RCAAP Repository

ABSTRACT Objective Investigate histological changes related to inflammatory response and collagen expression during wound healing in rats with protein malnutrition. Methods Twenty male Wistar rats underwent cutaneous surgery and were divided into two experimental groups: Malnourished (8% casein diet); Nourished (17% casein diet). Animals were euthanized after 5th and 10th days, descriptive and quantitative analyses were performed on sections stained with hematoxylin-eosin and sirius red, respectively. Statistical analysis of data using nonparametric Fisher's exact test with p<0.05 was carried out. Results At five days, increased fibroblast proliferation (p<0.01) and collagen expression (p<0.05) was observed in N5 group. After ten days, N10 and MN10 animals showed higher amount of granulation tissue and edema/inflammatory infiltrate independent of nutritional status (p>0.05), only N10 group showed fibroblast proliferation (p<0.01) and increased collagen expression (p<0.01). Conclusion Protein malnutrition seems not to influence inflammatory phase of healing, whereas it negatively effects fibroblast proliferation and collagen synthesis.

ABSTRACT Objective To study the relationship between exercise and malnourishment because recent evidence suggests that exercise can cause the beneficial adaptation of antioxidant systems, whereas malnourishment can cause harmful adaptation of these systems. Methods Thirty-two female Fischer rats were equally divided into Sedentary Control, Trained Control, Sedentary Malnourished and Trained Malnourished groups. The training protocol consisted of swimming for 30 minutes continuously for 5 days/week for 8 weeks. Results It was demonstrated that aspartate aminotransferase and alanine aminotransferase activities increased in malnourished rats, but physical training reversed these effects by lowering the raised levels. The glutathione level was diminished by malnourishment whereas physical training increased the levels of liver carbonyl protein and increased the levels of thiobarbituric acid reactive substances that were diminished by malnourishment. In addition, Trained Malnourished rats had a higher average body weight than Sedentary Malnourished ones (62.77g vs. 55.08g, respectively). Conclusion The data show that exercise was able to reverse or reduce damage caused by malnourishment, such as weight loss and liver dysfunction by a pathway independent of the participation of enzymes involved in antioxidant defense and that there is no interaction between exercise and malnutrition.

ABSTRACT Objective To analyze erythrocyte fatty acid composition and its association with serum cytokine levels in pediatric cystic fibrosis patients. Methods A cross-sectional study was performed at a reference center in Rio de Janeiro, Brazil. We have included all pediatric patients aged 5-19 years with confirmed cystic fibrosis diagnosis. Erythrocyte fatty acid composition and serum cytokine (TNF-α, IL-1β, IL-6 and IL-8) and C-reactive protein levels were measured. The cut-off point to determine essential fatty acids deficiency was the linoleic acid concentration of <21%. Results Twenty-six children (<10 years old) and thirty-one adolescents were studied. Most patients were female and heterozygous for DF508 mutation and suffered from exocrine pancreatic insufficiency. Both children and adolescents had lower linoleic acid concentration (<21%). TNF-α was the only pro-inflammatory marker whose levels were increased; the increase was greater in children. An association between fatty acid composition in erythrocytes and cytokines IL-1β and IL-6 was observed (p<0.05). Conclusion The pediatric cystic fibrosis patients studied presented a deficiency of essential fatty acids, and an association between fatty acid profile in erythrocytes and serum pro-inflammatory cytokines was observed. These findings highlight the importance of this type of assessment that may open new possibilities for studying pathophysiology and treating cystic fibrosis patients, such as the dietary supplementation with n-3 fatty acids (eicosapentaenoic and docosahexaenoic acids). However, further longitudinal studies are needed for better clarification of the imbalance in lipid metabolism and inflammation in cystic fibrosis

ABSTRACT Objective To analyze if aerobic capacity is related to Birth Weight and breastfeeding patterns in boys and girls, products of a term pregnancy and normal weight. Methods A representative sample of 230 Brazilian children (6-10 years old), born at term (after 37-weeks’ gestation) with normal weight (between 2.5 and 4.0kg). These children performed a Yo-Yo Test to estimate their aerobic capacity and mothers reported their children’s Birth Weight and breastfeeding patterns. The Pearson correlation coefficient was used to measure the association between aerobic capacity with Birth Weight and breastfeeding patterns. Results We did not observe any significant associations between aerobic capacity with Birth Weight and breastfeeding time in either sexes (p>0.05). Conclusion These results indicate that aerobic capacity is not related with Birth Weight or breastfeeding time in children born with normal weight and gestational age, suggesting that this complex physiological parameter does not appear to be determined by intrauterine factors that dictate the Birth Weight and breastfeeding patterns in the beginning of life.

ABSTRACT Objective The purpose of this study was to validate the card game The Enigma of the Pyramid about healthy eating, using judges (expert) for the validation of content and design; and the target population (students from the 4th and 5th grades, aged 9-10 years) for the semantic validation (pilot test). Methods The Item-Level Content Validity Index was used to verify the degree of agreement among the experts’ opinions, item by item; and the Scale Level Content Validity Index to determine the arithmetic mean of the proportion of items that receive judgments of “non-disagreement” by the judges. The item that obtained Item-Level Content Validity Index greater or equal to 0.80 and Scale Level Content Validity Index greater or equal to 0.90 was considered validated, which was the coefficient of validity. The binominal test was used to select the items that should be revised/modified, using the p-value of ratio (reject H0 if p≤0.8). Items were validated at significance level of ≤0.05. Results Twenty-two judges and 12 schoolchildren participated in the study. Of the 23 items of the card game, nine were selected for review/modification, of which five were from the language component and four from the suitability component for the target population. Conclusion Once the modifications were made, they were all approved by all participating students, making this educational tool on healthy eating habits available for use with the student population.

ABSTRACT Objective To evaluate the nutritional status and functional capacity of hospitalized adult patients. Methods Cross-sectional study of adult oncology patients at Hospital de Clínicas de Porto Alegre. Patients were evaluated according to Solid Tumors and Hematologic Tumors. The nutritional status was obtained using Patient Generated Subjective Global Assessment, and the functional capacity was evaluated by Handgrip Strength using a Jamar® dynamometer – and the Performance Index of the Eastern Cooperative Oncology Group. Results This study evaluated 76 patients (56±17 years old, 35.5% female), 63.2% with Solid Tumors and 36.8% with Hematologic Tumors. According to the Patient Generated Subjective Global Assessment, 53.9% of the patients were moderately and severely malnourished and demonstrated functional capacity, according to the Handgrip Strength and Performance Index of the Eastern Cooperative Oncology Group, of 47.9% and 32.2%, respectively. The functional capacity instruments showed a moderate agreement (Kappa=0.427, p<0.001) and positive correlation (r=0.136, p=0.028). Severely malnourished patients had a lower Handgrip Strength when compared to well nourished (24.0±10.4 vs. 34.2±16.6kg, p=0.015). The results were confirmed among moderately and severely malnourished patients, who were rated at the 40 percentile, considered low functional capacity. Conclusion In this study, hospitalized oncological patients presented poor nutritional status and low functional capacity. The Patient Generated Subjective Global Assessment identifies the nutritional specification earlier. In addition, Handgrip Strength dynamometry can be a useful tool to evaluate the low functional capacity and nutritional status. It can be included in cancer patient’s evaluation, along with other nutritional assessment tools.

ABSTRACT Objective To analyze the presence and characteristics of social, environmental and health dimensions identified in the current national food supply policy proposals and policies. Methods This is a study with a qualitative approach using a documentary analysis technique referring to the period between 2003 and 2015, in addition to the Agricultural Policy of 1991. Results The results of the analyzes of the documents of the Federal Executive Power and the Public Policy Councils are similar, policies that seek alternatives to the negative impacts of the hegemonic model of food supply, different from the document of the Federal Legislative Power and Agricultural Policy, which superficially approach alternatives to these impacts, or are limited to strengthening the dominant productive system. Conclusion Thus, a national food supply policy is needed for the planning of actions, considering social, environmental and health impacts and taking as reference the initiatives already built by sectors of the Executive Power and by the Public Policy Councils.

ABSTRACT Objective To investigate whether acute citrulline supplementation might influence post-exercise hypotension in normotensive and hypertensive individuals. Methods Following a randomized double-blind design, twenty normotensive (28±7 years, 74±17kg, 1.7±0.09m) and 20 hypertensive individuals (55±12 years, 76±15kg, 1.59±0.09m) were randomly assigned to one of the four experimental groups (Normotensive-Placebo; Normotensive-Citrulline; Hypertensive-Placebo; Hypertensive-Citrulline). The placebo groups ingested 6g of corn starch and the citrulline groups ingested 6g of citrulline dissolved in water. The participants performed 40 minutes of walking/running on a treadmill at 60-70% heart rate reserve. Blood pressure was measured immediately after a 60-min exercise session using an oscillometric device and 24-h ambulatory monitoring. Results The post-exercise hypotension was more pronounced in hypertensives and the Hypertensive-Citrulline group showed a consistent systolic blood pressure reduction during the laboratorial phase, which can be seen by looking at the mean of 60 minutes (-15.01mmHg vs -3.14mmHg [P=0.005]; -4.16mmHg [P=0.009]; -6.30mmHg [P=0.033] in comparison with the Normotensive-Placebo, Normotensive-Citrulline, and Hypertensive-Placebo groups, respectively). During ambulatory blood pressure monitoring, the Hypertensive-Citrulline group showed a significant reduction in systolic blood pressure (-21.05mmHg) in the awake period compared with the Normotensive-Citrulline group (-3.17mmHg [P=0.010]). Conclusion Acute citrulline oral supplementation can induce greater post-exercise hypotension response in hypertensive than normotensive individuals.

ABSTRACT Objective To estimate the prevalence of 25-hydroxyvitamin D deficiency and to analyze factors associated with lower serum vitamin levels in Brazilian adults. Methods A cross-sectional, population-based study consisted of 626 adult individuals of both sexes living in the urban area of Viçosa, Minas Gerais. The dependent variable used was the serum level of 25-hydroxyvitamin D and the independent variables were sociodemographic, anthropometric and body composition variables. The associations among the variables were verified using simple and multiple linear regression models, considering alpha lower than 0.05 for the input in the final model. Results The prevalence of 25-hydroxyvitamin D deficiency was 14.4% and the prevalence was 42.0%. Excess abdominal fat was higher in subjects with 25-hydroxyvitamin D sufficiency. The serum level of 25-hydroxyvitamin D was 30.34±9.85ng/ml. Body adiposity was higher in men with vitamin insufficiency. Negative associations were observed between serum 25-hydroxyvitamin D levels and age, educational level, body adiposity (p=0.028) and abdominal adiposity (p=0.023). Conclusion Our results showed that excess body and abdominal adiposity are strong predictors of alterations in the serum vitamin D levels, thus public policies for prevention and treatment in this population are essential.

ABSTRACT Objective This study evaluated the knowledge and practices of pediatricians and nutritionists about cow’s milk protein allergy in infants, with an emphasis on issues related to the exclusion diet and nutritional status. Methods A cross-sectional, descriptive study was performed with a convenience sample of 204 pediatricians and 202 nutritionists randomly invited in scientific events in the city of São Paulo, from November 2014 to March 2016. Results Between 1.5% and 21.0% of respondents indicated inadequate products for the treatment of cow’s milk protein allergy, including goat’s milk, beverages or juices based on soy extract, lactose-free milk formula and partially hydrolyzed formula. The daily calcium recommendation for children between zero and 36 months of age was correctly indicated by 27.0% of pediatricians and 46.0% of nutritionists (p=0.001). Additionally, 96.1% of pediatricians and 82.7% of dietitians (p<0.001) provided guidance on about labels of industrialized products. Conclusion Pediatricians and nutritionists present gaps in knowledge about cow’s milk protein allergy treatment in infants and educational strategies that increase the knowledge of the professionals are important for the management of cow’s milk protein allergy.

ABSTRACT Objective To evaluate the quality of raw human milk distributed in the Neonatal Intensive Care Unit of a University Hospital of the city of São Paulo. Methods A cross-sectional study with raw human milk samples from mothers who attended the Human Milk Collection Station of a University Hospital, analyzed between May 2016 and January 2017, excluding mothers of twins. The quality of the raw human milk was assessed by verifying the presence of dirt, the coloration of the milk, the titratable acidity using the Dornic method, and through its energy content. Kruskal-Wallis and Mann-Whitney tests were used for the analysis of the energy profile and the degree of Dornic acidity, according to the stage of the raw human milk and the gestational age of the child. Results The study was composed of 40 samples of 40 different women, with a mean age of 27 years, an average of 11.8 years of education, most of them were multiparous and with a partner. Regarding milk analysis, 55.0% was classified as colostrum, 27.5% as mature milk and 17.5% as transitional milk. All samples presented negative results for dirt and normal coloration. The mean milk acidity was 3.24º Dornic and most of the samples were classified as hypercaloric energy content. There was no association between the lactation stage and gestational age with the acidity value and energy content. Conclusion The quality of raw human milk distributed in the Neonatal Intensive Care Unit of the institution evaluated was considered adequate and the samples analyzed had a high energy content and excellent Dornic acidity.

ABSTRACT Objective To determine intuitive eating in young adults and the effects of factors such as gender, Body Mass Index and dietary intake, and dietary adequacy on intuitive eating. Methods This cross-sectional study was conducted with students at Gazi University in Ankara (N=665; 17.6% men; 82.4% women). The questionnaire, including the general characteristics, anthropometric measurements, Intuitive Eating Scale-2, and 24-H Dietary Recall sections, were applied to all participants. For the evaluation of the diet, Nutrient Adequacy Ratio and Mean Adequacy Ratio were used. Results The mean Intuitive Eating Scale-2 score was 3.2±0.33; men’s and women’s scores were 3.3±0.37 and 3.2±0.32, respectively (p<0.05). According to linear regression analysis, gender, age and mean adequacy ratio had an effect on the model for the score (p<0.05). In addition, there was a negative correlation between Intuitive Eating Scale-2 scores and Body Mass Index values in women (rp=-0.095, p=0.026). Conclusion The intuitive eating scores varied according to gender, dietary adequacy and age. Intuitive eating may be effective in the formation of long-term behavioral changes, which is beneficial for the treatment of obesity. The result of this study may encourage the development of this behavior in groups (may vary according to gender), that is thought to be effective by considering the changes of intuitive eating behavior.

ABSTRACT Objective To evaluate the internal validity and reliability of an index developed to assess the nutritional quality of meals. Methods The Main Meal Quality Index is composed of ten components. The final scores range from 0-100 points. The index performance was measured using strategies for assessing content validity, construct validity, discriminant validity and reliability. The analyses were performed using the Stata statistical software at a 5% significance level. Results The index was positively associated with carbohydrates, vegetable proteins, fibers, vitamins, folate and potassium and negatively associated with energy, total fat, saturated fat, animal protein, cholesterol, phosphorus, sodium, added sugar, and cholesterol biomarker. Significant differences were found between the two groups with marked disparities in dietary quality, smokers (50.2 points) and non-smokers (53.5 points). Conclusion The index might be a useful tool for assessing the nutritional quality of meals and for monitoring and comparing groups.

ABSTRACT Objective To evaluate the interpretation by adolescents of messages contained in the Dietary Guidelines for the Brazilian Population. Methods Qualitative study of adolescents distributed across “conversation circles”. Each group received messages about healthy eating from the Dietary Guidelines and was instructed to develop materials containing their own interpretation thereof, using appealing wording and format. Content analysis was then used to evaluate these materials. Results Presentation of the produced materials revealed a focus on placing the participants at the center of the process and highlighting the dynamic and innovative nature of each strategy. Corpus analysis identified three clusters of meaning: (I) Food classification and selection model: The participants showed comprehension of the different formulations of foods and their impacts on health, but using other terms. A reductionist understanding of the composition of a healthy diet was observed; (II) Environment and eating practices: the environment was characterized as conducive or not to healthy eating, and open-air markets were recognized as spaces for healthy choices. Creating recipes was judged a wise choice to be shared; and (III) Diet-related individual and collective wellness: consequences of unhealthy food intake were linked to physical and emotional well-being. Concerns were raised about the use of natural resources and the impact of pesticides on individuals and the environment. Conclusion To facilitate understanding of the Dietary Guidelines, the wording of its messages must be adapted, and the discussion about healthy eating and proper diet must be broadened to ascribe greater value to the act of cooking in this population.

ABSTRACT Objective To describe the development and validation of a workshop protocol for the implementation of the Dietary Guidelines for the Brazilian Population in primary healthcare units. Methods This descriptive study was developed in the state of São Paulo, Brazil, and it involved 20-25 professionals in the experimentation phase and 12 experts in the content validity phase. The workshop protocol was developed according to three theoretical references: Dietary Guidelines, Interprofessional Collaborative Practice and Critical Reflexive Methodology. The protocol consisted of four 4-hour modules, 16 activities in 16 hours. The activities matrix was composed of three axes: (a) organizational strategies, (b) dietary guideline comprehension and (c) dietary guideline implementation. For the validity analysis, the expert panel assessed clarity, relevance and theoretical representativeness. Content validity index was calculated, and adequate activities scored >0.80. The proportion of experts who recognized the presence of the theoretical framework in the activities was calculated. Results All 16 proposed activities obtained a score greater than the established cut-off point, both for clarity and relevance. For theoretical representativeness analysis, the dietary guidelines reached higher scores on the (b) and (c) axes of the protocol and was less recognized on the (a) axis, whose highest score was for the Critical Reflexive Methodology. Interprofessional Collaborative Practice presented a higher score on the (c) axis and a lower one on the (b) axis. Conclusion The protocol was considered appropriate for its purpose and with potential application in the different scenarios of primary health care in Brazil.

ABSTRACT Objective Food insecurity and child malnutrition are central topics in many food programs around the world; however, these indices do not diminish. The creation of strategies is necessary to increase the effectiveness of nutritional improvement programs. The objective of this research was to improve the nutritional quality of three local dishes included in the regular diet of the population by adding amaranth and to evaluate their acceptance by children from three communities in Tochimilco, Puebla, Mexico. Methods The study was carried out in three communities of “Tochimilco”, Puebla, Mexico, in order to evaluate three local dishes: banana smoothie, beans and corn tortillas, which were chosen by mothers of the region in participative workshops on preparation of local dishes enriched with amaranth. Two sensory tests were applied: paired-comparison and hedonic scale to 208 and 210 children of preschool and scholar age, respectively. Results It was found that consumers showed similar preference for banana smoothie and beans enriched with amaranth compared to non-enriched dishes; while the amaranth enriched tortilla gained more preference in the different statistical tests and it was the dish with higher content of amino acids. Sensory attributes were similarly assessed and there were no significant differences among rural and urban communities and school year. Conclusion Children easily accept the addition of amaranth to the dishes they are accustomed to, as it does not change their food culture. It is possible to improve child nutrition by designing healthier dishes and incorporating them into the daily cooking of those who prepare the food.

ABSTRACT Objective A strategic analysis was carried out in order to verify the relevance of the Food and Nutrition Security Plan of the state of Santa Catarina to the Brazilian concept of Food and Nutrition Security. Methods A matrix containing 7 dimensions, 16 sub-dimensions and 35 indicators was used for the evaluation, which were evaluated as poor, regular, good and excellent for each component. Results The Plan was evaluated as being of good relevance to its objective. However, it was only relevant to 53% of the analyzed dimensions, and the dimension of promoting universal access to adequate food had the worst result. The dimensions of developing permanent processes of education, research and training, and of evaluation and monitoring, obtained the best results, with the Plan being evaluated as of good relevance to these dimensions. Still, for half of the sub-dimensions and for 60% of the analyzed indicators, the Plan was evaluated as poor or regular. Conclusion It is hoped that the results of this research can qualify the Plan researched, as well as stimulate reflections for the construction of Plans in the other Brazilian states.

ABSTRACT Objective To carry out a mapping of the historical trajectory of the professional associations of nutritionists (scientific associations, councils and professional labor unions) in Brazil. Methods The study consists of a historical-documentary analysis. To obtain the data, information and documents, the websites of the Federal Council of Nutritionists; Brazilian Association of Food and Nutrition; National Federation of Nutritionists and Nutritionists’ Unions were browsed. A systematic bibliographic survey was carried out in the databases of the Scientific Electronic Library Online and National Library of Medicine to retrieve scientific articles about the associations of nutritionists in Brazil over the 80 years of their history, focusing on the last ten years. Results The historical analysis indicates that, over the course of eighty years, there has been strengthening of professional associations of nutritionists and achievements concerning training regulation, professional practice, fields of work and working conditions. The labor reform act of 2017 reduces the rights related to working conditions, creating setbacks in the achievements of nutritionists. Conclusion The professional associations of nutritionists have played an important role in the process of professionalization and legitimacy of training and performance of the profession in the country. There are indications of the unified performance of professional associations, but it is still incipient and scarce. Nowadays, unified, transparent and committed action of these professional associations is imperative for the professionalization and improvements of the working conditions of Brazilian nutritionists.

ABSTRACT Objective To analyze public policies on food and nutrition in Brazil, with emphasis on the last fifteen years (2003-2018). Methods Historical-documentary analysis based on a bibliographical survey on indexed bases and exploratory visits to websites of government agencies. Results The scientific and governmental findings were organized according to the Lula, Dilma and Temer governments. They explore the development of several public policies and welfare programs in food and nutrition, focusing mainly on Brazilian Hunger Eradication Program, Assistance for Needy Families Program, National Policy on Food and Nutrition Security, Food Acquisition Program, National School Nutrition Program, National Food and Nutrition Security Policy, National Food and Nutrition Surveillance System and Brazilian Misery Eradication Program. The centrality of the idea of the fight against hunger and misery in public policies during Lula’s first and second terms and Dilma’s first term stand out. Dilma’s second term is marked by the focus on healthy eating, as well as presenting the first signs of fragilization of public policies on food and nutrition. Currently, the Temer government is characterized by processes of institutional and programmatic rupture, budget cuts and setbacks in acquired rights. There is evidence of the need to activate national and international instruments to enforce the human right to adequate food and consequent strengthening of public policies on food and nutrition. Conclusion This period presents an expansion and qualification of public policies on food and nutrition, mainly in the Lula and Dilma administration, with setbacks in the Temer administration, in which continuous budget cuts weaken social, hunger reduction, poverty reduction and food and nutrition security policies.

ABSTRACT Objective To analyze the increase in the number of nutritionists and the aspects of the job market in the last decade. Methods Critical test based on literature review and official data provided by nutrition councils and other entities. Results There was an average yearly increase of 8,248 nutritionists in the period from 2010 to 2017, having the largest contingent of professionals concentrated in the Brazilian Southeast region. In 2017 there were 126,539 nutritionists registered in the country’s ten regional councils, practically twice as much as in 2009 (60,554 nutritionists). Even though the last nationwide research on the profile of nutritionists was performed in 2006, the production of local studies showed that more than half of the professionals voluntarily continued their education after graduating. In 2018 the Federal Council of Nutritionists updated the areas of work with details divided in subareas, segments and subsegments. Public spaces for food security, primary health care and sports nutrition are examples of new fields for the nutritionist. In the period of analysis there was an increase of 58.9% of the wage floor, however, still below the national average and other health professionals, and with longer working hours. The current wage floor for nutritionists is R$2,558.05. Conclusion In addition to the increase in the number of professionals, there were adjustments in specific labor legislation, as well as geographical repositioning, diversification and expansion of the job market. It is necessary to move ahead, mainly in what concerns a more extended and holistic understanding of the profession.