Validity of the GLIM criteria for the diagnosis of malnutrition in patients with colorectal cancer: A multicenter study on the diagnostic performance of different indicators of reduced muscle mass and disease severity.

OBJECTIVES: To assess the concurrent and predictive validity of different combinations of Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with colorectal cancer considering different indicators of reduced muscle mass (MM) and the effects of the disease. METHODS: A secondary analysis with patients with colorectal cancer. The reduced MM was assessed by arm muscle area, arm muscle circumference, calf circumference, fat-free mass index, skeletal muscle index (SMI) and skeletal muscle. Cancer diagnosis or disease staging (TNM) was considered for the etiologic criterion referred to as the effect of the disease. The other phenotypic and etiologic criteria were also evaluated, and we analyzed 13 GLIM combinations. Concurrent validity between GLIM criteria and Patient-Generated Subjective Global Assessment was evaluated. Logistic and Cox regression were used in the predictive validation. RESULTS: For concurrent validity (n = 208), most GLIM combinations (n = 6; 54.5%) presented a moderate agreement with Patient-Generated Subjective Global Assessment and none showed satisfactory sensitivity and specificity (>80%). Reduced MM evaluated by SMI and SMI were present in the GLIM combinations associated with postoperative complications (odds ratio, ≥2.0), independent of other phenotypic and etiologic criteria. The combinations with reduced MM considering any method and fixed phenotypic criteria and TNM were associated with mortality (hazard ratio, ≥2.0). CONCLUSIONS: Satisfactory concurrent validity was not verified. The GLIM diagnosis of malnutrition was associated with postoperative complications and mortality.

Validation of the Global Leadership Initiative on Malnutrition criteria for diagnosis of malnutrition and mortality prediction for people living with HIV or AIDS.

OBJECTIVES: To validate the Global Leadership Initiative on Malnutrition (GLIM) criteria to diagnose malnutrition in hospitalized people living with HIV or AIDS (HA) considering different combinations, using the Subjective Global Assessment (SGA) as the semi-gold standard, and to assess the predictive effects of malnutrition according to the GLIM criteria on hospital length of stay and mortality. METHODS: Retrospective observational study including hospitalized people living with HA aged >18 y. Forty GLIM combinations were obtained by combining the different phenotypic and etiologic criteria. The concurrent validity was assessed according to the sensitivity and specificity values, and the agreement with the SGA was tested using κ values. Multivariate logistic and Cox regression models were used to test the independent predictors for longer length of stay (LOS) and mortality, respectively. RESULTS: The sample comprised 320 patients (mean age, 44.6 ± 12.1 y; 69.1% were men, and 68.4% were malnourished, according to the SGA). The prevalence of malnutrition, according to GLIM, varied from 10.3% to 69.1%. The combination of any phenotypic criteria with the etiologic criteria of low food intake and the combination of any phenotypic criteria with the etiologic criteria of disease severity were independent predictors for mortality (Hazard Ratio: 2.09 [95% CI, 1.15-3.77] and 2.09 [95% CI, 1.25-3.51], respectively). The combination of low body mass index and reduced absorption was independently associated with LOS higher than the median value (Oodds Ratio; 2.57; 95% CI, 1.21-5.45). CONCLUSIONS: Nine GLIM combinations had satisfactory sensitivity and specificity values to determine concurrent validity, all of them including weight loss and low weight; two combinations were independent predictors of mortality (any phenotypic criteria and low food intake or opportunistic infections), and one combination predicted longer LOS. Combining any phenotypic criteria with low food intake resulted in adequate concurrent and predictive validity.

Dietary pattern in women with polycystic ovary syndrome with and without associated non-alcoholic fatty liver disease: A cross-sectional study.

INTRODUCTION: Women with Polycystic Ovary Syndrome (PCOS) have a higher prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) than the general population. PCOS and NAFLD have common metabolic risk factors, however, the role of diet in NAFLD development is still uncertain in PCOS women. OBJECTIVE: To evaluate and compare the dietary patterns and nutritional intake in patients with PCOS with and without NAFLD. METHOD: Cross-sectional study that included patients with PCOS diagnosed according to Rotterdam criteria. All participants were submitted to abdominal ultrasound to investigate liver steatosis. Dietary profile was assessed by 24-hour food recall (24hR), and Food Frequency Questionnaire (FFQ). Diet quality was assessed by the Healthy Eating Index (HEI) adapted for the Brazilian population. Physical activity practice was also assessed. RESULTS: 87 participants were included (average age 35.2 ± 5.7 years), among whom, 67 (77%) had NAFLD. The group with PCOS and NAFLD presented higher body mass index (BMI) (34.9 ± 4.5 vs. 30.4 ± 4.9 kg/m2; p = 0.001), Waist Circumference (WC) (103 [97‒113] vs. 95 [87.5‒100] cm; p < 0.001) and were considered physically active less frequently than those without NAFLD (34.3% vs. 60%; p = 0.04). Food intake and dietary patterns assessed by 24hR, FFQ and HEI presented no difference between the groups. CONCLUSIONS: PCOS women with coexistent NAFLD had higher BMI, WC and were less physically active than those without NAFLD. Dietary evaluation showed that PCOS women with NAFLD had no significant difference in macro and micronutrients or food group intake and diet quality in comparison to those without NAFLD.

Impact of implementation of front-of-package nutrition labeling on sugary beverage consumption and consequently on the prevalence of excess body weight and obesity and related direct costs in Brazil: An estimate through a modeling study.

RATIONALE: Intake of sugary beverages has been associated with obesity and chronic non-communicable diseases, thereby increasing the direct health costs related to these diseases. Front-of-package nutrition labeling (FoPNL) aims to help consumers understand food composition, thereby improving food choices and preventing the development of such diseases. OBJECTIVE: To estimate, over five years, the impact of implementing FoPNL in Brazil on the prevalence of excess body weight and obesity in adults who consume sugary beverages and the direct costs related to such problems. METHODS: A simulation study to performed to estimate the effect of FoPNL implementation on the prevalence of excess body weight and obesity. The VIGITEL research database (2019), published in the 2020 report, was used in this study (the final sample consisted of 12,471 data points representing 14,380,032 Brazilians). The scenarios were considered: base (trend in sugary beverage intake); 1 (base scenario associated with the changes in energy content of the purchased beverages observed after the first phase of the Chilean labeling law (-9.9%); and 2 (scenario 1 associated with reformulation of beverages, total energy reduction of -1.6%). Changes in body weight were estimated using the simulation model of Hall et al. (2011) over five years. A linear trend in the prevalence of obesity and excess body weight in the Brazilian population was considered. The impact of the prevalence of obesity and excess body weight on body mass index was estimated. In addition, the direct health costs related to obesity were estimated. RESULTS: Energy consumption from sugary beverages after FoPNL implementation is expected to be reduced by approximately 28 kcal/day (95% CI, -30 to -27) considering scenario 1. In scenarios 1 and 2, without FoPNL, the prevalence of obesity and excess body weight over five years was estimated to be 25.3% and 25.2%, and 64.4% and 64.2%, respectively. By extrapolating the results to the entire Brazilian population, it was observed that the implementation of FoPNL may reduce the prevalence of obesity by -0.32 percentage points and -0.35 percentage points (scenario 1 and 2, respectively) and excess body weight by -0.42 percentage points and -0.48 percentage points (scenarios 1 and 2, respectively) in five years. It is estimated that after five years of implementation, it will be possible to save approximately US$ 5,5 millions (95% CI 4,7 to 8,8) in scenario 1, reaching approximately US$ 6,1 millions (95% CI 5,3 to 9,8) in scenario 2. CONCLUSION: The results of this modeling study indicate that FoPNL may reduce prevalence of excess body weight and obesity, representing strategic public policies for obesity prevention.

Global Leadership Initiative on Malnutrition criteria for the diagnosis of malnutrition and prediction of mortality in patients awaiting liver transplant: A validation study.

OBJECTIVES: The Global Leadership Initiative on Malnutrition (GLIM) is a framework aiming to standardize malnutrition diagnosis. However, it still needs to be validated, in particular for patients with chronic liver disease. This study aimed to validate the GLIM criteria in patients with liver cirrhosis awaiting liver transplant (LTx). METHODS: This was a retrospective observational study carried out with adult patients on the waiting list for LTx, consecutively evaluated between 2006 and 2021. The phenotypic criteria were unintentional weight loss, low body mass index, and reduced muscle mass (midarm muscle circumference [MAMC]). The etiologic criteria were high Model for End-Stage Liver Disease (MELD) and MELD adjusted for serum sodium (MELD-Na) scores, the Child-Pugh score, low serum albumin, and low food intake and/or assimilation. Forty-three GLIM combinations were tested. Sensitivity (SE), specificity (SP), positive and negative predictive values, and machine learning (ML) techniques were used. Survival analysis with Cox regression was carried out. RESULTS: A total of 419 patients with advanced liver cirrhosis were included (median age, 52.0 y [46-59 y]; 69.2% male; 68.8% malnourished according to the Subjective Global Assessment [SGA]). The prevalence of malnutrition by the GLIM criteria ranged from 3.1% to 58.2%, and five combinations had SE or SP >80%. The MAMC as a phenotypic criterion with MELD and MELD-Na as etiologic criteria were predictors of mortality. The MAMC and the presence of any phenotypic criteria associated with liver disease parameters and low food intake or assimilation were associated with malnutrition prediction in ML analysis. CONCLUSIONS: The MAMC and liver disease parameters were associated with malnutrition diagnosis by SGA and were also predictors of 1-y mortality in patients with liver cirrhosis awaiting LTx.

The effect of ß-hydroxy ß-methylbutyrate (HMB) with nutritional counselling on anthropometric muscle mass markers, strength, functionality, and quality of life in patients on the waiting list for liver transplantation: A double-blind study.

OBJECTIVE: Patients on the waiting list for liver transplantation (LTx) usually lose muscle mass. Supplementation with ß-hydroxy ß-methylbutyrate (HMB) may have a promising effect on this clinical condition. This study aimed to evaluate the effects of HMB on muscle mass, strength, functionality, and quality of life in patients on the LTx waiting list. METHODS: A double-blind, randomized study was conducted of 3g supplementation of HMB or 3g supplementation of maltodextrin (active control) with nutritional counselling for 12 wk in patients >18 y, evaluated at five points or timepoints. Body composition and anthropometric data (resistance, reactance, phase angle, weight, body mass index, arm circumference [AC], arm muscle area, and adductor pollicis muscle thickness) were collected, and muscle strength was assessed through dynamometry and muscle function by the frailty index (FI). Quality of life was assessed. RESULTS: A total of 47 patients were enrolled (HMB: 23 and active control: 24). There was a significant difference in both groups for AC (P = 0.03), dynamometry (P = 0.02), and FI (P = 0.01). There was an increase in dynamometry between weeks 0 and 12 in both groups (HMB [Δdynamometry: 10.1% ± 16.4%; P < 0.05] and active control [Δdynamometry: 23.0% ± 70.3%; P < 0.05]). The AC increased in both groups between weeks 0 and 4 (HMB [ΔAC: 0.9% ± 2.8%; P < 0.05] and active control [ΔAC: 1.6% ± 3.6%; P < 0.05]) and between weeks 0 and 12 (HMB [ΔAC: 3.2% ± 6.7%; P < 0.05] and active control [ΔAC: 2.1% ± 6.6%; P < 0.05]). The FI decreased in both groups, between weeks 0 and 4 (HMB [ΔFI: -4.2% ± 6.9%; P < 0.05) and active control [ΔFI: -3.2% ± 9.6%; P < 0.05]) and between weeks 0 and 12 (HMB ΔFI: -4.4% ± 11.2%; P < 0.05] and active control [ΔFI: -5.5% ± 11.3%; P < 0.05]). The other variables did not change (P > 0.05). CONCLUSIONS: Nutritional counselling with supplementation with HMB or active control in patients on the LTx waiting list improved AC, dynamometry, and the FI in both groups.

Dietary pattern in women with polycystic ovary syndrome with and without associated non-alcoholic fatty liver disease: A cross-sectional study

Abstract Introduction Women with Polycystic Ovary Syndrome (PCOS) have a higher prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) than the general population. PCOS and NAFLD have common metabolic risk factors, however, the role of diet in NAFLD development is still uncertain in PCOS women. Objective To evaluate and compare the dietary patterns and nutritional intake in patients with PCOS with and without NAFLD. Method Cross-sectional study that included patients with PCOS diagnosed according to Rotterdam criteria. All participants were submitted to abdominal ultrasound to investigate liver steatosis. Dietary profile was assessed by 24-hour food recall (24hR), and Food Frequency Questionnaire (FFQ). Diet quality was assessed by the Healthy Eating Index (HEI) adapted for the Brazilian population. Physical activity practice was also assessed. Results 87 participants were included (average age 35.2 ± 5.7 years), among whom, 67 (77%) had NAFLD. The group with PCOS and NAFLD presented higher body mass index (BMI) (34.9 ± 4.5 vs. 30.4 ± 4.9 kg/m2; p = 0.001), Waist Circumference (WC) (103 [97‒113] vs. 95 [87.5‒100] cm; p < 0.001) and were considered physically active less frequently than those without NAFLD (34.3% vs. 60%; p = 0.04). Food intake and dietary patterns assessed by 24hR, FFQ and HEI presented no difference between the groups. Conclusions PCOS women with coexistent NAFLD had higher BMI, WC and were less physically active than those without NAFLD. Dietary evaluation showed that PCOS women with NAFLD had no significant difference in macro and micronutrients or food group intake and diet quality in comparison to those without NAFLD.

Coexistence of high content of critical nutrients and claims in food products targeted at Brazilian children / Coexistência de altos teores de nutrientes críticos e alegações em produtos alimentícios voltados para crianças brasileiras

ABSTRACT Objective: This study aimed to evaluate food labels targeted at children and identify the concomitant presence of claims and high levels of critical nutrients and/or the presence of sweeteners. As a secondary objective, it aimed to list different types of claims and check which marketing strategies are most used. Methods: We collected 409 products, from 8 popular food groups targeted at children, in Brazilian market (i.e., fruit drinks, dairy drinks, sandwich cookies, cakes, breakfast cereals, jellies, corn snacks, and yogurts). The contents of critical nutrients (e.g., sugar, total fat, saturated fat, and trans-fat, and sodium) and presence/absence of sweetener were calculated, considering Pan American Health Organization (PAHO) parameters. Then, we verified the presence and types of claims in these products. Results: Overall, 265 (64.7%) labels presented claims. In three of the eight categories (i.e., breakfast cereals, dairy drinks, and yogurt), all products with claims (50, 34, and 34 products, respectively) had one or more nutrients in harmful concentrations (critical nutrients above PAHO's nutritional profile and/or presence of sweeteners). In the other categories, only one product (of 63 sandwich cookies and 26 breakfast cereals with claims) and three products (of 22 cakes and 28 jellies with claims) had no nutrient in critical concentration. The presence of claims, like "rich/source" of micronutrient, was predominant in seven of the eight food groups. Conclusion: In the present study, there was a high presence of claims, of different types, in foods targeted at children, which, for the most part, also have excess of at least one critical nutrient, according to PAHO.

RESUMO Objetivo: Avaliar rótulos de alimentos direcionados ao público infantil e identificar a presença concomitante de alegações e de altos teores de nutrientes críticos e/ou presença de adoçantes. Como objetivo secundário, listar os diferentes tipos de alegações e verificar quais estratégias de marketing são mais utilizadas. Métodos: Foram coletados 409 produtos provenientes das oito categorias de alimentos mais populares entre crianças brasileiras (bebidas à base de frutas, bebidas lácteas, biscoitos recheados, bolos, cereais matinais, gelatinas, salgadinhos de milho e iogurtes). Foram calculados os teores de nutrientes críticos (açúcares, gorduras totais, saturadas e trans e sódio) e presença/ausência de adoçante, considerando-se os parâmetros da Organização Pan-Americana de Saúde (OPAS). Em seguida, verificamos a presença e os tipos de alegações nesses produtos. Resultados: No total, 265 (64,7%) rótulos apresentaram alegações. Em três das oito categorias (cereais matinais, bebidas lácteas e iogurtes), todos os produtos com alegações (50, 34 e 34 produtos, respectivamente) continham um ou mais nutrientes em concentrações prejudiciais (nutrientes críticos acima do preconizado pela OPAS e/ou presença de edulcorantes). Nas demais categorias, apenas um produto (de 63 biscoitos recheados e 26 cereais matinais com alegação) e três (de 22 bolos e 28 gelatinas com alegação) não apresentavam nutrientes em concentração crítica. A presença de alegações, como "rico" ou "fonte" de micronutriente, foi predominante em sete dos oito grupos de alimentos. Conclusões: Observou-se alta presença de alegações, de diferentes tipos, em alimentos destinados a crianças, que, em sua maioria, também possuem excesso de pelo menos um nutriente crítico, de acordo com a OPAS.

Daily Habits of Brazilians at Different Moments of the COVID-19 Pandemic.

BACKGROUND: The COVID 19 pandemic impacted the health and well-being of different populations around the world. The aim of this study is to investigate the changes in the daily habits of Brazilians before and during two moments of the COVID-19 pandemic. METHODS: A longitudinal study in which an online questionnaire (sleeping time, alcohol consumption, smoking, use of screen devices, physical activity, and dietary patterns) was applied at three moments. RESULTS: The frequency of alcohol consumption, smoking, and sleep hours did not change significantly at different times. For the number of alcoholic beverages, there was a reduction in consumption from T0 to T1 and an increase from T1 to T2. There was a significant increase in hours of screen device use from T0 to T1, remaining high at T2. Finally, the level of physical activity in minutes reduced from T0 to T1, returning to base levels at T2. As for eating habits, there was an increase in the frequency of consumption of instant meals, fast food, and sweets at the first moment, with a significant reduction at the second moment. The consumption of legumes, milk and dairy products, bakery products, and meats was higher at T2. CONCLUSIONS: Some habits returned to or approached T0 levels. However, other habits remained unchanged, such as screen time and frequency of consumption of some food groups, throughout the last evaluation.

Coexistence of high content of critical nutrients and claims in food products targeted at Brazilian children.

OBJECTIVE: This study aimed to evaluate food labels targeted at children and identify the concomitant presence of claims and high levels of critical nutrients and/or the presence of sweeteners. As a secondary objective, it aimed to list different types of claims and check which marketing strategies are most used. METHODS: We collected 409 products, from 8 popular food groups targeted at children, in Brazilian market (i.e., fruit drinks, dairy drinks, sandwich cookies, cakes, breakfast cereals, jellies, corn snacks, and yogurts). The contents of critical nutrients (e.g., sugar, total fat, saturated fat, and trans-fat, and sodium) and presence/absence of sweetener were calculated, considering Pan American Health Organization (PAHO) parameters. Then, we verified the presence and types of claims in these products. RESULTS: Overall, 265 (64.7%) labels presented claims. In three of the eight categories (i.e., breakfast cereals, dairy drinks, and yogurt), all products with claims (50, 34, and 34 products, respectively) had one or more nutrients in harmful concentrations (critical nutrients above PAHO's nutritional profile and/or presence of sweeteners). In the other categories, only one product (of 63 sandwich cookies and 26 breakfast cereals with claims) and three products (of 22 cakes and 28 jellies with claims) had no nutrient in critical concentration. The presence of claims, like "rich/source" of micronutrient, was predominant in seven of the eight food groups. CONCLUSION: In the present study, there was a high presence of claims, of different types, in foods targeted at children, which, for the most part, also have excess of at least one critical nutrient, according to PAHO.

Can Anthocyanins Reduce Delayed Onset Muscle Soreness or Are We Barking Up the Wrong Tree?

Exercise-induced muscular overload can trigger delayed onset muscle soreness (DOMS). DOMS is related to the indiscriminate use of analgesics and nonsteroidal anti-inflammatory drugs without proper guidance, decreased physical exercise adherence and degenerating sports performance, increased risk of injury, and reduced muscle strength and function. Dietary anthocyanins have been extensively studied as potential natural treatments for DOMS, but the indication, dosage, and form of use remain highly variable. Therefore, this review aims to synergize and present evidence relating to the effect of anthocyanins on DOMS in clinical studies. Notably, the results of anthocyanin supplementation for DOMS were found to be inconclusive. The use of protocols with lower anthocyanin doses yielded better results than those with high-dose supplements, suggesting that anthocyanin-rich foods are more accessible as therapeutic tools, leading to the conclusion that these foods could be used to prevent and treat DOMS. However, consumption protocols for this purpose are not yet well established, and the answer is dependent on the methodological quality of future studies.

Corrigendum: Comparison of two front-of-pack nutrition labels for Brazilian consumers using a smartphone app in a real-world grocery store: A pilot randomized controlled study.

[This corrects the article DOI: 10.3389/fnut.2022.898021.].

Influence of nutrition claims on different models of front-of-package nutritional labeling in supposedly healthy foods: Impact on the understanding of nutritional information, healthfulness perception, and purchase intention of Brazilian consumers.

Nutrition claims are positive information about foods, which are widely used as a marketing strategy on labels. On the contrary, front-of-package nutritional labeling (FoPNL) aims to make it easier for consumers to understand the nutritional composition of foods and favor healthy food choices. However, the concomitant presence of nutrition claims and FoPNL may hinder the understanding, judgment, and choices of consumers at the moment of purchase. Therefore, the objective of this study was to evaluate the influence of nutrition claims on the efficacy of FoPNL models in the understanding of nutritional information, healthfulness perception, and purchase intention of Brazilian consumers. It was an experimental cross-sectional study carried out using an online questionnaire, with a total of 720 participants randomly divided into four FoPNL conditions: control, octagon, triangle, and magnifying glass. Each participant looked at 12 food packages, which were produced following the factorial design: (i) food category (cereal bar, whole grain cookies, and snacks); (ii) product type (containing one critical nutrient × containing two critical nutrients); and (iii) nutrition claims (present × absent). The comprehension of nutritional information was evaluated through the identification of excessive nutrients, and the healthfulness perception and purchase intention were evaluated using a seven-point scale. The results indicated that the presence of FoPNL increased the understanding of the information and reduced healthfulness perception and purchase intention. The presence of nutrition claims influenced the three outcomes, decreasing the probability of understanding information about food composition by 32% (OR 0.68, 95% confidence interval 0.58-0.78, p < 0.01) and significantly increasing (p < 0.05) average health scores (1.95-2.02) and purchase intention (2.00-2.05). Nonetheless, the interaction "FoPNL × claims" was not significant, which indicated that claims act independently. All FoPNL models were more effective than the control. For the least healthful type of product (two nutrients in excess), the octagon and triangle models were superior to the magnifying glass, regarding the outcome of healthfulness perception. The results prove the efficacy of FoPNL in consumer understanding and judgment. Despite the positive effects of FoPNL, it did not cancel the positivity bias generated by the claims.

From the most to the least flexible nutritional profile: Classification of foods marketed in Brazil according to the Brazilian and Mexican models.

Nutrient profiling is the science of classifying or ranking foods according to their nutritional composition, for reasons related to disease prevention and health promotion. To be effective, policies such as front-of-pack nutrition labeling (FoPNL) must have an adequate nutritional profile model, since it will determine which products will be eligible to receive a FoPNL. This study aimed to determine the percentage of packaged food and drink products available in Brazil that would be subject to FoPNL under two different legislations: Brazilian and Mexican. This is a cross-sectional study in which we collected information on food products (photos of the ingredients list, the front label, the barcode, and the nutrition facts table) from one of the largest stores of a supermarket chain in the city of Belo Horizonte-MG, Brazil, from March to May 2021 (~6 months after the publication of the Brazilian legislation about FoPNL and a year and a half before the legislation came into force). The products were classified in relation to the BNPM (added sugars, saturated fats, and sodium) and the MNPM (energy, free sugars, saturated fats, trans fats, sodium, non-sugar sweeteners, and caffeine). A total of 3384 products were collected and, after applying the exclusion criteria, 3,335 products were evaluated. Of these, 2,901 would be eligible to receive FoPNL in Brazil and 2,914 would be eligible to receive FoPNL in Mexico. According to the BNPM, 56.7% (95% CI 54.9; 58.5%) of the products were "high in" critical nutrients, 27.1% (95% CI 25.5; 28.7%) of the products in added sugars, 26.7% (95% CI 25.2; 28.4%) of the products in saturated fats, and 21.4% (95% CI 19.9; 22.9%) of the products in sodium. As for the MNPM, 96.8% (95% CI 96.1; 97.4%) of them were "high in" up to five critical nutrients and up to two warning rectangles (caffeine and non-sugar sweeteners), 45.8% (95% CI 44.0; 47.6%) of them in free sugars, 43.7% (95% CI 41.9; 45.5%) of them in saturated fats, and 47.9% (95% CI 46.1; 49.7%) of them in sodium. We concluded that the eligibility to receive FoPNL by BNPM and MNPM was relatively similar between products; however, almost all products would have at least one FoPNL and/or warning rectangles according to Mexican legislation, and nearly half of them would have at least one FoPNL, considering BNPM. The MNPM is much more restrictive than the BNPM. The Nutrient Profile Model (NPM) that regulates FoPNL, and other health policies, must be carefully defined to ensure that foods are properly classified according to their healthiness.

Comparison of two front-of-pack nutrition labels for Brazilian consumers using a smartphone app in a real-world grocery store: A pilot randomized controlled study.

One of the suggestions for improving the understanding of food labels is implementing front-of-pack nutrition labeling (FoPNL), where nutritional information is objectively made available to consumers. Scientific data on the best FoPNL model to be adopted for the Brazilian population is still emerging, especially in real-world purchase situations. This study aims to evaluate/compare the proposed Brazilian and Mexican FoPNL systems, on different outcome measures, using an application, in dairy foods available in a supermarket aisle. This pilot randomized controlled trial in a real-world purchase situation was conducted in June/July 2021. A total of 230 participants were randomly allocated to one of the three study arms (Mexican and Brazilian FoPNL systems or control-nutritional information table and ingredients list). Using a smartphone, the participants scanned a product barcode and received the allocated FoPNL (with information about excessive added sugars, sodium, and/or saturated fat content) or the control. After, they answered questions related to our primary outcome (decision to buy or not to buy a product) and secondary outcomes (perceived healthiness, facilitation of a quick purchase decision, and identification of excess nutrients). The Mexican FoPNL system performed better in the primary outcome (3.74 ± 1.34) and "facilitation of a quick purchase decision" (3.59 ± 1.31), compared to the control (3.28 ± 1.45;p = 0.043 and 3.11 ± 1.42; p = 0.029). The Mexican FoPNL system performed better in supporting consumers to identify dairy foods, among the selected sample in this study, high in added sugars than the control (82.2% and 63.5% of correct answers, respectively; p = 0.009). For saturated fats, the Brazilian FoPNL resulted in 93.1% of correct answers against 48.2% for the control and 58.9% for the Mexican system (p ≤ 0.001). The Mexican FoPNL system facilitated consumer decision-making on when to buy or not to buy a selected dairy product and in helping to quickly decide which dairy products to buy, among the selected sample in this study, compared to the control. Considering the right answers of critical nutrients in excess or not, both models of FoPNL, delivered by a smartphone app, performed well.

Cinnamon Infusion Reduces Satiety and Increases Energy Intake: A Randomized Crossover Trial.

BACKGROUND/AIMS: This study aimed to evaluate the effects of the intake of a single dose of cinnamon infusion on energy metabolism, appetite responses, and food intake in healthy individuals. METHODS: This was an open randomized crossover clinical trial, with a minimum washout of 7 days, in which two standardized breakfasts were served randomly: one with cinnamon infusion (2 g, Cinnamomum sp.) and one with water (control). The study included 21 healthy volunteers. Energy expenditure (EE), diet-induced thermogenesis (DIT), respiratory quotient (RQ), substrate oxidation, and appetite responses were evaluated, as well as prospective food intake. RESULTS: Ingestion of cinnamon infusion did not alter EE, DIT, RQ, or substrate oxidation. The incremental area under the curve for hunger, satiety, and desire to eat did not differ between the treatment with cinnamon infusion and water; however, there was a reduction in the feeling of satiety (p = 0.021) compared to the control treatment. The energy consumption of the first meal after treatment was higher (p = 0.05) in the treatment with cinnamon infusion than in the control treatment. Regarding macronutrients or food intake throughout the day, there was no difference between treatments. CONCLUSIONS: Although it did not affect energy metabolism, consuming a single dose of cinnamon infusion promoted less feeling of satiety and increased energy intake in the first meal after treatment. The study protocol was registered at the Brazilian Clinical Trials Registry Platform (RBR-5ftg3z).

Acute green tea infusion ingestion effect on energy metabolism, satiety sensation and food intake: A randomized crossover trial.

BACKGROUND: Green tea (Camellia sinensis L.) has an effect on energy metabolism, but little is known about its infusion intake impact on satiety responses. OBJECTIVE: This paper aimed at analyzing the effect of green tea on energy expenditure, satiety response, and food intake in humans. METHODS: The study involved 21 individuals (11 women, 10 men), and consisted of an open-label, crossover, randomized clinical trial (RBR-928HCW). Evaluation of subjects was performed as an acute study on two different days, after having a standardized breakfast accompanied by water or green tea. Indirect calorimetry was used to evaluate resting energy expenditure (REE), and a visual analogue scale to assess satiety. Food records were used to assess food intake along the day of the trial. RESULTS: Acute ingestion of green tea infusion with the standardized breakfast increased REE (p = 0.014) by 7.2 ± 11.7% at 240min compared to fasting (mean difference of REE between the time of 240min and fasting: +91 ± 157.6 kcal). No significant alterations were observed for substrate oxidation and respiratory quotient compared to the water treatment. A greater feeling of hunger was observed when volunteers ingested green tea (water -828.75 ± 494.2  cm min; green tea -549.8 ± 545.6  cm min; p = 0.026). No significant differences were observed regarding food intake energy and macronutrients between treatments. CONCLUSIONS: Green tea increased energy expenditure and the subjective response of hunger in healthy individuals. This study is registered in the ReBEC Platform of the Brazilian Clinical Trials Registry (RBR-928HCW).

Incidence and Associated Factors of Weight Gain During the Covid-19 Pandemic.

Introduction and Aims: The behavioral changes that arose from quarantine due to the COVID-19 pandemic may have impacted the weight of people. This study aims to investigate the incidence and predictors of weight gain during the quarantine period. Methods: An online survey was performed five months after the social distance measures implementation. Participants recorded their current and usual weight before lockdown. A multivariate logistic regression model was performed. Results: Data on 1334 participants were evaluated (33.6y, 79.8% females), and 58.8% have gained weight (3.0 kg; 0.1 to 30.0 kg). Predictors of weight gain were increased food intake (OR = 5.40); snacking (OR = 2.86); fast food (OR = 1.11); canned products (OR = 1.08); and in physical activity (OR = 0.99) concerning the period before the pandemic; also time spent at work, including household chores (OR = 1.58); evening snack (OR = 1.54); higher frequency of alcoholic beverage intake (OR = 1.59) and dose of alcoholic beverage (OR = 1.11); uncontrolled eating (OR = 1.01), and vegetable intake (OR = 0.92) during the quarantine and physical activity before pandemic period (OR = 0.99). Conclusion: Most participants have gained weight during the pandemic because of working changes, lifestyle, eating habits changes, and uncontrolled eating behavior. These results can be useful to encourage changes during future quarantine periods to prevent weight gain.

Bioelectrical impedance vector analysis in patients on the waiting list for liver transplant: Associated factors and prognostic effects.

OBJECTIVES: The aim of this study was to assess patients on the waiting list for liver transplant (LTx) according to bioelectrical impedance vector analysis (BIVA), as well as to verify the association between the placement of the vectors on the graph with clinical outcomes and identify the predictors to vector placement in quadrant 4 (Q4; indicating more hydration and less cellularity). METHODS: This was a retrospective observational study including 129 patients ≥20 y of age awaiting LTx. Patients' nutritional status was assessed by using different tools, including single-frequency bioelectrical impedance analysis and the Subjective Global Assessment (SGA). Clinical data were registered. The BIVA was evaluated by comparing the individual vectors plotted for all patients to the tolerance ellipses of 50%, 75%, and 95% of the reference healthy population. The quadrant of the vector for each patient was registered. RESULTS: The majority of the vectors were placed in Q1 (n = 54; 41.9%) and Q4 (n = 39; 30.2%). The presence of ascites or edema (hazard ratio [HR], 2.43; 95% confidence interval [CI], 1.15-5.12; P = 0.019) and the BIVA vector placed in Q4 in any ellipse (HR, 2.10; 95% CI, 1.07-4.09; P = 0.029) were independent predictors for mortality on the waiting list or ≤1 y after LTx. BIVA was not associated with longer hospital length of stay. The predictors of vector placement in Q4 were higher age, malnutrition according to SGA, and presence of ascites or edema. CONCLUSION: Patients on the waiting list for LTx with BIVA vectors placed in Q4, in the 50%, 75%, or 95% tolerance ellipses, presented a worse prognosis.

Different combinations of the GLIM criteria for patients awaiting a liver transplant: Poor performance for malnutrition diagnosis but a potentially useful prognostic tool.

BACKGROUND & AIMS: Studies using the Global Leadership Initiative on Malnutrition (GLIM) criteria for patients with liver cirrhosis are limited. This study aimed to assess the impact of malnutrition according to the GLIM criteria on the outcomes of patients awaiting a liver transplant (LTx) and compare these criteria with Subjective Global Assessment (SGA). METHODS: This retrospective observational study included adult patients awaiting LTx. Patient clinical data, nutritional status according to various tools including SGA, and resting energy expenditure were assessed. The distinct phenotypic and etiologic criteria provided 36 different GLIM combinations. The GLIM criteria and SGA were compared using the kappa coefficient. The variables associated with mortality before and after the LTx and with a longer length of stay (LOS) after LTx (≥18 days) were assessed by Cox regression and logistic regression analyses, respectively. RESULTS: A total of 152 patients were included [median age 52.0 (interquartile range: 46.5-59.5) years; 66.4% men; 63.2% malnourished according to SGA]. The prevalence of malnutrition according to the GLIM criteria ranged from 0.7% to 30.9%. The majority of the GLIM combinations exhibited poor agreement with SGA. Independent predictors of mortality before and after LTx were presence of ascites or edema (p = 0.011; HR:2.58; CI95%:1.24-5.36), GLIM 32 (PA-phase angle + MELD) (p = 0.026; HR:2.08; CI95%:1.09-3.97), GLIM 33 (PA + MELD-Na≥12) (p = 0.018; HR:2.17; CI95%:1.14-4.13), and GLIM 34 (PA + Child-Pugh) (p = 0.043; HR:1.96; CI95%:1.02-3.77). Malnutrition according to GLIM 28 (handgrip strength + Child-Pugh) was independently associated with a longer LOS (p = 0.029; OR:7.21; CI95%:1.22-42.50). CONCLUSION: The majority of GLIM combinations had poor agreement with SGA, and 4 of the 36 GLIM combinations were independently associated with adverse outcomes.