Café da manhã : aspectos nutricionais e culturais entre frequentadores adultos de restaurantes populares do Brasil

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Nutrição Humana, 2016.Diante do estilo de vida inadequado adotado no mundo moderno, o café da manhã (CM) é a refeição mais negligenciada. O baixo consumo de alimentos regionais nas principais refeições, sobretudo no CM, pode indicar a não utilização de recursos alimentares locais de mais fácil acesso. Objetivo: Analisar a frequência de realização do café da manhã, sua composição nutricional e o hábito de consumo de alimentos regionais nessa refeição entre usuários adultos do Programa de Restaurantes Populares no Brasil. Materiais e Métodos: A primeira parte da pesquisa constitui-se de uma revisão bibliográfica do tipo integrativa, realizada no período de uma década nas bases de dados eletrônicas MEDLINE, LILACS e SciELO, com os seguintes descritores: “desjejum”, “desjejum regional”, “café da manhã” e “café da manhã regional”. A segunda parte da pesquisa constitui-se de dois estudos transversais exploratórios com amostra total constituída por 1.872 indivíduos frequentadores de 36 restaurantes vinculados ao Programa Restaurantes Populares. Os indivíduos informaram três dias de recordatórios de 24 horas, cujos dados de consumo alimentar foram analisados por indivíduo, por unidade de restaurante e por região geográfica. Na análise da composição nutricional foram considerados os dados de 1.547 entrevistados, cujos foram analisados por sexo, faixa etária, renda per capita, escolaridade e região de consumo. Os grupos dos lácteos, cereais, frutas, raízes/tubérculos e carnes/ovos foram analisados pela frequência de consumo, independentemente do tamanho da porção ingerida. O valor energético total, os macronutrientes, as fibras, os ácidos graxos monoinsaturados, saturados e trans foram analisados pelos valores de contribuição na recomendação de cada nutriente. O cálcio e o sódio foram avaliados em relação ao percentual de contribuição no dia de consumo. Para análise dos dados de consumo de alimentos regionais e classificação qualitativa do CM foi considerado o total da amostra de 1.872 usuários, cujos foram analisados por sexo, faixa etária, renda per capita, escolaridade, profissão, estado civil, participação em programas de governo e nacionalidade. Para a análise qualitativa do CM foi adotado um método que classifica a refeição de acordo com a presença/ausência dos alimentos: CM Padrão como a presença de alimentos fontes de cálcio e de energia; CM Completo como a presença de alimentos fontes de cálcio, energia, minerais, vitaminas e fibras; CM Incompleto como quaisquer outros alimentos que não contemplem as combinações do CM padrão ou CM completo; e CM Ausente ou supressão como a ausência total de consumo de alimento. Para análise dos marcadores de identidade alimentar do CM foram formados grupos de bebidas, cereais ou substitutos ricos em carboidratos complexos, complementos de cereais, frutas, açúcar, adoçante e alguns alimentos/preparações regionais. Resultados: na revisão integrativa, dos 242 artigos que atendiam aos critérios de inclusão, apenas 5 abordaram o tema regionalidade alimentar no CM. Tanto na análise da composição nutricional, como na análise qualitativa do CM houve predomínio de homens, de indivíduos na faixa etária entre 25 e 34 anos, com nível de escolaridade de ensino médio completo e faixa de renda per capita de 0,5 a um Salário Mínimo. Dos 4.641 CM previstos na análise da composição nutricional, 797 (17,2%) não foram realizados sendo analisados 3.844 CM. A análise de grupos de alimentos mostrou alto consumo de lácteos e cereais, e baixos consumo de frutas, raízes/tubérculos e carnes/ovos. Os percentuais nacionais de contribuição energética dos macronutrientes no valor energético total foram adequados a uma dieta equilibrada. Os percentuais nacionais de contribuição dos ácidos graxos saturados e ácidos graxos trans se encontraram dentro da recomendação, sendo que a análise regional mostrou níveis de consumo elevados desses mesmos nutrientes na região Centro-oeste e de ácidos graxos saturados na região Nordeste. A média nacional da ingestão de fibras do CM foi baixa, concordando com o resultado encontrado de baixo consumo de frutas. O consumo nacional de cálcio cobriu 73,49% do esperado e o consumo de sódio foi adequado. Em relação à análise qualitativa e ao consumo de alimentos regionais, das 5.616 refeições previstas para os três dias de consumo, 17,3% não foram realizadas, sendo analisados 4.642 CM. O CM do tipo padrão foi predominante em todas as regiões, e o CM completo foi pouco consumido entre os participantes. Os indivíduos que realizaram CM nos Restaurantes Populares consumiram mais alimentos regionais. A região com maior consumo de alimentos regionais foi a Centro-oeste (46,6%) e a Sul (45,9%), sendo os alimentos regionais mais consumidos em todas as regiões o presunto, o cuscuz e a laranja. Os alimentos mais consumidos no CM foram o café com leite (ou leite com café), açúcar, pão, margarina, indicando que esses são os marcadores de identidade alimentar do CM na amostra estudada. Conclusão: A revisão intregrativa realizada mostrou que o tema é pouco estudado no Brasil e no mundo e o enfoque no consumo de alimentos regionais é pouco frequente. Os indivíduos pesquisados consumiram um CM equilibrado em relação à composição de nutrientes, exceto em relação ao alto consumo de ácidos graxos saturados e trans na região Centro-oeste e ácidos graxos saturados da região Nordeste. Embora o consumo de lácteos tenha se apresentado como um dos grupos mais consumidos, o consumo de cálcio foi baixo, indicando a necessidade de maior consumo de alimentos fontes desse nutriente. Considerando que o percentual de CM do tipo padrão foi predominante e que o consumo de embutidos foi acentuado, são necessárias ações de estímulo ao consumo de frutas e de alimentos in natura em todas as refeições, sobretudo na primeira refeição do dia.With the lifestyle adopted in the modern world, the breakfast (B) is the most neglected meal. The low consumption of regional food in the main meals, especially in the B, may indicate not using local food resources more easily accessible. Objective: To analyze the frequency of B, its nutritional composition and the consumption habits of regional food in this meal among adult users of Popular Restaurants program in Brazil. Materials and Methods: The first part of the research consists of a literature review of the integrative type, carried out from a decade in electronic databases MEDLINE, LILACS and SciELO, with the following descriptors: "breakfast", "regional breakfast", "breakfast" and "regional breakfast." The second part of the research consists of two exploratory cross-sectional studies with a total sample of 1,872 individuals members of 36 restaurants linked to the Program Popular Restaurants. Individuals reported three-day 24-hour recalls, whose food consumption data were analyzed by individual, restaurant unit and by geographic region. In the analysis of the nutritional composition data of 1,547 respondents were considered, which were analyzed by sex, age group, per capita income, education and consumption region. The dairy groups, cereals, fruits, roots/tubers and meat/eggs were analyzed by frequency of use, regardless of the size of the intake portion. The total energy, macronutrients, fiber, monounsaturated fatty acids, saturated and trans were analyzed by contribution amounts on the recommendation of each nutrient. Calcium and sodium were evaluated for percentage contribution on consumption. For analysis of consumption data of regional food and qualitative classification of B was considered the total sample of 1,872 users, which were analyzed by sex, age group, per capita income, education, profession, marital status, participation in government programs and nationality. For the qualitative analysis of the B was adopted a method that classifies the meal according to the presence/absence of food: Standard B as the presence of food sources of calcium and energy; Complete B as the presence of food sources of calcium, energy, minerals, vitamins and fiber; Incomplete B and any other foods that do not offer the Standard B combinations or Complete B; Missing B as the total absence of food intake. For analysis of the food identity of B markers were formed beverage groups, cereals or substitutes rich in complex carbohydrates, cereal supplements, fruit, sugar, sweetener and some food/regional preparations. Results: the integrative review of 242 articles that meet the inclusion criteria, only 5 addressed the issue food regionality in B. Both in the analysis of the nutritional composition as in B qualitative analysis, predominated men, and individuals aged between 25 and 34 years with full high school education level and range of per capita income of 0.5 to a Salary Minimum. Of the 4,641 B provided in the analysis of the nutritional composition, 797 (17.2%) were not carried out and analyzed 3,844 B. The analysis of food groups showed high consumption of dairy products and cereals, and low consumption of fruits, roots/tubers and meat/eggs. The national energy contribution percentages of macronutrients in the total energy intake were adequate for a balanced diet. The national contribution percentages of saturated fatty acids and trans fatty acids are found in the recommendation, and the regional analysis showed consumption levels high of those nutrients in the Midwest region and saturated fatty acids in the Northeast. The national average intake of B fibers was low, according to the results found low consumption of fruit. The National calcium consumption covered 73.49% of the expected and sodium intake was adequate. Regarding the qualitative analysis and the consumption of regional foods of 5,616 meals planned for the three days of consumption, 17.3% were not performed and analyzed 4,642 B. The Standard B was prevalent in all regions, and the Complete B was little consumed among the participants. Individuals who underwent B in Popular Restaurants consumed more regional foods. The region with greater consumption of regional food was the Midwest (46.6%) and South (45.9%), and regional foods consumed in all regions ham, couscous and orange. The most consumed foods in B were the latte with coffee (or coffee with milk), sugar, bread, margarine, indicating that these are the B food identity markers in the sample. Conclusion: An integrative review conducted showed that the topic is little studied in Brazil and in the world and focus on the consumption of regional food is uncommon. Individuals surveyed consumed a balanced B in relation to the composition of nutrients, except for the high consumption of saturated and trans fatty acids in the Midwest region and saturated fatty acids in the Northeast. Although milk consumption has been presented as one of the most consumed groups, calcium intake was low, indicating a need for increased consumption of food sources of this nutrient. Whereas the B percentage of standard was prevalent and that consumption of embedded was pronounced, it is necessary actions that encourage consumption of fruits and fresh food at every meal, especially in the first meal of the day

Nutritional quality of breakfast consumed by the low-income population in Brazil : a nationwide cross-sectional survey

Objective: This study aimed to characterize the nutritional quality of breakfast consumed by the low-income Brazilian population. Methods: A cross-sectional study was conducted with a sample of 1547 low-income individuals attending 36 Community Restaurants (CRs) in Brazil. Food consumption was analyzed by the frequency of food groups presented in the 24 h recall for three days. The nutritional consumption consisted of the analysis of the total energetic value (TEV) and the macronutrients, fibers, monounsaturated fatty acids, saturated fatty acids, trans fatty acids, calcium, and sodium. The nutrients were evaluated considering the percentage of contribution concerning the daily recommendation of consumption. Results: Among the 4641 breakfasts expected to be consumed and reported, 17.2% (n = 797) of the consumers did not consume breakfast. Therefore, we analyzed the 3844 breakfasts. The analysis of food groups showed a high consumption of dairy and cereals, and low consumption of fruits, roots/tubers, and meat/eggs. The percentages of energy contribution of the macronutrients in the TEV were adequate for a balanced diet. The mean intake of monounsaturated fatty acids was low, and the contribution percentages of saturated fatty acids and trans fatty acids were within the recommendations. The mean fiber intake of the breakfast was low, agreeing with the result of low fruit consumption. Calcium intake covered 73.49% of that expected for this meal, and sodium intake was adequate in breakfast. Conclusion: The individuals studied consumed a nutritionally balanced breakfast. Although dairy was one of the most consumed groups, calcium consumption was low, indicating the need to consume higher portions of food sources of this nutrient

Breakfast characterization and consumption by low-income Brazilians : food identity and regional food

The study aimed to evaluate the breakfast (BF) of the Brazilian low-income population, analyzing cultural aspects, such as the habit of consuming regional foods and the BF food identity markers. This cross-sectional study used a sample of 1872 low-income Brazilians. For the food consumption analysis, three 24–hour dietary recalls were used. For the qualitative analysis of the BF, we used three classifications: standard, full, partial, and without BF. Also, BF was considered as regional when at least one regional food (contained in a predefined list of regional foods) was consumed. For the analysis of BF's food identity markers, we evaluated all food groups and their frequencies. Of the 5616 possible BF meals available for the three days of consumption, 17.3% were skipped, a low percentage. A total of 4642 BF examples were analyzed. Standard type BF was prevalent in all regions, and full BF was rarely consumed by participants. Women during the weekend skipped BF less often. Out of all five Brazilian regions, the ones with the highest consumption of regional foods were the Midwest (46.6%) and the South (45.9%). The highest frequency of consumed foods in BF were coffee with cow’s milk (or milk with coffee), added sugar, bread, and margarine, indicating that these are the identity markers of BF in the studied sample. Considering that the percentage of standard type BF was very high and that the consumption of added sugar and margarine was accentuated, actions to stimulate the intake of fresh fruits and foods in all meals are necessary, especially in the first meal of the day. There is a need for new proposals for actions and programs with the purpose of expanding access to healthy and adequate regional foods, especially to low-income families

Indicações da fototerapia em recém-nascidos com icterícia / Indications for phototherapy in newborns with jaundice

A fototerapia é um método eficaz, não invasivo de alto impacto, sem restrições enquanto a sua utilização independente da idade gestacional, comorbidades ou nível de pigmentação cutânea, tratamento utilizado para redução de bilirrubina usado devido a sua alta eficiência e ausência de efeitos adversos. Analisar as evidências científicas publicadas sobre as indicações da fototerapia em recém–nascidos com icterícia. Trata de uma revisão bibliográfica do método revisão integrativa de literatura, realizado no período compreendido entre os meses de janeiro a abril de 2021. A busca efetuou-se, através da BVS, utilizando as bases de dados LILACS, MEDLINE, e por meio do SCIELO. Aderindo-se através dos descritores/palavras chaves: “Fototerapia”, “Icterícia Neonatal”, “Terapêutica”, “Diagnóstico”, “Cuidados de Enfermagem”, combinados entre si com o operador booleano “AND”. Os profissionais da equipe de enfermagem são responsáveis pelo recebimento e preparação do recém-nascido para a terapêutica, bem como, preparam os aparelhos que serão usados para a fototerapia, como os focos de luz, as incubadoras, entre outros. Evidenciou-se que a fototerapia é utilizada como forma de tratamento mais eficaz no controle da hiperbilirrubinemia. Sendo indicada nas doenças hemolíticas ou não, incompatibilidade fator Rh e grupo ABO. Embora seja frequente o uso da técnica em neonatos, deve-se enquanto profissionais se atentar aos sinais e sintomas, como também os fatores de risco no manejo da técnica, intervir elaborando uma rotina para o controle e manutenção dos equipamentos, observando criteriosamente o tipo de aparelhos utilizados e se atentar a distância ideal das lâmpadas sob o RN, avaliando sempre possíveis complicações durante o tratamento

Health-related quality of life in patients with type 1 diabetes mellitus in the different geographical regions of Brazil : data from the Brazilian Type 1 Diabetes Study Group

Background: In type 1 diabetes mellitus (T1DM) management, enhancing health-related quality of life (HRQoL) is as important as good metabolic control and prevention of secondary complications. This study aims to evaluate possible regional differences in HRQoL, demographic features and clinical characteristics of patients with T1DM in Brazil, a country of continental proportions, as well as investigate which variables could influence the HRQoL of these individuals and contribute to these regional disparities. Methods: This was a retrospective, cross-sectional, multicenter study performed by the Brazilian Type 1 Diabetes Study Group (BrazDiab1SG), by analyzing EuroQol scores from 3005 participants with T1DM, in 28 public clinics, among all geographical regions of Brazil. Data on demography, economic status, chronic complications, glycemic control and lipid profile were also collected. Results: We have found that the North-Northeast region presents a higher index in the assessment of the overall health status (EQ-VAS) compared to the Southeast (74.6 ± 30 and 70.4 ± 19, respectively; p < 0.05). In addition, North- Northeast presented a lower frequency of self-reported anxiety-depression compared to all regions of the country (North-Northeast: 1.53 ± 0.6; Southeast: 1.65 ± 0.7; South: 1.72 ± 0.7; Midwest: 1.67 ± 0.7; p < 0.05). These findings could not be entirely explained by the HbA1c levels or the other variables examined. Conclusions: Our study points to the existence of additional factors not yet evaluated that could be determinant in the HRQoL of people with T1DM and contribute to these regional disparities

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Task (Re)Design to Enhance the Didactic-Mathematical Knowledge of Teachers

Background: Currently, studies in the field of design of tasks, especially when linked to teacher training actions, have made significant contributions to the area of Mathematics Education. Objectives: This research aimed to point out the contributions that task (re)design can bring to enhance the didactic-mathematic knowledge of the teachers, as well as to discuss the difficulties and advances of educators when dealing with tasks characterised by challenging situations. Design: Using a qualitative approach, based on the Intervention Research format, we held training meetings with teachers in two main stages: the first consisted of meetings to work on the concept of the design and redesign of tasks; the second focused on redesigning a school project, putting into practice the concepts acquired in the first stage. Setting and participants: The intervention took place in an elementary school of the city of Jaguaquara, Bahia, Brazil, with three Mathematics teachers and the teacher-researcher. Data collection and analysis: The data were produced using a field diary, the materials produced by the teachers, and the audio recording of the training meetings. Results: The results show that designing tasks increases the didactic-mathematical knowledge of teachers. Also, it showed that the participants presented difficulties, some of which they could overcome during the process, while others remained after the training. Conclusions: The remaining difficulties leave room for new training actions. On the other hand, the training contributed to diminish the difficulties of the participating teachers and instigated innovative actions in Mathematics teaching

Nutrição de mudas de açaizeiro sob relações cálcio:potássio:sódio em solução nutritiva Nutrition of açai seedlings (Euterpe oleracea Mart.) under different ratios of calcium:potassium: sodium in nutrient solution

Objetivando-se estudar diferentes relações entre os cátions cálcio, potássio e sódio na produção de matéria seca e acúmulo de macronutrientes em mudas de açaizeiro (Euterpe oleracea Mart.), realizou-se um experimento em casa-de-vegetação no Departamento de Ciência do Solo da UFLA. Utilizou-se o delineamento estatístico em blocos casualisados com nove tratamentos em quatro repetições. Os tratamentos foram constituídos por nove relações cálcio: potássio: sódio (4:2:1, 3:3:1, 2:4:1, 1:5:1, 5:1:1, 4:1:2, 6:0:1; 0:6:1, e 4:2:0) em solução nutritiva. A unidade experimental constituiu-se de um vaso com capacidade para três litros de solução, contendo duas plantas. Avaliaram-se as seguintes características: produção de matéria seca e o acúmulo dos macronutrientes fósforo, cálcio, potássio, magnésio e enxofre na matéria seca da planta. A relação cálcio:potássio:sódio influenciou todas as características avaliadas; as soluções contendo cálcio, potássio e sódio nas relações 4:2:1 e 3:3:1 resultaram no desenvolvimento de mudas com maior produção de matéria seca e maior acúmulo de nutrientes.Aiming to evaluate the effects of different ratios of calcium, potassium and sodium cations on the mineral nutrition of açai seedlings (Euterpe oleracea Mart.), a greenhouse experiment was carried out in the Soil Science Department at the Federal University of Lavras-UFLA. The randomized block design, with nine treatments and four replications, was used. The treatments were nine ratios of calcium, potassium and sodium (4:2:1, 3:3:1, 2:4:1, 1:5:1, 5:1:1, 4:1:2, 6:0:1; 0:6:1, e 4:2:0) in the nutrient solution. The experimental unit was a plastic pot with three liters of solution, containing two plants. The total dry matter and nutrient accumulation were evaluated. The relationship calcium:potassium:sodium influenced all the appraised characteristics, and the solutions containing calcium, potassium and sodium in the ratios 4:2:1 and 3:3:1 resulted in seedlings development with larger production of dry matter and larger accumulation of nutrients