los pacientes de las pautas prescritas por los nefrólogos en consulta. Metodología: Estudio piloto descriptivo transversal. Variables sociodemográficas: edad y sexo. Variables clínicas: diabético, paciente trasplantado alguna vez, tiempo en diálisis, peso seco y GID. Marcadores bioquímicos: potasio y fósforo sérico. Variables adhesión a dieta medidas con cuestionario DDFQ. Análisis estadístico: SPSS 20. Descriptivo, pruebas correlación Spearman, prueba t-Student, prueba U Mann-Whitney y tabla contingencia. Resultados: 42 pacientes; 59,5% hombres, 40,5% mujeres. Edad 63,64 ± 16,17 años. Diabéticos 11,9%. GID 1,96 ± 0,70 Kg. Potasio 5,08 ± 0,86 meq/l y fósforo 4,71 ± 1,63 mg/dl. Medido con DDFQ el 50% de pacientes no tiene adherencia a la dieta en 2 días de los 14 días y 50 % no tiene adherencia a líquidos en 1 día de los 14 días. Existen correlaciones entre adherencia a dieta y fósforo (=0,304) y adherencia a líquidos y GID (= 0,413). Conclusiones: Existe una falta de adhesión a las pautas dietéticas en los pacientes en diálisis, en contraste con la adhesión referida por los mismos. La revisión de las pautas dietéticas y de fluidos se hace necesaria en los pacientes con ERC en diálisis. De aquí la importancia de formar y apoyar a la enfermería que con ayuda de herramientas sencillas pueda detectar incumplimientos y actuar con una mayor educación dietética.

The impact of the nutritional state of patients on the results of the surgical treatment of Crohn's disease.

UNLABELLED: Crohn's disease (CD) patients are qualified for surgery in the acute phase of the disease or after ineffective medical therapy. The course of the disease and the medical treatment received to that point weaken the general state of patients, with that they also cause undernutrition. THE AIM OF THE STUDY: The assessment of the nutritional state of 168 CD patients, admitted for surgery and the evaluation of the influence of this state on the postoperative course. MATERIAL AND METHODS: We referred the results of the nutritional state assessment to the time of the postoperative hospitalization of patients. RESULTS: Applying the Kruskal-Wallis test we found statistically significant, but weakly expressed, differences between the values of nutritional state parameters and period of hospitalization of patients. The applied U Mann-Whitney test, with statistically significant results with p <0.05, showed that no one parameter of the nutritional state of patients expressed a statistically significant difference between dead and recovered groups. CONCLUSIONS: We propose the body mass loss in the 6 months period before admission, TLC and serum albumin level as parameters which well detect undernutrition in CD patients presenting for surgery.

To establish the parameters of optimal nutrition do we need to consider psychological in addition to physiological parameters?

The criteria used to establish dietary reference values are discussed and it is suggested that the too often the "need" they aim to satisfy is at the best vaguely specified. The proposition is considered that if we aim to establish optimal nutrition we will gain from considering psychological in addition to physiological parameters. The brain is by a considerable extent the most complex and metabolically active organ in the body. As such it would be predicted that the first signs of minor subclinical deficiencies will be the disruption of the functioning of the brain. The output of the brain is the product of countless millions of biochemical processes, such that if enzyme activity is only a few percentage points less than maximum, a cumulative influence would result. A series of studies of micronutrient supplementation in well-designed trials were reviewed. In metaanalyses the cognitive functioning of children and the mood and memory of adults has been shown to respond to multivitamin/mineral supplementation. Given the concerns that have been expressed about the negative responses to high levels of micronutrients, the implications are discussed of the finding that psychological functioning may benefits from an intake greater than those currently recommended.