[Adjuvant treatments to invasive mechanical ventilation in the management of acute respiratory distress syndrome secondary to COVID-19]. / Tratamientos coadyuvantes a la ventilación mecánica invasiva en el manejo del síndrome de distrés respiratorio agudo secundario a covid-19.

Introduction: This bibliographic review is carried out in order to obtain answers about aspects related to techniques and treatments, as well as care associated with the critically ill patient diagnosed with COVID-19. Objective: To analyze the available scientific evidence on the effectiveness of the use of invasive mechanical ventilation together with other adjuvant techniques, in reducing the mortality rate in patients with acute respiratory distress syndrome and clinical trial of COVID-19 treated in intensive care units. Methodology: A systematized bibliographic review was carried out in the PubMed, CUIDEN, LILACS, Medline, CINAHL and Google Scholar databases, using MeSH terms (adult respiratory distress syndrome, mechanical ventilation, prone position, nitric oxide, extracorporeal membrane oxygenation, nursing care) and the corresponding Boolean operators. The selected studies underwent a critical reading carried out between December 6, 2020 and March 27, 2021 using the Critical Appraisal Skills Program tool in Spanish and a cross-sectional epidemiological studies evaluation instrument. Results: A total of 85 articles were selected. After performing the critical reading, a total of 7 articles were included in the review, 6 being descriptive studies and one a cohort study. After analyzing these studies, it appears that the technique that has obtained the best results is extracorporeal membrane oxygenation, with the care provided by qualified and trained nursing staff being very important. Conclusion: Mortality from COVID-19 increases in patients treated with invasive mechanical ventilation compared to patients treated with extracorporeal membrane oxygenation. Nursing care and specialization can have an impact on improving patient outcomes.

Low genome-wide homozygosity in 11 Spanish ovine breeds.

The population of Spanish sheep has decreased from 24 to 15 million heads in the last 75 years due to multiple social and economic factors. Such a demographic reduction might have caused an increase in homozygosity and inbreeding, thus limiting the viability of local breeds with excellent adaptations to harsh ecosystems. The main goal of our study was to investigate the homozygosity patterns of 11 Spanish ovine breeds and to elucidate the relationship of these Spanish breeds with reference populations from Europe, Africa and the Near East. By using Ovine SNP50 BeadChip data retrieved from previous publications, we have found that the majority of studied Spanish ovine breeds have close genetic relatedness with other European populations; the one exception is the Canaria de Pelo breed, which is similar to North African breeds. Our analysis has also demonstrated that, with few exceptions, the genomes of Spanish sheep harbor fewer than 50 runs of homozygosity (ROH) with a total length of less than 350 Mb. Moreover, the frequencies of very long ROH (>30 Mb) are very low, and the inbreeding coefficients (FROH ) are generally small (FROH  < 0.10), ranging from 0.008 (Rasa Aragonesa) to 0.086 (Canaria de Pelo). The low levels of homozygosity observed in the 11 Spanish sheep under analysis might be due to their extensive management and the high number of small to medium farms.

The Role of Omega-3 Fatty Acids in Diets.

The article is a summary of Dra. Carmen Gómez Candela's presentation at the Science in Nutrition 3rd International Congress in Milan, March 2014. The article covers omega-3 fatty acids use in different medical areas and several institutions' opinions in relation to the topic. Omega-3 acids are essential fatty acids. A certain amount of omega-3 is needed in our daily diet; however, the usual consumption is generally less than the recommended amount. Changes in dietary patterns in the course of history have led to deficit levels of omega-3 in the human body. Currently, there is increasing evidence of the benefits of omega-3 in different medical specialities. There are still some gaps regarding its role in illnesses such as dementia, psychiatric disorders, and inflammatory diseases. Nevertheless, stronger evidence is being proved in cardiovascular diseases and cancer. This article provides a reflection on possible ways to increase omega-3 daily consumption and the constraints associated with food with high contents of heavy metals, which, in turn, are also rich in omega-3s.

Spontaneous subcapsular hepatic hematoma in pregnant patients.

Spontaneous subcapsular hepatic hematoma (SSHH) with or without previous history of preeclampsia and/or HELLP syndrome represents a very rare pathological condition in pregnancy and postpartum, (1/45,000-1/225,000 pregnancies). Its importance for the anesthesiologist lays in its association with high morbidity and mortality for the mother (60-86%, 39%) and newborn (42%). After a high clinical suspicion, the certainty clinical diagnosis is settled by different imaging techniques. However, in most cases the diagnosis of SSHH is a casual intraoperative finding associated to a maternal or foetal compromise. Nowadays the obstetric and anaesthetic management of a SSHH is not standardized and depends on its integrity, hemodynamic stability and the gestational period when diagnosed. The possibility of an acute critic haemorrhage with necessity of massive transfusion, makes advisable to provide updated protocols for the treatment of obstetric hemorrhage, adapting them to the clinical peculiarities of these patients. After the acute phase, close attention should be kept on thromboembolic complications.

Adjuvant treatments to invasive mechanical ventilation in the management of acute respiratory distress syndrome secondary to COVID-19.

INTRODUCTION: This bibliographic review is carried out in order to obtain answers about aspects related to techniques and treatments, as well as care associated with the critically ill patient diagnosed with Covid-19. OBJECTIVE: To analyze the available scientific evidence on the effectiveness of the use of invasive mechanical ventilation together with other adjuvant techniques, in reducing the mortality rate in patients with Acute Respiratory Distress Syndrome and clinical trial of Covid-19 treated in intensive care units. METHODOLOGY: A systematized bibliographic review was carried out in the Pubmed, Cuiden, Lilacs, Medline, Cinahl and Google Scholar databases, using MeSH terms (Adult Respiratory Distress Syndrome, Mechanical Ventilation, Prone Position, Nitric Oxide, Extracorporeal Membrane Oxygenation, Nursing Care) and the corresponding Boolean operators. The selected studies underwent a critical reading carried out between December 6, 2020 and March 27, 2021 using the Critical Appraisal Skills Program tool in Spanish and a cross-sectional epidemiological studies evaluation instrument. RESULTS: A total of 85 articles were selected. After performing the critical reading, a total of 7 articles were included in the review, 6 being descriptive studies and 1 cohort study. After analyzing these studies, it appears that the technique that has obtained the best results is ECMO, with the care provided by qualified and trained nursing staff being very important. CONCLUSION: Mortality from Covid-19 increases in patients treated with invasive mechanical ventilation compared to patients treated with extracorporeal membrane oxygenation. Nursing care and specialization can have an impact on improving patient outcomes.

7-Nitroindazole reduces L-DOPA-induced dyskinesias in non-human Parkinsonian primate.

Nitric oxide (NO) plays a pivotal role in integrating dopamine transmission in the basal ganglia and has been implicated in the pathogenesis of Parkinson disease (PD). The objective of this study was to ascertain whether the NO synthase inhibitor, 7-nitroindazole (7-NI), is able to reduce L-DOPA-induced dyskinesias (LIDs) in a non-human primate model of PD chronically intoxicated with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Six Parkinsonian macaques were treated daily with L-DOPA for 3-4 months until they developed LIDs. Three animals were then co-treated with a single dose of 7-NI administered 45 min before each L-DOPA treatment. Dyskinetic MPTP-treated monkeys showed a significant decrease in LIDs compared with their scores without 7-NI treatment (p < 0.05). The anti-Parkinsonian effect of L-DOPA was similar in all three monkeys with and without 7-NI co-treatment. This improvement was significant with respect to the intensity and duration of LIDs while the beneficial effect of L-DOPA treatment was maintained and could represent a promising therapy to improve the quality of life of PD patients.

Simultaneous determination of Cu(II), Ni(II) and Zn(II) by peroxyoxalate chemiluminescence using Partial Least Squares calibration.

It was found that the ions Cu(II), Ni(II) and Zn(II) can attenuate the peroxyoxalate chemiluminescence emission, which was used to develop an analytical procedure for the simultaneous determination of these ions in a stopped-flow system using Partial Least Square (PLS) calibration. Acetonitrile was used to dissolve TCPO and to prepare a mixture of fluorescein, H(2)O(2) and imidazole. These solutions were carried using two peristaltic pumps, while a third pump was employed to propel the aqueous solutions of the metallic ions. All solutions were mixed in the quartz cell of a Campsec CL detector connected to a personal computer to register the CL development using the Clarity software. Under the optimum operative conditions each ion produced a specific CL development with maximum intensities at 0.280 min for Zn(II), 0.307 min for Ni(II) and 0.327 min for Cu(II). The latter exhibited the highest inhibition effect. The experimental calibration set was composed of 16 sample solutions using a central design for three component mixtures with scaled values. The proposed method offers the advantages of simplicity, good precision and accuracy for the simultaneous determination of Ni(2+), Cu(2+) and Zn(2+) in water samples.

[Efficacy of low-dose oxytocin during elective cesarean section]. / Eficacia de la oxitocina a dosis bajas en cesáreas electivas.

BACKGROUND AND OBJECTIVE: In cesarean section, the optimal dose of oxytocin to reduce the risk of hemorrhage with the least risk of adverse effects has yet to be defined. We studied the effects of using 2 different doses of oxytocin in women undergoing elective cesarean section under spinal anesthesia. The women had had no prior labor. MATERIAL AND METHODS: Randomized multicenter trial enrolling 104 patients classified as ASA 1. Following fetal extraction and coinciding with umbilical cord clamping, a group of 52 women received 1 IU of oxytocin followed by an infusion of 2.5 IU x h(-1); a second group of 52 women received a continuous infusion of 20 IU at a rate of 700 mlU x min(-1) followed by 10 IU x min(-1). We compared uterine contractility (assessed as absent, moderate, satisfactory), postoperative vaginal bleeding (absent, light, moderate, heavy), hemodynamics, and adverse effects after administration of oxytocin and fetal extraction (electrocardiographic abnormalities, nausea, vomiting, discomfort, headache, blushing, trembling, chills, or chest pain). RESULTS: No significant between-group differences in patient, obstetric, or anesthetic variables were detected. Uterine contraction was satisfactory in over 90% of the patients in both groups on initial assessment during surgery. After surgery, vaginal bleeding was absent or light in over 90% of the women. No significant differences in adverse events were detected between groups. CONCLUSIONS: The incidence of obstetric bleeding is not higher when a lower dose of oxytocin is used; the rate of postoperative adverse events also does not increase.

[Parturient at full term with inferior vena cava thrombosis: anesthesia during surgical delivery]. / Gestante a término con trombosis de la vena cava inferior: tratamiento anestésico en el parto.

Emergency cesarean section is a high-risk situation because of potential maternal-fetal complications. We report a case in which risk increased due to a massive thrombus in the mother's left common femoral vein extending to the vena cava. A 31-year-old woman with no relevant medical history in the 41st week of pregnancy was scheduled for induction. Two days before the planned induction she was admitted to the emergency department, where she was diagnosed with deep vein thrombosis in the left lower limb. She was transferred to the postanesthetic recovery unit, where a multidisciplinary team (from gynecology, hematology, interventional radiology, and anesthesiology) discussed various therapeutic options (thrombectomy, vena cava filter, or anticoagulation by intravenous infusion of unfractionated heparin). Given that deep vein thrombosis coincided with obstetric delivery, it was crucial to decide on anesthetic and therapeutic approaches that would assure maternal and fetal safety and prevent such complications as massive pulmonary thromboembolism.

Identification of differentially expressed genes profiles in a combined mouse model of Parkinsonism and colitis.

Different cellular mechanisms have been described as being potentially involved in the progression of neurodegeneration in Parkinson's disease, although their role is still unclear. The present study aimed to identify in detail, through differentially expressed genes analysis by bioinformatics approaches, the molecular mechanisms triggered after a systemic insult in parkinsonian mice. To address this objective, we combined a dextran sodium sulfate (DSS)-induced ulcerative colitis experimental mice model with an acute 1-methyl-4-phenyl-1,2,3,6-tetradropyridine (MPTP) intoxication. The animals were divided into four experimental groups based on the different treatments: (i) control, (ii) DSS, (iii) MPTP and (iv) MPTP + DSS. The data obtained by microarray and functional enrichment analysis point out the implication of different molecular mechanisms depending on the experimental condition. We see, in the striatum of animals intoxicated only with DSS, dysfunction processes related to the blood. On the other hand, oxidative stress processes are more prominent at the MPTP intoxicated mice. Finally, differentially expressed genes within the MPTP + DSS show functional enrichment in inflammation and programmed cell death. Interestingly, we identify a significant synergistic negative effect of both toxins since the expression of differentially expressed genes (DEGs) related to balanced cellular homeostasis was not enough to prevent processes associated with cell death. This work provides detailed insights into the involvement of systemic inflammation, triggered after an insult in the colon, in the progression of the degeneration in Parkinsonism. In this way, we will be able to identify promising therapeutic targets that prevent the contribution of inflammatory processes in the progression of Parkinson's disease.

Vitamin B6 status improves in overweight/obese women following a hypocaloric diet rich in breakfast cereals, and may help in maintaining fat-free mass.

OBJECTIVE: To analyze the changes in vitamin B6 status in women following slightly hypocaloric diets based on the relative increase consumption of foods whose intakes are below those recommended, and to study how these changes influence the proportion of fat-free mass. DESIGN: Intervention study of two slightly hypocaloric diets: diet V (increased consumption of vegetables), or diet C (increased consumption of cereals, especially breakfast cereals). SUBJECTS: A total of 49 women with a body mass index (BMI) of 25-35 kg/m2. MEASUREMENTS: Dietetic, anthropometric and biochemical data were collected at the start of the study and at 2 and 6 weeks. RESULTS: Both the C and V subjects showed a reduction in their energy intake, body weight, BMI and fat mass. Pyridoxine intake increased in both groups and plasma pyridoxal phosphate (PLP) levels increased only with diet C. An association was found between the increase in plasma PLP at 6 weeks and the increase in pyridoxine intake (r=0.451; P<0.01). Multiple regression analysis showed a positive association between the increase in PLP at the end of the study and the increases in the pyridoxine intake, B6 density or B6/protein ratio. At the end of the study, and only in those women whose PLP levels were increased, the higher the increase in PLP level, the higher the increase in fat-free mass percentage (r=0.4426, P<0.05). CONCLUSIONS: Interventions aimed at weight control should also try to maintain or improve nutritional status. A diet rich in cereals (especially fortified breakfast cereals) appears to be useful in improving vitamin B6 status. Such an improvement could help maintain fat-free mass during periods of weight loss.

[Is oxygen therapy truly useful and necessary during elective cesarean section under spinal anesthesia?]. / Es realmente necesaria y útil la oxigenoterapia suplementaria en la cesárea programada bajo anestesia subaracnoidea?

OBJECTIVE: To analyze maternal and fetal well-being with and without the application of oxygen therapy. MATERIAL AND METHODS: Randomized trial of full-term parturients who had received prenatal care during pregnancy. The women were healthy and classified as ASA 1. They were scheduled for delivery by cesarean section under spinal anesthesia and randomized to 2 groups to breathe room air or air providing an inspired oxygen fraction of 40% through a face mask. We assessed the well-being of the neonate immediately after birth with the Apgar test and by measuring umbilical cord blood gases. RESULTS: One hundred thirty women were enrolled. Both groups were similar, with no differences in demographic or hemodynamic variables, time from uterine incision to fetal extraction, neonatal birth weight, presence of umbilical cord abnormalities, type of resuscitation required by the neonate, or Apgar score in the first or fifth minute. Oxygen saturation in maternal blood by pulse oximetry was higher after 10 minutes in the group of women who received supplemental oxygen through face masks. We also observed significant differences in umbilical cord arterial blood between the room air and supplemental oxygen groups, respectively, as follows: PaCO2, 51.14 mm Hg vs 54.33 mm Hg (P=.016); bicarbonate, 22.19 mEq L(-1) vs 23.23 mEq L(-1) (P=.012); lactate, 1.85 mmol L(-1) vs 1.64 mmol L(-1) (P=.038). The PO2 in venous blood also differed significantly: 25.53 mm Hg vs 28.13 mm Hg, respectively (P=033). CONCLUSIONS: Breathing supplemental oxygen or not during elective cesarean delivery of healthy parturients under spinal anesthesia does not have a significant effect on neonatal well-being.

Expression patterns and genetic variation of the ovine skeletal muscle transcriptome of sheep from five Spanish meat breeds.

The goal of the current study is to analyse the gene expression profile of the ovine skeletal muscle as well as to characterize the genetic variation of transcripts expressed in such tissue. This aim has been achieved by sequencing the longissimus dorsi transcriptomes of 50 sheep distributed in five pools representing the Canaria de Pelo, Roja Mallorquina, Gallega, Xisqueta and Ripollesa Spanish autochthonous breeds. Approximately, 363 million reads per pool have been produced and 71.9-82.9% have been successfully mapped to the ovine genome in a paired-end mode (2 × 75 bp). The 200 most expressed muscle transcripts (≈1% of the total transcript count) account for 51% (Canaria de Pelo) to 67% (Gallega) of the total ovine skeletal muscle mRNA expression. These highly expressed genes play key roles in pathways related with striated muscle contraction, gluconeogenesis, glycolysis, citric acid cycle and respiratory electron transport. RNA-Sequencing of muscle transcripts has also revealed that ~72% of the SNPs detected with this approach are shared by at least two pools, and 10% of them segregate in the five pools under analysis. Most of the substitutions detected by RNA-Seq are synonymous or missense and only a minority are predicted to have consequences on protein function.

Changes in thiamin intake and blood levels in young, overweight/obese women following hypocaloric diets based on the increased relative consumption of cereals or vegetables.

OBJECTIVE: To analyse the changes in thiamin intake and blood levels of young, overweight/obese women following slightly hypocaloric diets based on the increased relative consumption of foods whose intakes were most removed from the ideal: cereals and vegetables. DESIGN: The women were randomly assigned to one of two slightly hypocaloric diets: diet V, in which the consumption of vegetables was increased, or diet C, in which the consumption of cereals (especially breakfast cereals) was increased. SUBJECTS: The study subjects were 67 young women with a body mass index of 24-35 kg/m2. INTERVENTIONS: Dietetic, anthropometrics and biochemical data were collected at the start of the study and again at 2 and 6 weeks. RESULTS: The reduction in energy intake was similar in both groups. However, diet C subjects lost significantly more weight. Blood thiamin concentration was higher in group C women than in group V women at 2 and 6 weeks. Compared to initial values, group C subjects showed a higher blood thiamin level at 2 weeks. The highest blood thiamin levels seen in group C women may have been due to their greater thiamin intake, their higher thiamin dietetic density, and a higher thiamin/carbohydrates ratio at both week 2 and 6 of the intervention period. CONCLUSIONS: Increasing the relative consumption of breakfast cereals within the context of a slightly hypocaloric diet can help in weight control and improve thiamine intake and blood levels.

[Dietary habits and their relationship with the knowledge on the concept of a balanced diet in a group of young women with overweight/obesity]. / Hábitos alimentarios y su relación con los conocimientos, respecto al concepto de dieta equilibrada, de un colectivo de mujeres jóvenes con sobrepeso/obesidad.

OBJECTIVE: To know the dietary habits of a population of women with overweight/obesity and their knowledge on the concept of proper feeding in order to design nutrition educational campaigns focused on this population. MATERIALS AND METHODS: A group of 67 women, aged 20 to 35 years with body mass index 24-35 kg/m2 were asked about their frequency of food intake and what they thought to be correct to achieve a balanced diet. RESULTS: Studied women more frequently consumed oils (4.3 +/- 4.5 times/week) and sweets (2.5 +/- 3.6 times/week) and less frequently water (-19.1 +/- 22.7 times/week), vegetables (-4.3 +/- 5.7 times/week), fruits (-3.7 +/- 6.2 times/week), legumes (-1.3 +/- 2.0 times/week) and fish (-2.2 +/- 3.7 times/week) than what they thought they should consume. When comparing what they declare to consume to what has been established as minimal recommended intake for the different groups of foods it is observed that the intake of grains and legumes, fruits and vegetables, and slightly less that of fish and eggs, should de increased. CONCLUSIONS: given the incorrect dietary habits observed in a population of women with overweight/obesity, it should be convenient to carry out nutrition educational campaigns. This education could help improve the diet of all the population and the occurrence of overweight and obesity could be prevented in many cases. Besides, in those cases in which the pathology is already present, this could prevent following regimens that are harmful for the health and for weight management.

The relationship between antioxidant nutrient intake and cataracts in older people.

This study investigated the relationship between the intake of antioxidant nutrients and the suffering of cataracts in 177 institutionalized elderly people (61 men and 116 women) aged > or = 65 years. Dietary intake was monitored for 7 consecutive days using a "precise individual weighing" method. Subjects, who during their earlier years were exposed by their work to sunlight, had a greater risk of suffering cataracts (OR = 3.2; CI: 1.1-9.3, P < 0.05) than those who worked indoors. A relationship was found between increased vitamin C intake and a reduced prevalence of cataracts (i.e., when comparing those above P95 for vitamin C intake with those below P5; (OR = 0.08; CI: 0.01-0.75, P 0.05). Among subjects with cataracts, 12.1% had vitamin C intakes of < 61 mg/day (P10) and only 2.2% had intakes of > 183 mg/day (P95) (p < 0.01). Subjects who consumed > 3290 microg/day (P95) of lutein were less likely to have cataracts (OR = 0.086; CI: 0.007-1.084; p < 0.05) than those whose consumption was < 256 microg/day (P5). In men, high intakes of zeaxanthin seemed to provide a protective effect against the problem (OR = 0.96; CI: 0.91-0.99; p < 0.05). The results suggest an association exists between exposure to sunlight and the development of cataracts, and that vitamin C, lutein, and zeaxanthin offer some protection against this disorder.

Population structure of eleven Spanish ovine breeds and detection of selective sweeps with BayeScan and hapFLK.

The goals of the current work were to analyse the population structure of 11 Spanish ovine breeds and to detect genomic regions that may have been targeted by selection. A total of 141 individuals were genotyped with the Infinium 50 K Ovine SNP BeadChip (Illumina). We combined this dataset with Spanish ovine data previously reported by the International Sheep Genomics Consortium (N = 229). Multidimensional scaling and Admixture analyses revealed that Canaria de Pelo and, to a lesser extent, Roja Mallorquina, Latxa and Churra are clearly differentiated populations, while the remaining seven breeds (Ojalada, Castellana, Gallega, Xisqueta, Ripollesa, Rasa Aragonesa and Segureña) share a similar genetic background. Performance of a genome scan with BayeScan and hapFLK allowed us identifying three genomic regions that are consistently detected with both methods i.e. Oar3 (150-154 Mb), Oar6 (4-49 Mb) and Oar13 (68-74 Mb). Neighbor-joining trees based on polymorphisms mapping to these three selective sweeps did not show a clustering of breeds according to their predominant productive specialization (except the local tree based on Oar13 SNPs). Such cryptic signatures of selection have been also found in the bovine genome, posing a considerable challenge to understand the biological consequences of artificial selection.

[Response to a weight control program based on approximating the diet to its theoretical ideal]. / Respuesta ante un programa de control de peso basado en la aproximación de la dieta al ideal teórico.

UNLABELLED: Obesity is a risk factor for a number of degenerative diseases common in industrial societies and the number of overweight/obese people continues to grow. The control of body weight is therefore a priority public health objective. OBJECTIVE: To analyze the response to a weight loss program based on approximating the diet to the theoretical ideal (by increasing the consumption of recommended foods under-represented in the diet: cereals and vegetables). SUBJECTS: The study involved 67 women aged between 20 and 35 years with a body mass index (BMI) of between 24 and 35 kg/m2. These women were randomly assigned to two groups with the aim of improving weight control and of approximating the diet to the theoretical ideal. INTERVENTIONS: Both groups were advised to follow a slightly hypocaloric diet, but with one group increasing the intake of greens and vegetables (H) and the other increasing the intake of cereals (especially breakfast cereals) (C). Dietary data were obtained via the keeping of a daily food record over three days, including a Sunday. Anthropometric data were obtained at the start of the study and again 2 and 6 weeks later. RESULTS: Both treatments approximated the energy profile of the diets to the theoretical ideal. The amount of energy gained from lipids fell and that gained from carbohydrates increased (both at 2 and 6 weeks), significantly more so for group C. Fifty seven women completed the study and showed a mean reduction in body weight of 2.4 +/-1.4 kg. The weight lost by group C was significantly greater than that lost by group H (2.8 +/- 1.4 kg compared to 2.0 +/- 1.3 kg; p < 0.05). The women who followed diet C showed a greater number of skin folds of significantly reduced size, both at 2 and 6 weeks. More group C women completed the study (93.5% compared to 77.8% of group H women). CONCLUSION: In overweight or slightly obese women, approximating the diet to the theoretical ideal (by increasing the intake of vegetables of cereals) can help to control body weight and improve the quality of the diet (both in terms of the number and size of food rations, and the overall energy profile). The present results show that increasing the consumption of breakfast cereals may be of particular use owing to their high fiber, vitamin and iron contents.