Adecuación del aporte nutricional con la meta calórica en una unidad de cuidados intensivos pediátricos de referencia / Adequacy of nutritional intake with caloric goal in a reference pediatric intensive care unit

RESUMEN Objetivo. Describir el aporte nutricional en una unidad de cuidados intensivos pediátricos de referencia e identificar factores asociados al logro inadecuado de la meta calórica. Métodos. Estudio retrospectivo que revisa historias clínicas de menores de 14 años para identificar datos clínicos, valoración nutricional antropométrica y gasto energético según ecuación de Schofield. Resultados. Se incluyeron 65 pacientes, 54% de sexo masculino, edad de un mes a 13 años, 60% ingresó del servicio de urgencias, diagnósticos más frecuentes shock e insuficiencia respiratoria y 49,2% tenía estado nutricional normal. En el 28% de pacientes se alcanzó una adecuada meta calórica, 34% fue excesivo y 38% deficiente. El soporte nutricional se inició en las primeras 72 horas en 95% de pacientes, 84,6% por vía enteral y 80% tuvo interrupciones. El logro no adecuado de la meta fue más frecuente en menores de un año (51%, p=0,013) y en los que recibieron nutrición enteral (93%, p=0,019).

ABSTRACT Objetive. Nutritional intake in a reference pediatric intensive care unit is described and factors associated with inadequate achievement of the caloric goal are identified. Methods. Retrospective study that reviews the medical records of children under 14 years of age to identify clinical data, anthropometric nutritional assessment and energy expenditure according to the Schofield equation. Results. 65 patients were included, 54% male, age range from one month to 13 years, 60% admitted to the emergency department, most frequent diagnoses were shock and respiratory failure and and 49.2% presented normal nutritional status. In 28% of patients an adequate caloric goal was reached, 34% was excessive and 38% deficient. Nutritional support was started in the first 72 hours in 95% of patients, 84.6% by enteral route, 80% had nutrition interruptions. The inadequate achievement of the goal was more frequent in children under one year of age (51%, p=0.013) and in those who received enteral nutrition (93%, p=0.019).

Alimentos incluidos en la canasta básica tributaria de Costa Rica y su capacidad para suplir los requerimientos nutricionales en el caso de la población con menos ingresos / Food included in the basic tax basket in Costa Rica and its capacity to meet the nutritional requirements of the population with lower incomes

Resumen En el campo nutricional se han desarrollado diversas normas enfocadas en proteger a los sectores más vulnerables económicamente. Una de estas es el Reglamento de Canasta Básica Tributaria de Costa Rica (CBT), el cual establece una reducción en la carga impositiva a los alimentos consumidos por tales grupos, según la Encuesta Nacional de Ingresos y Gastos de los Hogares (ENIGH) de 2013. El objetivo de esta investigación es comparar el valor nutricional de la CBT y los requerimientos nutricionales para el caso del primer quintil de la ENIGH. El enfoque del estudio es cuantitativo y de tipo correlacional. La muestra la conforma el primer quintil de la ENIGH, 2013, compuesto por adultos sanos entre 19 y 60 años. El análisis se realizó durante el primer cuatrimestre de 2020, mediante un instrumento formulado en Excel, en el cual se elaboró un plan de alimentación con los productos de la CBT, calculando el contenido de energía, macronutrientes, ácidos grasos saturados, fibra, calcio, zinc, magnesio, vitamina E y vitamina D. Se identificó que el 46 % de ellos son fuente o buena fuente de alguno de los nutrientes en estudio y que 6 de los 11 nutrientes se adecuan satisfactoriamente a los requerimientos. Se concluyó que, a partir de dichos comestibles, se puede formular una dieta acorde a las necesidades nutricionales de una población, por cuanto la mayoría de los excesos y las deficiencias encontradas no son perjudiciales para la salud.

Abstract On a national level, several regulations have been developed with the aim of protecting the economically most vulnerable sectors of the population. One of these regulations is the Costa Ricas Basic Tax Basket Regulations (CBT by the Spanish acronym for Canasta Básica Tributaria), which establishes a decrease in the tax burden on food consumed by the most vulnerable population of the 2013 National Household Income and Expense Survey (ENIGH by the Spanish acronym for Encuesta Nacional de Ingresos y Gastos de los Hogares). The objective of this research is to compare the nutritional value of the foods included in the CBT and the nutritional requirements of the first quintile members of the 2013 ENIGH. The research is quantitative and co-relational in type. The sample is the first income quantile of the ENIGH of 2013 and is composed of healthy adults with ages between 19 and 60. The analysis was made during the first four months of 2020, using an instrument formulated in Excel, in which meal plans are formulated only with the foods that are part of the CBT, to calculate the content of energy, macronutrients, saturated fatty acids, fiber, calcium, zinc, magnesium, vitamin E and vitamin D. The results determined that 46% of CBT foods are classified as source or good source of some of the studied nutrients. As well as 6 of the 11 studied nutrients are satisfactorily adapted to the requirements of the population. The results allow to conclude that with the foods included in the CBT, an adequately balanced meal plan can be formulated, because excess or deficiency of nutrients found in the meal plan are not considered harmful to the health.

Perfil alimentar de transplantados cardíacos de um centro transplantador brasileiro - Atuação da enfermagem neste cenário / Perfil alimentario de los trasplantes de corazón en un centro de trasplante brasileño - Desempeño de la enfermería en este escenario / Food profile of heart transplants in a brazilian transplantation center - Nursing performance in this scenario

Objetivo- Descrever o perfil alimentar de pacientes pós transplante cardíaco (TC) tardio de um centro transplantador brasileiro. Método- Estudo observacional transversal com delineamento descritivo. O estudo ocorreu em uma instituição de ensino público de Minas Gerais. A coleta de dados ocorreu no período de 2017 a 2019. Resultados-. A amostra do estudo foi composta por 62 indivíduos transplantados entre os anos de 2006 a 2016. Aproximadamente 63% era do sexo masculino. A média de idade foi de 46,53 anos. O consumo de carboidratos e gorduras foi adequado em 46,77% e 59,68% da amostra, respectivamente. Já o consumo de proteínas foi acima do recomendado em 77,42% e o consumo de fibras abaixo do recomendado em 79,03%. Conclusão- Houve a predominância do sexo masculino. Os indivíduos apresentaram um consumo adequado somente de carboidratos e gorduras. Não houve na literatura estudos descrevendo a atuação do enfermeiro no processo de nutrição neste cenário(AU)

Objective- To describe the dietary profile of patients after late heart transplantation (HT) from a Brazilian transplant center. Method- Cross-sectional observational study with descriptive design. The study took place in a public education institution in Minas Gerais. Data collection took place from 2017 to 2019. Results-. The study sample consisted of 62 individuals transplanted between 2006 and 2016. Approximately 63% were male. The mean age was 46.53 years. The consumption of carbohydrates and fats was adequate in 46.77% and 59.68% of the sample, respectively. The consumption of proteins was above the recommended in 77.42% and the consumption of fibers below the recommended in 79.03%. Conclusion- There was a predominance of males. The individuals presented an adequate consumption of only carbohydrates and fats. There were no studies in the literature describing the role of nurses in the nutrition process in this scenario(AU)

Objetivo- Describir el perfil dietético de pacientes después de un trasplante cardíaco (TC) tardío de un centro de trasplante brasileño. Método- Estudio observacional transversal con diseño descriptivo. El estudio se llevó a cabo en una institución de educación pública en Minas Gerais. La recolección de datos se llevó a cabo de 2017 a 2019. Resultados-. La muestra del estudio estuvo compuesta por 62 individuos trasplantados entre 2006 y 2016. Aproximadamente el 63% eran hombres. La edad media fue de 46,53 años. El consumo de carbohidratos y grasas fue adecuado en el 46,77% y 59,68% de la muestra, respectivamente. El consumo de proteína estuvo por encima del nivel recomendado en un 77,42% y el consumo de fibra por debajo del nivel recomendado en un 79,03%. Conclusión- Hubo predominio del sexo masculino. Los individuos presentaron un consumo adecuado de solo carbohidratos y grasas. No hubo estudios en la literatura que describieran el papel del enfermero en el proceso de nutrición en este escenario.(AU)

Nutritional requirements for the elderly in India: A status paper

Advances in the medical field and healthcare sector during the last few decades have resulted in increased longevity. Increased lifespans have in turn led to a rapid global rise of the elderly population. However, ensuring the health and quality of life, especially in the context of chronic age-related ailments, among the growing geriatric population is a challenge. Ageing is associated with several changes in body composition including a decline in the lean body mass usually accompanied by an increase in body fat content which have a bearing on the nutrient requirements for the elderly. The nutrient requirements currently recommended for Indian adults are primarily computed using a factorial approach, that considers the cumulative loss of nutrients and is adjusted for optimal body weights and bioavailability. It is logical that physiological and metabolic changes associated with ageing influence several of these factors: body weight, lean mass, energy expenditure, nutrient retention and bioavailability and thus alter nutrient requirements compared to the adult population. Acknowledging these age-related changes, some international organizations have suggested nutrient requirements specific to the elderly. Given the contextual differences in physiology, caution needs to be exercised in adopting these guidelines for the Indian elderly. In addition, in the Indian context, there is sparse information on the diet and nutrient intakes vis-à-vis nutritional status and physiology of the elderly. This status paper highlights some of the pertinent issues related to nutritional requirements for the elderly that advocate a need for deriving nutritional requirements for the elderly in India

Multi-objective optimization of methionine+cysteine levels in diets for growing pigs / Nivel óptimo multiobjetivo de metionina+cisteína en dietas para cerdos en crecimiento / Otimização multiobjetivo do nível de metionina+cisteína em dietas para suínos em crescimento

Abstract Background: The addition of synthetic methionine to growing pig diets should consider the requirements of the methionine+cysteine complex, as most cysteine is obtained through dietary methionine. Objective: To determine an optimal level of methionine+cysteine (Met+Cys) in growing pig diets. Methods: Ninety-nine hybrid (Yorkshire×Landrace×Duroc) barrows were used in a completely randomized design (initial body weight: 25.90±3.99 kg). Nine levels of Met+Cys (0.500, 0.525, 0.550, 0.575, 0.600, 0.625, 0.650, 0.675, and 0.700%) were evaluated during 35 days. To determine a multi-objective optimal level of Met+Cys, growth performance and strongly related carcass traits were evaluated. Results: Average daily feed intake (ADFI) and feed:gain ratio (FGR) showed a linear response to the dietary Met+Cys level (p<0.05), with estimated optimal concentration at 0.700%. Average daily gain (ADG) did not show any effect on the Met+Cys level (p>0.05). Carcass characteristics were not affected by the Met+Cys concentration (p>0.05). The multi-objective optimal level for ADG, ADFI, and FGR was 0.667% Met+Cys. Conclusions: According to our results, 0.667% Met+Cys is the best concentration in diets for growing pigs.

Resumen Antecedentes: Las dietas para cerdos en crecimiento deben adicionarse con metionina sintética para suplir los requerimientos del complejo metionina+cisteína (Met+Cis), pues ellos producen gran parte de la cisteína que requieren a partir de la metionina dietaría. Objetivo: determinar el nivel óptimo multiobjetivo de Met+Cis en dietas para cerdos en crecimiento. Métodos: noventa y nueve machos castrados híbridos (Yorkshire×Landrace×Duroc) se utilizaron en un diseño completamente al azar (peso vivo inicial: 25,90±3,99 kg). Se evaluaron nueve niveles de Met+Cys (0,500, 0,525, 0,550, 0,575, 0,600, 0,625, 0,650, 0,675 y 0,700%) durante 35 d. Para determinar el nivel óptimo multiobjetivo de Met+Cis se consideraron las variables de rendimiento de crecimiento y características de la canal que mantienen una fuerte interrelación. Resultados: el promedio de consumo de alimento diario (ADFI) y la conversión alimenticia (FGR) mostraron una respuesta lineal al nivel de Met+Cis en la dieta (p<0,05), con una concentración óptima estimada en 0,700%. El nivel de Met+Cis no afecto a la ganancia diaria de peso (ADG; p>0,05). La concentración de Met+Cis tampoco afectó las características de la canal (p>0,05). El nivel óptimo multi- objetivo de Met+Cis para ADFI, FGR y ADG fue 0,667%. Conclusión: los resultados indican que 0,667% de Met+Cis es la mejor concentración en la dieta para cerdos en crecimiento.

Resumo Antecedentes: a adição de metionina em dietas para suínos em crescimento deve ser feita para atender às exigências do complexo metionina+cisteína (Met+Cis), porque grande parte da cisteína é obtida através da dieta com metionina. Objetivo: determinar o nível multiobjetivo ótimo de Met+Cis em dietas para suínos em crescimento. Métodos: noventa e nove suínos machos castrados híbridos (Yorkshire×Landrace×Duroc) foram utilizados em delineamento inteiramente casualizado, com peso inicial de 25,90±3,99 kg. Nove níveis de Met+Cis (0,500, 0,525, 0,550, 0,575, 0,600, 0,625, 0,650, 0,675 y 0,700%) foram avaliados em suínos em crescimento por 35 d. Para determinar o nível multiobjetivo ótimo de Met+Cis, foram consideradas as variáveis de comportamento de crescimento e características do canal que mantêm uma forte inter-relação. Resultados: a ingestão média diária de alimentos (ADFI) e a conversão alimentar (FGR) mostraram uma resposta linear ao nível de Met+Cis na dieta (p<0,05), estimando a concentração ótima em 0,700%. O ganho de peso diário (ADG) não mostrou efeito devido ao nível de Met+Cis na dieta (p>0,05). As características da carcaça não foram afetadas pela concentração de Met+Cis na dieta (p>0,05). Com ADFI, FGR e ADG, o nível ótimo de Met+Cis foi obtido, encontrando este nível em 0,667%. Conclusões: os resultados indicam que 0,667% de Met+Cis é a melhor concentração na dieta para suínos em crescimento.

Evaluación oxidativa, microbiológica, sensorial y perfil de ácidos grasos de un yogur con ácido docosahexaenoico (DHA) extraído de aceite de microalgas / Oxidative, sensory and fatty acid profile evaluation of a yogurt with docosahexaenoic acid (DHA) extracted from microalgae oil

RESUMEN Las necesidades de ácido docosahexaenoico (DHA), se incrementan en la mujer gestante para el desarrollo visual y neurológico del feto y el lactante. En este trabajo, se desarrolló y se evaluó un yogur adicionado con aceite de microalgas, que contribuyera a la recomendación dietaria de DHA en mujeres gestantes y lactantes. Se diseñaron tres formulaciones de yogur con 0,075; 0,125 y 0,175% de aceite de microalga y se compararon con una muestra control. Se evaluaron propiedades fisicoquímicas, sensoriales, microbiológicas, perfil de ácidos grasos, potencial antioxidante (ABTS, fenoles totales) y peroxidación lipídica (sustancias reactivas al ácido tiobarbitúrico [TBARS]). Los yogures adicionados con el aceite de microalga cubrieron en 30, 45 y 63% las recomendaciones de DHA para mujeres gestantes y lactantes por porción (200 mL). Se observó estabilidad del ácido graso, excepto en la muestra de mayor adición del aceite. La muestra con adición de 0,125% de aceite de microalga fue la de mejor calificación por el panel sensorial. Todas las muestras cumplieron con el estándar microbiológico y fisicoquímico para un yogur entero adicionado con dulce. Se observó potencial antioxidante promisorio en el yogur, capaz de proteger el DHA. Se concluye que las bebidas lácteas como el yogur son matrices adecuadas para la adición de aceite de microalga con la finalidad de aumentar el DHA en la dieta, especialmente en etapas en que las necesidades de este componente son más altas, como en periodo de gestación y lactancia.

ABSTRACT The needs for docosahexaenoic acid (DHA) are increased during pregnancy for the visual and neurological development of the fetus and the breastfed infant. In this study, a yogurt with microalgae oil added to contribute to the dietary recommendation of DHA in pregnant and breastfeeding women was developed and evaluated. Three yogurt formulations were designed with 0.075; 0.125 and 0.175 microalgae oil percentage and compared with a control sample. Fatty acid profile, antioxidant potential (ABTS, total phenols), lipid peroxidation (thiobarbitrical acid reactive substances [TBARS]), physicochemical, sensory, and microbiological properties were evaluated. Yogurts with microalgae oil added covered 30, 45 and 63% of DHA recommendations for pregnant and breastfeeding women per portion (200 mL). Fat acid stability was observed, except in the one with the greatest oil addition. The sample with 0.125% of microalgae oil added was rated the highest by the sensory panel. All samples met the microbiological and physicochemical standard for a whole yogurt added with sugar. Promising antioxidant potential capable of protecting DHA was observed in the yogurt. We conclude that dairy drinks such as yogurt are suitable matrices for adding microalgae oil in order to increase DHA in the diet, especially in stages where the needs of this component are higher as is the case during pregnancy and lactation periods.

Efeito dos níveis de lisina/proteína ideal sobre desempenho, características de carcaça, digestibilidade e parâmetros sanguíneos de suínos machos, castrados, da raça Duroc, de 30kg a 50kg / [Effects of lysine/ideal protein level on performance, carcass characteristics, digestibility and blood parameters of Duroc barrows from 30 to 50kg]

Objetivou-se avaliar níveis de proteína e aminoácidos, mantendo-se as relações entre os aminoácidos para suínos machos, castrados, de30kg a 50kg. Foram utilizados 50 suínos machos, castrados, com peso inicial de 30,35±1,96kg, distribuídos em delineamento experimental inteiramente ao acaso, com cinco tratamentos e cinco repetições com dois animais por unidade experimental. Os tratamentos consistiram em níveis de lisina digestível, mantendo-se a relação com os demais aminoácidos digestíveis: 0,73%; 0,83%; 0,93%; 1,03% e 1,13% na dieta. Avaliou-se desempenho, avaliação de carcaça, parâmetros sanguíneos e digestibilidade das dietas. Houve efeito quadrático para ganho de peso, conversão alimentar e níveis de creatinina em função dos níveis de lisina, com níveis ótimos estimados em 0,92%, 0,93% e 0,93%, respectivamente. As características de carcaça não foram influenciadas significativamente pelos tratamentos. Constatou-se efeito linear positivo para digestibilidade aparente da proteína bruta, da proteína total e da ureia sérica. Conclui-se que os níveis de proteína e lisina digestível recomendados para dietas de suínos machos, castrados, da raça Duroc, na fase de crescimento I, são de 16,70% e 0,93%, respectivamente, pois esses níveis proporcionaram melhorias no ganho de peso, na conversão alimentar e na creatinina sérica.(AU)

The objective of this study was to evaluate digestible lysine levels, keeping the relation among amino acids for Duroc barrows from 30 to 50kg. Fifty Duroc barrows (30.35±1.96kg live weight) were allotted in a completely randomized experimental design, divided in five treatments with five replicates and two animals in each experimental unit. The treatments consisted of digestible lysine levels (0.73%; 0.83%; 0.93%; 1.03% and 1.13%), keeping the relation with other essential amino acids. Performance, carcass characteristics, blood parameters and digestibility of the diets were evaluated. There was a quadratic response on weight gain, feed conversion and creatinine serum concentration as a function of the digestible lysine levels, with the greater levels obtained at 0.92%, 0.93% and 0.93%, respectively. The carcass characteristics were not influenced by the treatments. There was a linear increase of apparent digestibility of crude protein, total serum protein and urea. Results suggest that the requirement of protein and digestible lysine was 16.70% and 0.93%, respectively, providing improvements on weight gain, feed conversion and creatinine serum concentration of Duroc barrows in the growth phase.(AU)

Foliar mineral content of five shrub species with nutritional potential for small ruminants in semiarid regions in northeastern Mexico / Conteúdo mineral foliar de cinco espécies de arbustos com potencial nutricional para pequenos ruminantes em regiões semiáridas do nordeste do México

ABSTRACT: This study was conducted to determine the monthly composition of the minerals Ca, P, K, Mg, Cu, Fe, Mn and Zn in five shrub species that are consumed by small ruminants in the semi-arid regions of northeastern Mexico. Leaves samples of shrub species; Celtis pallida, Croton suaveolens, Forestiera angustifolia, Guaiacum angustifolium and Parkinsonia aculeata were randomly collected during twelve consecutive months from July 2018 to June 2019 in two sites, located in Linares and Los Ramones counties, in the state of Nuevo Leon, Mexico. Mineral content was analyzed using an atomic absorption spectrophotometer, while phosphorus was measured by the colorimetry method. The Linares county showed the highest content of macro- and micro-minerals. Among species, C. pallida showed the highest values of macro-minerals and P. aculeata content of micro-minerals was highest. Ca (total mean = 40.0 g kg-1 DM), K (15.4 g kg-1), Mg (3.7 g kg-1), Fe (87.2 mg kg-1), Mn (35.5 mg kg-1) were available in adequate quantities, while P (1.3 g kg-1 DM), Cu (6.4 mg kg-1) and Zn (17.7 mg kg-1) were found deficient. Shrub species in this study can be considered as a good source of Ca, K, Mg, Fe and Mn except in C. suaveolens. However, P, Cu and Zn must be supplemented.

RESUMO: O presente estudo foi realizado com o intuito de determinar os teores dos minerais Ca, P, K, Mg, Cu, Fe, Mn e Zn, ao longo do ano, em cinco espécies de arbustos consumidas por pequenos ruminantes nas regiões semiáridas do nordeste do México. Amostras de folhas de espécies arbustivas; Celtis pallida, Croton suaveolens, Forestiera angustifolia, Guaiacum angustifolium e Parkinsonia aculeata foram coletadas aleatoriamente durante doze meses consecutivos, de Julho de 2018 a Junho de 2019, em dois locais, nos municípios de Linares e Los Ramones, no estado de Nuevo Leon, México. O conteúdo mineral foi analisado através de um espectrofotômetro de absorção atômica, enquanto o fósforo foi medido pelo método da colorimetria. O município de Linares apresentou o maior conteúdo de macro e microminerais. Entre as espécies, C. pallida apresentou os maiores valores de macrominerais, enquanto o teor de microminerais foi maior na P. aculeata. Ca (média = 40.0 g kg-1 MS), K (15.4 g kg-1), Mg (3.7 g kg-1), Fe (87.2 mg kg-1), Mn (35.5 mg kg-1) estavam disponíveis em quantidades adequadas, enquanto P (1.3 g kg-1 MS), Cu (6.4 mg kg-1) e Zn (17.7 mg kg-1) foram encontrados deficientes. As espécies arbustivas deste estudo podem ser consideradas uma boa fonte de Ca, K, Mg, Fe e Mn, exceto na espécie C. suaveolens. No entanto, P, Cu e Zn devem ser suplementados.

Impacto nutricional da cirurgia bariátrica: estudo comparativo do Bypass gástrico em Y de Roux e do Sleeve entre pacientes dos sistemas público e privado de saúde / Nutritional impact of bariatric surgery: a comparative study of Roux-en-Y Gastric Bypass and Sleeve gastrectomy between patients from the public and private health systems

RESUMO Objetivos: Comparar a evolução do perfil nutricional de pacientes submetidos ao bypass gástrico em Y de Roux (BGYR) e ao Sleeve, em hospitais dos setores público e privado da Saúde de Pernambuco. Método: O estudo incluiu pacientes submetidos à cirurgia bariátrica nos setores público e privado de saúde de Pernambuco no período de 2008 a 2016. Foram avaliados dados antropométricos e bioquímicos (Hemoglobina, Vitamina B12, Ferro e Ferritina) no período pré-operatório e com 3, 6 e 12 meses de pós-operatório. Resultados: Não foram registradas diferenças significativas entre os pacientes internados nos dois setores da Saúde no tocante às variáveis: níveis hemoglobina, anemia por deficiência de ferro e vitamina B12 em nenhuma das avaliações e conforme o tipo de cirurgia. Entre os pacientes submetidos ao BGYR, os níveis de ferro sérico foram significativamente menores nos pacientes do setor privado da Saúde apenas na primeira avaliação. Baixos níveis de ferritina sérica foram observados na segunda avaliação, sendo os pacientes do setor privado os que apresentaram menores valores. O sucesso cirúrgico foi significativamente maior no grupo que realizou o BGYR na rede privada. Conclusões: Com um seguimento de 12 meses pós-cirurgia bariátrica, não foi observada diferença estatisticamente significante no que diz respeito às deficiências de micronutrientes entre pacientes usuários dos setores público e privado de Saúde.

ABSTRACT Purpose: To compare the nutritional status follow up of patients who underwent Roux-en-Y gastric bypass (BGYR) and Sleeve gastrectomy (SG) in hospitals of the private and public health systems, in Pernambuco. Methods: This study included patients who underwent bariatric surgery in the public and private health systems, in Pernambuco, from 2008 to 2016. Anthropometric and biochemical (hemoglobin, B12, iron and ferritin) data were evaluated in the preoperative period and at 3, 6 and 12 months after the operation. Results: There were no significant difference between patients seen at the two health systems regarding the levels of hemoglobin, iron, anemia and vitamin B12. Patients who underwent the RYGB, presented with iron deficiency which was significantly lower for those in the private system, but only at the 3 month evaluation. Low levels of ferritin were observed at the 6 month evaluation, and patients in the private health system presented with the highest ferritin deficiency. The rate of surgical success was significantly higher in those patients undergoing the RYGB at the private system. Conclusions: After a 12-month bariatric surgery follow-up, there was no statistically significant difference regarding micronutrient deficiency between patients followed up at the private and public health systems.

Designing optimized food intake patterns for Korean adults using linear programming (II): adjustment of the optimized food intake pattern by establishing stepwise intake goals of sodium / 한국영양학회지

PURPOSE: The Dietary Reference Intakes for Koreans (KDRIs) suggest that the goal for the intake of sodium should be less than 2,000 mg, which is thought to be infeasible to achieve when eating the typical Korean diet. This study aimed to obtain the new intake goals for sodium with improved feasibility to achieve, and also to design optimized food intake patterns for Korean adults by performing linear programming. METHODS: The data from a one day 24-hour dietary recall of the 2010 ~ 2014 Korea National Health and Nutrition Survey were used to quantify food items that Korean adults usually consumed. These food items were categorized into seven groups and 24 subgroups. The mean intakes and intake distributions of the food groups and the food subgroups were calculated for eight age (19 ~ 29, 30 ~ 49, 50 ~ 64, and over 65 years old) and gender (male and female) groups. A linear programming model was constructed to minimize the difference between the optimized intakes and the mean intakes of the food subgroups while meeting KDRIs for energy and 13 nutrients, and not exceeding the typical quantities of each of the food subgroups consumed by the respective age and gender groups. As an initial solution of the linear programming, the optimized intake of seasonings, including salt, was calculated as 0 g for all the age and gender groups when the sodium constraint was inserted not to exceed 2,000 mg. Therefore, the sodium constraint was progressively increased by 100 mg until the optimized intake of seasoning was obtained as the values closest to the 25(th) percentile of the intake distribution of seasonings for the respective age and gender groups. RESULTS: The optimized food intake patterns were mathematically obtained by performing linear programming when the sodium constraint values were 3,600 mg, 4,500 mg, 4,200 mg, 3,400 mg, 2,800 mg, 3,100 mg, 3,100 mg, and 2,500 mg for the eight age and gender groups. CONCLUSION: The optimized food intake patterns for Korean adults were designed by performing linear programming after increasing the sodium constraint values from 2,000 mg to 2500 ~ 4,500 mg according to the age and gender groups. The resulting patterns suggest that current diets should be modified to increase the intake of vegetables for all the groups, milk/dairy products for the female groups, and fruits for the female groups except for the females aged 50 ~ 64 years.

Validity of the dietary reference intakes for determining energy requirements in older adults

BACKGROUND/OBJECTIVES: The objectives of this study were to evaluate the accuracy of the Dietary Reference Intakes (DRI) for estimating the energy requirements of older adults, and to develop and validate new equations for predicting the energy requirements of this population group. MATERIALS/METHODS: The study subjects were 25 men and 23 women with a mean age of 72.2 ± 3.9 years and 70.0 ± 3.3 years, and mean BMI of 24.0 ± 2.1 and 23.9 ± 2.7, respectively. The total energy expenditure (TEE) was measured by using the doubly labeled water (DLW) method, and used to validate the DRI predictive equations for estimated energy requirements (EER) and to develop new EER predictive equations. These developed equations were cross-validated by using the leave-one-out technique. RESULTS: In men, the DRI equation had a −7.2% bias and accurately predicted the EER (meaning EER values within ±10% of the measured TEE) for 64% of the subjects, whereas our developed equation had a bias of −0.1% and an accuracy rate of 84%. In women, the bias was −6.6% for the DRI equation and 0.2% for our developed equation, and the accuracy rate was 74% and 83%, respectively. The predicted EER was strongly correlated with the measured TEE, for both the DRI equations and our developed equations (Pearson's r = 0.915 and 0.908, respectively). CONCLUSIONS: The DRI equations provided an acceptable prediction of EER in older adults and these study results therefore support the use of these equations in this population group. Our developed equations had a better predictive accuracy than the DRI equations, but more studies need to be performed to assess the performance of these new equations when applied to an independent sample of older adults.

Prevalence of consumption and nutritional content of breakfast meal among adolescents from the Brazilian National Dietary Survey / Prevalência de consumo e teor nutricional da refeição do café da manhã entre adolescentes da Pesquisa Nacional de Consumo Alimentar

Abstract Objective: To estimate the prevalence of breakfast consumption and describe the foods and nutrients consumed at this meal and throughout the day by Brazilian adolescents. Method: A total of 7276 adolescents aged 10-19 years were evaluated in the Brazilian National Dietary Survey 2008-9, a population-based cross-sectional study. Individuals' information was collected at home. Dietary data were obtained by two food records. Breakfast was defined as the first eating occasion of the day that occurred between 6 and 9:59 am. Differences between breakfast consumers, occasional consumers, and skippers were tested through Pearson's chi-squared test or F-test of regression analysis. Results: Breakfast was consumed by 93% of adolescents and it was associated with age, income, geographic region and household area. The most frequently consumed foods at breakfast were white bread, coffee, butter/margarine, refined cookies and crackers, and whole milk. The mean daily intakes of total energy, sugar, and calcium were higher among occasional consumers and skippers. Breakfast consumers had higher intake of vitamins B12, C, and D. Breakfast contributed more to total intake of calcium, phosphorus, thiamin, riboflavin, and vitamins A, B6, and D (17-32%), trans fat and sodium (about 30%) and less to folate, vitamin C, iron, zinc, and fiber (8-12%) and energy intake (16%). Conclusions: Although the prevalence of breakfast consumption among Brazilian adolescents was high, the overall nutritional quality of this meal is suboptimal, highlighting the need to support adolescents and their families to make more nutrient-dense food choices.

Resumo Objetivo: Estimar a prevalência de consumo de café da manhã e descrever os alimentos e nutrientes consumidos nessa refeição e durante todo o dia por adolescentes brasileiros. Método: Foram avaliados 7.276 adolescentes entre 10-19 anos no Inquérito Nacional de Alimentação 2008-2009, um estudo transversal de base populacional. As informações dos indivíduos foram coletadas nos domicílios. Os dados alimentares foram obtidos por dois registros alimentares. O café da manhã foi definido como a primeira refeição do dia entre 6h e 9h59. As diferenças entre os consumidores de café da manhã, consumidores ocasionais e aqueles que não tomam café da manhã foram testadas por meio do teste de qui-quadrado ou teste F para análise de regressão. Resultados: O café da manhã foi consumido por 93% dos adolescentes e seu consumo foi associado à idade, renda, região geográfica e área residencial. Os alimentos mais frequentemente consumidos foram pão branco, café, manteiga/margarina, biscoitos e bolachas refinados e leite integral. A ingestão média diária de energia total, açúcar e cálcio foi maior entre os consumidores ocasionais e aqueles que não tomam café da manhã. Aqueles que tomam café da manhã apresentam maior ingestão de vitaminas B12, C e D. O café da manhã contribuiu mais para a ingestão total de cálcio, fósforo, tiamina, riboflavina e vitaminas A, B6 e D (17%-32%), gordura trans e sódio (cerca de 30%) e menos para a ingestão de ácido fólico, vitamina C, ferro, zinco e fibras (8%-12%) e energia (16%). Conclusões: Apesar de a prevalência de consumo de café da manhã entre os adolescentes brasileiros ter sido alta, a qualidade nutricional dessa refeição está abaixo do ideal, destaca a necessidade de apoio aos adolescentes e suas famílias para possibilitar a escolha de alimentos mais densos em nutrientes.

Standardized ileal digestible lysine requirement of white commercial layers in peak egg production / Níveis de lisina digestível em rações para galinhas poedeiras leves no pico de produção

This study was conducted to determine the standardized ileal digestible lysine (SID Lys) requirements for white commercial layers in peak egg production phase. A total of two hundred eighty-eight 24 week-old Hy-Line W-36 layers were randomly assigned to one of six treatments groups, with eight replicates of six hens each. A basal diet, SID Lys-deficient, was graded supplemented with L-Lysine HCl (78.4%) in order to produce experimental treatments (6.0, 6.6, 7.2, 7.8, 8.4 and 9.0 g SID Lys/kg diet). Throughout the 16-week-feeding trial (24 to 40 weeks of age) hens had free access to water and mash feed. Data were analyzed as one-way ANOVA and optimum SID Lys level for each dependent variable assessed were estimated using polynomial and linear broken-line regression model. Feed intake and SID Lys intake were both linearly enhanced by graded SID Lys levels. According to linear broken-line regression model, the breakpoint for egg production, egg weight, and egg mass occurred at 8.14, 8.56 and 8.35 g SID Lys/kg diet, respectively. The breakpoint for feed conversion per egg mass (kg/kg) and per dozen of eggs (kg/dozen) occurred at 8.48 and 7.80 g SID Lys/kg diet, respectively. Eggshell weight and albumen weight were unaffected by dietary SID Lys supply. Weight gain and yolk weight reached optimum values at 8.33 and 8.03 g SID Lys/kg diet, respectively, according to linear broken-line regression model. In conclusion, SID Lys requirement for white commercial layers in peak egg production phase is 8.48 g/kg diet, which corresponds to an average daily SID Lys intake of 813 mg/hen.

Este estudo foi realizado para determinar a exigência de lisina digestível para galinhas poedeiras leves no pico de postura. Foram utilizadas 288 poedeiras Hy Line W-36 durante o período de 24 a 40 semanas de idade. As poedeiras foram distribuídas em delineamento inteiramente casualizado, com seis níveis de lisina digestível (6,0; 6,6; 7,2; 7,8; 8,4 e 9,0 g/kg de ração), oito repetições e seis aves por unidade experimental. Os níveis de lisina digestível na ração proporcionaram aumento linear do consumo de ração e de lisina digestível. O modelo Linear Response Plateau (LRP) foi o que melhor representou a distribuição dos dados para produção e peso dos ovos, ocorrendo os platôs nos níveis de lisina digestível de 8,14 e 8,56 g/kg, respectivamente. Para massa dos ovos e conversões alimentares por massa e por dúzia de ovos, os platôs ocorreram nos níveis de 8,35; 8,48 e 7,80 g/kg de lisina digestível, respectivamente. Os pesos de casca e de albúmen não foram influenciados pelos níveis de lisina da ração. O ganho de peso das aves e o peso de gema atingiram, respectivamente, os platôs nos níveis de 8,33 e 8,03 g/kg de lisina digestível. A exigência de lisina digestível para galinhas poedeiras leves no pico de postura é de 8,48 g/kg de ração, que corresponde ao consumo diário de lisina digestível de 813 mg/ave.

Diseño de un alimento infantil listo para consumir fortificado con hierro a base de arveja (Pisum sativum) / Design of a ready-to-eat child food fortified with pea-based iron (Pisum sativum)

Resumen Introducción: La deficiencia de hierro es uno de los problemas nutricionales más prevalentes a nivel mundial y afecta principalmente a la población vulnerable como niños menores de 5 años. Los alimentos fortificados de consumo infantil hacen parte de las estrategias de intervención y se elaboran a partir de la mezcla ingredientes como cereales, frutas, leguminosas, entre otros. La arveja, es una leguminosa que puede ser empleada con el fin de aprovechar sus propiedades nutricionales. Objetivo: Diseñar un alimento infantil con arveja (Pisum sativum) listo para consumir, fortificado con hierro e higienizado por pasteurización. Materiales y métodos: Se seleccionó el porcentaje de arveja adecuado en el alimento mediante análisis sensorial. La selección de la sal de hierro se realizó mediante análisis fisicoquímico y sensorial empleando sulfato ferroso y hierro aminoquelado. Posteriormente se evaluó el crecimiento de microorganismos mesófilos con el fin de seleccionar el tratamiento térmico de pasteurización. La evaluación de vida útil se llevó a cabo a través de pruebas sensoriales. Finalmente se realizó la evaluación fisicoquímica, composicional y microbiológica del alimento higienizado. Resultados: La adición de arveja en porcentajes no mayores al 6,5% dentro de la formulación del alimento resultó aceptable para los padres de niños menores de 5 años. Por otra parte la sal seleccionada por generar menos cambios sobre el color y la acidez del alimento durante el almacenamiento fue hierro aminoquelado. Los resultados de tratamiento térmico mostraron que para reducir la concentración inicial de mesófilos y obtener un alimento de buena calidad de acuerdo con la normativa colombiana vigente fue necesario someter el alimento a 85°C durante 13 minutos (0,45 D), con lo que se consiguió mantener la calidad inicial del alimento durante 12 días bajo refrigeración. Conclusiones: El alimento desarrollado cumple con los criterios sensoriales y microbiológicos exigidos en la normativa colombiana vigente y es apto para el consumo, además se puede catalogar como alto en hierro y buena fuente de proteína, aportando el 25% y el 15% de la recomendación diaria en Colombia respectivamente.

Abstract Introduction: Iron deficiency is one of the most prevalent nutritional problems at the global level which mainly affects the vulnerable population as children under 5 years of age. Fortified foods of child consumption are part of the intervention strategies, which are made from the mixture of ingredients such as cereals, fruits, legumes, among others. Pea is a legume that can be used in order to take advantage of its nutritional properties. Objective: To design a ready-to-eat child food with peas (Pisum sativum), fortified with iron and sanitized by pasteurization. Materials and methods: The appropriate percentage of peas in the food was selected by sensory analysis. The selection of iron salt was made by physicochemical and sensory analysis using ferrous sulphate and chelate iron. Subsequently, the growth of mesophilic microorganisms was evaluated in order to select the pasteurization heat treatment. The useful life evaluation was carried out through sensory tests. Finally, the physico-chemical, compositional and microbiological evaluation of the sanitized food was implemented. Results: The addition of peas in percentages not greater than 6.5% within the food formulation was acceptable for parents of children under 5. On the other hand, the selected salt to generate less changes on the color and acidity of the food during storage was chelate iron. The results of heat treatment showed that for reducing the initial concentration of mesophiles and obtaining a good quality food according to the Colombian regulations in force, it was necessary to submit the food to 85 °C for 13 minutes (0.45 D), which managed to maintain the initial quality of the food for 12 days under refrigeration. Conclusions: The developed food complies with the sensory and microbiological criteria demanded in the Colombian regulations in force and is suitable for consumption. Besides, it can be catalogued as high in iron and a good source of protein, contributing with 25% and 15% of the daily recommendation in Colombia, respectively.

Nutritional Support for Neurocritically Ill Patients

Nutritional assessment and support are often overlooked in the critically ill due to other urgent priorities. Unlike oxygenation, organ dysfunction, infection, or consciousness, there is no consensus of indicators. Making it difficult to evaluate the effectiveness of an intervention. Nevertheless, appropriate nutritional support in the critically ill has been associated with less morbidity and lower mortality. But, nutritional support has been considered an adjunct, for body weight maintenance and to help patients during the inflammatory phase of illness. Thus, it has been assigned a lower priority, compared to mechanical ventilation or hemodynamic stability. Recent findings have shown that nutritional support may prevent cellular injury due to oxidative stress and help strengthen the immune response. Large-scale randomized trials and clinical guidelines have shown a shift from nutritional support to nutritional therapy, with an emphasis on the importance of protein, minerals, vitamins, and trace elements. Nutrition is also important in neurocritically ill patients. Since there are few studies or recommendations with regard to the neurocritical population, the general recommendations for nutritional support should be applied.

Designing optimized food intake patterns for Korean adults using linear programming (I): analysis of data from the 2010~2014 Korea National Health and Nutrition Examination Survey / 한국영양학회지

PURPOSE: The aim of this study was to design optimized food intake patterns that meet the nutritional recommendations with minimal changes from the current food intake patterns among Korean adults using linear programming. METHODS: Data of a one day 24-hour dietary recall from the 2010~2014 Korea National Health and Nutrition Survey were used to quantify the food items that Korean adults usually consumed. These food items were categorized into seven groups and 24 subgroups. The mean intakes and intake distributions of the food groups and the food subgroups were calculated for eight age (19~29, 30~49, 50~64, and over 65 years old) and gender (male and female) groups. A linear programming model was constructed to minimize the difference between the optimized and mean intakes of the food subgroups while meeting the Dietary Reference Intakes for Koreans (KDRIs) for energy and 13 nutrients, and not exceeding the typical quantities of each food subgroup consumed by the respective age and gender groups. RESULTS: The optimized food intake patterns, which were a set of quantities of 24 food subgroups, were obtained mathematically for eight age and gender groups. Overall, major modifications of current diet were required to increase the intake of vegetables and milk/dairy products and decrease the Kimchi intake. The optimized intake of seasonings, including salt, was calculated to be 0 g for all the age and gender groups. CONCLUSION: The optimized food intake patterns designed using linear programming in this study lack feasibility because they suggest a seasoning consumption of 0 g. Modification of intake goal for sodium is needed to obtain optimized food intake patterns with improved feasibility.

Monitoramento da terapia nutricional enteral em unidade de terapia intensiva: adequação calóricoproteica e sobrevida / Monitoring of enteral nutrition therapy in intensive care unit: energy and protein adequacy and survival

Objetivos: Avaliar o estado nutricional, a adequação da terapia nutricional enteral, os fatores que interferem na sua administração e a sobrevida de pacientes críticos. Método: Estudo observacional prospectivo, com pacientes internados na Unidade de Terapia Intensiva de um Hospital Universitário. Foram incluídos pacientes com idade superior a 18 anos que receberam nutrição enteral por período superior a 72 horas.O estado nutricional foi avaliado pela Avaliação Subjetiva Global e a terapia nutricional enteral foi considerada adequada quando superior a 70% (valor prescrito/administrado quanto a calorias e proteínas). A sobrevida após seis meses da alta foi analisada pelo teste de Mann Whitney. Resultados: Foram avaliados 32 pacientes, com idade média de 56,4±17,4 anos, sendo 59,4% homens. Na admissão, 75% dos pacientes apresentavam algum grau de desnutrição. A adequação foi de 72,3% para valor calórico e 70,2% para proteínas. A principal causa de interrupção da nutrição enteral foi pausa para procedimentos e exames (81,3%). Pacientes bem nutridos no momento da internação apresentaram sobrevida significativamente maior que pacientes com algum grau de desnutrição após seis meses (p=0,03). Conclusão: A maior parte dos pacientes apresentou desnutrição na admissão e a meta calóricaproteica proposta foi alcançada pela maioria. A sobrevida em seis meses dos pacientes bem nutridos foi significativamente maior do que os demais.(AU)

Objectives: To evaluate the nutritional status, the adequacy of enteral nutritional therapy, the factors that influence enteral nutrition management and the survival analysis of critically ill patients. Methods: A prospective, observational study conducted with patients admitted to the intensive care unit of a university hospital. Patients above 18 years under exclusive enteral nutrition therapy for at least 72 hours were included. Nutritional status was evaluated by the Subjective Global Assessment and enteral nutritional therapy was considered adequate up to 70% of the prescribed (energy and protein). Survival after six months of discharge was analyzed by Mann Whitney test. Results: 32 patients were included; the mean of age was 56.4±17.4 years and 59.4% were man.On admission, 75% of patients had some degree of malnutrition. The adequacy was 72.3% for calories and 70.2% for proteins. The main cause of interruption of enteral nutrition was breaks procedures and tests (81.3%). Well-nourished patients at admission had a significantly longer survival than patients with some degree of malnutrition after six months (p=0.03). Conclusion: Most of the patients presented malnutrition at admission and the proposed caloric-protein target was reached by the majority. The survival rate at six months of well-nourished patients was higher than others.(AU)

Validation of dietary reference intake equations for estimating energy requirements in Korean adults by using the doubly labeled water method

BACKGROUND/OBJECTIVES: The doubly labeled water (DLW) method is considered the gold standard for the measurement of total energy expenditure (TEE), which serves to estimate energy requirements. This study evaluated the accuracy of predictive dietary reference intake (DRI) equations for determining the estimated energy requirements (EER) of Korean adults by using the DLW as a reference method. SUBJECTS/METHODS: Seventy-one participants (35 men and 36 women) aged between 20 and 49 years were included in the study. The subjects' EER, calculated by using the DRI equation (EER(DRI)), was compared with their TEE measured by the DLW method (TEE(DLW)). RESULTS: The DRI equations for EER underestimated TEE by -36.3 kcal/day (-1.3%) in men and -104.5 kcal/day (-4.9%) in women. The percentages of accurate predictions among subjects were 77.1% in men and 62.9% in women. There was a strong linear correlation between EER(DRI) and TEE(DLW) (r=0.783, P<0.001 in men and r=0.810, P<0.001 in women). CONCLUSIONS: The present study supports the use of DRI prediction equations to determine EER in Korean adults. More studies are needed to confirm our results and to assess the validity of these equations in other population groups, including children, adolescents, and older adults.

Estado nutricional de pacientes en dos centros hospitalarios de villavicencio, colombia, 2015

Objetivo. Establecer el estado nutricional en pacientes de dos instituciones hospitalarias de Villavicencio. Método. Estudio de corte transversal, prospectivo, mediante una encuesta en 2 instituciones hospitalarias de Villavicencio, Colombia, en febrero de 2015. Se incluyeron pacientes adultos hospitalizados en servicios quirúrgicos. Los datos fueron registrados en Excel y se realizaron análisis estadísticos con SPSS a fin de encontrar asociaciones entre las variables de estudio y los desenlaces. El nivel de significancia se estableció cuando la p<0,05 mediante la prueba de Chi cuadrado y la t de Student. Resultados. Se entrevistaron 116 pacientes. El 56% de los pacientes fueron del hospital público, 58,8% fueron de servicios quirúrgicos y 65% fueron hombres. La edad promedio fue 65,7 (± 20,6) años. Solo 37,1% de los pacientes tenía el peso registrado en la historia clínica, por lo cual solo se pudo determinar el estado nutricional al 31% de los encuestados. Solo se pudo determinar un 23,1% de malnutrición, entre los cuales había un 9,5% de bajo peso. Los pacientes con mayor estancia hospitalaria fueron los del hospital público, en condición de desnutrición, sobrepeso y obesidad. No se pudo establecer asociación con mortalidad. Conclusiones. La desnutrición es una enfermedad de alta prevalencia en pacientes hospitalizados pero no es diagnosticada frecuentemente. Las medidas antropométricas no son registradas en todas las historias clínicas de los pacientes hospitalizados y se requiere un mayor nivel de sensibilización de los trabajadores de salud para establecer medidas de intervención temprana a fin de obtener mejores desenlaces clínicos.

Objective. To determine the nutritional status and outcomes of patients in 2 hospitals in Villavicencio. Method. Prospective cross-sectional study, survey conducted in two hospitals in Villavicencio, Colombia, on February 24th, 2015. Adult patients from surgical or clinical wards were included. Data was registered in Excel and statistical analysis with SPSS was conducted to determine association between independent variables and outcomes (Mortality and length of stay). Significance was established as p<0,05 with Chi square and Student T test. Results. One hundred and sixteen patients were surveyed. Fifty-six percent of patients were from the public hospital, 58,5% were from surgical wards and 65% were men. Average age was 65,7 (± 20,6) years old. Only 37,1% of the patients had the weight registered in the clinical chart, so nutritional status could be determined in only 31%. Only 23,1% of malnutrition was found, including a 9,5% of underweighted patients. Longer length of stay was found in patients from the public hospital, as well as, under-nutrition, overweight and obesity. No association with mortality was found. Conclusions. Under-nutrition is a prevalent disease in hospitalized patients, but it is not often diagnosed. Anthropometric measures are not registered in all clinical charts of hospitalized patients and it is required a higher level of sensitivity among health care workers, in order to establish early intervention measures, and to get better clinical outcomes.

Objetivo. Estabelecer o estado nutricional em pacientes de dos hospitais de Villavicencio. Metodologia. Estudo de corte transversal, prospectivo, através de pesquisa em 2 hospitais de Villavicencio, Colômbia, em fevereiro de 2015. Pacientes adultos internados em serviços cirúrgicos foram incluídos. Os dados foram registrados em Excel y análise estadística com SPSS foi realizada a fim de encontrar associações entre as variáveis de estudo e os resultados. O nível de significância foi estabelecido quando p<0,05 através do teste Qui Quadrado e a distribuição t de Student. Resultados. 16 pacientes foram entrevistados. 56% dos pacientes eram do hospital público, 58,8% foram de serviços cirúrgicos e 65% eram homens. A idade média foi de 65,7 (20,6 ±) anos. Apenas 37,1% dos pacientes tiveram o peso registado na sua ficha, por isso só foi possível determinar o estado nutricional de 31% dos entrevistados. Foi possível determinar apenas 23,1% de desnutrição, entre os quais havia 9,5% de baixo peso. Os pacientes com maior tempo de internação foram aqueles do hospital público, com desnutrição, sobrepeso e obesidade. Não foi possível estabelecer associação com a mortalidade. Conclusões. A desnutrição é uma doença altamente prevalente em pacientes hospitalizados, mas muitas vezes não é diagnosticada. As medidas antropométricas não são registradas em todas as histórias clínicas de pacientes hospitalizados e um maior nível de sensibilização dos trabalhadores de saúde é necessário para estabelecer medidas de intervenção precoce para obter melhores resultados clínicos.

A review of trends in food and nutrition policy framework and Dietary Reference Intakes formulated by international organizations since the 1990s / 国際保健医療

<b>Objectives </b><BR>  Recently, there has been an increasing focus on nutrition in international health cooperation. However, little attention has been paid on global nutrition issues and their methodologies in Japan. One of the possible reasons is that the whole picture cannot be clearly grasped, because nutrition issues and actions have been considered separately at international organizations such as WHO, FAO, and UNICEF. Therefore, the aim of this study was to examine the trends in food and nutrition policy framework, dietary recommendations and nutritional requirements formulated by international organizations through a review of published nutrition policy guidelines and standards since the 1990s.<BR><b>Method</b><BR>  Policy guidelines, technical reports, annual reports, and other relevant materials published between 1990 and 2015, available on the WHO, FAO and UNICEF websites, were reviewed. Then, we extracted the study focused on nutrition problems and their solutions. The purpose and contents of each document and guidelines were identified and categorized in a summary table, so as to investigate their feasures and time trend.<BR><b>Results</b><BR>  This study identified 22 statements on food and nutrition policy frameworks, 14 dietary recommendations and nutritional requirements, and 5 information systems. It was revealed that, in the 1990s, the focus was to develop and standardize the methods for nutritional assessment of children. The goal during this period was to achieve food-based security through improvement in energy and nutrient intakes such as proteins and vitamin A, so as to reduce severe child malnutrition and maternal mortality. Later, various recommendations were formulated on double burden of malnutrition, the importance of breastfeeding and the context of the food system and nutrition in the 2000s, and on noncommunicable disease prevention and control policies and practical methodologies to reduce nutrition disparities after 2010. Several information systems were established, which have been utilized as the evidence database to develop policy frameworks.