International Journal of Nutrology
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Fórmulas enterais no mercado brasileiro: classificação e descrição da composição nutricional
Get PDFIntroduction: Several enteral formulations are available with different presentations and indications. Aim: To describe the basic characteristics of enteral formulations available in the Brazilian market. Material and Methods: The compilation of information comprised by different catalogues from pharmaceutical labs was performed. According to their characteristics, the products were classified in standard formulation with or without fiber and modified formulations, such as those specific for diabetics, patients with renal, hepatic and respiratory insufficiency, and semi-hydrolised and imunomodulatory formulations. Results and Discussion: Eighty enteral formulations are available in the Brazilian market and are commercialized by 6 different laboratories. The diets are presented in power, liquid in tetrapack or pack, with a relative uniformity in macronutrient distribution and a large variation in micronutrient composition. Forty-two standard formulations were found, from which 25 are fiber-free and 17 have fiber. Six formulations for renal insufficiency, 8 containing immunonutrients, 4 specific for respiratory insufficiency and 4 for liver insufficiency patients were identified. Conclusion: The Brazilian market has a great variety of standard and modified enteral formulations. The evaluation of the composition of enteral formulations available in the national market allows the professional to choose the best one for each clinical situation.
Introdução: No mercado brasileiro estão disponíveis inúmeras formulações de dietas enterais, com diferentes formas de apresentações e indicações. Objetivo: descrever as características básicas das formulações enterais disponíveis no mercado brasileiro. Material e Métodos: Foi realizado o tabulamento de informações contidas nos catálogos dos diferentes laboratórios farmacêuticos. De acordo com as suas características, os produtos foram classificadas em fórmulas padrão com ou sem fibras e fórmulas modificadas, específicas para pacientes diabéticos, para aqueles com insuficiência renal, hepática ou respiratória, além de fórmulas semi-hidrolisadas e imunomoduladoras. Resultados e discussão: Estão disponíveis no mercado brasileiro 80 fórmulas enterais comercializadas por 6 diferentes laboratórios. As dietas têm apresentações em pó ou líquida em pack (embalagem hermeticamente fechada com 6 camadas protetoras, garantindo as condições estéreis do produto) com relativa uniformidade na distribuição de macronutrientes e grande variação na composição de micronutrientes. Foram encontradas 42 fórmulas padrão, sendo 25 sem fibras e 17 com fibras. Dentre as fórmulas modificadas, foram identificadas 7 específicas para pacientes diabéticos, 6 para insuficiência renal, 9 semi-hidrolisadas, 8 fórmulas contendo imunonutrientes, 4 produtos específicos para insuficiência pulmonar e 4 para insuficiência hepática. Conclusão: O mercado brasileiro tem uma grande variedade de fórmulas enterais padrão e modificadas. A avaliação da composição das fórmulas enterais disponíveis no mercado nacional permite uma melhor seleção pelo profissional para cada situação clínica
Efeito de fermentado (utilizado como alimento funcional) sobre: a citoproteção gástrica, atividade anti-secretória e a motilidade intestinal em animais
Get PDFObjetivo: Confirmar o mecanismo de ação do fermentado, através da quantificação do muco gastroprotetor e da produção de secreção gástrica ácida em ratos Wistar, além de verificar a interferência na motilidade gastrointestinal em camundongos.
Métodos: Nesse estudo foi inicialmente utilizado o modelo de indução de úlcera com administração de solução salina (10mL/kg de peso) como controle negativo, carbenoxolona (200 mg/kg) como controle positivo e o produto fermentado em pó na dose de 2000 mg/kg de peso animal. Em seguida foi utilizado o modelo para determinação quantitativa do muco gastroprotetor e atividade anti-secretória em ratos. Para avaliação da atividade sobre a motilidade intestinal em camundongos cada grupo de animais recebeu, por via oral, solução salina (10mL/kg) como controle negativo, atropina (3mg/kg) como controle positivo e o produto fermentado em pó na dose de 2000mg/kg de peso corporal animal.
Resultados: O fermentado apresentou atividade antiulcerogênica de 57,1% e a carbenoxolona de 92,3%. Para a confirmação do mecanismo de ação via prostaglandinas foi realizado a quantificação do muco gástrico no qual o fermentado foi capaz de aumentá-lo em 48,9% e a carbenoxolona em 108,6%. Na avaliação da atividade antisecretória em ratos e da motilidade intestinal em camundongos o fermentado não interferiu na secreção acida gástrica e na motilidade.
Conclusão: Com base nos dados obtidos nesse experimento com ratos e camundongos, concluiu-se que o fermentado provavelmente promove a citoproteção da mucosa gástrica, através do aumento da produção de muco gastroprotetor especialmente por meio dos níveis de prostaglandinas
Climaterium, food intake and medicines
Get PDFBackground: Polytherapy treatment is a common practice observed among menopausal patients. This study aimed to quantify food intake and medications in climacteric patients living in community.
Methods: Eligible patients from Climacteric Outpatient Clinic (HCFMRP/USP) were recruited. The collected data were: food intake records, age, body weight, height, levels of physical activity and medications in use.
Results: Eighty women were studied. Their age was 548 years and body mass index 307kg/m2. They had inadequate dietary Fe, K, Mg, Ca, thiamin, pyridoxine, vitamin E, folate and fiber consumption; 62% used 3 or more medications/day among hypotensive, micronutrients and anti-depressants.
Conclusion: Climacteric women need special attention regarding nutrient intake and medication prescription
Clinical and Nutritional characterization of patients with massive intestinal resection in Ribeirão Preto, SP, Brazil
Get PDFBackground: Short bowel syndrome (SBS) is a clinical situation due to extensive intestinal resection or dysfunction of the absorptive system of the small intestine. When these patints are not submitted to nutritional therapy their maximum survival is six months. In Brazil there are few reference centers for the treatment and follow-up of these patients and information about their characterization is scarce. Objective: To describe enterectomized patients attended during the period from 1996 to 2007. Methods: All medical records of the patients attended at the Nutrology service of HCFMRP-USP were analyzed retrospectively. Data were collected and analyzed descriptively using the contingency test and the Wilcoxon- Mann-Whitney test for independent samples. Results: Thirty-eight patients with a mean age of 52 years at the time of enterectomy were analyzed, 47% of them males and 53% females. The main etiology of SBS was mesenteric ischemia (73%). Of these patients, 67% had some risk factor associated with atherosclerosis. No significant differences in eating habits were detected between the period before and after surgery. After surgery, 39% of the patients developed a significant weight loss and 79% developed some type of complication, surgical in 34%, infectious in 66% and of both types in 21%. Survival was 9.5 years. Conclusion: Extensive resections of the small bowel may be associated with atherosclerosis and represent an important nutritional risk, with a significant weight loss during the first year, which seems to be related to increased morbidity. Adequate nutritional therapy is associated with increased survival
Epigenetics and the exposomes: Obesity and beyond
Get PDFThe specific genetic alterations that result in diseases and complex syndromes have been and continue to be identified. Search for the origins of disease have led to investigations into the roles of dietary and environmental factors as potential triggers or modifiers of risk. Genome-wide association studies have identified concepts such as the rare variant-common disease hypothesis and the common variant-common disease hypothesis. Through association studies, unique gene-environment interactions, which may occur with or without specific periods of permissiveness or vulnerabilities, have also been identified. Major conditions where the role of exposomes and epigenetics are rapidly evolving are obesity, neurological disorders, immune disorders and cancers. These concepts are particularly intriguing in the context of obesity
Ultrashort Bowel Syndrome: long-term survival without Parenteral Nutrition
Get PDFShort Bowel Syndrome (SBS) is a condition in which nutrients are not absorbed (malabsorption) because a large part of the small intestine is missing or has been surgically removed, developing an Intestinal Failure (IF), that is defined as a loss of absorptive capacity secondary to obstruction, dysmotility, surgical resection, congenital defect, or mucosal disease resulting in chronic diarrhea, dehydration, electrolyte abnormalities, micronutrient imbalance, and malnutrition. The long-term survival without parenteral nutrition in patients with the diagnosis of ultrashort bowel syndrome is difficult. his is a case, first reported in the country, of a 63 years old woman with ultrashort bowel syndrome who after three abdominal surgeries was left with only about 35 cm of small intestine with a jejune-transverse anastomosis. During the first surgery the right colon was removed. From the beginning she received Total Parenteral Nutrition (TPN) lasting about three months, at which time she presented a serious reaction after which she refused further TPN treatment. She lived with oral feeding including nutritional supplements for almost five years, and one significant complication,diarrhea, was managed with loperamida and octreotride
Deficiência de tiamina em paciente com Síndrome do Intestino Curto: um relato de caso
Get PDFThis 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
Assessment of the scientific evidence of the potential use of açaí (Euterpe oleracea, Mart.) in clinical outcomes: analysis with focus on antioxidant and anti-inflammatory action
Get PDFThe açaí berry (Euterpe oleracea, Mart.), fruit native to the Amazon region and explored mainly in the region of Pará, gained importance in recent years due to potential health benefits, associated with its phytochemical composition and antioxidant capacity, related to its high content of flavonoids. Among these, anthocyanins are responsible for the anti-inflammatory and antioxidant capacity of this fruit. Experimental studies show that due to its composition, the acai berry has antioxidant activity related to its ability to reduce the reactive oxygen species (ROS) and its potential to inhibit cyclooxygenase 2 (COX-2). Another benefit studied is the analysis of their effectiveness in the anti-inflammatory process, being observed inhibition of araquedônico acid-derived mediators, suggesting that the fruit can act in the chronic inflammatory process. Also it was possible to observe that the fruit may have anti-inflammatory effects in healthy patients. Thus, the supplementation of diets with use of acai berry could attenuate inflammation process and oxidative stress, today with more consistent evidence derived primarily from in vitro studies. However, there is still need for further studies to prove the action of this fruit in the mechanisms involved in these processes, isolation of specific compounds and determining their optimal dosage
Terapia nutricional em pacientes com câncer do aparelho digestivo
Get PDFNutritional status in patients with cancer is a critical determinant of treatment success and life quality. Therapeutic approaches in cancer, including surgery, chemotherapy and radiation, are associated with malnutrition, and drugs used to treat cancer often result in vomiting, mucositis, diarrhea, and dysphagia. The main objective of this research is to understand the effect of nutritional interventions in GI cancer patients, analyzing several studies. For the accomplishment of this study we performed a systematic review of the literature, searching for scientific articles of the following databases PubMed, Bireme and Google academic. Results showed that neoplastic cachexia is a very common clinical manifestation in patients with GI cancer. Early nutritional therapy provides beneficial results in terms of minimizing weight loss, reducing deterioration of nutritional status, and physical function. The first nutritional choice should be the oral route. When patients are unable to ingest caloric and mainly oral protein supply, they may be candidates for NE or NP. Recent studies have suggested the association of enteral and parenteral therapies in reducing postoperative complications and in decreasing hospital stay
Indicações e contra-indicações no transplante hepático pediátrico
Get PDFAdvances in cirurgical techniques and immunessupressores result in better prognosis of patients elected to pediatric liver transplant. Many questions still arise as the transplant indications. Notes that in childhood the liver failure can occur faster than in adults. The main symptons are: progressive cholestasis, encephalopathy, ascites, bleeding of esophageal varices, Hepatopulmonary syndrome, malnutrition, recurrent infections, liver dysfunction, disabling itching and delayed growth and development