Effect of oral nutritional supplements with or without nutritional counselling on mortality, treatment tolerance and quality of life in head-and-neck cancer patients receiving (chemo)radiotherapy: a systematic review and meta-analysis.

Oral nutritional supplements are widely recommended to head-and-neck cancer patients undergoing anti-cancer treatment; however, their effects on the outcomes of most importance to patients are unclear. This study aimed to systematically review the evidence of effect of oral nutritional supplements on mortality, treatment tolerance, quality of life, functional status, body weight and adverse effects. We searched PubMed, Embase, CENTRAL, LILACS, Web of Science, CINAHL, two trial registry platforms, three sources of grey literature and reference lists of included studies. We assessed the risk of bias using the revised Cochrane risk-of-bias tool (RoB 2), and certainty of evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We used random-effects models with Hartung-Knapp correction for the meta-analyses. We included fifteen trials, of which five were ongoing or unpublished, providing evidence in four comparisons. We found very low to low certainty evidence for the effect of oral nutritional supplements on mortality, treatment tolerance, quality of life, functional status and adverse effects. When compared with nutritional counselling alone, nutritional counselling plus oral nutritional supplements probably increased body weight slightly. We also found adverse events relating to supplements use such as nausea, vomiting and feeling of fullness. Possible increases in mortality, treatment tolerance and quality of life besides a possible decrease in functional status are worthy of further investigation. Future research could attempt to address the clinical importance of a probable increase in body weight. Possible adverse effects of the use of oral nutritional supplements should not be overlooked.

Effects of Probiotic Use on Gastrointestinal Symptoms in the Late Postoperative Period of Bariatric Surgery: A Cross-Over, Randomized, Triple-Blind, Placebo-Controlled Study.

INTRODUCTION: Despite the benefits associated with weight reduction, the anatomical and functional changes of bariatric surgery may favor the development of undesirable side effects such as the appearance of gastrointestinal symptoms (GIS). The aim of this study was to evaluate the effects of using probiotics in individuals with GIS 1 year after being submitted to Roux-en-Y Gastric Bypass (RYGB). MATERIALS AND METHODS: This is an experimental, prospective, randomized, cross-over, triple-blind, placebo-controlled study, carried out with patients 1 year after being submitted to RYGB and who reported at least one moderate GIS. Subjects were randomized into two groups and completed the two research periods: in one they received placebo capsules, in the other 50 billion CFU of probiotics (Lactobacillus acidophilus, Bifidobacterium lactis, Lactobacillus rhamnosus, Bifidobacterium longum, Lactobacillus plantarum, Bifidobacterium bifidum and Lactobacillus gasseri), both for 8 weeks, with 8 weeks of wash-out period in between, and were evaluated for the presence of Small Intestine Bacterial Overgrowth (SIBO) and GIS, through the Hydrogen breath test and Gastric Symptom Rating Scale (GSRS) questionnaire. RESULTS: Of a total of 56 participants, 47 individuals completed the study. No significant effects were observed in neither the gastrointestinal symptoms or in the prevalence of SIBO with the use of probiotics. CONCLUSION: Supplementation of the probiotics chosen for this study does not seem to alleviate GIS or influence the improvement of SIBO in symptomatic patients after 1 year of RYGB.

Credibility at stake: only two-thirds of randomized trials of nutrition interventions are registered and lack transparency in outcome and treatment effect definitions.

OBJECTIVES: This study aimed to investigate the adherence of randomized controlled trials of nutrition interventions to transparency practices informing assessments of selective reporting biases, including the availability of a trial registration entry, protocol and statistical analysis plan (SAP). STUDY DESIGN AND SETTING: Retrospective observational study with cross-sectional design. We systematically searched for trials published from 1 July 2019, to 30 June 2020, and included a randomly selected sample of 400 studies. We searched for registry entries, protocols, and SAPs for all included studies. We extracted data to characterize the disclosure of sufficient information in the available materials to inform assessments of selective reporting biases, considering the definition of outcome domain, measure, metric, method of aggregation, time point, analysis population, methods to handle missing data and method of adjustment. RESULTS: Most trials (69%) were registered, but these often lacked sufficient specification of outcomes and intended treatment effects. Protocols and SAPs provided more details but were less often available (14% and 3%, respectively), and even then, almost all studies presented limited information to inform the assessments of risk of bias due to the selection of the reported result. CONCLUSION: Lack of full specification of outcomes and intended treatment effects hinder a full adherence of randomized controlled trials of nutrition interventions to transparency practices and may affect their credibility.

Suicidal behaviors and sedentary behavior in adolescents: systematic review and meta-analysis / Comportamientos suicidas y sedentarismo en adolescentes: revisión sistemática y metaanálisis / Comportamentos suicidas e sedentarismo em adolescentes: revisão sistemática e meta-análise

Objective:To determine the association between suicidal behaviors (ideation, planning and attempt) and sedentary behavior in adolescents.Method:Systematic searches were performed in eight databases (MEDLINE/PubMed; Web of Science; Scopus; SPORTDiscus; LILACS; SciELO; PsycINFO;CINAHL). The effect measures used for meta-analysis were odds ratios and 95% confidence intervals, directly collected from included studies.Results:Eleven studies were included in the systematic review and six articles were included in the meta-analysis. The meta-analysis showed thatadolescents who used video games/computers for ≥3 hours/day were more likely of having suicidal ideation. Adolescents who used television or videogame/computer for ≥3 hours/day were more likely of having suicide attempt. Boys who spent ≥3 hours/day in combined sedentary behavior were lesslikely of having suicidal attempt.Conclusions:There is an increased likelihood of suicidal behaviors, in special suicide ideation and attempt in adolescents who used videogames/computers and watched television for ≥3 hours/day.(AU)

Objetivo: Determinar la asociación entre comportamientos suicidas (ideación, planificación e intento) y sedentarismo en adolescentes.Método: Se realizaron búsquedas sistemáticas en ocho bases de datos (MEDLINE/PubMed; Web of Science; Scopus; SPORTDiscus; LILACS; SciELO;PsycINFO; CINAHL). Las medidas de efecto fueron los odds ratios y intervalos de confianza del 95%, recopilados directamente de los estudios.Resultados: Se incluyeron once estudios en la revisión sistemática y seis estudios en el metanálisis. El metanálisis mostró que los adolescentes que usabanvideojuegos/computadoras durante ≥3 horas/día tenían más probabilidades de tener ideación suicida. Los adolescentes que usaban televisión yvideojuego/computadora durante ≥3 horas/día tenían más probabilidades de tener un intento de suicidio. Los niños que pasaron ≥3 horas/día incomportamientos sedentarios combinados tenían más probabilidades de tener intento de suicidio.Conclusiones: Existe una mayor probabilidad de conductas suicidas, en ideación e intento de suicidio en adolescentes que usaronvideojuegos/computadoras y vieron televisión durante ≥3 horas/día.(AU)

Objetivo: Determinar a associação entre comportamentos suicidas (ideação, planejamento e tentativa) e comportamento sedentário em adolescentes.Método: Pesquisas sistemáticas foram realizadas em oito bancos de dados (MEDLINE/PubMed; Web of Science; Scopus; SPORTDiscus; LILACS; SciELO;PsycINFO; CINAHL). As medidas de efeito utilizadas para a metanálise foram odds ratio e intervalos de confiança de 95%, coletados diretamente dosestudos.Resultados: Onze estudos foram incluídos na revisão sistemática e cinco artigos foram incluídos na meta-análise. A meta-análise mostrou que osadolescentes que usavam videogame/computador por ≥3 horas/dia tinham maiores chances de ter ideação suicida. Os adolescentes que usavamtelevisão ou videogame/computador por ≥3 horas/dia apresentaram maiores chances de tentativa de suicídio. Os meninos com ≥3 horas/dia emcomportamentos sedentários combinados apresentaram menores chances de reportar tentativas de suicídio.Conclusões: Existe maiores chances de comportamentos suicidas, em especial ideação e tentativa de suicídio em adolescentes que usavamvideogame/computador e assistiam televisão por ≥3 horas/dia.(AU)

Chronic diseases, multimorbidity, and handgrip strength among older adults from Southern Brazil / Doenças crônicas, multimorbidade e força de preensão manual em idosos de uma comunidade do Sul do Brasil

ABSTRACT Objective: To investigate the association between various chronic diseases, multimorbidity, and handgrip strength in community dwelling older adults in Southern Brazil. Methods: A cross-sectional study carried out with 477 older adults (60 years and older) who resided in Antônio Carlos, Santa Catarina state. Subjects aged 60-79 years were selected by probability sampling (n=343) and all subjects aged 80 years or older (n=134) were evaluated. Chronic diseases were identified by self-report. A mechanical dynamometer verified handgrip strength (i.e., the outcome). Adjustments variables were age, literacy, living arrangement, smoking, body mass index, cognitive function, and comorbid chronic diseases. Sex-stratified analyses were conducted with simple and multiple linear regression. Results: A total of 270 women (73.2±8.8 years) and 207 men (73.3±9.0 years) were assessed. In the adjustment analysis, cancer (β=-3.69; 95%CI=-6.97 to -0.41) and depression (β=-1.65; 95%CI=-3.20 to -0.10) were associated with lower handgrip strength in women. For men, diabetes (β=-5.30; 95%CI=-9.64 to -0.95), chronic lung disease (β=-4.74; 95%CI=-7.98 to -1.50), and coronary heart disease (β=-3.07; 95%CI=-5.98 to -0.16) were associated with lower handgrip strength values. There was an inverse trend between number of diseases and handgrip strength for men only. Conclusion: The results showed an independent association between chronic diseases and handgrip strength. As such, handgrip strength is a valid measure to use for prevention or intervention in chronic disease and multimorbidity.

RESUMO Objetivo: Analisar associação entre doenças crônicas, multimorbidade e força de preensão manual em idosos de uma comunidade do Sul do Brasil. Métodos: Estudo epidemiológico, transversal, de base populacional e domiciliar, realizado com 477 indivíduos com idade a partir de 60 anos, residentes em Antônio Carlos, Santa Catarina. Os idosos de 60 a 79 anos foram selecionados por amostragem probabilística (n=343), e todos os indivíduos com 80 anos ou mais (n=134) foram avaliados. As doenças crônicas foram identificadas por autorrelato. A força de preensão manual (desfecho) foi mensurada por meio de dinamômetro mecânico. As variáveis de ajuste foram idade, escolaridade, arranjo familiar, tabagismo, índice de massa corporal, estado cognitivo e doenças crônicas. As análises, estratificadas por sexo, foram realizadas por meio de regressão linear simples e múltipla. Resultados: Foram avaliados 270 mulheres (73,2± 8,8 anos) e 207 homens (73,3± 9,0 anos). Na análise ajustada, câncer (β=-3,69; IC95%=-6,97 a -0,41) e depressão (β=-1,65; IC95%=-3,20 a -0,10) foram associados à menor força de preensão manual nas mulheres. Para os homens, diabetes (β=-5,30; IC95%=-9,64 a -0,95), doença pulmonar (β=-4,74; IC95%=-7,98 a -1,50) e doença coronariana (β=-3,07; IC95%=-5,98 a -0,16) foram associados a menor força de preensão manual. Houve tendência inversa entre número de doenças e força de preensão manual apenas para os homens. Conclusão: Os resultados mostraram associação independente entre doenças crônicas e força de preensão manual. Sendo assim, a força de preensão manual é uma medida válida para ser utilizada na prevenção ou na intervenção das doenças crônicas e nas multimorbidades.

Comparação do perfil socioeconômico e condições de saúde de idosos residentes em áreas predominantemente rural e urbana da Grande Florianópolis, Sul do Brasil / Comparison of sociodemographic profile and health conditions of elderly residents in predominantly rural and urban areas of the Greater Florianópolis, southern Brazil

Resumo Introdução Problemas de ordem social, prejuízo na capacidade funcional e isolamento são características afetadas pelas condições do local onde o idoso reside. Assim, o objetivo do artigo é verificar as diferenças sociodemográficas e de saúde em idosos residentes em áreas predominantemente rural e urbana da Grande Florianópolis, no Estado de Santa Catarina. Métodos Foram analisados estudos de base populacional: Saúde-AC em Antônio Carlos (477 idosos) e EpiFloripa Idoso em Florianópolis (1.705 idosos). As variáveis foram comparadas por intervalo de confiança. Resultados Em Antônio Carlos, as maiores prevalências e diferenças foram para: baixa escolaridade (97%), casados, viúvos, trabalham atualmente, percepção de saúde igual ou pior quando comparada a idosos da mesma idade e risco cardiovascular substancialmente aumentado (64%). Enquanto as menores prevalências foram para: fumantes, dependência em uma a três atividades (6%) e déficit cognitivo (10%). Em Florianópolis, houve maior prevalência de renda alta e de possuir plano de saúde (66%). Conclusão Os dados possibilitaram identificar as diferentes condições socioeconômicas e demandas de saúde. As informações podem colaborar para implementar ações específicas para os idosos considerando as características socioeconômicas do local onde vivem.

Abstract Background Social problems, impaired functional capacity and isolation are features affected by local conditions of elderly living. This article aims to verify the sociodemographic and health differences in the elderly living in predominantly rural and urban areas of Florianópolis (SC). Methods Population-based studies were analyzed: Saúde-AC in Antônio Carlos (477 subjects); and EpiFloripa Idoso in Florianópolis (1705 subjects). The variables were compared by confidence interval. Results The city of Antônio Carlos showed higher prevalence and the largest differences for people with lower educational level (97%), married, widowers, currently working, health perception equals/worst than those with the same age and substantially increased cardiovascular risk (64%); lower prevalence smokers, disability in 1 to 3 activities (6%) and cognitive impairment (10%). Florianópolis had a higher prevalence of high income and health insurance (66%). Conclusion These data allowed the identification of different health demands and their socioeconomic conditions. The information collaborates to implement specific actions for the elderly considering the living socioeconomic characteristics.

Cross-cultural equivalence and psychometric proprieties of the social support scale for healthy eating habits / Avaliação da equivalência transcultural e de propriedades psicométricas da escala de apoio social para hábitos alimentares saudáveis

ABSTRACT Objective: To assess the cross-cultural equivalence and psychometric proprieties of the Brazilian version of the Eating Habits Social Support Scale. Methods: The scale was administered to 381 subjects aged 24 to 86 years from Recife and Belo Horizonte, Brazil. Cross-cultural equivalence was evaluated by expert agreement. The psychometric proprieties were assessed by factor validity (factor analysis), internal consistency (Cronbach's alpha), and reproducibility (intraclass correlation coefficient), using a test-retest with an interval of seven days. Results: Factor analysis identified two factors for each social support group (friends and family). The questions were clustered by type of social support (positive or negative comments). The eigenvalues for family social support were 3.22 and 3.00, corresponding to 62.2% of the total variance. For friend social support, the eigenvalues were 3.02 and 2.95, explaining 59.7% of the total variance. In the internal consistency analysis, the alpha values ranged from 0.83 to 0.75. The reproducibility intraclass correlation coefficient ranged from 0.676 to 0.873. All these values were acceptable, indicating the validity and reliability of the scale. Conclusion: The Brazilian version of the Eating Habits Social Support Scale presented cross-cultural equivalence and psychometric characteristics that were appropriate for Brazilian adults and older adults. This scale is easy to use and obtained high scores for question clarity and answer options.

RESUMO Objetivo: Avaliar a equivalência transcultural e as propriedades psicométricas da versão brasileira da Escala de Apoio Social para Hábitos Alimentares Saudáveis. Métodos: A escala foi aplicada em 381 indivíduos com idade entre 24 e 86 anos, residentes em Recife e Belo Horizonte, Brasil. A equivalência transcultural foi avaliada por consenso de especialistas. As propriedades psicométricas foram analisadas pela validade fatorial (análise fatorial exploratória), consistência interna (alfa de Cronbach) e reprodutibilidade (Coeficiente de Correlação Intraclasse). Para análise de reprodutibilidade, foi utilizado o teste-reteste com intervalo de até sete dias entre as aplicações. Resultados: A análise fatorial identificou dois fatores para cada fonte de apoio social (amigos e família). O agrupamento das questões ocorreu de acordo com o tipo de apoio recebido (comentários positivos ou negativos). Os autovalores dos fatores de apoio social da família foram 3,22 e 3,00, correspondentes a 62,2% da variância. Para o apoio social dos amigos, os autovalores foram 3,02 e 2,95, explicando 59,7% da variância. Na avaliação de consistência interna, os valores de alfa variaram de 0,83 a 0,75. A reprodutibilidade resultou em valores de coeficiente de correlação intraclasse de 0,676 a 0,873. Todos os valores foram aceitáveis, indicando validade e confiabilidade do instrumento. Conclusão: A versão brasileira da Escala de Apoio Social para Hábitos Alimentares Saudáveis apresentou equivalência transcultural e propriedades psicométricas adequadas para aplicação em adultos e idosos. É um instrumento de fácil aplicação e bem avaliado em relação à clareza das questões e opções de resposta.

Dietary habits of older adults: a comparison between two distinct regions of Brazil (Southern and Northeastern) / Hábito alimentar de idosos: comparação entre duas regiões distintas do Brasil (sul e nordeste)

Objective: To identify the differences in the dietary habits of older adults from two cities of distinct regions of Brazil and to analyze the socio-demographic factors associated with adequate dietary habit. Method: Cross-sectional study, population-based household survey. A total of 793 persons (≥60 years) from southern and northeastern regions were evaluated. The dietary habits was obtained by daily consumption of milk, cheese or other dairy products; consumption of eggs, beans or pulses (once a week); consumption of meat, fish or poultry (3 times/week); consumption of vegetables, grains and fruits (4 times or more/week); number of glasses or cups of fluid ingested (>5 cups/day). The adequate dietary habit (principle category of analysis) were ranked when there was reference to the consumption of all the food groups. Results: Older adults from the southern region showed a greater consumption of most food group (except the consumption of eggs, beans or lentils) and rate of adequate dietary habits than older adults from the northeast. The Poisson regression models showed that the potential socio-demographic determinants of adequate dietary habits were younger subjects (southern) and higher schooling (in both municipalities). Discussion: These factors suggest the existence of a relationship between lower adequacy in dietary habits and poorer socioeconomic indicators. The sociodemographic inequalities in Brazil still affect dietary habits. Conclusion: Older adults from regions with better socio-demographic indicators are more likely to present a higher prevalence in consumption of the investigated food. Literacy stands out as a potential indicator of adequate dietary habits for older adults, regardless of the region investigated (AU)

Objetivo: Verificar as diferenças nos hábitos alimentares entre os idosos de duas cidades de regiões distintas do Brasil e os fatores sociodemográficos associados ao hábito alimentar adequado. Método: Estudo transversal, populacional de base domiciliar. Foram entrevistados 793 idosos (≥ 60 anos) das regiões sul e nordeste. O hábito alimentar foi verificado por meio de questões relacionadas à frequência alimentar: consumo diário de leite, queijo ou outros produtos lácteos; consumo de ovos, feijão ou leguminosas (1vez/ semana); consumo de carne, peixe ou aves (3 vezes / semana); consumo de verduras, legumes e frutas (4 vezes ou +/semana); número de copos ou xícaras de líquido ingeridos (>5 copos/dia). Foi considerado hábito alimentar adequado (categoria principal de análise) quando houve referência à ingestão de todos os grupos de alimentos. Resultados: A prevalência do consumo da maioria dos grupos de alimentos (exceto o consumo de ovos, feijão ou lentilhas) e do hábito alimentar adequado foi maior entre os idosos do sul. Os modelos de regressão de Poisson permitiram identificar que a menor idade (no sul) e a melhor escolaridade (ambos os municípios) foram os potenciais determinantes sociodemográficos do hábito alimentar adequado. Discussão: Os resultados reforçam a ideia de que diferentes contextos socioeconômicos, ambientais e culturais podem ter influência direta sobre os hábitos alimentares de diferentes populações. As desigualdades sociodemográficas do Brasil ainda afetam o hábito alimentar. Conclusão: Idosos de região com melhores indicadores sociodemográficos são mais propensos a apresentar maior prevalência no consumo dos alimentos investigados. O fato de saber ler e escrever destaca-se como potencial indicador do hábito alimentar adequado nos idosos, independente da região investigada (AU)