Adherence to nutritional recommendations and sociodemographic variables in patients with diabetes mellitus

OBJECTIVETo determine if there is a relationship between adherence to nutritional recommendations and sociodemographic variables in Brazilian patients with type 2 diabetes mellitus.METHODSCross-sectional observational study using a stratified random sample of 423 individuals. The Food Frequency Questionnaire (FFQ) was used, and the Fisher's exact test was applied with 95% confidence interval (p<0.05).RESULTSOf the 423 subjects, 66.7% were women, mean age of 62.4 years (SD = 11.8), 4.3 years of schooling on average (SD = 3.6) and family income of less than two minimum wages. There was association between the female gender and adherence to diet with adequate cholesterol content (OR: 2.03; CI: 1.23; 3.34), between four and more years of education and adherence to fractionation of meals (OR: 1 92 CI: 1.19; 3.10), and income of less than two minimum wages and adherence to diet with adequate cholesterol content (OR: 1.74; CI: 1.03, 2.95).CONCLUSIONAdherence to nutritional recommendations was associated with the female gender, more than four years of education and family income of less than two minimum wages.

Preoperative immunonutrition in patients at nutritional risk: results of a double-blinded randomized clinical trial.

Background/Objectives:To evaluate the impact of preoperative immunonutrition (IN) on postoperative morbidity in patients at risk of malnutrition undergoing major gastrointestinal (GI) surgery.Subjects/Methods:The combination of malnutrition and major GI surgery entails high morbidity. The Nutritional Risk Score (NRS) reliably identifies patients who need preoperative nutrition; the optimal nutritional formula for these patients still needs to be defined. In all, 152 patients with a NRS3 and undergoing elective major GI surgery were randomized between IN or isocaloric-isonitrogenous nutrition (ICN) given for 5 days preoperatively. Patients and caregivers were blinded for the allocated intervention. Thirty days complication rate was the primary endpoint. Infections, length of hospital stay and compliance were considered as secondary outcomes.Results:Overall, 145 patients were available for analysis; the 73 patients in the IN group matched well with the 72 ICN patients with regards to patient's and surgical characteristics. In all, 39 IN and 33 ICN patients experienced a total of 48 and 50 postoperative complications, respectively (P=0.723). Both groups did not differ significantly concerning infectious (13 vs 9) complications. Independent risk factors for overall complications were malignant disease (odds ratio (OR)=4.304; confidence interval (CI) 1.317-14.002) and operative time (OR=1.004; CI 1.000-1.008).Conclusion:In patients at nutritional risk, complications, infections and hospital stay after major GI surgery were comparable regardless of preoperative supplementation with IN or ICN.

Influence of male nutritional conditions on the performance and alimentary selection of wild females of Anastrepha obliqua (Macquart)(Diptera, Tephritidae)

Influence of male nutritional conditions on the performance and alimentary selection of wild females of Anastrepha obliqua (Macquart) (Diptera, Tephritidae). The behavior of A. obliqua females is regulated by endogenous and exogenous factors and among these the presence of males. Experiments were carried out to investigate whether the presence of males and their nutritional condition may affect the behavior of self-selection feeding and the performance of A. obliqua females. Females were sorted in groups containing yeast-deprived females and males, and non-yeast-deprived females and males. The females were maintained apart from the males by a transparent plastic screen. Several yeast and sucrose combinations were offered to the females in a single diet block or in separate blocks. Ingestion, egg production, longevity and diet efficiency were determined. The non-yeast-deprived males positively influenced the females performance when the latter were fed with yeast and sucrose in distinct diet blocks. Performance was better in the groups without males and with yeast-deprived males where the females could not select the nutrient proportions (yeast and sucrose in a single diet block).

Le poids, les habitudes alimentaires et l'activité physique dans la population en Suisse: le projet MONICA. [Weight, nutritional habits and physical-activity in Switzerland: the MONICA-Project].

La première enquête de prévalence des facteurs de risque pour les maladies cardio-vasculaires qui a été effectuée auprès de la population des cantons de Vaud, Fribourg et du Tessin, dans le cadre du Projet MONICA, a permis de décrire la distribution de l'indice de masse corporelle. Entre 25 et 74 ans, près d'une personne sur 4 a un excès de poids préjudiciable à sa santé, cette proportion étant même de plus de 1 sur 3 chez les hommes tessinois. Cet état de fait n'est peut-être pas irrémédiable puisque 1 femme sur 3 et 1 homme sur 5 a modifié ses habitudes alimentaires dans le sens d'une nourriture plus saine et moins énergétique au cours des 12 mois précédant l'enquête. Cependant une activité physique régulière, susceptible d'avoir un rôle préventif sur la survenue des maladies cardio-vasculaires et qui pourrait contribuer à la diminution de la fréquence de l'obésité, n'est exercée que par moins de la moitié de la population en moyenne. C'est probablement l'exercice régulier d'activités sportives qui permettrait le plus d'augmenter le niveau général de l'activité physique dans la population puisque peu de personnes exercent une profession exigeant d'intenses efforts physiques.

Nutritional ecology of blowflies (Diptera, Calliphoridae): estimates of critical larval weight for pupation on two different

Under natural environmental conditions, blowflies utilize discrete and ephemeral feeding resources such as decaying carcasses. Competition for food on such feeding substrates is usually very severe, and only the individuals that are capable of attaining the critical larval weight for pupation will be able to survive. This critical weight is hitherto unknown for several blowfly species; therefore, the current work is aimed at obtaining such a critical value for four blowfly species of the genera Chrysomya and Lucilia, deploying two types of feeding substrate, namely, artificial diet and macerated bovine meat. On the whole, the critical weights ranged from 30 to 35 mg. The lowest larval weight which permitted pupation was 30.0 mg for Chrysomya megacephala reared on macerated bovine meat. This species was also the best adapted to pupation at low larval weights in relation to the maximum larval weight for males. Regarding the pupation of females, the best-adapted individual was a C. albiceps specimen exhibiting a critical weight that was equal to 39.20 % of the maximum value obtained. Concerning all the species and diet types, the female individuals exhibited the lowest critical weights that produced viable pupae, probably representing an evolutionary strategy that favoured the survival of females, responsible for the egg formation, contributing to the establishment of future generations. Regarding the loss (in percentage) of adult biomass in relation to the third instar larvae, the females of C. megacephala lost less weight than males in both feeding substrates. On the other hand, such a loss of weight occurred in males of C. albiceps and L. cuprina.

Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status.

OBJECTIVE: To validate a revision of the Mini Nutritional Assessment short-form (MNA(R)-SF) against the full MNA, a standard tool for nutritional evaluation. METHODS: A literature search identified studies that used the MNA for nutritional screening in geriatric patients. The contacted authors submitted original datasets that were merged into a single database. Various combinations of the questions on the current MNA-SF were tested using this database through combination analysis and ROC based derivation of classification thresholds. RESULTS: Twenty-seven datasets (n=6257 participants) were initially processed from which twelve were used in the current analysis on a sample of 2032 study participants (mean age 82.3y) with complete information on all MNA items. The original MNA-SF was a combination of six questions from the full MNA. A revised MNA-SF included calf circumference (CC) substituted for BMI performed equally well. A revised three-category scoring classification for this revised MNA-SF, using BMI and/or CC, had good sensitivity compared to the full MNA. CONCLUSION: The newly revised MNA-SF is a valid nutritional screening tool applicable to geriatric health care professionals with the option of using CC when BMI cannot be calculated. This revised MNA-SF increases the applicability of this rapid screening tool in clinical practice through the inclusion of a "malnourished" category.

Postgraduate Symposium: Positive influence of nutritional alkalinity on bone health.

There is growing evidence that consumption of a Western diet is a risk factor for osteoporosis through excess acid supply, while fruits and vegetables balance the excess acidity, mostly by providing K-rich bicarbonate-rich foods. Western diets consumed by adults generate approximately 50-100 mEq acid/d; therefore, healthy adults consuming such a diet are at risk of chronic low-grade metabolic acidosis, which worsens with age as a result of declining kidney function. Bone buffers the excess acid by delivering cations and it is considered that with time an overstimulation of this process will lead to the dissolution of the bone mineral content and hence to reduced bone mass. Intakes of K, Mg and fruit and vegetables have been associated with a higher alkaline status and a subsequent beneficial effect on bone health. In healthy male volunteers an acid-forming diet increases urinary Ca excretion by 74% and urinary C-terminal telopeptide of type I collagen (C-telopeptide) excretion by 19% when compared with an alkali (base-forming) diet. Cross-sectional studies have shown that there is a correlation between the nutritional acid load and bone health measured by bone ultrasound or dual-energy X-ray absorptiometry. Few studies have been undertaken in very elderly women (>75 years), whose osteoporosis risk is very pertinent. The EVAluation of Nutrients Intakes and Bone Ultra Sound Study has developed and validated (n 51) an FFQ for use in a very elderly Swiss population (mean age 80.4 (sd 2.99) years), which has shown intakes of key nutrients (energy, fat, carbohydrate, Ca, Mg, vitamin C, D and E) to be low in 401 subjects. A subsequent study to assess net endogenous acid production (NEAP) and bone ultrasound results in 256 women aged > or = 75 years has shown that lower NEAP (P=0.023) and higher K intake (P=0.033) are correlated with higher bone ultrasound results. High acid load may be an important additional risk factor that may be particularly relevant in very elderly patients with an already-high fracture risk. The latter study adds to knowledge by confirming a positive link between dietary alkalinity and bone health indices in the very elderly. In a further study to complement these findings it has also been shown in a group of thirty young women that in Ca sufficiency an acid Ca-rich water has no effect on bone resorption, while an alkaline bicarbonate-rich water leads to a decrease in both serum parathyroid hormone and serum C-telopeptide. Further investigations need to be undertaken to study whether these positive effects on bone loss are maintained over long-term treatment. Mineral-water consumption could be an easy and inexpensive way of helping to prevent osteoporosis and could be of major interest for long-term prevention of bone loss.

Relationships between soil class and nutritional status of coffee plantations

Farm planning requires an assessment of the soil class. Research suggest that the Diagnosis and Recommendation Integrated System (DRIS) has the capacity to evaluate the nutritional status of coffee plantations, regardless of environmental conditions. Additionally, the use of DRIS could reduce the costs for farm planning. This study evaluated the relationship between the soil class and nutritional status of coffee plants (Coffea canephora Pierre) using the Critical Level (CL) and DRIS methods, based on two multivariate statistical methods (discriminant and multidimensional scaling analyses). During three consecutive years, yield and foliar concentration of nutrients (N, P, K, Ca, Mg, S, B, Zn, Mn, Fe and Cu) were obtained from coffee plantations cultivated in Espírito Santo state. Discriminant analysis showed that the soil class was an important factor determining the nutritional status of the coffee plants. The grouping separation by the CL method was not as effective as the DRIS one. The bidimensional analysis of Euclidean distances did not show the same relationship between plant nutritional status and soil class. Multidimensional scaling analysis by the CL method indicated that 93.3 % of the crops grouped into one cluster, whereas the DRIS method split the fields more evenly into three clusters. The DRIS method thus proved to be more consistent than the CL method for grouping coffee plantations by soil class.

Nutritional and insulin regulation of fatty acid synthetase and leptin gene expression through ADD1/SREBP1.

The ability to regulate specific genes of energy metabolism in response to fasting and feeding is an important adaptation allowing survival of intermittent food supplies. However, little is known about transcription factors involved in such responses in higher organisms. We show here that gene expression in adipose tissue for adipocyte determination differentiation dependent factor (ADD) 1/sterol regulatory element binding protein (SREBP) 1, a basic-helix-loop-helix protein that has a dual DNA-binding specificity, is reduced dramatically upon fasting and elevated upon refeeding; this parallels closely the regulation of two adipose cell genes that are crucial in energy homeostasis, fatty acid synthetase (FAS) and leptin. This elevation of ADD1/SREBP1, leptin, and FAS that is induced by feeding in vivo is mimicked by exposure of cultured adipocytes to insulin, the classic hormone of the fed state. We also show that the promoters for both leptin and FAS are transactivated by ADD1/SREBP1. A mutation in the basic domain of ADD1/SREBP1 that allows E-box binding but destroys sterol regulatory element-1 binding prevents leptin gene transactivation but has no effect on the increase in FAS promoter function. Molecular dissection of the FAS promoter shows that most if not all of this action of ADD1/SREBP1 is through an E-box motif at -64 to -59, contained with a sequence identified previously as the major insulin response element of this gene. These results indicate that ADD1/SREBP1 is a key transcription factor linking changes in nutritional status and insulin levels to the expression of certain genes that regulate systemic energy metabolism.

Escarres et dénutrition: dépistage et évaluation de l'état nutritionnel [Pressure ulcers and undernutrition: screening and assessment of nutritional status]

Acquired pressure ulcer is associated with significant human, economic and functional consequences. Its prevalence varies between 3 and 23% in a community hospital and between 7 and 54% in an elderly home residency. Pressure ulcer healing is a complex process which involves numerous cellular and molecular mechanisms. An altered nutritional status is a contributing factor in the development of pressure ulcers and the delay in pressure ulcer healing. The key to management of undernutrition is screening and early intervention. According to the gravity of undernutrition, various degrees of intervention will be required. Systematic oral supplementation with various nutrients may provide benefit in the prevention of pressure ulcers, but further studies have to be completed in human subjects prior to being recommended for the treatment of pressure ulcers.

Liming influence on soil chemical properties, nutritional status and yield of alfalfa grown in acid soil

Alfalfa is an important forage crop with high nutritive value, although highly susceptible to soil acidity. Liming is one of the most efficient and prevailing practices to correct soil acidity and improve alfalfa yield. The objective of this study was to evaluate response to liming of alfalfa grown in a greenhouse on a Typic Quartzipsamment soil. The treatments consisted of four lime rates (0, 3.8, 6.6 and 10.3 Mg ha-1) and two cuts. Alfalfa dry matter increased quadratically with increasing lime rates. In general, dry matter yield was maximized by a lime rate of 8.0 Mg ha-1. Except for the control, the dry matter nutrient contents in the treatments were adequate. The positive linear correlation between root and nodule dry matter with lime rates indicated improvement of these plant traits with decreasing soil acidity. The soil acidity indices pH, base saturation, Ca2+ concentration, Mg2+ concentration, and H + Al were relevant factors in the assessment of alfalfa yield. The magnitude of influence of these soil acidity indices on yield as determined by the coefficient of determination (R²) varied and decreased in the order: base saturation, H + Al, pH, Ca and Mg concentrations. Optimum values of selected soil chemical properties were defined for maximum shoot dry matter; these values can serve as a guideline for alfalfa liming to improve the yield of this forage on acid soils.