Analysing the composition of fortified foods and supplements: The case of vitamins

This chapter serves as a reference source for those with recent experience of qualitative and quantitative analysis of vitamins contained in a sample of food components of fortified foods and supplements. Emphasis is placed on the scientific basis of particular methods of analysis of foods. Procedures discussed here have been selected to show the more important methods of analysis of vitamins for fortified foods and supplements, and not the methods of examining a particular food product. © 2015 Elsevier Ltd. All rights reserved

Síndrome metabólica e estado nutricional de idosos cadastrados no HiperDia

Aims: To analyze the association of metabolic syndrome and its components with the nutritional status of elderly enrolled in the HiperDia system.Methods: This was a cross-sectional study with a sample of elderly enrolled in the HiperDia of Central Specialty Unit of Municipal Health Department from Cruz Alta, Rio Grande do Sul, whose records contained the information necessary for the study. Metabolic syndrome diagnosis was based on criteria established by the National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III) and recommended by the Brazilian Society of Cardiology in the I Brazilian Guidelines for Diagnosis and Treatment of Metabolic Syndrome. Nutritional status was assessed by body mass index, according to the classification of II Guidelines on Geriatric Cardiology of the Brazilian Society of Cardiology. In the statistical analysis, the Student t test and the chi-square test were used, with analysis of adjusted residuals.Results: At all 485 seniors met the inclusion criteria and were selected. The sample mean age was 68.9±6.8 years (range 60 to 94 years). Most participants were female (62.5%) had metabolic syndrome (61.2%), and overweight/obesity (59%). When analyzing the association between nutritional status and metabolic syndrome and its components, significant associations of obesity with metabolic syndrome, central obesity, hypertriglyceridemia, and presence of four/five components of the syndrome (p <0.001) were found. The most common metabolic syndrome component was high blood pressure (81.3%), and the less frequent was hypertriglyceridemia (48.2%). Regarding gender, the frequency of metabolic syndrome was significantly higher among women (p=0.004; 66.3% versus 52.7%).Conclusions: The frequency of metabolic syndrome and its components and its association with nutritional status of elderly enrolled in HiperDia provides evidence that metabolic syndrome and nutritional status should also be monitored through this system.Objetivos: Analisar a associação de síndrome metabólica e seus componentes com o estado nutricional de idosos cadastrados no sistema HiperDia.Métodos: Trata-se de um estudo transversal, com amostra composta por idosos cadastrados no HiperDia da Unidade Central de Especialidades da Secretaria Municipal de Saúde de Cruz Alta, Rio Grande do Sul, cujos registros continham as informações necessárias para este estudo. Para o diagnóstico de síndrome metabólica foram utilizados os critérios estabelecidos pelo National Cholesterol Education Program’s Adult Treatment Panel III (NCEP-ATP III) e recomendados pela Sociedade Brasileira de Cardiologia na I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome Metabólica. O estado nutricional foi avaliado através do índice de massa corporal, segundo a classificação das II Diretrizes em Cardiogeriatria da Sociedade Brasileira de Cardiologia. Na análise estatística, utilizou-se o teste t de Student e o teste Qui-quadrado de Pearson, com análise de resíduos ajustados.Resultados: Foram selecionados 485 idosos que preencheram os critérios de inclusão. A média de idade da amostra foi de 68,9±6,8 anos (variando entre 60 e 94 anos). A maioria dos participantes era do sexo feminino (62,5%), tinha síndrome metabólica (61,2%), e sobrepeso/obesidade (59%). Ao analisar a associação do estado nutricional com síndrome metabólica e seus componentes, encontrou-se associação significativa de obesidade com síndrome metabólica, obesidade central, hipertrigliceridemia, e presença de quatro/cinco componentes da síndrome (p<0,001). O componente da síndrome metabólica mais frequente foi pressão arterial elevada (81,3%) e o menos frequente foi hipertrigliceridemia (48,2%). Em relação ao sexo, a frequência de síndrome metabólica foi significativamente maior entre as mulheres (p=0,004; 66,3% versus 52,7%).Conclusões: A frequência de síndrome metabólica e seus componentes e sua associação com o estado nutricional de idosos cadastrados no HiperDia fornece indícios de que síndrome metabólica e estado nutricional também devem ser monitorados através deste sistema

Síndrome metabólica e estado nutricional de idosos cadastrados no hiperdia = Metabolic Syndrome and nutritional status of elderly enrolled in the hiperdia system

Objetivos: Analisar a associação de síndrome metabólica e seus componentes com o estado nutricional de idosos cadastrados no sistema HiperDia. Métodos: Trata-se de um estudo transversal, com amostra composta por idosos cadastrados no HiperDia da Unidade Central de Especialidades da Secretaria Municipal de Saúde de Cruz Alta, Rio Grande do Sul, cujos registros continham as informações necessárias para este estudo. Para o diagnóstico de síndrome metabólica foram utilizados os critérios estabelecidos pelo National Cholesterol Education Program’s Adult Treatment Panel III (NCEP-ATP III) e recomendados pela Sociedade Brasileira de Cardiologia na I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome Metabólica. O estado nutricional foi avaliado através do índice de massa corporal, segundo a classificação das II Diretrizes em Cardiogeriatria da Sociedade Brasileira de Cardiologia. Na análise estatística, utilizou-se o teste t de Student e o teste Quiquadrado de Pearson, com análise de resíduos ajustados. Resultados: Foram selecionados 485 idosos que preencheram os critérios de inclusão. A média de idade da amostra foi de 68,9±6,8 anos (variando entre 60 e 94 anos). A maioria dos participantes era do sexo feminino (62,5%), tinha síndrome metabólica (61,2%), e sobrepeso/ obesidade (59%). Ao analisar a associação do estado nutricional com síndrome metabólica e seus componentes, encontrou-se associação significativa de obesidade com síndrome metabólica, obesidade central, hipertrigliceridemia, e presença de quatro/cinco componentes da síndrome (p<0,001). O componente da síndrome metabólica mais frequente foi pressão arterial elevada (81,3%) e o menos frequente foi hipertrigliceridemia (48,2%). Em relação ao sexo, a frequência de síndrome metabólica foi significativamente maior entre as mulheres (p=0,004; 66,3% versus 52,7%). Conclusões: A frequência de síndrome metabólica e seus componentes e sua associação com o estado nutricional de idosos cadastrados no HiperDia fornece indícios de que síndrome metabólica e estado nutricional também devem ser monitorados através deste sistem

L’interruption volontaire de grossesse : recommandations pour la pratique clinique — Texte des recommandations (texte court).

National audienceObjectif Élaborer des recommandations pour la pratique des IVG. Matériel et méthodes Consultation de la base de données Medline, de la Cochrane Library et des recommandations des sociétés savantes françaises et étrangères. Résultats Le nombre d’IVG est stable depuis plusieurs décennies. Il existe plusieurs éléments expliquant le choix de l’IVG lorsqu’il existe une grossesse non prévue (GNP). L’initiation précoce de la contraception et le choix de la contraception en rapport avec la vie de la femme sont associés à une diminution des GNP. Les contraceptions réversibles de longue durée d’action apparaissent comme une contraception à positionner en première ligne pour l’adolescente du fait de son efficacité (grade C). L’échographie avant une IVG doit être encouragée mais n’est pas indispensable pour réaliser une IVG (accord professionnel). Dès l’apparition échographique de l’embryon, l’estimation de la datation de la grossesse se fait par la mesure de la longueur cranio-caudale (LCC) ou par la mesure du diamètre bipariétal (BIP) à partir de 11 SA (grade B). Les mesures étant fiables à ± 5 jours, l’IVG peut être réalisée lorsque les mesures de LCC et/ou de BIP sont respectivement inférieures à 90 mm et 30 mm (accord professionnel). L’IVG médicamenteuse réalisée avec la dose de 200 mg de mifépristone associé au misoprostol est efficace à tout âge gestationnel (NP1). Avant 7 SA, la prise de mifépristone sera suivie entre 24 et 48 heures de la prise de misoprostol par voie orale, buccale, sublinguale voire vaginale à la dose de 400 μg éventuellement renouvelé après 3 heures (NP1, grade A). Au-delà de 7 SA, les modes d’administration du misoprostol, par voie vaginale, sublinguale ou buccale, sont plus efficaces et mieux tolérés que la voie orale (NP1). Il est recommandé d’utiliser systématiquement une préparation cervicale lors d’une IVG instrumentale (accord professionnel). Le misoprostol est un agent de première intention pour la préparation cervicale à la dose de 400 μg (grade A). L’aspiration évacuatrice est préférable au curetage (grade B). Un utérus perforé lors d’une aspiration instrumentale ne doit pas être considéré en routine comme un utérus cicatriciel (accord professionnel). L’IVG instrumentale n’est pas associée à une augmentation du risque d’infertilité ultérieure ou de GEU (NP2). Les consultations médicales pré-IVG n’influent pas sur la décision d’interrompre ou non la grossesse et une majorité de femmes est assez sûre de son choix lors de ces consultations. L’acceptabilité de la méthode et la satisfaction des femmes semblent plus grandes lorsque celles-ci sont en mesure de choisir la méthode d’IVG (grade B). Il n’y a pas de relation entre une augmentation des troubles psychiatriques et le recours à l’IVG (NP2). Les femmes ayant des antécédents psychiatriques sont à risque accru de troubles psychiques après la survenue d’une grossesse non prévue (NP2). En cas d’IVG instrumentale, la contraception estro-progestative orale et le patch devraient être débutés dès le jour de l’IVG, l’anneau vaginal inséré dans les 5 jours suivant l’IVG (grade B). En cas d’IVG médicamenteuse, l’anneau vaginal devrait être inséré dans la semaine suivant la prise de mifépristone, la contraception estro-progestative orale et le patch devraient être débutés le jour même ou le lendemain de la prise des prostaglandines (grade C). En cas d’IVG instrumentale, l’implant devrait être inséré le jour de l’IVG (grade B). En cas d’IVG médicamenteuse, l’implant peut être inséré à partir du jour de la prise de mifépristone (grade C). Le DIU au cuivre et au lévonorgestrel doit être inséré préférentiellement le jour de l’IVG instrumentale (grade A). En cas d’IVG médicamenteuse, un DIU peut être inséré dans les 10 jours suivant la prise de mifépristone après s’être assuré par échographie de l’absence de grossesse intra-utérine (grade C). Conclusion L’application de ces recommandations devrait favoriser une prise en charge plus homogène et améliorée des femmes désirant une IVG. Summary Objective Develop recommendations for the practice of induced abortion. Materials and methods The Pubmed database, the Cochrane Library and the recommendations from the French and foreign Gyn-Obs societies or colleges have been consulted. Results The number of induced abortions (IA) has been stable for several decades. There are a lot of factors explaining the choice of abortion when there is an unplanned pregnancy (UPP). Early initiation and choice of contraception in connection to the woman's life are associated with lower NSP. Reversible contraceptives of long duration of action should be positioned fist in line for the teenager because of its efficiency (grade C). Ultrasound before induced abortion must be encouraged but should not be obligatory before performing IA (Professional consensus). As soon as the sonographic apparition of the embryo, the estimated date of pregnancy is done by measuring the crown-rump length (CRL) or by measuring the biparietal diameter (BIP) from 11 weeks on (grade B). Reliability of these parameters being ± 5 days, IA could be done if measurements are respectively less than 90 mm for CRL and less than 30 mm for BIP (Professional consensus). A medical IA performed with a dose of 200 mg mifepristone combined with misoprostol is effective at any gestational age (EL1). Before 7 weeks, mifepristone followed between 24 and 48 hours by taking misoprostol orally, buccally sublingually or eventually vaginally at a dose of 400 ug possibly renewed after 3 hours (EL1, grade A). Beyond 7 weeks, misoprostol given vaginally, sublingually or buccally are better tolerated with fewer side effects than oral route (EL1). It is recommended to always use a cervical preparation during an instrumental abortion (Professional consensus). Misoprostol is a first-line agent for cervical preparation at a dose of 400 mcg (grade A). Aspiration evacuation is preferable to curettage (grade B). A perforated uterus during an instrumental suction should not be considered as a scarred uterus (Professional consensus). IA is not associated with increased subsequent risk of infertility or ectopic pregnancy (EL2). The pre-abortion medical consultations does not affect, most of the time, the decision to request an IA. Indeed, a majority of women is quite sure of her choice during these consultations. Acceptability of the method of IA and satisfaction appears to be larger when they are able to choose the abortion method (grade B). There is no relationship between an increase in psychiatric disorders and IA (EL2). Women with psychiatric histories are at increased risk of mental disorders after the occurrence of an UPP (EL2). In case of instrumental abortion, oral estrogen-progestogen contraceptives and the patch should be started from the day of the abortion, the vaginal ring inserted within 5 days of IA (grade B). In case of medical abortion, the vaginal ring should be inserted within a week of taking mifepristone, oral estrogen-progestogen contraceptives and the patch should be initiated on the same day or the day after taking prostaglandins (grade C). In case of instrumental abortion, the contraceptive implant may be inserted on the day of the abortion (grade B). In case of medical abortion, the implant can be inserted on the day of mifepristone (grade C). The copper Intrauterine Device (IUD) and levonorgestrel should be inserted preferably on the day of instrumental abortion (grade A). In case of medical abortion, an IUD can be inserted within 10 days following mifepristone after ensuring by ultrasound of the absence of intrauterine pregnancy (grade C). Conclusion The implementation of these guidelines may promote a better and more homogenous care for women requesting IA in our country