Evaluation of nutritional status and energy expenditure in athletes

El ejercicio físico continuo conduce al atleta a mantener un equilibrio inestable entre la ingesta dietética, el gasto de energía y las exigencias adicionales de un alto grado de actividad física. Por lo tanto, una evaluación precisa del estado nutricional es esencial para optimizar el rendimiento, ya que afecta a la salud, la composición corporal, y la recuperación del atleta. Aspectos específicos como tipo de deporte, especialidad o posición de juego, programa de entrenamiento y calendario de competiciones, la categoría, objetivos específicos, que difieran de la población en general, deben ser tenidos en cuenta. La evaluación bioquímica nos puede dar una idea general del estado nutricional, del perfil lipídico, del funcionamiento de hígado o riñón, de si la dieta es demasiado alta en proteínas o grasas, así como las posibles deficiencias nutricionales y la necesidad de suplementación. La cineantropometría deportiva tiene gran utilidad ya que permite la evaluación de la masa corporal, altura, longitud, diámetro, perímetro y pliegues cutáneos, donde la información se procesa mediante la aplicación de diferentes ecuaciones, obteniendo información sobre el somatotipo, la composición corporal y la proporcionalidad de las distintas partes del cuerpo. Para poder dar una orientación nutricional adecuada, las necesidades de energía de los atletas deben ser conocidas. Si la medición objetiva no es posible, existen tablas que incluyen los requerimientos de energía teóricamente establecidos para diferentes deportes. La evaluación dietética debe incluir información sobre el consumo de alimentos y nutrientes para establecer la relación entre la dieta, el estado de salud y el rendimiento del atleta. Por otro lado, un estado adecuado de hidratación en los atletas es esencial para mantener un rendimiento óptimo. Se debe valorar específicamente la ingesta de líquidos por parte del deportista. La deshidratación puede causar efectos nocivos en la salud de los atletas. Como no existe un método “gold standard”, la gravidez y el color de la orina son los métodos más extendidos para analizar el estado de hidratación. Hay consenso en que la combinación de diferentes métodos asegura una captura efectiva de datos para la valoración nutricional del deportista que permitirá proceder a la intervención dietética y nutricional.

Utilização de embriões liofilizados e flocos de Artemia na diversificação nutricional de pós-larvas do camarão marinho Litopenaes vannamei (Boone, 1931)

The objective of the current study was to evaluate the zootechnical performance (survival and growth) of Litopenaeus vannamei post-Iarvae fed an artificial shrimp diet supplemented with Artemia flakes or freeze-dried Artemia embryos. For that purpose, 20 culturing units were individually stocked with 50 shrimp post-Iarvae (average dry weight of 0,3 ± 0,03 mg) at a stocking density of 20 post-larvae per liter, and fed the experimental diets to satiation during 20 days. The experimental design consisted of four diets (T1, T2, T3 and T4) with five repetitions each. For treatments T1, T2 and T3, dietary supplements of 5mg of Artemia flakes (T1), freeze-dried Artemia embryos (T2), and of the commercial shrimp diet (T3) were offered 2 hours after the shrimp were initially fed the commercial shrimp diet. For treatment T4 (control), no additive was offered 2 hours after the initial feeding. Shrimp survival, absolut (GPA) and relative increase in weight (GPR), and specific growth rate (TCR) were used as evaluation criteria. After the experimental period, no significant statistical differences (p>0,05) in survival were observed. Regarding growth, the dietary treatment which used freeze-dried Artemia embryos as an additive (T2) presented the best results for GPA (6,7 ± 0,7 mg). There were no statistical differences within treatments T1, T3 and T4 (p>0,05). AIso, post-larvae fed freeze-dried embryos (T2) showed a relative increase in weight (2241,4%) which differed significantly (p<0,05) from T4(1911,7%) but not from T1 (1801,6%) or T3 (1946,7%). In conclusion, the results of the current study indicate that an artificial shrimp diet supplemented with freeze-dried Artemia embryos fulfils the nutritional requirements of post-larvae L. vannamei and promotes a better growth than diets not supplemented with Artemia flakes

Caffeine Intake and its Association with Disease Progression, Sleep Quality and Anxiety Symptoms and Nutritional Alterations in People Living with HIV in the Miami Adult Studies on HIV Cohort

Miami-Dade County has approximately 27,000 people living with HIV (PLWH), and the highest HIV incidence in the nation. PLWH have reported several types of sleep disturbances. Caffeine is an anorexic and lipolytic stimulant that may adversely affect sleep patterns, dietary intakes and body composition. High caffeine consumption (>250 mg. per day or the equivalent of >4 cups of brewed coffee) may also affect general functionality, adherence to antiretroviral treatment (ART) and HIV care. This study assess the relationship of high caffeine intake with markers of disease progression, sleep quality, insomnia, anxiety, nutritional intakes and body composition. A convenience sample of 130 PLWH on stable ART were recruited from the Miami Adult Studies on HIV (MASH) cohort, and followed for three months. After consenting, questionnaires on Modified Caffeine Consumption (MCCQ), Pittsburg Insomnia Rating Scale (PIRS), Pittsburg Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), socio-demographics, drug and medication use were completed. CD4 count, HIV viral load, anthropometries, and body composition measures were obtained. Mean age was 47.89±6.37 years, 60.8% were male and 75.4% were African-Americans. Mean caffeine intake at baseline was 337.63 ± 304.97 mg/day (Range: 0-1498 mg/day) and did not change significantly at 3 months. In linear regression, high caffeine consumption was associated with higher CD4 cell count (β=1.532, P=0.049), lower HIV viral load (β=-1.067, P=0.048), higher global PIRS (β=1.776, P=0.046), global PSQI (β=2.587, P=0.038), and GAD-7 scores (β=1.674, P=0.027), and with lower fat mass (β=-0.994, P=0.042), energy intakes (β=-1.643, P=0.042) and fat consumption (β=-1.902, P=0.044), adjusting for relevant socioeconomic and disease progression variables. Over three months, these associations remained significant. The association of high caffeine with lower BMI weakened when excluding users of other anorexic and stimulant drugs such as cocaine and methamphetamine, suggesting that caffeine in combination, but not alone, may worsen their action. In summary, high caffeine consumption was associated with better measures of disease progression; but was also detrimental on sleep quality, nutritional intakes, BMI and body composition and associated with insomnia and anxiety. Large scale studies for longer time are needed to elucidate the contribution of caffeine to the well-being of PLWH.

Nutritional requirements of the critically ill patient

Objective: Given the inaccessibility of indirect calorimetry, intensive care units generally use predictive equations or recommendations that are established by international societies to determine energy expenditure. The aim of the present study was to compare the energy expenditure of critically ill patients, as determined using indirect calorimetry, to the values obtained using the Harris-Benedict equation. Methods: A retrospective observational study was conducted at the Intensive Care Unit 1 of the Centro Hospitalar do Porto. The energy requirements of hospitalized critically ill patients as determined using indirect calorimetry were assessed between January 2003 and April 2012. The accuracy (± 10% difference between the measured and estimated values), the mean differences and the limits of agreement were determined for the studied equations. Results: Eighty-five patients were assessed using 288 indirect calorimetry measurements. The following energy requirement values were obtained for the different methods: 1,753.98±391.13 kcal/ day (24.48 ± 5.95 kcal/kg/day) for indirect calorimetry and 1,504.11 ± 266.99 kcal/day (20.72±2.43 kcal/kg/day) for the HarrisBenedict equation. The equation had a precision of 31.76% with a mean difference of -259.86 kcal/day and limits of agreement between -858.84 and 339.12 kcal/day. Sex (p=0.023), temperature (p=0.009) and body mass index (p< 0.001) were found to significantly affect energy expenditure Conclusion: The Harris-Benedict equation is inaccurate and tends to underestimate energy expenditure. In addition, the Harris-Benedict equation is associated with significant differences between the predicted and true energy expenditure at an individual level

Fiber, a component for health gastrointestinal endocrine system

Dietary fiber was classified according to its solubility in an attempt to relate physiological effects to chemical types of fiber. Soluble fibers (B-glucans, gums, wheat dextrin, psyllium, pectin, inulin) were considered to have benefits on serum lipids, while insoluble fibers (cellulose, lignin, pectins, hemicelluloses) were linked with laxation benefits. More important characteristics of fiber in terms of physiological benefits are viscosity and fermentability. Viscous fibers (pectins, B-glucans, gums, psyllium) are those that have gel-forming properties in the intestinal tract, and fermentable fibers (wheat dextrin, pectins, B-glucans, gum, inulin) are those that can be metabolized by colonic bacteria. Objective: To summarize the beneficial effects of dietary fiber, as nutraceuticals, in order to maintain a healthy gastrointestinal system. Methods: Our study is a systematic review. Electronic databases, including PubMed, Medline, with supplement of relevant websites, were searched. We included randomized and non-randomized clinical trials, epidemiological studies (cohort and case-control). We excluded case series, case reports, in vitro and animal studies. Results: The WHO, the U.S. Food and Drug Administration (FDA), the Heart Foundation and the Romanian Dietary Guidelines recommends that adults should aim to consume approximately 25–30 g fiber daily. Dietary fiber is found in the indigestible parts of cereals, fruits and vegetables. There are countries where people don’t eat enough food fibers, these people need to take some kind of fiber supplement. Evidence has been found that dietary fiber from whole foods or supplements may (1) reduce the risk of cardiovascular disease by improving serum lipids and reducing serum total and low-density lipoprotein (LDL) cholesterol concentrations, (2) decreases the glycaemic index of foods, which leads to an improvement in glycemic response, positive impact on diabetes, (3) protect against development of obesity by increasing satiety hormone leptin concentrations, (4) reduced risk of developing colorectal cancer by normalizes bowel movements, improve the integrity of the epithelial layer of the intestines, increase the resistance against pathogenic colonization, have favorable effects on the gut microbiome, wich is the second genomes of the microorganisms, (5) have a positive impact on the endocrine system by gastrointestinal polypeptide hormonal regulation of digestion, (6) have prebiotic effect by short-chain fatty acids (SCFA) production; butyrate acid is the preferred energy source for colonic epithelial cells, promotes normal cell differentiation and proliferation, and also help regulate sodium and water absorption, and can enhance absorption of calcium and other minerals. Although all prebiotics are fiber, not all fiber is prebiotic. This generally refers to the ability of a fiber to increase the growth of bifidobacteria and lactobacilli, which are beneficial to human health, and (7) play a role in improving immune function via production of SCFAs by increases T helper cells, macrophages, neutrophils, and increased cytotoxic activity of natural killer cells. Conclusion: Fiber consumption is associated with high nutritional value and antioxidant status of the diet, enhancing the effects on human health. Fibers with prebiotic properties can also be recommended as part of fiber intake. Due to the variability of fiber’s effects in the body, it is important to consume fiber from a variety of sources. Increasing fiber consumption for health promotion and disease prevention is a critical public health goal.

Nutritional technological characterization and secondary metabolites in stored carioca bean cultivars.

The recommendation of bean cultivars and the use of appropriate storage techniques allow the quality characteristics of these grains to be preserved for human consumption. The aim of this study was to characterize the effects of storage on three cultivars of the common carioca bean in raw form and to determine the relationships between storage time and technological quality parameters involved in the darkening and hardening of grains, the chemical composition of the beans and the presence of secondary metabolites. The experiment followed a completely randomized design (CRD) with a full factorial scheme consisting of two factors: bean cultivars, with three levels and storage time, with five levels. The color parameters and the storage times significantly differed between the cultivars. The cooking time, when compared to the water absorption index, indicated that the cultivars had, on average, a high percentage of moisture (>95%) and an average cooking time of 17 min., this applies to the control, while values increase during the storage time. Storage under ambient conditions led to a reduction in grain brightness parameters, characterized by darkening and hardening; no reduction in protein and mineral content; and an increase in iron, phosphorous, tannin, and phytic acid contents at 180 days.

Composição botânica e qualidade do pasto selecionado por ovelhas em caatinga raleada e enriquecida.

Resumo: O presente estudo foi conduzido com o objetivo de determinar a composição botânica e a qualidade da dieta selecionada por ovelhas, através da técnica de micro-histologia fecal, em caatinga raleada e enriquecida com capim massai (Panicum maximum cv. Massai), recebendo diferentes quantidades de concentrado (0; 200; 350 e 500 g de concentrado por dia), e em diferentes períodos do ano (águas, transição água-seca e seca). Foram estimados também o consumo e digestibilidade dos nutrientes, bem como a degradabilidade de espécies forrageiras ingeridas pelas ovelhas. Os experimentos foram realizados na Fazenda Crioula do Meio, pertencente a Embrapa Caprinos e Ovinos em Sobral, CE no período de março a novembro de 2013. No Experimento 1, para a determinação da composição botânica e qualidade da dieta selecionada, foram utilizadas dezesseis ovelhas Somalis brasileira, gestantes, multíparas e peso médio de 30,58+2,48 kg. O acompanhamento da ingestão do pasto pelas ovelhas foi feito em três períodos (águas, transição água-seca e seca), referentes aos meses de abril, junho e agosto de 2013, respectivamente. Amostras das plantas foram coletadas para o preparo das lâminas de referência, e posterior identificação e caracterização dos descritores epidérmicos. O mesmo foi feito para as fezes coletadas nas ovelhas. Com base na proporção de cada espécie identificada nas lâminas fecais que compuseram a dieta, e na composição química das forrageiras identificadas, foi possível determinar a qualidade da dieta ingerida. De 76 espécies observadas no pasto, 33 foram identificadas na dieta das ovelhas, destacando as espécies sabiá (Mimosa caesalpiniaefolia), centrosema (Centrosema sp.), ervanço (Alternanthera brasiliana), massai (Panicum maximum cv Massai) e paco-paco (Wissadula rostrata) como as mais selecionadas pelos animais ao longo dos períodos, chegando a compor mais de 50% da dieta selecionada. Com a chegada do período seco, espécies indesejáveis como o marmeleiro (Croton sonderianus) e o mofumbo (Combretum lepreosum), também fizeram parte das plantas selecionadas. Quanto ao valor nutritivo da dieta selecionada, os animais selecionaram uma dieta com valor nutritivo superior ao amostrado no pasto. No Experimento 2, na mesma condição do experimento anterior, trinta e duas ovelhas Somalis brasileira foram utilizadas para determinação do consumo e digestibilidade dos nutrientes, realizado em três ensaios (abril - terço final de gestação; junho - lactação e agosto - desmame). Para predição do consumo, o indicador LIPE® foi utilizado. Pesagens quinzenais foram realizadas para avaliação do desempenho das ovelhas e dos cordeiros nascidos. O concentrado oferecido favoreceu a maior ingestão e digestibilidade da MS e PB, com efeito substitutivo em relação ao consumo de pasto (P<0,05). Para o período seco, menores consumos foram observados em relação aos períodos das águas e de transição água-seca (P<0,05). Maiores consumos e digestibilidades dos constituintes fibrosos foram observados para as ovelhas não suplementados (P<0,05). Na avaliação do desempenho, a suplementação oferecida determinou os maiores pesos verificados durante a lactação, ao desmame e para os pesos ao nascer e ao desmame dos cordeiros (P<0,05). No Experimento 3, dois ovinos Morada Nova foram utilizados para determinação da degradabilidade da matéria seca (MS), proteína bruta (PB) e fibra em detergente neutro (FDN) de cinco das forrageiras selecionadas pelas ovelhas no Experimento 1: M. caesalpiniaefolia, A. brasiliana, P. maximum cv. Massai, jurema-preta (Mimosa tenuiflora), C. leprosum, nos tempos 0, 6, 24, 48, 72 e 96 horas de incubação. Para cada forrageira, foram determinadas equações para o desaparecimento da MS, PB e FDN. Também foi feito o fracionamento da proteína em suas porções degradáveis e não degradáveis no rúmen. Foi observado maior desaparecimento da MS, PB e FDN, além dos melhores níveis de proteína efetivamente degradada no rúmen para A. brasiliana, seguido pelo P. maximum cv. Massai e M. caesalpiniaefolia. Com as informações obtidas, conclui-se que a micro-histologia fecal apresenta-se como uma técnica viável para avaliações da composição botânica da dieta selecionada por ovinos na caatinga. Ovelhas na caatinga possuem uma grande habilidade de selecionar a dieta, modificando-a ao longo das fases fenológicas, sempre na tentativa de estabelecer uma dieta com melhor valor nutritivo. Forrageiras como A. brasiliana, M. caesalpiniaefolia e o P. maximum cv. Massai, podem ser consideradas um interessante recurso alimentar, em virtude de seu valor nutricional e aproveitamento por ovelhas criadas na caatinga. Abstract: This study was conducted in order to determine the botanical composition and diet quality selected by sheep through fecal micro-histological technique, in thinned and enriched caatinga with Massai grass (Panicum maximum cv Massai.), receiving different amounts of concentrate (0; 200; 350 and 500 g of concentrate per day) at different periods (wet, transition wet-dry and dry). Were also estimated the intake, digestibility, as well as the degradability of forage species eaten by sheep. The experiments were performed in the "Fazenda Crioula do Meio", owned by Embrapa Goats and Sheep, in Sobral, Ceará State, Brazil, from march to november 2013. In Trial 1, sixteen female, pregnant, multiparous, with average body weight of 30,58+2,48 kg Somalis brasileira breed sheep were used to determine the botanical composition and the quality of the selected diet. The monitoring of pasture intake of sheep were conducted in three phenological periods of the caatinga's pasture (wet season, transition wet-dry and dry season). Plant samples were collected for the preparation of the reference slides, with subsequent identification and characterization of epidermal descriptors. The same was done for the feces collected in sheep. Considering the proportion of each species identified in fecal slides which composed the diet, and the chemical composition of forage identified, it was possible to determine the quality of the selected diet. From 76 species observed in the pasture, 33 species was identified in the sheep selected diet, emphasizing the Sabiá (Mimosa caesalpiniaefolia), centrosema (Centrosema sp.), ervanço (Alternanthera brasiliana), massai (Panicum maximum cv Massai) e paco-paco (Wissadula rostrata) as the most selected species by sheep during the study, composing more than 50% of the selected diet. In the Dry Season, undesirable species like marmeleiro (Croton sonderianus) and mofumbo (Combretum leprosum), were also constituent of the diet. Regarding to the nutritional value of selected diet, the sheep selected a diet with more protein than the sampled in the pasture. In the final late gestation, the sheep without supplementation ate a diet above 16% of CP, higher than the selected diet by treatments 350 and 500 g of concentrate per day (P<0.05). Were also observed to the non supplemented sheep, less fiber content intake (P<0.05). In the Trial 2, in the same condition of the first Trial, thirty two Somalis brasileira female sheep were used to determine the intake and digestibility, conducted in three assays (April - third late pregnancy; June - lactation and August - weaning). To predict the intake, the marker LIPE was used. Sheep and lambs were weighted every two weeks to performance evaluation. The concentrate offered to sheep favored to higher intake and digestibility of DM and CP than non supplemented sheep, with inverse relationship to the pasture intake (P<0.05). For the Dry Season, lower intake were observed than for Wet Season and Transition Wet-Dry (P<0.05). Higher intakes and digestibility of the fiber constituents were verified to non supplemented sheep (P<0.05). To performance evaluation, the offered supplementation determined the higher weights observed during lactation and weaning of sheep, and to birth and weaning weights of lambs (P<0.05). In Trial 3, two male sheep were used to determine the degradability of dry matter (DM), crude protein (CP) and neutral detergent fiber (NDF) of five forages selected by sheep in Trial 1: M. caesalpiniaefolia, A. brasiliana, P. maximum cv. Massai, jurema-preta (Mimosa tenuiflora) and C. lepreosum, at zero, 6, 24, 48, 72 and 96 hours of incubation. For each forage, were determined equations for the disappearance of DM, CP and NDF. It was also realized the protein fractions in their degradable and non-degradable in the rumen parts. Was detected a higher disappearance of DM, CP and NDF, as also better proportion of the rumen degradable protein to A. brasiliana, followed by P. maximum cv. Massai and M. caesalpiniaefolia. With the information obtained, it is concluded that the fecal micro histological technique presents as a viable technique to evaluate the selected diet by sheep in caatinga's pasture. On this pasture, the sheep are skilled to select the diet, changing during the phenological phases, trying to form a diet of better nutritive value. Forages as A. brasiliana, P. maximum cv. Massai and M. caesalpiniaefolia, can be considered an interesting food source to ewes kept in the caatinga.

Agronomic characteristics of sorghum genotypes and nutritional values of silage.

Objetivou-se avaliar as características agronômicas de genótipos de sorgo e o valor nutricional das silagens produzidas. Foram utilizados 15 genótipos de sorgo. O plantio foi realizado em blocos casualizados com três repetições por genótipo num total de 45 (quarenta e cinco) parcelas. Avaliaram-se as características agronômicas, nutricionais e qualidade da silagem. Houve diferença entre os genótipos para todas as características analisadas, com exceção dos teores de nitrogênio indisponível em detergente ácido (NIDA), proteína indisponível em detergente ácido (PIDA) e atividade de água (aw). Avaliando os parâmetros, com exceção dos genótipos 1016013, 1016025, 1016037, 1016039, Volumax, BRS 610, que apresentaram teor proteico abaixo de 7 %, os demais estão aptos a serem utilizados para a ensilagem, pois possuem um bom perfil de fermentação e digestibilidade in vitro da matéria seca; no entanto, o genótipo SF 15 é o mais favorável para a produção de silagem, devido à sua menor participação na fração de fibra em detergente neutro.

The Scored Patient-Generated Subjective Global Assessment (PG-SGA) and its Association with Quality of Life in Ambulatory Patients Receiving Radiotherapy

OBJECTIVE: To evaluate the scored Patient-generated Subjective Global Assessment (PG-SGA) tool as an outcome measure in clinical nutrition practice and determine its association with quality of life (QoL). DESIGN: A prospective 4 week study assessing the nutritional status and QoL of ambulatory patients receiving radiation therapy to the head, neck, rectal or abdominal area. SETTING: Australian radiation oncology facilities. SUBJECTS: Sixty cancer patients aged 24-85 y. INTERVENTION: Scored PG-SGA questionnaire, subjective global assessment (SGA), QoL (EORTC QLQ-C30 version 3). RESULTS: According to SGA, 65.0% (39) of subjects were well-nourished, 28.3% (17) moderately or suspected of being malnourished and 6.7% (4) severely malnourished. PG-SGA score and global QoL were correlated (r=-0.66, P<0.001) at baseline. There was a decrease in nutritional status according to PG-SGA score (P<0.001) and SGA (P<0.001); and a decrease in global QoL (P<0.001) after 4 weeks of radiotherapy. There was a linear trend for change in PG-SGA score (P<0.001) and change in global QoL (P=0.003) between those patients who improved (5%) maintained (56.7%) or deteriorated (33.3%) in nutritional status according to SGA. There was a correlation between change in PG-SGA score and change in QoL after 4 weeks of radiotherapy (r=-0.55, P<0.001). Regression analysis determined that 26% of the variation of change in QoL was explained by change in PG-SGA (P=0.001). CONCLUSION: The scored PG-SGA is a nutrition assessment tool that identifies malnutrition in ambulatory oncology patients receiving radiotherapy and can be used to predict the magnitude of change in QoL.

Non-alcoholic fatty liver disease : can ultrasound assist in early diagnosis of prediabetes and delay progression to type2 diabetes mellitus

Non Alcoholic Fatty Liver Disease (NAFLD) is a condition that is frequently seen but seldom investigated. Until recently, NAFLD was considered benign, self-limiting and unworthy of further investigation. This opinion is based on retrospective studies with relatively small numbers and scant follow-up of histology data. (1) The prevalence for adults, in the USA is, 30%, and NAFLD is recognized as a common and increasing form of liver disease in the paediatric population (1). Australian data, from New South Wales, suggests the prevalence of NAFLD in “healthy” 15 year olds as being 10%.(2) Non-alcoholic fatty liver disease is a condition where fat progressively invades the liver parenchyma. The degree of infiltration ranges from simple steatosis (fat only) to steatohepatitis (fat and inflammation) steatohepatitis plus fibrosis (fat, inflammation and fibrosis) to cirrhosis (replacement of liver texture by scarred, fibrotic and non functioning tissue).Non-alcoholic fatty liver is diagnosed by exclusion rather than inclusion. None of the currently available diagnostic techniques -liver biopsy, liver function tests (LFT) or Imaging; ultrasound, Computerised tomography (CT) or Magnetic Resonance Imaging (MRI) are specific for non-alcoholic fatty liver. An association exists between NAFLD, Non Alcoholic Steatosis Hepatitis (NASH) and irreversible liver damage, cirrhosis and hepatoma. However, a more pervasive aspect of NAFLD is the association with Metabolic Syndrome. This Syndrome is categorised by increased insulin resistance (IR) and NAFLD is thought to be the hepatic representation. Those with NAFLD have an increased risk of death (3) and it is an independent predictor of atherosclerosis and cardiovascular disease (1). Liver biopsy is considered the gold standard for diagnosis, (4), and grading and staging, of non-alcoholic fatty liver disease. Fatty-liver is diagnosed when there is macrovesicular steatosis with displacement of the nucleus to the edge of the cell and at least 5% of the hepatocytes are seen to contain fat (4).Steatosis represents fat accumulation in liver tissue without inflammation. However, it is only called non-alcoholic fatty liver disease when alcohol - >20gms-30gms per day (5), has been excluded from the diet. Both non-alcoholic and alcoholic fatty liver are identical on histology. (4).LFT’s are indicative, not diagnostic. They indicate that a condition may be present but they are unable to diagnosis what the condition is. When a patient presents with raised fasting blood glucose, low HDL (high density lipoprotein), and elevated fasting triacylglycerols they are likely to have NAFLD. (6) Of the imaging techniques MRI is the least variable and the most reproducible. With CT scanning liver fat content can be semi quantitatively estimated. With increasing hepatic steatosis, liver attenuation values decrease by 1.6 Hounsfield units for every milligram of triglyceride deposited per gram of liver tissue (7). Ultrasound permits early detection of fatty liver, often in the preclinical stages before symptoms are present and serum alterations occur. Earlier, accurate reporting of this condition will allow appropriate intervention resulting in better patient health outcomes. References 1. Chalasami N. Does fat alone cause significant liver disease: It remains unclear whether simple steatosis is truly benign. American Gastroenterological Association Perspectives, February/March 2008 www.gastro.org/wmspage.cfm?parm1=5097 Viewed 20th October, 2008 2. Booth, M. George, J.Denney-Wilson, E: The population prevalence of adverse concentrations with adiposity of liver tests among Australian adolescents. Journal of Paediatrics and Child Health.2008 November 3. Catalano, D, Trovato, GM, Martines, GF, Randazzo, M, Tonzuso, A. Bright liver, body composition and insulin resistance changes with nutritional intervention: a follow-up study .Liver Int.2008; February 1280-9 4. Choudhury, J, Sanysl, A. Clinical aspects of Fatty Liver Disease. Semin in Liver Dis. 2004:24 (4):349-62 5. Dionysus Study Group. Drinking factors as cofactors of risk for alcohol induced liver change. Gut. 1997; 41 845-50 6. Preiss, D, Sattar, N. Non-alcoholic fatty liver disease: an overview of prevalence, diagnosis, pathogenesis and treatment considerations. Clin Sci.2008; 115 141-50 7. American Gastroenterological Association. Technical review on nonalcoholic fatty liver disease. Gastroenterology.2002; 123: 1705-25

Open City, Rossellini and neorealism : sixty years on

For Bakhtin, it is always important to know from where one speaks. The place from which I speak is that of a person who grew up in Italy during the economic miracle (pre-1968) in a working class family, watching film matinees on television during school holidays. All sort of films and genres were shown: from film noir to westerns, to Jean Renoir's films, German expressionism, Italian neorealism and Italian comedy. Cinema has come to represent over time a sort of memory extension that supplements lived memory of events, and one which, especially, mediates the intersection of many cultural discourses. When later in life I moved to Australia and started teaching in film studies, my choice of a film that was emblematic of neorealism went naturally to Roma città aperta (Open city hereafter) by Roberto Rossellini (1945), and not to Paisan or Sciuscà or Bicycle Thieves. My choice was certainly grounded in my personal memory - especially those aspects transmitted to me by my parents, who lived through the war and maintained that Open City had truly made them cry. With a mother who voted for the Christian Democratic Party and a father who was a unionist, I thought that this was normal in Italian families and society. In the early 1960s, the Resistance still offered a narrative of suffering and redemption, shared by Catholics or Communists. This construction of psychological realism is what I believe Open City continues to offer in time.

Esophageal and head and neck cancer

Clinical Nutrition for Oncology Patients provides clinicians with the information they need to help cancer survivors and patients make informed choices about their nutrition and improve their short-term and long-term health. This comprehensive resource outlines nutritional management recommendations for care prior to, during, and after treatment and addresses specific nutritional needs and complementary therapies that may be of help to a patient. This book is written by a variety of clinicians who not only care for cancer survivors and their caregivers but are also experts in the field of nutritional oncology.

Ethnic differences in body composition and anthropometric characteristics in Australian Caucasian and urban Indigenous children

The objective was to compare ethnic differences in anthropometry, including size, proportions and fat distribution, and body composition in a cohort of seventy Caucasian (forty-four boys, twenty-six girls) and seventy-four urban Indigenous (thirty-six boys, thirty-eight girls) children (aged 9–15 years). Anthropometric measures (stature, body mass, eight skinfolds, thirteen girths, six bone lengths and five bone breadths) and body composition assessment using dual-energy X-ray absorptiometry were conducted. Body composition variables including total body fat percentage and percentage abdominal fat were determined and together with anthropometric indices, including BMI (kg/m2), abdominal:height ratio (AHtR) and sum of skinfolds, ethnic differences were compared for each sex. After adjustment for age, Indigenous girls showed significantly (P < 0·05) greater trunk circumferences and proportion of overweight and obesity than their Caucasian counterparts. In addition, Indigenous children had a significantly greater proportion (P < 0·05) of trunk fat. The best model for total and android fat prediction included sum of skinfolds and age in both sexes (>93 % of variation). Ethnicity was only important in girls where abdominal circumference and AHtR were included and Indigenous girls showed significantly (P < 0·05) smaller total/android fat deposition than Caucasian girls at the given abdominal circumference or AHtR values. Differences in anthropometric and fat distribution patterns in Caucasian and Indigenous children may justify the need for more appropriate screening criteria for obesity in Australian children relevant to ethnic origin.