Manejo nutrológico no pós-operatório de cirurgia bariátrica

Obesity is one of the largest epidemics of this century and is associated with several comorbidities, leading to poor quality of life and longevity. Obesity is related to genetic and environmental factors and is characterized by change in body composition, where there is more supply than energy expenditure, allowing the accumulation of body fat. The Bariatric Surgery (BC) is an effective method for sustained weight loss in obese patients, where the gastric bypass surgery Roux-Y (RYGB) is the most common technique in Brazil. BC is set by a procedure, which changes the gastrointestinal tract leading to reduced food intake and reduced absorption. Patients who undergo BC at risk for nutritional deficiencies in the postoperative period and obesity by itself is related to some deficiencies. Nutritional deficiencies in the postoperative period can be attributed to several factors such as the preoperative deficiency, reduced food intake, inadequate supplementation, malabsorption of nutrients and inadequate nutrological support, such as lack of monitoring or absence of postoperative follow-up. The most common deficiencies are iron, protein, calcium, folate, thiamine, zinc, copper and vitamins D, B12, A, C and K. The proper guidance, monitoring and follow-up postoperatively are the essential actions in identifying and/or prevention of these deficiencies

Deficiência de tiamina em paciente com Síndrome do Intestino Curto: um relato de caso

This is a case report of patient OG 70, which looked for assistance at the Hospital de Clinicas de Porto Alegre (HCPA) by fatigue, dyspnea, vomiting and diarrhea. Patient had undergone intestinal resection 5 years ago by strangulated abdominal hernia, came up with gastrointestinal symptoms and progressive weight loss. On admission, showed malnutrition and clinical and echocardiographic signs suggestive of heart failure (HF), with probable diagnosis of IC by thiamine deficiency. Thiamine replacement was initiated 300mg, EV, per day. The patient was also managed with replacement of electrolytes, antibiotics for bacterial overgrowth, antiparasitic, and oral diet with low osmolarity, lactose free, low in sucrose. Replacement of zinc and B vitamins were also accomplished. The patient was discharged after 30 days of hospitalization with clinical improvement and without clinical signs of HF. Conclusion: Deficiency of vitamin B1 should be investigated in patients with malnutrition and Short Bowell Syndrome, especially those with cardiac and neurological expressions characteristic of beriberi. The treatment of thiamine deficiency is relatively simple and leads to rapid improvement of symptoms

Tratamento da doença do refluxo gastrintestinal em crianças

Refluxo gastroesofágico e regurgitação são extremamente comuns durante a infância e com frequência resolvem espontaneamente com o aumento da idade. A maioria das crianças apresenta regurgitação simples, que não requer intervenção ou avaliação, após anamnese cuidadosa e exame físico. Já doença do refluxo gastroesofágico requer outras medidas, após diagnóstico clínico. Mais de 50 por cento das crianças demonstram melhora ou resolução dos sintomas com medidas conservadoras que incluem alimentos espessados, adequado volume de ingestão e fracionamento de refeições; não exposição à fumaça do tabaco; posição vertical após alimentação e decúbito dorsal para lactentes; elevação do ângulo da cama para crianças. Tratamento medicamentoso tem por base a supressão ácida, exercida por antissecretores do ácido (antagonistas H2 e inibidores da bomba de prótons). Os últimos (IBP) são considerados superiores, mas seu uso não deve ser indiscriminado, em face dos efeitos adversos a eles atribuídos, principalmente em uso prolongado. Assim, administração por longo prazo não é aconselhável, devendo-se preferir a mínima dose possível. Não há grande diferença de eficácia entre representantes, mas seus preços de mercado e as apresentações farmacológicas são bastante variáveis. Lactentes só devem ser medicados se apresentarem manifestação clínica exuberante não contornável com medidas conservadoras, preferindo-se ranitidina devido a custo e apresenação mais favorável. Crianças maiores, com sinais e sintomas de DRGE, fazem teste terapêutico por 4 semanas com omeprazol; se houver retorno das manifestações clínicas, faz-se endoscopia digestiva alta

Autismo: aspectos nutrológicos das dietas e possível etiologia

Autism spectrum disorders (ASDs) refer to a group of disorders characterized by a shared spectrum of qualitative impairments in social interaction, associated with repetitive behavior and pronounced restricted interests. The causes of this illness are still unknown, but due to the great incidence of affected children, nowadays, dietary interventions have been studied and disseminated in order to improve the psychiatric and physical symptoms of the patients affected by ASDs. Exclusion diets have become more popular among parents who seek treatment for children diagnosed with autism, such as the ketogenic diet, the specific carbohydrate diet, the Feingold diet, the low oxalate diet, the gluten-free and casein-free diet (GFCF), as well as vitamin complex supplementation. The goal of the present literature review is to assess whether the GFCF diet, which is the most widespread and adopted option lately, is effective and also its nutritional consequences. Method: A bibliographic review of articles published during the past 5 years was performed. Conclusion: The GFCF diet is the most studied one and seems to improve the behavior and the gastrointestinal disorders of children with ASDs

Uso de fibras no tratamento da constipação infantil : revisão sistemática com metanálise

Objective: To gather current evidence on the use of fiber for constipation treatment in pediatric patients. Source of data: Systematic review with meta-analysis of studies identified through Pubmed, Embase, LILACS and Cochrane databases published up to 2016. Inclusion criteria: Randomized controlled trials; patients aged between 1 and 18 years and diagnosed with functional constipation receiving or not drug treatment for constipation; articles published in Portuguese, English, Spanish, French, and German in journals accessible to the researchers. Synthesis of data: A total of 2963 articles were retrieved during the search and, after adequate evaluation, nine articles were considered relevant to the study objective. A total of 680 children were included, of whom 45% were boys. No statistical significance was observed for bowel movement frequency, stool consistency, therapeutic success, fecal incontinence, and abdominal pain with fiber intake in patients with childhood constipation. These results should be interpreted with care due to the high clinical heterogeneity between the studies and the methodological limitation of the articles selected for analysis. Conclusions: There is a scarcity of qualified studies to evaluate fiber supplementation in thetreatment of childhood constipation, generating a low degree of confidence in estimating thereal effect of this intervention on this population. Today, according to the current litera-ture, adequate fiber intake should only be recommended for functional constipation, and fibersupplementation should not be prescribed in the diet of constipated children and adolescents.commetanáliseResumoObjetivo: Reunir evidências atuais sobre o uso de fibras no tratamento da constipac¸ão funcionalem pacientes pediátricos.Fontes dos dados: Revisão sistemática com metanálise de estudos identificados por pesquisanas bases de dados Pubmed, Embase, LILACS e Cochrane publicados até o ano de 2016.Critérios de inclusão: estudos controlados randomizados; pacientes com idade entre 1 a 18 anoscom diagnóstico de constipac¸ão funcional em uso ou não de tratamento medicamentoso paraconstipac¸ão; artigos publicados em língua portuguesa, inglesa, espanhola, francesa e alemã emrevistas acessíveis aos pesquisadores.Síntese dos dados: Foram encontrados 2.963 artigos na busca e, após avaliac¸ão adequada,nove artigos mostraram-se relevantes frente aos objetivos do estudo. Um total de 680crianc¸as foram incluídas, sendo 45% meninos. Não foi demonstrado significância estatística dafrequência evacuatória, da consistência evacuatória, do sucesso terapêutico, da incontinênciafecal e da dor abdominal com o uso de fibras nos pacientes com constipac¸ão infanto-juvenil.Esses resultados devem ser interpretados com atenc¸ão devido à alta heterogeneidade clínicaentre os estudos e à limitac¸ão metodológica dos artigos analisados.Conclusões: Existe uma grande falta de estudos qualificados para avaliar a suplementac¸ão defibras no tratamento da constipac¸ão infanto-juvenil, gerando um baixo grau de confianc¸a para seestimar o efeito real dessa intervenc¸ão na populac¸ão em questão. Até esse momento, conformea literatura atual, deve-se apenas recomendar a ingestão adequada de fibras na constipac¸ãofuncional, não se podendo prescrever a suplementac¸ão de fibras na dieta das crianc¸as e ado-lescentes constipados

Alergia alimentar ao trigo

Food allergy is the name given to the adverse reactions to foods that surround immunological mechanisms, resulting in a range of clinical manifestations. Wheat allergy develops when the body's immune system becomes sensitive and reacts immoderately to any of the wheat proteins. Allergic reaction is classified according to the immunological mechanism involved, may be measured by IgE, or by mixed reactions when they occur with the collaboration of mechanisms mediated with cytokines and proinflammatory T-lymphocytes, or by immunocomplexes, or cytotoxic reactions. Approximately 6% of children under the age of 3, and ∼ 4% of adults have allergic disorders caused by food. The present study aims to do a revision about food allergy to wheat, including its clinical manifestation, diagnoses and treatment. This monograph was performed in the reference databases Lilacs and Scielo using the following health descriptors: allergy, allergic reaction, and wheat. Regarding the treatment, the most efficient and guaranteed still is the absolute extraction of the allergen from the diet, which in the present case is wheat Taking into account the above considerations, this study verified the frequent concern about the development of food allergies worldwide and concludes the importance of new studies related to the treatment of allergy to wheat to reduce allergic reactions, maintain the nutritional state, and increase the quality of life

Manejo da obesidade infanto-juvenil

The issue addressed here was presented at the Parallel Symposium: “Clinical management of obesity and NAFLD in children“, coordinated by: Anil Dhawan (UK) and Mary Fewtrell (UK). Here are presented some aspects highlighted in the presentation of Cristina Campoy (Granada, Spain), entitled “Nonsurgical Management of childhood obesity.

Knowledge, Attitudes and Practices of Primary School Teachers on Nutrition and Food

Introdution: The teacher's formation is a paramount condition for the education in health. Objective: To develop a questionnaire and assess knowledge, attitudes and practices of early years school teachers. Methodology: a questionnaire about nutrition and feeding was applied. The subjects were teachers from pre-school to 5th grade of Elementary School. Results: There were 288 teachers in the survey. They were all in favor of the promotion of a healthy feeding in school. The source of information mostly used was the textbook. 76% thought they had good knowledge about a healthy diet. The average number of positive/correct answers was 21 (48%). Conclusions: The knowledge about nutrition and feeding were insufficient and the general performance in the questionnaire was low. Actions that aim at qualifying the teachers are urgent, so that they can develop the necessary tools to promote a healthy feeding in schools

How to evaluate the inflammatory process in children with excess weight?

A obesidade é um fenômeno mundial com o aumento da prevalência especialmente em áreas urbanas e na população infantil. O tecido adiposo não é mais considerado apenas como um regulador de temperatura corporal ou um protetor mecânico, mas um órgão endócrino que libera adipocinas de ação pró-inflamatória, formando um elo entre adiposidade, síndrome metabólica e doenças cardiovasculares e a inflamação é um estado consequente à obesidade. O Fator de Necrose Tumoral (TNF-α), Interleucina- 6 (IL-6) e Fator Inibidor do Plasminogênio (PAI-1) são exemplos de substâncias liberadas pelo tecido adiposo, especialmente pelo depósito de gordura abdominal, que contribuem para a resistência à insulina. A leptina e adiponectina são as adipocinas mais abundantes sintetizadas pelo tecido adiposo que tem atuação no metabolismo dos lipídeos e carboidratos, regulando os processos metabólicos. A proteína C reativa ultrassensível (PCR-us) é um biomarcador do processo aterosclerótico, e também está envolvida na patogênese da aterosclerose, pois é produzida no fígado em resposta a citocinas inflamatórias. O tecido adiposo em excesso promove o aumento das adipocinas circulantes, as quais desencadeiam uma série de alterações corporais, relacionados a eventos cardiovasculares. O tratamento da obesidade que acarrete em mudanças no estilo de vida, com a redução da gordura visceral, ainda são as medidas mais eficazes para diminuição do processo inflamatório, especialmente na população infantojuvenil.Obesity is a global phenomenon with increasing prevalence, especially in urban areas and in children. Adipose tissue is no longer considered only as a regulator of body temperature or shield mechanic, but an endocrine organ that releases proinflammatory adipokines, forming a link between adiposity, metabolic syndrome and cardiovascular diseases and inflammation is a consequence of obesity. The TNF-α, IL-6 and PAI-1 are examples of substances released by adipose tissue, especially the deposition of abdominal fat, which contribute to resistance to insulin. Leptin and adiponectin are the most abundant adipokines synthesized by adipose tissue that is active in carbohydrate and lipid metabolism, regulating metabolic processes. hs- CRP is a biomarker of atherosclerosis, and also is involved in the pathogenesis of atherosclerosis, it is produced in the liver in response to inflammatory cytokines. The excess fat promotes the increase of circulating adipokines which trigger a series of body changes, related to cardiovascular events. The treatment of obesity which leads to changes in lifestyle, with the reduction of visceral fat, are still, the most effective measures for reducing inflammation, especially among young children