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- Care causing diagnosis, comorbidities and nutritional status of patients in continuous long term care unitPublication . Marques, M; Gonçalves, V; Vieira, A; Magalhães, F; Godinho, J; Lemos, A; Costa, V; Faria, AnaIntroduction: Poor nutritional status has negative implications on prognosis, cost of care, morbidity and mortality. However, when nutritional assessment is not implemented, malnutrition can go untreated. Objectives: The aim of this study was to establish a relationship between care causing diagnosis, existing comorbidities and nutritional status of patients admitted to a long-term care unit. Methods: In the context of Nutrition Day audit, from 2016 to 2018, nutritional status was assessed using Mini Nutritional Assessment. Sociodemographic and anthropometric data, as well as medical history were collected. Results: Sixty-two individuals were included (51.6% male), with a mean age of 7711 years. Mean BMI was 22.94.3kg/m2. Most of the patients were bedridden or in wheelchair (51.6%). A great part of the sample was at risk of malnutrition (40.3%) and 27.4% was malnourished. The majority of the sample showed dementia (75.8%) and 66.2% had depression. A correlation was found between nutritional status and cognitive status(r = 0.445; p = 0.000); and between nutritional status and functional capacity(r = 0.284; p = 0.025). Care causing diagnosis for most of the patients was central nervous system disease (66.1%), followed by heart disease (59.7%), skeletal muscle disease (30.6%) and cancer (17.7%). An association was found between heart disease and malnutrition (p = 0.023). Almost all of the sample was polymedicated (91.9%) and most was taking antypsychotics and/or neuroleptics (71.0%). Conclusions: In this long-term care unit, malnutrition presented a significant prevalence. Cognitive status decline and low functional capacity seem to be correlated with a worse nutritional status. Also, heart disease was associated with malnutrition, meaning that these are significant risk factors for the development of malnutrition. Nutrition Day audit brings awareness to the importance of nutritional care, as well as the need for development of nutritional screening and assessment protocols.
- Body mass index and body composition in institutionalized older adults with malnutrition sarcopenia and frailtyPublication . Marques, Maria Armanda; Faria, Ana; Cebola, MarisaIntroduction: Malnutrition, sarcopenia and frailty are multifactorial and highly prevalent conditions among institutionalized older adults Objectives: The aim of this study was to asses body mass index and body composition in older adults, according to the diagnosis of malnutrition, sarcopenia and frailty. Methods: Institutionalized older adults with 60 or more years old were included. Nutritional status (Mini Nutritional Assessment), sarcopenia (European Working Group Sarcopenia in Older People criteria) and frailty (Fried Phenotype) were assessed. Body composition was assessed through bioelectrical impedance Results: One-hundred and forty-six individuals, with a mean age of 83 years old and mainly females (63.3%) were included. Malnutrition was diagnosed in 26.2%, sarcopenia in 25.0% and frailty in 61.0%. Mean Body Mass Index (BMI) was 20.7, 25.8 and 26.6kg/m2 in malnourished, at risk and well- nourished individuals, respectively(p = 0.000); 21.6 and 26.8 kg/m2 in sarcopenic and non-sarcopenic individuals(p = 0.000); and 24.3 and 27.7 kg/m2 in fragile and robust individuals(p=0.000). Mean Fat Mass Index was 9.6 and 13.3 kg/m2 in sarcopenic and non-sarcopenic individuals (p=0.007); and 10.3 and 16.0kg/m2 in fragile and robust individuals (p=0.000). Mean Free Fat Mass Index was 12.5, 14.9 and 17.0kg/m2 in malnourished, at risk and well- nourished individuals; 12.0 and 17.0 kg/m2 in sarcopenic and non-sarcopenic individuals(p=0.000); and 14.7 and 17.1kg/ m2 in fragile and robust individuals(p = 0.002) Conclusions: BMI, free fat mass and fat mass were significantly lower in older adults with malnutrition, sarcopenia and frailty. BMI is a practical nutritional status marker, however it needs to be interpreted cautiously in older adults, as it seems that a lower value is associated with a worse prognosis and existing cutoffs may not apply. Nutritional screening and assessment of older adults is essential for a prompt intervention, in order to prevent and reverse these conditions
- Self-control feeding in childrenPublication . Reis, C; Faria, Ana; Pocinho, M; Loureiro, HelenaIntroduction: Overweight and childhood obesity are a public health problem. Therefore, it is fundamental to intervene in the factors at the behavioural level that can lead to changes. Objectives: To evaluate children’s food self-control and to relate it to gender, the phratry, nutritional status and food preferences. To verify the influence of the nutritionist (about food literacy and the nutritional education) in the children’s self-control and dietary preferences. Methods: The study was carried out in a sample of 66 children, aged between 4 and 6 years old, from four kindergarten in the district of Leiria. The criteria used for the analysis was: food self-control, food preferences, nutritional status, food literacy of the head of education and the effect of food education. The statistical treatment of data was performed using SPSS ß version 21 software. Results: In the analysed sample, mainly female (53.0%), 57.6% of the children were not the first children and had normal nutritional status (77.3%); 19.7% were overweight and obese and 3.0% were thinner. The majority of the children (54.5%) presented food self- control. The caregivers showed good knowledge in the scope of food, with an average score of 82.0%. There was a positive significant correlation between the educator and the first choice of the children. Regarding the children’s choices secondary to the nutritionist’s intervention, no significant differences were found. However, although not statistically significant it is clinically relevant, because 25 of the 66 participating children improved their choices. Conclusions: In the preschool stage, the nutritionist intervention can be highly beneficial. Educating for healthy habits and lifestyles, increasing awareness for food good practices and strengthening children self-control might contribute positively to the struggle against childhood obesity.
- Impacto da glicemia pós-prandial e otimização da dosagem de insulina em refeições ricas em proteína e gordura na diabetes tipo 1Publication . Fernandes, Tatiana; Faria, Ana; Loureiro, HelenaO efeito hiperglicémico pós-prandial dos hidratos de carbono tem contribuído para que seja o nutriente mais estudado em indivíduos com diabetes tipo 1. Contudo, outros macronutrientes, como a proteína e a gordura podem afetar significativamente a glicémia pós-prandial. O método da contagem de hidratos de carbono permite flexibilidade na composição das refeições, porém atingir um adequado controlo glicémico é um desafio para indivíduos com diabetes tipo 1, especialmente quando realizam refeições com considerável conteúdo de proteína e gordura. Este artigo de revisão tem como objetivo analisar a evidência sobre o efeito de refeições ricas em proteína e gordura na resposta glicémica pós-prandial e identificar métodos alternativos de dosagem de insulina neste tipo de refeições em indivíduos com diabetes tipo 1. Após o consumo de refeições mistas ocorre redução do aumento da glicemia pós-prandial precoce e hiperglicemia pós-prandial tardia. Nos últimos anos têm surgido estratégias e algoritmos promissores com o objetivo de melhorar os níveis de glicemia após o consumo de refeições mistas, como a contagem de unidades de proteína e gordura, além dos hidratos de carbono, e a administração de insulina em bolus de onda dupla em terapia com bomba infusora de insulina.
- Nutrition Day in nursing homes – risk factors for malnutritionPublication . Marques, M; Damas, M; Costa, E; Brás, M; Lemos, A; Costa, V; Faria, AnaIntroduction: Malnutrition in institutionalized older adults has a significant prevalence, and is associated with cognitive decline, higher morbidity and mortality rates. Objectives: The aim of this study was to assess risk factors for malnutrition in nursing home residents. Methods: Through Nutrition Day audit (2016–2018), demographic and anthropometric data was collected, as well as medical history and nutritional status according to Mini Nutritional Assessment. Results: Sixty-three individuals were included (57.1% male), with a mean age of 849 years. Mean Body Mass Index was 21.55.1 kg/m2. Malnutrition was identified in 47.6% of the patients and nutritional risk in 28.6%. Most of the sample (61.9%) was bedridden or in wheelchair. Most of the individuals showed dementia (82.5%) and depression (79.3%). A positive moderate significant correlation was found between nutritional status and cognitive status (r = 0.407;p=0.001); and between nutritional status and functional capacity (r = 0.474;p=0.000). Considering the diagnosis which caused institutionalization, brain pathologies were the most prevalent (79.4%), followed by cardiovascular diseases (49.2%) and skeletal muscle diseases (27.0%). Mean number of medications taken daily was 74 and 74.6% of the residents were polymedicated. The majority (61.9%) was taking antipsychotics and/or neuroleptics and 28.6% were taking antidepressives. Conclusions: In this sample, individuals are essentially older adults with a high prevalence of malnutrition. The high level of dependence and the presence of dementia are significant risk factors for the development of this condition. Disturbed emotional status and the use of multiple drugs associated with impaired appetite, although without statistically significant associations with nutritional status, are highly prevalent in this sample. Nutritional screening in this population is essential and timely necessary, aiming to prevent deterioration or improve nutritional status.
- Nutritional assessment of patients with mucopolysaccharidosis: a cross-sectional portuguese studyPublication . Faria, Ana; Garcia, P.; Rodrigues, E.; Macário, M.C.; Martins, E.; Janeiro, P.; Diogo, L.
- Body composition, energy and protein intake in institutionalized portuguese older adultsPublication . Marques, M.A.; Faria, Ana; Cebola, M.
- Influence of physical exercise and protein supplementation in quality of life (SF36) in seniors living in the communityPublication . Loureiro, Helena; Pocinho, Margarida; Faria, Ana; Lages, M.; Silva, Marco; Martins, Raul; Veríssimo, Manuel Teixeira
- Dietary practices in methylmalonic acidaemia: a European surveyPublication . Pinto, Alex; Evans, Sharon; Daly, Anne; Almeida, Manuela Ferreira; Assoun, Murielle; Bélanger-Quintana, Amaya; Bernabei, Silvia Maria; Bollhalder, Sandra; Cassiman, David; Champion, Helena; Chan, Heidi; Corthouts, Karen; Dalmau, Jaime; Boer, Foekje de; Laet, Corinne De; Meyer, An de; Desloovere, An; Dianin, Alice; Dixon, Marjorie; Dokoupil, Katharina; Dubois, Sandrine; Eyskens, Francois; Faria, Ana; Fasan, Ilaria; Favre, Elisabeth; Feillet, François; Fekete, Anna; Gallo, Giorgia; Gingell, Cerys; Gribben, Joanna; Hansen, Kit Kaalund; Horst, Nienke Ter; Jankowski, Camille; Janssen-Regelink, Renske; Jones, Ilana; Jouault, Catherine; Kahrs, Gudrun Elise; Kok, Irene; Kowalik, Agnieszka; Laguerre, Catherine; Verge, Sandrine Le; Liguori, Alessandra; Lilje, Rina; Maddalon, Cornelia; Mayr, Doris; Meyer, Uta; Micciche, Avril; Och, Ulrike; Robert, Martine; Rocha, Júlio César; Rogozinski, Hazel; Rohde, Carmen; Ross, Kathleen; Saruggia, Isabelle; Schlune, Andrea; Singleton, Kath; Sjoqvist, Elisabeth; Skeath, Rachel; Stolen, Linn Helene; Terry, Allyson; Timmer, Corrie; Tomlinson, Lyndsey; Tooke, Alison; Kerckhove, Kristel Vande; van Dam, Esther; Hurk, Dorine van den; Ploeg, Liesbeth van der; Van Driessche, Marleen; van Rijn, Margreet; Wegberg, Annemiek van; Vasconcelos, Carla; Vestergaard, Helle; Vitoria, Isidro; Webster, Diana; White, Fiona; White, Lucy; Zweers, Heidi; MacDonald, AnitaBackground -The dietary management of methylmalonic acidaemia (MMA) is a low-protein diet providing sufficient energy to avoid catabolism and to limit production of methylmalonic acid. The goal is to achieve normal growth, good nutritional status and the maintenance of metabolic stability. Aim -To describe the dietary management of patients with MMA across Europe. Methods - A cross-sectional questionnaire was sent to European colleagues managing inherited metabolic disorders (IMDs) (n=53) with 27 questions about the nutritional management of organic acidaemias. Data were analysed by different age ranges (0-6 months; 7-12 months; 1-10 years; 11-16 years; >16 years). Results - Questionnaires were returned from 53 centres. Twenty-five centres cared for 80 patients with MMA vitamin B12 responsive (MMAB12r) and 43 centres managed 215 patients with MMA vitamin B12 non-responsive (MMAB12nr). For MMAB12r patients, 44% of centres (n=11/25) prescribed natural protein below the World Health Organization/Food and Agriculture Organization/United Nations University (WHO/FAO/UNU) 2007 safe levels of protein intake in at least one age range. Precursor-free amino acids (PFAA) were prescribed by 40% of centres (10/25) caring for 36% (29/80) of all the patients. For MMAB12nr patients, 72% of centres (n=31/43) prescribed natural protein below the safe levels of protein intake (WHO/FAO/UNU 2007) in at least one age range. PFAA were prescribed by 77% of centres (n=33/43) managing 81% (n=174/215) of patients. In MMAB12nr patients, 90 (42%) required tube feeding: 25 via a nasogastric tube and 65 via a gastrostomy. Conclusions - A high percentage of centres used PFAA in MMA patients together with a protein prescription that provided less than the safe levels of natural protein intake. However, there was inconsistent practices across Europe. Long-term efficacy studies are needed to study patient outcome when using PFAA with different severities of natural protein restrictions in patients with MMA to guide future practice.
- O consumo de hidratos de carbono em futebolistas masculinos: revisão sistemática e meta-análisePublication . Martinho, Diogo V.; Fernandes, Marlene; Loureiro, Helena S.; Fernandes, Joana; Lemos, João; Faria, AnaINTRODUÇÃO: As diretrizes relativas ao consumo de hidratos de carbono têm sido extensivamente discutidas. Apesar deste macronutriente ser reconhecidamente determinante no rendimento desportivo, escassas revisões sistemáticas e meta-análises foram conduzidas para avaliar a ingestão de hidratos de carbono em futebolistas masculinos. OBJETIVOS: O objetivo desta revisão sistemática, com meta-análise, foi avaliar a ingestão de hidratos de carbono em diferentes períodos da época competitiva. Adicionalmente, foi examinado o consumo de hidratos de carbono por grupo posicional. METODOLOGIA: As bases de dados utilizadas foram PubMed, SPORTDiscus e Web of Science Core Collection. Os estudos incluídos consideraram os seguintes critérios de elegibilidade: jogadores de futebol masculino, idade superior a 18 anos e consumo de hidratos de carbono expresso em g.kg-1.dia-1. RESULTADOS: Inicialmente, foram identificados 1992 artigos. Destes, 11 foram considerados elegíveis para a revisão sistemática e 10 foram incluídos na meta-análise. Os resultados demonstraram que os futebolistas masculinos, consomem em média, 4,3 g.kg-1.dia-1 e 5,0 g.kg-1.dia-1 nos períodos competitivos e preparatórios (pré-época), respetivamente. Não foi encontrado qualquer estudo que reportasse o consumo de hidratos de carbono durante a off-season. Apenas três estudos examinaram a variação do consumo de hidratos de carbono por grupo posicional. Embora as amostras sejam limitadas, os guarda-redes parecem ingerir uma menor quantidade de hidratos de carbono comparativamente a atletas de outras posições em campo. CONCLUSÕES: Considerando as limitações associadas às metodologias utilizadas para aferir o consumo de hidratos de carbono em atletas, a presente revisão sistemática realça a necessidade de desenvolver estratégias nutricionais para o cumprimento das diretrizes deste macronutriente.