The Clinical Testing of the Serious Game Digest-Inn: A Tool to Increase Diet Adherence in Overweight Individuals.

Objective: Overweight and obesity are serious health issues often caused by a combination of high-energy consumption and limited physical activity. Diets that focus on limiting the energy intake are effective in the short term, but adherence to a diet is difficult and many individuals drop out prematurely. Materials and Methods: The serious game Digest-Inn is designed to increase diet adherence and to stimulate physical activity. The game was evaluated in three studies, assessing playability (in the general population; N = 76), usefulness (in dietetics practice; N = 7), and effectiveness (in reducing weight in overweight individuals; N = 47). Results: In the 3 studies, in total, 108 individuals played the game. The results show that the game supports dietetics practice and increases the effectiveness of the diet as prescribed by a dietitian. Overweight subjects showed an increased diet adherence (from 45% [in nonplayers] to 100% [in players]), increased weight loss (2.2 kg), and their physical activity was 3800 steps per day, during an average study period of 1 month. Conclusion: These results indicate that the game Digest-Inn is valued by dietitians to support the treatment of overweight clients. The game increases the adherence, and the game mechanics may also be of use for other conditions that suffer from low compliance and treatment adherence.

Effects of eating with an augmented fork with vibrotactile feedback on eating rate and body weight: a randomized controlled trial.

BACKGROUND: Eating rate is a basic determinant of appetite regulation: people who eat more slowly feel sated earlier and eat less. A high eating rate contributes to overeating and potentially to weight gain. Previous studies showed that an augmented fork that delivers real-time feedback on eating rate is a potentially effective intervention to decrease eating rate in naturalistic settings. This study assessed the impact of using the augmented fork during a 15-week period on eating rate and body weight. METHODS: In a parallel randomized controlled trial, 141 participants with overweight (age: 49.2 ± 12.3 y; BMI: 31.5 ± 4.48 kg/m2) were randomized to intervention groups (VFC, n = 51 or VFC+, n = 44) or control group (NFC, n = 46). First, we measured bite rate and success ratio on five consecutive days with the augmented fork without feedback (T1). The intervention groups (VFC, VFC+) then used the same fork, but now received vibrotactile feedback when they ate more than one bite per 10 s. Participants in VFC+ had additional access to a web portal with visual feedback. In the control group (NFC), participants ate with the fork without either feedback. The intervention period lasted four weeks, followed by a week of measurements only (T2) and another measurement week after eight weeks (T3). Body weight was assessed at T1, T2, and T3. RESULTS: Participants in VFC and VFC+ had a lower bite rate (p < .01) and higher success ratio (p < .0001) than those in NFC at T2. This effect persisted at T3. In both intervention groups participants lost more weight than those in the control group at T2 (p < .02), with no rebound at T3. CONCLUSIONS: The findings of this study indicate that an augmented fork with vibrotactile feedback is a viable tool to reduce eating rate in naturalistic settings. Further investigation may confirm that the augmented fork could support long-term weight loss strategies. TRIAL REGISTRATION: The research reported in this manuscript was registered on 4 November 2015 in the Netherlands Trial Register with number NL5432 ( https://www.trialregister.nl/trial/5432 ).

Effectiveness of Low Glycemic Index Diet Consultations Through a Diet Glycemic Assessment App Tool on Maternal and Neonatal Insulin Resistance: A Randomized Controlled Trial.

BACKGROUND: Low glycemic index (LGI) diet has shown to be effective in reducing maternal and neonatal complications in high-risk pregnancies. OBJECTIVE: This trial aimed to examine the effectiveness of individualized LGI diet consultations based on the accurate diet glycemic load (GL) assessment tool on maternal and neonatal insulin resistance levels and diet behavior changes in overweight and obese pregnant women. METHODS: Overweight and obese pregnant women were recruited before 16 weeks of gestation and randomized to the LGI diet arm or the control arm. All participants received standard dietary education according to the Chinese Dietary Guide for Pregnant Women. In the intervention arm, additional individualized dietary GL assessments were performed using an app and instructions of lowering diet glycemic index (GI) to achieve LGI diet were provided by a clinical dietitian at early, middle, and late gestation. Primary outcomes were serum insulin at late gestation, incidence of gestational diabetes mellitus (GDM) for mothers, and cord blood C-peptide level of neonates. RESULTS: In total, 400 subjects were randomized and received different interventions. There were no significant differences in maternal serum insulin levels (13.2 [9.3-13.2] uU/mL vs 12.4 [10.5-12.4] uU/mL), incidence of GDM (45 [22.5%] vs 43 [21.5%]), or cord blood C-peptide levels (mean 0.9ng/mL [SD 0.7] vs mean 0.8ng/mL [SD 0.6]) in the intervention group compared with the controls. The diet GI at late gestation was similar (mean 63.2 [SD 10.4] vs mean 64.3 [SD 10.4]), whereas greater diet fiber intake was observed in the intervention group (mean 11.6 grams [SD 8.0] vs mean 9.0 grams [SD 5.6]; P=.006). Adherence measurements did not significantly differ between 2 groups. CONCLUSIONS: Individualized LGI diet consultations for overweight and obese pregnant women failed to make a significant difference in maternal or neonatal insulin resistance compared with the standard gestational diet consultation. TRIAL REGISTRATION: ClinicalTrials.gov NCT01628835; http://clinicaltrials.gov/ct2/show/NCT01628835 (Archived by WebCite at http://www.webcitation.org/77LHgWP0k).

Image-Based Mobile System for Dietary Management in an American Cardiology Population: Pilot Randomized Controlled Trial to Assess the Efficacy of Dietary Coaching Delivered via a Smartphone App Versus Traditional Counseling.

BACKGROUND: Randomized controlled trials conducted in Mediterranean countries have shown that the Mediterranean diet lowers adverse cardiovascular events. In the American population, diet remains the biggest uncontrolled risk factor for cardiovascular disease. OBJECTIVE: This study aimed to test the hypothesis that asynchronous dietary counseling supplied through a custom smartphone app results in better adherence to a Mediterranean diet in a non-Mediterranean population than traditional standard-of-care (SOC) counseling. METHODS: In total, 100 patients presenting to the cardiology clinic of an academic medical center were randomized to either the SOC or smartphone app-based experimental (EXP) Mediterranean diet intervention after informed consent and 1 hour of individual face-to-face dietary counseling with a registered dietitian. Participants in EXP received a custom smartphone app that reinforced the Mediterranean diet, whereas participants in SOC received 2 additional sessions of in-person dietary counseling with the registered dietitian-30 min at 1 month and 30 min at 3 months. Preexisting knowledge of a Mediterranean diet was measured by the validated Mediterranean Diet Score (MDS) instrument. Baseline height, weight, blood pressure (BP), and laboratory biomarkers were collected. At 1, 3, and 6 months, participants presented for a follow-up appointment to assess compliance to the Mediterranean diet using the MDS as well as a patient satisfaction survey, BP, and weight. Repeat laboratory biomarkers were performed at 3 and 6 months. RESULTS: Enrolled participants had a mean age with SE of 56.6 (SD 1.7) for SOC and 57.2 (SD 1.8) for EXP; 65.3% of SOC and 56.9% of EXP were male, and 20.4% of SOC and 35.3% of EXP had coronary artery disease. There were no significant differences between EXP and SOC with regard to BP, lipid parameters, hemoglobin A1c, or C-reactive protein (CRP). Participants in EXP achieved a significantly greater weight loss on average of 3.3 pounds versus 3.1 pounds for participants in SOC, P=.04. Adherence to the Mediterranean diet increased significantly over time for both groups (P<.001), but there was no significant difference between groups (P=.69). Similarly, there was no significant difference in diet satisfaction between EXP and SOC, although diet satisfaction increased significantly over time for both groups. The proportion of participants with high Mediterranean diet compliance (defined as the MDS ≥9) increased significantly over time (P<.001)-from 18.4% to 57.1% for SOC and 27.5% to 64.7% for EXP; however, there was no significant difference between the groups. CONCLUSIONS: Both traditional SOC counseling and smartphone-based counseling were effective in getting participants to adhere to a Mediterranean diet, and these dietary changes persisted even after counseling had ended. However, neither method was more effective than the other. This pilot study demonstrates that patients can change to and maintain a Mediterranean diet with either traditional or smartphone app-based nutrition counseling. TRIAL REGISTRATION: ClinicalTrials.gov NCT03897426;https://clinicaltrials.gov/ct2/show/NCT03897426.

Efectos del té verde y su contenido de galato de epigalocatequina (EGCG) sobre el peso corporal y la masa grasa en humanos. Una revisión sistemática / Effects of green tea and its epigallocatechin (EGCG) content on body weight and fat mass in humans: a systematic review

La prevalencia e incidencia del sobrepeso y la obesidad continúan en aumento a nivel mundial, así como las enfermedades relacionadas con estas condiciones. Ello se atribuye a un incremento en la ingesta de energía y una disminución en el gasto de la misma. El consumo de té verde se ha relacionado con una reducción en la grasa y el peso corporal. Sin embargo, las investigaciones realizadas con el té verde han sido muy diversas. Esta revisión sistemática explora las investigaciones que se han realizado con té verde y su contenido de galato de epigalocatequina (EGCG) evaluando su efecto sobre la grasa y el peso corporal en humanos. Se realizó una búsqueda en las bases de datos PubMed y Web of Science que dio como primer resultado un total de 424 artículos potenciales. Fueron excluidos 409, por lo que se utilizaron 15 artículos para esta revisión sistemática. Las investigaciones han sido muy diversas; sin embargo, el consumo diario de té verde con dosis de EGCG entre los 100 y los 460 mg/día ha mostrado mayor efectividad sobre la reducción de masa grasa y peso corporal en periodos de intervención de 12 semanas o más. Además, la utilización de dosis de cafeína entre 80 y 300 mg/día ha mostrado ser un factor de importancia para los efectos obtenidos, siempre y cuando los participantes no tuviesen previo a la intervención una ingesta habitual de cafeína alta (> 300 mg/día) (AU)

The prevalence and incidence of overweight and obesity worldwide continues to increase, as well as diseases related to these conditions. This is attributed to an increase in energy intake and a decrease in energy expenditure. Consumption of green tea has been linked to a reduction in body fat and body weight. However, research on green tea has been very diverse. This review assesses the investigations that have been made with green tea and its epigallocatechin gallato (EGCG) content, evaluating its effect on body fat and body weight in humans. A search was made in the PubMed and Web of the Science databases that gave a first total result of 424 potential articles; 409 were excluded and 15 articles were used for this systematic review. Research has been very varied, however, daily consumption of green tea with doses of EGCG between 100 and 460 mg/day has shown greater effectiveness on body fat and body weight reduction in intervention periods of 12 weeks or more. In addition, the use of caffeine doses between 80 and 300 mg/day has been shown to be an important factor for this effects, when the participants did not have a high caffeine intake (> 300 mg/day) prior to the intervention (AU)

Persistent weight loss with a non-invasive novel medical device to change eating behaviour in obese individuals with high-risk cardiovascular risk profile.

In evidence-based weight-loss programs weight regain is common after an initial weight reduction. Eating slowly significantly lowers meal energy intake and hunger ratings. Despite this knowledge, obese individuals do not implement this behaviour. We, thus tested the hypothesis of changing eating behaviour with an intra-oral medical device leading to constant weight reduction in overweight and obesity. Six obese patients (6 men, age 56 ± 14, BMI 29 ± 2 kg / m2) with increased CVRF profile were included in this prospective study. All patients had been treated for obesity during the last 10 years in a single centre and had at least 3 frustrate evidence-based diets. Patients received a novel non-invasive intra-oral medical device to slow eating time. Further advice included not to count calories, to avoid any other form of diet, to take their time with their meals, and to eat whatever they liked. This device was used only during meals for the first 4 to 8 weeks for a total of 88 [20-160] hours. Follow-up period was 23 [15-38] months. During this period, patients lost 11% [5-20%] (p<0.001) of their initial weight. At 12 months, all patients had lost >5%, and 67% (4/6) achieved a >10% bodyweight loss. In the course of the study, altered eating patterns were observed. There were no complications with the medical device. Of note, all patients continued to lose weight after the initial intervention period (p<0.001) and none of them had weight regain. With this medical device, overweight and obese patients with a history of previously frustrating attempts to lose weight achieved a significant and sustained weight loss over two years. These results warrant the ongoing prospective randomised controlled trial to prove concept and mechanism of action. TRIAL REGISTRATION: German Clinical Trials Register DRKS00011357.

Epidemiología de la urolitiasis en España: revisión de los datos demográficos publicados en el período 1977-2016 / Current status of extracorporeal shock wave lithotripsy in urinary lithiasis. Epidemiology of urolithiasis in Spain: review of published demographic data in the period 1977-2016

OBJETIVO: Los datos epidemiológicos sobre urolitiasis en España han aparecido sobre todo en publicaciones de ámbito comarcal y autonómico, siendo escasas las de carácter nacional español. El objetivo de este trabajo es revisar y sistematizar los datos epidemiológicos publicados sobre urolitiasis en España en los distintos trabajos. MÉTODOS: Revisión de las publicaciones en revistas científicas nacionales e internacionales, reuniones y congresos, e informes de investigación (1977-2016). Búsqueda en PubMed (trabajos indexados) y rastreo bibliográfico manual (trabajos no indexados). Datos bibliométricos evaluados: año de publicación, zona geográfica, número de casos, tipo de muestra, diseño del estudio y formato de publicación. Datos demográficos sistematizados: edad, distribución de edad y frecuencia por género, antecedente familiar, estrato social, profesión, lugar de residencia, aspectos étnicos, estacionalidad y hábitos dietéticos. RESULTADOS: Publicaciones revisadas: 79, correspondientes a 56 autores principales. Publicaciones seleccionadas con datos originales: 42 (2 compuestas de parte I y II), correspondientes a 35 autores. Se muestran en tablas los datos bibliométricos y demográficos del conjunto de publicaciones, ordenados por variables. CONCLUSIONES: La revisión completa de trabajos sobre epidemiología en España constituye una base sólida para establecer futuras investigaciones epimiológicas sobre urolitiasis

OBJECTIVE: Epidemiological data on urolithiasis in Spain have appeared in publications especially local and regional level, with few referrals to Spanish national territory. The aim of this paper is to review and systematize the epidemiological data published on urolithiasis in Spain. METHODS: We reviewed publications in national and international scientific journals, meetings and conferences, and research reports (1977-2016). PubMed search (indexed papers) and manual bibliography search (not indexed works) were performed. Bibliometric data evaluated: Year of publication, geographic area, number of cases, sample systematization of data: age, age and frequency distribution by gender, family history, social stratum, profession, place of residence, ethnics, seasonality and dietary habits. RESULTS: Publications revised: 79 corresponding to 56 main authors. Selected publications with original data: 42 (2 composed by Part I and II, and 2 composed by paper and thesis), corresponding to 35 authors. Bibliometric and demographic data of all publications are displayed in tables, sorted by variables. CONCLUSIONS: The comprehensive review of studies on epidemiology in Spain constitutes a solid basis for future research about epidemiology of urolithiasis

Dieta cetogênica clássica e modificada: risco cardiometabólico e potencial terapêutico em pacientes pediátricos com epilepsia refratária / Classic and modified ketogenic diet: cardiometabolic risk and therapeutic potential in pediatric patients with refractory epilepsy

A dieta cetogênica (DC) é um tratamento não farmacológico prescrito especialmente para crianças e adolescentes com epilepsia refratária. A composição da dieta cetogênica é baseada no alto teor de gorduras, baixo teor de carboidratos e teor proteico moderado, sendo a produção de corpos cetônicos o mecanismo provável envolvido no controle das crises epilépticas. Apesar dos benefícios clínicos, a relação entre DC e o risco cardiometabólico não está bem estabelecida, especialmente sob os fatores de risco não clássicos. Objetivo: comparar os efeitos da dieta cetogênica clássica com a dieta cetogênica modificada nas subfrações de LDL e HDL, nos marcadores oxidativos, no perfil de apolipoproteinas e no perfil lipídico de crianças e adolescentes com epilepsia refratária, além do efeito clínico no controle da epilepsia. Métodos: Estudo de intervenção com recrutamento de crianças e adolescentes com epilepsia refratária de 1 a 19 anos de ambos os sexos do Instituto da Criança do Hospital das Clínicas da FMUSP. O grupo controle recebeu DC clássica e o grupo caso recebeu a DC modificada com redução em pelo menos 20% de ácidos graxos saturados (AGS) e redução da relação w6/w3 em pelo menos 50% em comparação a DC clássica. Para ambos os grupos foram analisados os seguintes parâmetros bioquímicos no período basal, após 3 meses e 6 meses de DC: perfil lipídico clássico, concentração de ácidos graxos não esterificados (AGNEs), substâncias reativas ao ácido tiobarbitúrico (TBARs), subfrações de lipoproteina de baixa densidade (LDL) e lipoproteína de alta densidade (HDL), e perfil de apolipoproteínas (APOA-I e APOB). Além da avaliação clínica, antropométrica e de consumo alimentar. Resultados: A redução de crises e dos fármacos antiepilépticos foi semelhante entre os grupos. O aumento na concentração de colesterol total (CT) e LDL foi inferior no grupo caso, a Não-HDL manteve-se significativamente menor no grupo caso em comparação ao grupo controle e a relação LDL/APOB foi superior no grupo controle após 6 meses de DC. O percentual de partículas pequenas de LDL apresentou aumento superior em 208% no grupo controle comparado ao grupo caso, e consequentemente o tamanho de LDL apresentou maior redução no grupo controle. A incidência de dislipidemia foi significativamente inferior no grupo caso considerando os pontos de corte para LDL (>=130 mg/dL) e não-HDL (>=145 mg/dL). Não houve diferença entre os grupos na concentração de ácidos graxos não esterificados (AGNES) e substâncias reativas ao ácido tiobarbitúrico (TBARs). Conclusão: A mudança do perfil de gorduras 10 contribuiu para melhora das concentrações de marcadores de risco cardiometabólico (CT, LDL e LDL pequenas) e consequentemente, perfil mais cardioprotetor nos pacientes do grupo caso

The ketogenic diet (KD) is a non-pharmacological treatment especially prescribed to children and adolescentes with refractory epilepsy. The composition of the ketogenic diet is based on the high fat, low carbohydrate and moderate protein. The production of ketone bodies is the probable mechanism involved in the control of epileptic seizures. Despite the clinical benefits, the relationship between KD and cardiometabolic risk is not well established, especially under non-classical risk factors. Objective: to compare the effects of the classical KD with the modified KD on the LDL and HDL subfractions, in oxidative biomarkers, in apolipoprotein profile and lipid profile of children and adolescentes with refractory epilepsy, as well as the clinical effect on control of seizure. Methods: Dietary intervention study with recruitment of children and adolescentes with refractory epilepsy aged 1 to 19 years of both sexes from the Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da USP. The control group received classical KD and the case group received modified KD with a reduction of at least 20% saturated fatty acids (SFA) and a reduction of the w6/w3 ratio by at least 50% compared to classic KD. For both groups, the following biochemical parameters were analyzed at baseline and after 3 and 6 months of the KD: classical lipid profile, concentration of non-esterified fatty acids (NEFAs), thiobarbituric acid reactive substances (TBARs), low density lipoprotein (LDL) and high density lipoprotein (HDL) subfractions, size LDL, and apolipoprotein profile (APOA-I and APOB). In addition to clinical, anthropometric and food consumption assessment. Results: The reduction of seizures and antiepileptic drugs was similar between the groups. The increase in total cholesterol (TC) and LDL levels was lower in the case group, non-HDL remained significantly lower in the case group compared to the control group and the LDL/APOB ratio was higher in the control group after 6 months of KD. The percentage of small LDL particles showed a 208% higher in the control group than case group. Consequently, the LDL size showed a greater reduction in the control group. The incidence of dyslipidemia was significantly lower in the case group considering cut-off points for LDL (>=130 mg/dL) and non-HDL (>=145 mg/dL). There was no difference between the groups in the NEFAs and TBARs levels. Conclusion: The change in the fatty acids profile contributed to improvement the concentrations of cardiometabolic risk markers (TC, 12 LDL and small LDL), and consequently, a more cardioprotective profile in the patients of case group

Existen diferencias entre las dietas en el peso corporal / There are differences in body weight between diets

Fundamento: La efectividad de las dietas bajas en grasas (DBG) en la pérdida de peso a largo plazo ha sido probada en infinidad de ensayos clínicos aleatorizados (ECA); sin embargo, revisiones recientes muestran resultados discordantes. El objetivo de este estudio es valorar toda la evidencia publicada en forma de ECA sobre si las DBG contribuyen a generar mayor pérdida de peso que aquellas dietas bajas en hidratos de carbono (DBHC) u otras intervenciones dietéticas con mayor contenido graso. étodo: Se hizo una revisión sistemática y metaanálisis con metodología de efectos aleatorios sobre ECA que compararan a largo plazo (≥ 1 año) la DBG y aquellas con alto contenido en grasas, sobre la pérdida de peso, en bases de datos médicas del tipo MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), y la Cochrane Database of Systematic Reviews, sobre estudios publicados hasta julio del 2014. Se excluyeron los ECA si en alguno de los grupos de intervención se incluyó algún componente no dietético relacionado con la pérdida de peso, o suplementos dietéticos o con intervenciones que supusieran cambios en las bebidas o los alimentos. Los objetivos principales fueron las diferencias medias en el cambio de peso entre las intervenciones dietéticas y el mantenimiento del mismo en el tiempo. Se estimaron las diferencias entre las medias ponderadas (DMP) con el método de efectos aleatorios de Der Simonian y Laird. RESULTADOS: Se identificó a 3.517 citaciones, entre las cuales 53 estudios cumplieron los criterios de inclusión, que supuso el análisis de 68.128 individuos (69 comparaciones). Según este, en los ECA con el objetivo de pérdida de peso las DBHC generaron mayor pérdida de peso que las DBG, DMP de 1,15 kg (IC del 95%, 0,52-1,79, 18 comparaciones, I[2]=10%). Las DBG no generaron mayores diferencias en la pérdida de peso cuando se comparaban con otras dietas con mayor contenido en grasa, DMP 0,36kg (IC del 95%, -0,66 a 1,37; 19 comparaciones, I[2]=82%), al tiempo que solo se documentó una mayor reducción del peso cuando las DBG se compararon con una dieta habitual DMP -5,41kg (IC del 95%, -7,29 a -3,54]; I[(2]=68%, 8 comparaciones). De la misma forma, los ECA no realizados para perder peso y los ECA para el mantenimiento del mismo, en los cuales no se hizo una comparación con DBHC, mostraron que la DBG frente a dietas más altas en grasas tuvieron efectos parecidos sobre la pérdida de peso y que las DBG solo redujeron el peso cuando se comparaban con dietas habituales. En ECA para la pérdida de peso, las intervenciones para perder el máximo de grasa generó mayor pérdida de peso que las que menos cuando los grupos difirieron en más de un 5% de las calorías obtenidas a partir de las grasas DMP 1,04kg (IC del 95%, 0,06 a 2,03; I[2]=78%, 18 comparaciones) y cuando la diferencia en el seguimiento entre las concentraciones de triglicéridos del suero entre las 2 intervenciones fue de al menos 0,06mmol/l; DMP 1,38kg (IC del 95%, 0,50 a 2,25; I[2]=62%, 17 comparaciones). CONCLUSIONES: Estos resultados sugieren que a largo plazo el efecto de la DBG sobre el peso corporal depende de la intensidad de la intervención en el grupo con el que se compara. En el momento que se comparan intervenciones de intensidad parecida la evidencia encontrada muestra que los ECA no avalan a las DBG frente a otras intervenciones dietéticas en la pérdida de peso a largo plazo

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Effects of a nutritional intervention in a fast-track program for a colorectal cancer surgery: systematic review / Efectos de la intervención nutricional en los programas fast-track en cirugía de cáncer colorrectal: revisión sistemática

Background and aim: Preoperative nutritional status (NS) has consequences on postoperative (POSTOP) recovery. Our aim was to systematically review the nutritional interventions (NI) in fast-track protocols for colorectal cancer surgery and assess morbidity-mortality and patient´s recovery. Method: Systematic review of scientific literature after consulting bibliographic databases: Medline, The Cochrane Library, Scopus, Embase, Web of Science, Institute for Scientific Information, Latin American and Caribbean Health Sciences Literature, The Cumulative Index to Nursing and Allied Health Literature. MeSH Descriptors: ‘colorectal surgery’, ‘fast-track’, ‘perioperative care’, ‘nutrition therapy’ and ‘enhanced recovery programme’. Filters: ‘humans’, adult (19+ years) and ‘clinical trial’. Variables POSTOP outcomes: bowel recovery (BR), hospital stay (HS), complications and death. Results: Selected studies, 27, had good or excellent methodological quality. From 25 to 597 patients were included. Aged between 16-94 years, men were predominant in 66.6%. NS was evaluated in 13 studies; 7 by body mass index while one by subjective global assessment. One presented POSTOP data. Fast-track groups had solids, liquids or supplements (SS) in prior 2-8 hours. SS were high in carbohydrates, immune-nutrients and non-residue. Free liquids, solids and SS intake was allowed in POSTOP. Half traditional groups fasted between 3-12 hours and resumed POSTOP food intake progressively. Conclusions: Fast-track groups had early BR (p < 0.01). Traditional groups had more infections episodes, deaths and a longer HS. Great variability between NI but had a common item; early intake. Although was seen patient’s recovery. Future studies with detailed NI characteristics are need. Nutritional status must be assessed for a higher acknowledgement of NI impact (AU)

Introducción y objetivo: el estado nutricional (NS) preoperatorio tiene consecuencias sobre la recuperación postoperatoria (POSTOP). El objetivo fue revisar sistemáticamente las intervenciones nutricionales (NI) en los protocolos de fast-track en la cirugía de cáncer colorrectal y evaluar la morbilidad-mortalidad y la recuperación del paciente. Método: revisión sistemática de la literatura científica previa consulta a las bases de datos bibliográficas: Medline, Cochrane Library, Scopus, Embase, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS), The Cumulative Index to Nursing and Allied Health Literature (CINAHL). Descriptores MeSH: ‘colorectal surgery’, ‘fast-track’, ‘perioperative care’, ‘nutrition therapy’ and ‘enhanced recovery programme’. Filtros: ‘humans’, ‘adult (19+ years)’ and ‘clinical trial’. Variables resultados después de la operación: recuperación del intestino (BR), estancia hospitalaria (HS), complicaciones y la muerte. Resultados: los 27 estudios seleccionados tenían buena o excelente calidad metodológica. Incluían desde 25 a 597 pacientes, con edades comprendidas entre 16-94 años; los hombres fueron predominantes en el 66,6%. El estado nutricional se evaluó en 13 estudios; 7 por el índice de masa corporal, mientras que uno lo fue por la evaluación subjetiva general. Uno de ellos presentó datos después de la operación. Los grupos fast-track ingirieron, líquidos o suplementos (SS) en 2-8 horas antes. SS contenían altas cantidades de hidratos de carbono, inmunonutrientes y sin-residuos. En POSTOP se administraron líquidos, sólidos y SS. Los grupos tradicionales estuvieron en ayunas entre 3-12 horas y se reanudó la ingesta de alimentos progresivamente. Conclusiones: los grupos fast-track presentaron BR temprana (p < 0,01), los tradicionales tuvieron más infecciones, muertes y un HS más larga. Se observó gran variabilidad en las NI, pero había un punto común: ingesta temprana. A pesar de que se observó una recuperación del paciente, se necesitan futuros estudios con características de la NI más detalladas. Se debe evaluar el NS para poder reconocer el estado nutricional para un mayor reconocimiento del impacto NI (AU)

Relationship between respiratory and food allergy and evaluation of preventive measures

Food allergy and respiratory allergy are two frequently associated diseases and with an increasing prevalence. Several reports show the presence of respiratory symptoms in patients with food allergy, while certain foods may be related to the development or exacerbation of allergic rhinitis and asthma. The present update focuses on this relationship, revealing a pathogenic and clinical association between food and respiratory allergy. This association is even more intense when the food hypersensitivity is persistent or starts in the early years of life. Food allergy usually precedes respiratory allergy and may be a risk factor for allergic rhinitis and asthma, becoming a relevant clinical marker for severe atopic asthma. Furthermore, the presence of co-existing asthma may enhance life-threatening symptoms occurring during a food allergic reaction. Recommendations for dietary restrictions during pregnancy and breastfeeding to prevent the development of respiratory allergy are controversial and not supported by consistent scientific data. Current recommendations from medical societies propose exclusive breastfeeding during the first four months of life, with the introduction of solid food in the fourth to the seventh month period of life. A delayed introduction of solid food after this period may increase the risk of developing subsequent allergic conditions. Further studies are encouraged to avoid unjustified recommendations involving useless dietary restrictions

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Metabolic Diet App Suite for inborn errors of amino acid metabolism.

BACKGROUND: An increasing number of rare inborn errors of metabolism (IEMs) are amenable to targeted metabolic nutrition therapy. Daily adherence is important to attain metabolic control and prevent organ damage. This is challenging however, given the lack of information of disorder specific nutrient content of foods, the limited availability and cost of specialty products as well as difficulties in reliable calculation and tracking of dietary intake and targets. OBJECTIVES: To develop apps for all inborn errors of amino acid metabolism for which the mainstay of treatment is a medical diet, and obtain patient and family feedback throughout the process to incorporate this into subsequent versions. METHODS & RESULTS: The Metabolic Diet App Suite was created with input from health care professionals as a free, user-friendly, online tool for both mobile devices and desktop computers (http://www.metabolicdietapp.org) for 15 different IEMs. General information is provided for each IEM with links to useful online resources. Nutrient information is based on the MetabolicPro™, a North American food database compiled by the Genetic Metabolic Dietitians International (GMDI) Technology committee. After user registration, a personalized dashboard and management plan including specific nutrient goals are created. Each Diet App has a user-friendly interface and the functions include: nutrient intake counts, adding your own foods and homemade recipes and, managing a daily food diary. Patient and family feedback was overall positive and specific suggestions were used to further improve the App Suite. DISCUSSION: The Metabolic Diet App Suite aids individuals affected by IEMs to track and plan their meals. Future research should evaluate its impact on patient adherence, metabolic control, quality of life and health-related outcomes. The Suite will be updated and expanded to Apps for other categories of IEMs. Finally, this Suite is a support tool only, and does not replace medical/metabolic nutrition professional advice.

Valoración del estado nutricional y del gasto energético en deportistas / Evaluation of nutritional status and energy expenditure in athletes

El ejercicio físico continuo conduce al atleta a mantener un equilibrio inestable entre la ingesta dietética, el gasto de energía y las exigencias adicionales de un alto grado de actividad física. Por lo tanto, una evaluación precisa del estado nutricional es esencial para optimizar el rendimiento, ya que afecta a la salud, la composición corporal, y la recuperación del atleta. Aspectos específicos como tipo de deporte, especialidad o posición de juego, programa de entrenamiento y calendario de competiciones, la categoría, objetivos específicos, que difieran de la población en general, deben ser tenidos en cuenta. La evaluación bioquímica nos puede dar una idea general del estado nutricional, del perfil lipídico, del funcionamiento de hígado o riñón, de si la dieta es demasiado alta en proteínas o grasas, así como las posibles deficiencias nutricionales y la necesidad de suplementación. La cineantropometría deportiva tiene gran utilidad ya que permite la evaluación de la masa corporal, altura, longitud, diámetro, perímetro y pliegues cutáneos, donde la información se procesa mediante la aplicación de diferentes ecuaciones, obteniendo información sobre el somatotipo, la composición corporal y la proporcionalidad de las distintas partes del cuerpo. Para poder dar una orientación nutricional adecuada, las necesidades de energía de los atletas deben ser conocidas. Si la medición objetiva no es posible, existen tablas que incluyen los requerimientos de energía teóricamente establecidos para diferentes deportes. La evaluación dietética debe incluir información sobre el consumo de alimentos y nutrientes para establecer la relación entre la dieta, el estado de salud y el rendimiento del atleta. Por otro lado, un estado adecuado de hidratación en los atletas es esencial para mantener un rendimiento óptimo. Se debe valorar específicamente la ingesta de líquidos por parte del deportista. La deshidratación puede causar efectos nocivos en la salud de los atletas. Como no existe un método «gold standard», la gravidez y el color de la orina son los métodos más extendidos para analizar el estado de hidratación. Hay consenso en que la combinación de diferentes métodos asegura una captura efectiva de datos para la valoración nutricional del deportista que permitirá proceder a la intervención dietética y nutricional (AU)

Continuous physical exercise leads the athlete to maintain an unstable balance between dietary intake, energy expenditure and the additional demands of a high amount of physical activity. Thus, an accurate assessment of nutritional status is essential to optimize the performance, since it affects health, body composition, and the recovery of the athlete. Specific aspects like the type of sport, specialty or playing position, training schedule and competition calendar, category, specific objectives, which differ from the general population, must be considered. A biochemical assessment can give us a general idea of the nutritional status, lipid profile, liver or kidney function, if diet is too high in proteins or fats, as well as possible nutritional deficiencies and the need for supplementation. Sport kinanthropometry has great utility that enables the assessment of body mass, height, length, diameter, perimeter and skinfolds, where information is processed by applying different equations, obtaining information on somatotype, body composition, and the proportionality of different parts of the body. To give proper nutritional counselling, energy needs of the athlete must be known. If objective measurement is not possible, there are tables including theoretically established energy requirements of different sports by different procedures. Dietary assessment should include information about food consumption and nutrient intake to establish the relationship between diet, health status and athlete’s performance. On the other hand, an adequate hydration status in athletes is essential to maintain adequate performance. Hence, the knowledge of fluid intake by the athlete is a matter of the utmost importance. Dehydration can cause harmful effects on athletes’ health. As there is no gold standard, urine gravidity and urine colour are the most extended methods for analyzing hydration status. There is consensus that due to complexity, the combination of different methods assures an effective data collection which will be useful to proceed in dietary and nutritional intervention (AU)

Evidencias científicas sobre la eficacia y seguridad de la dieta proteinada. Dieta proteinada y ejercicio físico / Scientific evidence on the efficacy and safety of dietary protein. protein diet and exercise

La obesidad se ha convertido en una pandemia a nivel mundial, 2,8 millones de personas mueren cada año como resultado de padecer sobrepeso u obesidad, según ha declarado la Organización Mundial de la Salud (OMS). Dentro del marco de las estrategias para combatir la obesidad, encontramos diferentes propuestas dietéticas y de actividad física. En el marco de las dietas muy bajas en calorías (VLCD), encontramos la dieta proteinada, una variedad de dieta cetogénica (KD) con un aporte mínimo de grasas, de acuerdo a las indicaciones del grupo de consenso y cooperación de los estados miembros en materia de examen científico sobre cuestiones relacionadas con los alimentos (SCOOP) para la aplicación de una dieta muy baja en calorías. El objetivo de esta revisión científica es recopilar las evidencias científicas que valoren la efectividad, seguridad y mantenimiento a largo plazo de los efectos de las VLCD, y en concreto de la dieta proteinada, aplicada en el marco de un método multidisciplinar como el método Pronokal®, sobre el sobrepeso y la obesidad y su relación con el ejercicio físico (AU)

Obesity has become a global pandemic, 2.8 million people die each year as a result of being overweight or obese, as declared by the World Health Organization (WHO). There are different approaches in the field of nutrition and physical activity to combat obesity. In the context of very low calorie diets (VLCD), we found the protein diet, a variety of ketogenic diet (KD) with a low fat content, according to the guidelines made by the commission and co-operation by the member states in the scientific examination of questions related to food (SCOOP) for the application of a very low calorie diet. The aim of this review is to provide scientific evidence to assess the effectiveness, safety and long-term maintenance of the effects of VLCD, and specifically protein diet, applied in the context of a multidisciplinary approach as the method Pronokal®, on overweight and obesity and its relationship with exercise (AU)

Water intake adequacy and dietary sources in schoolchildren from Madrid by physical activity level / Adecuación de la ingesta de agua y fuentes dietéticas en escolares de Madrid en función del nivel de actividad física

Introduction: Inadequate fluid intake may contribute to lower cognitive and exercise performance in children. Objective: To evaluate the adequacy of water intake and dietary sources in schoolchildren from the Community of Madrid by physical activity level. Methods: 564 schoolchildren (258 boys and 306 girls) aged between 9 and 12 were studied. Dietary data was obtained by applying a food intake record (3 days) and the weighing method. Water intake was compared with the adequate intake established by the EFSA. Physical activity level was obtained by applying a questionnaire and criteria established by IOM. All calculations were made using SPSS (v19.0) and statistical significance was set at p < 0.05. Results: Three point five percent of schoolchildren had a sedentary level (S), 77.7% had a low active level (LA) and 18.8% had an active level (A). Mean total water intake was 1,504.6 ± 329.35 mL/day (S: 1,526.3 ± 386.05 mL/day, LA: 1,504.8 ± 326.17 s and A: 1,499.3 ± 334.27 mL/day; p > 0.05). Ninety-one percent of the studied children did not meet the adequate intake for total water intake (S: 90%, LA: 91.1% and A: 90.6%; p > 0.05). The major dietary sources were beverages (S: 48.92%, LA: 40.05%, A: 38.63%), dairy products (S: 22.45%, LA: 27.06%, A: 28.268%), fruits (S: 7.98%, LA: 10.69%, A: 10.93%) and vegetables (S: 8.74%, LA: 9.38%, A: 9.34%). Conclusions: Most of the studied children had an inadequate water intake, independently of physical activity level. Main water food sources were beverages (not including milk or dairy drinks), dairy products, fruits and vegetables. It would be advisable to increase the intake of water through beverages and water-rich foods (AU)

Introducción: El consumo inadecuado de líquidos puede provocar un menor rendimiento cognitivo y deportivo en los niños. Objetivo: Evaluar la adecuación de la ingesta de agua y determinar sus fuentes dietéticas en escolares de la Comunidad de Madrid en función del nivel de actividad física. Material y Métodos: Se estudiaron 564 escolares (258 varones y 306 niñas) de 9 a 12 años. La ingesta de agua y las fuentes dietéticas se obtuvieron aplicando el registro de consumo de alimentos durante 3 días y por pesada precisa. La ingesta de agua se comparó con la ingesta adecuada propuesta por la EFSA. El nivel de actividad física se obtuvo aplicando un cuestionario y los criterios establecidos por el IOM. El análisis estadístico se realizó mediante el SPSS (versión 19.0). Se consideran significativas las diferencias con p < 0,05. Resultados: El 3,5% de los escolares estudiados fueron sedentarios (S), 77,7% poco activos (PA) y el 18,8% activos (A). La ingesta media de agua total de los escolares estudiados fue de 1.504,6 ± 329,35 mL/día (S: 1.526,3 ± 386,05 mL/día, PA: 1.504,8 ± 326,17 mL/día y A: 1.499,3 ± 334,27 mL/día; p > 0,05). El 91% de los escolares estudiados no alcanzaron a cubrir la ingesta adecuada para la ingesta total de agua (S: 90%, PA: 91,1% y A: 90,6%; p > 0,05). Las principales fuentes dietéticas fueron bebidas (S: 48,92%, PA: 40,05%, A: 38,63%), lácteos (S: 22,45%, PA: 27,06%, A: 28,26%), frutas (S: 7,98%, PA: 10,69%, A: 10,93%) y verduras (S: 8,74%, PA: 9,38%, A: 9,34%). Conclusiones: La ingesta de agua fue inadecuada en la mayoría de los escolares estudiados, independientemente del nivel de actividad física. Las principales fuentes de agua fueron las bebidas (sin incluir leche o bebidas lácteas), lácteos, frutas y verduras. Sería recomendable aumentar el consumo de agua a través de alimentos con alto contenido de agua (AU)

¿Qué recomendaciones dietéticas debemos dar a nuestros pacientes con hiperuricemia para prevenir las crisis gotosas? / No disponible

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25 años de investigación en nutrición y alimentación en el espacio iberoamericano del conocimiento / 25 years in nutrition and food research in the iberoamerican knowledge área

Introducción: La investigación suele considerarse un indicador del grado de desarrollo. La investigación de un área problemática como la alimentación y nutrición para una determinada región, debería tener un impacto sobre la producción científica en consonancia con la importancia del problema, la capacidad investigadora y los recursos disponibles para generar dicha investigación. Objetivo: Conocer algunos indicadores de la investigación iberoamericana en nutrición y alimentación. Método: Estudio retrospectivo de la producción científica iberoamericana en nutrición y alimentación en los últimos 25 años. Los datos se obtuvieron de la base bibliográfica Science Citation Index Expanded (SCI), Journal Citation Reports Database. Science edition 2011 (Web of Knowledge, Thomson Reuters), y la base de datos del Banco Mundial. Resultados: Se registraron 49.808 artículos, el 3,20% de la producción en Ciencias de la Salud recogida en SCI. La evolución se ajustó al modelo exponencial, N&D (R2 0,962) y FS&T (R2 0,995). La producción media en N&D por población media fue mayor en España con 0,659 artículos/millón. Los mayores índices de productividad y rentabilidad se presentaron en Guatemala 12,963 artículos/1.000 investigadores, y 1,486 artículos/ millón $ respectivamente. La producción media en FS&T de los países por población media fue mayor en Cuba con 21,624 artículos/millón. El índice de productividad fue mayor en Uruguay con 25,999 artículos/mil investigadores. El índice de rentabilidad fue mayor en Guatemala con 0,271 artículos/ millón $. Conclusiones: Existe crecimiento exponencial en las dos categorías estudiadas, N&D y FS&T. La productividad y rentabilidad fue mayor en países con bajo presupuesto en I+D (AU)

Introduction: Research is usually considered a reliable indicator of the degree of development. Research in a problematic area such as food and nutrition for a given region, should have an impact on scientific production in agreement with the importance of the problem, the research capacity and the available resources for generating such a research. Objective: To identify some indicators of Iberoamerican research in nutrition and food. Method: Retrospective study of Iberoamerican scientific production in nutrition and food in the last 25 years. The data were obtained from the bibliographic database Science Citation Index Expanded, Journal Citation Reports Science Edition Database 2011, both included in the Web of Knowledge (Thomson Reuters), and the database of the World Bank. Results: 49,808 papers were registered, the 3.20% of the Health Sciences collection in SCI. The evolution was fitted to an exponential model, N&D (R2 0.962) and FS&T (R2 0.995). The average production in N&D per average population was higher in Spain with 0.659 papers/million. The highest rates of productivity and profitability were f oundin Guatemala with 12.963 papers/1000 researchers and 1.486 papers/million $ respectively. The average production in FS&T of the different countries per average population was higher in Cuba with 21.624 papers/million. The productivity index was higher in Uruguay with 25.999 papers/thousand researchers. The profitability index was higher in Guatemala with 0.271 papers/million $. Conclusion: There is exponential growth in the two categories studied N&D and FS&T. Productivity and profitability was higher in countries with low R&D (Research & Development) budget (AU)

Diagnóstico y tratamiento de la hipercolesterolemia familiar / Diagnosis and treatment of familial hypercholesterolemia

La hipercolesterolemia familiar es la enfermedad hereditaria monogénica más frecuente. Se transmite de forma autosómica dominante y se caracteriza por cifras de colesterol unido a lipoproteínas de baja densidad (cLDL) muy elevadas, con posibilidad de presentar depósitos en distintos tejidos. Su presencia entraña un elevado riesgo vascular y un acortamiento de las expectativas de vida si no se trata adecuadamente. Es necesario, por tanto, diseñar estrategias de detección precoz en la población que nos permitan iniciar el tratamiento en edades tempranas de la vida. El riesgo vascular se estima por métodos distintos de los aceptados para la población general debido a las peculiaridades que presentan. El tratamiento con fármacos (fundamentalmente estatinas) es prácticamente obligado para la totalidad de personas afectadas, a causa de los valores de cLDL tan elevados que suelen presentar. El tratamiento farmacológico se ha mostrado seguro y eficaz para prevenir las complicaciones vasculares que amenazan a este colectivo (AU)

Familial hypercholesterolemia is the most frequent monogenetic disease. The mode of transmission is autosomal dominant. This disease is characterized by severe elevations of low-density lipoprotein cholesterol (LDLc), with the possibility of deposits in different tissues. Unless treated appropriately, this disorder carries a high risk of vascular complications and shortened life expectancy. Therefore, strategies for its early detection in the population should be designed to allow early treatment in affected individuals at young ages. Due to the peculiarities of this disease, vascular risk is estimated by methods that differ from those used in the general population. Drug treatment (mainly statins) is almost mandatory in all affected individuals due to their extremely high LDL-c levels. This type of treatment has been shown to be safe and effective in preventing the vascular complications for which this population is at risk (AU)

Papel del azúcar en el tratamiento de la obesidad / No disponible

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