Adequação calórico proteica da terapia nutricional enteral em pacientes críticos / Caloric-protein adequacy of enteral nutritional therapy in critical patients

A doença crítica promove um estado hipercatabólico associado a uma resposta inflamatória intensa. Admite-se que essas alterações contribuem para o aumento do gasto de energia e para a elevação do catabolismo proteico. Objetivo: analisar a adequação calórico-proteica da terapia de nutrição enteral e o seu impacto no desfecho clínico de pacientes críticos. Método: Trata-se de um estudo longitudinal prospectivo realizado com 36 pacientes internados em unidades de terapia intensiva. A adequação da oferta calórico-proteica foi obtida pela relação percentual a partir do quarto dia de implementação da terapia nutricional. Realizou-se o teste de Shapiro Wilk para averiguar a normalidade dos dados e a partir disso, foi aplicado o teste de Mann-Whitney ou de t-Student não pareado. Foi realizada a análise de regressão logística com estimativa de seu coeficiente. Para a regressão estimou-se o intervalo de confiança de 95% e nível de significância de 5%. Foi utilizado o software STATA® versão 14.0 nesta análise. Resultados: Ao avaliar 36 pacientes verificou-se que a sobrevida foi menor entre os indivíduos que apresentaram o menor percentual de adequação calórica (p=0,010) e proteica (p=<0,001). Observou-se que oferta proteica impactou mais expressivamente os desfechos clínicos, ao aumento de 1% na média de adequação proteica as chances de óbito diminuíram 21%. Conclusão: O menor percentual de adequação calórico-proteica foi associado a menor sobrevida de pacientes críticos. Ainda, observou-se que o percentual de adequação proteica se associou mais expressivamente aos desfechos clínicos nessa amostra

The critical illness promotes a hypercatabolic state associated with an intense inflammatory response. It is recognized that those changes contribute to the rise of consumption of energy expenditure and to protein metabolism rise. Objective: to analyze the adequacy caloric-protein of enteral nutrition therapy and its impact on the clinical outcome of critical patients. Method: This is a prospective longitudinal study conducted with 36 hospitalized patients in intensive care units. The caloric-protein adequacy was acquired by percent ratio from the fourth day of nutritional therapy implementation. The Shapiro Wilk test was performed to check the data normality and based on that the Mann-Whitney test or unpaired Student t test was applied. The logistic regression analysis was performed with an estimate of its coefficient. For regression, it was estimated the confidence interval of 95% and significance level of 5%. In this analysis was utilized the STATA® software version 14.0. Results: In the evaluation of 36 patients, it was found that survival was lower among the individuals who had the lower percentage of caloric adequacy (p=0,010) and protein (p=<0,001). It was observed that the protein supply impacted expressively the clinical outcome with an increase of 1% in the average protein adequacy, the chances of death decreased by 21%. Conclusion: The lower percentage of caloric-protein adequacy was associated with lower mortality of critical patients. In addition, in this sampling, it was observed that the protein adequacy percentual joined expressively in the clinical outcome

Effect of Protein Supplementation plus Hyper-Caloric intake and Exercise on Hypertrophy, Hormones and Energy components among Underweight Males

The purpose of the study was to examine the efficacy of 8 weeks of protein supplementation plus hyper-caloricintake and resistance training on hypertrophy, hormones, and energy components of underweight males. Onehundred sixty-seven underweight males from Dhahran region aged 18 to 20 years with BMI of less than 18.5Kg/m2 were divided into protein supplementation with hyper-caloric intake and resistance training group 1 (G1, n =21), the resistance training group 2 (G-2, n=48), protein supplementation group 3 (G-3, n=32) and acontrol group 4 (G-4, n=38). The subjects were measured before and after the training Physical Characteristics(PC) [body mass (BM), optimal body mass (OBM), height (H), body mass index (BMI), percent body fat (%BF),fat-free mass (FFM)], hormones [Triiodothyronine (FT3), Thyroxine (FT4), Thyroid-stimulating hormone (TSH),cortisol and testosterone], energy components, food intake (FI), energy needs (EN) and 1Resistance Maximum(1RM) tests [leg press (LP), chest press (CP) and abdomen press (ABDO)]. The resistance training (RT) was for8 weeks, twice per week 30 minutes per session for G-1 and G-2. The data was analyzed using SPSS version 20.0software. Mean and the standard deviation was calculated for all subjects. One-way analysis of variance(ANOVA) was utilized to compare the mean differences between groups and the level was at P≤0.05. The resultsshowed that BM and FFM had main effects for time and interaction effects for a time by groups (P<0.05) but notfor groups (P>0.05). In 1RM strength tests for LP, CP, and ABDO there were main effects for the time, groups,and interaction effects for time for groups (P<0.05). FT3 and FT4 showed main effects for time only (P<0.05)but TSH, CORTI, and TESTO did show any changes. FI showed main effects for the time, groups, and interactioneffects for a time by groups (P<0.05). It was concluded that the intervention program helps in gaining bodyweightand increasing the fat-free mass. Besides, the resistance training aided to raise the strength, food intake with nochanges in the hormones

Effect of early enough protein intake on outcomes of critically ill patients / 中华临床营养杂志

Objective To investigate the effects of protein intake in the early phase and later phase on the outcomes of critically ill patients.Methods A total of 326 critically ill patients admitted in intensive care unit of our hospital from September 2016 to March 2018 were enrolled in this prospective observational study.According to the 28-day prognosis of patients,they were divided into death group and survival group.Early protein target (EPT) was defined as the daily protein intake≥0.8 g/ (kg · d) on days 1-3,and late protein target (LPT) was defined as the daily protein intake≥0.8 g/ (k · d) on days 4-7.Results Daily protein intakes on day 1 and day 3 and cumulative protein intakes on days 1-3 were significantly higher in non-survivors than in the survivors (P＜0.05),but daily protein intakes on day 2,4,5,6 and 7 and cumulative protein intakes on days 4-7 and 1-7 showed no significant difference between two groups (P＞0.05).Hospital mortality was the lowest in the LPT group,the highest in the EPT,and in the middle in the EPT+LPT group and non-EPT+non-LPT group (P＜0.05).The survival curve analysis showed that the survival time of the EPT-only group was significantly lower than that of the LPT-only group (P＜0.05).Multivariate analysis showed that age,sex,cumulative protein and caloric intakes on days 1-7 were the independent risk factors for mortality.Conclusion Early low protein intake is benefit for the outcomes of critically ill patients,and combined with adequate intake of protein in the later stage may further improve the outcomes.

Nutrition support in neonates with congenital heart disease during the perioperative period / 肠外与肠内营养

Objective:To investigate the impact of hospital-based nutritional practices on weight gain in neonates during the immediate postoperative period.Methods:It is a retrospective study of 45 neonates who underwent modified systemic-to-pulmonary artery shunt in Huai'an First People's Hospital.We reviewed the weight-for-age Z-score (WAZ score) at the time points of the date of surgery,transfer from cardiac intensive care unit (CICU) to general ward,and day of hospital discharge.Caloric intake (calories/kg/day) and total fluid intake (ml/kg/day) at different time points were measured too.We also reviewed the initiation time of enteral feeding and CICU stay (days) postoperatively.Results:An overall median WAZ score decrease of-1.3 (IQR-1.7 to-0.7) from time of shunt palliation to hospital discharge.A length of stay of ＞5 days in the CICU,initiation of enteral feeding beyond the postoperative days (POD) 5 and the severity of diseases were significantly associated with a great mean difference in WAZ score(P ＜ 0.001,P ＜ 0.001,P =0.003).Conclusion:The nutrition support in immediate postoperative period is substantially lower than what is needed;initiation time of enteral feeding,a length of stay ＞ 5 days in the CICU and the severity of diseases were independent predictors of a greater change in WAZ score.

Estudio venezolano de nutrición y salud: consumo de energía y nutrientes. Grupo del estudio latinoamericano de nutrición y salud / The venezuelan study of nutrition and health: energy and nutrients intake. Latin american study of nutrition and health study group

La información del consumo de alimentos y bebidas en la población venezolana es indispensable para identificar problemas nutricionales y grupos en riesgo, por edad, áreas geográficas y niveles socioeconómicos. El objetivo de este estudio fue analizar las características de la ingesta promedio de alimentos en la población entre 15 y 65 años en Venezuela durante el año 2015. Se realizó un estudio transversal en 1132 sujetos, a quienes se les aplicó 2 recordatorios de 24 horas, no consecutivos con la metodología de pasos múltiples, y un cuestionario de frecuencia cualitativa sobre la ingesta de bebidas. El consumo promedio de calorías fue de 1.925 kcal, distribuidas en: 16,3% proteínas, 30,2% grasas, 52,4% carbohidratos y 1,1% alcohol. El 79,2% de la muestra presenta una dieta habitual inadecuada por déficit en calorías. La deficiencia en minerales fue mayor en mujeres, calcio (92,9%), hierro (42,2%) y zinc (76,6%). La mayoría de los encuestados realizaron 3 comidas al día. El almuerzo fue la comida que predominó en la ingesta diaria, seguida en orden decreciente por desayuno y cena. Las bebidas azucaradas jugos de frutas y gaseosas son una importante fuente de carbohidratos simples. El estudio EVANS 2015 muestra una caída importante en el consumo de macro y micronutrientes, en especial en los estratos sociales y niveles educativos más bajos y en los adultos mayores, que es diferente por regiones, lo cual está generando en sectores vulnerables un estado nutricional y de salud deficiente, con el aumento consecuente de las enfermedades por déficit de calorías y nutrientes(AU)

Obtaining reliable information on food and beverage consumption in Venezuelan population is imperative for identifying nutritional problems and groups of populations at risk. The objective of this study was to analyze average intake of foods on population between 15 and 65 years in Venezuela during 2015. A cross sectional study was carried out in a sample of 1132 subjects, to which two nonconsecutives 24h recalls were applied using the multiple pass methodology, also a food frequency questionnaire for beverage intake was performed. This study reported an average caloric intake of 1925 kcal, distributed as follows: 16.3% of proteins, 30.2% of fats and 52.4% of carbohydrates and 1.1% of alcohol. 79.2% of the sample showed an inadequate caloric intake. Mineral deficiency was higher in women, calcium (92.9%), iron (42.2%) and zinc (76.6%). The majority of the subjects had 3 meals per day during the days of the interviews. Lunch was the predominant meal on daily intake, followed by breakfast and dinner. Sugary sweetened beverages appeared as an important source of simple carbohydrates. EVANS intake study reported a relevant decrease on the intake of macro and micro nutrients, particularly within lower socioeconomic status and education levels, as well as in older adults, which eventually could lead to an impaired nutrition and health status, with an increase of diseases associated to caloric and nutrients deficit(AU)

A comparative between the supply and energy needs of hospitalized patients under enteral nutritional therapy

Introduction: Patients who are at risk of malnutrition are potential candidates for the use of enteral nutritional therapy (ENT), since it allows a more effective control of the patient's nutrition. When oral food intake is impossible or insufficient, enteral nutrition is the most appropriate physiological option aiming at the maintenance of gastrointestinal trophism. Studies show us that the protein-caloric needs of the hospitalized patients are seldom reached in the feeding tube supply, staying routinely between 70% and 80% of their needs. Methods: A descriptive study was conducted based on secondary data collected by the Multidisciplinary Team of Nutritional Therapy of a university hospital in Brazil to compare the caloric intake received by the hospitalized patients when in enteral nutritional therapy with their real needs. Results: A total of 43 adult inpatients who were in exclusive enteral nutrition were assessed. It was observed that the mean caloric intake received by the patients was 1,767±271kcal/day, reaching 94% of the estimated caloric needs, which were 321kcal/day. In relation to the nutritional status of the analyzed patients, it was found that 38% were at nutritional risk. Conclusion: The creation of protocols of nutritional support is of great importance to guide professionals in the prescription of ENT, aiming to improve the nutritional intake offered to hospitalized patients (AU)

Energy intake from commercially-prepared meals by food source in Korean adults: Analysis of the 2001 and 2011 Korea National Health and Nutrition Examination Surveys

BACKGROUND/OBJECTIVES: The commercial foodservice industry in Korea has shown rapid growth recently. This study examined Korean adults' consumption of commercially-prepared meals based on where the food was prepared. SUBJECTS/METHODS: Data from a 24-hour dietary recall of the 2001 and 2011 Korea National Health and Nutrition Examination Surveys were analyzed. A total of 10,539 subjects (n = 6,152 in 2001; n = 4,387 in 2011) aged 19-64 years were included for analysis. Commercially-prepared meals were classified into four food source groups based on where the food was prepared: Korean restaurants, Chinese/Western/Japanese restaurants, fast-food restaurants, and retail stores. Subjects' energy intake, including the amount and proportion of calories, was examined for each food source. The analysis was also conducted by gender for age-stratified groups: 19-29, 30-49, and 50-64 years old. RESULTS: Korean adults' energy intake from commercially-prepared meals increased in the amount of calories (551 kcal to 635 kcal, P < 0.01), but not in the proportion of daily calories (27% to 28%) from 2001 to 2011. The most frequent food source of commercially-prepared meals was Korean restaurants in both years. The amount and proportion of calories from retail stores increased from 83 kcal to 143 kcal (P < 0.001) and from 4% to 7% (P < 0.001), respectively, during the same period. Males aged 30-49 years (34%) and females aged 19-29 years (35%) consumed the highest proportion of daily calories from commercially-prepared meals in 2011. CONCLUSIONS: Korean adults consumed about one-fourth of their energy intake from commercially-prepared meals. In particular, males aged 30-49 years and females aged 19-29 years consumed more than one-third of their energy intake from commercially-prepared meals. Korean restaurants played a significant role in Korean adults' energy intake. Retail stores increased influence on Korean adults' energy intake. These results could be useful for developing health promotion policies and programs.

Riesgo de trastornos alimentarios y perfil antropométricos en modelos profesionales de México / Risk of eating attitudes and anthropometric profile among professional fashion models of Mexico

Objective: The aim of this study was to compare the risk of Eating Disorders Behaviour (EDB), and its anthropometric profile, physical activity and alimentary intake between Mexican fashion models (FM) and control women Methods: We included 50 FM and 50 control women, of the same social group, all over 18 years old, from Guadalajara, Mexico, matched by age. We evaluated the risk of EDB with the Eating Attitudes Test (EAT-26); the anthropometric measures were taken according to the criteria of the International Society for the Advancement of Kinanthropometry (ISAK), 24-hour recall to estimate energy intake and physical activities. Results: The risk prevalence of EDB was 10% for both groups. The mean and standard deviation of the percentage of body fat in FM was 22,4±2, lower than in the controls (27,8±4, p<0.001). There were no differences in anthropometric measurements in women with and without risk of EDB, except in the weight (FM without risk of EDB 56,3±3 kg and 59,9±3 kg with risk of EDB (p<0.02). Caloric intake in women with risk of EDB reduced was 1094±208 kcal in FM versus 1269±435 kcal in control woman. Conclusion: The anthropometric measurements, alimentary intake and previous history of eating disorders, suggests that FM of Mexico are a vulnerable population for eating disorder.

Objetivo: Comparar el riesgo de trastornos de la conducta alimentaria (TCA), perfil antropométrico, actividad física e ingesta alimentaria entre las mujeres mexicanas dedicadas al modelaje profesional (MP) con mujeres control. Métodos: Se incluyeron 50 MP y 50 mujeres controles, del mismo grupo social, mayores de 18 años, de Guadalajara, México, pareadas por edad. Se evaluó el riesgo de TCA con el test de Trastornos de Actitudes Alimentarias (EAT-26), se tomaron las medidas antropométricas de acuerdo a los criterios de la International Society for the Advancement of Kinanthropometry (ISAK). Se estimó el consumo de energía utilizando el recordatorio de 24 horas y se registró la práctica de actividades físicas. Resultados: La prevalencia de riesgo de TCA fue 10% para ambos grupos. La media y desviación estándar del porcentaje de grasa corporal en las MP fue 22,4±2,5 menor al de las controles (27,8±4,9) (p<0.001). No hubo diferencias en la medidas antropométricas en las mujeres con y sin riesgo de TCA, excepto en el peso de las MP de 56,3±3,1 kg sin riesgo de TCA y 59,9±3,6 en las con riesgo de TCA (p<0.02). La ingesta alimentaria se encontró reducida en las mujeres con riesgo de TCA con respecto a las sin riesgo, con 1094,2±208,3 kcal versus 1269,8±435,0 kcal en las MP y controles respectivamente. Conclusión: Las medidas antropométricas, la ingesta alimentaria y la historia previa de trastornos de la alimentación, sugiere que la MP de México es una población vulnerable para trastornos de la alimentación.

Efecto del ayuno sobre la conducta alimentaria en estudiantes universitarios / Fasting effect on eating behavior in university students

La evidencia científica sobre la caracterización de la conducta alimentaria señala que situaciones de privación de alimento, como el ayuno, aumentan el valor del alimento y modifican el patrón alimentario. En consecuencia se incrementa el consumo de alimentos y por ende el consumo calórico. La situación se agrava cuando los alimentos preferidos después del periodo de privación son poco saludables o se consumen en exceso convirtiéndose en detonadores de problemas de salud (Capaldi, 1993; Gottschalk, Libby & Graff, 2000; Vélez & Garcia, 2003). Con el objetivo de evaluar el efecto del ayuno sobre el consumo calórico y la modificación de las preferencias alimentarias, se diseñó un estudio en el cual participaron nueve jóvenes universitarios que fueron clasificados de acuerdo a su Índice de Masa Corporal (IMC) en tres grupos: Bajo-peso, Normo-peso y Sobre-peso. Fueron expuestos durante la línea base a ocho alimentos diferentes. Durante la fase experimental se expuso a los mismos participantes a un periodo de ayuno y posteriormente a los mismos alimentos registrando su consumo. Los resultados mostraron que el consumo calórico y la preferencia entre alimentos se modificaron. El grupo Bajo-peso aumentó su consumo de alimento mientras que en los grupos Normo-peso y Sobre-peso lo disminuyeron.

Scientific evidence on the characterization of eating behavior indicates that food deprivation situations, such as fasting, the food value increases and alter the feeding pattern. Consequently food consumption increases and therefore caloric intake. The situation worsens when after a deprivation period the preferred foods are unhealthy or consumed in excess becoming tiggers for health problems (Capaldi, 1993; Gottschalk , Libby & Graff , 2000; Velez & Garcia , 2003). The aim of this study was to evaluate the effect of fasting on caloric intake and changing food preferences. This study was conducted with the participation of 9 university students who were classified according to their Body Mass Index (BMI) into three groups: Low-weight, Normo-weight and Over-weight. At the baseline participants were exposed to eight different foods. Same participants during the experimental phase were exposed to a period of fasting, subsequently were exposed to the same foods and record their consumption. Results showed that caloric intake and food preferences were altered after the fasting condition, differential effects among participants were observed. Low-weight group increased their food consumption while Normal-weight and Over-weight groups decreased.

Impact of target energy intake on outcomes in septic patients: a prospective randomized controlled trial / 中华危重病急救医学

Objective To observe the impact of the diverse caloric energy intake on the outcomes and occurrence rate of complications in septic patients.Methods A prospective single-blind randomized controlled trial was conducted.158 cases of septic patients in intensive care unit (ICU) were enrolled and randomly assigned to three groups according to their different target value of nutrition:group A [measurements of resting energy expenditure (MREE)＜90％],B (MREE 90％-110％) and C (MREE ＞ 110％).The caloric intake,mechanical ventilation duration (MVD),nosocomial infection rate,28-day and 60-day mortality were analyzed.Results Daily energy intake in 7 days after ICU admission was as follows:the difference in target value of nutrition(kJ/d:7 075.0 ± 1 046.5,5 667.8 ± 1 908.8,4 428.8 ± 1 377.8),calory intake (kJ/d:4 671.6 ± 1 205.6,5 655.3 ± 1 373.0,6 053.0 ± 1 557.2),enteral nutrition value (kJ/d:2 051.1 ± 1 046.5,3 980.9 ± 1 586.5,5 337.1 ±2 921.8) and average intake rate [(66.0 ± 15.8)％,(100.0 ± 5.7)％,(134.0 ± 19.7)％],and they were statistically significant difference among A,B,C groups (all P＜0.05).The parenteral nutrition in group C were much higher than that in group A and group B (kJ/d:2 055.3 ± 273.4vs.427.0 ± 273.4,473.0 ± 332.0,both P＜0.05).The calories provided by glucose and diprivan were similar among three groups.The MVD and ICU stay were shorter in group B than that in groups A and C [MVD (days):8.4 ± 6.3 vs.11.0 ± 8.2,17.8 ± 13.0,P＞ 0.05 and P＜ 0.05 ; ICU stay (days):11.0 ± 6.4 vs.14.9 ± 9.6,17.8 ± 13.0,respectively,P＞0.05 and P＜0.05].The total hospital stay (days:32.0 ± 22.5,26.8 ± 7.0,30.4 ± 21.4) and nosocomial infection rate [91.1％ (51/56),84.0％ (42/50),90.4％ (47/52)] were similar among A,B,C groups (all P＞0.05).There was no difference in survival rate at 28 days among three groups as shown by the Kaplan-Meier survival curve (F=3.145,P=0.076).The survival rate at 60 days showed a tendency of lowering in groups A and C,especially in group C (F=9.284,P=0.010).Conclusion Both higher and lower caloric energy intake may be associated with an adverse impact,but appropriate caloric intake would improve the outcome and reduce the complication rate in septic patients.

Itens alimentares no consumo alimentar de crianças de 7 a 10 anos / Food items in the food intake of children aged seven to ten years

OBJETIVO: Descrever os itens alimentares mais representativos para o consumo total de energia, carboidratos, proteínas e lipídios de crianças de 7 a 10 anos. MÉTODOS: Elaborou-se uma lista com todos os alimentos consumidos com suas respectivas quantidades e quantificou-se a composição da dieta em energia e macronutrientes. A lista foi baseada em informações fornecidas pelo preenchimento de três Diários Alimentares (DA) por 85 escolares de 7 a 10 anos que frequentavam uma escola pública na cidade de São Paulo. Obteve-se o agrupamento dos alimentos em 129 itens, calculou-se o percentual de contribuição de cada item no consumo alimentar dos nutrientes e identificaram-se aqueles que contribuíram com até 95% da ingestão total de calorias e dos nutrientes selecionados. RESULTADOS: Os itens "Arroz branco, arroz à grega, arroz com legumes" e "Feijão marrom, preto, branco, lentilha" contribuíram de forma importante para o consumo de energia e carboidratos. O item "Leite integral fluido, leite integral em pó" foi representativo para o consumo de lipídios, além de proteínas e energia. Ressalta-se a importância no consumo em energia e carboidratos das bebidas doces (refrigerantes e sucos industrializados) na dieta deste grupo populacional. CONCLUSÕES: É evidente a participação do arroz no consumo alimentar total de energia e carboidratos; do feijão em energia, carboidratos e proteínas; do leite em energia, proteínas e lipídios; carnes em energia, proteínas e lipídios; e pão em energia e carboidratos. Merece destaque a participação das bebidas doces no consumo total de energia e carboidratos e das guloseimas no consumo total de lipídios.

OBJECTIVE: To describe the most representative food items regarding the total intake of energy, carbohydrates, proteins and lipids in children with ages between 7 and 10 years. METHODS: A list was prepared with all food intake and quantities, and the diet composition in relation to energy and macronutrients was calculated. The list was based on information provided by a 3-day-Food Diary completed by 85 schoolchildren ranging from seven to ten years old and enrolled in a public school in São Paulo, Brazil. After dividing the food into 129 items, we calculated the percentage in which each item contributed to diet nutrient intake and identified those which contributed to up to 95% of the total intake of calories and selected nutrients. RESULTS: The items "White rice, Greek rice, rice with vegetables" and "Brown, black and white beans, lentils" contributed significantly to the total intake of energy and carbohydrates. The item "Whole milk, powdered milk" had a significant participation in the total intake of lipids, protein and energy. We emphasize the importance of carbohydrates and energy intake from sugar-sweetened beverages (sodas and processed juices) in the total diet intake of the children. CONCLUSIONS: the contribution of rice in the total food intake of energy and carbohydrates; of beans in energy, carbohydrates and proteins; of milk and meat in energy, protein and lipids; and bread in energy and carbohydrates is noticeable. The participation of sugar-sweetened beverage in the total intake in energy and carbohydrates and of candies in the total intake of lipids is also evident.

Application of Factor Analysis to Identify Dietary Patterns and Use of Factor Scores to Study Their Relationship with Nutritional Status of Adult Rural Populations.

The prevalence of chronic energy deficiency (CED) among one-third of the Indian population is attributed to inadequacy of consumption of nutrients. However, considering the complexity of diets among Indians, the relationship between a particular dietary pattern and the nutritional status of the population has not been established so far. A community-based cross-sectional study was undertaken to assess estimates, at district level, of diet and nutritional status in Orissa State, India. Factor analysis was used for exploring the existence of consumption pattern of food and nutrients and their relationship with the nutritional status of rural adult population. Data on 2,864 adult men and 3,525 adult women in Orissa state revealed that there exists six patterns among food-groups explaining 59% of the total variation and three patterns among nutrients that explain 73% of the total variation among both adult men and women. The discriminant function analysis revealed that, overall, 53% of the men were correctly classified as either with chronic energy deficiency (CED) or without CED. Similarly, overall, 54% of the women were correctly classified as either with CED or without CED. The sensitivity of the model was 65% for both men and women, and the specificity was 46% and 41% respectively for men and women. In the case of classification of overweight/ obesity, the prediction of the model was about 75% among both men and women, along with high sensitivity. Using factor analysis, the dietary patterns were identified from the food and nutrient intake data. There exists a strong relationship between the dietary patterns and the nutritional status of rural adults. These results will help identify the community people with CED and help planners formulate nutritional interventions accordingly.

Obesity Patterns among Women in a Slum Area in Brazil.

High-energy diet and sedentary lifestyle fail to completely explain the epidemic of obesity in developing countries. In this cross-sectional survey, the prevalence and patterns of overweight/obesity were assessed among women in a slum in Brazil. Using anthropometric measurements, shorter form of the International Physical Activity Questionnaire (IPAQ), and a 24-hour diet recall questionnaire, data were collected from 632 women aged 20-60 years. The prevalence of overweight and obesity was 29% and 17% respectively. Physical inactivity was found in 17% of the women; 12% of them had short stature, and 44% had energy intake below the recommended dietary allowance. Results of multiple logistic regression showed that overweight/ obesity differed significantly (p<0.05) in the following aspects: abdominal circumference, energy intake, and short stature. A high prevalence of overweight/obesity was found in a very poor community associated with high-energy intake and short stature.

Interação entre polimorfismos de genes envolvidos na homeostase energética e na sensibilidade à insulina e a resposta a uma intervenção dietética para a redução do peso corporal em indivíduos obesos / Interaction between polymorphisms of genes involved in energy homeostasis andinsulin sensitivity and response to a dietary intervention for weight reduction in obese individuals

Neste estudo, foram incluídos 201 indivíduos com idade de 30 a 80 anos, sendo 100 obesos (IMC> 30 kg/m2) e 101 indivíduos do grupo controle. Os obesos participaram do programa de orientação nutricional para redução do peso corporal. As medidas antropométricas, avaliação da composição corporal e o perfil metabólico foram avaliados no grupo total. Os polimorfismos genéticos foram analisados pela técnica de PCR em tempo real e apenas o polimorfismo do gene IL 6 por PCR convencional. A avaliação de consumo alimentar foi realizada em apenas 73 indivíduos obesos que completaram o programa de orientação nutricional. Não encontramos associação entre os polimorfismos estudados e a obesidade em nosso estudo. No polimorfismo LEP -2548G>A, os indivíduos do grupo controle apresentaram concentração elevada de VLDL-c e triglicérides. Para o polimorfismo LEP 19A>G, os indivíduos obesos apresentaram concentração elevada de VLDL-c, insulina, HDL-c e valores aumentados de Homaß e o grupo controle apresentou a concentração elevada de hemoglobina glicada. Para o polimorfismo LEPR Lys109Arg (c.326A>G), os obesos apresentaram valores aumentados de CA e RCQ e concentração elevada de ApoB e HDL-c, enquanto que os indivíduos do grupo controle apresentaram os valores aumentados de IMC, CA e teor de gordura e usPCR. Para o polimorfismo Gln223Arg (c.668A>G), os obesos apresentaram valores aumentados de teor de gordura e a concentração elevada de hemoglobina glicada e usPCR . Os indivíduos obesos, para o polimorfismo ADIPOQ 45T>G, apresentaram as concentrações elevadas de colesterol total e LDL-c ao passo que no grupo controle as concentrações elevadas de glicose e triglicérides. Para o polimorfismo 276G>T, os obesos apresentaram valores aumentados de IMC, CA, RCQ e teor de gordura e concentração elevada de IL-6. Os mesmos indivíduos apresentaram também o valor de IMC aumentado e a concentração de usPCR elevada para o polimorfismo PPARG Pro12Ala (34G>C). Já para o polimorfismo 161C>T os indivíduos obesos demosntraram a concentração elevada de HDL-c enquanto o grupo controle apresentou a concentração elevada de insulina e IL-1ß. Os indivíduos obesos para o polimorfismo IL-6 -174 G>C, apresentaram os valores de CA aumentados e a concentração elevada de PAI-1 já para os indivíduos do grupo controle a concentração elevada de ApoA, IL1ß e usPCR. No programa intervencional, foi possível observarmos uma adequação em relação ao consumo recomendado de carboidrato e lipídios, excedendo apenas proteínas. O consumo de carboidratos foi maior nos grupos com graus II e III de obesidade. Após a intervenção nutricional, observamos mudanças no hábito alimentar dos envolvidos devido à diminuição da ingestão calórica e á redução do perfil lipídico, inflamatório, nos polimorfismos LEP, LEPR, ADIPOQ, PPARG e IL6. Os indivíduos obesos portadores dos haplótipos TG+GG/GG, para os polimorfismos do gene ADIPOQ, apresentaram valor aumentado de CA, RCQ e concentração elevada de glicose. Os portadores do haplótipo TG+GG/GT+TT demonstraram hemoglobina glicada e ApoB. Os indivíduos obesos portadores dos haplótipos AG+GG/GG, para os polimorfismos do gene LEPR, apresentaram valores aumentados de CA, RCQ e teor de gordura, já portadores do haplótipo AG+GG/AG+GG demonstraram concentração elevada de leptina, adiponectina, glicose, usPCR e HDL-c

This study included 201 individuals aged 30 to 80 years, and 100 obese (BMI> 30 kg/m2) and 101 control subjects. The obese participated in the program of nutritional guidelines for weight reduction. Anthropometric measurements, assessment of body composition and metabolic profile were evaluated in the total group. The genetic polymorphisms were analyzed by PCR in real time and only the IL 6 gene polymorphism by conventional PCR. The assessment of food intake was performed in only 73 obese subjects who completed the program of nutrition education. We found no association between the studied polymorphisms and obesity in our study. Polymorphism in the LEP-2548G> A, the control subjects showed high concentration of VLDL-C and triglycerides. For LEP polymorphism 19A> G, obese individuals showed high concentration of VLDL-C, insulin, HDL-C and increased values of Homaß and the control group had a high concentration of glycated hemoglobin. To LEPR polymorphism Lys109Arg (c.326A> G), obese patients presented increased values of WC and WHR and high concentration of ApoB and HDL-c, while those in the control group showed increased values of BMI, WC and content values of fat and high concentration of usPCR. To polymorphism Gln223Arg (c.668A> G), obese patients presented increased values of fat content and high concentration of glycated hemoglobin and usPCR. Obese people, for the ADIPOQ polymorphism 45T> G, showed elevated concentrations of total cholesterol and LDL-C while in the control group the concentrations of glucose and triglycerides. For the polymorphism 276G> T, the obese had increased values of BMI, WC, WHR and fat content and high concentration of IL-6. The same individuals also had increased the value of BMI and the concentration of high usPCR for the PPARg polymorphism Pro12Ala (34G> C).As for the polymorphism 161 C> T obese individuals demonstrated the high concentration of HDL-C while the control group had a high concentration of insulin and IL-1ß. Obese individuals for polymorphism IL-6 -174 G> C showed increased values of WC and the high concentration of PAI-1 as for individuals in the control group, the high concentration of ApoA, and IL1ß usPCR. In the interventional program was able to observe a suitability in relation to recommended intake of carbohydrates and lipids, exceeding only protein. The carbohydrate intake was higher in groups II and III degree of obesity. After nutritional intervention, we observed changes in dietary habits of those involved due to decreased caloric intake and reducing the lipid profile, inflammatory, polymorphisms in the LEP, LEPR, ADIPOQ, PPARg and IL6. Obese individuals carring the haplotype TG+GG/GG, for the polymorphisms ADIPOQ gene showed increased values of WC, WHR end elevated glucose. Carries of haplotype TG+GG/GT showed glycate hemoglobin and ApoB. Obese individuals carrying the haplotype GG + AG / GG for the LEPR gene polymorphisms showed increased values of WC, WHR and fat, as carriers of the haplotype AG+GG/AG+GG showed high concentration of leptin, glucose, HDL-c and us PCR

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.

Estudio del consumo y aporte nutricional de bocadillos en escolares de la Región Metropolitana de Chile / Study of snacks consumption and their nutritional composition levels of school age children of Metropolitan Region of Chile

Snack foods are products easy to handle. The objective of this work was to determine their consumption, proximate composition and fatty acid profile of snack food consumed by school age children of Metropolitan Region of Chile. To reach these goals, 203 schoolchildren were interviewed to determine snack foods consumption frequency and preference. Results showed that, this type of food represents an important pattern in diet. The highest snack consumption were potatoes chips type American and plain, chocolate cookies (small package) and corn chips. Proximate composition and fatty acids profile were determinate for these foods, each analysis was carried out in duplicate and three samplings were performed. Four snack foods analyzed had a significant fat content near 25 g/100 g and low contents of protein and total dietary fiber, indicating that these foods are products with high fat and caloric intake. For fatty acids profile, cookies presented the highest content of SFA, with 63 g/100 for PUFA content, the potato chips plain showed a high content, 60,3 g/100 g. These products present a high contribution in fat and energy, their high frequency consumption could be an important factor in the high rates of obesity observed in recent years in school age-children in the Metropolitan Region of Chile.

Los alimentos tipo bocadillo son productos fáciles de manipular que no requieren preparación. El objetivo de esta investigación fue determinar la incidencia del consumo, composición química, aporte calórico y perfil de ácidos grasos de alimentos tipo bocadillo de mayor consumo en la población escolar de la Región Metropolitana de Chile. Se realizó una encuesta a 203 escolares para determinar su frecuencia y preferencia. Los resultados indicaron un alto consumo, mostrando mayor preferencia por cuatro tipos de bocadillo, chips de papas fritas corte americano y liso, galletas con chispas de chocolate en paquete pequeño y chips de maíz. A estos alimentos se les determinó análisis proximal y perfil de ácidos grasos, para lo cual se realizó 3 muéstreos con muestras compuestas y análisis en duplicado. Los cuatro alimentos tipo de bocadillo estudiados presentan un alto contenido de materia grasa con valores cercanos al 25 g/100 g, además de tener bajos contenidos de proteínas y fibra dietaria total llevando a considerar por consiguiente a este tipo de alimento como productos con un alto contenido graso y aporte calórico. El perfil de ácidos grasos demostró, en tres de los cuatro tipos de bocadillo analizados, un alto contenido de AGS, mostrando la grasa de las galletas un valor de AGS cercano a 64g/100 g, solo los chips de papas fritas corte liso mostraron una adecuada relación AGPI/AGS. Estos productos presentan un alto aporte en grasa y energía, su alta frecuencia de consumo podría ser un factor importante en los altos índices de obesidad observados en los últimos años en escolares de la Región Metropolitana.

Effect of exercise on the caloric intake of breast cancer patients undergoing treatment

The purpose of this study was to examine the effects of an exercise intervention on the total caloric intake (TCI) of breast cancer patients undergoing treatment. A secondary purpose was to determine whether or not a relationship existed between changes in TCI, body fat composition ( percentBF), and fatigue during the study, which lasted 6 months. Twenty females recently diagnosed with breast cancer, scheduled to undergo chemotherapy or radiation, were assigned randomly to an experimental (N = 10) or control group (N = 10). Outcome measures included TCI (3-day food diary), percentBF (skinfolds), and fatigue (revised Piper Fatigue Scale). Each exercise session was conducted as follows: initial cardiovascular activity (6-12 min), followed by stretching (5-10 min), resistance training (15-30 min), and a cool-down (approximately 8 min). Significant changes in TCI were observed among groups (F1,18 = 8.582; P = 0.009), at treatments 2 and 3, and at the end of the study [experimental (1973 ± 419), control (1488 ± 418); experimental (1946 ± 437), control (1436 ± 429); experimental (2315 ± 455), control (1474 ± 294), respectively]. A significant negative correlation was found (Spearman rho(18) = -0.759; P < 0.001) between TCI and percentBF and between TCI and fatigue levels (Spearman rho(18) = -0.541; P = 0.014) at the end of the study. In conclusion, the results of this study suggest that an exercise intervention administered to breast cancer patients undergoing medical treatment may assist in the mitigation of some treatment side effects, including decreased TCI, increased fatigue, and negative changes in body composition.

Análise da taxa metabólica de repouso avaliada por calorimetria indireta em mulheres obesas com baixa e alta ingestão calórica / Analysis of resting metabolic rate evaluated by indirect calorimetry in obese women with low and high caloric intake

Este trabalho analisou se mulheres obesas com baixa ingestão calórica (IC), aferidas por questionário alimentar, apresentam valores diminuídos de taxa metabólica de repouso (TMR), o que favoreceria um desequilíbrio no balanço energético (BE) e conseqüente ganho de peso. Foram avaliados o índice de atividade física (AF) e sua relação com a IC em 77 mulheres obesas, com índice de massa corporal (IMC) acima de 30 kg/m², entre 20 e 45 anos. A partir dos valores da IC, as mulheres foram divididas em três grupos: baixa (G1), média (G2) e alta (G3) IC e submetidas a exame de calorimetria indireta de repouso. Foram avaliados: peso, altura, superfície de área corpórea (SAC), composição corporal por bioimpedância. O G1 apresentou maior valor de peso, SAC, peso de gordura corpórea e também valores abaixo de 1,2 na razão IC:TMR, o que indica provável subestimação da IC. Os maiores valores de AF e de TMR (por quilo de massa magra) foram verificados no G3. O G1 apresentou o BE mais negativo. O G3 apresentou valores positivos. Em suma, este estudo mostrou que existe tendência à subestimação da IC de algumas mulheres obesas e que a manutenção do peso corporal em algumas pacientes se deve ao baixo nível de AF.

The aim of this study was to evaluate if obese women with the lowest values of caloric intake (CI) determined by food questionnaire also present the lowest values of resting metabolic rate (RMR), which could lead to excessive weight gain, caused by changes in energy balance. With this porpouse, 77 obese women, with IMC > 30kg/m², aged 20 to 45 years, had their physical activity level and CI evaluated. According to the values of CI obtained from food intake reports, the participants were divided in 3 groups: low (G1), medium (G2), high (G3) CI and were submitted to indirect calorimetry. Height, weight, body surface area (BSA), fat free mass and fat mass measured by bioimpedance were evaluated. The highest values of weight, BSA an fat mass were obtained in G1, as well as values above 1.2 for the CI:RMR ratio, which indicates a probable underestimation of CI. The highest values of physical activity and RMR were observed in the G3 (with high caloric intake). In conclusion, this paper shows that a tendency towards underestimation of self-reported caloric intake exists among obese women and that the maintenance of weight in some patients can be due to their low level of physical activity.

The Caloric Intake Status and the Eating Habits in College Male Students Living Alone or Sharing Accommodation with Friends / 대한지역사회영양학회지

To investigate effects of the shared living on nutrient intakes,250 college male students who were living alone (104 men) or sharing accommodation with friends (134 men) were participated. Their average age was 22.6 years, their average height was 171.8 cm, their average weight was 65.6 kg and their average Body Mass Index (BMI) was 22.2. The caloric intakes of the men living alone or sharing accommodation were 55.9% and 72.5% of the Korean Recommended Dietary Allowance (RDA), respectively. The decreased caloric level of the group living alone seemed to be due to their decreased protein and fat consumption as compared to that of the group sharing accommodation. The group living alone consumed increased amounts of fiber for breakfast and half the carbohydrates, but more fat (p<0.05) in snacks than the group sharing accommodation. The daily carbohydrate : protein : fat (C : P : F) ratio averaged 58.6 14.1 27.3, which is a lower carbohydrate and a higher fat ratio than the Korean recommended ratio. However, the group living alone was closer to the Korean recommended ratio than the group sharing accommodation. The food intake habits were evaluated as being poorer in the group living alone as compared to the group sharing accommodation, less frequent consumption of fried/pan-fried dishes, and fruits/juices, but more frequent consumption of instant/processed foods. In comparing the eating patterns of the two groups, the group living alone showed better eating habits, such as more 'breakfast eating' and less 'snacking in the morning, afternoon or late at night' whereas the group sharing accommodation showed better eating habits such as less 'picky eaters' and less 'eating out'. In the group living alone, their lower caloric intake was assumably due to their fewer side dishes, however they showed higher eating frequencies of instant i processed foods. Since the lifestyle of living alone seems to grow gradually among young men, we strongly recommend dietary education for them.

Avaliação nutricional de lactentes hospitalizados / Nutritional evaluation of hospitalized suckling children

Investigou-se a evolução ponderal, conforme o valor das quotas calóricas de dietas prescritas (QCP) e aceitas (QCA) de lactentes internados por diarréia ou broncopnemonia no Instituto Materno Infantil de Pernambuco, Brasil. A proporção de crianças que ganharam ou não ganharam peso foi avaliada em função das QCP E QCA que atingiram as quotas calóricas ideais (QCI) durante o internamento, verificando-se que 46% das crianças perderam ou mantiveram o peso nos dois primeiros dias. Houve maior freqüência de ganho de peso associado às QCP e QCA que atingiram as QCI, bem como entre as crianças amamentadas. Concluiu-se existir deficiente evolução ponderal relacionada às baixas quotas calóricas oferecidas ou aceitas durante a hospitalização

This work investigated the body weight evolution according to prescribed or accepted dietetic caloric value, in children with diarrhea or bronchopneumonia, admitted at Instituto Materno Infantil de Pernambuco, Brazil. The proportions of children who increased or did not increase body weight were evaluated as a function of the prescribed caloric quota (PCQ) and the accepted caloric quota (ACQ) that attained the ideal caloric quota (ICQ) during hospitalization. 46% children lost or maintained the weight during the two first days. A higher frequency of increased weight was observed when PCQ or ACQ attained the ICQ, as well as in breast feeding children. Therefore, this study confirmed the relationship between low caloric values offered or accepted with a deficient body weight evolution