Nutritional Interventions for the Prevention of Cognitive Decline in Patients With Mild Cognitive Impairment and Alzheimer Disease: Protocol for a Network Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Mild cognitive impairment (MCI) is the stage between cognitive decline due to physiological aging and the severity of decline seen in neurodegenerative disorders like Alzheimer disease (AD), which is among the most prevalent neurodegenerative disorders characterized by cognitive impairment. People with MCI are at increased risk of developing AD. Although MCI and AD are incurable, nutritional interventions can potentially delay or prevent their onset. Consequently, effective interventions used to decelerate or alleviate the progress of cognitive impairment in older people are a significant focus in geriatric care. Given the synergistic effects of nutrition on health, assessing the effectiveness of nutritional supplements or dietary composition in preventing MCI or AD is essential for developing interventional strategies. OBJECTIVE: Our study aims to assess the effectiveness of various nutritional interventions, including special dietary types, dietary patterns, specific foods, nutritional intake, and nutritional supplements, in preventing cognitive decline among patients diagnosed with MCI or AD. To achieve this, we will use a comprehensive approach, including network meta-analysis, pairwise meta-analysis, and systematic review of randomized controlled trials (RCTs). METHODS: The review will follow the Population, Intervention, Comparison, Outcome (PICO) model and the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. Two investigators will independently search PubMed electronically. Data extraction will follow the inclusion criteria, and data will be assessed for risk of bias using a revised tool. Additionally, evidence quality will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. The outcomes of interest are assessing the cognitive outcomes in patients with MCI or AD. A systematic literature search will be conducted, identifying randomized controlled trials that investigate the impact of these nutritional interventions on cognitive function decline in individuals with MCI and AD. Network meta-analyses (random-effects model) and pairwise meta-analyses will then estimate the relative effectiveness of different nutritional interventions. RESULTS: We included 51 studies, published between 1999 and 2023 (27 studies for AD and 24 studies for MCI) and involving 8420 participants. We completed data extraction for all 51 studies by December 2023. Currently, we are actively engaged in data analysis and manuscript preparation. We plan to finalize the manuscript and publish the comprehensive results by the end of 2024. CONCLUSIONS: Our study holds significant clinical relevance given the rising prevalence of AD and the potential influence of nutritional interventions on cognitive function in individuals with MCI and AD. By investigating this relationship, our research aims to inform evidence-based decision-making in the development of prevention strategies for MCI and AD. The outcomes are expected to contribute to the establishment of reliable recommendations for MCI or AD management, providing substantial support in the field. TRIAL REGISTRATION: PROSPERO CRD42022331173; http://tinyurl.com/3snjp7a4. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/47196.

Características clínicas e fonoaudiológicas de neonatos hospitalizados em uma Unidade de Tratamento Intensivo neonatal com suspeita de doença genética / Clinical and speech-language pathology characteristics of neonates hospitalized in a neonatal Intensive Care Unit with suspected genetic disease / Características clínicas y de patología del habla y lenguaje de neonatos hospitalizados en una Unidad de Cuidados Intensivos neonatales con sospecha de enfermedad genética

Introdução: A prematuridade é um fator de risco para o crescimento e o desenvolvimento dos neonatos. Objetivo: Analisar as características clinicas e fonoaudiológicas de neonatos hospitalizados na unidade de tratamento intensivo (UTI) neonatal com suspeita de doença genética. Material e Método:Estudo transversal descritivo, conduzido em um hospital na região sul do Brasil com coleta de dados entre novembro de 2020 e setembro de 2021. Todos os neonatos que se encontravam internados na UTI, atendidos pelo Sistema Único de Saúde e que apresentavam suspeita de etiologias genéticas foram acompanhados pela equipe de Fonoaudiologia. Foram analisados todos os prontuários dos recém-nascidos com suspeita de alteração genética, extraindo-se os dados médicos e fonoaudiológicos. Resultados:A amostra foi constituída por 14 neonatos prematuros com média de idade gestacional de 36 semanas e 5 dias e uma média de tempo de nascimento, no momento da avaliação fonoaudiológica, de 14,6 dias de vida. No que se refere às comorbidades, 71,4% dos recém-nascidos apresentavam alguma malformação, sendo múltiplas na maior parte dos casos (64,29%). Todos os neonatos estavam fazendo uso de via enteral de alimentação durante a avaliação fonoaudiológica. Na avaliação de reflexos orais, observou-se que houve um predomínio de pacientes com reflexo de procura débil, sendo que a maior parte apresentava reflexo de sucção presente. Conclusões: Pode-se afirmar que, neste estudo, a amostra foi composta por pacientes principalmente prematuros que apresentavam malformações múltiplas e que todos faziam uso de via alternativa de alimentação sugerindo, assim, a necessidade de atendimento fonoaudiológico como parte da assistência multidisciplinar desses neonatos. (AU)

Introduction: Prematurity is a risk factor for the growth and development of neonates. Objective: To analyze clinical and speech therapy characteristics of neonates hospitalized in the neonatal intensive care unit with suspected genetic disease. Method: Descriptive cross-sectional study conducted in a hospital in southern Brazil with data collection between November 2020 and September 2021. All neonates who were hospitalized in the ICU attended by the public health system and who were suspected of having genetic etiologies were followed up by the Speech-Language Pathology team. All newborn`s medical records with suspected genetic alterations were analyzed and the medical and the speech-language pathology data were analyzed. Results: The sample consisted of 14 premature neonates with a mean gestational age of 36 weeks and 5 days and a mean time of birth, at the time of the speech-language pathology assessment, of 14.6 days of life. Regarding to comorbidities, 71.4% of newborns had some malformation, being multiple in most cases (64.29%). All neonates were using enteral feeding at the time of the speech-language evaluation. At the oral reflexes evaluation it was observed that there was a predominance of patients with a weak rooting reflex and most of them had a present sucking reflex. Conclusions: In this study the sample consisted of mainly premature patients who had multiple malformations and all of them used an alternative feeding route, thus suggesting the demand for speech therapy as part of the multidisciplinary care of these neonates. (AU)

Introducción: La prematuridad es un factor de riesgo para el crecimiento y desarrollo de los recién nacidos. Objetivo: Analizar las características clinicas y de terapia del habla de recién nacidos hospitalizados en la unidad de cuidados intensivos neonatales (UCI) con sospecha de enfermedad genética. Método: Estudio transversal descriptivo realizado en un hospital en la región del Sur de Brasil. Todos los recién nacidos que fueron hospitalizados en la UTI y que tenían sospecha de tener etiologías genéticas, fueron atendidos por el equipo de Patología del Habla y Lenguaje. Se analizaron todas las historias clínicas de los recién nacidos con sospecha de alteraciones genéticas, extrayéndose datos médicos y de patología del habla y del lenguaje. Resultados: La muestra estuvo constituida por 14 neonatos prematuros con una edad gestacional media de 36 semanas. En cuanto a las comorbilidades, el 71,4% de los recién nacidos presentó alguna malformación, siendo múltiples en la mayoría de los casos (64,29%). Con respecto a los datos de la evaluación de la patología del habla y el lenguaje, todos los recién nacidos estaban usando alimentación enteral. En la evaluación de los reflejos orales, se observó que hubo un predominio de pacientes con reflejo de búsqueda débil, y la mayoría de ellos tenían presente el reflejo de succión. Conclusiones: Se puede decir que en este estudio la muestra estuvo compuesta principalmente por pacientes prematuros, que presentaban plurimalformaciones y que todos utilizaban una vía alternativa de alimentación, sugiriendo así, la necesidad de la fonoaudiología como parte del cuidado multidisciplinario de estos neonatos. (AU)

Improving complementary feeding practice and child growth in Indonesia through family empowerment intervention.

Objectives: This study aimed to evaluate the effectiveness of family empowerment intervention in improving complementary feeding practices and child growth in Indonesia. METHODS: A quasi-experimental design was used to gather data from 60 mothers and their youngest children, aged 6-11 months, who participated in this project from two urban areas in Surabaya, East Java, Indonesia. The independent variable was an eleven-week family empowerment intervention, including pre- and post-test. The dependent variable was complementary feeding practice and child growth. Complementary feeding practice indicators consist of minimum dietary diversity (MDD), meal frequency (MMF), acceptable diet (MAD), energy, protein, and zinc adequacy, assessed using a 3x24 hour food recall. Child growth indicators consist of weight-for-age (WAZ), length/height-for-age (HAZ), and weight-for-length/height (WHZ) measured using an infantometer and baby scales. The data obtained were then analysed using the McNemar test, the Wilcoxon Signed-Rank test, and the Mann Whitney U test, with a significance level of a<0.05. RESULTS: Family empowerment intervention significantly improved complementary feeding practice indicators, including MDD, MMF, MAD, energy, protein, and zinc adequacy. It also significantly increased the child's WAZ, HAZ, and WHZ scores (p<0.05). CONCLUSIONS: The family empowerment intervention can be used as a nursing intervention to improve a family's ability to provide appropriate complementary feeding practices and support a child's optimal growth.

Síntomas de estreñimiento funcional y métodos de alimentación complementaria: ensayo clínico aleatorizado / Functional constipation symptoms and complementary feeding methods: A randomized clinical trial

Introducción: El objetivo del estudio fue investigar el impacto de diferentes métodos de alimentación complementaria en la prevalencia de síntomas de estreñimiento funcional en lactantes a los 12 meses de edad. Materiales y métodos: Ensayo clínico aleatorizado realizado en díadas madre-lactante sometidas a intervención a los 5,5 meses del nacimiento, con asignación aleatoria a uno de los tres métodos de introducción de sólidos: destete dirigido por la madre, o parent-led weaning (PLW), método Baby-Led Introduction to Solids (BLISS) dirigido por el lactante, y mixto. Los síntomas de estreñimiento se evaluaron a los 12 meses mediante un cuestionario en línea basado en los criterios diagnósticos de Roma IV y adaptado a la muestra. Los análisis se realizaron mediante la prueba χ2 y los datos se expresaron como frecuencias absolutas y porcentajes. El proyecto fue aprobado por el comité de ética del Hospital de Clínicas de Porto Alegre con el número 2019-0230. Resultados: Se analizaron los datos de 135 lactantes, 45 asignados al método PLW, 48 al BLISS y 42 al método mixto. La prevalencia de síntomas de estreñimiento fue del 49,6% en la muestra global (n=67), siendo del 60% (n=27) en el método PLW, 47,9% (n=23) en el BLISS y 40,5% (n=17) en el mixto. No hubo asociación entre los síntomas de estreñimiento funcional y el método de introducción de la alimentación complementaria (p=0,183). Conclusiones: La prevalencia de estreñimiento y sus síntomas fue alta en la población estudiada. La prevalencia de los síntomas de estreñimiento funcional no se asoció con el método de alimentación complementaria. (AU)

Introduction: The aim of the study was to investigate the impact of different complementary feeding methods on the prevalence of functional constipation symptoms in infants at 12 months of age. Material and methods: Randomized clinical trial in mother–infant dyads that underwent the intervention at 5.5 months post birth, randomly allocated to one of three complementary food introduction methods: PLW (parent-led weaning), baby-led introduction to solids (BLISS) and a mixed approach. The symptoms of constipation were assessed at 12 months with an online questionnaire based on the Rome IV diagnostic criteria and adapted to our sample. The data were summarised as absolute frequencies and percentages and compared by means of the χ2 test. The project was approved by the ethics committee of the Hospital de Clínicas de Porto Alegre under number 2019-0230. Results: We analysed data corresponding to 135 infants, 45 allocated to PLW, 48 to BLISS and 42 to the mixed approach. The prevalence of constipation symptoms was 49.6% in the overall sample (n=67), 60% (n=27) in the PLW group, 47.9% (n=23) in the BLISS group and 40.5% (n=17) in the mixed approach group. We found no association between functional constipation symptoms and the method used to introduce complementary foods (P=.183). Conclusions: The prevalence of functional constipation symptoms was high in the study population. The presence of constipation symptoms was not associated with the complementary feeding approach. (AU)

Functional constipation symptoms and complementary feeding methods: A randomized clinical trial.

INTRODUCTION: The aim of the study was to investigate the impact of different complementary feeding methods on the prevalence of functional constipation symptoms in infants at 12 months of age. MATERIAL AND METHODS: Randomized clinical trial in mother-infant dyads that underwent the intervention at 5.5 months post birth, randomly allocated to one of three complementary food introduction methods: PLW (parent-led weaning), Baby-led Introduction to SolidS (BLISS) and a mixed approach. The symptoms of constipation were assessed at 12 months with an online questionnaire based on the Rome IV diagnostic criteria and adapted to our sample. The data were summarised as absolute frequencies and percentages and compared by means of the χ2 test. The project was approved by the ethics committee of the Hospital de Clínicas de Porto Alegre under number 2019-0230. RESULTS: We analysed data corresponding to 135 infants, 45 allocated to PLW, 48 to BLISS and 42 to the mixed approach. The prevalence of constipation symptoms was 49.6% in the overall sample (n = 67), 60% (n = 27) in the PLW group, 47.9% (n = 23) in the BLISS group and 40.5% (n = 17) in the mixed approach group. We found no association between functional constipation symptoms and the method used to introduce complementary foods (P = .183). CONCLUSIONS: The prevalence of functional constipation symptoms was high in the study population. The presence of constipation symptoms was not associated with the complementary feeding approach.

Nutritional Strategies in the Rehabilitation of Musculoskeletal Injuries in Athletes: A Systematic Integrative Review.

It is estimated that three to five million sports injuries occur worldwide each year. The highest incidence is reported during competition periods with mainly affectation of the musculoskeletal tissue. For appropriate nutritional management and correct use of nutritional supplements, it is important to individualize based on clinical effects and know the adaptive response during the rehabilitation phase after a sports injury in athletes. Therefore, the aim of this PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science PERSiST-based systematic integrative review was to perform an update on nutritional strategies during the rehabilitation phase of musculoskeletal injuries in elite athletes. After searching the following databases: PubMed/Medline, Scopus, PEDro, and Google Scholar, a total of 18 studies met the inclusion criteria (Price Index: 66.6%). The risk of bias assessment for randomized controlled trials was performed using the RoB 2.0 tool while review articles were evaluated using the AMSTAR 2.0 items. Based on the main findings of the selected studies, nutritional strategies that benefit the rehabilitation process in injured athletes include balanced energy intake, and a high-protein and carbohydrate-rich diet. Supportive supervision should be provided to avoid low energy availability. The potential of supplementation with collagen, creatine monohydrate, omega-3 (fish oils), and vitamin D requires further research although the effects are quite promising. It is worth noting the lack of clinical research in injured athletes and the higher number of reviews in the last 10 years. After analyzing the current quantitative and non-quantitative evidence, we encourage researchers to conduct further clinical research studies evaluating doses of the discussed nutrients during the rehabilitation process to confirm findings, but also follow international guidelines at the time to review scientific literature.

A thickened formula reduces feeding-associated oxygen desaturation and bradycardia in preterm infants.

BACKGROUND: Although preterm infants often experience desaturation or bradycardia during oral feeding, specific guidelines for its management are lacking. PURPOSE: This study aimed to investigate the effects of a commercial thickened formula (TF) on oxygen saturation and heart rate stabilization during oral feeding in preterm infants. METHODS: This retrospective study included 122 infants born at a median (interquartile range [IQR]) 31+6 weeks (29+4 -34+6 weeks) of gestation weighing 1,725 g (1,353-2,620 g) and fed commercial cornstarch-containing TF due to feeding-associated desaturation or bradycardia. We excluded infants fed TF to treat symptomatic regurgitation. Desaturation and bradycardia events were compared between 3 days prior to the change and 3 days after the change to TF. Desaturation and bradycardia were defined as SpO2 <85% and heart rate <100 beats/min during or immediately after oral bottle feeding, respectively. RESULTS: The median (IQR) postmenstrual age and weight were 36+1 weeks (34+6-38+0 weeks) and 2,395 g (2,160-2,780 g), respectively, at the time of change to TF. The frequency of desaturation significantly decreased after TF feeding (median [IQR]: 2.3 [1.3-3.3] events/day vs. 0.3 [0-1.7] events/day, P< 0.001). Bradycardia also decreased after TF feeding (0.3 [0-1] events/day vs. 0 [0-0.7] events/day, P=0.006). There were no cases of diarrhea or electrolyte abnormalities after TF feeding. Defecation frequency decreased (P=0.037), and polyethylene glycol was prescribed to 27% of the TF-fed infants. In a subgroup analysis of 16 infants with bronchopulmonary dysplasia, the frequency of desaturation was reduced (2.3 [1.8-3.8] events/day vs. 0.5 [0-1.5] events/day, P=0.042), and weight gain improved (22.5 [3.1-36.3] g/day vs. 41.3 [28.1-55.1] g/day, P=0.019), after TF feeding. CONCLUSION: TF feeding significantly reduces oral feeding-associated oxygen desaturation and bradycardia in preterm infants. TF may be useful for stabilizing oxygen saturation and heart rate among preterm infants with difficulties in oral feeding.

The association of maternal sugary beverage consumption during pregnancy and the early years with childhood sugary beverage consumption.

OBJECTIVES: A woman's food choices during pregnancy may be associated with her offspring's food choices. Several studies support an association between childhood sugary beverage (SB) consumption and poor cardiometabolic health. This study aimed to assess the association of maternal SB consumption during pregnancy and later, with her offspring's SB consumption in early infancy and childhood. METHODS: A total of 1945 women and 1595 children participating in 3 Canadian studies reported SB consumption during pregnancy, at 2 years of age, and/or at school age (5 to 8 years old). Mother and offspring SB intakes were self-reported by mothers. Multivariable linear regression analyses were conducted within each cohort and cohort data were combined using fixed effect meta-analyses. RESULTS: Maternal SB consumption during pregnancy was associated with higher offspring SB consumption at 2 years of age (standardized ß = 0.19 predicted change in the number of standard deviations of offspring SB intake for an increase of 1 standard deviation in maternal serving [95% CI: 0.16 to 0.22]). Concurrent maternal SB consumption was associated with higher offspring SB intake when children were aged 5 to 8 years (standardized ß= 0.25 [95% CI: 0.10 to 0.40]). CONCLUSION: Maternal SB consumption during pregnancy is associated with a marginally higher SB intake among their offspring at age 2, and concurrent maternal consumption is associated with a higher SB intake among school-aged offspring (5 to 8 years old). Future interventions tailored for pregnancy and early childrearing years to reduce SB intakes of mothers may reduce young children's SB intake.

RéSUMé: OBJECTIFS: Il peut y avoir un lien entre les choix alimentaires d'une femme pendant la grossesse et ceux de son enfant. Plusieurs études font état d'une association entre la consommation de boissons sucrées (BS) durant l'enfance et la mauvaise santé cardiométabolique. Notre étude visait à évaluer l'association entre la consommation de BS des mères pendant et après la grossesse et la consommation de BS de leurs enfants durant la petite enfance et l'enfance. MéTHODE: En tout, 1 945 femmes et 1 595 enfants participant à 3 études canadiennes ont fait état de leur consommation de BS pendant la grossesse, à l'âge de 2 ans et/ou à l'âge scolaire (5 à 8 ans). La consommation de BS des mères et des enfants a été déclarée par les mères. Des analyses de régression linéaire multivariée ont été menées dans chaque cohorte, et les données des cohortes ont été combinées à l'aide de méta-analyses à effets fixes. RéSULTATS: La consommation maternelle de BS pendant la grossesse était associée à une consommation de BS plus élevée chez les enfants à l'âge de 2 ans (le coefficient ß standardisé = 0,19 prédisait le changement du nombre d'écart-types de consommation de BS chez les enfants pour chaque hausse de 1 écart-type de la portion maternelle [IC de 95 % : 0,16 à 0,22]). La consommation maternelle concomitante de BS était associée à une consommation de BS plus élevée chez les enfants lorsqu'ils étaient âgés de 5 à 8 ans (coefficient ß standardisé = 0,25 [IC de 95 % : 0,10 à 0,40]). CONCLUSION: La consommation maternelle de BS pendant la grossesse est associée à une consommation de BS marginalement plus élevée chez l'enfant à l'âge de 2 ans, et la consommation maternelle concomitante est associée à une consommation de BS plus élevée chez l'enfant d'âge scolaire (5 à 8 ans). De futures interventions visant à réduire la consommation de BS des mères pendant la grossesse et durant les premières années où elles élèvent leurs enfants pourraient réduire la consommation de BS des jeunes enfants.

Edentulism and number of medications are associated with nutritional status in older adults: a population-based cross-sectional study / Edentuslimo e número de medicações estão associados com estado nutricional em idosos: um estudo transversal de base populacional

ABSTRACT Objective: This study evaluated the nutritional status and associated factors among older adults of a southern Brazilian city. Methods: A cross-sectional home-based study, with a probabilistic sample per cluster, was carried out with 282 older adults aged ≥60 years in the city of Veranópolis, Brazil. Through a structured questionnaire, socioeconomic, general and behavioral health aspects were assessed. Nutritional status was assessed using the Mini Nutritional Assessment (MAN®) instrument, categorizing the sample into eutrophic or nutritional risk (risk of malnutrition + malnourished). Oral health was assessed by counting teeth and the use of and need for dental prosthesis. Two independent multivariate models were constructed, using number of daily medication and polypharmacy (≥2 daily medications). Logistic regression was used to verify associations. Results: The prevalence of nutritional risk was 14.5% (N=41). In the final multivariate analysis, users of ≥6 daily medications demonstrated a greater odds ratio (OR) of being at nutritional risk when compared to those who did not use medication daily (OR: 12.16; 95% confidence interval [95%CI]: 1.47 - 100.82). Non-edentulous older adults had 67.7% (p = 0.006) lower OR for nutritional risk when compared to edentulous. Conclusion: The prevalence of nutritional risk was low among this sample, and it was associated with edentulism and number of daily medications.

RESUMO Objetivo: Esse estudo avaliou o estado nutricional e fatores associados em idosos de uma cidade do Sul do Brasil. Métodos: Um estudo transversal de base populacional, com amostragem probabilística por cluster, foi realizado com 282 idosos com idade ≥60 anos na cidade de Veranópolis, Brasil. Por meio de um questionário estruturado, aspectos socioeconômicos, comportamentais e de saúde geral foram aferidos. Estado nutricional foi verificado usando a Mini Avaliação Nutricional (MAN), categorizando a amostra em eutróficos e risco nutricional (risco de desnutrição + desnutridos). Saúde bucal foi verificada pela contagem dos dentes e uso e necessidade de prótese dentária. Dois modelos multivariados independentes foram construídos, utilizando o número de medicações diárias e polifarmácia (≥2 medicamentos por dia). Regressão logística foi utilizada para verificar as associações. Resultados: A prevalência de risco nutricional foi de 14,5% (N=41). Na análise multivariada final, usuários de ≥6 medicamentos por dia demonstraram uma maior razão de chance (RC) de terem risco nutricional quando comparados com aqueles que não utilizaram medicamento diariamente (RC: 12,164; intervalo de confiança de 95% [IC95%]: 1,468 - 100,821). Idosos não edêntulos tiveram 67,7% (p=0,006) menor RC para risco nutricional quando comparados com não edêntulos. Conclusão: A prevalência de risco nutricional foi baixa nessa amostral, ela foi associada com edentulismo e número diário de medicações.

Analysis of muscle fatigue recovery in skiers: a nutritional intervention / Análise na recuperação da fadiga muscular em esquiadores: intervenção nutricional / Análisis en la recuperación de la fatiga muscular en esquiadores: intervención nutricional

ABSTRACT Introduction: Skiing is a sport that demands the high performance of motor coordination with high energy consumption, factors that strongly influence muscle fatigue. Athletes who experience this phenomenon tend to present a decline in performance, generating psychological irritability and impairment in concentration. Diet is closely related to athletic performance, but the proper prescription for skiing athletes still lacks studies. Objective: To explore the methods of recovery from sports fatigue in skiers by providing up-to-date perspectives for effective nutritional intervention during the recovery stage. Methods: Seven young male skiers were selected as research subjects, and caloric intake, among other conditions, was recorded in detail. After three weeks, indices of body weight, body fat rate, serum metabolism, cardiopulmonary capacity, and energy metabolism, among other relevant information, were duly recorded and compared. Results: The intervention did not significantly impact lean body mass indices (p>0.05). The athletes' body weight decreased significantly, and the body fat rate decreased significantly after the nutritional intervention; The analyzed biomarkers were positively impacted, except the urea nitrogen concentration that showed a tendency to increase after the nutritional intervention, an effect that may be linked to the proportional increase of protein intake. Conclusion: The proposed nutritional intervention positively impacted the skiers' energy metabolism, directly impacting the athletes' recovery from sports fatigue. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: O esqui é um esporte que exige alto desempenho de coordenação motora com um elevado consumo de energia, fatores que influenciam fortemente a fadiga muscular. Atletas que experienciam esse fenômeno, tendem a apresentar um declínio no nível do desempenho, gerando irritabilidade psicológica e prejuízos na concentração. A dieta está intimamente relacionada ao desempenho atlético, porém a receita adequada para os atletas em esqui ainda carece de estudos. Objetivo: Explorar os métodos de recuperação da fadiga esportiva nos esquiadores fornecendo perspectivas atualizadas para uma intervenção nutricional eficaz durante a etapa de recuperação. Métodos: Sete jovens esquiadores do sexo masculino foram selecionados como sujeitos da pesquisa, e a ingestão calórica, entre outras condições foram detalhadamente registradas. Após três semanas, índices de peso corporal, taxa de gordura corporal, metabolismo sérico, capacidade cardiopulmonar, metabolismo energético, entre outras informações relevantes foram devidamente registradas e comparadas. Resultados: A intervenção não impactou significativamente nos índices de massa magra corporal (p>0,05). O peso corporal dos atletas diminuiu significativamente e a taxa de gordura corporal diminuiu significativamente após a intervenção nutricional; os biomarcadores analisados foram positivamente impactados, a exceção da concentração de nitrogênio ureico que apresentou tendência de alta após a intervenção nutricional, efeito que pode estar atrelado ao aumento proporcional da ingesta proteica. Conclusão: A proposta de intervenção nutricional apresentou impactos positivos no metabolismo energético dos esquiadores, impactando diretamente na recuperação da fadiga esportiva dos atletas. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: El esquí es un deporte que exige un alto rendimiento de coordinación motora con un elevado consumo de energía, factores que influyen fuertemente en la fatiga muscular. Los deportistas que experimentan este fenómeno, tienden a presentar un descenso en el nivel de rendimiento, generando irritabilidad psicológica y daños en la concentración. La dieta está estrechamente relacionada con el rendimiento deportivo, pero la prescripción adecuada para los atletas de esquí aún carece de estudios. Objetivo: Explorar los métodos de recuperación de la fatiga deportiva en los esquiadores proporcionando perspectivas actualizadas para una intervención nutricional eficaz durante la etapa de recuperación. Métodos: Se seleccionaron siete jóvenes esquiadores varones como sujetos de investigación, y se registró detalladamente la ingesta calórica, entre otras condiciones. Al cabo de tres semanas, se registraron y compararon debidamente los índices de peso corporal, el índice de grasa corporal, el metabolismo sérico, la capacidad cardiopulmonar y el metabolismo energético, entre otros datos relevantes. Resultados: La intervención no tuvo un impacto significativo en los índices de masa corporal magra (p>0,05). El peso corporal de los atletas disminuyó significativamente y el índice de grasa corporal disminuyó significativamente después de la intervención nutricional. Los biomarcadores analizados tuvieron un impacto positivo, con la excepción de la concentración de nitrógeno ureico que mostró una tendencia a aumentar después de la intervención nutricional, efecto que puede estar relacionado con el aumento proporcional de la ingesta de proteínas. Conclusión: La propuesta de intervención nutricional presentó impactos positivos en el metabolismo energético de los esquiadores, impactando directamente en la recuperación de la fatiga deportiva de los atletas. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Prevalence and determinants of complementary feeding indicators in the first year of life in the Southwest of Bahia State / Prevalência e determinantes de indicadores da alimentação complementar no primeiro ano de vida no Sudoeste baiano

Abstract Objectives: to estimate the prevalence of complementary feeding indicators and investigate its determinants. Methods: cross-sectional study with 12-month-old children from Vitória da Conquista, Bahia. The indicators minimum diet diversity, minimum meal frequency and minimally acceptable diet were constructed and adapted to the current recommendations of the food guide for Brazilian children under two years of age. Poisson regression analysis was used, with hierarchical entry of variables in the multivariate model. Results: the prevalence of minimum diet diversity was 38.8%, minimum meal frequency 47.9% and minimally acceptable diet 18.5%. Family income greater than one minimum wage was associated with minimal diet diversity (PR= 1.49; CI95%= 1.39-2.26); receiving guidance on complementary feeding was associated with a minimum meal frequency (PR= 1.37; CI95%= 1.05-1.78); and children who received exclusive breastfeeding for up to 6 months had significantly higher prevalences of all indicators compared to those who did not. Conclusions: low prevalence of complementary feeding indicators was observed. The variables family income, receiving guidance on complementary feeding and offering exclusive breastfeeding for six months were associated with the highest prevalence of the studied indicators.

Resumo Objetivos: estimar as prevalências de indicadores da alimentação complementar e investigar seus determinantes. Métodos: estudo transversal com crianças aos 12 meses de idade do município de Vitória da Conquista, Bahia. Os indicadores diversidade mínima da dieta, frequência mínima de refeição e dieta minimamente aceitável foram construídos e adaptados às atuais recomendações do Guia alimentar para crianças brasileiras menores de dois anos. Utilizou-se análise de regressão de Poisson, com entrada hierarquizada das variáveis no modelo multivariado. Resultados: a prevalência de diversidade mínima da dieta foi de 38,8%, de frequência mínima de refeição 47,9% e de dieta minimamente aceitável 18,5%. A renda familiar maior que um saláriomínimo foi associada a diversidade mínima da dieta (RP= 1,49; IC95%= 1,39-2,26); o recebimento de orientações sobre alimentação complementar associou-se a frequência mínima de refeição (RP=1,37; IC95%= 1,05-1,78); e as crianças que receberam aleitamento materno exclusivo até 6 meses apresentaram prevalências significativamente maiores de todos os indicadores comparadas às que não receberam. Conclusões: foram observadas baixas prevalências dos indicadores da alimentação complementar. As variáveis renda familiar, recebimento de orientações sobre alimentação complementar e a oferta de aleitamento materno exclusivo por seis meses foram associadas as maiores prevalências dos indicadores estudados.

Beneficios del uso del hierro parenteral como alternativa eficaz en el manejo de la anemia gestacional en Colombia / Benefits of the Use of Parenteral Iron as an Efficient Alternative in the Management of Gestational Anemia in Colombia / Benefícios do uso de ferro parenteral como alternativa eficaz no manejo da anemia gestacional na Colômbia

Introducción. La Organización Mundial de la Salud (OMS) estima que más del 40% de las mujeres embarazadas a nivel mundial tienen anemia, y la mitad de estas padecen deficiencia de hierro. La prevalencia en América Latina es del 40% y en Colombia del 44.7%. Fisiológicamente en el embarazo se produce una mal llamada "anemia dilucional", existen condiciones en la embarazada que la predisponen a tener una anemia patológica. Esta última es causada principalmente por un déficit de hierro, de allí la importancia de diagnosticar a tiempo esta entidad e iniciar el manejo. La administración de hierro es la base del tratamiento de la anemia por deficiencia de hierro. Puede ser administrado por vía oral, la cual es la preferida en la mayoría de las pacientes; sin embargo, cuando este no es posible administrarlo, es esencial recurrir al hierro parenteral. No obstante, el hierro parenteral es poco usado como primera línea en el manejo de la anemia gestacional. El presente artículo tiene como objetivo realizar una revisión que permita identificar la terapia con hierro parenteral como una alternativa eficaz de manejo para la anemia gestacional, teniendo en cuenta las características farmacológicas, la administración y el uso entre las diferentes moléculas disponibles en Colombia. Metodología. Corresponde a un estudio de revisión de literatura en bases de datos y bibliotecas electrónicas, los criterios que se tuvieron en cuenta fueron textos publicados entre 1996 y 2020, en español e inglés. Se obtuvo un resultado de 95 artículos, de los cuales se seleccionaron 49. Las palabras clave para su búsqueda fueron fisiología, hierro parenteral, anemia gestacional, déficit de hierro, complicaciones del embarazo, compuestos de hierro, farmacocinética, diagnóstico y tratamiento. División de temas tratados. Fisiología; ayudas diagnósticas; características farmacológicas del hierro parenteral; ventajas, indicaciones y contraindicaciones del hierro parenteral; efectos secundarios y forma de aplicación. Conclusiones. El hierro parenteral es un tratamiento seguro y eficaz para manejar la anemia en el embarazo, se debe tener en cuenta las indicaciones y la farmacología de las moléculas para elegir la más adecuada. Además, repone más rápidamente las reservas de hierro y los niveles de hemoglobina.

Introduction. The World Health Organization (WHO) estimates that more than 40% of pregnant women worldwide have anemia, and that half of them suffer from iron deficiency. The prevalence of this in Latin America is 40%, and in Colombia, 44.7%. Physiologically, a problem called "dilutional anemia" occurs during pregnancy. There are conditions in pregnant women that predispose them to suffering from pathological anemia. The latter is mainly caused by iron deficiency, hence the importance of diagnosing this entity on time and starting treatment. Iron administration is the basis of treatment of anemia caused by iron deficiency. It can be administered orally, which is the preferred option in the majority of patients. However, when this is not possible, parenteral iron must be used. However, parenteral iron is rarely used as the first line of treatment of gestational anemia. The objective of this article is to carry out a review that allows for the identification of therapy with parenteral iron as an efficient alternative for the treatment for gestational anemia, considering the pharmacological characteristics, administration, and use among the different molecules available in Colombia. Methodology. We carried out a search in databases and electronic libraries. The criteria considered were texts published between 1996 and 2020 in Spanish and English. 95 articles were obtained, of which 49 were selected. The keywords for their search were physiology, parenteral iron, gestational anemia, iron deficit, pregnancy complications, iron compounds, pharmacokinetics, diagnosis, and treatment. Division of Covered Topics. Physiology; diagnostic aids; pharmacological characteristics of parenteral iron; advantages, indications, and contraindications of parenteral iron; secondary effects and application method. Conclusions. Parenteral iron is a safe and efficient treatment to handle anemia during pregnancy. The indications and pharmacology of the molecules must be considered to choose the most appropriate option. In addition, it replaces iron reserves and hemoglobin levels more quickly.

Introdução. A Organização Mundial de Saúde (OMS) estima que mais de 40% das mulheres grávidas em todo o mundo são anêmicas, e metade delas sofre de deficiência de ferro. A prevalência na América Latina é de 40% e na Colômbia de 44.7%. Fisiologicamente na gravidez ocorre a chamada "anemia dilucional", e existem condições na gestante que a predispõem a ter uma anemia patológica. Esta última é causada principalmente por deficiência de ferro, daí a importância de diagnosticar esta entidade a tempo e iniciar o manejo. A administração de ferro é a base do tratamento da anemia por deficiência de ferro. Pode ser administrado por via oral, o que é preferido pela maioria das pacientes; porém, quando não for possível administrá-lo dessa forma, é imprescindível recorrer ao ferro parenteral. No entanto, o ferro parenteral é raramente usado como primeira linha no manejo da anemia gestacional. O objetivo deste artigo é realizar uma revisão que permita identificar a terapia com ferro parenteral como uma alternativa eficaz de tratamento da anemia gestacional, levando em consideração as características farmacológicas, administração e uso entre as diferentes moléculas disponíveis na Colômbia. Metodologia. Foi realizada uma busca em bases de dados e bibliotecas eletrônicas, os critérios levados em consideração foram textos publicados entre 1996 e 2020, em espanhol e inglês. Foi obtido um total de 95 artigos, dos quais 49 foram selecionados. As palavras-chave para a busca foram fisiologia, ferro parenteral, anemia gestacional, deficiência de ferro, complicações na gravidez, compostos de ferro, farmacocinética, diagnóstico e tratamento. Divisão dos temas abordados. Fisiologia; auxiliares de diagnóstico; características farmacológicas do ferro parenteral; vantagens, indicações e contraindicações do ferro parenteral; efeitos colaterais e método de aplicação. Conclusões. O ferro parenteral é um tratamento seguro e eficaz para o manejo da anemia na gravidez, as indicações e farmacologia das moléculas devem ser levadas em consideração a fim de escolher a mais adequada. Além disso, reabastece mais rapidamente as reservas de ferro e os níveis de hemoglobina.

[A follow-up study on the introduction of vegetables and fruits during infants aged 4-8 months in Beijing and Chenzhou City of Hunan Province].

OBJECTIVE: To investigate the introduction of vegetables and fruits in 4-8 months old infants, and to describe the maternal and infants' characteristics associated with the introduction of vegetables and fruits. METHODS: Mother-infant dyads (n=228) were recruited from 12 to 16 weeks postpartum and formally entered the study at 4 months of age. Data collected via face to face interview at 4-8 months postpartum, including the timing and types of added vegetables and fruits, as well as a variety of maternal and infant characteristics (n=204). Rank sum test and multiple linear regression were used to analyze the maternal and infant characteristics related to the introduction of vegetables and fruits. RESULTS: The time of introducing vegetables was concentrated at the age of 7 months, and the time of adding fruits was mainly at 6 months. Fruits were added earlier than vegetables (P < 0.001), and the variety of the added fruits was higher than that of vegetables (P=0.045). 48% (n=98) of infants had no more than three types of fruits and vegetables at 8 months. Only 9.8% (n=20) had added more than 10 kinds of fruits and vegetables at 8 months. Green leafy vegetables were the most commonly added vegetable, and apple was the most popular fruit. Compared with women who were 35 years of age or younger, women beyond 35 years old introduced vegetables to their babies 0.6 months later. 4-month-old exclusively breastfed infants had vegetables 0.4 months later than mixed-fed infants. Women with a bachelor's degree or above added 2-3 more types of fruits and vegetables to their babies than those with junior high school education and below. CONCLUSION: The adding time of fruits was earlier than that of vegetable. Apples and green leafy vegetables are commonly added. Women with lower educational backgrounds add fewer types of fruits and vegetables to their babies. Mothers who choose exclusive breastfeeding and those over 35 years of age at childbirth add vegetables to their babies later than others. They should be targeted for health promotion programs that aim to improve the intake of fruits and vegetables among infants.

Knowledge and attitudes towards baby-led-weaning by health professionals and parents: A cross-sectional study.

OBJECTIVE: Baby-led-weaning (BLW) is a novel model of complementary feeding. Although there is little scientific evidence to support the suitability or superiority of this complementary feeding model, BLW is followed by many families today. The aim was to evaluate the knowledge and attitudes of a group of parents and health professionals regarding BLW in Spain. METHODS: This research was designed as a cross-sectional study in a sample of 502 parents and 364 health professionals. Two questionnaires generated and disseminated through Google forms were used. The differences between groups of professionals were analyzed using the Chi-Square test. RESULTS: 92.3% of professionals and 93.4% of parents knew about BLW. They recommend BLW "always" in 39.8% and 69.3% of the cases, and "sometimes" in 49.7% and 24.9%, respectively. Of the health professionals, 80.5% recommended starting complementary feeding as of six months, 36% of them using BLW, 24% followed traditional weaning, 3.3% bottle feeding and the remaining 36% did not indicate. Eighty-three percent recommended chewing as soon as the child showed interest. CONCLUSION: Both health professionals and parents recommend BLW and consider it helps promote the developmental milestones of the baby. Providing nurses with an adequate number of resources to guide parents on complementary feeding will continue to improve childcare.

Breastfeeding in infants seen in private pediatric practices and its relation with type of delivery and history of prematurity

Abstract Objective: To describe the type of milk used to feed infants seen in private pediatric practices in Brazil. To evaluate the relationship between breastfeeding, type of delivery, and history of prematurity. Methods: This is a cross-sectional and observational study that included 4929 infants in the first year of life seen in private pediatric practices in the five geographic regions of Brazil. Mothers provided information about the type of milk used by their infant, the type of delivery (vaginal or cesarean), and whether the birth was premature. Results: Breastfeeding was the only source of milk for 56.1% (1546/2755) of infants in the first six months of life and 32.9% (716/2174) in the second. Of the infants who received other types of milk besides breastfeeding, there was a predominance of infant formula in 98.6% and 93.8% of the infants, respectively, in the first and in the second six months of life. Whole cow's milk was used by 0.7% (20/2755) of infants in the first six months and by 4.1% (90/2174) of infants in the second (p < 0.001). In the first six months of life, breastfeeding as the only type of milk was associated with vaginal delivery (OR = 1.79; p < 0.001) and not having a history of prematurity (OR = 2.48; p < 0.001). Conclusion: Breastfeeding was the only milk source for more than half of infants before 180 days of life. Birth by cesarean section and history of prematurity were negatively associated with breastfeeding as the only source of milk used in infant feeding.

The Impact of Human Milk on Outcomes for Infants with Congenital Heart Disease: A Systematic Review.

Background: Infants with congenital heart disease (CHD) are at risk for feeding-related morbidity and mortality, with growth failure and oral feeding problems associated with poor outcomes. The benefits of human milk (HM) for preterm infants have been well documented, but evidence on HM for infants with CHD has recently begun to emerge. Objectives: Our primary aim was to examine the impact of HM feeding on outcomes for infants with CHD. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, a search was conducted using MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews. The quality of each study was assessed using the Joanna Briggs Critical Appraisal Tools. A total of 16 studies were included. Results: There was evidence that an exclusive HM diet reduces the risk of necrotizing enterocolitis (NEC) for infants with CHD. Evidence with a higher risk for bias indicated that a well-managed HM diet may be associated with improved growth, shorter length of stay, and improved postoperative feeding and nutritional outcomes. Chylothorax outcomes were similar between modified HM and medium-chain triglyceride formula. The studies had significant limitations related to power, lack of control for covariates, and inconsistent delineation of feeding groups. Conclusions: Based on the reduced risk for NEC and given the conclusive benefits in other vulnerable populations, we recommend that clinicians and institutions prioritize programs to support HM feeding for infants with CHD. Large high-quality studies are needed to validate these results. Future work should clarify best practices in managing an HM diet to support optimal growth and development for these infants.

Breastfeeding in infants seen in private pediatric practices and its relation with type of delivery and history of prematurity.

OBJECTIVE: To describe the type of milk used to feed infants seen in private pediatric practices in Brazil. To evaluate the relationship between breastfeeding, type of delivery, and history of prematurity. METHODS: This is a cross-sectional and observational study that included 4929 infants in the first year of life seen in private pediatric practices in the five geographic regions of Brazil. Mothers provided information about the type of milk used by their infant, the type of delivery (vaginal or cesarean), and whether the birth was premature. RESULTS: Breastfeeding was the only source of milk for 56.1% (1546/2755) of infants in the first six months of life and 32.9% (716/2174) in the second. Of the infants who received other types of milk besides breastfeeding, there was a predominance of infant formula in 98.6% and 93.8% of the infants, respectively, in the first and in the second six months of life. Whole cow's milk was used by 0.7% (20/2755) of infants in the first six months and by 4.1% (90/2174) of infants in the second (p < 0.001). In the first six months of life, breastfeeding as the only type of milk was associated with vaginal delivery (OR = 1.79; p < 0.001) and not having a history of prematurity (OR = 2.48; p < 0.001). CONCLUSION: Breastfeeding was the only milk source for more than half of infants before 180 days of life. Birth by cesarean section and history of prematurity were negatively associated with breastfeeding as the only source of milk used in infant feeding.