Estudo de fibras alimentares em frutas e hortaliças para uso em nutrição enteral ou oral

Dietas enterais com alimentos convencionais são usadas em nutrição domiciliar para fornecer macronutrientes, obter dietas individualizadas e de menor custo. O objetivo deste trabalho foi estudar frutas e hortaliças (alface, berinjela, cenoura, chicória, goiaba e tamarindo) como fontes de fibras alimentares solúveis e insolúveis para serem usadas em nutrição enteral ou suplemento nutricional oral. As hortaliças e frutas foram adicionadas a uma formulação enteral domiciliar e também preparadas em solução com água. Foram determinadas a composição centesimal, as fibras solúveis e insolúveis dos alimentos, a atividade de água e o pH das formulações. Foram realizados testes de gotejamento das formulações com os alimentos experimentais. A melhor proporção de alimento/dieta enteral domiciliar foi de 100 g/2 L para dieta enteral e de 150 g/2 L para suplemento nutricional oral (ingestão por boca). As quantidades de cada alimento adicionadas à formulação enteral equivalem a duas porções (100 g) diárias de cada alimento para 2 L e 2000 kcal. A maior contribuição para aumentar a quantidade de fibras foi da goiaba e a menor, da berinjela. Os valores de atividade de água ficaram entre 0,95 e 1,00, indicando que as dietas são susceptíveis à contaminação microbiana. Nessas condições, devem ser consumidas imediatamente após o preparo.

Disponibilidade de ferro, digestibilidade de proteína e teor de β-caroteno em formulados alternativos de baixo custo para alimentação enteral de idosos

O objetivo geral deste trabalho foi elaborar formulados alternativos à base de mistura de alimentos convencionais provenientes da cesta básica distribuída por entidades do município de Piracicaba-SP, entre outros alimentos, com o intuito de suplementar a alimentação enteral de idosos. Os alimentos utilizados para elaboração dos formulados foram fubá, óleo de soja, arroz, feijão, macarrão, sardinha, leite em pó, amido de milho, ovos, proteína texturizada de soja, couve-manteiga e cenoura. Foram realizadas análises químicas: composição centesimal, digestibilidade de proteína, determinação do mineral ferro, diálise de ferro in vitro, determinação de β-caroteno e fatores antinutricionais, assim como fenólicos totais e ácido fítico; e análise de custos dos formulados. Os resultados obtidos foram submetidos às análises estatísticas empregando o teste de Tukey e análises de regressão. Concluiu-se com este estudo que os formulados líquidos apresentaram os melhores resultados nutricionais e viabilidade econômica. Dentre estes, podem-se eleger duas alternativas. O formulado F3 se destacou na disponibilidade de ferro, quantidades de β-caroteno e digestibilidade. O formulado F4 se destacou na distribuição do valor calórico total de macronutrientes. Os formulados contribuem com percentual médio de 20% de adequação para idosos, quando ingeridas duas porções de 250 mL/dia de formulados líquidos ou em pó.

GB virus C/Hepatitis G virus and other putative hepatitis non A-E viruses

The identification of the major agents causing human hepatitis (Hepatitis A, B, C, D and E Viruses) was achieved during the last 30 years. These viruses are responsible for the vast majority of human viral hepatitis cases, but there are still some cases epidemiologically related to infectious agents without any evidence of infection with known virus, designated as hepatitis non A - E. Those cases are considered to be associated with at least three different viruses: 1 - Hepatitis B Virus mutants expressing its surface antigen (HBsAg) with altered epitopes or in low quantities; 2 - Another virus probably associated with enteral transmitted non A-E hepatitis, called Hepatitis F Virus. Still more studies are necessary to better characterize this agent; 3 - Hepatitis G Virus or GB virus C, recently identified throughout the world (including Brazil) as a Flavivirus responsible for about 10% of parenteral transmitted hepatitis non A-E. Probably still other unknown viruses are responsible for human hepatitis cases without evidence of infection by any of these viruses, that could be called as non A-G hepatitis.

Low blood glucose levels and other complications during growth hormone supplementation in sepsis

Blood glucose levels in the high normal range or even moderate hyperglycemia is the expected profile in septic postoperative patients receiving high-calorie enteral alimentation. The addition of growth hormone as an anabolic agent should additionally reinforce this tendency. In a cancer patient undergoing partial gastrectomy with lymphadenectomy and suffering from postoperative subphrenic abscess and prolonged sepsis, tube feeding (38.3 kcal/kg/day) and growth hormone (0.17 IU/kg/day) were simultaneously administered for 25 days. Blood glucose levels were in the lower limits of the normal range before growth hormone introduction, and continued with a similar tendency during most of the therapeutic period. Two additional complications, namely heart arrest and peripheral edema, were documented during the same period. It is concluded that sepsis was the most likely mechanism for low glucose values, and that high-calorie enteral diet and growth hormone supplementation did not prevent that result. It is uncertain whether heart arrest was due to the drug, but its association with peripheral edema is well documented in clinical series.

Nutritional follow-up of critically ill infants receiving short term parenteral nutrition

Few studies have tried to characterize the efficacy of parenteral support of critically ill infants during short period of intensive care. We studied seventeen infants during five days of total parenteral hyperalimentation. Subsequently, according to the clinical conditions, the patients received nutritional support by parenteral, enteral route or both up to the 10th day. Evaluations were performed on the 1st, 5th, and 10th days. These included: clinical data (food intake and anthropometric measurements), haematological data (lymphocyte count), biochemical tests (albumin, transferrin, fibronectin, prealbumin, retinol-binding protein) and hormone assays (cortisol, insulin, glucagon). Anthropometric measurements revealed no significant difference between the first and second evaluations. Serum albumin and transferrin did not change significantly, but mean values of fibronectin (8.9 to 16 mg/dL), prealbumin (7.7 to 18 mg/dL), and retinol-binding protein (2.4 to 3.7 mg/dL) increased significantly (p < 0.05) from the 1st to the 10th day. The hormonal study showed no difference for insulin, glucagon, and cortisol when the three evaluations were compared. The mean value of the glucose/insulin ratio was of 25.7 in the 1st day and 15.5 in the 5th day, revealing a transitory supression of this hormone. Cortisol showed values above normal in the beginning of the study. We conclude that the anthropometric parameters were not useful due to the short time of the study; serum proteins, fibronectin, prealbumin, and retinol-binding protein were very sensitive indicators of nutritional status, and an elevated glucose/insulin ratio, associated with a slight tendency for increased cortisol levels suggest hypercatabolic state. The critically ill patient can benefit from an early metabolic support.

The effects of glutamine-supplemented diet on the intestinal mucosa of the malnourished growing rat

Glutamine is the most abundant amino acid in the blood and plays a key role in the response of the small intestine to systemic injuries. Mucosal atrophy is an important phenomenon that occurs in some types of clinical injury, such as states of severe undernutrition. Glutamine has been shown to exert powerful trophic effects on the gastrointestinal mucosa after small bowel resection or transplant, radiation injury, surgical trauma, ischemic injury and administration of cytotoxic drugs. Since no study has been performed on the malnourished animal, we examined whether glutamine exerts a trophic effect on the intestinal mucosa of the malnourished growing rat. Thirty-five growing female rats (aged 21 days) were divided into 4 groups: control - chow diet; malnutrition diet; malnutrition+chow diet; and malnutrition+glutamine-enriched chow diet (2%). For the first 15 days of the experiment, animals in the test groups received a malnutrition diet, which was a lactose-enriched diet designed to induce diarrhea and malnutrition. For the next 15 days, these animals received either the lactose-enriched diet, a regular chow diet or a glutamine-enriched chow diet. After 30 days, the animals were weighed, sacrificed, and a section of the jejunum was taken and prepared for histological examination. All the animals had similar weights on day 1 of experiment, and feeding with the lactose-enriched diet promoted a significant decrease in body weight in comparison to the control group. Feeding with both experimental chow-based diets promoted significant body weight gains, although the glutamine-enriched diet was more effective. RESULTS: The morphological and morphometric analyses demonstrated that small intestinal villous height was significantly decreased in the malnourished group, and this change was partially corrected by the two types of chow-based diet. Crypt depth was significantly increased by malnutrition, and this parameter was partially corrected by the two types of chow-based diet. The glutamine-enriched diet resulted in the greatest reduction of crypt depth, and this reduction was also statistically significant when compared with control animals. CONCLUSIONS: Enteral glutamine has some positive effects on body weight gain and trophism of the jejunal mucosa in the malnourished growing rat.

Inflammatory bowel diseases: principles of nutritional therapy

Inflammatory Bowel Diseases - ulcerative colitis and Crohn's disease- are chronic gastrointestinal inflammatory diseases of unknown etiology. Decreased oral intake, malabsorption, accelerated nutrient losses, increased requirements, and drug-nutrient interactions cause nutritional and functional deficiencies that require proper correction by nutritional therapy. The goals of the different forms of nutritional therapy are to correct nutritional disturbances and to modulate inflammatory response, thus influencing disease activity. Total parenteral nutrition has been used to correct and to prevent nutritional disturbances and to promote bowel rest during active disease, mainly in cases of digestive fistulae with high output. Its use should be reserved for patients who cannot tolerate enteral nutrition. Enteral nutrition is effective in inducing clinical remission in adults and promoting growth in children. Due to its low complication rate and lower costs, enteral nutrition should be preferred over total parenteral nutrition whenever possible. Both present equal effectiveness in primary therapy for remission of active Crohn's disease. Nutritional intervention may improve outcome in certain individuals; however, because of the costs and complications of such therapy, careful selection is warranted, especially in patients presumed to need total parenteral nutrition. Recent research has focused on the use of nutrients as primary treatment agents. Immunonutrition is an important therapeutic alternative in the management of inflammatory bowel diseases, modulating the inflammation and changing the eicosanoid synthesis profile. However, beneficial reported effects have yet to be translated into the clinical practice. The real efficacy of these and other nutrients (glutamine, short-chain fatty acids, antioxidants) still need further evaluation through prospective and randomized trials.

Necrotizing enterocolitis, pathogenesis and the protector effect of prenatal corticosteroids

Necrotizing enterocolitis is the most frequently occurring gastrointestinal disorder in premature neonates. Animal models of necrotizing enterocolitis and prenatal administration of cortisone have demonstrated that cortisone may accelerate maturation of the mucosal barrier, therefore reducing the incidence of this gastrointestinal disorder. The authors present a review of the literature of the most important risk factors associated with necrotizing enterocolitis, such as inflammatory gastrointestinal mediators, enteral feeding and bacterial colonization, and immaturity of the gastrointestinal barrier, and we emphasize the necessity for additional studies to explore the prenatal administration of cortisone as a preventive strategy for necrotizing enterocolitis.

Nutrition for the pediatric surgical patient: approach in the peri-operative period

Nutrition is essential for maintenance of physiologic homeostasis and growth. Hypermetabolic states lead to a depletion of body stores, with decreased immunocompetence and increased morbidity and mortality. The purpose of this paper is to provide an update regarding the provision of appropriate nutrition for the pediatric surgical patient, emphasizing the preoperative and postoperative periods. Modern nutritional support for the surgical patient comprises numerous stages, including assessment of nutritional status, nutritional requirements, and nutritional therapy. Nutritional assessment is performed utilizing the clinical history, clinical examination, anthropometry, and biochemical evaluation. Anthropometric parameters include body weight, height, arm and head circumference, and skinfold thickness measurements. The biochemical evaluation is conducted using determinations of plasma levels of proteins, including album, pre-albumin, transferrin, and retinol-binding protein. These parameters are subject to error and are influenced by the rapid changes in body composition in the peri-operative period. Nutritional therapy includes enteral and/or parenteral nutrition. Enteral feeding is the first choice for nutritional therapy. If enteral feeding is not indicated, parenteral nutrition must be utilized. In all cases, an individualized, adequate diet (enteral formula or parenteral solution) is obligatory to decrease the occurrence of overfeeding and its undesirable consequences.

Gastric myoelectrical activity in neonates of different gestational ages by means of electrogastrography

PURPOSE: to describe the patterns of the gastric myoelectrical activity, pre-and postprandially, in clinically stable neonates of different gestational ages, during their first two weeks of life by means of Electrogastrography. PATIENTS AND METHODS: Electrogastrography was recorded in forty-five clinically stable neonates of different gestational ages (group I: 15 neonates of > 37 weeks, group II: 15 premature neonates of 32-37 weeks; Group III: 15 premature neonates of 28-31 weeks) receiving intermittent enteral feedings during their first two weeks of life. Electrogastrography recordings were performed for 1 hour pre-and postprandially. The Electrogastrography signal was recorded using the portable MicroDigitrapper Electrogastrography recording device and after motion artifacts were deleted, the remaining Electrogastrography data were submitted to quantitative analysis based on the "Running Spectrum Analysis". RESULTS: The percentages of normogastria, pre-and postprandially were greater than the percentages of gastric dysrythmias in all three studied groups. Furthermore, all neonates had the mean values of the Electrogastrography dominant frequency predominantly within the normogastria range, in both periods analyzed. There were no significant differences in the relative change of the Electrogastrography dominant power among the groups. CONCLUSION: This study demonstrates that the Electrogastrography patterns are similar between premature and full term neonates during the pre-and postprandial periods. The results of this study also indicate that the gastric myoelectrical activity in premature and full term neonates is immature, as compared to that described for older neonates, children and adults.

La vegetación de las lajas en la región de Lomerío, Santa Cruz, Bolivia

Estudiamos la riqueza y composición de especies vegetales en tres afloramientos rocosos (lajas) en Lomerío, Santa Cruz, Bolivia, dentro de un bosque seco tropical. Determinamos la variación de la vegetación desde el centro hacia el borde de las lajas, además que caracterizamos algunas especies propias de este hábitat. La riqueza de especies varía entre lajas, pero, en forma conjunta esta riqueza puede ser mayor a otros tipos de bosque aledaños a las lajas. La riqueza de especies fue mayor en el borde que en el centro de las lajas. En el borde de las lajas, la riqueza de especies varia según la distancia al centro de las lajas; la mayor riqueza se encontró en los primeros 10 m del borde. En el centro de las lajas Deuterocohnia meziana Kuntze ex Mez fue la especie más dominante, mientras que las especies más abundantes fueron D. meziana y Monvillea kroenleinii R. Kiesling. En el borde de las lajas Anthurium plowmanii Croat, Pseudananas sagenarius (Arruda) Camargo, Urera baccifera L., Casearia gossypiosperma Briq., Aspidosperma rigidum Rusby y Cereus tacuaralensis Cárdenas fueron las especies más abundantes. De acuerdo a las clases diamétricas, se puede considerar que existe regeneración natural para las principales especies arbóreas. Las lajas son hábitats muy importantes que deben considerarse dentro del manejo forestal de bosques naturales adyacentes, puesto que constituyen lugares de alta diversidad y endemismo de plantas y animales y que son refugios y fuentes de alimentación de muchas especies de animales.

Hematoma retroesofágico com grave disfagia após estreptoquinase para tratamento da trombose venosa axilo-subclávia

Homem de 72 anos, portador de neoplasia de próstata estádio IV, submetido à osteossíntese da coluna cervical para descompressão metastática da raiz nervosa, responsável por dor intensa no membro superior direito. Após três meses da internação, apresentou trombose total da veia axilo-subclávia direita, complicação da cateterização prolongada da veia subclávia direita para controle de septicemia secundária a pneumonia hospitalar. Foi submetido a terapia trombolítica com estreptoquinase por via venosa, no membro superior contra-lateral, na dose de 250.000UI em 15min, seguida de 100.000UI/h durante cinco dias, com total recanalização do trombo e redução do edema. Após 24h do término da trombólise, apresentou disfagia a líquidos e o esofagograma mostrou extensa compressão extrínseca do esôfago, por provável hematoma retroesofágico. Necessitou de nutrição enteral durante três meses, quando ocorreu normalização da deglutição, reabsorção do hematoma retroesofágico e passagem adequada do contraste pelo esôfago. No seguimento evolutivo não apresentou seqüelas da trombose venosa profunda, não tem disfagia e permaneceu em uso profilático de meias elásticas e heparina de baixo peso molecular.

A comparative study of the TF-Test®, Kato-Katz, Hoffman-Pons-Janer, Willis and Baermann-Moraes coprologic methods for the detection of human parasitosis

This study compares the diagnostic accuracy of the TF-Test® (TFT) for human parasitosis with results obtained using the traditional Kato-Katz (KK), Hoffman-Pons-Janer (HPJ), Willis and Baermann-Moraes (BM) techniques. Overall, four stool samples were taken from each individual; three alternate-day TFT stool samples and another sample that was collected in a universal container. Stool samples were taken from 331 inhabitants of the community of Quilombola Santa Cruz. The gold standard (GS) for protozoa detection was defined as the combined results for TFT, HPJ and Willis coproscopic techniques; for helminth detection, GS was defined as the combined results for all five coproscopic techniques (TFT, KK, HPJ, Willis and BM). The positivity rate of each method was compared using the McNemar test. While the TFT exhibited similar positivity rates to the GS for Entamoeba histolytica/dispar (82.4%) and Giardia duodenalis (90%), HPJ and Willis techniques exhibited significantly lower positivity rates for these protozoa. All tests exhibited significantly lower positivity rates compared with GS for the diagnosis of helminths. The KK technique had the highest positivity rate for diagnosing Schistosoma mansoni (74.6%), while the TFT had the highest positivity rates for Ascaris lumbricoides (58.1%) and hookworm (75%); HPJ technique had the highest positivity rate for Strongyloides stercoralis (50%). Although a combination of tests is the most accurate method for the diagnosis of enteral parasites, the TFT reliably estimates the prevalence of protozoa and selected helminths, such as A. lumbricoides and hookworm. Further studies are needed to evaluate the detection accuracy of the TFT in samples with varying numbers of parasites.

Effect of myrrh and thyme on Trichinella spiralisenteral and parenteral phases with inducible nitric oxide expression in mice

Trichinellosis is a serious disease with no satisfactory treatment. We aimed to assess the effect of myrrh (Commiphora molmol) and, for the first time, thyme (Thymus vulgaris L.) against enteral and encysted (parenteral) phases of Trichinella spiralis in mice compared with albendazole, and detect their effect on inducible nitric oxide synthase (iNOS) expression. Oral administration of 500 mg/kg of myrrh and thyme led to adult reduction (90.9%, 79.4%), while 1,000 mg/kg led to larvae reduction (79.6%, 71.3%), respectively. Administration of 50 mg/kg of albendazole resulted in adult and larvae reduction (94.2%, 90.9%). Positive immunostaining of inflammatory cells infiltrating intestinal mucosa and submucosa of all treated groups was detected. Myrrh-treated mice showed the highest iNOS expression followed by albendazole, then thyme. On the other hand, both myrrh and thyme-treated groups showed stronger iNOS expression of inflammatory cells infiltrating and surrounding encapsulated T. spiralis larvae than albendazole treated group. In conclusion, myrrh and thyme extracts are highly effective against both phases of T. spiralis and showed strong iNOS expressions, especially myrrh which could be a promising alternative drug. This experiment provides a basis for further exploration of this plant by isolation and retesting the active principles of both extracts against different stages of T. spiralis.

Efeito do triacilglicerídeo de cadeia média, da fibra e do cálcio na disponibilidade de magnésio e de zinco pelo método in vitro e metodologia de superfície de resposta

Nutritional therapy with enteral diets became highly specialized in the last years. This work aims to study the effect of the components of a formulation, namely fiber, calcium and medium-chain triglycerides, for dialysability of minerals. Analysis of multiple variables was done using response surface methodology. The level curve showed that the tertiary interaction MCT-fiber-calcium was the one that presented the highest synergism in the formulation. The proportion of 33% MCT, 25% fiber and 42% calcium, gave the best formulation for availability of magnesium.