Características de preparo, cálculo nutricional e preços de dois tipos de dietas enterais artesanais para terapia nutricional domiciliar

Trabalho de Conclusão de Curso (graduação)—Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Nutrição, 2016.Introdução: A Terapia Nutricional Enteral Domiciliar é o tratamento relacionado à administração de nutrientes por meio de sondas nasogástricas ou entéricas, com orientações e acompanhamento de nutricionistas realizadas no domicilio do paciente. A administração de nutrientes é feita através de formulações caseiras que podem ser preparadas com alimentos in natura, que são aqueles em seu estado natural, ou com módulos de nutrientes, tais como suplementos. O objetivo deste estudo foi comparar dois tipos de dietas artesanais, com produtos in natura ou modulares, em termos de características de preparo, segurança microbiológica, composição nutricional e preço da prescrição diária. Metodologia: Foram preparadas duas formulações artesanais no laboratório de Técnica e Dietética da Faculdade de Saúde da Universidade de Brasília: uma dieta enteral padrão com produtos in natura (TNEA in natura) e uma dieta composta por módulos nutricionais (TNEA modular), ambas com 1800 Kcal. Foram avaliados e comparados o preço final de cada dieta relativo a um dia de prescrição, variações das medidas caseiras e peso em gramas dos ingredientes, o tempo de preparo, a fluidez e o perfil microbiológico. Resultados: Os preços foram semelhantes para aquisição de produtos, com valor ligeiramente superior da preparação da TNE in natura (R$13,47 reais diários em média) em relação a modular (R$11,26 reais diários em média). Com relação às medidas caseiras e valores em gramas dos ingredientes, as variações não seguiram nenhum padrão, foram extremamente variadas na TNE in natura. O tempo de preparo foi menor na TNEA modular (7 minutos) quando comparado ao tempo utilizado para preparar a TNEA in natura (56 minutos). Ambas as formulações apresentaram boa fluidez sem resistência a administração gravitacional, porém também apresentaram contaminação por microrganismo aeróbio mesófilo acima do permitido pela ANVISA (10³ UFC/g). Conclusão: A formulação modular foi ligeiramente mais barata e preparada de forma mais rápida. As características físico-químicas foram semelhantes, assim como o valor nutricional. Existe uma grande variação quanto às medidas caseiras e gramaturas prescritas, especialmente em relação aos alimentos in natura. A dieta modular é viável e deve ser considerada como alternativa terapêutica para atenção domiciliar

Maternal consumption of ultra-processed foods-rich diet and perinatal outcomes : a systematic review and meta-analysis

The consumption of ultra-processed food (UPF)-rich diets represents a potential threat to human health. Considering maternal diet adequacy during pregnancy is a major determinant for perinatal health outcomes, this study aimed to systematically review and meta-analyze studies investigating the association between maternal consumption of a UPF-rich diet and perinatal outcomes. Conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, five electronic databases and gray literature using Google Scholar and ProQuest Dissertations and Theses Global were searched up to 31 May 2022. No restrictions were applied on language and publication date. Two reviewers independently conducted the study selection and data extraction process. Meta-analysis was conducted according to the random-effects model. In total, 61 studies were included in the systematic review and the overall population comprised 698,803 women from all gestational trimesters. Meta-analysis of cohort studies showed that maternal consumption of UPF-rich diets was associated with an increased risk of gestational diabetes mellitus (odds ratio (OR): 1.48; 95% confidence interval (CI): 1.17, 1.87) and preeclampsia (OR: 1.28; 95% CI: 1.15, 1.42). Neonatal outcomes showed no association. The overall GRADE quality of the evidence for the associations was very low. The findings highlight the need to monitor and reduce UPF consumption, specifically during the gestational period, as a strategy to prevent adverse perinatal outcomes

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Consumo de ultraprocessados durante a gestação e associação com desfechos perinatais e composição nutricional da dieta

Dissertação (mestrado) — Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Nutrição Humana, 2023.Introdução: O alto consumo de alimentos ultraprocessados (UTP) tem sido associado ao aumento de doenças crônicas não transmissíveis, e à redução da qualidade da dieta em adultos saudáveis, ao mesmo tempo em que se observa o progressivo aumento do consumo destes alimentos pela população, incluindo gestantes. O maior consumo de energia proveniente de UTP afeta negativamente diferentes indicadores nutricionais e está associados ao desenvolvimento de doenças crônicas em mulheres grávidas e lactantes. A dieta materna adequada durante a gestação é um dos determinantes para a saúde materna e infantil a curto e longo prazos, sendo essencial para a prevenção de desfechos gestacionais negativos. Objetivo: Investigar o efeito do consumo de dietas ricas em UTP por gestantes em desfechos perinatais (ganho de peso gestacional, diabetes gestacional, desordens hipertensivas da gestação, peso ao nascer e prematuridade) e sobre a composição nutricional da dieta materna. Método: O efeito do consumo de dietas ricas em UTP sobre desfechos perinatais foi analisado por meio de revisão sistemática, conduzida conforme as diretrizes do Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA). A busca compreendeu as seguintes bases de dados: Medline (PubMed), Embase, Scopus, Web of Science, Literatura Científica e Técnica da América Latina e Caribe (Lilacs), Google Scholar e ProQuest Dissertations & Theses Global. Foram incluídos estudos observacionais que reportavam medida de associação entre pelo menos um alimento classificado como UTP pela NOVA e desfechos perinatais. A metanálise foi calculada a partir do modelo de efeitos aleatórios e ponderada pelo inverso da variância pelo método proposto por DerSimonian–Laird. O impacto do consumo materno de UTP sobre a qualidade nutricional da dieta foi avaliado por meio de estudo transversal, conduzido em gestantes em acompanhamento pré-natal em dez Unidades Básicas de Saúde (UBS) do Distrito Federal (DF). O consumo alimentar foi avaliado por dois recordatórios de 24 horas, em dias não consecutivos, e categorizados pela extensão do processamento usando a classificação NOVA. Modelos de regressão linear multivariada foram utilizados para analisar a associação entre os quintis de consumo de UTP e a ingestão de nutrientes. Resultados: A revisão sistemática incluiu 61 estudos, totalizando 698.803 participantes. A metanálise dos estudos de coorte indicou que o consumo de dietas ricas em UTP na gestação está associado a maior risco de Diabetes Mellitus Gestacional (DMG) [Odds Ratio (OR)= 1,48; intervalo de confiança 95% (IC): 1,17; 1,87] e pré-eclâmpsia [OR: 1,28; 95% IC: 1,15, 1,42]. O estudo transversal incluiu 229 gestantes, com idade média de 28 ± 6.2 anos. A ingestão energética média diária foi de 1741 ± 646 kcal. Em média, as gestantes consumiram 64,3 ± 18,2% da energia total de alimentos in natura ou minimamente processados, 4,5 ± 4,3% de ingredientes culinários, 8,6 ± 9,9% de alimentos processados e 22,6 ± 17,2% de UTP. O maior consumo de UTPs foi associado à redução da ingestão de alimentos in natura/minimamente processados e ingredientes culinários pelas gestantes atendidas nas UBS do DF. Ademais, o maior consumo de UTP esteve associado positivamente com maior ingestão total de energia, gordura trans e sódio; e inversamente associado ao teor de proteína, fibra, ferro, magnésio, potássio, cobre, zinco, selênio e folato da dieta. Conclusão: O maior consumo de dietas ricas em UTP durante a gestação está associado a desfechos maternos adversos e impacta na redução da qualidade nutricional da dieta. Estes resultados destacam a necessidade de monitorar e reduzir o consumo de UTP, especificamente durante o período gestacional, como estratégia para prevenir v desfechos perinatais adversos e mostram a necessidade da adoção de melhores estratégias para educação alimentar e nutricional para esta população.Introduction: High consumption of ultra-processed foods (UPF) has been associated with increased non-communicable chronic diseases, and lower overall diet quality in healthy adults. At the same time, there is a progressive increase in the consumption of these foods by the population, including pregnant women. Higher energy consumption from UTP negatively affects different indicators of nutrition and it is associated with chronic disease development in pregnant and lactating women. Adequate maternal diet during pregnancy is one of the determinants of maternal and child health in the short and long term, and it is essential for preventing adverse perinatal outcomes. Objective: To review the effect of maternal ultra processed foods consumption on perinatal outcomes (gestational weight gain, gestational diabetes, hypertensive disorders of pregnancy, birth weight and preterm birth), and to investigate the impact of UPF consumption during pregnancy on the nutritional quality of the maternal diet. Method: The effect of the consumption of UTP-rich diets on perinatal outcomes was analyzed through a systematic review, which was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA). The following databases were searched: Medline (PubMed), Embase, Scopus, Web of Science, Scientific and Technical Literature from Latin America and the Caribbean (Lilacs), Google Scholar, and ProQuest Dissertations & Theses Global. Observational studies reporting an association measure between at least one food from the UPF group and perinatal outcomes were included. Meta-analysis was conducted according to the random-effects model. The impact of maternal UPF consumption on the nutritional quality of the diet was evaluated through a cross sectional study, conducted with pregnant women who followed-up prenatal care in ten Primary Health Care (PHC) units in the Federal District (FD). Food consumption was assessed using two non-consecutive 24-hour food recall and categorized according to the extent and purpose of processing using NOVA classification. Multivariate linear regression models were used to analyze the association between quintiles of UPF consumption and nutrient intake. Results: The systematic review included 61 studies. The overall population included 698.803 women from all gestational trimesters. Meta-analysis of cohort studies showed that consumption of UPF foods during pregnancy is associated with an increased risk of Gestational Diabetes Mellitus (GDM) [Odds Ratio (OR)= 1.48; 95% confidence interval (CI): 1.17, 1.87] and preeclampsia [OR: 1.28; 95% CI: 1.15, 1.42]. The cross-sectional study included 229 pregnant women and the mean age was 28 ± 6.2 years. The average daily energy intake was 1741 ± 646 kcal. On average, pregnant women consumed 64.3 ± 18.2% of their total energy from unprocessed or minimally processed foods, 4.5 ± 4.3% from culinary ingredients, 8.6 ± 9.9% from processed foods and 22 .6 ± 17.2% of UPF. Higher consumption of UPF was associated with reduced intake of unprocessed/minimally processed foods and culinary ingredients by vi pregnant women assisted at PHC units in the FD. Furthermore, it was positively associated with higher total energy, trans fat and sodium intake; and inversely associated with the diet’s protein, fiber, iron, magnesium, potassium, copper, zinc, selenium, and folate content. Conclusion: Higher consumption of UPF-rich diets during pregnancy is associated with adverse maternal outcomes and lower nutritional quality of the diet. These results highlight the need to monitor and reduce the consumption of UPF, especially during the gestational period, as a strategy to prevent adverse perinatal outcomes, and show the need to adopt better strategies for food and nutrition education for this population.Faculdade de Ciências da Saúde (FS)Programa de Pós-Graduação em Nutrição Human

Maternal consumption of ultra-processed foods-rich diet and perinatal outcomes : a systematic review and meta-analysis

The consumption of ultra-processed food (UPF)-rich diets represents a potential threat to human health. Considering maternal diet adequacy during pregnancy is a major determinant for perinatal health outcomes, this study aimed to systematically review and meta-analyze studies investigating the association between maternal consumption of a UPF-rich diet and perinatal outcomes. Conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, five electronic databases and gray literature using Google Scholar and ProQuest Dissertations and Theses Global were searched up to 31 May 2022. No restrictions were applied on language and publication date. Two reviewers independently conducted the study selection and data extraction process. Meta-analysis was conducted according to the random-effects model. In total, 61 studies were included in the systematic review and the overall population comprised 698,803 women from all gestational trimesters. Meta-analysis of cohort studies showed that maternal consumption of UPF-rich diets was associated with an increased risk of gestational diabetes mellitus (odds ratio (OR): 1.48; 95% confidence interval (CI): 1.17, 1.87) and preeclampsia (OR: 1.28; 95% CI: 1.15, 1.42). Neonatal outcomes showed no association. The overall GRADE quality of the evidence for the associations was very low. The findings highlight the need to monitor and reduce UPF consumption, specifically during the gestational period, as a strategy to prevent adverse perinatal outcomes

Resistência à insulina em mulheres com síndrome dos ovários policísticos: relação com as variáveis antropométricas e bioquímicas

OBJETIVO: Analisar a prevalência de resistência à insulina de acordo com diferentes medidas antropométricas e bioquímicas em mulheres com síndrome dos ovários policísticos. MÉTODOS: Foram analisadas, retrospectivamente, 189 pacientes com síndrome dos ovários policísticos. O diagnóstico de resistência à insulina foi obtido utilizando-se insulinemia, HOMA-IR, QUICKI, índice de sensibilidade à insulina e relação glicemia/insulina. Foram utilizados o índice de massa corpórea e o lipid accumulation product. Para análise dos resultados, aplicou-se a estatística descritiva, a ANOVA, o pós-teste de Tukey e a correlação de Pearson. RESULTADOS: As pacientes apresentaram média de idade de 24,9±5,2 e de índice de massa corpórea de 31,8±7,6. O percentual de pacientes obesas foi de 57,14%. Dentre os métodos de investigação de resistência à insulina, o índice de sensibilidade à insulina foi a técnica que mais detectou (56,4%) a presença de resistência à insulina nas mulheres com síndrome dos ovários policísticos. em 87% das pacientes obesas, detectou-se a resistência à insulina. A relação glicemia/insulinemia de jejum e o índice de sensibilidade à insulina apresentaram correlação forte com o lipid accumulation product. CONCLUSÃO: A prevalência de resistência à insulina variou de acordo com o método utilizado e foi maior quanto maior o índice de massa corpórea. O lipid accumulation product também está relacionado à resistência à insulina.PURPOSE: To analyze the prevalence of insulin resistance, according to different biochemical and anthropometric measurements in women with polycystic ovary syndrome. METHODS: A total of 189 patients with polycystic ovary syndrome were retrospectively analyzed. Insulin resistance diagnosis was performed using fasting insulin, HOMA-IR, QUICKI, insulin sensibility index and glucose/fasting insulin ratio. Body mass index and lipid accumulation product were used. Data were analyzed statistically by descriptive statistics, ANOVA, Tukey post-test, and Pearson's correlation. RESULTS: The polycystic ovary syndrome patients had a mean age of 24.9±5.2 and a mean body mass index of 31.8±7.6. The percentage of obese patients was 57.14%. Among the methods of insulin resistance investigation, the insulin sensibility index was the technique that most detected (56.4%) the presence of insulin resistance in women with polycystic ovary syndrome. The insulin resistance was detected in 87% of obese patients. The fasting glucose/fasting insulin ratio and insulin sensibility index were strongly correlated with lipid accumulation product. CONCLUSION: The prevalence of insulin resistance varied according to the method used, and it was greater the higher the body mass index. Lipid accumulation product was also related to insulin resistance

A importância do teste de tolerância à glicose oral no diagnóstico da intolerância à glicose e diabetes mellitus do tipo 2 em mulheres com síndrome dos ovários policísticos

PURPOSE: To evaluate the importance of the oral glucose tolerance test for the diagnosis of glucose intolerance (GI) and type 2 diabetes mellitus (DM-2) in women with PCOS. METHODS: A retrospective study was conducted on 247 patients with PCOS selected at random. The diagnosis of GI was obtained from the two-hour oral glucose tolerance test with 75 g of glucose according to the criteria of the World Health Organization (WHO) (GI: 120 minutes for plasma glucose =140 mg/dL and <200 mg/dL), and the diagnosis of DM-2 was obtained by both the oral glucose tolerance test (DM: 120 minutes for plasma glucose =200 mg/dL) and fasting glucose using the criteria of the American Diabetes Association (impaired fasting glucose: fasting plasma glucose =100 and <126 mg/dL; DM: fasting glucose =126 mg/dL). A logistic regression model for repeated measures was applied to compare the oral glucose tolerance test with fasting plasma glucose. ANOVA followed by the Tukey test was used for the analysis of the clinical and biochemical characteristics of patients with and without GI and/or DM-2. A p<0.05 was considered statistically significant. RESULTS: PCOS patients had a mean age of 24.8±6.3, and body mass index (BMI) of 18.3 to 54.9 kg/m2 (32.5±7.6). The percentage of obese patients was 64%, the percentage of overweight patients was 18.6% and 17.4% had healthy weight. The oral glucose tolerance test identified 14 cases of DM-2 (5.7%), while fasting glucose detected only three cases (1.2%), and the frequency of these disorders was higher with increasing age and BMI. CONCLUSIONS: The results of this study demonstrate the superiority of the oral glucose tolerance test in relation to fasting glucose in diagnosing DM-2 in young women with PCOS and should be performed in these patients