Macronutrients and energy in home-prepared enteral tube feeding: Comparison between food composition table estimates, nutrition labels, and laboratory analysis.

BACKGROUND: The effectiveness of home enteral nutrition depends on the supply and delivery of the prescribed nutrients. This study compared the macronutrient and energy values of home-prepared enteral tube feeding analyzed in the laboratory with the same information calculated from labels and food composition tables. METHODS: A total of 107 enteral formulations were analyzed: 66 commercial enteral formulas (CEFs), 19 homemade enteral preparations, and 22 blended enteral preparations (BEPs). The values of macronutrients and energy and the ratio between the values found in the laboratory and the calculated values were all evaluated. The tolerance limit of acceptable variation was 20%. The results were subjected to chemometric methods using principal component analysis (PCA) and hierarchical cluster analysis (HCA). RESULTS: In the three categories of the enteral formulations, the calculated values for protein and fat were higher than those obtained in the laboratory. The calculated values for energy were higher than those obtained in the laboratory for the BEPs and CEFs. The CEFs had the highest percentage within the limit of acceptable variation for carbohydrate and protein, whereas the BEPs presented the lowest values for fat and energy. In the exploratory analysis of data using PCA and HCA, it was possible to verify similarities and discrepancies between the enteral formulations analyzed in the laboratory with those calculated from the labels and food composition tables. CONCLUSION: The enteral formulations showed differences between the values of macronutrients and energy analyzed in the laboratory and those calculated from labels and/or food composition tables.

Nutrition assistance improves skeletal muscle function and performance in community-dwelling older women / Assistência nutricional melhora o desempenho muscular esquelético de mulheres idosas residentes na comunidade

To analyze the effects of nutritional assistance focusing on protein intake (in the individual's usual diet) in relation to muscle mass, and the muscle strength and functional performance of community-dwelling older women. Methods: This is a non-randomized controlled clinical trial. Forty-three community-dwelling older women, who were allocated to the Control Group (CG; n = 20) or the Nutrition Group (NG; n = 23). The NG received individualized nutrition assistance and participated in group activities that focused on dietary protein intake once a week for 12 weeks. Main outcome measures: protein and energy intake; handgrip strength (HGS); gait speed (GS); quadriceps cross-sectional area (CSA); and intramuscular non-contractile tissue (IMNCT). The Student's t-test for independent samples, the Mann-Whitney U test, and a mixed model ANOVA with two factors (group and time) were adopted, followed by a post hoc Bonferroni test. A Spearman's correlation test was performed on tests for HGS; GS; CSA; IMNCT; age; and protein intake adjusted for weight (g/kg) (p ≤ 0.050). Results: Participants in the NG showed higher CSA values than those in the CG (p < 0.001). NG participants also had higher HGS (p < 0.001) and GS (p = 0.037) when compared to pre-intervention. Correlations were observed between IMNCT and protein intake adjusted for weight (g/kg) (r = -0.517; p = 0.020); HGS, and CSA (r = 0.827; p = 0.000); and CSA and age (r = -0.520, p = 0.009).

Analisar os efeitos da assistência nutricional com foco na ingestão proteica (na dieta habitual do indivíduo) em relação a massa muscular, força muscular e desempenho funcional de idosas de uma comunidade. Métodos: Trata-se um ensaio clínico controlado não randomizado. Quarenta e três idosas da comunidade foram alocadas no Grupo Controle (GC; n = 20) ou no Grupo Nutrição (GN; n = 23). O GN recebeu atendimento nutricional individualizado e participou de atividades grupais com foco na ingestão proteica da dieta uma vez por semana, durante 12 semanas. Principais medidas de resultado: ingestão de proteína e energia; força de preensão palmar (FPP); teste de velocidade da marcha (TVM); área de secção transversa do quadríceps (ASTq); e tecido intramuscular não contrátil (TIMNC). Utilizou-se o teste t de Student para amostras independentes, o teste U de Mann-Whitney e um modelo misto de análise de variância (ANOVA) com dois fatores (grupo e tempo), seguido de teste post hoc de Bonferroni. Um teste de correlação de Spearman foi realizado para FPP; TVM; ASTq; TIMNC; idade; e ingestão proteica ajustada para peso (g/kg) (p ≤ 0,050). Resultados: Os participantes do GN apresentaram valores de ASTq superiores aos do GC (p < 0,001). Os participantes do GN também exibiram maior FPP (p < 0,001) e GS (p = 0,037) quando comparados à pré-intervenção. Foram observadas correlações entre TIMNC e ingestão proteica ajustada para peso (g/kg) (r = -0,517; p = 0,020); HGS e ASTq (r = 0,827; p = 0,000); e ASTq e idade (r = -0,520, p = 0,009).

ARE ENTEROTYPES IN OBESE MODIFIED BY BARIATRIC SURGERY, THE USE OF PROBIOTIC SUPPLEMENTS AND FOOD HABITS?

INTRODUCTION: Studies suggest that bariatric surgery, use of probiotic supplements and the dietary pattern can change enterotypes, as well as the entire microbial population. OBJECTIVE: To verify the influence of bariatric surgery, the use of probiotic supplements and eating habits on enterotypes in obese patients. METHODS: Articles published between the 2015 and 2020 were searched in Lilacs and PubMed with the headings: probiotics, eating behavior, food consumption, food, diet, microbiota, gastrointestinal microbiome, bariatric surgery, gastric bypass and the keyword enterotype in Portuguese, English and Spanish. RESULTS: Of the 260 articles found, only studies carried out in obese adults relating changes in the enterotype after bariatric surgery or use of probiotics or dietary patterns and original articles were selected. In the end, eight papers on enterotype change and bariatric surgery were selected and categorized, four on the relationship between food consumption and microbiota and one on the effects of probiotics on enterotypes. CONCLUSION: The microbial structure is widely modified after bariatric surgery, since the use of probiotic supplement does not bring lasting changes. Enterotypes appear to be shaped by long-term dietary patterns, can modulate how nutrients are metabolized and can be a useful biomarker to improve clinical management.

Consensus on the standard terminology used in the nutrition care of adult patients with chronic kidney disease / Consenso sobre a terminologia padronizada do processo de cuidado em nutrição para pacientes adultos com doença renal crônica

Abstract This nutrition consensus document is the first to coordinate the efforts of three professional organizations - the Brazilian Association of Nutrition (Asbran), the Brazilian Society of Nephrology (SBN), and the Brazilian Society of Parenteral and Enteral Nutrition (Braspen/SBNPE) - to select terminology and international standardized tools used in nutrition care. Its purpose is to improve the training delivered to nutritionists working with adult patients with chronic kidney disease (CKD). Eleven questions were developed concerning patient screening, care, and nutrition outcome management. The recommendations set out in this document were developed based on international guidelines and papers published in electronic databases such as PubMed, EMBASE(tm), CINHAL, Web of Science, and Cochrane. From a list of internationally standardized terms, twenty nutritionists selected the ones they deemed relevant in clinical practice involving outpatients with CKD. The content validity index (CVI) was calculated with 80% agreement in the answers. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to assess the strength of evidence and recommendations. A total of 107 terms related to Nutrition Assessment and Reassessment, 28 to Diagnosis, nine to Intervention, and 94 to Monitoring and Evaluation were selected. The list of selected terms and identified tools will be used in the development of training programs and the implementation of standardized nutrition terminology for nutritionists working with patients with chronic kidney disease in Brazil.

Resumo Este consenso representa a primeira colaboração entre três organizações profissionais com foco em nutrição: Associação Brasileira de Nutrição (Asbran), Sociedade Brasileira de Nefrologia (SBN) e Sociedade Brasileira de Nutrição Parenteral e Enteral (Braspen/SBNPE), com o objetivo de identificar a terminologia e instrumentos padronizados internacionalmente para o processo de cuidado em nutrição. O foco é facilitar a condução de treinamentos de nutricionistas que trabalham com pacientes adultos com doenças renais crônicas (DRC). Foram levantadas onze questões relacionadas à triagem, ao processo de cuidado e à gestão de resultados em nutrição. As recomendações foram baseadas em diretrizes internacionais e em bancos de dados eletrônicos, como PubMed, EMBASE(tm), CINHAL, Web of Science e Cochrane. A partir do envio de listas de termos padronizados internacionalmente, vinte nutricionistas especialistas selecionaram aqueles que consideraram muito claros e relevantes para a prática clínica com pacientes ambulatoriais com DRC. Foi calculado o Índice de Validade de Conteúdo (IVC), com 80% de concordância nas respostas. O Grading of Recommendations, Assessment, Development and Evaluation (GRADE) foi usado para atribuir força de evidência às recomendações. Foram selecionados 107 termos de Avaliação e Reavaliação, 28 de Diagnóstico, 9 de Intervenção e 94 de Monitoramento e Aferição em Nutrição. A lista de termos selecionados e identificação de instrumentos auxiliará no planejamento de treinamentos e na implementação de terminologia padronizada em nutrição no Brasil, para nutricionistas que trabalham com pacientes renais crônicos.

Consensus on the standard terminology used in the nutrition care of adult patients with chronic kidney disease.

This nutrition consensus document is the first to coordinate the efforts of three professional organizations - the Brazilian Association of Nutrition (Asbran), the Brazilian Society of Nephrology (SBN), and the Brazilian Society of Parenteral and Enteral Nutrition (Braspen/SBNPE) - to select terminology and international standardized tools used in nutrition care. Its purpose is to improve the training delivered to nutritionists working with adult patients with chronic kidney disease (CKD). Eleven questions were developed concerning patient screening, care, and nutrition outcome management. The recommendations set out in this document were developed based on international guidelines and papers published in electronic databases such as PubMed, EMBASE(tm), CINHAL, Web of Science, and Cochrane. From a list of internationally standardized terms, twenty nutritionists selected the ones they deemed relevant in clinical practice involving outpatients with CKD. The content validity index (CVI) was calculated with 80% agreement in the answers. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to assess the strength of evidence and recommendations. A total of 107 terms related to Nutrition Assessment and Reassessment, 28 to Diagnosis, nine to Intervention, and 94 to Monitoring and Evaluation were selected. The list of selected terms and identified tools will be used in the development of training programs and the implementation of standardized nutrition terminology for nutritionists working with patients with chronic kidney disease in Brazil.

Nutritional composition and cost of home-prepared enteral tube feeding.

BACKGROUND & AIMS: To aid in dietary prescription and contribute to the promotion of food and nutritional safety of individuals, this study's objective was to compare the nutritional composition and cost of homemade preparations, blended preparations, and commercial enteral formula prescribed for adults and elderly people at hospital discharge. METHODS: All hospitals in a Brazilian city that prescribed the three types of enteral formulations provide information about enteral formulations prescribed for home use. Enteral formulations were estimated in relation to energy content, macronutrients, micronutrients, and cost. RESULTS: Homemade diets, blended and commercial enteral formulations showed, on average, normoproteic, normoglicidic and normolipidic features, with average daily costs (US$/2000 kcal) of US$ 29.77, 50.56 and 154.44, respectively. The cost was higher in the commercial enteral formulas (P < .001); vitamin and mineral content were poorer in homemade preparations. CONCLUSIONS: The homemade and blended enteral preparations cost less, but were generally lower in micronutrients, calling for more adequate dietary prescription.

Effects of Probiotics Supplementation on Gastrointestinal Symptoms and SIBO after Roux-en-Y Gastric Bypass: a Prospective, Randomized, Double-Blind, Placebo-Controlled Trial.

Bariatric surgery may cause undesirable gastrointestinal symptoms due to anatomical, functional and intestinal microbiota changes. PURPOSE: The aim of this study was to evaluate the effect of probiotic supplementation on gastrointestinal symptoms and small intestine bacterial overgrowth (SIBO) in patients after Roux-en-Y gastric bypass (RYGB). MATERIALS AND METHODS: This is a prospective, randomized, double-blind, placebo-controlled trial. The patients were randomized into Control Group (CG) (n = 39) and Probiotic Group (PG) (n = 34). The PG received tablets containing Lactobacillus acidophilus and Bifidobaterium lactis (5 billion CFU/strain) for 90 days, and the CG received tablets with starch. Both the Gastric Symptom Rating Scale (GSRS) questionnaire and 3-day food record were answered before surgery (T0) and after 45 days (T1) and 90 days of surgery (T2). At T0 and T2, hydrogen breath test was used to verify the presence of SIBO. RESULTS: The prevalence of SIBO was similar among times, and the mean score of GSRS responses did not differ between groups at any time. However, PG patients reported less bloating compared to CG, more abdominal pain at T1 (which reduced at T2), more episodes of soft stools and nausea and less hunger pain after surgery, with no reports of urgent episodes to evacuate, even though they consumed more fat than the CG. CONCLUSIONS: The supplementation of L. acidophilus and B. lactis is effective in reducing bloating, but without influencing the development of SIBO in the early postoperative period.

Home-Prepared Enteral Tube Feeding: Evaluation of Microbiological Contamination, Hygiene, and the Profile of the Food Handler.

BACKGROUND: Little is known about the risk to patients' health when using home-prepared enteral tube feeding. The objective of this study was to explore the differences in hygiene conditions and microbial load of different types of home-prepared enteral tube feeding and explore associations between those differences and food handlers' characteristics. METHODS: We evaluated 96 enteral formulations, considering 3 types used by adult patients: homemade enteral preparations (HEPs), blended enteral preparations (BEPs), and commercial enteral formulas (CEFs). Enteral formulations were collected from homes and microbiologically analyzed. Hygiene criteria were assessed using a checklist, applied during the handling stages. The profile of the food handler was reviewed using a questionnaire. RESULTS: 82.3% (79/96) exceeded acceptable bacterial counts, which was 10³ colony-forming units per gram for aerobic mesophilic microorganisms and for total coliforms (35 °C), Escherichia coli, Staphylococcus sp, and Staphylococcus coagulase-positive, if present in the enteral formulations. The number of inadequate samples was higher in HEPs and BEPs than in CEFs. Considering the hygiene criteria, the home-prepared enteral tube feedings did not differ significantly. There was a significant difference among hygiene conditions considering the variables "monthly family income" and "food training." CONCLUSION: Regardless of the type of enteral formulations used by patients, when handled at home, there was a risk of contamination. However, contaminants present in enteral formulations can be easily controlled with improvements in hygiene measures as well as with greater guidance and control during the handling stages.

Qualidade da dieta de idosas não institucionalizadas de uma capital do sul do Brasil: baixo consumo de gorduras saturadas, sódio, cereais integrais e de gorduras cardioprotetoras / Diet quality ofnon-institutionalized elderly women from a Brazilian southern capital city: low consumption of saturated fats, sodium, whole grains, and cardioprotective fats

Introdução:A população idosa é suscetível às alterações no estado nutricional devido aos fatores relacionados às modificações socioeconômicas e fisiológicas; porém, estudos que avaliaram a situação alimentar atual de idosos no Brasil ainda são escassos. Objetivo: Avaliar a qualidade da dieta de idosas não institucionalizadas de uma capital do sul do Brasil. Métodos: Trata-se de um estudo de caráter transversal, com 174 idosas selecionadas por conveniência. A avaliação do consumo alimentar foi realizada por meio de registro alimentar de três dias. Avaliou-se a qualidade da dieta por meio do Índice de Qualidade da Dieta ­ Revisado (IQD-R) adaptado para a população brasileira.Resultados: Verificou-seque56,9% (n=99), 40,8% (n=71) e 2,3% (n=4) das participantes apresentaram dieta que "necessita de modificação", dieta "saudável", e dieta "inadequada", respectivamente. A pontuação média obtida por meio do IQD-R foi de 62,5 (± 9,6), com mínimo de 30,2 pontos e máximo de 84,9 pontos.Na análise do consumo dos grupos alimentares, constatou-se baixa pontuação de gordura saturada (9,96±0,50), mono e poli-insaturada (1,08±2,21), cereais integrais (1,7±1,54), sódio (7,31±2,27), e maior pontuação para o grupo de cereais totais (4,61±0,54).Conclusão: A maioria das idosas avaliadas necessitam de melhoria na qualidade da dieta, com ênfase no consumo de cereais integrais e gorduras mono e poli-insaturadas, porém com ingestão adequada de gordura saturada e sódio.

Introduction: The elderly population is susceptible to changes in nutritional status due to factors related to socioeconomic and physiological changes; however, studies that evaluated the current dietary status of the elderly in Brazil are still scarce. Objective: To evaluate the quality of the diet of non-institutionalized elderly women from a capital city in southern Brazil. Methods: This was a cross-sectional study, with 174 convenience sampled elderly women. Food intake was assessed by means of a three-day dietary record. Diet quality was assessed through the Diet Quality Index - Revised (IQD-R) adapted for the Brazilian population. Results: This work showed that 56.9% (n=99), 40.8% (n=71), and 2.3% (n=4) of the diets of the participants were classified as "needs modification", "healthy", and "inadequate", respectively. The mean score obtained through the IQD-R was 62.5 (± 9.6), with a minimum of 30.2 points and a maximum of 84.9 points. In the analysis of food group consumption, there was a low score for saturated fat (9.96±0.50), mono and polyunsaturated fats (1.08±2.21), whole grains (1.7±1.54), sodium (7.31±2.27), and a higher score for the total grains group (4.61±0.54). Conclusion: Most of the elderly women assessed needed improvement in the quality of their diets, with emphasis on the consumption of whole grains and mono and polyunsaturated fats, but with adequate intake of saturated fat and sodium.

Are enterotypes in obese modified by bariatric surgery, the use of probiotic supplements and food habits? / Enterótipos em obesos são modificados pela cirurgia bariátrica, uso de suplementos probióticos e hábitos alimentares?

ABSTRACT Introduction: Studies suggest that bariatric surgery, use of probiotic supplements and the dietary pattern can change enterotypes, as well as the entire microbial population. Objective: To verify the influence of bariatric surgery, the use of probiotic supplements and eating habits on enterotypes in obese patients. Methods: Articles published between the 2015 and 2020 were searched in Lilacs and PubMed with the headings: probiotics, eating behavior, food consumption, food, diet, microbiota, gastrointestinal microbiome, bariatric surgery, gastric bypass and the keyword enterotype in Portuguese, English and Spanish. Results: Of the 260 articles found, only studies carried out in obese adults relating changes in the enterotype after bariatric surgery or use of probiotics or dietary patterns and original articles were selected. In the end, eight papers on enterotype change and bariatric surgery were selected and categorized, four on the relationship between food consumption and microbiota and one on the effects of probiotics on enterotypes. Conclusion: The microbial structure is widely modified after bariatric surgery, since the use of probiotic supplement does not bring lasting changes. Enterotypes appear to be shaped by long-term dietary patterns, can modulate how nutrients are metabolized and can be a useful biomarker to improve clinical management.

RESUMO Introdução: Estudos sugerem que a cirurgia bariátrica, uso de suplementos probióticos e o padrão alimentar podem mudar enterótipos, assim como toda a população microbiana. Objetivo: Verificar a influência da cirurgia bariátrica, do uso de suplementos probióticos e de hábitos alimentares nos enterótipos de pacientes obesos. Métodos: Foi realizada a busca de artigos publicados entre os anos de 2015 e 2020 nas bases de dados Lilacs e PubMed com os descritores: probióticos, comportamento alimentar, consumo alimentar, alimentação, dieta, microbiota, microbioma gastrointestinal, cirurgia bariátrica, bypass gástrico e a palavra-chave enterótipo em português, inglês e espanhol. Resultados: Dos 260 artigos encontrados, foram selecionados os estudos originais realizados em adultos obesos relacionando mudanças de enterótipo após cirurgia bariátrica, a padrões alimentares ou ao uso de probiótico. Ao final, foram selecionados e categorizados oito estudos sobre mudança de enterótipo e cirurgia bariátrica, quatro sobre relação entre consumo alimentar e microbiota e somente um sobre efeitos dos probióticos nos enterótipos. Conclusão: A estrutura microbiana é amplamente modificada após a cirurgia bariátrica. O uso de suplemento probiótico não parece trazer mudanças duradouras. Os enterótipos parecem ser moldados por padrões alimentares em longo prazo e podem modular como os nutrientes são metabolizados, podendo vir a ser um biomarcador útil para melhorar o manejo clínico de pacientes obesos.

Relations between serum magnesium and calcium levels and body composition and metabolic parameters in women with fibromyalgia.

OBJECTIVE: Correlate serum magnesium (Mg) and Calcium (Ca) levels with body composition and metabolic parameters in women with fibromyalgia (FM). PATIENTS AND METHODS: Cross-sectional study compared with a control group paired by age and body mass index (BMI) of adult women diagnosed with fibromyalgia. All participants went through assessment of their body composition through dual-energy X-ray absorptiometry (DXA) and had blood samples collected for dosing of Mg, Ca, C-reactive Protein (CRP), lipidogram and glycemia. RESULTS: 53 women with FM (average age 48.1 ± 8.2 years, average BMI 26.6 ± 4.5 kg/m2) and 50 control women (average age 47.1 ± 9.9 years, average BMI 25.6 ± 3.6 kg/m2) participated in the study. Serum levels turned out to have inverse correlation with CRP in the FM group (r = - 0.29, p = 0.03) and with BMI and glycemia in the control group (r = 0.31; p = 0.02 and r = 0.48; p = 0.0004 respectively). Serum levels of calcium correlated with triglycerides (r = 0.29; p = 0.03) in the FM group and with glycemia in the control group (r = 0.64; p = 0.0001). CONCLUSIONS: In patients with FM, magnesemia turned out to have inverse correlation with CRP and calcemia had positive association with triglycerides.

Relations between serum magnesium and calcium levels and body composition and metabolic parameters in women with fibromyalgia

Abstract Objective: Correlate serum magnesium (Mg) and Calcium (Ca) levels with body composition and metabolic parameters in women with fibromyalgia (FM). Patients and methods: Cross-sectional study compared with a control group paired by age and body mass index (BMI) of adult women diagnosed with fibromyalgia. All participants went through assessment of their body composition through dual-energy X-ray absorptiometry (DXA) and had blood samples collected for dosing of Mg, Ca, C-reactive Protein (CRP), lipidogram and glycemia. Results: 53 women with FM (average age 48.1 ±8.2 years, average BMI 26.6 ±4.5 kg/m2) and 50 control women (average age 47.1 ±9.9 years, average BMI 25.6 ± 3.6 kg/m2) participated in the study. Serum levels turned out to have inverse correlation with CRP in the FM group (r = −0.29, p = 0.03) and with BMI and glycemia in the control group (r = 0.31; p = 0.02 and r = 0.48; p = 0.0004 respectively). Serum levels of calcium correlated with triglycerides (r = 0.29; p = 0.03) in the FM group and with glycemia in the control group (r = 0.64; p = 0.0001). Conclusions: In patients with FM, magnesemia turned out to have inverse correlation with CRP and calcemia had positive association with triglycerides.(AU)

Home enteral nutrition: clinical-nutritional analysis and outcomes of 10 years of public policy / Nutrición enteral domiciliaria: análisis clínico-nutricional de los 10 años de política pública

Background and aims: home enteral nutrition (HEN) is an established treatment for clinically stable patients. The objective of this study was to determine the frequency and the situation of patients in HEN, in the capital city in the south of Brazil. Methods: in this retrospective study, we recorded all new cases of HEN in adults in Curitiba, Brazil, from January 2006 to December 2015. Data were collected by a dietitian from medical records of patients attending public health settings. The following data were analyzed: clinical diagnosis, diet prescribed during hospitalization and at discharge, and feeding access types. Kaplan-Meier and Cox regression analyses were used to calculate survival. Results: a total of 1,231 patients were included. There was a 425% increase in the frequency of HEN over the years studied. The mean age was 66.7 years, and 54.4% were men. Neurological diseases were the most prevalent (46.4%), followed by cancer (33.6%). Eight hundred and one patients (65.1%) died during this period. Mean HEN duration was 180 days (95% CI 163.6-193.4), with a significant difference between neurological diseases (median: 180 days) and cancer (median: 210 days) (p < 0.05). Neurological disease was an independent risk factor for mortality in patients on HEN (HR: 1.17; CI: 1.08-1.27). Conclusions: the study shows an increase in HEN. Neurological diseases prevailed and presented a risk of mortality, and more than half of the patients with NED died in this period

Introducción y objetivos: la nutrición enteral domiciliaria (NED) es un tratamiento establecido para pacientes clínicamente estables. El objetivo de este estudio fue determinar la frecuencia y la situación de los pacientes con NED en la capital del sur de Brasil. Métodos: en este estudio retrospectivo se registraron todos los nuevos casos de NED en adultos en Curitiba, Brasil, de enero de 2006 a diciembre de 2015. Los datos fueron recolectados por un nutricionista de historiales clínicos de pacientes que frecuentan establecimientos de salud pública. Se analizaron los siguientes datos: diagnóstico clínico, dieta prescrita durante la estancia hospitalaria y en el momento del alta y acceso alimenticio. Se utilizaron los análisis de Kaplan-Meier y regresión de Cox para calcular la supervivencia. Resultados: fueron incluidos 1.231 pacientes. Hubo un aumento del 425% en la frecuencia de NED a lo largo de los años estudiados. La edad media fue de 66,7 años y el 54,4% eran hombres. Las enfermedades neurológicas fueron las más prevalentes (46,4%), seguidas de las neoplasias (33,6%). Durante este periodo murieron 801 pacientes (65,1%). La duración media de la NED fue de 180 días (IC 95%, 163,6-193,4), con una diferencia significativa entre enfermedades neurológicas (mediana: 180 días) y cáncer (mediana: 210 días) (p < 0,05). La enfermedad neurológica fue un factor de riesgo independiente para la mortalidad en pacientes en NED (HR: 1,17; IC: 1,08-1,27). Conclusiones: el estudio muestra un aumento en la NED. Las enfermedades neurológicas prevalecieron y presentaron riesgo de mortalidad y más de la mitad de los pacientes murieron durante la NED

Phase angle as a screening tool for mortality risk among hematopoietic stem cell transplanted adult patients.

BACKGROUND: Mortality among adult patients undergoing hematopoietic stem cell transplantation (HSCT) is high, especially within the first 100 days after the event. Therefore, identifying prognostic factors would be useful as screening tools to protect patients at risk throughout early intervention. In our previous work, the standardized phase angle (SPA) was explored as a useful indicator of survival and nutritional status among children and adolescent within the first 180 days after HSCT. The aim of this study was to evaluate the SPA and the arm muscle area (AMA) as prognostic indicators of mortality and nutritional status among adults in the same population. METHODS: This study was conducted with 29 adult patients undergoing allogeneic HSCT and 28 controls. Anthropometric assessment as well as body composition and laboratory data were analyzed. The phase angle was standardized according to reference values for healthy population. The correlation of SPA and AMA with other variables was verified and sensibility and specificity were tested by constructing ROC curves considering mortality and nutritional status as outcomes. Kaplan-Meier analysis was applied to calculate survival considering the cut-off points found in ROC curves. Chi-squared test and Kappa coefficient were used for evaluate the agreement among methods of nutritional assessment. RESULTS: SPA presented a predictive value for mortality and nutritional status considering the cut-off point at -0.19. In fact, the mortality incidence was higher among patients with values below the cut-off point for SPA as compared to the ones with SPA above this value up to 90 days after the HSCT. Regarding to AMA, mortality was higher using the values bellow P15 (percentile 15) as reference. The average SPA decreased after the beginning of conditioning and after the HSCT, while the decrease of AMA was observed only 90 days after the transplant. CONCLUSIONS: In this study SPA was confirmed as a prognostic tool for adult HSCT patients. In addition, it seems that SPA is more sensitive to detect structural body changes among the transplanted patients as compared to AMA. More studies are needed to confirm it as a tool to screen patients at risk of mortality for early intervention.

Content of Poorly Absorbed Short-Chain Carbohydrates (FODMAP) in Enteral Homemade Diets.

BACKGROUND: Recent studies have shown that commercial enteral formulas with low FODMAP (FO, fermentable oligosaccharides; D, disaccharides; M, monosaccharides; AP, and polyols) content decrease diarrhea of individuals receiving enteral nutrition therapy (ENT). There is no information, however, regarding the content of FODMAP in homemade enteral formula. The objective of this study was to assess energy and macronutrient content, and to quantify the amount of FODMAP content in homemade enteral formula, commonly prescribed for home use after hospital discharge. METHODS: Recipes of homemade enteral formula were requested from all hospitals and healthcare centers in a Brazilian city, totaling 24 recipes. The diets were quantified in relation to their energy content, macronutrients, and FODMAP content. RESULTS: Of the 19 hospitals, 68.4% prescribe only commercial enteral formulas at the time of hospital discharge, and 31.6% prescribe homemade enteral formula, both conventional and commercial. The homemade enteral formula showed a variation from 700 to 3000 kcal/d. The macronutrient levels of carbohydrates, proteins, and fats were 49.0% ± 6.8%, 17.4% ± 3.1%, and 33.5% ± 6.2%, respectively. On average, homemade enteral formula had 58.5% of high FODMAP content, 7.1% of moderate content, and 34.5% of low FODMAP content, considering that milk is the main food responsible for the high content of FODMAP. CONCLUSIONS: Homemade enteral formula presented adequate nutrition characteristics and is rich in FODMAP. It is important to consider FODMAP in enteral diets prescribed for individuals intolerant to these carbohydrates by individualizing the diet prescription.

Impact of the preoperative use of synbiotics in colorectal cancer patients: A prospective, randomized, double-blind, placebo-controlled study.

OBJECTIVES: Gastrointestinal microflora is involved in the development and regulation of the immune response. Non-pathogenic bacteria are important to prevent the development and subsequent invasion of enteropathogenic bacteria. Surgical trauma and intestinal preparation can disrupt the intestinal microbiota balance. Modulating the microbiota in the preoperative period in patients with colorectal cancer may have an effect on the occurrence of postoperative complications. The aim of this study was to assess the effect of preoperative synbiotic administration in patients with colorectal cancer subjected to colorectal resection. METHODS: This was a prospective, randomized, double-blind, placebo-controlled study of 73 patients with colorectal cancer. Eight days before surgery, patients were randomized to receive either synbiotics (Simbioflora, Farmoquimica, São Paulo, Brazi) or placebo (maltodextrin). The envelopes were identical and labeled A or B. All patients underwent nutritional assessment and measurements of C-reactive protein (CRP), interleukin (IL)-6, serum albumin, and transferrin. Patients were given a diluted envelope in 100 mL of water twice daily for 7 d. The occurrence of infectious or non-infectious complications, time of antibiotic use, duration of hospitalization, and occurrence of deaths were recorded for 30 d postoperatively. RESULTS: Mean age, demographic data, and tumor staging were similar between the groups at baseline. After 7 d of synbiotic intake, there were significant reductions in IL-6 levels (163.2 ± 19.5 versus 138.8 ± 12.5, P < 0.001) and CRP (10 ± 5.2 versus 7.17 ± 3.2, P < 0.001), whereas the control group did not present significant changes I IL-6 levels (154.2 ± 18.3 versus 160.9 ± 18.6, NS) or CRP (10.6 ± 6.18 versus 10.4 ± 6.1, NS). Serum albumin and transferrin did not show significant changes. Postoperative infectious complications occurred in 2.8% of patients in the synbiotic group and in 18.9% of the control group (P = 0.02). The mean antibiotic usage time was 1.42 ± 0.5 d in the synbiotic group and 3.74 ± 4.3 d in the control group (P < 0.001). The mean hospital length of stay was 3 ± 1 d in the synbiotic group and 4 ± 18 in the control group (P < 0.001). Three deaths were reported in the control group and none in the synbiotic group (P = 0.115). CONCLUSIONS: The use of synbiotics for 7 d preoperatively in patients with colorectal cancer attenuates the inflammatory state and is associated with reductions in morbidity, hospital length of stay, and use of antibiotics.

Relation between magnesium and calcium and parameters of pain, quality of life and depression in women with fibromyalgia

Abstract Objective: Determine food intake and levels of serum magnesium (Mg) and calcium (Ca) and correlate these minerals with pain, quality of life and depression risk in women with and without fibromyalgia (FM). Patients and methods: Fifty-three women diagnosed with FM and 50 healthy women participated in the study, where all of them had equivalent age and body mass index (BMI). All women underwent anthropometric assessment, physical exams of pain perception threshold and tender point (TP) count, blood sample collection, and filling out of FM impact questionnaire (FIQ), Patient Health Questionnaire-9 (PHQ-9), and 3-day dietary record (DR). Results: Dietary intake of Mg and Ca was substantially lower by women with FM. There were no differences in levels of serum Mg and Ca in the groups under analysis. For the FM group, dietary intake of Mg and Ca had inverse correlation with TP and direct relation with the pain threshold. Conclusions: Although women with FM had lower dietary intake of Mg and Ca, serum levels for these nutrients were not different between the groups. Low dietary intake of minerals correlated with worsened pain threshold parameters.

POSTOPERATIVE CHANGES IN INTESTINAL MICROBIOTA AND USE OF PROBIOTICS IN ROUX-EN-Y GASTRIC BYPASS AND SLEEVE VERTICAL GASTRECTOMY: AN INTEGRATIVE REVIEW.

INTRODUCTION: Studies suggest that weight loss induced by bariatric surgery and the remission of some comorbidities may be related to changes in the microbiota profile of individuals undergoing this procedure. In addition, there is evidence that manipulation of the intestinal microbiota may prove to be a therapeutic approach against obesity and metabolic diseases. OBJECTIVE: To verify the changes that occur in the intestinal microbiota of patients undergoing bariatric surgery, and the impact of the usage of probiotics in this population. METHODS: Articles published between 2007 and 2017 were searched in Medline, Lilacs and Pubmed with the headings: bariatric surgery, microbiota, microbiome and probiotics, in Portuguese, English and Spanish. Of the 166 articles found, only those studies in adults subjected to either Roux-en-Y gastric bypass or sleeve vertical gastrectomy published in original articles were enrolled. In the end, five studies on the change of intestinal microbiota composition, four on the indirect effects of those changes and three on the probiotics administration on this population were enrolled and characterized. CONCLUSION: Bariatric surgery provides changes in intestinal microbiota, with a relative increase of the Bacteroidetes and Proteobacteria phyla and reduction of Firmicutes. This is possibly due to changes in the gastro-intestinal flux, coupled with a reduction in acidity, in addition to changes in eating habits. The usage of probiotics seems to reduce the gastro-intestinal symptoms in the post-surgery, favor the increase of vitamin B12 synthesis, as well as potentiate weight loss.

[School Food in Brazil and the United States: an integrative review]. / Alimentação Escolar no Brasil e Estados Unidos: uma revisão integrativa.

This paper is an integrative review of the literature that sought to identify the factors that influence the adhesion and acceptance of school food among Brazilian and American students, and to show the main differences between the programs of these two countries. the following databases were consulted: Latin American and Caribbean Health Sciences (Lilacs); Pubmed; Scientific Electronic Library Online (Scielo); and Science Direct. Data were collected between July and August 2015, using the following key words in Portuguese and English: "adherence to school food" (adesão à alimentação escolar), "accepting of school feeding" (aceitação à alimentação escolar) and the "National School Lunch Program" ("Programa Nacional de Alimentação Escolar"). The search resulted in 7 Brazilian articles and 7 Americans articles published between 2004 and 2014, besides the current laws of each program, selected in the electronic sites of agencies responsible for administrating them. After descriptive and comparative analysis, the results revealed that adherence and acceptance are low in both programs, and they are influenced by socioeconomic factors, competitive foods present in the school environment and students' food preferences.

Trata-se de uma revisão integrativa da literatura que teve como objetivo identificar os fatores que influenciam a adesão e a aceitação da alimentação escolar entre estudantes brasileiros e americanos, e apontar as principais diferenças entre os programas desses dois países. A busca dos trabalhos científicos foi realizada nas bases de dados da Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Pubmed, Scientific Eletronic Library Online (SciELO) e Science Direct. Os dados foram coletados no período de julho a agosto de 2015, utilizando os seguintes descritores em português e inglês: "adesão à alimentação escolar" (adherence of school feeding), "aceitação à alimentação escolar" (accepting of school feeding), "Programa Nacional de Alimentação Escolar" e "National School Lunch Program". A busca resultou em 07 artigos brasileiros e 07 artigos americanos, publicados entre os períodos de 2004 a 2014, além das legislações vigentes de cada programa, selecionadas nos sites eletrônicos dos órgãos responsáveis pelo gerenciamento dos mesmos. Após análise descritiva e comparativa, os resultados demonstraram que a adesão e a aceitação foram baixas em ambos os programas, e que são influenciadas por fatores socioeconômicos, alimentos competitivos presentes no ambiente escolar e pelas preferências alimentares dos alunos.

Alimentação Escolar no Brasil e Estados Unidos: uma revisão integrativa / School Food in Brazil and the United States: an integrative review

Resumo Trata-se de uma revisão integrativa da literatura que teve como objetivo identificar os fatores que influenciam a adesão e a aceitação da alimentação escolar entre estudantes brasileiros e americanos, e apontar as principais diferenças entre os programas desses dois países. A busca dos trabalhos científicos foi realizada nas bases de dados da Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Pubmed, Scientific Eletronic Library Online (SciELO) e Science Direct. Os dados foram coletados no período de julho a agosto de 2015, utilizando os seguintes descritores em português e inglês: "adesão à alimentação escolar" (adherence of school feeding), "aceitação à alimentação escolar" (accepting of school feeding), "Programa Nacional de Alimentação Escolar" e "National School Lunch Program". A busca resultou em 07 artigos brasileiros e 07 artigos americanos, publicados entre os períodos de 2004 a 2014, além das legislações vigentes de cada programa, selecionadas nos sites eletrônicos dos órgãos responsáveis pelo gerenciamento dos mesmos. Após análise descritiva e comparativa, os resultados demonstraram que a adesão e a aceitação foram baixas em ambos os programas, e que são influenciadas por fatores socioeconômicos, alimentos competitivos presentes no ambiente escolar e pelas preferências alimentares dos alunos.

Abstract This paper is an integrative review of the literature that sought to identify the factors that influence the adhesion and acceptance of school food among Brazilian and American students, and to show the main differences between the programs of these two countries. the following databases were consulted: Latin American and Caribbean Health Sciences (Lilacs); Pubmed; Scientific Electronic Library Online (Scielo); and Science Direct. Data were collected between July and August 2015, using the following key words in Portuguese and English: "adherence to school food" (adesão à alimentação escolar), "accepting of school feeding" (aceitação à alimentação escolar) and the "National School Lunch Program" ("Programa Nacional de Alimentação Escolar"). The search resulted in 7 Brazilian articles and 7 Americans articles published between 2004 and 2014, besides the current laws of each program, selected in the electronic sites of agencies responsible for administrating them. After descriptive and comparative analysis, the results revealed that adherence and acceptance are low in both programs, and they are influenced by socioeconomic factors, competitive foods present in the school environment and students' food preferences.