Resumo A amamentação é considerada o método ideal de alimentação no início da vida, porém tem baixa prevalência mundial, sendo o trabalho materno um dos obstáculos para a continuidade dessa prática. O objetivo deste artigo é revisar sistematicamente estudos que avaliaram a associação entre aspectos institucionais e aleitamento materno e aleitamento materno exclusivo em mulheres trabalhadoras. Foi realizada uma revisão sistemática da literatura nas bases de dados PubMed, LILACS e SciELO, até junho de 2016 (termos de indexação: breastfeeding, workplace e observational study). Dezoito estudos foram incluídos nesta revisão sistemática, sendo demonstrada associação positiva com a amamentação: o retorno tardio e o não retorno ao trabalho, o trabalho em tempo parcial, a sala de apoio à amamentação, a disponibilidade de tempo para a expressão do leite materno, a consulta com enfermeiro após o retorno ao trabalho e a participação em programa de apoio à amamentação. Associação negativa com a amamentação foi demonstrada em relação ao trabalho em tempo integral. Intervenções simples no local de trabalho e algumas mudanças na política da empresa direcionadas ao incentivo da amamentação podem influenciar positivamente a continuidade dessa prática após as mães retornarem ao trabalho.

Abstract Breastfeeding is considered the ideal feeding method early in life. Despite the scientific evidence, the worldwide prevalence of breastfeeding is low. Maternal work is pointed out as one of the obstacles to maintain this practice. To systematically review studies that evaluated the association between institutional aspects and breastfeeding and exclusive breastfeeding among working women. A literature search until June 2016 was carried out using PubMed, LILACS, and SciELO (MeSH terms: breastfeeding, workplace and observational study). Eighteen observational studies were included. A positive association with breastfeeding were found for later or not return to work, part-time work, availability or the use of lactation room, breast pumping breaks, professional advice on maintaining breastfeeding after returning to work, and attendance at breastfeeding support program. A negative association with breastfeeding was shown for full-time work. Simple interventions in the workplace and some changes in company policy to encourage breastfeeding can positively influence its maintenance after women return to work.

Resumo A amamentação é considerada o método ideal de alimentação no início da vida, porém tem baixa prevalência mundial, sendo o trabalho materno um dos obstáculos para a continuidade dessa prática. O objetivo deste artigo é revisar sistematicamente estudos que avaliaram a associação entre aspectos institucionais e aleitamento materno e aleitamento materno exclusivo em mulheres trabalhadoras. Foi realizada uma revisão sistemática da literatura nas bases de dados PubMed, LILACS e SciELO, até junho de 2016 (termos de indexação: breastfeeding, workplace e observational study). Dezoito estudos foram incluídos nesta revisão sistemática, sendo demonstrada associação positiva com a amamentação: o retorno tardio e o não retorno ao trabalho, o trabalho em tempo parcial, a sala de apoio à amamentação, a disponibilidade de tempo para a expressão do leite materno, a consulta com enfermeiro após o retorno ao trabalho e a participação em programa de apoio à amamentação. Associação negativa com a amamentação foi demonstrada em relação ao trabalho em tempo integral. Intervenções simples no local de trabalho e algumas mudanças na política da empresa direcionadas ao incentivo da amamentação podem influenciar positivamente a continuidade dessa prática após as mães retornarem ao trabalho.

Abstract Breastfeeding is considered the ideal feeding method early in life. Despite the scientific evidence, the worldwide prevalence of breastfeeding is low. Maternal work is pointed out as one of the obstacles to maintain this practice. To systematically review studies that evaluated the association between institutional aspects and breastfeeding and exclusive breastfeeding among working women. A literature search until June 2016 was carried out using PubMed, LILACS, and SciELO (MeSH terms: breastfeeding, workplace and observational study). Eighteen observational studies were included. A positive association with breastfeeding were found for later or not return to work, part-time work, availability or the use of lactation room, breast pumping breaks, professional advice on maintaining breastfeeding after returning to work, and attendance at breastfeeding support program. A negative association with breastfeeding was shown for full-time work. Simple interventions in the workplace and some changes in company policy to encourage breastfeeding can positively influence its maintenance after women return to work.

ABSTRACT Elevated hepatic glucose production, impaired insulin secretion, and insulin resistance - abnormalities of glucose metabolism typically found in subjects with obesity - are major factors underlying the pathogenesis of type 2 diabetes (DM2) and the metabolic syndrome (MS). Adiponectin is a major regulator of glucose and lipid homeostasis via its insulin-sensitizing properties, and lower levels seems to be associated with the development of DM2 and MS. The purpose of this review is to clarify the mechanisms whereby adiponectin relates to the development of DM2 and MS and the association between polymorphisms of the adiponectin gene, circulating levels of the hormone, and its relationships with DM2. In addition, the impact of dietary lipids in the circulating levels of adiponectin will be addressed. According to the literature, circulating adiponectin levels seem to decrease as the number of MS components increases. Lower adiponectin concentrations are associated with higher intra-abdominal fat content. Therefore, adiponectin could link intra-abdominal fat with insulin resistance and development of MS. Therapeutic strategies that target the MS and its components, such as lifestyle modification through physical activity and weight loss, have been shown to increase adiponectin concentrations. Possible roles of diets containing either low or high amounts of fat, or different types of fat, have been analyzed in several studies, with heterogeneous results. Supplementation with n-3 PUFA modestly increases adiponectin levels, whereas conjugated linoleic acid supplementation appears to reduce concentrations when compared with unsaturated fatty acid supplementation used as an active placebo.

Introduction: Although guidelines emphasize that the provision of enteral nutrition (EN) should be as close as the patient's needs, prospective studies question this strategy. Objective: To compare the effect of two EN strategies (underfeeding versus full-feeding) on ICU and overall mortality (hospital mortality or 60-day mortality) and length of stay (LOS), duration of mechanical ventilation (MV), infectious complications, and gastrointestinal tolerance in ICU patients. Methods: Random effects meta-analysis of randomized controlled trials (RCT). Our search covered MEDLINE, EMBASE, SCOPUS and CENTRAL databases until May 2015. Underfeeding was assigned into two different groups according to the level of energy intake achieved (moderate feeding 46-72% and trophic feeding 16-25%) for subgroup analysis. Results: Five RCTs were included among the 904 studies retrieved (n = 2,432 patients). No difference was found in overall mortality when all five studies were combined. In the subgroup analysis, moderate feeding (three studies) showed lower mortality compared with full-feeding (RR 0.82; 95% CI, 0.68-0.98; I2 0% p = 0.59 for heterogeneity). No differences were found for ICU mortality, ICU and hospital LOS, duration of MV, and infectious complications. Underfeeding showed lower occurrence of GI signs and symptoms except for aspiration and abdominal distention (no difference was found). Conclusions: This meta-analysis found no differences in ICU and overall mortality, ICU and hospital LOS, duration of MV, and infectious complications between underfeeding and full-feeding. The subgroup analysis showed lower overall mortality among patients receiving moderate underfeeding. This result should be cautiously interpreted due to the limitations of the small number of studies analyzed and their methodology.

Introducción: a pesar de las directrices que hacen hincapié en que la cantidad de la Nutrición Enteral (NE) administrada debe estar próxima a las necesidades del paciente, los estudios prospectivos cuestionan esta estrategia. Objetivo: comparar el efecto de dos estrategias de NE (subalimentación vs. alimentación completa) sobre la mortalidad en la UCI y general (mortalidad hospitalaria o la mortalidad en 60 días), el tiempo de internación en la UCI y en el hospital, duración de la ventilación mecánica (VM), complicaciones infecciosas y la tolerancia gastrointestinal en pacientes críticos. Métodos: metaanálisis de efectos aleatorios de ensayos clínicos aleatorizados (ECA). Nuestra búsqueda se basa en MEDLINE, EMBASE, SCOPUS y CENTRAL hasta mayo de 2015. La subalimentación fue asignada a dos grupos diferentes de acuerdo con el nivel de consumo de energía (alimentación moderada 46-72% y la alimentación trófica 16-25%) para el análisis de subgrupos. Resultados: se incluyeron cinco ECA entre los 904 estudios que se encontraron en la búsqueda (n = 2.432 pacientes). No se encontraron diferencias en la mortalidad general cuando se combinaron los cinco estudios. En el análisis de subgrupos, la alimentación moderada (tres estudios) mostró una mortalidad más baja en comparación con la alimentación completa (RR 0,82; IC 95% 0,68-0,98; I² 0% p = 0,59 para la heterogeneidad). No se encontraron diferencias de mortalidad en la UCI ni en el tiempo de internación hospitalaria, la duración de la VM y las complicaciones infecciosas. La subalimentación mostró menor aparición de signos y síntomas gastrointestinales, excepto para aspiración y distensión abdominal (no se encontró ninguna diferencia). Conclusiones: este metaanálisis no encontró diferencias significativas de mortalidad, duración de la estancia, duración de VM ni complicaciones infecciosas en la UCI o hospitalización total entre los grupos de subalimentación y alimentación completa. El análisis de subgrupos mostró menor mortalidad global entre los pacientes que recibieron la subalimentación moderada. Este resultado debe interpretarse con cautela debido a las limitaciones del pequeño número de estudios analizados y su metodología.