Optimizing perinatal wellbeing in pregnancy with obesity: a clinical trial with a multi-component nutrition intervention for prevention of gestational diabetes and infant growth and neurodevelopment impairment.

Pregnancy complicated by obesity represents an increased risk of unfavorable perinatal outcomes such as gestational diabetes mellitus (GDM), hypertensive disorders in pregnancy, preterm birth, and impaired fetal growth, among others. Obesity is associated with deficiencies of micronutrients, and pregnant women with obesity may have higher needs. The intrauterine environment in pregnancies complicated with obesity is characterized by inflammation and oxidative stress, where maternal nutrition and metabolic status have significant influence and are critical in maternal health and in fetal programming of health in the offspring later in life. Comprehensive lifestyle interventions, including intensive nutrition care, are associated with a lower risk of adverse perinatal outcomes. Routine supplementation during pregnancy includes folic acid and iron; other nutrient supplementation is recommended for high-risk women or women in low-middle income countries. This study is an open label randomized clinical trial of parallel groups (UMIN Clinical Trials Registry: UMIN000052753, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000060194) to evaluate the effect of an intensive nutrition therapy and nutrient supplementation intervention (folic acid, iron, vitamin D, omega 3 fatty acids, myo-inositol and micronutrients) in pregnant women with obesity on the prevention of GDM, other perinatal outcomes, maternal and newborn nutritional status, and infant growth, adiposity, and neurodevelopment compared to usual care. Given the absence of established nutritional guidelines for managing obesity during pregnancy, there is a pressing need to develop and implement new nutritional programs to enhance perinatal outcomes.

Time matters: an insight into the relationship between chrononutrition and diabetes.

Chrononutrition is a branch of chronobiology that evaluates nutrients and the pathways implicated in their regulation in accordance with circadian rhythms. Sleep deprivation and disturbances have been strongly associated with the progression of different metabolic alterations, and the time of food intake plays a fundamental role in maintaining metabolic homeostasis. It has been demonstrated that not only the components of food are important, but quantity and quality are also crucial elements of a healthy eating pattern. Chrononutrition is an emerging tool that could help improve dietary interventions beyond those derived from consuming an adequate amount of each nutrient. Diabetes is a complex endocrine pathology characterized by sustained hyperglycemia. Dietary changes are a key component in obtaining adequate control and preventing long-term complications. Recent studies emphasize the use of chrononutrition and its components as a novel dietary intervention that could improve metabolic control. The use of chrononutrition as a dietary intervention is faced with challenges such as the presence of gaps in the literature that limit its implementation. This emphasizes the imperative need for additional research that can lead to an evidence-based use of this intervention.

Time Matters: An Insight into the Relationship Between Chrononutrition and Diabetes

ABSTRACT Chrononutrition is a branch of chronobiology that evaluates nutrients and the pathways implicated in their regulation in accordance with circadian rhythms. Sleep deprivation and disturbances have been strongly associated with the progression of different metabolic alterations, and the time of food intake plays a fundamental role in maintaining metabolic homeostasis. It has been demonstrated that not only the components of food are important, but quantity and quality are also crucial elements of a healthy eating pattern. Chrononutrition is an emerging tool that could help improve dietary interventions beyond those derived from consuming an adequate amount of each nutrient. Diabetes is a complex endocrine pathology characterized by sustained hyperglycemia. Dietary changes are a key component in obtaining adequate control and preventing long-term complications. Recent studies emphasize the use of chrononutrition and its components as a novel dietary intervention that could improve metabolic control. The use of chrononutrition as a dietary intervention is faced with challenges such as the presence of gaps in the literature that limit its implementation. This emphasizes the imperative need for additional research that can lead to an evidence-based use of this intervention. (Rev Invest Clin. 2024;76(2):80-90)

Bioelectrical Impedance in Premature Newborns and Its Relationship with Diet Therapy in a Neonatal Intensive Care Unit.

(1) Background: To estimate resistance, reactance, and phase angle values among moderate preterm infants and their variation according to neonatal and maternal characteristics and nutritional intake. (2) Methods: This was a cohort that evaluated 43 moderate preterm infants using bioelectrical impedance analysis. The study variables included resistance, reactance, and phase angle measurements, in addition to classification of nutritional intake. (3) Results: Mean resistance was 602.0 ± 118.2 Ω, reactance was 57.2 Ω (IQR = 42.6-65.2), and phase angle was 522° (IQR = 4.1-6.6). Lower resistance values were found in the presence of risky pregnancy (532.2 ± 111.9 Ω vs. 650.9 ± 97.9 Ω, p < 0.001) and lower reactance values, in the presence of harmful maternal lifestyle habits at both the first (p = 0.01) and second assessments (p = 0.01). Eight preterm infants were considered to have insufficient nutritional intake (23.5%); 17, sufficient (50.0%) and 9, partially sufficient (26.5%). There was less reactance among preterm infants with insufficient nutritional intake (p < 0.001). (4) Conclusions: The bioelectrical impedance analysis measurements were within the range of values reported in other studies. There was an association between full diet and adequate nutritional intake with higher resistance values, while a lower reactance value was associated with the presence of risky pregnancy and harmful maternal lifestyle.

Perioperative care in digestive surgery: the eras and acerto protocols - brazilian college of digestive surgery position paper / Cuidados perioperatórios em cirurgia digestiva: protocolos eras e acerto - posicionamento do colégio brasileiro de cirurgia digestiva

ABSTRACT BACKGROUND: The concept introduced by protocols of enhanced recovery after surgery modifies perioperative traditional care in digestive surgery. The integration of these modern recommendations components during the perioperative period is of great importance to ensure fewer postoperative complications, reduced length of hospital stay, and decreased surgical costs. AIMS: To emphasize the most important points of a multimodal perioperative care protocol. METHODS: Careful analysis of each recommendation of both ERAS and ACERTO protocols, justifying their inclusion in the multimodal care recommended for digestive surgery patients. RESULTS: Enhanced recovery programs (ERPs) such as ERAS and ACERTO protocols are a cornerstone in modern perioperative care. Nutritional therapy is fundamental in digestive surgery, and thus, both preoperative and postoperative nutrition care are key to ensuring fewer postoperative complications and reducing the length of hospital stay. The concept of prehabilitation is another key element in ERPs. The handling of crystalloid fluids in a perfect balance is vital. Fluid overload can delay the recovery of patients and increase postoperative complications. Abbreviation of preoperative fasting for two hours before anesthesia is now accepted by various guidelines of both surgical and anesthesiology societies. Combined with early postoperative refeeding, these prescriptions are not only safe but can also enhance the recovery of patients undergoing digestive procedures. CONCLUSIONS: This position paper from the Brazilian College of Digestive Surgery strongly emphasizes that the implementation of ERPs in digestive surgery represents a paradigm shift in perioperative care, transcending traditional practices and embracing an intelligent approach to patient well-being.

RESUMO RACIONAL: O conceito introduzido pelos protocolos de recuperação após a cirurgia modifica os cuidados perioperatórios tradicionais em cirurgia digestiva. A integração desses componentes modernos de recomendações, durante o período perioperatório, é de grande importância para garantir menos complicações pós-operatórias, redução do tempo de internação hospitalar e diminuição dos custos cirúrgicos. OBJETIVOS: Enfatizar os pontos mais importantes de um protocolo multimodal de cuidados perioperatórios. MÉTODOS: Análise criteriosa de cada recomendação dos protocolos ERAS e ACERTO, justificando sua inclusão no atendimento multimodal recomendado para pacientes de cirurgia digestiva. RESULTADOS: Os programas de recuperação avançada (PRAs), tais como os protocolos ERAS e ACERTO, são a base dos cuidados perioperatórios modernos. A terapia nutricional é de grande importância na cirurgia digestiva e, portanto, tanto os cuidados nutricionais pré-operatórios, quanto pós-operatórios são fundamentais para garantir menos complicações pós-operatórias e reduzir o tempo de internação hospitalar. O conceito de pré-habilitação é outro elemento-chave nos PRAs. O manuseio de fluidos cristalóides em perfeito equilíbrio é vital. A sobrecarga de fluidos pode atrasar a recuperação dos pacientes e aumentar as complicações pós-operatórias. A abreviação do jejum pré-operatório para duas horas antes da anestesia é agora aceita por diversas diretrizes das sociedades cirúrgicas e de anestesiologia. Combinadas com a realimentação pós-operatória precoce, essas prescrições não são apenas seguras, mas também podem melhorar a recuperação de pacientes submetidos a procedimentos digestivos. CONCLUSÕES: Este posicionamento do Colégio Brasileiro de Cirurgia Digestiva enfatiza fortemente que a implementação de PRAs em cirurgia digestive, representa uma mudança de paradigma no cuidado perioperatório, transcendendo as práticas tradicionais e adotando uma abordagem inteligente para o bem-estar do paciente.

Effect of a texture-modified and controlled bolus volume diet on all-cause mortality in older persons with oropharyngeal dysphagia: Secondary analysis of a randomized controlled trial.

BACKGROUND: Oropharyngeal dysphagia (OD) is common among older adults. Some studies have evaluated the efficacy of a texture-modified diet on mortality but with short-term follow-up. We aimed to evaluate the effect of a texture-modified diet and controlled bolus volume on all-cause mortality after 12 months in older persons with OD. METHODS: This secondary analysis of a randomized clinical trial included patients aged ≥60 years with a diagnosis of OD. They were concurrently and randomly assigned to receive either a texture-modified food diet and controlled bolus volume (intervention group) or standard treatment (control group) with 12 months of follow-up. Secondary outcomes were oral intake, weight, handgrip strength, phase angle, and aspiration pneumonia. Kaplan-Meier analysis and the Cox proportional hazards model were used for mortality analysis. RESULTS: A total of 127 participants (intervention group: 64 and control group: 63) were recruited, with a mean age of 76 years. The probability of all-cause mortality was significantly lower in the intervention group (n = 8, 12%) than in the control group (n = 18, 29%) (hazard ratio = 0.36 [95% CI = 0.16-0.86]; P = 0.01). There were 5 (7.9%) and 10 (16.1%) aspiration pneumonia events in the intervention and control groups, respectively (not significant) in 12 months of follow-up. Changes were observed in protein consumption (P = 0.01), body weight (P = 0.04), body mass index (P = 0.004), handgrip strength (P = 0.02), and phase angle (P = 0.04) between the treatment groups. CONCLUSION: Compared with the standard treatment, the dietary intervention improved efficacy by limiting nutrition complications, aspiration pneumonia, and all-cause mortality.

Night fasting as an alternative to improve nutritional support and glycaemic control in hospitalised patients with exclusive enteral nutrition.

BACKGROUND: Enteral nutrition (EN) assists in the nutritional status of hospitalised patients unable to feed orally. The aim of this study was to determine which method-continuous EN or discontinuous EN, a diet in which the infusion is discontinued for 4h during the night,-is more effective in meeting nutrient recommendations and improving glycaemic control and biochemical parameters related to protein anabolism. METHODS: Patients were divided into two groups: discontinuous (EN administered in mL/h, 18h/day, 4-h night fasting) and continuous (EN administered in mL/h, 22h/day). All patients with EN receive the diet over a 22-h daily period, in which the diet is suspended for two hours/day for daily hospital routines such as bathing, and physiotherapy, and followed for seven days. Evaluated data: prescribed and administered volume, calories, protein, and fibre; capillary blood glucose; erythrogram; serum albumin. RESULTS: 52 patients were followed-up, with 23 (44.2%) in the discontinuous group and 29 (55.8%) in the continuous group. Compared with the continuous group, the discontinuous group received volumes closer to those prescribed, equal or higher calories, and more protein. The capillary glucose values were within the reference range in the discontinuous group, while the continuous group presented elevated values. Both groups presented hypoalbuminaemia, haemoglobin, and haematocrit below the reference values; however, in the discontinuous group, the serum albumin values improved during hospitalisation relative to the continuous. CONCLUSIONS: The method involving discontinuation of EN for 4h was more effective in meeting nutrient recommendations compared with the continuous method. Additionally, in the discontinuous group, we observed a better control of glycaemia when compared to that of the continuous group.

Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022).

Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.

Efficacy of nutrition therapy with food rich in methionine for treating nonalcoholic fatty liver / Eficacia de la terapia nutricional con alimentos ricos en metionina para el tratamiento de hígado graso no alcohólico

Non-Alcoholic Fatty Liver disease (NAFLD) can lead to Non Alcoholic steatohepatitis (NASH), cirrhosis, and liver cancer. The treatment for NAFLD involves modification of caloric intake and physical activity. NAFLD has a pro-oxidant nature; therefore, it is logical to suppose that the antioxidant methionine can be used as a treatment for this disease. Aim. This study aimed to evaluate the effect of high-methionine dietary therapy on patients with NAFLD. Materials and methods. A randomized clinical study was conducted over three months. In this study, 121 NAFLD patients participated, and the age of the participants was ≥ 20 years (experimental group included 56 and control group 65), all of whom were randomized and matched by sex, recluted from the ISSSTE hospital in Xalapa, Mexico. The patients were instructed to consume food to cover the recommended methionine daily doses, and the daily amount consumed was calculated. Methionine effect was measured as NAFLD regression and quality of life improvement. Results. Nutritional therapy induced NAFLD regression and diminished central fat accumulation, blood pressure, and the fatty liver index. Some parameters, such as liver enzymes, did not changed. The quality of life of patients improved after treatment. Conclusions. In this study, we show a hepatoprotective effect induced only in three months of chances in the diet, thus, a longer diet may generate more relevant benefits in the resistant parameters of our study(AU)

La enfermedad del hígado graso no alcohólico (NAFLD) puede conducir a la esteatohepatitis no alcohólica (NASH), la cirrosis y el cáncer de hígado. El tratamiento para NAFLD es la modificación de la ingesta calórica y la actividad física. Debido a que NAFLD tiene una naturaleza pro-oxidante; es lógico suponer que el antioxidante metionina puede utilizarse en el tratamiento de esta enfermedad. Objetivo. el presente trabajo evaluó el papel de la terapia nutricional con alimentos ricos en metioninaen pacientes con NAFLD. Materiales y Métodos. Se realizó un ensayo clínico aleatorizado durante tres meses. Participaron en el estudio 121 pacientes con NAFLD con edad ≥ 20 años (56 en el grupo experimental y 65 en el control), todos aleatorizados y pareados por sexo, reclutados de la Clínica Hospital ISSTE en la ciudad de Xalapa, México, en el año 2015. Se instruyó a los pacientes en consumir los alimentos hasta completar la dosis diaria recomendada de metioninay se calculó la cantidad diaria consumida. Su efecto se midió como la regresión de NAFLD y la mejora de la calidad de vida. Resultados. La terapia nutricional retrocedió NAFLD; disminuyó la acumulación de grasa central, la presión arterial y el índice de hígado graso. Algunos parámetros, como las enzimas de la función hepática, no se modificaron con el tratamiento. Otro parámetro fue la mejora de la calidad de vida de los pacientes tratados. Conclusiones. En este trabajo mostramos un impacto hepatoprotector producido con tan solo tres meses de cambios en la dieta, por lo que una dieta más prolongada podría generar beneficios aún más significativos en los parámetros resistentes en nuestro protocolo(AU)

Adaptations in the transformation of cassava (Manihot esculenta Crantz; Euphorbiaceae) for consumption in the dietary management of diabetes: the case of Palikur, or Parikwene People, from French Guiana.

Introduction: In the French overseas department of French Guiana, in South America, nutrition therapy for the management of diabetes is based on French guidelines. However, this region is demographically diverse and includes several populations of Indigenous Peoples, Parikwene among others, also called Palikur. Due to socio-economical, cultural, and geographical differences, along with distinctions in the local food system, dietary recommendations, which many consider in the context of post-colonial power dynamics, are not well suited to local populations. In the absence of suitable recommendations, it is hypothesized that local populations will adapt their dietary practices considering diabetes as an emerging health problem. Methods: Seventy-five interviews were conducted with community members and Elders, as well as healthcare professionals and administrators providing services to the Parikwene population of Macouria and Saint-Georges de l'Oyapock communes. Data regarding the representation of cassava (Manihot esculenta Crantz) consumption and diabetes were collected via semi-structured interviews and participant observation (i.e., observation and participation in community activities), namely via participating in activities related to the transformation of cassava tubers at swidden and fallow fields. Results and Discussion: Parikwene have adapted the transformation of cassava tubers for their consumption in the management of diabetes.The importance of cassava tubers as a staple and core food to the Parikwene food system was established by identifying it as a cultural keystone species. Narratives illustrated conflicting perceptions regarding the implication of cassava consumption in the development of diabetes. Adaptations to the operational sequence involved in the transformation of cassava tubers led to the production of distinct cassava roasted semolina (i.e., couac), based on organoleptic properties (i.e., sweet, and acidic couac). Preferences for the consumption of acidic couac were grounded in the Parikwene knowledge system, as well as attention to diabetes related symptoms and glucometer readings. Conclusion: These results provide important insights related to knowledge, attitudes, and practices in developing locally and culturally adapted approaches to providing dietary recommendations in the treatment of diabetes.

Terapia nutricional enteral y parenteral en pacientes con diagnóstico de COVID-19 en UCI / Enteral and parenteral nutritional therapy in patients with a diagnosis of COVID-19 in ICU / Terapia nutricional enteral e parenteral em pacientes com diagnóstico de COVID-19 na UTI

Se evidencia una gran cifra de casos de enfermedad por el contagio de COVID-19, llamando la atención la desnutrición que está asociada directamente con la exposición y estancia prolongada en Unidad de Cuidados Intensivos, desencadenando a su paso un síndrome de mala alimentación o desnutrición por Sarcopenia. Objetivo. Detallar los beneficios de la nutrición enteral y parenteral en un cuadro de desnutrición en pacientes críticos con diagnóstico de COVID-19 en la Unidad de Cuidados Intensivos, rescatando los beneficios en la evolución clínica del paciente en términos de mortalidad y estancia hospitalaria. Metodología. Se realizó un estudio de revisión sistemática sobre la nutrición enteral y parenteral en pacientes críticos con diagnóstico de COVID-19, con enfoque de búsqueda de información en la base de datos como: PubMed, Lilacs, Scielo, Scopus, Web of Science. La búsqueda comprendió desde el periodo 2020-2022. Conclusión. Los pacientes en estado crítico por infecciones de COVID-19 están ligados a un estado grave de inflamación que se asocian con una serie de procesos miopáticos agudos, precoces y agresivos que desencadenan un mayor consumo calórico- proteico, menor tolerancia a la terapia nutricional y por ende a la pérdida muscular. Se determinó con esta investigación que la nutrición enteral y parenteral en pacientes críticos con diagnóstico de COVID-19 desencadenan diversos beneficios de carácter clínico al mejorar la ingesta nutricional, menor infección nosocomial, menor mortalidad en unidad de cuidados intensivos y predisposición a la mejora funcional disminuyendo la estancia hospitalaria y mejorando la evolución clínica del paciente.

There is evidence of a large number of cases of disease due to COVID-19 infection, drawing attention to the malnutrition that is directly associated with exposure and prolonged stay in the Intensive Care Unit, triggering a syndrome of malnutrition or malnutrition due to sarcopenia. Objective. To detail the benefits of enteral and parenteral nutrition in a case of malnutrition in critically ill patients diagnosed with COVID-19 in the Intensive Care Unit, highlighting the benefits in the clinical evolution of the patient in terms of mortality and hospital stay. Methodology. A systematic review study was conducted on enteral and parenteral nutrition in critically ill patients with diagnosis of COVID-19, with an information search approach in databases such as: PubMed, Lilacs, Scielo, Scopus, Web of Science. The search covered the period 2020-2022. Conclusion. Critically ill patients with COVID-19 infections are linked to a severe state of inflammation associated with a series of acute, early and aggressive myopathic processes that trigger a higher caloric-protein consumption, lower tolerance to nutritional therapy and thus muscle loss. It was determined with this research that enteral and parenteral nutrition in critical patients diagnosed with COVID-19 trigger several clinical benefits by improving nutritional intake, lower nosocomial infection, lower mortality in the intensive care unit and predisposition to functional improvement, reducing hospital stay and improving the clinical evolution of the patient.

Há evidências de um grande número de casos de doença devido à infecção por COVID-19, chamando a atenção para a desnutrição que está diretamente associada à exposição e à permanência prolongada na Unidade de Terapia Intensiva, desencadeando uma síndrome de desnutrição ou desnutrição por sarcopenia. Objetivo. Detalhar os benefícios da nutrição enteral e parenteral em um caso de desnutrição em pacientes críticos diagnosticados com COVID-19 na Unidade de Terapia Intensiva, destacando os benefícios na evolução clínica do paciente em termos de mortalidade e permanência hospitalar. Metodologia. Foi realizado um estudo de revisão sistemática sobre nutrição enteral e parenteral em pacientes graves com diagnóstico de COVID-19, com foco na busca de informações em bases de dados como: PubMed, Lilacs, Scielo, Scopus, Web of Science. A pesquisa abrangeu o período de 2020 a 2022. Conclusão. Pacientes criticamente enfermos com infecções por COVID-19 estão ligados a um estado grave de inflamação associado a uma série de processos miopáticos agudos, precoces e agressivos que desencadeiam maior consumo calórico-proteico, menor tolerância à terapia nutricional e, portanto, perda muscular. Esta pesquisa determinou que a nutrição enteral e parenteral em pacientes críticos diagnosticados com COVID-19 desencadeia vários benefícios clínicos, melhorando a ingestão nutricional, reduzindo a infecção nosocomial, reduzindo a mortalidade em unidades de terapia intensiva e predispondo à melhora funcional, reduzindo a permanência hospitalar e melhorando a evolução clínica do paciente.

Associação do risco nutricional com parâmetros clínicos e nutricionais de pacientes internados em um hospital universitário / Association of nutritional risk with clinical and nutritional parameters of patients hospitalized in a university hospital

Introdução: O reconhecimento do risco nutricional na admissão do indivíduo hospitalizado é fundamental, pois possibilita que intervenções nutricionais adequadas e especializadas sejam implementadas precocemente. Objetivo: Identificar o risco nutricional dos pacientes internados e associar com parâmetros clínicos e nutricionais. Materiais e Métodos: O estudo foi transversal, descritivo, cuja amostra foi não-probabilística, realizado em pacientes com faixa etária superior a 18 anos admitidos nas enfermarias de clínica médica e cirúrgica do Hospital Universitário da Universidade Federal de Juiz de Fora (HU-UFJF/Ebserh). Para identificação do risco nutricional, foi aplicado instrumento de triagem nutricional (NRS-2002) na admissão hospitalar, além da verificação de peso, altura, dados demográficos (sexo, idade, raça/cor), clínicos (diagnóstico médico, tipo e número de comorbidades, tempo de internação hospitalar e desfecho clínico) e nutricionais (risco nutricional, uso e tempo em terapia nutricional). Para as associações estatísticas, foram utilizados os testes qui-quadrado ou exato de Fisher (a depender do tamanho amostral) para as variáveis categóricas e teste de Mann-Witney, para as variáveis contínuas. Em todas as análises foi considerado o nível de significância de 0,05. Resultados: Foram avaliados ao final 147 pacientes, sendo 74 (50,34%) do sexo feminino, 94 (63,95%) de raça/cor branca e 91 (61,90%) adultos. Apenas 15,65% desta população apresentou risco nutricional e este parâmetro foi associado aos indivíduos com doenças hematológicas (p= 0,02) e pulmonares (p= 0,02), àqueles em uso de terapia nutricional (p<0,01), ao maior tempo de internação (p<0,01) e ao menor Índice de Massa Corporal (IMC) (p= 0,02). Os pacientes em risco que fizeram uso de terapia nutricional permaneceram mais dias internados. Conclusão: Este estudo revelou que o risco nutricional, determinado pela NRS-2002, apresentou associação significativa à presença de doenças hematológicas e pulmonares, bem como ao uso de terapia nutricional, número de dias em uso de terapia nutricional, maior tempo de internação hospitalar e menor IMC, estando em concordância com outros trabalhos. Os resultados poderão contribuir para a melhoria do serviço e do tratamento dos pacientes internados.

Introduction: The recognition of the nutritional risk in the admission of the hospitalized individual is essential, as it allows appropriate and specialized nutritional interventions to be implemented early. Objective: To identify the nutritional risk of hospitalized patients and associate with clinical and nutritional parameters. Materials and Methods: The study was cross-sectional, descriptive, whose sample was non-probabilistic, carried out on patients aged over 18 years admitted to the medical and surgical clinic wards of the University Hospital of the Federal University of Juiz de Fora (HU-UFJF/Ebserh). To identify the nutritional risk, a nutritional screening instrument (NRS-2002) was applied on hospital admission, in addition to checking weight, height, data demographic (gender, age, race/color), clinical (medical diagnosis, type and number of comorbidities, hospital length of stay and clinical outcome) and nutritional (nutritional risk, use and time in nutritional therapy). For statistical associations, the chi-square test or Fisher's exact test (depending on the sample size) were used for categorical variables and the Mann-Witney test for continuous variables. In all the analyzes considered a significance level of 0,05. Results: In the end, 147 patients were evaluated, 74 (50,34%) females, 94 (63,95%) white and 91 (61,90%) adults. Only 15,65% of this population presented nutritional risk and this parameter was associated with individuals with hematological (p= 0,02) and pulmonary (p= 0,02) diseases, those using nutritional therapy (p<0,01), longer hospital lengths of stay (p<0,01) and lower Body Mass Index (BMI) (p= 0,02). Patients at risk who used nutritional therapy spent more days in hospital. Conclusion: This study revealed that nutritional risk, determined by NRS-2002, was significantly associated with the presence of hematological and pulmonary diseases, as well as the use of nutritional therapy, number of days using nutritional therapy, longer hospital stay and lower BMI, agreeing with other studies. The results may contribute to improving the service and treatment of hospitalized patients.

Quality appraisal of clinical nutrition practice guidelines for critically ill adult patients: a systematic review using the Advancing Guideline Development, Reporting and Evaluation in Health Care instrument II (AGREE-II) and AGREE-Recommendation Excellence (AGREE-REX).

Nutritional therapy should follow evidence-based practice, thus several societies regarding nutrition and critical care have developed specific Clinical Practice Guidelines (CPG). However, to be regarded as trustworthy, the quality of the CPG for critically ill patients and its recommendations need to be high. This systematic review aimed to appraise the methodology and recommendations of nutrition CPG for critically ill patients. We performed a systematic review (protocol number CRD42020184199) with literature search conducted on PubMed, Embase, Cochrane Library and other four specific databases of guidelines up to October 2021. Two reviewers, independently, assessed titles and abstracts and potentially eligible full-text reports to determine eligibility and subsequently four reviewers appraised the guidelines quality using the Advancing Guideline Development, Reporting and Evaluation in Health Care instrument II (AGREE-II) and AGREE-Recommendation Excellence (AGREE-REX). Ten CPG for nutrition in critically ill patients were identified. Only Academy of Nutrition and Dietetics and European Society of Intensive Care Medicine had a total acceptable quality and were recommended for daily practice according AGREE-II. None of the CPG recommendations had an overall quality score above 70 %, thus being classified as moderate quality according AGREE-REX. The methodological evaluation of the critically ill adult patient CPG revealed significant discrepancies and showed a need for improvement in its development and/or reporting. In addition, recommendations about nutrition care process presented a moderate quality.

Effects of sports training associated with nutritional intervention on athletes' post-competition recovery / Efeitos do treinamento esportivo associado à intervenção nutricional sobre a recuperação dos atletas pós-competição / Efectos del entrenamiento deportivo asociado a una intervención nutricional en la recuperación post competición de los deportistas

ABSTRACT Introduction: The athletes' physiological capacity and psychological level are raised to the limit during the competition, which is necessary for adequate recovery after the dispute. Objective: Study the effect of sports training associated with nutritional intervention on athletes' post-competition recovery. Methods: In the first two weeks of the experiment, training was done in slow aerobic exercise, aerobics, and running. Strength training and a small amount of anaerobic training were added to the training with the gradual practice of the experiment. Results: The proportion of breakfast, lunch, and dinner was 25.33%, 42.55%, and 32.12%, respectively; protein intake decreased from 34.23% to 20.13%, and the proportion of fat intake decreased from 15. 56% to 12.3%, and IgG content changed from 7.654 ± 0.283 (mmol/L) at the end to 8.586 ± 0.651 (mmol/L); IgM content changed from 3.382 ± 0.875 (g/L) at the end to 3.169 ± 1.002 (g/L). Conclusion: Athletes can effectively, through sports training and nutritional intervention, adjust body changes caused by competition while maintaining a good exercise level. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: A capacidade fisiológica e o nível psicológico dos atletas são elevados ao limite durante a competição, sendo necessária uma recuperação adequada após a disputa. Objetivo: Estudar o efeito do treinamento esportivo associado à intervenção nutricional para a recuperação dos atletas após a competição. Métodos: Nas duas primeiras semanas da experiência, realizou-se o treinamento na forma de exercício aeróbico lento, aeróbica e corrida. O treinamento de força e uma pequena quantidade de treinamento anaeróbico foram adicionados ao treinamento com a prática gradual do experimento. Resultados: A proporção de café da manhã, almoço e jantar foi de 25,33%, 42,55% e 32,12% respectivamente, a proporção de ingestão de proteínas diminuiu de 34,23% para 20,13%, a proporção de ingestão de gordura diminuiu de 15,56% para 12,3%, e o conteúdo de IgG mudou de 7,654 ± 0,283 (mmol/L) no final para 8,586 ± 0,651 (mmol/L); o conteúdo de IgM mudou de 3,382 ± 0,875 (g/L) no final para 3,169 ± 1,002 (g/L). Conclusão: Os atletas podem de maneira eficaz, através de treinamento esportivo e intervenção nutricional, ajustar as alterações corporais ocasionadas pela competição, mantendo um bom nível de exercício. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: La capacidad fisiológica y el nivel psicológico de los atletas se elevan al límite durante la competición, siendo necesaria una adecuada recuperación tras la disputa. Objetivo: Estudiar el efecto del entrenamiento deportivo asociado a la intervención nutricional para la recuperación de los deportistas tras la competición. Métodos: En las dos primeras semanas del experimento, el entrenamiento se realizó en forma de ejercicio aeróbico lento, aeróbic y carrera. El entrenamiento de fuerza y una pequeña cantidad de entrenamiento anaeróbico se añadieron al entrenamiento con la práctica gradual del experimento. Resultados: La proporción de desayuno, comida y cena fue del 25,33%, 42,55% y 32,12% respectivamente, la proporción de ingesta de proteínas descendió del 34,23% al 20,13%, la proporción de ingesta de grasas descendió del 15. 56% a 12,3%, y el contenido de IgG pasó de 7,654 ± 0,283 (mmol/L) al final a 8,586 ± 0,651 (mmol/L); el contenido de IgM pasó de 3,382 ± 0,875 (g/L) al final a 3,169 ± 1,002 (g/L). Conclusión: Los atletas pueden ajustar eficazmente, mediante el entrenamiento deportivo y la intervención nutricional, los cambios corporales provocados por la competición, manteniendo un buen nivel de ejercicio. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Indicadores de qualidade em terapia nutricional enteral em unidades de terapia intensiva / Quality indicators in enteral nutritional therapy in intensive care units

desnutrição é uma condição frequente em pacientes críticos. Isso pode ser acentuado devido uma oferta inadequada, por meio da nutrição enteral. Objetivo: Analisar indicadores de qualidade para identificar frequência de eventos relacionados à terapia nutricional enteral. Métodos: Estudo transversal, retrospectivo, realizado em um hospital de urgência e trauma, na cidade de Goiânia (GO), com pacientes internados em Unidades de Terapia Intensiva (UTIs), no período de outubro de 2021. A coleta de dados foi realizada por meio de prontuários eletrônicos preenchidos por profissionais médicos, enfermeiros e nutricionistas da unidade. Resultados: A adequação de volume prescrito versus volume infundido foi de 86,59%. A frequência de administração de energia resultou em 3,23% de adequação de energia. A frequência de dias de administração adequada de proteína apresentou-se adequada, correspondendo a ≥ 10% da frequência de dias de administração adequada de proteína. Conclusão: O volume prescrito versus volume infundido e dias de administração adequada de proteína apresentaram-se adequados. Houve relevantes inadequações calóricas entre calorias prescritas e calorias recebidas, sugerindo que os pacientes se encontravam com déficits energéticos importantes. Esta inadequação de ingestão calórica, caso não seja revertida, é prejudicial a estes pacientes, ocasionando diversas complicações clínicas, afetando diretamente o desfecho e/ou a alta do paciente

Malnutrition is a frequent condition in critically ill patients. This can be accentuated due to inadequate supply through enteral nutrition. Objective: To analyze quality indicators to identify the frequency of events related to enteral nutritional therapy. Methods: Cross-sectional, retrospective study, carried out in an emergency and trauma hospital, in the city of Goiânia (GO), with patients admitted to Intensive Care Units (ICUs), in the period of October 2021. Data collection was carried out through electronic medical records completed by medical professionals, nurses and nutritionists at the unit. Results: The adequacy of prescribed volume versus infused volume was 86.59%. The frequency of energy delivery resulted in 3.23% energy adequacy. The frequency of days of adequate protein administration was adequate, corresponding to ≥ 10% of the frequency of days of adequate protein administration. Conclusion: The prescribed volume versus infused volume and days of adequate protein administration were adequate. There were relevant caloric inadequacies between prescribed and received calories, suggesting that patients had significant energy deficits. This inadequacy of caloric intake, if not reversed, is harmful to these patients, causing several clinical complications, directly affecting the outcome and/or discharge of the patient

Fatores associados à terapia nutricional domiciliar em pacientes sob cuidados paliativos / Factors associated with home nutritional therapy in patients under palliative care

ntrodução: A desnutrição é uma das condições frequentemente observadas em pacientes sob cuidados paliativos, afetando a via de alimentação e impactando na diminuição da ingestão alimentar. O atendimento nutricional permite a identificação das alterações nutricionais, direcionando para terapia nutricional adequada. Objetivo: Analisar a terapia nutricional domiciliar e identificar o estado nutricional em pacientes sob cuidados paliativos no domicílio. Método: Estudo prospectivo, observacional com pacientes do Programa Melhor em Casa, em Guarapuava-PR. Foram avaliados por meio de anamnese, que compreendia diagnóstico clínico, exame físico, caracterização e intercorrências da dieta, SARC-F e avaliação antropométrica. Resultados: Participaram do estudo 24 pacientes, com média de idade 70,2+15,0 anos. Os principais diagnóstico clínicos foram: 45,83% câncer e 45,83% doença neurológica. O baixo peso e a classificação sugestiva de sarcopenia predominaram nos avaliados, sendo 54,17% e 87,5%, respectivamente. A via de acesso para alimentação prevalente foi a oral (45,8%), seguida de 41,7% para sonda nasoenteral; a fórmula mais utiliza foi a hiperproteica. A maioria apresentou sinal da asa quebrada (70,8%), perda da bola de Bichat (66,7%) e perda de massa nos membros superiores e inferiores. O diagnóstico nutricional padronizado mais frequente foi NC-3.2 (perda de peso não intencional), seguido de 41,7% com NI-1.2 (ingestão de energia subótima). Conclusão: Observou-se que a maioria dos pacientes eram idosos, acamados, com doença neurológica e câncer. Em relação ao estado nutricional, a maioria apresentou baixo peso e sinais de desnutrição. O atendimento nutricional com pacientes em cuidados paliativos se faz necessário, pois são pacientes com risco nutricional.

Introduction: Malnutrition is one of the most common conditions seen in palliative care patients, which can affect the feeding route and decrease food intake. Nutritional counseling allows the detection of dietary changes, and referral to appropriate nutritional therapy. Aim: The purpose of this study was to analyze home nutritional therapy, and identify nutrient-related diagnoses in home palliative care patients. Materials and methods: It's a prospective, observational study involving patients assisted by the "Better at Home Program", in Guarapuava - PR. Anamnesis was carried out to assess the patients, which included clinical diagnosis, physical examination, diet characterization and complications, SARC-F, and anthropometric assessment. Results: The study included 24 patients, with an average age of 70,2+15,0. The most frequent clinical diagnoses were cancer (45.83 percent) and neurological disease (45.83 percent). Low weight and a classification indicative of sarcopenia predominated among the patients, accounting for 54.17% and 87.55%, respectively. The most common feeding route was oral (45.8%), followed by nasoenteral feeding l (41.7%). The most commonly used formula was the hyperproteic. The majority of patients had sunken temples (70.8%), loss of Bichat's fat pad (66.7%), and loss of muscle mass in the upper and lower limbs. The most frequent standardized nutrition diagnosis was NC-3.2 (unintentional weight loss), followed by 41.7% NI-1.2 (suboptimal energy intake). Conclusion: Most patients were elderly, bedridden, and had neurologic disease or cancer. Regarding the nutritional status, the majority were underweight and exhibited signs of malnutrition. Palliative care patients require nutritional therapy since they are at risk of malnutrition

Gastrointestinal and sensory manifestations, nutrition management, and energy-protein intake in hospitalized patients with COVID-19.

BACKGROUND: Gastrointestinal and sensory manifestations (GSMs) of coronavirus disease 2019 (COVID-19) may affect food intake, resulting in malnutrition and poor outcomes. We characterized the impact of GSMs and oral nutrition supplementation on energy-protein intake (EPI) and hospital discharge in adult patients with COVID-19. METHODS: Patients from two hospitals were enrolled (n = 357). We recorded the presence and type of GSM at admission, estimated energy requirements (EER) and the EPI based on regular food intake (plate diagram sheets) during hospital stays. Patients not achieving 60% of their EER from food over 2 consecutive days received oral nutrition supplementation (ONS) with a high-energy-protein oral drink. RESULTS: Most patients (63.6%) presented with GSMs at admission. Anorexia was the most common manifestation (44%). Patients with anorexia or more than one GSMs were more likely to not achieve 60% EER on the first day of follow-up and to require the ONS intervention (P ≤ 0.050). Prevalence of at least one GSM was higher in patients who did not achieve hospital discharge than in patients who achieved it (74.2% vs 54.6%, P = 0.038). The patients requiring ONS (26.9%) demonstrated good adherence to the intervention (79.3%), achieved their EER during 95.7% of the supplementation time, and presented with hospital discharge rates similar to patients not requiring ONS (92.2% vs 91.9%, respectively; P = 1.000). CONCLUSIONS: GSM were prevalent in COVID-19 and it impaired EER attendance and patient recovery. ONS was well-tolerated, aided EER attendance, and potentially facilitated hospital discharge.

Microbiological quality of enteral formulations handled at home: A systematic review.

BACKGROUND: Studies have shown an increase in the number of patients who use enteral nutrition at home and the benefits of this type of nutrition care. However, little is known about the risk of bacterial contamination of enteral formulations prepared at home. Therefore, the aim of the study was to assess the microbiological quality of home-prepared enteral formulations. METHODS: This study is a systematic review, registered in PROSPERO. The search for articles was carried out in databases and gray literature. Eligible studies that microbiologically analyzed homemade enteral preparations (HEPs), blended enteral preparations (BEPs), and commercial enteral formulas (CEFs) that were prepared at home were selected. The types and quantities of microorganisms, sources of contamination in the handling area, and the consequences of contamination (signs and symptoms) were the subjects extracted from the studies. RESULTS: Five studies evaluated 217 enteral formulations. It was found that 72.81% of the enteral formulations exceeded the acceptable bacterial count in the case of at least one of the analyzed microorganisms. This result corresponded to 93.58% (n = 73) of the HEPs, 81.96% (n = 50) of the BEPs, and 44.87% (n = 35) of the CEFs. The presence of 10 different microorganisms was identified in the enteral formulations, and total coliforms and mesophilic aerobics were the microorganisms found in the greatest quantity in the samples. CONCLUSION: The three types of home-prepared enteral formulations showed unsatisfactory microbiological quality, indicating poor hygiene conditions during food handling.

Association between Palliative Performance Scale and nutritional aspects in individuals with cancer in exclusive palliative care.

BACKGROUND & AIMS: Palliative care in incurable cancer should be focused on symptom control, especially those impacting nutrition. This study aims to verify associations between functional performance using the Palliative Performance Scale Version 2 (PPS2) and nutritional and clinical aspects in cancer patients in exclusive palliative care (EPC). METHODS: Through a cross-sectional study, twenty-seven patients recently referred to the EPC outpatient clinic were evaluated. PPS2 was used to define functional performance, while nutritional aspects were obtained using the Patient-Generated Subjective Global Assessment (PG-SGA). Fisher's Exact test and correspondence analysis were used with a 5% level of significance. RESULTS: Of 27 eligible patients, a higher frequency of PPS2 levels 50% and 40% (70.3%) was observed, reflecting important functional impairments. The sample was mainly composed of severely malnourished patients (70.4%), polysymptomatic, and in critical need of nutritional intervention (96.3%). Regarding the primary diagnosis, gastrointestinal (37%) and lung (26%) cancer were the most prevalent. No associations between PPS2 and nutritional and clinical aspects were observed; however, the correspondence analysis demonstrated proximity between low PPS2 levels and worse nutritional markers. CONCLUSIONS: PG-SGA and PPS2 tools combined are suggested due to their importance in guiding assistance to cancer patients in EPC.

Increased energy and/or protein intake improves anthropometry and muscle strength in chronic obstructive pulmonary disease patients: a systematic review with meta-analysis on randomised controlled clinical trials.

Compromised nutritional status is associated with a poor prognosis in chronic obstructive pulmonary disease (COPD) patients. However, the impact of nutritional support in this group of patients is controversial. The present study systematically reviewed the effect of energy and or protein supplements or food fortification on anthropometry and muscle strength of COPD patients. We searched MEDLINE (PubMed), EMBASE, Cochrane Library and Scopus for all published randomised clinical trials without language restriction up to May 2021. Three reviewers performed study selection and data extraction independently. We judged the risk of bias by RoB 2 and the certainty of evidence by the GRADE approach. We included thirty-two randomised controlled trials and compiled thirty-one of them (1414 participants) in the random-effects model meta-analyses. Interventions were energy and/or protein oral nutritional supplements or food fortification added to the diet for at least one week. Pooled analysis revealed that nutritional interventions increased body weight (muscle circumference (MD) = 1·44 kg, 95 % CI 0·81, 2·08, I2 = 73 %), lean body mass (standardised mean difference (SMD) = 0·37; 95 % CI 0·15, 0·59, I2 = 46 %), midarm muscle circumference (MD = 0·29 mm2, 95 % CI 0·02, 0·57, I2 = 0 %), triceps skinfold (MD = 1·09 mm, 95 % CI 0·01, 2·16, I2 = 0 %) and handgrip strength (SMD = 0·39, 95 % CI 0·07, 0·71, I2 = 62 %) compared with control diets. Certainty of evidence ranged from very low to low, and most studies were judged with some concerns or at high risk of bias. This meta-analysis revealed, with limited evidence, that increased protein and/or energy intake positively impacts anthropometric measures and handgrip strength of COPD patients.