Carbohydrate restriction during lactation: A systematic review.

The quality of a mother's diet is important to ensure child growth and development and keep women healthy. This systematic review aimed to identify the outcomes of a carbohydrate-restricted diet during lactation. PubMed, EMBASE, Scopus, Web of Science, and LILACS were searched for studies published between 2012 and 2023; 16 studies were selected, all of them case reports or care series. The carbohydrate restriction described in the papers mainly was ketogenic, low-carb, low-carbohydrate and high-fat, and modified ketogenic diets. The main goal of women undertaking these diets was weight loss, with therapeutic purposes (monitored and supervised by health professionals) in only 2 cases: (1) ketogenic diet therapy for treatment of seizures in the infant and (2) to reduce symptoms of mother's gastroesophageal reflux. Most articles reported that lactating women were hospitalized, experiencing symptoms such as vomiting, muscle weakness, nausea, abdominal pain, general malaise, and fatigue. However, articles did not mention poor outcomes for the infants. Most of the studies in this review were published in the past 3 years, indicating a possible increase in cases of women practicing carbohydrate restriction during lactation for weight loss caused by body dissatisfaction. In conclusion, carbohydrate restriction during lactation may be harmful to the lactating woman and contribute to the state of lactational ketoacidosis, but infant outcomes are mainly a change in feeding patterns. Thus, education on food and nutrition is necessary for this population.

Nutritional counseling in childhood and adolescence: a systematic review.

Healthy eating habits are the basis for good health status, especially for children and adolescents, when growth and development are still ongoing. Nutrition educational programs are essential to prevent and treat chronic diseases. Nutritional counseling (NC), as a collaborative process between the counselor and the client process, could help to achieve better outcomes. This review aims to collect information about the utilization of NC during childhood and adolescence and to highlight its possible impact on adherence/compliance rates, nutrition knowledge, status and dietary intake. The methods applied in this systematic review followed the instruction of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search in PubMed/Medline, Scopus, Web of Science, LILACS, and Science Direct included observational or randomized studies. RoB 2.0 and Robins-I tools was used for the risk of bias assessment in randomized and non-randomized studies, respectively. The quality of evidence was checked by the Mixed Methods Appraisal Tool system. A total of 21 articles were selected, computing 4,345 individuals. 11 achieved at least 4 stars quality level. The highest risk of bias for randomized studies was related to the randomization process. 42.9% of non-randomized studies had some concerns of bias, mainly because of a lack of control of all confounding factors. Different strategies of NC were used in children and adolescents with positive results for health or diseases. NC strategies can be effectively used in children and adolescents. In general, NC showed benefits in pediatrics age for anthropometric or body composition parameters, dietary intake, nutrition knowledge and physical activity improvement. Performing NC in pediatrics is challenging due to the counseling strategies that must be adapted in their contents to the cognitive ability of each age. More structured research must be done focused on this population. Investments in healthy eating behaviors in pediatrics can lead to better health outcomes in the future population with substantial benefits to society. Systematic review registration: [https://www.crd.york.ac.uk/prospero/#recordDetails], identifier [CRD42022374177].

Nutritional counseling in athletes: a systematic review.

Many studies report poor adherence to sports nutrition guidelines, but there is a lack of research on the effectiveness of nutrition education and behavior change interventions in athletes. Some studies among athletes demonstrate that nutrition education (NE), often wrongly confused with nutritional counseling (NC), alone is insufficient to result in behavior change. For this reason, a clear distinction between NC and NE is of paramount importance, both in terms of definition and application. NE is considered a formal process to improve a client's knowledge about food and physical activity. NC is a supportive process delivered by a qualified professional who guides the client(s) to set priorities, establish goals, and create individualized action plans to facilitate behavior change. NC and NE can be delivered both to individuals and groups. To our knowledge, the efficacy of NC provided to athletes has not been comprehensively reviewed. The aim of this study was to investigate the current evidence on the use and efficacy of nutritional counseling within athletes. A systematic literature review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. The search was carried out in: PubMed, Scopus, Web of Science, Science Direct, Cochrane Library between November 2022 and February 2023. Inclusion criteria: recreational and elite athletes; all ages; all genders; NC strategies. The risk of bias was assessed using the RoB 2.0 Cochrane tool. The quality of evidence checking was tested with the Mixed Methods Appraisal Tool system. From 2,438 records identified, 10 studies were included in this review, with athletes representing different levels of competition and type of sports. The most commonly applied behavior change theory was Cognitive Behavioral Theory. NC was delivered mainly by nutrition experts. The duration of the intervention ranged from 3 weeks to 5 years. Regarding the quality of the studies, the majority of articles reached more than 3 stars and lack of adequate randomization was the domain contributing to high risk of bias. NC interventions induced positive changes in nutrition knowledge and dietary intake consequently supporting individual performance. There is evidence of a positive behavioral impact when applying NC to athletes, with positive effects of NC also in athletes with eating disorders. Additional studies of sufficient rigor (i.e., randomized controlled trials) are needed to demonstrate the benefits of NC in athletes. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022374502.

Ketosis and migraine: a systematic review of the literature and meta-analysis.

Introduction: Headaches are a prevalent disorder worldwide, and there is compelling evidence that certain dietary interventions could provide relief from attacks. One promising approach is ketogenic therapy, which replaces the brain's glucose fuel source with ketone bodies, potentially reducing the frequency or severity of headaches. Aim: This study aims to conduct a systematic review of the scientific literature on the impact of ketosis on migraine, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. Results: After a careful selection process and bias evaluation, 10 articles were included in the review, primarily from Italy. The bias assessment indicated that 50% of the selected articles had a low risk of bias in all domains, with the randomization process being the most problematic domain. Unfortunately, the evaluation of ketosis was inconsistent between articles, with some assessing ketonuria, some assessing ketonemia, and some not assessing ketosis levels at all. Therefore, no association could be made between the level of ketosis and the prevention or reduction of migraine attacks. The ketogenic therapies tested in migraine treatments included the very low-calorie ketogenic diet (VLCKD, n = 4), modified Atkins diet (MAD, n = 3), classic ketogenic diet (cKDT, n = 2), and the administration of an exogenous source of beta-hydroxybutyrate (BHB). The meta-analysis, despite reporting high heterogeneity, found that all interventions had an overall significant effect (Z = 9.07, p < 0.00001; subgroup differences, Chi2 = 9.19, dif = 3, p = 0.03; I2, 67.4%), regardless of the type of endogenous or exogenous induction of ketosis. Conclusion: The initial findings of this study suggest that metabolic ketogenic therapy may provide some benefit in treating migraines and encourage further studies, especially randomized clinical trials with appropriate and standardized methodologies. The review strongly recommends the use of the adequate measurement of ketone levels during ketogenic therapy to monitor adherence to the treatment and improve knowledge of the relationship between ketone bodies and efficacy. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022330626.

Ketogenic therapy in childhood and adolescence: recommendations of the Brazilian experts group.

Ketogenic dietary therapies (KDTs) are a safe and effective treatment for pharmacoresistant epilepsy in children. There are four principal types of KDTs: the classic KD, the modified Atkins diet (MAD), the medium-chain triglyceride (MCT) diet, and the low glycemic index diet (LGID). The International Ketogenic Diet Study Group recommends managing KDTs in children with epilepsy. However, there are no guidelines that address the specific needs of the Brazilian population. Thus, the Brazilian Child Neurology Association elaborated on these recommendations with the goal of stimulating and expanding the use of the KD in Brazil.

As terapias dietéticas cetogênicas (TDC) são um tratamento seguro e eficaz para epilepsia farmacorresistente em crianças. Existem quatro tipos principais de TDCs: a dieta cetogênica (DC) clássica, a dieta de Atkins modificada (DAM), a dieta de triglicerídeos de cadeia média (DTCM) e a dieta de baixo índice glicêmico (DBIG). O Grupo Internacional de Estudos de Dietas Cetogênicas (International Ketogenic Diet Study Group) propõe recomendações para o manejo da DC em crianças com epilepsia. No entanto, faltam diretrizes que contemplem as necessidades específicas da população brasileira. Assim, a Associação Brasileira de Neurologia Infantil elaborou essas recomendações com o objetivo de estimular e expandir o uso da DC no Brasil.

Ketogenic therapy in childhood and adolescence: recommendations of the Brazilian experts group / Terapia cetogênica na infância e adolescência: recomendações do grupo de especialistas brasileiros

Abstract Ketogenic dietary therapies (KDTs) are a safe and effective treatment for pharmacoresistant epilepsy in children. There are four principal types of KDTs: the classic KD, the modified Atkins diet (MAD), the medium-chain triglyceride (MCT) diet, and the low glycemic index diet (LGID). The International Ketogenic Diet Study Group recommends managing KDTs in children with epilepsy. However, there are no guidelines that address the specific needs of the Brazilian population. Thus, the Brazilian Child Neurology Association elaborated on these recommendations with the goal of stimulating and expanding the use of the KD in Brazil.

Resumo As terapias dietéticas cetogênicas (TDC) são um tratamento seguro e eficaz para epilepsia farmacorresistente em crianças. Existem quatro tipos principais de TDCs: a dieta cetogênica (DC) clássica, a dieta de Atkins modificada (DAM), a dieta de triglicerídeos de cadeia média (DTCM) e a dieta de baixo índice glicêmico (DBIG). O Grupo Internacional de Estudos de Dietas Cetogênicas (International Ketogenic Diet Study Group) propõe recomendações para o manejo da DC em crianças com epilepsia. No entanto, faltam diretrizes que contemplem as necessidades específicas da população brasileira. Assim, a Associação Brasileira de Neurologia Infantil elaborou essas recomendações com o objetivo de estimular e expandir o uso da DC no Brasil.

A Review of Ketogenic Dietary Therapies for Epilepsy and Neurological Diseases: A Proposal to Implement an Adapted Model to Include Healthy Mediterranean Products.

Based on the growing evidence of the therapeutic role of high-fat ketogenic dietary therapies (KDTs) for neurological diseases and on the protective effect of the Mediterranean diet (MD), it could be important to delineate a Mediterranean version of KDTs in order to maintain a high ketogenic ratio, and thus avoid side effects, especially in patients requiring long-term treatment. This narrative review aims to explore the existing literature on this topic and to elaborate recommendations for a Mediterranean version of the KDTs. It presents practical suggestions based on MD principles, which consist of key elements for the selection of foods (both from quantitative and qualitative prospective), and indications of the relative proportions and consumption frequency of the main food groups that constitute the Mediterranean version of the KDTs. We suggest the adoption of a Mediterranean version of ketogenic diets in order to benefit from the multiple protective effects of the MD. This translates to: (i) a preferential use of olive oil and vegetable fat sources in general; (ii) the limitation of foods rich in saturated fatty acids; (iii) the encouragement of high biological value protein sources; (iv) inserting fruit and vegetables at every meal possible, varying their choices according to seasonality.

Quality of anthropometric data measured in children and adolescents with cystic fibrosis: a scoping review.

OBJECTIVE: This study aimed to identify methodological aspects involved in determining anthropometric measurements among studies assessing the nutritional status of individuals with cystic fibrosis (CF). METHODS: A search of the literature was performed on MEDLINE via Pubmed, Embase, and Web of Science databases. The population comprised children and adolescents with CF. Observational studies and clinical trials using anthropometric and body composition measures and indices determined by dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance assessment (BIA) were included. Use of a standardized procedure for data collection was defined when details on the instruments and their calibration were given, the measuring procedures were described, and when it was clear measures had been determined by a trained team, or the use of an anthropometric reference manual was cited. Data extracted were expressed as absolute and relative frequencies. RESULTS: A total of 32 articles were included, and a total of 233 measures or indices were observed. The most frequently used measures were body mass index (kg/m2; 35%), weight (kg; 33%), and height (cm; 33%). Among the 28 studies that used anthropometric measures, 21 (75%) provided a complete or partial description of the measurement instruments used, 3 (11%) reported information on equipment calibration, 10 (36%) indicated the measurement procedures employed by assessors, and 2 (7%) stated a trained team had carried out the measurements. CONCLUSIONS: The poor description of measuring procedures precluded a meaningful evaluation of data quality. Scientific debate on this theme can help raise awareness of the need to ensure quality in collecting and fully presenting data.

Quality of anthropometric data measured in children and adolescents with cystic fibrosis: a scoping review / Qualidade dos dados antropométricos aferidos em crianças e adolescentes com fibrose cística: uma revisão de escopo

Abstract Objective: This study aimed to identify methodological aspects involved in determining anthropometric measurements among studies assessing the nutritional status of individuals with cystic fibrosis (CF). Methods: A search of the literature was performed on MEDLINE via Pubmed, Embase, and Web of Science databases. The population comprised children and adolescents with CF. Observational studies and clinical trials using anthropometric and body composition measures and indices determined by dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance assessment (BIA) were included. Use of a standardized procedure for data collection was defined when details on the instruments and their calibration were given, the measuring procedures were described, and when it was clear measures had been determined by a trained team, or the use of an anthropometric reference manual was cited. Data extracted were expressed as absolute and relative frequencies. Results: A total of 32 articles were included, and a total of 233 measures or indices were observed. The most frequently used measures were body mass index (kg/m2; 35%), weight (kg; 33%), and height (cm; 33%). Among the 28 studies that used anthropometric measures, 21 (75%) provided a complete or partial description of the measurement instruments used, 3 (11%) reported information on equipment calibration, 10 (36%) indicated the measurement procedures employed by assessors, and 2 (7%) stated a trained team had carried out the measurements. Conclusions: The poor description of measuring procedures precluded a meaningful evaluation of data quality. Scientific debate on this theme can help raise awareness of the need to ensure quality in collecting and fully presenting data.

Resumo Objetivo: Identificar os aspectos metodológicos relacionados à aferição de medidas antropométricas em pesquisas que avaliaram o estado nutricional de indivíduos com fibrose cística (FC). Métodos: Realizou-se busca nas bases Medical Literature Analysis and Retrieval System Online (MEDLINE) via United States National Library of Medicine (PubMed), Embase e Web of Science. A população foi composta de crianças e adolescentes com FC. Foram incluídos estudos observacionais e ensaios clínicos que utilizaram medidas e índices antropométricos ou dados de composição corporal obtidos pela dual-energy X-ray absorptiometry (DXA) e bioimpedância elétrica (BIA). Considerou-se o uso de procedimento padronizado na coleta dos dados quando o estudo apresentou informações sobre os instrumentos, a calibração dos equipamentos, os detalhes dos procedimentos de mensuração e a realização de treinamento. Foram apresentadas as frequências absolutas e relativas dos dados extraídos. Resultados: Trinta e dois artigos foram selecionados, sendo observadas 233 medidas ou índices. Desse total, os mais utilizados foram índice de massa corporal (kg/m2; 35%), peso corporal (kg; 33%) e altura (cm; 33%). De 28 estudos que utilizaram medidas antropométricas, 21 (75%) apresentaram detalhes totais ou parciais dos instrumentos utilizados nas aferições, três (11%) apresentaram informações sobre a calibração dos equipamentos, dez (36%) apresentaram a indicação dos procedimentos de mensuração utilizados pelos avaliadores e dois (7%) mencionaram a realização de treinamento da equipe responsável pelas aferições. Conclusões: Há pouco detalhamento dos procedimentos de mensuração nas publicações, dificultando a avaliação da qualidade dos dados. O debate científico sobre o tema pode contribuir para conscientizar sobre a necessidade de assegurar a qualidade na coleta dos dados e sua apresentação completa nos artigos.

Validation of ketogenic diet adherence questionnaire: Keto-check.

BACKGROUND: The ketogenic diet is a therapeutic option to control drug-resistant epileptic seizures and has difficult compliance standards due to adverse effects, psychosocial factors, or dietary restriction. OBJECTIVE: To create and validate a ketogenic diet compliance questionnaire. METHODS: Methodological study, convergent care. The instrument was analyzed (construct validation) by five judges during two cycles of the Delphi technique. The judges assessed the relevance and clarity by using the Likert scale with three levels and made suggestions. The validation of the instrument was calculated using the agreement rate and content validity index (CVI). The application by two nutritionists made it possible to test reproducibility using the Kappa coefficient. When comparing the classification with a template developed by the health professionals who cared for the patients in question, the Pearson correlation and Fisher exact tests were used. For the reliability test, self-applied data were collected and evaluated using Cronbach Alpha coefficient. RESULTS: The questionnaire initially created with 11 multiple choice questions on a Likert scale was reduced to 10 questions with an agreement rate and the CVI classified as excellent after two rounds with judges. In the application of the tool, a kappa of 0.6087 was obtained, a Pearson that showed no significant difference between evaluators and a Cronbach α of 0.6483, with substantial consistency. CONCLUSIONS: This work resulted in the creation of an unprecedented and reliable questionnaire on adherence to the national ketogenic diet. Further studies should be performed to extrapolate the use of this questionnaire in different populations.

ANTECEDENTES: A dieta cetogênica é um tratamento para epilepsia refratária e tem difícil adesão devido aos efeitos adversos, fatores psicossociais ou à própria restrição alimentar. OBJETIVO: Criar e validar um questionário de adesão à dieta cetogênica. MéTODOS: Estudo metodológico, convergente assistencial. O instrumento foi analisado (validação de constructo) por cinco juízes durante dois ciclos da técnica Delphi. Os juízes avaliaram a pertinência e a clareza com respostas na escala Likert com três níveis, além de sugestões. A validação do instrumento foi calculada pela taxa de concordância e índice de validade de conteúdo (IVC). Posteriormente, houve aplicação por duas nutricionistas (reprodutibilidade), sendo analisada a concordância pelo coeficiente de Kappa. Ao comparar a classificação com um gabarito, elaborado pelos profissionais da saúde responsáveis pelos pacientes em questão, foram utilizados os coeficientes de correlação de Pearson e teste exato de Fisher. Para teste de fidedignidade, a coleta de dados auto-aplicados foi avaliada pelo coeficiente de Alpha de Cronbach. RESULTADOS: O questionário inicialmente criado com 11 questões de múltipla escolha em escala Likert foi reduzido para 10 questões com taxa de concordância e IVC excelentes após 2 rodadas com juízes. Na aplicação da ferramenta obteve-se coeficiente de Kappa de 0,6087, o coeficiente de Pearson não demostrou diferença significativa entre avaliadores, e o coeficiente α de Cronbach de 0,6483, com consistência substancial. CONCLUSõES: Este trabalho resultou na criação do inédito questionário nacional de adesão à dieta cetogênica, válido e fidedigno. Outros estudos devem ser realizados para extrapolar a utilização deste questionário em diferentes populações.

Validation of ketogenic diet adherence questionnaire: Keto-check / Validação de questionário de adesão à dieta cetogênica: Keto-check

Abstract Background The ketogenic diet is a therapeutic option to control drug-resistant epileptic seizures and has difficult compliance standards due to adverse effects, psychosocial factors, or dietary restriction. Objective To create and validate a ketogenic diet compliance questionnaire. Methods Methodological study, convergent care. The instrument was analyzed (construct validation) by five judges during two cycles of the Delphi technique. The judges assessed the relevance and clarity by using the Likert scale with three levels and made suggestions. The validation of the instrument was calculated using the agreement rate and content validity index (CVI). The application by two nutritionists made it possible to test reproducibility using the Kappa coefficient. When comparing the classification with a template developed by the health professionals who cared for the patients in question, the Pearson correlation and Fisher exact tests were used. For the reliability test, self-applied data were collected and evaluated using Cronbach Alpha coefficient. Results The questionnaire initially created with 11 multiple choice questions on a Likert scale was reduced to 10 questions with an agreement rate and the CVI classified as excellent after two rounds with judges. In the application of the tool, a kappa of 0.6087 was obtained, a Pearson that showed no significant difference between evaluators and a Cronbach α of 0.6483, with substantial consistency. Conclusions This work resulted in the creation of an unprecedented and reliable questionnaire on adherence to the national ketogenic diet. Further studies should be performed to extrapolate the use of this questionnaire in different populations.

Resumo Antecedentes A dieta cetogênica é um tratamento para epilepsia refratária e tem difícil adesão devido aos efeitos adversos, fatores psicossociais ou à própria restrição alimentar. Objetivo Criar e validar um questionário de adesão à dieta cetogênica. Métodos Estudo metodológico, convergente assistencial. O instrumento foi analisado (validação de constructo) por cinco juízes durante dois ciclos da técnica Delphi. Os juízes avaliaram a pertinência e a clareza com respostas na escala Likert com três níveis, além de sugestões. A validação do instrumento foi calculada pela taxa de concordância e índice de validade de conteúdo (IVC). Posteriormente, houve aplicação por duas nutricionistas (reprodutibilidade), sendo analisada a concordância pelo coeficiente de Kappa. Ao comparar a classificação com um gabarito, elaborado pelos profissionais da saúde responsáveis pelos pacientes em questão, foram utilizados os coeficientes de correlação de Pearson e teste exato de Fisher. Para teste de fidedignidade, a coleta de dados auto-aplicados foi avaliada pelo coeficiente de Alpha de Cronbach. Resultados O questionário inicialmente criado com 11 questões de múltipla escolha em escala Likert foi reduzido para 10 questões com taxa de concordância e IVC excelentes após 2 rodadas com juízes. Na aplicação da ferramenta obteve-se coeficiente de Kappa de 0,6087, o coeficiente de Pearson não demostrou diferença significativa entre avaliadores, e o coeficiente α de Cronbach de 0,6483, com consistência substancial. Conclusões Este trabalho resultou na criação do inédito questionário nacional de adesão à dieta cetogênica, válido e fidedigno. Outros estudos devem ser realizados para extrapolar a utilização deste questionário em diferentes populações.

Brazilian Guidelines for Nutrition in Cystic Fibrosis.

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

Brazilian Guidelines for Nutrition in Cystic Fibrosis

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

Construction and validation of the neonatal nutritional risk screening tool / Construção e validação da ferramenta de avaliação de risco nutricional neonatal

ABSTRACT Objective: To develop and validate both the content and reliability of the Neonatal Nutritional Risk Screening Tool (FARNNeo). Methods: Methodological study, convergent care. The instrument was built prior to the literature review and was analyzed by eight judges, during three cycles of the Delphi technique. The judges assessed their relevance and clarity with responses on the Likert scale with three levels, in addition to suggestions. The validation of the instrument was calculated using the agreement rate and content validity index (CVI). After content validation, the instrument was applied by four assisting nutritionists to verify reliability, using Cronbach`s alpha coefficient and the agreement between the evaluators by the Kappa coefficient. Results: All items of the instrument`s content reached the minimum agreement rate (90%) and/or CVI (0.9), except for item three, which in the first cycle obtained CVI 0.77 and 40% of agreement and, in the second cycle, CVI 0.75 and 38% agreement. At the end of the third cycle, all items had CVI values above 0.9. In the instrument application, alpha of 0.96 and Kappa of 0.74 were obtained, which reflect adequate values of internal consistency and agreement between the evaluators. Conclusions: FARNNeo proved to be reliable, clear, relevant, and reproducible for tracking early nutritional risk, systematizing the care of Brazilian newborns admitted to an intensive care unit.

RESUMO Objetivo: Desenvolver e validar o conteúdo e a confiabilidade da Ferramenta de Avaliação do Risco Nutricional Neonatal (FARNNeo). Métodos: Estudo metodológico, convergente assistencial. O instrumento foi construído previamente à revisão da literatura e analisado por oito juízes, durante três ciclos da técnica Delphi. Os juízes avaliaram sua pertinência e clareza com respostas na escala Likert com três níveis, além de sugestões. A validação do instrumento foi calculada pela taxa de concordância e índice de validade de conteúdo (IVC). Após a validação do conteúdo, o instrumento foi aplicado por quatro nutricionistas assistenciais para verificar a fidedignidade, utilizando o coeficiente de alfa de Cronbach e a concordância entre os avaliadores pelo coeficiente Kappa. Resultados: Todos os itens do conteúdo do instrumento alcançaram o valor mínimo da taxa de concordância (90%) e/ou IVC (0,9), com exceção do item três, que no primeiro ciclo obteve IVC 0,77 e 40% de concordância e, no segundo ciclo, IVC 0,75 e 38% de concordância. No fim do terceiro ciclo, todos os itens obtiveram valores de IVC acima de 0,9. Na aplicação da ferramenta, obteve-se alfa de 0,96 e Kappa de 0,74, que refletem valores adequados de consistência interna e concordância entre os avaliadores. Conclusões: A FARNNeo mostrou-se confiável, clara, pertinente e reprodutível para rastreamento do risco nutricional precoce, sistematizando o atendimento de recém-nascidos brasileiros internados em centro de terapia intensiva.

Alterações alimentares e hábitos de vida de pacientes com fibrose cística na pandemia de COVID-19 / Dietary changes and life habits of patients with cystic fibrosis in the COVID-19 pandemic / Cambios en la dieta y hábitos de vida de pacientes con fibrosis quística en la pandemia COVID-19

Objetivo: verificar alterações no consumo alimentar e hábitos de vida em pacientes com fibrose cística brasileiros durante o período de isolamento social devido a pandemia de COVID-19. Método: pesquisa transversal com levantamento de dados por meio de questionário elaborado pela equipe de nutricionistas especialistas no tratamento de pacientes com fibrose cística, com questões referentes às manifestações respiratórias recentes de pacientes ou familiares, alterações nos hábitos de aquisição e compras de alimentos e alterações quanto ao consumo de grupos alimentares e suplementos. Os dados foram tabulados e foi realizada uma análise descritiva. Resultados: 40,34% das famílias de pacientes com fibrose cística mudaram os hábitos de compras de alimentos, cerca de 40% dos pacientes diminuíram a prática de atividade física e aumentaram o tempo de uso de telas em mais de 50% durante o período da pandemia de COVID-19. Conclusão: Apesar de algumas dificuldades relacionadas à aquisição dos alimentos e alterações em hábitos de vida, houve manutenção do consumo alimentar da maioria dos grupos alimentares e suplementos pelos pacientes pediátricos com fibrose cística brasileiros durante o isolamento social devido a pandemia de COVID-19.

Objective: to verify changes in food consumption and lifestyle in Brazilian cystic fibrosis patients during the period of social isolation due to the COVID-19 pandemic. Method: cross-sectional survey with data collection through a questionnaire prepared by the team of nutritionists specialized in the treatment of patients with cystic fibrosis, with questions regarding the recent respiratory manifestations of patients or family members, changes in the habits of purchasing food and changes regarding the consumption of food groups and supplements. The data were tabulated and a descriptive analysis was performed. Results: 40.34% of the families of patients with cystic fibrosis changed their food shopping habits, about 40% of the patients decreased their physical activity and increased the time spent using screens by more than 50% during the pandemic COVID-19. Conclusion: despite some difficulties related to the acquisition of food and changes in lifestyle, there was maintenance of the food consumption of most food groups and supplements by Brazilian pediatric patients with cystic fibrosis during social isolation due to the COVID-19 pandemic.

Objetivo: verificar cambios en el consumo de alimentos y estilo de vida en pacientes brasileños con fibrosis quística durante el período de aislamiento social por la pandemia de COVID-19. Método: encuesta transversal con recolección de datos por medio de un cuestionario elaborado por un equipo de nutricionistas especializados en el tratamiento de pacientes con fibrosis quística, con preguntas sobre las manifestaciones respiratorias recientes de pacientes o familiares, cambios en los hábitos de compra de alimentos y cambios en el consumo de grupos de alimentos y suplementos. Los datos se tabularon y se realizó un análisis descriptivo. Resultados: el 40,34% de los familiares de pacientes con fibrosis quística cambiaron sus hábitos de compra de alimentos, alrededor del 40% de los pacientes disminuyó la práctica de actividad física y aumentó el tiempo de uso de pantallas en más del 50% durante el período pandémico. COVID-19. Conclusión: A pesar de algunas dificultades relacionadas con la adquisición de alimentos y cambios en el estilo de vida, hubo mantenimiento del consumo de alimentos de la mayoría de los grupos de alimentos y suplementos por parte de pacientes pediátricos brasileños con fibrosis quística durante el aislamiento social debido a la pandemia COVID-19.

Projeto piloto de implantação de uma cozinha cetogênica para tratamento de epilepsia refratária / Pilot project of Implementation of a keto-kitchen for the treatment of refractory epilepsy / Proyecto piloto para implementar una cocina cetogénica para el tratamiento de la epilepsia refractaria

Objetivo: verificar alterações no consumo alimentar e hábitos de vida em pacientes com fibrose cística brasileiros durante o período de isolamento social devido a pandemia de COVID-19. Métodos: pesquisa transversal com levantamento de dados por meio de questionário elaborado pela equipe de nutricionistas especialistas no tratamento de pacientes com fibrose cística, com questões referentes às manifestações respiratórias recentes de pacientes ou familiares, alterações nos hábitos de aquisição e compras de alimentos e alterações quanto ao consumo de grupos alimentares e suplementos. Os dados foram tabulados e foi realizada uma análise descritiva. Resultados: 40,34% das famílias de pacientes com fibrose cística mudaram os hábitos de compras de alimentos, cerca de 40% dos pacientes diminuíram a prática de atividade física e aumentaram o tempo de uso de telas em mais de 50% durante o período da pandemia de COVID-19. Conclusões: Apesar de algumas dificuldades relacionadas à aquisição dos alimentos e alterações em hábitos de vida, houve manutenção do consumo alimentar da maioria dos grupos alimentares e suplementos pelos pacientes pediátricos com fibrose cística brasileiros durante o isolamento social devido a pandemia de COVID-19

Objective: This study describes the creation of the first ketogenic diet-teaching kitchen at a ketogenic reference center in Brazil aimed at developing ketogenic recipes and holding keto-culinary workshops with caregivers. Method: In this prospective study, 26 recipes were tested and assessed by sensory panel testing. Eighteen recipes were selected to be prepared in culinary workshops with parents or legal guardians of children with refractory epilepsy receiving the ketogenic diet as outpatients. All recipes were selected, calculated, and approved by registered dietitians. Results: Eight parents or legal guardians participated in four culinary workshops. The activities were extremely satisfactory: participants were able to clear out their doubts, learn, practice recipes, and develop new skills. In general, all participants enjoyed the prepared recipes and praised the culinary workshop. Conclusion: The ketogenic teaching kitchen enabled the development of ketogenic recipes adapted to Brazilian eating habits. Providing alternative meals to children is essential for enhancing compliance with the ketogenic diet because they contribute to expand the dietary repertoire of these patients. Future studies with high methodological quality should test the efficacy of the ketogenic kitchen in increasing compliance with the ketogenic diet in the long term.

Objetivo: Este estudio describe la creación de la primera cocina cetogénica para enseñar dieta cetogénica en un centro de referencia en Brasil, con el objetivo de desarrollar recetas cetogénicas y realizar talleres culinarios con los cuidadores. Método: En este estudio prospectivo, un panel sensorial probó y evaluó 26 recetas. Se seleccionaron dieciocho recetas para ser elaboradas en talleres de cocina con padres o tutores legales de niños con epilepsia refractaria que reciben una dieta cetogénica ambulatoria. Todas las recetas fueron seleccionadas, calculadas y aprobadas por nutricionistas. Resultados: Ocho padres o tutores participaron en cuatro talleres culinarios. Las actividades fueron sumamente satisfactorias: los participantes pudieron despejar sus dudas, aprender, practicar recetas y desarrollar nuevas habilidades. En general, a todos los participantes les gustaron las recetas elaboradas y elogiaron el taller de cocina. Conclusión: La cocina de enseñanza cetogénica permitió el desarrollo de recetas cetogénicas adaptadas a los hábitos alimentarios brasileños. Proporcionar comidas alternativas a los niños es fundamental para mejorar la adherencia a la dieta cetogénica, ya que contribuyen a ampliar el repertorio dietético de estos pacientes. Los estudios futuros con alta calidad metodológica deberían probar la efectividad de la cocina cetogénica para aumentar la adherencia a la dieta cetogénica a largo plazo.

CONSTRUCTION AND VALIDATION OF THE NEONATAL NUTRITIONAL RISK SCREENING TOOL.

OBJECTIVE: To develop and validate both the content and reliability of the Neonatal Nutritional Risk Screening Tool (FARNNeo). METHODS: Methodological study, convergent care. The instrument was built prior to the literature review and was analyzed by eight judges, during three cycles of the Delphi technique. The judges assessed their relevance and clarity with responses on the Likert scale with three levels, in addition to suggestions. The validation of the instrument was calculated using the agreement rate and content validity index (CVI). After content validation, the instrument was applied by four assisting nutritionists to verify reliability, using Cronbach`s alpha coefficient and the agreement between the evaluators by the Kappa coefficient. RESULTS: All items of the instrument`s content reached the minimum agreement rate (90%) and/or CVI (0.9), except for item three, which in the first cycle obtained CVI 0.77 and 40% of agreement and, in the second cycle, CVI 0.75 and 38% agreement. At the end of the third cycle, all items had CVI values above 0.9. In the instrument application, alpha of 0.96 and Kappa of 0.74 were obtained, which reflect adequate values of internal consistency and agreement between the evaluators. CONCLUSIONS: FARNNeo proved to be reliable, clear, relevant, and reproducible for tracking early nutritional risk, systematizing the care of Brazilian newborns admitted to an intensive care unit.

Avaliação do perfil nutricional em pacientes portadores de fibrose cística de acordo com faixa etária / Evaluation of nutritional status in patients with cystic fibrosis according to age group

RESUMO Objetivo: Avaliar o perfil nutricional da população atendida em centro de referência em fibrose cística. Métodos: Estudo transversal incluindo pacientes com fibrose cística de um centro pediátrico de referência de São Paulo, em 2014. Todos os sujeitos que concordaram em participar do estudo foram incluídos. Foi aplicado um questionário sobre hábitos alimentares (recordatório de 24 horas) e características socioeconômicas. Dados antropométricos (comparados com referencial da Organização Mundial da Saúde de 2006 e 2007) e função pulmonar foram coletados do prontuário. Os integrantes da pesquisa foram estratificados em faixas etárias para análise estatística. Resultados: Dos 101 pacientes incluídos no estudo, 59,4% eram masculinos, sendo a maioria caucasiana (86,4%), com mediana de idade de 10 anos. A maioria dos pacientes (n=77, 75%) foi classificada como eutrófica, mas valores menores de escore Z de índice de massa corpórea (IMC) foram observados em escolares e adolescentes. A proporção de pacientes com peso abaixo do esperado foi de 10% (n=2) na faixa etária pré-escolar e de 35% (n=6) em escolares. O consumo alimentar mostrou-se adequado, e somente dois suplementos (triglicérides de cadeia média e suplemento em pó completo) tiveram utilização ligada à adequação da ingesta de macronutrientes. Características socioeconômicas não apresentaram associação com o estado nutricional ou com o consumo nutricional. Valores de função pulmonar não apontaram diferença significante em adolescentes nem em indivíduos com pior estado nutricional no grupo estudado. Conclusões: A maioria dos pacientes apresentou estado nutricional e consumo alimentar adequados, indicando bom manejo das ações nutricionais. Novos estudos com foco em pré-escolares devem ser realizados para avaliar se é possível reduzir o risco nutricional de pacientes com fibrose cística em idades posteriores.

ABSTRACT Objective: To evaluate the nutritional profile of the population assisted at a reference center for cystic fibrosis treatment. Methods: Cross-sectional study including patients with cystic fibrosis assisted at a pediatric reference center in São Paulo, Brazil, in 2014. All patients attending regular visits who agreed to participate in the study were included. A questionnaire on dietary habits (24-hour diet recall) and socioeconomic characteristics was applied. Anthropometric data (compared with the reference from the World Health Organization, 2006 and 2007) and pulmonary function data were collected from medical records. Patients were stratified into age groups for statistical analysis. Results: A total of 101 patients were included in the study (59.4% male, 86.4% Caucasian), with median age of 10 years old. Most patients (n=77; 75%) were classified as eutrophic, but lower values of body mass index (BMI) Z scores were observed in schoolchildren and adolescents. The proportion of underweight patients was 10% (n=2) among preschoolers and 35% (n=6) of the school age group. Dietary intake was adequate, and the use of only two supplements (medium chain triglycerides and complete powdered supplement) was associated with adequacy of macronutrient intake. The socioeconomic characteristics did not show any statistical association with the nutritional state or nutritional consumption. Lung function was not significantly different between neither adolescents nor individuals with worse nutritional status in this sample. Conclusions: Most of the patients presented adequate nutritional status and adequate consumption of calories and macronutrients, indicating appropriate nutritional management. New studies focusing on preschool children should be performed to assess if it is possible to reduce the nutritional risk of patients with cystic fibrosis at older ages.

Systematic Review of Probiotics for Cystic Fibrosis Patients: Moving Forward.

BACKGROUND: Cystic fibrosis (CF) is associated with chronic respiratory disease and pancreatic insufficiency and results in the malabsorption of nutrients and intestinal inflammation. There is evidence that probiotic supplementation may impact the gastrointestinal and respiratory microbiota. This study aimed to categorize current evidence regarding the effects of supplementing with probiotics in CF patients on gastrointestinal and respiratory outcomes according to the type of intervention. METHODS: The initial database search included all identified studies according to the recommendations of the Cochrane Collaboration, regardless of language, publication date or design. Studies were categorized by probiotic strain (Lactobacillus reuteri; Lactobacillus rhamnosus GG or a mix of strains); dosage (low dosage if <10 CFU [colony forming units] or high dosage if >10 CFU); and duration of intervention (1, 3, 6, or 12 months). Assessment of quality was performed based on the Cochrane risk of bias criteria and the Downs & Black checklist. RESULTS: A total of 205 studies were identified; however, only 9 met the criteria for inclusion. The studies were considered to have a high risk of bias, hampering the possibility of performing a meta-analysis. Eighty percent of the studies (4 of 5) reported a positive result for intestinal inflammation, and another 4 studies (4 of 5) reported a positive result for pulmonary exacerbation frequency, regardless of the treatment approach. CONCLUSIONS: The present data indicate a promising future for probiotic use in cystic fibrosis, which has an impact on exacerbations and intestinal inflammation; however, further studies of standardized therapeutic interventions are required.

EVALUATION OF NUTRITIONAL STATUS IN PATIENTS WITH CYSTIC FIBROSIS ACCORDING TO AGE GROUP. / AVALIAÇÃO DO PERFIL NUTRICIONAL EM PACIENTES PORTADORES DE FIBROSE CÍSTICA DE ACORDO COM FAIXA ETÁRIA.

OBJECTIVE: To evaluate the nutritional profile of the population assisted at a reference center for cystic fibrosis treatment. METHODS: Cross-sectional study including patients with cystic fibrosis assisted at a pediatric reference center in São Paulo, Brazil, in 2014. All patients attending regular visits who agreed to participate in the study were included. A questionnaire on dietary habits (24-hour diet recall) and socioeconomic characteristics was applied. Anthropometric data (compared with the reference from the World Health Organization, 2006 and 2007) and pulmonary function data were collected from medical records. Patients were stratified into age groups for statistical analysis. RESULTS: A total of 101 patients were included in the study (59.4% male, 86.4% Caucasian), with median age of 10 years old. Most patients (n=77; 75%) were classified as eutrophic, but lower values of body mass index (BMI) Z scores were observed in schoolchildren and adolescents. The proportion of underweight patients was 10% (n=2) among preschoolers and 35% (n=6) of the school age group. Dietary intake was adequate, and the use of only two supplements (medium chain triglycerides and complete powdered supplement) was associated with adequacy of macronutrient intake. The socioeconomic characteristics did not show any statistical association with the nutritional state or nutritional consumption. Lung function was not significantly different between neither adolescents nor individuals with worse nutritional status in this sample. CONCLUSIONS: Most of the patients presented adequate nutritional status and adequate consumption of calories and macronutrients, indicating appropriate nutritional management. New studies focusing on preschool children should be performed to assess if it is possible to reduce the nutritional risk of patients with cystic fibrosis at older ages.

OBJETIVO: Avaliar o perfil nutricional da população atendida em centro de referência em fibrose cística. MÉTODOS: Estudo transversal incluindo pacientes com fibrose cística de um centro pediátrico de referência de São Paulo, em 2014. Todos os sujeitos que concordaram em participar do estudo foram incluídos. Foi aplicado um questionário sobre hábitos alimentares (recordatório de 24 horas) e características socioeconômicas. Dados antropométricos (comparados com referencial da Organização Mundial da Saúde de 2006 e 2007) e função pulmonar foram coletados do prontuário. Os integrantes da pesquisa foram estratificados em faixas etárias para análise estatística. RESULTADOS: Dos 101 pacientes incluídos no estudo, 59,4% eram masculinos, sendo a maioria caucasiana (86,4%), com mediana de idade de 10 anos. A maioria dos pacientes (n=77, 75%) foi classificada como eutrófica, mas valores menores de escore Z de índice de massa corpórea (IMC) foram observados em escolares e adolescentes. A proporção de pacientes com peso abaixo do esperado foi de 10% (n=2) na faixa etária pré-escolar e de 35% (n=6) em escolares. O consumo alimentar mostrou-se adequado, e somente dois suplementos (triglicérides de cadeia média e suplemento em pó completo) tiveram utilização ligada à adequação da ingesta de macronutrientes. Características socioeconômicas não apresentaram associação com o estado nutricional ou com o consumo nutricional. Valores de função pulmonar não apontaram diferença significante em adolescentes nem em indivíduos com pior estado nutricional no grupo estudado. CONCLUSÕES: A maioria dos pacientes apresentou estado nutricional e consumo alimentar adequados, indicando bom manejo das ações nutricionais. Novos estudos com foco em pré-escolares devem ser realizados para avaliar se é possível reduzir o risco nutricional de pacientes com fibrose cística em idades posteriores.