International Journal of Nutrology

Post-COVID-19 multisystem inflammatory syndrome in children: a case report

Tauane Rene Martins — 2022-07-13

Objective: Report of a case of Multisystem Inflammatory Syndrome in Children (MIS-C) post-COVID 19 and review of articles on the topic. Results: Coronavirus 2 (SARS-CoV-2) infection is a disease whose symptoms are similar between the adult and pediatric population, ranging from asymptomatic cases to more serious conditions that have spread global terror due to the high number of infections worldwide deaths. However, children have presented a milder clinic. It is worth mentioning, however, that this population is not completely risk-free, with reports of the association of the Coronavirus triggering inflammatory diseases, such as the so-called MIS-C whose complications can be as serious as the forms of symptoms experienced by adults. Conclusion: The temporal and serological relationship of a link with SARS-CoV-2 infection is supported by consistent data, however further studies are needed to establish SARS-CoV-2 as an inciting agent. Due to the severity of MIS-C, knowledge about this disease is necessary for a quick diagnosis and early treatment, aiming to reduce systemic lesions. Due to the increase in the number of cases of children affected by MIS-C, the use of immunomodulatory drugs, such as intravenous immunoglobulin (IVIG), aspirin, and systemic glucocorticoids, has been instituted as first-line therapy, to reduce inflammation and late complications.

Major clinical outcomes of melatonin use in COVID-19 patients: a systematic review

Mariana Tolentino Chaves — 2022-05-25

Introduction: In the context of the Sars-Cov-2 (COVID-19) pandemic, as well as other viral infections, these viruses can lead to significant morbidity and mortality. Thus, in the context of melatonin science in viral infections such as influenza and COVID-19, there is a growing realization that the regulation of melatonin pathways, both pineal and systemic, may be an important aspect of the regulation of viruses in cellular functions. Objective: It was to list the main results of clinical studies of the use of melatonin in patients infected with Sars-Cov-2 through a systematic review. Methods: The rules of the Systematic Review-PRISMA Platform. The search was carried out from December 2021 to April 2022 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: It was found 164 articles. A total of 86 articles were fully evaluated and 30 studies were developed in a systematic review. Melatonin is known as an anti-inflammatory agent and immune modulator that may address the progressive pathophysiology of coronavirus disease 2019 (COVID-19). According to the objective and results obtained in the present study that evaluated the treatment in patients with COVID-19, the use of melatonin can help reduce thrombosis, sepsis and mortality. Furthermore, the combination of 3.0 mg oral melatonin tablets and standard care can substantially improve sleep quality and blood oxygen saturation in hospitalized patients. Clinical symptoms such as cough, dyspnea and fatigue, as well as the polymerase chain reaction (PCR) level and lung involvement in patients receiving melatonin can improve significantly. Also, the mean time of patients' hospital discharge and return to initial health was significantly shorter in patients who received melatonin compared to the control group. There was evidence of benefit of sustained-release melatonin 2 mg in therapy in patients, as well as evidence that the use of melatonin was associated with a reduced probability of a positive SARS-CoV-2 test result compared to the use of blockers of the angiotensin II receptor or angiotensin-converting enzyme inhibitors.

False hyperparathyroids secondary to biotin prolonged use: a case report

Georgeanne Neves — 2022-05-25

A 55-year-old overweight female patient with elevated parathyroid hormone (PTH) levels, without any other major plasma biochemical abnormalities, and with normal vitamin D and calcium levels. The condition was suggestive of normocalcemic primary hyperparathyroidism. Bone densitometry and 24-hour calciuria were normal. After extensive investigation and possible referral for exploratory surgery, the patient reported continued and chronic use of biotin supplementation (2.5 mg per day). Repeated tests after discontinuing the use of vitamin B7 showed normal PTH levels without surgical or pharmacological interventions. Biotin supplementation associated with the use of this vitamin as a component of biological assays for hormone dosage can generate incorrect laboratory results, which puts medical conduct at risk with inaccurate diagnoses and unnecessary procedures. Although, different substances or emotional conditions can interfere with hormone dosages, one must consider the use of food supplements such as biotin since it can also generate unreliable results. Discontinuation of the use of biotin, in addition to the assessment of serum biotin levels prior to hormone dosing is necessary for a correct evaluation of serum PTH levels. This study was analyzed and approved by the Research Ethics Committee, and obtaining the Informed Consent Form according to CNS/CONEP Resolution 466/12.

Lifestyle under the light of nutrological and psychological aspects in the COVID-19 pandemic: a systematic review

Lorena Gigli — 2022-05-25

Introduction: Due to the emergence of the new coronavirus (whose disease is COVID-19), in 2020 the WHO declared COVID-19 a global pandemic. Preventive measures can radically change individuals' daily habits, including lifestyle-related behaviors. Sedentary behavior, anxiety, and boredom caused by home confinement can influence motivation to eat and change lifestyle patterns. Objective: To carry out a systematic review on the impacts of COVID-19 on people's diet and lifestyle, as well as to point out the main dietary and lifestyle precautions during and after the new coronavirus pandemic, based on the results of clinical studies. Methods: The rules of the Systematic Review-PRISMA Platform were followed. The search was carried out from December 2021 to April 2022 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: Were found 264 articles. A total of 116 articles were fully evaluated and 34 studies were developed in a systematic review. There is scientific evidence that foods/nutrients and natural substances from human physiology and biochemistry such as melatonin and coenzyme Q10 control immune system functions, and many metabolic or chronic diseases have been implicated in poor diet and lifestyle. The results of the pandemic indicate there have been a variety of lifestyle changes, physical inactivity, and psychological problems. Still, adults over 40 years old, with children, unemployed, and those living in a macroeconomic region were shown to be more exposed to unhealthy behaviors. Maintaining dietary intervention through telemedicine can reduce the negative impact of eating habits and physical activity patterns.

Major clinical findings of β-alanine in sports performance: a systematic review

Leandro Reis Woitas — 2022-05-25

Introduction: Dietary supplements offer ergogenic aid in an attempt to increase energy, improve recovery and modulate body composition, enabling improved performance. Thus, β-alanine is a substrate of carnosine and is becoming an ergogenic aid for sports performance. Objective: To carry out a systematic review to highlight the main scientific evidence on the improvement of sports performance with the use of β-alanine. Methods: The PRISMA Platform rules were used. The research was developed using the SCOPUS, PUBMED, and SCIENCE DIRECT databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: Studies have shown that β-alanine has an important ergogenic role in sports performance. Weeks of beta-alanine supplementation (4-6g per day) significantly increases muscle carnosine concentrations. The only side effect reported is paresthesia. Beta-alanine attenuates neuromuscular fatigue, particularly in older individuals. Also, combining beta-alanine with other supplements can be advantageous when beta-alanine supplementation is high enough (4-6 g per day) and long enough (minimum 4 weeks).

Assessment of the nutritional profile through the 24-hour record in truckers in the central-southern Brazilian region: a prospective observational cross-sectional study

Giovanna Rodrigues de Castro Castellani — 2022-05-25

Introduction: Truck drivers are of great importance to the Brazilian economy. The exorbitant workload and long periods away from home are causes of the adoption of unhealthy eating habits, such as the intake of foods that are sources of lipids with high caloric value. Extensive travel contributes to a sedentary lifestyle. This causes health damage and comorbidities such as diabetes, obesity, hypertension, stress, and depression. Based on these considerations, the present study evaluates the nutritional profile of truck drivers. Objective: It was to evaluate the food quality of truck drivers in the Center-South Geoeconomic Region of the country, comparing the portions of macronutrients consumed with those recommended by the Brazilian Food Pyramid. Methods: Observational and cross-sectional study. The consumption of macronutrients by 100 truck drivers from the states of São Paulo, Minas Gerais, Mato Grosso do Sul and Goiás was qualitatively evaluated. The research used 24-hour food recalls, completed online, via Google Forms, between June and September 2020. Statistical analysis was obtained by calculating the Wilcoxon's non-parametric test to compare the medians of ingested portions and the ideas. Results: The Wilcoxon test identified significant differences between the number of servings consumed by truck drivers and the recommended ideal with regard to fruits, vegetables/vegetables, oils/fats, meats/eggs, sweets/sugars, milk, cheese and derivatives (p<0.0001). Only the portions of carbohydrates were in accordance with the nutritional recommendations, that is, six portions a day (ns). In the class of sugars and sweets, consumption four times higher than recommended was observed. In the meat and eggs category, consumption was double the ideal. In oils and fats, triple the recommended value. The consumption of milk and dairy products is three times less than ideal, such as vegetables. Finally, the average value of fruit portions eaten by truck drivers was zero, while the recommended value is three. Conclusion: Among the food groups analyzed, carbohydrates were the only group in which consumption was adequate. There was a significant excess of sweets and fats intake by truck drivers, when compared to the ideal amount indicated by the food pyramid. The intake of milk and dairy products, vegetables and legumes was deficient, three times lower than recommended. Fruits counted as a median intake value of zero servings.

Caffeine ingestion by students at the Brazil faculty of medicine: a prospective observational cross-sectional study

Marilia Vilela Galhardo — 2022-05-25

Introduction: In higher education, the consumption of stimulant substances such as coffee is increasing intensely due to the high demand of concentration and disposition of individuals. This occurs mainly among medical students. Objective: It was to quantify and analyze caffeine intake and its effects on medical students at the Faculty of Medicine of Catanduva, Centro Universitário Padre Albino (UNIFIPA). Methods: This study followed a prospective observational cross-sectional model, following the rules of clinical research of the STROBE. Data collection took place from June 2019, through an objective questionnaire and self-application, which was answered by students from the first to the sixth year of FAMECA who were interested in answering and contributing to the research, which had as objective to quantify and analyze the use of caffeine, in addition to its motivations and side effects on the physiology of these students. This study was analyzed and approved by the Research Ethics Committee according to a substantiated opinion number 5,347,594, and obtaining the Informed Consent Form. For data analysis, a common descriptive analysis was performed, obtaining the values of total N, and statistical percentage (%) for all predictors. The One-Way test (ANOVA) was applied, adopting the α level lower than 0.05, with a statistically significant difference for the 95% CI. Results and Conclusion: The results of this study revealed that a very large number of university students ingest caffeine. Most of the students started consumption in the pre-college course and in college, with the aim of compensating for sleep, because they like the taste of energy drinks and improve academic performance, due to the intense routine due to the high workload requires greater attention, in order to to meet the demand for studies. Most students consume moderately caffeine, which is not harmful to health. However, a minority ingest excessive amounts of substances that contain caffeine and side effects are noted. Among these, the ones that stood out were stomach problems, anxiety and tachycardia. Thus, even representing the minority, it is of fundamental importance to carry out more studies on this topic. With this, it will be possible to provide more information to the population so that it is able to assess the impacts of the use of stimulants in clinical practice, in order to minimize possible adverse effects. Finally, the population will be able to use caffeine properly, according to the recommended dose, avoiding major health problems.

Ethics in medical research and the essential bureaucracy of ethics committees: an experience report

Alessandra Luiza Lara Poloni — 2022-04-28

Since October 1996, Brazil has a new regulation on research involving human beings, it is the Resolution nº 196 of 1996 of the National Health Council, instance in which the National Research Ethics Commission and the Ethics Committees were created in Research – EC. This resolution says that each and every research project, in any area, involving human beings must contain an analysis of ethical aspects – carried out by the researcher himself – and be approved by the Research Ethics Committee. Research involving human beings is understood to be that which, individually or collectively, directly or indirectly involves human beings, in their entirety or parts of them. This article reports the difficulties in developing a research project that will later be approved by an EC, but with an emphasis on why these difficulties exist.

Regenerative nutrition and gut microbiota signaling in skeletal muscle metabolism: a concise systematic review

Michelle Silva Rocha — 2022-04-05

Introduction: Recent progress has been made to gut microbiota, regenerative nutrition and skeletal muscle metabolism. In this context, regular physical training associated with nutrological health has broad benefits for the health of the intestinal microbiota. The triad physical exercise, nutrition and intestinal microbiota for the process of muscle regeneration, adult stem cells stand out as gut stem cells. Objective: the present study aimed to carry out a systematic review on the main cellular and molecular aspects of regenerative nutrition in the modulation of the intestinal microbiota and the metabolism of skeletal muscle. Methods: The rules of the Systematic Review-PRISMA Platform. The research was carried out from June 2021 to January 2022 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 215 studies were analyzed, with only 32 medium and high-quality studies selected, according to the rules of the GRADE, and with bias risks that do not compromise scientific development, based on the Cochrane instrument. A current focus in the field of sport and metabolism is the investigation of how specific metabolites and nutrients affect the progression and treatment of muscle injuries. Nutrients can also regulate normal homeostatic processes, altering the decisions of muscle stem cells and satellites. Thus, the implications for understanding how diet influences cellular transitions are immense and will guide precision-based nutrition to improve overall health and therapeutic strategies for muscle injuries. Thus, metabolic pathways and chromatin modifications are closely linked, and hence many changes in metabolism influence epigenetic changes and alter gene expression. For example, signaling pathways including mTORC, AMPK, MAPK, and others are all sensitive to changes in nutrient levels.

Prospective randomized controlled trial of the closure of gastrojejunal anastomosis in RYGB with absorbable and inabsorbable thread

Mário Flamini Júnior — 2022-04-05

Introduction: The Roux-en-Y gastric bypass (RYGB) is, currently, the most performed technique in Brazil. Suture threads are classified according to their degradation properties. Objective: To analyze the influence on the size of the gastrojejunal anastomosis performed in Roux-en-Y gastric bypass surgery, as well as the main complications with the use of absorbable or inabsorbable thread. Methods: This study followed a prospective and randomized clinical trial, initially with 40 participants, with only 37 participants being duly selected, 19 of whom underwent gastrojejunostomy closure with an absorbable (Abs) polydioxanone suture (PDS II®) and 18 with the inabsorbable (Inb) ETHIBOND®. Statistical analysis was performed using the ANOVA and logistic regression tools (p<0.05 significant). Results: General complications and Upper Digestive Endoscopy (UDE) were less frequent at the end of 12 months in both groups. At the end of twelve months, the number of complications of the Inb thread decreased considerably, while the number of complications of the Abs thread showed an increase in other complications, including marginal ulcer and intrusive thread. Despite this, there was no significant difference between groups in terms of total weight loss. There was no statistically significant difference between the final values of the anastomotic diameter. The percentage of weight loss over the 12 months was 33.77 ± 6.97% for the Inb group and 36.10 ± 4.89% for the Abs group (p<0.05). Conclusion: Both suture threads (Inb and Abs) presented similar complications and did not present significant differences between the values of weight, gastrojejunal anastomosis, and pouch.

Parenteral nutrition: how to prescribe your inputs

Hayslan Theobaldo Boemer — 2022-04-05

Parenteral nutrition (PN) is a vital therapeutic modality for a specific group of patients in need of nutritional support. The proper use of this complex therapy is capable of maximizing its clinical benefits, minimizing the potential risks of adverse events. In certain situations, the clinical lability in which the patient finds himself requires the prescription of customized parenteral formulas. Due to the number of components used in these solutions, the possibilities of Physico-chemical incompatibilities are common and represent a serious problem. For this, prescribers must be familiar with its composition process in order to guarantee a safe formula for infusion. The objective of this work is to present the various inputs (amino acids, carbohydrates, lipids, vitamins, trace elements, electrolytes, and drugs) commonly prescribed in PN formulas, as well as their possibilities of interaction for the formation of precipitates. The concept of osmolarity and its relationship with infusion sites (central or peripheral) will also be addressed. However, an excellent understanding of the different types of inputs used in PN formulas, and also of their physical-chemical interactions capabilities, associated with good clinical judgment in the individualization of these solutions, has reduced sources of errors and ensured greater safety and quality in this type. of intervention to patients.

Self-image disorders and susceptibility for the development of eating disorders in medicine academics: a cross-sectional observational study

Ana Beatriz Travaini — 2022-04-05

Introduction: when talking about eating disorders (ED), reflects a lot on how it affects young people and, currently, it is known that the most varied types of ED are quite prevalent in the university environment, with medical students being part of this groups that are significantly exposed to the onset of ED. The development of these disorders is commonly associated with self-image disorders, while body dissatisfaction is precisely one of the diagnostic criteria for ED. Objective: identify the prevalence of body dissatisfaction among medical students and how it affects the susceptibility to the development of eating disorders, relating this information to the impact of the pandemic and the gender of the participants. Methods: a cross-sectional observational study, with a quality-quantitative data approach. The research was carried out with medical students of both sexes, over 18 years old, through the application of an online questionnaire, which allowed the sample to be characterized in terms of sociodemographic and anthropometric aspects. In addition, the occurrence of self-image disorders was evaluated through the Kakeshita Silhouette Scale and the risk of developing ED through the Eating Attitudes Test (EAT 26). For statistical analysis, differences in EAT scores between categories were assessed using the Independent T-Test and the proportion of participants with self-image disorder was compared using Fisher's exact test. Results: 268 participants were included in the research, with a mean age of 21.23 years (standard deviation = 2.47), with 216 female participants (80.6%) and 52 male participants (19.4%). The body mass and height were self-reported by the students to calculate the body mass index (BMI), whose mean value was 23.57 (standard deviation = 4.79), showing that 27.6% of the participants are above the weight or obesity (BMI > 25) and 4.85% with low weight (BMI < 18.5). The present study showed a positive correlation between self-image disorders and eating disorders (p = 0.0002), regardless of the individual's gender. For the variables evaluated, there was no significant difference between genders (p = 0). Furthermore, the current COVID-19 pandemic is not an influential factor in the increase in self-image disorders among participants. Conclusion: through the study, it became evident that students who have self-image disorders have a higher risk of developing eating disorders. In addition, a significant part of the participants is dissatisfied with their bodies, regardless of gender or the impacts brought about by the pandemic.

Myo-inositol in polycystic ovary syndrome: a systematic review and positioning of its use

Durval Ribas Filho — 2022-03-30

Introduction: Polycystic Ovary Syndrome (PCOS) is the most common endocrine disease among women of reproductive age 6 to 15% its presentation is complex and heterogeneous and is characterized by clinical and laboratory findings of hyperandrogenism, oligo-anovulation, metabolic abnormalities such as insulin resistance (IR), overweight, obesity, type 2 diabetes mellitus, dyslipidemia and increased risk of cardiovascular disease. Objective: To evaluate the effects of myo-inositol in pregnant and non-pregnant women with polycystic ovary syndrome in relation to fertility improvement, gestational outcomes, and metabolic and hormonal parameters. Methods: Data from randomized clinical trials on the efficacy of myo-inositol in women with PCOS were used in this review. The PubMed database was used for literature search. Results: Insulin resistance is one of the mechanisms that explain the emergence of metabolic and reproductive changes in women with PCOS. When compared to placebo, myo-inositol was effective in improving fertility, increasing ovulation and fertilization rates, in addition to improving metabolic parameters as indicators of insulin resistance (HOMA index). Even when compared to more traditional insulin sensitizers like metformin, myoinositol showed similar efficacy in restoring fertility. Myo-inositol was also effective when associated with clomiphene acetate and in women undergoing in vitro fertilization processes. There was also an improvement in pregnancy outcomes and a reduction in the risk of developing gestational diabetes with the use of myo-inositol. Conclusions: Myo-inositol improves clinical and laboratory parameters in both pregnant and non-pregnant PCOS patients, increasing the fertility rate and improving pregnancy outcomes.

Infant Formulas: A Long Story

Mário Cícero Falcão — 2022-03-07

The ideal feeding for infants is the breast milk because it has a balanced nutritional composition, which includes all essential nutrients, in addition to many bioactive factors that contribute to the growth and development of the child, as well as to the maturation of the gastrointestinal tract. Among them are immunological factors, antimicrobials and anti-inflammatory components, digestive enzymes, various types of hormones, and growth factors. If human milk is not available, there is an indication of infant formulas that should follow the recommendations of the Codex Alimentarius of the Food and Agriculture Organization/World Health Organization (WHO). In a century of history, infant formulas have gone from a simple combination of cow milk (evaporated or condensed) and water to highly sophisticated products, elaborated by very refined technological processes to produce lactose-free, antiregurgitation, based on soy protein, hydrolyzed protein in various grades, and only amino acids formulas. The major milestones in the modification of infant formulas were the incorporation of nutrients/ingredients such as: iron, nucleotides, alpha lactalbumin, long-chain polyunsaturated fatty acids, prebiotics, probiotics, postbiotics, oligosaccharides similar to human milk, lactoferrin, and milk fat globule membrane. Many of these ingredients have shown benefits on the immunological system. Despite the technological advances, breast milk remains irreplaceable, being the gold standard for infant feeding.

Smartphone-based photo analysis for the evaluation of anemia, jaundice and COVID-19

Thiago Mazzu-Nascimento — 2022-03-07

Anemia and jaundice are common health conditions that affect millions of children, adults, and the elderly worldwide. Recently, the pandemic caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), the virus that leads to COVID-19, has generated an extreme worldwide concern and a huge impact on public health, education, and economy, reaching all spheres of society. The development of techniques for non-invasive diagnosis and the use of mobile health (mHealth) is reaching more and more space. The analysis of a simple photograph by smartphone can allow an assessment of a person's health status. Image analysis techniques have advanced a lot in a short time. Analyses that were previously done manually, can now be done automatically by methods involving artificial intelligence. The use of smartphones, combined with machine learning techniques for image analysis (preprocessing, extraction of characteristics, classification, or regression), capable of providing predictions with high sensitivity and specificity, seems to be a trend. We presented in this review some highlights of the evaluation of anemia, jaundice, and COVID-19 by photo analysis, emphasizing the importance of using the smartphone, machine learning algorithms, and applications that are emerging rapidly. Soon, this will certainly be a reality. Also, these innovative methods will encourage the incorporation of mHealth technologies in telemedicine and the expansion of people's access to health services and early diagnosis.

Children with Feeding Difficulties Present Changes in the Development of Feeding Skills: A Study with a Control Group

Cláudia de Cássia Ramos — 2022-03-07

Introduction: Feeding skills (FS) are important to child development, as the delay in their presence could suggest feeding difficulties (FD) symptoms. The aim of the present study was to compare the development of three types of FS (autonomy to eat, posture at meals, and adequate use of cutleries) among children with FD and without FD. Methods: This was a case-control retrospective observational study. The sample consisted of 316 children from case and control groups in accordance with the presence (or not) of FD. The control group was recruited by convenience (verbal approaching at the emergency care unit), and the case group was based on the medical records collected at the reference center. A same-structured questionnaire was used for both groups. Results: Children with FD (63.2%) used baby-bottles in an inadequate way with a higher frequency after 24 months of age. Inadequate posture at meals was observed with higher frequency in children with FD (78.1%). Children without FD (89.1%) had more autonomy to eat. In children > 18 months old, this frequency was higher (90.6%). Conclusion: Children with FD showed changes on the development of FS. Inadequate posture at meals was associated with a 36-fold higher risk of having FD. Not eating alone after the age of 18 months was associated with a 6-fold higher risk of having FD, while not using baby bottles was associated with a lower risk (52%) of FD complaints. Delays in FS can be predictors of FD during childhood.

Dietary Modifications during Pregnancy through Decades

Yamini Bhatt — 2022-03-07

The present study aimed to explore the modifications in diet during pregnancy over three generations in the Garhwal region of Uttarakhand. For the selection of the sample, the respondents were categorized in 3 age groups: 20 to 34 years; 35 to 55 years; and ≥ 56 years. Structured diet recall interviews were scheduled for the collection of data. The subjects were asked about their dietary habits during pregnancy and food items that they included and excluded during that period. Most food items mentioned included were milk, fruits, and nutritional supplements. The exclusion of fruits like banana and papaya, of rice, and of leafy green vegetables (LGVs) was mainly observed. Among the age group of ≥ 56 years, the respondents with no changes in their diet during pregnancy were more from rural areas (92%) than from urban areas (62.26%), while in the age group of 20 to 34 years, 25% of the respondents with no change in their diet lived in rural areas, and 8.06% lived in urban areas. There has been an increase in the population with dietary modifications through generations; however, the overall changes are still not satisfying. The present study shows that there is a high need for nutritional education during pregnancy, especially in rural areas.

Vitamin Dietary Supplement: Changes and Challenges with the New ANVISA Regulations

Lucile Tiemi Abe-Matsumoto — 2022-03-07

In July 2018, the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária, ANVISA, in Portuguese) published new regulations for food supplements, leading to changes both in the sales denomination and labeling statements, and in the composition of these products. Among dietary supplements, those containing vitamins are the most consumed by the population. The objective of the present work is to discuss the changes in the parameters established for the products containing vitamins, mainly in relation to the required and allowed concentrations of micronutrients, and to verify the impact of these changes for the population since the publication of the new standards. Until July 2018, vitamin-based products containing between 15% and 100% of the recommended daily intake (RDI) of these micronutrients were classified as vitamin supplements; above this dosage, they were considered medicines. The new legislation changed the minimum and maximum limits allowed for vitamin food supplements. Taking into account the maximum vitamin limits established for adults, the most relevant differences were the increase in these limits in a proportion of 100, 76 and 43 times in regarding vitamins E, B6 and C respectively, when compared to those previously established. For the required minimum limits, the major difference was observed for vitamin D, with a four-fold increase in its concentration. In conclusion, changes in legislation can influence the health of the population, so the ideal amounts of vitamin in supplements and the recommendation to consume these products require extensive discussion and reflection.

Facing the BANI World

Moacir Fernandes de Godoy — 2022-03-07

We have already passed through the VUCA World. We must now face the BANI World. In VUCA World, the pillars were Volatility, Unpredictability, Complexity, and Ambiguity. In more recent times, especially with the Covid-19 Pandemic, we live in what the anthropologist, historian, and futurologist Jamais Cascio called BANI World, an acronym for the terms Brittle, Anxiety, Non-Linearity and Incomprehensible.

IJN is aware of this change and has sought to bring in its publications, current concepts, and rules of procedure in line with this new vision. And this, we Editors consider being extremely relevant because we want everyone to be able to assimilate the advance of knowledge that grows in a fast and non-linear way, without the wear and tear of anxiety and in the most understandable way possible.

We look forward to your contributions by sending your studies and research for publication.

Good reading

The Editors

Evaluation of Nutritional Risk and Prevalence of Obesity in Patients with Covid-19 in A Reference Hospital in Salvador, Bahia, Brazil: A Cross-Sectional Study

Rodrigo Fernandes Weyll Pimentel — 2022-03-07

Introduction: The Coronavirus has spread to almost every country in the world, causing the coronavirus disease (COVID-19). The coronavirus stands out among the other infections especially by it's high contagious power and important effects on the respiratory system. The COVID-19 has differents ways of presentation and these are influenced by the patient's previous nutricional status, correlated with the patient's lifestyle and comorbities. Objective: this survey seeks to analyze the nutritional status and the prevalence of obesity in patients hospitalized with SARS-CoV-2. Methods: this is a descriptive, prospective and cross-sectional study type, which 41 patients affected by COVID-19 were interviewed. Patient's weight and height were used to assess the BMI, and nutritional risk assessment was performed using the Nutritional Risk Screening tool (NRS 2002). For the analysis, Absolute (AF) and Relative Frequency (RF), the mean and the standard deviation were calculated. Results: It was observerd that 78% of the participants had a high nutritional risk, while only 22% had a low nutritional risk. Besides that, 34% showed overweight and 41.4% showed obesity. Conclusion: the existence of a high prevalence of increased nutritional risk was evidenced, in addition to the high frequency of overweight in patients affected by SARS-CoV-2.

Caring for Overweight Children and Adolescents at a Reference Clinic in Nutrology: Habits and Attendance

Valeria Moro — 2022-03-07

Introduction: The global obesity epidemic has mobilized health services to offer care at all levels, with reference outpatient clinics playing a prominent role in cases of greater complexity. Objectives: The present study aimed to identify soft drinks consumption and physical activity habits among children and adolescents diagnosed with overweight and obesity during the first visit at a secondary level nutrology outpatient clinic, and to verify attendance at follow-up visits in a 2-year period from the first visit. Materials and Methods: This is a retrospective, descriptive study based on data collection from medical records of overweighted or obese patients receiving first care at the Nutrology Clinic of the Municipal Health Secretariat from Ribeirão Preto, São Paulo, Brazil. The study population included children and adolescents aged between 2 and 18 years old cared for from January 2, 2013 to December 30, 2017. Age, weight, height, soft drinks consumption, physical activity, and attendance in scheduled follow-up visits during a 2-year period were analyzed. Results: During the study period, 316 patients were registered, including 302 (95.5%) diagnosed with obesity. Of these, 112 (35.4%) were children and 204 (64.6%) were adolescents. Only 2.0% of the children and adolescents did not consume soft drinks, while 23.5 and 26.2% of the children and adolescents, respectively, consumed them daily. Physical inactivity was reported by 31.8% of the children and by 35.8% of the adolescents. Among those who practiced some type of physical activity, 81.3% of the children and 78.2% of the adolescents did not meet the recommendation of moderate to vigorous activity for 60 minutes per day. Dropout rates within the 1st year were of 41.9% for children and of 34.3% for adolescents, increasing to 76.9% and 73.8%, respectively, within the 2nd year. Conclusion: There was a high consumption of soft drinks and low adherence to physical activity among patients who started outpatient follow-up. A small adherence to the follow-up program was also identified, with high dropout rates within the 2-year period following the first visit.

Nutritional Management of Critically Ill Patients Infected with SARS-CoV-2

Sérgio dos Anjos Garnes — 2022-03-07

Early nutritional therapy is essential to ensure the maintenance of adequate energy/protein intake for critically ill patients infected with severe acute respiratory syndrome caused by COVID-19 (SARS-CoV-2) infection. However, this poses a major challenge when it comes to individuals on mechanical ventilation in prone position. Therefore, the present work presents a nutritional therapy flowchart developed for patients with SARS-CoV-2 infection to guide nutritional management and ensure that energy/protein intake goals are met, thus favoring a positive clinical outcome.

Good News!

Moacir Fernandes de Godoy — 2022-03-07

The International Journal of Nutrology (IJN) brings good news!

Connected with the exponential advancement of knowledge in the areas of Health and seeking to contribute to the dissemination of this knowledge, starting with this issue, IJN will publish its articles entirely in English.

It is already well known that articles published in the English language are significantly more likely to be read and cited by other authors, thus expanding the web of communications.

This possibility is advantageous for IJN since one focus on obtaining insertion among the most prominent indexing bases.

With this new and vital step, we hope to be taking another action to contribute to our future indexations and improve IJN to the top of best international journals, benefits our authors, readers, and collaborators.

Good reading!

The Editors

Vitamin D Deficiency in Brazil: Questions about Potential Causes and Clinical Characteristics

Fabrícia Belloni dos Santos Vieira — 2022-03-07

Vitamin D is a micronutrient essential to various systems from the human body, and it is not restricted to the classical function of bone mineralization. Its synthesis is mainly related to ultraviolet B (UVB) radiation exposure. Although Brazil is a tropical country with high levels of UVB radiation, counter-intuitively, a large number of Brazilians present vitamin D deficiency, which is also a worldwide issue. This review aims to approach clinical features and explore potential causes for this apparent contradiction through questions that could explain vitamin D deficiency in the Brazilian population.

The Time for Parenteral Nutrition is Now: 12 Months Caring for Patients with Severe COVID-19

Claudio de Lima Barbosa — 2022-03-07

The coronavirus disease 2019 (COVID-19) pandemic has brought new challenges to adequate nutrition, especially in critically ill patients. Physicians caring for these patients face great difficulties, including a different pathophysiology compared with other diseases, inadequately trained personnel, pressure from the media and family members, logistical and economic obstacles, and lack of robust medical evidence. Although the literature on COVID-19 is still limited, evidence demonstrates the need to reevaluate the use of effective nutritional support in this unprecedented, challenging clinical context. Supplemental parenteral nutrition must be considered due to the energy expenditure from COVID-19, the difficulty in achieving protein and energy goals in patients under enteral nutrition in prone position, and the worsened gastroparesis related to high doses of sedative/neuromuscular blocking agents.

Efeitos e segurança do uso pré-operatório de glutamina ou Whey Protein: Uma revisão sistemática

Laura Naspitz — 2022-03-07

Background and Aim: Prolonged fasting increases postoperative insulin resistance, complicating surgical convalescence. Carbohydrate oral load 2 hours before surgery reduces unfavorable clinical outcomes. Would adding glutamine or whey protein to this solution be safe and could the patients have even greater benefits? Methods: Systematic review made from two databases using the following Medical Subject Headings: preoperative care or preoperative period associated with glutamine and then with whey protein. A total of 160 articles were found. After applying search filters and exclusion criteria, 16 articles were included in the present review. Results: All articles included are randomized clinical trials. Among those evaluating safety, none found adverse events or increased anesthesia risk when using glutamine or whey protein. Articles that investigated efficacy showed a reduction in insulin resistance and in inflammatory mediators and an increase in serum proteins and total antioxidant capacity in those who used the protein solution. Few authors could relate these laboratory findings to optimized clinical outcomes, except for two that used preoperative glutamine before cardiac surgery. Conclusion: Preoperative glutamine or whey protein has shown safety and postoperative laboratory benefits. Studies still need to be able to demonstrate greater clinical recovery when using preoperative protein.

Benefícios do ômega 3 na prevenção de doença cardiovascular: Revisão integrativa de literatura

Paulo Marcos do Nascimento — 2022-03-07

Introduction: Omega-3 polyunsaturated fatty acids such as alpha-linolenic acid (ALA), a fat found in plant foods, and eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), both found in fish, have been considered relevant substances for the maintenance of health, so that supplementation is being considered relevant for the reduction of cardiovascular risks. Objective: To identify and analyze the scientific evidence available in the literature on the contribution of omega 3 in the prevention and treatment of cardiovascular disease. Materials and Methods: Integrative literature review, with deference to materials published in the Scielo and PubMed databases, which considered as inclusion criteria articles published in the last 5 years, available in full, in English, Spanish, and Portuguese, which addressed the proposed theme; the exclusion criteria were editorials, letters to the editor, review studies, theses, dissertations, and duplicate articles that did not correspond to the theme. Results: Based on the aforementioned scientific evidence, the body's omega-3 indices are relevant to identify possible cardiovascular risk, so it can therefore be used as an objective for treatment when there is a possible risk for these manifestations. This risk factor can be modified by taking EPA and DHA. The standard 1 g/day dose of EPA and DHA recommended by cardiac societies is, however, probably far from ideal for everyone, as not only this standard dose but also diet, individual genetic history, body mass index, calorie intake and disposal, and other factors all together probably determine a person's level of omega-3 fatty acids. Therefore, it is suggested that the omega-3 index acts not only as a risk factor for cardiovascular disease, but that other contexts allied to the patient's lifestyle should be considered. Conclusion: Diet or supplementation of these nutrients may result in cardiovascular and other types of benefits to society as a whole.

Sarcopenia em idosos: um estudo de revisão

Marcela Cardoso Yanaga — 2022-03-07

With aging, there are several physiological changes throughout the body. In the skeletal musculature, there is a change in the pattern from fast to slow fibers, leading to a loss of muscle mass, strength and quality, which causes the individual to become weaker and slower. This loss of muscle mass and strength generates in the elderly a decrease in mobility, increased functional disability and dependence on activities, and may even lead to more serious consequences such as falls and fractures. We call this process sarcopenia. The mechanisms responsible for the development of sarcopenia are not yet fully known, but it is known that factors such as decreased steroid hormone levels, decreased protein intake, increased proinflammatory cytokine levels and physical inactivity are contributing factors. The present study is a review of the literature, which used scientific studies to investigate the impact of sarcopenia on the functionality of individuals > 65 years old.

Intervenções nutricionais na prevenção e tratamento de pacientes oncológicos em nível ambulatorial

Aline Portes Tonon — 2022-03-07

Malnutrition in cancer patients (CPs) is frequent, particularly in cases of head and neck cancer, and cancer of the digestive tract, due the location of the tumors, which may prevent nutrient intake and absorption. Given the severity of cancer-related malnutrition, adequate food intake measures are required, especially in relation to the energy consumed by these patients. Nutritional interventions (NIs) should be initiated whenever current or expected nutritional risk is diagnosed, when patients should be referred to specialized CP nutritionists. The main approaches of the NIs are nutritional counseling, prescription of oral nutritional supplements, and enteral nutrition, to be determined and selected through nutritional screening and assessment. Different nutritional guidelines help professionals in the provision of nutritional support. The aim of the present study was to conduct a narrative literature review regarding the role of nutrition and the main means of nutritional intervention, which contribute to the prevention and treatment of cancer outpatients through a literary research in Portuguese and English using electronic resources. We concluded that nutritional interventions are imperative in cases of cancer-associated malnutrition, but further research is needed to determine the true role of food in the prevention of cancer.

Importantes aspectos da Nutrologia e suas aplicações nos pacientes oncológicos

Ricardo Zylberberg — 2022-03-07

Global estimates show that the incidence of cancer all over the world has been increasing and, consequently, the mortality related to this diagnosis. Several cancer-related risk factors have been identified, such as smoking, overweight, western diets and physical inactivity. Robust scientific evidence shows that most cancers can be prevented with behavioral measures. Despite extensive knowledge of cancer-related modifiable risk factors, the implementation of prevention measures is still incipient. Interventions aiming at weight control, diet customization and physical activity stimulation can improve the quality of life and some outcomes related to cancer and its treatment. The present article aims to review the impacts of these variables on the diagnosis, treatment and mortality of cancer patients. In addition, it discusses the main recommendations of the specific nutritional aspects of this population.