Rosa Wanda Diez-Garcia

A culinária como objeto de estudo e de intervenção no campo da Alimentação e Nutrição

Culinary is approached here as an object of food and nutritional studies and interventions aimed at dietary changes. In order to explore the culinary potential, two studies are presented: one qualitative, focusing on dietary intake, with subjects from two socioeconomic sectors submitted to salt restrictions; the other uses cooking as structural axis of an educational method for promoting healthy eating. In both studies one can observe the potential of culinary: in the first, as a medium which allows access to information about food procedures that can improve the quality of information about food intake and food practices and, in the second, as an effective space for interventions aimed at food habit changes by addressing their sensorial, cognitive, symbolic and procedural dimensions.

Upper trunk fat assessment and its relationship with metabolic and biochemical variables and body fat in polycystic ovary syndrome

BACKGROUND Fat accumulation in the upper region of the body is common in polycystic ovary syndrome (PCOS) and is associated with metabolic complications. The present study aimed to assess the relationship between trunk circumference, metabolic indicators, and abdominal and visceral fat in obese PCOS women. METHODS The weight, fat mass, and subcutaneous arm fat (SAF) of 30 obese PCOS women and 15 healthy controls matched for age and body mass index were evaluated by bioelectrical impedance analysis. Trunk (TrC), neck (NC) and hip circumferences were measured, and the trunk/hip (Tr/H) ratio was determined. Total abdominal fat (TAF), visceral fat (VF) and trunk fat (TrF) were determined by computed tomography. Biochemical evaluation included glycaemia, insulinaemia, testosterone and lipid profile, insulin resistance (IR) was assessed by the QUICKI index. RESULTS In the PCOS group, there were positive correlations between NC and TAF (r = 0.49, P < 0.0006), TrC and VF (r = 0.62, P = 0.01), and NC and VF (r = 0.70, P < 0.0002). There was good correlation between TrC and TrF (r = 0.69, P = 0.003). TrF correlated with triglycerides levels positively (r = 0.44, P = 0.02). Women with PCOS and IR had a larger quantity of VF and TrF, but a smaller amount of SAF. Within the PCOS group, women with Tr/H ratio above the median had higher basal insulin levels and lower QUICKI indices compared to women presenting a Tr/H ratio below the median. CONCLUSIONS TrC is associated with important metabolic variables in PCOS, proving to be a valuable and innovative tool for assessment of body adiposity distribution in obese PCOS women.

Food energy content influences food portion size estimation by nutrition students.

BACKGROUND Food portion size estimation involves a complex mental process that may influence food consumption evaluation. Knowing the variables that influence this process can improve the accuracy of dietary assessment. The present study aimed to evaluate the ability of nutrition students to estimate food portions in usual meals and relate food energy content with errors in food portion size estimation. METHODS Seventy-eight nutrition students, who had already studied food energy content, participated in this cross-sectional study on the estimation of food portions, organised into four meals. The participants estimated the quantity of each food, in grams or millilitres, with the food in view. Estimation errors were quantified, and their magnitude were evaluated. Estimated quantities (EQ) lower than 90% and higher than 110% of the weighed quantity (WQ) were considered to represent underestimation and overestimation, respectively. Correlation between food energy content and error on estimation was analysed by the Spearman correlation, and comparison between the mean EQ and WQ was accomplished by means of the Wilcoxon signed rank test (P < 0.05). RESULTS A low percentage of estimates (18.5%) were considered accurate (+/-10% of the actual weight). The most frequently underestimated food items were cauliflower, lettuce, apple and papaya; the most often overestimated items were milk, margarine and sugar. A significant positive correlation between food energy density and estimation was found (r = 0.8166; P = 0.0002). CONCLUSIONS The results obtained in the present study revealed a low percentage of acceptable estimations of food portion size by nutrition students, with trends toward overestimation of high-energy food items and underestimation of low-energy items.

Sweet craving and ghrelin and leptin levels in women during stress.

UNLABELLED Ingesting sweet substances in excess may attenuate the effects of stress in women and impact leptin levels, which are also affected by alcohol dependence and overeating. Excess intake of sweet substances also influences ghrelin levels, involved in the onset of food intake and stress. This paper aimed to identify sweet craving (SC) in women with stress to assess how it impacts basal leptin and active ghrelin levels, anthropometric measurements, and body composition. This observational, transversal study included 57 women and used the Stress Symptoms Inventory Lipp in Adults (ISSL); it verified that 31 of the participants were stressed, whereas 26 were symptom-free. The Questionnaire for Assessment of Sweet Substance Dependence and Abuse helped to characterize SC. ELISA furnished leptin and active ghrelin serum levels. HOMA was also evaluated. Electrical bioimpedance provided body composition values. Among the women with stress, 77.42% had SC, and they behaved differently from women without SC. Women with SC exhibited significantly higher basal leptin levels (P < 0.01), but women with and without stress did not differ statistically in terms of leptin levels. Active ghrelin levels in stressed and non-stressed women and in women with and without SC were similar. A larger number of women with SC presented body fat percentage higher than 30% (P < 0.04). Stressed women had significantly higher waist circumference than non-stressed women (P < 0.02). CONCLUSION Stressed women are more prone to SC, and this condition is associated with increased basal leptin levels, larger hip circumference, and altered body composition.

Gauging food and nutritional care quality in hospitals

BackgroundFood and nutritional care quality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional care quality in public and private hospitals.MethodsInvestigation of the Hospital Food and Nutrition Service (HFNS) of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ) and hospital food service quality (FSQ). HFNS was also evaluated with respect to human resources per hospital bed and per produced meal.ResultsComparison between public and private institutions revealed that there was a statistically significant difference between the number of hospital beds per HFNS staff member (p = 0.02) and per dietitian (p < 0.01). The mean compliance with NCQ criteria in public and private institutions was 51.8% and 41.6%, respectively. The percentage of public and private health institutions in conformity with FSQ criteria was 42.4% and 49.1%, respectively. Most of the actions comprising each corpus, NCQ and FSQ, varied considerably between the two types of institution. NCQ was positively influenced by hospital type (general) and presence of a clinical dietitian. FSQ was affected by institution size: large and medium-sized hospitals were significantly better than small ones.ConclusionsFood and nutritional care in hospital is still incipient, and actions concerning both nutritional care and food service take place on an irregular basis. It is clear that the design of food and nutritional care in hospital indicators is mandatory, and that guidelines for the development of actions as well as qualification and assessment of nutritional care are urgent.

Avaliação e monitoramento do estado nutricional de pacientes hospitalizados: uma proposta apoiada na opinião da comunidade científica

OBJETIVO: A desnutricao pode afetar adversamente a evolucao clinica de pacientes hospitalizados e aumentar o tempo de permanencia hospitalar. O objetivo deste estudo foi certificar criterios para avaliacao e acompanhamento do estado nutricional de pacientes hospitalizados aceitos pela comunidade de pesquisadores, docentes e profissionais da area de nutricao clinica. METODOS: Com este proposito aplicou-se um questionario via Internet, a comunidade cientifica, cadastrada na Plataforma Lattes - sistema nacional de cadastro curricular unificado on-line -, para apoiar atividades de fomento de agencias federais e estaduais. O questionario e composto de recomendacoes acompanhadas por uma escala Likert e espacos para justificativas dos participantes em relacao a opcao de aceitacao parcial ou discordância do procedimento proposto. Foi considerado aprovado o procedimento que teve concordância total ou parcial maior ou igual a 70,0%. RESULTADOS: Responderam ao questionario 35,2% dos profissionais contatados. A maioria (84,0%) era professor universitario, sendo 62,0% de universidade publica; 67,0% eram doutores; 63,0% tinha mais de 20 anos de formado; 74,0% eram nutricionistas e 25,0% medicos. Os procedimentos propostos versam sobre as seguintes necessidades: triagem para definicao de complexidade da atencao nutricional, indicadores de avaliacao e monitoramento nutricional durante a internacao e equipamentos e protocolos para o atendimento nutricional. Todos os procedimentos foram aceitos pelos entrevistados. Foi proposto pelos autores um modelo de triagem para definicao da complexidade do atendimento nutricional, considerando os procedimentos aceitos. CONCLUSAO: A aceitacao dos procedimentos propostos fortalece o reconhecimento da necessidade de implantacao de padroes para a avaliacao e monitoramento nutricional nas instituicoes hospitalares.

Weight and body composition variations in overweight women along outpatient nutritional treatment

INTRODUCTION To evaluate the treatment of obesity it is necessary to understand the weight changes, to improve intervention strategies. OBJECTIVE To assess the progression of weight and body parameters in overweight women along a diet therapy. METHODS 163 women participated in this study. They were evaluated for weight, circumferences (waist and hip), and body composition (lean mass and body fat) along the three treatment phases. RESULTS AND DISCUSSION The weight loss percentage was higher in the first treatment phase than in the second one (-6.8 ± 4.8% vs. -4.0 ± 2.7%, p < 0.0001). In the two first phases the circumferences and the lean mass decreased among women with weight loss. Body fat reduction occurred (-2.6%) during the first phase only. CONCLUSION Weight loss and reduction in body parameters occurred mainly in the first treatment phase, showing that it is necessary to rethink intervention strategies.

Dimensionamento de recursos humanos em serviços de alimentação e nutrição de hospitais públicos e privados

The objective of this paper was to characterize and compare the human resources dimensioning in food and nutrition hospital services (FNHS) and the qualification of the dietitian technical personnel in public and private hospitals. We studied 27 hospitals, 17 from Campinas and 10 from Ribeirao Preto, through a structured questionnaire applied to coordinators of the FNHS. The questionnaires addressed working conditions, by the number of beds per dietitian and per FNHS workers and number of meals per beds, per dietitian and per FNHS workers; academic background; and professional experience of dietitians. We found significant differences in the number of beds per dietitian between public (38.2 SD 11.4) and private (94.6 SD 46.4) hospitals, and of FNHS workers per dietitian (11.4 SD 4.9 and 23.8 SD 13.3 for public and private hospitals respectively). The number of meals per bed was greater in public hospitals (p = 0.04). Dietitians with stricto sensu post-graduation degrees are concentrated in public hospitals whereas the ones with lato sensu post-graduation degrees are present in larger numbers in private hospitals. The wide heterogeneity in the dimension of human resources of FNHS in public and private hospitals has been found yet. The public setor showed more favorable conditions hospitals had in some indicators, although short of the needs in the area mainly for nutritional care for hospitalized patients. The results point to the need to provide specific indicators of human resources in FNHS, for the performance of shares in the production of food and nutritional care to hospitalized patients. Build mechanisms for training of nutritionists for areas of competence of hospital food could contribute to improvement of the sector.

Imbalance Between Postprandial Ghrelin and Insulin Responses to an Ad Libitum Meal in Obese Women With Polycystic Ovary Syndrome

Obese women with polycystic ovary syndrome (PCOS) may have impairment in the regulation of food intake associated with ghrelin and insulin. In order to compare postprandial ghrelin and insulin responses to an ad libitum meal, we assessed 30 obese women with PCOS and 23 obese women without PCOS (control group). Blood samples were taken under fasting conditions, preprandially, and 15, 45, 75, and 135 minutes after the beginning of an ad libitum meal and ghrelin and insulin concentrations were analyzed. Insulin resistance (IR) was classified using basal insulin, quantitative insulin sensitivity check index, and homeostasis model assessment index. Mean ad libitum food intake was similar between the groups (468 ± 150 vs 444 ± 165 g, P = .60). The IR was found in 56.6% in PCOS group compared with 30.4% in the control group (P < .01). The postprandial ghrelin response was similar in both the groups but the insulin area under the curve (AUC) tend to be greater in the PCOS group (12807 ± 8149.4 vs 8654.4 ± 7232.3 μIU/mL/min; P = .057). The ghrelin AUC was negatively correlated with the insulin AUC (r = −.5138; P = .01) only in the control group. The imbalance in the feedback mechanisms between insulin and ghrelin, present in obese women, especially those with IR, may affect food intake throughout the day and that could be a mechanism for the development of obesity in PCOS.

Good response of low-fat/high-protein diet in a patient with chyluria

Abstract Chyluria is an inappropriate urinary excretion of chyle that turns the urine milky. A nutritional approach based on low-fat/high-protein content diet associated or not with medium-chain triglyceride (MCT) showed to be an efficient conservative treatment to improve the milky urine appearance in a patient with chyluria. Case report: A 30-year-old female patient was admitted with chyluria of unknown etiology. An ureteropyeloscopy revealed a single lesion in each kidney, both with linear aspect and measuring 5 mm in extension. These lesions were located close to the renal papillae and were leaking a cloudy and milky fluid. Both lesions were laser cauterized followed by improvement of the milky urine. However, the chyluria relapsed after few months and a low-fat/high-protein content diet with 10 g of soybean oil to meet the requirements essential fatty acids (EFA) and with MCT from coconut oil as alternative to prepare foods was started. Few weeks later the patient returned reporting consistent improvement of the milky urine appearance related with the use of the diet. However since the diet was tasteless and time consuming to prepare, she reported low compliance to diet with MCT and the milky urine relapsed. The MCT was discontinued and the diet with EFA source was maintained with better compliance. Since then the chyluria remains in remission. In conclusion, the dramatic improvement of the milky urine with low-fat/high-protein diet with EFA source observed in our patient demonstrates that this nutritional approach is efficient with fast results to treat chyluria during long term.