Nutritional evaluation of stage 5 chronic kidney disease patients on dialysis

CONTEXTO E OBJETIVO: Portadores de insuficiência renal crônica em diálise apresentam alta prevalência de desnutrição proteico-energética. Não existe ainda um método uniforme para avaliar o estado nutricional desses pacientes. Recomenda-se a aplicação de um conjunto de métodos subjetivos e objetivos para se chegar aos diagnósticos nutricionais adequados. O objetivo deste estudo é traçar o perfil nutricional de pacientes submetidos a hemodiálise. TIPO DE ESTUDO E LOCAL: Estudo transversal descritivo realizado na Unidade de Tratamento Dialítico de Araraquara, São Paulo, Brasil, em 2008. MÉTODOS: 48 pacientes tiveram seus indicadores antropométricos e bioquímicos caracterizados, sendo também submetidos ao questionário Avaliação Global Subjetiva modificada (SGAm), verificando-se possíveis correlações entre esses indicadores. RESULTADOS: A frequência de desnutrição moderada e grave variou de 22% a 54%, de acordo com o parâmetro utilizado. Com relação à adequação do peso ideal, 29% da amostra estavam com porcentagem de adequação abaixo do percentil 75, classificados como portadores de desnutrição moderada e grave. As correlações mais significativas foram observadas entre índice de massa corporal (IMC) e adequações de prega triciptal (PCT), circunferência do braço (CB) e circunferência muscular do braço (CMB); e entre o SGAm e adequações de CB e CMB. CONCLUSÃO: A desnutrição apresentou grande variabilidade de frequência entre os pacientes de acordo com o critério escolhido para avaliação. O acompanhamento nutricional de rotina e a validação de métodos que avaliem a composição corporal desses pacientes são de extrema importância para diagnosticar precocemente a desnutrição e assim prevenir complicações e reduzir as taxas de morbimortalidade nesta população.

Perfil dos beneficiários do Programa de Suplementação Alimentar de uma unidade básica de saúde de Botucatu, São Paulo

OBJETIVO: Este estudo objetivou apreender algumas características sócio-sanitárias do grupo de beneficiários do Programa de Suplementação Alimentar de unidade básica de saúde de um município de médio porte do interior paulista. Especificamente, buscou-se delinear o perfil deste grupo quanto aos fatores de risco para a desnutrição infantil a que estava exposto e dimensionar a utilização dos critérios de inclusão neste programa. MÉTODOS: A pesquisa é de cunho descritivo e se baseou em documentos oficiais vigentes para a definição dos fatores de risco a serem analisados. Foram avaliadas 290 crianças cujas mães ou responsáveis foram entrevistados, segundo um protocolo previamente estabelecido. RESULTADOS: O grupo de beneficiários caracterizou-se por ser heterogêneo quanto à freqüência e ao grau da exposição a fatores de risco para a desnutrição, denotando que há diferenças nos problemas socioeconômicos e sanitários apresentados, como também na combinação entre eles, em cada família. CONCLUSÃO: Para a otimização do programa, ainda vigente no município, sugere-se a padronização loco-regional de critérios de inclusão, conforme a proposta oficial central, com o registro claro dos mesmos e, também, a aplicação de métodos avaliativos periódicos, adequada capacitação da equipe de saúde e maior envolvimento da população usuária.

Causas da desnutrição pós-gastrectomia

Racional A retirada total ou parcial do estômago resulta em conseqüências nutricionais, agudas ou crônicas, perfeitamente prognosticáveis, mas nem sempre ponderadas na terapia pós-operatória. Objetivo - Rever as participações mecânicas e químicas do estômago no aproveitamento do nutriente dietético, e as conseqüências nutricionais da gastrectomia. Resultados - A deficiência energética, com conseqüente perda de peso, acompanha inversamente o volume gástrico remanescente e o tempo pós-operatório; tem a anorexia e diarréia (má absorção) como principais causas, sendo a primeira decorrente de fatores emocionais ou de mediadores químicos de ação hipotalâmica. A diarréia pode ser decorrente da maior motilidade ou do supercrescimento bacteriano intestinais, com o agravante da insuficiência pancreática exócrina e maior esvaziamento da vesícula biliar. A má absorção traz conseqüências não apenas energética-protéica com a perda fecal de gordura e nitrogênio, como também vitamínico-mineral pelo menor aproveitamento da vitamina D e cálcio dietéticos. A anemia verificada no gastrectomizado é conseqüente à diminuição da produção de HCl (e menor solubilização do ferro) e do fator intrínseco (com menor absorção da vitamina B12). Conclusão - Perda de peso e anemia são os sinais de desnutrição mais comumente observados nestes pacientes, em intensidade e duração variáveis dependentes do tipo de cirurgia e do tempo e tratamento nutricional pós-operatório, sendo recomendável o tratamento dietético supervisionado.

Compensatory lung growth: protein, DNA and RNA lung contents in undernourished trilobectomized rats

OBJETIVO: demonstrar se ocorre crescimento pulmonar compensatório (CPC) representado pelos conteúdos de proteínas, DNA e RNA no rato adulto jovem, subnutrido, submetido à trilobectomia pulmonar. MÉTODOS: Utilizamos 137 ratos Wistar, machos, distribuídos por sorteio, em 9 grupos, submetidos a três tratamentos (controle, toracotomia, trilobectomia), sacrificados em três momentos (7, 30 e 90 dias). Na trilobectomia foram extirpados os lobos médio, acessório e caudal direitos. Variáveis estudadas: conteúdos pulmonares de proteínas, DNA e RNA. RESULTADOS: No lobo cranial e pulmão esquerdo o conteúdo protéico foi maior nos trilobectomizados. Ocorreu CPC insuficiente para suprir a perda desta variável, sendo menor nos pulmões dos trilobectomizados. O incremento nos conteúdos de DNA do lobo cranial e pulmão esquerdo dos trilobectomizados foram suficientes para compensar a perda desta variável, resultando num conteúdo de DNA dos pulmões semelhante aos controle. O conteúdo de RNA, nos trilobectomizados, foi maior no lobo cranial e pulmão esquerdo, com maior eficiência no primeiro, insuficiente para que se aproximassem aos obtidos nos demais grupos, ficando menores. CONCLUSÃO: Nos trilobectomizados ocorreu CPC, provavelmente com hiperplasia celular e pouca hipertrofia, devido a grande compensação do DNA e pequena do RNA. Esta foi a grande diferença quando comparamos este resultado ao obtido com animais nutridos, que apresentavam hipertrofia pronunciada.

Effects of intrauterine malnutrition on brain free amino acids of young rats, after nutritional recovery during lactation period

The effect of protein-calorie malnutrition during gestation on the brain amino acids of rat pups was studied following nutritional recovery during lactation. The brain amino acids of rat pups born to dam rats malnourished during gestation were studied after these rat pups received proper nutrition during lactation. Pregnant rats were fed a 1% protein diet with total caloric intake restricted to half that of controls. After birth, the offspring of rats fed on deficient diets were nurtured up to the 28th day postpartum by foster mothers receiving adequate diets. At this time, the offspring were killed. The control group consisted of offspring from pregnant rats fed a diet with adequate protein (21%) and calories during the entire gestation and lactation period. Quantitation of brain amino acids in the pups at 28 days postpartum showed lower concentrations of essential and nonessential amino acids in the rats malnourished during gestation. Concentrations of histidine, glycine, and α-aminobutyric acids were all reduced. These findings demonstrate that the brains of rat pups malnourished during gestation show persistent decreases in specific brain amino acids after adequate postpartum nutrition.

Implicações nutricionais no tratamento e recuperação de pacientes adultos com diarréia crônica.

The nutritional assessment by 24 hour-dietary recall, anthropometry and blood-components measurements was undertaken in 23 adult patients, 17 males and 6 females suffering of chronic diarrhea from pancreatitis (30%), inflammatory bowel disease (22%), short intestine syndrome (9%) and unknown diarrhea (35%). The nutritional assessment was done at the entry and repeated at the discharge of the hospitalization that averaged 35 days, during which the patients received specific medical treatment along with obstipating diets. The hospitalization resulted in overall improvement of the patients either clinically by reducing their defecation rate or nutritionally by increasing their protein-energy intake and the values of anthropometry and blood components (albumin, free-tryptophan and lymphocytes). When the patients where divided into two groups based on their fecal-fat output one could note the better nutritional response of the group showing steatorrhea than the non-steatorrhea group, with the serum albumin and the arm-muscle circumference being discriminatory between groups. However even in the better recovered patients the indicative values of a satisfactory nutritional status were not accomplished. Thus, these data suggest that besides the overall nutritional improvement seen in the studied chronic diarrhea patients the full-nutrition recovering would demand either or both a longer hospitalization and/or an early-aggressive nutritional support.

Alterações histológicas de glândulas submandibulares e testículos induzidas por dietas à base de soja e dieta zinco deficiente em ratos.

The purpose of this study was to examine in rats the histologic alterations of the submandibular glands and testicles induced by soy diets and zinc deficient diet. The zinc deficiency produced testicles alterations including seminiferous tubulus atrophy, germinative epithelium degeneration, spermatogenesis alterations and a significant atrophy of the submandibular glands which presented no much delimitated acines. The soy diet without complementations also compromised the spermatogenesis by showing seminiferous tubulus atrophied and a reduction of the germinative epithelium. The soy diet complemented by saline and vitaminic mixtures didn't produced testicles alterations but its induced in the submandibular glands a hypertrophy of the ductal component mainly in relation to the granular component.

Is chronic hypoxemia in patients with chronic obstructive pulmonary disease associated with more marked nutritional deficiency?: A study of the fat-free mass evaluated by anthropometry and bioelectrical impedance methods

In order to determine wheter blood gases abnormalities, specially hypoxemia, are associated with more marked changes in fat-free mass in patients with chronic obstructive pulmonary disease (CPOD), nutritional assessment was performed on 16 normoxemic (PaO 2 > 55 mm Hg) and 16 hypoxemic (PaO 2 < 55 mm Hg) COPD patients in stable clinical condition. Body weight was expressed as percentage of the ideal body weight. Fat-free mass was estimated by anthropometry (FFM-Anthr) and by bioelectrical impedance (FFM- BI). Handgrip-strength was assessed as a measure of peripheral skeletal muscle strength. Patients were age-matched and presented similar degree of airway obstruction. Malnutrition, defined as body weight less than 90% of the ideal, was observed in 19% of the normoxemic patients and in 25% of the hypoxemic patients (p>0,05). FFM values in hypoxemic patients, estimated by both methods, were not different from those observed in normoxemic patients. No significant difference was observed on handgrip values between the two groups. No correlation was found between nutritional indices and pulmonary function and gases exchange parameters. FFM correlated positively with values of peripheral muscle function in normoxemic and hypoxemic patients. These data add further evidence to the hypothesis that hypoxemia is not a primary cause of the nutritional deficiency observed in COPD patients.

Manifestações sistêmicas na doença pulmonar obstrutiva crônica

Chronic obstructive pulmonary disease is progressive and is characterized by abnormal inflammation of the lungs in response to inhalation of noxious particles or toxic gases, especially cigarette smoke. Although this infirmity primarily affects the lungs, diverse extrapulmonary manifestations have been described. The likely mechanisms involved in the local and systemic inflammation seen in this disease include an increase in the number of inflammatory cells (resulting in abnormal production of inflammatory cytokines) and an imbalance between the formation of reactive oxygen species and antioxidant capacity (leading to oxidative stress). Weakened physical condition secondary to airflow limitation can also lead to the development of altered muscle function. Chronic obstructive pulmonary disease presents diverse systemic effects including nutritional depletion and musculoskeletal dysfunction (causing a reduction in exercise tolerance), as well as other effects related to the comorbidities generally observed in these patients. These manifestations have been correlated with survival and overall health status in chronic obstructive pulmonary disease patients. In view of these facts, the aim of this review was to discuss findings in the literature related to the systemic manifestations of chronic obstructive pulmonary disease, emphasizing the role played by systemic inflammation and evaluating various therapeutic strategies.

Implications of intrauterine protein malnutrition on prostate growth, maturation and aging

Aims Maternal malnutrition by low protein diet is associated with an increased incidence of metabolic disorders and decreased male fertility in adult life. This study aimed to assess the impact of maternal protein malnutrition (MPM) on prostate growth, tissue organization and lesion incidence with aging. Main methods Wistar rat dams were distributed into two groups, which were control (NP; fed a normal diet containing 17% protein) or a restricted protein diet (RP, fed a diet containing 6% protein) during gestation. After delivery all mothers and offspring received a normal diet. Biometrical parameters, hormonal levels and prostates were harvested at post-natal days (PND) 30, 120 and 360. Key findings MPM promoted low birth weight, decreased ano-genital distance (AGD) and reduced androgen plasma levels of male pups. Prostatic lobes from RP groups presented reduced glandular weight, epithelial cell height and alveolar diameter. The epithelial cell proliferation and collagen deposition were increased in RP group. Incidences of epithelial dysplasia and prostatitis were higher in the RP offspring than in the NP offspring at PND360. Significance Our findings show that MPM delays prostate development, growth and maturation until adulthood, probably as a result of low testosterone stimuli. The higher incidence of cellular dysplasia and prostatitis suggests that MPM increases prostate susceptibility to diseases with aging. © 2013 Elsevier Inc.

Circulating thyroid hormone levels in young pregnant rats and their fetuses: Effect of malnutrition

In order to evaluate some factors likely to be involved in the maternal and fetal growth impairment due to alimentary protein deficiency, the circulating levels of triiodothyronine (T 3) and thyroxine (T 4) were studied in 4 young (45-day-old) female rat groups: control and malnourished, both nonpregnant and pregnant; similarly schedules groups were studied using adult (100-day-old) rats. Circulating levels of T 4 were higher in nonpregnant, malnourished young rats in their corresponding controls. T 3 levels were higher in young malnourished animals and lower in adult malnourished animals, nonpregnant or pregnant, as compared to controls. Pups from young malnourished mothers showed significantly lower birth weights than those from controls. The present results suggest that there are age differences in thyroid function, as affected by protein-calorie malnutrition in pregnant and non-pregnant rats. On the other hand, the circulating thyroid hormone levels were not importantly affected by the mother dietary protein restriction under our experimental conditions.

Enteral nutrition feeding alters antioxidant activity in unstimulated whole saliva composition of patients with neurological disorders

Patients with neurological disorders have an increased risk of oral and systemic diseases due to compromised oral hygiene. If patients lose the ability to swallow and chew food as a result of their disorder, enteral nutrition is often utilized. However, this type of feeding may modify salivary antioxidant defenses, resulting in increased oxidative damage and the emergence of various diseases. The aim of this study was to evaluate the effects of enteral nutrition on biochemical parameters in the unstimulated whole saliva composition of patients with neurological disorders. For this, enzymatic (superoxide dismutase - SOD; glutathione peroxidase - GPx) and non-enzymatic (uric acid; ferric ion reducing antioxidant power - FRAP) antioxidant activity, as well as a marker for oxidative damage (thiobarbituric acid reactive substances - TBARS) were analyzed. Unstimulated whole saliva was collected from 12 patients with neurological disorders and tube-feeding (tube-fed group - TFG), 15 patients with neurological disorders and normal feeding via the mouth (non-tube-fed group - NTFG), and 12 volunteers without neurological disorders (control group - CG). The daily oral hygiene procedures of TFG and NTFG patients were similar and dental care was provided monthly by the same institution's dentist. All patients exhibited adequate oral health conditions. The salivary levels of FRAP, uric acid, SOD, GPx, TBARS, and total protein were compared between studied groups. FRAP was increased (p < 0.05) in the NTFG (4651 +/- 192.5 mmol/mL) and the TFG (4743 +/- 116.7 mmol/mL) when compared with the CG (1844 +/- 343.8 mmol/mL). GPx values were lower (p < 0.05) in the NTGF (8.24 +/- 1.09 mmol/min/mg) and the TFG (8.37 +/- 1.60 mmol/min/mg) than in the CG (15.30 +/- 2.61 mmol/min/mg). Uric acid in the TFG (1.57 +/- 0.23 mg/dL) was significantly lower than in the NTFG (2.34 +/- 0.20 mg/dL) and the CG (3.49 +/- 0.21 mg/dL). Protein was significantly lower in the TFG (5.35 +/- 0.27 g/dL) than in the NTFG (7.22 +/- 0.57 g/dL) and the CG (7.86 +/- 0.54 g/dL). There was no difference in the salivary flow rate and SOD between groups. Enteral nutrition in patients with neurological disorders was associated with lower oxidative damage, resulting in increased salivary. antioxidant capacity. These results emphasize the importance of oral care for this population to prevent oral and systemic diseases. (C) 2014 Elsevier Ltd. All rights reserved.

Effects of eating disorders on oral fungal diversity

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Growth and nutritional disorders of eggplant cultivated in nutrients solutions with suppressed macronutrients

The objective was to evaluate the effects of omitting macronutrients in the nutrients solution on growth characteristics and nutritional status of eggplants. The treatments were complete nutrients solution and solutions with nutrient omission: nitrogen (N), phosphorus (P), potassium (K), calcium (Ca), magnesium (Mg), and sulfur (S). The experiment was carried out under greenhouse conditions with three replicates in a completely random design. Plant height, number of leaves per plant, leaf area, relative chlorophyll index, photosynthesis rate, stomatal conductance, dry matter, concentration levels of macronutrients in plant aerial part and root system, and nutritional disorders were evaluated. Omitting elements interfered in the concentration of elements in the various plant tissues and this had as consequences limited vegetative growth, reduced dry matter and led to the development of the typical deficiency symptoms of each element. Although potassium was the most demanded of all elements, nitrogen and calcium were the most growth limiting ones.