The Importance Of Nutritional Counseling For Hyperphosphatemia In Maintenance Hemodialysis Patients

Aim: To assess the impact of dietetic intervention on the nutritional status and calcium–phosphorus metabolism in maintenance hemodialysis (MHD) patients. Material and methods: Six-month longitudinal intervention study of 162 MHD patients selected from one dialysis unit in Romania. They were divided into 4 groups according to serum albumin (SA) level and the comorbid condition of chronic liver disease (CLD). Clinical and biochemical parameters were measured at baseline and 6 months after PNC (personalized nutritional counseling). Nutritional status was assessed by mSGA (modified Subjective Global Assessment) and dietary calorie and protein intake by diet history with the help of 72 h recall method. Nutritional counselling and personalized diets were recommended by the dietician bimonthly for a period of 6 months only to groups I and III (groups with hypoalbuminemia). Results: Comparison of data collected prior PNC (T0) and 6 months after (T6) showed: phosphorus (P) level decreased significantly in all 4 groups: group I- T0 vs. T6 p=0.005, group II: T0 vs. T6 p= 0.002; group III: T0 vs. T6 p=0.001, and group IV T0 vs. T6 p=0.042; serum Ca followed a similar trend; serum parathyroid hormone (PTH) remained stationary; SA level was significantly improved in both nutrition counseling groups (group I: T0 vs. T6 p= 0.001, group III: T0 vs. T6 p=0.001, respectively). Conclusions: Our study suggests that dietetic intervention focused on phosphate and albumin control in MHD patients with hyperphosphatemia and hypoalbuminemia contributes to an improvement in important nutritional parameters and to a positive calcium-phosphorus balance.

Percepción de usuarios con exceso de peso sobre los factores que intervienen en la implementación de las pautas alimentarias sugeridas en la Consejería Nutricional del Programa Estaciones Saludables en la Ciudad de Buenos Aires / Perception of users with excess of weight upon the factors that intervene in the implementation of the dietary guidelines suggested in the Nutritional Counseling of the Healthy Stations Program in the City of Buenos Aires

Introducción: actualmente el sobrepeso y la obesidad representan una epidemia a nivel mundial y constituyen factores de riesgo para enfermedades cardiovasculares, diabetes y algunos tipos de cáncer. En la Ciudad Autónoma de Buenos Aires (CABA) desde el año 2012 se ofrece el servicio de Consejería Nutricional (CN) en espacios públicos con acceso libre y gratuito. Este estudio explora, desde la perspectiva de los usuarios frecuentes con exceso de peso, cuáles son los factores cotidianos que intervienen en la implementación de las pautas alimentarias sugeridas en la CN. Materiales y método: estudio cualitativo exploratorio y diseño transversal. Entre el mes de junio y diciembre de 2017 se realizaron entrevistas en profundidad a usuarios frecuentes de la CN del Programa Estaciones Saludables. Resultados: casi la totalidad de los entrevistados declararon incorporar o estar en proceso de incorporación de al menos una pauta alimentaria desde que asisten a la CN. Entre los aspectos facilitadores para la incorporación de estas recomendaciones destacaron: la periodicidad de la visita a la CN, la facilidad de acceso a la CN, el vínculo con el nutricionista, el acompañamiento de familiares y amigos, la realización de actividad física, las herramientas brindadas en CN y el uso de internet. Entre los aspectos obstaculizadores destacaron las preferencias gustativas que muchas veces no coinciden con las recomendaciones, la ingesta de alimentos poco saludables en espacios de comensalidad colectiva, el ambiente alimentario, la falta de tiempo, características de la jornada laboral y cambios en los estados emocionales. Conclusiones: el servicio de CN fue percibido por los consultados como un factor facilitador que contribuyó a incorporar hábitos alimentarios más saludables a partir de la implementación de las pautas recibidas.

Introduction: currently overweight and obesity represent an epidemic worldwide and are risk factors for cardiovascular diseases, diabetes and some types of cancer. Since 2012, in the Autonomous City of Buenos Aires (CABA), the Nutritional Counseling Service (NC) has been offered in public spaces with free and open access. This study explores, from the perspective of frequent users with excess of weight, which are the daily factors that intervene in the implementation of dietary guidelines suggested in the NC. Materials and method: exploratory qualitative study and transversal design. Between June and December 2017, in-depth interviews were conducted with frequent users of the Healthy Stations Program. Results: almost all of the interviewees stated they had incorporated or were in the process of incorporating at least one food guideline since attending the NC. Among the facilitating aspects for the incorporation of these recommendations they pointed out: the periodicity of the visit to the NC, easy access to the NC, the relationship with the nutritionist, the accompaniment of family and friends, physical activity, the tools provided in CN and the use of internet. Among the obstacles they highlighted taste preferences that do not often match the recommendations, the intake of unhealthy foods in spaces of collective commensality, the food environment, lack of time, characteristics of the workday and changes in emotional states. Conclusions: the CN service was perceived by the respondents as a facilitating factor that contributed to incorporating healthier eating habits following the implementation of received guidelines.

Pictorial instrument to guide the classification of foods in the dietary Guidelines for the Brazilian Population / Instrumento iconográfico para orientação da classificação de alimentos do Guia Alimentar para a População Brasileira

ABSTRACT This communication describes an instrument for food and nutrition education of food categories based on the new classification according to type of commercial processing, used by the Dietary Guidelines for the Brazilian Population published by the Ministry of Health. The instrument uses, in a practical and schematic manner, the visual resources of food "circles", colors and images. This scheme aims to guide the most appropriate and healthy proportions, as follows: the largest circle contains the foods that should be consumed in the greatest amounts, and so on, until the smallest circle. The front of the circles presents images of foods of each food category, and the back contains a brief explanation about what the foods are and the recommended intake for each category. The instrument aims to mediate and facilitate the guidance of this classification by using a pictorial resource, helping individuals to make food choices autonomously. It is not only aimed at the population, but also at health professionals and educators who seek to promote the population's health. The instrument may be used as a visual aid in individual nutrition care and in groups of food and nutrition education.

RESUMO Esta comunicação descreve um instrumento para educação alimentar e nutricional de categorias de alimentos de acordo com a nova classificação baseada no tipo de processamento industrial, usada no Guia Alimentar para a População Brasileira do Ministério da Saúde. O instrumento foi desenvolvido utilizando-se de forma prática e esquemática os recursos visuais de proporção dos "círculos", cores e imagens de alimentos. Esse esquema é usado para orientar as proporções mais adequadas e saudáveis, de modo que, no círculo maior, constam os alimentos que devem ser consumidos em maior quantidade e, no menor deles, os que devem ser consumidos em menor quantidade. Utilizando-se da face principal de cada círculo, são apresentadas imagens de alimentos os quais representam cada categoria alimentar e, no verso, uma breve explicação sobre o que são e as recomendações de ingestão de cada categoria. O instrumento visa mediar e facilitar a orientação dessa classificação por meio de recurso visual iconográfico, de modo a apoiar indivíduos em escolhas alimentares com autonomia. Dirige-se à população e, também, a profissionais de saúde e educadores que buscam a promoção da saúde na população. O instrumento pode ser utilizado como material de apoio em atendimentos nutricionais individuais e em grupos de educação alimentar e nutricional.

Programa estaciones saludables en la ciudad autónoma de Buenos Aires / Health stations program in the autonomous city of Buenos Aires

INTRODUCCIÓN: el programa estaciones saludables (ES) cuenta con puntos de promoción de salud en la vía pública con acceso libre y gratuito para personas que transitan la CiudadAutónoma de Buenos Aires (CABA). OBJETIVOS: Describir el perfil de los usuarios de ES. MÉTODOS: Se realizó un estudio de tipo descriptivo. RESULTADOS: Entre enero de 2012 y octubre de 2015 se atendió a 831 784 personas (44% varones y 56% mujeres). El 37,7% asistió más de una vez (promedio: 3,28 visitas/persona),la mayoría eran adultos de CABA. Se destacó el exceso de peso en todos los grupos etarios y en ambos sexos: el sobrepeso y la obesidad alcanzaron el 51,4% entre los niños de 5 a 12 años y el 34,8% entre los adolescentes. En los adultos, el exceso de peso se incrementó junto con el rango etario y fue más prevalente en los hombres. El 60% de las embarazadas presentó exceso de peso para la edad gestacional. La tensión arterial se observó elevada en el 41,5% de los usuarios, y la glucemia, en el 10,5%. Entre los principales motivos de consejería nutricional se destacaron: sobrepeso/obesidad y alimentación saludable; entre los objetivos: disminuir el consumo de hidratos de carbono, aumentar el consumo de frutas y vegetales, ordenar comidas y comenzar a realizar actividad física.CONCLUSIONES: Las ES son un espacio propicio para implementar acciones de prevención y promoción de salud, orientadas a producir mejoras en la alimentación y los estilos de vida de los usuarios.

ABSTRACT: the health stations (HS) program consists of health promotion points located in publicspaces, which are available free of charge for people being in the Autonomous City of Buenos Aires (CABA). OBJECTIVES: To describe the profile of HS users. METHODS: A descriptive study was performed. RESULTS: From January 2012 to October 2015, a total of 831, 784 people visited the HS (44% men; 56%women). Most of them were adults from CABA, and 37.7% went to HS more than once (average: 3.28 visits per person). Excess weight was present in all age groups and in both sexes: 51.4% of children 5 to 12 years of age and 34.8% of teenagers wereoverweight or obese. Among adults, excess weight increased along with age, and was more prevalent in men. The weight of pregnant women was excessive for gestational age in 60%of the cases. Blood pressure levels were elevated in 41.5% of users, and blood sugar levels were high in 10.5%. The main reasons for nutritional counseling (NC) were overweight/obesity and healthy eating, while the main NC objectives were to reduce carbohydrate consumption, increase fruit and vegetable consumption, organize the diet and start doing physical activity. CONCLUSIONS: HS are a good space to implement health promotion and prevention actions, aimed at achieving improvements in eating habits and lifestyles.

Effect of nutritional counseling combined with oral nutritional supplements on clinical outcome of esopha-geal cancer patients under radiotherapy treatment / 中华临床营养杂志

Objective To investigate the effect of nutritional counseling combined with oral high-fat, high-protein nutritional supplement (Ensource) on nutritional status and clinical outcomes of esophageal cancer patients under radiotherapy treatment.Methods Totally 80 esophageal cancer patients under radiotherapy treat-ment who were able to take oral feeding and with Nutritional Risk Screening 2002 (NRS 2002) score≥3 were se-lected and divided into a study group (n=41, nutritional counseling combined with oral nutritional supplements) and a control group ( n=39, nutritional counseling) with a random number table.Energy intake, nutritional sta-tus, and incidences of radiotherapy complications of the two groups before and after radiotherapy were compared. Results Energy intakes in the study group increased significantly during radiotherapy compared with the control group [ (2 445 ±686) kJ vs.(1 747 ±456) kJ, P=0.003];and the level of prealbumin and transferrin were increased significantly compared with before radiotherapy [ (17.35 ±5.83) mg/L vs.(20.15 ±6.02) mg/L, P=0.008;(213.74 ±52.66) mg/L vs.(264.19 ±43.78) mg/L, P=0.002].Besides, compared with the control group, incidence of radiation esophagitis ( GradeⅢ) and radiation skin injury ( GradeⅢ) in the study group decreased significantly (24%vs.38%, P=0.000;27%vs.41%, P=0.000).Conclusion Nutritional counseling combined with oral nutritional supplements in esophageal cancer patients could help improve the patients'nutritional profile and decrease the incidence of complications related with radiotherapy.

Consejería nutricional incrementa el consumo de alimentos ricos en calcio, pero la ingesta se mantiene por debajo del requierimiento diario / Nutritional counseling increases consumption of calcium-rich foods, but mean intake remains below the daily requirement

Calcium (Ca) plays a crucial role in the regulation of metabolic processes, especially neuromuscular function and bone health. In Chile, calcium intake in women of childbearing age does not meet the dietary requirement. Objective: To determine whether standard and virtual nutritional counseling increases the dietary calcium intake in Chilean women of childbearing age. Subjects and Methods: Dietary calcium intake in 20 women (mean age 39 ± 5 years) before and after a nutritional education intervention was compared. Nutritional counseling was provided to promote daily consumption of calcium-rich foods. Subsequently, a virtual space was provided to enhance standard counseling. On days 1, 30 and 62 a semi-quantitative food frequency questionnaire was completed by the women. Calcium intake significantly increased post intervention (ANOVA F = 4.43, P= 0.02). Dietary calcium intake was 308 ± 116mg/d at baseline, 354 ± 138mg/d at 30 days, and 412 ± 188mg/d after 62 days. Post intervention, 95% of the participants did not meet the daily intake requirement for calcium; the average percent of adequate intake of calcium was 68 ± 19%. Conclusion: Nutritional counseling increased dietary calcium intake in women of reproductive age, but the increase was not enough to meet the daily calcium requirements.

El calcio juega un rol crucial en la regulación de procesos metabólicos, especialmente en la función neuromuscular y en la salud ósea. Sin embargo, la ingesta dietaria de calcio en mujeres en edad fértil de Chile no cubre los requerimientos. Objetivo: determinar sí la consejería nutricional presencial y virtual incrementa la ingesta dietaria de calcio en mujeres chilenas de edad fértil. Sujetos y métodos: la ingesta dietaria de calcio en 20 mujeres (edad media de 39 ± 5 años) antes y después de una intervención de educación alimentaria y nutricional fue comparada. La consejería nutricional fue impartida para promover el consumo diario de alimentos ricos en calcio. Además, se habilitó un espacio virtual para reforzar la consejería nutricional. En el día 1, 30 y 62 se aplicaron cuestionarios de frecuencia de consumo semi-cuantitativos. La ingesta dietaria de calcio incrementó significativamente (ANOVA F = 4.43, P= 0.02) después de la intervención. La ingesta dietaria de calcio fue 308 ± 116mg/d al día 1, 354 ± 138mg/d al día 30, e incrementó a 412 ± 188mg/d después de 62 días. Al final de la intervención, el 95% de las participantes no cubrieron sus requerimientos diarios de calcio; la media del porcentaje de adecuación para la ingesta de calcio fue 68 ± 19%. La consejería nutricional podría incrementar la ingesta dietaria de calcio en mujeres de edad media en Chile. Sin embargo, el aumento no es suficiente para cubrir los requerimientos de calcio.

Implicações nutricionais da gravidez após cirurgia debypass gástrico: uma revisão da literatura / Nutritional implications of pregnancy after gastric bypass surgery: aliterature review

Introdução: A cirurgia bariátrica destaca-se como a melhor formade tratamento para obesidade mórbida, proporcionando melhora eresolução de comorbidades, além de benefícios sobre a fertilidade.A gestação no pós-operatório pode ser preocupante para a mãe e ofeto, pelo risco de aborto, subnutrição e desenvolvimento de deficiênciasnutricionais.Objetivo: Realizar uma revisão crítica da literatura científica sobreas principais implicações nutricionais para mãe e seu respectivorecém-nascido após a cirurgia de Bypass gástrico em Y-de -Roux.Materiais e métodos: Realizou-se estudo exploratório tipo revisãobibliográfica nas bases de dados SciELO, LILACS, PubMed, Medline,sob os seguintes indexadores: “obesidade”, “gestação”, “cirurgiabariátrica”, “acompanhamento nutricional” e “Bypass”.Resultados: De 57 referências analisadas relativas à gestação apóscirurgia bariátrica, 53 foram selecionadas. Os estudos mostraramque o bypass gástrico exerce influência benéfica sobre a fertilidade,reduz o risco de hipertensão arterial e diabetes gestacional. Asdeficiências nutricionais podem ser prevenidas ou revertidas como adequado manejo nutricional, no entanto, o ganho de peso gestacionalé menor nessa população e há uma tendência maior paracrianças nascidas PIG.Conclusão: A gestação pós-cirurgia bariátrica tem se mostrado segura,tanto para a mãe quanto para o feto, desde que acompanhadaadequadamente. É fundamental que as mulheres que engravidamapós a cirurgia bariátrica sejam acompanhadas por uma equipemultidisciplinar, a fim de prevenir riscos de complicações durantea gestação, tratar precocemente deficiências, proporcionando condiçõesfavoráveis para a mãe e o feto.

Introduction: Bariatric surgery stands out as the best form of treatmentfor morbid obesity, providing improvement and resolutionof comorbidities, and benefits on fertility. The postoperative pregnancycan be worrisome for both mother and fetus at risk of miscarriage,malnutrition and development of nutritional deficiencies.Objective: To conduct a critical review of the scientific literatureon major nutritional implications for mother and their newborn aftersurgery Gastric Bypass Roux-in- Y.Materials and methods : We conducted an exploratory review indatabases SciELO , LILACS , PubMed , Medline, under the followingindexes: “obesity”, “pregnancy” , “bariatric surgery” , “nutritionalcounseling” and “Bypass”.Results: From 57 analyzed references related to pregnancy afterbariatric surgery, 53 were selected. Studies have shown that gastricbypass exerts beneficial influence on fertility, reduces the risk ofhypertension and gestational diabetes. Nutritional deficiencies canbe prevented or reversed with the proper nutritional management,however, the gestational weight gain in this population is lowerand there is a greater tendency for children born SGA.Conclusion: Women who become pregnant after bariatric surgerymust to be is accompanied by a multidisciplinary team in order toprevent risks of complications during pregnancy, early treatmentfailures, providing favorable conditions for mother and fetus.

Lipid and lipoprotein responses of dyslipidemic patients to exclusive nutritional counseling by gender and age / Resposta nos lípides e nas lipoproteínas séricas ao aconselhamento nutricional exclusivo em indivíduos dislipidêmicos segundo o sexo e a idade

OBJECTIVE: The aim of the present study was to evaluate the plasma lipid responses of dyslipidemic patients to nutritional counseling according to gender and age. METHODS: One-hundred and twenty nine dyslipidemic subjects comprised the study, 56 men and 73 women, aged 20 to 73 years, treated at the Dyslipidemia Outpatient Clinic of the Universidade Estadual de Campinas Clinic Hospital. The inclusion criteria established that no lipid-lowering medication had been used in the 30 days prior to and during the nutritional counseling. Blood samples were collected in the morning after a 12 hour fast. The participants were divided into groups according to gender and age (age <60 and > 60 years). The hypercholesterolemic patients were instructed to restrict saturated fats (<7%) and cholesterol (<200mg/day). Those presenting with high triglyceride levels (>300mg/dL) were asked to consume a low fat diet. Those with mixed hyperlipidemia were instructed to do both. Statistical analyses included the Wilcoxon, Mann-Whitney, Chi-square and Fisher's exact tests and Analysis of Covariance. RESULTS: After nutritional counseling, total cholesterol and triglycerides decreased by 16% and 36% in males, and by 12% and 26% in females, respectively, and Low Density Lipoprotein-cholesterol decreased by 12% in females. Only triglycerides decrease significantly. In the mixed hyperlipidemia group, the male and female triglyceride (-44% and -29%), Low Density Lipoprotein-cholesterol (+12% and -15%) and High Density Lipoprotein-cholesterol (+7% and -3%) levels differed significantly. Between the age groups, only triglyceride levels differed significantly, with adults experiencing the highest reductions (33%). CONCLUSION: Nutritional counseling effectively lowered plasma lipid and lipoprotein levels, reinforcing the benefits of dietary interventions for the treatment of dyslipidemia.

OBJETIVO: Avaliar a resposta do perfil lipídico e das lipoproteínas plasmáticas ao aconselhamento nutricional em indivíduos dislipidêmicos analisando as respostas entre os sexos e as faixas etárias. MÉTODOS: Participaram do estudo 129 indivíduos dislipidêmicos, 56 homens e 73 mulheres, de 20 a 73 anos, atendidos no Ambulatório de Dislipidemias do Hospital de Clínicas da Universidade Estadual de Campinas. Os critérios de exclusão foram: uso de medicação hipolipemiante no mínimo 30 dias antes da entrevista inicial e/ou durante o acompanhamento. Os participantes foram divididos em grupos segundo sexo e faixa etária (> 60 ou <60 anos). Orientou-se restrição de gorduras saturadas (<7%) e colesterol (<200mg/dia), além das gorduras totais (<20%) para valores de triglicérides >300mg/dL, nos hipercolesterolêmicos. Na hiperlipidemia mista utilizou-se ambas orientações. RESULTADOS: No sexo masculino, a redução de colesterol total e triglicerides foi de 16% e 36% respectivamente; no feminino 12%, 26%, e de 12% para a Lipoproteína de Baixa Densidade, com significância apenas para o triglicerides. Na hiperlipidemia mista, as diferenças entre os sexos foram significativas para triglicerides (-44% e -29%), Lipoproteína de Baixa Densidade (+12% e -15%) e Lipoproteína de Alta Densidade +7% e -3%), respectivamente. Entre as faixas etárias, a diferença foi significativa apenas para o triglicerides; os adultos apresentaram maiores reduções (33%). CONCLUSÃO: O aconselhamento nutricional mostrou-se efetivo na redução de lípides e lipoproteínas plasmáticos, reforçando os benefícios das intervenções dietéticas no tratamento das dislipidemias.

Nutritional Management of Bariatric Surgery / 임상당뇨병

Bariatric surgery is becoming increasingly more common for the treatment of morbid obesity. Preoperative weight loss leads to decreases in the size of the liver and the amount of intra-abdominal fat, which improve the surgical field and therefore the operative times and complication rates as well. Well-planned dietary advancement ensures proper healing from the surgery and develops life-long healthy eating habits. The recommended postoperative diet starts with soft food and gradually advances to solid food. Bariatric surgery has the potential to cause a variety of nutritional and metabolic complications, which are mostly due to the extensive surgically-induced anatomical changes incurred by the patient's gastrointestinal tract. Counseling, monitoring, and nutrient and mineral supplementation are essential for treatment, and dietary intake and eating behavior after bariatric surgery should also be changed to achieve long-lasting success. Structured nutritional counseling can help weight reduction and maintenance.

Importância da orientação nutricional e do teor de fibras da dieta no controle glicêmico de pacientes diabéticos tipo 2 sob intervenção educacional intensiva / Importance of nutritional counseling and dietary fiber content on glycemic control in type 2 diabetic patients under intensive educational intervention

OBJETIVO: Avaliar a orientação nutricional dentro de um conjunto de intervenções multidisciplinares. SUJEITOS E MÉTODOS: Quarenta e sete pacientes diabéticos tipo 2, hiperglicêmicos, tratados de forma convencional (n = 19) ou intensiva (n = 28) e avaliados pela glicemia média semanal (GMS) no início e após 6 semanas. RESULTADOS: GI reduziu o consumo de calorias (p = 0,001), carboidratos (p = 0,004), lipídios (p = 0,001) e aumentou o de fibras, enquanto o GC reduziu o consumo de fibras (p = 0,018). Controle glicêmico (GMS < 150 mg/dL) ocorreu em 75% do GI e, em 31,6% do GC (p = 0,003), houve correlação negativa entre as variações do consumo de fibras e a GMS (r =-0,309; p = 0,035). Os resultados mantiveram-se por 12 semanas. CONCLUSÃO: A intervenção educacional intensiva de curto prazo mostrou-se mais eficaz que o tratamento convencional para a obtenção do controle glicêmico. Nossos resultados ainda indicam que um consumo mais adequado de fibras na alimentação contribui para a obtenção de um melhor controle da glicemia.

OBJECTIVE: To evaluate the importance of nutritional counseling within a set of multidisciplinary interventions. SUBJECTS AND METHODS: Forty-seven patients with type 2 diabetes and hyperglycemia (A1C > 8%), treated conventionally (n = 19, GC) or intensively in six weekly visits (n = 28, GI) were analyzed. We evaluated mean weekly blood glucose (MWG) at baseline and after 6 weeks in both groups. RESULTS: GI reduced caloric (p = 0.001), carbohydrate (p = 0.004), and fat (p = 0.001) intake, and increased fiber consumption, while GC reduced fiber intake (p = 0.018). Glycemic control (MWG < 150 mg/dL) occurred in 75% of GI patients and in 31.6% of CG patients (p = 0.003), with negative correlation between changes in fiber intake and MWG values (r =-0.309; P = 0.035). Results were maintained after 12 weeks. CONCLUSION: Educational short-term intensive intervention was more effective than conventional treatment to achieve glycemic control. Our results also indicate that a more appropriate fiber content in the diet contributes for better blood glucose control in these patients.

Nutrição Estética: valorização do corpo e da beleza através do cuidado nutricional / Esthetic nutrition: body and beauty enhancement through nutritional care

Atualmente, observa-se um crescimento da busca pela beleza e dos modelos propostos pelos segmentos da moda, de bens e serviços em torno do corpo perfeito. O modelo de beleza corresponde a um corpo magro, sem considerar aspectos relacionados à saúde. O número de mulheres que se submetem a dietas para o controle de peso vem aumentando cada vez mais, e diante de tais considerações o presente estudo tem por objetivo realizar uma revisão bibliográfica e abstrair elementos sobre estética e imagem corporal para subsidiar a prática da atenção nutricional. Para a revisão foram abordados aspectos socioculturais que incentivam uma busca pelo corpo perfeito, bem como o corpo, a beleza, a estética, o aconselhamento nutricional e a terapia cognitiva comportamental. A partir deste trabalho é possível concluir que a preocupação contínua com o corpo pode levar a dietas e a outros métodos drásticos de controle de peso, bem como de procedimentos cirúrgicos. Neste sentido, o atendimento nutricional é mais do que fornecer um padrão de dieta ou informação, representa a atuação de um efetivo modelo de reeducação alimentar, priorizando uma melhora no estilo e na qualidade de vida. O presente artigo traz dados sobre a valorização estética e da beleza, através da nutrição.

Nowadays, there is an increasing quest for beauty and the models proposed by fashion goods and service segments, to achieve the perfect body. The standard of beauty corresponds to a thin body, without considering health aspects. The number of women who go on diets to control weight is increasing; and taking this into consideration the objective of this study is to conduct a bibliographical review and extract data on esthetics and body image to support the practice of nutritional care. Socio-cultural aspects, which motivate the quest for the perfect body, as well as body, beauty, esthetics, nutritional counseling and cognitive behavior therapy were examined in this survey. On the basis of this work, it is possible to conclude that the continuing obsession with the body may lead the person to go on diets and other drastic methods to control weight, such as surgical procedures. In this respect, nutritional care is far more than merely recommending a standard diet or giving information, as it represents providing an effective model for nutritional reeducation, prioritizing improvement in the style and quality of life. This article provides data about enhancing esthetics and beauty by means of appropriate nutrition.

Impacto de um programa de orientação dietética sobre a velocidade de ganho de peso de gestantes atendidas em unidades de saúde / Impact of a dietary counseling program on the gain weight speed of pregnant women attended in a primary care service

OBJETIVO: avaliar o impacto das orientações alimentares sobre o controle de ganho de peso entre gestantes atendidas em um serviço público de saúde. MÉTODOS: o estudo foi desenvolvido em uma unidade de saúde de referência localizada na região metropolitana da cidade de Porto Alegre, no Rio Grande do Sul, Brasil. Trezentos e quinze gestantes entre a 10ª e 29ª semana gestacional foram randomizadas entre Grupo Controle e Intervenção. O Grupo Intervenção recebeu orientações alimentares de acordo com o estado nutricional, e as gestantes do Grupo Controle permaneceram no atendimento de rotina. Foram realizadas medidas de peso e altura, e calculou-se o índice de massa corporal (IMC). O estado nutricional pré-gestacional foi determinado de acordo com os seguintes critérios de IMC: baixo peso (<18,5 kg/m²); eutrofia (18,5 a 24,9 kg/m²); sobrepeso (25,0 a 29,9 kg/m²) e obesidade (>30 kg/m²). O estado nutricional durante a gestação foi obtido de acordo a com a curva de IMC para idade gestacional adotada pelo Ministério da Saúde no Brasil. Para análise dos dados, utilizou-se o risco relativo e respectivo intervalo de confiança de 95 por cento e os testes t de Student e χ2. Considerou-se significância estatística o valor de p<0,05. RESULTADOS: a avaliação do estado nutricional pré-gestacional mostrou que 28,0 por cento das mulheres apresentavam excesso de peso e 4,1 por cento, baixo peso. Na primeira e última entrevista durante a gestação, as prevalências de excesso de peso foram de 36,2 e 46,0 por cento, respectivamente. A intervenção mostrou-se efetiva em reduzir a velocidade do ganho de peso semanal das gestantes com excesso de peso (342,2 versus 420,2; p=0,01) e a prevalência de intercorrências clínicas (9,2 versus 24,85; p<0,001)...

PURPOSE: to evaluate the impact of dietary counseling on controlling weight gain in pregnant women, who were served in a public health service facility. METHODS: the study was conducted at a known health unit located in the metropolitan region of the city of Porto Alegre, in Rio Grande do Sul, Brazil. Three hundred and fifteen pregnant women between the 10th and 29th week of gestation were randomized to Control and Intervention Groups. The Intervention Group received dietary counseling according to nutritional status, and pregnant women in the Control Group were instructed to follow the routine of the health service facility. Weight and height were measured, and the body mass index (BMI) was calculated. The pre-gestational nutritional status was determined according to the following BMI criteria: low weight (<18.5 kg/m²), eutrophy (18.5 to 24.9 kg/m²), overweight (25.0 to 29.9 kg/m²), and obesity (>30 kg/m²). The nutritional status during pregnancy was determined according to the BMI curve for gestational age adopted by the Health Ministry of Brazil. Data were analyzed by the relative risk and respective 95 percent confidence interval, and by the Student's t-test and χ2 test. Statistical significance was set at p<0.05. RESULTS: the assessment of nutritional status before pregnancy showed that 28.0 percent of the women were overweight and 4.1 percent were underweight. In the first and last interview during pregnancy, the rates of prevalence of excessive weight were 36.2 and 46.0 percent, respectively. The intervention proved to be effective in reducing the rate of weekly weight gain of pregnant women with excess weight (342.2 versus 420.2; p=0.015) and the prevalence of clinical complications (9.2 versus 24.85; p<0.001)...

Nutritional approach to failure to thrive / 소아과

Failure to thrive (FTT) is a term generally used to describe an infant or child whose current weight or rate of weight gains is significantly below that expected of similar children of the same age, sex and ethnicity. It usually describes infants in whom linear growth and head circumference are either not affected, or are affected to a lesser degree than weight. FTT is a common problem, usually recognized within the first 1-2 years of life, but may present at any time in childhood. Most cases of failure to thrive involve inadequate caloric intake caused by behavioral or psychosocial issues. The most important part of the outpatient evaluation is obtaining an accurate account of a child's eating habits and caloric intake. Routine laboratory testing rarely identifies a cause and is not generally recommended. FTT, its evaluation, and its therapeutic interventions are best approached by a multi-disciplinary team includes a nutritionist, a physical therapist, a psychologist and a gastroenterologist. Long term sequelae involving all areas of growth, behavior and development may be seen in children suffering from FTT. Early detection and early intervention by a multi-disciplinary team will minimize its long term disadvantage. Appropriate nutritional counseling and anticipatory guidance at each well child visit may help prevent some cause of FTT.

Adesão a um programa de aconselhamento nutricional para adultos com excesso de peso e comorbidades / Adherence to a nutritional counseling program for adults with excess weight and comorbidities

OBJETIVO: Investigar adesão a programa de aconselhamento nutricional em grupo para indivíduos com excesso de peso e comorbidades. MÉTODOS: Estudo analítico de intervenção controlada e aberta. Oitenta adultos, de ambos os sexos, com índice de massa corporal entre 25 e 35kg/m², portadores de dois ou mais fatores de risco cardiovascular associados foram alocados aleatoriamente em dois grupos para acompanhamento por três meses. O grupo de intervenção com aconselhamento nutricional em grupo recebeu atendimento individual e participou de seis reuniões grupais para discussão sobre alimentação saudável e atividade física, com dinâmicas e método participativo. O grupo-controle, com atendimento padrão individual, foi assistido em três consultas ambulatoriais. Consideraram-se repercussões dietéticas antes e após a intervenção e assiduidade às reuniões como parâmetros de adesão ao tratamento. RESULTADOS: Trinta e três participantes concluíram o estudo. Do total inicial, 45,8 por cento e 40,7 por cento do grupo de intervenção com aconselhamento nutricional em grupo e do grupo-controle com atendimento padrão individual, respectiva-mente, atingiram nível ótimo de assiduidade. Os fatores mais citados como barreiras à adesão ao tratamento foram fazer refeições fora de casa (46,7 por cento - grupo-controle com atendimento padrão individual) e dificuldade em aplicar os conhecimentos na prática, principalmente em eventos sociais (33,3 por cento - grupo de intervenção com aconselhamento nutricional em grupo). Verificou-se aumento significativo do percentual médio do uso de temperos naturais e do número de refeições ao dia nos dois grupos após a intervenção. Porém, não houve diminuição significativa do consumo energético intra ou entre os grupos. CONCLUSÃO: Apesar da abrangência do conteúdo e do emprego de um método participativo no grupo de intervenção, a adesão foi insuficiente para alterar significativamente os principais parâmetros dietéticos estudados. O apro-fundamento da abordagem comportamental, continuada e multiprofissional deve ser objeto de mais investigações.

OBJECTIVE: The objective of this study was to verify adherence to a nutritional group counseling program for patients with excess weight and comorbidities. METHODS: This was an analytical, open, controlled, intervention study. Eighty adults from both genders with a body mass index ranging from 25 to 35kg/m² with two or more associated cardiovascular risk factors were randomly allocated to two groups for a three-month follow-up. The intervention group with nutritional group counseling received personalized care and participated in six group meetings to discuss healthy eating and physical activity, with group dynamics and participatory method. The control group was given standard personalized care in three outpatient visits. The parameters of adherence to treatment were the dietary repercussions before and after the intervention and attendance to the meetings. RESULTS: Thirty-three participants concluded the study. In all, 45.8 percent and 40.7 percent of intervention group and control group, respectively, had excellent attendance. The main barriers to adherence to treatment were the need of eating out (46.7 percent - control group) and the difficulty of putting their knowledge to use, especially in social occasions (33.3 percent - intervention group). There was a significant increase in the mean percentage use of natural seasonings and in the number of daily meals of both groups after the intervention. However, there was no significant decrease in energy intake within groups or between groups. CONCLUSION: Despite the breadth of the content and the use of a participatory method in the intervention group, adherence was not enough to change the main dietary parameters significantly. A deeper, continuous and multidisciplinary behavioral approach should be object of further investigations.

High Infant Mortality Presumably Due to Thiamine Deficiency in Lao PDR / 国際保健医療

<b>Introduction</b><br> During the course of primary health care activities in Khammouane province of Lao PDR by non- profit organization, international support and partnership for health, an exceedingly high infant mortality rate was recognized in some villages. As thiamine deficiency was strongly suspected for the main cause of the high mortality, the household survey with an emphasis on nutritional aspect and the measurement of thiamine level in the blood of mothers as well as their breast-milk were carried out for the confirmation.<br><b>Methods</b><br> The survey was conducted at Sibounhouane sub-district (Group 1) with the highest infant mortality and Hatkhamhieng sub-district (Group 2) with the lowest mortality. Fifty families of the two groups, each consisting of randomly selected 25 families with less than one year old infant(s) were interviewed by using prepared questionnaire. The body weight of both mother and infant was measured and blood and milk were taken from the mother.<br><b>Results</b><br> The ethnic minorities of the group 1 consisted of Lao Lum (44%) and Lao Theung (56%), whereas only Lao Lum in the group 2. The economical indicators and the mother's educational level in the group 1 were inferior to those in the group 2. There was no significant difference in the methods of preparing staple glutinous rice, likely to flux thiamine and intake of thiaminases between the two groups. High infant mortality rate was documented in the group 1 whose clinical symptoms were mostly consistent with those of infantile beriberi. The concentration of thiamine in the blood and milk of mothers in both groups were considerably lower and significant reduction of thiamine level was observed in the group 1 than the group 2. Nevertheless, both groups of those infants tended to be inadequately fed with the foods except for breast-milk during their early infantile phase.<br><b>Conclusions</b><br> The low concentration of thiamine in the blood and milk of mothers was strongly suggestive that infantile beriberi due to thiamine deficiency was the principal cause of the infant mortality in the study region. We hereby surmise that thiamine deficiency could be extensively prevalent in Lao PDR than the currently studied areas because of their traditional preparing methods of staple dietary rice, postpartum food taboos and intake of thiaminases. For the prevention of infant death due to severe thiamine deficiency, necessary measures including the exchange of information among the institutions concerned, adequate thiamine supplementation and nutritional counseling have to be urgently adopted.

Nutritional Assessment and the Effectiveness of Dietary Counseling in Infants and Young Children with Iron Deficiency Anemia

PURPOSE: Iron deficiency is still the most common nutrient deficient disorder despite the improvement in general health and nutrition. This study is designed to evaluate the dietary history of infants and young children with iron deficiency anemia(IDA) and the effects of nutritional counseling. METHODS: This study was conducted on 120 children from 6 to 36 months of age with IDA. Their parents completed a questionnaire and took counsel for nutrition. IDA was defined as Hb 1 g/dL after iron preparation. The questionnaire consisted of their feeding patterns, weaning time and kinds of food. RESULTS: In the 120 infants and young children aged from 6 to 36 months, the parents of 82 cases was counseled about nutrition. Fifty six infants among 82 cases have started weaning and the main foods of weaning were rice and/or rice gruel. Nutritional problems in weaning were that some children over one year of age were using a bottle, and parents restricted weaning food at will because of allergic disease or chronic disease. Most parents were satisfied with the nutritional counseling given from a clinical dietitian and showed good compliance. CONCLUSION: Many infants and young children with IDA were provided with non iron-fortified foods and made an inadequate wean. Most parents were satisfied with the nutritional counseling and showed good compliance. The need of dietary counseling was required for prevention and treatment of iron deficiency anemia because of inadequate weaning.

Effect of Oral Intake on Nutritional Status after Gastric Resection

PURPOSE: Malnutrition is a common postoperative complication that occurs after gastric resection. Several causes for malnutrition have been proposed, which include malabsorption and poor oral calorie intake. We performed this study to evaluate whether nutritional counseling would increase oral calorie intake and improve nutritional status in patients who had undergone gastrectomy. MATENRIALS AND METHODS: Twenty-two patients were randomly selected as the study group from among patients who had undergone gastrectomy for early gastric cancer and gastric polyp between October 1999 and December 2000. Body weight, hemoglobin, serum albumin, and serum transferrin were checked before and after the gastrectomy. Oral calorie intake was evaluated by using a 3-day oral-intake diary, and one nutritionist performed outpatient-based nutritional counseling. Eighteen patients who had undergone gastrectomy for the same disease during the same period were selected as the control group. RESULTS: During an average interval of 14.8 months, the study patients received nutritional counseling an average of 3.4 times at an average interval of 4.4 months. The study group took a mean of 2055.6+/-418.1 Cal per day and the control group 1792.1+/-421.9 Cal (P=0.05). Sixty-eight percent (15 patients) of the study group patients reached the daily-required calorie intake. Postoperative bodyweights were 64.0+/-9.9 kg for the study group and 64.3+/-10.8 kg for the control group (P>0.05). No statistically significant differences were observed among the other. Sixty-five percent of the patients (26 patients) had a weight loss of less than 10% of the preoperative body weight, and 35% had more than a 10% weight loss, but there was no statistical difference between the calorie intakes of these patients. CONCLUSION: Nutritional counselling increased the oral calorie intake, but nutritional status was not improved. These results suggest that nutritional derangement after gastrectomy cannot be corrected by adequate oral intake itself.

A Behavior Modification Approach to Losing Weight : Office Workers Reduce through Nutritional Counseling Sessions

Behavior-modification approaches are among the most widely used methods for losing weight. The most important concern in these approaches is that the client is helped to achieve long-term weight loss. The purpose of this study was to determine the effectiveness of nutritional counseling for weight reduction in office workers. Sixteen overweight office workers (BMI=25.8+/-.5 age=34.1+/-.0) were selected from Poscohuls. Prior to nutritional counseling, their dietary intakes were assessed using the 24-hour recall method, and survey questionnaires for lifestyle and dietary habits were collected. Nutrient intakes were calculated using the Food Processor II program modified for Korean foods. Nutritional counseling sessions were conducted every 2-3 weeks for 5 months. Various techniques tailored to the individual participants were used to facilitate weight loss. After 5 to 6 counseling sessions, questionnaires for lifestyle and dietary habits were re-evaluated. Daily energy intake showed great individual differences. The energy intake of every client decreased by about 15% (p=0.08). Fat consumption was lowered by 39.3%, but consumption of carbohydrate and protein was not changed. The common dietary and lifestyles problems were overeating, binges, dinning out, snacking, and drinking alcohol. Before counseling began, clients ate out an average of 2.8 times per week, and they ate high-fat foods such as belly pork. After counseling, they consumed low-fat dishes such as fish and lean meat in fewer dinning-out sessions. Also, the number of binges decreased slightly, and clients consumed smaller meals. Similar changes occurred with respect to the consumption of alcohol. During the counseling sessions, 25 percent of clients lost weight by approximately 2kg, while 75 percent maintained their weight. In conclusion, multiple nutritional counseling sessions are an effective and efficient approach to change eating pattern to keep losing weight. Furthermore, through multiple nutritional counseling sessions, clients can gain good dietary habits and learn to control their weight through behavior modification. However, clients need to have patience and trust to lose weight since it takes longer periods to show losing weight multiple nutritional counseling sessions.