Clinical usefulness of the patient-generated subjective global assessment short form© for nutritional screening in patients with head and neck cancer: a multicentric study.

Nutritional screening and assessment are considered essential steps in nutritional care for cancer patients, malnutrition remains underreported in clinical practice. The aim of this study was to analyse the clinical usefulness of the Patient-Generated Subjective Global Assessment short form (PG-SGA SF©) for nutritional screening in patients with head and neck cancer (HNC). This is a multicentre, cross-sectional study involving patients with HNC. The final score of the PG-SGA SF© was obtained and the nutritional status was diagnosed using the Patient-Generated Subjective Global Assessment (PG-SGA)®, classifying them as well-nourished or malnourished. Receiver operating characteristic curve, ordinal logistic regression, and C-statistic were used. In total, 353 patients with HNC were enrolled and the prevalence of malnutrition, according to the PG-SGA®, was 64.02% and the median final score of PG-SGA SF© was 11 points. The final score of the PG-SGA SF© had high accuracy (area under the curve = 0.915), and scores ≥9 had the best performance in diagnosing malnutrition. PG-SGA SF© final score ≥9 was associated with malnutrition (odds ratio = 28.32, 95% confidence interval= 15.98-50.17), with excellent discriminatory power (C-statistic = 0.872). In conclusion, the PG-SGA SF© demonstrated excellent performance for nutritional screening in patients with HNC. Given that it is a simple instrument that is faster to administer than the PG-SGA®, we recommend its use in clinical practice among such patients.

Gestational weight gain and adverse maternal and perinatal outcomes among women with gestational diabetes mellitus according to International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria: A cross sectional study.

AIMS: To evaluate the association of gestational weight gain and adverse maternal and perinatal outcomes among Brazilian women with gestational diabetes mellitus (GDM). METHODS: Cross-sectional study conducted in women with GDM, and their newborns, who attended a public maternity hospital. The Institute of Medicine criteria were adopted to assess adequacy of gestational weight gain (GWG). Cesarean delivery, maternal hypertensive disorders of pregnancy (HDP), premature birth, macrosomia, and birth weight adequacy for gestational age were analyzed as outcomes. Simple and multiple logistic regression models were tested to assess the effect of adequacy of GWG on maternal and newborn outcomes. RESULTS: Among the 545 women studied, 64.2% (n = 344) had inadequate weight gain: 27.2% (n = 146) insufficient and 37% (n = 198) excessive. Women with insufficient GWG were more likely to have a preterm birth (OR 2.57; 95% CI: 1.06-6.19), while those with excessive GWG had a greater chance of HDP (OR 2.62; 95% CI: 1.54-4.45) and large for gestational age newborn (OR 1.88; 95% CI: 1.08-3.29), compared with those with adequate weight gain. CONCLUSIONS: Inadequate gestational weight gain was frequent in women with GDM, especially in pregnant women with overweight and obesity, and is associated with unfavorable outcomes.

Performance of subjective global nutritional assessment in predicting clinical outcomes: Data from the Brazilian survey of pediatric oncology nutrition.

BACKGROUND: Methods for assessing nutritional status in children and adolescents with cancer is a difficult in clinical practice. The study aimed to evaluate the performance of Subjective Global Nutritional Assessment (SGNA) in predicting clinical outcomes in children and adolescents with cancer in Brazil. METHODS: This was a prospective cohort multicenter study. It was included 723 children and adolescents with cancer aged 2-18 years between March 2018 and August 2019. Nutritional assessment was performed according to World Health Organization recommendations and using SGNA within 48h of hospitalization. Unplanned readmission, length of hospital stay, and post-discharge death were analyzed. Cohen's kappa coefficient was used to ascertain the agreement between body mass index for age (BMI/A) and SGNA. The sensitivity, specificity, positive and negative predictive values, and accuracy of SGNA were estimated. Odds ratios (ORs) with 95% confidence intervals (CIs) were evaluated using multiple logistic regression. RESULTS: The mean patient age was 9.4 ± 4.9 years. SGNA showed that 29.7% (n = 215) and 6.5% (n = 47) patients had moderate and severe malnutrition, respectively. Considering the concurrent validity criterion, SGNA had an OR (95% CI) of 6.8 (3.1-14.9) for predicting low and very low weight for age at admission, with a sensitivity and specificity of 72.4% (59%-82.1%) and 72% (64.2%-78.9%), respectively. SGNA could predict death in children with severe/moderate malnutrition, with an accuracy of 63.8% (63%-65.1%). Logistic multivariate analysis showed that the adjusted effect of death; hematological tumor; living in the northeast, southeast, and midwest regions of Brazil; and older age was associated with malnutrition according to SGNA. CONCLUSION: Based on concurrent validity between SGNA and anthropometry, SGNA performed well and had a good ability to predict death in Brazilian children with cancer.

Gestational weight gain adequacy for favourable obstetric and neonatal outcomes: A nationwide hospital-based cohort gestational weight gain for favourable obstetric and neonatal outcomes.

BACKGROUND & AIMS: Most Brazilian women fail to gain weight within recommendations during pregnancy but current guidelines about gestational weight gain was based on North American population analysis. There are no standardized recommendations developed from Brazilian population data, which should be particularly analysed due to ethnic and sociodemographic characteristics. This study analyses the gestational weight gain of Brazilian women with favourable obstetric and neonatal outcomes according to the pre-pregnancy body mass index, considering maternal sociodemographic characteristics. METHODS: We analysed data from the Birth in Brazil: national survey into labour and birth study, a nationwide hospital-based cohort carried out in 266 Brazilian hospitals from February/2011 to July 2012, including adult pregnant women who have no chronic diseases and who have single foetal gestation, born alive and without malformation. Favourable obstetric and neonatal outcomes considered were gestational age at birth greater than or equal to 37 and less than 42 weeks, birthweight between 2500 g and 4000 g, and birthweight suitable for gestational age. Sociodemographic characteristics were obtained from medical records and interviews. Weight and height information was obtained from the prenatal card or self-reported. The pre-pregnancy BMI was classified in low weight, normal weight, overweight, obesity I, obesity II, and obesity III. For the missing cases on pre-pregnancy weight or height, body mass index was imputed by multiple imputation prediction model. Gestational weight gain was the difference between the last weight before delivery and the pre-pregnancy weight and was presented as mean and confidence interval, mean and standard deviation, and percentiles distribution (10th to 90th) for each pre-pregnancy body mass index, thus compared to Institute of Medicine recommendations. RESULTS: The analysis included 8184 Brazilian women. The gestational weight gain was lower in women with less favoured social conditions. The mean gestational weight gain according to pre-pregnancy body mass index was within the Institute of Medicine recommendations, except for women with overweight or obesity class I, who have the mean weight gain higher than upper limit of the Institute of Medicine range. Gestational weight gain decreased with an increase in the categories of body mass index; the mean (±standard deviation) were: 15.41 kg (±5.53), 13.54 kg (±4.97), 12.45 kg (±5.86), 9.38 kg (±6.31), 7.15 kg (±6.43), and 5.04 kg (±7.10), for low weight, normal weight, overweight, and obesity I, II and III, respectively. Women had favourable obstetric and neonatal outcomes gaining less, within or more than the recommendations with higher range of variation amongst obesity classes I, II, and III which do not have specific ranges stated in Institute of Medicine guidelines. CONCLUSION: Brazilian women had favourable obstetric and neonatal outcomes gaining less, within or more than the Institute of Medicine recommendations. We highlight the need of population-based high-quality research to investigate the optimal GWG recommendations for this population.

Determinants of ultra-processed food consumption in Brazilian children and adolescents with type 1 diabetes mellitus: a cross-sectional study.

OBJECTIVES: To analyze the determinants of UPP consumption among children and adolescents with type 1 diabetes mellitus. METHODS: Cross-sectional study at a reference hospital for the treatment of diabetes in Rio de Janeiro, Brazil. The sociodemographic, anthropometric, dietary, and clinical factors associated with the percentage of total energy intake (TEI) consumed in the form of UPP were investigated. Food consumption was assessed by 24 h recall and the foods were classified according to the degree of processing as described in the NOVA classification, after which the TEI of each food group was calculated. Multiple linear regression was adopted in the analysis, and associations with p<0.05 were considered significant. RESULTS: The study included 120 children and adolescents with a mean age of 11.74 ± 2.88 years, 53.3% female. Body mass index z-score was 0.65 (± 0.89) and 31.7% (n=38) were overweight. The average total energy consumption was 1,756.38 kcal (± 518.38). The mean percentage of TEI from UPP was 24.2% ± 17.9, meaning that 425.59 kcal (± 380.15) of all calories ingested came from such foods. The independent variables associated with the percentage of ultra-processed foods (UPP) in TEI were: per capita household income up to one the minimum wage (ß: -22.03; CI 95% -35.24 to -8.82); and parents/guardians schooling of the up to nine years in formal education (ß: 19.86; CI 95% 8.27-31.45). CONCLUSIONS: Lower household income and fewer years in formal education seem to determine a preference for UPP over fresh and minimally processed foods.

Changes of Physical Activity and Ultra-Processed Food Consumption in Adolescents from Different Countries during Covid-19 Pandemic: An Observational Study.

AIM: to describe physical activity and ultra-processed foods consumption, their changes and sociodemographic predictors among adolescents from countries in Europe (Italy and Spain) and Latin America (Brazil, Chile, and Colombia) during the SARS-CoV-2-pandemic period. METHODS: Cross-sectional study via web survey. International Physical Activity Questionnaire (IPAQ) and weekly ultra-processed food consumption data were used. To compare the frequencies of physical activity status with sociodemographic variables, a multinomial logistic and a multiple logistic regression for habitual ultra-processed foods was performed. In final models, p < 0.05 was considered significant. RESULTS: Sample of 726 adolescents, mostly females (59.6%) aged 16-19 years old (54.3%). Adolescents from Latin America presented odds ratio (OR) 2.98 (CI 95% 1.80-4.94) of being inactive and those whose mothers had higher level of education were less active during lockdown [OR 0.40 (CI 95% 0.20-0.84)]. The habitual ultra-processed consumption was also high during this period in all countries, and more prevalent in Latin America. CONCLUSION: A higher prevalence of inactivity was observed in this population, but reductions of physical activity and habitual ultra-processed consumption during the pandemic were more pronounced in Latin America. Our findings reinforce the importance of promoting a healthy lifestyle, i.e., exercise and diet, during periods of social isolation.

Covid-19 Confinement and Changes of Adolescent's Dietary Trends in Italy, Spain, Chile, Colombia and Brazil.

Confinement due to the COVID-19 pandemic can influence dietary profiles, especially those of adolescents, who are highly susceptible to acquiring bad eating habits. Adolescents' poor dietary habits increase their subsequent risk of degenerative diseases such as obesity, diabetes, cardiovascular pathologies, etc. Our aim was to study nutritional modifications during COVID-19 confinement in adolescents aged 10 to 19 years, compare them with their usual diet and dietary guidelines, and identify variables that may have influenced changes. Data were collected by an anonymous online questionnaire on food intake among 820 adolescents from Spain, Italy, Brazil, Colombia, and Chile. The results show that COVID-19 confinement did influence their dietary habits. In particular, we recorded modified consumption of fried food, sweet food, legumes, vegetables, and fruits. Moreover, gender, family members at home, watching TV during mealtime, country of residence, and maternal education were diversely correlated with adequate nutrition during COVID-19 confinement. Understanding the adolescents' nutrition behavior during COVID-19 lockdown will help public health authorities reshape future policies on their nutritional recommendations, in preparation for future pandemics.

Gestational weight gain and adverse maternal outcomes in Brazilian women according to body mass index categories: An analysis of data from the Birth in Brazil survey.

BACKGROUND & AIMS: Monitoring gestational weight gain (GWG) is relevant for perinatal outcomes, especially in the context of increasing obesity and overweight in the female population. This study analyses the association between GWG in Brazilian women, according to different body mass index (BMI) categories, and different outcomes, including hypertensive disorders of pregnancy (HDP), gestational diabetes (GD) and caesarean section. METHODS: Data on women from all the major regions of Brazil with a single pregnancy of a gestational age of 28 weeks or more and information available for anthropometric evaluation were included in the Birth in Brazil survey. Adequacy of GWG was assessed according to the percentile distribution of GWG of women with favourable neonatal outcomes, with the median of the distribution referred to as 100% adequacy in the GWG evaluation. RESULTS: The study consisted of 18,953 women, 58.3% of whom were normal weight and 35.1% were overweight. The adequacy of GWG was better amongst the normal weight women (91.1%) and worse amongst those with class III obesity (46.0% with excessive GWG), with the latter showing the highest occurrence of adverse outcomes. Results of the multivariate logistic regression analysis revealed that weight gain above 200% of the median in the normal weight, overweight and obese women was positively associated with HDP and caesarean section, but not with GD. CONCLUSIONS: The proposed ranges of appropriate GWG associated with favourable neonatal outcomes based on the data from the Birth in Brazil survey proved good predictors of HDP and caesarean section amongst the women included in the study.

Impact of energy deficit during hospitalization and biomarkers at admission on clinical outcomes in critically ill children: A longitudinal study.

BACKGROUND & AIMS: To evaluate the impact of energy deficit during hospitalization and the biomarkers albumin and C-reactive protein (CRP) on the clinical outcomes length of stay (LOS) and duration of mechanical ventilation (DMV) in children and adolescents admitted to the pediatric intensive care unit (PICU) of a private hospital in Rio de Janeiro. METHODS: A longitudinal, retrospective study was conducted of the medical records of patients admitted to the PICU from May 2016 to June 2017 who received enteral nutrition (EN) for 72 h or longer. The cut-off points for serum albumin and CRP were set at ≥3.5 and <2.0, respectively. The energy balance was calculated as the difference between the energy prescribed and the energy received by the patient. The comparison of continuous variables related to LOS and DMV was assessed using Student's t-test and the Mann-Whitney test. The significance value was set at p < 0.05. RESULTS: Ninety-three patients were selected, with a median age of 32 (±39.49) months. The mean serum albumin and CRP levels were 4.04 (±0.59) and 4.67 (±7.40), respectively. In linear regression models adjusted for length of stay, reduced albumin, increased CRP, and negative energy balance were positively associated. In the models adjusted to DMV, the values for reduced albumin and increased CRP were significant. CONCLUSION: A significant association was found between serum albumin and CRP at admission and the outcomes under investigation, LOS and DMV. Energy deficit was also associated with LOS.

Predictive factors of non-HDL cholesterol in children and adolescents with type 1 diabetes mellitius: A cross-sectional study.

AIMS: To assess predictors of non-HDL cholesterol in children and adolescents with T1DM. METHODS: A cross-sectional study of 120 children and adolescents aged 7-16 with T1DM, but without any other chronic morbidities, at a referral outpatient clinic for the treatment of diabetes in Rio de Janeiro, Brazil. Socio-demographic, anthropometric, dietary, and clinical factors were assessed, which included measurements of serum lipids and glycated hemoglobin (HbA1c). Food intake was assessed by 24-h dietary recall. Multiple linear regression was adopted in the analysis. RESULTS: The mean age of of the subjects was 11.74 ±â€¯2.88 years, 53.3% were female, and the mean duration of T1DM was 6.68 ±â€¯3.33 years. The mean energy intake from carbohydrates, proteins, and lipids was 51.98% (±9.20), 21.43% (±6.13), and 26.57% (±9.98), respectively. The energy intake from processed and ultra-processed foods represented 40.79% of total energy intake. The predictors of non-HDL cholesterol were: HbA1c (%) (p = 0.000, ß = 8.5, CI: 4.8-12.1), duration of T1DM (p = 0.000, ß = 2.8, CI: 1.3-4.3), and sex (p = 0.032, ß = 10.1, CI: 0.9-19.4). CONCLUSION: Glycemic control was the major modifiable predictor of non-HDL cholesterol concentrations, a significant indicator of cardiovascular risk.

Patient-generated subjective global assessment predicts cachexia and death in patients with head, neck and abdominal cancer: A retrospective longitudinal study.

BACKGROUND & AIMS: Cancer is a complex disease, with poor prognosis when associated with malnutrition. This condition can lead to Cancer Cachexia (CC), a syndrome characterized by loss of muscle mass with or without fat loss, often associated with higher risk of death. Although there are recommended screening tools to assess nutritional status in cancer patients, such as Patient-Generated Subjective Global Assessment (PG-SGA), little is known about CC prediction. The aim was to investigate the association between nutritional status of patients with head, neck and abdominal cancer, assessed by PG-SGA at the day of hospitalization, with CC, hospitalization time and death. METHODS: This is a retrospective longitudinal study, where we collected data of 97 patients about PG-SGA nutritional classification, anthropometry, gender, age, cachexia diagnosis and death. RESULTS: PG-SGA classification was strongly associated with all the anthropometric measures (p < 0.0001). According to PG-SGA classification, 30.61% (n = 15) of patients in group A developed pre-cachexia; 38.24% in group B developed CC (n = 13); and 60% (n = 9) in group C developed refractory cachexia (p < 0.0001). Death rate was 24.49% (n = 12), 54.55% (n = 18) and 80% (n = 12) in groups A, B and C, respectively (p < 0.0001). PG-SGA had good sensibility (89.5%) and accuracy (72%) for CC, and also good specificity (75.51%) and accuracy (69%) for death. CONCLUSIONS: PG-SGA demonstrated a significative association with the variables measured and was able to predict CC and death. This, in addition to its simple applicability, suggests that PG-SGA can be a useful tool to screen cancer patients for CC establishment and death risk.

Food intake of women with gestational diabetes mellitus, in accordance with two methods of dietary guidance: a randomised controlled clinical trial.

The aim of the study was to evaluate the food intake of pregnant women with gestational diabetes mellitus (GDM) according to two methods of dietary guidance. A randomised controlled clinical trial was conducted by appointment with a nutritionist and by using data from hospital records (2011-2014). The study population comprised adult women diagnosed with GDM treated in a public maternity hospital in Rio de Janeiro, Brazil. The control group (CG) received nutritional advice by the traditional method and the intervention group (IG) were instructed on carbohydrate counting. The analysis of food intake and the consumption of processed foods (PF) and ultra-processed foods (UPF) were evaluated in the second and third trimester. A total of 286 pregnant women were initially assessed (145 in the CG and 141 in the IG). It was observed that 89/120 (74·2 %) and 183/229 (79·9 %) consumed PF daily in the second and third trimesters, respectively, whereas 117/120 (97·5 %) and 225/231 (97·4 %) consumed UPF daily in the second and third trimesters, respectively. When analysing the intake of macronutrients (%) by quartiles, women who had fat intake in the third quartile had the highest average postprandial blood glucose compared with those who consumed fat in the second quartile (P=0·02). The consumption of PF and UPF was high and dietary intake was similar in both groups, regardless of dietary guidance method deployed, suggesting that both methods tested in the study can be used for monitoring the nutritional status of pregnant women with GDM.

Phase angle assessment in critically ill cancer patients: Relationship with the nutritional status, prognostic factors and death.

PURPOSE: To evaluate the relationship between phase angle (PA) and nutritional status and the prognostic significance of PA in critically ill cancer patients. METHODS: 31 patients that had been admitted to the intensive care unit (ICU) of a center on oncology were evaluated. Their PA was obtained from their bioelectrical impedance within 48 h of the ICU admission. The logistic regression analysis of Cox was used in order to identify the independent predictors of the outcomes. RESULTS: Negative and significant correlations were observed between the PA and the following variables: the length of hospital ward stay, the length of ICU stay, the total time of hospital stay, the mechanical ventilation time, and the acute physiology and chronic health evaluation II (APACHE II) scores. A positive correlation was ascertained between the PA and albumin. PA was significantly associated with death. Patients with a PA ≤3.8° presented a significantly shorter survival time than those with a PA >3.8°. CONCLUSION: PA was a prognostic marker in this population, independently of previously established prognostic factors. PA can represent a clinically feasible approach for the initial identification of critically ill cancer patients who require an early and specialized nutritional intervention.

Hypertensive disorders of pregnancy in women with gestational diabetes mellitus from Rio de Janeiro, Brazil.

Pregnant women with Gestational Diabetes Mellitus (GDM) have a greater chance of developing Hypertensive Disorders of Pregnancy (HDP) by the effect of insulin resistance in nitric oxide action.This study aims to describe factors associated with the development of HDP in pregnant women with GDM, assisted in a public maternity hospital in Rio de Janeiro, Brazil. This is a cross-sectional study including 292 pregnant adult women with GDM assisted at Maternidade Escola of the Universidade Federal do Rio de Janeiro. The women were examined during pregnancy and postpartum. Data were collected between 2011 and 2014 from medical records and through in-person interviews. The Student t-test and the chi-square test were applied; additionally, the magnitude of the association between independents variables and HDP was estimated by logistic regression models. The occurrence of HDP was observed in 19.5% (n=57) of the evaluated women: 9.2% had pregnancy hypertension and 10.3% had preeclampsia. The chance of HDP was higher among women with GDM in a previous pregnancy (Odds Ratio-OR=3.8; Confidence Interval of 95%-95% CI: 1.1; 12.8) and among those who were 35 years old or older (OR 3.3; 95% CI: 1.2; 8.7) after controlling the effects of pre-gestational weight and dietary ingestion of calcium, riboflavin, thiamine, vitamin A and protein. Women that had any alteration in blood pressure in a previous pregnancy and those over 35 years old were under higher risk of HDP. The findings may help in the design of interventions aiming to prevent HDP in adult women.

Carbohydrate Counting during Pregnancy in Women with Type 1 Diabetes: Are There Predictable Changes That We Should Know?

BACKGROUND/AIMS: Carbohydrate counting (CC) is a helpful strategy for the treatment of type 1 diabetes mellitus (T1DM) and the main parameters used in this method are the insulin to carbohydrate ratio (ICR) and the sensitivity factor (SF). Throughout pregnancy, a state of insulin resistance develops. Therefore, we hypothesized that ICR and SF change and our aim was to describe the pattern of modification of these parameters in pregnant women with T1DM on CC. METHODS: This study followed 21 women with T1DM throughout pregnancy. Starting ICR was 1:15 and SF was calculated using the formula: 1,500/total daily insulin dose (TDID; for regular insulin) or 1,800/TDID (for ultra-rapid analogs). ICR was adjusted every 1-2 weeks according to self-monitoring of blood glucose. SF was recalculated every 1-2 weeks. RESULTS: Throughout gestation there was a mean decrease in the ICR in breakfast, lunch and dinner of 8.2 (p < 0.0001), 7.7 (p = 0.003) and 7 (p = 0.005) grams per international units (g/IU), respectively. Mean SF reduction from first to third trimester was 10 mg/dL per IU (mg/dL/IU; p < 0.0001). CONCLUSIONS: Women with T1DM in CC during pregnancy evolve with a progressive reduction in the ICR at every meal (mean of 8.2 g/IU for breakfast, 7.7 g/IU for lunch and 7 g/IU for dinner) and also in the SF (10 mg/dL/IU).

Overweight among children and adolescent with type I diabetes mellitus: prevalence and associated factors.

OBJECTIVES: Describe the overweight frequency (overweight and obesity) and identify the factors associated with this in children and adolescents with type 1 diabetes mellitus (T1DM) treated at a University Children's Hospital in Rio de Janeiro. METHODS: This is an analytical cross-sectional study, which included patients diagnosed with T1DM who had complete anthropometric data (weight and height) and excluded those using drugs with effect on weight gain, genetic syndromes, celiac disease, hypothyroidism, renal failure and other chronic diseases, and pregnant women. The data collection was referring to the last consultation, and with respect to laboratory tests, the most recent data was collected. The dependent variable was the overweight, defined as Z score ≥1. The independent variables were gender, age, insulin dose, duration of disease, lipid profile, glycated hemoglobin, type of prescribed food planning, and place of residence. A logistic regression model was built for each outcome studied, considering significant associations those with p < 0.05. RESULTS: The study included 195 patients with a mean age of 10.6 (±3.8) years, and 49.7 % (n = 97) aged less than 10 years. The overweight frequency was 40 % (n = 78). The age ≥10 years (OR 0.41; 95 % CI 0.20-0.86; p = 0.019) and the dose of insulin/kg ideal weight (OR 3.38; 95 % CI 1:55-7:39; p = 0.002) were considered the variables associated with overweight. CONCLUSIONS: There was a high prevalence of overweight, which explains strategies for promoting healthy eating habits and changing lifestyle with a focus on children and adolescents with diabetes.

EVALUATION OF EFFICACY AND EFFECTIVENESS OF PRENATAL NUTRITIONAL CARE ON PERINATAL OUTCOME OF PREGNANT WOMEN; RIO DE JANEIRO, BRAZIL.

AIM: to evaluate the impact of a prenatal nutritional assistance proposal (PNA) for adult pregnant women. METHODS: a study of the impact of an applied nutritional intervention throughout the prenatal on perinatal outcomes - adequacy of total gestational weight gain, gestational anemia frequency and pregnancy complications in a public maternity hospital in Rio de Janeiro. The data represent three groups of adult pregnant women, during 10 years: GI (1999-2001, n = 225), GII (2005-2006, n = 208) and GIII (2007-2008, n = 394). RESULTS: in GII (reference group) it was included a detailed nutritional assessment, an individualized eating plan and an attendance of at least four scheduled appointments with a nutritionist. PNA coverage occurred in only 20.4% of GI, 100% of GII and 42.1% in GIII (p < 0.001). Women in GI had a higher proportion of inadequate total weight gain (OR 1.82, 95% CI: 1.20 -2.75), anemia (OR 2.18, 95% CI: 1.35 - 3.55) and pregnancy complications (OR 1.57, 95% CI: 1.04 - 2.36), as well as those who joined GIII, - OR 1.68 (95% CI: 1.16 - 2.44), OR 2.45 (95% CI: 1.56 - 3.84), OR 2.07 (95% CI: 1.42 - 3.00) - when compared to women in GII. CONCLUSIONS: the model tested in GII PNA demonstrated to be effective in the outcomes studied.

Objetivo: evaluar el impacto de una propuesta de asistencia nutricional prenatal (ANP) para las mujeres embarazadas adultas. Métodos: estudio del impacto de una intervención nutricional prenatal en los resultados perinatales, adecuación de la ganancia total de peso durante la gestación, frecuencia de anemia gestacional y complicaciones en el embarazo en una maternidad pública de Río de Janeiro. Los datos representan tres grupos de mujeres embarazadas adultas, durante 10 años: GI (1999-2001, n = 225), GII (2005-2006, n = 208) y GIII (2007-2008, n = 394). Resultados: en el GII (grupo de referencia) se incluyó una evaluación nutricional detallada, un plan de alimentación individualizado y una asistencia de por lo menos cuatro citas programadas con un nutricionista. La cobertura PNA se produjo en solo el 20,4% en el GI, el 100% en el GII y el 42,1% en el GIII (p < 0,001). Las mujeres del GI tenían una mayor proporción de ganancia total de peso insuficiente (OR 1,82; IC 95%: 1,20 -2,75), anemia (OR 2,18; IC 95%: 1,35-3,55) y complicaciones del embarazo (OR 1.57, IC 95%: 1,04 - 2,36), así como aquellas que se unieron al GIII, - OR 1,68 (IC 95%: 1.16 - 2.44), OR 2,45 (IC 95%: 1,56-3,84), OR 2,07 (IC 95%:1,42- 3,00), en comparación con las mujeres del GII. Conclusiones: el modelo probado en el GII PNA demostró ser eficaz según los resultados estudiados.

Association between maternal glucose levels during pregnancy and gestational diabetes mellitus: an analytical cross-sectional study.

BACKGROUND: To evaluate the association between fasting glucose levels in women throughout pregnancy and the occurrence of gestational diabetes mellitus (GDM) and other pregnancy complications, macrosomia, and cesarean delivery. METHODS: An analytical cross-sectional study with 829 healthy pregnant women receiving health care at a public maternity unit in Rio de Janeiro between 1999 and 2008. The dependent variables assessed in the study were: GDM (was confirmed when two or more values were above the glucose curve using 100 g glucose), complications, mode of delivery and birth weight. Macrosomia was defined as a birth weight of >4000 g. The independent variables assessed were: maternal fasting glucose per trimester as a continuous variable, divided into three categories, socio-demographic data on the mothers. The level of statistical significance was set at 5%. RESULTS: The mean fasting glucose levels of the women who had GDM were higher in the second trimester than for those who had no pregnancy complications (90.5 mg/dL vs. 78.5 mg/dL, p = 0.000). Higher mean fasting glucose levels were also found in the third trimester for women who developed GDM than for those with no pregnancy complications (90 mg/dL vs. 77.8 mg/dL, p = 0.016). Women who had a cesarean delivery had higher fasting glucose levels in the second (80.4 mg/dL vs. 78 mg/dL, post hoc = 0.034) and third (80.4 mg/dL and 77.1 mg/dL; post hoc = 0.005) trimesters than women who had a normal delivery. Also, higher fasting glucose levels were found in the second semester for women whose infants had macrosomia than for women whose newborns were normal weight (86.2 mg/dL and 78.8 mg/dL; post hoc = 0.003). The chance of develop GDM was higher for the women with glucose levels in the 90-94 mg/dL range in the second trimester (OR = 7.2; 95% CI = 2.33-22.24) than for the women whose glucose levels were in the <80 mg/dL and 80-90 mg/dL ranges. CONCLUSION: Second and third trimester fasting glucose levels below the cut-off values for the diagnosis of GDM are associated with an increased risk of pregnancy complications. The dependent variables assessed in the study were: GDM (present/absent), complications, mode of delivery (normal, forceps, cesarean), and birth weight.

The role of prenatal nutrition assistance on the prevalence of night blindness in pregnant adults.

INTRODUCTION: In developing countries, night blindness is a very common public health problem among pregnant women. OBJECTIVE: Evaluate the effect of the changes occurred on prenatal care concerning prenatal nutritional care on the occurrence of night blindness (XN) in adult pregnant women in public maternity hospital in Rio de Janeiro between 1999-2001 and between 2007-2008. METHODS: Two cross-sectional studies were conducted, been the first one conducted between 1999-2001 and the second one between 2007-2008. Were studied 402 puerperal women, 225 between 1999-2001 (GI) and 177 between 2007-2008 (GII). The gestational XN was investigated during the immediate puerperium (GI) and during the prenatal/puerperium (GII), diagnosed by the World Health Organization. The study collected sociodemographic, clinical, obstetric, anthropometric and prenatal care information. RESULTS: It verified significant reduce of prevalence of gestational XN (GI = 18.7% e GII = 0.6%, p < 0.001). The occurrence of gestational XN was associated to sanitary conditions, education level, more than six prenatal consultations, miscarriage at last pregnancy, higher average number of deliveries, average number of prenatal care consultations and prenatal nutritional (p < 0.05). There was no association between gestational XN and marital status, skin color, pre-gestational nutritional status, adequacy of gain of total gestational weight, gestational anaemia and average number of pregnancies (p > 0.05). CONCLUSION: The inclusion of nutritional care in routine prenatal care may have contributed to the reduction of gestational XN. Studies to assess the nutritional intervention in the prevention and treatment of gestational XN at regions at greatest risk are suggested.

Introducción: En los países en desarrollo, la ceguera nocturna (CN) es un problema muy común de la salud pública entre las mujeres embarazadas. Objetivo: Evaluar el efecto de los cambios ocurridos en la atención prenatal sobre el cuidado nutricional prenatal sobre la aparición de CN en mujeres adultas embarazadas en una maternidad pública en Rio de Janeiro entre 1999-2001 y entre 2007-2008. Métodos: Se realizaron dos estudios transversales, el primero entre 1999-2001 y el segundo entre 2007-2008. Se estudiaron 402 mujeres puérperas, 225 entre 1999-2001 (GI) y 177 entre 2007-2008 (GII). La CN gestacional fue investigada durante el puerperio inmediato (GI) y durante el prenatal/puerperio (GII), diagnosticada por la Organización Mundial de La Salud. El estudio incluió informaciones sociodemográficas, clínicas, obstétricas, antropométricas y del cuidado prenatal. Resultados: Se verificó reducción significativa de la prevalencia de CN gestacional (GI = 18,7% e GII = 0,6%, p < 0,001). La ocurrencia de CN gestacional se asoció con las condiciones sanitarias, el nivel de educación, más de seis consultas prenatales, abortos espontáneos en el último embarazo, mayor número promedio de partos, el número promedio de consultas de atención prenatal y de nutrición prenatal (p < 0,05). No hubo asociación entre CN gestacional y el estado civil, color de piel, estado nutricional pregestacional, adecuación de la ganancia de peso durante la gestación, incluyendo anemia gestacional y el número medio de embarazos (p > 0,05). Conclusión: La inclusión de la atención nutricional en el cuidado prenatal de rutina puede haber contribuido para la reducción de CN gestacional. Se sugiere más estudios para evaluar la intervención nutricional en la prevención y el tratamiento de CN gestacional en las regiones de mayor riesgo.

Effect of the use of probiotics in the treatment of children with atopic dermatitis; a literature review.

INTRODUCTION: Atopic dermatitis (AD) is a disease that mainly affects the pediatric population involving chronic and repetitive inflammatory skin manifestations. Its evolution is known as atopic march, which is characterized by the occurrence of respiratory and food allergies. AIM: To carry out a classical review of the state-of-theart scientific literature regarding the effect of probiotics on the treatment of children with AD. METHODS: Searches were conducted in Medline and Lilacs through the portals PubMed (http://www.ncbi.nlm. nih.gov/pubmed/) and SciELO (http://www.scielo.br). There was a selection of the available publications in the period from 2001 to 2011, using the keywords atopic dermatitis and probiotics (in English and in Portuguese). RESULTS: After applying the inclusion and exclusion criterias, we selected 12 case-control studies which were conducted in four European countries and Australia. The methodological quality of the studies was assessed according to the STROBE recommendations. Assessment of agreement among researches in classifying the quality of the articles showed excellent agreement (k = 1.00, 95%) with a total of 9 papers at B level. The majority of the studies (75%) indicated a beneficial biological effect of probiotics on AD, including protection against infections, enhancement of the immune response, inflammation reduction and changes in gut the flora. The remaining studies showed no beneficial effects according to the outcomes of interest. CONCLUSION: The majority of the studies in the scientific literature in this review showed improvements in some inflammatory parameters and in intestinal microbiota and not exactly, changes in clinical parameters. However, the biological effects observed in most of them suggest the possibility of benefits of the use of probiotics as an adjuvant in the treatment of AD.

Introducción: La dermatitis atópica (DA) es una enfermedad que afecta principalmente a la población pediátrica, la participación de crónica y repetitiva inflamatoria de la piel la evolución manifestations.Its se conoce como marcha atópica, que se caracteriza por la aparición de alergias respiratorias y la alimentación. Objetivo: Realizar una revisión sistemática de la literatura del estado de la técnica científica sobre el efecto de los probióticos en el tratamiento de niños con DA. Métodos: Se realizaron búsquedas en Medline y Lilacs a través del PubMed portales (http://www.ncbi.nlm.nih. gov/PubMed/) y SciELO (http://www.scielo.br). Había una selección de las publicaciones disponibles en el perío do comprendido entre 2001 y 2011, con la dermatitis atópica palabras clave y los probióticos (en inglés y en portugués). Resultados: Después de aplicar los criterios de inclusión y exclusión, se seleccionaron 12 estudios caso-control que se realizaron en cuatro países europeos y Australia. La calidad metodológica de los estudios se evaluó de acuerdo a las recomendaciones STROBE. Evaluación de un acuerdo entre los investigadores en la clasificación de la calidad de los artículos mostraron una excelente concordancia (k = 1,00, IC del 95%) con un total de 9 trabajos en el nivel B. La mayoría de los estudios (75%) indica un efecto beneficioso de los probióticos en DA, incluida la protección contra las infecciones, la mejora de la respuesta inmune, la reducción de la inflamación y cambios en la flora intestinal, la mejora de la condición clínica de la EA. Los estudios restantes no mostraron efectos beneficiosos de acuerdo a los resultados de interés. Conclusión: La mayoría de los estudios en la literatura científica, en el período estudiado, mostró evidencia de beneficios en el uso de probióticos para controlar las manifestaciones clínicas de la DA, sin embargo el costo/ beneficio del tratamiento siempre debe ser evaluada.