Brazilian Guidelines for Nutrition in Cystic Fibrosis.

OBJECTIVE: To develop a scientific consensus on nutrition in cystic fibrosis. METHODS: Sixteen coordinators elaborated relevant questions on nutritional therapy in cystic fibrosis, which were divided into six sections: nutritional assessment, nutritional recommendations, nutritional intervention, dietary counseling, special situations and enzyme replacement, and gastrointestinal manifestations. Two to three specialists in the field were responsible for each section and obtaining answers formulated based on standardized bibliographic searches. The available literature was searched in the PubMed®/MEDLINE database, after training and standardization of search strategies, to write the best level of evidence for the questions elaborated. Issues related to disagreement were discussed until a consensus was reached among specialists, based on the current scientific literature. RESULTS: Forty-two questions were prepared and objectively answered, resulting in a consensus of nutritional therapy in cystic fibrosis. CONCLUSION: This work enabled establishing a scientific consensus for nutritional treatment of cystic fibrosis patients.

Brazilian Guidelines for Nutrition in Cystic Fibrosis

ABSTRACT Objective To develop a scientific consensus on nutrition in cystic fibrosis. Methods Sixteen coordinators elaborated relevant questions on nutritional therapy in cystic fibrosis, which were divided into six sections: nutritional assessment, nutritional recommendations, nutritional intervention, dietary counseling, special situations and enzyme replacement, and gastrointestinal manifestations. Two to three specialists in the field were responsible for each section and obtaining answers formulated based on standardized bibliographic searches. The available literature was searched in the PubMed®/MEDLINE database, after training and standardization of search strategies, to write the best level of evidence for the questions elaborated. Issues related to disagreement were discussed until a consensus was reached among specialists, based on the current scientific literature. Results Forty-two questions were prepared and objectively answered, resulting in a consensus of nutritional therapy in cystic fibrosis. Conclusion This work enabled establishing a scientific consensus for nutritional treatment of cystic fibrosis patients.

Antioxidant Micronutrients and Essential Fatty Acids Supplementation on Cystic Fibrosis Outcomes: A Systematic Review.

BACKGROUND: Antioxidant micronutrients and essential fatty acids supplementation intake appears to have a protective effect in some diseases such as cardiovascular disease, cancer, and asthma. OBJECTIVE: The aim of this study was to perform a systematic review to evaluate the effects of these nutrients on nutritional and clinical outcomes of patients with cystic fibrosis (CF). METHODS: This is a systematic review of randomized clinical trials (RCTs) in CF. MEDLINE (via PubMed), Embase, and Scopus databases were searched for RCTs published from 1948 through February 2019. Two investigators independently reviewed the titles and abstracts and then extracted the data from the included studies using a standardized predesigned form. Two reviewers independently performed the quality assessment of the RCTs according to the Cochrane risk of bias tools. RESULTS: A total of 4,792 studies were identified, and 23 were eligible (8 antioxidant micronutrient and 15 essential fatty acids). The interventions found were beta-carotene, zinc, magnesium, multivitamin, docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), linoleic acid and lipid matrix with choline supplementation. A significant improvement was observed in: (a) pulmonary function with magnesium (n=1) and essential fatty acids (n=2) supplementation; (b) less pulmonary exacerbations with beta-carotene (n=1), zinc (n=1), antioxidant-enriched multivitamin (n=1) and essential fatty acids (n=2) supplementation. One study with antioxidant-enriched multivitamin and four studies with EPA/DHA supplementation reported significant reductions in inflammatory markers. Nutritional status was not modified by antioxidants supplementation in any of the studies, while in five studies there was an improvement with fatty acids supplementation. The risk of bias of the majority of the parallel studies was high. CONCLUSIONS: The benefits of antioxidants or DHA/EPA supplementation for CF, although observed in some studies, are not consistent enough to recommend routine use of these supplements. The mechanisms of action of these nutrients, dose levels and timing should be further explored in future studies.

TRANSLATION AND CULTURAL ADAPTATION OF THE MEDITERRANEAN DIET QUALITY INDEX IN CHILDREN AND ADOLESCENTS.

OBJECTIVE: To translate and culturally adapt the Mediterranean Diet Quality Index in Children and Adolescent (KIDMED) for the Brazilian population. METHODS: The processes of translation and cultural adaptation followed internationally standardized methodological norms. We used the intraclass correlation coefficient and the Bland-Altman dispersion analysis to assess the reproducibility and calculated the internal consistency with Cronbach's alpha coefficient. RESULTS: A total of 102 children and adolescents participated in the cross-cultural adaptation, of whom 58 (56.9%) were females, with a mean age of 9.8±4.9 years. The mean overall scores of adherence to the Mediterranean diet in the test and retest were similar (8.00 and 3.80 versus 8.01 and 3.84) for children and adolescents, respectively. The intraclass correlation coefficient for children and adolescents was 0.893 and 0.998, respectively. The internal consistency was 0.72. The Bland-Altman plot analysis showed good agreement between the final scores of the test and retest questionnaires, with no statistically significant difference. CONCLUSIONS: The KIDMED questionnaire was translated into Brazilian Portuguese and culturally adapted, presenting high reproducibility. This questionnaire can, therefore, be included and used in Brazilian studies that aim at evaluating the adherence to the Mediterranean diet among children and adolescents.

Translation and cultural adaptation of the mediterranean diet quality index in children and adolescents / Tradução e adaptação cultural do mediterranean diet quality index in children and adolescents

ABSTRACT Objective: To translate and culturally adapt the Mediterranean Diet Quality Index in Children and Adolescent (KIDMED) for the Brazilian population. Methods: The processes of translation and cultural adaptation followed internationally standardized methodological norms. We used the intraclass correlation coefficient and the Bland-Altman dispersion analysis to assess the reproducibility and calculated the internal consistency with Cronbach's alpha coefficient. Results: A total of 102 children and adolescents participated in the cross-cultural adaptation, of whom 58 (56.9%) were females, with a mean age of 9.8±4.9 years. The mean overall scores of adherence to the Mediterranean diet in the test and retest were similar (8.00 and 3.80 versus 8.01 and 3.84) for children and adolescents, respectively. The intraclass correlation coefficient for children and adolescents was 0.893 and 0.998, respectively. The internal consistency was 0.72. The Bland-Altman plot analysis showed good agreement between the final scores of the test and retest questionnaires, with no statistically significant difference. Conclusions: The KIDMED questionnaire was translated into Brazilian Portuguese and culturally adapted, presenting high reproducibility. This questionnaire can, therefore, be included and used in Brazilian studies that aim at evaluating the adherence to the Mediterranean diet among children and adolescents.

RESUMO Objetivo: Traduzir e adaptar culturalmente a escala do Mediterranean Diet Quality Index in Children and Adolescent (KIDMED) para a população brasileira. Métodos: Os processos de tradução e adaptação cultural seguiram normas metodológicas padronizadas internacionalmente. A reprodutibilidade foi avaliada pelo coeficiente de correlação intraclasse e pela análise de dispersão de Bland-Altman, e a consistência interna foi calculada pelo coeficiente de Cronbach. Resultados: Participaram da etapa de adaptação transcultural 102 crianças e adolescentes, sendo 58 (56,9%) meninas com idade média de 9,8±4,9 anos. Os escores totais médio de aderência à dieta mediterrânea no teste e no reteste foram semelhantes (8,00 e 3,80 versus 8,01 e 3,84) para as crianças e os adolescentes, respectivamente. O coeficiente de correlação intraclasse para as crianças e os adolescentes foi de 0,893 e 0,998, respectivamente. A consistência interna obtida foi de 0,72. A análise do gráfico de Bland-Altman demonstrou boa concordância entre os escores finais dos questionários de teste e de reteste, sem diferença estatisticamente significativa. Conclusões: O questionário KIDMED foi traduzido e adaptado culturalmente para a língua portuguesa do Brasil, apresentando alta reprodutibilidade. Esse questionário pode ser, portanto, incluído e utilizado em estudos brasileiros que visem avaliar a aderência à dieta mediterrânea de crianças e adolescentes.

Body mass index and albumin levels are associated with pulmonary function parameters in pediatric subjects with cystic fibrosis / índice de massa corporal e níveis de albumina estão associados a parâmetros de função pulmonar em pacientes pediátricos com fibrose cística

ABSTRACT Objective: To evaluate the association of body mass index (BMI) and albumin with pulmonary function in cystic fibrosis (CF) pediatric subjects. Methods: This is a cross-sectional study with clinically stable CF's subjects. Clinical (pulmonary function) and nutritional evaluation (body mass index and albumin) were performed. Univariate analysis was performed using simple linear correlations. Regression analysis was performed using an exit level of p<0.05. Results: Seventy-eight CF's subjects (mean age 12.8±3.8 years) with mean albumin 4.2±0.4 mg/dL, predicted forced expiratory volume in 1 second (FEV1%) 80.8±22.6 and BMI median percentile 51.2 (1.3-97.7). In the multiple regression models, albumin, age and BMI percentile were associated with pulmonary function. Subjects with lower than 25 BMI percentile had 12.2% lower FEV1%. An albumin increase of 0.1 mg was associated with 2.7% increase in predicted FEV1%, and one year increase in age was associated with reduction in 1.2% of predicted FEV1%. Conclusions: BMI percentile, albumin and age were independently associated with predicted FEV1% in a tertiary referral hospital.

RESUMO Objetivo: Avaliar a associação do Índice de Massa Corporal (IMC) e da albumina com a função pulmonar em pacientes pediátricos com fibrose cística (FC). Métodos: Estudo transversal com pacientes pediátricos com FC clinicamente estáveis. Foram realizadas avaliação clínica (função pulmonar) e nutricional (IMC e albumina). Análise univariada foi realizada usando correlação linear simples. Análise de regressão foi realizada usando o nível de significância de p<0,05. Resultados: Foram incluídos 78 pacientes com FC (média de idade 12,8±3,8 anos) com média de albumina de 4,2±0,4 mg/dL, volume expiratório forçado em um segundo (VEF1%) predito de 80,8±22,6 e mediana do percentual de IMC de 51,2 (1,3-97,7). No modelo de regressão múltipla, albumina, idade e percentual de IMC apresentaram associação com a função pulmonar. Indivíduos com IMC abaixo de 25% apresentaram VEF1% predito 12,2% menor. Um aumento de 0,1 mg de albumina teve associação com aumento de 2,7% no VEF1% predito, e um ano a mais de idade mostrou relação com a redução de 1,2% de VEF1% predito. Conclusão: O percentual de IMC, albumina e idade apresentaram associação independente com o VEF1% predito em um hospital terciário de referência.

BODY MASS INDEX AND ALBUMIN LEVELS ARE ASSOCIATED WITH PULMONARY FUNCTION PARAMETERS IN PEDIATRIC SUBJECTS WITH CYSTIC FIBROSIS.

OBJECTIVE: To evaluate the association of body mass index (BMI) and albumin with pulmonary function in cystic fibrosis (CF) pediatric subjects. METHODS: This is a cross-sectional study with clinically stable CF's subjects. Clinical (pulmonary function) and nutritional evaluation (body mass index and albumin) were performed. Univariate analysis was performed using simple linear correlations. Regression analysis was performed using an exit level of p<0.05. RESULTS: Seventy-eight CF's subjects (mean age 12.8±3.8 years) with mean albumin 4.2±0.4 mg/dL, predicted forced expiratory volume in 1 second (FEV1%) 80.8±22.6 and BMI median percentile 51.2 (1.3-97.7). In the multiple regression models, albumin, age and BMI percentile were associated with pulmonary function. Subjects with lower than 25 BMI percentile had 12.2% lower FEV1%. An albumin increase of 0.1 mg was associated with 2.7% increase in predicted FEV1%, and one year increase in age was associated with reduction in 1.2% of predicted FEV1%. CONCLUSIONS: BMI percentile, albumin and age were independently associated with predicted FEV1% in a tertiary referral hospital.

The role of neonatal screening in nutritional evolution in the first 12 months after diagnosis of cystic fibrosis.

OBJECTIVE: to assess the progression of pediatric cystic fibrosis (CF) patients' nutritional status during the first 12 months after diagnosis and to establish its association with neonatal screening and clinical variables. Patients were recruited from two reference centers in Southern Brazil. METHODS: Retrospective cohort study was carried out with all the patients diagnosed between 2009 and 2014. Anthropometric, clinic and neonatal screening were collected from medical files. Analysis of anthropometric markers over time was performed by generalized estimating equations. A multivariate regression analysis model to predict the Δ percentile body mass index (BMI) (BMI percentile difference between one year after the treatment and BMI percentile at diagnosis) was done. RESULTS: Forty-seven patients were included in the study. Analysis of nutritional data over the period between six months and one year after diagnosis showed significant improvement of BMI, weight/age and weight/height percentiles and Z scores. The neonatal screening was associated with a significant increase of 31.2 points in ΔBMI percentile at the one-year evaluation (p<0.05). On the other hand, a one-point increase of initial BMI percentile was associated with a reduction of 0.6 points in ΔBMI percentile. CONCLUSION: This study demonstrated the role of neonatal screening in the nutritional status of patients diagnosed with CF in the first year after diagnosis. Early diagnosis can significantly contribute to the achievement of appropriate anthropometric indicators and important nutritional recovery of CF patients.

The role of neonatal screening in nutritional evolution in the first 12 months after diagnosis of cystic fibrosis

SUMMARY OBJECTIVE: to assess the progression of pediatric cystic fibrosis (CF) patients' nutritional status during the first 12 months after diagnosis and to establish its association with neonatal screening and clinical variables. Patients were recruited from two reference centers in Southern Brazil. METHODS: Retrospective cohort study was carried out with all the patients diagnosed between 2009 and 2014. Anthropometric, clinic and neonatal screening were collected from medical files. Analysis of anthropometric markers over time was performed by generalized estimating equations. A multivariate regression analysis model to predict the Δ percentile body mass index (BMI) (BMI percentile difference between one year after the treatment and BMI percentile at diagnosis) was done. RESULTS: Forty-seven patients were included in the study. Analysis of nutritional data over the period between six months and one year after diagnosis showed significant improvement of BMI, weight/age and weight/height percentiles and Z scores. The neonatal screening was associated with a significant increase of 31.2 points in ΔBMI percentile at the one-year evaluation (p<0.05). On the other hand, a one-point increase of initial BMI percentile was associated with a reduction of 0.6 points in ΔBMI percentile. CONCLUSION: This study demonstrated the role of neonatal screening in the nutritional status of patients diagnosed with CF in the first year after diagnosis. Early diagnosis can significantly contribute to the achievement of appropriate anthropometric indicators and important nutritional recovery of CF patients.

RESUMO OBJETIVO: Avaliar a evolução do estado nutricional de pacientes pediátricos com fibrose cística (FC), provenientes de dois centros de referência do sul do Brasil, durante os 12 primeiros meses após o diagnóstico e estabelecer associação com a triagem neonatal e com variáveis clínicas. MÉTODOS: Estudo de coorte retrospectivo realizado com todos os pacientes diagnosticados entre 2009 e 2014. Foram coletados dados antropométricos, clínicos e de realização da triagem neonatal a partir dos prontuários dos pacientes. A análise dos indicadores antropométricos ao longo do tempo foi realizada por equações de estimativas generalizadas. Utilizou-se o modelo de análise de regressão multivariada para predizer o D percentil índice de massa corporal - IMC/I (diferença entre percentil de IMC/I um ano após o tratamento e percentil de IMC/I no momento do diagnóstico). RESULTADOS: Participaram do estudo 47 pacientes. A análise dos dados antropométricos ao longo do período de seis meses e um ano após o diagnóstico demonstrou melhora significativa dos parâmetros de percentil e escore Z de IMC/I, peso/idade e peso/estatura em cada período analisado. A realização da triagem neonatal foi associada com um aumento significativo de 31,2 pontos no Δ percentil de IMC/I durante o período de um ano (p<0,05). Por outro lado, um ponto a mais de percentil de IMC/I inicial foi associado com uma redução de 0,6 ponto no Δ percentil de IMC/I (p<0,01). CONCLUSÃO: O presente estudo evidencia o papel da triagem neonatal na evolução antropométrica de pacientes com FC no primeiro ano após o diagnóstico. O diagnóstico precoce pode contribuir significativamente para a recuperação nutricional desses pacientes.

Avaliação nutricional dos profissionais do serviço de nutrição e dietética de um hospital terciário de Porto Alegre / Nutritional evaluation of employees on a nutritional and dietary service of a tertiary hospital in Porto Alegre

Este estudo objetivou identificar o perfil antropométrico e bioquímico e analisar a evolução do ganho de peso dos profissionais do Serviço de Nutrição e Dietética (SND) do Hospital de Clínicas de Porto Alegre (HCPA). Estudo de caráter longitudinal retrospectivo, com 190 funcionários. Aplicou-se questionário estruturado e foram realizadas análises bioquímicas e avaliação antropométrica. Observou-se excesso de peso em 60,8% dos funcionários. O ganho de peso encontrou-se associado ao tempo de serviço, turno de trabalho e prática de atividade física. O estudo demonstrou que 1 ano a mais de trabalho esteve associado ao ganho de peso médio de 500 g, o turno de trabalho com ganho de peso médio de 4 kg e a prática de atividade física com perda de peso médio de 3,3 kg. A associação entre ganho de peso, tempo e turno de trabalho em colaboradores de serviços de nutrição remete à necessidade de criação de programas de educação nutricional que promovam hábitos alimentares saudáveis.

This study aimed to identify anthropometric and biochemical status and to analyze the weight gain of collaborators of nutrition and dietetics services of Hospital de Clínicas de Porto Alegre (HCPA). This was a retrospective longitudinal study enrolled 190 employees. Nutritional assessment and clinical analysis was measurement. A structured questionnaire was applied all employees. The prevalence of excess weight was 60.8%. Weight gain was significantly associated to length of service, working shift and physical activity. The study showed that an additional year of work was associated with weight gain around 500 g, the shift in average gain of 4 kg and physical activity with average weight loss of 3.3 kg. The association between weight gain, working time and working shift in employees refers to the need to create nutrition intervention program aiming to promote healthy eating habits.

Anthropometric and dietary intake indicators as predictors of pulmonary function in cystic fibrosis patients.

OBJECTIVE: To evaluate whether anthropometric and dietary intake indicators are predictors of pulmonary function in cystic fibrosis (CF) patients. METHODS: This was a cross-sectional study involving 69 patients (age range, 5.4-16.5 years) diagnosed with CF under follow-up at the Hospital de Clínicas de Porto Alegre, located in the city of Porto Alegre, Brazil. Anthropometric assessment was based on body mass index (BMI), mid-arm muscle circumference (MAMC), and triceps skinfold thickness (TST). Dietary intake was assessed by using recall data, which were compared with the recommended dietary allowances. Pulmonary function was assessed by ventilatory capacity, expressed as FEV(1). Prevalence ratios for the outcome studied (FEV(1) < 80% of predicted) were calculated by indicator. RESULTS: In patients with MAMC and TST below the 25th percentile, the prevalence of FEV(1) < 80% of predicted was significantly higher than in those with higher MAMC and TST (p < 0.001 and p = 0.011, respectively). In comparison with other patients, those with a BMI below the 50th percentile showed a 4.43 times higher prevalence of FEV(1) < 80% of predicted (95% CI: 1.58-12.41), and that prevalence was 2.54 times higher in those colonized with methicillin-resistant Staphylococcus aureus (MRSA) than in those not so colonized (95% CI: 1.43-4.53). The association between dietary intake and the prevalence of FEV1 < 80% of predicted was of only borderline significance (95% CI: 0.95-3.45). CONCLUSIONS: Not being colonized with MRSA and having a BMI above the 50th percentile appear to preserve pulmonary function in CF patients.

Indicadores antropométricos e de ingestão alimentar como preditores da função pulmonar em pacientes com fibrose cística / Anthropometric and dietary intake indicators as predictors of pulmonary function in cystic fibrosis patients

OBJETIVO: Avaliar se indicadores antropométricos e de ingestão alimentar são preditores da função pulmonar em pacientes com fibrose cística (FC). MÉTODOS: Estudo transversal com 69 pacientes (variação, 5,4-16,5 anos de idade) diagnosticados com FC e em acompanhamento no Hospital de Clínicas de Porto Alegre, em Porto Alegre (RS). A avaliação antropométrica consistiu nas medidas do índice de massa corpórea (IMC), da circunferência muscular do braço (CMB) e da dobra cutânea tricipital (DCT). A ingestão alimentar foi avaliada pelo recordatório de ingestão habitual e comparada com recommended dietary allowances. A avaliação da função pulmonar foi realizada através da capacidade ventilatória, representada pelo VEF1. Razões de prevalência foram calculadas entre os preditores e o desfecho estudado (VEF1 < 80% do previsto). RESULTADOS: Os pacientes com CMB e DCT abaixo do percentil 25 apresentaram significativamente maior prevalência de VEF1 < 80% do previsto (p < 0,001 e p = 0,011, respectivamente). Os pacientes com IMC menor que o percentil 50 apresentaram 4,43 vezes (IC95%: 1,58-12,41) a prevalência de VEF1 < 80% do previsto. Os pacientes colonizados por Staphylococcus aureus resistente a meticilina apresentaram 2,54 vezes (IC95%: 1,43-4,53) a prevalência do desfecho do que os não colonizados. A associação entre consumo calórico e o desfecho estudado apresentou significância limítrofe (IC95%: 0,95-3,45). CONCLUSÕES: O IMC superior ao percentil 50 e a ausência de colonização por S. aureus resistente a meticilina apresentaram uma associação direta com função pulmonar preservada em pacientes com FC.

OBJECTIVE: To evaluate whether anthropometric and dietary intake indicators are predictors of pulmonary function in cystic fibrosis (CF) patients. METHODS: This was a cross-sectional study involving 69 patients (age range, 5.4-16.5 years) diagnosed with CF under follow-up at the Hospital de Clínicas de Porto Alegre, located in the city of Porto Alegre, Brazil. Anthropometric assessment was based on body mass index (BMI), mid-arm muscle circumference (MAMC), and triceps skinfold thickness (TST). Dietary intake was assessed by using recall data, which were compared with the recommended dietary allowances. Pulmonary function was assessed by ventilatory capacity, expressed as FEV1. Prevalence ratios for the outcome studied (FEV1 < 80% of predicted) were calculated by indicator. RESULTS: In patients with MAMC and TST below the 25th percentile, the prevalence of FEV1 < 80% of predicted was significantly higher than in those with higher MAMC and TST (p < 0.001 and p = 0.011, respectively). In comparison with other patients, those with a BMI below the 50th percentile showed a 4.43 times higher prevalence of FEV1 < 80% of predicted (95% CI: 1.58-12.41), and that prevalence was 2.54 times higher in those colonized with methicillin-resistant Staphylococcus aureus (MRSA) than in those not so colonized (95% CI: 1.43-4.53). The association between dietary intake and the prevalence of FEV1 < 80% of predicted was of only borderline significance (95% CI: 0.95-3.45). CONCLUSIONS: Not being colonized with MRSA and having a BMI above the 50th percentile appear to preserve pulmonary function in CF patients.

Intervenção nutricional em grupo de funcionários com sobrepeso ou obesidade praticantes de atividade física: um ensaio clínico randomizado / Nutritional intervention in a group of overweight or obese practitioners of physical activity: a randomized clinical trial

Objetivo: Avaliar o impacto da intervenção nutricional em praticantes de atividade física com sobrepeso ou obesidade. Métodos: Ensaio clínico randomizado com adultos praticantes de atividade física com sobrepeso ou obesidade (n=35). Os indivíduos foram divididos em dois grupos: controle (n=15) e intervenção (n=20). Ambos os grupos foram submetidos a um protocolo de exercício misto composto de atividades aeróbicas e com pesos durante três meses. O grupo intervenção recebeu prescrição de dieta individualizada e acompanhamento nutricional. Foram mensurados peso e estatura para cálculo posterior do IMC, circunferência abdominal, circunferência de quadril, percentual de massa magra e percentual de gordura corporal. Resultados: O grupo intervenção reduziu 3 kg de peso ao final do estudo, enquanto o grupo controle, apenas 1 kg (p=0,008). Após três meses, o IMC (p=0,008) e a relação cintura-quadril (p=0,011) foram menores no grupo intervenção. Conclusões: A intervenção nutricional aliada à atividade física promoveu redução no peso, IMC e RCQ em grupo de praticantes de atividade física com sobrepeso ou obesidade.

Aim: To evaluate the impact of nutritional intervention in overweight or obese practitioners of physical activity. Methods: Randomized clinical trial of overweight or obese adult practitioners of physical activity (n=35). The subjects were divided into two groups: control (n=15) and intervention (n=20). Both groups were submitted to a mixed exercise protocol of aerobic activities and weight training during three months. The intervention group was prescribed an individualized diet and nutritional follow-up. Weight and height were measured to calculate later BMI, waist circumference, hip circumference, percentage of lean mass, and percentage of body fat. Results: The intervention group reduced 3 kg at the end of the study, whereas the control group reduced only 1 kg (p=0.008). After three months, both BMI (p=0.008) and waist–hip ratio (WHR) (p=0.011) were reduced in the intervention group. Conclusions: Nutritional intervention combined with physical activity promoted reduction in weight, BMI, and WHR in a group of overweight or obese practitioners of physical activity.

Fibrose cística: aspectos nutricionais e manejo / Cystic fibrosis: nutritional aspects and management

Nutrição é um dos aspectos críticos do manejo de pacientes com fibrose cística, e o estado nutricional está diretamente associado com função pulmonar e sobrevida. Desnutrição é uma complicação frequente devido ao balanço energético proteico negativo. Diversos fatores, incluindo insuficiência pancreática, doença pulmonar supurativa crônica e anorexia podem afetar o balanço energético, contribuindo com a desnutrição. A desnutrição pode interferir no crescimento pulmonar e reduzir massa magra com consequente diminuição da força de contração do diafragma e músculos respiratórios. Pode levar, também, à diminuição da tolerância ao exercício, à diminuição da resposta imunológica e a um déficit de antioxidantes favorecendo o estabelecimento de um estado de infecção e inflamação. A doença pulmonar eleva a demanda energética, diminui o apetite e aumenta o trabalho respiratório devido à obstrução progressiva do fluxo aéreo. O processo inflamatório, as infecções recorrentes e a anorexia promovida pelos mediadores inflamatórios condicionam um balanço energético negativo que leva à desnutrição. Acompanhamento periódico do estado clínico e nutricional é fundamental para esses pacientes. Pacientes com fibrose cística devem receber uma dieta hipercalórica e hiperproteica, com alto conteúdo de gordura e normal quantidade de carboidratos com suplemento pancreático em caso de insuficiência pancreática. Se a meta nutricional não for alcançada ou mantida com modificações dietéticas, podem ser adicionados suplementos.

Nutrition is a critical component of the manegement of cystic fibrosis, and nutritional status is directly associated with both pulmonary status and survival. Malnutrition is a very frequent complication due to negative energy-proteic balance. Several factors, including pancreatic insufficiency, chronic suppurative pulmonary disease and anorexia may affect the energy balance, contributing to malnutrition. Malnutrition may affect lung growth and reduce lean body mass, leading to diminished force in the contraction of the diaphragm and other respiratory muscles. It may also be associated with reduced exercise tolerance, impaired immune response and antioxidant deficit, easing the way for the onset of infection and inflammation. Pulmonary disease increases energy demands, diminishes appetite and increases respiratory work due to progressive air flow obstruction. Pulmonary inflammation and anorexia triggered by the inflammatory mediators, as well as recurrent infections, create a negative energy balance that leads to malnutrition. Periodic monitoring of clinical, antropometrical nutritional status is mandatory. Patients with cystic fibrosis must receive a hypercaloric and hyperproteotic diet, with a high fat content, a normal quantity of carbohydrates and with pancreatic supplements in case of pancreatic insufficiency. If the nutritional goals are not achieved or maintained with diet modifications, supplements may be added.

Perfil nutricional de pacientes com fibrose cística em um centro de referência no sul do Brasil / Nutritional status in patients with cystic fibrosis in a specialized centre in south Brazil

Introdução: A Fibrose Cística (FC) é uma doença genética caracterizada pela insuficiência pancreática, doença pulmonar obstrutiva crônica e desnutrição. A manutenção de um bom estado nutricional está associada à maior sobrevida desses pacientes. Objetivo: Caracterizar o perfil nutricional dos pacientes com FC em acompanhamento no Hospital de Clínicas de Porto Alegre. Métodos: Estudo transversal com pacientes fibrocísticos até 18 anos de idade. A avaliação antropométrica consistiu de dados de peso, estatura, índice de massa corporal (IMC), circunferência muscular do braço e dobra cutânea tricipital. O diagnóstico nutricional foi estabelecido segundo critérios da Cystic Fibrosis Foundation Pediatric Nutrition Consensus Report. A ingestão alimentar foi avaliada pelo recordatório de ingestão habitual e comparada com os valores da Recommended Dietary Allowance (RDA). Os dados foram estratificados e comparados por faixa etária. Resultados: Foram avaliados 82 pacientes e a prevalência de eutrofia foi de 73,2%. A média do percentil de IMC foi significativamente menor nos pacientes acima de 12 anos (p=0,007). Observou-se ainda que 9,8% dos pacientes apresentaram depleção significativa do tecido adiposo e 7,3% do tecido muscular. Quanto à ingestão alimentar, a mediana encontrada foi de 127% (IQ: 105; 153) da RDA. A média do % da RDA foi menor nos pacientes maiores de 12 anos (p=0,038) Conclusões: Os resultados do presente estudo caracterizam a população em bom estado nutricional, demonstrando uma boa adesão ao tratamento dietético. Quando categorizados por idade, observa-se um pequeno declínio dos indicadores antropométricos e da ingestão alimentar nos pacientes maiores de 12 anos.

Background: Cystic fibrosis (CF) is a genetic disorder characterized by pancreatic insufficiency, chronic obstructive pulmonary disease and malnutrition. Epidemiological studies have demonstrated the impact of nutritional status on patient survival. Aim: To describe the profile of the nutritional status of CF patients followed at Hospital de Clínicas de Porto Alegre. Methods: Cross-sectional study involving 82 patients with cystic fibrosis at birth until 18 years of age. Nutritional assessment was performed using percentile for body mass index (BMI) and body composition measurements. Dietary intake was evaluated by diet habitual record and compared with the values of the Recommended Dietary Allowance (RDA). Results: The prevalence of well-nourished patients was 73,2%. The mean percentile for BMI was significantly lower in patients over 12 years old (p= 0,007). Depletion of adipose tissue was identified in 9,8% patients and the muscle tissue in 7,3%. As dietary intake, the median was found to be 127% (IQ: 105,153) of the RDA. The mean percentage of the RDA was lower in patients older than 12 years of age (P = 0,038). Conclusions: The results of this study indicate that the patients presented good nutritional status, demonstrated a good adherence to dietary treatment. When categorized by age, there was a small decline of anthropometric indicators and dietary intake in patients over 12 years of age.

Evolução do estado nutricional de pacientes com fibrose cística em uso de suplementação nutricional por gastrostomia / Nutritional status of patientes with cystic fibrosis in use of nutritional supplementation by gastrostomy

Introdução: A nutrição tem papel essencial na sobrevida e qualidade de vida de pacientes com Fibrose Cística (FC). O objetivo desse estudo foi acompanhar a evolução do estado nutricional de pacientes com FC em uso de suplementação nutricional por gastrostomia. Métodos: Estudo longitudinal retrospectivo com todos os pacientes com FC e em uso de suplementação nutricional com dieta hipercalórica por gastrostomia em um centro de referência no sul do Brasil. Os pacientes foram acompanhados nos períodos de 6 meses antes, no momento da instalação da gastrostomia, 6 meses, 1 ano e 2 anos após o procedimento. Os parâmetros nutricionais utilizados foram escore Z para peso/idade e estatura/idade, percentil de índice de massa corpórea (PIMC), além de medidas de composição corporal. Foram obtidos dados de função pulmonar e de ingestão alimentar. Resultados: Foram avaliados dez pacientes, sendo sete (70%) do sexo masculino. A idade média da instalação da gastrostomia foi de 9,8 ± 3,8 anos. O ganho de peso foi de 8,35 Kg (P =0,007) e o de estatura de 16,2 cm (P <0,001). O PIMC passou de 14,2 para 27,1 no período de 2 anos e meio (P =0,282). Com relação à composição corporal houve aumento da reserva muscular e de gordura. Houve queda não significativa na função pulmonar ao longo do tempo. A média de calorias ofertadas comparada com a recomendação alimentar diária passou de 111,6 ± 24,6% para 157,7 ± 37,86% (P =0,048). Conclusão: A suplementação nutricional por gastrostomia resultou em significativo ganho de peso e estatura, bem como aumento da reserva muscular e de gordura, no entanto não houve melhora ou estabilização da função pulmonar nesse grupo de pacientes.

Background: Nutrition plays an essential role in the survival and quality of life of cystic fibrosis (CF) patients. The aim was to follow nutritional status of patients with CF in use of nutritional supplementation by gastrostomy. Methods: Retrospective longitudinal study including all patients with CF on nutritional supplementation by gastrostomy at a referral center in southern Brazil. Patients were followed up in periods of 6 months before the installation of gastrostomy, and then, 6 months, 1 year and 2 years after the procedure. The nutritional parameters used were Z scores for weight/age and height/age, percentile of body mass index (PBMI), and body composition measurements. Data of pulmonary function and food intake were recorded. Results: Ten patients were evaluated, of which seven (70%) were male. The average age when gastrostomy was made was 9.8 ±3.8 years. The weight earning was 8.35 Kg (P =0.007) and the height was 16.2 cm (P <0.001). The PBMI increased from 14.2 to 27.1 over two and a half years (P =0.282). In relation to body composition an increase of muscular and fat reserve was observed. There was no significant decline in pulmonary function over the time. Average calories offered compared with the Recommended Dietary Allowance increased from 111.6 ±24.6% to 157.7 ±37.86% (P =0.048). Conclusion: nutritional supplementation by gastrostomy resulted in significant weight and height gain, as well as increased muscle and fat reserves, however there wasn’t improvement or stabilization of pulmonary function in this group of patients.

Association between nutritional status and dietary intake in patients with cystic fibrosis.

OBJECTIVE: To determine the relationship between nutritional status and dietary intake in patients with cystic fibrosis. METHODS: Cross-sectional study involving 85 cystic fibrosis patients between 6 and 18 years of age. Dietary intake was evaluated by the 3-day diet record (weighing the food consumed). The outcome measures were the following nutritional status indicators: weight/height (W/H%) percentage, body mass index (BMI) percentiles, Z score for weight/age (W/A), Z score for height/age (H/A) and percentage of dietary intake compared with the Recommended Dietary Allowance (RDA). RESULTS: The prevalence of well-nourished patients was 77.7%, using BMI above the 25th percentile as the cut-off value, and the W/H% was above 90% in 83.5%. The mean dietary intake, evaluated in 82 patients, was 124.5% of the RDA. In the univariate logistic regression analyses, we found a significant association between the independent variable calorie intake and the Z score for W/A. The multivariate analysis, based on the Z score for H/A and adjusted for FEV1, methicillin-resistant Staphylococcus aureus colonization and number of hospitalizations, demonstrated that a 1% increase in the calorie intake decreases the chance of having short stature by 2% (OR: 0.98; 95% CI: 0.96-1.00). Maternal level of education showed a borderline association (p = 0.054). CONCLUSIONS: The prevalence of malnutrition was low in this sample of patients. The study model demonstrated an association between dietary intake and nutritional status. Dietary intake was a predictive factor of statural growth in patients with cystic fibrosis.

Associação entre o estado nutricional e a ingestão dietética em pacientes com fibrose cística / Association between nutritional status and dietary intake in patients with cystic fibrosis

OBJETIVO: Determinar a relação entre o estado nutricional e a ingestão dietética de pacientes com fibrose cística. MÉTODOS: Estudo transversal com 85 pacientes com fibrose cística entre 6 e 18 anos de idade. A ingestão dietética foi avaliada pelo registro alimentar de 3 dias com a pesagem dos alimentos consumidos. Os desfechos avaliados foram os seguintes indicadores do estado nutricional: percentual da relação peso/estatura ( por centoP/E), percentil do índice de massa corpórea (IMC), escore Z para estatura/idade (E/I) e peso/idade (P/I), e percentual de ingestão dietética comparada a Recommended Dietary Allowances (RDAs). RESULTADOS: A prevalência de pacientes eutróficos foi de 77,7 por cento, considerando o IMC acima do percentil 25 como ponto de corte, e 83,5 por cento estavam acima de 90 por cento do por centoP/E. A média de ingestão, avaliada em 82 pacientes, foi de 124,5 por cento da RDA. Nas análises de regressão logística univariada, encontrou-se uma associação significativa entre a variável independente ingestão calórica e o desfecho escore Z E/I. O modelo de análise multivariado, elaborado a partir do desfecho escore Z E/I e ajustado para idade, VEF1, colonização por Staphylococcus aureus resistente à meticilina e número de internações hospitalares, demonstrou que um aumento de 1 por cento da ingestão calórica em relação à RDA diminui em 2 por cento a chance de ter déficit de estatura (OR = 0,98; IC95 por cento: 0,96-1,00). A escolaridade materna demonstrou uma associação limítrofe (p = 0,054). CONCLUSÕES: Houve baixa prevalência de desnutrição nesta amostra. O modelo de estudo demonstrou evidências da associação entre a ingestão dietética e o estado nutricional, sendo esta ingestão um fator preditor de crescimento nesses pacientes.

OBJECTIVE: To determine the relationship between nutritional status and dietary intake in patients with cystic fibrosis. METHODS: Cross-sectional study involving 85 cystic fibrosis patients between 6 and 18 years of age. Dietary intake was evaluated by the 3-day diet record (weighing the food consumed). The outcome measures were the following nutritional status indicators: weight/height (W/H percent) percentage, body mass index (BMI) percentiles, Z score for weight/age (W/A), Z score for height/age (H/A) and percentage of dietary intake compared with the Recommended Dietary Allowance (RDA). RESULTS: The prevalence of well-nourished patients was 77.7 percent, using BMI above the 25th percentile as the cut-off value, and the W/H percent was above 90 percent in 83.5 percent. The mean dietary intake, evaluated in 82 patients, was 124.5 percent of the RDA. In the univariate logistic regression analyses, we found a significant association between the independent variable calorie intake and the Z score for W/A. The multivariate analysis, based on the Z score for H/A and adjusted for FEV1, methicillin-resistant Staphylococcus aureus colonization and number of hospitalizations, demonstrated that a 1 percent increase in the calorie intake decreases the chance of having short stature by 2 percent (OR: 0.98; 95 percent CI: 0.96-1.00). Maternal level of education showed a borderline association (p = 0.054). CONCLUSIONS: The prevalence of malnutrition was low in this sample of patients. The study model demonstrated an association between dietary intake and nutritional status. Dietary intake was a predictive factor of statural growth in patients with cystic fibrosis.

Diagnóstico nutricional: uma nova perspectiva na assistência ao paciente adulto do Hospital de Clínicas de Porto Alegre / Nutritional diagnosis: a new perspective on adult patient care, Hospital de Clinicas de Porto Alegre / Diagnóstico nutricional: una nueva perspectiva en la atención de pacientes adultos, el Hospital de Clínicas de Porto Alegre

O objetivo desse trabalho é relatar os procedimentos utilizados na determinação do diagnóstico nutricional e níveis assistenciais que possam ser aplicáveis na área hospitalar. Foram criados protocolos a serem executados rotineiramente na avaliação e identificação do estado nutricional que pudessem priorizar o atendimento conforme risco nutricional. Essa proposta possibilitou uniformidade de condutas, maior agilidade de atendimento e maior abrangência no número de pacientes atendidos, bem como uma racionalização dos recursos humanos disponíveis.

The aim of this study is to describe the procedures used in determining the diagnosis and nutritional healthcare levels which may be applicable in the hospital. Protocols were created to be performed routinely in the assessment and identification of nutritional status that could prioritize care as nutritional risk. The proposal allowed for uniformity of conduct, faster service and more comprehensive number of patients seen, and a rationalization of human resources available.

El objetivo de este estudio es describir los procedimientos utilizados para determinar el diagnóstico y los niveles nutricionales de salud que sean de aplicación en el hospital. protocolos fueron creados para llevar a cabo rutinariamente en la evaluación y la identificación del estado nutricional que podría dar prioridad a los cuidados de riesgo nutricional. La propuesta permite la uniformidad de conducta, un servicio más rápido y más amplio número de pacientes atendidos, y una racionalización de los recursos humanos disponibles.

Qualidade microbiológica e temperatura de dietas enterais antes e após implantação do sistema de análise de perigos e pontos críticos de controle / Microbiological quality and temperatures of enteral feedings before and after implementation of hazard analysis and critical control point

OBJETIVOS: Avaliar a qualidade microbiológica e a temperatura de dietas enterais antes e após a implementação do sistema Análise de Perigos e Pontos Críticos de Controle na Central de Produção de Alimentação Enteral do Hospital de Clínicas de Porto Alegre. MÉTODOS: Durante o período de setembro de 2001 a janeiro de 2002, foram coletadas 320 amostras de 4 tipos de dietas enterais produzidas na Central de Produção de Alimentação Enteral (dietas padrão I, II, III e dieta especial), as quais foram submetidas a análises microbiológicas e de temperatura. As amostras foram coletadas semanalmente em dois pontos do processo: logo após o preparo e após 16 horas de armazenamento refrigerado. Para comparação dos dados pré e pós análise dos perigos em pontos criticos e de controle, utilizou-se o teste "t" de Wilcoxon para amostras pareadas (teste não-paramétrico equivalente ao teste "t" de Student para amostras pareadas) com nível de significância de 0,05. RESULTADOS: Antes da análise de perigos e pontos críticos de controle, 92 por cento das temperaturas de armazenamento estavam acima dos valores de refererência vigentes. Após a implantação da análise de perigos e pontos críticos de controle, houve reduções significantes (p<0,05) nas contagens de microrganismos mesófilos totais das dietas II, III e Especial, logo após preparo. Reduções significantes também foram encontradas nas dietas II e III armazenadas sob refrigeração. Não foram encontrados coliformes fecais, Staphylococcus aureus, Bacillus cereus, Clostridium sulfito redutores, Salmonella sp., Yersinia enterocolitica ou Listeria monocytogenes em nenhum dos momentos avaliados. A análise crítica do fluxograma de produção identificou as etapas de aquisição de matéria-prima e de armazenamento sob refrigeração como Pontos Críticos de Controle das dietas produzidas. CONCLUSÃO: Com a implantação deste sistema na central de produção de alimentação enteral foram realizadas mudanças que contribuíram...

OBJECTIVE: This study evaluated microbiological quality and temperature of enteral formulas before and after the implementation of the Hazard Analysis Critical Control Points system at the Central of Enteral Feedings of Hospital de Clínicas de Porto Alegre. METHODS: During the period of September 2001 and January 2002, 320 samples of four kinds of enteral feeding identified as diets I, II, III, and Special diet were collected and submitted to temperature and microbiological analysis. Samples were collected weekly in two steps of the flow chart of production: immediately after preparation and after 16 hours of storage at refrigeration. For statistical analysis, the Wilcoxon's test was used. RESULTS: Before Hazard Analysis Critical Control Points system, 92 percent of the storage temperatures were considered inadequate according to the Brazilian legislation. After Hazard Analysis Critical Control Points system implementation, significant reductions (p<0.05) were observed in the counts of mesophilic microorganisms of diets II, III, and Special diet, immediately after preparation. Significant reductions were also observed in the diets II and III stored at refrigeration. Fecal coliforms, Staphylococcus aureus, Bacillus cereus, Clostridium sp., Salmonella sp., Yersinia enterocolitica or Listeria monocytogenes were not found in any of the analyzed samples. Hazard analysis identified the acquisition of raw materials and refrigerated storage as the Critical Control Points of the produced diets. CONCLUSION: After the implementation of the Hazard Analysis Critical Control Points system at the Center of Enteral Feedings, the quality of the final product increased significantly, reducing the risk of food contamination.