Performance of subjective global nutritional assessment in predicting clinical outcomes: Data from the Brazilian survey of pediatric oncology nutrition.

BACKGROUND: Methods for assessing nutritional status in children and adolescents with cancer is a difficult in clinical practice. The study aimed to evaluate the performance of Subjective Global Nutritional Assessment (SGNA) in predicting clinical outcomes in children and adolescents with cancer in Brazil. METHODS: This was a prospective cohort multicenter study. It was included 723 children and adolescents with cancer aged 2-18 years between March 2018 and August 2019. Nutritional assessment was performed according to World Health Organization recommendations and using SGNA within 48h of hospitalization. Unplanned readmission, length of hospital stay, and post-discharge death were analyzed. Cohen's kappa coefficient was used to ascertain the agreement between body mass index for age (BMI/A) and SGNA. The sensitivity, specificity, positive and negative predictive values, and accuracy of SGNA were estimated. Odds ratios (ORs) with 95% confidence intervals (CIs) were evaluated using multiple logistic regression. RESULTS: The mean patient age was 9.4 ± 4.9 years. SGNA showed that 29.7% (n = 215) and 6.5% (n = 47) patients had moderate and severe malnutrition, respectively. Considering the concurrent validity criterion, SGNA had an OR (95% CI) of 6.8 (3.1-14.9) for predicting low and very low weight for age at admission, with a sensitivity and specificity of 72.4% (59%-82.1%) and 72% (64.2%-78.9%), respectively. SGNA could predict death in children with severe/moderate malnutrition, with an accuracy of 63.8% (63%-65.1%). Logistic multivariate analysis showed that the adjusted effect of death; hematological tumor; living in the northeast, southeast, and midwest regions of Brazil; and older age was associated with malnutrition according to SGNA. CONCLUSION: Based on concurrent validity between SGNA and anthropometry, SGNA performed well and had a good ability to predict death in Brazilian children with cancer.

Impacto da estocagem sobre atividade antioxidante e teor de ácido ascórbico em sucos e refrescos de tangerina / Storage impact on the antioxidant activity and ascorbic acid level of mandarin juices and drinks

OBJETIVO: Objetivou-se avaliar a estabilidade do ácido ascórbico em suco in natura de tangerina cultivar Ponkan sob diferentes condições de armazenamento, e em 13 amostras de bebidas industrializadas de tangerina, bem como a estabilidade da atividade antioxidante no suco in natura. MÉTODOS: O suco in natura de tangerina foi armazenado em três temperaturas: ambiente, refrigeração e congelamento. Amostras de tangerinas foram armazenadas sob refrigeração. Treze marcas de bebidas industrializadas de tangerina foram adquiridas e mantidas sob refrigeração. Foram determinados o teor de ácido ascórbico pelo método titulométrico de Tillmans (Association of Official Analytical Chemists) e a atividade antioxidante por meio da capacidade sequestradora do radical 2,2-difenil-1-picril-hidrazila. RESULTADOS: O suco in natura apresentou teor médio de ácido ascórbico de 32,40mg/100mL; a taxa de redução deste nutriente foi maior em temperatura de estocagem mais elevada. A atividade antioxidante média foi de 89,74% de inibição do radical 2,2-difenil-1-picril-hidrazila, apresentando variações de até 4,26% durante o armazenamento. Nas bebidas industrializadas, o teor médio de ácido ascórbico variou entre 1,01 e 10,72mg/100mL, com perdas de até 82,76%. Com base na legislação brasileira, seis marcas de bebidas industrializadas apresentaram não conformidades em relação à declaração do teor de ácido ascórbico nos rótulos. CONCLUSÃO: O suco de tangerina cultivar Ponkan apresenta elevada atividade antioxidante, inclusive durante o armazenamento. Observou-se superioridade nutricional do suco fresco em comparação às bebidas industrializadas, considerando o teor de ácido ascórbico e sua estabilidade. Adicionalmente, os dados obtidos apontam para a necessidade de maior fiscalização em relação à rotulagem nutricional.

OBJECTIVE: The objective of this study was to analyze the ascorbic acid stability of mandarin juice from the cultivar Ponkan under different storage conditions, and of 13 samples of processed mandarin beverages, as well as the antioxidant activity stability of fresh juice. METHODS: Fresh mandarin juice was stored under three temperatures: room temperature, refrigeration and freezing. Mandarin samples were kept under refrigeration. Thirteen brands of processed mandarin beverages were purchased and kept under refrigeration. Ascorbic acid level was determined by the Tillman's titrimetric method (Association of Official Analytical Chemists) and antioxidant activity by the radical scavenger capacity using the 2,2-diphenyl-1-picrylhydrazyl radical. RESULTS: The mean ascorbic acid level in fresh juice was 32.40mg/100mL and the reduction rate of this nutrient was higher when the samples were stored under higher temperatures. The average antioxidant activity was 89.74% of 2,2-diphenyl-1-picrylhydrazyl radical inhibition, with variations of up to 4.26% during storage. Among the processed beverages, the mean ascorbic acid content varied from 1.01 to 10.72mg/100mL, with losses of up to 82.76%. Six brands of processed beverages were considered noncompliant with the Brazilian legislation regarding the ascorbic acid content reported in the labels. CONCLUSION: Mandarin juice from the Ponkan cultivar has high antioxidant activity, even during storage. The fresh juice was nutritionally better than the processed beverages, considering ascorbic acid content and stability. Additionally, the results indicated the need of greater surveillance of nutritional labeling.