Nutritional and microbiological quality of commercial and homemade blenderized whole food enteral diets for home-based enteral nutritional therapy in adults.

BACKGROUND & AIMS: Serious nutritional and contamination risks may be involved in the preparation of blenderized tube-feeding diets and in the handling of commercial diets. Their nutritional and microbiological quality in home settings is unknown. The objective of this study was to assess the nutritional and microbiological quality of commercial enteral and homemade blenderized whole foods diets intended to adult patients in home nutritional therapy. METHODS: In a cross sectional study, 66 samples of commercial (CD) and noncommercial (NCD) enteral diets were collected at the homes of patients in home enteral nutritional therapy, 33 of each type. Commercial diets were either powder (PCD; n = 13) or liquid (LCD; n = 20). The samples were analyzed in laboratory to assess their nutritional and microbiological quality. Anthropometric data of mid upper arm circumference (MUAC) and triceps skinfold (TST) thickness were obtained from the patients' medical records. RESULTS: NCD presented significantly lower values for protein, fat, fiber, carbohydrate and energy while water content was significantly higher. PCD and LCD did not show any statistically significant differences between them. In the NCD, the values measured for macronutrients and energy corresponded to less than 50% of the prescribed values (except for fat). In CD, protein value was about 20% more than the prescribed value; fat and energy values corresponded to approximately 100% of the prescription, while carbohydrate corresponded to 92%. Regardless the type of the diet, prevalence of undernutrition was high in both groups though patients of the NCD presented a higher percentage. Samples of NCD complied significantly less with the microbiological standards; only 6.0% complied with the standard for coliform bacteria. Escherichia coli was detected in 10, 2, and 2 samples of NCD, PCD and LCD, respectively. CONCLUSIONS: Homemade blenderized enteral diets showed low values of energy and macronutrients, delivered less than 50% of the prescribed values and had high levels of bacterial contamination.

Intestinal absorption of iron and calcium from soy and cow's milk-based infant formulas in weanling rats pups / Absorção intestinal de ferro e cálcio de fórmulas infantis à base de leite de vaca e de soja em filhotes de ratos recém-desmamados

ABSTRACT Objective: This study aimed to compare the intestinal absorption of iron and calcium between soy-based and cow's milk-based infant formulas in weanling rats. Methods: Twenty male Wistar rats, twenty-one days old on the first day of weaning, were used in this experiment, divided in two Groups, one Group was fed soy protein-based infant formula the other, cow's milk protein-based infant formula. During the study period (ten consecutive days) the animals received food and water ad libitum. Hematocrit and hemoglobin were evaluated on the first, fifth, and tenth days by the Wintrobe and cyanomethemoglobin methods. Feces and urine were collected, beginning on the fifth day, for three consecutive days. On the tenth day, hepatic iron content was also analyzed. Hepatic iron as well as fecal and urinary iron and calcium analyses were performed using an atomic absorption spectrophotometer. At thirty-one days of age, the animals were anesthetized with ketamine and xylazine and sacrificed by exsanguination via the vena cava. Results: The final concentration of hemoglobin in the group soy-based infant formula and milk-based infant formula were: 10.3±1.3g/dL and 10.9±1.0g/dL (p=0.310). The apparent absorption of iron and calcium, in that order, were: 73.4±10.2% and 70.2±9.5%; 97.2±0.7% and 97.6±1.0% (p=0.501; p=0.290). The apparent calcium retention was: 88.4% ±2.2 and 88.6±2.6% (p=0.848). Hepatic iron content was: 522.0±121.1mg/g and 527.8±80.5mg/g (p=0.907) . Conclusion: Intestinal iron and calcium absorption from soy-based infant formula is similar to that from milk-based infant formula in weanling rats.

RESUMO Objetivo: Este estudo objetivou comparar a absorção intestinal de ferro e cálcio entre fórmulas infantis à base de leite de vaca e de soja em ratos recém-desmamados. Métodos: Vinte ratos machos Wistar, com 21 dias de vida e no primeiro dia do desmame foram utilizados neste experimento, divididos em dois grupos: um alimentado com fórmula infantil à base de proteína de soja e o outro com fórmula infantil à base de proteína do leite de vaca. Durante o período de estudo (10 dias consecutivos), os ratos receberam dieta e água ad libitum. Hematócrito e hemoglobina foram mensurados no primeiro, quinto e décimo dia pelo método de Wintrobe e da cianometaemoglobina. As fezes e a urina foram recolhidas a partir do quinto dia durante durante três dias consecutivos. No décimo dia, o conteúdo de ferro hepático também foi analisado. O conteúdo de ferro hepático e a análise de ferro e cálcio nas fezes e na urina foram realizados utilizando espectrofotômetro de absorção atômica. Aos 31 dias de vida, os animais foram anestesiados com ketamina e xilasina e sacrificados por exsanguinação da veia vaca. Resultados: A concentração final de hemoglobina no grupo fórmula infantil à base de soja e fórmula infantil à base de leite de vaca foram 10,3±1,3g/dL e 10,9± 1,0g/dL (p=0,310), respectivamente. A absorção aparente de ferro e cálcio foi de: 73,4±10,2% e 70,2±9,5%, para o primeiro grupo; e 97,2±0,7% e 97,6±1,0%, para o segundo (p=0,501; p=0,290). A retenção aparente de cálcio foi: 88,4±2,2% e 88,6±2,6% (p=0,848). O teor de ferro hepático foi: 522,0±121,1µg/g e 527,8±80,5µg/g (p=0,907), respectivamente. Conclusão: A absorção intestinal de ferro e cálcio da fórmula infantil à base de soja é similar à da fórmula infantil à base de leite em ratos recém-desmamados.

Mothers 'don't like it; never tried it': Blind Sensory Test of a Homemade Chicken Liver Baby Food, a Source of Iron, by Infants and their Mothers.

A homemade chicken liver baby food (CLBF) that meets infants' nutritional requirements was developed and its acceptance by children and their mothers determined. CLBF's nutritional content was determined by chemical analyses. A blind sensory test (ST) by 50 infants 7-12 months old and their mothers of CLBF and ground beef baby food (GBBF) was applied. Mothers' preferences for liver and beef, answers of an hedonic scale and infants' acceptance were investigated. CLBF met the nutritional requirements for infants. There were no significant differences in the ST between the CLBF and GBBF, either for infants or for their mothers. There was no correlation between mothers' like or dislike of liver and the ST scores. Infants tried and liked the CLBF that match dietary recommendations and could help prevent iron deficiency. Mothers, on the other hand, demonstrated an 'I don't like it; I never tried it' attitude.

Effects of soy beverage and soy-based formula on growth, weight, and fecal moisture: experimental study in rats / Efeitos de bebida e de fórmula de soja no crescimento, peso e umidade fecal: estudo experimental em ratos

OBJECTIVE: To compare body growth, weight, and fecal moisture in recently weaned rats fed exclusively on infant soy formula and soy-based beverage. METHODS: Three similar groups were formed (n = 10/group) consisting of weanling Wistar rats, maintained in metabolic cages. One group was fed soy protein-based beverage, another with soy-based infant formula, and another with cow's milk infant formula (control group). Water and diet were offered ad libitum. Body weight and length were measured. Stool was collected for three consecutive days. RESULTS: Weight and length were lower (p = 0.001; p = 0.001) in the groups receiving soy protein-based beverage (73.16 ± 5.74 g; 23.94 ± 1.04 cm) and soy-based formula (71.11 ± 5.84 g; 24.74 ± 0.60 cm) in relation to the group receiving cow's milk formula (84.88 ± 9.75 g; 26.01 ± 0.91 cm). Fresh fecal weight was greater (p < 0.001) in the soy-based beverage (3.44 ± 0.48 g) than in the soy-based formula (0.79 ± 0.20 g) and cow's milk-based formula (0.42 ± 0.17 g). Fecal moisture was higher (p < 0.001) in the group receiving soy protein-based beverage (47.28 ± 9.02%) and soy-based formula (37.21 ± 13.20%) than in the group receiving cow's milk formula (22.71 ± 10.86%). CONCLUSION: The growth of rats fed soy protein-based beverage and soy-based formula was lower than those fed cow's milk-based formula. The soy protein-based beverage resulted in significant increase in fecal weight and moisture. .

OBJETIVO: Comparar o crescimento corporal, o peso e a umidade das fezes de ratos recém-desmamados alimentados exclusivamente com fórmula infantil de soja e com bebida de extrato de soja. MÉTODOS: Constituíram-se três grupos similares (n = 10/grupo) de ratos machos Wistar recém-desmamados, mantidos em gaiolas metabólicas. Um grupo foi alimentado com bebida de extrato de soja, outro com fórmula infantil de soja e o outro com fórmula infantil de leite de vaca (grupo controle). Água e dieta foram oferecidas ad libitum. Foram mensurados o peso e o comprimento corporal. Fezes foram coletadas durante três dias consecutivos. RESULTADOS: Peso e comprimento foram menores (p = 0,001; p = 0,001) nos grupos com bebida de extrato de soja (73,16 ± 5,74 g; 23,94 ± 1,04 cm) e fórmula infantil de soja (71,11 ± 5,84 g; 24,74 ± 0,60 cm) em relação ao grupo de fórmula infantil de leite de vaca (84,88 ± 9,75 g; 26,01 ± 0,91 cm). O peso fresco fecal foi maior (p < 0,001) na bebida de extrato de soja (3,44 ± 0,48 g) do que com as fórmulas infantis de soja (0,79 ± 0,20 g) e de leite de vaca (0,42 ± 0,17 g). A umidade fecal foi maior (p < 0,001) na bebida de extrato de soja (47,28 ± 9,02%) e fórmula infantil de soja (37,21 ± 13,20%) do que na fórmula infantil de leite de vaca (22,71 ± 10,86%). CONCLUSÃO: O crescimento de ratos alimentados com bebida de soja e fórmula infantil de soja foi menor do que os alimentados com fórmula com proteína do leite de vaca. A bebida à base de extrato de soja proporcionou aumento expressivo do peso e da umidade fecal. .

Public Daycare Noncompliance with Prescribed Lunch Menus and Dietary Guidelines.

OBJECTIVE: In Brazil, menus for public child daycare centers (PDC) must be planned by a nutritionist in order to meet the infants' nutritional needs and to conform to dietary recommendations. Failure to follow them may jeopardize the infants' health and growth. Therefore, the objectives of this study were to investigate the compliance of actually served lunch menus with the prescribed menus, according to age (7- to 12-month-olds and 13- to 24-month-olds) and whether prescribed and served menus followed the recommended dietary guidelines. METHODS: Five PDCs were randomly selected for observation, out of 14 existing in the city of Concordia, Brazil. Data collection was carried out during 6 consecutive weeks in September (fall/winter menus) and October (spring/summer menus) in order to cover the menus representative of the entire year. RESULTS: Of 60 lunches recorded, only 20% of them matched the prescribed ones entirely; none of the lunches served to infants aged 7-12 months did so. Fourteen food items were prescribed 157 times throughout the year. Omission (number of times on menu but not served) was the most frequent form of noncompliance in the younger group: 62.4% (98/157). Foods more frequently omitted by the cooks were beef, pork, chicken, and lentils. Compliance with dietary guidelines was higher in the prescribed menus and in those actually served to the 13- to 24-month-old age group. CONCLUSIONS: Infants in the 7- to 12-month-old group may be more vulnerable to nutritional inadequacies because menus served to them were less compliant with the prescribed menus. Dietetics professionals should improve the variety of foods on the menus as well as supervise their execution.

Effects of soy beverage and soy-based formula on growth, weight, and fecal moisture: experimental study in rats.

OBJECTIVE: To compare body growth, weight, and fecal moisture in recently weaned rats fed exclusively on infant soy formula and soy-based beverage. METHODS: Three similar groups were formed (n=10/group) consisting of weanling Wistar rats, maintained in metabolic cages. One group was fed soy protein-based beverage, another with soy-based infant formula, and another with cow's milk infant formula (control group). Water and diet were offered ad libitum. Body weight and length were measured. Stool was collected for three consecutive days. RESULTS: Weight and length were lower (p = 0.001; p = 0.001) in the groups receiving soy protein-based beverage (73.16 ± 5.74 g; 23.94 ± 1.04 cm) and soy-based formula (71.11 ± 5.84 g; 24.74 ± 0.60 cm) in relation to the group receiving cow's milk formula (84.88 ± 9.75 g; 26.01 ± 0.91 cm). Fresh fecal weight was greater (p < 0.001) in the soy-based beverage (3.44 ± 0.48 g) than in the soy-based formula (0.79 ± 0.20 g) and cow's milk-based formula (0.42 ± 0.17 g). Fecal moisture was higher (p < 0.001) in the group receiving soy protein-based beverage (47.28 ± 9.02%) and soy-based formula (37.21 ± 13.20%) than in the group receiving cow's milk formula (22.71 ± 10.86%). CONCLUSION: The growth of rats fed soy protein-based beverage and soy-based formula was lower than those fed cow's milk-based formula. The soy protein-based beverage resulted in significant increase in fecal weight and moisture.

Home-made feeding bottles have inadequacies in their nutritional composition regardless of socioeconomic class.

Fifty-four and fifty samples of home-prepared feeding bottles for infants from a public health unit (low socioeconomic group, LSG) and from a private pediatric clinic (high socioeconomic group, HSG), respectively, were chemically analyzed, and their energy, macronutrient and iron contents were compared with the standard composition recommended for follow-up formulas. Cow's milk and sucrose and cereals added to the bottles were largely used in the study. Energy, protein and carbohydrate contents were higher than the recommended level in 75.9, 27.7 and 81.5% of LSG samples and 62.0, 48.0 and 34.0% of HSG samples, respectively. Fat content was lower than the recommended level in 83.3% of LSG and 58.0% of HSG samples. Excessive values of energy, carbohydrates and protein, low fat content and macronutrient imbalance were found regardless of the socioeconomic class, thus indicating the need to improve the domestic feeding bottles' preparation practices and discourage the use of cow's milk and the addition of other ingredients.

Qualidade nutricional e microbiológica de dietas enterais artesanais padronizadas preparadas nas residências de pacientes em terapia nutricional domiciliar / Nutritional and microbiological quality of standardized homemade enteral diets for patients in home nutritional therapy

OBJETIVO: Avaliar as propriedades físico-químicas, microbiológicas e nutricionais de dietas enterais artesanais padronizadas preparadas nos domicílios de pacientes em terapia nutricional domiciliar. MÉTODOS: Foram desenvolvidas duas formulações de dietas enterais (F1=1,2kcal/mL e F2=1,5kcal/mL), elaboradas com maltodextrina (155/155g), concentrado proteico de soro de leite (30/15g) e óleos vegetais (30/60g) dissolvidos em água (q.s.p.1000mL). Os cuidadores receberam os ingredientes e as medidas padrão e foram orientados quanto ao preparo e às boas práticas de manipulação. O estudo teve duração de quatro meses, e amostras das dietas preparadas nos domicílios de 33 pacientes foram coletadas e analisadas no início e no final deste período. As amostras foram avaliadas quanto à sua adequação percentual em relação aos valores prescritos de macronutrientes e energia, bem como aos padrões microbiológicos estabelecidos pela legislação vigente. RESULTADOS: As dietas formuladas (Formulação 1/Formulação 2) apresentaram os seguintes teores de macronutrientes, energia e osmolalidade: água - 73,5/70,0%; proteína - 4,4/6,0%; lipídeo - 4,3/6,6%; carboidrato - 16,9/16,4%; energia - 120/150kcal/100mL; osmolalidade - 440/450mOsm/kg.H2O. As variações nas adequações percentuais das amostras domiciliares foram menores que 20,0% tanto na primeira quanto na última amostragem. As proporções de amostras em desacordo com os padrões legais foram significantemente menores nas amostras finais, 24,0% e 36,0% para bactérias mesófilas e coliformes, respectivamente. CONCLUSÃO: O preparo das dietas nos domicílios apresentou boa reprodutibilidade; no entanto, a qualidade microbiológica ainda permanece uma questão preocupante, exigindo uma atuação cuidadosa do profissional de saúde nos domicílios.

OBJECTIVE: This study assessed the physical, chemical, microbiological and nutritional properties of standardized enteral diets prepared at the homes of patients receiving nutritional therapy. METHODS: Two enteral diet formulations were developed (F1=1.2kcal/mL and F2=1.5kcal/mL) containing maltodextrin (155/155g), whey protein concentrate (30/15g) and vegetable oils (30/60g) dissolved in water (q.s.p.1000mL). The ingredients and measuring devices were given to the caregivers, along with preparation instructions and advice on good handling practices. The study lasted four months and the diets prepared at the homes of 33 patients were collected at baseline and endline for analysis. The samples were analyzed to determine the compliance of their macronutrient and energy contents with the prescription and their microbiological contents with the legislation. RESULTS: The study diets (Formulation 1/Formulation 2) contained the following macronutrient and energy contents and osmolality: water - 73.5/70.0%; protein - 4.4/6.0%; lipids - 4.3/6.6%; carbohydrate - 16.9/16.4%; energy - 120/150kcal/100mL; osmolality - 440/450mOsm/kg.H2O. The percent adequacy of the homemade diets did not vary by more than 20.0% at baseline or end of study. The percentages of samples that did not meet the legal standards were significantly lower at the end of the study: 24.0% and 36.0% for mesophilic bacteria and coliforms, respectively. CONCLUSION: Homemade diets presented good reproducibility but their microbiological quality remains a matter of concern, indicating that health professionals must be careful when working at home.

A novel and potentially valuable exposure measure: Escherichia coli in oral cavity and its association with child daycare center attendance.

This study investigated the occurrence of Escherichia coli, an indicator of fecal contamination, in saliva samples from 141 children up to 36 months old, 53 not attending and 88 attending a child daycare center after exposure to a public daycare center and home environments. Two samples from each child were collected on the same day at 07:00 and 15:00 h and plated on MacConkey agar for identification. Samples E. coli negative in the morning and positive in the afternoon were statistically associated with the condition of the child attending daycare center (Odds ratio = 2.72; 95% confidence interval = 1.15/6.46). Exposure to the daycare center environment favored the potential risk of transmission of enteropathogens, as demonstrated by the presence of E. coli in saliva. The method proved to be easy to sample, non-invasive and feasible in young children. The findings suggest a novel and potentially valuable exposure measure.

Excess sodium and insufficient iron content in complementary foods.

OBJECTIVES: To determine, by chemical analysis, the macronutrient, energy, sodium, and iron contents of homemade foods prepared for infants in two socioeconomic classes in Belém, state of Pará, Brazil. METHODS: Cross-sectional study of 78 infants (aged 6 to 18 months) distributed into two groups according to socioeconomic status (high or low). Chemical analyses were performed on samples of homemade complementary foods prepared for each infant's lunch. Daily food intake was estimated on the basis of two 24-hour dietary intake recall. RESULTS: Chemical analyses showed that the energy content of some food samples was lower than recommended, both in the low socioeconomic status (SES) group (29.8% of samples) and in the high-SES group (43.0%; p = 0.199). The iron content of all samples, regardless of group, was lower than minimum recommended levels (6.0 mg/100 g). On the other hand, excessive sodium levels (200 mg/100 g) were found in 89.2 and 31.7% of samples in the low- and high-SES groups, respectively (p = 0.027). Dietary recalls showed that energy intake exceeded 120% of the Estimated Energy Requirement in 86.5% of infants in the low-SES group and 92.7% of those in the high-SES group (p = 0.483). Lunch and dinner provided 35.2+/-14.6 and 36.4+/-12.0% of daily energy intake in the low- and high-SES groups, respectively (p = 0.692). CONCLUSION: Homemade complementary foods for infants were found to be low in iron. A significant portion of samples had excessive sodium content, most frequently those prepared for infants in low-SES status families.

Excesso de sódio e déficit de ferro em alimentos de transição / Excess sodium and insufficient iron content in complementary foods

OBJETIVOS: Determinar, por análise química, a composição nutricional de macronutrientes, energia, sódio e ferro de alimentos preparados no domicílio para lactentes de dois estratos socioeconômicos em Belém (PA). MÉTODOS: Estudo transversal com 78 lactentes (6 a 18 meses) distribuídos em dois grupos com condição socioeconômica alta ou baixa. Foi realizada análise química de amostras de alimentos de transição preparados no domicílio para o almoço. Foi estimada a ingestão alimentar diária, com base em dois inquéritos alimentares de 24 horas. RESULTADOS: As análises químicas revelaram que parcela das amostras dos alimentos apresentava baixo teor de energia em relação ao recomendado, tanto no estrato socioeconômico baixo (29,8 por cento) como no alto (43,0 por cento; p = 0,199). Todas as amostras analisadas, em ambos os grupos, apresentaram quantidade de ferro abaixo do mínimo recomendado (6,0 mg/100 g). Por outro lado, excesso de sódio (200 mg/100 g) foi constatado em 89,2 e 31,7 por cento, respectivamente, das amostras dos grupos de baixo e alto nível socioeconômico (p = 0,027). De acordo com os inquéritos alimentares, a estimativa da ingestão energética foi maior que 120 por cento da necessidade média estimada em 86,5 por cento dos lactentes do grupo de nível socioeconômico baixo e em 92,7 por cento do alto (p = 0,483). O almoço e o jantar forneceram 35,2±14,6 e 36,4±12,0 por cento da energia, respectivamente, nos grupos de baixo e alto nível socioeconômico (p = 0,692). CONCLUSÃO: Alimentos de transição preparados no domicílio para lactentes apresentaram baixo teor de ferro. Parcela expressiva das amostras apresentou quantidade excessiva de sódio, mais frequentemente nos alimentos preparados para os lactentes de baixo nível socioeconômico.

OBJECTIVES: To determine, by chemical analysis, the macronutrient, energy, sodium, and iron contents of homemade foods prepared for infants in two socioeconomic classes in Belém, state of Pará, Brazil. METHODS: Cross-sectional study of 78 infants (aged 6 to 18 months) distributed into two groups according to socioeconomic status (high or low). Chemical analyses were performed on samples of homemade complementary foods prepared for each infant's lunch. Daily food intake was estimated on the basis of two 24-hour dietary intake recall. RESULTS: Chemical analyses showed that the energy content of some food samples was lower than recommended, both in the low socioeconomic status (SES) group (29.8 percent of samples) and in the high-SES group (43.0 percent; p = 0.199). The iron content of all samples, regardless of group, was lower than minimum recommended levels (6.0 mg/100 g). On the other hand, excessive sodium levels (200 mg/100 g) were found in 89.2 and 31.7 percent of samples in the low- and high-SES groups, respectively (p = 0.027). Dietary recalls showed that energy intake exceeded 120 percent of the Estimated Energy Requirement in 86.5 percent of infants in the low-SES group and 92.7 percent of those in the high-SES group (p = 0.483). Lunch and dinner provided 35.2±14.6 and 36.4±12.0 percent of daily energy intake in the low- and high-SES groups, respectively (p = 0.692). CONCLUSION: Homemade complementary foods for infants were found to be low in iron. A significant portion of samples had excessive sodium content, most frequently those prepared for infants in low-SES status families.

Nutritional quality and osmolality of home-made enteral diets, and follow-up of growth of severely disabled children receiving home enteral nutrition therapy.

This study evaluated the nutritional quality of home-made enteral diets and their effect on growth parameters. Thirty pediatric patients receiving only homemade enteral diets were enrolled. Samples of milk-based (MB) and soup-based (SP) feeds were taken for chemical analyses. The children's anthropometric indexes were assessed. In the MB, the measured values for the macronutrients and energy corresponded to approximately 70% of the prescribed values. Conversely, the SP measured values corresponded to less than 50% of the prescribed values, except for carbohydrate. The prevalence of underweight was 30% (9/30) at the time of entry into home nutritional therapy and declined to 20% (6/30) at the time of the study (p = 0.007). Stunting increased throughout the follow up, from 30% (9/30) to 53% (16/30; p = 0.511). Obesity prevalence fell from 17% (4/23) to 9% (2/23; p < 0.001). Despite their inconsistent levels of macronutrients and energy, home-made enteral diets had no negative effect on the patients' weights.

O trabalho sob a ótica das manipuladoras de alimentos de uma unidade hospitalar / Work according to the viewpoint of hospital food handlers

OBJETIVO: Analisar as percepções acerca da atividade profissional de um grupo de manipuladores de alimentos de um hospital público. MÉTODOS: A pesquisa, de cunho qualitativo, foi realizada em um serviço de nutrição e dietética de um hospital público de ensino da Cidade de São Paulo. Desenvolveu-se a partir de corpus obtido por técnica do grupo focal realizada com 15 funcionárias, sendo 8 vinculadas ao lactário e 7 à cozinha dietética. Os depoimentos foram gravados, transcritos e analisados sob o ponto de vista do conteúdo e das representações sociais. Posteriormente, a validação da análise foi realizada com as participantes. A caracterização socioeconômica foi realizada com uso de um formulário auto-aplicável. RESULTADOS: O trabalho é percebido como crucial para a sobrevivência, porém de grande responsabilidade social, além de implicar em rotina exaustiva. Além disso, constitui instância que possibilita apoio e relacionamento entre as trabalhadoras, embora não lhes proporcione o status que julgam merecer. O trabalho é representado como instância simultânea de sofrimento e apoio; embora importante, tanto para elas mesmas, quanto para o grupo social. Ao mesmo tempo, chefias e os superiores se mostram alheios a todas as dificuldades. CONCLUSÃO: Por conseqüência, percebe-se que há necessidade de mudanças na organização do trabalho, a fim de reduzir os fatores que ocasionam cansaço, descontentamentos e desânimo nas manipuladoras. Faz-se necessário maior investimento, por parte da chefia do serviço, na adoção de estratégias gerenciais mais descentralizadas e participativas, respeitando, na medida do possível, as opiniões e diferenças individuais, bem como investindo em treinamentos periódicos dos trabalhadores.

OBJECTIVE: The objective was to analyze how a group of food handlers from a public hospital perceive their professional activities. METHODS: This qualitative research was carried out in a nutrition and dietetic service of a public hospital school in the city of São Paulo. Its development was based on a corpus obtained by doing the focus group technique with 15 employees, of which 8 worked in the milk dispensary and 7 in the dietetic kitchen. The statements were recorded, transcribed and analyzed according to content and social representations. Later, the analysis was validated together with the participants. Socioeconomic status was determined with a self-assessment form. RESULTS: Labor is perceived as crucial for survival and of great social responsibility, in addition to being exhausting. Furthermore, work represents an instance that allows workers to support and relate to each other, although it does not provide the status they believe they deserve. Labor is simultaneously represented as an instance of suffering and support while it is important for themselves and for the whole social group. Meanwhile, supervisors and managers do not seem to notice their difficulties. CONCLUSION: Consequently, the organization of the work needs changes in order to reduce factors that generate fatigue, unhappiness and discouragement among food handlers. Supervisors need to invest more in the implementation of decentralizing and more participative management strategies, respecting, whenever possible, the opinions and individual differences, as well as in the periodical training of the employees.

Hurdles at work: perceptions of hospital food handlers.

BACKGROUND: Food handlers have a very important role in preventing food contamination during its preparation and distribution. This responsibility is even greater in hospitals, since a large number of patients have low immunity and consequently food contamination by pathogenic bacteria could be particularly harmful. Therefore, a good working environment and periodic training should be provided to food handlers by upper management. METHODS: This study is qualitative research by means of focus group and thematic content analysis methodologies to examine, in detail, the statements by food handlers working in the milk and specific-diet kitchens in a hospital to understand the problems they face in the workplace. RESULTS: We found that food handlers are aware of the role they play in restoring patients' health; they consider it important to offer a good-quality diet. However, according to their perceptions, a number of difficulties prevent them from reaching this aim. These include: upper management not prioritizing human and material resources to the dietetic services when making resource allocation decisions; a perception that upper management considers their work to be of lesser importance; delayed overtime payments; lack of periodic training; managers lacking administrative skills; insufficient dietitian staff assistants, leading to overwork, at the same time as there is an excess of dietitians; unhealthy environmental working conditions--high temperature, high humidity, loud and constant noise level, poor ventilation; lack of food, and kitchen utensils and equipment; and relationship conflicts with chief dieticians and co-workers. CONCLUSION: From these findings, improvement in staff motivation could be achieved by considering non-financial incentives, such as improvement in working conditions and showing appreciation and respect through supervision, training and performance appraisal. Management action, such as investments in intermediary management so that managers have the capacity to provide supportive supervision, as well as better use of performance appraisal and access to training, may help overcome the identified problems.

A training course on food hygiene for butchers: measuring its effectiveness through microbiological analysis and the use of an inspection checklist.

The effectiveness of food hygiene training for a group of retail butchers was evaluated with the aim of verifying whether the butchers modified their behavior in the light of knowledge gained and whether their acquired knowledge or behavior change was sustained over a period of time. Microbiological analysis (enumeration of mesophilic and coliform bacteria and Escherichia coli) of a raw semiprocessed product (stuffed rolled beef) was conducted, and an inspection checklist was issued before the training course (T0). Initial results were later compared with results obtained 1 month (T1) and 6 months (T6) after the training. The checklist comprised 89 items classified into five categories: A, approved suppliers and product reception; B, storage conditions and temperature control; C, flow process, food handling procedures, and conditions of the window display unit; D, facility design and proper cleaning and sanitizing of equipment, utensils, and work surfaces; and E, pest control system, water supply control, and garbage disposal. The inspection results were recorded as "yes" or "no" for each item. Compliance with food safety procedures was recorded as the percentage of "yes" answers. The bacterial counts were significantly higher at T0. At T6, there was no significant increase in bacterial counts. There was a significant improvement in food safety practices at T1 and T6 compared with T0 for all categories. When comparing T0 and T1, the largest increases in the compliance scores were seen within categories C and D. No significant decrease in scores for compliance with food safety practices was observed at T6. Supervision and refresher activities may be necessary to maintain behavioral changes for a longer period of time.

Bacterial contamination and nutrient content of home-prepared milk feeding bottles of infants attending a public outpatient clinic.

To evaluate the bacterial contamination and the nutrient content of home-prepared milk feeding bottles, 48 samples of their lacteal contents were collected; of these, 29 samples were cultured and 48 were analyzed to determine their macronutrients composition by chemical analyses. The medians (percentiles 25 and 75) of the counts (bacteria/ml) were mesophilic bacteria, 78,000 (500-1,125,000) and coliforms, 600 (0-44,000). Adding sugar (41/48) and cereals (39/48) to the milk was a common practice. The medians of the macronutrients contents (g/dl or kcal/dl) of the feeding bottles with and without the addition of cereals were, respectively: protein, 2.8/2.4; fat, 1.1/2.2; carbohydrate, 14.5/8.6; energy, 88.7/57.2. Feeding bottles with the addition of cereals had carbohydrate and energy contents significantly higher. Home-prepared milk feeding bottles were heavily contaminated. Most milk feeding bottles met or exceeded the recommended values proposed by European Society of Pediatric Gastroenterology and Nutrition for follow-up formulas, except for fat.

[Food composition tables: laboratory comparative analysis]. / Tabelas de composição química de alimentos: análise comparativa com resultados laboratoriais.

OBJECTIVE: To evaluate the agreement between macronutrients and food energy values analyzed in laboratory and data of food composition tables and software available in Brazil. METHODS: Eleven types of food were analyzed totaling 701 samples. Student's t-test was performed consisting of the comparison between the mean values obtained in laboratory and the unique constant value of each table or software at 5% confidence level. RESULTS: It was noted that depending on the type of food, nutrient and table or software selected for comparison, there were significant statistically differences between laboratory and tables and software data. Concerning the studied types of food it was observed a trend of overestimating protein and carbohydrate content in two tables while carbohydrate content was overestimated in a third table. One of the software programs showed overestimated lipid content and, consequently, the total energetic values while a second software program underestimated all nutrients when compared to laboratory results. CONCLUSIONS: The results showed it is essential to create a Brazilian food composition table from laboratory data to assure more accurate data.

Tabelas de composiçäo química de alimentos: análise comparativa com resultados laboratoriais / Food composition tables: laboratory comparative analysis

OBJETIVO: Avaliar a concordância entre os valores de macronutrientes e energia de alimentos analisados em laboratório com os dados apresentados em tabelas e softwares de composiçäo de alimentos em uso no Brasil. MÉTODOS: Foram analisados 11 alimentos totalizando 701 amostras. Foram selecionadas para comparaçäo três tabelas e dois softwares de composiçäo de alimentos. Foi aplicado o teste t de Student univariado, que consistiu na comparaçäo entre a média dos valores obtidos em laboratório e o valor único e constante de cada tabela ou software, com significância no nível de 5 por cento. RESULTADOS: Verificou-se que dependendo do alimento, do nutriente estudado e da tabela ou software escolhido para a comparaçäo, ocorreram diferenças estatisticamente significantes entre os dados analisados em laboratório e os dados de tabelas e softwares. Para os alimentos estudados, foi observado: duas tabelas mostraram tendência à superestimaçäo dos teores de proteína e HCT, enquanto uma outra superestima os teores de HCT; um dos softwares tendeu a superestimar os teores de lipídios e, consequentemente, o valor energético total, e em um outro software todos os nutrientes foram subestimados em relaçäo aos valores obtidos em laboratório. CONCLUSOES: Concluiu-se que é fundamental a elaboraçäo de uma tabela brasileira de composiçäo de alimentos, a partir de dados obtidos em laboratório, para garantir melhor exatidäo das informaçöes

Determination of macronutrients, by chemical analysis, of home-prepared milk feeding bottles and their contribution to the energy and protein requirements of infants from high and low socioeconomic classes.

OBJECTIVES: To determine the macronutrients composition of home-prepared milk feeding bottles, by chemical analysis, and assess their contribution to the energy and protein requirements of children under two years of age from high (HSE) and low (LSE) socioeconomic classes. METHODS: 72 samples were analyzed for energy density and protein, fat and carbohydrate content: 41 from the LSE group and 31 from the HSE group. The assessment of the percentages of the energy and protein requirements met by the consumption of the milk bottles was calculated as follows: the energy and protein per 100 mL obtained through chemical analysis were multiplied by the volume consumed at each feeding, then by the number of feedings per day, the results divided by the energy and protein requirements and multiplied by 100. Energy and protein requirements were those recommended by the FAO/WHO/UNU Committee and the Food and Nutrition Board. The children's weight-for-age index was assessed. RESULTS: Unmodified cow's milk was largely consumed by both groups. The addition of sugar and other ingredients to the milk was significantly higher in the LSE group. Moisture, protein and fat content were lower in the LSE group, whereas carbohydrate and energy content were higher. The percentages of energy and protein requirements provided by feeding bottles were higher in the LSE group. Children in the LSE group had lower z-scores for weight-for-age. CONCLUSIONS: Differences in the preparation practices led to differences in the chemical results. The feeding bottles in the LSE group were high in energy, due to the addition of sugar and cereals to the milk in the bottle. The milk feeding bottles were an important weaning food providing more than 50% and 100% of the children's energy and protein requirements, respectively. The children's weight-for-age index was within the normal limits.

Pontos críticos no controle da manipulaçäo de dietas enterais no Município de Säo Paulo / Critical points in the control of enteral diets manipulation in the City of Sao Paulo

As dietas enterais, ricas em macro e micronutrientes, säo excelentes meios para o crescimento de microorganismos. A administraçäo de dietas eventualmente contaminadas pode näo somente causar distúrbios gastrointestinais, mas contribuir para infecçöes mais graves, principalmente em pacientes imonossuprimidos. Com o objetivo de avaliar a qualidade microbiológica de dietas enterais e determinar os pontos críticos de controle no processamento das formulaçöes, desenvolveu-se um estudo entres hospitais do município de Säo Paulo. Foram avaliadas 116 dietas enterais, pelo sistema denominado Análise de Perigos e Pontos Críticos de Controle. Utilizou-se como técnicas o monitoramento da higienizaçäo e desinfecçäo de utensílios e equipamentos, controles de tempo e de temperaturas e análises microbiológicas, por meio de contagens de bactérias mesofilas facultativas, bolores e leveduras e determinaçäo de coliformes totais e de Echerichia coli. Quanto a adequaçäo, as dietas foram avaliadas segundo as recomendaçöes da British Dietetic Association (19986) e da Food and Drug Administration (FDA,1995). As dietas artesanais e em pó apresentaram em elevado percentual de inadequaçäo. Identificou-se como pontos críticos de controle a higienizaçäo e desinfecçäo de utensílios e equipamentos; o tempo de preparo, associado a temperatura do produto final e a exposiçäo a temperatura ambiental; a temperatura de refrigeraçäo; a água; a higienizaçäo e anti-sepsia das mäos das manipuladoras e a higienizaçäo e desinfecçäo externa das embalagens das dietas