Percepciones sobre el manejo nutricional del estreñimiento idiopático en el adulto mayor / Perceptions on the Nutritional Management of Idiopathic Constipation in the Elderly

Introducción: Los adultos mayores son la población más propensa a presentar desórdenes gastrointestinales, específicamente y en mayor proporción el estreñimiento idiopático. La alimentación es un factor clave, pero poco estudiado a la hora de tratar el estreñimiento. Objetivo: Comprender las diferentes percepciones por parte de los profesionales de la salud, los cuidadores y el adulto mayor acerca del manejo del estreñimiento idiopático, desde un enfoque alimentario, teniendo en cuenta las preferencias y gustos en el adulto mayor institucionalizado de Medellín. Métodos: La técnica de generación de la información se realizó a través de grupos focales, efectuando seis grupos: uno conformado por los profesionales del área de la salud, tres por los adultos mayores y dos por los cuidadores. Resultados: Se identificó que una de las recomendaciones que más se repite es el incremento del aporte de fibra y líquidos. En general, los adultos mayores tienen poca adherencia a las estrategias nutricionales para el manejo del estreñimiento, ya que los alimentos que se les ofrecen no se adecuan a sus preferencias. Conclusiones: No existe una percepción unánime en el personal de salud y los cuidadores con respecto a la efectividad del tratamiento nutricional para el manejo del estreñimiento en el adulto mayor; sin embargo, se identificaron testimonios exitosos sobre el uso de algunas frutas, la inclusión de fibra en la dieta y el aumento en el consumo de líquidos(AU)

Introduction: Older adults are the population most likely to present with gastrointestinal disorders specifically and idiopathic constipation to a greater extent. Diet is a key factor, but it has been little studied when it comes to treating constipation. Objective: To understand the different perceptions by health professionals, caregivers and older adults about the management of idiopathic constipation, from a dietary approach, taking into account the preferences and tastes of institutionalized older adults in Medellín. Methods: The information generation technique was carried out through focus groups, establishing six groups: one made up of health professionals, three for older adults and two for caregivers. Results: It was identified that one of the most repeated recommendations is to increase the intake of fiber and fluids. In general, older adults have poor adherence to nutritional strategies for managing constipation, since food offered to them do not suit their preferences. Conclusions: There is no unanimous perception among health personnel and caregivers regarding the effectiveness of nutritional treatment for the management of constipation in older adults; however, successful testimonies were identified regarding the use of some fruits, the inclusion of fiber in the diet and the increase in fluid consumption(AU)

Utilização de métodos alternativos como indutor de muda forçada em codornas poedeiras / Use of alternative methods as an inducer of forced molting in laying quail

Objetivou-se avaliar métodos alternativos de restrição alimentar qualitativa e quantitativa em comparação à técnica convencional de muda forçada em codornas japonesas para o segundo ciclo de produção. O período de muda forçada teve duração de 10 dias e dois períodos de 21 dias de pós-muda. Foram utilizadas 72 codornas japonesas fêmeas, emfinal de produção com 72 semanas deidade. As aves foram distribuídas em delineamento inteiramente casualizado com três tratamentos e quatro repetições cada, com seiscodornas por repetição. Os tratamentos experimentais foram:T1 ­aves submetidas a três dias de jejum com posterior fornecimento de ração de postura à vontade por setedias; T2 ­aves que receberam alimentação controlada (10 g/ave/dia) por 10 dias; T3 ­aves que receberam farelo de arroz à vontade por 10 dias. Durante todo o experimento todasas aves foram submetidas a iluminação natural com média de 12 horas de luz diária e água a vontade e após os 10 dias de muda foi fornecido ração de postura a vontade. A utilização do T2 (10 g/ave/dia de ração de postura) e de farelo de arroz como alimentoalternativo no programa de muda forçada foi viável. Mesmo a perda de peso sendo abaixo do recomentado, as aves que receberam 10 g de ração ave/dia e farelo de arroz à vontade apresentaram resultados de desempenho e qualidade do ovo pós muda semelhantes àsaves que ficaram em jejum, além de possibilitar melhores condições de bem-estar animal.(AU)

The objective was to evaluate alternative methods of qualitative and quantitative feed restriction compared to theconventional technique of forced moulting in Japanese quails for the second production cycle. The forced moulting period lasted 10 days and two 21-day post-molt periods. 72 female Japanese quails were used, at the end of production at 72 weeks of age. Thebirds were distributed in a completely randomized design with three treatments and four replications each, with sixquails per replicate. The experimental treatments were: T1 ­birds submitted to three days of fasting with subsequent provision of layingfeed ad libitum for sevendays; T2 ­birds that received controlled feeding (10 g/bird/day) for 10 days; T3 ­birds that received rice bran ad libitum for 10 days. Throughout the experiment, all birds were submitted tonatural lighting with an average of12hours of daily light and water ad libitum and after 10 days of molting, laying feed was provided ad libitum. The use of T2 (10 g/bird/day of laying ration) and ricebran as an alternativefood in the forced molt program was feasible. Even the weight loss being below the recommended, the birds that received 10 g of poultry feed/day and rice bran ad libitum showed similar post-moult performance and egg quality results to birds that were fasted, in addition to enabling better conditions. of animal welfare.(AU)

Diseño de dietas alimentarias para soldadores y paileros a partir de su gasto energético / Design of food diets for welders and smiths based on their energy expenditure

RESUMEN Introducción: el desempeño laboral en algunos puestos de trabajo, determina un alto nivel de carga física por parte de los trabajadores, por lo que se impone la necesidad de disponer de una adecuada dieta alimentaria para mantener la salud física y mental. Objetivo: se desarrolló una investigación para diseñar una dieta alimentaria para soldadores y paileros a partir del gasto energético en actividades laborales. Materiales y métodos: se realizó un estudio de campo que partió de una muestra no probabilística de soldadores y paileros de la Empresa Industrial Ferroviaria José Valdés Reyes. Se ejecutó un procedimiento que permitió la determinación de la dieta alimentaria de los trabajadores a partir del gasto energético de las actividades que desarrollan. Se aplicaron ciertas técnicas de observación directa, entrevistas, tormenta de ideas, medición directa de variables fisiológicas y ecuaciones para el cálculo del gasto energético. Resultados: se diseñaron tres variantes de dietas ajustadas al gasto energético de tres puestos de trabajo de la mencionada empresa. Conclusiones: se espera que la aplicación de las dietas diseñadas contribuya a mantener una buena salud de los trabajadores de esos puestos de trabajo (AU).

ABSTRACT Introduction: the working performance of certain jobs determines a high level of physical load from the part of the workers, for what the necessity is imposed of having an appropriate food diet to preserve the physical and mental health. Objective: to design a food diet for welders and smiths starting from the energy expense in working activities. Materials and methods: a field study was carried out starting from a probabilistic sample of welders and smiths from the Industrial Railroad Enterprise Jose Valdes Reyes. A procedure was performed allowing to determine the energy expenditure of the activities they develop. Several techniques like direct observation, interviews, brain storm, direct measure of physiological variable and equations were used to calculate the energy expenditure. Results: three diet variants were designed adjusted to the energy expenditure of the three working places of the before mentioned enterprise. Conclusions: it is expected the application of the designed diets will contribute to keeping good health of the workers in those working places (AU).

Personalized Web-Based Weight Loss Behavior Change Program With and Without Dietitian Online Coaching for Adults With Overweight and Obesity: Randomized Controlled Trial.

BACKGROUND: The effect of computer- or human-delivered personalized feedback on the effectivess of web-based behavior change platforms for weight loss is unclear. OBJECTIVE: We aimed to compare the effectiveness of a web-based behavior change intervention personalized through either computerized or human-delivered feedback with a nonpersonalized intervention in promoting weight loss in community-based adults with overweight or obesity. METHODS: This pragmatic, 3-group, parallel-arm, randomized trial recruited students and staff in a Brazilian public university who were aged 18 to 60 years, had a BMI of ≥25 kg/m2, and were not pregnant. Participants were allocated to one of 3 groups: platform only (24-week behavior change program delivered using a web platform with personalized computer-delivered feedback), platform plus coaching (same 24-week web-based behavior change program plus 12 weeks of personalized feedback delivered online by a dietitian), or waiting list (nonpersonalized dietary and physical activity recommendations delivered through an e-booklet and videos). Self-reported weight at 24 weeks was the primary outcome. Changes in dietary and physical activity habits within 24 weeks were secondary outcomes. RESULTS: Among the 1298 participants, 375 (28.89%) were lost to follow-up. In the intention-to-treat analysis, the platform-only and platform plus coaching groups had greater mean weight loss than the waiting-list group at 24 weeks (-1.08 kg, 95% CI -1.41 to -0.75 vs -1.57 kg, 95% CI -1.92 to -1.22 vs -0.66 kg, 95% CI -0.98 to -0.34, respectively). The platform-only and platform plus coaching groups, compared with the waiting list group, had a greater increase in the consumption of vegetables (3%, 95% CI 1% to 6% vs 5%, 95% CI 2% to 8% vs -3%, 95% CI -5% to 0%) and fruits (9%, 95% CI 6% to 12% vs 6%, 95% CI 2% to 9% vs 2%, 95% CI 0% to 6%) and a larger reduction in ultraprocessed food intake (-18%, 95% CI -23% to -13% vs -25%, 95% CI -30% to -20% vs -12%, 95% CI -16% to -8%). Changes in physical activity did not differ across the groups. Engagement was higher in the platform plus coaching group than in the platform-only group (7.6 vs 5.2 completed sessions; P=.007). Longer usage of the platform was associated with clinically meaningful (≥5%) weight loss (odds ratio 1.02, 95% CI 1.01 to 1.04). CONCLUSIONS: The web-based behavior change programs with computer- and human-delivered personalized feedback led to greater, albeit small-magnitude, weight loss within 24 weeks. Improvement in multiple dietary habits, but not physical activity, were also greater in the personalized programs compared with the nonpersonalized one. The human-delivered personalized feedback by the online dietitian coach increased user engagement with the program and was associated with a significantly higher chance of clinically meaningful weight loss. TRIAL REGISTRATION: ClinicalTrials.gov NCT03435445; https://clinicaltrials.gov/ct2/show/NCT03435445. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/10.1186/s12889-018-5882-y.

Effect of restricted-feeding strategies on blood concentrations of hormones, metabolites, and minerals in Holstein × Zebu finishing steers / Efeitos de diferentes estratégias de restrição alimentar sobre as concentrações de hormônios, metabólitos e minerais de machos Holandês × Zebu não castrados em terminação

The objectives were to determine the effects of restricted-feeding strategies on blood concentrations of hormones, metabolites, and minerals in Holstein × Zebu finishing steers. Twenty steers (body weight = 319 ± 16.2 kg; age = 19 ± 1 months) were randomly allotted in 4 groups of 5 steers, which were restricted to 85% ad libitum feed intake for either 0 (R0; n = 5), 28 (R28; n = 5), 42 (R42; n = 5) or 84 (R84; n = 5) days of an 84-d finishing period. Steers were individually housed and considered the experimental unit. Blood samples were collected on d 0, 21, 42, 63, and 84, and were assayed for insulin-like growth factor 1 (IGF-1), thyroid hormones (T3 and T4), albumin, creatinine, urea, total protein, glucose, triglycerides, calcium, and phosphorus. Steers had increasing IGF-1 concentrations until d 42 when restricted-fed. Steers fed R84 had the greatest IGF-1 concentrations on d 84. Urea concentrations were greatest in steers fed R0 and least in steers fed R28; steers fed R42 and R84 were intermediate and not different from one another. Concentrations of IGF-1, urea, albumin, and calcium, but not T3, T4, glucose, triglycerides, creatinine, total protein, and phosphorus were affected by restricted-feeding strategies in Holstein × Zebu finishing steers.(AU)

Objetivou-se avaliar os efeitos de diferentes estratégias de alimentação restrita sobre as concentrações sanguíneas de hormônios, metabólitos e minerais de machos Holandês × Zebu castrados em terminação. Vinte machos Holandês × Zebu castrados (peso corporal inicial [PC] = 319 ± 16,2 kg; idade = 19 ± 1 meses) foram aleatoriamente distribuídos em 4 grupos de 5 animais, os quais receberam alimentação restrita a 85% do consumo ad libitum por 0 (R0; n=5), 28 (R28; n=5), 42 (R42; n=5) ou 84 (R84; n=5) dias. Os animais foram alojados individualmente e considerados como unidades experimentais. Amostras de sangue foram coletadas nos dias 0, 21, 42 e 84, e analisadas quanto às concentrações de fator de crescimento semelhante à insulina 1 (IGF-1), hormônios tireiodianos (T3 e T4), albumina, creatinina, ureia, proteína total, glicose, triglicerídeos, cálcio e fósforo. Animais que receberam alimentação restrita apresentaram aumento nas concentrações de IGF-1 até o dia 42 (P < 0,05). Animais R84 apresentaram as maiores (P < 0,05) concentrações de IGF-1 no dia 84. As concentrações de ureia foram maiores (P < 0,05) para os animais AL84 e menores (P < 0,05) para os animais R28; os animais R42 e R84 apresentaram valores intermediários e não diferentes (P > 0,05) entre si. As concentrações de IGF-1, ureia, albumina, e calcium, mas não as de T3, T4, glicose, triglicerídeos, creatinina, proteína total e fósforo, foram influencias pelas diferentes estratégias de alimentação restrita utilizadas em machos Holandês × Zebu castrados em terminação.(AU)

ORAL AND ENTERAL NUTRITION THERAPY IN INFLAMMATORY BOWEL DISEASES AMONG THE PEDIATRIC POPULATION: A LITERATURE REVIEW.

OBJECTIVES: To review the literature on oral and enteral nutrition therapy and investigate the evidence of its efficacy as a treatment, as well as in preventing relapses and reducing symptoms of inflammatory bowel diseases in the pediatric population. DATA SOURCE: We performed a bibliographic search in the PubMed, Web of Science, and Latin American and Caribbean Health Sciences Literature (Literatura Latino-Americana e do Caribe em Ciências da Saúde - Lilacs) databases, using the keywords "inflammatory bowel disease," "diet," and "diet therapy" in English and Portuguese, with filters for pediatric studies published in the previous five years. DATA SUMMARY: We selected 16 articles for this study, nine on exclusive and/or partial enteral nutrition and seven on modified oral diets, such as the specific carbohydrate diet (SCD) and the Crohn's Disease exclusion diet (CDED). The studies found evaluated the anthropometric profile of patients and the inflammatory profile of diseases in children before and after the introduction of each specific nutrition therapy. All interventions presented positive changes in these parameters; however, the results were inconclusive regarding the efficacy of SCD and CDED in the treatment and prevention of relapses. CONCLUSIONS: Exclusive enteral nutrition has proven to be effective in inducing remission of Crohn's Disease, and the use of partial enteral nutrition for maintenance treatment has shown promising results. Other modified oral diets are inconclusive concerning their effectiveness, requiring further randomized controlled clinical trials.

Effect of restricted-feeding strategies on blood concentrations of hormones, metabolites, and minerals in Holstein × Zebu finishing steers / Efeitos de diferentes estratégias de restrição alimentar sobre as concentrações de hormônios, metabólitos e minerais de machos Holandês × Zebu não castrados em terminação

The objectives were to determine the effects of restricted-feeding strategies on blood concentrations of hormones, metabolites, and minerals in Holstein × Zebu finishing steers. Twenty steers (body weight = 319 ± 16.2 kg; age = 19 ± 1 months) were randomly allotted in 4 groups of 5 steers, which were restricted to 85% ad libitum feed intake for either 0 (R0; n = 5), 28 (R28; n = 5), 42 (R42; n = 5) or 84 (R84; n = 5) days of an 84-d finishing period. Steers were individually housed and considered the experimental unit. Blood samples were collected on d 0, 21, 42, 63, and 84, and were assayed for insulin-like growth factor 1 (IGF-1), thyroid hormones (T3 and T4), albumin, creatinine, urea, total protein, glucose, triglycerides, calcium, and phosphorus. Steers had increasing IGF-1 concentrations until d 42 when restricted-fed. Steers fed R84 had the greatest IGF-1 concentrations on d 84. Urea concentrations were greatest in steers fed R0 and least in steers fed R28; steers fed R42 and R84 were intermediate and not different from one another. Concentrations of IGF-1, urea, albumin, and calcium, but not T3, T4, glucose, triglycerides, creatinine, total protein, and phosphorus were affected by restricted-feeding strategies in Holstein × Zebu finishing steers.

Objetivou-se avaliar os efeitos de diferentes estratégias de alimentação restrita sobre as concentrações sanguíneas de hormônios, metabólitos e minerais de machos Holandês × Zebu castrados em terminação. Vinte machos Holandês × Zebu castrados (peso corporal inicial [PC] = 319 ± 16,2 kg; idade = 19 ± 1 meses) foram aleatoriamente distribuídos em 4 grupos de 5 animais, os quais receberam alimentação restrita a 85% do consumo ad libitum por 0 (R0; n=5), 28 (R28; n=5), 42 (R42; n=5) ou 84 (R84; n=5) dias. Os animais foram alojados individualmente e considerados como unidades experimentais. Amostras de sangue foram coletadas nos dias 0, 21, 42 e 84, e analisadas quanto às concentrações de fator de crescimento semelhante à insulina 1 (IGF-1), hormônios tireiodianos (T3 e T4), albumina, creatinina, ureia, proteína total, glicose, triglicerídeos, cálcio e fósforo. Animais que receberam alimentação restrita apresentaram aumento nas concentrações de IGF-1 até o dia 42 (P 0,05) entre si. As concentrações de IGF-1, ureia, albumina, e calcium, mas não as de T3, T4, glicose, triglicerídeos, creatinina, proteína total e fósforo, foram influencias pelas diferentes estratégias de alimentação restrita utilizadas em machos Holandês × Zebu castrados em terminação.

Osteoporosis and osteoarthritis are two sides of the same coin paid for obesity.

Obesity is characterized by adipose tissue expansion and chronic low-grade inflammation. Among the inflammatory mediators related to obesity development are the adipokines. These cytokines are released from fatty tissues and act in an autocrine, paracrine, or endocrine manner. Adipocytes influence the comorbidities of obesity such as osteoporosis (OP) and osteoarthritis (OA). It is still controversial as to whether OP is associated with either a low or high body mass index, but it is quite clear that the latter condition increases the risk for OA development. Bone marrow adipocytes (BMAs) have the same precursors of osteoblasts, which are the primary cells involved in bone formation, and the amount of BMAs appears to be inversely related to bone mineral density. Although adipokines released by these adipocytes influence bone loss progress, their exact role remains controversial. Differently, the infrapatellar fat pad (IPFP) is indicated to protect the function of joint regarding OA. However, there is relatively limited information about the secretion of adipokines and other inflammatory mediators by the IPFP. Despite some inconsistencies, nutritional interventions targeting obesity may also benefit patients with OP and OA. The association among obesity, OP, and OA is quite complex, and many factors need to be explored that are mainly related to the role of adipokines derived locally rather than from visceral and subcutaneous adipose tissue. Also, nutritional intervention may affect fatty tissue mass and secretion of inflammatory mediators that may, at least in part, influence other tissues in the organism such as bone and articular cartilage. The aim of this review was to present the latest knowledge about the interrelationship between obesity and OA or OP and to discuss whether a dietary intervention for obesity will hold promise for patients with OA or OP.

Oral and enteral nutrition therapy in inflammatory bowel diseases among the pediatric population: a literature review / Terapia nutricional oral e enteral nas doenças inflamatórias intestinais em crianças e adolescentes: uma revisão de literatura

ABSTRACT Objectives: To review the literature on oral and enteral nutrition therapy and investigate the evidence of its efficacy as a treatment, as well as in preventing relapses and reducing symptoms of inflammatory bowel diseases in the pediatric population. Data source: We performed a bibliographic search in the PubMed, Web of Science, and Latin American and Caribbean Health Sciences Literature (Literatura Latino-Americana e do Caribe em Ciências da Saúde - Lilacs) databases, using the keywords "inflammatory bowel disease," "diet," and "diet therapy" in English and Portuguese, with filters for pediatric studies published in the previous five years. Data summary: We selected 16 articles for this study, nine on exclusive and/or partial enteral nutrition and seven on modified oral diets, such as the specific carbohydrate diet (SCD) and the Crohn's Disease exclusion diet (CDED). The studies found evaluated the anthropometric profile of patients and the inflammatory profile of diseases in children before and after the introduction of each specific nutrition therapy. All interventions presented positive changes in these parameters; however, the results were inconclusive regarding the efficacy of SCD and CDED in the treatment and prevention of relapses. Conclusions: Exclusive enteral nutrition has proven to be effective in inducing remission of Crohn's Disease, and the use of partial enteral nutrition for maintenance treatment has shown promising results. Other modified oral diets are inconclusive concerning their effectiveness, requiring further randomized controlled clinical trials.

RESUMO Objetivos: Revisar a literatura quanto à terapia nutricional oral e enteral e verificar evidências de sua eficácia tanto para tratamento quanto para prevenção de recidivas e redução de sintomas das doenças inflamatórias intestinais em pediatria. Fonte de dados: Foi realizada pesquisa bibliográfica nas bases de dados PubMed, Web of Science e Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) utilizando os seguintes descritores em inglês: inflammatory bowel disease, diet e diet therapy; e os seguintes descritores em português: doenças inflamatórias intestinais e dietoterapia, com os filtros de estudo em Pediatria e no máximo cinco anos de publicação. Síntese dos dados: Foram selecionados 16 artigos para este estudo, sendo nove sobre o uso de nutrição enteral exclusiva e/ou parcial e sete sobre modificações da dieta oral, como a dieta específica de carboidratos (SCD) e a dieta de exclusão na Doença de Crohn (CDED). Os estudos encontrados avaliaram o perfil antropométrico dos pacientes e o perfil inflamatório das doenças em crianças antes e depois da introdução de cada terapia nutricional específica. Em todas as intervenções, foram observadas mudanças positivas nesses parâmetros, entretanto os resultados mostraram-se inconclusivos em relação à eficácia da SCD e da CDED no tratamento e na prevenção de recidivas. Conclusões: A nutrição enteral exclusiva mostrou-se uma terapia eficaz para a indução da remissão na Doença de Crohn, e o uso da nutrição enteral parcial para tratamento de manutenção vem exibindo resultados promissores. As demais modificações de dietas orais são inconclusivas a respeito de sua eficácia, sendo necessários mais ensaios clínicos randomizados e controlados.

Eosinophilic esophagitis: Current concepts in diagnosis and treatment.

Eosinophilic esophagitis is an immune-allergic pathology of multifactorial etiology (genetic and environmental) that affects both pediatric and adult patients. Its symptoms, which include heartburn, regurgitation, and esophageal stenosis (with dysphagia being more frequent in eosinophilic esophagitis in young adults and children), are similar to those of gastroesophageal reflux disease, causing delays in diagnosis and treatment. Although endoscopic findings such as furrows, esophageal mucosa trachealization, and whitish exudates may suggest its presence, this diagnosis should be confirmed histologically based on the presence of more than 15 eosinophils per high-power field and the exclusion of other causes of eosinophilia (parasitic infections, hypereosinophilic syndrome, inflammatory bowel disease, among others) for which treatment could be initiated. Currently, the 3 "D"s ("Drugs, Diet, and Dilation") are considered the fundamental components of treatment. The first 2 components, which involve the use of proton pump inhibitors, corticosteroids, immunosuppressants and empirical diets or guided food elimination based on allergy tests, are more useful in the initial phases, whereas endoscopic dilation is reserved for esophageal strictures. Herein, the most important aspects of eosinophilic esophagitis pathophysiology will be reviewed, in addition to evidence for the various treatments.

Assessment of a Multidisciplinary Intervention in Patients With BMI ≥35 kg/m2 and Recently Diagnosed Type 2 Diabetes.

CONTEXT: Patients with a body mass index (BMI) ≥35 kg/m2 have lower benefits with intensive treatments and metabolic control goals are more difficult to reach. OBJECTIVE: Evaluate the effect of a comprehensive care program in patients with a BMI ≥35 kg/m2. DESIGN: Prospective cohort study. SETTING: Comprehensive Care Center in a National Institute of Health. PATIENTS: Patients with type 2 diabetes, ≤5 years of diagnosis, without disabling complications, nonsmokers, and a BMI <45 kg/m2. INTERVENTIONS: Exercise and nutritional interventions are modified for patients with a higher BMI to achieve metabolic control. MAIN OUTCOME MEASURES: Main outcome is achievement of treatment goals defined as HbA1c <7%, low-density lipoprotein cholesterol (LDL-c) <100 mg/dL, and blood pressure <130/80 mm Hg. Secondary measures were the percentage of patients achieving three metabolic goals. RESULTS: A total of 587 patients with annual evaluation were included. Mean age was 55.3 ± 9.5 years, 56.6% women, time since diagnosis of 1 year (0 to 5). BMI <35 kg/m2 group included 521 patients and BMI ≥35 kg/m2 group included 66 patients. In the BMI ≥35 kg/m2 group, we observed a greater decrease in weight and fat mass at 3 months compared with <35 kg/m2 group, but the HbA1c, LDL-c, or blood pressure goals were similar at 3 months and 1 year between groups. CONCLUSIONS: Comprehensive interventions are equally effective in patients with recently diagnosed type 2 diabetes with BMI ≥35 kg/m2 compared with patients with a lower BMI.

Grape pomace flour alleviates Pseudomonas aeruginosa-induced hepatic oxidative stress in grass carp by improving antioxidant defense.

Pseudomonas aeruginosa is a Gram-negative opportunistic bacterial pathogen in aquaculture systems being associated to extensive liver damage caused by oxidative stress in both marine and freshwater fish. Dietary supplementation with natural antioxidants is considered a rational strategy to prevent hepatic diseases involved with oxidative stress. Bio-residues resulting from the wine industry, such as grape pomace, are potential sources of bioactive phenolic compounds that can be applied as supplement for animal production. Thus, the aim of this study was to evaluate whether dietary supplementation with grape pomace flour (GPF) was able to prevent or reduce the hepatic oxidative damage of grass carp, Ctenopharyngodon idella, experimentally infected by P. aeruginosa. Hepatic reactive oxygen species (ROS), metabolites of nitric oxide (NOx), thiobarbituric acid reactive substances, and protein carbonylation levels were higher in fish experimentally infected by P. aeruginosa compared to the control group. Hepatic superoxide dismutase and catalase activities and antioxidant capacity against peroxyl radical levels were also higher in fish experimentally infected by P. aeruginosa compared to the control group. Dietary supplementation with 300 mg/kg GPF prevented all alterations elicited by P. aeruginosa, with the exception of protein carbonylation levels. The dietary supplementation with 150 mg/kg GPF was not able to avoid alteration of the analyzed variables, being results similar to those infected (positive control). Based on these results, dietary supplementation with 300 mg/kg GPF prevented P. aeruginosa-induced liver damage in grass carp, and this protective effect occurred through prevention on excessive ROS and NOx production, as well as via prevention of lipid damage. Moreover, 300 mg/kg GPF exerted its hepatoprotective effects by improving enzymatic and non-enzymatic antioxidant defense system. In summary, this supplementation can be an interesting approach to prevent P. aeruginosa-induced liver damage.

Prevention of rocuronium induced mast cell activation with prophylactic oleuropein rich diet in anesthetized rabbits1.

PURPOSE: The effect of a prophylactic oleuropein-rich diet before anesthesia accompanied by the widely-used steroid-based neuromuscular drug rocuronium on mast cell activation was investigated in the study. METHODS: 14 rabbits used in the study. The rabbits in the oleuropein group were given oleuropein-rich extract added to the animals' water at doses of 20 mg/kg oleuropein for 15 days orally. After 15 days, all rabbits in the two groups were given general anesthesia with rocuronium of 1 mg/kg. After 1 day, animals were sacrificed and the liver tissue sections stained with H&E, toluidine blue and tryptase for immunohistochemical study. RESULTS: There was no statistically significant difference between ALT, AST and albumin averages of the oleuropein and control groups (p> 0.05). The tryptase average of the control group was higher than the tryptase average of the oleuropein group and this difference was statistically significant (p=0.003). The T. blue average in the oleuropein group was higher than the control group. However, there was no statistically significant difference between groups (p=0.482). CONCLUSIONS: Rocuronium adverse effects, like hypersensitivity and anaphylaxis, may limit routine use of this substance. The use of oleuropein reduced the number of inflammatory cells and prevented degranulation.

Prevention of rocuronium induced mast cell activation with prophylactic oleuropein rich diet in anesthetized rabbits

Abstract Purpose: The effect of a prophylactic oleuropein-rich diet before anesthesia accompanied by the widely-used steroid-based neuromuscular drug rocuronium on mast cell activation was investigated in the study. Methods: 14 rabbits used in the study. The rabbits in the oleuropein group were given oleuropein-rich extract added to the animals' water at doses of 20 mg/kg oleuropein for 15 days orally. After 15 days, all rabbits in the two groups were given general anesthesia with rocuronium of 1 mg/kg. After 1 day, animals were sacrificed and the liver tissue sections stained with H&E, toluidine blue and tryptase for immunohistochemical study. Results: There was no statistically significant difference between ALT, AST and albumin averages of the oleuropein and control groups (p> 0.05). The tryptase average of the control group was higher than the tryptase average of the oleuropein group and this difference was statistically significant (p=0.003). The T. blue average in the oleuropein group was higher than the control group. However, there was no statistically significant difference between groups (p=0.482). Conclusions: Rocuronium adverse effects, like hypersensitivity and anaphylaxis, may limit routine use of this substance. The use of oleuropein reduced the number of inflammatory cells and prevented degranulation.

Recomendaciones para el tratamiento médico de la obesidad exógena en el nivel primario de atención / Recommendations for the Medical Treatment of Exogenous Obesity at the Primary Care Level

Introducción: Las medidas tomadas para el control integral de la obesidad han sido objeto de debate, y ante tal situación se recomienda un tratamiento que incluya varias orientaciones que pueden ser aplicadas por el médico y la enfermera de la familia, en colaboración con otros especialistas. Objetivo: Describir las recomendaciones de mayor interés en el tratamiento médico de la obesidad exógena, haciendo hincapié en las medidas que pueden tomar el médico y la enfermera de la familia para la implementación exitosa del mismo. Métodos: Se utilizó como buscador de información científica a Google Académico, utilizando como palabras claves: obesidad, tratamiento, prevención, dietoterapia, ejercicio físico, educación terapéutica. Se evaluaron artículos de revisión y de investigación, provenientes de diferentes bases de datos (PubMed, LILACS, Cochrane y SciElo) y páginas Web, en idioma español, portugués e inglés. Se tuvo en cuenta la calidad, según la importancia de los autores de dichos artículos, así como tipo e impacto de los mismos y la actualidad de las citas que en general, tenían menos de 10 años de publicados. Esto permitió el estudio de 150 artículos, de los cuales 107 fueron referenciados. Conclusiones: Realizar un enfoque multidisciplinario y cumplir con las recomendaciones básicas para el tratamiento de la obesidad exógena es fundamental en el control del peso corporal. El cumplimiento de estas recomendaciones por parte del médico y la enfermera de la familia deben facilitar el control del peso corporal en el nivel primario de atención(AU)

Introduction: The measures taken for the comprehensive control of obesity have been subject of debate, and in such a situation treatment is recommended including several guidelines that can be useful by the family doctor and the nurse, in collaboration with other specialists. Objective: To describe the recommendations of highest interest in the medical treatment of exogenous obesity, emphasizing the measures that can be taken by the family doctor and nurse for successful implementation. Methods: Google Scholar was used as a scientific information search engine, using as keywords: obesity, treatment, prevention, diet therapy, physical exercise, therapeutic education. Review and research articles were evaluated, from different databases (PubMed, LILACS, Cochrane and SciElo) and Web pages, in Spanish, Portuguese and English. Quality was taken into account, according to the importance of the authors of these articles, as well as their type and impact and relevance of citations that, in general, were published less than 10 years. This allowed the study of 150 articles, 107 of them were referenced. Conclusions: A multidisciplinary approach and basic recommendations for the treatment of exogenous obesity are fundamental in the control of body weight. The compliance of these recommendations by the family doctor and nurse should facilitate the control of body weight at the primary level of care(AU)

Statin dose reduction with complementary diet therapy: A pilot study of personalized medicine.

OBJECTIVE: Statin intolerance, whether real or perceived, is a growing issue in clinical practice. Our aim was to evaluate the effects of reduced-dose statin therapy complemented with nutraceuticals. METHODS: First phase: Initially, 53 type 2 diabetic statin-treated patients received a supplementation with fish oil (1.7 g EPA + DHA/day), chocolate containing plant sterols (2.2 g/day), and green tea (two sachets/day) for 6 weeks. Second phase: "Good responders" to supplementation were identified after multivariate analysis (n = 10), and recruited for a pilot protocol of statin dose reduction. "Good responders" were then provided with supplementation for 12 weeks: standard statin therapy was kept during the first 6 weeks and reduced by 50% from weeks 6-12. RESULTS: First phase: After 6 weeks of supplementation, plasma LDL-C (-13.7% ± 3.7, P = .002) and C-reactive protein (-35.5% ± 5.9, P = .03) were reduced. Analysis of lathosterol and campesterol in plasma suggested that intensity of LDL-C reduction was influenced by cholesterol absorption rate rather than its synthesis. Second phase: no difference was observed for plasma lipids, inflammation, cholesterol efflux capacity, or HDL particles after statin dose reduction when compared to standard therapy. CONCLUSIONS: Although limited by the small sample size, our study demonstrates the potential for a new therapeutic approach combining lower statin dose and specific dietary compounds. Further studies should elucidate "good responders" profile as a tool for personalized medicine. This may be particularly helpful in the many patients with or at risk for CVD who cannot tolerate high dose statin therapy. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02732223.

Effects of Latino children on their mothers' dietary intake and dietary behaviors: The role of children's acculturation and the mother-child acculturation gap.

RATIONALE: Research shows that acculturation is important to Latinas' dietary intake and related behaviors. Although evidence suggests children may also play a role, it remains unclear whether children's acculturation is related to mothers' dietary intake/behaviors. OBJECTIVES: We examined the relationship between Latino children's acculturation and mothers' dietary intake/behaviors. We also examined the mother-child acculturation gap to identify dyad characteristics associated with mothers' diet. METHODS: Baseline surveys were collected in 2010 from 314 Latino mother-child (7-13 years old) dyads of Mexican-origin enrolled in a family-based dietary intervention in Southern California, USA. Mother's daily intake of fruits, vegetables, and sugary beverages, percent of calories from fat, weekly away-from-home eating, and percent of weekly grocery dollars spent on fruits and vegetables were assessed via self-report. Mothers' and children's bidimensional acculturation were examined using acculturation groups (e.g., assimilated, bicultural) derived from Hispanic and non-Hispanic dimensions of language. We also assessed the acculturation gap between mothers and children with the a) difference in acculturation between mothers' and children's continuous acculturation scores and b) mother-child acculturation gap typologies (e.g., traditional mothers of assimilated children). RESULTS: Findings show that having an assimilated versus a bicultural child was negatively associated with mothers' vegetable intake and positively associated with mothers' sugary beverage intake, percent of calories from fat, and frequency of away-from-home eating, regardless of mothers' acculturation. Traditional mothers of assimilated children reported more sugary beverage intake, calories from fat, and more frequent away-from-home eating than traditional mothers of bicultural children. CONCLUSION: Results suggest that children's acculturation is associated with their mothers' dietary intake/behaviors and traditional mothers of assimilated children require more attention in future research.

Current clinical nutrition practices in critically ill patients in Latin America: a multinational observational study.

BACKGROUND: Malnutrition in critically ill adults in the intensive care unit (ICU) is associated with a significantly elevated risk of mortality. Adequate nutrition therapy is crucial to optimise outcomes. Currently, there is a paucity of such data in Latin America. Our aims were to characterise current clinical nutrition practices in the ICU setting in Latin America and evaluate whether current practices meet caloric and protein requirements in critically ill patients receiving nutrition therapy. METHODS: We conducted a cross-sectional, retrospective, observational study in eight Latin American countries (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, Panama, and Peru). Eligible patients were critically ill adults hospitalised in the ICU and receiving enteral nutrition (EN) and/or parenteral nutrition (PN) on the Screening Day and the previous day (day -1). Caloric and protein balance on day -1, nutritional status, and prescribed nutrition therapy were recorded. Multivariable logistic regression analysis was performed to identify independent predictors of reaching daily caloric and protein targets. RESULTS: The analysis included 1053 patients from 116 hospitals. Evaluation of nutritional status showed that 74.1% of patients had suspected/moderate or severe malnutrition according to the Subjective Global Assessment. Prescribed nutrition therapy included EN alone (79.9%), PN alone (9.4%), and EN + PN (10.7%). Caloric intake met >90% of the daily target in 59.7% of patients on day -1; a caloric deficit was present in 40.3%, with a mean (±SD) daily caloric deficit of -688.8 ± 455.2 kcal. Multivariable logistic regression analysis showed that combined administration of EN + PN was associated with a statistically significant increase in the probability of meeting >90% of daily caloric and protein targets compared with EN alone (odds ratio, 1.56; 95% confidence interval, 1.02-2.39; p = 0.038). CONCLUSIONS: In the ICU setting in Latin America, malnutrition was highly prevalent and caloric intake failed to meet targeted energy delivery in 40% of critically ill adults receiving nutrition therapy. Supplemental administration of PN was associated with improved energy and protein delivery; however, PN use was low. Collectively, these findings suggest an opportunity for more effective utilisation of supplemental PN in critically ill adults who fail to receive adequate nutrition from EN alone.

Management of Gout and Hyperuricemia in CKD.

Hyperuricemia and gout, the clinical manifestation of monosodium urate crystal deposition, are common in patients with chronic kidney disease (CKD). Although the presence of CKD poses additional challenges in gout management, effective urate lowering is possible for most patients with CKD. Initial doses of urate-lowering therapy are lower than in the non-CKD population, whereas incremental dose escalation is guided by regular monitoring of serum urate levels to reach the target level of <6mg/dL (or <5mg/dL for patients with tophi). Management of gout flares with presently available agents can be more challenging due to potential nephrotoxicity and/or contraindications in the setting of other common comorbid conditions. At present, asymptomatic hyperuricemia is not an indication for urate-lowering therapy, though emerging data may support a potential renoprotective effect.