Fatores associados ao consumo de açúcares de adição de idosos da região de Campinas-SP, Brasil / Factors associated with added sugar consumption of older adults from the region of Campinas-SP, Brazil

Resumo A alimentação adequada tem profundo impacto na saúde dos idosos, e uma especial atenção deve ser dada ao consumo de açúcares de adição na dieta, que em excesso está associado a pior controle das doenças crônicas nesta fase. O objetivo do estudo foi avaliar a prevalência do consumo de açúcares de adição de idosos da região de Campinas-SP, seus fatores associados e suas principais fontes alimentares. Trata-se de estudo transversal realizado na região de Campinas-SP, com amostra de conveniência de 586 idosos. O consumo foi obtido por meio de dois recordatórios de 24 horas, sendo inadequado se >5% do consumo energético total. Também foi calculada a contribuição dos alimentos em relação ao teor total de açúcares. Considerou-se nível crítico de p<0,05. O consumo médio de açúcares de adição estava acima do recomendado (7,0%), inadequado em mais da metade da população estudada, sendo o açúcar de mesa e o mel as principais fontes dietéticas. A prevalência de inadequação do consumo foi maior entre mulheres (69,8%; p=0,004) e em indivíduos com baixo peso (83,7%; p=0,014), e o consumo foi menor em portadores de diabetes (47,8%; p<0,001). Os resultados apontam para que sejam elaboradas ações de saúde e nutrição a fim de garantir um consumo adequado de açúcares nesta fase.

Abstract Adequate nutrition has a profound impact on older adults' health. Therefore, special attention should be given to the dietetic intake of added sugars, which in excess is associated with poorer control of chronic diseases in this phase. The aim of the study was to evaluate the prevalence of consumption of added sugars in older adults in the Campinas-SP region, its associated factors, and its main dietary sources. A cross-sectional study was conducted in the region of Campinas-SP, with a convenience sample of 586 older individuals. Intake was obtained using two 24-hour food recalls, and values >5% of total energy consumption were considered inadequate. The contribution of the groups and foods in relation to the total content of sugars was also calculated. A critical level of p<0.05 was considered. The average intake of added sugars was higher than recommended (7.0%), and this inadequacy was observed in more than half of the sample, being table sugar and honey the main dietary sources. The prevalence of inadequate consumption was higher among women (69.8%; p=0.004) and individuals with low weight (83.7%; p=0.014), and lower in those with diabetes (47.8%; p<0.001). Results indicate that health and nutrition actions should be developed to ensure adequate sugar intake at this stage.

Approach to food processing in the main messages of food-based dietary guidelines: A qualitative analysis / Abordagem sobre o processamento de alimentos nas mensagens principais de guias alimentares mundiais: uma análise qualitativa

ABSTRACT Objective: Analyze the content of the main messages of the world food guides, identifying the approach regarding the food processing level. Methods: This qualitative exploratory study was conducted through documentary research based on analyzing the main messages of 96 consumption guides selected from the database provided by the Food and Agriculture Organization of the United Nations. The unit of analysis consisted of segments of the main messages whose content was scrutinized using the document analysis technique. Recommendations that referred to food processing were identified after repeated readings. Data were extracted according to the developed protocol, including terms used, consumption guidance, scope of approach, and complementary information (definition, justification, exemplification, and advice on the recommended consumption amount). Results: We identified 21 Food Guides (21.88%) with recommendations related to the food processing level in their main messages, primarily published after 2012 (76.19%). The analyzed guides used terms "highly processed", "ultra-processed", "processed", "minimally processed", and "non-processed". Guidelines regarding limiting consumption were primarily used by the guides, and few specified the related food. The messages did not define the terms used. When identified, the justifications were of a nutritional or health nature. Conclusion: We observed a lack of agreement and standardization concerning the terms used, the guidelines for consumption, and the scope of the identified recommendations, with little or no additional information to explain or justify the approach adopted regarding the food processing level.

RESUMO Objetivo: Analisar o conteúdo das mensagens principais dos guias alimentares mundiais identificando a abordagem quanto ao nível de processamento dos alimentos. Métodos: Estudo exploratório qualitativo, realizado por meio de pesquisa documental, com base na análise das mensagens principais de 96 guias alimentares selecionadas no banco de dados disponibilizado pela Food and Agriculture Organization of the United Nations. A unidade de análise consistiu em segmentos das mensagens principais cujo conteúdo foi analisado através da técnica de análise documental. Após repetidas leituras foram identificadas as recomendações que faziam referência ao processamento dos alimentos. Os dados foram extraídos segundo protocolo desenvolvido, contemplando: termos utilizados; orientação de consumo; abrangência da abordagem; presença de informações complementares (definição; justificativa; exemplificação; e orientação sobre quantidade recomendada de consumo). Resultados: Constatou-se que 21 guias alimentares (21,88%) faziam recomendações relacionadas ao nível de processamento do alimento em suas mensagens principais, a maioria (76,19%) publicado após 2012. Os guias analisados utilizaram os termos: altamente processado, ultraprocessado, processado, minimamente processado e não processado. Orientações referentes à limitação de consumo foram as mais utilizadas pelos guias e poucos especificavam o alimento relacionado. As mensagens não apresentavam definição para os termos utilizados. Quando presentes, as justificativas eram de cunho nutricional ou de saúde. Conclusão: Foi observada falta de consenso e padronização no que se refere aos termos utilizados, às orientações de consumo e à abrangência das recomendações apresentadas, além de pouca ou nenhuma informação complementar capaz de explicar ou justificar a abordagem realizada em relação ao nível de processamento dos alimentos.

Herramientas para identificar consumo y desperdicio de la dieta hospitalaria. Revisión Sistemática

RESUMEN Introducción: Uno de los factores que influyen en la desnutrición hospitalaria es la incapacidad del paciente para alimentarse correctamente. Un bajo consumo de la dieta hospitalaria aumenta el riesgo a sufrir complicaciones de salud, además genera impacto económico y ambiental, producto del aumento de desperdicio de alimentos. Generar estrategias encaminadas a mitigar este problema debe ser prioridad para el sector salud. Objetivo: Identificar herramientas técnicas utilizadas para medir el consumo y/o desperdicio de alimentos en la dieta hospitalaria. Materiales y métodos: Búsqueda sistemática de estudios publicados en las bases de datos de EMBASE y MEDLINE a través de la plataforma Pubmed, en febrero del 2019, temporalidad 20 años. Se buscaron por términos controlados sobre dieta hospitalaria, desperdicio de alimentos y la satisfacción del paciente. Resultados: Se encontraron 410 artículos en inglés, español y portugués. Se seleccionaron 21 artículos para análisis de texto completo por cumplimiento de criterios de selección. Conclusiones: Las herramientas encontradas para la medición del desperdicio de alimentos se basaron principalmente en el pesaje, y la medición visual ya sea directa o por imágenes; otras aproximaciones incluyeron cuestionarios y métodos de múltiples componentes, la mayoría sin hacer discriminación del componente alimenticio desperdiciado.

ABSTRACT Introduction: One of the factors that influences hospital malnutrition is the inability of the patient to eat properly. A low consumption of the hospital diet increases the risk of suffering health complications, in addition to generating an economic and environmental impact, as a result of the increase in food waste. Generating strategies aimed at mitigating this problem should be a priority for the health sector. Objective: Identify technical tools used to measure food consumption and / or waste in the hospital diet. Materials and methods: Systematic search for studies published in the EMBASE and MEDLINE databases through the Pubmed platform was conducted in February 2019, searching articles published in the last 20 years. We searched for controlled terms on hospital diet, food waste, and patient satisfaction. Results: 410 articles were found in English, Spanish and Portuguese. Twenty-one articles were selected for full-text analysis by meeting the selection criteria. Conclusions: The tools found for the measurement of food consumption were based mainly on weighing, and visual measurement either direct or by images; other approaches included questionnaires and multi-component methods, most of the tools did not discriminate the food component wasted.

Brazilian Guidelines for Nutrition in Cystic Fibrosis

ABSTRACT Objective To develop a scientific consensus on nutrition in cystic fibrosis. Methods Sixteen coordinators elaborated relevant questions on nutritional therapy in cystic fibrosis, which were divided into six sections: nutritional assessment, nutritional recommendations, nutritional intervention, dietary counseling, special situations and enzyme replacement, and gastrointestinal manifestations. Two to three specialists in the field were responsible for each section and obtaining answers formulated based on standardized bibliographic searches. The available literature was searched in the PubMed®/MEDLINE database, after training and standardization of search strategies, to write the best level of evidence for the questions elaborated. Issues related to disagreement were discussed until a consensus was reached among specialists, based on the current scientific literature. Results Forty-two questions were prepared and objectively answered, resulting in a consensus of nutritional therapy in cystic fibrosis. Conclusion This work enabled establishing a scientific consensus for nutritional treatment of cystic fibrosis patients.

Avaliação do consumo alimentar de pacientes em hemodiálise: comparação com recomendações do Kidney Disease Outcome Quality Initiative / Assessment of food consumption in hemodialysis patients: comparison with recommendations from the Kidney Disease Outcome Quality Initiative

Introdução: A análise da ingestão alimentar de pacientes com doença renal crônica (DRC) em tratamento dialítico é eficaz para fornecer informações a fim de auxiliar no diagnóstico nutricional e nortear as condutas dietéticas necessárias. Objetivo: Analisar a adequação do consumo alimentar de acordo com as recomendações publicadas pelo Kidney Disease Outcome Quality Initiative (KDOQI) para macro e micronutrientes, além de avaliar a capacidade antioxidante total da dieta (CATd), de portadores de DRC. Materiais e Métodos: Estudo transversal, com 60 voluntários portadores de DRC em tratamento hemodialítico de um Hospital Universitário de Juiz de Fora ­ MG. A caracterização da amostra foi feita no período de junho de 2019 a fevereiro de 2020, através da aplicação de um Questionário Quantitativo de Frequência Alimentar (QQFA) e de coleta de dados pessoais, clínicos e comorbidades. As análises estatísticas foram conduzidas utilizando-se o software SPSS, versão 20.0. As variáveis numéricas foram apresentadas na forma de média (± desvio-padrão), mediana, mínimo e máximo, enquanto as categóricas em frequência absoluta e relativa. Resultados: Observou-se que 43% e 55% dos pacientes apresentaram um consumo calórico e proteico acima do preconizado pela KDOQI, respectivamente. Para os micronutrientes, foi observado que 77% dos pacientes apresentaram consumo de cálcio abaixo do recomendado e de fósforo 65% maior do que a recomendação atual. Percebeu-se que 67% e 40% dos pacientes apresentaram adequado consumo de sódio e potássio. O perfil lipídico da dieta dos pacientes, demonstrou uma desproporção da razão ômega 6/ômega 3, além de um CATd de 4,05 mmol/dia. Conclusão: Através do presente estudo podemos concluir que o consumo alimentar dos pacientes em hemodiálise avaliados apresenta algumas inadequações em relação às recomendações propostas pela literatura.

Introduction: The analysis of food intake in patients with chronic kidney disease (CKD) undergoing dialysis is effective to provide information to assist in nutritional diagnosis and guide the necessary dietary behaviors. Objective: To analyze the adequacy of food consumption according to the recommendations published by the Kidney Disease Outcome Quality Initiative (KDOQI) for macro and micronutrients, in addition to evaluating the total antioxidant capacity of the diet (CATd) of patients with CKD. Materials and Methods: Cross-sectional study with 60 volunteers with CKD undergoing hemodialysis treatment at a University Hospital in Juiz de Fora ­ MG. The characterization of the sample was carried out from June 2019 to February 2020, through the application of a Quantitative Food Frequency Questionnaire (QQFA) and the collection of personal, clinical and comorbid data. Statistical analyzes were conducted using SPSS software, version 20.0. Numerical variables were presented as mean (± standard deviation), median, minimum and maximum, while categorical variables in absolute and relative frequency. Results: It was observed that 43% and 55% of the patients had a caloric and protein consumption above that recommended by the KDOQI, respectively. For micronutrients, it was observed that 77% of the patients had calcium intake below the recommended level and phosphorus consumption 65% higher than the current recommendation. It was noticed that 67% and 40% of the patients had adequate consumption of sodium and potassium. The lipid profile of the patients' diet showed a disproportion of the omega 6/omega 3 ratio, in addition to a CATd of 4.05 mmol/day. Conclusion: Through the present study we can conclude that the food consumption of the evaluated hemodialysis patients presents some inadequacies in relation to the recommendations proposed by the literature

Tartrazina induce genotoxicidad en linfocitos de BALB/c Mus musculus / Tartrazine induces genotoxicity in BALB/c Mus musculus lymphocytes

RESUMEN Objetivos. Determinar el efecto genotóxico de la tartrazina en linfocitos de sangre periférica de Mus musculus BALB/c. Materiales y métodos. Se realizó un estudio experimental, a través de cinco grupos, con cinco ratones en cada uno. Se les registró el peso durante 17 semanas y, en la semana 15 se les administró suero fisiológico (control negativo), dicromato de potasio 25 mg/kg de peso corporal (pc) (control positivo) y tartrazina a dosis de 0,75 mg/kg pc, 7,5 mg/kg pc y 75 mg/kg pc, durante siete días, a excepción del control positivo que fue en dosis única. Luego, cada 24 h se obtuvo una muestra de sangre periférica de la cola y se realizó el frotis, secado y coloración. Posteriormente, se realizó el conteo de 1000 linfocitos por muestra de cada ratón, en todos los tratamientos. Resultados. Los tres tratamientos con tartrazina no causaron diferencias significativas en el peso de ratones a la semana 15, pero sí produjeron diferencias significativas en la frecuencia de linfocitos micronucleados, siendo el tratamiento con tartrazina de 75 mg/kg pc el de mayor efecto genotóxico, induciendo un promedio de 1,63 ± 0,08 linfocitos micronucleados, comparado con el control positivo que generó un promedio de 1,42 ± 0,08 linfocitos micronucleados. Conclusiones. La tartrazina produjo un efecto genotóxico, incrementando el número de linfocitos micronucleados, a dosis de 0,75; 7,5 y 75 mg/kg pc y no afecta el peso corporal durante siete días de administración en M. musculus BALB/c.

ABSTRACT Objectives. To determine the genotoxic effect of tartrazine on peripheral blood lymphocytes of BALB/c Mus musculus. Materials and methods. An experimental study was carried out using five groups, with five mice in each group. Their weight was registered for 17 weeks, and at week 15 they were administered physiological saline solution (negative control), potassium dichromate at 25 mg/kg body weight (bw) (positive control) and tartrazine at doses of 0.75 mg/kg bw, 7.5 mg/kg bw and 75 mg/kg bw, for seven days, with the exception of the positive control which was a single dose. Then, every 24 hours, a peripheral blood sample was obtained from the tail, which was then smeared, dried and stained. Subsequently, 1000 lymphocytes were counted for each sample from each mouse, for all treatment groups. Results. The three tartrazine treatments did not cause significant differences in the weight of mice at week 15, but did produce significant differences in the frequency of micronucleated lymphocytes, with the 75 mg/kg bw tartrazine treatment having the greatest genotoxic effect, inducing an average of 1.63 ± 0.08 micronucleated lymphocytes, compared to the positive control which obtained an average of 1.42 ± 0.08 micronucleated lymphocytes. Conclusions. Tartrazine produced a genotoxic effect, increasing the number of micronucleated lymphocytes, at doses of 0.75; 7.5 and 75 mg/kg bw and did not affect body weight during seven days of administration to BALB/c M. musculus.

Alimentos processados e Diabetes Mellitus: avaliação de rotulagem de alimentos industrializados indicados para diabéticos / Processed foods and Diabetes Mellitus: labeling evaluation of processed foods indicated for diabetics

O Diabetes Mellitus (DM) afeta cerca de 400 milhões de pessoas em todo o mundo. É de senso comum que esses indivíduos devem priorizar o consumo de alimentos minimamente processados e in natura. No entanto, o consumo racional de alimentos processados torna-se um desafio devido ao estilo de vida ocidental e a alta oferta desses produtos, incluindo aqueles específicos para pacientes diabéticos. Esse trabalho visa verificar a adequação dos rótulos de alimentos dietéticos industrializados. Avaliou-se rótulos de biscoitos, doces e pães destinados para diabéticos, disponíveis em supermercados, lojas de produtos naturais e lojas de suplementos alimentares. Além das informações nutricionais, foi avaliada a adequação da rotulagem segundo a Portaria nº 29, de 13 de janeiro de1998. Foram analisados 98 alimentos, sendo 57 doces, 27 biscoitos e 14 pães. Observamos que há uma grande inadequação desses produtos, bem como falta de informações acerca de importantes nutrientes. É necessária a adequação da rotulagem e a conferência de cada item, e os profissionais de saúde, principalmente os nutricionistas, devem estar atentos ao recomendar esses alimentos aos pacientes. (AU)

Diabetes Mellitus (DM) affects about 400 million people worldwide. It is common knowledge that diabetic individuals should prioritize the consumption of fresh foods or minimally processed foods. However, the rational consumption of processed foods becomes a challenge due to the western lifestyle and the high source of these products, including those specific for diabetic people. This manuscript aims to verify the label adequacy of processed dietary foods. We performed the evaluation of diabetic cookies, candy and bread labels available at supermarkets, health food stores and food supplement stores. The adequacy of the nutritional items, and the labeling was evaluated according the Brazilian current legislation. A total of 98 items were analyzed: 57 candies, 27 cookies and 14 breads. We observed that there was a great inadequacy of these products, as well as a lack of information about important nutrients. It is necessary to adapt the labeling and to perform the conference of each item, and the health professionals, especially the nutritionists, must pay close attention before recommending these foods to their patients. (AU)

Atualização dos parâmetros de aquisição do Programa Nacional de Alimentação Escolar com base no Guia Alimentar para a População Brasileira / Actualización de los parámetros de adquisición del Programa Nacional de Alimentación Escolar en base a la Guía Alimentaria para la Población Brasileña / Update of the acquisition parameters of the Brazilian National School Feeding Program based on the Dietary Guidelines for the Brazilian Population

O Guia Alimentar para a População Brasileira é reconhecido como um potente indutor de políticas públicas de alimentação e nutrição. Nessa perspectiva, este artigo apresenta o percurso metodológico e as evidências que subsidiaram a elaboração dos novos parâmetros de aquisição de alimentos do Programa Nacional de Alimentação Escolar (PNAE). Tal elaboração envolveu as análises de: (1) participação dos recursos federais utilizados para compra de alimentos, agrupados segundo a classificação NOVA, empregada no Guia Alimentar para a População Brasileira, pelo conjunto de municípios brasileiros e segundo classificação da execução (positiva ou negativa); (2) cardápios mensais de referência que foram elaborados seguindo recomendações do Guia Alimentar para a População Brasileira; (3) aquisição de alimentos por amostra de 525 municípios, envolvendo a participação relativa dos grupos de alimentos (segundo a NOVA) no total de gastos e de energia e a qualidade nutricional dos alimentos adquiridos; e (4) alimentos ultraprocessados que não devem ser ofertados no ambiente escolar. Foi proposta a adoção dos seguintes parâmetros para participação dos grupos de alimentos em relação ao total de recursos federais empregados na compra de alimentos: ≥ 75% de recursos para alimentos in natura ou minimamente processados; < 20% para alimentos processados ou ultraprocessados e < 5% para ingredientes culinários processados e a ampliação da lista de alimentos cuja aquisição com recursos federais do PNAE é proibida. Esse processo subsidiou a elaboração da Resolução CD/FNDE nº 6, de 8 de maio de 2020, que dispõe sobre o atendimento da alimentação escolar aos alunos da educação básica no âmbito do PNAE.

La Guía Alimentaria para la Población Brasileña está reconocida como un potente inductor de políticas públicas de alimentación y nutrición. Desde esta perspectiva, este artículo presenta la trayectoria metodológica y evidencias que apoyaron la elaboración de los nuevos parámetros de adquisición de alimentos del Programa Nacional de Alimentación Escolar (PNAE). Tal elaboración implicó los análisis de: (1) participación de los recursos federales utilizados para la compra de alimentos, agrupados según la clasificación NOVA, empleada en el Guía Alimentaria para la Población Brasileña, por el conjunto de municipios brasileños, y según la clasificación de la ejecución (positiva o negativa); (2) menús mensuales de referencia que fueron elaborados siguiendo recomendaciones del Guía Alimentaria para la Población Brasileña; (3) adquisición de alimentos mediante una muestra de 525 municipios, implicando la participación relativa de los grupos de alimentos (según NOVA) en el total de gastos y de energía, así como la calidad nutricional de los alimentos adquiridos; y (4) alimentos ultraprocesados que no deben ser ofrecidos en el entorno escolar. Se propuso la adopción de los siguientes parámetros para la participación de los grupos de alimentos, en relación con el total de recursos federales empleados en la compra de alimentos: ≥ 75% de recursos para alimentos in natura o mínimamente procesados; < 20% para alimentos procesados o ultraprocesados, y < 5% para ingredientes culinarios procesados, así como la ampliación de la lista de alimentos, cuya adquisición con recursos federales del PNAE está prohibida. Este proceso apoyó la elaboración de la Resolución CD/FNDE nº 6, del 8 de mayo de 2020, que organiza la atención de la alimentación escolar a alumnos de educación básica en el ámbito del PNAE.

The Dietary Guidelines for the Brazilian Population is acknowledged as a powerful inducer of public food and nutrition policies. In this perspective, this article presents the methodological path and evidence that supported the elaboration of the new parameters of food acquisition of the Brazilian National School Feeding Program (PNAE). This elaboration involved the analyses of: (1) participation of federal resources used to purchase food, grouped according to the NOVA classification, used in Dietary Guidelines for the Brazilian Population, by the set of Brazilian municipalities and according to the classification of the execution (positive or negative); (2) monthly reference menus that were prepared following Dietary Guidelines for the Brazilian Population recommendations; (3) analysis of food acquisition by the sampling of 525 municipalities, involving the relative participation of food groups (according to NOVA) in total expenditures and energy and nutritional quality of purchased foods; and (4) analysis of ultra-processed foods that should not be offered in the school environment. We proposed the adoption of the following parameters for the participation of food groups in relation to the total federal resources used in the purchase of food: ≥ 75% of resources for fresh or minimally processed foods; < 20% for processed or ultra-processed foods and < 5% for processed culinary ingredients, as well as the expansion of the list of foods whose acquisition with federal resources from PNAE is prohibited. This process supported the elaboration of Resolution CD/FNDE n. 6 of May 8, 2020, which provides for the attendance of school feeding to primary education students within the PNAE.

Avaliação da adequação energética dos cardápios programados para a alimentação escolar / Assessment of energy adequacy of menus programmed for school meals

Introdução: O Programa Nacional de Alimentação Escolar busca, entre outros objetivos, atender às necessidades nutricionais dos escolares das diferentes modalidades de ensino durante sua permanência em sala de aula. Objetivo: Comparar os valores estimados para adequação do valor calórico total (VCT) dos cardápios da alimentação escolar de um município. Métodos: Foram incluídas no estudo as seis modalidades de ensino do município, e foram analisados 12 cardápios, totalizando 60 dias, através de duas tabelas de composição centesimal de alimentos, a fim de comparar as diferenças existentes nos valores fornecidos por cada uma delas. Os valores encontrados foram comparados com as recomendações por modalidade de ensino e faixa etária da Resolução CD/FNDE nº 26/2013 e categorizados em "adequado", "acima" ou "abaixo" da recomendação. Resultados: Dos dias analisados pela tabela do IBGE, cinco semanas (41,7%) estavam com a média semanal do VCT adequada para o valor preconizado pelo FNDE. A média das semanas restantes ficou acima do recomendado (58,3%). Já de acordo com a TACO, nenhuma média semanal se adequou ao FNDE. Conclusão: A avaliação dos cardápios revelou predominantemente valores calóricos acima daqueles preconizados para a alimentação escolar. Sobressai-se assim a importância do nutricionista na alimentação escolar e, neste caso, na avaliação do programa, que requer respeito à cultura alimentar local, mas também a abordagem da alimentação como estratégia educacional. (AU)

Introduction: The National School Feeding Program seeks, among other goals, to meet the nutritional needs of students of different teaching modalities during their stay in the classroom. Objective: To compare the estimated values for adequacy of the Total Caloric Value (VCT) of the school feeding menus of a municipality. Methods: The six teaching modalities of the municipality were included in the study, and 12 menus were analyzed, totaling 60 days, through two tables of centesimal food composition, in order to compare the differences in the values provided by each one of them. The values found were compared with the recommendations by teaching modality and age group of Resolution CD/FNDE nº 26/2013 and categorized as "adequate", "above" or "below" the recommended values. Results: Of the days analyzed by the IBGE table, five weeks (41.7%) were with the appropriate weekly VCT average for the value recommended by the FNDE. The average of the remaining weeks was above recommended (58,3%). Already according to TACO, no weekly average fit the FNDE. Conclusion: The evaluation of the menus revealed predominantly caloric values above those recommended for school feeding. Within this, the importance of the nutritionist in school feeding stands out and, in this case, in the evaluation of the program, which requires respect for the local food culture, but also the approach of food as an educational strategy. (AU)

Assessment of Levels of Nutrients in Selected ALVs at Different Harvesting Stages and Locations of Production in Western Kenya

Proper nutrition contributesto declines under-five mortality rates and improves the productivity of adults.Addressing nutritional problems requires adequate information on the diets of individuals and populations. African leafy vegetables (ALVs) are widely consumed and often harvested at different stages after planting with the help of different communities. Four ALVs namely Vigna unguiculata, Amaranthus hybridus, Cleome gynandraand Solanum scabrumare commonly grown vegetables in western Kenya, their potentials have not been evaluated to supply the nutrients. However, nutritional values may vary depending on the species, harvesting stage and location of production. The effects of species, harvesting stages and location of production on the nutritional valueof selected ALVs were evaluated. The trials were laid out in a randomized complete block design in three replicates in Busia, Kisumu, andLela. Leaves were sampled at different harvesting stages and analyzed for N, P, K, Na, Ca, Mg, Mn, Fe, andZn levels. Amaranthus hybridushad significantly (P≤0.05) higher levels ofP,Ca,Zn, Mn, andNa.TheN, P,K, Ca,Mg, Zn and Fe levelssignificantly (P≤0.05) increased then decreased with harvesting stage.The levels of nutrients significantly (P≤0.05) varied with location of production except forNa. The ALVs from Kisumu site hadsignificantly(P≤0.05) higher levels of N, P, K, Ca, Mg and Zn, ALVs from Lela site had higher levels of Mn and Na while ALVs from Busia site had higher levels of Fe. Amaranthus hybridusis a better contributor of-ofP, Ca, Zn, Mn, andNa. The Fe, Mg and Zn levels were above the Recommended Dietary Allowance and may be used to alleviate deficiencies associated with such nutrients. Harvesting the ALVs at the stage the nutrients attain their optimum levels is recommended. There is a needfor the developmentof regional food composition tables for all ALVs in Kenya.

Evaluation of a low-residue diet for bowel preparation of colonoscopy / 中华消化内镜杂志

Objective@#To evaluate the clinical value of a commercial low-residue diet (LRD) for bowel preparation of colonoscopy.@*Methods@#This study was a prospective, endoscopist-blind, and randomized controlled trial. Participants were randomly assigned to two groups according to administration of LRD: the experimental group and the control group. Bowel preparation quality, compliance and tolerability of the two groups were compared.@*Results@#A total of 61 patients were enrolled, with 32 in the experimental group and 29 in the control group. The outcomes were as follows: Boston Bowel Preparation Scale (BBPS) (7.8±1.0 VS 7.1±1.3, P=0.037), the rate of bowel preparation adequacy (87.5% VS 79.3%, P=0.388), compliance rate of dietary restriction (78.1% VS 55.2%, P=0.057), preparation completion rate (93.8% VS 93.1%, P=0.919), cecal intubation rate (both were 100.0%) and cecum arrival time (9.1±2.9 min VS 9.8±3.7 min, P=0.417), incidence of adverse (3.1% VS 3.4%, P=0.944), and hunger rate before colonoscopy (34.4% VS 48.3%, P=0.102).@*Conclusion@#The LRD for bowel preparation of colonoscopy significantly improves BBPS, but its effect on improving the bowel preparation adequacy, patient compliance and tolerability needs to be confirmed by further larger-scale trials.

Evaluation of a low-residue diet for bowel preparation of colonoscopy / 中华消化内镜杂志

Objective To evaluate the clinical value of a commercial low-residue diet (LRD) for bowel preparation of colonoscopy. Methods This study was a prospective, endoscopist-blind, and randomized controlled trial. Participants were randomly assigned to two groups according to administration of LRD:the experimental group and the control group. Bowel preparation quality, compliance and tolerability of the two groups were compared. Results A total of 61 patients were enrolled, with 32 in the experimental group and 29 in the control group. The outcomes were as follows:Boston Bowel Preparation Scale ( BBPS) (7. 8±1. 0 VS 7. 1±1. 3, P=0. 037), the rate of bowel preparation adequacy (87. 5％ VS 79. 3％, P=0. 388), compliance rate of dietary restriction (78. 1％ VS 55. 2％, P=0. 057), preparation completion rate (93. 8％ VS 93. 1％, P=0. 919), cecal intubation rate (both were 100. 0％) and cecum arrival time (9. 1± 2. 9 min VS 9. 8±3. 7 min, P=0. 417), incidence of adverse (3. 1％ VS 3. 4％, P=0. 944), and hunger rate before colonoscopy (34.4％ VS 48.3％, P=0.102). Conclusion The LRD for bowel preparation of colonoscopy significantly improves BBPS, but its effect on improving the bowel preparation adequacy, patient compliance and tolerability needs to be confirmed by further larger-scale trials.

Country-specific nutrient requirements & recommended dietary allowances for Indians: Current status & future directions

Nutrient requirements and recommended dietary allowances (RDAs) are set and revised periodically by the Indian Council of Medical Research. These are meant to guide the population and provide policy directions regarding nutrient requirements corresponding to a healthy population. This review article provides an overview of the current recommendations (RDA, 2010) and the challenges faced by the committee to contextualize RDA to the Indian scenario which has a background of double burden of malnutrition, diverse dietary habits but predominantly home-based cereal-pulse vegetarian diet with low bioavailability of several nutrients and lower consumption of packaged fortified foods. The need for country-specific requirements and harmonization of methodologies related to nutrient requirements and RDA are also discussed. The recommendations fixed for iron have been provided in detail as an example. The measures to carry forward RDA revisions to ensure its sustainability have been emphasized.

Nutrigenomics: Opportunities & challenges for public health nutrition

The hierarchical information flow through DNA-RNA-protein-metabolite collectively referred to as 'molecular fingerprint' defines both health and disease. Environment and food (quality and quantity) are the key factors known to affect the health of an individual. The fundamental concepts are that the transition from a healthy condition to a disease phenotype must occur by concurrent alterations in the genome expression or by differences in protein synthesis, function and metabolites. In other words, the dietary components directly or indirectly modulate the molecular fingerprint and understanding of which is dealt with nutrigenomics. Although the fundamental principles of nutrigenomics remain similar to that of traditional research, a collection of comprehensive targeted/untargeted data sets in the context of nutrition offers the unique advantage of understanding complex metabolic networks to provide a mechanistic understanding of data from epidemiological and intervention studies. In this review the challenges and opportunities of nutrigenomic tools in addressing the nutritional problems of public health importance are discussed. The application of nutrigenomic tools provided numerous leads on biomarkers of nutrient intake, undernutrition, metabolic syndrome and its complications. Importantly, nutrigenomic studies also led to the discovery of the association of multiple genetic polymorphisms in relation to the variability of micronutrient absorption and metabolism, providing a potential opportunity for further research toward setting personalized dietary recommendations for individuals and population subgroups.

Práticas alimentares em crianças menores de dois anos: consumo de açúcar e bebidas adoçadas / Feeding practices in childrend under two years: consuption of sugar and sweetened beverages

O objetivo do presente trabalho foi analisar as práticas de aleitamento materno e alimentação complementar em menores de dois anos, bem como o padrão de consumo de açúcar e bebidas adoçadas. Foi realizado um estudo transversal realizado com 82 crianças internadas no Hospital Nossa Senhora da Conceição de Tubarão no período de Fevereiro a Agosto de 2016. Aplicou-se um questionário levando em conta dados do nascimento da criança, bem como realização e modo de realização de aleitamento materno e alimentação complementar e também características maternas. Observou-se que 72% das crianças mamaram na primeira hora após o nascimento, mas apenas 42,7% realizaram aleitamento materno exclusivo (AME) por algum período, sendo a mediana do AME de 30 dias. A idade média do inicio da alimentação complementar foi de 5,88 meses. Pode-se observar também que 12,5% das crianças com 0 a 5 meses ingeriram leite adoçado e 30,8% das crianças com 12 a 17 meses ingeriram refrigerante. Os resultados sugerem baixas taxas de AME e início precoce da alimentação complementar e consumo de açúcar.

The objective of the present study was to analyze the practices of breastfeeding and complementary feeding in children under the age of two, as well as the pattern of consumption of sugar and sweetened beverages. A cross-sectional study was carried out with 82 children hospitalized at the Hospital Nossa Senhora da Conceição de Tubarão from February to August 2016. A questionnaire was conducted comprising questions about children's birth, breastefeeding and complementary feeding, as wll as maternal characteristics. 72% of the children were breastfed within the first hour after birth, but only 42.7% had exclusive breastfeeding for some period, the median being 30 days. The averange age of complementary feeding initiation was 5.88 months. Moreover, 12.5% of the children aged 0-5 months ingested sweetened milk and 30.8% of the children aged 12- 17 months ingested soda. The results suggest low rates of exclusive breastfeeding and early onset of complementary feeding and sugar consumption.

Avaliação da ingestão nutricional de pacientes com doença renal crônica em tratamento hemodialítico / Nutritional intake assessment in patients with chronic kidney disease in hemodialitic treatment

Introdução: A hemodiálise é um tratamento comumente realizado em pacientes que apresentam perda da função renal, com o intuito de liberar resíduos prejudiciais à saúde do corpo. Esta terapêutica ocasiona perdas de nutrientes do sangue, sendo, dessa forma, contribuinte para a desnutrição, o que reforça o papel da nutrição como tratamento coadjuvante.A análise da ingestão alimentar é capaz de fornecer informações para nortear as condutas dietéticas,portanto, este estudo objetivou verificar a adequabilidade da ingestão nutricional com as recomendações nutricionais específicas e sua relação com o estado nutricional de pacientes submetidos a tratamento hemodialítico em uma clínica do município de Vitória da Conquista, BA. Método: A avaliação da ingestão nutricional foi procedida determinando a ingestão proteica por quilo de peso, de quilocalorias por quilo de peso, cálcio, ferro, potássio e fósforo,comparando-as com as recomendações específicas. O estado nutricional foi determinado por meio da Avaliação Subjetiva Global modificada. Resultados: Um total de 122 pacientes foram incluídos no estudo, estando a maioria em risco nutricional e nenhum com desnutrição gravíssima. A maioria também apresentou inadequação quanto à ingestão de calorias e dos nutrientes avaliados. Não foram encontradas correlações entre a ingestão calórica vs. estado nutricional e ingestão proteica vs. estado nutricional, mas analisando a ingestão calórica e proteica foi observada forte correlação (r=0,799). Conclusão: As ingestões de proteínas, quilocalorias, cálcio, ferro, potássio e fósforo apresentaram-se inadequadas na população estudada, o que pode influenciar o estado clínico e nutricional destes pacientes.(AU)

Introduction: Hemodialysis is a treatment commonly performed in patients who had loss of kidney function, in order to release harmful waste to body's health. This therapy causes loss of nutrients from the blood, and thus contributes to malnutrition, which reinforces the role of nutrition as adjuvant treatment. Analysis of food intake is able to provide information to guide dietetic conducts, so this study aimed to verify the nutritional intake adequacy with specific nutritional recommendations and their relation with the nutritional status of patients undergoing hemodialysis treatment at a clinic in the city of Vitória da Conquista, BA. Method: The assessment of nutritional intake was done determining the protein intake per kilogram of weight, kilocalories per kilogram of weight, calcium, iron, potassium and phosphorus comparing it to the specific recommendations. Nutritional status was determined using the Subjective Global Assessment modified. Results: A total of 122 patients were included in the study, with the majority in nutritional risk and none had very serious malnutrition. Similarly, most also had impairments as to intake of calories and nutrients evaluated. No correlations were found between calorie intake vs. nutritional status and protein intake vs. nutritional status, but in the analyse caloric and protein intake was found strong correlation (r=0.799). Conclusion: The intake of protein, kilocalories, calcium, iron, potassium and phosphorus showed to be inadequate in the study population, which may influence the clinical and nutritional status of these patients.(AU)

Vitamina e no leite humano e sua relação com o requerimento nutricional do recém-nascido a termo / Vitamin e in human milk and its relation to the nutritional requirement of the term newborn

RESUMO Objetivos: Determinar a concentração de alfa-tocoferol no leite materno em diferentes períodos de lactação e estimar o provável fornecimento de vitamina E ao lactente. Métodos: Estudo longitudinal observacional realizado com 100 puérperas atendidas para o parto no Hospital Universitário Ana Bezerra (HUAB) da Universidade Federal do Rio Grande do Norte (UFRN), em Santa Cruz (RN). Foram coletados leite colostro (n=100), leite de transição (n=77) e leite maduro (n=63) no seguimento da lactação. O alfa-tocoferol foi analisado por cromatografia líquida de alta eficiência. O fornecimento de vitamina E para o neonato foi estimado comparando-se o requerimento nutricional de vitamina E (4 mg/dia) com a ingestão diária de leite. Resultados: A concentração média de alfa-tocoferol encontrada nos leites colostro, de transição e maduro foi 40,5±15,0 µmol/L, 13,9±5,2 µmol/L e 8,0±3,8 µmol/L, respectivamente (p<0,001). A possível ingestão desses leites pelo lactente forneceu 6,2 mg/dia de vitamina E no colostro, 4,7 mg/dia no de transição e 2,7 mg/dia no maduro (p<0,0001), evidenciando que apenas o último não garantiu a quantidade recomendada dessa vitamina. Conclusões: Os níveis de alfa-tocoferol no leite diminuíram com a progressão da lactação, e a provável ingestão dos leites colostro e de transição conseguiu atender ao requerimento nutricional do lactente. O leite maduro pode fornecer menores quantidades da vitamina E, o que torna importante o estudo dos fatores que se associam a esses baixos níveis.

ABSTRACT Objectives: To determine the alpha-tocopherol concentration in breast milk at different periods of lactation and to estimate the possible supply of vitamin E to the infant. Methods: A longitudinal observational study was carried out with 100 mothers at University Hospital Ana Bezerra (HUAB), at Universidade Federal do Rio Grande do Norte, in Santa Cruz (RN), Northeast Brazil. Samples of colostrum (n=100), transitional milk (n=77), and mature milk (n=63) were collected. Alpha-tocopherol was analyzed by high-performance liquid chromatography. Vitamin supply to the newborn was estimated by comparing the nutritional requirement of vitamin E (4 mg/day) with the potential daily intake of milk. Results: The mean alpha-tocopherol concentration found in colostrum, transitional, and mature milk was 40.5±15.0 µmol/L, 13.9±5.2 µmol/L, and 8.0±3.8 µmol/L, respectively (p<0.001). The possible effect of these milks offered to the infant 6.2 mg/day of vitamin E in colostrum, 4.7 mg/day in transitional milk, and 2.7 mg/day in mature milk (p<0.0001), shows that only the mature milk did not guarantee the recommended quantity of this vitamin. Conclusions: Alpha-tocopherol levels in human milk decrease through the progression of lactation, and the possible intake of colostrum and transitional milk met the nutritional requirement of the infant. Mature milk may provide smaller amounts of vitamin E. Thus, it is important to study the factors that are associated with such low levels.

Balanço de macronutrientes na dieta de idosos brasileiros: análises da Pesquisa Nacional de Alimentação 2008-2009 / Balance of macronutrient intake among Brazilian elderly: analysis of the National Dietary Survey 2008-2009

RESUMO: Objetivo: Analisar a contribuição de proteína, lipídio e carboidrato no total de energia da dieta de idosos das diferentes regiões brasileiras. Métodos: Foram analisados dados de 4.286 idosos (60 a 104 anos) provenientes da Pesquisa de Orçamentos Familiares 2008/2009. Baseado no consumo obtido por dois registros alimentares, o programa Multiple Source Method estimou o consumo habitual de macronutrientes e gordura saturada. As recomendações do Institute of Medicine (IOM), segundo os Acceptable Macronutrient Distribution Ranges (AMDR), foram utilizadas para avaliar a participação relativa dos macronutrientes de acordo com percentual energético (PE). Modelos de regressão linear identificaram diferenças entre PE dos macronutrientes, situação do domicílio, macrorregiões e gênero. Resultados: A proteína foi o macronutriente que apresentou maior concordância com o AMDR (99,8%). Com relação ao PE lipídico, observou-se que 9,2% da população ficaram acima da recomendação, sendo o dobro do encontrado para carboidrato (4,9%) e nove vezes o percentual de idosos, cujo PE-proteico (1,0%) foi acima do recomendado. Em 14,5% dos idosos a ingestão de carboidratos foi abaixo da AMDR, sendo que essas dietas apresentaram maior PE lipídico (β = 8,19; p < 0,001), revelando que 50% dos idosos que consumiam carboidratos abaixo do PE recomendado apresentou um consumo excessivo de lipídio. Segundo macrorregiões, o Centro-Oeste foi o único a apresentar diferença para carboidrato, sendo esta de menor percentual (51,6%; p < 0,05). A região Sul (17,9%; p < 0,01) apresentou o menor PE proteico e o maior de lipídios (28,7%; p < 0,01). Conclusões: A elevada frequência de inadequação da ingestão de lipídio pode significar uma pior qualidade da dieta, contribuindo com o aumento no risco de desenvolvimento de doenças crônicas.

ABSTRACT: Objective: This study aimed at evaluating the balance in the intake of protein, carbohydrate, and fat among the Brazilian elderly population. Methods: The data analyzed were taken from the National Dietary Survey 2008-2009, from a total of 4,286 Brazilian elders (60-104 years old). Based on the dietary intake obtained from two food records, the Multiple Source Method (MSM) was used to evaluate the macronutrients and saturated fat. The AMDR (Acceptable Macronutrient Distribution Range), by the Institute of Medicine (IOM), was used to evaluate the macronutrient energy percentage (%E). Linear regression models identified differences between macronutrients %E and household location (urban or rural), Brazilian macro-regions and gender. Results: Protein intake showed higher agreement with the AMDR reference value (99.86%). It was observed that in 9.2% of the population, fat intake was higher than the reference value, almost twice as high as the carbohydrate-energy percentage (4.9%) and nine times higher than protein (1.0%). Among those with low carbohydrate-energy percentage, 14.5% had higher fat-energy percentage (β = 8.19; p < 0.001), which means that 50% of the elderly whose carbohydrate intake was above the recommendation presented an overconsumption of fat. According to the macro-regions, the Midwest region was the only one to show differences for carbohydrate-energy percentage, which was lower than the others regions (51.6%; p < 0.05). The South region presented the lowest protein-energy percentage (17.9%; p < 0.01) and the highest fat-energy percentage (28.7%; p < 0.01). Conclusion: Higher prevalence of inadequate fat intake among the Brazilian elderly may indicate an important public health problem that is associated with an increased risk of chronic diseases.

Macronutrient Distributions in Nutrition Recommendation for Type 2 Diabetes Management / 임상당뇨병

Dietary intake is a major contributor to both the development and management of type 2 diabetes. Multiple studies have provided evidence that diabetes nutrition therapy is effective for improving glycemic control and other metabolic outcomes. However, there remains no conclusive evidence as to which diet, if any, is the most effective for optimizing glycemic control in patients with diabetes. The roles of differing macronutrient percentages, eating patterns and weight loss interventions are controversial topics concerning dietary intake. In particular, there are no ideal percentages of macronutrients or eating patterns that can simultaneously apply to all persons with diabetes. A reduced energy intake for persons with type 2 diabetes, referred to as nutrition therapy intervention, has been shown to be effective for achieving glycemic and other metabolic outcomes. For such a treatment option to be effective, diabetes nutrition therapy must be individualized. Thus, treatment goals, personal preference, individual ability and willingness to make lifestyle changes must all be considered when educating or counseling individuals with diabetes.

FATORES ASSOCIADOS AO USO DE SUPLEMENTOS ALIMENTARES ENTRE ATLETAS: REVISÃO SISTEMÁTICA / FACTORS ASSOCIATED WITH THE USE OF DIETARY SUPPLEMENTS AMONG ATHLETES: A SYSTEMATIC REVIEW / FACTORES ASOCIADOS AL USO DE SUPLEMENTOS DIETÉTICOS ENTRE ATLETAS: UNA REVISIÓN SISTEMÁTICA

RESUMO A prevalência de consumo de suplementos alimentares entre atletas tem sido estudada exaustivamente. Contudo, não foi encontrado estudo que reúna e discuta, de forma sistematizada, os fatores que podem desencadear o consumo de suplementos entre atletas. O objetivo foi descrever a prevalência e as características do consumo e compreender quais fatores estão associados ao uso dos suplementos alimentares nessa população específica. Realizou-se uma pesquisa bibliográfica nas seguintes bases de dados: PubMed, Lilacs e Scielo. O Google Scholar foi consultado para identificação de material adicional. Foram incluídos estudos que investigaram a prevalência do uso de suplementos alimentares entre atletas, seus fatores associados, sem limite de idade e em ambos os sexos. De 374 estudos identificados, dezessete foram incluídos nesta revisão. Todos os estudos utilizaram delineamento transversal e o instrumento de coleta mais utilizado foi o questionário autoadministrado. A prevalência do uso de suplementos variou de 37,5% a 98%. Os atletas têm consumido mais vitaminas buscando informações com seus técnicos, visando melhorar o estado geral de saúde. "Prática de esporte individual" e "alto volume de treinamento" foram identificados como fatores associados ao uso de suplementos alimentares. A partir dos dados revisados, verificou-se um amplo intervalo de variação na utilização de suplementos pelos atletas. Os atletas têm consumido mais vitaminas e procuraram informações sobre o consumo com seus treinadores, com o objetivo de melhorar a sua saúde. Esta revisão também destaca a necessidade de uma investigação de alta qualidade sobre os correlatos de consumo de suplemento em atletas, uma vez que os dados foram discrepantes para muitos fatores relatados pelos estudos.

ABSTRACT The prevalence of consumption of dietary supplements among athletes has been studied extensively. However, there was no study that gathers and discusses, in a systematic way, the factors that can trigger the consumption of supplements among athletes. The objective was to describe the prevalence and characteristics of consumption, and understand which factors are associated with the use of dietary supplements in this specific population. We conducted a literature search in the following databases: PubMed, Lilacs and Scielo. Google Scholar has been consulted to identify additional material. We included studies that investigated the prevalence of dietary supplements among athletes, associated factors, irrespective of age and in both sexes. Of the 374 studies identified, seventeen articles were included in this review. All studies used cross-sectional design and the most widely data collection tool used was a self-administered questionnaire. The prevalence of supplements ranged from 37.5% to 98%. Athletes have consumed more vitamins seeking information with their coaches aiming to improve the general health. "Individual sport practice" and "high volume training" were identified as the factors associated with the use of dietary supplements. Based on the revised data, a wide range of variation in the use of supplements by the athletes was observed. Athletes have consumed more vitamins and sought more information from their coaches, in order to improve their health. This review also highlights the need for high-quality research on the correlates of supplement intake in athletes, since the data were inconsistent to many factors reported by the studies.

RESUMEN La prevalencia de consumo de suplementos dietéticos entre atletas ha sido estudiada ampliamente. Sin embargo, no fueron encontrados estudios que reúnan y discutan, de manera sistematizada, los factores que pueden desencadenar el consumo de suplementos entre los atletas. El objetivo fue describir la prevalencia y las características del consumo y comprender qué factores están asociados con el uso de suplementos dietéticos en esta población específica. Se realizó una búsqueda bibliográfica en las siguientes bases de datos: PubMed, Lilacs y SciELO. El Google Scholar ha sido consultado para la identificación de material adicional. Se incluyeron los estudios que investigaron la prevalencia de los suplementos dietéticos entre los atletas, los factores asociados, independientemente de la edad y en ambos sexos. De los 374 estudios identificados, diecisiete artículos fueron incluidos en esta revisión. Todos los estudios utilizaron diseño transversal y el instrumento de recolección de datos más utilizado fue un cuestionario autoadministrado. La prevalencia del uso de suplementos varió de 37,5% a 98%. Los atletas han consumido más vitaminas buscando informaciones con sus técnicos y con objetivo de mejorar la salud en general. "práctica del deporte individual" y el " entrenamiento de alto volumen" fueron identificados como factores asociados al uso de suplementos dietéticos. A partir de los datos revisados, se ha verificado un amplio intervalo de variación en la utilización de suplementos por los atletas. Los atletas han consumido más vitaminas y buscaron informaciones sobre el consumo con sus entrenadores, con el objetivo de mejorar su salud. Esta revisión también destaca la necesidad de una investigación de alta calidad sobre los correlatos de consumo de suplemento en atletas, una vez que los datos fueron incompatibles con muchos factores reportados en los estudios.