RESUMO Este relato descreve a evolução pós-cirurgia bariátrica de uma paciente obesa que apresentou baixa adesão à dieta e suplementação de micronutrientes. Quatro anos após duas cirurgias bariátricas, a paciente foi internada por perda transitória de consciência, raciocínio lento, anasarca, hipoalbuminemia grave, além de deficiências vitamínicas e minerais. Apresentava abscesso subcutâneo no pé, mas não apresentava febre. Recebeu antibióticos, vitaminas A, D, B12, tiamina, cálcio e nutrição parenteral. Após a internação (28 dias) houve redução significativa do peso corporal, provavelmente devido ao desaparecimento clínico da anasarca. A nutrição parenteral foi suspensa após 25 dias e a dieta oral foi mantida fracionada. Após a internação (atendimento ambulatorial semanal) houve uma melhora gradativa dos dados laboratoriais, que estavam próximos dos valores de referência. Tal desfecho mostra a necessidade de cuidados especializados na prevenção e tratamento de complicações nutricionais após cirurgias bariátricas, bem como manifestações clínicas de infecção em pacientes previamente desnutridos.

SUMMARY This report describes the post-bariatric-surgery evolution of an obese patient who had low adherence to the diet and micronutrient supplementation. Four years after two bariatric surgeries, the patient was admitted due to transient loss of consciousness, slow thinking, anasarca, severe hypoalbuminemia, in addition to vitamin and mineral deficiencies. She had subcutaneous foot abscess but did not present fever. Received antibiotics, vitamins A, D, B12, thiamine, calcium, and parenteral nutrition. After hospitalization (twenty-eight days), there was a significant body weight reduction probably due to the disappearance of clinical anasarca. Parenteral nutrition was suspended after twenty-five days, and the oral diet was kept fractional. After hospitalization (weekly outpatient care), there was a gradual laboratory data improvement, which was now close to the reference values. Such outcome shows the need for specialized care in preventing and treating nutritional complications after bariatric surgeries as well as clinical manifestations of infection in previously undernourished patients.

RESUMO Racional: A cirurgia bariátrica promove importante perda ponderal e melhora das comorbidades associadas; entretanto, deficiências nutricionais e reganho de peso podem ocorrer no pós-operatório médio e tardio. Objetivo: Investigar a evolução do estado nutricional de pacientes após cinco e 10 anos de pós-operatório. Método: Estudo retrospectivo longitudinal, no qual indicadores antropométricos, bioquímicos e a ingestão alimentar foram avaliados no período pré-operatório e após um, dois, três, quatro, cinco e dez anos da operação, por meio de revisão de prontuários. Resultados: Após 10 anos observou-se redução de 29,2% do peso inicial; no entanto, 87,1% dos pacientes tiveram reganho significativo de peso. Além disso, houve aumento da incidência de deficiência de ferro (9,2% para 18,5%), vitamina B12 (4,2% para 11,1%) e magnésio (14,1% para 14,8%). As concentrações de ácido fólico aumentaram e a porcentagem de indivíduos com alterações na glicemia (40,4% a 3,7%), triglicérides (38% a 7,4%), colesterol HDL (31% a 7,4%) e ácido úrico (70,5% a 11,1%) diminuiu. Além disso, houve redução na ingestão alimentar no primeiro ano de pós-operatório. Após 10 anos, houve aumento na ingestão de energia, proteína e lipídios, e redução na de ácido fólico. Conclusões: A derivação gástrica em Y-de-Roux é procedimento eficaz para promover perda de peso e melhorar as comorbidades associadas à obesidade. Entretanto, a comparação entre os períodos pós-operatórios de cinco e 10 anos mostrou que uma porcentagem de pacientes apresenta deficiências de vitaminas e minerais e reganho de peso significativo, evidenciando a necessidade do acompanho nutricional no período pós-operatório.

ABSTRACT Background : Bariatric surgery promotes significant weight loss and improvement of associated comorbidities; however, nutrients deficiencies and weight regain may occur in the middle-late postoperative period. Aim: To investigate nutritional status in 10 years follow-up. Methods : Longitudinal retrospective study in which anthropometric, biochemical indicators and nutritional intake were assessed before and after one, two, three, four, five and ten years of Roux-en Y gastric bypass through analysis of medical records. Results : After ten years there was a reduction of 29.2% of initial weight; however, 87.1% of patients had significant weight regain. Moreover, there was an increase of incidence of iron (9.2% to 18.5%), vitamin B12 (4.2% to 11.1%) and magnesium deficiency (14.1% to 14.8%). Folic acid concentrations increased and the percentage of individuals with glucose (40.4% to 3.7%), triglycerides (38% to 7.4%), HDL cholesterol (31 % to 7.4%) and uric acid (70.5% to 11.1%) abnormalities reduced. Also, there is a reduction of food intake at first year postoperative. After 10 years, there was an increase in energy, protein and lipid intake, also a reduction in folid acid intake. Conclusions : Roux-en Y gastric bypass is an effective procedure to promote weight loss and improve comorbidities associated with obesity. However, comparison between postoperative period of five and 10 years showed a high prevalence of minerals deficiency and a significant weight regain, evidencing the need for nutritional follow-up in the postoperative period.

Abstract Introduction: inflammation and oxidative stress are factors that may play a substantial role in telomere attrition. In line of this, obesity is associated with telomere shortening. Green tea had anti-inflammatory and antioxidant effects and may alter telomere length (TL). Objectives: we evaluated the effect of decaffeinated green tea supplementation in obese women on TL. Methods: we conducted a cross-sectional interventional study with ten obese (body mass index [BMI] > 40 kg/m²) and eight normal weight (BMI > 18.5 and < 24.9 kg/m²) women (age between 27 and 48 years). The supplementation was carried out with capsules (each contained 450.7 mg of epigallocatechin-3-gallate) during eight weeks. Anthropometric and dietary intake assessment, and blood collection (for biochemical and TL analysis by quantitative PCR) were performed before and after supplementation. Normal weight patients were evaluated at a single moment. Results: we observed a significant increase on TL after supplementation (1.57 ± 1.1 to 3.2 ± 2.1 T/Sratio; p < 0.05). Moreover, we found shorter TL in obese patients (day 0) when compared to normal weight individuals (3.2 ± 1.9 T/Sratio; p < 0.05) and an inverse association between TL and BMI, even after age adjustment (beta = -0.527; r² = 0.286; IC = -0.129, -0.009). Conclusion: obesity is related to shorter telomeres. Green tea supplementation during eight weeks promotes telomere elongation in obese women.

Resumen Introducción: la inflamación y el estrés oxidativo son factores que pueden jugar un papel importante en el desgaste de los telómeros. En línea con esto, la obesidad está asociada con el acortamiento de los telómeros. El té verde tiene efectos antiinflamatorios y antioxidantes y puede alterar la longitud de los telómeros (LT). Objetivos: evaluamos el efecto de la suplementación de té verde descafeinado en la LT en mujeres obesas. Métodos: realizamos un estudio intervencionista de corte transversal con 10 mujeres obesas (IMC > 40 kg/m²) y 8 con peso normal (IMC > 18,5 y < 24,9 kg/m²) (edad entre 27 y 48 años). La suplementación se llevó a cabo con cápsulas (cada una contenía 450,7 mg de epigalocatequina-3-galato) durante 8 semanas. La evaluación de la ingesta antropométrica y dietética y la recolección de sangre (para análisis bioquímicos y LT por PCR cuantitativa) se realizaron antes y después de la administración de suplementos. Los pacientes de peso normal fueron evaluados en un solo momento. Resultados: observamos un aumento significativo en LT después de la suplementación (1,57 ± 1,1 a 3,2 ± 2,1 T/S ratio; p < 0,05). Además, encontramos LT más corta en pacientes obesos (día 0) en comparación con individuos de peso normal (3,2 ± 1,9 T/S ratio; p < 0,05) y una asociación inversa entre LT e IMC, incluso después del ajuste de edad (beta = -0,527; r² = 0,286; IC = -0,129, -0,009). Conclusión: la obesidad está relacionada con los telómeros más cortos. La administración de suplementos de té verde durante 8 semanas promueve la elongación de los telómeros en mujeres obesas.

Abstract AIM Taurine is considered a semi-essential amino acid characterized by having various physiological functions in the body that modulate mechanisms of action involved in the muscle contraction process, increased energy expenditure, insulin signaling pathway, carbohydrate metabolism, and scavenging free radicals. These functions are crucial for aerobic exercise performance; thus, taurine supplementation may benefit athletes’ performance. The objective of this study was to evaluate the effects of taurine supplementation on the resting energy expenditure and physical performance of swimming athletes. METHODS In a double-blind study, 14 male swimmers were randomized into two groups: the taurine group (n = 7) and the placebo group (n = 7), which received 3 g per day of taurine or placebo in capsules during 8 weeks. Resting energy expenditure, plasma taurine, physical performance, anthropometry, dietary consumption were measured and an incremental test was performed to determine their maximal front crawl swimming performances before and after the 8-week period. RESULTS The levels of serum taurine (p < 0.0001) and lactate (p = 0.0130) showed a significant increase in the taurine group; however, the other variables were not different. No changes were observed in the resting energy expenditure, mean speed performed, and the anaerobic threshold of the swimmers post-supplementation period. CONCLUSION Supplementation of taurine increased plasma concentrations of this amino acid, but did not lead to significant changes in food intake, rest energy expenditure, and athletes’ performance. However, the supplemented group presented a higher lactate production, suggesting a possible positive effect of taurine on the anaerobic lactic metabolism.

Abstract Introduction: Gene expression analyses from peripheral blood mononuclear cells (PBMC) and white adipose tissue are conflicting. It seems that results from single tissue are not enough to explain how changes affect humans as a complex biological system. Objective: The aim of this study was to compare, from obesity subjects, PBMC and white adipose tissue gene expression that regulates adipogenesis (perilipin 1 [PLIN1], adrenoreceptor beta 3 [ADRB3] and peroxisome proliferator-activated receptor [PPARG2]) and the energy metabolism (uncoupling protein UCP1, UCP2 and UCP3) process. Methods: This study enrolled 35 obese patients, with a body mass index (BMI) > 40 kg/m2 (obesity group [OG]), and ten eutrophic health subjects, 18 > BMI > 24.9 kg/m2 (control group [CG]). Anthropometric and body composition data were assessed at recruitment using standardized protocols. Samples of peripheral blood and subcutaneous adipose tissue (biopsy) were collected to analyze gene expression by RT-qPCR technique. For statistical analysis, we used the Shapiro-Wilk test and Wilcoxon tests by the SPSS software version 20.0; a p < 0.05 significance level was adopted. Results: There were significant differences of PLIN1, ADRB3, PPARG2 and UCP3 expression between blood against adipose tissue samples, showing that these genes are upregulated in adipose tissue. UCP2 expression was upregulated in PBMC. Conclusion: The PLIN1, ADRB3, PPARG2 and UCP3 genes were preferentially expressed in adipose tissue. However, UCP2 was upregulated in PBMC, suggesting that this gene may be assessed in a peripheral blood cell, which is easily accessible, safe and practical.

Resumen Introducción: la expresión de genes de células mononucleares de sangre periférica y de tejido adiposo blanco es contradictoria. Los resultados del tejido no son suficientes para explicar cómo afectan los cambios al ser humano como un sistema biológico complejo. Objetivo: el objetivo de este estudio fue comparar, en individuos con obesidad, la expresión de genes que regulan los procesos de adipogénesis (PLIN1, ADRB3 y PPARg2) y el metabolismo energético (UCP1, UCP2 y UCP3) en sangre y tejido adiposo blanco. Métodos: este estudio incluyó a 35 pacientes con obesidad e índice de masa corporal (IMC) > 40 kg/m2 en el grupo obesidad (GO) y a diez personas sanas con peso normal (18 > IMC > 24,9 kg/m2) en el grupo control (GC). Los datos antropométricos y de composición corporal fueron obtenidos por protocolos estandarizados. Se recogieron muestras de sangre periférica y tejido adiposo subcutáneo (biopsia) para analizar la expresión génica por la técnica de RT-qPCR. Para el análisis estadístico se utilizaron el test de Shapiro-Wilk y pruebas de Wilcoxon mediante el programa SPSS versión 20.0 (p < 0,05). Resultados: no se encontraron diferencias significativas en la expresión de genes PLIN1, ADRB3, PPARg2 y UCP3 entre la sangre y las muestras de tejido adiposo, mostrando que estos genes son regulados positivamente en el tejido adiposo. La expresión del gen UCP2 fue regulada positivamente en sangre. Conclusión: los genes PLIN1, ADRB3, PPARg2 y UCP3 se expresaron de forma preferente en el tejido adiposo. Sin embargo, el gen UCP2 se reguló positivamente en sangre, lo que sugiere que puede ser evaluado en sangre periférica, que es fácilmente accesible, de forma segura y práctica.

Nutritional iron deficiency anemia is considered the main public health problem of poor less-developed and developing countries. The World Health Organization has estimated that 1.5-2.0 billion persons are anemic. It has been said that close to 1 million deaths are linked to iron deficiency anemia. The groups most vulnerable to this form of anemia are said to be small children and women of reproductive age. Our goal is to show that iron fortification in the water, will control anemia. The method used was a literature review. Methods have been identified to control anemia, but the fortification of water is a more efficient, low cost, reaches the entire population, prevents and treats deficiency anemia. We concluded that the iron fortification of drinking water at home is a simple, effective, and low-priced approach for the prevention of iron deficiency anemia prevalent in poor and developing countries.

A anemia por deficiência nutricional de ferro é considerada o principal problema de saúde pública dos países menos-desenvolvidos e em desenvolvimento. A Organização Mundial de Saúde estimou que 1,5-2,0 milhões de pessoas são anêmicas. Aproximadamente 1 milhão de mortes estão ligadas a anemia por deficiência de ferro. Os grupos mais vulneráveis a anemia são crianças e mulheres em idade reprodutiva. Nosso objetivo é mostrar que fortificação de ferro na água, irá controlar anemia. O método utilizado foi revisão da literatura. Diversos métodos têm sido identificados para controle da anemia, mas a fortificação da água é uma forma mais eficiente e de baixo custo, atingindo toda a população, previnindo e tratando a anemia por deficiência. Concluímos que a fortificação de ferro na água potável em casa é uma abordagem simples, eficaz e de baixo custo para a prevenção da anemia ferropriva prevalente nos países pobres e em desenvolvimento.

Objetivo Avaliar se a temperatura da superfície corporal nas proximidades da área de inserção do cateter venoso central é diferente quando os pacientes desenvolvem infecções da corrente sanguínea relacionadas ao cateter.Métodos Estudo transversal observacional. Usando um termômetro infravermelho sem contato, 3 medições consecutivas de temperatura da superfície corporal foram coletadas de 39 pacientes com cateter venoso central nos seguintes locais: nas proximidades da área de inserção do cateter ou do reservatório do cateter totalmente implantável, na região contralateral equivalente (sem cateter), e na fronte do mesmo paciente.Resultados Um total de 323 observações foram coletadas. Respectivamente nos pacientes do sexo masculino e feminino, desconsiderando a ocorrência de infecção, a temperatura média na área do cateter menos a da região contralateral (média ± desvio padrão: -0,3±0,6°C versus -0,2±0,5°C; p=0,36) e a da área do cateter menos a da fronte (média ± desvio padrão: -0,2±0,5°Cversus -0,1±0,5°C; p=0,3) resultaram em valores negativos. Além disso, em pacientes infectados, foram obtidos valores mais elevados na área do cateter (IC95%: 36,6-37,5ºC versus36,3-36,5ºC; p<0,01) e nas subtrações de temperaturas: área do cateter menos região contralateral (IC95%: -0,17 - +0,33°C versus-0,33 - -0,20°C; p=0,02) e a área do cateter menos fronte (IC95%:-0,02 - +0,55°C versus -0,22 - -0,10ºC; p<0,01).Conclusão Utilizando um termômetro infravermelho sem contato, os pacientes com infecções da corrente sanguínea associadas ao cateter apresentaram valores de temperatura mais elevados, tanto ao redor da área de inserção do cateter e na subtração das temperaturas das regiões contralateral e fronte, em relação àquelas da área do cateter.

Objective To evaluate if body surface temperature close to the central venous catheter insertion area is different when patients develop catheter-related bloodstream infections.Methods Observational cross-sectional study. Using a non-contact infrared thermometer, 3 consecutive measurements of body surface temperature were collected from 39 patients with central venous catheter on the following sites: nearby the catheter insertion area or totally implantable catheter reservoir, the equivalent contralateral region (without catheter), and forehead of the same subject.Results A total of 323 observations were collected. Respectively, both in male and female patients, disregarding the occurrence of infection, the mean temperature on the catheter area minus that on the contralateral region (mean ± standard deviation: -0.3±0.6°C versus-0.2±0.5ºC; p=0.36), and the mean temperature on the catheter area minus that on the forehead (mean ± standard deviation: -0.2±0.5°C versus-0.1±0.5ºC; p=0.3) resulted in negative values. Moreover, in infected patients, higher values were obtained on the catheter area (95%CI: 36.6-37.5ºC versus 36.3-36.5ºC; p<0.01) and by temperature subtractions: catheter area minus contralateral region (95%CI: -0.17 - +0.33ºC versus -0.33 - -0.20ºC; p=0.02) and catheter area minus forehead (95%CI: -0.02 - +0.55ºC versus-0.22 - -0.10ºC; p<0.01).Conclusion Using a non-contact infrared thermometer, patients with catheter-related bloodstream infections had higher temperature values both around catheter insertion area and in the subtraction of the temperatures on the contralateral and forehead regions from those on the catheter area.

Background/aims: micronutrient deficiency may contribute to a poorer control of diabetes. Thus, the objective of the present study was to assess the urinary excretion of micronutrients in patients with type 2 diabetes mellitus. Methods: patients with diabetes and controls were assessed regarding food intake, anthropometry, urinary loss of micronutrients and compared by the nonparametric Mann-Whitney test (p<0.05). Results: nine diabetic volunteers (52 ± 14 years, BMI 30 ± 11 kg/m² and abdominal circumference (AC) of 99 ± 25 cm) and 9 control individuals (51 ± 16 years, BMI 26 ± 5 kg/m² and AC of 90 ± 13 cm) were studied. Higher iron excretion was observed in the diabetic group and higher magnesium excretion in the control group. Conclusions: the type 2 diabetic patients here studied did not show increased micronutrient excretion in urine when compared to controls.

Introducción/objetivos: la deficiencia de micronutrientes puede contribuir a un menor control de la diabetes. El objetivo de este estudio fue evaluar la excreción urinaria de micronutrientes en pacientes con diabetes mellitus tipo 2. Métodos: los pacientes con diabetes y los controles fueron evaluados por la ingesta de alimentos, la antropometría, la pérdida urinaria de micronutrientes y comparados por Mann Whitney no paramétrico (p<0,05). Resultados: fueron evaluados nueve sujetos diabéticos (52 ± 14 años con un IMC de 30 ± 11 kg/m² y la circunferencia de la cintura (CC) de 99 ± 25 cm) y nueve sujetos control (51 ± 16 años, IMC 26 ± 5 kg/m² y CA total de 90 ± 13 cm). La excreción de hierro más alta se observó en el grupo diabético y la mayor excreción de magnesio en el grupo de control. Conclusiones: el tipo 2 de pacientes diabéticos estudiados aquí no mostraron un aumento en la excreción de micronutrientes en la orina en comparación con los controles.

Contexto Ressecções intestinais extensas resultam em perda de fluídos e eletrólitos. Objetivo Avaliar os níveis séricos de minerais e eletrólitos em pacientes com síndrome do intestino curto, dependentes ou não de nutrição parenteral. Métodos O estudo incluiu 22 adultos com síndrome de intestino curto, sendo 11 dependentes de nutrição parenteral (Grupo NP) e 11 sujeitos que recebiam todo aporte nutricional por via oral (Grupo VO). Foram incluídos 14 voluntários saudáveis, pareados para a idade e o gênero (Grupo Controle). A avaliação da ingestão alimentar, antropometria, níveis sanguíneos de sódio, potássio, fósforo, magnésio, cálcio, zinco, ferro e cobre foram documentados em todos os voluntários. Resultados Os níveis sanguíneos de sódio, potássio, fósforo, cálcio e zinco foram similares entre os grupos de estudo. Os níveis séricos de magnésio foram menores no Grupo NP (1,0±0,4 mEq/L) em relação aos demais grupos. Além disso, a concentração desse eletrólito foi menor no Grupo VO (1,4±0,3 mEq/L) em relação ao Grupo Controle (1,8±0,1 mEq/L). Foram documentados menores valores cobre (69±24 vs 73±26 vs 109±16 µg/dL) nos grupos NP e VO quando comparados com o Grupo Controle, respectivamente. Conclusão Hipomagnesemia e hipocupremia são distúrbios eletrolíticos comumente observados na síndrome de intestino curto. Os pacientes com ressecção intestinal extensa requerem monitorização e suplementação de magnésio e cobre a fim de prevenir deficiências.

Background Patients with short bowel syndrome have significant fluid and electrolytes loss. Objective Evaluate the mineral and electrolyte status in short bowel syndrome patients receiving intermittent parenteral nutrition or oral feeding. Methods Twenty two adults with short bowel syndrome, of whom 11 were parenteral nutrition dependent (PN group), and the 11 remaining had been weaned off parenteral nutrition for at least 1 year and received all nutrients by oral feeding (OF group). The study also included 14 healthy volunteers paired by age and gender (control group). Food ingestion, anthropometry, serum or plasma levels of sodium, potassium, phosphorus, magnesium, calcium, zinc, iron and copper were evaluated. PN group subjects were evaluated before starting a new parenteral nutrition cycle. Results The levels of sodium, potassium, phosphorus, calcium and zinc were similar between the groups. The magnesium value was lower in the PN group (1.0 ± 0.4 mEq /L) than other groups. Furthermore, this electrolyte was lower in the OF group (1.4 ± 0.3 mEq /L) when compared to the Control group (1.8 ± 0.1 mEq/L). Lower values of copper (69±24 vs 73±26 vs 109±16 µg/dL) were documented, respectively, for the PN and OF groups when compared to the control group. Conclusion Hypomagnesemia and hypocupremia are electrolyte disturbances commonly observed in short bowel syndrome. Patients with massive intestinal resection require monitoring and supplementation in order to prevent magnesium and copper deficiencies.

Objective Bone loss has been established as a major extra-intestinal complication of short bowel syndrome (SBS). The purpose of this study was to correlate bone mineral density (BMD) with body mass index (BMI), serum vitamin and mineral levels in patients with SBS.Material and methods The study was conducted on 13 patients (8 male and 5 female, 54.7 ± 11.4 years) with SBS (residual small bowel length of 10 to 100 cm). We determined the food ingestion, anthropometry, serum levels of vitamins C, A, D, E and K, as well as serum and urinary levels of phosphorus and calcium. BMD was measured by dual-energy x-ray absorptiometry (DXA).Results Osteopenia and osteoporosis was diagnosed in all but one SBS patient. Serum levels of vitamin D were low in all volunteers. Sixty-one percent of patients had vitamin E deficiency; hypovitaminosis A and C occurred in one subject. BMI and C, E and K vitamin serum levels correlated with T-score of BMD.Conclusions Osteopenia and osteoporosis were common in SBS patients. There was a correlation between BMD and the serum levels of vitamins C, E and K, an indicative that such vitamins may influence bone health. Arch Endocrinol Metab. 2015;59(3):252-8

Introduction: Informatization contributes to the integration among various sectors, cost reduction, and improved quality of services. This study aimed to assess the impact on cost/benefit of the integration of electronic prescription of pediatric formulas and enteral diets in the respective production areas in a hospital. Methods: We analyzed the quantitative consumption and financial cost of the products corresponding to 80% of the budget ceiling for the annual programming of each modality during 2 consecutive months in two steps, i.e., before and after the implementation of the new module. Results: A more effective control of the quantities produced and of the final products dispensed was observed, reducing both the traceable and untraceable demands (an 85% reduction in financial terms from R$ 3770.25/months before to R$ 566.73/month after). Conclusion: The change represented a technological innovation that improved the quality of the service provided and contributed to waste reduction.

Introducción: La informatización contribuye para la integración entre distintos sectores, la reducción de costes y la mejora de la calidad de los servicios. Este estudio tuvo como objetivo evaluar el impacto sobre los costes y beneficios que ofrece la integración de la receta electrónica de formulaciones pediátricas y la alimentación enteral con sus respectivas zonas de producción de un hospital. Métodos: Se analizaron el consumo cuantitativo y financiero de los productos correspondientes al 80% del límite máximo del presupuesto de la programación anual de cada modalidad durante 2 meses consecutivos en dos etapas, antes y después de la implementación del nuevo módulo. Resultados: Hubo un control más efectivo de las cantidades producidas, dio a conocer los productos finales, reduciendo las demandas tanto trazables y no rastreables (reducción de 85% en términos financieros, de R$ 3770,25 / mes por adelantado y R$ 566,73 / mes más tarde). Conclusión: El cambio representó una innovación tecnológica que proporciona una mejor calidad de servicio y ha contribuido a la reducción de residuos.

Introduction: Short bowel syndrome is associated with weight loss due to nutrient, electrolyte and fluid malabsorption. In view of the pathophysiology of SBS, all patients would be expected to exhibit similar clinical signs and symptoms, whereas many variations occur probably due to the adaptive capacity of the remaining small intestine in order to compensate for the resected area. Objective: To determine whether there is a difference in nutritional status and food intake between patients receiving PNT, patients who do not receive PNT but are monitored on an ambulatory basis, and control subjects, and 2) to determine body composition by two different methods, i.e., electrical bioimpedance and skin fold measurement. Methods: This was a case-control study where the subjects were divided into three groups: parenteral group (PG) - adults with a history of SBS intermittently using PNT; ambulatory group (AG) - adults with a history of SBS who do not receive PNT; control group (CG) - adults with no history of intestinal resections and/or use of PNT. The volunteers were submitted to measurements of body weight, height, body composition by bioimpedance analysis and assessment of food intake using a food frequency questionnaire. Univariate analysis of variance (ANOVA) with the aid of the SAS® 9.2. software, using the PROC GLM feature. The Student t-test was used to compare the instruments for the assessment of body composition, with the aid of the PROC TTEST feature of the SAS® 9.2 software. Results: Thirty-two volunteers, 19 women and 13 men, participated in the study. The PNT group consisted of 9 volunteers, 4 women and 5 men, with a mean (± SD) age of 57 ± 9 years. The nutrition status and food intake were different between the groups. There was no difference in percent body fat measured by anthropometry and bioimpedance analysis. Discussion and conclusion: Large resections, as well as the resected portions, explain the greater nutritional impairment of PG compared to AG and CG, although no significant difference in food consumption was detected between these three groups. Since the use of PNT can lead to a state of hyperhydration, the results of BIA should be interpreted with caution, in view of the fact that the lean mass determined by this method varies positively with the hydration state of an individual.

Introducción: El síndrome del intestino corto se asocia con pérdida de peso por la malabsorción de nutrientes, electrolitos y líquidos. A la vista de la fisiopatología del SIC, se esperaría que todos los pacientes exhibieran signos y síntomas clínicos similares, mientras que pueden ocurrir variaciones probablemente por la capacidad de adaptación del intestino delgado restante con el fin de compensar el área resecada. Objetivo: Determinar si existen diferencias en el estado nutritivo y en el consumo de alimentos entre pacientes que reciben TNP, aquellos que no reciben TNP pero que están monitorizados de forma ambulatoria e individuos control, y 2) determinar la composición corporal mediante dos métodos distintos: la bioimpedancia eléctrica y la medición del pliegue cutáneo. Métodos: Éste fue un estudio de casos-control en el que se dividió a los sujetos en tres grupos: el grupo de parenteral (GP) - adultos con una historia de SIC y con uso intermitente de TNP; grupo ambulatorio (GA) - adultos con una historia de SIC que no recibían TNP; grupo control (GC) - adultos sin antecedentes de resecciones intestinales ni uso de TNP. Los voluntarios fueron sometidos a mediciones del peso corporal, talla, composición corporal mediante análisis de bioimpedancia y evaluación del consumo de alimentos utilizando un cuestionario de frecuencia de alimentos. Se realizó un análisis de varianza (ANOVA) con la ayuda del programa SAS® 9.2, utilizando la aplicación PROC GLM. Se empleó el test t de Student para comparar los instrumentos de la evaluación de la composición corporal, con la ayuda de la aplicación PROC TTEST del programa SAS® 9.2. Resultados: 32 voluntarios, 19 mujeres y 13 hombres, participaron en el estudio. El grupo TNP estaba compuesto de 9 voluntarios, 4 mujeres y 5 hombres, con una edad media (± DE) de 57 ± 9 años. El estado nutritivo y el consumo de alimentos fueron diferentes entre los grupos. No hubo diferencias en el porcentaje de grasa corporal medida por antropometría y análisis de bioimpedancia. Discusión y conclusión: Las resecciones largas, así como las porciones resecadas, explican la mayor alteración nutricional del grupo GP en comparación con los grupos GA y GC, aunque no se detectaron diferencias significativas en el consumo de alimentos entre los tres grupos. Puesto que el empleo de TNP puede conducir a un estado de hiperhidratación, los resultados del ABI deberían interpretarse con precaución puesto que la masa magra determinada por este método varía positivamente con el estado de hidratación de un individuo.

Introduction: Energy balance is influenced by the oxidation of macronutrients (proteins, carbohydrates and lipids). Objective: To characterize substrate utilization in normal weight and obese. Subjects and Methods: Bioelectrical impedance analysis and indirect calorimetry were used to determine the oxidation of carbohydrates and lipids in hospitalized patients. Subjects were divided into three groups: group 1: BMI 18.5-24.9 kg/m, group 2: BMI 25-29.9 kg / m and Group 3: BMI> 30 k/m². Groups of individuals were compared using ANOVA and, in some cases, after the Dunn test was applied (p <0.05 were considered significant). Results: 38 individuals (11 men and27 women) with a mean age of 44.3 ± 16.5 years ofwhich 18 were eutrophic, 10 overweightand10 obese. Obese subjects had higher resting energy expenditure than normal individuals. Obese and non-obese individuals oxidized similar amounts of carbohydrates and lipids. Conclusions: BMI was not associated with the oxidation oflipids and carbohydrates in hospitalized patients. The amount offat mass is associated with the total amount of carbohydrate and lipid oxidation.

Introducción: El balance de energía se ve influenciado por la oxidación de macronutrientes (proteínas, carbohidratos y lípidos). Objetivo: Caracterizar la utilización de sustratos en sujetos con peso normal y obesos. Metodología: se realizó una impedancia bioeléctrica y una calorimetría indirecta para determinar la oxidación de carbohidratos y lípidos de pacientes hospitalizados. Los sujetos fueron divididos en tres grupos, el grupo 1: IMC 18,5-24,9 kg / m2, grupo 2: IMC 25-29.9 kg / m2 y el grupo 3: IMC> 30 kg / m2. Los grupos de individuos se compararon mediante la prueba de ANOVA y, en algún caso, después de la prueba se aplicó el Dunn (p< 0,05 consi-derado significativo). Resultados: Se estudiaron 38 personas (11 hombres y 27 mujeres) con una edad media de 44,3±16,5 años; 18 normales, 10 con sobrepeso y 10 obesos. Los sujetos obesos tenían un mayor gasto energético en reposo que los individuos normales. Obesos y no obesos oxidan cantidades similares de carbohidratos y lípidos. Conclusiones: El índice de masa corporal no se asoció con la oxidación de los lípidos y carbohidratos en pacientes hospitalizados. La cantidad de masa sin grasa se asocia con la cantidad total de hidratos de carbono y oxidación de lípidos.

Objectives: The bioavailability of dietary iron present in a nutritional formulation may be evaluated by in vitro and in vivo methods since they provide for a cohesive line study and provided in the literature. The aim of this study was to evaluate the bioavailability of iron targeting a comparative analysis of two nutritional supplement formulations (A and B). Methods: For this study were using in vitro and in vivo methods, both described in the literature for availability of iron in an enteral feeding after ingestion supplement nutrition with much nutrients. Results: The results obtained by in vitro simulation of the human gastrointestinal tract were 0.70 ± 0.02 and 0.80 ± 0.01 % iron availability by formulations A and B. In vivo studies, as measured by the curves of serum iron in humans after ingestion of formulations allowed the calculation of coefficient of variation Δ < 0, indicating that there was a low absorption of iron. The bioavailability of iron as two multinutrients solutions obtained by in vitro and in vivo showed that there were comparisons of those methodologies used in this study.

Objetivos: La biodisponibilidad de hierro presente en una formulación nutricional puede ser evaluada por in vitro y in vivo, ya que proporcionan para un estudio de línea cohesiva y proporcionado en la literatura. El objetivo de estudio fue evaluar la biodisponibilidad de hierro con in vitro y in vivo, dirigida a un análisis comparativo de dos formulaciones de suplementos nutricionales (A y B). Métodos: Fueron utilizados dos métodos descritos en la literatura que para evaluar la biodiponibilidad de hierro. Uno que es la simulación de digestión humana y otro por los niveles de hierro sérico después de la ingestión de la formulación en los seres humanos. Resultados: Los resultados obtenidos por la simulación in vitro de la digestión del tracto gastrointestinal humano fueron 0,70 ± 0,02 y 0,80 dialisibilidad 0,01% de hierro, respectivamente, para las formulaciones A y B. Los estudios in vivo, segú n se mide por las curvas de hierro en suero en seres humanos después de la ingestión de las formulaciones mostró coeficiente de variación Δ < 0, lo que indica que había una baja absorción de hierro. La biodisponibilidad de hierro a los dos multinutrientes soluciones fueron obtenidos por in vitro y in vivo mostraron que había una comparación de las metodologías utilizadas en soluciones acuosas de muchos nutrientes.