International Journal of Nutrology

The role of leucine in the activation of cellular metabolism: a large integrative review

Amir Salomão Gebrin — 2022-11-23

This review addressed the signaling of cellular activation by leucine, discussed the risks of excessive signaling by proteins in the Western diet, and explored the potential of leucine stimulation in tissue regeneration. As result, amino acids are, in addition to building blocks of macromolecules, cellular activation signals. Essential amino acids are not produced by animals and leucine appears to be the main signaling amino acid. Mammals adjusted the cell activation and growth rate of their young by the leucine concentration of the milk produced. Several studies demonstrate the benefits of leucine supplementation in preventing sarcopenia, improving muscle and liver performance, as well as a possible neuroprotective role in head trauma and dementia. However, its excess, so common in the Western diet, is related to obesity, type II diabetes, neurodegenerative diseases, and cancer. The mTORC1 kinase integrates cellular activation stimuli from macro protein synthesis to epigenetic regulation. Controlling mTORC1 activity by consuming leucine can prevent, treat, or cause disease. A greater understanding of the regulatory effects of leucine and mTOR in unstable tissues such as tumors or fragile tissues such as the CNS are areas of great relevance and with extensive fields still to be explored.

Relationship between nutrology and oral health: a systematic review of major clinical findings

Vivian Teixeira Martins Yamaguchi — 2022-11-14

Introduction: Food and nutrition are fundamental in maintaining the general and oral health of populations. Health status can be affected by nutrient deficiency and vice versa. Dietary guidelines were developed to provide evidence-based food and beverage recommendations to populations to promote a diet that meets nutritional needs and prevents diet-related illness. Objective: Aimed to carry out a concise systematic review to elucidate through clinical studies the real relationship between nutrition and oral health. Methods: The rules of the Systematic Review-PRISMA Platform. The research was carried out from August to October 2022 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, using scientific articles from 2005 to 2022. 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 125 articles were found. In total, 75 articles were fully evaluated and 35 were included and evaluated in this systematic review. It was concluded that food and nutrition are fundamental in maintaining the general and oral health of populations. Health status can be affected by nutrient deficiency and vice versa. Nutrology can promote a diet that meets nutritional needs and prevent diet-related diseases such as tooth decay. It was evidenced that malnutrition can significantly affect oral health and vice versa. A diet lacking in nutrients can lead to the progression of oral cavity disease by altering tissue homeostasis, reducing resistance to microbial biofilm, and decreasing tissue healing. It can also affect the development of the oral cavity.

Major approaches to melatonin and nutrients regulation in the bone regeneration process with exosomes and microRNAs: a systematic review

Danillo Gomes Leite — 2022-10-31

Introduction: Bone diseases comprise a large group of common diseases, including fractures, osteoporosis, and osteoarthritis that affect a large number of individuals. Without intervention, the prevalence of osteopenia is projected to increase to 64.3 million Americans and that of osteoporosis to 11.9 million by the year 2030. Melatonin exerts numerous physiological effects, including the induction of anti-inflammatory and antioxidants, resetting circadian rhythms, and promoting wound healing and tissue regeneration, participating in the maintenance and regenerative processes of bones and cartilage. Objective: A systematic review was carried out to present the state of the art of melatonin regulation, mesenchymal stem cells, exosomes, microRNAs, and nutrients in the bone regeneration process. Methods: The systematic review rules (PRISMA) were followed. The search was carried out from July to September 2022 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using scientific articles from 2019 to 2022. 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 126 articles were found. A total of 59 articles were fully evaluated and 46 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 9 studies at high risk of bias and 24 studies that did not meet the GRADE. Most studies showed homogeneity in their results, with I2 =97.8%>50%. The symmetrical funnel plot does not suggest a risk of bias between small sample-size studies. Based on the results, melatonin has important functions in regulating the regenerative activities of mesenchymal stem cells that modulate, together with nutrients, the activities of exosomes and microRNAs in the bone regeneration process.

Nutrological and metabolic approaches to the action of the some special micronutrients in heart failure and metabolic syndrome: a systematic review

Vanessa Piovesan Freitas Assumpção — 2022-10-28

Introduction: In the heart disease scenario, heart failure (HF) is the leading cause of hospitalizations in the United States in patients over 65 years of age, and there is evidence that this pathology affects 26 million people worldwide. Dietary guidance for patients with HF has focused on sodium restriction and fluid intake, but diet quality is often poor in HF patients and can contribute to morbidity and mortality. Restrictive diets can lead to inadequate intake of macro and micronutrients by patients with HF, highlighting deficiencies in calcium, magnesium, coenzyme Q10, zinc, iron, thiamine, vitamins D, E, and K, and folate. Objective: Through a systematic literature review, the main nutrological approaches to the action of the micronutrients magnesium, coenzyme Q10, and vitamin D in heart failure and metabolic syndrome were evidenced. Methods: The present study followed a concise systematic review model (PRISMA). The literary search process was carried out from August 2022 to September 2022 and was developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, using scientific articles from 1998 to 2022. The low quality of evidence was attributed to reports of cases, editorials, and brief communications, according to the GRADE instrument. The risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: The total of 136 studies were found for eligibility analysis, and then 75 of the 84 total studies were selected for this systematic review. According to the GRADE instrument, most studies showed homogeneity in their results, with I2 =98.7% >50%. The Funnel Plot showed a symmetrical behavior, not suggesting a significant risk of bias in studies with smaller sample sizes. Studies have shown that magnesium deficiency or changes in its metabolism are related to the pathophysiology of heart failure, hypertension, arrhythmias, preeclampsia, insulin resistance, and diabetes. Vitamin D plays an important role in innate and adaptive immune responses, cell cycle, and metabolic processes, evidenced by the reported relationship between its deficiency and the prevalence of immunity-mediated disorders, cancer, and cardiometabolic diseases. The VDR results in β cells, endothelium, cardiac myocytes, and renin production suggesting a role for vitamin D in these diseases. Coenzyme Q10 is part of the electron transport chain and is found in large concentrations in the mitochondrial, especially in the muscles, brain, and heart. Clinical studies have shown that pathologies such as acute myocardial infarction, arterial hypertension, and myopathies induced by statins, physical fatigue inherent in physical exercise, male infertility, preeclampsia, Parkinson's disease, periodontal disease, and migraine had low plasma concentrations of coenzyme Q10.

Major evidence of nutrological regulation in obese patients with meta-inflammation: a systematic review

Paulo Mageste Lessa — 2022-10-25

Introduction: Obesity stands out as a multifactorial disease that can cause several public health problems. There are 2.0 billion overweight and obese people in the world, and Brazil ranks fifth in the world. A healthy nutritional status promotes immune function and can prevent the onset of a serious inflammatory process and severe infections, especially in times of a pandemic such as COVID-19. Objective: It was to highlight the main clinical considerations of nutrological and dietary regulation in obese patients with marked inflammatory processes and meta-inflammation through a systematic review. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from August to September 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: A total of 127 articles were found. A total of 74 articles were fully evaluated and 29 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 32 studies at high risk of bias and 25 studies that did not meet the GRADE. Research has shown that unbalanced dietary patterns, such as the Western diet, rich in simple sugars, refined carbohydrates, and saturated and trans fatty acids, lead to chronic inflammatory responses, increased fat deposits, and future comorbidities associated with overweight and obesity. Caloric restriction decreased polymerase chain reaction (PCR) in obese patients and diet administration over 12 weeks had a beneficial effect. Furthermore, obese patients with antioxidant supplementation had lower values of BMI, waist circumference, fasting blood glucose level, and insulin resistance homeostasis model assessment when compared to the placebo group, as well as lower total cholesterol levels, triglycerides, LDL, malondialdehyde and tumor necrosis factor-alpha. Supplementation of n-3 PUFA can significantly reduce serum PCR, tumor necrosis factor α (TNFα), and interleukin 6 (IL-6) concentrations.

Evaluation of premenstrual syndrome and its relationship with changes in food consumption during the luteal phase in a university center in northwest paulista: a prospective observational cross-sectional study

Beatriz Rosa Meneghesso — 2022-10-07

Introduction: The menstrual cycle is a natural phenomenon that occurs in two phases: follicular and luteal. Several hormonal, physical and psychological changes occur during this period, which influence the female diet. These changes and consequences are felt mainly in the luteal phase, that is between 1 to 5 days before the menstrual flow, characterizing the premenstrual syndrome (PMS) or premenstrual tension (PMS). Objective: This article aims to evaluate food intake and dietary changes in adult women of reproductive age during the luteal phase of the menstrual cycle. Methods: Quali-quantitative descriptive exploratory study, carried out with 207 female students, between 18 and 41 years of age, from all courses at a University Center in northwestern São Paulo. An online questionnaire was applied via Google Forms with closed and open questions that characterized the sample regarding the participants' personal and dietary aspects in the luteal phase. The work complied with Resolution 466/12 of the National Health Council and was approved by the Ethics Committee and all participants signed the Informed Consent Term. Results: It was observed that there was a predominance of women aged between 19 and 22 years (64.25%). With regard to physical symptoms in the luteal phase, 95.65% of women reported having at least one symptom, such as swollen and/or painful breasts (67.7%) and colic (55.1%). Regarding the intensity of food craving, 5.3% of the women reported no changes, 10.6% had low intensity (mild), 50.7% had moderate intensity, 27.5% had high intensity (high) and 5, 8% very high intensity (severe). According to the change in dietary pattern, among the foods presented, 85% of the participants claimed to have a higher consumption of sugars and sweets during this period and 38.6% higher consumption of carbohydrates, representing most of the responses collected. It was found that food cravings among the participants occurred with high frequency in 91.78% of the cases, with emphasis on the high craving for sweets (87%) and fast food (33.8%). The increase in food consumption in the luteal phase was significant, as it was present in 70.5% of women. Conclusion: The luteal phase interferes with the pattern and intensity of food craving, as well as with the increased intake of macronutrients, especially carbohydrates, sugars and sweets.

Anais XXVI Congresso Brasileiro de Nutrologia - n. 26, v. 1, 2022

Carlos Alberto Nogueira-de-Almeida — 2022-10-07

O XXVI Congresso Nacional de Nutrologia é o maior evento de nutrologia da América Latina e, em 2022, tem como objetivo geral transmitir conhecimentos científicos e atuais com palestrantes de renome nacional e internacional.
Além disso, promove o envolvimento de acadêmicos, médicos, nutricionistas, psicólogos na elaboração e apresentação de trabalhos científicos, visando fomentar a produção científica na nossa área.
Desejamos que todo o conteúdo aqui apresentado seja de grande utilidade na aplicação do seu trabalho, no dia a dia, contribuindo para a honra dos princípios da Nutrologia, que é promover saúde e bem-estar.

The role of intestinal and vaginal dysbiosis in endometrial cancer: an integrative review

Patrícia Alves de Oliveira Ferreira Sbragi — 2022-09-30

The increase in the incidence of endometrial neoplasms in the female population is associated with increased life expectancy and the lifestyle adopted in our daily lives. The way we eat influences the profile of our bacterial flora and the production of substances that can work as suppressor tumors or oncogenic. Dysbiosis leads to changes in the intestinal and vaginal bacterial barrier and promotes chronic inflammation and metabolic and hormonal changes that influence the carcinogenesis of gynecological tumors. Chemotherapy treatments can also change the composition of the intestinal microbiota and influence the efficacy and toxic effects, as well as the quality of life of these patients. The use of prebiotics, probiotics, or fecal transplantation can be useful both in prevention and in obtaining better results with chemotherapy treatment and better quality of life. The objective of this review is to provide further elucidation about the interaction mechanisms between the intestinal microbiota and the gynecological tract and assess future perspectives through the modification of the feeding pattern, use of prebiotics, probiotics, and fecal transplant both in the prevention and during the treatment of carrier patients of endometrial neoplasm.

Pseudohipoaldosteronism Type 1: a case report supported by a literature review

Natália Cavalheiro Braz Fernandes — 2022-09-30

In the neonatal period, hydro electrolytic disorders with dehydration and metabolic acidosis can cause admission to an intensive care unit and become a diagnostic challenge. Among such disorders, hyponatremia and hyperkalemia become diagnostic challenges with hormonal involvement, including aldosterone. Pseudohypoaldosteronism (PHA) resulting from the lack of response to aldosterone in target cells can be classified into three types and its suspected diagnosis in cases of hyponatremia, hyperkalemia with an elevation of serum aldosterone, can be confirmed by exome sequencing with identification of a potentially pathogenic. This study was based on the case report of a newborn of consanguineous parents who, after birth, evolved in the first week of life with shock, hyponatremia, hyperkalemia, and metabolic acidosis. An initial investigation ruled out congenital adrenal hyperplasia. The presence of hyperaldosteronism with increased plasma renin activity, associated with hyperkalemia and hyponatremia difficult to control with electrolyte replacement, led to a molecular investigation that confirmed PHA type 1 by a mutation in the SCCN1A gene. In neonates with severe hyponatremia that is difficult to resolve with conventional treatment and elevation of serum aldosterone, this pathology must be remembered and investigated, avoiding high morbidity and mortality.

First 2,200 days of life as a window of opportunity for multidisciplinary action regarding the developmental origin of health and disease: positioning of the Brazilian Association of Nutrology

Carlos Alberto Nogueira-de-Almeida — 2022-08-25

Introduction: From the beginning of the 21st century, a new concept began to emerge in scientific and social circles: the first 1,000 days of life. Along the same lines, an international movement started in the same period began to discuss the “developmental origin of health and disease”. Numerous problems that affect human beings throughout their life cycle begin in the early years and often can be avoided or minimized when early recognized and addressed. This document discusses, based on the scientific literature, the idea of expanding the window of opportunity for 2,200 days, encompassing the preconception phase to the end of the fifth year of life. Methods: Scientific articles published up to 2022 in Pubmed/Medline, SciELO, Google Scholar, and Lilacs databases, in Portuguese, English, and Spanish, were reviewed in an integrative manner. The search for articles was directed to topics related to intervention targets that could impact the present and future health of the child. Results: Biological, social and psychological aspects were studied in five phases: preconception, gestational, first year, second year, and third to the fifth year of life. The data obtained show the importance of expanding the period of greater professional attention at the beginning of life. Conclusion: The Brazilian Association of Nutrology recommends a window of 2,200 days (100 days in preconception + 270 days of gestation + 1,830 days from the first to the fifth year of life) as the ideal period of professional activity to guarantee present and children's future.

II Consensus of the Brazilian Nutrology Association on DHA recommendations during pregnancy, lactation and childhood

Carlos Alberto Nogueira-de-Almeida — 2022-08-25

Objective: To update of the consensus of the Brazilian Association of Nutrology regarding DHA consumption and supplementation during pregnancy, lactation and childhood. Methods: Scientific articles published until 2022 were reviewed in Pubmed/Medline, SciELO and Lilacs databases. Results: Considering the information obtained, the authors drafted the consensus, which was approved by the Brazilian Association of Nutrology board. Conclusions: The recommendations of the Brazilian Nutrology Association are presented based on scientific evidence.

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