Resting energy expenditure depends on energy intake during weight loss in people with obesity: a retrospective cohort study

Abstract Objective: Resting energy expenditure (REE) decreases if there is reduced energy intake and body weight (BW). The decrease in REE could make it difficult for patients with obesity to maintain decreased BW. This study aimed to investigate the correlation among changes in REE, energy intake, and BW during the weight loss process in patients with obesity. Materials and methods: We conducted a retrospective cohort study of patients hospitalized for the treatment of obesity in Japan. Patients received fully controlled diet during hospitalization and performed exercises if able. REE was measured once a week using a hand-held indirect calorimetry. Energy intake was determined by actual dietary intake. Results: Of 44 inpatients with obesity, 17 were included in the analysis. Their BW decreased significantly after 1 week (−4.7 ± 2.0 kg, P < 0.001) and 2 weeks (−5.7 ± 2.2 kg, P < 0.001). The change in REE after 1 and 2 weeks was positively correlated with the energy intake/energy expenditure ratio (r = 0.66, P = 0.004 at 1 week, r = 0.71, P = 0.002 at 2 weeks). Using a regression equation (y = 0.5257x - 43.579), if the energy intake/energy expenditure ratio within the second week was 82.9%, the REE after 2 weeks was similar to the baseline level. There was no significant correlation between the change in REE and BW. Conclusions: Our data suggest that changes in REE depend on energy intake/energy expenditure ratio and that the decrease in REE can be minimized by matching energy intake to energy expenditure, even during the weight loss process.

Obesity and diet contents of protein and fat are associated with underreport of energy at pregnancy / Obesidade e conteúdo de proteína e gordura na dieta estão associados ao sub-relato do consumo energético na gravidez

Abstract Objectives: to evaluate the association of pre-pregnancy and current body mass index and the density of dietary macronutrients on underreporting of energy intake at pregnancy. Methods: cross-sectional analysis of 327 postpartum women from the city of Mesquita, in Rio de Janeiro. A food frequency questionnaire was administered at maternity ward having the last six months of the pregnancy as the time frame. Energy balance was considered as the outcome, and it was calculated as the division of energy intake by basal metabolic rate (underreport <1.35). Multivariate logistic regression was applied to test the associations between body mass index (pre-gestational and postpartum) on energy balance (underreport or not). Dietary density of protein (4th quartile), carbohydrate (1st quartile) and fat intake (1st quartile) were tested. Results: mean energy intake was 2,894 kcal and near of 25% of the women were considered as underreported during pregnancy. Obese women had higher chance (OR=1.90; CI95%=1.09-3.33) of being underreported at pregnancy. Underreported women presented greater chance of report dietary intake with higher contents of protein (OR=2.37; CI95%=1.37-4.09) and lower density of fat (OR= .81; CI95%=1.04-3.15). Conclusion: underreported pregnant women had higher chance of report great and lower amounts of protein and fat dietary densities.

Resumo Objetivos: avaliar a associação entre o índice de massa corporal pré-gestacional e pós-parto e a densidade de macronutrientes da dieta com o sub-relato de energia da dieta na gestação. Métodos: análise transversal com 327 puérperas da cidade de Mesquita, no Rio de Janeiro. Aplicou-se o questionário de frequência alimentar na primeira semana após o parto tendo como base o consumo dos dois últimos trimestres gestacionais. O balanço energético foi calculado a partir da divisão da ingestão de energia pela taxa metabólica basal (sub-relato<1,35). Adotou-se a regressão logística multivariada para analisar as associações entre os índices de massa corporal e a densidade dos macronutrientes da dieta (proteína, carboidratos e lipídios) com o balanço energético (sub-relato ou não). Resultados: a ingestão média de energia foi de 2.894 kcal e 25% das mulheres foram classificadas com sub-relato. Mulheres obesas no pós-parto tiveram maiores chances (OR=1,90; IC95%=1,09-3,33) de sub-relato de energia na gravidez e gestantes com balanço energético <1,35 apresentaram dieta com maior densidade de proteína (OR=2,37; IC95%=1,37-4,09) e menor densidade de gordura (OR=1,81; IC95%=1,04-3,15). Conclusão: a obesidade no pós-parto foi associada ao sub-relato de energia na gravidez e o balanço energético associou-se a densidade dos macronutrientes da dieta

Review of recommended energy and nutrient intake values in Southeast Asian countries

@#This review summarises the officially published recommended energy and nutrient intake values in five Southeast Asia (SEA) countries namely Indonesia, Malaysia, Philippines, Thailand and Vietnam. The background information, general approaches and references used for setting up recommendations and the recommended intakes levels for energy, protein, fat and carbohydrate, dietary fibre, sugars,14 vitamins and 15 minerals of these countries were tabulated and compared. The recommended intake values show remarkable similarities in terms of approaches and principles taken, as well as references used as the basis for the recommendations development and the application of the recommendations in respective country. There are nevertheless some differences in age groupings, reference height and weight used, as well as the final recommendations of the intake levels for some nutrients, after adjustment to suit local situations. All five countries had provided recommendations in terms of recommended nutrient intakes (RNI) or recommended dietary allowance (RDA) for almost all the nutrients. Due to the limited availability of local data and resources, countries in the region have referred to several references, including those from Food and Agriculture Organization/World Health Organization (FAO/WHO) consultation report and recommendations from research organisations in United States and Europe and adapted the values for local uses. Opportunities should be created to enable closer dialogue and collaboration regarding future developments in nutrient recommendations for populations in the region. These could include consideration of establishing more appropriate nutrient recommendations and the call for setting up harmonised approaches to establishing recommended nutrient intake values for the region.

Estimation of underreporting of energy intake using different methods in a subsample of the ELSA-Brasil study / Estimativa da subnotificação de ingestão energética através de diferentes métodos em uma subamostra do estudo ELSA-Brasil / Estimación de la infradeclaración de la ingesta de energía utilizando diferentes métodos en una submuestra del estudio del ELSA-Brasil

Existing methods for assessing food consumption are subject to measurement errors, especially the underreporting of energy intake, characterized by reporting energy intake below the minimum necessary to maintain body weight. This study aimed to compare the identification of energy intake underreporters using different predictive equations and instruments to collect dietary data. The study was conducted with 101 selected participants in the third wave of the Longitudinal Study of Adult Health (ELSA-Brasil) at the University Hospital of the University of São Paulo. For the dietary assessment, we applied a food frequency questionnaire (FFQ), two 24-hour diet recall (24hR) using the GloboDiet software, and two 24hR using the Brasil-Nutri software. The energy intake underreport obtained from the FFQ was 13%, 16%, and 1% using the equations proposed by Goldberg et al. (1991), Black (2000), and McCrory et al. (2002), respectively. With these same equations, the 24hR described an underreport of 9.9%, 14.9%, and 0.9% respectively with the GloboDiet software and 14.7%, 15.8%, and 1.1% respectively with the Brasil-Nutri software. We verified a low prevalence of underreported energy intake among the three self-report-based dietary data collection methods (FFQ, 24hR with GloboDiet, and Brasil-Nutri). Though no statistically significant differences were found among three methods, the equations for each method differed among them. The agreement of energy intake between the methods was very similar, but the best was between GloboDiet and Brasil-Nutri.

Os métodos existentes para avaliar consumo alimentar estão sujeitos a erros de medição, especialmente à subnotificação de ingestão calórica, que descreve a ingestão calórica abaixo do mínimo necessário para manter o peso corporal. Este estudo buscou comparar a identificação de subnotificações de ingestão calórica através de diferentes equações preditivas e instrumentos para coletar dados dietéticos. Este estudo foi realizado com 101 participantes selecionados na terceira onda do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) do Hospital Universitário da Universidade de São Paulo. A partir da avaliação dietética, aplicamos um questionário de frequência alimentar (QFA), dois recordatórios de 24 horas (24hR) pelo software GloboDiet e dois 24hR utilizando o software Brasil-Nutri. A subnotificação de ingestão calórica obtida pelo QFA foi de 13%, 16% e 1%, utilizando-se as equações propostas por Goldberg et al. (1991), Black (2000) e McCrory et al. (2002), respectivamente. Com essas mesmas equações, o 24hR achou uma subnotificação de 9,9%, 14,9% e 0,9%, respectivamente, com o software GloboDiet e de 14,7%, 15,8% e 1,1%, respectivamente, com o software Brasil-Nutri. Verificou-se baixa prevalência de ingestão calórica subnotificada entre os três métodos de captação de dados dietéticos por autorrelato (FFQ e 24hR com GloboDiet e Brasil-Nutri). As equações para cada método diferem entre si embora não tenhamos encontrado diferenças estatisticamente significativas entre os três métodos. A concordância de ingestão calórica entre os métodos foi muito semelhante, mas a melhor foi entre a GloboDiet e a Brasil-Nutri.

Los métodos existentes para evaluar el consumo de alimentos están sujetos a errores de medición, especialmente la infradeclaración de la ingesta de energía, caracterizada por la notificación de la ingesta de energía por debajo del mínimo necesario para mantener el peso corporal. El objetivo de este estudio era comparar la identificación de las infradeclaraciones de ingesta energética utilizando diferentes ecuaciones de predicción e instrumentos de recogida de datos dietéticos. El estudio se realizó con 101 participantes seleccionados en la tercera ola del Estudio Longitudinal de Salud del Adulto (ELSA-Brasil) en el Hospital Universitario de la Universidad de São Paulo. Para la evaluación de la dieta, se aplicó un cuestionario de frecuencia de alimentos (QFA), dos recordatorios de dieta de 24 horas (24hR) utilizando el software GloboDiet, y dos 24hR utilizando el software Brasil-Nutri. La infradeclaración de la ingesta energética obtenida del QFA fue del 13%, el 16% y el 1,0% utilizando las ecuaciones propuestas por Goldberg et al. (1991), Black (2000) y McCrory et al. (2002), respectivamente. Con estas mismas ecuaciones, el 24hR describió una infradeclaración del 9,9%, el 14,9% y el 0,9% respectivamente con el software GloboDiet y del 14,7%, el 15,8% y el 1,1% respectivamente con el software Brasil-Nutri. Se verificó una baja prevalencia de ingesta de energía subdeclarada entre los tres métodos de recogida de datos dietéticos basados en el autoinforme (QFA, 24hR con GloboDiet y Brasil-Nutri). Aunque no se encontraron diferencias estadísticamente significativas entre los tres métodos, las ecuaciones de cada uno de ellos diferían entre sí. La concordancia de la ingesta de energía entre los métodos fue muy similar, pero la mejor fue entre GloboDiet y Brasil-Nutri.

A key issue of national health in China: excess energy intake and oxidative inflammation / 中国中药杂志

This study expounded the great impacts of excess energy intake and oxidative inflammation on national health in China and put forward the pathological mirror-image hypothesis of the relationship between obesity and oxidative inflammation. On this basis, an ideological framework was constructed to deal with oxidative stress and oxidative inflammation centered on the development of natural antioxidant products. The study contained the following four parts: the ways to improve national health in China; the promotion of cognition to oxidative inflammation to improve national health in China; prospects for the prevention and treatment of oxidative inflammation in China; the reason why Northwest Yunnan is a good place to develop high-quality natural antioxidants.

Duração do sono, ingestão de energia e macronutrientes em indivíduos com síndrome metabólica / Sleep duration, energy and macronutrient intake in individuals with Metabolic syndrome

Introdução: a duração do sono tem sido associada à síndrome metabólica e o principal mediador entre tais fatores parece ser a dieta, pois a ingestão de quilocalorias e macronutrientes pode variar conforme as horas dormidas. Objetivo: avaliar se existe associação entre duração do sono e o consumo de energia e de macronutrientes em indivíduos com síndrome metabólica. Metodologia: trata-se de um estudo retrospectivo, transversal, com dados secundários de prontuários de pacientes adultos, atendidos entre os anos de 013-2020. A duração do sono foi categorizada em: curta para ≤6 horas por noite; adequada para 7-8 horas por noite; e longa para ≥9 horas por noite; já os dados dietéticos foram obtidos por meio da aplicação e cálculo de recordatórios alimentares de 24 horas. Após ajustes para idade e sexo, as variáveis foram avaliadas por meio do teste Qui-Quadrado, sendo considerados significativos valores de p< 0,05. Resultados: das 375 pessoas avaliadas, quase metade relatou uma curta duração de sono; entretanto, não foram encontradas associações estatisticamente significativas entre a duração do sono e o consumo calórico (p=0,957), de carboidratos (p=0,975), proteínas (p=0,865) e lipídios (p=0,382). Discussão: a maior prevalência encontrada de curta duração do sono pode estar associada a algumas características sociodemográficas da população estudada, como o sexo feminino, o sedentarismo, o aumento da idade, a baixa renda e a ocupação ativa no mercado de trabalho. Conclusão: indivíduos com síndrome metabólica parecem ter menor tempo de sono, contudo, a associação do sono com o consumo alimentar ainda requer maiores investigações.

Introduction: Sleep duration has been associated with metabolic syndrome and the main mediator between these factors seems to be diet, as the ingestion of kilocalories and macronutrients can vary according to the hours of sleep. Objective: to assess whether there is an association between sleep duration and energy and macronutrient intake in individuals with metabolic syndrome. Methods: this is a retrospective, cross-sectional study, with secondary data from medical records of adult patients, treated between the years 2013- 2020. Sleep duration was categorized into: short for ≤6 hours per night; suitable for 7-8 hours per night; and long for ≥9 hours per night; dietary data were obtained through the application and calculation of 24-hour dietary recalls. After adjustments for age and sex, the variables were evaluated using the Chi-Square test, with values p<0.05 being considered significant. Results: of the 375 people surveyed, nearly half reported a short sleep duration; however, no statistically significant associations were found between sleep duration and caloric intake (p=0.957), carbohydrates (p=0.975), proteins (p=0.865) and lipids (p=0.382). Discussion: the higher prevalence of short sleep duration found may be associated with some sociodemographic characteristics of the studied population, such as female gender, sedentary lifestyle, increasing age, low income and active occupation in the labor market. Conclusion: Individuals with metabolic syndrome seem to have less sleep time; however, the association of sleep with food consumption still requires further investigation.

Variaciones en el estado nutricional, presión arterial y en los patrones dietéticos de jóvenes posterior al ingreso a la educación superior

RESUMEN El objetivo fue analizar los cambios en el estado nutricional, presión arterial y patrones dietéticos de jóvenes evaluados durante la primera semana de inducción y seis meses posterior al ingreso a la Facultad de Ciencias de la Salud de una universidad pública de Valparaíso, Chile. Estudio comparativo, con diseño longitudinal de cohorte, análisis por-protocolo. Los patrones dietéticos se determinaron mediante una Encuesta de Tendencia de Consumo Cuantificado, la evaluación antropométrica incluyó mediciones estandarizadas de peso, estatura y perímetro de cintura, la composición corporal se determinó mediante impedancia bioeléctrica, y la presión arterial con esfigmomanómetro digital. Las mediciones se realizaron al inicio y término del primer semestre de 2017 (n= 76). En ambos sexos se observó una ganancia significativa de peso corporal, IMC, masa grasa e incremento de la presión arterial sistólica, además en hombres aumentó el perímetro de cintura y la presión arterial diastólica (p<0,05). Los hombres disminuyeron significativamente el consumo de lácteos (-43,1%) y aumentaron el consumo de carnes procesadas y comida rápida (40,6%), en cambio las mujeres disminuyeron significativamente el consumo de bebidas y refrescos (-58,0%) y de alimentos con cafeína (-54,1%). No hubo cambios en el consumo de energía y macronutrientes, sin embargo, un alto porcentaje presentó un consumo deficiente de ácidos grasos poliinsaturados ω-3, fibra dietética, ciertas vitaminas y minerales, y principalmente excesivo en ácidos grasos saturados, fósforo y sodio. Se identificaron cambios negativos en el estado nutricional, presión arterial y en los patrones dietéticos posterior al ingreso a la educación superior.

ABSTRACT The objective was to analyze the changes in nutritional status, blood pressure and dietary patterns, of young people evaluated during their induction week and six months after being admitted to the Faculty of Health Sciences of a public university in Valparaiso, Chile. This was a comparative study, with a longitudinal cohort, per-protocol analysis. Anthropometric evaluation included standardized measures of weight, height and waist circumference. Body composition was determined through bioelectrical impedance, and blood pressure was measured using a digital sphygmomanometer. Dietary patterns were determined through a survey of quantified consumption trends. Measurements were taken at the beginning (n= 139) and end of the first term in 2017 (n=76). In both sexes, significant increases in body weight, BMI, fat mass and systolic blood pressure were observed. Furthermore, in men, increases in waist circumference and diastolic blood pressure (p<0.05) were observed. Men significantly decreased their dairy consumption (-43.1%) and increased their consumption of processed meats and fast-food (40.6%). Conversely, women significantly decreased their soft drink consumption (-58.0%) and caffeinated products (-54.1%). No changes in energy and macronutrient consumption were observed. A high percentage of the participants presented a deficient consumption of polyunsaturated fatty acids ω-3, dietary fiber, and certain vitamins and minerals. They also presented excessive consumption of saturated fatty acids, phosphorus and sodium. Negative changes were identified in nutritional state, blood pressure and dietary patterns when admitted in tertiary education.

A single session of low-volume high-intensity interval and moderate-intensity continuous exercise elicits a transient reduction in ghrelin levels, but not in post-exercise energy intake in obese men

ABSTRACT Objective: This study investigated the acute effects of high-intensity interval (HIIE) and moderate-intensity continuous (MICE) exercise on ghrelin levels in obese men. Subjects and methods: A total of 10 obese men (age 27.6 ± 1.8 years, body mass index 35.4 ± 4.5 kg/m², body fat 39.9 ± 2.1%) performed two exercise sessions in a randomized order: HIIE (10 × 1 min intervals at 90% of the maximal heart rate [HRmax] interspersed by 1 min of active recovery) and MICE (20 min at 70% of the HRmax). Ghrelin levels were assessed pre-, post- and 1h post-exercise, and energy intake was assessed 1h post-exercise through an ad libitum meal. Results: HIIE and MICE showed a trend to decrease ghrelin levels immediately post-exercise (-14.1 ± 21.6% and −9.6 ± 23.8%, respectively, p = 0.07) and decreased 1h post-exercise (-12.7 ± 31.8% and −13.8 ± 21.7%, respectively, p < 0.05). No changes were observed for post-exercise energy intake (p > 0.05). There was a positive correlation between the change in ghrelin levels and post-exercise energy intake only for HIIE (r = 0.63, p = 0.05). Conclusion: In summary, a single session of HIIE and MICE elicits a reduction on ghrelin levels without changing post-exercise energy intake in obese men.

Ingesta calórica y de macronutrientes en los primeros seis meses post cirugía bariátrica / Calorie and macronutrient intake during the first six months after bariatric surgery

Background: Bariatric surgery (BS) is the most effective procedure in the management of obesity, achieving a significant decrease in energy intake. Aim: To measure calorie and macronutrient intake in patients subjected to gastric bypass (GBP) or sleeve gastrectomy (SG). Material and Methods: We studied 53 patients subjected to SG and 27 subjected to GBP, who were in the first, second or sixth postoperative month. A food frequency consumption survey was applied by specialized nutritionists and their nutritional status was assessed. Results: Mean calorie intake in months 1, 2 and 6 were 505, 600 and 829.8 kcal, respectively. A significantly higher intake was observed at month 1 in patients with those subjected to SG, compared with GBP patients. Protein consumption was <60 g/d, except at 6 months in patients with GBP. At months 1, 2 and 6, mean consumption of lipids were 17, 28 and 30 g/day, respectively. The figures for carbohydrates were 42, 31 and 77 g/day, respectively. At month 1, patients with GBP had a higher BMI, equalizing at 6 months with those of SG. At 6 months 37% of patients had a normal body mass index and 17% remained obese. A negative correlation was observed between weight loss and energy intake during the first month (rho: −0.40; p = 0.033). Conclusions: Patients subjected to BS had a low calorie and macronutrient intake in the first six postoperative months. Their calorie intake is negatively associated with weight loss, mainly during the first postoperative month.

Residual feed intake of Nellore calves is not repeatable across pre and post weaning periods / Consumo alimentar residual de bezerros Nelore na pré e pós-desmama tem baixa repetibilidade

ABSTRACT: This study measured milk and solid feed intake in pre- weaning period and feed intake in postweaning period of Nellore calves, and to correlated them with performance traits and ingestive behavior of animals classified as most and least efficient. During pre weaning phase, feed efficiency was evaluated in 51 cow-calf pairs from 21±5 days after calving until weaning. During post-weaning phase, only male calves (n=23) were evaluated. Pre-weaning milk intake of calves was estimated based on cow's milk production. Pre-weaning daily metabolizable energy intake (MEI) of calves was estimated as the sum of MEI from milk and solid diet. There was no difference in ADG between calves with negative and positive pre RFI, with a consequent better feed conversion to more efficient calves. The most efficient calves spent less time at the feed bunk, with a shorter feeding duration and higher rate of intake, compared to the least efficient animals. Correlations between feed intake and metabolic body weight of the animals during pre- and postweaning phases were positive, of medium to high magnitude, and significant, while correlation between ADG values was close to zero. Results suggested that part of the animals ranked based on pre weaning feed intake won't maintain their rank during postweaning phase. In conclusion, calves classified as most efficient during pre-weaning phase have similar weight gain but lower milk intake and MEI than least efficient animals. The estimated pre RFI is weakly correlated with post RFI, showing that RFI is not consistent or repeatable across two periods.

RESUMO: Este estudo teve como objetivo mensurar o consumo de leite e sólidos no período pré-desmama e o consumo alimentar no período pós-desmama, e relacioná-los com características de desempenho e comportamento ingestivo de animais classificados como mais eficientes e menos eficientes. Na fase pré-desmama foram avaliados 51 pares vaca-bezerro da raça Nelore quanto à eficiência alimentar dos 21±5 dias após o parto até a desmama. Na fase pós-desmama, apenas os bezerros machos (n=23) foram avaliados. O consumo de leite dos bezerros na pré-desmama foi estimado pela produção de leite das vacas. O consumo diário de energia metabolizável do bezerro na pré-desmama (CEM), foi estimado pela soma do consumo de energia metabolizável do leite e do consumo diário de energia metabolizável da dieta. Bezerros CARpre negativo não diferiram dos bezerros CARpre positivo quanto ao GMD, resultando em melhor CA dos bezerros mais eficientes. Bezerros mais eficientes ficaram menos tempo no cocho, com menor duração da refeição e com maior taxa de alimentação comparativamente aos animais menos eficientes. As correlações entre o consumo alimentar e peso corporal metabólico dos animais na pré e pós-desmama foram positivas, de média a alta magnitudes e significativas, enquanto que a correlação entre ganho médio diário foi próxima de zero. Os resultados sugerem que parte dos animais classificados pelo consumo alimentar na pré-desmama manterão a classificação na pós-desmama. Na fase pré-desmama bezerros classificados como mais eficientes tem ganho de peso similar, porém com menor consumo de leite e consumo de energia metabolizável do que bezerros menos eficientes. A estimativa do consumo alimentar residual na fase pré-desmama é fracamente relacionada à estimativa do consumo alimentar residual na fase pós-desmama, mostrando que o consumo alimentar residual não é consistente e repetível nos dois períodos.

Evolution of energy and nutrient intake in Brazil between 2008-2009 and 2017-2018 / Evolução da ingestão de energia e nutrientes no Brasil entre 2008-2009 e 2017-2018

ABSTRACT OBJECTIVE: To assess the evolution of energy and nutrient intake and the prevalence of inadequate micronutrients intakes according to sociodemographic characteristics and Brazilian regions. METHODS: The food consumption of 32,749 individuals from the National Dietary Survey of the Household Budget Survey 2008-2009 was analyzed by two food registries, as well as 44,744 subjects from two 24-hour recalls in 2017-2018. Usual intake and percentage of individuals with consumption below the average recommendation for calcium, magnesium, phosphorus, copper and zinc, vitamins A, C, D, E, thiamine, riboflavin, pyridoxine and cobalamin were estimated. Sodium intake was compared to the reference value to reduce the risk of chronic diseases. Analyses were stratified by sex, age group, region and income. RESULTS: Mean daily energy intake was 1,753 kcal in 2008-2009 and 1,748 kcal in 2017-2018. The highest prevalence of inadequacy (> 50%) in the two periods were calcium; magnesium; vitamins A, D and E; pyridoxine and, only among adolescents, phosphorus. There was an increase in the prevalence of inadequate vitamin A, riboflavin, cobalamin, magnesium, and zinc among women, and riboflavin among men. The prevalence of inadequacy decreased for thiamine. Sodium intake was excessive in approximately 50% of the population in both periods. The highest variations (about 50%) in the prevalence of inadequacy between the lowest and highest income (< 0.5 minimum wage and > 2 minimum wages per capita) were observed for vitamin B12 and C in both periods. The North and Northeast regions had the highest prevalence of inadequacy. CONCLUSION: Both surveys found high prevalence of inadequate nutrient intake and excessive sodium intake. The inadequacy varies according to income strata, increasing in the poorest regions of the country.

RESUMO OBJETIVO: Avaliar a evolução da ingestão de energia e nutrientes e a prevalência de inadequação da ingestão de micronutrientes segundo características sociodemográficas e regiões brasileiras. MÉTODOS: Foi analisado o consumo alimentar de 32.749 indivíduos do Inquérito Nacional de Alimentação da Pesquisa de Orçamentos Familiares de 2008-2009, por dois registros alimentares, e de 44.744 indivíduos a partir de dois recordatórios de 24 horas em 2017-2018. Estimaram-se a ingestão usual e o percentual de indivíduos com consumo abaixo da necessidade média para cálcio, magnésio, fósforo, cobre e zinco, vitaminas A, C, D, E, tiamina, riboflavina, piridoxina e cobalamina. A ingestão de sódio foi comparada ao valor de referência para reduzir risco de doenças crônicas. As análises foram estratificadas por sexo, faixa etária, região e renda. RESULTADOS: A ingestão energética diária média foi de 1.753 kcal em 2008-2009 e 1.748 kcal em 2017-2018. As prevalências de inadequação mais elevadas (> 50%) nos dois períodos foram de cálcio, magnésio, vitaminas A, D e E, piridoxina e, somente entre adolescentes, fósforo. Houve aumento na prevalência de inadequação de vitamina A, riboflavina, cobalamina, magnésio e zinco entre as mulheres, e de riboflavina entre os homens. A prevalência de inadequação diminuiu para a tiamina. A ingestão de sódio foi excessiva em aproximadamente 50% da população nos dois períodos. As variações mais altas (cerca de 50%) nas prevalências de inadequação entre os extremos de renda (< 0,5 salário-mínimo e > 2 salários-mínimos per capita) foram observadas para vitamina B12 e C nos dois períodos. As regiões Norte e Nordeste apresentaram maiores prevalências de inadequação. CONCLUSÃO: Ambos os inquéritos verificaram prevalências elevadas de inadequação de ingestão de nutrientes e consumo excessivo de sódio. A inadequação varia de acordo com os estratos de renda, aumentando nas regiões mais pobres do país.

Association between dietary intake, physical activity and stress level with constipation among undergraduate students

@#Introduction: Constipation is one of the most common health problems among university students. This study aims to determine the association between sociodemographic characteristics, dietary intake, physical activity, and stress level with constipation among undergraduate students. Methods: The study was a crosssectional study and the participants comprised of 140 undergraduate students (27.9% males and 72.1% females). A 3-day dietary record was obtained to determine energy, fibre and fluid intakes, while physical activity was determined using the International Physical Activity Questionnaire. Stress level and constipation were assessed using the Cohen’s Perceived Stress Scale and Agachan’s Constipation Score System Questionnaire, respectively. Data were analysed using IBM SPSS Statistics version 23. Multivariate linear regression analysis was done to determine factors that were associated with constipation. Results: Mean age of the participants was 20.9±1.5 years old and majority were third year students (32.1%). Mean intakes of energy, dietary fibre, and fluids per day were 1567±438kcal, 5.6±3.5g, and 2301±946ml, respectively. The median score for physical activity was 1135.5 METminutes/week. Most of the participants (77.1%) had a high or a very high stress level and 64.3% had slight constipation. Age, dietary fibre, fluid, energy, and perceived stress scale explained a significant amount of the variance in the occurrence of constipation [F(6.133)=16.373, p<0.001, R2=0.425, R2Adjusted=0.399]. Conclusion: Age, energy, fluid and fibre intakes, as well as perceived stress were factors that were associated with constipation among undergraduate students. Therefore, undergraduate students should be encouraged to practise a healthy lifestyle to modify these identified risk factors.

Effectiveness evaluation of dietary intervention among migrant children in Hongshan District of Wuhan / 中国学校卫生

Objective@#To understand nutrient intake and dietary structure among migrant children in primary schools in Hongshan District of Wuhan, so as to carry out dietary nutrition intervention and evaluate the effectiveness of the intervention.@*Methods@#Stratified random sampling was used to select children in grade 3-6 who were randomly assigned to the intervention group (n=218) and the control group (n=222) from primary schools with a large number of migrant children in Hongshan District of Wuhan. After the baseline survey, the intervention group was given a two month diet intervention with "nutrition class" and knowledge lecture, and the caregivers of the intervention group were also given an intervention.@*Results@#At baseline, both groups had inadequate nutrient intake, with adequate intake rate of calcium, selenium, vitamin B 1 and vitamin B 2 less than 5%; children were lack of dietary diversity with adequate intake of vegitable, milk and milk product less than 5%. After intervention, the intake of energy, three main macronutrients, calcium, vitamin A, and vitamin C in the intervention group were higher than that of before intervention, as well as than the control group, differences were statistically significant (Z=2.22-8.65，2.62-8.46，P<0.05). In terms of dietary structure, adequate intake rate of cereals and miscellaneous beans increased from 55.5% to 68.8%, livestock and poultry meat increased from 45.9% to 56.4%, which were higher than that of the control group (56.3% and 44.6%) (χ 2=5.29-13.25，4.39-14.13，P<0.05).@*Conclusion@#Inadequate nutrient intake and unreasonable dietary structure of migrant children can be improved through short term dietary intervention including nutrition education to both parents and children.

Nutritional of assessment school lunches for primary and secondary school students in the Pearl River Delta / 中国学校卫生

Objective@#To investigate nutritional quality of school lunch in some primary schools and middle schools in the Pearl River Delta, and to provide the scientific basis for improving the nutritional quality of students lunch and formulating scientific and effective interventions.@*Methods@#Five-day lunch meal survey by chemical analysis were conducted, and students lunch at school were recorded by meal review in three age groups from 8 primary and middle schools in the Pear River Delat area. The energy and nutrient content were obtained and compared with the reference intake of dietary nutrients of student.@*Results@#The average protein intake at lunch of all age groups had reached the recommended standard (80%-95%), the energy supply ratio of carbohydrate in the range of 38.3%-42.3%, the energy supply ratio of fat in 63% school meal exceeded the recommended standard. Vitamin A, vitamin B 1, vitamin B 2, calcium, iron and other nutrients were seriously inadequate; while sodium intake far exceeded the recommended standard.@*Conclusion@#The main nutrients of school lunch of primary and middle school in Pearl River Delta can basically meet the growth and development needs, but there are still some deficiency and unbalanced diet nutrient content which are lower than the recommended intake. It is recommended to strengthen nutrition education of catering enterprises and school to improve the scientific combination of diets.

Energy and protein intakes are associated with stunting among preschool children in Central Jakarta, Indonesia: a case-control study

@#Introduction: Stunting is a major nutritional problem in Indonesia. The prevalence of stunting in DKI Jakarta province was relatively high at 27.5% in 2013 and 17.7% in 2018. This study aims to describe nutrient intakes of children aged 25-30 months and to determine the proportional differences in nutrient intakes between stunting and normal children in Central Jakarta, Indonesia. Methods: A case-control study with a total sample of 121 children aged 25-30 months was conducted in Gambir and Sawah Besar sub-districts, Central Jakarta, where the prevalence of stunting was high. All children were exclusively breastfed for at least four months and had similar socio-economic levels. Data collected included height measurement, questionnairebased interview, and 24-hour food recall. T-test and chi-square test were used to investigate the differences between two groups and logistic regression was used in multivariate analysis. Results: Factors associated with stunting were energy intake (AOR=6.0; 95% CI=1.0-35.0) and protein intake (AOR=4.0; 95% CI=1.1-15.5) after controlling for fat, carbohydrate, vitamin C, iron, and zinc intakes. The percentage of children with energy intake below the recommendation was much higher in stunted children (86.1%) compared to normal children (43.5%). Similarly, the percentage of children with protein intake below the recommendation was very much higher among stunted children (30.6%) compared to 8.2% in normal children. Conclusion: Children who lacked energy and protein intakes were at a higher risk of stunting than children who had sufficient intakes. Macronutrient intakes are important and should be consumed in sufficient quantities every day to prevent stunting.

Factors associated with malnutrition among head and neck cancer in-patients before radiotherapy in National Cancer Institute, Putrajaya

@#Introduction: Head and neck cancer (HNC) patients are often malnourished during diagnosis and before treatment. This study determined the prevalence of malnutrition and factors associated with malnutrition among HNC patients. Methods: A crosssectional study among HNC in-patients before radiotherapy was conducted. Malnutrition status of the patients was determined using scored Patient GeneratedSubjective Global Assessment (PG-SGA). Nutritional parameters of muscle mass, fat mass, albumin, energy and protein intakes were collected. Nutrition impact symptoms (NIS) of the patients were assessed using a validated Head and Neck Symptoms Checklist© (HNSC©). Results: Fifty HNC patients were recruited in this study and the age range of patients was 21 to 78 years old, with gender distribution of 78% males and 22% females. More than half of the patients were malnourished, with 20% severely malnourished before radiotherapy. The lack of dietitian referral before treatment was found to significantly affect nutritional status (p=0.027). There was a significant negative relationship between energy intake (r=0.342, p=0.015) and protein intake (r=0.386, p=0.006) with PG-SGA, indicating lower energy and protein intakes related with poor nutritional status. The result showed a significant positive relationship between NIS score (r=0.731, p<0.001) and PG-SGA, indicating the lower the NIS, the better the nutritional status among HNC patients. More than half of the HNC patients had difficulty chewing. Conclusion: A strong association between nutritional status and NIS showed the importance of dietary management in HNC patients. Early identification of the nutritional status of HNC patients can ensure optimal nutritional status to improve treatment outcomes.

Factors Associated With Adherence to Low Protein Diet Among Patients With Stage III-V of Chronic Kidney Disease in an Outpatient Clinic at Hospital Pakar Sultanah Fatimah

@#Introduction: Although the benefit of low protein diet (LPD) on chronic kidney disease (CKD) progression is well documented, patients’ adherence remains as the main challenge. Therefore, this study sought to identify adherence towards LPD among CKD patients and determine possible associating factors. Methods: This cross-sectional study was done at the Hospital Pakar Sultanah Fatimah in Muar, Johor, among stage III to V CKD patients. Three-day dietary recalls were used to quantify dietary energy (DEI) and protein intake (DPI). Factors investigated include socio-demographic characteristics, medical history, anthropometry and body composition measurements, dietary knowledge, appetite level, handgrip strength, perceived stress, and health locus of control. Associating variables were analysed with logistic regression analysis. Results: The final analysis included 113 patients (54% male) with a mean estimated glomerular filtration rate of 17.5±11.2mL/min/1.73m2 and the average age of 56.3±12.8 years. Mean DEI and DPI were 22.4±5.9kcal/kg/day and 0.83±0.28g/kg/day, respectively. Only 34.5% of patients adhere to the LPD diet with 59% exceeding the DPI recommendation. Poorer LPD adherence was associated with longer duration of hospitalization (OR 0.707, 95%CI 0.50-1.00, p=0.048), higher energy intake (OR 0.744, 95%CI 0.65-0.85, p<0.001), advance CKD stage (OR 0.318, 95%CI 0.13-0.77, p=0.012) and having better dietary knowledge (OR 0.380, 95%CI 0.170.85, p=0.018). Conclusion: LPD adherence of CKD patients in our institution is very poor signifying the need for engagement at the earlier stage of CKD to identify and stratify the patients for a targeted dietary intervention.

Relationship of Calories Intake and Physical Activity in Adolescents in Colima, Mexico: A Cross-sectional Study

Aims: To identify the relationship between calories intake, physical activity and body mass index in adolescents in Colima Mexico.Study Design: A cross-sectional study analytic, observational.Place and Duration of the Study: Colima and Tecoman, Mexico.Methodology: Itwas designed in adolescents, of both genders, with a BMI in 85thpercentile or greater, where the average daily calorie intake was quantified with the SNUT survey and the level of physicalactivity with the International Physical Activity Questionnaire. Anthropometry to obtain the BMI. The stage of change of the trans-theoretical model was identified. Statistical analysis was Pearson's r between calories and BMI and between physical activity and BMI, systolic and diastolicblood pressure with BMI, and the stages of change

Comparação entre três softwares de cálculo de dietas: uma análise do valor energético de uma dieta enteral semiartesanal / Comparing three softwares for diet calculation: analysis of energetic value in a semi-amateur enteral diet

O objetivo do presente estudo foi recalcular as dietas enterais semiartesanais padrões apresentados em uma Cartilha de Terapia Nutricional Enteral Domiciliar. Foram selecionadas as dietas 1.500, 1.800 e 2.100 kcal. Utilizaram-se três softwares de cálculo de dietas, Programa A, B, C, e cálculo manual com o auxílio de três referências bibliográficas. A dieta de 1.500 kcal pelo Programa A apresentou percentual de inadequação de -22,62%, Programa B -13,9%, Programa C +15,73% e pelo cálculo manual -1,1%. A dieta de 1.800 kcal apresentou no Programa A -26,6%, Programa B -15,6%, Programa C +11,17% e no cálculo manual -1,8%. A dieta de 2.100 kcal pelo Programa A -25,5%, Programa B -15,8%, Programa C +7,2% e no cálculo manual -4,8%. No estudo foi inviável reproduzir as dietas com auxílio do Programa A, B e C. O cálculo manual foi o método que mais se aproximou dos valores de oferta calórica apresentados pela cartilha.

Current analysis recalculates standard semi-amateur enteral diets given in a handout for Home Enteral Nutrition Therapy. Diets with 1,500, 1,800 and 2,100 kcal were selected. Three softwares for diet calculation were employed, namely, Program A, B, C, and a manual calculation, with the help of three bibliographical references. Diet 1,500 kcal of Program A had a non-adequacy percentage of -22.62%; Program B featured -13.9%; Program C featured +15.73%; manual calculation featured -1.1%. Diet 1,800 kcal features -6.6% in Program A; -15.6% in Program B; +11.17% in Program C; and -1.8% in manual calculation. Diet 2,100 kcal of Program A featured -25.5%; Program B featured -15.8%; Program C featured +7.2%; manual calculation featured -4.8%. Analysis showed unfeasibility of diets with Programs A, B and C. Manual calculation was the method that was closest to values of calorie calculation presented in the guideline.

Impacto da dieta usual no risco de doença hepática gordurosa não alcoólica (DHGNA) / Impact of current diet at the risk of non-alcoholic fatty liver disease (nafld)

ABSTRACT The nonalcoholic fatty liver disease (NAFLD) affects approximately 20%-30% of general population and is even more prevalent among obese individuals. The risk factors mainly associated with NAFLD are diseases related to the metabolic syndrome, genetics and environment. In this review, we provide a literature compilation evaluating the evidence behind dietary components, including calories intake, fat, protein, fibers and carbohydrate, especially fructose which could be a trigger to development and progression of the NAFLD. In fact, it has been demonstrated that diet is an important factor for the development of NAFLD and its association is complex and extends beyond total energy intake.

RESUMO A doença hepática gordurosa não alcoólica (DHGNA) afeta aproximadamente de 20% a 30% da população geral sendo prevalente entre os indivíduos obesos. Os fatores de risco associados à DHGNA são: doenças relacionadas à síndrome metabólica, fatores genéticos e meio ambiente. Nesta revisão, fornecemos uma compilação bibliográfica avaliando como as evidências relacionadas aos componentes da dieta, incluindo ingestão calórica, de gorduras, de proteínas, de fibras e de carboidratos, especialmente a frutose, poderiam ser um estímulo para o desenvolvimento e progressão da DHGNA. Foi demonstrado que a dieta é um fator importante para o desenvolvimento da DHGNA e sua associação se estende além do consumo total de calorias.