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The study aimed to evaluate the effects of three supplementation strategies on intake, apparent digestibility, feeding behavior, performance, carcass traits, proximate composition, and the fatty acid profile of meat from steers on tropical pasture during the post-weaning and finishing stages. The experiment involved 33 1/2 Holstein × 1/2 castrated Zebu steers weighing 335 ± 42.90 kg, aged 22 ± 2 m. The animals were managed on Urochloa brizantha cv. Marandu using an intermittent grazing system with continuous stocking and variable stocking rates for 310 days. The supplementation strategies were as follows: MS/US (mineral salt/urea supplementation): mineral salt in the rainy season and mineral salt with urea in the dry season; US/PS1 (urea supplementation/protein supplementation): mineral salt with urea in the rainy season and protein supplement at 1 g/kg body weight (BW) in the dry season; and PS1/PS2 (protein supplementation 1/protein supplementation 2): protein supplement at 1 g/kg BW in the rainy season and 2 g/kg BW in the dry season. The dry matter intake did not differ significantly (p > 0.05) between strategies. However, the post-weaning PS1/PS2 strategy resulted in higher (p < 0.05) crude protein intake. The final body weight did not differ (p > 0.05) between the strategies, but the average daily gain in post-weaning and finishing was higher (p < 0.05) for MS/US (restricted) animals. Carcass weight, subcutaneous fat thickness, and lipid content in meat were significantly higher (p < 0.05) for steers in the PS1/PS2 group. Steers finished on MS/US produced meat with a higher content of polyunsaturated fatty acids and ω-3 fatty acids (p < 0.05). Concentrate supplementation at 1 g/kg BW during the rainy season and 2 g/kg BW during the dry season is recommended for post-weaning and finishing steers on tropical pasture.

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Post-Covid-19 Syndrome (PCS) is a condition that causes persistent symptoms and impacts nutritional status such as loss of muscle mass. The objective of this study was to review and map scientific evidence on nutritional management in the loss of muscle mass in patients with PCS. The scoping review protocol was prepared following the PRISMA-ScR guidelines. Review articles not written in English or those that included only hospitalized patients and pertained to conditions other than PCS were excluded. Data extraction followed the methodology outlined by the Cochrane Review Group. Of the 81 articles initially identified, only five met the inclusion criteria. The selected studies emphasized the importance of recovering muscle mass, higher protein and caloric intake, and physical strength exercises. Consequently, nutritional interventions aimed at mitigating muscle mass loss should prioritize strategies that increase caloric and protein consumption.

A Síndrome Pós-covid-19 (SPC) é uma condição que acarreta sintomas persistentes e impactam o estado nutricional, como a perda de massa. O objetivo deste estudo foi realizar revisão para mapear evidências científicas acerca do manejo nutricional na perda de massa muscular em pacientes com SPC. O protocolo da revisão de escopo foi elaborado de acordo com o PRISMA-ScR. Foram excluídos artigos de revisão que não estivessem em inglês ou português, que incluíssem apenas pacientes hospitalizados e com outras condições que não a SPC. Os dados foram extraídos com base no Cochrane Review Group. 81 artigos foram identificados e a amostra final incluiu cinco estudos. Para a recuperação da massa muscular, maior ingestão proteica, calórica e exercícios físicos de força foram descritos nos estudos. A intervenção nutricional para recuperar a perda de massa muscular deve considerar estratégias que visam o aumento do consumo calórico e proteico.

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The neuropeptide pituitary adenylate cyclase-activating polypeptide (PACAP) belongs to the glucagon/secretin family. PACAP interacts with the pituitary adenylate cyclase-activating polypeptide receptor type 1 (PAC1) and vasoactive intestinal peptide receptors 1 and 2 (VPAC1 and VPAC2), exhibiting functions in the immune, endocrine, and nervous systems. This peptide is upregulated in numerous instances of brain injury, acting as a neuroprotective agent. It can also suppress HIV-1 and SARS-CoV-2 viral replication in vitro. This work aimed to identify, in each peptide-receptor system, the most relevant residues for complex stability and interaction energy communication via Molecular Dynamics (MD), Free Energy calculations, and Protein-energy networks, thus revealing in detail the underlying mechanisms of activation of these receptors. Hydrogen bond formation, interaction energies, and computational alanine scanning between PACAP and its receptors showed that His1, Asp3, Arg12, Arg14, and Lys15 are crucial to the peptide's stability. Furthermore, several PACAP interactions with structurally conserved positions deemed necessary in GPCR B1 activation, including Arg2.60, Lys2.67, and Glu7.42, were significant for the peptide's stability within the receptors. According to the protein-energy network, the connection between Asp3 of PACAP and the receptors' conserved Arg2.60 represents a critical energy communication hub in all complexes. Additionally, the ECDs of the receptors were also found to function as energy communication hubs for PACAP. Although the overall binding mode of PACAP in the three receptors was found to be highly conserved, Arg12 and Tyr13 of PACAP were more prominent in complex with PAC1, while Ser2 of PACAP was with VPAC2. The detailed analyses performed in this work pave the way for using PACAP and its receptors as therapeutic targets.Communicated by Ramaswamy H. Sarma.

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RESUMEN Objetivo Evaluar el cumplimiento de los lineamientos para la desnutrición aguda, moderada y severa en menores de cinco años del Departamento de Córdoba (Colombia). Materiales y Métodos Se realizó un estudio descriptivo correlacional de corte transversal. Participaron 23 Unidades Primarias Generadoras de Datos (UPGD) de instituciones públicas que diligenciaron una encuesta física de acuerdo con los lineamientos de la normativa vigente, con un nivel de confianza de 95% y un máximo error permisible de 5%. Resultados El 83% de las UPGD públicas no realiza búsquedas activas institucionales. El 74% no realiza mantenimiento de los equipos de medidas antropométricas. El 78% no garantiza la prescripción de la Fórmula Terapéutica Lista para el Consumo (FTLC). El 83% no presta la atención en salud con calidad. El 78% de los profesionales no está adherido al lineamiento técnico. Conclusiones Los resultados son concluyentes, no hay adherencia e implementación de los lineamientos en las UPGD públicas y esto se refleja en la atención y los casos notificados al Sistema de Vigilancia Epidemiológica. Algunos reactivos se cumplen en su totalidad, pero estos no se reflejan en la atención integral.

ABSTRACT Objective To evaluate compliance with the guidelines for the management of acute, moderate, and severe malnutrition in children under five years of age in the department of Córdoba (Colombia). Materials and Methods A cross-sectional correlational descriptive study was conducted with 23 Primary Data Generating Units (UPGD) from public institutions participating. The study involved completing a physical survey in accordance with the guidelines of the current standard, with a confidence level of 95% and a maximum permissible error of 5% Results 83% of the public UPGD do not carry out active institutional searches.74% do not perform maintenance on anthropometric measurement equipment. 78% do not guarantee the prescription of the therapeutic formula ready for consumption. Additionally, 83% do not provide quality healthcare, and 78% of professionals do not adhere to the technical guideline. Conclusions The results are conclusive: there is a lack of adherence to and implementation of guidelines in public UPGD, and this is reflected in the quality of care provided and in the cases reported to the Epidemiological Surveillance System. While some criteria are fully met, they do not contribute to comprehensive care.

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Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD) and is associated with increased morbidity and mortality, and lower quality of life. It is a complex syndrome, in which inflammation and retention of uremic toxins are two main factors. Causes of inflammation and uremic toxin retention in CKD are multiple; however, gut dysbiosis plays an important role, serving as a link between those entities and PEW. Besides, there are several pathways by which microbiota may influence PEW, e.g., through effects on appetite mediated by microbiota-derived proteins and hormonal changes, or by impacting skeletal muscle via a gut-muscle axis. Hence, microbiota disturbances may influence PEW independently of its relationship with local and systemic inflammation. A better understanding of the complex interrelationships between microbiota and the host may help to explain how changes in the gut affect distant organs and systems of the body and could potentially lead to the development of new strategies targeting the microbiota to improve nutrition and clinical outcomes in CKD patients. In this review, we describe possible interactions of gut microbiota with nutrient metabolism, energy balance, hunger/satiety signals and muscle depletion, all of which are strongly related to PEW in CKD patients.

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ABSTRACT Objective Evaluate the effects of maternal low-protein diet on the oxidative stress in the hypothalamus of 60-day-old rats. Methods Male Wistar rats were divided into two experimental groups according to the mother's diet during pregnancy and lactation; control group (NP:17% casein n=6) and a malnourished group (LP:8% casein n=6). At 60 days of life, the rats were sacrificed for the collection of the hypothalamus for further biochemical analysis. Results Our results showed an increase in oxidative stress in malnourished group, observed through an increase in carbonyl content (p=0.0357), a reduction in the activity of the glutathione-S-transferase enzyme (p=0.0257), and a reduction in the non-enzymatic antioxidant capacity evidenced by the decrease in the ratio reduced glutathione/oxidized glutathione (p=0.0406) and total thiol levels (p=0.0166). Conclusion A low-protein diet during pregnancy and lactation is closely associated with increased oxidative stress and reduced antioxidant capacity in the hypothalamus of sixty-day-old rats.

RESUMO Objetivo Avaliar os efeitos da restrição proteica materna sobre o estresse oxidativo no hipotálamo de ratos de 60 dias de idade. Métodos Ratos Wistar machos foram divididos em dois grupos experimentais de acordo com a dieta da mãe durante a gestação e lactação: grupo controle (NP: 17% caseína n=6) e grupo desnutrido (LP: 8% caseína n=6). Aos 60 dias de vida, os ratos foram sacrificados para coleta do hipotálamo para posterior análise bioquímica. Resultados Os resultados demonstraram aumento do estresse oxidativo no grupo desnutrido, observado através do aumento do conteúdo de cabonilas (p=0,0357) e redução da atividade da enzima glutationa-S-transferase (p=0,0257) e da capacidade antioxidante não enzimática, evidenciada pela queda da razão glutationa reduzida/glutationa oxidada (p=0,0406) e dos níveis de tióis totais (p=0,0166). Conclusão Uma dieta com baixo teor de proteínas durante a gestação e lactação está intimamente associada ao aumento do estresse oxidativo e à redução da capacidade antioxidante no hipotálamo de ratos de 60 dias de vida.

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The objective of this study was to evaluate the performance, feed intake, carcass traits, and economic aspects of cattle fed different levels of supplementation during the growing phase (mineral supplementation-MS; low protein supplementation-PS, at 0.15% of body weight (BW); and a high protein-energy supplementation-PES at 0.40% of BW) and finished on the pasture with concentrate supplementation at 1.6% of BW. Ninety bulls were distributed in a completely randomized design and allocated into paddocks predominantly composed of Urochloa brizantha cv. Marandu grass. During the finishing phase, cattle were managed in paddocks of Urochloa decumbens grass. The average daily gain (ADG) and total weight gain during the growing phase were not different between animals fed PS (0.670 kg/day; 57.1 kg, respectively) and PES (0.730 kg/day; 62.4 kg, respectively), but both differed significantly from those supplemented with MS (0.540 kg/day; 45.1 kg). There was no difference between groups for average daily gain and total weight gain during the finishing phase (0.600 kg/day; 48.3 kg) and the same response was observed for carcass yield (55.18%, on average). However, bulls fed PES had higher hot carcass weight compared with those supplemented with MS and PS. Protein supplementation (0.15% of BW) and protein-energy supplementation (0.40% of BW) improved beef cattle performance during the growing phase. However, supplementation during the growing phase has a small impact on cattle performance in the finishing phase, although protein-energy supplementation at the growing phase improves the hot carcass weight and carcass traits during the finishing phase.

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Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status. AIM: To evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD. This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form™, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured. Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p=0.06) and severe (p=0.005) PEW had lower HRQoL score [68 (52-75), 55 (45-72), 46 (43-58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ2 58.2, p<0.0001). As conclusion, PEW severity was related with worse HRQoL, either as overall score or in every component or subscale in CAPD patients. Poor HRQoL was predicted independently by PEW severity and obesity; additional predictors were hypoalbuminemia and low education.

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INTRODUCTION: The protein-energy wasting (PEW) syndrome is a common complication in hemodialysis (HD) patients associated to morbidity and mortality. Our objective was to assess the prevalence of PEW and its association with erythropoietin resistance index (ERI) score, body composition by impedance, health-related quality of life, and muscle strength. METHODS: In this cross-sectional, observational, multicenter study, we included data from 191 HD patients from three HD clinics located in Mexico City, Mexico. Clinical and biochemistry variables, body composition, handgrip strength, and the KDQOL-SF36 questionnaire were collected for each patient. FINDINGS: Prevalence of PEW was 22% (n = 41/191), with a higher frequency in those with diabetes mellitus (59% vs. 49%, p = 0.04). Subjects with PEW had lower hemoglobin levels (9.5 + 1.6 g/dl vs. 10.3 + 1.7 g/dl; p = 0.005) and higher ERI scores (19.2 ± 11.2 vs. 15.6 ± 8.2; p = 0.04) compared with the non-PEW group. In analysis of body composition, PEW was associated to higher overhydration status (42.2 vs. 24.9 OH/kg; p = 0.009), higher extracellular water (263 ± 40 vs. 246 ± 32 ml/kg; p = 0.019), lower lean tissue index (12.2 ± 3.2 vs. 14.1 ± 3.7 ml/m2 ; p = 0.021), and lower fat tissue index (9.6 ± 5.7 vs. 12.3 ± 6.2 ml/m2 ; p = 0.043). Handgrip strength was lower in PEW patients (22.5 vs. 28.1 kg; p = 0.002). Finally, no significant differences were observed between groups in quality-of-life assessment. DISCUSSION: In this study, PEW was associated to poor responsiveness to erythropoiesis-stimulating agents, lower muscle strength, and higher overhydration status due to the increase in extracellular water which replaced the loss of tissue. Nevertheless, quality-of-life assessment was not different in patients with PEW compared with those without this complication.

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Malnutrition is characterised by deficient nutrient ingestion and absorption and is still one of the most important causes of morbidity and mortality in children worldwide. Our main rationale was that protein-energy malnutrition (PEM) may affect eye movement in children with malnutrition. Twenty children without PEM (mean age = 10.8; SD = 1.0 years) and 18 children with PEM (mean age = 10.9; SD = 1.2 years) were included in the present study. We applied three types of tests: one that consisted of a maze and two versions of the Spot the Seven Errors test using boats and elephants. Our results indicated that children with PEM exhibited performance deficits in the maze test (p < .001) and Spot the Seven Errors test for both boats (p < .001) and elephants (p < .001). These data suggest that nutritional impairments during the first year of life (i.e., a critical period) can directly impact eye movement. Eye tracking is a reliable technique to investigate higher-order processes, but our results should be interpreted with caution. Our findings highlight the relevance of cognitive development in malnourished children, which can negatively affect their development. Screening, assessment and rehabilitation strategies are essential in this at-risk population.

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OBJECTIVE: The aim is to verify the association between nutritional status and muscle strength, considering handgrip strength (HGS) cutoffs associated with sarcopenia and mortality. METHODS: Cross-sectional analysis, including hemodialysis patients. Malnutrition Inflammation Score (MIS) was used to assess nutritional status. Muscle function was assessed by HGS, and the considered cutoffs were established by other studies. Cutoffs for sarcopenia diagnosis were 27 and 16 kg for males and females, respectively; cutoffs associated with mortality were 22 and 7 kg for males and females, respectively. Two binary logistic regression models were built, with HGS categorized according to the cutoff for sarcopenia and mortality as dependent variables. RESULTS: Of the 218 patients who were included, 56.9% were male, the mean age was 58.3 years, and 44.7% diabetic; 132 patients (60.6%) had HGS <27 or 16 kg. Age, prevalence of diabetes, and MIS were higher, creatinine and albumin were lower in patients with HGS below these values; 77 patients (35.2%) had HGS <22 or 7 kg. Age, male, and diabetes prevalence, CRP and MIS were higher, midarm muscle circumference (MAMC), creatinine, albumin, and urea were lower in patients with HGS below these values. In the logistic regression MIS (OR 1.202; 95% CI 1.073-1.347; P < .01), age, male, diabetes, and MAMC were associated with the risk of HGS below the cutoffs for sarcopenia. MIS (OR 1.322; 95% CI 1.192-1.467; P < .01), age, male, and diabetes were associated with the risk of HGS below the cutoffs associated with mortality. CONCLUSION: Worse nutritional status increases the risk of HGS below the cutoffs associated with sarcopenia and mortality in hemodialysis patients.

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BACKGROUND: The prevalence of mental health concerns is growing worldwide, along with lack of access to and receipt of needed treatment. Current gaps in treatment provision have led to exploring alternative methods of prevention, with research linking nutrition and mental health, of particular relevance in low- and middle-income countries, with a high prevalence of undernutrition. OBJECTIVES: To examine whether exposure to a protein-energy nutritional supplement during the first 1000 d of life decreased odds of mental distress in adulthood among men and women in Guatemala compared with receiving a low energy-no protein supplement or supplementation outside the 1000-d window. METHODS: Data from participants (n = 1249) in a longitudinal cohort protein-energy supplementation trial (early-life, supplementation data from 1969 to 1977, ages 0-7 y; life course, outcome data from 2017-2018 follow-up, ages 40-57 y) were analyzed for associations between nutrition in the first 1000 d and mental distress in adulthood (WHO Self-Reporting Questionnaire 20 [SRQ-20]), controlling for early-life variables and current life stress; life course variables (e.g. education) were examined as potential mediators of this relation. Generalized linear mixed models and zero-inflated Poisson generalized linear mixed models were utilized. RESULTS: Both partial and full supplementation with Atole during the first 1000 d were associated with 63% (95% CI: 0.16, 0.87) and 56% (95% CI: 0.19, 1.03) lower odds, respectively, of experiencing mental distress in adulthood. Results did not differ by sex. These inverse relations remained relatively unchanged (partial OR = 0.34 [95% CI: 0.14, 0.83]; full OR = 0.38 [95% CI: 0.16, 0.92]) after controlling for early-life and life course variables, including life stress. CONCLUSIONS: Protein-energy supplementation during the first 1000 d of life in Guatemala, where undernutrition is prevalent, may reduce the prevalence of later mental distress in adulthood. This effect appears to occur directly, rather than indirectly, through pathways of life course variables such as education, wealth, and marital status.

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PURPOSE: The study assessed the impact of intradialytic oral nutritional supplementation on the quality of life in patients receiving hemodialysis and diagnosed with protein energy wasting. METHODS: A pre-test post-test quasi-experimental study was conducted before and after 3 months of intradialytic oral nutritional supplementation on 109 older hemodialysis patients. We measured before and after 3 months of intradialytic oral nutritional supplementation, the quality of life score, the burden of kidney disease, three quality of life scales and the mental and physical health status using KDQoL-SF™ 1.3, body composition and biochemical parameters of nutritional condition. RESULTS: The mean age of the patients was 69.4 ± 3.4 years, 59% were male, and the time on dialysis was 63.5 ± 52.6 months. Comparing the baseline with month 3 of intradialytic oral nutritional supplementation, we observed to better quality of life. In contrast to malnutrition, score, specifically increased significantly score of symptoms/problems list related to hemodialysis, sexual function, social and cognitive function, sleep, pain, energy/fatigue and general state of health. Significant changes were also found in nutritional status, energy intake and body composition indicators. After 3 months of intradialytic oral nutritional supplementation, we observed a nutritional status recovery in one or more indicators in 92% of the patients. CONCLUSION: Our findings indicate that 3 months of intradialysis oral nutritional supplementation improves the components of physical and mental quality of life and nutritional status in older patients receiving hemodialysis diagnosed with loss of protein energy. These results are relevant to improve the experience of patients with protein energy loss receiving hemodialysis.

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BACKGROUND: The prevalence of mental health concerns is growing worldwide, along with lack of access to and receipt of needed treatment. Current gaps in treatment provision have led to exploring alternative methods of prevention, with research linking nutrition and mental health, of particular relevance in low- and middle-income countries, with a high prevalence of undernutrition. OBJECTIVES: To examine whether exposure to a protein-energy nutritional supplement during the first 1000 d of life decreased odds of mental distress in adulthood among men and women in Guatemala compared with receiving a low energy-no protein supplement or supplementation outside the 1000-d window. METHODS: Data from participants (n = 1249) in a longitudinal cohort protein-energy supplementation trial (early-life, supplementation data from 1969 to 1977, ages 0-7 y; life course, outcome data from 2017-2018 follow-up, ages 40-57 y) were analyzed for associations between nutrition in the first 1000 d and mental distress in adulthood (WHO Self-Reporting Questionnaire 20 [SRQ-20]), controlling for early-life variables and current life stress; life course variables (e.g. education) were examined as potential mediators of this relation. Generalized linear mixed models and zero-inflated Poisson generalized linear mixed models were utilized. RESULTS: Both partial and full supplementation with Atole during the first 1000 d were associated with 63% (95% CI: 0.16, 0.87) and 56% (95% CI: 0.19, 1.03) lower odds, respectively, of experiencing mental distress in adulthood. Results did not differ by sex. These inverse relations remained relatively unchanged (partial OR = 0.34 [95% CI: 0.14, 0.83]; full OR = 0.38 [95% CI: 0.16, 0.92]) after controlling for early-life and life course variables, including life stress. CONCLUSIONS: Protein-energy supplementation during the first 1000 d of life in Guatemala, where undernutrition is prevalent, may reduce the prevalence of later mental distress in adulthood. This effect appears to occur directly, rather than indirectly, through pathways of life course variables such as education, wealth, and marital status.

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This study evaluated the influence of the quantitative traits measured by real-time ultrasound (adjusted longissimus muscle area [AdjLMA], adjusted rump fat thickness [AdjRFT], and adjusted marbling [AdjMAR]) as well as age at first breeding [AFB] and adjusted weight [AdjWeight], on the probability of occurrence of early pregnancy (EP) in 55 Nellore heifers, and also performed an economic analysis. All calves received supplementation in creep-feeding (ad libitum), and at weaning (average age= 210 ± 30 days; average weight= 241 ± 33 kg) until first breeding by artificial insemination (May to November) all heifers were managed in the same group (two paddocks of 25 ha each evenly covered with Urochloa Marandu Grass) and received protein-energy supplementation (1% of average BW per animal/day). The quantitative variables were collected immediately after timed artificial insemination (average age= 392 ± 27 days; average weight= 431.90 kg), and the pregnancy diagnosis was completed at 30 days following insemination. For economic analysis, two systems were compared (age at first breeding at 13 and 24 months). The greater adjusted weight on the first breeding increased the probability of occurrence of early pregnancy, while the greater adjusted longissimus muscle area reduced. In addition, intensive meat production systems provide greater economic return throughout cow-calf operation.(AU)

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Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status. AIM: To evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD. This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form™, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured. Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p=0.06) and severe (p=0.005) PEW had lower HRQoL score [68 (52-75), 55 (45-72), 46 (43-58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ2 58.2, p<0.0001). As conclusion, PEW severity was related with worse HRQoL, either as overall score or in every component or subscale in CAPD patients. Poor HRQoL was predicted independently by PEW severity and obesity; additional predictors were hypoalbuminemia and low education.

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OBJECTIVE: This study aimed to develop two non-industrial food products as financially accessible options to prevent and treat malnutrition in hemodialysis (HD) patients. These food products were developed and intended for use as dialysis snacks. METHODS: This is a cross-sectional and multi-step study. First, 183 adult HD patients (55 ± 14 years; 50.8% males), replied to a questionnaire with their food preferences regarding taste (salty, sweet, bitter, sour) and consistency (liquid, solid, pasty) for a dialysis snack. Most patients preferred a food product with a solid consistency (90%) and a salty flavor (81.4%). Second, three muffin formulations of fine herbs were developed; one enriched with whey protein concentrate (WPC), a second with textured soy protein (TSP) and a third standard formulation without protein for comparison with the protein-enriched muffins, for which the chemical and nutritional compositions were analyzed. In the third step, 60 patients on HD (61 ± 15 years; 53% males) were enrolled in a sensory analysis by applying a 9-point structured hedonic scale, ranging from "extremely liked" (score 9) to "extremely disliked" (score 1). RESULTS: When compared with the standard formulation, the formulations enriched with WPC and TSP protein had a significantly higher amount of protein/serving (Standard: 5.9 ± 0.3 g vs WPC: 14.5 ± 0.9 g and TSP 10.8 ± 0.7 g; P < 0.05) but a lower amount of carbohydrate (Standard: 13.1 ± 2.2 g vs WPC: 5.6 ± 0.8 g and TSP 6.0 ± 1.2 g vs; P < 0.05). The mineral content/serving of the protein-enriched muffins was low in phosphorus (50 mg) and sodium (180 mg). The potassium content/serving was moderate for the WPC muffin (225.2 mg) and low for the TSP muffin (107.9 mg). The acceptability index (AI) for the enriched protein muffins was higher than 70% and similar to the standard formulation. CONCLUSION: The muffins with fine herbs and enriched with protein were well-accepted by all patients and appropriate to serve as dialysis snacks for HD patients.

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Resumen Introducción: la enfermedad renal crónica (ERC) es un problema de salud mundial con una prevalencia aproximada del 7,2 % en países desarrollados y del 10 % en todo el mundo; además, es un factor independiente de morbilidad y riesgo cardiovascular que se caracteriza por la pérdida progresiva de la función renal. Objetivo: evaluar la frecuencia de desgaste proteico energético (DPE) en pacientes con ERC en estadios III a IV. Materiales y métodos: estudio descriptivo y de corte transversal. Se realizó una evaluación de los registros de las base de datos de la Sociedad Internacional de Nutrición y Metabolismo Renal sobre pacientes con ERC que contaran con variables sociodemográficas, bioquímicas, valoración global subjetiva (VGS) y medidas antropométricas para el diagnóstico de DPE. Resultados: de 200 pacientes revisados en consulta externa de Nefrología, 60 cumplieron con los criterios de inclusión. El promedio de edad fue de 68,4 años, con una media de tasa de filtración glomerular (TFG) de 47,1 mL/min. Respecto a la ERC, el 61,66 % (n=37) de los participantes fue clasificado en estadio IIIa; el 31,6 % (n=19), en estadio IIIb, y el 6,66 % (n=4), en estadio IV. Ninguno de los pacientes cumplió con los criterios para el DPE. La evaluación de la VGS mostró que el 53,33 % (n=32) de los pacientes estaba en categoría VGS-A (bien nutridos), el 45 % (n=27) en VGS-B (malnutrición moderada) y solo un paciente en VGS-C (malnutrición grave). La mayor proporción de pacientes con bajos niveles de albúmina y colesterol estuvo en pacientes con ERC en estadio IIIb, y los pacientes con índice de masa corporal <23, en estadios IIIb y IV. Conclusión: según los criterios de la Sociedad Internacional de Nutrición y Metabolismo Renal, ningún paciente presentó DPE.

Abstract Introduction: Chronic kidney disease (CKD) is a condition that is recognized as a global health problem and has an approximate prevalence of 7.2% in developed countries, and 10% in the world population, it is also an independent factor of cardiovascular morbidity and risk characterized by progressive loss of kidney function. Objective: To evaluate the frequency of DPE in patients with CKD stages III to IV. Methods: Descriptive, cross-sectional study. Evaluation of a database of patients with CKD, which will have sociodemographic, biochemical variables, Subjective Global Assessment (VGS), and anthropometric measures, for the diagnosis of DPE of the International Society for Nutrition and Renal Metabolism. Results: Of 200 reviewed patients from the Nephrology outpatient clinic, 60 met the inclusion criteria. The average age was 68.4 years, with a mean glomerular filtration rate (GFR) of 47.1ml / min. Regarding CKD, 61.66% (37) of the patients classified in stage IIIa, 31.6% (19) in stage IIIb, and 6.66% (4) in stage IV. None of the patients met the criteria for DPE. The VGS evaluation showed that 53.33% (32) of the patients were in the VGS A category (well nourished), 45% (27) VGS B (moderate malnutrition) and only one patient was classified as VGS C (severe malnutrition). The highest proportion of patients with low levels of albumin and cholesterol was in patients with CKD stage IIIb, and patients with BMI less than 23 in stages IIIb and IV. Conclusion: According to the criteria of the International Society for Renal Nutrition and Metabolism, no patient had DPE. outpatient clinic in Caldas, with CKD stages III to IV-. METHODS: Descriptive, cross-sectional study. Evaluation of a database of patients with CKD, which will have sociodemographic, biochemical variables, Subjective Global Assessment (SGA), and anthropometric measures, for the diagnosis of PEW of the International Society for Nutrition and Renal Metabolism. RESULTS: Of200 reviewed patients from the Nephrology outpatient clinic, 60 met the inclusion criteria. The average age was 68.4 years, with a mean glomerular filtration rate (GFR) of 47.1ml / min. Regarding CKD, 61.66% (37) of the patients were classified in stage IIIa, 31.6% (19) in stage IIIb, and 6.66% (4) in stage IV. None of the patients met the criteria for PEW. The SGA evaluation showed that 53.33% (32) of the patients were in SGAA category (well nourished), 45% (27) SGA B (moderate malnutrition) and only one patient was classified as SGA C (severe malnutrition). The highest proportion of patients with low albumin and cholesterol levels was in patients with CKD in stage IIIb, and patients with BMI less than 23 in stages IIIb and IV. Conclusion: According to the criteria of the International Society for Nutrition and Renal Metabolism, no patient had PEW.

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ABSTRACT BACKGROUND: The protein-energy malnutrition alters the prognosis of patients with cirrhosis. Its prevalence may vary according to the etiology of liver disease, it´s severity and the evaluation of the method applied. The infection by the hepatitis C virus (HCV) and alcoholism are the main etiologies of cirrhosis and result in a significant morbidity and mortality. OBJECTIVE: To evaluate the nutritional status of patients with cirrhosis according the liver disease etiology and severity. METHODS: It is a prospective study, in which the sample was for convenience and consisted of patients with cirrhosis, infected by HCV or alcoholic etiology. The nutritional status evaluation was carried out through anthropometry, food consumption, bioelectrical impedance (BIA) and subjective global assessment (SGA). The anthropometric data evaluated were weight, height, body mass index (BMI), triceps skinfold (TSF), circumference of the arm (CA), non-dominant handshake strength (FAM) and the adductor pollicis muscle thickness (APM). Patients were classified according to the severity of liver disease, using the Child-Pugh and Model for End-stage Liver Diseases (MELD) scores. RESULTS: Ninety patients with cirrhosis were evaluated, 47 with HCV and 43 with alcoholic etiology. The prevalence of protein-calorie malnutrition ranged from 10.9% to 54.3% in the HCV group and from 4.7% to 20.9% in the alcoholic group, depending on the method used for evaluation. The group with HCV infection presented a higher malnutrition prevalence in comparison to the alcoholic in the following evaluations: TSF (P<0.001), phase angle (PA) (P=0.016) and SGA (P=0.010). PA values were lower in patients with viral cirrhosis (5.68±1.05) when compared to those with alcoholic etiology (6.61±2.31) (P=0.016). When all patients were analyzed, regardless of etiology, an inversely correlation was observed among Child-Pugh score and PA values (P=0.018). CONCLUSION: HCV cirrhosis showed worse nutritional parameters in comparison to alcoholic etiology; however, the PA was associated with worse liver function in both etiologies.

RESUMO CONTEXTO: A desnutrição proteico-calórica altera o prognóstico dos pacientes com cirrose. Sua prevalência pode variar de acordo com a etiologia da hepatopatia, gravidade da doença e o método de avaliação empregado. A infeção pelo vírus da hepatite C (VHC) e o alcoolismo, estão entre as principais etiologias da cirrose e acarretam significativa morbidade e mortalidade. OBJETIVO: Avaliar o estado nutricional do paciente com cirrose de acordo com a etiologia e gravidade da hepatopatia. MÉTODOS: Estudo prospectivo, em que a amostra foi por conveniência constituída de pacientes com cirrose, infectados pelo vírus da hepatite C (VHC) ou etiologia alcoólica. A avaliação do estado nutricional foi realizada através da antropometria, consumo alimentar, bioimpedância elétrica (BIA) e da avaliação subjetiva global (ASG). Os dados antropométricos avaliados foram: peso, altura, índice de massa corporal (IMC), prega cutânea triciptal (PCT), circunferências do braço (CB), força do aperto de mão não dominante (FAM) e a espessura do músculo adutor do polegar (MAP). Os pacientes foram classificados de acordo com a gravidade da hepatopatia, através do escore Child-Pugh e Model for End-stage Liver Diseases (MELD). RESULTADOS: Foram avaliados 90 pacientes com cirrose, 47 com etiologia pelo VHC e 43 com etiologia alcoólica. A prevalência de desnutrição proteico-calórica variou de 10,9% a 54,3% no grupo do VHC e de 4,7% a 20,9% no grupo dos alcoolistas, dependendo do método utilizado para avaliação. O grupo com infecção pelo VHC apresentou maior prevalência de desnutrição em relação ao de etiologia alcoólica nas seguintes avaliações: PCT (P<0,001), ângulo de fase (AF) (P=0,016) e ASG (P=0,010). Os valores do AF foram menores nos pacientes com cirrose viral (5,68±1,05) quando comparados aos com etiologia alcoólica (6,61±2,31) (P=0,016). Quando analisados todos os pacientes, independente da etiologia da hepatopatia, observou-se uma correlação inversamente proporcional entre a classificação de Child-Pugh e os valores de AF (P=0,018). CONCLUSÃO: A cirrose pelo VHC demonstrou piores parâmetros nutricionais em relação à etiologia alcoólica; entretanto, em ambas etiologias o AF foi associado com pior função hepática em ambas etiologias.

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