Alimentação e nutrição na atenção primária à saúde

Com o objetivo de construir um arcabouço conceitual de Nutrição na Atenção Primária em Saúde (APS) e apontar cenários futuros, estão sendo elaborados dois documentos que subsidiarão a atualização da Matriz de ações de alimentação e nutrição na APS. Este Webinário traz para o debate as recomendações e possibilidades para avançar nas ações de A&N e apresenta algumas experiências empiricamente qualificadas como exitosas no intuito de que o compartilhamento das mesmas possa fortalecer a qualificação e efetividade desse cuidado.

Intervenciones para aumentar la adherencia a la suplementación de hierro en menores de 5 años / Interventions to increase adherence to Hierro supplementation for children under 5 years old

INTRODUCCIÓN: La anemia se define como una reducción de la hemoglobina por debajo del rango de normalidad, lo cual dependerá del sexo, la edad y la altitud a la que se encuentre la persona. Al 2011, a nivel mundial se documentó una prevalencia promedio del 43% en niños menores de 5 años (1). Existen diversas causas por las que se origina la anemia; siendo la causa más común la deficiencia de hierro (2). La anemia por deficiencia de hierro acarrea diversas consecuencias dado que el hierro es esencial para el funcionamiento y el metabolismo de las neuronas. Un estudio evidenció una afectación del desarrollo psicomotor en aquellos niños que padecían anemia por deficiencia de hierro (3). También se ha documentado una asociación entre la deficiencia de hierro y el trastorno por déficit de atención con hiperactividad (4). Sin duda estas consecuencias a nivel individual impactan el desarrollo del país. Un estudio realizado en Perú demostró que el costo per cápita por la pérdida cognitiva asociada a la anemia es de s/. 44,38, lo que equivale al 0,33% del PBI per cápita. En ese sentido, prevenir la anemia en esta población es de suma importancia. En el año 2001, la Organización Mundial de la Salud (OMS) presentó un documento en el cual se establecen estrategias para prevenir la anemia por deficiencia de hierro; considerando así los siguientes enfoques: alimentación (mejoramiento de la dieta, fortificación de alimentos) y suplementación con hierro (6). En el año 2016, la OMS publicó una guía global basada en evidencia, en la cual recomienda la administración diaria preventiva de suplementos de hierro durante tres meses consecutivos en un año en áreas donde la prevalencia de anemia es por encima del 40%. Adicionalmente, se menciona que en caso la prevalencia de anemia sea entre 20 y 40%, se pueden ser considerados esquemas intermitentes. En tanto, si el niño es diagnosticado con anemia, la Guía indica que se deben seguir las pautas nacionales para el tratamiento respectivo (7). OBJETIVOS: Objetivo general: Evaluar las evidencias existentes sobre las estrategias de intervención para aumentar la adherencia a la suplementación de hierro en menores de 5 años. Objetivos específicos: Realizar una búsqueda sistemática de la evidencia en diversas bases electrónicas considerando los criterios de elegibilidad. Sintetizar los hallazgos a partir de los estudios seleccionados. METODOLOGÍA: La presente revisión ha seguido la guía para reportar revisiones sistemáticas de "Preferred Reporting Items for Systematic reviews and Meta-Analysis" (PRISMA) y ha sido elaborada en el marco de la elaboración de una Guía de Práctica Clínica nacional para el manejo de anemia por deficiencia de hierro. RESULTADOS: Se identificaron 842 registros para realizar la lectura de títulos y resúmenes. Se excluyeron 129 registros duplicados y quedaron 713, de estos, 3 fueron seleccionados para la revisión a texto completo. Finalmente, dos de ellos fueron excluidos, uno porque no se encontró y otro porque no se diseñó una intervención específica para mejorar la adherencia de un suplemento, sino se compararon dos tipos de suplementos. CONCLUSIONES: Se identificó un solo estudio, probablemente, debido a la complejidad para evaluar la adherencia a la suplementación en niños. El estudio identificado fue de tipo controlado aleatorizado y realizó una evaluación del uso de recordatorio por mensajes de texto dirigidos a cuidadores para mejorar la adherencia a la suplementación con sobres de micronutrientes en niños entre 6 y 12 meses. Se encontró que el uso de los recordatorios por mensajes de texto tiene un efecto sobre la mejora de la adherencia a la suplementación con sobres de micronutrientes. Adicionalmente, se pudo evidenciar que este tipo de intervención también produce una reducción de la prevalencia de anemia.

Suplementação nutricional oral para pacientes clínicos ou cirúrgicos desnutridos ou em risco de desnutrição / Oral nutritional supplementation for patients malnourished clinical or surgical malnutrition

INTRODUÇÃO: A desnutrição, uma das condições clínicas mais comuns no ambiente hospitalar, é considerada um estado secundário a uma deficiência, causada pelo desequilíbrio energético e frequentemente associada ao aumento de morbimortalidade, aumento de complicações e prognóstico desfavorável dos pacientes internados. Estima-se uma ocorrência em aproximadamente 30% dos pacientes hospitalizados no oeste da Europa e cerca de 50% dos pacientes hospitalizados na América Latina e Brasil. Em um grande estudo epidemiológico multicêntrico, conduzido em 2001, denominado IBRANUTRI, foi identificada no Brasil uma prevalência de desnutrição em pacientes internados de 48,1%, sendo que 12,5% dos pacientes foram classificados como desnutridos graves. Na admissão, foi observada uma frequência de 33,2% de desnutrição. Neste estudo, observou-se que em pacientes com mais de 60 anos a prevalência de desnutrição foi particularmente elevada (52,8% vs 44,7%; OR= 1,39; IC 95% = 1,21-1,58; p ≤ 0,05), assim como em pacientes com infecções (61,4% vs 38,8%; OR = 2,56; IC 95% = 2,24-2,93; p<0,05). Diante deste cenário, estima-se que o envelhecimento da população brasileira se torne em breve um fator ainda m

Suplementação nutricional oral para pacientes clínicos ou cirúrgicos desnutridos ou em risco de desnutrição / Oral nutritional supplementation for patients malnourished clinical or surgical malnutrition

INTRODUÇÃO: A desnutrição, uma das condições clínicas mais comuns no ambiente hospitalar, é considerada um estado secundário a uma deficiência, causada pelo desequilíbrio energético e frequentemente associada ao aumento de morbimortalidade, aumento de complicações e prognóstico desfavorável dos pacientes internados. Estima-se uma ocorrência em aproximadamente 30% dos pacientes hospitalizados no oeste da Europa e cerca de 50% dos pacientes hospitalizados na América Latina e Brasil. Em um grande estudo epidemiológico multicêntrico, conduzido em 2001, denominado IBRANUTRI, foi identificada no Brasil uma prevalência de desnutrição em pacientes internados de 48,1%, sendo que 12,5% dos pacientes foram classificados como desnutridos graves. Na admissão, foi observada uma frequência de 33,2% de desnutrição. Neste estudo, observou-se que em pacientes com mais de 60 anos a prevalência de desnutrição foi particularmente elevada (52,8% vs 44,7%; OR= 1,39; IC 95% = 1,21-1,58; p ≤ 0,05), assim como em pacientes com infecções (61,4% vs 38,8%; OR = 2,56; IC 95% = 2,24-2,93; p<0,05). Diante deste cenário, estima-se que o envelhecimento da população brasileira se torne em breve um fator ainda mais i

Community pharmacists' use, perception and knowledge on dietary supplements: a cross sectional study

BACKGROUND: Pharmacists are commonly tasked with recommending the appropriate dietary supplement and advising the patients of their correct and safe use. Previous research, conducted on pharmacy students, showed that they did not always use the evidence based sources of information, with personal use identified as a significant predictor influencing the decision to recommend a supplement. OBJECTIVES: To compare use, perceptions and knowledge of dietary supplements of pharmacists with different years of work experience and to explore factors that could influence their recommendation of supplements. METHODS: A questionnaire based cross-sectional study was conducted on Croatian community pharmacists in September 2017. The questionnaire explored pharmacists' demographic characteristics, use, perceptions and knowledge of dietary supplements. Pharmacists (N=102) were divided in two groups based on their work experience: P0 (<10 years) and P1 (≥10 years). RESULTS: All included pharmacists had high knowledge scores without differences between groups (P0=10, IQR 9-12 vs P1=11, IQR 9-12, expressed as median and interquartile range (IQR), p = 0.275). Less experienced pharmacists perceived there was less research conducted on the dietary supplements compared to their more experienced counterparts (P0=1, IQR 1-2 vs P1=2, IQR 2-3, expressed as median and interquartile range, p < 0.001). Groups differed in sources used when choosing the appropriate supplement with P0 using higher quality sources such as systematic reviews in comparison to P1 (32.1% vs 8.7%, p = 0.004). Pharmacists' decision to recommend a dietary supplement was influenced by their personal use (odds ratio 0.216, 95%CI 0.068:0.689, p = 0.01) and work experience (odds ratio 0.154, 95%CI 0.045:0.530, p = 0.003). CONCLUSIONS: Pharmacists did not use the high quality sources when recommending dietary supplements and their decision to recommend the supplement was not based on objective evaluation of evidence. Further education about the practice of evidence-based pharmacy is necessary, with special emphasis on senior pharmacists who might have missed that aspect during their formal education

No disponible

Effects of saffron (Crocus sativus L.) supplementation on inflammatory biomarkers: A systematic review and meta-analysis.

The effect of saffron supplementation on subclinical inflammation remains inconclusive. We performed a systematic review and meta-analysis to summarize available findings on the effect of saffron supplementation on inflammatory biomarkers (C-reactive protein [CRP], tumor necrosis factor-α [TNF-α], and interleukin-6 [IL-6]) in adults. We searched PubMed/Medline, Scopus, Web of Science, and Google Scholar databases up to November 2019 using relevant keywords to identify eligible trials. All randomized controlled trials (RCTs) that examined the effect of oral saffron supplementation on plasma concentrations of CRP, TNF-α, and IL-6 were included. For each outcome, mean differences and SDs were pooled using a random-effects model. Overall, eight RCTs were included in this meta-analysis. The pooled results showed that saffron supplementation did not result in significant changes in serum CRP (weighted mean difference [WMD]: -0.43 mg/L; 95% confidence interval [CI]: -1.04 to 0.17; p = .16), serum TNF-α (WMD: -1.29 pg/mL; 95% CI: -4.13 to 1.55; p = .37), and IL-6 concentrations (WMD: 0.11 pg/mL; 95% CI: -0.79 to 1.00; p = .81). Subgroup analysis indicated a significant reduction in serum CRP levels in studies with baseline CRP of ≥3 mg/L, saffron dosage of ≤30 mg/day, and intervention duration of <12 weeks, as well as trials that used crocin. Similarly, saffron was found to decrease TNF-α in studies that recruited non-diabetic subjects, subjects with baseline levels of ≥15 pg/mL, and participants with <50 years old, as well as trials that administered saffron at the dosage of ≤30 mg/day. We also found a significant non-linear effect of saffron dosage on serum CRP concentrations (pnon-linearity = .03). The overall results indicated that saffron supplementation did not affect inflammatory cytokines. Further high-quality studies are needed to firmly establish the clinical efficacy of supplemental saffron on inflammatory biomarkers.

Thiamine-responsive acute severe pulmonary hypertension in exclusively breastfeeding infants: a prospective observational study.

OBJECTIVES: Severe pulmonary hypertension (PH) causing right heart failure can occur due to thiamine deficiency in exclusively breastfeeding infants. This study describes the clinical profile and management of thiamine-responsive acute pulmonary hypertension. METHODS: A prospective observational study of infants presenting with severe PH without any other significant heart or lung disease. History of symptoms, clinical examination, echocardiography and basic investigations were performed. Dietary patterns of mothers were recorded. Thiamine was administered and serial echocardiography was performed. RESULTS: A total of 250 infants had severe PH and 231 infants responded to thiamine. The mean age was 3.2±1.2 months. Fast breathing, poor feeding, vomiting and aphonia were the main symptoms. Tachypnoea, tachycardia and hepatomegaly were found on examination. Echocardiogram revealed grossly dilated right heart with severe PH. Intravenous thiamine was administered to all the babies based on clinical suspicion. Clinical improvement with complete resolution of PH was noticed within 24-48 hours. Babies were followed up to a maximum of 60 months with no recurrence of PH. All the mothers consumed polished rice and followed postpartum food restriction. CONCLUSION: Thiamine deficiency is still prevalent in selected parts of India. It can cause life-threatening PH in exclusively breastfeeding infants of mothers who are on a restricted diet predominantly consisting of polished rice. It can contribute to infant mortality. Thiamine administration based on clinical suspicion leads to remarkable recovery. High degree of awareness and thiamine supplementation in relevant geographical areas is required to tackle this fatal disease.

Primary prevention of asthma: from risk and protective factors to targeted strategies for prevention.

Asthma is a complex disease that often starts in childhood. Genomic and environmental factors as well as aberrant immune maturation early in life can contribute to the onset of disease, with great disparity over time and geographical regions. Epidemiological studies have scrutinised environmental exposures and attempted to translate these exposures into prevention strategies. Some approaches for patients with asthma have been successful (eg, smoking ban, the Finnish Asthma Programme), and primary prevention of wheeze in pre-school children (age 0-5 years) by the supplementation of vitamin D or fish oil, or both, to pregnant women seems promising. Several recent prevention initiatives are based on strong asthma-protective environmental microbial exposures associated with traditional rural lifestyles. Preclinical studies with various bacterial lysates, bacterial and dietary metabolites, or helminthic compounds have yielded promising results that await translation into clinical practice. Given the immense societal and individual burden of asthma, there is an urgent need to further develop novel strategies to eradicate the disease.

Autocuidado y prevención del cáncer: de los nahuas prehispánicos a los nutracéuticos contemporáneos / Self-care and cancer prevention: from pre-Hispanic Nahuas to contemporary nutraceuticals

RESUMEN Hace unos cuantos siglos, en la materia médica de los nahuas prehispánicos se incluían alimentos curativos. En la actualidad, legitimado por las ciencias experimentales, nace el nutracéutico como un alimento con propiedades curativas que se utiliza en los modelos de salud preventivos del cáncer. En este artículo, comienzo por proponer que el conocimiento prehispánico puede ser validado epistémica y metodológicamente, si se apela al particular marco conceptual de los prehispánicos. Después, arguyo que el consumo de nutracéticos, como anticancerígenos, puede pensarse como parte de medidas preventivas primarias y secundarias, así como en la comprensión de las prácticas de autocuidado en el marco de la ética contemporánea del cáncer. Concretamente, que el consumo de nutracéticos y los alimentos prehispánicos mexicanos pueden legitimarse como prácticas de bienestar y prevención cada vez más pertinentes, en la intersección de la experiencia del enfermo y de su contexto. La responsabilidad de quien padece, dentro de un contexto sociopolítico cada vez más estructurado por las exigencias de vulnerabilidad del mercado terapéutico y de las estrategias confesionarias que otorgan verdad y validez a las figuras de autoridad, se gana en la práctica de conocerse y entenderse a sí mismo en la intersubjetividad contextual.(AU)

ABSTRACT The pre-Hispanic Nahuas had a medical system that included healing foods among their therapeutic practices. Nowadays, a new knowledge is born, legitimated by experimental sciences: the nutraceutical, a food with curative properties used in cancer preventive health models. In this article, I begin by proposing that pre-Hispanic knowledge can be validated epistemically and methodologically, if we appeal to the particular conceptual framework of the pre-Hispanic. Later, that the consumption of nutraceuticals, as anti-cancer drugs, can be thought of as part of primary and secondary preventive measures, as well as in the understanding of self-care practices in the framework of contemporary cancer bioethics. Specifically, that the consumption of nutraceuticals and Mexican pre-Hispanic foods can be legitimized as increasingly relevant wellness and prevention practices, at the intersection of the patient's experience and his or her context. The responsibility of those who suffer, within a sociopolitical context that is increasingly structured by the demands of vulnerability of the therapeutic market and the confessional strategies that give truth and validity to the figures of authority over whom they suffer, is gained in the practice of knowing and understanding oneself within contextual intersubjetivity.(AU)

Vitamin D Toxicity / Toxicidade da Vitamina D

Abstract Fortification of food products with vitamin D was central to the eradication of rickets in the early parts of the 20th century in the United States. In the subsequent almost 100 years since, accumulating evidence has linked vitamin D deficiency to a variety of outcomes, and this has paralleled greater public interest and awareness of the health benefits of vitamin D. Supplements containing vitamin D are now widely available in both industrialized and developing countries, and many are in the form of unregulated formulations sold to the public with little guidance for safe administration. Together, this has contributed to a transition whereby a dramatic global increase in cases of vitamin D toxicity has been reported. Clinicians are now faced with the challenge of managing this condition that can present on a spectrum from asymptomatic to acute life-threatening complications. This article considers contemporary data on vitamin D toxicity, and diagnostic and management strategies relevant to clinical practice.

Resumo A suplementação de produtos alimentares com vitamina D foi fundamental para a erradicação do raquitismo no início do século XX nos Estados Unidos. Nos quase 100 anos subsequentes, o acúmulo de evidências vinculou a deficiência de vitamina D a uma variedade de desfechos, e isso tem levantado grande interesse público e conscientização dos benefícios à saúde da vitamina D. Os suplementos que contêm vitamina D estão agora amplamente disponíveis tanto nos países desenvolvidos quanto naqueles em desenvolvimento, e muitos estão na forma de formulações não regulamentadas, vendidas ao público com poucas orientações para uma administração segura. Juntos, isso contribuiu para uma transição na qual um aumento global dramático nos casos de toxicidade da vitamina D tem sido relatado. Médicos agora enfrentam o desafio de tratar essa condição que pode apresentar um espectro de complicações assintomáticas a agudas, com risco de vida. Este artigo considera dados atualizados sobre a toxicidade da vitamina D e estratégias de diagnóstico e manejo relevantes para a prática clínica.

Death from cardiac glycoside "pong-pong" following use as weight-loss supplement purchased on Internet.

Cerbera odollam or "pong-pong" tree contains cardiac glycosides similar to digoxin, oleander and yellow oleander. Cerbera odollam is a common method of suicide in South East Asia and has also been used as a weight loss supplement. We present a case of a 33-year-old female presenting with lethargy, vomiting, bradycardia, severe hyperkalemia of 8.9 mEq/L, slow atrial fibrillation followed by cardiovascular collapse following the ingestion of "pong-pong", the kernel of Cerbera odollam, as a weight loss supplement. Despite the administration of a total of nine vials of digoxin-specific Fab the patient could not be resuscitated. Clinicians should be aware of natural cardiac glycosides being uses as weight-loss agents and consider acute cardiac glycoside poisoning in patients with hyperkalemia, abnormal cardiovascular signs, symptoms and abnormal ECG findings.

Vitamin D Toxicity.

Fortification of food products with vitamin D was central to the eradication of rickets in the early parts of the 20th century in the United States. In the subsequent almost 100 years since, accumulating evidence has linked vitamin D deficiency to a variety of outcomes, and this has paralleled greater public interest and awareness of the health benefits of vitamin D. Supplements containing vitamin D are now widely available in both industrialized and developing countries, and many are in the form of unregulated formulations sold to the public with little guidance for safe administration. Together, this has contributed to a transition whereby a dramatic global increase in cases of vitamin D toxicity has been reported. Clinicians are now faced with the challenge of managing this condition that can present on a spectrum from asymptomatic to acute life-threatening complications. This article considers contemporary data on vitamin D toxicity, and diagnostic and management strategies relevant to clinical practice.

The Influence of Donor Milk Supplementation on Duration of Parenteral Nutrition in Preterm Infants.

BACKGROUND: Data are limited on the association between the use of donor human milk and improvements in feeding tolerance. OBJECTIVE: To determine the influence of the duration of parenteral nutrition on the growth and morbidity of the breastfed newborn when using donated human milk in the absence of mother's own milk. METHODS: We conducted a retrospective study before and after the intervention that compared two groups of newborns (N = 284; each group n = 142). We used a convenience sample of all newborns ≤32 weeks gestation consecutively admitted in a single unit before (Group 1 between December 2012 and May 2014) or after (Group 2 between October 2014 and December 2016) the availability of donor human milk. In Group 2, donor human milk was administered at least 3 to 4 weeks or until the baby weighed 1,500 g. Weight was recorded daily and length and head circumference weekly. Parenteral nutrition was continued until enteral feeding volume reached 120 ml/kg/day. Additional variables measured were the number of days with a central venous catheter, age that the enteral feeding volume reached 150 ml/kg/day, and duration of stay. RESULTS: The duration of parenteral feeding was the same before and after: 12 (8.23) and 11 (7.19) days (p = .822). The z scores for weight and height of newborns was lower in Group 2 = -1.8 (1.0) and -2.3 (1.1) and Group 1 = -1.2 (1.1) (p < .001) and -1.8 (1.4) (p = .005). CONCLUSION: We did not find an association between the administration of donor human milk as a supplement to mother's own milk and reduced number of days of parenteral nutrition. Back translation by Laurence Grummer-Strawn.

Availability and composition of weight-loss supplements in Sri Lanka.

AIM: The present study aims to investigate the composition and availability of weight-loss supplements in Sri Lanka and explore the evidence for their effectiveness. METHODS: Data were collected by visiting drug stores, searching the Internet for websites and referring to advertisements in national newspapers and magazines from August to October 2017. RESULTS: A total of 100 weight-loss products were identified of which the majority (n = 57) were available from drug stores. Most commonly, products were available in capsule form (36.0%). The number of active ingredients in products varied from 1 to a maximum of 22 with a total of 155 different active ingredients distinguished. The ingredients mainly originated from plants (77.4%) while green tea (Camellia sinensis), garcinia (Garcinia cambogia) and caffeine anhydrous were the three most common. At least one of the top 10 ingredients was included in 75 of the products sourced. Directions for use were specified in only 72 products, while a further 6 products lacked any information on ingredients. Literature predicted positive weight-loss effects for green tea and ginger while garcinia was reported for both positive and negative effects. CONCLUSIONS: The ingredients are reported to have both beneficial and adverse effects. Many consumers may find it challenging to make informed purchase decisions as a number of products failed to provide adequate nutritional information and safety measures. Government regulatory authorities should pay closer attention to the availability and provision of products sold to the general public.

Food Purchasing Behavior of Food Insecure Cancer Patients Receiving Supplemental Food Vouchers.

PURPOSE: Food insecure cancer patients experience worse health outcomes and poorer quality of life than food secure patients. There has been little research in programs to alleviate food insecurity in cancer patients. The objective of this paper is to report on the food purchasing behaviors of cancer patients enrolled in a supplemental food voucher program. METHODS: This paper utilized data from a three-arm randomized controlled trial investigating the impact of food interventions on alleviating food insecurity in cancer patients receiving chemotherapy and/or radiation therapy. In one arm, patients received a monthly $230 voucher with which to purchase food. Receipts were collected for items purchased with the voucher and were coded to analyze purchasing behaviors. RESULTS: Thirty-three patients provided receipts for more than 11,000 individual items. Patients spent 50% of voucher funds on animal protein, fruits, and vegetables. Patients spent, on average, 77% of voucher funds on items categorized as "healthy." CONCLUSIONS: Patients who received a food voucher purchased more fruits and vegetables than national averages would suggest. They also spent less on sweetened beverages than national samples. Patients who were born outside of the United States or who were limited English proficient purchased significantly more healthy foods than English-speaking and American-born study patients. Supplemental food vouchers for food insecure cancer patients resulted in the purchase of healthy food items.

Disparities in Donor Human Milk Supplementation Among Well Newborns.

BACKGROUND: Donor human milk supplementation for healthy newborns has increased. Racial-ethnic disparities in supplementation have been described in the neonatal intensive care unit but not in the well newborn setting. RESEARCH AIM: The aim of this study was to identify maternal characteristics associated with donor human milk versus formula supplementation in the well newborn unit. METHODS: This retrospective cohort study includes dyads of well newborns and their mothers (N = 678) who breastfed and supplemented with formula (n = 372) or donor human milk (n = 306) during the birth hospitalization at a single hospital in the midwestern United States. Maternal characteristics and infant feeding type were extracted from medical records. Chi-square and logistic regression were used to examine associations between maternal characteristics and feeding type. RESULTS: Nonwhite women were less likely to use donor human milk. Compared to non-Hispanic white women, the largest disparity was with Hispanic (adjusted odds ratio [OR] = 0.28, 95% CI [0.12, 0.65]), then non-Hispanic black (adjusted OR = 0.32, 95% CI [0.13, 0.76]) and Asian women (adjusted OR = 0.34, 95% CI [0.16, 0.74]). Lower donor human milk use was associated with primary language other than English and public versus private insurance. CONCLUSION: The goal of improving public health through breastfeeding promotion may be inhibited without targeting donor human milk programs to these groups. Identifying the drivers of these disparities is necessary to inform person-centered interventions that address the needs of women with diverse backgrounds.

Innovative Green Technologies of Intensification for Valorization of Seafood and Their by-Products.

The activities linked to the fishing sector generate substantial quantities of by-products, which are often discarded or used as low-value ingredients in animal feed. However, these marine by-products are a prominent potential good source of bioactive compounds, with important functional properties that can be isolated or up-concentrated, giving them an added value in higher end markets, as for instance nutraceuticals and cosmetics. This valorization of fish by-products has been boosted by the increasing awareness of consumers regarding the relationship between diet and health, demanding new fish products with enhanced nutritional and functional properties. To obtain fish by-product-derived biocompounds with good, functional and acceptable organoleptic properties, the selection of appropriate extraction methods for each bioactive ingredient is of the outmost importance. In this regard, over the last years, innovative alternative technologies of intensification, such as ultrasound-assisted extraction (UAE) and supercritical fluid extraction (SFE), have become an alternative to the conventional methods in the isolation of valuable compounds from fish and shellfish by-products. Innovative green technologies present great advantages to traditional methods, preserving and even enhancing the quality and the extraction efficiency, as well as minimizing functional properties' losses of the bioactive compounds extracted from marine by-products. Besides their biological activities, bioactive compounds obtained by innovative alternative technologies can enhance several technological properties of food matrices, enabling their use as ingredients in novel foods. This review is focusing on analyzing the principles and the use of UAE and SFE as emerging technologies to valorize seafoods and their by-products.