Barriers and Opportunities for Clinical Nutritionists in 13 Latin American Countries: A Qualitative Study.

A clinical nutritionist (CN) is a university-educated professional trained to perform preventive and recovery functions in the health of patients. The actions of these professionals, both worldwide and in Latin America, may face barriers and opportunities that require careful identification and examination. The main objective of this study is to identify the most important barriers and opportunities for the clinical nutritionist in 13 Latin American countries. A qualitative study was carried out; the initial phase involved conducting in-depth individual interviews with 89 informants, experienced CNs from 13 Latin American countries. After calculating the mean and standard deviation, we ranked the top 10 most frequently reported barriers by assigning a score ranging from 1 to 10. Additionally, 3 opportunities were identified with a lower score from 1 to 3. Means and standard deviation were calculated to sort the responses. Results: the most important barrier was the absence of public policies that regulate and/or monitor compliance with the staffing of CNs according to the number of hospital beds, while the most important opportunity was the advances in technology such as software, body analysis equipment and other tools used in Nutritional Care. The identified barriers can interfere with the professional performance of CNs and, moreover, make it difficult to monitor the good nutritional status of patients. It is recommended to consider the barriers identified in this study, as well as the opportunities, with a view to improving the quality of hospital services with an adequate supply of nutritionists.

Effects of total parenteral nutrition associated with glutamine, enteral fluid therapy, with or without glutamine, and fluid therapy on the lipidogram of horses subjected to starvation after laparotomy / [Efeitos da nutrição parenteral total associada à glutamina, à fluidoterapia enteral, associada ou não à glutamina, e fluidoterapia sobre o lipidograma de equinos submetidos à inanição após laparotomia]

ABSTRACT In order to evaluate the effect of total parenteral nutrition associated with glutamine and enteral fluid therapy, associated or not with glutamine, on the lipidogram of horses subjected to starvation (phase 1) and refeeding (phase 2), 16 adult healthy horses were used, mixed breed, aged between four and fourteen years and average weight of 248.40 ± 2.28kg, divided into four experimental groups, with four animals per group: Group ENTGL: enteral fluid therapy with electrolytes associated with glutamine; Group PARGL: total parenteral nutrition associated with glutamine; Group ENTFL: enteral fluid therapy with electrolytes; and Group PARFL: parenteral fluid therapy. This study was divided into two phases: phase 1 and phase 2. Phase 1 consisted of performing exploratory laparotomy and beginning of starvation, in addition to the administration of treatments, according to the group, while phase 2 consisted of re-feeding the animals. Total cholesterol values remained within the normal range for the species throughout the experimental period, but there was a slight increase during phase 1, followed by a decrease in values in phase 2. Hypertriglyceridemia in the ENFL, ENTGL and PARFL groups during phase 1 occurred because of the negative energy balance. The provision of enteral fluid therapy with electrolytes and an energy source, with or without glutamine, or parenteral fluid therapy were not effective in reversing the effects of negative energy balance. Thus, therapeutic protocols that combine enteral or parenteral fluid therapy for prolonged periods and food deprivation need additional nutritional support to avoid the deleterious effects of negative energy balance.

RESUMO Com o objetivo de avaliar o efeito da nutrição parenteral total associada à glutamina e da fluidoterapia enteral, associada ou não à glutamina, sobre o lipidograma de equinos submetidos à inanição (fase 1) e realimentação (fase 2), foram utilizados 16 equinos adultos hígidos, sem raça definida, com idade variando entre quatro e 14 anos e peso médio de 248,40 ± 2,28kg, divididos em quatro grupos experimentais, quatro animais por grupo: grupo ENTGL: fluidoterapia enteral com eletrólitos associada à glutamina; grupo II PARGL: nutrição parenteral total associada à glutamina; grupo ENTFL: fluidoterapia enteral com eletrólitos; e grupo PARFL: fluidoterapia parenteral. Este estudo foi dividido em duas fases: fase 1 e fase 2. A fase 1 consistiu na realização da laparotomia exploratória e no início da inanição, além da administração dos tratamentos, de acordo com o grupo; a fase 2 consistiu na realimentação dos animais. Os valores de colesterol total se mantiveram dentro da faixa de normalidade para a espécie durante todo o período experimental, porém houve discreta elevação ao longo da fase 1, seguida de diminuição dos valores na fase 2. Hipertrigliceridemia nos grupos ENTFL, ENTGL e PARFL durante a fase 1 ocorreu em decorrência do equilíbrio energético negativo. O fornecimento de fluidoterapia enteral com eletrólitos e uma fonte de energia, associada ou não à glutamina, ou o de fluidoterapia parenteral não foram efetivos em reverter os efeitos do equilíbrio energético negativo. Dessa forma, protocolos terapêuticos que associem fluidoterapia enteral ou parenteral por períodos prolongados e privação alimentar necessitam de suporte nutricional adicional para evitar os efeitos deletérios do equilíbrio energético negativo

Undervalued professionals: placement of nutritionist in the Ecuadorian health system.

BACKGROUND: Currently, many public health issues are directly related to malnutrition, and are made worse by social inequities. Nutrition professionals must be a key player in improving epidemiological aspects of nutrition-related diseases and must be part of clinical teams to control nutritional concerns. OBJECTIVE: To identify and analyze the nutritionists´ employment situation in Ecuador and areas of work covered and determine if type of university has an impact over work situation. METHODOLOGY: A cross-sectional study was conducted, approved by the ethics committee of Universidad San Francisco de Quito. It included 442 nutritionists in Ecuador who graduated in 13 universities (5 private (PR) and 8 public (PU)) between 2008 and 2019. It implied an online survey that questioned their satisfaction with their education and current work situation. All the statistical analyses were performed using R version 4.0.3, two-sided weighted chi-square test was performed to estimate the difference between public and private university graduates, IC 95%, p between 0.01 and 0.05. RESULTS: 38,6% of participants are unemployed, 68,28% private university graduates (PR) are currently employed and 58.87% work as nutritionists, compared to 56,86% from a public university (PU) currently working and 44.69% working in the field. 76% have reported being unemployed at some point in their careers, being difficulty finding jobs the main reason. Regarding the professional field, most professionals have their own business, and the less common area of work was public and community nutrition. One third of the participants had another paid activity. The main salary is 800USD per month and graduated from PR perceived better salaries than from PU. CONCLUSION: There is a lack of job opportunities for Ecuadorian nutritionists despite the high demand in every level of the health system. Most have been unemployed at some point in their careers due to difficulties finding jobs. There is a minimum nutrition staff working in community and public health nutrition.

Comendo nas encruzilhadas: contribuições interseccionais para a Nutrição Clínica Ampliada e Implicada / Eating at the crossroads: intersectional contributions to an Expanded and Implicated Clinical Nutrition

Resumo Este ensaio, que traz contribuições póstumas da primeira autora, parte da compreensão da interseccionalidade como ferramenta teórica-metodológica e oferenda analítica que evidencia como sistemas múltiplos de subordinação e discriminação, suas consequências e dinâmicas estruturais, se relacionam entre dois ou mais eixos de opressão social. Propomos uma aproximação epistemológica entre esta compreensão e o campo da Alimentação e Nutrição, que contribua para pensar um cuidado alimentar e nutricional interseccional e uma práxis integral. Corroborando a metáfora da intersecção (e da encruzilhada), afirmamos que vários eixos de poder - raça, gênero, sexualidade, etnia, idade, classe, tamanho corporal, (dis)capacidades, entre outros - conformam as avenidas que estruturam o terreno do cuidado em saúde, inclusive o alimentar e nutricional. Entre tais avenidas e encruzilhadas, traçamos uma proposição inicial de Nutrição Clínica Ampliada e Implicada. Entre as implicações propostas, destacamos a reflexividade e a ação nas relações de poder e opressão, situando o(a) nutricionista como agente político, implicado com práxis emancipatórias, participativas e referenciadas socialmente. A interseccionalidade se traveste aqui como estratégia para o trabalho de justiça social, incluindo nesta a alimentação e a nutrição. Tratamos de relações em construção, constituindo práticas reflexivas, de composição de sentidos no ato do trabalho vivo alimentar e nutricional.

Abstract This essay, which brings posthumous contributions from the first author, starts from the understanding of intersectionality as a theoretical-methodological tool and analytical offering that shows how multiple systems of subordination and discrimination, their consequences and structural dynamics, relate between two or more axes of social oppression. We propose an epistemological approximation between this understanding and the field of Eating and Nutrition, which contributes to thinking an intersectional eating and nutritional care and an integral praxis. Corroborating the intersection (and crossroads) metaphor, we state that several axes of power - race, gender, sexuality, ethnicity, age, class, body size, (dis)abilities, among others - shape the avenues that structure the field of health care, including eating and nutritional care. Among such avenues and crossroads, we outline an initial proposal of an Extended and Implicated Clinical Nutrition. Among the proposed implications, we highlight reflexivity and action in power and oppression relations, placing the nutritionist as a political agent, involved with emancipatory, participatory, and socially referenced praxis. Intersectionality, therefore, is treated here as a strategy for social justice work, including eating and nutrition. We deal with relationships under construction, constituting reflective practices, the composition of meanings in the act of living eating and nutrition work.

Risco nutricional e fatores associados em pacientes hospitalizados pelo sistema único de saúde: comparação entre os sexos / Nutricional risk and associated factors in hospitalized patients: comparison between genders

Introdução: a desnutrição representa um problema clínico-nutricional frequente em pacientes hospitalizados, sendo que a detecção precoce do risco nutricional torna-se fundamental, pois possibilita à equipe multidisciplinar o início imediato de uma conduta dietética adequada, minimizando o sinergismo entre a desnutrição e os demais fatores clínicos. Objetivo: determinar o risco nutricional, associando com o estado nutricional, estilo de vida e variáveis clínicas de hospitalização de pacientes internados pelo SUS, comparando tais condições entre os sexos. Metodologia: trata-se de estudo transversal. Para avaliação do risco nutricional dos pacientes hospitalizados foi utilizado o protocolo de triagem nutricional Nutricional Risk Screening (NRS) 2002, além disso foram coletados dados antropométricos, clínicos, sociodemográficos e dietéticos para comparação com o risco nutricional. Resultados: a amostra foi composta por 100 pacientes, sendo 50% adultos e 50% idosos, com média de idade de 56,11±19 anos, sendo a maioria do sexo masculino (51%). O risco nutricional esteve presente em 34% dos pacientes avaliados, sendo 58,8% no sexo feminino e 41,2% no sexo masculino. Não houve diferença das demais variáveis quando comparadas entre os sexos (p>0,05). A maior prevalência de risco observada foi em idosos (27%). Conclusão: o risco nutricional obteve maior prevalência nos pacientes idosos, porém não houve diferença entre os sexos. Sabe-se que a presença de comorbidades e uma inadequada aceitação da dieta por parte dos mesmos pode levar a uma piora significativa do estado nutricional.

Malnutrition is a frequent clinical and nutritional problem in hospitalized patients, and early detection of nutritional risk is essential, as it allows the multidisciplinary team to immediately start an adequate dietary approach, minimizing the synergism between malnutrition and other clinical factors. Objective: to determine the nutritional risk, associating it with the nutritional status, lifestyle and clinical variables of hospitalization of patients hospitalized by the SUS, comparing such conditions between the sexes. Methodology: this are a cross-sectional study. To assess the nutritional risk of hospitalized patients, the Nutritional Risk Screening (NRS) 2002 protocol was used. In addition, anthropometric, clinical, sociodemographic and dietary data were collected for comparison with nutritional risk. Results: the sample consisted of 100 patients, 50% adults and 50% elderly, with a mean age of 56.11±19 years, the majority being male (51%). Nutritional risk was present in 34% of the patients evaluated, being 58.8% female and 41.2% male. There was no difference in the other variables when compared between the sexes (p>0.05). The highest prevalence of risk observed was in the elderly (27%). Conclusion: nutritional risk was more prevalent in elderly patients, but there was no difference between the sexes. It is known that the presence of comorbidities and an inadequate acceptance of the diet by them can lead to a significant worsening of the nutritional status.

Therapeutic supplementation with zinc in the management of COVID-19-related diarrhea and ageusia/dysgeusia: mechanisms and clues for a personalized dosage regimen.

Zinc supplementation is indicated for diarrhea and taste disorders, which are both features of COVID-19 . Nevertheless, this strategy has not been tested for the treatment of these secondary complications in the current pandemic. Through an updated review, a practical appraisal was considered as a means of providing a medical nexus of therapeutic zinc regimens as an adjunct in the management of COVID-19-related diarrhea and ageusia/dysgeusia. While diarrhea and taste disorders are consequences of COVID-19, zinc supplementation is useful for non-COVID-19 patients with these clinical problems. The overwhelming evidence for supplementing with zinc in diarrhea and pneumonia is associated with the treatment of children, while for taste disorders the use of supplementing with zinc is more examined in adults. Whereas COVID-19 is more prevalent in adults, precautions should be exercised not to translate the zinc dosage used for children with diarrhea and taste disorders into the current pandemic. Therapeutic doses of zinc used for adults (∼50-150 mg/day of elemental zinc) could be included in the treatment strategies for COVID-19, but this proposal should be examined through randomized studies.

Association of breakfast skipping with cardiovascular outcomes and cardiometabolic risk factors: an updated review of clinical evidence.

"Eat breakfast like a king, lunch like a prince and dinner like a pauper" (Adelle Davis, 1904-1974) is a concept that appears to align with some contemporary evidence concerning the appropriate proportioning of daily meals. At the same time, with the popular and scientific dissemination of the concepts of intermittent fasting and time-restricted feeding, well-controlled clinical trials have emerged showing the safety or even possible benefits of skipping breakfast. In this comprehensive literature review, we discuss recent evidence regarding breakfast intake, cardiovascular outcomes and cardiovascular risk markers. Overall, breakfast omission appears to be associated with a higher risk for atherosclerotic and adverse cardiovascular outcomes. However, caution should be employed when deciphering these data as many complex, unmeasured confounders may have contributed. Unfortunately, long-term randomized, clinical trials with detailed dietary control that have assessed clinical outcomes are sparse. Notwithstanding the observational findings, current trials conducted so far-albeit apparently smaller number-have shown that breakfast addition in subjects who do not habitually consume this meal may increase body weight, particularly fat mass, through caloric excess, whereas skipping breakfast may be a feasible strategy for some people aiming for calorie restriction. To date, definitive benefits of breakfast omission or consumption are not supported by the best evidence-based research, and the question of whether skipping breakfast per se is causally associated with cardiovascular outcomes remains unresolved.

Predictive equations of maintenance energy requirement for healthy and chronically ill adult dogs.

Maintenance energy requirement (MER) is the energy amount necessary for dogs to maintain their weight and body condition. Some factors can influence the MER, such as gender, age, neutering status and also diseases. The present retrospective study aimed to evaluate MER of adult dogs with several diseases and compare with the MER of healthy adult dogs, observing the influence of parameters such as body condition score (BCS), neutering status, gender, age, diagnosis and type of food on MER of these dogs. A total of 165 adult dogs with weight changes of ≤5% were included and divided in groups according to diagnosis. Mean MER for healthy dogs was 86.09 kcal/BW0.75 , which differed from NRC and FEDIAF recommendations for inactive adult dogs (p = .047). Lowest MERs were of the endocrinopathies (78.52 ± 19.32 kcal/BW0.75 ), orthopaedic diseases (59.71 ± 19.30 kcal/BW0.75 ) and neurologic diseases (78.83 ± 32.66 kcal/BW0.75 ) groups. Gastrointestinal diseases (99.59 ± 20.36 kcal/BW0.75 ), orthopaedic diseases (59.71 ± 19.30 kcal/BW0.75 ) and neoplasia (95.61 ± 21.02 kcal/BW0.75 ) groups were the only groups that differed from the mean MER of healthy adult dogs. Regarding BCS, for each increasing point in a 9-point scale, there was a decrease of 9.8 kcal/BW0.75 on MER, independent of diagnosis (p < .0001; r2  = .55). There was no difference regarding breed size gender and age, but neutered dogs presented lower MER (p = .031). Based on data obtained from the present study, it can be concluded that it is necessary to consider BCS, age, neutering status and diagnosis when calculating MER, both in healthy dogs and chronically ill dogs.

Dynamic Macronutrient Meal-Equivalent Menu Method: Towards Individual Nutrition Intervention Programs.

Nutrition interventions should reflect the state of the art in science and dietetics to meet each patient's requirements. Incorporating new knowledge into individualized food-based nutrition interventions is a major challenge, and health care professionals constantly search for novel approaches through specific and standardized methods. The dynamic macronutrient meal-equivalent menu method involves individuals making informed food choices that match their requirements, schedule, and food availability and affinity, helping them maintain a sense of control and motivation to adhere to a nutrition intervention program. This protocol includes the steps required to prepare a nutrition plan containing equivalent meal options consistent with the patient's needs and preferences. Standard food servings are planned according to population specific dietary guidelines and individual characteristics. Servings are distributed at required mealtimes, and are all equivalent in energy and macronutrient content, providing every patient with interchangeable choices within each mealtime. This empowers individuals to select foods in a guided format whilst adhering to a dietary plan. Acceptable variations for calculated energy and macronutrient content are as follows: protein ±1 g/day, fat ±1 g/day, carbohydrate ±2 g/day, and energy ±15 kcal/day. Following this method, health care professionals can develop individualized nutrition intervention programs that may improve patients' adherence, nutritional status, and health.

Nutrição parental e enteral na clínica de pets exóticos (Revisão de Literatura) / Parenteral and enteral nutrition in exotic pets clinic / Nutrición parenteral y enteral en clínica de mascotas exóticas

Os animais exóticos têm sido alvo de grande interesse no mercado pet, necessitando de médicos veterinários especializados para atender com eficiência esta demanda. Para isso, é preciso adequar técnicas,geralmente aplicadas apenas aos pequenos animais de companhia à rotina clínica de animais exóticos. A nutrição parenteral e enteral além de ser fundamental no tratamento de animais desnutridos, são vitais na recuperação de pacientes hospitalizados. Desse modo, a nutrição clínica de animais exóticos tem sido cada vez mais estudada devido à especificidade nutricional de cada espécie animal. Neste contexto, esta revisão visa elucidar os principais aspectos relacionados ao emprego da nutrição parenteral e enteral em pets exóticos na rotina clínica.

Interest about exotic animais have been increasing in pet business, requiring specialized veterinarians to atlend efficiently the great demando Hence, it is needed to adequate the techniques that are usually applied onlyto small pets to the clinical routine of exotic pets. Parenteral and enteral nutrition in addition to being fundamental in malnourished animais treatment, are vital to hospitalized patients recovery. Thereby, clinical nutrition of exotic pets have been increasingly studied because of the nutritional specificity of each species of animal. Therefore, this review aim to elucidate the main aspects related to the application of parenteral and enteral nutrition to exotic petsin clinical routine.

Los animales exóticos han sido de gran interés en el mercado de mascotas, necesitando médicos veterinarios especializados para atender con eficiencia la gran demanda. Para ello, es necesario adecuar las técnicas de rutina clínica de animales exóticos que generalmente son aplicadas a las mascotas de compañía. La nutrición parenteral y enteral además de ser fundamental en el tratamiento de animales desnutridos, son vitales en la recuperación de pacientes hospitalizados. De ese modo, la nutrición clínica de animales exóticos ha sido cada vez más estudiada debido a la especificidad nutricional de cada especie animal. Así, esta revisión trata de dilucidar los principales aspectos relacionado ai empleo de la nutrición parenteral y enteral en la rutina clínica de los animales exóticos.

Nutrição parental e enteral na clínica de pets exóticos (Revisão de Literatura) / Parenteral and enteral nutrition in exotic pets clinic / Nutrición parenteral y enteral en clínica de mascotas exóticas

Os animais exóticos têm sido alvo de grande interesse no mercado pet, necessitando de médicos veterinários especializados para atender com eficiência esta demanda. Para isso, é preciso adequar técnicas,geralmente aplicadas apenas aos pequenos animais de companhia à rotina clínica de animais exóticos. A nutrição parenteral e enteral além de ser fundamental no tratamento de animais desnutridos, são vitais na recuperação de pacientes hospitalizados. Desse modo, a nutrição clínica de animais exóticos tem sido cada vez mais estudada devido à especificidade nutricional de cada espécie animal. Neste contexto, esta revisão visa elucidar os principais aspectos relacionados ao emprego da nutrição parenteral e enteral em pets exóticos na rotina clínica.(AU)

Interest about exotic animais have been increasing in pet business, requiring specialized veterinarians to atlend efficiently the great demando Hence, it is needed to adequate the techniques that are usually applied onlyto small pets to the clinical routine of exotic pets. Parenteral and enteral nutrition in addition to being fundamental in malnourished animais treatment, are vital to hospitalized patients recovery. Thereby, clinical nutrition of exotic pets have been increasingly studied because of the nutritional specificity of each species of animal. Therefore, this review aim to elucidate the main aspects related to the application of parenteral and enteral nutrition to exotic petsin clinical routine.(AU)

Los animales exóticos han sido de gran interés en el mercado de mascotas, necesitando médicos veterinarios especializados para atender con eficiencia la gran demanda. Para ello, es necesario adecuar las técnicas de rutina clínica de animales exóticos que generalmente son aplicadas a las mascotas de compañía. La nutrición parenteral y enteral además de ser fundamental en el tratamiento de animales desnutridos, son vitales en la recuperación de pacientes hospitalizados. De ese modo, la nutrición clínica de animales exóticos ha sido cada vez más estudiada debido a la especificidad nutricional de cada especie animal. Así, esta revisión trata de dilucidar los principales aspectos relacionado ai empleo de la nutrición parenteral y enteral en la rutina clínica de los animales exóticos.(AU)

Nutrologia aplicada à medicina veterinária / Nutrology applied to veterinary medicine

Doctors and Veterinarians for a long time are concerned largely with the development of new drugs that could help clinical routine forgetting therefore of the most important factors in the care of sick patients, nutritional support. In the area of nutrology, medical specialty that studies the nutrients, their functions in the body and the treatment of nutrient disorders in diseases, numerous studies have been carried out in recent decades, with the aim of developing strategies for the nutritional management of diseases. In veterinary medicine, the primary focus is the determination of nutritional requirements and disease prevention, so that the application of certain nutrients in the modulation of disease is still in the early stages. Thus, with this revision, the objective is to report the dietary measures, previously determined scientifically, that assist in the treatment and maintenance of dogs and cats with obesity, chronic kidney disease, liver disease, cardiomyopathies and food allergies.

Os médicos e médicos veterinários por muito tempo preocuparam-se amplamente com o desenvolvimento de novos fármacos que auxiliassem na rotina clínica esquecendo, no entanto, de um dos fatores mais importantes no cuidado de pacientes enfermos, o suporte nutricional. Na área da nutrologia, especialidade médica que estuda os nutrientes, suas funções no organismo e o tratamento dos distúrbios de nutrientes nas doenças, inúmeros estudos passaram a ser realizados nas últimas décadas, com o objetivo de desenvolver estratégias para o manejo nutricional de doenças. Na medicina veterinária, o foco principal está na determinação de exigências nutricionais e prevenção de doenças, de forma que a aplicação de determinados nutrientes na modulação de doenças ainda se encontra em estágios iniciais. Desse modo, com a presente revisão, objetiva-se relatar as medidas dietéticas, até então determinadas cientificamente, que auxiliam no tratamento e manutenção de cães e gatos obesos, com doença renal crônica, hepatopatias, cardiomiopatias e alergias alimentares.

Nutrologia aplicada à medicina veterinária / Nutrology applied to veterinary medicine

Doctors and Veterinarians for a long time are concerned largely with the development of new drugs that could help clinical routine forgetting therefore of the most important factors in the care of sick patients, nutritional support. In the area of nutrology, medical specialty that studies the nutrients, their functions in the body and the treatment of nutrient disorders in diseases, numerous studies have been carried out in recent decades, with the aim of developing strategies for the nutritional management of diseases. In veterinary medicine, the primary focus is the determination of nutritional requirements and disease prevention, so that the application of certain nutrients in the modulation of disease is still in the early stages. Thus, with this revision, the objective is to report the dietary measures, previously determined scientifically, that assist in the treatment and maintenance of dogs and cats with obesity, chronic kidney disease, liver disease, cardiomyopathies and food allergies.(AU)

Os médicos e médicos veterinários por muito tempo preocuparam-se amplamente com o desenvolvimento de novos fármacos que auxiliassem na rotina clínica esquecendo, no entanto, de um dos fatores mais importantes no cuidado de pacientes enfermos, o suporte nutricional. Na área da nutrologia, especialidade médica que estuda os nutrientes, suas funções no organismo e o tratamento dos distúrbios de nutrientes nas doenças, inúmeros estudos passaram a ser realizados nas últimas décadas, com o objetivo de desenvolver estratégias para o manejo nutricional de doenças. Na medicina veterinária, o foco principal está na determinação de exigências nutricionais e prevenção de doenças, de forma que a aplicação de determinados nutrientes na modulação de doenças ainda se encontra em estágios iniciais. Desse modo, com a presente revisão, objetiva-se relatar as medidas dietéticas, até então determinadas cientificamente, que auxiliam no tratamento e manutenção de cães e gatos obesos, com doença renal crônica, hepatopatias, cardiomiopatias e alergias alimentares.(AU)

Utilidad del CONUT frente al MNA en la valoración del estado nutricional del paciente adulto mayor hospitalizado / Utility of CONUT against MNA for assessing the status of hospitalized elderly patients

Objetivo: conocer la utilidad del CONUT frente a la aplicación del instrumento MNA y evaluación bioquímica, en la valoración del estado nutricional de pacientes adultos mayores (AM), hospitalizados en el Servicio de Medicina Interna 6C del Hospital Nacional Edgardo Rebagliati Martins de EsSalud. Material y Métodos: estudio transversal, en el que se aplió a 74 pacientes AM hospitalizados, el cuestionario MNA y el CONUT. El análisis estad¡stico se realiz¢ usando el chi cuadrado y análisis de varianza. Resultados: la edad promedio fue 75.65 ñ 4.8 años, predominó el sexo masculino. El peso fue de 66.95 ñ 10 kg; talla 1.62 ñ 0.07 mts; el IMC 27.4 ñ 6.6; albúmina 3.26 ñ 0.5 g/dL; colesterol 184.3 ñ 59.3 mg/d; y el recuento de linfocitos, 1847 ñ 967 cel/mm3. El resultado del MNA identificó 26 desnutridos (35.15%), 32 con riesgo de desnutrición (43.25%) y 16 con estado nutricional normal (21.60%). Según las variables del CONUT, asociada a los resultados del MNA, se comprueba que a medida que aumenta el grado de desnutrición, los valores de albúmina, colesterol y linfocitos descienden. Los porcentajes de las categorías del MNA, para los distintos grados de nutrición según las categor¡as de CONUT, se asocian significativamente en la variable albúmina. La sensibilidad y la especificidad para el CONUT frente al MNA, fue alta (86% y 62% respectivamente). Concluciones: estadísticamente, el CONUT se asociócon el MNA en la identificación de pacientes hospitalizados con riesgo de desnutrición.

Objective: to determine the usefulness of CONUT against the application of MNA instrument and biochemical evaluation in the assessment of the nutritional status of elderly patients (EP), hospitalized in the Internal Medicine 6C National Hospital Edgardo Rebagliati Martins EsSalud. Material and Methods: Cross-sectional study, in which CONUT MNA questionnaires were applied to 74 hospitalized EP. Statistical analysis was performed using the chi square test and analysis of variance. Results: the mean age was 75.65 ñ 4.8 years, predominantly male. The weight was 66.95 ñ 10 kg, height 1.62 ñ 0.07 m, BMI 27.4 ñ 6.6, 3.26 ñ 0.5 g albumin / dL, cholesterol 184.3 ñ 59.3 mg / d, and the lymphocyte count, 1847 ñ 967 cells/mm3. The result of the MNA identified 26 malnourished (35.15%), 32 with risk of malnutrition (43.25%) and 16 with normal nutritional status (21.60%). According to CONUTïs variables associated with the results of MNA, we found that with increasing degree of malnutrition, albumin, cholesterol and lymphocyte levels decline. The percentages of the categories of MNA, for different degrees of nutrition as CONUT categories are significantly associated in the variable albumin. The sensitivity and specificity for the CONUT against MNA was high (86% and 62% respectively). Conclusions: statistically, CONUT was associated with MNA in the identification of hospitalized patients at risk of malnutrition.

Ingestión calórica y el alta en hospitalización de perros y gatos / Energy consumption and hospital discharge in dogs and cats / Ingestão calórica e alta hospitalar em cães e gatos

Objetivo: Investigar la correlación entre ingestión calórica y tiempo de internación con la alta de hospitalización o el óbito de perros y gatos. Material y Método: Animales internados en el Hospital Veterinario de la Facultad de Ciencias Agrarias y Veterinarias de la Universidad Estadual Paulista (HV-FCAV/UNESP), Campus de Jaboticabal, Sp, Brasil, que por cualquier motivo o enfermedad sea en el pre o posquirúrgico, tuvieron estimada su necesidad energética de manutención (NEM): 132 x (peso corporal)O.75 kcal por día en perros; 70 x (peso corporal) kcal por día para gatos. Recibieron alimento comercial super-premium, soporte enteral y parenteral. Fueron incluidos 279 animales (233 perros y 56 galos). Resultados: Tuvieron alta en el hospital el 76,7% de los pacientes, la ingestión porcentual media de la NEM de esos animales fue de 71,12%, ya los que murieron ingirieron apenas 33,97% de la NEM (p 0,001). Los animales del grupo Alta permanecieron 7,18 días hospitalizados y los del grupo Óbito solamente 5,45 días (p = 0,16). Dentro del grupo de animales que recibieron de 0% a 33% de la NEM, el 38% tuvo alta y el 62% murió, para los que recibieron entre un 34% a un 66% de la NEM, 84% tuvieron alta y el 16% murió y para los que recibieron más que 67% de la NEM, 89% de los animales tuvieron alta y un 11% murió, demostrando menor mortalidad en los intervalos de mayor equilibrio ca

Objective: To investigate the correlation between caloric ingestion, hospital discharge and death rate of dogs and cats. Material and Method: Animals hospitalized at the Hospital Veterinário da Faculdade de Ciências Agrárias e Veterinárias da Universidade Estadual Paulista (HV-FCAV/UNESP), (Veterinarian Hospital of the College of Agrarian and Veterinarian Sciences of Paulista State University) Campus of Jaboticabal, Sp, for any disease or in pre or post surgery period, had their maintenance energy requirement (MER): 132 x (body weighjO·75 kc a day for dogs; 70 x (body weigh) kcal a day for cats. Animals were fed commercial super-premium food and received enteral and parenteral nutrition support. A total of 279 animals were studied, 223 dogs and 56 cats. Results: Were discharged from hospital 76,7% of patients, the average percentage ingestion of (MER) of those animals was 71,12%, while those who died ingested only 33.97% of (MER) (p 0,001). Animals of the Discharge group remained 7.18 days in hospital, while those in the group that died 5.45 days (p = 0,16). Among the animals that received from 0% lo 33% of MER, 38% were discharged and 62% died, out of those who received 34% to 66% of MER, 84% were discharged and 16% died and for those who received more than 67% of MER, 89% of the animals were discharged and 11% died, indicating lower mortality rate in the group with highe

Objetivo: Investigar a correlação entre ingestão calórica e tempo de internação com a alta ou o óbito de cães e gatos. Material e Método: Animais internados no Hospital Veterinário da Faculdade de Ciências Agrárias e Veterinárias da Universidade Estadual Paulista (HV-FCAV/UNESP), Campus de Jaboticabal, SP, por qualquer motivo de doença no pré ou pós-cirúrgico, tiveram estimada sua necessidade energética de manutenção ( EM): 132 x (peso corporal)o.75 kcal por dia para cães; 70 x (peso corporal) kcal por dia para gatos. Receberam alimento comercial super-premium, suporte enteral e parenteral. Foram incluídos 279 animais (223 cães e 56 gatos). Resultados: Tiveram alta hospitalar 76,7% dos pacientes, cuja ingestão percentual média da NEM foi de 71,12%. Já os que vieram a óbito ingeriam apenas 33,97% da NEM (p  0,00 I). Os animais do grupo Alta permaneceram , 18 dias no hospital, enquanto os do grupo Óbito 5,45 dias (p =0,16). Dentre os animais que receberam de 0% a 33% da NEM, 38% tiveram alta e 62% vieram a óbito; dos que receberam entre 34% e 66% da NEM, 84% tiveram alta e 16% vieram a óbito; para os que receberam mais de 67% da NEM, 89% tiveram alta e 11% vieram a óbito, demonstrando menor mortalidade nas faixas de maior balanço calórico (p 0,00 I). Nestas faixas, os animais permaneceram mais tempo hospitalizados (p 0,002), o que também pode ser verificado pela associa

Ingestión calórica y el alta en hospitalización de perros y gatos / Energy consumption and hospital discharge in dogs and cats / Ingestão calórica e alta hospitalar em cães e gatos

Objetivo: Investigar la correlación entre ingestión calórica y tiempo de internación con la alta de hospitalización o el óbito de perros y gatos. Material y Método: Animales internados en el Hospital Veterinario de la Facultad de Ciencias Agrarias y Veterinarias de la Universidad Estadual Paulista (HV-FCAV/UNESP), Campus de Jaboticabal, Sp, Brasil, que por cualquier motivo o enfermedad sea en el pre o posquirúrgico, tuvieron estimada su necesidad energética de manutención (NEM): 132 x (peso corporal)O.75 kcal por día en perros; 70 x (peso corporal) kcal por día para gatos. Recibieron alimento comercial super-premium, soporte enteral y parenteral. Fueron incluidos 279 animales (233 perros y 56 galos). Resultados: Tuvieron alta en el hospital el 76,7% de los pacientes, la ingestión porcentual media de la NEM de esos animales fue de 71,12%, ya los que murieron ingirieron apenas 33,97% de la NEM (p 0,001). Los animales del grupo Alta permanecieron 7,18 días hospitalizados y los del grupo Óbito solamente 5,45 días (p = 0,16). Dentro del grupo de animales que recibieron de 0% a 33% de la NEM, el 38% tuvo alta y el 62% murió, para los que recibieron entre un 34% a un 66% de la NEM, 84% tuvieron alta y el 16% murió y para los que recibieron más que 67% de la NEM, 89% de los animales tuvieron alta y un 11% murió, demostrando menor mortalidad en los intervalos de mayor equilibrio ca

Objective: To investigate the correlation between caloric ingestion, hospital discharge and death rate of dogs and cats. Material and Method: Animals hospitalized at the Hospital Veterinário da Faculdade de Ciências Agrárias e Veterinárias da Universidade Estadual Paulista (HV-FCAV/UNESP), (Veterinarian Hospital of the College of Agrarian and Veterinarian Sciences of Paulista State University) Campus of Jaboticabal, Sp, for any disease or in pre or post surgery period, had their maintenance energy requirement (MER): 132 x (body weighjO·75 kc a day for dogs; 70 x (body weigh) kcal a day for cats. Animals were fed commercial super-premium food and received enteral and parenteral nutrition support. A total of 279 animals were studied, 223 dogs and 56 cats. Results: Were discharged from hospital 76,7% of patients, the average percentage ingestion of (MER) of those animals was 71,12%, while those who died ingested only 33.97% of (MER) (p 0,001). Animals of the Discharge group remained 7.18 days in hospital, while those in the group that died 5.45 days (p = 0,16). Among the animals that received from 0% lo 33% of MER, 38% were discharged and 62% died, out of those who received 34% to 66% of MER, 84% were discharged and 16% died and for those who received more than 67% of MER, 89% of the animals were discharged and 11% died, indicating lower mortality rate in the group with highe

Objetivo: Investigar a correlação entre ingestão calórica e tempo de internação com a alta ou o óbito de cães e gatos. Material e Método: Animais internados no Hospital Veterinário da Faculdade de Ciências Agrárias e Veterinárias da Universidade Estadual Paulista (HV-FCAV/UNESP), Campus de Jaboticabal, SP, por qualquer motivo de doença no pré ou pós-cirúrgico, tiveram estimada sua necessidade energética de manutenção ( EM): 132 x (peso corporal)o.75 kcal por dia para cães; 70 x (peso corporal) kcal por dia para gatos. Receberam alimento comercial super-premium, suporte enteral e parenteral. Foram incluídos 279 animais (223 cães e 56 gatos). Resultados: Tiveram alta hospitalar 76,7% dos pacientes, cuja ingestão percentual média da NEM foi de 71,12%. Já os que vieram a óbito ingeriam apenas 33,97% da NEM (p  0,00 I). Os animais do grupo Alta permaneceram , 18 dias no hospital, enquanto os do grupo Óbito 5,45 dias (p =0,16). Dentre os animais que receberam de 0% a 33% da NEM, 38% tiveram alta e 62% vieram a óbito; dos que receberam entre 34% e 66% da NEM, 84% tiveram alta e 16% vieram a óbito; para os que receberam mais de 67% da NEM, 89% tiveram alta e 11% vieram a óbito, demonstrando menor mortalidade nas faixas de maior balanço calórico (p 0,00 I). Nestas faixas, os animais permaneceram mais tempo hospitalizados (p 0,002), o que também pode ser verificado pela associa

Índice glicêmico dos alimentos / Glycemic index of foods

Carbohydrates provide over half of the energetic value in human nutrition. It is important to know about the food chemical composition when elaborating a diet. However, this knowledge is not enough to describe what physiological effects the carbohydrates will produce in human body. The glycemic index (GI) aims food classification according to their glycemic response in established patterns. The objective of this work is to discuss GI methodological procedures, factors that interfere in carbohydrate digestion and absorption, as well as GI clinical application. Some studies have related low GI diets with low diabetes prevalence, with glycemic control in treatment of diabetes and cardiovascular diseases, and with obesity nutritional treatment. The glycemic index can help the food choice, but professionals in the nutrition area must consider the correct interpretation of each value, since several variables can interfere on carbohydrate physiological effects

Los carbohidratos suministran más del50% de las calorías de la alimentación. Debido a esto, el conocimiento de la composición química de los alimentos es importante para escoger aquellos que serán incluidos en la dieta, pero solamente esa información no es suficiente para pronosticar los efectos fisiológicos que los carbo-hidratos van a provocar en el organismo humano. El uso del índice glicémico permite classificar los alimentos de acuerdo con la respuesta de la glucemia en condiciones uniformes. El objetivo de este trabajo fue examinar la metodología que se usa en la determinación del IG, los factores que intervienen en la digestión y la absorción de los carbohidratos y su aplicación en la práctica clínica. Los estudios realizados hasta ahora, vinculan las dietas con bajo IG a menos surtos de diabetes. El IG puede ser solo uma herramienta auxiliar, pero el nutricionista debe estar atento para la interpretación de sus valo-res, considerando los elementos que pueden intervenir en los efectos fisiológicos de los carbohidratos

Os carboidratos fornecem mais da metade do valor energético da alimentação. Assim sendo, na seleção dos alimentos que irão compor a dieta, o conhecimento da composição química é importante, mas somente essa informação não é suficiente para prever os efeitos fisiológicos que os carboidratos irão produzir no organismo humano. O índice glicêmico (IG) visa classificar os alimentos de acordo com a resposta glicêmica em condições padronizadas. O objetivo deste trabalho é abordar aspectos sobre a metodologia empregada na determinação do IG, os fatores que interferem na digestão e absorção de carboidratos, bem como sua aplicação na prática clínica. Estudos têm relacionado dietas com baixo IG com a menor incidência de diabetes, com um maior controle glicêmico no diabetes e doenças cardiovasculares e com a terapia nutricional na obesidade. O IG pode ser considerado um instrumento auxiliar, mas o profissional da área de nutrição deve estar atento para a correta interpretação de cada valor, levando em conta as diversas variáveis que podem interferir nos efeitos fisiológicos dos carboidratos