Course Of Nutrition Research Articles

A real-life pediatric experience of Crohn's disease exclusion diet at disease onset and in refractory patients.

We aimed to appraise the real-life efficacy of Crohn's disease exclusion diet (CDED) coupled with partial enteral nutrition (PEN) in inducing clinical and biochemical remission at disease onset and in patients with loss of response to biologics and immunomodulators. We retrospectively gathered data of patients aged less than 18 years of age with a diagnosis of Crohn's disease (CD), who received CDED coupled with PEN at a tertiary level pediatric inflammatory bowel disease center. Sixty-six patients were identified. Forty (60.6%) started CDED plus PEN at disease onset and 26 (39.4%) received CDED with PEN as add-on therapy. Forty-six (69.7%) patients achieved clinical remission (weighted Pediatric Crohn's Disease Activity Index < 12.5) at the end of phase 1, 44 (66.7%) normalized c-reactive protein levels (<0.5 mg/dL) and 18 (27.2%) patients normalized calprotectin levels (<150 µg/g). Nine of 19 (47.3%) of patients with clinically severe disease (defined by Physician Global Assessment) achieved clinical remission at the end of phase I. Patients with extraintestinal manifestations had statistically lower clinical response rates to the dietary regimen (p = 0.018). Among patients who received CDED + PEN as add-on treatment, a previous successful course of Exclusive Enteral Nutrition was associated with statistically higher clinical remission rates at Week 8 (p = 0.026). Clinical response at Week 4 was an independent predictor of clinical remission and fecal calprotectin normalization at Week 8 (p = 0.002). CDED with PEN confirmed its efficacy in a real-life setting, proving to be effective also in refractory patients and those with severe disease. Early clinical response predicts clinical remission at the end of phase 1.

P648 Dietary therapy using a short course of Exclusive Enteral Nutrition followed by the Crohn’s Disease Exclusion Diet in children with mild to severe Crohn’s Disease; maintenance update on the DIETOMICS trial

Abstract Background Exclusive enteral nutrition (EEN) is the first-line treatment for active Crohn’s disease (CD) in children. CD Exclusion Diet (CDED) combined with Partial Enteral Nutrition (PEN) has demonstrated better tolerance with a comparable effect in inducing remission among children with mild to moderate CD. This study evaluated the effectiveness of 2 weeks of EEN followed by CDED+PEN for maintaining remission for up to 24 weeks in children with mild-severe disease. Methods We conducted an international, multicenter, randomized controlled trial comparing 2 weeks of EEN using Modulen®, followed by 3 phases of the CDED+PEN (hereafter CDED), to 8 weeks of EEN followed by PEN with a free diet (hereafter EEN), all extended up to week 24 with a follow up till week 52. Children aged 8-18 with luminal CD duration less than 3 years, mild-severe disease [pediatric CD activity index (PCDAI),15-47.5], and active inflammation [elevated C-reactive protein (CRP),or fecal calprotectin (FC)] were included. Remission was defined as PCDAI≤10. Stable immunomodulator (IM) treatment was allowed, and naïve patients could initiate IM from week 4. Results We randomized 56 patients into two groups: Group CDED (n=30) and Group EEN (n=26); mean age 12.7±2.4, 37% female. Intention-to-treat analysis revealed remission in 18/30(60%) patients with CDED compared to 11/26(42%) with EEN at week 24,p=0.18 and 27% in CDED and 23% in EEN at week 52,p=0.75. Per protocol analysis showed 18/20(90%) remission in CDED compared to 11/14(78%) in EEN at week 8, p=0.35. Among patients who achieved remission at week 8, 18/23(78%) with CDED and 9/14(64%) with EEN maintained remission up to week 24, p=0.15. In CDED,15/20(75%) and 100% of EEN used IM, p=0.04. All CDED patients without IM remained in remission. Reduction of &amp;gt;50% in FC from baseline was obtained in 55% in the CDED and 28% in EEN, p=0.12. PCDAI improved from 31.2[20-35.6] to 5[0-12.5] in CDED and from 22.5[20-29.3] to 5[0-15.6] at week 24 in EEN, p&amp;lt;0.001 to all. CRP and FC significantly improved in both groups. Z score BMI improved from -1.3 [-2.1-(-0.1)] to -0.2 [-0.9-0.4], p=0.003 in CDED and from 0.08[-1.1-0.4] to 0.2[-1.7-0.7] at week 24 in EEN,p=0.098. Remission at week 2 (p=0.006) and overall high compliance (p=0.009) were identified as predictors of response at week 24. Conclusion While 2 weeks of EEN followed by CDED+PEN was not superior to EEN at 14 weeks (as previously reported), extending CDED+PEN for 24 weeks successfully maintained remission for up to 52 weeks in children with mild-to-severe CD. Moreover, a subset of patients maintained sustained clinical remission following CDED monotherapy. The long-term implementation of dietary therapy using CDED+PEN resulted in a significant improvement in nutritional status.

Nutrition of the preterm infant with persistent ductus arteriosus: existing evidence and practical implications.

The persistence of a patent ductus arteriosus (PDA) is a common condition in preterm infants with a prevalence inversely proportional to gestational age. PDA is associated with mild-to-severe gastrointestinal complications such as feeding intolerance, gastrointestinal perforation, and necrotizing enterocolitis, which represent a major challenge for the nutritional management in preterm infants. In this context, the Section on Nutrition, Gastroenterology and Metabolism and the Circulation Section of the European Society for Pediatric Research have joined forces to review the current knowledge on nutritional issues related to PDA in preterm infants. The aim of the narrative review is to discuss the clinical implications for nutritional practice. Because there is little literature on postnatal nutrition and PDA in preterm infants, further research with well-designed studies on this topic is urgently needed. Guidelines should also be developed to clearly define the implementation and course of enteral nutrition and the target nutritional intake before, during, and after pharmacologic or surgical treatment of PDA, when indicated. IMPACT: Persistent ductus arteriosus (PDA) is associated with gastrointestinal complications such as feeding intolerance, gastrointestinal perforation, and necrotizing enterocolitis, which pose a major challenge to the nutritional management of preterm infants. In PDA infants, fluid restriction may lead to inadequate nutrient intake, which may negatively affect postnatal growth and long-term health. The presence of PDA does not appear to significantly affect mesenteric blood flow and splanchnic oxygenation after enteral feedings. Initiation or maintenance of enteral nutrition can be recommended in infants with PDA.

Inflammation and micronutrient deficiency as major risk factors for anemia in children with intestinal failure:A longitudinal cohort study.

Most data on anemia in children with intestinal failure (IF) have been obtained from studies in which the data were collected at a single point in time. We aimed to identify the frequency of anemia and factors associated with hemoglobin levels in children with IF during their course of home parenteral nutrition. We performed a longitudinal cohort study of patients with IF followed up at a pediatric intestinal rehabilitation center. Outcome variables were hemoglobin levels and prevalence of anemia during the follow-up period. The exposure variables were age, duration of parenteral nutrition, chronic disease, and serum concentrations of C-reactive protein, iron, copper, selenium, vitamins A, D, B12 , and folic acid. Twenty-five children with a median time of receiving parenteral nutrition of 40.7 months were included. A median (and interquartile range) of 40.7 (25.2-58) hemoglobin measurements were performed per patient. Mean (SD) hemoglobin was 10.7 (1.8) g/dL at baseline and 11.6 (0.9) g/dL in the last observation (paired t test, P = 0.07); 32% of patients had mean hemoglobin values below the lower limit for age. In a multivariable predictive model, having C-reactive protein >1 mg/dL was associated with a decrease of 0.57 g/dL in hemoglobin (95% CI, -0.90 to -0.24, P = 0.01), and an increase of 1 mg/L in vitamin A concentration was associated with the increase of 0.93 g/dL in Hb level (95% CI, 0.24-1.61; P = 0.008). Anemia affects almost one-third of children with IF and its frequency decreases during the follow-up period. Hemoglobin levels are associated with inflammatory response and serum micronutrient concentrations.

P716 A 2-week course of Exclusive Enteral Nutrition followed by the Crohn Disease Exclusion Diet is effective for Induction and Maintenance of Remission in children with Crohn Disease; the DIETOMICS-CD trial

Abstract Background Exclusive enteral Nutrition (EEN) is considered a first line therapy for children with active Crohn disease (CD). CD Exclusion Diet (CDED)+Partial Enteral Nutrition (PEN) is effective for induction of remission in mild-moderate CD at weeks 6 and 12, with better tolerance than EEN. We assessed whether a 2-week course of EEN, followed by CDED+PEN is superior to 8 weeks of EEN in sustaining clinical remission at week 14, outcomes of CDED up to 24 weeks, and the utility of CDED in mild-severe CD. Methods This international, multicenter, randomized-controlled trial compared 2 weeks of EEN (Modulen, Nestle Health Science) followed by 3 phases of the CDED+PEN to 8 weeks of EEN, followed by PEN with free diet, both up to week 24. Children aged 8-18 with CD&amp;lt;3 years, mild-severe disease [paediatric CD activity index (PCDAI) 15-47.5], and active inflammation [elevated C-reactive protein (CRP) or faecal calprotectin (FCP)] were included. Stable immunomodulator (IM) treatment was allowed. Naïve patients were allowed to start an IM from week 4. Results Of the 63 eligible patients enrolled, 55 were randomized and included in the final intention to treat analysis (target recruitment failed due to COVID); Group 1 (CDED+PEN;29) and group 2 (EEN;26), mean age 12.7±2.4. Steroids-free sustained remission at week 14 was obtained in 20/29(69%) in group 1 and 16/26(61.5%) in group 2, p=0.56. Remission at week 8 was obtained in 22/29(76%) in group 1 and 14/26(54%) in group 2, p=0.08. 16/29(55%) in group 1 and 9/26(34%) in group 2 maintained clinical remission at week 24; p=0.12. Median PCDAI declined from 32.5[20-36.2] to 2.5[0-5.6] and 1.2[0-5.6] in group 1 (p&amp;lt;0.001 for all), and from 22.5[20-29.3] to 0[0-4.3] and 0[0-2.5] in group 2 (p&amp;lt;0.005 for all) at baseline, week 8 and 14 respectively. Median CRP improved in group 1 from 32 mg/L[6-69] to 5[2-16] and 3[2-10.1] (p&amp;lt;0.001 for both) and in group 2 from 10.35 mg/L[5-33] to 3.7[2.2-7.2], p=0.012 and 3.2[2.8-5], p=0.006 at baseline, week 8 and 14 respectively. Median FCP declined in group 1 from 1946 µg/g [862-3304] to 802[196-1312] at week 8 and 241[82-1175] at week 14 (p&amp;lt;0.01 for both), and in group 2 from 1615[605-2692] at baseline to 436[252-1389] at week 8, which then increased to 731[349-1305] at week 14 (p&amp;lt;0.01 for both). At week 14, 12/22(54%) received IM from group 1 and 15/16(93%) from group 2; p= 0.009. Conclusion Two weeks of EEN followed by CDED&amp;PEN and EEN were successful in induction of clinical and biochemical remission in mild-severe paediatric CD, and most CDED+PEN patients-maintained remission to 24 weeks. Sustained clinical remission at week 14 was similar despite higher IM use in the EEN Group, suggesting that CDED might prevents diet-induced inflammation regardless of IM use.

Does body concern, food desire and academic variables associated with anxiety symptoms in women Nutrition students?

PurposeThis study aims to assess the relationship between anxiety with body concern, academic variables and food desire in undergraduate Nutrition students.Design/methodology/approachThis was a cross-sectional study conducted with 173 students from the undergraduate course of Nutrition in the Midwest region of Brazil. Socioeconomic, academic and behavioral data (Beck Anxiety Inventory, Body Shape Questionnaire and Food Desires Questionnaire) were collected.FindingsOne-third of the students had moderate or severe anxiety symptoms. There were no differences between socioeconomic characteristics in terms of the intensity of anxiety symptoms. Students with minimal symptoms of anxiety had a higher average grade in the course, when compared to those with mild or moderate symptoms and those with severe symptoms (p = 0.001). It was observed that 46.2% had some concerns about their bodies and 11% had severe body concerns. The average grade was associated with anxiety so that 1 point in the global grade is associated to 54% (p < 0,001) less chance of having moderate; severe anxiety. In conclusion, average grade was associated with anxiety in undergraduate Nutrition students.Originality/valueAverage grade was a protection factor for anxiety in undergraduate Nutrition students.

Instagram, fast food e Pedagogia Histórico-Crítica: ingredientes para o discurso a favor de uma alimentação saudável no contexto de ensino de inglês

Abstract The purpose of this article is to analyze the discourse of high school students in favor of healthy eating in the context of English language teaching in a public professional education school. Based on Dialogic Discourse Analysis, a corpus composed of 2 posts on Instagram by high school students enrolled in the technical course of Nutrition and Dietetics who produced verbal-visual texts during an action research with English classes inspired by Historical-Critical Pedagogy is explored. The analysis of the posts reveals that the discourse in favor of healthy eating is interrelated with the technical discourse, the everyday discourse, and the discourse about the consequences of fast food consumption. The analysis also shows that the posts have a negative value emphasis in relation to the consumption of fast food, and, through the pamphlet and the informative poster, they denounce the dangers of unhealthy food choices, also seeking to raise awareness among their interlocutors and promote a change in the social practice of these subjects. It is concluded that English classes inspired by Historical-Critical Pedagogy provide students with opportunities to disseminate discourses in a far-reaching social network, expanding their interlocutors, committing themselves to collaborate for a society that is more aware of its eating habits.

Perceptions of students regarding innovative approaches introduced in nutrition and metabolism module at Shifa college of medicine.

To assess the perceptions of 2nd year medical students regarding certain approaches introduced in the course of Nutrition and Metabolism module. The descriptive study was conducted at the Shifa College of Medicine, Islamabad, Pakistan, in December 2020, and comprised all 2nd year medical students who completed the Nutrition and Metabolism module in which new components had been added, including introduction to community nutrition, school visits, Islamic perspective of nutrition, journal club and e-posters. Data was collected using a questionnaire based on the modified Dundee Ready Education Environment Measure, and had 5 categories with a total of 25 questions that were scored on a 5-point Likert scale. Data was analysed using SPSS 22. Of the 100 students, 65(65%) were females and 35(35%) were males. The overall mean age was 20.5 ± 0.5 years. The total mean score was 74.68±2.53. Mean score for student's perception of learning was 38.17±0.17, student's perception of teachers 9.27±0.18, student's academic self-perceptions 12.1±0.11, student's perceptions of atmosphere 9.03±0.03 and student's social self-perceptions 6.11± 0.01. The perceptions medical students about innovations were positive, showing an encouraging attitude in terms of learning approach and outcome.

An Increased Anticholinergic Drug Burden Index Score Negatively Affect Nutritional Status in Older Patients Without Dementia.

Introduction/AimAnticholinergic drugs, which have severe central and peripheric side effects, are frequently prescribed to older adults. Increased anticholinergic drug burden is associated with poor physical and cognitive functions. On the other side, the impact of anticholinergics on nutritional status is not elaborated in the literature. Therefore, this study was aimed to investigate the effect of the anticholinergic burden on nutrition.Materials and MethodsPatients who underwent comprehensive geriatric assessment (CGA) 6 months apart were included in the study. Patients diagnosed with dementia were excluded because of the difference in the course of cognition, physical performance and nutrition. Nutritional status and global cognition were evaluated using Mini Nutritional Assessment-short form (MNA-SF), Mini-Mental State Examination (MMSE). Anticholinergic drug burden was assessed with the Drug Burden Index (DBI), enabling a precise dose-related cumulative exposure. Patients were divided into three groups according to DBI score: 0, no DBI exposure; 0–1, low risk; and ≥1, high risk. Regression analysis was performed to show the relationship between the difference in CGA parameters and the change in DBI score at the sixth month.ResultsA total of 423 patients were included in the study. Participants' mean age was 79.40 ± 7.50, and 68.6% were female. The DBI 0 score group has better MMSE and MNA-SF scores and a lower rate of falls, polypharmacy, malnutrition, and risk of malnutrition in the baseline. Having malnutrition or risk of malnutrition is 2.21 times higher for every one-unit increase in DBI score. Additionally, during the 6-month follow-up, increased DBI score was associated with decreased MNA-SF and MMSE score, albumin.ConclusionsThe harmful effects of anticholinergics may be prevented because anticholinergic activity is a potentially reversible factor. Therefore, reducing exposure to drugs with anticholinergic activity has particular importance in geriatric practice.

65 Complication rate of cuffed versus uncuffed PICC lines placed by interventional radiology in pediatric patients

Abstract Primary Subject area Paediatric Radiology Background Peripherally inserted central catheters are commonly used in pediatrics to offer stable access for administering prolonged courses of antibiotics, chemotherapy, parenteral nutrition, or other intravenous fluids. Objectives To assess the complication rates of cuffed versus uncuffed PICCs in a pediatric tertiary referral centre. Design/Methods Research ethics board approval was sought and granted. A dual arm study design was employed with a retrospective chart review of PICCs inserted between June 2017 - June 2018, and a prospective chart review of PICCS inserted between January 2019 - June 2019 at a large tertiary pediatric referral center. Data collected from the electronic record included age, weight, and diagnosis. Line type, size, location, insertion and removal dates, and indications were recorded. Primary outcome was removal of PICC after completion of therapy or premature removal due to the following complications: infection, thrombosis, or mechanical failure (defined as catheter breakage, blockage, or dislodgement). Results The study included 266 patients. Across all patients weighing &amp;lt; 10 kg, 90.5% of those with cuffed PICCs and 65% of those with uncuffed catheters completed therapy. The predominant complication resulting in premature removal was mechanical failure, but this was only observed in patients with uncuffed catheters (25%). Infection was also observed only in uncuffed catheters (10%), and thrombosis (4.8%) was only in the cuffed lines. For patients weighing ≥ 10 kg, 86% of those with cuffed PICCs and 77.2% with uncuffed catheters completed therapy. More complications were observed in uncuffed catheters (infection 7.7%, mechanical failure 6.6%, thrombosis 5%). Infection resulting in premature removal occurred in 7% of cuffed catheters. There was no reported mechanical failure or thrombosis in the cuffed group. The distribution of diagnoses was relatively homogenous between the groups for most diagnoses. However, there was a higher percentage of oncology patients in the uncuffed group (23%) than the cuffed group (7%) due to the need for power-injectable lines, which were not available in a cuffed variant during this study. Conclusion All-cause pediatric PICC-associated complications rate in the neonate group for patients &amp;lt; 10kg in the uncuffed group is 35% and in the cuffed group is 4.8%. Whereas in the pediatric group ≥ 10kg, all-cause pediatric PICC-associated complications rate in the uncuffed group is 19.3% and in the cuffed group is 7%. There were no mechanical complications in the cuffed group and the vast majority of lines made it to completion of therapy. This work supports utilization of cuffed PICC lines in selected pediatric patients.

Investigation of the impact of a balanced diet according to the method of alfitherapy on the human body

In the late 1980s – early 1990s, General A.V. Shcherbakov and Professor I.V. Pronin, who participated in the creation of the Russian Rescue Corps, developed a new method for saving all living things during disasters, dangerous climatic conditions, deadly situations, using the latest developments of Professor I.V. Pronin, which have no analogues in the world and named it "Medicine of support in extreme situations". For civilians, this system, based on the intersection of microbiology, algology and herbal medicine, became known as Alphitherapy. Initially, the method was intended for special forces operating in rescue operations during man-made disasters, as well as disasters caused by natural disasters. Alphitherapy is a method of balanced nutrition of plant origin with biologically active substances of medicinal plants, algae, microorganisms due to a combination of essential oils and active substances in high concentrations. The composition of a balanced diet according to the method of alfitherapy includes a living bactericidal environment, which many times exceeds the therapeutic capabilities of drugs of chemical origin. Purpose of work – investigation of the effect of accelerating regenerative processes and a healing effect as a result of the use of a balanced diet according to the method of alfitherapy. It has been established that a course of balanced nutrition according to the method of alfitherapy has antibacterial, antiviral and antimetastatic effects, making it possible in some cases to dispense with operations or surgical intervention. In the process of completing a course of balanced nutrition in a period from several days to three months, many types of damaged tissues and organs are regenerated, blood vessels are restored and the blood supply to the brain is enhanced, the liver and other organs are cleared of toxins, isotopes (radiation) and heavy metals at the intracellular and intercellular levels. It is possible to restore the cognitive, speech and motor functions lost as a result of strokes due to the complete regeneration of the damaged vessels of the brain.

Self-perception of body image in college students of a nutrition course

Objective: To evaluate the body image of university students in the course of nutrition. Materials and methods: A cross-sectional study was carried out with 181 students of both genders from the Nutrition Undergraduate of Maranhão, Brazil. The presence and degree of dissatisfaction with body shape were evaluated by Body Shape Questionnaire (BSQ 34), another instrument used in this study was Body Figure Silhouettes (BFS). Results: The participants presented mean age of 23.1 (±5.2) years, majority women (89.5%). Most of the subjects were eutrophic (66.9%) according to BMI, and no image perception disorder according to BSQ34. According to the BSF, 56 students had the silhouette represented by figure 4, however, the figure most desired by 111 students was demonstrated by silhouette 3, (p-value 0.000). Demonstrating the desire for weight loss of the majority, despite being represented by a silhouette eutrophic. Conclusion: Most (66.9%) eutrophic, according to BMI and without image disturbances (54.7%) according to BSQ 34. However, there is a trend of overweight and obese individuals presenting with image disorders.

O acolhimento ao cuidador de crianças internadas

A presença dos cuidadores/familiares no hospital é reconhecida como um fator que potencializa a melhora do paciente. Este artigo objetiva conhecer as percepções dos cuidadores de crianças internadas sobre as atividades desenvolvidas pelo projeto de extensão Educar e Humanizar em saúde. A metodologia adotada foi qualitativa na perspectiva da concepção freiriana de educação. O Círculo de Cultura foi formado pelos cuidadores das crianças internadas e acadêmicos dos cursos de Fisioterapia, Nutrição e Psicologia. Estas avaliações foram abordadas categoricamente da seguinte maneira: O acolhimento ao cuidador; compartilhando vivências, a troca de saberes; e tirando o foco da doença, conversas que modificam. O processo de hospitalização revela sentimentos de angústia, solidão, tristeza e expectativas. As estratégias utilizadas pelos alunos trouxeram resultados positivos como diminuição dessas tensões onde eles relatam sentimentos de alívio, confiança, motivação e descontração.

Can Executive Education Fill the Nutrition Science Knowledge Gap for Practicing Clinicians? An Evaluation of an Innovative Translational Biochemistry Curriculum (P07-004-19)

ObjectivesDespite the epidemic of nutrition-related metabolic diseases, training in basic nutrition science is lacking for most healthcare professionals. To fill this training gap, Columbia University’s Institute of Human Nutrition created an inter-professional executive program for practicing clinicians. The program consists of six courses that provide a core of basic nutrition science knowledge and skills to improve clinical practice. Biochemical and Physiological Bases of Nutrition; Macro and Micro Nutrients is taught for 6 hours per weekend over the course of one year to inter-professional clinicians. This course lays the foundation for the overall curriculum which aims to improve health care providers’ understanding of the scientific underpinnings of the etiology, prevention and treatment of nutrition-related diseases.The main objective of this work was to evaluate the interest, feasibility and learning outcomes of the core course, Biochemical and Physiological Bases of Nutrition; Macro and Micro Nutrients MethodsWe used course evaluations and focus groups to assess students’ appraisal of the course, and exams to assess the extent to which course objectives were met. The course evaluations have close-ended scale answer categories and open-ended qualitative components. Results51 health professionals completed the course and 70% of these completed course evaluations. Over 93% of students agreed or strongly agreed that the course contributed to the pursuit of their clinical goals. Effectiveness of teaching by the instructor was rated very effective or extremely effective by 100% of students. 91% of students rated the quality of the nutritional biochemistry course as excellent. Qualitative data support these quantitative findings and are enriched by quotes from the students. ConclusionsOur program demonstrates that inter-professional training in the underlying pathways of metabolic disease and treatment is feasible and effective in a weekend executive education format. Future research will determine how the coursework and program impact participants’ clinical practice. Funding SourcesNone.

Effect of case-based teaching in optimization of the optional course of maternal and child nutrition for medical undergraduates

Objective To investigate the application effect of case-based teaching versus traditional teaching in the optional course of maternal and child nutrition for medical undergraduates. Methods The students who completed the course through the traditional teaching method in 2016 were enrolled as control group, and those who completed the course through the case-based teaching method in 2017 were enrolled as experimental group. In the process of teaching, the teachers in the experimental group needed to write cases, prepare lessons collectively, give guidance and inspiration, and summarize after class. During the learning process, the students in the experimental group needed to collect information before class and perform role play, group discussion, and intergroup communication about the case during class. After the course ended, a questionnaire for nutrition during pregnancy preparation, pregnancy, and lactation, breastfeeding, and complementary feeding was developed for assessment. With sex and grade as related factors, SPSS 18.0 was used for the chi-square test of two sample rates according to knowledge points, and the correct rate of each item was analyzed. Results A total of 107 valid questionnaires were collected from the control group, and 109 valid questionnaires were collected from the experimental group. For the questions on the knowledge of maternal and child nutrition, the experimental group had slightly higher correct rates than the control group (all P>0.05). For the questions on the comprehension and practical application of the knowledge of maternal and child nutrition, the experimental group had significantly higher correct rates than the control group (all P<0.05). Further stratified analysis based on sex and grade showed that the experimental group had higher correct rates than the control group. Conclusion Compared with traditional teaching, case-based teaching may not have advantages in enhancing students' memorizing ability, but it can make it easier for students to understand the theoretical knowledge of maternal and child nutrition and master the practical application of such knowledge. Key words: Case-based teaching; Medical student; Maternal and child nutrition

Clinical efficacy of early combined nutrition in neurosurgical intensive patients.

Objective To explore the clinical efficacy of early combined application of parenteral nutrition and enteral nutrition among patients in neurosurgical intensive care unit(NICU). Methods Two hundred fifty-five patients with severe neurological diseases were admitted to NICU of Shanghai Tenth People's Hospital from January 1 to August 31 in 2018. The patients were divided into two groups: traditional enteral nutrition group (control group, n=170), who were treated with enteral nutrition management at the early stage, and early combined application of parenteral and enteral nutrition group (experimental group, n=85), who were at first treated with parenteral nutrition since admission and then enteral nutrition management 72 hours later. The differences of Glasgow outcome scale (GOS), incidence of individual adverse reactions, daily average enteral nutrition, human albumin supplement, daily average fluid supplement, pulmonary infection rate, infection time and albumin level during hospitalization between the two groups were compared. The relationship among the course of enteral nutrition, nutrient content, pulmonary infection and serum albumin level in the experimental group were also discussed. The GOS was predicted by decision tree, random forests, nearest neighbor algorithm, adaboost and bagging. Results There was no significant difference between baseline scores after 1:2 propensity score matching. The dominance ratio of GOS between the two groups was 1.853 (95%CI: 1.018-3.385) (P=0.043). The change of albumin level was not related to the choice of nutritional regimen, but was related to the level of consciousness after admission and the level of basic albumin before admission. The level of consciousness in the experimental group was higher than that of the control group, and the fluid infusion volume was decreased while the daily average enteral nutrition and albumin supplementation were increased, the types of adverse reactions occurred more and earlier (P<0.05). The misjudgment rate of GOS prediction models ranged from 0.482 to 0.606. Conclusions Compared with traditional early enteral nutrition therapy, early combined parenteral nutrition and enteral nutition can improve the prognosis of patients with severe neurological diseases. Key words: Neurosurgical intensive patients; Early combined application; Enteral nutrition; Glasgow outcome scale

Complications and solutions related to home enteral nutrition for patients with acute pancreatitis

Acute pancreatitis is a common disease, the mortality of severe acute pancreatitis (SAP) is high and early enteral nutrition can effectively reduce the complications and mortality of SAP. However, it is difficult to complete the whole course of enteral nutrition in the hospital, so that home enteral nutrition(HEN) becomes necessary. The main limitation of HEN is the occurrence of various problems in the procedure. This article is intended to explore and summarize the problems related to HEN, including mechanical complications, gastrointestinal side effects, metabolic problems, infection, and psychologic problems, expense, quality of life and others. In consideration of these problems, we also give feasible suggestions for HEN. Key words: Pancreatitis, acute necrotizing; Home enteral nutrition; Complication; Prevention

The teaching practice and reflection of a public course of nutrition and health by adding views from top research papers

Objective To explore the impact of introducing cutting-edge scientific and technological literature into the general course of nutrition and health on the teaching effect. Methods Undergrad-uates were divided into experimental group and control group, with 50 students per group. The views from top research papers, as a part of teaching substance, were introduced to experimental group but not control group. The results of studying were evaluated by quiz and team presentation, and the effects of teaching were evaluated by questionnaire. The data were analyzed by the statistic method of independent sample double t-test. Results Statistical difference was found in average score between experiment group and control group [(54.40±5.47) vs. (47.96±4.29) in quiz, and (38.54±0.85) vs. (36.14±1.21) in team presentation, P=0.000]. Meanwhile, the score of questionnaire survey for interest, active thinking, studying effect, satisfaction and peer recommendation in experimental group were significantly higher than control group (P<0.05). Conclusion The introduction of cutting-edge research papers in class helps students to be more thoughtful and creative, thus it is an effective way to improve the integrative quality of the under-graduates. In the selection of literature content, we should adopt topics that are close to life, so as to arouse students' interest in active learning. Key words: Nutrition and health; Public course; Top research papers; Culture of creative thinking

Avaliação do desenvolvimento das competências gerais em graduandos de cursos de nutrição

As Diretrizes Curriculares Nacionais direcionam a educação para mudanças no processo ensino-aprendizagem, buscam a valorização da formação quando estabelecem em sua estrutura, competências gerais e específicas, enfatizando a importância do acompanhamento pela avaliação sistemática e permanente visando à melhoria na graduação. A presente pesquisa teve por objetivo avaliar o desenvolvimento das competências gerais em graduandos de nutrição. Trata-se de um estudo analítico com abordagem quantitativa e método transversal onde se utilizou um questionário, elaborado e validado por Matia e Coelho (2015) composto por 44 questões, aplicado em estudantes e professores de quatro instituições de ensino por meio do Software Google forms. Para análise descritiva dos dados foram utilizadas medidas de tendência central e medidas de variabilidade e os testes Mann Whitney, Tukey e Teste- t com nível de significância de p &lt; 0,05, realizadas por meio do Software livre R versão 3.1.1. Obteve-se um total de 210 respostas, sendo 110 de estudantes de ambos os sexos e 100 de professores. A média de idade de estudantes foi de 24,66 ± 7,41 anos. A amostra foi composta por predominância de participantes do gênero feminino (87,3%). Na visão dos professores, os estudantes avaliados parecem estar desenvolvendo mais competências e habilidades de Gestão em saúde e Educação em saúde e na visão dos estudantes houve pequeno destaque apenas na Educação em saúde. Conclui-se que os estudantes dos cursos de nutrição envolvidos na pesquisa não estão desenvolvendo as competências profissionais gerais necessárias a formação, apontadas nas diretrizes, em sua totalidade

INTERFACES ENTRE A GORDOFOBIA E A FORMAÇÃO ACADÊMICA EM NUTRIÇÃO: UM DEBATE NECESSÁRIO

Este estudo propõe refletir sobre como a formação em Nutrição é passível de reproduzir gordofobia, e os riscos impostos às pessoas gordas por essa opressão. A gordofobia, enquanto discriminação dos indivíduos gordos, consequente da estigmatização, traduz-se em desigualdades nos mais diversos ambientes, repercutindo nos níveis biológico, psicológico, social e econômico. A hierarquização das populações consideradas mais ou menos saudáveis, baseada na lógica médico-estatística polarizada entre normal e patológico, sustenta a predominância da fisiologia no estudo das ciências da saúde, consolidando práticas de intervenção e controle sobre os desviantes, como medidas de prevenção. A formação teórica, enquanto definidora da prática, apresenta dilemas criando uma tendência de atuação patologizante, direcionando os Cursos de Nutrição a priorizarem interesses econômicos em detrimento das demandas sociais. Essa patologização contribui para a manutenção do modelo de saúde que corrobora a busca incessante pelo tipo corpóreo ideal, favorecendo a mercantilização das práticas em saúde. O debate conceitual e teórico mostra-se essencial para a discussão da abordagem prática, uma vez que a crença na obesidade enquanto reflexo das qualidades morais dos indivíduos tem importantes consequências sociais. De forma agravante, ao reproduzir a estigmatização das pessoas gordas, os profissionais as afastam do acesso aos serviços de saúde. Para desenvolver práticas humanizadas, promotoras de saúde e que reconheçam o indivíduo em sua historicidade e sociabilização, é preciso desenvolver outras concepções de saúde, já que a abordagem clínico-biomédica se mostra insuficiente para atuar de maneira satisfatória diante desta complexidade.DOI: 10.12957/demetra.2018.33311