Fatores associados à deficiência de vitamina D em mulheres gestantes e lactantes / Factores asociados a la deficiencia de vitamina D en mujeres embarazadas y lactantes / Factors associated with vitamin d deficiency in pregnant and lactatingwomen

Introdução: A deficiência de vitamina D durante a gestação e a lactação pode repercutir negativamente no desenvolvimento fetal e infantil, devido seu papel fundamental nos sistemas imunológico, cardíaco, ósseo, muscular e neural. Objetivo: Realizar uma revisão de literatura para integrar estudos que evidenciam a deficiência de vitamina D em gestantes e lactantes, e os fatores de risco associados a essa carência. Metodologia: Foi realizado um levantamento bibliográfico entre agosto e outubro de 2021, com atualização entre outubro e novembro de 2022 através de pesquisas às bases Pubmed e Scielo, bem como às listas de referências dos artigos selecionados. Foram empregados os descritores consumo alimentar, vitamina D, deficiência de vitamina D, gestantes e lactantes, usando-se o operador booleano AND para a associação entre eles. Como critérios de inclusão foram adotados o tipo de estudo (epidemiológicos, ensaios clínicos e revisões integrativa e sistemática), o idioma (espanhol, inglês e português) e o período de publicação (2010 a 2022). Resultados: Evidenciou-se que existem vários fatores de riscos para a inadequação do status de vitamina D em gestantes e lactantes como a baixa exposição da pele à luz solar e fatores relacionados (uso excessivo de protetor solar, menor tempo de atividades ao ar livre, clima, religião e hábitos culturais, maior escolaridade);a pigmentação mais escura da pele; o baixo consumo alimentar de vitamina D e variáveis associadas; a menor idade materna; o primeiro trimestre gestacional; a primiparidade e o excesso de tecido adiposo. Conclusões: Em gestantes e lactantes, a carência de vitamina D associa-se a distintos fatores, com destaque principalmente para a baixa exposição à luz solar, a pigmentação mais escura da pele e o excesso de tecido adiposo, sendo de extrema importância que sejam abordados com cautela, visando ações voltadas a variáveis modificáveis, de modo a auxiliar na redução da hipovitaminose D nestes grupos (AU).

Introduction: Vitamin D deficiency during pregnancy and breastfeeding can have a negative impact on fetal and infant development due to its fundamental role in the immune, cardiac, bone, muscular and neural systems. Objective: To conduct a literature review to integrate studies which show the Vitamin D deficiency in pregnant andlactating women, and the risk factors associated with this deficiency. Methodology: A bibliographic survey was carried out between August and October 2021, with an update between October and November 2022 through searches in the Pubmed and Scielo databases, as well as the reference lists of the selected articles. The descriptors food consumption, vitamin D, vitamin D deficiency, pregnant and lactating women were used, using the Boolean operator AND for the association between them. The type of study (epidemiological, clinical trials and integrative and systematic reviews), language (Spanish, English and Portuguese) and publication period (2010 to 2022) was adopted as inclusion criteria.Results:It was shown that there are several risk factors for inadequate vitamin D status in pregnant and lactating women, such as low skin exposure to sunlight and related factors (excessive use of sunscreen, less time spent outdoors, climate, religion and cultural habits, higher education); darker skin pigmentation; low dietary intake of vitamin D and associated variables; the lowest maternal age; the first gestational trimester; primiparity and excess adipose tissue.Conclusions: Vitamin D deficiency in pregnant and lactating women is associated with different factors, witha main emphasis on low exposure to sunlight, darker skin pigmentation and excess adipose tissue. Furthermore, it is extremely important that these factors are approached with caution, implementing actions aimed at modifiable variables in order to help reduce hypovitaminosis D in these groups (AU).

Introducción: La deficiencia de vitamina D durante el embarazo y la lactancia puede tener un impacto negativo en el desarrollo fetal e infantil, por su papel fundamental en los sistemas inmunológico, cardíaco, óseo, muscular y neural. Objetivo: Realizar una revisión bibliográfica para integrar estudios que evidencien la deficiencia de vitamina D en mujeres embarazadas y lactantes, y los factores de riesgo asociados. Metodología:Se realizó un levantamiento bibliográfico entre agosto y octubre de 2021, con actualizaciones entre octubre y noviembre de 2022 mediante búsquedas en las bases de datos Pubmed y Scielo, así como en las listas de referencias de los artículos seleccionados. Se utilizaron los descriptores consumo de alimentos, vitamina D, deficiencia de vitamina D, gestantes y lactantes, utilizándose el operador booleano AND para la asociación entre ellos. Se adoptaron como criterios de inclusión el tipo de estudio (epidemiológicos, clínicos, revisiones integradoras y sistemáticas), idioma (español, inglés y portugués) y período de publicación (2010 a 2022).Resultados: Existen varios factores de riesgo para un estado inadecuado de vitamina D en mujeres embarazadas y lactantes, como la baja exposición de la piel a la luz solar y factores relacionados (uso excesivo de protector solar, menor tiempo al aire libre, clima, religión y hábitos culturales, educación más alta); pigmentación de la piel más oscura; baja ingesta dietética de vitamina D y variables asociadas; la edad materna más baja; el primer trimestre gestacional; Primiparidad y exceso de tejido adiposo. Conclusiones:En mujeres embarazadas y lactantes, el déficit de vitamina D se asocia a diferentes factores, especialmente la baja exposición solar, la pigmentación de la piel más oscura y el exceso de tejido adiposo, y es de suma importancia abordarlos con precaución, apuntando a acciones dirigidas a variables modificables, con el fin de ayudar a reducir la hipovitaminosis D en estos grupos (AU).

Factores nutricionales y alimentarios asociados al desarrollo y comportamiento del Espectro Autista: Un resumen de la evidencia

La incidencia de individuos con Trastorno Espectro Autista (TEA) va en aumento. Por lo tanto, es importante la detección oportuna de la condición y conocer los factores de riesgo asociado a nutrición, en especial porque se trata de una población nutricionalmente vulnerable. Desde la última década, las investigaciones han aportado evidencia sobre los mecanismos que subyacen al TEA. Se ha comprobado la coexistencia de diversas complicaciones asociadas al TEA, tales como: trastornos metabólicos, deficiencias nutricionales y condiciones asociadas a la microbiota y funcionalidad gastrointestinal, que podrían estar relacionadas con la etiología o comportamiento en este grupo en particular. Es de suma importancia realizar un resumen de la evidencia con la finalidad de entregar información relacionada a los factores alimentarios y nutricionales asociados a modificación de comportamiento en TEA y desarrollo del mismo, para llevar a cabo una evaluación e intervención oportuna e individualizada, con un enfoque multidimensional, sistémico, multi e interdisciplinario.

The incidence of individuals with autism spectrum disorder (ASD) is increasing. Early detection of the condition and recognizing risk factors associated with nutrition is essential, mainly because this population is nutritionally vulnerable. In the last decade, research has provided evidence on the mechanisms underlying ASD. The coexistence of various complications associated with ASD, such as metabolic disorders, nutritional deficiencies, and conditions associated with the microbiota and its gastrointestinal functionality, have been proven to be related to the etiology of behavior in this particular group. Therefore, it is of utmost importance to summarize the evidence to provide information related to dietary and nutritional factors associated with behavior modification in ASD and to carry out a timely and individualized assessment and intervention, with a multidimensional, systemic, multi and interdisciplinary approach.

Dermatological manifestations relating to nutritional deficiencies after bariatric surgery: case report and integrative literature review

ABSTRACT BACKGROUND: The number of bariatric surgeries performed worldwide is growing. Among the main short, medium or long-term complications after surgery are nutritional deficiencies. Many of these, such as those of Zn, Cu and vitamins A, B1, B3, B6 and B12, are manifested by dermatological lesions before potentially fatal systemic disorders occur. OBJECTIVE: To identify the main dermatological manifestations associated with nutritional deficiencies after bariatric surgery, and the associated variables. DESIGN AND SETTING: Integrative literature review carried out at a public university in Brazil. METHODS: This was a case report and a review of health research portals and databases of national and international biomedical journals, without publication date limitation. The descriptors used for searches followed the ideal methodology for each database/search portal: "bariatric surgery", "skin", "skin disease", "skin manifestation", "deficiency disease" and "malnutrition". RESULTS: A total of 59 articles were selected, among which 23 were review articles or articles that addressed specific dermatological manifestations. The other 36 articles described 41 cases, which were organized into a table with the clinical variables. CONCLUSIONS: Although nutritional deficiencies are expected as complications after bariatric surgery, few articles relating them to their dermatological manifestations were found. It is important to recognize skin changes caused by nutritional deficiencies in patients treated via bariatric surgery, as these may occur before systemic complications appear and are easier to diagnose when the patient does not have any systemic symptoms yet. However, there is generally a delay between the appearance of skin lesions and making the diagnosis of nutritional deficiency.

Vitamin D status in Mexican children 1 to 11 years of age: an update from the Ensanut 2018-19 / Estado de vitamina D en niños mexicanos de 1 a 11 años de edad: una actualización de la Ensanut 2018-19

Abstract Objective: To evaluate vitamin D status and deficiency in Mexican children and related factors, with updated data from a representative national survey. Materials and methods: Data and serum samples of child participants were collected in the Ensanut 2018-19. The measurement 25-(OH)-D was obtained through chemiluminescence. Height and weight, as well as dietary information, were measured using a semi-quan- titative food frequency questionnaire and sociodemographic information. Results: Data of 4 691 children aged 1-11 years were analyzed. Vitamin D deficiency (25-OH-D70% of vitamin D intake. Conclusions: Vitamin D deficiency is important in Mexican children. Actions and programs to fight this deficiency are required.

Resumen Objetivo: Evaluar el estado y la deficiencia de vitamina D en niños mexicanos, así como los factores relacionados, con datos actualizados de una encuesta nacional representativa. Material y métodos: Los datos y muestras de suero de niños participantes se recolectaron en la Ensanut 2018-19. La medición de 25- (OH)- D se realizó mediante quimiolu- miniscencia. Se obtuvo estatura, peso e información dietética a través de un cuestionario semicuantitativo de frecuencia alimentaria e información sociodemográfica. Resultados: Se analizaron datos de 4 691 niños entre 1 y 11 años. Se observó deficiencia de vitamina D (25-OH-D 70% de la ingesta. Conclusiones: La deficiencia de vitamina D es considerable en los niños mexicanos. Se requieren acciones y programas para combatirla.

Estomatitis aftosa recurrente y deficiencias nutricionales: Reporte de tres casos y revisión de literatura / Recurrent Aphthous Stomatitis and Nutritional Deficiencies: Report of Three Cases with Literature Review

RESUMEN Introducción: La estomatitis aftosa recurrente (EAR) es la enfermedad ulcerativa más común que afecta la mucosa oral no queratinizada. La etiología aún se desconoce, pero se han propuesto varios factores locales y sistémicos como agentes causales. Descripción del caso: se informa tres pacientes con presencia de EAR asociada a deficiencias nutricionales, debidas a dietas de restricción alimentaria. El primer caso, una mujer de 19 años con deficiencia de hierro, refirió tomar té verde a diario y consumir poca cantidad de carbohidratos, grasas y carne. El segundo caso, un hombre de 32 años con deficiencia de hierro y vitamina B12 asociada a dieta tipo vegana, aunque a veces si consumía carne. El tercer caso, hombre de 50 años, vegano y exfumador desde hace un año, presentó deficiencia de hierro, vitamina B12 y ácido fólico. En los tres casos un detallado interrogatorio, examen clínico y análisis sanguíneo completo, permitió establecer un adecuado diagnóstico, manejo odontológico y derivación con un nutricionista, con el fin de tratar la patología de base y no sólo brindarles un tratamiento sintomático de las lesiones. Discusión: Ante un cuadro de EAR es recomendable realizar un análisis que incluya hemograma, ácido fólico, hierro y vitamina B12, para descartar posibles causas sistémicas y eventualmente tratarlas. El manejo clínico tiene como objetivo mejorar la función del paciente y la calidad de vida mediante terapias tópicas y sistémicas; sin embargo, es fundamental identificar y controlar los factores causales que contribuyen; así como, la exclusión o tratamiento de la enfermedad sistémica subyacente.

ABSTRACT Introduction: Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease that affects the non-keratinized oral mucosa. The etiology is still unknown, but several local and systemic factors have been proposed as causal agents. Case description: three patients are reported with RAS associated with nutritional deficiencies, due to dietary restriction diets. The first case, a 19-year- old woman with iron deficiency, reported taking green tea daily and consuming a small amount of carbohydrates, fats and meat. The second case, a 32-year-old man with iron deficiency and vitamin B12 associated with vegan diet, although sometimes if he consumed meat. The third case, man of 50 years, vegan and ex-smoker for a year, presented deficiency of iron, vitamin B12 and folic acid. In all three cases a detailed questioning, clinical examination and complete blood analysis allowed to establish an adequate diagnosis, dental management and referral with a nutritionist, in order to treat the underlying pathology and not only provide a symptomatic treatment of the injuries. Discussion: In the setting of RAS, it is advisable to perform an analysis that includes a blood count, folic acid, iron and vitamin B12, to rule out possible systemic causes and eventually treat them. Clinical management aims to improve patient function and quality of life through topical and systemic therapies; however, it is essential to identify and control the causal factors that contribute; as well as, the exclusion or treatment of the underlying systemic disease.

Prevalence of nutritional deficiencies among school going adolescents of Vadodara, Gujarat, India: a cross sectional study

Background: Adolescent constitutes over 23% of the population in India. Critical development occurs during adolescence period. Growth spurt and increase in physical activity during adolescent period increases the nutrition and health needs of the adolescent. Objective was to study prevalence of nutritional deficiencies among school going adolescents of Vadodara city, Gujarat.Methods: The study was carried during period from September 2018 to August 2019. After taking the permission of principals of 3 schools and consent of the parents of adolescents, 511 adolescents from 3 schools of Vadodara city were examined for signs of various nutritional deficiencies. The data was collected by predesign, pretested proforma and analyzed using SPSS 17.0 (Trial Version).Results: Out of total 511 adolescents 253(49.5%) were female. Mean age of the study adolescents was 15.6±1.81 years. Maximum numbers of the adolescents were in the age group of 10-14 years (60.3%). Mean age of female and male adolescents was 15.2±1.71 years and 15.6±2.01 years respectively. The study revealed that vitamin A deficiency was present in 38(7.4%) adolescents. Vitamin B complex deficiency signs were seen in 112(21.9%) adolescents. Vitamin C deficiency signs were seen in 43(8.4%) adolescents. Protein Energy Malnutrition was observed in 52(10.1%) adolescents. Essential fatty acid deficiency was observed in 56(10.9%) adolescents.Conclusions: High prevalence of nutritional deficiencies among these adolescents needs great attention and health education.

Avaliação do consumo de macro e micronutrientes de pacientes submetidos à gastroplastia redutora em uma clínica particular do Distrito Federal / Evaluation of the consumption of macronutrients and micronutrients of patients submitted to reducing gastroplasty in a particular clinic of the Federal District

Objetivo ­ Avaliar a alimentação dos pacientes que foram submetidos à gastroplastia redutora após 3 meses de pós-operatório. Métodos ­ Trata-se de um estudo transversal analítico, que foi realizado em uma clínica particular de Taguatinga Sul/DF, a amostra foi composta por pacientes adultos de ambos os sexos. Para avaliação da alimentação foi utilizado um registro ou diário alimentar, o mesmo foi utilizado para quantificar todos os alimentos e bebidas dos pacientes ingeridos em três dias não consecutivos. Também foi utilizado um questionário para saber sobre o possível uso de suplementos tais como: vitaminas, minerais e outros produtos. Resultados ­ A amostra foi composta por 20 pacientes que foram submetidos à gastroplastia redutora no Distrito Federal, com idades entre 40 e 55 anos de ambos os sexos, com a maior prevalência de cirurgia nas mulheres (85%) e a maioria dos pacientes avaliados tinham mais de 12 meses de P.O. Toda amostra apresentou inadequação no consumo de macronutrientes como carboidratos, lipídeos e proteínas e o consumo dos micronutrientes apresentaram inadequados para o Cálcio, Retinol, Ferro e Tiamina (B1), apenas a Vitamina C apresentou 100% de adequação quando comparado com as recomendações. Conclusão ­ Com o presente estudo pode-se concluir que cirurgia bariátrica é um tratamento eficaz contra a obesidade, contribuindo assim para a melhora das doenças associadas. É importante que o nutricionista conheça as principais deficiências que ocorrem após o tal procedimento, para assim poder oferecer um tratamento nutricional direcionado a cada paciente

Objective ­ To evaluate the feeding of patients who underwent reductive gastroplasty after 3 months postoperatively. Methods ­ This is a cross-sectional analytical study, which was performed in a private clinic in Taguatinga Sul / DF, the sample was composed of adult patients of both sexes. A dietary record or diary was used to evaluate the diet, which was used to quantify all foods and beverages of patients ingested on three nonconsecutive days. A questionnaire was also used to know about the possible use of supplements such as vitamins, minerals and other products. Results ­ The sample consisted of 20 patients who underwent reductive gastroplasty in the Federal District, aged between 40 and 55 years of both sexes, with the highest prevalence of surgery in women (85%) and the majority of patients evaluated had more than 12 months of PO All intakes of macronutrients such as carbohydrates, lipids and proteins and micronutrient intake were inadequate for Calcium, Retinol, Iron and Thiamine (B1), only Vitamin C presented 100% adequacy when compared with recommendations. Conclusion ­ With the present study it can be concluded that bariatric surgery is an effective treatment against obesity, thus contributing to the improvement of the diseases associated. It is important that the nutritionist knows the main deficiencies that occur after this procedure, in order to offer a nutritional treatment directed to each patient

Is there any change in phenotypic characteristics comparing 5 to 10 years of follow-up in obese patients undergoing roux-en-y gastric bypass? / Características fenotípicas de pacientes com obesidade submetidos a derivação gástrica em y-de-roux: qual as reais mudanças comparando-se 5 a 10 anos de acompanhamento?

ABSTRACT Background : Bariatric surgery promotes significant weight loss and improvement of associated comorbidities; however, nutrients deficiencies and weight regain may occur in the middle-late postoperative period. Aim: To investigate nutritional status in 10 years follow-up. Methods : Longitudinal retrospective study in which anthropometric, biochemical indicators and nutritional intake were assessed before and after one, two, three, four, five and ten years of Roux-en Y gastric bypass through analysis of medical records. Results : After ten years there was a reduction of 29.2% of initial weight; however, 87.1% of patients had significant weight regain. Moreover, there was an increase of incidence of iron (9.2% to 18.5%), vitamin B12 (4.2% to 11.1%) and magnesium deficiency (14.1% to 14.8%). Folic acid concentrations increased and the percentage of individuals with glucose (40.4% to 3.7%), triglycerides (38% to 7.4%), HDL cholesterol (31 % to 7.4%) and uric acid (70.5% to 11.1%) abnormalities reduced. Also, there is a reduction of food intake at first year postoperative. After 10 years, there was an increase in energy, protein and lipid intake, also a reduction in folid acid intake. Conclusions : Roux-en Y gastric bypass is an effective procedure to promote weight loss and improve comorbidities associated with obesity. However, comparison between postoperative period of five and 10 years showed a high prevalence of minerals deficiency and a significant weight regain, evidencing the need for nutritional follow-up in the postoperative period.

RESUMO Racional: A cirurgia bariátrica promove importante perda ponderal e melhora das comorbidades associadas; entretanto, deficiências nutricionais e reganho de peso podem ocorrer no pós-operatório médio e tardio. Objetivo: Investigar a evolução do estado nutricional de pacientes após cinco e 10 anos de pós-operatório. Método: Estudo retrospectivo longitudinal, no qual indicadores antropométricos, bioquímicos e a ingestão alimentar foram avaliados no período pré-operatório e após um, dois, três, quatro, cinco e dez anos da operação, por meio de revisão de prontuários. Resultados: Após 10 anos observou-se redução de 29,2% do peso inicial; no entanto, 87,1% dos pacientes tiveram reganho significativo de peso. Além disso, houve aumento da incidência de deficiência de ferro (9,2% para 18,5%), vitamina B12 (4,2% para 11,1%) e magnésio (14,1% para 14,8%). As concentrações de ácido fólico aumentaram e a porcentagem de indivíduos com alterações na glicemia (40,4% a 3,7%), triglicérides (38% a 7,4%), colesterol HDL (31% a 7,4%) e ácido úrico (70,5% a 11,1%) diminuiu. Além disso, houve redução na ingestão alimentar no primeiro ano de pós-operatório. Após 10 anos, houve aumento na ingestão de energia, proteína e lipídios, e redução na de ácido fólico. Conclusões: A derivação gástrica em Y-de-Roux é procedimento eficaz para promover perda de peso e melhorar as comorbidades associadas à obesidade. Entretanto, a comparação entre os períodos pós-operatórios de cinco e 10 anos mostrou que uma porcentagem de pacientes apresenta deficiências de vitaminas e minerais e reganho de peso significativo, evidenciando a necessidade do acompanho nutricional no período pós-operatório.

Relationship between food consumption, nutritional status and school performance / Relação entre consumo alimentar, estado nutricional e rendimento escolar

INTRODUCTION: Adequate feeding during childhood and adolescence is extremely important, due to its act directly on physical and cognitive development. OBJECTIVE: To verify the relationship between dietary intake and nutritional status with school performance. METHODS: It is an observational, quantitative and cross-sectional study of 134 students aged 9 to 11 years. The nutritional status was measured using the Body Mass Index by age and gender, and food consumption was assessed through the 3-day Dietary Recall. For the knowledge of the school performance, the report cards of 2016 were consulted. A questionnaire was used to collect data regarding the marital status. RESULTS: Regarding nutritional status, 59,7% of the students presented eutrophy, 18,7% overweight, 15,6% obesity and 6,0% underweight. The consumption of calcium (p<0,001) and iron (p<0,001) were significantly below the values recommended by the Dietary Reference Intakes. Obese children consumed significantly more lipids (p=0,026) and calories (p=0,003) than the other students. The participation of ultra processed foods represented 35.50% of the total energy value, with a positive correlation between their consumption and the amount of calories consumed (p=0,022) and inverse correlation with zinc intake (p=0,007). CONCLUSION: There was no significant association between dietary intake and nutritional status with school performance, but it was found that the marital status of the parents was associated with student performance, the children of married parents had a higher educational achievement than the children of separated parents.

INTRODUÇÃO: A alimentação adequada durante a infância e a adolescência é extremamente importante, pois atua diretamente no desenvolvimento físico e cognitivo. OBJETIVO: Verificar a relação entre o consumo alimentar e o estado nutricional com o rendimento escolar. MÉTODO: Trata-se de um estudo observacional, quantitativo e transversal, realizado com 134 escolares com idades entre 9 e 11 anos. O estado nutricional foi mensurado por meio do Índice de Massa Corporal por idade e gênero e a avaliação do consumo alimentar foi realizada através do Recordatório Alimentar de 3 dias. Para o conhecimento do rendimento escolar foram consultados os boletins do ano letivo de 2016. Utilizou-se um questionário para coletar dados referentes ao estado civil. Quanto ao estado nutricional, 59,7% dos escolares apresentaram eutrofia, 18,7% sobrepeso, 15,6% obesidade e 6,0% baixo peso. RESULTADO: O consumo de cálcio (p=0,000 ) e ferro (p=0,000) foram significativamente abaixo dos valores recomendados pela Dietary Reference Intakes. Os escolares com obesidade consumiram significativamente mais lipídios (p=0,026) e calorias (p=0,003) que os demais estudantes. A participação dos alimentos ultraprocessados representou 35,50% do valor energético total, observando-se correlação positiva entre o seu consumo e a quantidade de calorias da alimentação (p=0,022) e correlação inversa com a ingestão de zinco (p=0,007 CONCLUSÃO: Não foi encontrada associação significativa entre o consumo alimentar e estado nutricional com o rendimento escolar, porém verificou-se que o estado civil dos pais apresentou associação com o desempenho dos estudantes, os filhos de pais casados tiveram um rendimento escolar superior aos filhos de pais separados

Complicações neurológicas pós-cirurgia bariátrica: uma revisão de literatura / Neurological complications post-bariatric surgery: a review of the literature

A obesidade é um grave problema de saúde em todo o mundo. Apresenta alta prevalência e grande impacto sobre a mortalidade. A cirurgia bariátrica é cada vez mais utilizada no tratamento de obesidade mórbida por se mostrar o mais eficaz tratamento mantendo a perda de peso sustentada e diminuindo a incidência das comorbidades associadas. Complicações neurológicas agudas e crônicas têm sido relatadas após este procedimento, e podem resultar principalmente por deficiência nutricional. Objetivo: Destacar as complicações neurológicas comuns e raras que podem ocorrer após cirurgia bariátrica. Metodologia: Revisão narrativa da literatura. Resultados: Complicações neurológicas pós-cirurgia bariátrica podem ocorrer em qualquer nível do neuroeixo ou em músculos. As mais comuns são por deficiências nutricionais, mas outros mecanismos mais raros podem ocorrer como inflamatórios mecânicos. Conclusão: Com o aumento de incidência da obesidade, a cirurgia bariátrica tem se tornado cada vez mais frequente para perda de peso. É importante avaliar corretamente a indicação desse procedimento uma vez que ele não é isento de complicações. Embora a maioria das complicações do sistema nervoso central, periférico e musculoesquelético após a cirurgia bariátrica seja devido a deficiências nutricionais, existem outras neuropatias associadas com envolvimento inflamatório do nervo periférico. Um processo autoimune tem sido aceito como fisiopatologia subjacente. (AU)

Obesity is a serious health problem throughout the world. It has high prevalence and significant impact on mortality. Bariatric surgery is increasingly used in the treatment of morbid obesity out to be the most effective treatment maintaining sustained weight loss and decreasing the incidence of comorbidities. Acute and chronic neurological complications have been reported after this procedure, and may result primarily by nutritional deficiency. Objective: To emphasize the common and rare neurological complications that may occur after bariatric surgery. Methodology: Narrative review of the literature. Results: Neurological complications after bariatric surgery can occur at any neuraxial level or muscle. The most common are by nutritional deficiency, but other rarer mechanisms may occur, like mechanical or inflammatory. Conclusion: With increasing incidence of obesity, bariatric surgery has become increasingly common for weight loss. It is important to properly evaluate the indication for this procedure since it is not without complications. Although most of the central and peripheral nervous system and musculoskeletal complications after bariatric surgery are due to nutritional deficiencies, there are other neuropathies associated with inflammatory involvement of the peripheral nerve. An autoimmune process has been accepted as an underlying pathophysiology. (AU)

Dietary intake and adequacy of energy and nutrients in Mexican older adults: results from two National Health and Nutrition Surveys / Ingesta y adecuación dietética de energía y nutrimentos en adultos mayores mexicanos. Resultados de dos encuestas nacionales de salud y nutrición

Abstract: Objective: To describe energy and nutrient intakes and their adequacies in older Mexican adults participating in the National Health and Nutrition Survey (Ensanut) 2006 and 2012. Materials and methods: Dietary information was obtained through a semiquantitative food frequency questionnaire (SFFQ) from 526 adults 60 y and older participating in Ensanut 2012 and 3 326 in Ensanut 2006 in Mexico. Quantile and logistic regression models were used to obtain medians and marginal effects of each nutrient, adjusting by confounders and survey design. Results: Dietary intake of energy and nutrients was similar in both surveys. Most common micronutrients at risk of dietary deficiency were, for vitamins: A, B-12, C, D and folate, and for minerals: calcium, iron and zinc, in both surveys. Excessive intake of sugar and saturated fat and low fiber intake were common. Conclusions: Diet in older Mexican adults is low in micronutrient essentials, and excessive in fat and sugar. Attention to the diet in this age group through targeted interventions is necessary to promote a healthy diet.

Resumen: Objetivo: Describir la ingesta y adecuación de energía y nutrimentos de la dieta de adultos mexicanos mayores de 60 años (AM) participantes en la Encuesta Nacional de Salud y Nutrición (Ensanut) 2006 y 2012 de México. Material y métodos: El cuestionario semicuantitativo de frecuencia de consumo de alimentos se analizó en 526 AM de la Ensanut 2012 y en 3 326 de Ensanut 2006. Modelos de regresión por cuantiles y logístico se emplearon para estimar las medianas y riesgos de inadecuación para los nutrimentos evaluados, ajustando por confusores y diseño de encuesta. Resultados: La ingesta de energía y nutrimentos no fue diferente entre las dos encuestas. Los micronutrimentos con mayor riesgo de deficiencia dietética fueron las vitaminas A, B-12, C, D y folato, y los minerales calcio, hierro y zinc, en ambas encuestas. La ingesta excesiva de azúcar y grasa saturada y la baja ingesta de fibra fueron comunes. Conclusiones: La dieta de AM mexicanos es deficiente en micronutrimentos importantes y excesiva en grasa y azúcar. Se sugiere atención a la dieta en este grupo de población por medio de programas sociales e intervenciones focalizadas.

Nutritional aspects and the use of nutritional supplements by women who underwent gastric bypass / Aspectos nutricionais e o uso de suplementos alimentares em mulheres submetidas ao bypass gástrico

ABSTRACT Background: Bariatric surgery is deemed one of the most effective procedures for the treatment of obesity and it aims at the reduction and maintenance of weight loss in long term, as the control of the related comorbidities. Aim: Quantify the occurrence of alterations of the gastrointestinal tract, suggestive signs of nutritional deficiencies and the use of supplements in a group of women undergoing bariatric surgery. Methods: The sample consisted of women aged 20-65 years submitted to Roux-en-Y gastric bypass with monitoring equal to or higher than 24 months. For the qualitative analysis, the Feeding Frequency Questionnaire was used. Results: In the postoperative period, alopecia was the most reported (79.3%), followed by changes in the texture of the nails, both considered predictive of nutritional deficiencies. Changes in the gastrointestinal tract were described in 86.2%, and episodes of dumping were reported in 65.5%. Qualitative analysis has shown reduced daily consumption of sources of animal and plant proteins. Conclusion: After bariatric surgery can occur flatulence, vomiting and dumping syndrome as the most frequent representative symptoms of digestive functional disorders. Alopecia and nail changes are the most important signs of nutritional deficiency. The use of dietary supplements in the postoperative period is scarce and sporadic.

RESUMO Racional: A cirurgia bariátrica é considerada um dos procedimentos mais eficazes para tratamento da obesidade e objetiva a redução e manutenção da perda de peso em longo prazo, assim como, o controle das comorbidades associadas. Objetivo: Quantificar a ocorrência de alterações funcionais do trato gastrointestinal, sinais sugestivos de carências nutricionais e o uso de suplementos em um grupo de mulheres submetidas à cirurgia bariátrica. Métodos: A amostra foi constituída por mulheres com idades entre 20-65 anos submetidas ao bypass gástrico em Y-de-Roux com seguimento igual ou superior a 24 meses. Para análise qualitativa foi utilizado o Questionário de Frequência Alimentar. Resultados: No período pós-operatório a alopecia foi a mais relatada (79,3%), seguida de alteração na textura das unhas, ambas consideradas preditivos de carências nutricionais. As alterações do trato gastrointestinal foram descritas por 86,2%, e os episódios de dumping foram relatados em 65,5%. Na análise qualitativa foi observado consumo diário reduzido de fontes de proteínas animal e vegetal. Conclusão: Após a cirurgia bariátrica pode ocorrer flatulência, vômitos e síndrome de dumping como sintomas representativos mais frequentes das alterações funcionais digestivas. Alopecia e alterações ungueais são os sinais mais relevantes de carência nutricional. O uso de suplementos alimentares no pós-operatório é escasso e esporádico.

Saúde bucal e periodontal podem ser afetadas após cirurgia bariátrica e deficiências nutricionais? / an oral and periodontal health may be affected after bariatric surgery and nutritional deficiencies?

Objetivo: tentar entender como as deficiências nutricionais no paciente pós-operatório à cirurgia bariátrica impactam a saúde oral e periodontal. Material e métodos: uma pesquisa na base de dados PubMed com os termos "by-pass gástrico e doenças periodontais", "cirurgia bariátrica e deficiências nutricionais", e "saúde bucal e obesidade" tentando esclarecer a relação com doença periodontal e as deficiências nutricionais. Resultados: foi realizada uma revisão de artigos sobre o fato da cirurgia bariátrica ser um procedimento cirúrgico indicado para o tratamento da obesidade mórbida e promover alteração da anatomia gastrintestinal, levando à perda de peso, diminuindo a absorção de açúcares, gorduras e outros nutrientes importantes, como vitaminas A, C, D, B12, cálcio e ferro, responsáveis pela regulação de muitas funções críticas no organismo e participantes efetivos na produção de colágeno e matriz óssea. Conclusão: a cavidade oral sofre complicações em vista dessa nova situação, e os dentistas precisam entender como essas deficiências podem afetar na doença periodontal, a fim de desenvolver estratégias de prevenção e tratamento para este novo grupo de população.

Objective: the aim of this article is try to understand how the nutritional deficiencies in the post-operative patient submitted to bariatric surgery impact on oral and periodontal health. Material and methods: a survey in PubMed database with these terms "gastric by-pass and periodontal diseases", "bariatric surgery and nutritional deficiencies" and "oral health and obesity" was done trying to clarify the relationship with periodontal disease. Results: bariatric surgery is a surgical procedure indicated for the treatment of morbid obesity and promotes an alteration of gastrointestinal anatomy leading to a marked weight loss by decreasing the absorption of sugars and fats, but other important nutrients such as decreased absorption of vitamins A, C, D, B12, calcium and iron, which are also responsible for the regulation of many critical functions in organism, and effectively participate in the production of collagen and bone matrix and an overview of papers about this topic was conducted. Conclusion: the oral cavity suffers complications from this new situation and dentists need to understand how these deficiencies may impact on periodontal disease in order to develop treatment and prevention strategies for this new population group.

Severe protein-calorie malnutrition in two brothers due to abuse by starvation / Desnutrição proteico-calórica grave em dois irmãos devido ao abuso por privação alimentar

Abstract Objective: To describe the case of two siblings with severe protein-calorie malnutrition due to abuse by starvation. Cases description: The two patients were simultaneously referred to the Hospital Municipal, where they were admitted to the Pediatric Gastroenterology clinic of a university hospital for diagnostic investigation of the cause of severe malnutrition and screening tests for Celiac Disease, Cystic Fibrosis and Environmental enteropathy among others. The exams were all normal, and after detailed research on the interactions of this family, we reached the conclusion that the malnutrition was due to abuse by starvation. The children spent approximately two months in the hospital, receiving a high-protein and high-calorie diet, with significant nutritional recovery. Comments: Abuse by starvation, although rare, should always be considered of as one of the causes of child malnutrition and pediatrician should be aware of the child's development, as well as the family interactions, to prevent more severe nutritional and emotional consequences in the future.

Resumo Objetivo: Descrever os casos de dois irmãos acometidos de desnutrição proteico-calórica grave causada por abuso por privação alimentar. Descrição dos caso: Os dois pacientes vieram simultaneamente encaminhados de hospital municipal, onde estavam internados, ao Ambulatório de Gastrenterologia Pediátrica de um hospital universitário para investigação diagnóstica da causa de desnutrição grave. Foram feitos exames para pesquisa de doença celíaca, fibrose cística e enteropatia ambiental, entre outras. Os exames mostraram-se todos normais e, após investigação detalhada sobre o relacionamento dessa família, chegou-se à conclusão de que a desnutrição tinha como causa o abuso por privação alimentar. As crianças passaram cerca de 2 meses internadas, receberam uma dieta hiperproteica e hipercalórica, com recuperação nutricional significativa. Comentários: O abuso por privação alimentar, embora raro, deve sempre ser pensado como uma das causas de desnutrição infantil, deve o pediatra estar atento ao desenvolvimento da criança, bem como ao seu relacionamento familiar, para evitar consequências nutricionais e emocionais mais graves no futuro.

Disability-Adjusted Life Years for Maternal, Neonatal, and Nutritional Disorders in Korea

Maternal and child health is an important issue throughout the world. Given their impact on maternal and child health, nutritional issues need to be carefully addressed. Accordingly, the effect of maternal, child, and nutritional disorders on disability-adjusted life years (DALYs) should be calculated. The present study used DALYs to estimate the burden of disease of maternal, neonatal, and nutritional disorders in the Korean population in 2012. For this purpose, we used claim data of the Korean National Health Insurance Service, DisMod II, and death data of the Statistics Korea and adhered to incidence-based DALY estimation methodology. The total DALYs per 100,000 population were 376 in maternal disorders, 64 in neonatal disorders, and 58 in nutritional deficiencies. The leading causes of DALYs were abortion in maternal disorders, preterm birth complications in neonatal disorders, and iron-deficiency anemia in nutritional deficiencies. Our findings shed light on the considerable burden of maternal, neonatal, and nutritional conditions, emphasizing the need for health care policies that can reduce morbidity and mortality.

Consumo de nutrientes em idosos residentes em Porto Alegre (RS), Brasil: um estudo de base populacional / Consumption of nutrients among the elderly living in Porto Alegre in the State of Rio Grande do Sul, Brazil: a population-based study

Resumo Para descrever o perfil de consumo de nutrientes e verificar a sua associação com as variáveis sociodemográficas e de saúde, desenvolveu-se um estudo transversal, de base populacional em uma amostra aleatória de 427 idosos residentes em Porto Alegre, Brasil. O consumo alimentar foi avaliado através do Inquérito Recordatório de 24 Horas e Investigação da História Dietética. Dos idosos entrevistados, 70% eram mulheres; 48,5% possuíam entre 60 e 69 anos; 68,8% possuíam menos de 8 anos de escolaridade; 39,0%, renda familiar entre 2 e 5 salários mínimos; e 58,4% não praticava exercício físico. A hipertensão foi a doença mais prevalente, e 54,9% dos idosos estavam abaixo do peso. Os homens consumiam mais calorias, proteínas, fibras, minerais e vitaminas do que as mulheres. O consumo de carboidrato e cálcio aumentou conforme o avanço da idade, assim como diminuiu a ingestão de zinco. A prática de exercício físico elevou o consumo de calorias, magnésio, potássio e fósforo. Quanto maior a escolaridade, maior é o consumo de vitaminas B6 e B12; quanto maior a renda familiar, maior o consumo de vitamina B6 e ácido fólico. Os resultados demonstram que há deficiências nutricionais na alimentação diária da nossa população de idosos, principalmente entre as mulheres e os indivíduos acima de 80 anos.

Abstract A cross-sectional, population-based study was conducted on a random sample of 427 elderly individuals living in Porto Alegre, Brazil, to establish the nutrient consumption profile and verify its association with sociodemographic and health variables. Dietary intake was assessed using the 24-hour Food Recall Survey and the Dietetic Research Investigation technique. Seventy percent of the elderly respondents were women: 48.5% were between 60 and 69 years old; 68.8% had less than 8 years of schooling; 39% had a family income of between 2 and 5 minimum wages and 58.4% took no physical exercise. Hypertension was the most prevalent disease among the elderly and 54.9% were underweight. Men consumed more calories, protein, fiber, minerals and vitamins than women. Carbohydrate and calcium intake increases with advancing age, while zinc intake decreases. Physical exercise increased the intake of calories, magnesium, potassium and phosphorus. The higher the schooling the greater the intake of vitamins B6 and B12; the higher the family income, the greater the consumption of vitamin B6 and folic acid. The results show that there are nutritional deficiencies in the daily diet of the Brazilian elderly population, especially among women and individuals over 80 years of age.

Prevalence of multiple nutritional deficiencies among the street children of Khammam City of Telangana State.

Background: To study the nutritional status of the street children in Khammam city. Methods: Type of study: A prospective and descriptive study. Study Population: All the street children in the city who are less than 18 years of age. 3 Sample size: out of total 384 street children in the city, 250 were included in the study. Selection criteria: Children in different age groups of both sexes were selected. Data regarding nutritional and health status was collected by using pretested structured questionnaire after obtaining proper consent. Results: A total of 250 street children were interviewed. Out of total 250 children included in the study 162 (68.4%) were undernourished (BMI< 18.5).157 (62.8%) were suffering from nutritional anaemia. 38 (15.2%) children had various symptoms of Vitamin A deficiency.( Night blindness 8%, conjunctival xerosis 1.2%, Bitots spots 6%).A total of 62 (24.7%) children had various symptoms of group B vitamins deficiencies. Conclusion: There is an urgent need of coordination among development agents working for the rights of street children and information sharing among all stakeholders to enhance implementation strategies.

SECONDARY HYPERPARATHYROIDISM AFTER BARIATRIC SURGERY: TREATMENT IS WITH CALCIUM CARBONATE OR CALCIUM CITRATE? / HIPERPARATIREOIDISMO SECUNDÁRIO APÓS CIRURGIA BARIÁTRICA: TRATAR COM CARBONATO OU CITRATO DE CÁLCIO?

Background:Bariatric surgery, especially Roux-en-Y gastric bypass, can cause serious nutritional complications arising from poor absorption of essential nutrients. Secondary hyperparathyroidism is one such complications that leads to increased parathyroid hormone levels due to a decrease in calcium and vitamin D, which may compromise bone health.Aim: To compare calcium carbonate and calcium citrate in the treatment of secondary hyperparathyroidism.Method: Patients were selected on the basis of their abnormal biochemical test and treatment was randomly done with citrate or calcium carbonate.Results: After 60 days of supplementation, biochemical tests were repeated, showing improvement in both groups.Conclusion: Supplementation with calcium (citrate or carbonate) and vitamin D is recommended after surgery for prevention of secondary hyperparathyroidism.

Racional:A cirurgia bariátrica, especialmente a gastroplastia em Y-de-Roux, pode causar complicações nutricionais importantes que derivam da má absorção de nutrientes essenciais. O hiperparatireoidismo secundário é uma delas que cursa com o aumento do hormônio da paratireoide e consequente diminuição de cálcio e vitamina D, o que pode comprometer a saúde óssea.Objetivo: Comparar o tratamento do hiperparatireoidismo secundário com o uso de carbonato e citrato de cálcio.Métodos: Os pacientes foram selecionados a partir de seus exames bioquímicos alterados e o tratamento foi sugerido aleatoriamente com citrato ou carbonato de cálcio.Resultados: Após 60 dias de suplementação foram reavaliados os exames bioquímicos e percebeu-se melhora em ambos os grupos, tanto com citrato como com carbonato de cálcio.Conclusão: Recomenda-se o uso de suplementação de cálcio (citrato ou carbonato) e vitamina D após a operação para prevenção do hiperparatireoidismo secundário.

Deficiências de micronutrientes no pré-operatório de cirurgia bariátrica / Micronutrient deficiencies in the pre-bariatric surgery

INTRODUÇÃO: Achados epidemiológicos têm demonstrado o aumento da prevalência de obesidade em diversos segmentos da população mundial. Neste contexto, a cirurgia bariátrica é aceita, atualmente, como a ferramenta mais eficaz no tratamento e controle da obesidade mórbida. Vários estudos vêm avaliando o estado nutricional após operações bariátricas, principalmente as mistas, detectando redução no consumo alimentar de proteínas, vitaminas e minerais. No entanto, outros investigam a presença de deficiências nutricionais antes da realização da operação, que podem ser agravadas com o procedimento cirúrgico, resultando em complicações pós-operatórias graves. OBJETIVO: Analisar a literatura para as deficiências de micronutrientes em pacientes obesos antes da cirurgia bariátrica. MÉTODO: Realizou-se revisão sistemática em bases eletrônicos, a saber: PubMed/Medline, Scielo, Lilacs e Bireme. As seguintes palavras-chave foram utilizadas individualmente ou em associação: bariatric surgery, obesity, preoperative, gastric bypass, vitamin deficiencies, mineral deficiencies and absorption nutrient. Foram incluídos 40 artigos de revisão e originais, publicados entre 2005 a 2012. RESULTADOS: Encontrou-se como consenso o fato de que a combinação de deficiências nutricionais no pré-operatório, as restrições e má absorção induzidas pela cirurgia bariátrica podem levar a importante déficits nutricionais durante o período pós-operatório tardio, principalmente de micronutrientes, resultando em complicações graves. CONCLUSÃO: A alta ocorrência de deficiência de micronutrientes no pré-operatório detectada em obesos mórbidos candidatos à cirurgia bariátrica, somado a um processo disabsortivo, pode envolver pior prognóstico durante o período pós-operatório tardio. Avaliação pré-operatória dos parâmetros nutricionais e da ingestão de alimentos é recomendado em conjunto com as intervenções.

INTRODUCTION: Data already demonstrated the increased prevalence of obesity in various segments of the population. In this context, bariatric surgery is accepted nowadays as the most effective tool in the treatment and control of morbid obesity. Several studies have evaluated the nutritional status after bariatric surgery, especially mixed by detecting a reduction in food intake of protein, vitamins and minerals. However, other studies have investigated the presence of nutritional deficiencies prior to surgery, which may be aggravated by the surgical procedure, resulting in serious postoperative complications. AIM: To analyze the literature in relationship to micronutrient deficiencies in obese patients before bariatric surgery. METHOD: Was carried out a systematic review in several electronic databases, such as PubMed/ Medline, Scielo, Lilacs and Bireme. The following keywords were used alone or in combination: bariatric surgery, obesity, preoperative, gastric bypass, vitamin deficiencies, deficiencies and mineral nutrient absorption. Were included 40 review and original articles published between 2005 to 2012. RESULTS: There were consensus on the combination of preoperative nutritional deficiencies, restrictions and malabsorption, possibly induced by bariatric surgery that can lead patients to experience significant nutritional deficits during the late postoperative period, especially of micronutrients, resulting in serious complications. CONCLUSIONS: The high occurrence of micronutrient deficiencies preoperatively detected in morbidly obese candidates for bariatric surgery, plus a malabsorptive procedure, may involve worse prognosis during the late postoperative period. Preoperative evaluation of nutritional parameters and food intake is recommended in conjunction with surgical interventions.