Nutritional status in perianal Crohn's disease: are we underestimating the impact?

Symptomatic perianal disease is common in patients with Crohn's disease (CD), and perianal fistulas represent the primary form of anal involvement. This type of involvement is associated with a poor prognosis and a disabling course. The treatment is challenging and involves both surgical and medical approaches. Despite combined therapy, a significant portion of patients may still require proctectomy to control the symptoms. Consequently, investigating factors that may influence the outcome of perianal disease remains a priority area of research in CD. Nutritional deficiencies are well documented among CD patients with luminal forms of involvement and are closely related to poor clinical outcomes, therapy response, and postoperative complications. As a result, leading guidelines recommend regular nutritional assessment and correction of nutritional deficiencies in patients requiring a surgical approach. Despite these recommendations and the high rate of surgeries among CD patients with perianal disease, there is a shortage of studies addressing the real impact of nutritional status on the course and outcomes of perianal disease. This knowledge gap underscores the importance of further research to understand better and improve the management of perianal CD. This narrative review aims to provide an overview of nutritional status assessment and the influence of nutritional status on the outcomes of patients with perianal CD.

Nutritional factors associated with mortality in hospitalized patients with COVID-19.

Background & aims: Malnutrition is a risk factor that can lead to diminished physical and mental function and impaired clinical outcome from diseases. This study was performed to investigate the influence of nutritional characteristics, age and the presence of pre-comorbidities in hospital mortality or medical discharge in a sample of hospitalized patients with COVID-19. Methods: This historical cohort study was conducted in adults and elderly patients with COVID-19 who were admitted to a nursing ward at the University Hospital of Brasilia (Brazil). Data regarding demographics, comorbidities, laboratory parameters, nutritional characteristics (NRS 2002, SARC-F, BMI) and discharge or death were retrospectively extracted from medical records. Differences in each group (in-hospital mortality or discharge) were assessed using unpaired Student's t test for continuous variables, or Pearson Chi-square tests for categorical data. Results: A total of 222 patients with COVID-19 were enrolled in this study. Nutritional risk and sarcopenia risk were higher in patients who died compared to patients who were discharged (3.55 ± 1.30 vs 2.96 ± 1.30; p = 0.005, 6.81 ± 1.84 vs 4.96 ± 2.95; p < 0.001, respectively). BMI, albumin, and total protein were lower in mortality group than in the discharge group (25.10 ± 5.46 vs 27.82 ± 6.76; p = 0.009, 2.81 ± 0.62 vs 3.27 ± 0.53; p < 0.001, 6.08 ± 0.87 vs 6.48 ± 0.86; p = 0.007, respectively). The mean age between groups was also different with a higher age in the mortality group (70.24 ± 16.23) than in the discharge group (60.54 ± 16.57). Conclusions: Uses of validated tools to identify risk for malnutrition and sarcopenia would be beneficial in hospitalized patients with COVID-19 in order to optimize the treatment between them.

Usual consumption of ultra-processed foods and its association with sex, age, physical activity, and body mass index in adults living in Brasília City, Brazil.

OBJECTIVE: To evaluate the usual consumption of ultra-processed foods (UPF) and its association with body mass index (BMI), physical activity (PA), age, and sex in adults living in Brasília City, Brazil. METHODOLOGY: A total of 506 individuals aged ≥ 20 years old were interviewed. Dietary intake was assessed with two non-consecutive 24-h food recalls. The distributions of usual intakes of energy and the amount of UPF were estimated using the Iowa State University method. The association of age, BMI, PA, and sex with the proportions of UPF consumption (%Kcal and %grams) was investigated with linear regression models. RESULTS: UPF represented 9.2% of the total dietary consumption (grams/day) and 25% of total energy intake. Compared to eutrophic, subjects with obesity consumed a higher percentage of UPF in grams, whereas subjects with overweight had a higher percentage of UPF in kilocalories. The share of UPF in energy intake was lower in male than female individuals, and PA and age were inversely associated with UPF consumption. CONCLUSION: Careful monitoring of intake of UPF is recommended. Its consumption should be reduced among people with overweight/obesity and sedentary individuals. Appropriate choices for methods to evaluate the usual distribution of intake will strengthen future analysis of UPF assessment.

Barreiras e facilitadores do consumo de frutas e hortaliças em adultos de Brasília / Fruit and vegetable intake barriers and facilitators among adults from Brasilia, Brazil

Objetivos: Avaliar as características e as barreiras e motivadores do consumo de frutas e hortaliças em adultos de Brasília.Métodos: Por meio de um roteiro de entrevista foram obtidos dados sociodemográficos, antropométricos, de frequência e porção da ingestão de frutas e hortaliças e razões do padrão atual de consumo. Foram incluídos indivíduos com 20 anos ou mais, a partir de uma amostra pré-selecionada que participou de uma pesquisa sobre atividade física de adultos. Foram empregados frequência, proporções de respostas e análise de conteúdo.Resultados: Foram entrevistados 98 sujeitos. A maioria dos indivíduos consumia menos que três porções diárias de frutas (68%) e hortaliças (77%), entretanto uma proporção elevada apresentava ingestão desses alimentos em cinco ou mais dias da semana (69,5% e 81,5%, respectivamente). As principais razões que motivavam os entrevistados a consumirem frutas e hortaliças eram o fato destas serem saudáveis, de sabor agradável e auxiliarem na manutenção ou perda de peso. As barreiras mais citadas foram sabor desagradável, falta de hábito, comer pouco e achar o consumo suficiente, pouco tempo disponível e perecibilidade elevada.Conclusões: A maioria dos indivíduos apresentava consumo de frutas e hortaliças abaixo do recomendado segundo o guia alimentar da população brasileira, principalmente em função do número reduzido de porções consumidas. A motivação para o consumo de frutas e hortaliças foi vinculada a saúde e sabor. O sabor desagradável e a falta de hábito foram as principais barreiras mencionadas para o consumo de frutas e hortaliças.

Aims: To evaluate characteristics of, barriers to and motivators for consumption of fruit and vegetables among adults in Brasília.Methods: By means of a scripted interview the following data were collected: socio-demographic and anthropometric details, frequency and portion size of fruit and vegetable intake, and reasons for current consumption pattern. Individuals aged 20 years or more, from a pre-selected sample who participated in a survey on physical activity in adults, were selected. Frequency and proportions of responses and content analysis were used.Results: Ninety-eight subjects were interviewed. Most individuals consumed fewer than 3 daily portions of fruit (68%) and vegetables (77%), while a large proportion of them presented intake on 5 or more days of the week (69.5% and 81.5%, respectively). The main reasons that motivated the interviewees to consume fruit and vegetables were: to be healthy, because of the pleasant taste, and because they help lose or maintain weight. Most cited barriers were unpleasant taste, lack of habit, eating little and thinking it is enough, limited time available and high perishability.Conclusions: The majority of subjects presented fruit and vegetable intake below the recommended level indicated by the Brazilian food guide, mainly due to the reduced number of consumed portions. Fruit and vegetable intake were motivated by health and taste. The unpleasant taste and lack of habit were cited as the main barriers for intake.