Semíramis Martins Álvares Domene

Dietary reference intakes: aplicabilidade das tabelas em estudos nutricionais

Diet planning and food intake evaluation are professional activities classically performed by comparing mean values of ingestion against reference values of nutrient and energy intakes, for either groups or individuals. Without considering certain intrinsic limitations of the reference values, such task may render equivocal conclusions with regard to nutritional adequacy. The nutritional recommendations, prepared as a joint effort between the US Institute of Medicine and Health Canada published since 1997 and known as Dietary Reference Intakes, offer a new model by establishing indices of nutrient intake and refining the concept of risk associated with diet evaluation. Errors of both intra and interindividual nature, due to the variability of an individuals feeding pattern, the uneven distribution of requirements within a population, respectively, and the small number of days of observation, are factors that together can have a large impact on the confidence of the analysis. For these reasons, only the judicious selection of the reference values, published in the form of tables from 1997 through 2005, should enable the user to reach the proper assessment. This paper had the objective of highlighting various critical characteristics of application and compiling the values in order to facilitate their use by both professionals and students of the area.Diet planning and food intake evaluation are professional activities classically performed by comparing mean values of ingestion against reference values of nutrient and energy intakes, for either groups or individuals. Without considering certain intrinsic limitations of the reference values, such task may render equivocal conclusions with regard to nutritional adequacy. The nutritional recommendations, prepared as a joint effort between the US Institute of Medicine and Health Canada published since 1997 and known as Dietary Reference Intakes, offer a new model by establishing indices of nutrient intake and refining the concept of risk associated with diet evaluation. Errors of both intra and interindividual nature, due to the variability of an individuals feeding pattern, the uneven distribution of requirements within a population, respectively, and the small number of days of observation, are factors that together can have a large impact on the confidence of the analysis. For these reasons, only the judicious selection of the reference values, published in the form of tables from 1997 through 2005, should enable the user to reach the proper assessment. This paper had the objective of highlighting various critical characteristics of application and compiling the values in order to facilitate their use by both professionals and students of the area.

Fatores de risco associados ao desmame precoce e ao período de desmame em lactentes matriculados em creches

OBJECTIVE: To evaluate risk factors associated with weaning of infants enrolled in daycare centers. METHODS: Analytical cross-sectional study comprising 56 children aged nine to 18 months in five daycare centers of Sao Paulo. A pre-tested questionnaire was applied to their mother, including questions on demographics and socioeconomic issues, gestation and birth, illness, breastfeeding, complementary feeding (when and how new foods were introduced) and children activities in daycare centers. Factors associated with early weaning and short weaning period (defined as the difference between exclusive breastfeeding period and total breastfeeding period) were determined by bivariate analyses. Conceptual hierarchical multivariate analysis (logistic regression) was applied. RESULTS: In the multivariate analysis, the independent risk factors for early weaning were: family income 25 years (OR 4.91; 95%CI 1.35-17.95); mother living without a partner (OR 6.42; 95%CI 1.28-32.20); use of pacifier before 30 days of life (OR 8.75; 95%CI 1.90-40.23). Risk factors for insufficient weaning period were: attending public daycare centers (OR 3.20; 95%CI 0.77-14.29) and late start of prenatal care (OR 4.13; 95%CI 0.70-31.29). CONCLUSIONS: Characteristics related to family and to daycare centers are risk factors for breastfeeding weaning among institutionalized infants. Such factors approach is strategic to define nutrition and health actions for favoring breastfeeding practice and to qualify daycare centers as infant health and nutrition promoters.

A escola como ambiente de promoção da saúde e educação nutricional

Education as a strategy to fight poverty and undernutrition is a proposal that comes together with the growth and development of a nation. The elementary school environment seems to offer unique conditions for the acquisition of healthy feeding practices, considering the presence of both children and teachers sharing the same place and time. Feeding behavior is a consequence of experiences from many relational levels, from interpersonal, to environmental, community, and even political. The interaction between education area and the National Scholar Feeding Program can result in a relevant proposal with feasibility and sustainability. However, the policy execution faces technical limitations, which demand attention of the nutritionists and policy managers and, moreover, the teachers commitment is still in the beginning. The challenge is to promote collaboration and exchange of knowledge across nutrition and education areas. The paper discusses the technical approach that sustains the nutritionist practice, as well as the limits faced by teachers, considering the quality of the educational system in Brazil.

Dietary zinc improves and calcium depresses growth and zinc uptake in rats fed rice bran

Abstract Wistar rats were fed a basal stabilized-rice bran diet (B), and five additional ones, fortified to supply either 50 or 100% of zinc and calcium requirements, and a combination furnishing 100% of both minerals. Another diet supplemented with the complete mineral mix (MM) was also used. Results show that the low feed efficiency of B was maximized either by supplementation with MM, or by supplementing bran with 50% of the zinc requirement. Attempts to compensate for the low calcium content of bran by supplementation with 50 or 100% of the mineral requirement, did not increase either feed efficiency, growth or liver zinc. These data confirm that only about 11% of zinc contained in bran is nutritionally available and that supplementing with calcium is detrimental, indicating that this by-product is not a recommendable source of minerals.

DRI: síntese comentada das novas propostas sobre recomendações nutricionais para antioxidantes

This is a brief, commented review of the 1998-2000 reports of the Institute of Medicine/Food and Nutrition Board, of the US National Academy of Sciences, particularly that concerning the recommendations for dietary antioxidants. Dietary Reference Intakes (DRI) include Recommend Dietary Allowance (RDA), the new Adequate Intakes and the concepts of Upper Tolerable Intake Levels and Estimated Average Requirements. The term RDA therefore has not disappeared and continues to represent the most refined value known for a numerical recommendation. The Dietary Reference Intakes table is an ensemble of Recommended Dietary Allowance that were either updated, complemented with the Canadian Recommended Nutrient Intake, or completed with Adequate Intake values. Upper Tolerable Intake Leved for the antioxidants, except for the carotenoids, have been proposed in a separate table.

Prescrição e uso de formulados para nutrição enteral pelos Serviços de Nutrição Hospitalares do município de Campinas (SP)

Tube feeding is a recognized means, for dietary management of a disease, successfully surpassing the limits of patients with impaired feeding. Nevertheless, there is no local data about utilization of industrialized or domestic formulae by the Hospital Nutrition Services. In order to evaluate the utilization of both industrialized and the domestic formulae, as well as the health professional involved with diet prescription, all hospitals located in the city of Campinas, Sao Paulo, Brazil were interviewed. Results show that enteral nutrition is a routine for most institutions, and there is no significant deference between the use of industrialized or domestic formulae. In Campinas, the physician is responsible for the diet prescription, despite of the presence of a dietitian in the staff.

Experiências de políticas em alimentação e nutrição

Strategies to face hunger and undernutrition have been directly associated to actions to prevent bad nutrition effects, mainly chronic diseases and obesity. This complex epidemiological scenario requires initiative of medium and long-term projects, with simultaneously immediate and creative measures for emergency situations when no food is available. Among proposals initiated by the public and private sectors, by Universities and by non-governmental organizations, it is common to observe ineffectiveness, despite the commitment and integrity of the proponents, leading to harmful consequences to both community and the initiative. This paper contains reports of some well-succeeded experiences, including elements for analyzing the main problems common to food and nutrition sectors policy and ways of overcoming them. This work was produced by researchers, public policy makers and technicians as a result of the interdisciplinary workshop they attended in 2005. Offered by the Nutrition and Poverty Study Group of Advanced Studies Institute, Sao Paulo University, its goal was to subsidize the improvement of public policies in the area.

La escuela como ambiente para promover la salud y la educación nutricional

Education as a strategy to fight poverty and undernutrition is a proposal that comes together with the growth and development of a nation. The elementary school environment seems to offer unique conditions for the acquisition of healthy feeding practices, considering the presence of both children and teachers sharing the same place and time. Feeding behavior is a consequence of experiences from many relational levels, from interpersonal, to environmental, community, and even political. The interaction between education area and the National Scholar Feeding Program can result in a relevant proposal with feasibility and sustainability. However, the policy execution faces technical limitations, which demand attention of the nutritionists and policy managers and, moreover, the teachers commitment is still in the beginning. The challenge is to promote collaboration and exchange of knowledge across nutrition and education areas. The paper discusses the technical approach that sustains the nutritionist practice, as well as the limits faced by teachers, considering the quality of the educational system in Brazil.

The school as environment to promote the health and nutritional education

Education as a strategy to fight poverty and undernutrition is a proposal that comes together with the growth and development of a nation. The elementary school environment seems to offer unique conditions for the acquisition of healthy feeding practices, considering the presence of both children and teachers sharing the same place and time. Feeding behavior is a consequence of experiences from many relational levels, from interpersonal, to environmental, community, and even political. The interaction between education area and the National Scholar Feeding Program can result in a relevant proposal with feasibility and sustainability. However, the policy execution faces technical limitations, which demand attention of the nutritionists and policy managers and, moreover, the teachers commitment is still in the beginning. The challenge is to promote collaboration and exchange of knowledge across nutrition and education areas. The paper discusses the technical approach that sustains the nutritionist practice, as well as the limits faced by teachers, considering the quality of the educational system in Brazil.