Nutrition in times of Covid-19, how to trust the deluge of scientific information.

PURPOSE OF REVIEW: The Covid-19 pandemic has daunted the world with its enormous impact on healthcare, economic recession, and psychological distress. Nutrition is an integral part of every person life care, and should also be mandatorily integrated to patient care under the Covid-19 pandemic. It is crucial to understand how the Covid-19 does develop and which risk factors are associated with negative outcomes and death. Therefore, it is of utmost importance to have studies that respect the basic tenets of the scientific method in order to be trusted. The goal of this review is to discuss the deluge of scientific data and how it might influence clinical reasoning and practice. RECENT FINDINGS: A large number of scientific manuscripts are daily published worldwide, and the Covid-19 makes no exception. Up to now, data on Covid-19 have come from countries initially affected by the disease and mostly pertain either epidemiological observations or opinion papers. Many of them do not fulfil the essential principles characterizing the adequate scientific method. SUMMARY: It is crucial to be able to critical appraise the scientific literature, in order to provide adequate nutrition therapy to patients, and in particular, to Covid-19 infected individuals.

Neurology of Nutritional Deficiencies.

PURPOSE OF REVIEW: The goal of this chapter is to educate clinicians on the neurologic manifestations of certain nutritional deficiencies in order to promptly identify and appropriately treat these patients. RECENT FINDINGS: Many vitamin and nutritional deficiencies have been described dating back to the early days of neurology and medicine. Some are very rare and thus, there are no randomized controlled studies to assess supplementation or dosage; however, there are reviews of case reports that can assist clinicians in choosing treatments. While endemic vitamin and nutritional deficiencies may be rarely encountered in many countries, vulnerable populations continue to be at risk for developing neurologic complications. These populations include those with diseases causing malabsorption, the elderly, chronic alcohol users, as well as pregnant mothers with hyperemesis gravidarum to name a few. It is important to recognize syndromes associated with these nutritional deficiencies, as prompt identification and treatment may prevent permanent neurologic damage.

Medical system and nutrition improvement for the rural elderly.

BACKGROUND: Insufficient nutrition intake has negatively influenced the health of the elderly in rural China where the problem of population aging is serious. The present study aims to explore whether the medical system, called the New Rural Cooperative Medical System (NRCMS), can improve the rural elderly's nutrition intake and the mechanism behind it. METHODS: The difference in differences (DID) model and the propensity score matching-difference in differences (PSM-DID) model are both performed to investigate the impact of the medical system on nutrition improvement for the rural elderly. Two thousand seven hundred eighty rural elderly samples tracked in 2000 and 2006 from the China Health and Nutrition Survey are analyzed. Indices for the elderly's nutrition intake includes daily average intake of energy, fat, protein, and carbohydrate. RESULTS: The results show that participation in the NRCMS can significantly increase the rural elderly's total energy intake, carbohydrate intake, and protein intake by 206.688 kcal, 36.379 g, and 6.979 g, respectively. A more significant impact of the NRCMS on nutrition intake is observed in the central and near-western where economic development is lagging behind. Also, compared to people of 18-60 age group, such impact is statistically more significant in the elderly for the carbohydrate intake. CONCLUSIONS: The NRCMS can improve the rural elderly's nutrition intake in China. As the population ages rapidly in rural China, the present study provides recommendations on how to improve nutrition and health status of the elderly from the aspect of the medical system.

Biocultural determinants of overweight and obesity in the context of nutrition transition in Senegal: a holistic anthropological approach.

Senegal is experiencing a rising obesity epidemic, due to the nutrition transition occurring in most African countries, and driven by sedentary behaviour and high-calorie dietary intake. In addition, the anthropological local drivers of the social valorization of processed high-calorie food and large body sizes could expose the population to obesity risk. This study aimed to determine the impact of these biocultural factors on the nutritional status of Senegalese adults. A mixed methods approach was used, including qualitative and quantitative studies. Between 2011 and 2013, fourteen focus group discussions (n=84) and a cross-sectional quantitative survey (n=313 women; n=284 men) of adults in three different socio-ecological areas of Senegal (rural: n=204; suburban: n=206; urban: n=187) were conducted. Dietary intake (Dietary Diversity Scores), physical activity (International Physical Activity Questionnaire), body weight norms (Body Size Scale), weight and health statuses (anthropometric measures and blood pressure) were measured. Middle-aged and older Senegalese women were found to value overweight/obesity more than younger Senegalese in all regions. In addition, young urban/suburban adults had a tendency for daily snacking whilst urban/suburban adults tended to be less physically active and had higher anthropometric means. A binary logistic regression model showed that being female, older, living in urban/suburban areas and valuing larger body size were independently associated with being overweight/obese, but not high-calorie diet. Univariate analyses showed that lower physical activity and higher socioeconomic status were associated with being overweight/obese. Finally, overweight/obesity, which is low in men, is associated with hypertension in the total sample. The nutrition transition is currently underway in Senegal's urban/suburban areas, with older women being more affected. Since several specific biocultural factors jointly contribute to this phenomenon, the study's findings suggest the need for local public health interventions that target women and which account for the anthropological specificities of the Senegalese population.

[Consensus document about the nutritional evaluation and management of eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder, and others]. / Resumen ejecutivo "Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: anorexia nerviosa, bulimia nerviosa, trastorno por atracón y otros".

Eating disorders (ED) are characterized by persistent changes in eating habits that negatively affect a person's health and psychosocial abilities. They are considered psychiatric disorders, highly variable in their presentation and severity, with a huge impact on nutrition, which conditions various therapeutic approaches within a key multidisciplinary context. A group of experts in nutrition, we decided to set up a task force adscribed to the "Sociedad Española de Nutrición Parenteral y Enteral" (SENPE), which has stated as one of its goals the development of a consensus document to generate a protocol based on the best scientific evidence and professional experience available in order to improve health care in this field.

Valor pronóstico del índice de riesgo nutricional en receptores de trasplante cardiaco / Prognostic value of the nutritional risk index in heart transplant recipients

Introducción y objetivos: Analizar el impacto del estado nutricional preoperatorio, evaluado mediante el índice de riesgo nutricional (IRN), en el pronóstico tras el trasplante cardiaco (TxC). Métodos: Se realizó un estudio retrospectivo de 574 pacientes que recibieron un TxC entre 1991 y 2014 en un centro. El IRN preoperatorio se calculó como 1,519 × albúmina (g/l) + 41,7 × (peso real [kg] / peso ideal [kg]). La asociación entre IRN preoperatorio y eventos clínicos posoperatorios se analizó mediante modelos multivariables de regresión logística y regresión de Cox. Resultados: El IRN preoperatorio medio de la población del estudio era de 100,9 ± 9,9. Según este parámetro, las prevalencias de riesgo nutricional grave (IRN < 83,5), moderado (83,5 ≤ IRN < 97,5) y leve (97,5 ≤ IRN < 100) antes del TxC eran el 5, el 22 y el 10% respectivamente. Las tasas de mortalidad a 1 año tras el TxC en estas 4 categorías fueron del 18,2, el 25,3, el 7,9 y el 10,2% (p < 0,001) respectivamente. El IRN preoperatorio resultó predictor independiente de menor riesgo de infección posoperatoria (odds ratio ajustada [ORa] = 0,97; intervalo de confianza del 95% [IC95%], 0,95-1,00; p = 0,027) y ventilación mecánica prolongada posoperatoria (ORa = 0,96; IC95%, 0,94-0,98; p = 0,001). Los pacientes con riesgo nutricional moderado a grave mostraron mayor mortalidad a 1 año tras el TxC (hazard ratio ajustada = 1,55; IC95%, 1,22-1,97; p < 0,001). Conclusiones: Los pacientes desnutridos tienen mayor riesgo de complicaciones posoperatorias y muerte tras el TxC. La determinación del IRN podría facilitar la identificación de candidatos a TxC que se beneficien de intervenciones nutricionales en espera del órgano (AU)

Introduction and objectives: To study the prognostic impact of preoperative nutritional status, as assessed through the nutritional risk index (NRI), on postoperative outcomes after heart transplantation (HT). Methods: We conducted a retrospective, single-center study of 574 patients who underwent HT from 1991 to 2014. Preoperative NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (body weight [kg] / ideal body weight [kg]). The association between preoperative NRI and postoperative outcomes was analyzed by means of multivariable logistic regression and multivariable Cox regression. Results: Mean NRI before HT was 100.9 ± 9.9. According to this parameter, the prevalence of severe nutritional risk (NRI < 83.5), moderate nutritional risk (83.5 ≤ NRI < 97.5), and mild nutritional risk (97.5 ≤ NRI < 100) was 5%, 22%, and 10%, respectively. One year post-transplant mortality rates in these 4 categories were 18.2%, 25.3%, 7.9% and 10.2% (P < .001), respectively. The NRI was independently associated with a lower risk of postoperative infection (adjusted OR, 0.97; 95%CI, 0.95-1.00; P = .027) and prolonged postoperative ventilator support (adjusted OR, 0.96; 95%CI, 0.94-0.98; P = .001). Patients at moderate or severe nutritional risk had significantly higher 1-year post-HT mortality (adjusted HR, 1.55; 95%CI, 1.22-1.97; P < .001). Conclusions: Malnourished patients have a higher risk of postoperative complications and mortality after HT. Preoperative NRI determination may help to identify HT candidates who might benefit from nutritional intervention (AU)

Risk Factors for Growth Retardation in HIV-infected Senegalese Children on Antiretroviral Treatment: The ANRS 12279 MAGGSEN Pediatric Cohort Study.

OBJECTIVES: To describe prevalence and risk factors for wasting and stunting among HIV-infected children with a median duration of 3 years of antiretroviral therapy (ART) at the time of their enrollment in the cohort study. METHODS: Wasting and stunting at ART initiation and enrollment were defined as weight-for-height/body mass index-for-age Z scores < -2 and height-for-age Z scores < -2, respectively. Logistic regression was used to assess risk factors for wasting and stunting. Main predictive factors were age at enrollment, nutritional status and age (< or ≥5 years) at ART initiation and ART duration (< or ≥3 years on first-line, or ≥3 years including a switch to second-line ART). RESULTS: Two hundred forty-four children 2-16 years of age were enrolled. Overall, wasting and stunting prevalence dropped off consistently in children 2-10 years of age, between ART initiation and enrollment, while it remained at high levels, 52% and 42%, respectively, in children 10-16 years of age. Risk factors for wasting at enrollment were ART duration of ≥3 years including a switch to second-line [adjusted odds ratio (aOR): 3.9, 95% confidence interval (CI): 1.7-8.9] and wasting at ART initiation (aOR: 2.7, 95% CI: 1.4-5.2). The risk factor for stunting at enrollment was stunting at ART initiation (aOR: 11.6, 95% CI: 5.4-25.0), independent of ART duration. CONCLUSIONS: Malnutrition at the time of ART initiation was the main predictor of malnutrition at enrollment among HIV-infected children on ART. Longer duration on ART had no overall protective effect on wasting and stunting. Growth and virologic monitoring are of utmost importance in the comprehensive care of children with HIV infection.

Predictors of Vitamin Adherence After Bariatric Surgery.

BACKGROUND: Vitamin supplementation in bariatric aftercare is essential to prevent nutrient deficiencies; however, rates of vitamin adherence have been as low as 30 % 6 months post-surgery. Preliminary literature suggests non-adherence to prescribed treatments can be linked to demographic and psychological factors. We aimed to determine the relationship between these factors to vitamin adherence in post-bariatric surgery patients. METHODS: A total of 92 bariatric patients were assessed 6 months post-surgery. Patients were administered a questionnaire collecting demographic information, psychological scores, and self-reported adherence. Nutrient deficiencies were analyzed through serum vitamin levels measured 3 and 6 months after surgery. Wilcoxon rank-sum and chi-square tests were used for analysis. RESULTS: Non-adherence was associated with male sex and full-time employment (p = 0.027, p = 0.015). There were no differences with respect to living situation, education level, or relationship type. Non-adherent patients did not have significantly higher scores for generalized anxiety, depressive symptoms, or avoidant behaviors. However, non-adherent patients displayed greater attachment anxiety than their adherent counterparts (p = 0.0186). Non-adherence was also associated with lower vitamin B12 levels 6 months post-surgery (p = 0.001). CONCLUSIONS: Male gender and full-time work have previously been shown to be associated with non-adherence. This is the first study to demonstrate that attachment anxiety is associated with poor multivitamin adherence in the post-surgical bariatric population. This result is concordant with recent literature that has demonstrated attachment anxiety is associated with poor adherence to dietary recommendations in bariatric patients 6 months postoperatively. Presurgical screening for attachment anxiety could facilitate early interventions to promote better bariatric aftercare in this group.

Outcomes and Cost-Effectiveness of Integrating HIV and Nutrition Service Delivery: Pilots in Malawi and Mozambique.

This paper provides the first estimates of impact and cost-effectiveness for integrated HIV and nutrition service delivery in sub-Saharan Africa. HIV and undernutrition are synergistic co-epidemics impacting millions of children throughout the region. To alleviate this co-epidemic, UNICEF supported small-scale pilot programs in Malawi and Mozambique that integrated HIV and nutrition service delivery. We use trends from integration sites and comparison sites to estimate the number of lives saved, infections averted and/or undernutrition cases cured due to programmatic activities, and to estimate cost-effectiveness. Results suggest that Malawi's program had a cost-effectiveness of $11-29/DALY, while Mozambique's was $16-59/DALY. Some components were more effective than others ($1-4/DALY for Malawi's Male motivators vs. $179/DALY for Mozambique's One stop shops). These results suggest that integrating HIV and nutrition programming leads to a positive impact on health outcomes and should motivate additional work to evaluate impact and determine cost-effectiveness using an appropriate research design.

Hipovitaminosis D en la población anciana institucionalizada: variables asociadas y valoración geriátrica / Hypovitaminosis D in elderly population in nursing home: associated variables and geriatric assessment

Introducción: Los datos más recientes sugieren que el déficit de vitamina D es frecuente en ancianos, especialmente en los mayores institucionalizados. La vitamina D desempeña un papel importante en la hemostasia del calcio, en el metabolismo del hueso y afecta en términos de salud tanto a la mortalidad como al riesgo de caídas. El objetivo de este estudio fue determinar la prevalencia de hipovitaminosis D, cuáles son los factores de riesgo asociados y la utilidad de las herramientas de valoración geriátrica. Método: Estudio descriptivo transversal. Población: 83 residentes de la Residencia de 3.ª edad ‘Gerontos’, Pedrezuela, Madrid, España. Fue desarrollado de enero del 2014 a diciembre del 2015. Variables sociodemográficas: edad y sexo; variables clínico-asistenciales: peso, talla e índice de masa corporal, y variables analíticas: niveles de hemoglobina, creatinina, urea, albúmina y 25 hidroxivitamina D; instrumentos de medida: escala de capacidad cognoscitiva e Índice de Barthel como escala de valoración funcional. Resultados: El análisis bivariado encontró asociación entre el déficit cognitivo y la hipovitaminosis D (p 0,007). La prevalencia de hipovitaminosis D fue del 80,7%. Conclusión: La prevalencia de hipovitaminosis D es alta entre población anciana en las residencias geriátricas. Aunque los estudios observacionales no establecen causalidad, nuestros resultados muestran que la hipovitaminosis D se asocia a deterioro cognitivo. La determinación de niveles de vitamina D en este grupo de población y la instauración de la suplementación farmacológica en pacientes con niveles inadecuados sería recomendable

Introduction: Most recent data suggest that the vitamin D deficiency is frequent in the elderly, and it is specially prevalent among patients in the nursing home. In addition, the vitamin D plays a significant role in calcium homeostasis and bone metabolism and affects other health outcomes like mortality and risk of falls. The objective of this study was to determine the prevalence of hypovitaminosis D, which risk factors are related and the utility of geriatric assessment tools. Method: A cross-sectional descriptive study. Population: 83 residents in the nursing home ‘Gerontos’, Pedrezuela, Madrid, Spain. It was developed from January 2014 to December 2015. Sociodemographic, clinical variables, blood test were measured: hemoglobin, creatinine, urea, albumin and 25 (OH) vitamin D. Functional status according to the Barthel Index and cognitive status by Mini-Mental State Examination were recorded. Results: The bivariate analyses identified an association between poor cognitive status and hypovitaminosis D (p 0,007). The prevalence of hipovitaminosis D was 80,7%. Conclusion: the prevalence of hypovitaminosis D is high in the elderly population in nursing home. Even though transversal study does not allow a causal link, our results show a relationship between hypovitaminosis D and cognitive impairment. The determination of vitamin D levels in this high risk group and the establishment of the pharmacological supplementation in patients with inadequate levels would be advisable

Avaliação do consumo dietético e estado nutricional em mulheres com câncer de mama em tratamento quimioterápico / Assessment of the dietary consumption and nutritional status of women with breast cancer undergoing chemotherapy

Introdução: O câncer de mama é uma das neoplasias que mais acomete mulheres no mundo. O excesso de peso associado ao desenvolvimento desta neoplasia, também esta relacionado ao mau prognóstico em pacientes com câncer de mama. Objetivo: Avaliar o consumo dietético e o estado nutricional em mulheres com câncer de mama em tratamento quimioterápico. Metodologia: Estudo de modelo transversal com 57 mulheres. Aplicou-se Avaliação Subjetiva Global Produzida pelo Paciente, recordatório alimentar de 24 horas, questionário estruturado e avaliação antropométrica. O consumo alimentar de macronutrientes foi comparado com o Guia Alimentar para a população Brasileira e as vitaminas e minerais de acordo com pelas Dietary Reference Intakes. Analise estatística foi realizada através do Software Statistical Package for Social Sciences (SPSS) versão 13.0. As variáveis foram avaliadas através de teste t- student, teste Análise de Variância (ANOVA), teste Exato de Fischer. O nível de significância adotado foi de 5% (p< 0,05). Resultados: A média de idade foi de 53,9 (+ 11,2) anos, 79% estavam com excesso de peso segundo Índice de Massa Corporal, e 86% com estado nutricional adequado segundo Avaliação Subjetiva Global Produzida pelo Paciente. O consumo médio de Vitamina D 1,0 ng e de vitamina E (7,4 mg), selênio (0,1 ng), carboidratos (54,6%), fibras (14,4 g) abaixo do recomendado pelas Dietary Reference Intakes e pelo Guia Alimentar para a População Brasileira. Conclusão: Conclui- se que a maioria das participantes apresentou excesso de peso. O consumo de vitamina A, D, E, de selênio, e fibras, apresentou- se abaixo do recomendado (AU)

Introduction: Breast cancer is one of the neoplasias that most affect women worldwide. Overweight associated with the development of this neoplasia, is also related to poor prognosis in patients with breast cancer. Objective: To evaluate the dietary intake and the nutritional status of women with breast cancer undergoing chemotherapy. Methodology: Cross-sectional study model with 57 women. There were applied the Patient-generated Subjective Global Assessment, the 24-hour food recall, the structured questionnaire and the anthropometric evaluation. The dietary intake of macronutrients was compared to the Dietary Guidelines for the Brazilian Population and the vitamins and minerals according to the Dietary Reference Intakes. Statistical analysis was performed by using the Statistical Package for Social Sciences (SPSS) software version 13.0. The variables were evaluated through the Student’s t-test, the Analysis of Variance (ANOVA) test, and the Fischer’s exact test. The adopted significance level was 5% (p< 0.05). Results: The mean age was 53.9 (±11,2) years; 79% were overweight, according to the Body Mass Index, and 86% with adequate nutritional status, according to the Patient-generated Subjective Global Assessment. The average consumption of 1.0 ng of vitamin D and of E vitamin (7.4 mg), selenium (0.1 ng), carbohydrates (54.6%), fiber (14.4 g) under the recommended by the Dietary Reference Intakes and by the Dietary Guidelines for the Brazilian Population. Conclusion: There is concluded that most of the participants showed overweight. The consumption of vitamin A, D, E, selenium, and fiber, was under the recommended (AU)

Gestión de la nutrición enteral: factores clave en las mejores guías de práctica clínica y brechas en su aplicación / Enteral nutrition management: key factors and application gaps in the best clinical practice guidelines

Introducción: Una adecuada práctica clínica en soporte nutricional requiere de recomendaciones basadas en la mejor evidencia disponible, para apoyar a los profesionales en salud en la toma de aquellas decisiones concernientes al manejo del soporte nutricional enteral en las patologías de interés. Objetivo: Identificar los factores clave en la gestión de la nutricion enteral para prevenir y tratar la malnutrición a partir de las recomendaciones establecidas en las mejores Guías de Práctica Clínica (GPC). Métodos: Se realizó una búsqueda estructurada de las GPC en soporte nutricional. La selección de las guías se llevó a cabo de forma independiente por cinco evaluadores, que incluyeron las GPC basadas en la evidencia publicadas entre 2005 y 2015. La evaluación de la calidad se llevó a cabo mediante la herramienta AGREE II. Se seleccionaron las GPC teniendo en cuenta que la calificación de los dominios rigor metodológico e independencia editorial, fuera como mínimo 60% cada uno.Se compararon los hallazgos con la práctica en Colombia. Resultados: Se evaluaron 24 GPC, de las cuales 79.1% (n=19) desarrolladas por sociedades científicas, 12.6% (n=3) por entidades gubernamentales y 8.3% (n=2) por organismos desarrolladores de GPC. Las GPC seleccionadas fueron la elaborada por NICE con puntuación global de 92%, y dos guías elaboradas por CENETEC, que puntuaron 79.7% y 81.9%. Discusión: Con el fin de disminuir la heteroge - neidad en la práctica, abordar nuevas opciones terapéuticas y brindar una atencion con calidad, se sugiere adoptar las mejores GPC, las cuales son desarrolladas por entidades gubernamentales y organismos desarrolladores de guías como CENETEC y NICE respectivamente, las cuales son poco estudiadas e implementadas en Colombia, donde las más consultadas son las ASPEN y ESPEN. Conclusión: Los factores claves recomendados en las mejores GPC de nutrición son: tamizaje nutricional de ingreso, seguimiento del riesgo nutricional, apoyo nutricional en el paciente desnutrido y/o malnutrido, soporte nutricional en el paciente con limitación de ingesta de alimentos, soporte nutricional especializado, educación en nutrición y creación del comité institucional de nutrición. Estos factores son útiles para generar confianza en la sociedad sobre la práctica asistencial. Debería incentivarse la consulta de GPC en Nutrición de alta calidad científica, con el fin de optimizar las capacidades técnicas ante las limitaciones en el sector salud (AU)

Introduction: Adequate nutrition-support clinical practice requires recommendations based on the best available evidence, in order to help health professionals making decisions concerning the management of enteral nutritional support in pathologies of interest. Objective: To identify the key factors in the management of enteral nutrition, in order to prevent and treat malnutrition based upon the recommendations made in the best Practice Guidelines (CPG). Methods: A structured search of nutritional support in CPG was performed. Five referees independently selected the CPG among those published between 2005 and 2015. They used AGREE II in order assess quality and selected those CPG with a score no lower than 60% in the domains of methodological rigor and editorial independence. The findings were compared to the Colombian clinical practice. Results: 24 GPC were evaluated, of which 79.1% (n = 19) were developed by scientific societies, 12.6% (n = 3) by government agencies and 8.3% (n = 2) by CPG developing bodies. Selected CPG were those produced by NICE (global score 92%), and those developed by CENETEC, which scored 70.89% and 87.2%.8. Discussion: In order to decrease clinical-practice heterogeneity, take into account new therapeutic options and provide quality care, it is suggested to adopt the best CPG, such as those developed by governmental institutions and CPG developing agencies like CENETEC and NICE. Attention and implementation of their recommendations in Colombia has been poor, as the most consulted CPG are the ASPEN and ESPEN ones. Conclusion: Key elements recommended in the best nutrition CPG, are: income nutritional screening, nutritional risk monitoring, nutritional support for malnourished patients, nutritional support for patients with limiting food intake, specialized nutritional support, nutrition education, and creation of institutional nutrition committees. These elements would be useful to build societal trust in clinical practice. Encouraging consultation of high quality nutrition CPG would help to optimize capacities in the face of technical limitations in the health sector (AU)

A call-to-action from the feedM.E. Middle East study group. Use of a screen-intervene-supervene strategy to address malnutrition in healthcare.

Up to 50% of hospitalized patients worldwide are malnourished or at risk of malnutrition. Guidelines recommend nutritional screening of all patients on hospital admission. Results from studies of hospitalized patients show that screening, with follow-up nutritional assessment and care when indicated, can improve patients' clinical outcomes and reduce healthcare costs. Despite compelling evidence, attention to nutritional care remains suboptimal in clinical settings worldwide. The feedM.E. Global Study Group developed a simple, stepwise Nutrition Care Pathway to facilitate best-practice nutrition care. This pathway guides clinicians to screen patients' nutritional status on hospital admission or at initiation of care; intervene promptly with nutrition care when needed; and supervene or follow-up routinely with adjustment and reinforcement of nutrition care plans. The feedM.E. Middle East Study Group seeks to extend this program to our region. We advise clinicians to adopt and adapt the Nutrition Care Pathway, bringing quality nutrition care to everyday practice.

The epidemiology of global micronutrient deficiencies.

Micronutrients are essential to sustain life and for optimal physiological function. Widespread global micronutrient deficiencies (MNDs) exist, with pregnant women and their children under 5 years at the highest risk. Iron, iodine, folate, vitamin A, and zinc deficiencies are the most widespread MNDs, and all these MNDs are common contributors to poor growth, intellectual impairments, perinatal complications, and increased risk of morbidity and mortality. Iron deficiency is the most common MND worldwide and leads to microcytic anemia, decreased capacity for work, as well as impaired immune and endocrine function. Iodine deficiency disorder is also widespread and results in goiter, mental retardation, or reduced cognitive function. Adequate zinc is necessary for optimal immune function, and deficiency is associated with an increased incidence of diarrhea and acute respiratory infections, major causes of death in those <5 years of age. Folic acid taken in early pregnancy can prevent neural tube defects. Folate is essential for DNA synthesis and repair, and deficiency results in macrocytic anemia. Vitamin A deficiency is the leading cause of blindness worldwide and also impairs immune function and cell differentiation. Single MNDs rarely occur alone; often, multiple MNDs coexist. The long-term consequences of MNDs are not only seen at the individual level but also have deleterious impacts on the economic development and human capital at the country level. Perhaps of greatest concern is the cycle of MNDs that persists over generations and the intergenerational consequences of MNDs that we are only beginning to understand. Prevention of MNDs is critical and traditionally has been accomplished through supplementation, fortification, and food-based approaches including diversification. It is widely accepted that intervention in the first 1,000 days is critical to break the cycle of malnutrition; however, a coordinated, sustainable commitment to scaling up nutrition at the global level is still needed. Understanding the epidemiology of MNDs is critical to understand what intervention strategies will work best under different conditions.

Giving a nutritional FAST HUG in the Intensive Care Unit / Dando un abrazo rápido (FAST HUG) nutricional en la terapia intensiva

Implementing a nutrition support protocol in critical care is a complex and dynamic process that involves the use of evidence, education programs and constant monitoring. To facilitate this task we developed a mnemonic tool called the Nutritional FAST HUG (F: feeding, A: analgesia, S: stools, T: trace elements, H: head of bed, U: ulcers, G: glucose control) with a process also internally developed (both modified from the mnemonic proposed by Jean Louis Vincent) called MIAR (M: measure, I: interpret, A: act, R: reanalysis) showing an easy form to perform medical rounds at the intensive care unit using a systematic process (AU)

Implementar un protocolo de soporte nutricional en cuidados críticos es un proceso complejo y dinámico que envuelve el uso de evidencia, uso de programas y monitoreo constante. Para facilitar esta tarea desarrollamos una herramienta nemotécnica llamada el FAST HUG (“Abrazo Rápido” en español) Nutricional (F: feeding, A: analgesia, S: stools, T: trace elements, H: head of bed, U: ulcers, G: glucose control) con un proceso también desarrollado internamente (ambos modificados de la nemotecnia propuesta por Jean Louis Vincent) llamada MIAR (M: measure, I: interpret, A: act, R: reanalysis) mostrando una forma fácil de realizar las visitas médicas en la unidad de cuidados intensivos usando un proceso sistemático (AU)

Factores de riesgo nutricionales para dismorfia muscular en usuarios de sala de musculación / Nutritional risk factors to users in dysmorphia muscular strength of room

Objetivo: Se muestra un estudio novedoso en el cual se han analizado la prevalencia y el tipo de suplementos consumidos entre usuarios de gimnasio de la provincia de Alicante que padecen dismorfia muscular (DM). Metodología: Se analizaron gimnastas de varias salas de musculación de Alicante (zona urbana del sureste español), donde se recogieron las medidas de 141 varones de edad comprendida entre 18-45 años, que persiguen el aumento de su masa muscular. Se tuvieron en cuenta el IMC (kg/m2 ), si consumían suplementos y que tipos. Y se ha determinado si padecían o no DM, a través de la Escala de satisfacción muscular. Resultados: La muestra está constituida por 141 varones, de los cuales 45 son DM y 96 no lo son. Un 89,9% y un 71,9% consumen o han consumido suplementos respectivamente. El consumo de los suplementos: proteínas, hidratos de carbono y creatina han resultado significativamente mayores entre los DM (p=0,007, p=0,016 y p=0,016 respectivamente). Los resultados del test Kidmed no han resultado significativos según el test Chi-cuadrado, pero con un porcentaje de dieta mediterránea superior en el grupo de los que padecen DM. Según el análisis multivariante son factores de riesgo el consumo de suplementos con una OR = 3.4 (IC95% = 1.1-10.9; p=0,041), el estar en sobrepeso con una OR = 20.9 (IC95% = 2.2-195.6; p=0,008) y ser obesos con OR = 15.5 (IC95% = 1.6-145.8; p=0,017). Conclusión: La prevalencia de consumo de suplementos tanto en DM como en no DM ha dado valores relativamente altos con respecto a la mayoría de estudios. Los suplementos mas consumidos fueron proteínas, creatina e hidratos de carbono. El riesgo de padecer DM aumenta con el grado de obesidad y el grado en que se consumen suplementos (AU)

Objective: To analyze the prevalence and diet supplements used among gym users with muscle dysmorphia (MD) in the province of Alicante. Methodology: Several gymnasts weights-lift rooms of the urban area of Alicante were analyzed, collecting measurements of 141 (18-45 years of age) males that pursue an increase in their muscle mass. BMI (kg/m2 ), type and consume of diet supplements have been checked; and has been determined whether or not the presence of DM through the muscle scale satisfaction. Results: The sample consisted of 141 men, of whom 45 are with MD and 96 not. 89.9% and 71.9% use or have used diet supplements respectively. The consumption of supplements: proteins, carbohydrates and creatine have been significantly higher in MD´s users (p=0.007, p=0.016 and p=0.016 respectively). The Kidmed´s test results have not been significant according to the Chi-square test, but with a higher percentage of the Mediterranean diet in the group of those with DM. According to multivariate analysis are risk factors consuming supplements with an OR=3.4 (95%CI=1.1-10.9; p=0.041), being overweight with an OR=20.9 (95% CI=2.2-195.6; p =0.008) and obese with an OR=15.5 (95% CI=1.6-145.8; p=0.017). Conclusion: The use prevalence of diet supplements among MD and non-MD has relatively higher values compared to most studies. The most consumed diet supplements were protein, creatine and carbohydrates. The risk of suffering MD increases with the obesity degree and supplements consumption (AU)

Evaluation of Nutritional Status of Cancer Patients during Treatment by Patient-Generated Subjective Global Assessment: a Hospital-Based Study.

Cancer patients frequently experience malnutrition. Cancer and cancer therapy effects nutritional status through alterations in the metabolic system and reduction in food intake. In the present study, fifty seven cancer patients were selected as subjects from the oncology ward of Cachar Cancer Hospital and Research Centre, Silchar, India. Evaluation of nutritional status of cancer patients during treatment was carried out by scored Patient-Generated Subjective Global Assessment (PG-SGA). The findings of PG-SGA showed that 15.8% (9) were well nourished, 31.6% (18) were moderately or suspected of being malnourished and 52.6% (30) were severely malnourished. The prevalence of malnutrition was highest in lip/oral (33.33%) cancer patients. The study showed that the prevalence of malnutrition (84.2%) was high in cancer patients during treatment.

Evolução do estado nutricional de pacientes internados na clínica médica de um hospital filantrópico de Pernambuco - Brasil / Evolution of nutritional status of hospitalized patients in medical clinic hospital philanthropic of Pernambuco - Brazil

Introdução: A desnutrição ainda é um achado frequente entre os pacientes hospitalizados e o cuidado nutricional permanente é parte integrante de um bom tratamento clínico. Objetivo: avaliar a evolução do estado nutricional de pacientes internados na clínica médica de um hospital filantrópico de Pernambuco (PE). Métodos: Trata-se de um estudo prospectivo, com pacientes internados na clínica médica do Instituto de Medicina Integral Professor Fernando Figueira - IMIP, de abril a outubro de 2014. Os pacientes foram avaliados na admissão e na alta hospitalar por meio das seguintes medidas antropométricas: peso, estatura, dobra cutânea triciptal (DCT) e circunferência do braço (CB). A partir da razão do peso pelo quadrado da altura foi calculado o índice de massa corporal (IMC); e a circun ferência muscular do braço (CMB) foi calculada mediante fórmula pré- estabelecida, a partir das informações da DCT e CB. Foi coletado também o tempo de internamento, o número de episódios em que o paciente ficou em jejum, a principal patologia que motivou o internamento e a variação de peso no internamento. Os dados foram analisados no programa Sigma Stat 13.0. Foi adotado o nível de significância de 5% para rejeição da hipótese de nulidade. Resultados: Foram avaliados 99 pacientes, adultos e idosos. Na admissão, a desnutrição esteve presente em 21% da amostra, segundo o IMC. 59,59% dos pacientes perderam peso durante o internamento. O sexo feminino apresentou associação estatisticamente significativa com a perda de peso (p=0,038) e observou-se uma correla- ção negativa significativa entre o IMC com o tempo de internamento (r= - 0,296) e o número de episódios de jejum (r= - 0,245). A evolução do estado nutricional, segundo IMC, mostrou que na alta hospitalar o diagnóstico de desnutrição teve um aumento de 4,03%. Discussão: Apesar de atualmente se discutir muito o aumento crescente da obesidade, como consequência da transição nutricional, a desnutrição hospitalar ainda merece atenção e destaque por estar fortemente associada com uma maior prevalência de morbimortalidade. Conclusão: Os achados evidenciam uma correlação negativa do estado nutricional, segundo o IMC, com o tempo de internamento e o número de episódios em jejum, além da elevada prevalência de perda de peso e condição praticamente inalterada da desnutrição nos pacientes durante a hospitalização (AU)

Introduction: Malnutrition is a frequent finding among hospitalized patients and permanent nutritional care is an integral part of good medical treatment. Objective: To evaluate the evolution of nutritional status of patients admitted to the clinic of a philanthropic hospital in Pernambuco (PE). Methods: This was a prospective study, patients admitted to the medical clinic of Integrative Medicine Institute Professor Fernando Figueira - IMIP, from April to October 2014. Patients were assessed on admission and at discharge through the following anthropometric measurements: weight, height, triceps skinfold (TSF) and arm circumference (AC). From the ratio of the weight by the square of height we calculated the body mass index (BMI); and the arm muscle circumference (MAMC) was calculated by pre-established formula, from the information of the TSF and AC. It was also collected the hospital stay, the number of episodes in which the patient was fasted, the main condition which led to hospitalization and weight variation during hospitalization. Data were analyzed in Sigma Stat 13.0. The 5% significance level to reject the null hypothesis was adopted. Results: We evaluated 99 patients, adults and seniors. On admission, malnutrition was present in 21% of the sample, according to BMI. 59.59% of patients lost weight during hospitalization. Females were significantly associated with weight loss (p = 0.038) and was a significant negative correlation between BMI with the length of stay (r = - 0.296) and the number of episodes of fasting (r = - 0.245). The evolution of nutritional status according to BMI showed that at hospital discharge diagnosis of malnutrition increased by 4.03%. Discussion: Although currently very discuss the increasing obesity as a result of nutritional transition, hospital malnutrition still deserves attention and prominence to be strongly associated with a higher prevalence of morbidity and mortality. Conclusion: The findings show a negative correlation of nutritional status according to BMI, with the length of stay and the number of episodes fasting, in addition to the high prevalence of weight loss and virtually unchanged condition of malnutrition in patients during hospitalization (AU)

Distúrbios nutricionais e metabólicos provocados pela utilização da terapia antirretroviral e abordagem nutricional: uma revisão narrativa / Nutritional and metabolic disorders caused by antiretroviral therapy and nutritional approach: a narrative review

O uso da terapia antirretroviral (TARV) tem aumentado à sobrevida das pessoas vivendo com HIV/AIDS (PVHA) alterando consideravelmente a história natural da infecção. Entretanto, em alguns casos, o uso destes medicamentos tem sido associado à distúrbios nutricionais e metabólicos. O objetivo deste estudo foi descrever os distúrbios nutricionais e metabólicos ocasionados pelo uso da TARV e o respectivo papel terapêutico da abordagem nutricional em PVHA. Trata-se de uma revisão narrativa, realizada durante o segundo semestre do ano de 2012, utilizando os seguintes descritores: AIDS, HIV, PVHA, TARV, estado nutricional, acompanhamento nutricional. O principal distúrbio nutricional encontrado nesta revisão, relacionado ao uso de TARV, foi a síndrome lipodistrófica associada à dislipidemias e hiperglicemias, bem como, alterações ósseas e aumento de gordura corporal. Neste sentido, o acompanhamento nutricional é extremamente importante para a melhora da qualidade de vida e prevenção de demais complicações metabólicas em PVHA (AU)

The use of antiretroviral therapy has increased the survival of people living with HIV/AIDS considerably altering the natural history of infection. However, in some cases, the use of these drugs have been associated with nutritional and metabolic disorders. The objective of this study was to describe the nutritional and metabolic disorders caused by antiretroviral therapy and their therapeutic role of nutritional approach for people living with HIV/AIDS. This is a narrative review, conducted during the second half of 2012, using the following descriptors: AIDS, HIV, people living with HIV/AIDS, antiretroviral therapy, nutritional status, nutritional counseling. The main nutritional disorder found in this review, related to the use of antiretroviral therapy was the lipodystrophy syndrome associated with dyslipidemia and hyperglycemia, as well as bone changes and increase in body fat. In this sense, the nutritional monitoring is extremely important to improve the quality of life and prevention of other metabolic complications in people living with HIV/AIDS (AU)