Nutritional status and prognosis in children with immunodeficiencies undergoing hematopoietic stem cell transplantation.

BACKGROUND: Primary immunodeficiencies (PID) are diseases resulting from genetic dysfunctions in the immune system, which can result in recurrent infections, autoimmunity and even malignancy. It is estimated that approximately one-third of the PID described have gastrointestinal components or symptoms involved and may present an increased risk of weight loss and failure to thrive. It is also known that, in patients with other diagnoses, malnutrition may be associated with worse outcomes after hematopoietic stem cell transplantation (HSCT). OBJECTIVE: to characterize the nutritional status of pediatric patients with PID at the time of admission for HSCT and to establish the relationship between baseline nutritional status measures and post-HSCT clinical outcomes. METHODS: a retrospective analytical observational study, based on data from pediatric patients, of both sexes and all ethnicities, with PID, submitted to HSCT in the period from 2004 to 2019. The risk factors analyzed were the Z-scores of weights for age (W/A), height for age (H/A), BMI for age (BMI/A) and Sum score, obtained by through the sum of the W/A and H/A scores. The primary outcomes were overall survival at 6 months, occurrence of acute Graft Versus Host Disease (aGVHD) at 6 months, and occurrence of chronic Graft Versus Host Disease (cGVHD) at 1 year. Secondary outcomes were occurrence and degree of mucositis, length of stay, and total number of infectious episodes. As statistical analysis, the ANOVA model, the Tukey test, ROC curves and Kaplan Meier and Log-Rank analysis were used. Multivariate survival and logistic regression models were also performed. RESULTS: The study showed important indicators of malnutrition in patients with PID, especially those diagnosed with Severe Combined Immunodeficiency Syndrome (SCID) and Hemophagocytic Syndromes (HS). Among those with SCID, 60% had low or very low weight for their age, 52% had low or very short stature for their age, and 44% were classified as being thin or very thin. Among patients with HS, 75% had short or very short stature for their age. Multivariate analysis only demonstrated association between W/A score with extensive cGVHD, controlling for diagnosis, compatibility, conditioning and immunoprophylaxis. Lower W/A values were associated with higher occurrences of these events. Although W/A was only associated with cGVHD and H/A had no association with chronic or acute GVHD, when Sum scores were used, the lower values the higher rates of severe aGVHD and total cGVHD according to multivariate controlled models for diagnosis, compatibility, conditioning and immunoprophylaxis. CONCLUSIONS: Our study characterized the nutritional status of children with PID undergoing HSCT and found alarming rates of underweight and short stature in patients with SCID and HS. We also demonstrated a relationship between anthropometric parameters and outcomes such as mortality, the occurrence of GVHD and severe mucositis after HSCT. In this sense, W/A and Sum score measures would be good prognostic methods for these outcomes. Henceforth, prospective studies are needed to confirm these findings and establish new nutritional assessment criteria for this population.

Oral nutritional support to adult patients with acute intestinal Graft Versus Host Disease (GVHD): A proposal for dietary intervention as a model to clinical trials.

BACKGROUND: Acute Graft Versus Host Disease (GVHD) affects about 20%-80% of the patients after the hematopoietic stem cell transplant (HSCT) and it is amongst the main causes of morbidity and mortality both in children and adults. The intestine is one of the most affected organs by GVHD causing important alterations in the nutritional status and quality of life, considering that the dysfunctional intestine could decrease food intake as well as an inappropriate dietary plan could worsen the clinical condition. In addition to GVHD, chemotherapy conditioning regimen suppresses the immune system, promotes mucositis and increases the risk of infectious complications. Taking the above into consideration, when per oral diet is possible; the food choices should be carefully planned and monitored to promote nutritional support and avoid worsening the intestinal function and clinical condition. OBJECTIVE: This work was aimed to present a practice guideline proposal, to be validated, based on literature review, regarding to oral dietary recommendations for acute intestinal GVHD after HTSC. METHODS: Two research phases were defined: Phase one: evidence-based literature review; Phase 2: Practice Guideline Proposal. 1: Evidence based literature review SEARCH METHODS: A literature review (1997-2019) was performed including PubMed, in English, and Lilacs, in Portuguese electronic database to address the subject of dietary intervention for intestinal GVHD related to the HSCT, with children and adults, whose receiving oral or tube feeding nutrition therapy. SELECTION CRITERIA: The study selection was based on the PRISMA method. Controlled clinical trials were searched. Randomization was not possible considering the rare condition. DATA COLLECTION AND ANALYSIS: Two independent authors assessed the abstracts of the selected studies to determine the articles feasible to compose the review as the base to elaborate the practice guideline proposal protocol, object of the present study. To determine the level of evidence of the selected article, GRADE criteria were used. MAIN RESULTS: One controlled clinical trial study was included. The study was developed in Japan with a total of 35 patients. The dietary plan was characterized by gradual increasing food consistency/density. They found better nutritional parameters in the treated group, however, following GRADE criteria, we rated the quality of evidence as very low. AUTHORS' CONCLUSIONS: We could not demonstrate confidence in the effect estimate based on the selected study. However, considering the lack of literature information and the relevance of the topic, we decided to proceed and propose a practice guideline for an oral diet protocol for acute intestinal GVHD as a reference to be a starting point to validate protocols in future clinical trials. 2: Practice Guideline Proposal The criteria to elaborate the protocol were based on the RIGHT Statement. In addition to the literate information about diet and intestinal health, recommendations already adopted in the Service of Bone Marrow Transplant in the Complex Hospital of Clinics of Curitiba, in the state of Paraná, Brazil, were also considered.

Impact of dietary patterns according to NOVA food groups: 2 y after Roux-en-Y gastric bypass surgery.

INTRODUCTION: Appropriate eating habits are crucial for sustained weight loss after bariatric surgery. A qualitative analysis of food consumption in the late postoperative period of bariatric surgery is thus advisable, even more so considering the increasing consumption of obesity-impacting ultra-processed foods. OBJECTIVE: This study aimed to analyze the contribution of unprocessed, processed, and ultra-processed foods 2 y after Roux-en-Y gastric bypass (RYGB). METHODS: This was a prospective study performed with 32 patients undergoing RYGB. Anthropometric and food intake data were analyzed. A food intake evaluation was conducted with a focus on quantitative and qualitative analyses. The latter was performed by categorizing food according to the NOVA classification. RESULTS: There was a reduction in body mass, representing an excess weight loss of 83.80 ± 24.50% at 24 months postoperatively; and a reduction in calorie intake, macronutrients, fiber, and sodium after surgery. Regarding the qualitative analysis, 6 months after RYGB the calorie intake from processed and ultra-processed food decreased from 1398.47 ± 623.82 kcal to 471.80 ± 48.94 kcal (P < 0.05). However, between 6 and 24 months postoperatively there was an increase in 60.04% of the calorie consumption of these type of food (P < 0.01). The most important finding was that the consumption of processed and ultra-processed food exceeded 50% of the total calorie intake of the diet in all periods analyzed. CONCLUSIONS: RYGB promotes quick results in weight loss and a reduction of food intake, but the quality of food may affect long-term prognosis and deserves attention in the population studied. These results highlight the importance of dietary counseling aimed at guiding better food choices, in the interest of promoting sustained weight loss after bariatric surgery.

Impact of Weight Loss on Inflammation State and Endothelial Markers Among Individuals with Extreme Obesity After Gastric Bypass Surgery: a 2-Year Follow-up Study.

BACKGROUND: The medium-term impact of gastric bypass (GB) surgery on the inflammatory state and endothelial function of patients has yet to be confirmed. OBJECTIVE: This study aims to elucidate the inflammatory profile and endothelial dysfunction response of adults with obesity 6 and 24 months after undergoing GB surgery. METHODS: The anthropometric and biochemical markers of 32 adults with obesity (two men and 30 females) were collected preoperatively, and 6 and 24 months postoperatively. RESULTS: Body mass index (BMI) and excess weight had decreased by 15.79 ± 1.21 kg/m2 (p < 0.01) and 83.80 ± 24.50% respectively at 24 months. Leptin, C-reactive protein (CRP), plasminogen activator inhibitor-1 (PAI-1) levels, and the leptin/adiponectin ratio decreased significantly at both postoperative follow-up points compared with preoperative values (p < 0.01). IL-6 and ICAM-1 levels decreased between 6 and 24 months post-GB (p < 0.01). IL-6 and ICAM-1 levels decreased between 6- and 24-months post-GB (p < 0.01). Resistin levels were significantly decreased (p < 0.01) at 6-month follow-up. The levels of the anti-inflammatory biomarkers IL-10, adiponectin, and the adiponectin/leptin ratio significantly increased postoperatively. There was an improvement in metabolic disorders after surgery. CONCLUSION: Our results demonstrated that after GB there was an improvement in the inflammatory profile, identified by a reduction in pro-inflammatory markers (CRP, IL-6, leptin) and an increase in anti-inflammatory markers (adiponectin, IL-10). The decrease in PAI-1 and ICAM-1 levels may suggest improvement in endothelial function. These findings provide clear evidence of the medium-term impact of GB on inflammation state and a number of endothelial markers, and a consequent reduction in the risk of cardiovascular diseases.

Comparison of the dietary intake amongst women in the late postoperative period after Roux-en-Y gastric bypass with the bariatric food pyramidof dietary intake with reference values among women in late postoperative of y-en-roux gastric bypass / Comparación de la ingesta dietética entre las mujeres en el postoperatorio tardío después del bypass gástrico en Y de Roux con la pirámide nutricional bariátrica

Introduction: the Roux-en-Y gastric bypass (RYGB) is considered to be an efficient treatment of obesity. There is an improvement in the dietary intake in the immediate postoperative period, but after the first year there is a tendency to return to the old pre-surgery habits. The objective of the present study was to compare the dietary intake of women in the late postoperative period after RYGB with the recommendations of the specific bariatric food pyramid. Methodology: the whole population of patients submitted to RYGB being accompanied by two out-patients departments of the Complexo Hospital de Clínicas of Universidade Federal do Paraná in the period from March to September 2017 were considered, selecting only those who conformed to the inclusion criteria. The analyses carried out were: the hospital records, anthropometric evaluation, basal metabolic rate by indirect calorimetry, food consumption and questionnaires concerning physical activity, food intolerance and the dumping syndrome. The food consumption was separated into food groups in order to compare with the specific pyramid. Descriptive analyses were used to characterize the sample. Results: it can be seen that the percent of macronutrients in relation to the total energy value (TEV) was within the values established by the recommended dietary allowances (RDA), although with respect to fiber, 68% of the participants showed a consumption below the adequate intake (AI). Inadequacy was observed for practically all the components when comparing the number of portions per food group of the bariatric pyramid, with the exception of the protein group. Conclusion: after RYGB, the dietary consumption was compromised in quantity and quality. In addition, in the late postoperative period, women tended to choose high calorie dense foods poor in fiber, a fact that is aggravated by the presence of food intolerances

Introducción: el bypass gástrico en Y de Roux (BGYR) es considerado un tratamiento eficaz de la obesidad. Normalmente, se percibe una mejoría en la ingesta dietética en el postoperatorio inmediato, pero después del primer año hay una tendencia a volver a los viejos hábitos preoperatorios. El objetivo del presente estudio fue comparar la ingesta dietética de las mujeres en el postoperatorio tardío después del BGYR con las recomendaciones de la pirámide nutricional bariátrica. Material y métodos: se consideró a toda la población de pacientes sometidos a BGYR, además de dos ambulatorios del Complexo Hospital de Clínicas de la Universidade Federal de Paraná en el periodo de marzo a septiembre de 2017, seleccionando solo a aquellos que cumplían con los criterios de inclusión. Los análisis realizados fueron: registros hospitalarios, evaluación antropométrica, tasa metabólica basal por calorimetría indirecta, consumo de alimentos y cuestionarios sobre actividad física, intolerancia alimentaria y síndrome de dumping. El consumo de alimentos se dividió en grupos de alimentos para compararlos con la pirámide específica. Se utilizaron análisis descriptivos para caracterizar la muestra. Resultados: podemos observar que el porcentaje de macronutrientes en relación con el valor energético total (VET) estuvo dentro de los valores recomendados por las ingestas diarias recomendadas (IDR), aunque con respecto a la fibra, el 68% de los participantes mostró un consumo inferior a la ingesta adecuada (AI, por sus siglas en inglés). Se observó una insuficiencia en prácticamente todos los componentes al comparar el número de porciones por grupo de alimentos de la pirámide bariátrica, con la excepción del grupo de proteínas. Conclusión: después del BGYR, el consumo dietético se vio comprometido en cantidad y calidad. Además, en el postoperatorio tardío, las mujeres tendían a elegir alimentos ricos en calorías y pobres en fibra, un hecho que se agrava por la presencia de intolerancias alimentarias

Comparison of the dietary intake amongst women in the late postoperative period after Roux-en-Y gastric bypass with the bariatric food pyramidof dietary intake with reference values among women in late postoperative of y-en-roux gastric bypass.

INTRODUCTION: Introduction: the Roux-en-Y gastric bypass (RYGB) is considered to be an efficient treatment of obesity. There is an improvement in the dietary intake in the immediate postoperative period, but after the first year there is a tendency to return to the old pre-surgery habits. The objective of the present study was to compare the dietary intake of women in the late postoperative period after RYGB with the recommendations of the specific bariatric food pyramid. Methodology: the whole population of patients submitted to RYGB being accompanied by two out-patients departments of the Complexo Hospital de Clínicas of Universidade Federal do Paraná in the period from March to September 2017 were considered, selecting only those who conformed to the inclusion criteria. The analyses carried out were: the hospital records, anthropometric evaluation, basal metabolic rate by indirect calorimetry, food consumption and questionnaires concerning physical activity, food intolerance and the dumping syndrome. The food consumption was separated into food groups in order to compare with the specific pyramid. Descriptive analyses were used to characterize the sample. Results: it can be seen that the percent of macronutrients in relation to the total energy value (TEV) was within the values established by the recommended dietary allowances (RDA), although with respect to fiber, 68% of the participants showed a consumption below the adequate intake (AI). Inadequacy was observed for practically all the components when comparing the number of portions per food group of the bariatric pyramid, with the exception of the protein group. Conclusion: after RYGB, the dietary consumption was compromised in quantity and quality. In addition, in the late postoperative period, women tended to choose high calorie dense foods poor in fiber, a fact that is aggravated by the presence of food intolerances.

INTRODUCCIÓN: Introducción: el bypass gástrico en Y de Roux (BGYR) es considerado un tratamiento eficaz de la obesidad. Normalmente, se percibe una mejoría en la ingesta dietética en el postoperatorio inmediato, pero después del primer año hay una tendencia a volver a los viejos hábitos preoperatorios. El objetivo del presente estudio fue comparar la ingesta dietética de las mujeres en el postoperatorio tardío después del BGYR con las recomendaciones de la pirámide nutricional bariátrica. Material y métodos: se consideró a toda la población de pacientes sometidos a BGYR, además de dos ambulatorios del Complexo Hospital de Clínicas de la Universidade Federal de Paraná en el periodo de marzo a septiembre de 2017, seleccionando solo a aquellos que cumplían con los criterios de inclusión. Los análisis realizados fueron: registros hospitalarios, evaluación antropométrica, tasa metabólica basal por calorimetría indirecta, consumo de alimentos y cuestionarios sobre actividad física, intolerancia alimentaria y síndrome de dumping. El consumo de alimentos se dividió en grupos de alimentos para compararlos con la pirámide específica. Se utilizaron análisis descriptivos para caracterizar la muestra. Resultados: podemos observar que el porcentaje de macronutrientes en relación con el valor energético total (VET) estuvo dentro de los valores recomendados por las ingestas diarias recomendadas (IDR), aunque con respecto a la fibra, el 68% de los participantes mostró un consumo inferior a la ingesta adecuada (AI, por sus siglas en inglés). Se observó una insuficiencia en prácticamente todos los componentes al comparar el número de porciones por grupo de alimentos de la pirámide bariátrica, con la excepción del grupo de proteínas. Conclusión: después del BGYR, el consumo dietético se vio comprometido en cantidad y calidad. Además, en el postoperatorio tardío, las mujeres tendían a elegir alimentos ricos en calorías y pobres en fibra, un hecho que se agrava por la presencia de intolerancias alimentarias.

Phase angle as a screening tool for mortality risk among hematopoietic stem cell transplanted adult patients.

BACKGROUND: Mortality among adult patients undergoing hematopoietic stem cell transplantation (HSCT) is high, especially within the first 100 days after the event. Therefore, identifying prognostic factors would be useful as screening tools to protect patients at risk throughout early intervention. In our previous work, the standardized phase angle (SPA) was explored as a useful indicator of survival and nutritional status among children and adolescent within the first 180 days after HSCT. The aim of this study was to evaluate the SPA and the arm muscle area (AMA) as prognostic indicators of mortality and nutritional status among adults in the same population. METHODS: This study was conducted with 29 adult patients undergoing allogeneic HSCT and 28 controls. Anthropometric assessment as well as body composition and laboratory data were analyzed. The phase angle was standardized according to reference values for healthy population. The correlation of SPA and AMA with other variables was verified and sensibility and specificity were tested by constructing ROC curves considering mortality and nutritional status as outcomes. Kaplan-Meier analysis was applied to calculate survival considering the cut-off points found in ROC curves. Chi-squared test and Kappa coefficient were used for evaluate the agreement among methods of nutritional assessment. RESULTS: SPA presented a predictive value for mortality and nutritional status considering the cut-off point at -0.19. In fact, the mortality incidence was higher among patients with values below the cut-off point for SPA as compared to the ones with SPA above this value up to 90 days after the HSCT. Regarding to AMA, mortality was higher using the values bellow P15 (percentile 15) as reference. The average SPA decreased after the beginning of conditioning and after the HSCT, while the decrease of AMA was observed only 90 days after the transplant. CONCLUSIONS: In this study SPA was confirmed as a prognostic tool for adult HSCT patients. In addition, it seems that SPA is more sensitive to detect structural body changes among the transplanted patients as compared to AMA. More studies are needed to confirm it as a tool to screen patients at risk of mortality for early intervention.

Segurança e Benefício do Uso de Probióticos em Pacientes Submetidos ao TCTH: Revisão Integrativa / Safety and Benefit of Using Probiotics in Patients Undergoing HSCT: Integrative Review / Seguridad y Beneficio del Uso de Probióticos en Pacientes Sometidos al TCTH: Revisión Integradora

Introdução: O transplante de células-tronco hematopoiéticas (TCTH) é um dos potenciais tratamentos curativos utilizados para pacientes com doenças hematológicas e outras doenças imunes. Durante o transplante, o paciente é submetido ao condicionamento e a outros tratamentos, como radioterapia e quimioterapia, o que pode causar a perda da diversidade da microbiota intestinal. A manipulação da microbiota intestinal com probióticos vem sendo apontada como uma estratégia de prevenção de complicações nos pacientes submetidos ao TCTH. Objetivo: Identificar se há evidências científicas relacionadas à segurança e aos benefícios da utilização de probióticos em pacientes submetidos ao TCTH. Método: Revisão integrativa com base em estudos que abordassem o uso de probióticos para o caso específico de pacientes submetidos ao TCTH publicados entre 2000 a 2018. Resultados: Foram selecionados cinco estudos que atenderam aos critérios de inclusão e exclusão, com um total de 52 pacientes. A utilização de probióticos na prevenção e/ou tratamento da diarreia tem mostrado resultados positivos em pacientes com diarreia induzida por antibióticos ou por infecções bacterianas, porém os estudos ainda não destacam benefícios no uso de probióticos no caso específico de pacientes submetidos ao TCTH. Poucos estudos mostram o uso de probióticos para auxílio na melhora dos sintomas associados a infecções ou bacteremias em pacientes imunossuprimidos. Conclusão: O uso de probióticos na população submetida ao TCTH e em imunossuprimidos ainda é controverso, sendo necessários mais estudos que demonstrem os benefícios no uso dessa estratégia para esse público.

Introduction: Hematopoietic stem cell transplantation (HSCT) is one of the potential curative treatments used for patients with hematological and other immune diseases. During transplantation, the patient undergoes conditioning and other treatments, such as radiotherapy and chemotherapy, which may cause loss of the intestinal microbiota diversity. The manipulation of the intestinal microbiota with probiotics has been pointed out as a strategy to prevent complications in patients undergoing HSCT. Objective: To identify if there is scientific evidence related to the safety and benefits of the use of probiotics in patients submitted to HSCT. Method: Integrative review based on studies addressing the use of probiotics for the specific case of patients undergoing HSCT published between 2000 and 2018. Results: Five studies that met the inclusion and exclusion criteria were eligible, with a total of 52 patients. The use of probiotics in the prevention and/or treatment of diarrhea has shown positive results in patients with antibiotic-induced diarrhea or bacterial infections, but the studies do not yet emphasize the benefits of using probiotics in the specific case of patients submitted to HSCT. Few studies show the use of probiotics to help the improvement of the symptoms associated to infections or bacteremia in immunosuppressed patients. Conclusion: The use of probiotics in the population submitted to HSCT and immunosuppressed is still controversial, and further studies are necessary to demonstrate the benefits of using probiotics for this public.

Introducción: El trasplante de células madre de las hematopoyéticas (TCTH) es uno de los posibles tratamientos curativos utilizados para pacientes con enfermedades hematológicas y otras enfermedades inmunes. Durante el transplante, el paciente es sometido al condicionamiento ya otros tratamientos, como radioterapia y quimioterapia, lo que puede causar la pérdida de la diversidad de la microbiota intestinal. La manipulación de la microbiota intestinal con probióticos viene siendo apuntada como una estrategia de prevención de complicaciones en los pacientes sometidos al TCTH. Objetivo: Identificar si hay evidencias científicas relacionadas con la seguridad y beneficios de la utilización de probióticos en pacientes sometidos al TCTH. Método: Revisión integradora basada em estúdios que abordan el uso de probióticos para el caso específico de pacientes sometidos a TCMH publicados entre 2000 y 2018. Resultados: Fueron elegibles 4 estudios que atendieron a los criterios de inclusión y exclusión, con un total de 52 pacientes. La utilización de probióticos en la prevención y/o tratamiento de la diarrea ha mostrado resultados positivos en pacientes con diarrea inducida por antibióticos o por infecciones bacterianas, pero los estudios aún no aportan beneficios en el uso de probióticos en pacientes sometidos al TCTH. Pocos estudios muestran infecciones o bacterias en pacientes inmunosuprimidos que utilizaron probióticos para ayudar en la mejora de los síntomas asociados al tratamiento. Conclusión: El uso de probióticos en la población sometida al TCTH e inmunosuprimidos aún es controvertido, siendo necesarios más estudios que comprueben los beneficios en el uso de probióticos para este público.

Short-term follow-up of the nutritional status of children with Fanconi anemia undergoing hematopoietic stem cell transplant.

OBJECTIVE: The objective of this study was to evaluate the nutritional status of children diagnosed with Fanconi anemia (FA) during hematopoietic stem cell transplant (HSCT), comparing it with healthy children and children with other hematologic diseases. METHODS: Observational retrospective study was conducted with patients submitted to HSCT in a period of 5 years. We assessed anthropometric and biochemical data, food intake, and gastrointestinal complications in 49 FA patients. We compared the anthropometric information with those of transplanted patients with other diagnoses (n = 54) in three periods (pre-transplant, 15 and 30 days after the HSCT), and with a group of healthy children (n = 24). RESULTS: Throughout the post-HSCT period, there was a significant decline in the nutritional status of FA patients: 83.3% presented weight loss equal to or greater than 5%. A progressive decrease in food intake after the transplantation was observed, with weekly deficits reaching 7841.3 kcal and 347.6 g of protein (both p < 0.05). When comparing FA with other diagnoses patients, the former displayed a poorer nutritional status prior to HSCT (p < 0.01 for BMI/age z-score), and that difference was maintained during the transplant (p < 0.01 for the same parameter), with similar weight loss values for both groups (8.99 vs 7.91%, respectively; p > 0.05). When compared to the control group of healthy children, FA patients prior HSCT showed substantially lower z-scores for Ht./age (p < 0.01) and BMI/age (p < 0.05). CONCLUSION: Although FA patients demonstrated poorer nutritional status as compared to other diagnosis and healthy children, the decline of anthropometric measures along the treatment is similar to other transplanted patients, imposing a greater risk to FA patients.

Vegetarians at the University's restaurants: are they doing well? / Vegetarianos nos restaurantes da universidade: eles estão se saindo bem?

Objective: Vegetarians might be at nutritional risk due to their food preferences. The goal of this study was to compare nutritional status and food intake of vegetarians and omnivores that use restaurants at the Federal University of Parana in Brazil. Methods: Clinical cross-sectional observational study performed between May 2014 and March 2015, assessing 84 vegetarians and 131 omnivores, adults, of both sexes. Anthropometric and body composition characteristics were evaluated on the total sample. In a subsample of 38 vegetarians and 63 omnivores, food intake of macronutrients, fibers, vitamin B12, vitamin D, calcium, iron and zinc were evaluated. Blood tests for vitamin B12, iron, and ferritin were performed in a subsample of 40 individuals of each group. Results: The studied groups presented similar anthropometric data and body composition, although both had individuals classified as at risk for cardiovascular diseases according to body mass index (BMI) (16.7% and 24.4% above 25 kg/m2 among vegetarians and omnivores, respectively). The caloric intake did not differ as well, although the main sources of energy intake among vegetarians were carbohydrates as compared to omnivores that had lipids as the main source of energy in their meals. Vegetarians reached the recommended intake of fibers, and the omnivores, had a lower intake of this nutrient as expected. For vitamin B12 the prevalence of inadequate intake was 37.8% on the vegetarians group and 0.6% on the omnivores, and for calcium, 49% for both groups. Both presented vitamin D intake below the estimated average requirement. The intake of iron did not differ among groups, however, in the vegetarian group the inadequacy reached 50% for men and 100% for women; and in the omnivore group 93% for women. For zinc, the inadequacy risk was 100% for men and 90% for women in the vegetarian group and 25% of men and 4.5% for women on the omnivore group. Regarding the biochemical exams, the most evident deficiency was of serum vitamin B12 on vegetarians. Conclusions: The food choices among the investigated undergraduate vegetarians do not guarantee nutritional security as detected in this study. Except for calcium, the prevalence of inadequate intake of macro and micronutrients was higher among vegetarians as compared to omnivores, stablishing a nutritional risk status to this group regarding to intake of sources of vitamin B12, vitamin D, iron and zinc.

Objetivo: Os vegetarianos podem estar em risco nutricional devido às suas preferências alimentares. O objetivo deste estudo foi comparar o estado nutricional e a ingestão alimentar de vegetarianos e onívoros que utilizam restaurantes da Universidade Federal do Paraná, no Brasil. Método: Estudo clínico observacional de corte transversal realizado entre maio de 2014 e março de 2015, avaliando 84 vegetarianos e 131 onívoros, adultos, de ambos os sexos. As características antropométricas e de composição corporal foram avaliadas na amostra total. Em uma subamostra de 38 vegetarianos e 63 onívoros, a ingestão alimentar de macronutrientes, fibras, vitamina B12, vitamina D, cálcio, ferro e zinco foram avaliados. Exames de sangue para vitamina B12, ferro e ferritina foram realizados em uma subamostra de 40 indivíduos de cada grupo. Resultados: Os grupos estudados apresentaram dados antropométricos e composição corporal semelhantes, embora ambos apresentassem indivíduos classificados como de risco para doenças cardiovasculares de acordo com o índice de massa corporal (IMC) (16,7% e 24,4% acima de 25 kg/m2 entre vegetarianos e onívoros, respectivamente). A ingestão calórica também não diferiu, embora as principais fontes de ingestão de energia entre os vegetarianos fossem carboidratos em comparação aos onívoros que tinham lipídios como principal fonte de energia em suas refeições. Os vegetarianos atingiram a ingestão recomendada de fibras, e os onívoros tiveram uma ingestão menor desse nutriente como esperado. Para a vitamina B12, a prevalência de ingestão inadequada foi de 37,8% no grupo dos vegetarianos e de 0,6% nos onívoros, e para o cálcio de 49% nos dois grupos. Ambos apresentaram ingestão de vitamina D abaixo do requisito médio estimado. A ingestão de ferro não diferiu entre os grupos, no entanto, no grupo vegetariano a inadequação chegou a 50% para os homens e 100% para as mulheres; e no grupo onívoro, 93% para as mulheres. Para o zinco, o risco de inadequação foi de 100% para homens e 90% para mulheres no grupo vegetariano e 25% de homens e 4,5% para mulheres no grupo onívoro. Em relação aos exames bioquímicos, a deficiência mais evidente foi de vitamina B12 sérica nos vegetarianos. Conclusões: As escolhas alimentares entre os vegetarianos de graduação investigados não garantem a segurança nutricional, como detectado neste estudo. Com exceção do cálcio, a prevalência de ingestão inadequada de macro e micronutrientes foi maior entre os vegetarianos em relação aos onívoros, estabelecendo um risco nutricional para esse grupo em relação à ingestão de fontes de vitamina B12, vitamina D, ferro e zinco.

Body composition of Fanconi anemia patients after hematopoietic stem cell transplantation

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Body composition of Fanconi anemia patients after hematopoietic stem cell transplantation.

INTRODUCTION: Fanconi anemia is a rare genetic disease linked to bone marrow failure; a possible treatment is hematopoietic stem cell transplantation. Changes in the nutritional status of Fanconi anemia patients are not very well known. This study aimed to characterize body composition of adult, children and adolescent patients with Fanconi anemia who were submitted to hematopoietic stem cell transplantation or not. METHODS: This cross-sectional study enrolled 63 patients (29 adults and 34 children and adolescents). Body composition was assessed based on diverse methods, including triceps skin fold, arm circumference, arm muscle area and bioelectrical impedance analysis, as there is no established consensus for this population. Body mass index was also considered as reference according to age. RESULTS: Almost half (48.3%) of the transplanted adult patients were underweight considering body mass index whereas eutrophic status was observed in 66.7% of the children and adolescents submitted to hematopoietic stem cell transplantation and in 80% of those who were not. At least 50% of all groups displayed muscle mass depletion. Half of the transplanted children and adolescents presented short/very short stature for age. CONCLUSION: All patients presented low muscle stores, underweight was common in adults, and short stature was common in children and adolescents. More studies are needed to detect whether muscle mass loss measured at the early stages of treatment results in higher risk of mortality, considering the importance of muscle mass as an essential body component to prevent mortality related to infectious and non-infectious diseases and the malnutrition inherent to Fanconi anemia.

Cross-cultural adaptation and validation to Brazil of the Obesity-related Problems Scale.

OBJECTIVE: To validate a reliable version of the Obesity-related Problems Scale in Portuguese to use it in Brazil. METHODS: The Obesity-related Problems Scale was translated and transculturally adapted. Later it was simultaneously self-applied with a 12-item version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), to 50 obese patients and 50 non-obese individuals, and applied again to half of them after 14 days. RESULTS: The Obesity-related Problems scale was able to differentiate obese from non-obese individuals with higher accuracy than WHODAS 2.0, correlating with this scale and with body mass index. The factor analysis determined a two-dimensional structure, which was confirmed with χ2/df=1.81, SRMR=0.05, and CFI=0.97. The general a coefficient was 0.90 and the inter-item intra-class correlation, in the reapplication, ranged from 0.75 to 0.87. CONCLUSION: The scale proved to be valid and reliable for use in the Brazilian population, without the need to exclude items.

Cross-cultural adaptation and validation to Brazil of the Obesity-related Problems Scale / Adaptação transcultural e validação para o Brasil da Obesity-related Problems Scale

ABSTRACT Objective To validate a reliable version of the Obesity-related Problems Scale in Portuguese to use it in Brazil. Methods The Obesity-related Problems Scale was translated and transculturally adapted. Later it was simultaneously self-applied with a 12-item version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), to 50 obese patients and 50 non-obese individuals, and applied again to half of them after 14 days. Results The Obesity-related Problems scale was able to differentiate obese from non-obese individuals with higher accuracy than WHODAS 2.0, correlating with this scale and with body mass index. The factor analysis determined a two-dimensional structure, which was confirmed with χ2/df=1.81, SRMR=0.05, and CFI=0.97. The general a coefficient was 0.90 and the inter-item intra-class correlation, in the reapplication, ranged from 0.75 to 0.87. Conclusion The scale proved to be valid and reliable for use in the Brazilian population, without the need to exclude items.

RESUMO Objetivo Validar uma versão confiável da Obesity-related Problems Scale em português para utilização no Brasil. Métodos A Obesity-related Problems Scale foi traduzida e adaptada transculturalmente. Posteriormente, foi autoaplicada simultaneamente à versão de 12 itens da World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) a 50 pacientes obesos e a 50 indivíduos não obesos, sendo reaplicada à metade deles após 14 dias. Resultados A Obesity-related Problems Scale foi capaz de diferenciar obesos de não obesos com maior acurácia que a WHODAS 2.0, estando correlacionada a esta e com o índice de massa corporal. A análise fatorial determinou estrutura bidimensional, que foi confirmada com χ2/df=1,81, SRMR=0,05, and CFI=0,97. O coeficiente a geral foi de 0,90 e a correlação intraclasse interitem, na reaplicação, variou de 0,75 a 0,87. Conclusão A escala provou ser válida e confiável para ser utilizada na população brasileira, sem necessidade de exclusão de itens.

Polyphenol-Rich Foods Alleviate Pain and Ameliorate Quality of Life in Fibromyalgic Women.

Objectives: The present study aimed to describe the antioxidant dietary intake of patients with fibromyalgia and explore the association of the results with glutathione status, pain, quality of life, and socioeconomic status. METHODS: 38 fibromyalgic female patients and 35 female controls (mean age = 48.6 ± 8.1 and 47.6 ± 10.0 years, respectively) were evaluated. The number of tender points, pain threshold, quality of life, physical activity, socioeconomic status, nutritional status, intake of antioxidant micronutrients and foods with high total antioxidant capacity, and total salivary glutathione were evaluated. RESULTS: The number of tender points, pain threshold, and quality of life were worse in the fibromyalgia group. The consumption of vegetable juices was more common among women with fibromyalgia and consumption of red wine and beer were more common among healthy women. The adjusted mean intakes of antioxidant vitamins as well as selenium were higher for the control group (p ≤ 0.01). There was no difference for salivary levels of glutathione between the groups and no correlation for intake of antioxidant micronutrients and pain or quality of life among fibromyalgic women. However, intake of foods rich in polyphenols was associated with lower numbers of tender points (coffee, r = - 0.346; pear, r = - 0.331) and better quality of life (red fruits, r = - 0.342; dark chocolate, r = - 0.404) in the fibromyalgic group. In these women, associations between glutathione levels and food intake, pain or quality of life were not found. CONCLUSION: This study indicated that antioxidant protection from bioactive compounds present in fruit and vegetables could have an adjuvant role in fibromyalgia treatment.

Comparação de métodos de detecção da desnutrição no ambiente hospitalar / Comparison of methods for detection of malnutrition in hospital environment

Objetivo: Comparar o diagnóstico de desnutrição em pacientes hospitalizados por meio da Avaliação Subjetiva Global (ASG) e o consenso de desnutrição proposto pela American Society for Parenteral and Enteral Nutrition (ASPEN). Método: Estudo retrospectivo, observacional, sendo a amostra composta de pacientes com idade superior a 18 anos internados no período de 2011 a 2014 nas clinicas médicas e cirúrgica de um Hospital Público terciário. Foram incluídos pacientes identificados como risco nutricional por meio da Triagem de Risco Nutricional (NRS-2002). Os diagnósticos de desnutrição foram estabelecidos com base nos dados das fichas de acompanhamento nutricional e a classificação realizada conforme a proposta da Avaliação Subjetiva Global (ASG) e do consenso de desnutrição da American Society for Parenteral and Enteral Nutrition (ASPEN). Para verificar a concordância entre as ferramentas foi aplicado o Coeficiente de Kappa. Resultados: A amostra totalizou em 963 pacientes, na maioria adultos (52,6%) e do sexo masculino (56,2%). Ao verificar a concordância entre as ferramentas obteve-se o valor de kappa=0,392 mostrando assim que não houve concordância entre as classificações de desnutrição. Melhor concordância foi encontrada ao comparar os instrumentos considerando a presença ou ausência da desnutrição (kappa=0,513). Conclusão: As ferramentas analisadas não apresentaram concordância na identificação dos graus de desnutrição. Ressalta-se, porém, a importância da análise de métodos diagnósticos para que sejam utilizados instrumentos sensíveis na identificação de pacientes desnutridos, para que a intervenção nutricional precoce possa ser realizada

Objective: Compare the diagnosis of malnutrition in hospitalized patients by means of the Subjective Global Assessment (ASG) and the consensus of malnutrition proposed by American Society for Parenteral and Enteral Nutrition (ASPEN). Methods: Retrospective study, observational, the sample consisted of patients with age above 18 years admitted in the period 2011 to 2014 in medical and surgical clinics of a tertiary public hospital. Patients included were identified as nutritional risk by means of screening of nutritional risk (NRS- 2002). To verify the concordance between the tools were applied the Kappa Coefficient. Results: The sample totaled in 963 patientes, in most adults (52,6%) and male (56,2%). To check the concordance between the tools it was obtained the kappa value=0,392 thus showing that there was no concordance between the classifications of malnutrition. Best concordance was found when comparing the instruments considering the presence or absence of malnutrition (kappa=0,513). Conclusions: The tools analyzed didn't agree in the identification of degrees of malnutrition. It must be highlighted the importance of analysis of diagnostics methods to be used sensitive instruments in the identification of malnourished patients for which the early nutritional intervention can be performed

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Pre-transplant arm muscle area: a simple measure to identify patients at risk.

PURPOSE: This study aims to explore parameters of nutritional assessment and food intake as predictors of clinical outcomes after hematopoietic stem cell transplant (HSCT). METHODS: The study was conducted retrospectively with 56 adult patients undergoing allogeneic HSCT. Energy and protein daily intake were used to calculate the energy and protein cumulative deficit. The nutritional assessment tools were weight, body mass index (BMI), triceps skinfold (TSF), and arm muscle area (AMA) before HSCT and after HSCT. RESULTS: Food intake decreased immediately after the transplant and the energy and protein cumulative deficit increased during hospitalization (p < 0.01). Almost 70 % of patients had severe weight loss (greater than 5 %), and the average percentage of weight loss was 8.5 ± 3.9 %. BMI and weight loss percentage were not correlated with the presence of acute graft versus host disease (GVHD) and mortality within 180 days in this population. On the other hand, correlation was found between the initial (pre-HSCT) AMA equal to or below the 15th percentile, with the presence of acute GVHD (p = 0.024), and mortality within 180 days after HSCT (p = 0.010). CONCLUSIONS: The AMA measured pre-HSCT showed to be a potential predictor of acute GVHD and mortality up to 180 days after transplant in adult patients.

Phase angle from BIA as a prognostic and nutritional status tool for children and adolescents undergoing hematopoietic stem cell transplantation.

BACKGROUND & AIMS: The phase angle (PA) has been considered a prognostic and nutritional status indicator in several clinical situations considering its use as a body cell mass estimate value. The aim of this study was to evaluate the association between PA and other methods of nutritional assessment, as well as its prognostic value for children and adolescents undergoing hematopoietic stem cell transplantation (HSCT). METHODS: The nutritional status of 67 patients and 35 controls was assessed by bioelectric impedance analysis and anthropometric measurements. The phase angle was calculated and expressed in degrees and standardized (SPA) according to reference values. The Kaplan-Meier method was used to calculate survival and Kappa coefficient to determine the concordance between the SPA and other parameters of nutritional assessment. The correlation was established by using Pearson's correlation analysis. RESULTS: SPA progressively decreased during the treatment. The agreement between SPA and the diagnosis of malnutrition was moderate to %ideal weight, %TSF and %AMC and weak for BMI and weight/age z-score. Patients who had severe weight loss after transplantation had lower levels of SPA as compared to the group that did not lose weight (p < 0.001). Patients who developed chronic graft-versus-host disease had lower levels of SPA (p = 0.02), as well as patients who had been using corticosteroids during the post-transplant phase (p = 0.03). In this case, there was an inverse correlation between drug dose and SPA (p = 0.01). Patients with SPA ≤ 0 SD had a lower survival time as compared to the group of patients with SPA > 0 SD (p = 0.02) and showed an increased risk of death of 5.1as compared to the other group (95% CI: 1.41-18.94). CONCLUSION: The present study suggests that SPA could be useful as an indicator of survival and nutritional status for patients undergoing HSCT.

Cookies sem glúten a partir da farinha de sorgo / Gluten free cookies prepared with sorghum flour

O sorgo, por ser desprovido de glúten, pode ser utilizado na fabricação de produtos de panificação para indivíduos com Doença Celíaca, que dispõem de poucas alternativas culinárias disponíveis no mercado. Em razão disso, o presente trabalho teve como objetivo desenvolver cookies de chocolate utilizando farinha de sorgo (Sorghum vulgare). Foi aplicado o delineamento experimental fator simplex-lattice com farinhas isentas de glúten: farinha de sorgo (50-100 por cento), farinha de arroz (0-50 por cento) e amido de milho (0-50 por cento); totalizando dez experimentos. As formulações IX e X foram selecionadas por apresentarem melhores características sensoriais. Foram realizadas análises físicas e químicas da farinha de sorgo, dos cookies comerciais com glúten e dos isentos de glúten elaborados neste trabalho. Nas amostras comerciais foram também realizadas análises físicas e sensoriais pela Análise descritiva quantitativa e Escala hedônica. Os resultados das análises físicas e químicas da farinha de sorgo mostraram-se próximos aos preconizados pela legislação. As formulações que apresentaram características sensoriais satisfatórias foram as que continham 58 e 67 por cento de farinha de sorgo, 8 e 17 por cento de farinha de arroz, 33 e 17 por cento de amido de milho, respectivamente. O rendimento das formulações IX e X foi de 0,92 e o volume específico de 1,54 e 1,46cm³/g, respectivamente. A maioria dos atributos sensoriais avaliados dos cookies com farinha de sorgo em relação ao comercial não apresentou diferença estatística significativa em nível de 5 por cento, com exceção da cor e odor. Cem por cento dos provadores com Doença Celíaca atribuíram valores iguais ou superiores a 7 para ambas as amostras, sendo que a maioria atribuiu valor 8. Os resultados demonstraram a viabilidade do uso da farinha mista com sorgo na elaboração de cookies sem glúten.

Considering that sorghum is a gluten free flour, it could be proposed as an ingredient to produce alternative bakery products for the subjects with Celiac Disease, since they do not have many food options available in the market. For this reason, the main goal of this study is to develop chocolate cookies with sorghum flour (Sorghum vulgare). The experimental design used was the simplex-lattice factor to compare the following variables: sorghum flour (50-100 percent), rice flour (0-50 percent) and corn starch (0-50 percent), totaling up to ten experiments. The formulations IX and X were selected as the ones with the highest sensorial scores The sorghum flour, regular chocolate cookies and gluten free cookies were submitted to physicochemical analysis. Physical and sensorial analysis using Quantitative Descriptive Analysis (QDA) and hedonic analysis were performed for the two cookies preparation. Sorghum flour presented characteristics compared with the described by the food regulation laws. The preparations that presented satisfactory sensorial characteristics were the ones that had 58 and 67 percent of sorghum flour, 8 and 17 percent of rice flour, 33 and 17 percent of corn starch, respectively. The performance for both IX and X formulations was 0,92 and the specific volume was 1,54 and 1,46cm³/g, respectively. When compared with regular cookies, the differences on most of the sensorial attributes evaluated on sorghum cookies were not statistically significant (P < 0.05), except for the color and the odour. All the sensorial scores reached values equal or higher than 7 for both samples and most of them scored 8. The results showed the feasibility of including sorghum flour on the manufacture of gluten free cookies.