Informe de Rotación Electiva

El presente informe tiene como propósito dar cuenta del trabajo realizado y los aprendizajes alcanzados durante el desarrollo de la rotación de elección libre. La misma ha sido llevada a cabo entre el 16 de marzo y el 21 de abril de 2020 en el Centro de Investigación en Nutrición y Salud (CINyS) perteneciente al Instituto Nacional de Salud Pública (INSP) de México. En las siguientes páginas se presentará la sede de rotación y la fundamentación relativa a la relevancia de la elección de la misma. Asimismo, se explicitarán los objetivos propuestos y las actividades desarrolladas a lo largo del mencionado período. Finalmente, se presentará una reflexión a partir de los aprendizajes logrados y los aportes que se intentó realizar tanto desde el campo de la nutrición como desde la Educación y Promoción de la Salud. (AU)

Cuidar da alimentação e nutrição é cuidar das pessoas e proteger vidas

Fragilização de políticas de alimentação e nutrição potencializam Covid-19, dizem especialistas em live do CNS. A pandemia deixou mais evidente as diferenças no acesso à alimentação saudável, além do aumento no consumo de industrializados e aumento da obesidade A pandemia da Covid-19 no Brasil acentuou desigualdades históricas. A crise levou milhões de brasileiros e brasileiras a situação de extrema vulnerabilidade, com escassez inclusive de alimentos. A Live do Conselho Nacional de Saúde (CNS), realizada nesta quarta (30/09), trouxe para debate o tema “Cuidar da alimentação e nutrição é cuidar das pessoas e proteger vidas”. Ruth Guilherme, representante da Associação Brasileira de Nutrição (Asbran), explicou que a pandemia deixou mais evidente as diferenças no acesso à alimentação saudável, além do aumento no consumo de industrializados e aumento da obesidade. Para ela, é necessário que o governo fortaleça as ações norteadoras do Guia Alimentar para a População Brasileira 2014. “Estão querendo reformar o guia sem participação popular. Não há necessidade, o guia é com base na Política Nacional de Alimentação e Nutrição”. Carol Dalabona, representante da Pastoral da Criança, destacou o aumento da insegurança alimentar e nutricional das populações negra, indígena, de rua, dentre outras populações que mais estão sofrendo agravos nesse período. “A pandemia acirrou ainda mais essas vulnerabilidades”. A debatedora trouxe à tona a recente extinção do Conselho Nacional de Segurança Alimentar e Nutricional (Consea) por meio do Decreto nº 9.759/2019, que também extinguiu outras centenas de conselhos sociais. “O Consea nos ajudava muito nessa luta. E agora estamos diante da ameaça ao Guia Alimentar, que é nosso cargo chefe de diretrizes para alimentação saudável”, afirmou. A coordenadora do Observatório de Políticas de Segurança Alimentar e Nutrição da Universidade de Brasília, Elisabetta Recine, apresentou o conceito de Sindemia Global, que vem sendo trabalhado por diversos pesquisadores internacionalmente. “Há três grandes pandemia que se articulam em termos determinantes no mundo: a fome, a obesidade e a crise climática”. Segundo ela, o sistema alimentar predominante faz uso intensivo da água, da terra, emite gases para efeito estufa, além de fornecer matéria prima para a produção de industrializados. Myrian Cruz, coordenadora da Comissão Intersetorial de Alimentação e Nutrição (Cian) do CNS, disse que “a questão ambiental atravessa a pandemia da Covid. Estamos vendo nosso país em chamas em meio à pandemia. O meio ambiente nos alimenta e nos mantém vivos. É a saúde do nosso planeta que nos mantem vivos”, afirmou. Elisabetta também lamentou a interrupção das articulações dentro do governo federal que tratavam do tema. “O governo ficou patinando para saber o que era melhor fazer diante da pandemia. Além do corte drástico de orçamento dos principais programas públicos, equipes foram desmontadas, setores extintos”, criticou, em referência à Emenda Constitucional 95/2016, que congelou recursos na saúde e outras áreas até 2036. Representando o segmento de gestores no CNS, a assessora do Conselho Nacional de Secretarias Municipais de Saúde (Conasems), Marcela Alvarenga, afirmou que diversos municípios se articularam para implementarem iniciativas nesse período. “Uns fizeram repasse de valor para refeições, outros atuaram com dispensação de alimentação para crianças, outros de cestas básicas para as famílias”. Segundo ela, uma portaria já está pactuada na Comissão Intergestora Tripartite (CIT), espaço que une gestores do Sistema Único de Saúde (SUS) em nível municipal, estadual, distrital e federal. “Estamos prevendo recursos específicos para doentes crônicos: diabéticos, hipertensos, obesos”. Marcela afirmou que a atenção voltada à obesidade, desnutrição e amamentação “são pautas permanentes e prioritárias” na gestão.

Desarrollo de un índice de complejidad en consultas externas de Endocrinología y Nutrición / Development of an index of complexity for outpatient endocrinology and nutrition clinics

INTRODUCCIÓN: Las herramientas para analizar la casuística en consultas externas son escasas e insatisfactorias. El objetivo de este trabajo de la Sociedad Castellano Manchega de Endocrinología, Nutrición y Diabetes (SCAMEND) fue el desarrollo de una herramienta que permita analizar la casuística de las consultas externas de Endocrinología y Nutrición teniendo en cuenta la complejidad de la patología atendida. MATERIAL Y MÉTODOS: Se definió el Índice SCAMEND de Complejidad en Consultas Externas de Endocrinología y Nutrición (ISCCE-EyN) mediante método Delphi con dos rondas entre especialistas en Endocrinología y Nutrición, comparando la complejidad de cada patología con la de una revisión de hipotiroidismo primario. RESULTADOS: Las primeras visitas fueron consideradas más complejas que las visitas sucesivas. La patología tiroidea no neoplásica y el sobrepeso/obesidad sin complicaciones fueron consideradas las patologías menos complejas, mientras que las metabolopatías, los síndromes de neoplasias endocrinas múltiples y el carcinoma suprarrenal fueron consideradas las más complejas. El grado de consenso fue elevado en la mayoría de las patologías analizadas. CONCLUSIONES: Presentamos una herramienta que permite analizar la casuística de las consultas externas de Endocrinología y Nutrición teniendo en cuenta la complejidad inherente a la patología del paciente atendido. Esta herramienta puede servir para realizar comparaciones entre centros, para asignar mejores recursos dentro de un determinado servicio o para la autoevaluación

INTRODUCTION: The tools for analyzing the case-mix in outpatient clinics are scarce few and unsatisfactory. The objective of this study conducted by Sociedad Castellano Manchega de Endocrinología, Nutrición y Diabetes (SCAMEND) was to develop a tool that allows for analyzing the case-mix in outpatient endocrinology and nutrition clinics, considering bearing in mind the complexity of the conditions seen. MATERIAL AND METHODS: Using the Delphi method, the SCAMEND index of complexity in outpatient endocrinology and nutrition clinics (ISCCE-EyN) was developed by endocrinologists in two rounds, comparing the complexity of each condition being compared with that of a review visit of primary hypothyroidism. RESULTS: The first visits were considered more complex than the subsequent visits. Non-neoplastic thyroid disease and uncomplicated overweight/obesity were considered as the least complex diseases, while metabolic diseases, multiple endocrine neoplasia syndromes, and adrenal carcinoma were considered as the most complex. The degree of agreement was high in most of the diseases analyzed. CONCLUSIONS: This tool allows for analyzing the case-mix in outpatient endocrinology and nutrition clinics, based on the inherent complexity of the disease of the patient is reported. This tool may be used for comparisons between centers, to better allocate resources within a given service, or for self-evaluation

To Wean or Not to Wean: The Role of Autologous Reconstructive Surgery in the Natural History of Pediatric Short Bowel Syndrome on Behalf of Italian Society for Gastroenterology, Hepatology and Nutrition (SIGENP).

Pediatric Short Bowel Syndrome (SBS) can require prolonged parenteral nutrition (PN). Over the years, SBS management has been implemented by autologous gastrointestinal reconstructive surgery (AGIR). The primary objective of the present review was to assess the effect of AGIR on weaning off PN. We also evaluated how AGIR impacts survival, the need for transplantation (Tx) and the development of liver disease (LD). We conducted a systematic literature search to identify studies published from January 1999 to the present and 947 patients were identified. PN alone was weakly associated with higher probability of weaning from PN (OR = 1.1, p = 0.03) and of surviving (OR = 1.05, p = 0.01). Adjusting for age, the probability of weaning off PN but of not surviving remained significantly associated with PN alone (OR = 1.08, p = 0.03). Finally, adjusting for age and primary diagnosis (gastroschisis), any association was lost. The prevalence of TX and LD did not differ by groups. In conclusion, in view of the low benefit in terms of intestinal adaptation and of the not negligible rate of complications (20%), a careful selection of candidates for AGIR should be required. Bowel dilation associated with failure of advancing EN and poor growth, should be criteria to refer for AGIR.

The American Nutrition Association®: Championing the Science and Practice of Personalized Nutrition.

Poor nutrition is the leading cause of our chronic disease and obesity crisis. To unleash the potential of personalized nutrition to reverse this crisis, five leading nutrition organizations have affiliated together as the American Nutrition Association® (ANA®). The ANA envisions a society of Healthy People Powered by Nutrition. The ANA brings that vision to life through its mission to Champion the Science and Practice of Personalized Nutrition and its strategy to Educate, Certify, Advocate, and Connect.

Toward the Definition of Personalized Nutrition: A Proposal by The American Nutrition Association.

Personalized nutrition holds tremendous potential to improve human health. Despite exponential growth, the field has yet to be clearly delineated and a consensus definition of the term "personalized nutrition" (PN) has not been developed. Defining and delineating the field will foster standardization and scalability in research, data, training, products, services, and clinical practice; and assist in driving favorable policy. Building on the seminal work of pioneering thought leaders across disciplines, we propose that personalized nutrition be defined as: a field that leverages human individuality to drive nutrition strategies that prevent, manage, and treat disease and optimize health, and be delineated by three synergistic elements: PN science and data, PN professional education and training, and PN guidance and therapeutics. Herein we describe the application of PN in these areas and discuss challenges and solutions that the field faces as it evolves. This and future work will contribute to the continued refinement and growth of the field of PN.Teaching pointsPN approaches can be most effective when there is consensus regarding its definition and applications.PN can be delineated into three main areas of application: PN science and data, PN education and training, PN guidance and therapeutics.PN science and data foster understanding about the impact of genetic, phenotypic, biochemical and nutritional inputs on an individual's health.PN education and training equip a variety of healthcare professionals to apply PN strategies in many healthcare settings.PN professionals have greater ability to tailor interventions via PN guidance and therapeutics.Favorable policy allows PN to be more fully integrated into the healthcare system.

The Importance of Lactose in the Human Diet: Outcomes of a Mexican Consensus Meeting.

Lactose is a unique component of breast milk, many infant formulas and dairy products, and is widely used in pharmaceutical products. In spite of that, its role in human nutrition or lactose intolerance is generally not well-understood. For that reason, a 2-day-long lactose consensus meeting with health care professionals was organized in Mexico to come to a set of statements for which consensus could be gathered. Topics ranging from lactase expression to potential health benefits of lactose were introduced by experts, and that was followed by a discussion on concept statements. Interestingly, lactose does not seem to induce a neurological reward response when consumed. Although lactose digestion is optimal, it supplies galactose for liver glycogen synthesis. In infants, it cannot be ignored that lactose-derived galactose is needed for the synthesis of glycosylated macromolecules. At least beyond infancy, the low glycemic index of lactose might be metabolically beneficial. When lactase expression decreases, lactose maldigestion may lead to lactose intolerance symptoms. In infancy, the temporary replacing of lactose by other carbohydrates is only justified in case of severe intolerance symptoms. In those who show an (epi)genetic decrease or absence of lactase expression, a certain amount (for adults mostly up to 12 g per portion) of lactose can still be consumed. In these cases, lactose shows beneficial intestinal-microbiota-shaping effects. Avoiding lactose-containing products may imply a lower intake of other important nutrients, such as calcium and vitamin B12 from dairy products, as well as an increased intake of less beneficial carbohydrates.