Association of specialized enteral nutrition with glycemic control and clinical outcomes in critically ill patients: A meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the association of glycemic-control formulae (GCF) with measurements of glycemic control and clinical outcomes compared to standard enteral formulae (SF) in critically ill patients. DATA SOURCES: MEDLINE, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials were searched from inception up to January, 2021. STUDY SELECTION: RCTs that assessed the effects of GCF relative to SF in adult critically ill patients. DATA EXTRACTION: Measurements of glycemic control were the primary outcomes. Secondary outcomes included insulin requirements, mechanical ventilation (MV), length of intensive care unit (ICU) stay and mortality. Two authors independently extracted data and assessed risk of bias using the Cochrane's RoB 2 tool and the GRADE approach was used to assess the quality of evidence. DATA SYNTHESIS: Ten studies (12 reports, 685 patients) were included. The use of GCFs was associated with lower blood glucose (WMD, -16.06 mg/dL; 95% CI -23.48 to -8.63; I2 = 47%) and lower daily administered insulin (WMD, -7.20 IU; 95% CI -13.92 to -0.48; I2 = 53%). Glycemic variability, measured by the coefficient of variation, was also associated with the use of GCFs (WMD, -6.84%; 95% CI, -13.57 to -0.11; I2 = 95%). In contrast, analyses for length of ICU stay (WMD, -0.12, 95% CI -1.77 to 1.52; I2 = 0%), duration of MV (WMD, -0.34 days; 95% CI, -1.72 to 1.04; I2 = 0%) and mortality (RR, 1.13; 95% CI 0.82 to 1.56; I2 = 0%) were not statistically significant. Quality of evidence ranged from low to very low, and only one study was judged as at low risk of bias. CONCLUSIONS: In this meta-analysis, GCFs were significantly associated with lower insulin requirements and improved glycemic control. Although results for clinical outcomes were not statistically significant, there is insufficient evidence to confirm or exclude important differences due to serious imprecision in the effect estimates and overall low quality of evidence. The effects of GCFs on clinical outcomes require confirmation in larger randomized trials.

Contribution of ultra-processed foods consumption in sodium ingestion of atherosclerotic disease patients, residents in the southern region of Brazil.

BACKGROUND AND OBJECTIVE: Recent studies have related the consumption of ultra-processed foods with the development of cardiovascular diseases and have considered this relation with excessive sodium intake. While Brazilian studies have analysed that this consumption may have no direct relationship with the processing, but rather with the addition of salt. The purpose of this study is to investigate the contribution of the consumption of processed products in the daily intake of sodium ingestion by atherosclerotic disease patients. METHODS: A sub study, conducted with data from 630 cardiopathic patients who take part in "Effect of Brazilian Cardioprotective Food Program study on the reduction of events and risk factors in secondary prevention of cardiovascular disease part". Food was classified as: unprocessed or minimally processed foods, processed culinary ingredients, processed foods, ultra-processed food and beverages. Twenty-four-hour food recall (R24h) was collected from patients, and the estimation of total calories and sodium intake were calculated, as well as the percentage of sodium contribution according to the categories already mentioned. For the adequacy ratio analysis, the daily values of sodium intake were used to compared to the recommendations of the World Health Organization (<2000 mg / day). RESULTS: The average sodium intake was 1970.87 mg for women and 2642.86 mg for men, being higher for males' patients aged 60-79. It was observed that 64% of the studied population demonstrated sodium intake > 2000 mg. When considered levels > 3001 mg, a higher incidence of consumption was observed in the male group. Only 21.1% were intaking sodium within the recommended amount. Industrialized foods contributed to 33% of the mineral intake. CONCLUSION: These findings have demonstrated that the majority of the studied patients exceeded the dietary sodium recommendation. It has also indicated that patient's male, have presented increased consumption of the mineral. Consequently, warning for the necessity of greater investments in the nutritional re-education of these patients.