Abstract Although organic export agriculture is affected by climate change, it is an essential climate adaptation mechanism. The objective of this article is to examine the link between climate change, organic Peruvian agro-exports, and food security. Using Pearson's correlation and multiple regression methods, the study found that climate change as measured by air and seawater temperatures was related to Peruvian organic agro-exports in the period 2000-2022. There was also a strong association between organic agro-exports and food security both in Peru and globally. It is concluded that the prevalence of global undernourishment is directly affected by air and sea surface temperatures and that this phenomenon is inversely affected by Peruvian organic agro-exports; i.e., higher organic agro-exports increase food security. It is recommended that policymakers promote organic agro-exports as a climate change adaptation strategy in support of healthier diets for populations, global food security, and climate resilience. mechanism agroexports, agroexports agro exports, exports Pearsons Pearson s methods 20002022. 20002022 2000 2022. 2022 2000-2022 globally ie i e i.e. populations resilience 2000202 200 202 2000-202 i.e 200020 20 2000-20 20002 2 2000-2 2000-

Resumen A pesar que la agricultura orgánica de exportación es afectada por el cambio climático, es un transcendental mecanismo de adaptación al clima. El objetivo es analizar el vínculo del cambio climático con las agroexportaciones de productos orgánicos peruanos y la seguridad alimentaria. Usando los métodos de correlación de Pearson y regresión múltiple, se halló que el cambio climático a través de las temperaturas del aire y del agua de mar se relacionan con las agroexportaciones orgánicas peruanas en el período 2000-2022, también existe asociación fuerte entre las agroexportaciones orgánicas y la seguridad alimentaria en Perú y a nivel mundial. Se concluye que la prevalencia de la subalimentación mundial es afectada directamente por las temperaturas del aire y de la superficie del agua de mar e inversamente por las agroexportaciones de productos orgánicos peruanos, esto es, que las mayores agroexportaciones orgánicas aumentan la seguridad alimentaria. Se recomienda a los responsables políticos impulsar las agroexportaciones de productos orgánicos como una opción de adaptación al cambio climático a favor de dietas más saludables para la gente, la seguridad alimentaria mundial y la resilencia climática. clima múltiple 20002022, 20002022 2000 2022, 2022 2000-2022 gente climática 2000202 200 202 2000-202 200020 20 2000-20 20002 2 2000-2 2000-

SUMMARY OBJECTIVE: The objective of this study was to compare the nutritional status and dietary intake of pregnant women with sickle cell disease (SS hemoglobinopathy and SC hemoglobinopathy) to healthy controls and report the maternal and perinatal outcomes. METHODS: This is a prospective, longitudinal cohort study. Pregnant women with a diagnosis of sickle cell disease and control group were recruited in an outpatient clinic of a tertiary care hospital in São Paulo, Brazil. Maternal anthropometric data and dietary intake data were collected at the second and third trimesters. RESULTS: A total of 49 pregnancies complicated by sickle cell disease were included. Prepregnancy body mass index was significantly lower in the SS hemoglobinopathy group (n=26, median 20.3 kg/m2) than the SC hemoglobinopathy group (n=23, 22.7 kg/m2) or control group (n=33, 23.2 kg/m2, p<0.05). The prepregnancy nutritional status revealed significantly more women classified as underweight in the SS hemoglobinopathy group (15.4%) than in the SC hemoglobinopathy group (4.4%) and control group (1.6%, p=0.009). In the second trimester, maternal protein intake was significantly lower in SS hemoglobinopathy (73.2 g/day) and SC hemoglobinopathy (68.8 g/day) than in the control group (95.7 g/day, p=0.004). In the third trimester, only SS hemoglobinopathy mothers showed dietary intake of protein significantly lower than that of the controls (67.5 g/day vs. 92.8 g/day, p=0.02). Vitamin A and E consumption was also reduced in the third trimester in the SS hemoglobinopathy group (p<0.05). CONCLUSION: The nutritional status of pregnant women with SS hemoglobinopathy is characterized by a state of undernutrition. The lower protein intake in the second and third trimesters of pregnant women with SS hemoglobinopathy may contribute to this condition. Undernourishment is a serious complication of sickle cell disease, primarily during pregnancy, and it should be addressed during the prenatal period. OBJECTIVE outcomes METHODS prospective Paulo Brazil RESULTS 4 included n=26, n26 n 26 (n=26 203 20 3 20. kg/m2 kgm2 kgm kg m2 m n=23, n23 23 (n=23 227 22 7 22. n=33, n33 33 (n=33 232 2 23. p<0.05. p005 p p<0.05 . 0 05 p<0.05) 15.4% 154 15 (15.4% 4.4% 44 (4.4% 1.6%, 16 1 6 (1.6% p=0.009. p0009 p=0.009 009 p=0.009) 73.2 732 73 (73. gday g day 68.8 688 68 8 (68. 95.7 957 95 (95. p=0.004. p0004 p=0.004 004 p=0.004) 67.5 675 67 5 (67. vs 928 92 92. p=0.02. p002 p=0.02 02 p=0.02) (p<0.05) CONCLUSION undernutrition condition pregnancy period n=26 n2 (n=2 kg/m n=23 n=33 n3 (n=3 p00 p<0.0 15.4 (15.4 4.4 (4.4 1.6% (1.6 p000 p=0.00 00 73. (73 68. (68 95. 9 (95 67. (67 p=0.0 (p<0.05 n=2 (n= n=3 p0 p<0. 15. (15. 4. (4. 1.6 (1. (7 (6 (9 p=0. (p<0.0 n= (n p<0 (15 (4 1. (1 ( p=0 (p<0. p< p= (p<0 (p< (p

Resumo: A má nutrição afeta bilhões de indivíduos em todo o mundo e representa um desafio de saúde global. Este estudo teve como objetivo determinar a prevalência de má nutrição (desnutrição ou excesso de peso) entre díades mãe-filho em crianças menores de cinco anos no Brasil em 2019 e estimar as mudanças nessa prevalência de 2006 a 2019. Foram analisados dados individuais do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) e da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher realizada em 2006 (PNDS 2006). Os desfechos de má nutrição incluíram mãe e filho com excesso de peso, mãe e filho desnutridos e a dupla carga de má nutrição, ou seja, mãe com excesso de peso e filho com qualquer forma de desnutrição (défict de crescimento, magreza ou baixo peso). Foram estimadas a prevalência e os intervalos de 95% de confiança (IC95%). A maioria das mulheres (58,2%) e 9,7% das crianças estavam acima do peso, 6,9% apresentaram déficit de crescimento e 3,1% das mães e 2,9% das crianças estavam abaixo do peso. A prevalência de excesso de peso na díade mãe-filho foi de 7,8% e foi estatisticamente maior no Sul do Brasil (9,7%; IC95%: 7,5; 11,9) do que no Centro-oeste (5,4%; IC95%: 4,3; 6,6). A prevalência de mãe com sobrepeso e filho com déficit de crescimento foi de 3,5%, com uma diferença estatisticamente significante entre os extremos de escolaridade materna [(0-7 vs. ≥ 12 anos de estudo), 4,8% (IC95%: 3,2; 6,5) and 2,1% (IC95%: 1,2; 3,0), respectivamente]. O excesso de peso na díade aumentou de 5,2% para 7,8% e a dupla carga de má nutrição aumentou de 2,7% para 5,2% desde 2006. A má nutrição nas díades mãe-filho brasileiras parece ser um problema crescente, sendo as mais vulneráveis aquelas com menor escolaridade e maior idade materna e residentes na Região Sul do Brasil.

Resumen: La malnutrición afecta a muchas personas en todo el mundo y representa un desafío para la salud mundial. Este estudio tuvo como objetivo determinar la prevalencia de malnutrición (desnutrición o sobrepeso) entre díadas madre-hijo en niños menores de cinco años en Brasil en 2019 y estimar cambios en esta prevalencia de 2006 a 2019. Se analizaron datos individuales del Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019) y de la Encuesta Nacional de Demografía y Salud del Niño y de la Mujer de 2006 (PNDS 2006). Los resultados de la malnutrición incluyeron a madre e hijo con sobrepeso, madre e hijo desnutridos y la doble carga de mala nutrición, es decir, madre con sobrepeso e hijo con cualquier forma de desnutrición (retardo en el crecimiento, emaciación o bajo peso). Se calcularon prevalencias y los intervalos de 95% de confianza (IC95%). La mayoría de las mujeres (58,2%) y el 9,7% de los niños tenían sobrepeso, el 6,9% de los niños presentaban retraso en el crecimiento, y el 3,1% de las madres y el 2,9% de los niños, bajo peso. La prevalencia de sobrepeso en la díada madre-hijo fue del 7,8%, estadísticamente mayor en el Sur de Brasil (9,7%; IC95%: 7,5; 11,9) que en el Centro-Oeste (5,4%; IC95%: 4,3; 6,6). La prevalencia de madres con sobrepeso y de niños con retraso del crecimiento fue del 3,5%, con una diferencia estadísticamente significativa entre los extremos de nivel educativo de la madre [(0-7 vs. ≥ 12 años de nivel educativo), 4,8% (IC95%: 3,2; 6,5) y 2,1% (IC95%: 1,2; 3,0), respectivamente]. El sobrepeso en la díada tuvo un aumento del 5,2% al 7,8%, y la doble carga de mala nutrición aumentó del 2,7% al 5,2% desde 2006. La malnutrición en la díada madre-hijo brasileña resulta ser un problema creciente, siendo las más vulnerables aquellas con menor escolaridad y mayor edad materna y residentes en la Región Sur de Brasil.

Abstract: Malnutrition affects billions of individuals worldwide and represents a global health challenge. This study aimed to determine the prevalence of malnutrition (undernutrition or overweight) among mother-child dyads in children under 5 years old in Brazil in 2019 and to estimate changes in this prevalence from 2006 to 2019. Individual-level data from the Brazilian National Survey on Child Nutrition (ENANI-2019) and the Brazilian National Survey of Demography and Health of Women and Children carried out in 2006 (PNDS 2006) were analyzed. Malnutrition outcomes in mother-child dyads included overweight mother and child, undernourished mother and child, and the double burden of malnutrition, i.e., overweight mother and child having any form of undernourishment (stunting, wasting, or underweight). Prevalence and 95% confidence intervals (95%CI) were estimated. Most women (58.2%) and 9.7% of the children were overweight, 6.9% were stunted, and 3.1% of mothers and 2.9% of the children were underweight. The prevalence of overweight in the mother-child dyad was 7.8% and was statistically higher in Southern Brazil (9.7%; 95%CI: 7.5; 11.9) than in the Central-West (5.4%; 95%CI: 4.3; 6.6). The prevalence of overweight mother and stunted child was 3.5%, with statistically significant difference between the extremes of the mother’s education [0-7 vs. ≥ 12 years, 4.8% (95%CI: 3.2; 6.5) and 2.1%, (95%CI: 1.2; 3.0), respectively]. Overweight in the dyad increased from 5.2% to 7.8%, and the double burden of malnutrition increased from 2.7% to 5.2% since 2006. Malnutrition in Brazilian mother-child dyads seems to be a growing problem, and dyads with lower formal education, higher maternal age, and from the South Region of Brazil were more vulnerable.

Resumen: La malnutrición afecta a muchas personas en todo el mundo y representa un desafío para la salud mundial. Este estudio tuvo como objetivo determinar la prevalencia de malnutrición (desnutrición o sobrepeso) entre díadas madre-hijo en niños menores de cinco años en Brasil en 2019 y estimar cambios en esta prevalencia de 2006 a 2019. Se analizaron datos individuales del Estudio Nacional de Alimentación y Nutrición Infantil (ENANI-2019) y de la Encuesta Nacional de Demografía y Salud del Niño y de la Mujer de 2006 (PNDS 2006). Los resultados de la malnutrición incluyeron a madre e hijo con sobrepeso, madre e hijo desnutridos y la doble carga de mala nutrición, es decir, madre con sobrepeso e hijo con cualquier forma de desnutrición (retardo en el crecimiento, emaciación o bajo peso). Se calcularon prevalencias y los intervalos de 95% de confianza (IC95%). La mayoría de las mujeres (58,2%) y el 9,7% de los niños tenían sobrepeso, el 6,9% de los niños presentaban retraso en el crecimiento, y el 3,1% de las madres y el 2,9% de los niños, bajo peso. La prevalencia de sobrepeso en la díada madre-hijo fue del 7,8%, estadísticamente mayor en el Sur de Brasil (9,7%; IC95%: 7,5; 11,9) que en el Centro-Oeste (5,4%; IC95%: 4,3; 6,6). La prevalencia de madres con sobrepeso y de niños con retraso del crecimiento fue del 3,5%, con una diferencia estadísticamente significativa entre los extremos de nivel educativo de la madre [(0-7 vs. ≥ 12 años de nivel educativo), 4,8% (IC95%: 3,2; 6,5) y 2,1% (IC95%: 1,2; 3,0), respectivamente]. El sobrepeso en la díada tuvo un aumento del 5,2% al 7,8%, y la doble carga de mala nutrición aumentó del 2,7% al 5,2% desde 2006. La malnutrición en la díada madre-hijo brasileña resulta ser un problema creciente, siendo las más vulnerables aquellas con menor escolaridad y mayor edad materna y residentes en la Región Sur de Brasil. Resumen mundial madrehijo 201 200 ENANI2019 ENANI (ENANI-2019 PNDS . 2006) decir retardo peso peso) 95 IC95%. IC95 IC IC95% (IC95%) 58,2% 582 58 2 (58,2% 97 9 7 9,7 69 6 6,9 31 3 1 3,1 29 2,9 78 8 7,8% (9,7% 7,5 75 5 11,9 119 11 CentroOeste Centro Oeste 5,4% 54 4 (5,4% 4,3 43 6,6. 66 6,6 6,6) 35 3,5% 07 0 [(0- vs educativo, , educativo) 48 4,8 (IC95% 3,2 32 6,5 65 21 2,1 1,2 3,0, 30 3,0 3,0) respectivamente. respectivamente respectivamente] 52 5,2 27 2,7 creciente 20 ENANI201 (ENANI-201 IC9 58,2 (58,2 9, 6, 3, 2, 7,8 (9,7 7, 11, 5,4 (5,4 4, 3,5 [(0 (IC95 1, 5, ENANI20 (ENANI-20 58, (58, (9, (5, [( (IC9 ENANI2 (ENANI-2 (58 (9 (5 [ (IC (ENANI- ( (ENANI

Abstract: Malnutrition affects billions of individuals worldwide and represents a global health challenge. This study aimed to determine the prevalence of malnutrition (undernutrition or overweight) among mother-child dyads in children under 5 years old in Brazil in 2019 and to estimate changes in this prevalence from 2006 to 2019. Individual-level data from the Brazilian National Survey on Child Nutrition (ENANI-2019) and the Brazilian National Survey of Demography and Health of Women and Children carried out in 2006 (PNDS 2006) were analyzed. Malnutrition outcomes in mother-child dyads included overweight mother and child, undernourished mother and child, and the double burden of malnutrition, i.e., overweight mother and child having any form of undernourishment (stunting, wasting, or underweight). Prevalence and 95% confidence intervals (95%CI) were estimated. Most women (58.2%) and 9.7% of the children were overweight, 6.9% were stunted, and 3.1% of mothers and 2.9% of the children were underweight. The prevalence of overweight in the mother-child dyad was 7.8% and was statistically higher in Southern Brazil (9.7%; 95%CI: 7.5; 11.9) than in the Central-West (5.4%; 95%CI: 4.3; 6.6). The prevalence of overweight mother and stunted child was 3.5%, with statistically significant difference between the extremes of the mother’s education [0-7 vs. ≥ 12 years, 4.8% (95%CI: 3.2; 6.5) and 2.1%, (95%CI: 1.2; 3.0), respectively]. Overweight in the dyad increased from 5.2% to 7.8%, and the double burden of malnutrition increased from 2.7% to 5.2% since 2006. Malnutrition in Brazilian mother-child dyads seems to be a growing problem, and dyads with lower formal education, higher maternal age, and from the South Region of Brazil were more vulnerable. Abstract challenge undernutrition motherchild 201 200 Individuallevel Individual level ENANI2019 ENANI (ENANI-2019 PNDS analyzed ie i e i.e. stunting, stunting (stunting wasting underweight . underweight) 95 95%CI 95CI CI (95%CI estimated 58.2% 582 58 2 (58.2% 97 9 7 9.7 69 6 6.9 31 3 1 3.1 29 2.9 78 8 7.8 (9.7% 7.5 75 11.9 119 11 CentralWest Central West 5.4% 54 4 (5.4% 4.3 43 6.6. 66 6.6 6.6) 35 3.5% s 07 0 [0- vs 48 4.8 3.2 32 6.5 65 21 2.1% 1.2 3.0, 30 3.0 , 3.0) respectively. respectively respectively] 52 5.2 27 2.7 problem age vulnerable 20 ENANI201 (ENANI-201 i.e 58.2 (58.2 9. 6. 3. 2. 7. (9.7 11. 5.4 (5.4 4. 3.5 [0 2.1 1. 5. ENANI20 (ENANI-20 58. (58. (9. (5. [ ENANI2 (ENANI-2 (58 (9 (5 (ENANI- ( (ENANI

Resumo: A má nutrição afeta bilhões de indivíduos em todo o mundo e representa um desafio de saúde global. Este estudo teve como objetivo determinar a prevalência de má nutrição (desnutrição ou excesso de peso) entre díades mãe-filho em crianças menores de cinco anos no Brasil em 2019 e estimar as mudanças nessa prevalência de 2006 a 2019. Foram analisados dados individuais do Estudo Nacional de Alimentação e Nutrição Infantil (ENANI-2019) e da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher realizada em 2006 (PNDS 2006). Os desfechos de má nutrição incluíram mãe e filho com excesso de peso, mãe e filho desnutridos e a dupla carga de má nutrição, ou seja, mãe com excesso de peso e filho com qualquer forma de desnutrição (défict de crescimento, magreza ou baixo peso). Foram estimadas a prevalência e os intervalos de 95% de confiança (IC95%). A maioria das mulheres (58,2%) e 9,7% das crianças estavam acima do peso, 6,9% apresentaram déficit de crescimento e 3,1% das mães e 2,9% das crianças estavam abaixo do peso. A prevalência de excesso de peso na díade mãe-filho foi de 7,8% e foi estatisticamente maior no Sul do Brasil (9,7%; IC95%: 7,5; 11,9) do que no Centro-oeste (5,4%; IC95%: 4,3; 6,6). A prevalência de mãe com sobrepeso e filho com déficit de crescimento foi de 3,5%, com uma diferença estatisticamente significante entre os extremos de escolaridade materna [(0-7 vs. ≥ 12 anos de estudo), 4,8% (IC95%: 3,2; 6,5) and 2,1% (IC95%: 1,2; 3,0), respectivamente]. O excesso de peso na díade aumentou de 5,2% para 7,8% e a dupla carga de má nutrição aumentou de 2,7% para 5,2% desde 2006. A má nutrição nas díades mãe-filho brasileiras parece ser um problema crescente, sendo as mais vulneráveis aquelas com menor escolaridade e maior idade materna e residentes na Região Sul do Brasil. Resumo global mãefilho 201 200 ENANI2019 ENANI (ENANI-2019 PNDS . 2006) seja défict 95 IC95%. IC95 IC IC95% (IC95%) 58,2% 582 58 2 (58,2% 97 9 7 9,7 69 6 6,9 31 3 1 3,1 29 2,9 78 8 7,8 (9,7% 7,5 75 5 11,9 119 11 Centrooeste Centro oeste 5,4% 54 4 (5,4% 4,3 43 6,6. 66 6,6 6,6) 35 3,5% 07 0 [(0- vs estudo, , estudo) 48 4,8 (IC95% 3,2 32 6,5 65 21 2,1 1,2 3,0, 30 3,0 3,0) respectivamente. respectivamente respectivamente] 52 5,2 27 2,7 crescente 20 ENANI201 (ENANI-201 IC9 58,2 (58,2 9, 6, 3, 2, 7, (9,7 11, 5,4 (5,4 4, 3,5 [(0 (IC95 1, 5, ENANI20 (ENANI-20 58, (58, (9, (5, [( (IC9 ENANI2 (ENANI-2 (58 (9 (5 [ (IC (ENANI- ( (ENANI

ABSTRACT Introduction: The diagnosis of malnutrition has had a difficult historical process and its concept has gone through numerous attempts to define it. The word undernourishment and especially the term malnutrition creates a lot of confusion among scholars of the subject. In the last decade, various consensuses have emerged to classify malnutrition associated with diseases together with the burden represented by overweight and obesity in the presence of chronic and acute diseases. Objective: To identify how new technologies improve knowledge of nutritional disorders through the description and integration of their body compartments, but they are not available to health teams or patients in various work settings. Findings: Nutrition is a science made up of a set of scientific disciplines that range from exact sciences to political sciences. The application of the clinical method as a modality of the scientific method makes it necessary to consider nutrition also with this vision and not as the last option of the doctor in a diagnostic or therapeutic intervention, contaminated by myths, taboos and cultural prejudices. Clinical medicine provides hard skills acquired in the form of knowledge and skills throughout pre-professional and postgraduate training, which together with soft skills will guarantee successful work, including hostile, toxic and/or chaotic cultural environments. Conclusions: There are tendencies to follow patterns and guides of societies in countries with great financial and technological resources for research, which are not always in line with our realities. The appearance of the COVID-19 pandemic has posed new challenges and serious threats to both people and health systems globally, significantly affecting elderly patients, those with cancer and chronic diseases, along with the shock of the COVID-19 pandemic, obesity with that of the Coronavirus.

RESUMEN Introducción: El diagnóstico de la desnutrición ha tenido un complejo proceso histórico y su concepto ha transitado por numerosas tentativas para definirla. La palabra desnutrición y especialmente el término malnutrición crean bastante confusión entre los estudiosos del tema. En la última década han surgido consensos variados para clasificar la desnutrición asociada a las enfermedades unida a la carga que representan el sobrepeso y obesidad en la presencia de enfermedades crónicas y agudas. Objetivo: Conocer cómo las nuevas tecnologías mejoran el conocimiento de los trastornos nutricionales mediante la descripción e integración de sus compartimentos corporales, pero no están al alcance de los equipos de salud ni de los pacientes en los diversos escenarios de trabajo. Desarrollo: La nutrición constituye una ciencia integrada por un conjunto de disciplinas científicas que transitan desde las ciencias exactas, hasta las ciencias políticas. La aplicación del método clínico como una modalidad del método científico obliga a considerar a la nutrición también con esta visión y no como la última opción del médico en una intervención diagnóstica o terapéutica, contaminada por mitos, tabúes y prejuicios culturales. La medicina clínica proporciona competencias duras adquiridas en forma de conocimientos y habilidades a lo largo de la formación preprofesional y de postgrado, que unidas a la competencias blandas garantizarán una labor exitosa incluidos los entornos culturales hostiles, tóxicos y /o caóticos. Conclusiones: Existen tendencias a seguir patrones y guías de sociedades de países con grandes recursos financieros y tecnológicos para la investigación, que no siempre en están en consonancia con nuestras realidades. La aparición de la pandemia COVID-19, ha planteado nuevos desafíos y serias amenazas tanto para las personas, como a los sistemas de salud de forma global que afectó de manera importante a los pacientes ancianos, con cáncer y enfermedades crónicas junto al choque de la pandemia de la obesidad con la del Coronavirus.

Food insecurity and undernourishment constitute a major challenge in Africa and the world at large. To meet key nutritional targets and tackle the menace of undernourishment, we need to exploit available but underutilised food crops. A common underutilised food crop with the potential to improve daily nutrition is tiger nut. This potential is evidenced in the number of essential amino acids detected, which constitute 74.425% of the entire amino acids detected, in addition to important minerals and vitamins. The nutritional composition of the yellow variety of tiger nut (Cyperus esculentus) was determined using the standard methods of high-performance liquid chromatography and UV-spectroscopy. Ten amino acids were identified and quantified, including six essential amino acids, of which valine had the highest concentration (67.59 μg/100 g), followed by leucine (3.019 μg/100 g), phenylalanine (1.767 μg/100 g), lysine (0.946 μg/100 g), histidine (1.048 μg/100 g) and tryptophan (0.055 μg/100 g). The other amino acids were proline (24.124 μg/100 g), cysteine (1.269 μg/100 g), glycine (0.024 μg/100 g), and glutamine (0.022 μg/100 g). Monosaccharides detected were ribose (41.76%), glucose (21.52%), sedoheptulose (17.94%), fructose (4.566%), rhamnose (1.78%) and mannose (1.58%), whilst disaccharides detected were sucrose (87.66%) and maltose (11.39%). Mineral concentrations were K 144.80 ± 1.10 mg/100 g, Ca 94.39 ± 0.02 mg/100 g, Na 83.92 ± 0.04 mg/100 g, Fe 19.36 ± 0.54 mg/100 g, Mg 17.63±0.13 mg/100 g, Cu 13.28±0.05 mg/100 g and Zn 5.18±0.01 mg/100 g Vitamins A, B2, C and E were detected and quantified as 53.93±1.03, 7.61±1.20, 31.70±1.25 and 128.75±0.74 μg/100 g, respectively. The chemical and nutritional properties of the yellow variety of tiger nut suggest that it is rich in essential amino acids, minerals, and some vitamins. Hence, it should be recommended to persons with nutritional deficiencies as it is cheap and available all year round. SIGNIFICANCE: • The nutritional composition of the yellow tiger nut will assist in meeting the recommended daily intake of essential amino acids, monosaccharides, disaccharides, minerals, and vitamins, thus contributing towards solving the challenge of food insecurity and malnutrition, particularly in the African sub-region. • The rich concentration of these nutrients could be harnessed in the biofortification of food materials known to be deficient in one nutrient or another. • These important attributes of tiger nut, if harnessed, will add value to this underutilised crop and enhance the economic livelihood of the local farmers.

Abstract This review aimed to describe and comment on how experimental intrauterine nutritional stress in animals produced some changes in tryptophan-5-hydroxylases (TPH) 1 and 2 in the brain and other key proteins such as plasma albumin, and how the intrauterine nutritional stress could produce long-lasting alterations in serotonin function in the brain of human infants.

Resumen El objetivo de esta revisión es describir y comentar cómo el estrés nutricional intrauterino experimental en animales produjo algunos cambios en las triptófano-5-hidroxilasas 1 y 2 en el cerebro y en otras proteínas clave, como la albúmina plasmática, y de qué manera el estrés nutricional intrauterino podría producir alteraciones duraderas en la función de la serotonina en el cerebro de lactantes.

Resumen Un tercio de la producción global de alimentos es perdida o desperdiciada, generando impactos en los sistemas alimentarios. Sin embargo, los datos indican que, en el mundo, una de cada nueve personas sufre subalimentación o escasez de comida. Además, este problema genera impactos adversos en el ambiente y la economía. Costa Rica no escapa de este fenómeno, por lo que, en concordancia con la meta 12.3 de los Objetivos de Desarrollo Sostenible, se han iniciado acciones a través de la Red Costarricense para Disminución de Pérdida y Desperdicio de Alimentos (Red PDACR) junto a uno de sus miembros, la Red Costarricense de Instituciones Educativas Sostenibles (REDIES). Esta última se comprometió a cuantificar la pérdida y desperdicio de alimentos (PDA) provenientes de los restaurantes de un grupo piloto de cinco de sus miembros. El objetivo del estudio fue determinar las PDA generadas en los restaurantes de esas instituciones para generar experiencia que permitiera crear indicadores e información útil en la búsqueda de estrategias para evitar el desperdicio alimentario. Las PDA fueron cuantificadas empleando la metodología estandarizada que contiene la ''Guía para medición de desperdicio de alimentos en cocinas institucionales o comerciales'' publicada por la Red PDACR. En general, la mayoría de las PDA detectadas en este caso provienen de alimento dejado en los platos de los usuarios. Consecuentemente, se concluye y recomienda enfocar las intervenciones en campañas de concientización, calidad y porcionamiento, para atender este problema, y considerar a su vez, que cada institución deberá colocar énfasis en un plan de reducción según los hallazgos particulares para cada restaurante.

Abstract One-third of the worldwide food production is lost or wasted, generating impacts in the food systems. However, data indicates that one in nine people suffer from undernourishment or shortage of food in the world. Furthermore, this problem generates adverse impacts in the environment and the economy. Costa Rica is not exempt from this phenomenon; therefore, in compliance with target 12.3 of the Sustainable Development Goals, the country initiated actions through the Costa Rican Food Loss and Waste Reduction Network and one of its members, the Costa Rican Network of Sustainable Educational Institutions (REDIES). This latter committed itself to quantify the food loss and waste (FLW) in the canteens from a pilot group of their members. The objective of this case study was to determine the FLW in the restaurants of five institutions to generate data experience that allows to create indicators and useful information in the search for strategies against food waste. The amount of FLW was measured using the standardized methodology explained in the Guide for this purpose, published by the Costa Rican Network. In general terms, most FLW in this case study comes from the amount of food leftovers. Consequently, it is concluded and recommended to focus on awareness campaigns, quality and portioning to address the issue, and to consider that each institution must place emphasis through its reduction plan with respect to the findings generated in each food service or canteen.

An increasing number of elderly people in renal support is expected in the coming years. The objective of this study was to report the clinical and socio-demographic data of end-stage renal disease (ESRD) adult patients undergoing regular dialysis treatment comparing elderly (≥65 years old) and non-elderly subjects using data from the Brazilian Dialysis Registry database. The regional distribution of the sample was Southeast (48.8%), South (33.7), Northeast (13.1%), Midwest (5.1%), and North (0.1%). A total of 18,030 patients were included in the analysis with elderly patients accounting for 29.5% of the sample. The elderly patients were predominantly male, white, retired, and literate. Elderly ESRD patients had a slightly higher frequency of undernourishment and a lower frequency of obesity than the non-elderly adults. A higher frequency of elderly patients were from the South and Southeast regions. The dialysis treatment of patients from both groups was predominantly funded by the public system, but the percent of non-public funding was higher for the elderly group. The most used initial access in the elderly was the central venous catheter and hemodialysis was the main modality at the beginning of treatment (93.2%), as well as during maintenance therapy (91.8%). Advanced age was associated with greater use of central venous catheter in the first dialysis session. The survival of the elderly on dialysis was lower than that of the non-elderly early in the course of dialysis and this difference increased over time. This is yet the largest national epidemiological study of elderly people on chronic dialysis.

ABSTRACT Introduction: The Geriatric nutritional risk index is a simple and accurate instrument that allows identifying hospitalized patients with this risk. Objective: To assess the prevalence of nutritional risk in patients admitted for presenting a vascular disease. Methods: There were evaluated in cross-sectional way 102 patients older than 18 years (65% male) admitted consecutively from October to December, 2018 at the National Institute of Angiology and Vascular Surgery in Havana, Cuba, regardless of the underlying disease and who agreed to participate in the study. The main variable was the proportion of patients with nutritional risk: high risk (<82), moderate (82-92), low (93-98) and without risk (>98); secondary variables were age, sex, body mass index and the concentration of albumin. Results: The 12.9% (95% confidence interval: 6,2-19,6); the 16.8% (9,4-24,2) and the 22.8% (14,5-31,3) of the patients had high, moderate, and light nutritional risks, respectively. Only 47.5% (37,6-57,4) of the patients did not present nutritional risk. The age and sex showed no correlation with the nutritional risk; the concentration of albumin and body mass index and the index of nutritional risk were significantly associated (R2: 0.98 and 0.59, respectively). Conclusions: The prevalence of patients with nutritional risk is high in the hospital scope and it can be evaluated through the geriatric nutritional risk index.

RESUMEN Introducción: El índice de riesgo nutricional geriátrico es un instrumento simple y exacto que permite identificar a pacientes hospitalizados con este riesgo. Objetivo: Valorar la prevalencia de riesgo nutricional en pacientes ingresados por presentar una enfermedad vascular. Métodos: Se evaluaron de forma transversal 102 pacientes mayores de 18 años (65 % hombres) ingresados de forma consecutiva entre octubre y diciembre de 2018 en el Instituto Nacional de Angiología y Cirugía Vascular en La Habana Cuba, independientemente de la enfermedad de base y que estuvieran de acuerdo en participar en el estudio. La variable principal de salida fue la proporción de pacientes con riesgo nutricional: riesgo alto (< 82), moderado (82-92), bajo (93-98) y sin riesgo (> 98); las variables secundarias resultaron la edad, el sexo, el índice de masa corporal y la concentración de albúmina. Resultados: El 12,9 % (intervalo de confianza 95 %: 6,2-19,6); el 16,8 % (9,4-24,2) y el 22,8 % (14,5-31,3) de los pacientes presentaron un riesgo nutricional alto, moderado y ligero, respectivamente. Solo el 47,5 % (37,6-57,4), de los pacientes no presentó riesgo nutricional. La edad y el sexo no mostraron correlación con el riesgo nutricional; la concentración de albúmina y el índice de masa corporal y el índice de riesgo nutricional sí se asociaron de forma importante (R2: 0,98 y 0,59, respectivamente). Conclusiones: La prevalencia de pacientes con riesgo nutricional es elevada en el ámbito hospitalario y puede evaluarse por intermedio del índice de riesgo nutricional geriátrico.

In recent years, irregular migration from sub-Saharan Africa has been under the spotlight. Western media and politicians often use doomsday scenarios to describe the supposedly millions of desperate people knocking at the gates of the European Eldorado to escape poverty and warfare at home. Such a stereotypical conception of sub-Saharan African migration is not only overlooking its root causes, but it is also far from its real dynamics. Thus, inspired by the extensive literature on international migration and based on data availability, 27 potential root causes of migration were selected to cover 30 sub-Saharan countries for the period between 2002 and 2016. The sensitivity and robustness of each potential determinant of both net migration and refugee population is tested using the two approaches of extreme bounds analysis proposed by Leamer and Leonard, and Sala-I-Martin. The results reveal that gross domestic product per capita, domestic credit, trade, foreign direct investment inflows, external debt, youth unemployment, natural resources rents, international tourism, military expenditure, health expenditure, undernourishment, food production, life expectancy, HIV prevalence, population growth, corruption, voice and accountability, rule of law, government effectiveness, regulatory quality, and common law are the root causes of migration in sub-Saharan Africa.

Abstract: The household’s demand analysis is very crucial in the sense that undernourishment negatively affects productivity. Food demand is crucial to gauge the household’s ability or willingness to purchase/consume different food commodities. The study attempts to analyze the household’s food demand in Pakistan by estimating the Quadratic Almost Ideal Demand System (QUAIDS) on Household Integrated Income and Consumption Survey (HIICS) 2015-16 data. It has been found that the household’s locality, dependency ratio, living in own house, age and level of education of household head have significant impacts on demand for different food commodities. It has been further found that hoteling, fruits & dry fruits, soft drinks & bottled water, bakery products, beef & mutton, chicken &seafood are luxury goods. Eggs, sugar & sweets, pulses, tea & coffee, vegetables, rice, and edible oil & ghee are necessity goods. The spices, milk & yogurt and wheat are close to sticky food items. The price elasticities suggest that the demand for beef & mutton, seafood, eggs, and soft drinks is relatively elastic in comparison to other food commodity groups. Moreover, the demand for tea & coffee is least elastic revealing that price of tea has a very marginal impact on its demand.

Resumen: El análisis de la demanda de alimentos de los hogares es crucial porque la des- nutrición afecta negativamente a la productividad y porque permite evaluar sus posibilidades de comprar y consumir diferentes alimentos. Este trabajo aplica el Sistema cuadrático casi ideal de demanda (QUAIDS) a la encuesta integrada de hogares de Pakistan para el periodo 2015-2016. Se encuentra que los princi- pales determinantes de la demanda son la localización, razón de dependencia, propiedad de vivienda, edad y educación, estimando las elasticidades precio e ingreso para los distintos bienes.

ABSTRACT The liver plays a role in the caloric homeostasis; it is involved in the digestive process, so it is not surprising to find malnutrition in cirrhosis, because they have an inability to meet their macro and micronutrient requirements. The pathogenesis of malnutrition is multifactorial and complex and frequently difficult to understand and includes reduced nutrient intake, decreased protein biosynthesis and increased loss, poor intestinal absorption, disturbances in the use of the substrate, abnormalities in the metabolism of carbohydrates, lipids and proteins and increased of pro-inflammatory cytokines resulting in a hypermetabolic state as well as increase in protein-energy expenditure and requirements. The evaluation of nutritional status is transcendental for a clinical-therapeutic approach, due to its influence on the prognosis and response to liver transplantation. Despite the evidence on the prevalence of malnutrition in liver cirrhosis, this condition remains poorly recognized, poorly diagnosed and poorly treated. It is controversial, if malnutrition can be reversed in cirrhotic; there is an agreement about the need to improve the food intake, avoiding limitations and restrictions that are not based on evidence.

RESUMEN El hígado juega un rol en la homeostasis calórica; está comprometido en el proceso digestivo, y es frecuente encontrar desnutrición en la cirrosis, por incapacidad para satisfacer sus requerimientos de macro y micronutrientes. La patogénesis de desnutrición en la cirrosis es multifactorial, compleja y difícil de ser comprendida, incluye ingesta reducida de nutrientes, biosíntesis disminuida, aumento de la perdida de proteína, absorción intestinal deficiente, disturbios en la utilización del substrato, anormalidades en el metabolismo de carbohidratos, lípidos y proteínas así como aumento de citoquinas pro inflamatorias, resultando en hipermetabolismo y aumento del gasto proteína-energía y de los requerimientos. La evaluación nutricional es trascendental para un enfoque clínico-terapéutico, por su implicancia pronóstica y la respuesta al trasplante hepático. Aún con la evidencia de la prevalencia de desnutrición en cirróticos, continúa poco reconocida, poco diagnosticada y muy poco tratada. Existe controversia si la desnutrición puede ser revertida en cirróticos; aunque hay un acuerdo sobre la necesidad de mejorar la ingesta de alimentos evitando las limitaciones y restricciones no basadas en la evidencia.

Resumen: Introducción: La prevalencia de desnutrición en menores de 5 años en el contexto rural indígena se encuentra entre las más alarmantes, al mismo tiempo que sus poblaciones se ven afectadas por el hambre y la pobreza; esta problemática ha sido abordara a través de programas sociales como el Programa de Comedor Comunitario (PCC) de la Cruzada Nacional contra el Hambre (CNCH). Objetivo: analizar el impacto del PCC sobre la desnutrición de niñez en edad escolar en un ejido rural indígena de la zona alta cafetalera de Tapachula, Chiapas, México, tras dos años de su instrumentación, se analizó bajo el enfoque de seguridad alimentaria. Metodología: Se realizó un estudio de casos explicativo en el que se evaluó el estado de nutrición de 31 menores de cinco años en 2014 y posteriormente en 2016. Se realizaron mediciones antropométricas y encuestas a la jefa o el jefe de hogar para la obtención de información sociodemográfica de los hogares. Se analizaron los resultados de ambas intervenciones (2014 y 2016) considerándose relevantes los ingresos, programas sociales presentes en el ejido y gastos en el interior de los hogares. Resultados: Se identificó que, para el 2016, hubo un impacto positivo marginalmente significativo en el indicador de talla para la edad (t=1.83, p=0.077) y un impacto negativo en los indicadores de peso para la talla (t=-4.03, p<0.001) y peso para la edad (t=-3.584, p=0.001). Conclusión: Los niños y las niñas se encuentran en un estado de desnutrición relacionada a una fase de enfermedades o a hábitos alimentarios inadecuados. El PCC no mostró suficiente evidencia de su impacto tras dos años de su implementación.

Abstract: Introduction: Undernutrition in children under five years old, especially in the rural-indigenous context, where hunger and poverty prevail remain a public health concern, is alarming. This problem has been addressed by social programs such as the Community Dining Program (PCC) of the National Crusade Against Hunger (CNCH). Objective: To assess the impact of the PCC over school children after two years of enforcement at an indigenous rural common land in the coffee highlands of Tapachula, Chiapas, Mexico, through the food security approach. Methods: We conducted an explanatory case study were nutritional status of 31 children under five years old was evaluated in 2014 and again in 2016. We carried out anthropometric measurements and applied household surveys to obtain socio-demographic information. The results of both interventions (2014 and 2016) were analyzed, including income, social programs executed in the common land and the household expenditure. Results: We identified that by 2016 there was a marginal positive impact on the length-for-age z-scores (t=1.83, p=0.077); however, there was a negative impact in the weight-for-height (indicating an increase in acute malnutrition) and weight-for-age z-scores. Conclusion: Children undernourishment in the studied area persists and might be related to a phase of illness and inadequate food intake. The PCC did not show evidence of its impact after two years of enforcement.

Resumen Introducción: La tuberculosis (TB) hace parte del grupo de enfermedades infectocontagiosas, producida por Mycobacterium tuberculosis. Aunque se encuentra principalmente en los pulmones, puede afectar otros órganos. Objetivo: Comparar los factores socioeconómicos y los métodos diagnósticos relacionados con tuberculosis pulmonar (tuberculosis pulmonar) y extrapulmonar (tuberculosis extrapulmonar) en el departamento de Boyacá durante 2015. Materiales y métodos: Se realizó un estudio observacional de tipo retrospectivo. Contó con los datos proporcionados por la Secretaría de Salud de Boyacá ante los eventos de notificación obligatoria de posibles casos de TB reportados en el sistema Sivigila. Se seleccionaron 103 eventos reportados de diagnóstico de TB en el departamento de Boyacá, Colombia; luego se dividieron en grupos de análisis según el tipo de TB, excluyendo los datos duplicados. Resultados: El mayor número de aislamientos fue de tuberculosis pulmonar. En cuanto a los pacientes con tuberculosis extrapulmonar, requirieron mayor atención médica, y los aislamientos más frecuentes fueron, meníngeo, pleural y osteoarticular; adicionalmente, la desnutrición se asoció con la presentación de tuberculosis pulmonar. Conclusión: La generación de nuevos abordajes sociales, culturales y económicos frente al comportamiento de la TB es primordial para controlar esta enfermedad.

Abstract Introduction: Tuberculosis (TB) is an infectious disease caused by Micobacterium tuberculosis. It usually affects the lungs, but can also affect other systems. The objective of this study was to make a comparison of the socioeconomic factors and diagnostic test between pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (ETB) in Boyacá (Colombia) in 2015. Methods: A retrospective analytical observational study was conducted on the data provided by the Boyacá Department of Health about the TB possible cases reported in the SIVIGILA system. 103 TB possible cases were selected, then these cases were divided in accordance with the TB type in two groups, PTB and ETB. Duplicated data were excluded. Results: The highest number of isolates was of PTB. With regard to the ETB group, they required more medical attention, and the most frequent isolates were meningeal, pleural and osteoarticular. In addition, undernourishment was related with PTB. Conclusion: The creation of new social, cultural and economic approaches against the TB dissemination becomes a primary point for the control of this disease.