Objective: The objective of this systematic review is to discuss the feeding difficulties (FD) in premature infant (PI), the factors involved, and, when applicable, to compare these FD with full-term infants. Method: Articles were considered eligible in the databases Pubmed, Lilacs, and Scopus, published until March 2020, in Portuguese or English. Results: 11 studies were included. FD mentioned was food selectivity, food refusal, and vomiting. In studies comparing IP with full-term children, PI showed less impulse to eat, a tendency to have less food variety, less appetite, and less pleasure with food. Discussion: It is still inconclusive whether there is a pattern of FD related to prematurity and which may be associated with their involved factors in PI. Therefore, we highlighted the importance of clarifying how to promote healthy feeding, observing families that have PI, as well as the need for further studies that can better elucidate the occurrence of FD in PI.

Introdução: O impacto do consumo de frutas sobre a saúde de pacientes com diabetes mellitus tipo 2 (DM2) requer investigações. Objetivo é avaliar o consumo de frutas em pacientes com DM2 e identificar a sua associação com parâmetros de controle glicêmico. Métodos: Incluídos 197 pacientes ambulatoriais com DM2, submetidos à avaliação clínica, sociodemográfica, antropométrica, laboratorial e de consumo alimentar. A ingestão alimentar total e o consumo de frutas foram avaliados por questionário quantitativo de frequência alimentar. Pacientes com menor e maior consumo de frutas (de acordo com a mediana) foram comparados. Resultados: Média do consumo de frutas foi de 593,66 ± 330,74 g/dia. Entre os menores e maiores consumidores de frutas, os valores de glicemia (169,42 ± 70,83 vs. 158,62 ± 64,56 mg/dL; p = 0,273) e hemoglobina glicada (8,39 ± 1,68 vs. 8,68 ± 2,38%; p = 0,319) não foram diferentes, assim como as demais variáveis. O grupo que mais consumiu frutas apresentou uma maior ingestão de vitamina C (p < 0,001) e potássio (p < 0,001) e um menor consumo de sódio (p = 0,001). Observou-se uma correlação negativa entre o consumo de frutas e o índice glicêmico da dieta (p = 0,05). Conclusão: Não houve diferença na glicemia em jejum e no valor de hemoglobina glicada entre os pacientes com DM2 com maior e menor consumo de frutas

Evaluation of association of eating patterns with diabetes kidney disease (DKD) in patients with type 2 diabetes (T2DM) was performed. Cross-sectionally, T2DM patients underwent clinical, laboratory, and nutritional assessments. Dietary information was evaluated by a quantitative food frequency questionnaire validated for diabetes and converted into daily intakes. The eating patterns were identified by cluster analysis. DKD was defined as estimated glomerular filtration rate <60 mL/min/1.73m2 and persistently elevated urinary albumin excretion (≥14 mg/dL). A chi-square test, one-way analysis of variance (ANOVA/Bonferroni’s post hoc test) and Kruskal-Wallis test (Bonferroni post hoc correction) were used to test differences across the eating patterns. Poisson regression analysis was used to investigate the associations between eating patterns and DKD. IBM SPSS Statistics 25.0 (p<0.05). A total of 329 T2DM patients were evaluated: 10 years (5-19) diabetes duration; HbA1c=8.7±2.0%; 62±10 years old; BMI=30.9±4.2kg/m². Four eating patterns were identified: (1) high intake of dairy products, fruits, and vegetables; (2) ultra-processed foods; (3) high intake of refined carbohydrates, processed meats, and solids fats; and (4) high intake of red meat and sugary beverages. Age, sex, sedentary lifestyle, maximum doses of anti-glycemic agent in addition to fasting plasma glucose levels were different among the patterns. Poisson regression models confirmed the association of Pattern 2 (PR=1.48; 95% CI=1.10-1.99; P=0.010) and Pattern 4 (PR=1.93; 95% CI=1.29-2.89; P=0.001) with presence of DKD after adjusting for confounders. In conclusion, eating patterns with higher consumption of ultra-processed foods or red meat and sugary beverages were associated with the presence of DKD when compared to patterns rich in dairy products, fruits, and vegetables in this sample of T2DM outpatients. Disclosure C. C. R. Rodrigues: None. B. P. Riboldi: None. T. C. Rodrigues: None. R. A. Sarmento: None. J. P. Antonio: None. R. A. Borba: None. A. P. Vieira: None. I. S. Pasini: None. J. C. De almeida: None.

BACKGROUND:Preterm newborns have higher nutrition risk and mortality. Nutrition risk screening enables early intervention. This article evaluates a nutrition screening tool in a neonatal intensive care unit (NICU).METHOD:Retrospective longitudinal study of preterm newborns (aged <37 weeks) in a NICU in Brazil from May 2018 to January 2019. Weight, length, and head circumference (HC) were analyzed. Nutrition screening was defined by care levels (CLs). Outcomes analyzed were bronchopulmonary dysplasia (BPD), peri-intraventricular hemorrhage (PIVH), retinopathy of prematurity (ROP), late sepsis, length of stay, mortality, and time receiving enteral and parenteral nutrition.RESULTS:Data on 110 newborns were studied, with median gestational age 34 (31-35) weeks, mean weight 1914.92 g (±657.7), length 42.2 cm (±4.45), and HC 29.9 cm (±2.97). Most (82.7%) of them were adequate for gestational age. Screening classifications were 41.8% (n = 46) at CL 2, 41.8% (n = 46) at CL 3, and 16.4% (n = 18) at CL 4. CL 3 and CL 4 patients had higher frequencies of BPD (P = .003), ROP (P = .027), and PIVH (P = .006) and longer enteral time (P < .001) and length of stay (P < .001). All mortality occurred in CL 4 patients (P < .001).CONCLUSIONS:CL 3 and CL 4 patients had more BPD, ROP, PIVH, and mortality and longer enteral nutrition. Hospital stay was longer for CL ≥3 than CL 2 patients. Patients classified as CL 3 and CL 4 by the nutrition screening tool may have higher nutrition risk.

Este trabajo fue recibido el 05 de junio de 2019. Aceptado con modificaciones: 24 de septiembre de 2019. Aceptado para ser publicado: 20 de noviembre de 2019. ABSTRACT The objective of this study was to identify dietary patterns in an outpatient cohort of coronary heart disease (CHD) patients, to compare these patterns with dietary recommendations of the international cardiology guidelines, and verify associations with cardiovascular risk factors. Dietary intake was assessed through a food frequency questionnaire. Dietary patterns were identified by cluster analysis. The total energy intake, fiber, cholesterol, macro and micronutrients were calculated. Two dietary patterns were identified in 123 patients. Pattern I was characterized by a greater consumption of whole carbohydrates, beans, meats, vegetables, and fruits. Pattern II was rich in refined carbohydrates, fried foods, and sweets. Participants in pattern I had lower values of diastolic blood pressure (DBP) with 77.1 ± 9.9 mmHg (p= 0.002) and glycated hemoglobin (HbA1c) of 7.83 ± 1.76 % (p= 0.029) compared to pattern II with 84.1 ± 14.3 mmHg and 9.02 ± 2.29 %, respectively. Therefore, pattern I had a healthier nutritional composition, however, nutritional adequacy was still lacking. Despite this, participants in pattern I had significantly lower values of DBP and HbA1c, in addition to being associated with a better control of DBP.

Background The overall diet quality of individuals and populations can be assessed by dietary indexes based on information from food surveys. Few studies have evaluated the diet quality of individuals with type 2 diabetes or its potential associations with glycemic control. Objective To evaluate the relationship between diet quality and glycemic control. Design Cross-sectional study with consecutive enrollment from 2013 to 2016. Participants Outpatients with type 2 diabetes treated at a university hospital in southern Brazil. Main outcome measures Dietary information was obtained by a quantitative food frequency questionnaire validated for patients with diabetes. Overall diet quality was evaluated by the Healthy Eating Index 2010. Glycemic control was assessed by fasting plasma glucose and glycated hemoglobin. Statistical analyses A receiver operating characteristic curve was constructed to find the optimal Healthy Eating Index cutoff point to discriminate diet quality, considering good glycemic control as glycated hemoglobin level <7%. Patients were then classified as having lower vs higher diet quality, and the two groups were compared statistically. Logistic regression models were constructed with glycated hemoglobin level >= 7% as the dependent variable, adjusted for age, current smoking, diabetes duration and treatment, physical activity, body mass index, high-density lipoprotein cholesterol level, and energy intake. Results A total of 229 patients with type 2 diabetes (median age=63.0 years [interquartile range=58.0 to 68.5 years]; diabetes duration=10.0 years [interquartile range=5 to 19 years]; body mass index 30.8 +/- 4.3; and glycated hemoglobin=8.1% [interquartile range=6.9% to 9.7%]) were evaluated. A Healthy Eating Index score >65% yielded the best properties (area under the receiver operator characteristic curve=0.60; sensitivity=71.2%; specificity=52.1%; P=0.018). Patients with lower-quality diets were younger and more likely to be current smokers than patients with higher-quality diets. After adjusting for confounders, patients with lower-quality diets had nearly threefold odds of poorer glycemic control (2.92; 95% CI 1.27 to 6.71; P=0.012) than those in the higher-quality diet group. Conclusions Lower diet quality, defined as an Healthy Eating Index 2010 score <65%, was associated with poor glycemic control in this sample of outpatients with type 2 diabetes.

AbstractObjectiveTo evaluate the reproducibility and validity of a previously constructed FFQ to assess the usual diet of patients with type 2 diabetes mellitus (T2DM).DesignCross-sectional survey using two quantitative FFQ (1-month interval) supported by a food photograph portfolio, a 3 d weighed diet record (WDR) and urinary N output measurement (as a biomarker of protein intake).SettingGroup of Nutrition in Endocrinology, southern Brazil.SubjectsOut-patients with T2DM.ResultsFrom a total of 104 eligible T2DM patients, eighty-eight were included in the evaluation of FFQ reproducibility and seventy-two provided data for the validity study. The intakes estimated from the two FFQ did not differ (P> 0·05) and the correlation coefficients were significant (P< 0·01) for energy and nutrients, ranging from 0·451 (soluble fibre) to 0·936 (PUFA). Regarding the validity evaluation, data from the FFQ were higher than those from the WDR for total (28·3 %), soluble (27·4 %) and insoluble fibres (29·1 %), and SFA (13·5 %), MUFA (11·1 %) and total lipids (9·2 %; allP< 0·05). There were significant correlation coefficients between the FFQ and WDR for most nutrients, when adjusted for energy intake and de-attenuated. Also, the Bland–Altman plots between the FFQ and WDR for energy and macronutrient intakes showed that the FFQ may be used as alternative method to the WDR. The validity coefficient (using the method of triads) for the FFQ protein intake was 0·522 (95 % CI 0·414, 0·597).ConclusionsThis quantitative FFQ was valid and precise to assess the usual diet of patients with T2DM, according to its validity and reproducibility.

BACKGROUND Despite the association between cardiovascular diseases and periodontitis, there are scarce data on the impact of oral health in the dietary intake of patients with coronary artery disease (CAD). The aim of this study was to assess the association between dietary intake with periodontitis and present teeth in individuals with stable CAD. METHODS This cross-sectional study included 115 patients with stable CAD (76 males, aged 61.0 ± 8.3 years) who were under cardiovascular care in an outpatient clinic for at least 3 months. Dietary intake was recorded applying a food frequency questionnaire previously validated. Periodontal examinations were performed by two calibrated examiners in six sites per tooth from all present teeth. Blood samples were collected to determine serum levels of lipids. Multivariable logistic and linear regression models were fitted to evaluate the association between dietary outcomes and oral health variables. RESULTS Individuals with periodontitis had significantly higher percentage of total energy intake from fried foods, sweets, and beans, and also had lower consumption of fruits than those without periodontitis. Presence of periodontitis was associated with lower percentage of individuals who reached the nutritional recommendation of monounsaturated fatty acids and higher blood concentration of triglycerides. Having a greater number of present teeth (≥20 teeth) was associated with higher intake of fibers and total calories. CONCLUSION In patients with stable CAD, the presence of periodontitis and tooth loss were associated with a poor dietary intake of nutrients and healthy foods, which are important for cardiovascular prevention.

Purpose: To evaluate the relationship between eating patterns and therapeutic target’s achieving in patients with type 2 diabetes. Methods: In this cross-sectional study, patients underwent clinical, laboratory, and nutritional evaluations. Dietary intake was assessed by a quantitative food frequency questionnaire and eating patterns identified by cluster analysis. The therapeutic targets were as follows: blood pressure, <140/90 mm Hg; BMI, <25 kg/m2 (<27 kg/m2 for elderly); waist circumference, <94 cm for men and <80 cm for women; fasting plasma glucose, <130 mg/dL; HbA1c, <7%; triglycerides, <150 mg/dL; HDL-cholesterol, >40 mg/dL for men and >50 mg/dL for women; LDL-cholesterol, <100 mg/dL. Results: One hundred ninety seven patients were studied. We identified two eating patterns: “unhealthy” (n = 100)—high consumption of refined carbohydrates, ultra-processed foods, sweets and desserts (P < 0.05); and “healthy” (n = 97)—high intake of whole carbohydrates, dairy, white meat, fish, fruits and vegetables (P < 0.05). The healthy group more frequently achieved therapeutic targets for fasting plasma glucose, HbA1c, and LDL-cholesterol than the unhealthy group. Poisson regression confirmed the association of healthy eating pattern with attaining the therapeutic target for fasting plasma glucose [PR, 1.59 (95% CI, 1.01 to 2.34); P = 0.018], HbA1c [PR, 2.09 (95% CI, 1.17 to 3.74); P = 0.013], and LDL-cholesterol [PR, 1.37 (95% CI, 1.01 to 1.86); P = 0.042]. Conclusions: A healthy eating pattern, including the frequent intake of whole carbohydrates, dairy, white meat, fish, fruits, and vegetables, is associated with reduced fasting plasma glucose, HbA1c, and LDL cholesterol levels in patients with type 2 diabetes.

Introduction Progranulin (PGRN) is secreted by adipose tissue and has been linked to obesity, insulin resistance and type 2 diabetes mellitus. There is evidence that a high fat diet increases PGRN expression in rodent adipose tissue. In humans, the relationship between diet composition and concentration of PGRN is still unknown. Objective To investigate the association between dietary intake and serum PGRN levels. Methods This is an exploratory cross-sectional study including 85 subjects. Demographic, clinical, laboratory and anthropometric data were collected. Serum PGRN was determined by enzyme-linked immunosorbent assay after overnight fasting. Dietary intake was assessed by food frequency questionnaire validated for Brazilian southern population. Focused principal component analyses (FPCA) was used to verify the association of dietary components and food groups with PGRN levels. Sensitivity analyses were performed including only subjects with reporting according to the Goldberg and Black cut-offs of energy intake-energy expenditure ratio between 0.76 and 1.24. Results The median PGRN was 51.96 (42.18 to 68.30) ng/mL. Analyzing all sample, the FPCA showed no association of serum PGRN with total energy, protein, carbohydrate, fat and its types, fiber intake and dietary glycemic index; but a significant and positive association between solid fats and PGRN levels (p<0.05). Including only subjects with reporting according cut-off of energy intake-energy expenditure ratio between 0.76 and 1.24, FCPA showed significant and positive association of serum PGRN with saturated fatty acids and solid fats intake (p<0.05). In this subgroup, PGRN correlated with saturated fatty acids (r = 0.341; p = 0.031). Solid fats intake was independently associated to serum PGRN (beta = 0.294; p = 0.004) in multivariate model. Conclusion The dietary intake of solid fats, mainly represented by saturated fatty acids, is associated to serum PGRN concentration in human subjects.

Objective This systematic review aimed to evaluate the association between shift work and eating habits. Methods The protocol was registered in PROSPERO (number 42015024680). PubMed, EMBASE, Scopus, and Web of Science were searched for published reports. Of 2432 identified articles, 33 observational studies met the inclusion criteria. Their methodological approaches were assessed using the Newcastle-Ottawa Scale. Data were extracted using a standardized form. Studies were considered to have a low or a high risk of bias according to a percentage score of quality. Results The majority of the studies presented a quality score of <70% and a high risk of bias for comparability, sample selection and non-respondents. Shift workers show changes in meal patterns, skipping more meals and consuming more food at unconventional times. They also show higher consumption of unhealthy foods, such as saturated fats and soft drinks. Conclusions This review suggests that shift work can affect the quality of workers' diets, but new studies, especially longitudinal studies, which examine the time of exposure to shift work, the duration of the workday and sleep patterns, are necessary to confirm this association.

This study aimed to evaluate the concordance between two dietary indexes, the Healthy Eating Index (HEI) and the Diabetes Healthy Eating Index (DHEI), in evaluating diet quality and its possible association with therapeutic targets in patients with type 2 diabetes.

OBJECTIVE:To analyze possible associations of dietary components, especially protein intake, with blood pressure (BP) during ambulatory BP monitoring (ABPM) in patients with type 2 diabetes.METHODS:In this cross-sectional study, BP of outpatients with type 2 diabetes was evaluated by 24-hour ABPM (Spacelabs 90207) and usual diet by 3-day weighed diet records. Patients were divided into 2 groups according to their daytime ABPM: uncontrolled BP (systolic BP ≥ 135 mmHg or diastolic BP ≥ 85 mmHg) and controlled BP (systolic BP < 135 mmHg and diastolic BP < 85 mmHg). Logistic regression models unadjusted and adjusted for possible confounders (covariates) were used to analyze the association of protein and uncontrolled BP.RESULTS:A total of 121 patients with type 2 diabetes aged 62.3 years, 54.5% of whom were women, were studied. The uncontrolled BP group had higher glycated hemoglobin (HbA1C) values (8.4 ± 2.0 vs 7.6 ± 1.3%; p = 0.04) and consumed more protein (20.0 ± 3.8 vs 18.2 ± 3.6% of energy; p = 0.01) and meat, (2.6 [1.45, 2.95] vs 2.0 [1.49, 2.90] g/kg weight; p = 0.04) than the controlled BP group. In a multivariate analysis, protein intake (% of energy) increased the chance for uncontrolled BP (odds ratio [OR] = 1.16; 95% confidence interval [CI], 1.02, 1.30; p = 0.02), adjusted for body mass index (BMI), HbA1C, low-density lipoprotein (LDL) cholesterol, number of antihypertensive medications, and ethnicity. Meat consumption higher than 3.08 g/kg weight/day more than doubled the chance for uncontrolled BP (OR = 2.53; 95% CI, 1.01, 7.60; p = 0.03).CONCLUSION:High protein intake and meat consumption were associated with high daytime ABPM values in patients with type 2 diabetes. Reducing meat intake might represent an additional dietary intervention in hypertensive patients with type 2 diabetes.

Obesity is linked to the development of cancer. Previous studies have suggested that there is a relationship between bariatric surgery and reduced cancer risk. Data sources were from Medline, Embase, and Cochrane Library. From 951 references, 13 studies met the inclusion criteria (54,257 participants). In controlled studies, bariatric surgery was associated with a reduction in the risk of cancer. The cancer incidence density rate was 1.06 cases per 1000 person-years within the surgery groups. In the meta-regression, we found an inverse relationship between the presurgical body mass index and cancer incidence after surgery (beta coefficient −0.2, P < 0.05). Bariatric surgery is associated with reduced cancer risk in morbidly obese people. However, considering the heterogeneity among the studies, conclusions should be drawn with care.

Obesity is a public health problem of epidemic proportions that affects a significant portion of the world population. The increase of morbidity associated with obesity is particularly important because it is related to increased risk of chronic diseases. Diets and stimulation to physical activity, in association to behavioral therapy, are the initial approach to the problem, which may include the use of pharmacological agents. Exhausted the chances of success of clinical treatment, surgical treatment is indicated. Besides the benefit of significant weight reduction, bariatric surgery is associated with reduction in the incidence of diabetes, dyslipidemia and mortality. However, adverse effects of bariatric surgery should be considered, which can occur both in the short term, as in the long term. Changes in calcium and vitamin D metabolism and bone loss in post-operative care are significant adverse effects that have been reported in recent years. Deficiency of vitamin D leads to decreased intestinal calcium absorption, reduced calcium levels and parathyroid hormone rise, determining increased bone calcium mobilization and decreased renal elimination, along with increased phosphate clearance. Obese subjects who undergo procedures that promote restriction and/or malabsorption of nutrients are at greatest risk of changes in the metabolism of calcium, phosphorus and vitamin D deficiency. Bone loss begins in the first months after surgery. Surgical techniques that cause malabsorption are at the higher risk levels for developing bone diseases. However, there are studies demonstrating changes in bone metabolism in purely restrictive techniques. Regarding fractures risk, it is known that low body weight is a risk factor for fractures, especially in the elderly. However, few studies have demonstrated the occurrence of fractures after bariatric surgery, which is controversial. Based on this review, bariatric surgery is associated with reduced calcium absorption, vitamin D deficiency, bone loss and possibly increased risk of fractures.

FUNDAMENTO: Associações inversas entre a ingestão de micronutrientes e desfechos cardiovasculares foram demonstradas previamente na população geral. OBJETIVO: Revisar sistematicamente o papel de micronutrientes no desenvolvimento/presença de desfechos cardiovasculares em pacientes com diabetes. MÉTODOS: Foi realizada uma busca nas bases de dados Medline, Embase e Scopus (Janeiro/1949-Março/2012) por estudos observacionais que avaliaram micronutrientes antioxidantes e desfechos cardiovasculares em pacientes com diabetes e, em seguida, os dados foram selecionados e extraídos (dois revisores independentes). RESULTADOS: Dos 15658 estudos identificados, cinco foram incluídos, sendo três de caso-controle e dois de coorte, com um acompanhamento de 7-15 anos. Uma metanálise não foi realizada devido aos diferentes micronutrientes antioxidantes (tipos e métodos de medição) e os desfechos avaliados. Os micronutrientes avaliados foram: vitamina C (dieta e/ou suplementação), cromo e selênio em amostras de unha, e α-tocoferol e zinco no soro. A ingestão de > 300 mg de vitamina C a partir de uplementos esteve associada a um risco aumentado de doença cardiovascular, doença arterial coronariana (DAC) e acidente vascular cerebral (RR 1,69-2,37). Altos níveis de α-tocoferol no soro foram associados a um risco 30% inferior de DAC em outro estudo (RR 0,71, IC 95% 0,53-0,94). Entre os minerais (zinco, selênio e cromo), foi observada uma associação inversa entre o zinco e a DAC: níveis inferiores a 14,1 μmol/L foram associados a um risco aumentado para DAC (RR 1,70, IC 95% 1,21-2,38). CONCLUSÃO: A informação disponível sobre essa questão é escassa. Estudos prospectivos adicionais são necessários para elucidar o papel desses nutrientes no risco cardiovascular de pacientes com diabetes.

BACKGROUND:Inverse associations between micronutrient intake and cardiovascular outcomes have been previously shown, but did not focus on diabetic patients.OBJECTIVE:To systematically review the role of micronutrients in the development/presence of cardiovascular outcomes in patients with diabetes.METHODS:We searched Medline, Embase, and Scopus (January/1949-March/2012) for observational studies that evaluated micronutrients and cardiovascular outcomes in patients with diabetes, and then selected and extracted the data (two independent reviewers).RESULTS:From the 15 658 studies identified, five were included, comprising three case-control and two cohorts, with a follow-up of 7-15 years. A meta-analysis was not performed due to the different antioxidant micronutrients (types and measurement methods) and outcomes evaluated. The micronutrients assessed were vitamin C intake in diet and/or supplementation, chromium and selenium in toenail samples, and α-tocopherol and zinc in serum levels. Intake of >300 mg of vitamin C through supplementation was associated with increased risk of cardiovascular disease, coronary artery disease (CAD), and stroke (RR 1.69-2.37). High levels of α-tocopherol in serum were associated with 30% lower CAD risk in another study (HR 0.71; 95%CI 0.53-0.94). Among minerals (zinc, selenium, and chromium), an inverse association between zinc and CAD was observed; levels lower than 14.1 µmol/L were associated with an increased risk for CAD (RR 1.70; 95%CI 1.21-2.38).CONCLUSION:The information available on this issue is scarce. Further prospective studies are needed to elucidate the role of these nutrients in the cardiovascular risk of patients with diabetes.