Educación alimentaria nutricional: Estrategias para mejorar la adherencia al plan dietoterapéutico

RESUMEN La educación alimentaria nutricional es la combinación de estrategias educativas, acompañadas de apoyos ambientales, diseñadas para facilitar la adopción voluntaria de elecciones alimentarias que conducen a un estado óptimo de salud y bienestar. La educación alimentaria nutricional tiene tres componentes: 1) motivación, 2) acción y 3) ambiente. Para elegir la técnica de educación adecuada para cada persona, se deben considerar las características psicoemocionales individuales, especialmente las motivaciones para el cambio y el tipo de personalidad, ya que ambos han mostrado ser buenos predictores de la conducta alimentaria. Dentro de los recursos educativos posibles de utilizar para realizar la educación en alimentación nutricional se encuentran indicaciones verbales, material escrito, uso de internet, dispositivos portátiles, aplicaciones de teléfonos inteligentes, e incluso la clase de cocina. La evidencia demuestra que la educación alimentaria nutricional impacta favorablemente la adherencia a las intervenciones nutricionales, lo cual a la vez se ve reflejado en efectos positivos en la salud.

ABSTRACT Food and nutrition education is the combination of educational strategies, accompanied by environmental supports designed to facilitate voluntary adoption of food choices conducive of health and well-being. It has a motivational phase, an action phase, and an environmental component. To choose the right educational technique for each patient, their individual psychoemotional characteristics must be considered; especially what their motivations for change are, as well as their personality type, because both are good predictors of food behavior. Among the resources that can be used to perform nutrition education are verbal indications, written material, the internet, mobile devices, smartphone applications, and even the kitchen as a place for education. Evidence shows that nutrition education has a favorable impact on diet adherence in different conditions that have an important nutritional component, such as celiac disease, inflammatory bowel disease, diabetes and obesity, which at the same time produces positive health outcomes.

Intervención nutricional participativa en adolescentes de enseñanza media del municipio Habana Vieja / Participative nutritional intervention in middle school adolescents from Habana Vieja municipality

Introducción: Los hábitos alimentarios no saludables potencian las enfermedades crónicas que constituyen las primeras causas de muerte en Cuba. Objetivos: Evaluar los efectos de una intervención nutricional sobre los cambios en los conocimientos de alimentación-nutrición y hábitos alimentarios en adolescentes. Métodos: Se realizó una intervención nutricional participativa con adolescentes de 12-15 años del municipio Habana Vieja, durante sus tres años curriculares. De los 604 adolescentes que comenzaron el estudio 155 formaron los grupos promotores que lideraron las actividades realizadas. Se aplicaron encuestas de conocimientos, consumo y hábitos alimentarios antes y después de la intervención. Para comparar la puntuación alcanzada se utilizó la prueba t de Student para muestras pareadas. Para la comparación entre escuelas se utilizó análisis de la varianza simple y para comparar los porcentajes de respuestas correctas de las preguntas de conocimientos, consumo de hortalizas y azúcar antes y después de la prueba de estimación de diferencias entre proporciones. Se definió como umbral de significación estadística p < 0,05. Resultados: Los grupos promotores mostraron aumentos significativos de los conocimientos (p < 0,001). Se encontraron diferencias entre escuelas para los grupos promotores (p < 0,001) y para el resto de los estudiantes (p = 0,024). Decreció el azúcar añadido a los refrescos para los grupos promotores (p < 0,001) y a la leche para todos los adolescentes (p = 0,002). No hubo cambios en el hábito de desayunar, en el gusto por alimentos fritos, ni en el consumo de refrescos, frituras, dulces y pizzas. Conclusiones: Las intervenciones de educación nutricional son necesarias para alcanzar patrones dietéticos más saludables y de esta manera contribuir a detener la epidemia de enfermedades no transmisibles, además permiten que los adolescentes tengan un acercamiento al tema alimentación-nutrición(AU)

Introduction: Non-healthy food habits boost chronic diseases that represent the main death causes in Cuba. Objectives: To assess the effects of a nutritional intervention on the changes in the knowledge of diet-nutrition and food habits of adolescents. Methods: It was carried out a participative nutritional intervention with adolescents from 12 to 15 years from Habana Vieja municipality during their 3 middle school years. From 604 adolescents that started the study, 155 formed the promoter groups which leadered the activities implemented. There were applied knowledge surveys on food consumption and habits before and after the intervention. For comparing the scores, it was used t-Student test for paired samples. It was used the analysis of simple variance for comparing among schools and the percentages of right answers in the knowledge questions, intake of vegetables and sugar before and after of the test for the estimation of differences among proportions. It was defined p<0,05 as the threshold of statistical signification. Results: The promoter groups showed significative increase of knowledge (p<0,001). There were found differences among schools for promoter groups (p<0,001) and for the rest of the students (p<0,024). In the promoter groups decreased the intake of sugar added to soft drinks (p<0,001) and to milk for all the adolescents studied (p<0,002). There were no changes in breakfast habits, liking fried food, or the consumption of soft drinks, fritters, sweets and pizzas. Conclusions: Nutritional education interventions are needed to reach healthier diet patterns and in this way contributing to stop the epidemic of non-communicable diseases; in addition, they allow adolescents to have an approach to food-nutrition topic(AU)

Effects of energetic restriction diet on butyrylcholinesterase in obese women from southern Brazil - A longitudinal study

Objective Butyrylcholinesterase (BChE) activity has been associated with obesity, lipid concentrations, and CHE2 locus phenotypes. This, the aim of this study was to evaluate the effects of an energetic restriction diet intervention on anthropometrical and biochemical variables and on absolute and relative BChE activity in CHE2 C5+ and CHE2 C5- individuals. Subjects and methods One hundred eleven premenopausal obese women from Southern Brazil participated in an energetic restriction diet intervention (deficit of 2500 kJ/day) for 8 weeks. Their anthropometric and biochemical parameters were evaluated before and after the intervention. Plasma BChE activity was measured, and BChE bands in plasma and CHE2 locus phenotypes were detected by electrophoresis. Results The dietetic intervention decreased anthropometric and biochemical parameters as well as absolute BChE activity and relative activity of the G4 band. The CHE2 C5+ phenotype presented a different effect when compared with the CHE2 C5- phenotype. The CHE2 C5+ phenotype showed an effect in absolute BChE activity and in the relative activity of the G4 form, maintaining higher BChE activity regardless of the metabolic changes. Conclusion In our study, 8 weeks was not sufficient time to lower the body mass index to normal, but it was enough to significantly reduce the absolute BChE activity, which became similar to the levels in nonobese individuals. CHE2 C5+ individuals were resistant to the decrease in BChE activity compared to CHE2 C5- individuals. This shows that the diet did not affect the CHE2 and G4 fraction complex and that the products of the CHE2 locus in association with BChE have a role in energy metabolism, maintaining high levels of enzymatic activity even after dietary intervention.

Clinical study of relationship between sleep apnea syndrome and metabolic syndrome of petrol field workers / 中华急诊医学杂志

Objective To analyze the relationship between obstructive sleep apnea syndrome (OSAS) and metabolic syndrome (MS) in petrol field workers.Methods A total of 100 cases of OSAS patients of petrol field workers were enrolled as the study objects from March 2013 to August 2015 in emergency and respiratory department in Daqing Longnan Hospital and were divided into three groups:simple snoring group (Group A,n =26),mild OSAS group (Group B,n =42),and severe OSAS group (Group C,n =32).The comparison of dietetic status score,sleep status score and the patients with MS among 3 groups were carried out.The relationship between OSAS and MS was analyzed by using univariate and multivariable Logistic regression analyses were used.Results In Group C,sleep status score (8.3 ± 1.2) and dietetic status score (7.6 ± 1.4) and the rates of MS (23/32) were higher than those in the other two groups (P ＜ 0.05).Univariate and multivariable Logistic regression analyses,showed OSAS was the risk factorofMS [r=11.211 (OR =9.412,95％ CI:5.992～15.202)].Conclusions Dietetic status and sleep status were obviously influenced by OSAS in petrol field workers.The incidence of MS were more common in petrol field workersevere with OSAS and OSAS was a risk factor of MS.

Efeitos dos diferentes tipos de adoçantes dietéticos isolados nos parâmetros nutricionais e bioquímicos de ratos / Effects of different types of isolated dietary sweeteners on nutritional and biochemical parameters of rats

OBJECTIVE: This study aimed to evaluate the effects of using different types of isolated sweeteners in nutritional and biochemical parameters of rats. METHODS: We used 36 adult male rats, maintained on diet for 42 days and divided into six groups: Group C - Control, Group AS - Aspartame; Group ES - Stevia; Group SU - Sucralose; Group CI - Cyclamate; group SA - Saccharin. The animals were fed a standard AIN 93M with replacement of sucrose by its sweetener and water ad libitum. The animals were kept in metabolic cages in a controlled environment and were recorded body weight, food and water consumption, urinary and fecal excretion. At the end of the study the animals were anaesthetized intraperitoneally with a combination of ketamine, hydrochloride xylazine and acepromazine and euthanized by cardiac puncture. Theserum was used to determine glucose, lipid, liver and kidney profiles. RESULTS: Animals receiving sweeteners had lower food intake compared to Group C, highlighting the SA Group. The results indicated that the sweeteners used in this study and the maximum proportion suggested by ANVISA, particularly saccharin, stevia, sucralose and cyclamate, decreased the animals food intake. Sweeteners did not influence the other study variables. CONCLUSIONS: The sweeteners reduced food intake, but no change was noticed in the animal's final weight gain and other variables. We suggest additional long term research

OBJETIVO: Avaliar os efeitos do uso de diferentes tipos de adoçantes isolados nos parâmetros nutricionais e bioquímicos de ratos. MÉTODOS: Foram utilizados 36 ratos machos, Wistar, adultos, mantidos sob dieta durante 42 dias e distribuídos em seis Grupos: Grupo C ­ Controle; Grupo AS ­ Aspartame; Grupo ES ­ Estévia; Grupo SU ­ Sucralose; Grupo CI ­ Ciclamato; Grupo SA ­ Sacarina. Os animais receberam dieta padrão AIN 93M com substituição da sacarose pelo respectivo adoçante e amido, com água ad libitum. Os animais foram mantidos em ambiente controlado e foram registrados peso corporal, consumo alimentar e hídrico, excreção urinária e fecal. Os animais foram anestesiados via intraperitoneal, com Cloridrato de Cetamina, Cloridrato de Xilazina e Acepromazina. A eutanásia foi realizada por punção cardíaca. O soro foi utilizado para determinar perfil glicídico, lipídico, hepático e renal. RESULTADOS: Os animais que receberam adoçante apresentara menor consumo alimentar em relação ao Grupo C, destacando-se o Grupo SA. Os resultados indicaram que os adoçantes utilizados no presente estudo e na proporção máxima sugerida pela ANVISA, principalmente sacarina, estévia, sucralose e ciclamato, diminuíram o consumo alimentar dos animais. Os adoçantes não influenciaram as demais variáveis do estudo. CONCLUSÕES: Os adoçantes reduziram o consumo alimentar, porém sem alteração no ganho de peso final dos animais e nas demais variáveis estudadas. Sugere-se a realização de pesquisas adicionais em longo prazo

Dietetic Practices in the Management of Childhood Obesity in Malaysia

Introduction: Dietitians play an essential role in the management of childhood obesity and consistency in dietetic practices is required to ensure the effectiveness of treatment. This study assessed dietitians’ current practices in the management of childhood obesity, compared the practices with nutrition practice guidelines used by dietitians in other countries and identified practice components for the development of nutrition practice guidelines for the management of childhood obesity in Malaysia. Methods: A cross-sectional study was conducted among 40 dietitians in 16 Ministry of Health hospitals and three teaching hospitals. Information on current dietetic practices in the management of childhood obesity was obtained through a mailed survey questionnaire. The practices included nutritional assessment, determination of energy requirement, dietary prescription and physical activity modification. Emails were sent to 31 dietetic associations in other countries to obtain information on practice guidelines used by dietitians. Results: Frequently used dietary intervention and physical activity modification approaches were high fibre diet (65%), low fat diet (40%), reduction of sedentary pursuits and screen times (67.5%) and an increase in duration of current physical activities (60%). In comparison to other dietetic practice guidelines, the current dietetic practices in Malaysia do not usually include waist circumference, biochemical and blood pressure data. However, similar to other guidelines, the current dietetic practices included low dietary fat, high fibre diet, decreased sedentary activity and increased physical activity level. Conclusions: The dietetic practices in the management of childhood obesity in Malaysia are diverse. A comprehensive nutrition practice guideline for management of childhood obesity is urgently needed for standardisation of dietetic practices in Malaysia.

Respuesta glicémica al consumo de una barra de cereales-leguminosa (Phaseolus vulgaris) en individuos sanos / Glycemic response to consumption of a cereals and legume (Phaseolus vulgaris) bar on healthy individuals

El objetivo de la presente investigación fue formular una barra de cereales y leguminosa (Phaseolus vulgaris) y evaluar su impacto sobre la respuesta glicémica de individuos sanos, a fin de contribuir con la oferta de alimentos beneficiosos para la salud del consumidor. Para esto se formuló una barra con una mezcla de cereales (maíz y avena) y dos porcentajes (20% y 30%) de Phaseolus vulgaris. Adicionalmente, se preparó una barra de cereales sin leguminosa (barra control). Mediante evaluación sensorial, se seleccionó la barra con 30% de Phaseolus vulgaris, por ser evaluada con mejor sabor y textura, además esa combinación de cereales y leguminosas favorece la complementación aminoacídica y los criterios de formulación previamente establecidos. La caracterización química indicó un contenido de proteínas mayor en la barra con 30% de Phaseolus vulgaris (13,55%), en relación a la barra control (8,5%). Los contenidos de grasa, cenizas y fibra dietética no presentaron diferencias (p>0,05) entre ambas barras evaluadas. Sin embargo, el contenido de fibra soluble y de almidón resistente de la barra seleccionada resultó un 32,05% y 18,67% mayor, respectivamente, que en la barra control, con lo cual se podría contribuir con la disminución de la velocidad de absorción de la glucosa. La barra seleccionada presentó un índice glicémico bajo (49) y carga glicémica intermedia (12,0) en voluntarios sanos, lo que podría traducirse en una posible reducción de la tasa de absorción de glucosa al torrente sanguíneo, asociada a un contenido de carbohidratos de absorción lenta. La barra formulada representa una propuesta de merienda saludable para el consumidor.

The objective of this work was to formulate a cereals and legume (Phaseolus vulgaris) bar and assess its impact on the glycemic response of healthy individuals, in order to contribute to the healthy food supply beneficial to consumers. A mixture of cereals (corn and oats) and different percentages (20 and 30%) of Phaseolus vulgaris was used to formulate the bar. Additionally, a legume cereal bar without legumes (bar control) was prepared. The bar with 30% of Phaseolus vulgaris was selected through sensory evaluation, being scored with better flavor and texture. This combination of cereals and legumes aminoacid improves complementation and reaches the formulation criteria previously established. Chemical characterization indicated a higher protein content in the bar with 30% of Phaseolus vulgaris (13,55%) relative to the bar control (8,5%). The contents of fat, ash and dietary fiber did not differ between the two bars evaluated. However, the soluble fiber and resistant starch of the selected bar was a 32,05% and 18,67%, respectively, than in the control bar; this may contribute to decreasing the rate of glucose uptake. The selected bar presented a low glycemic index (49) and intermediate glycemic load (12,0) in healthy volunteers, which could lead to a possible reduction in the rate of absorption of glucose into the bloodstream, associated with a carbohydrate content of slow absorption. This bar represents a proposal of a healthy snack for the consumer.

Leukocyte infiltration and anti-myeloperoxidase immunoreactivity in granulocytes of the mucosa and submucosa of the large intestine of horses submitted to dietetic starch overload / Infiltração de leucócitos e imunorreatividade antimieloperoxidase em granulócitos da mucosa e submucosa do intestino grosso de equinos submetidos à sobrecarga dietética com amido

This study was carried out to evaluate leukocyte infiltration and anti-myeloperoxidase immunoreactivity in granulocytesof the mucosa and submucosa of the large intestine of horses submitted to dietetic starch overload. Eight adult horseswere allocated randomly in three treatments: Treatment I (Control) (n = 2), animals euthanized without starch overload;and Treatments II (n = 3) and III (n = 3), animals undergoing starch overload, with gastric infusion of 17.6 g starch perkg of body weight, euthanized after 24 and 36 hours, respectively. Only afflux of neutrophils in the intestinal mucosa andsubmucosa blood vessels (leukocyte stasis) was observed. Eosinophils were the predominant cells in the mucosa andsubmucosa in all horses, independent of dietetic overload, with infiltration grade from mild to moderate. Lymphocyteinfiltration was also observed in all horses, but with lower intensity when compared to eosinophils. Congestion, edemaand dilatation of lymphatic vessels were the main circulatory alterations observed, with more intensity in the submucosa.Higher immunoreactivity to the anti-myeloperoxidase antibodies was observed in the mucosa and submucosa of horses36 hours after overload. Horses submitted to dietetic starch overload showed intestinal inflammatory response withprevalence of eosinophils, leukocyte stasis and circulatory alterations, varying from discreet to moderate

Este estudo teve como objetivo avaliar a infiltração de leucócitos e a imunorreatividade antimieloperoxidase emgranulócitos da mucosa e submucosa do intestino grosso de equinos submetidos à sobrecarga dietética com amido.Oito equinos adultos foram distribuídos aleatoriamente em três tratamentos: Tratamento I (Controle) (n = 2), equinoseutanasiados sem sobrecarga com amido; Tratamento II (n = 3) e III (n = 3), equinos submetidos à sobrecarga comamido, com infusão gástrica de 17,6 g de amido/kg de peso vivo e eutanasiados após 24 e 36 horas, respectivamente.Observou-se apenas afluxo de neutrófilos (leucocitoestase) nos vasos sanguíneos da mucosa e submucosa intestinal.Eosinófilos foram as células predominantes na mucosa e submucosa em todos os equinos, independente da sobrecargadietética, com grau de infiltração de leve a moderada. Infiltração por linfócitos também foi observado em todos osequinos, porém com menor intensidade quando comparado aos eosinófilos. Congestão, edema e dilatação de vasoslinfáticos foram as principais alterações circulatórias observadas, com maior intensidade na submucosa. Maiorimunorreatividade para anticorpos antimieloperoxidase foi observado na mucosa e submucosa dos equinos 36 horasapós a sobrecarga. Equinos submetidos à sobrecarga dietética com amido apresentam resposta inflamatória intestinalcom predominância de eosinófilos, leucocitoestase e alterações circulatórias variando de discreta a moderada

Utilização de adoçantes dietéticos entre adultos em Pelotas, Rio Grande do Sul, Brasil: um estudo de base populacional / Use of diet sweeteners by adults in Pelotas, Rio Grande do Sul State, Brazil: a population-based study

Estudo de base populacional avaliou o uso de adoçantes dietéticos na população com idade ≥ 20 anos, residente na zona urbana do Município de Pelotas, Rio Grande do Sul, Brasil. A coleta de dados ocorreu entre janeiro e julho de 2010, e 2.732 indivíduos foram entrevistados. Além das questões específicas quanto ao uso de adoçante dietético, foram coletadas informações sobre características demográficas, socioeconômicas e de saúde. Para as análises estatísticas, foram utilizados testes qui-quadrado de heterogeneidade e de tendência linear. A prevalência de uso de adoçante dietético foi 19 por cento (IC95 por cento: 17,1; 20,9), sendo 3,7 vezes maior entre idosos do que entre aqueles com 20-29 anos de idade. Nível econômico e estado nutricional apresentaram associação direta e significativa com o desfecho. Quase 98 por cento da amostra utilizou adoçantes na forma líquida, sendo os mais consumidos (89,2 por cento) aqueles constituídos por sacarina e ciclamato de sódio. A mediana de ingestão diária foi 10 gotas (P25; P75 = 6; 18), entre usuários de adoçante líquido, ou 1,5 sachet (P25; P75 = 1; 4), para adoçante em pó. O uso de adoçante dietético foi maior entre mulheres e idosos.

This population-based study evaluated the use of diet sweeteners by adults (> 20 years) in Pelotas, Rio Grande do Sul State, Brazil. Data were collected from January to July 2010 (n = 2,732). Besides specific questions on diet sweeteners, demographic, socioeconomic, and health characteristics were recorded. Heterogeneity and linear trend chi-square tests were used for the statistical analysis. Prevalence of sweetener use was 19 percent (95 percentCI: 1.1-20.9), and was 3.7 times higher in elderly individuals as compared to 20-29-year-olds. Economic level and nutritional status were significantly associated with sweetener use. Nearly 98 percent of the sample used liquid sweeteners; the most frequently consumed (89.2 percent) were those containing saccharin or sodium cyclamate. Average intake was 10 drops of liquid sweetener or 1.5 sachets of powdered sweetener. Use of diet sweeteners was higher among women and the elderly.

Fórmula dietética institucional para trabajadores amparados por la ley de alimentación del trabajador / Formulates dietetic institutional for workers protected by the law of feeding of the worker

El objetivo es demostrar la importancia que tiene la aplicación de la Fórmula Dietética Institucional (FDI), mediante resultados obtenidos a partir de una muestra, los cuales son confiables y permiten inferir la FDI para la población de trabajadores y trabajadoras, beneficiarios de la Ley de Alimentación para los Trabajadores, aprobada según Gaceta Oficial N° 38.094 de la República Bolivariana de Venezuela, de fe-cha 27 de diciembre de 2004; y su Reglamento, aprobado según Gaceta Oficial Nº 38.426 de fecha 28-04-06, Decreto Nº 4.448 del 25-04-06, la cual obliga a las empresas a suministrar a los beneficiarios, al menos una comida diaria, según los Requerimientos de Energía y Nutrientes para la población venezolana. Se consideraron las variables: Edad, Género, Actividad y Requerimiento Energético; se estudió una población de 1.644 trabajadores y trabajadoras de una empresa A, clasificados según el tipo de trabajo realizado, así como 1038 trabajadores y trabajadoras de una empresa B, con cuatro sedes. Se seleccionó una muestra probabilística de 150 de la primera empresa con el fin de comprobar la contabilidad de los resultados basados en dicha muestra, se comparó el resultado obtenido para la población y para la muestra, mediante la prueba z, y se encontró que no hay diferencias estadísticamente significativas (p > 0,05). Se compararon los requerimientos promedios por género y por actividad, mediante la aplicación de la prueba t y las diferencias fueron estadísticamente significativas (p < 0,05). Se concluye que la FDI es válida y los resultados obtenidos a partir de una muestra probabilística son confiables.

The objective is to demonstrate the importance has the application the diet formula Institutional (IDF), using results obtained in a sample, which are reliable and allow you to infer the IDF for the population of workers, beneficiaries of food law for workers, adopted according to Gazette official Nº 38.094 of the Bolivarian Republic of Venezuela, dated 27 December 2004; and its regulations, approved accor-ding to official Gazette Nº 38.426 dated 28-04-06, Decree Nº 4.448 of the 25-04-06, which requires companies to pro-vide the beneficiaries to the least a daily meal according to energy and nutrient requirements for the Venezuelan popu-lation. The variables were considered: Age, Sort, Activity and Energetic Requirement; a population of 1644 workers and workers of a company studied, classified according to the type of made work, as well as 1038 workers and workers of a B company, with four seats. A probabilistic sample of 150 of the first company with the aim was selected to verify the trustworthiness of the results based on this sample, com-pared the result obtained for the population and the sam ple, by means of test t of Student, and one was that p are statisti-cally no significant differences (p > 0,05). Ave rages by sort were compared the requirements and by activity, by means of the application of the test t and the dif ef rences they were statistically significant (p < 0,05). One concludes that the IDF is valid and the results obtained from a probabilistic sample are reliable.

Consumo de adoçantes e produtos dietéticos por indivíduos com diabetes melito tipo 2, atendidos pelo Sistema Único de Saúde em Ribeirão Preto, SP / Consumption of sweeteners and dietetic foods by individuals with type 2 diabetes mellitus, assisted by the National Health System in Ribeirão Preto, SP

OBJETIVO: Analisar o consumo de adoçantes e produtos dietéticos por indivíduos com diabetes melito tipo 2, atendidos pelo Sistema Único de Saúde (SUS) em Ribeirão Preto, SP. SUJEITOS E MÉTODOS: Por meio de questionário, foram entrevistados 120 pacientes, estratificados por sexo, faixa etária e nível de atendimento. RESULTADOS: Os resultados mostram que o uso de adoçantes é frequente na população em estudo, com predomínio do tipo líquido, e o uso de produtos dietéticos é menor, com predomínio dos refrigerantes. O diagnóstico do DM foi determinante para o uso dos produtos e o critério de seleção mais utilizado foi o sabor. É pequena a porcentagem da amostra que sabe a diferença entre diet e light, que tem o hábito de ler o rótulo dos alimentos e que se preocupa com a quantidade utilizada de adoçante. CONCLUSÃO: É uma necessidade a inclusão de informações sobre o uso adequado desses produtos nas atividades assistenciais aos pacientes com DM nos diversos níveis do SUS.

OBJECTIVE: To analyze the consumption of sweeteners and dietetic foods by individuals with type 2 diabetes, assisted by the Brazilian National Health System, in the city of Ribeirão Preto, SP. SUBJECTS AND METHODS: Through a questionnaire were interviewed 120 patients were interviewed, stratified by sex, age and level of health care. RESULTS: The use of sweeteners is very frequent by the population in study, with predominance of the liquid type, and the use of dietetic foods is less common, with predominance of soft drinks. The diagnosis of diabetes was determinant for starting the use of both and the used criterion for selection of the sweetener is its flavor. The percentage of the population that knows the difference between diet and light products, that has the habit to read labels, and that is worried with the amount used of sweetener, is small. CONCLUSION: There is a need to include information about the adequate use of these products in the health care activities for patients with diabetes in the different levels of the Brazilian National Health System.

Análise crítica das recomendações da Associação Americana de Diabetes para doença cardiovascular no diabetes melito: [revisão] / Critical analysis of the American Diabetes Association dietary recommendations for cardiovascular disease in diabetes mellitus: [review]

A doença cardiovascular (DCV) é a principal causa de mortalidade em pacientes com diabetes melito (DM), sendo essencial a intervenção dietética no manejo dessa complicação. O objetivo deste manuscrito foi revisar as evidências científicas que fundamentam as recomendações dietéticas da American Diabetes Association (ADA) para prevenção e tratamento da DCV nos pacientes com DM. As diretrizes da ADA baseiam-se, em sua maioria, em estudos com pacientes com DCV, porém sem DM. Nos pacientes com DM, um aumento na ingestão de peixe e de fibras solúveis são as recomendações dietéticas com benefício comprovado. Embora o DM possa ser considerado um equivalente de DCV estabelecida, a adoção das recomendações dietéticas de pacientes sem DM e com DCV para todos pacientes com DM é questionável - em especial quando são consideradas as peculiaridades da DCV no DM. Ensaios clínicos aleatorizados em pacientes com DM deverão fundamentar melhor os benefícios das intervenções dietéticas sobre a DCV.

Cardiovascular disease (CVD) is the main cause of mortality among patients with diabetes mellitus (DM), and dietary intervention is an essential measure to prevent and treat this complication. The aim of this manuscript was to review scientific evidence that underlies the dietetic recommendations of the American Diabetes Association (ADA) for prevention and treatment of CVD in patients with DM. The ADA guidelines are mostly based on studies performed on patients with CVD and without DM. The evidence-based dietary recommendations for patients with DM are to increase the intake of fish and soluble fibers. Although DM has been considered as an equivalent of established CVD, the adoption of the same dietary recommendations for patients without DM and with CVD for all patients with DM is still questionable - especially considering the peculiarities of CVD in DM. Randomized clinical trials including patients with DM should provide further information regarding the benefits of these dietary interventions for CVD.

Calidad nutricional de la cena consumida por adultos mayores hospedados en un hotel del municipio de balneário Camboriú, Santa Catarina, Brasil / Nutritional quality of the dinner consumed by elderly people staying in a hotel in Balneário Camboriú, Brazil

Objetivo: evaluar la calidad nutritional de la cena consumida por 105 turistas de la tercera edad hospedados en un hotel. Método: para la estandarización previa del peso medio de los alimentos consumidos fueron pesadas tres porciones de cada una de las opciones ofrecidas. El consumo alimentario fue verificado por la observación directa de las porciones servidas en el plato, convertidas posteriormente en gramos. En la evaluación de la composición nutritional de la comida, se consideraron los datos sobre valor energético, macronutrientes, grasa saturada, colesterol, sodio y fibra. Resultados: la mayoría de los turistas era de Argentina (88 por ciento), del sexo femenino (70 por ciento), con edades entre 60 y 84 años (85 por ciento). Se notó un alto consumo de energía (175 por ciento), grasas totales (235 por ciento), grasas saturadas (207 por ciento), colesterol (151 por ciento), proteína (170 por ciento) y sodio (133 por ciento). Se observó un consumo mayor de grasa saturada entre el sexo masculino. La ingestión fue adecuada para carbohidratos (102 por ciento) y fibras (98 por ciento).

Objective: To evaluate the nutritional quality of the meals consumed by 105 elderly tourists in a hotel. Method: To ensure the accuracy of the data, three portions of each option were collected and weighed. The three weights were then averaged to create a standard measure. The number of portions that each tourist took for their meal were recorded and later converted to grams using the standard measure. When evaluating the nutritional composition of the selected foods, calories, macronutrients, saturated fat, cholesterol, sodium and fiber content were all taken into consideration. Results: Most of the tourists were females (70 percent) from Argentina (88 percent) between the ages of 60 and 85 (85 percent). It was noted that the males consumed foods with a higher caloric content (175 percent of recommended amounts), total fat (235 percent), and saturated fat, cholesterol (151 percent), proteins (170 percent) and sodium (133 percent). The quantities of carbohydrates (102 percent) and fiber (98 percent) were appropriate to meet dietary needs.

American dietetics education and registered dietitian training system / 中华临床营养杂志

A registered dietitian credential is generally accepted and recognized as the most authoritative certificate of eligibility for American dietitians.In this article we describe in detail the American Registered Dieti-tian (RD) training system,administered by the Commission on Accreditation for Dietetics Education (CADE) and the Commission on Dietetic Registration (CDR) of the American Dietetic Association (ADA).Taking the Division of Nutritional Sciences of Cornell University as a good example of the RD training unit,we describe the Cornell Un-dergraduate Didactic Program in Dietetics and Dietetic Internship.Career opportunities and job outlook for Ameri-can registered dietitians are also presented.

Excreção de gordura fecal de ratos (Rattus norvegicus, Wistar), submetidos a dietas hiperlipídicas e hipercolesterolêmicas suplementadas com quitosana / Faecal fat excretion of mice (Rattus norvegicus, Wistar), submitted to hypercholesterolemic and hyperlipidic diets supplemented with chitosan

Investigou-se o efeito de duas marcas comerciais de quitosana na excreção de gordura fecal, em ratos submetidos a dietas hipercolesterolêmicas e hiperlipídicas. Utilizou-se 32 ratos Wistar, distribuídos aleatoriamente em quatro grupos (n=8): grupo controle (GC), recebeu dieta AIN-93G, grupo hiperlipídico (GH):dieta AIN-93G modificada no teor de lipídios (12%) e suplementada com colesterol (1%), e os grupos hiperlipídico quitosana 1 (GHQ1) e hiperlipídico quitosana 2 (GHQ2), quereceberam a mesma dieta do GH, suplementados com suas respectivas quitosanas (5%). Realizou-se coleta de fezes nos dias 0, 14o e 28o do experimento. A determinação da gordura fecal (g) foi realizada através do método de Soxhlet. Não foram observadas diferenças estatísticas significativas (p>0,05) entre os 4 grupos quanto ao teor de gordura fecal no início do experimento. No 14o dia, o grupo GHQ1 teve aumento significativo na excreção de gordura fecal quando comparado aos outros três grupos (p<0,05). No 28º dia, no grupo GHQ1, a excreção de gordura fecal foi maiorque nos demais grupos (p<0,05), enquanto que o grupo GHQ2 não diferiu estatisticamente do grupo GH. Os resultados sugerem que as diferenças entre estes dois grupos podem ser devidas ao grau de pureza, viscosidade e grau de desacetilação das quitosanas.

The effect of two comercial brands of chitosan in the faecal fat excretion was investigated in mice submitted tohypercholesterolemic and hyperlipidic diets. 32 rats Wistar, recently weaned, distributed randomly in four groups (n=8): control group (CG), received diet of AIN- 93G; hyperlipidic group (HG): diet of AIN-93G modified in the lipids content (12%) and supplemented withcholesterol (1%); and the chitosan hyperlipidic groups 1 (QHG1) and chitosan hyperlipidic 2 (QHG2), thatreceived the same diet of the HG, supplemented with their respective chitosan (5%). The faecal collection wasconducted on the days 0, 14th and 28th of the experiment. The faecal fat determination (g) was conducted through the Soxhlet method. No significant statistical differences (p>0.05) were observed among the 4 groups as to the fat content in the beginning of the experiment. On the 14th day, the GHQ1 group had a significant increase of faecal fatwhen compared to the other three groups (p<0.05). On the 28th day, in the GHQ1 group, the faecal fat excretion was larger than in the other groups (p<0.05), while the group GHQ2 had not statistically differed from the group GH. The results suggest that the differences between these two groups can be caused by the purity degree, viscosity and deacetylation degree of the chitosans.

Resistência à insulina com a suplementação de creatina em animais de experimentação / Resistencia a la insulina con la suplementación de creatina en animales de experimentación / Insulin resistance with creatine supplementation in laboratory animals

INTRODUÇÃO E OBJETIVO: A suplementação de creatina tem sido usada para melhorar o desempenho muscular. Esta afeta o metabolismo da glicose e estimula a secreção de insulina in vitro e in vivo. No entanto, a hipersecreção de insulina em longo prazo pode induzir também resistência à insulina. O presente trabalho analisou os efeitos da suplementação oral de creatina para avaliar a possibilidade da ocorrência de resistência à insulina in vivo. MÉTODOS: Quarenta e oito ratos Wistar (24 fêmeas/24 machos) foram divididos em dois grupos de 24 (controle e estudo) e subdivididos em seis grupos de oito. Por quatro semanas, foram alimentados com ração padrão, tendo livre acesso a água. Além disso, o grupo de estudo recebeu dieta suplementar de creatina (0,4g de creatina para 30mL de água por rato/dia). Nos 7°, 14°, 21° e 28° dias do experimento, 12 ratos foram anestesiados (tiopental sódico 0,15mL/100g), após jejum de seis horas, sendo submetidos ao teste intravenoso de tolerância à insulina (0,5mL de uma solução de 30 por cento de insulina humana regular e 70 por cento de salina). As amostras de sangue foram coletadas das veias dos rabos dos ratos, nos tempos basal, três, seis, nove, 12 e 15 minutos após a administração da insulina. A mensuração da glicose foi feita pelo método da glicose-oxidase. O trabalho foi previamente aprovado pelo Comitê de Ética em Pesquisa do CCMB- PUCSP. RESULTADOS: A média da constante de decaimento da glicose (K ITT) foi calculada pela fórmula 0,693/T1/2. O grupo de estudo, quando comparado com o grupo controle, apresentou resistência insulínica no 21° dia (p < 0,0004) e 28° dia (p < 0,0001). CONCLUSÃO: Este trabalho mostra que a suplementação prolongada de creatina pode levar à resistência à insulina e que deveria ser usada com cautela em indivíduos com distúrbios do metabolismo da glicose.

INTRODUCTION AND OBJECTIVE: Creatine supplementation has been used in order to improve muscular performance. This substance affects glucose metabolism and stimulates the in vitro as well as the in vivo insulin secretion. Nevertheless, long-term insulin hypersecretion may also induce insulin resistance. The present work analyzed the effects of creatine oral supplementation in order to evaluate the possibility of occurrence of resistance to in vivo insulin. METHODS: Forty-eight Wistar rats (24 female/24 male) were divided in two groups of 24 (control and study) and subdivided in six groups of eight. They were fed with standard food during four weeks, having water ad libitum. Moreover, the study group received dietetic supplement of creatine (0.4 g creatine for 30 ml of water per rat/day). In the 7th, 14th, 21st and 28th day of the experiment, 12 rats were anesthetized (sodium thiopental 0.15 mL/100 g) after six hour-fasting, being submitted to intravenous insulin tolerance test (0.5 mL of 30 percent regular human insulin and 70 percent saline solution). The blood samples were collected from the tail veins of the rats, in the basal, three, six, nine, 12 and 15 minutes after insulin administration times. The glucose measurement was performed through the glucose oxidase method. The study was previously approved by the Research Ethics Committee of CCMB- PUC-SP. RESULTS: The mean of the glucose decrease constant (K ITT) was calculated through the formula 0.693/T1/2. The study group, when compared with the control group, presented insulin resistance at day 21 (p < 0.0004) and day 28 (p < 0.0001). CONCLUSION: This study shows that extended creatine supplementation may lead to insulin resistance. Besides that, it should be carefully used in individuals with glucose metabolism disturbances.

INTRODUCCION Y OBJETIVO: La suplementación con creatina viene siendo usada para mejorar el desempeño muscular. Esta afecta el metabolismo de la glucose y estimula la secreción de insulina in vitro e in vivo. Entretanto, la hipersecreción de insulina a largo plazo puede inducir tambien resistencia a la insulina. El presente trabajo analizó los efectos de la suplementación oral de creatina para evaluar la posibilidad de la ocurrencia de resistencia a la insulina in vivo. MÉTODOS: Cuarenta y ocho ratones Wistar (24 hembras/24 machos) fueron divididos en dos grupos de 24 (control y estudio) y subdivididos en seis grupos de ocho. Por cuatro semanas, fueron alimentados con ración padrón, teniendo libre acceso al agua. Además de eso, el grupo estudio recibió dieta suplementaria de creatina (0,4 g de creatina para 30 mL de água por ratón/día). En los días 7, 14, 21 e 28 del experimento, 12 ratones fueron anestesiados (tiopental sódico 0,15 mL/100 g), despues de seis horas de ayuno, y sometidos a un test intravenoso de tolerancia a la insulina (0,5 ml de una solución de 30 por ciento de insulina humana regular y 70 por ciento de salina). Las muestras de sangre fueron colectadas de las venas de los rabos de los ratones, en los tiempos basal, tres, seis, nueve, 12 y 15 minutos trás la administración de insulina. La medida de la glucosa fué hecha por el método de la glucosa oxidasa. El trabajo fué previamente aprobado por lo Comité de Ética en Investigación del CCMB-PUCSP. RESULTADOS: La media constante de descenso de la glucosa (K ITT) fué calculada por la fórmula 0,693/T1/2. El grupo de estudio cuando fué comparado con el grupo control presentó resistencia insulínica en el día 21 (p < 0,0004) y en el dia 28 (p < 0,0001). CONCLUSION: Este trabajo muestra que la suplementación prolongada con creatina puede llevar a resistencia a la insulina y que debería ser usada con cautela en individuos con disturbios del metabolismo de la glucose.

Study on the Dietetic Internship Program of Catering Company / 대한지역사회영양학회지

The purposes of this research were to examine the effect of the catering company's dietetic internship program through a self-evaluating ability test about management performance between pre and post internship programs and consequently to suggest improvement in the internship program. In this study, two types of questionnaires were conducted in July and October 2006, targeting 41 dietetic interns who trained in a 6 months internship program. Except the 4 dropped interns, data from 37 interns were collected and used for statistical analysis, using the SPSS Win 11.0 version. The results of this study were as follows: First of all, the analysis on the effect of the internship program according to classified management segments showed significant improvements in the following order: purchase management (p < 0.001), computer program management (p < 0.001), facilities management (p < 0.001), accounting management (p < 0.01), personnel management (p < 0.01), retention management (p < 0.01), sanitation management (p < 0.01), service management (p < 0.01) and foodservice management (p < 0.01). However, there was no significantly improvement in management of clients. Secondly, the result of the analysis on the details of each management segment that were significant improvement and changing score was the top 5 duties were as follows: In the purchase management, the score of weekly and daily order management was increased 1.0 (p < 0.001), the score of weekly inventory management was 0.81 (p < 0.001). In the computation office management, expenses handling through a computer program was 0.65 (p < 0.01). In the personnel management, the score of work schedule management increased 0.81 (p < 0.001). In the accounting management, the score of monthly profit and loss account management was 0.65 (p < 0.001). Furthermore, qualified educational programs connected with the internship program will have to be systematically developed and continually carried out in order to improve service and management abilities of branch managers.

Utilização dos substitutos do cloreto de sódio e da sacarose no tratamento de hipertensos e diabéticos atendidos em uma unidade básica de saúde / Use of sodium chloride and sucrose substitutes in the treatment of hipertensive and diabetic patients at a basic health unit / Utilización de los sustitutos de cloruro de sódio y sacarosa en el tratatamiento de hipertensos y diabéticos atendidos en una unidad básica de salúd

A pesquisa foi realizada com 57 pessoas hipertensas e/ou diabéticas atendidas em uma Unidade Básica de Saúde de Ipatinga, para avaliá-las quanto ao conhecimento e à utilização dos substitutos do sal e do açúcar. O consumo de adoçantes foi relatado em ambos os sexos e prevaleceu no sexo masculino, sendo que 100% da amostra relatou utilizar adoçantes na sua forma isolada ou mesclada (2 ou vários tipos). O consumo de cloreto de potássio foi relatado por apenas 1 paciente do sexo feminino, demonstrando a necessidade de maiores orientações quanto a sua utilização.

The study involved 57 hypertensive and/or diabetic patients of the Ipatinga Basic Health Unit, and aimed to assess their knowledge and use of salt and sugar substitutes. Use of sweeteners was reported by men and women, but mostly by men. 100% of the sample reported use of sweeteners in single or mixed forms (2 or more types of sweeteners). Use of potassium chloride was reported by one woman, demonstrating the need for further orientation about its use.

La presente investigación se llevó a cabo con 57 hipertensos y/o diabéticos atendidos en una Unidad Básica de Salud de Ipatinga con el objetivo de evaluar su conocimiento en cuanto a la utilización de los sustitutos de la sal y del azúcar. Ambos sexos relataron el consumo de edulcorantes, que prevaleció en los varones; el 100% de la población en estudio utilizó edulcorantes de forma aislada o mezclada (2 ó varios tipos). Sólo 1 paciente del sexo femenino relató consumo de cloruro de potasio, lo que demuestra la necesidad de orientar más su utilización.

Consumo de fibra dietética en un grupo de niños de la consulta externa del servicio de gastroenterología pediátrica del Hospital Infantil Club Noel de Cali, Colombia / Dietetic fiber in 22 children from the Hospital Infantil Club Noel of Cali, Colombia

Introducción: El estreñimiento crónico funcional (ECF) es causa importante de consulta en gastroenterología pediátrica. El papel de la fibra dietética en niños como agente causal de estreñimiento es tema de controversia. Objetivo: Informar el consumo de fibra dietética en 22 niños del Hospital Infantil Club Noel (HICN) de Cali, Colombia. Informe de casos: Se trata de 22 niños (3-13 años), de ambos géneros, que consultaron por primera vez al HICN de Cali, por diversas causas digestivas. Se realizó una historia clínica médica, y una entrevista nutricional por recordatorio de 24 horas. Se definió desnutrición aguda cuando el déficit para peso/talla (P/T) era >10% y sobrepeso cuando el exceso para P/T era >10%. El análisis químico de la fibra dietética se hizo con base en el Contenido de Fibra Dietética y Almidón Resistente en Alimentos y Productos Iberoamericanos del CYTED. Se dividieron según género, hábito intestinal y signos y síntomas; en niños con estreñimiento (n=9) y sin estreñimiento (n=13) (p=0.865, 95% IC -6.71 a 7.91). Conclusión: Los 22 niños del HICN de Cali, independiente de la presencia de estreñimiento, consumen 12.8±7.8 g de fibra dietaria al día, que son los recomendados por la mayoría de estudios descritos.

Introduction: Functional chronic constipation is an important cause of consultation in pediatric gastroenterology. The role of the dietetic fiber in children is controversial as a cause of the constipation. Objective: To report the dietetic fiber consumption in 22 children of the Hospital Infantil Club Noel (HICN) of Cali. Report of cases: Were included 22 children (3-13 years), both gender, from the HICN of Cali with digestive diagnoses for the first time. A medical clinical history was made, and one interviews nutritional by reminder of 24 hours. Acute undernourishment was defined when the deficit for weight/height (W/H) was >10% and overweight when the excess for W/H was >10%. The chemical analysis of the dietetic fiber was made following the Content of Dietetic Fiber and Resistant Starch in Foods and Latin American Products of the CYTED. The patients were divided according to gender, intestinal habit, signs and symptoms; in children with constipation (n=9) and without constipation (n=13) (p=0.865, 95% IC -6.71 to 7.91). Conclusion: The 22 children of the HICN of Cali, independent of the constipation presence, consume 12.8±7.8 grams of dietetic fiber to the day, an amount that is the recommended one by almost all of the consulted studies.