Dissertations / Theses on the topic 'Nutritional deficiencies'

Disruptions in folate metabolism are known to increase the risk for neural tube defects (NTD) and this is preventable by folic acid supplementation. However, the relationship between folate metabolism and cardiac development remains unclear. The interaction between other folate pathway nutrients, choline and riboflavin, and folate metabolism was studied in a murine model of methylenetetrahydrofolate reductase (MTHFR) deficiency. Maternal choline deficiency, riboflavin deficiency and MTHFR deficiency adversely affected embryonic or heart development. The promoters of MTHFR were also examined for interactions with GATA-4, TBX5, MEF2A and NKX-2.5, known transcription factors of cardiac development. Upstream promoter activity was increased in the presence of GATA-4 and this interaction was further enhanced upon the addition of MEF2A. TBX5 appeared to decrease upstream promoter activity. GATA-4 modestly increased downstream promoter activity. These results highlight the importance of adequate nutrient intake during pregnancy and provide a link between folate metabolism and cardiac development.

Interactions between manganese (Mn) deficiency and streptozotocin (STZ)-diabetes with respect to tissue antioxidant status were investigated in male, Sprague-Dawley rats. All rats were fed either a Mn-deficient (1 ppm) or a Mn-sufficient (45 ppm) diet for 8 weeks. Diabetes was then induced by tail-vein injection of STZ (60 mg/kg body weight), after which the rats were kept for an additional 4 to 8 weeks. The control groups comprised rats not injected with STZ, which were either Mn-deficient or Mn-sufficient. The Mn-deficient diet decreased the activities of manganese superoxide dismutase (MnSOD) in kidney and heart, and of copper-zinc superoxide dismutase (CuZnSOD) in kidney, in non-diabetic animals. In the diabetic rats, the Mn-deficient diet induced more pronounced decreases in activities of these same enzymes, and also increased liver MnSOD activity. Pancreas weights were significantly lower in Mn-deficient, compared to Mn-sufficient rats. Also, Mn-deficient, diabetic rats were significantly more hyperglycemic in response to a glucose load than Mn-sufficient, suggesting that they may have been more severely diabetic. Surprisingly, plasma and hepatic vitamin E levels increased progressively with the duration of diabetes. Lipid peroxidation, as measured by H₂O₂ -induced production of thiobarbituric acid reactive substances in erythrocytes, plasma lipoperoxides, and renal adipose tissue fluorescence, also increased concomitant with decreased liver and kidney glutathione levels. The effect of vitamin E-deficiency on Mn-deficient, diabetic rats was also investigated. Predictably, vitamin E-deficient rats were almost entirely depleted of plasma and liver vitamin E after 12 weeks on the deficient diets (4 weeks after STZ treatment). Consistent with this, tissue lipid peroxides were elevated compared to vitamin E-sufficient rats. Superimposing vitamin E-deficiency on manganese deficiency failed to add any further deficits in tissue antioxidant status. Higher glycosylated hemoglobin levels were observed in vitamin E-deficient, compared to vitamin E-sufficient, diabetic rats. These findings demonstrate for the first time an interactive effect between manganese deficiency and STZ-diabetes resulting in amplification of tissue antioxidant changes seen with either manganese deficiency or STZ-diabetes alone. This effect of cofactor deprivation in experimental diabetes raises the question of adequacy of the nominally Mn-sufficient diet in insulin-dependent diabetes mellitus.
Land and Food Systems, Faculty of
Graduate

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.
Nutritional deficiencies detection for coffee leaves is a task which is often undertaken manually by experts on the field known as agronomists. The process they follow to carry this task is based on observation of the different characteristics of the coffee leaves while relying on their own experience. Visual fatigue and human error in this empiric approach cause leaves to be incorrectly labeled and thus affecting the quality of the data obtained. In this context, different crowdsourcing approaches can be applied to enhance the quality of the data extracted. These approaches separately propose the use of voting systems, association rule filters and evolutive learning. In this paper, we extend the use of association rule filters and evolutive approach by combining them in a methodology to enhance the quality of the data while guiding the users during the main stages of data extraction tasks. Moreover, our methodology proposes a reward component to engage users and keep them motivated during the crowdsourcing tasks. The extracted dataset by applying our proposed methodology in a case study on Peruvian coffee leaves resulted in 93.33% accuracy with 30 instances collected by 8 experts and evaluated by 2 agronomic engineers with background on coffee leaves. The accuracy of the dataset was higher than independently implementing the evolutive feedback strategy and an empiric approach which resulted in 86.67% and 70% accuracy respectively under the same conditions.
Revisión por pares

Objectives: The goal of this project was to determine the nutritional needs of preschool age children to help guide intervention development. The research aims were 1) to examine and describe young child (ages one to five) nutritional status as it relates to key nutrients associated with stunting and wasting; 2) to determine what key macro- and micro-nutrient deficiencies (primarily iron and zinc) are associated with wasting and stunting. Methodology: Study sample: Sixty-seven families with children ages one to five who participating in routine health care clinic visits during the UK Shoulder to Shoulder Global health brigade visits. Study design: A cross-sectional survey was conducted collecting demographic data, medical history, and dietary intake. Objective measures of height/length and weight were completed; and blood samples were drawn to measure serum micronutrient levels. Nutrition Data System for Research (NDSR) identified nutrient intakes for analytical comparison based on growth parameters. Nutritional and health status were compared to food security and World Health Organization growth reference points of standard deviations on Z-scores of height-for-age and weight-for-age. Analyses: Chi Square, ANOVA, and binary logistic regression tests were run using Statistical Analysis System (SAS) Results: Low serum levels of zinc and iron corresponded to low levels of dietary intake of zinc and iron, limited food security and moderate stunting z = -0 to 1.99 Standard Deviation. Conclusion: This study will inform a comprehensive nutritional intervention for this population. The evidence that specific nutrients are limiting will focus the health promotion objectives.

This study examines the relative influence of traditional and biomedical theories of health and disease on the reasoning about childhood nutritional problems by mothers in rural South India. Mothers with different levels of schooling, traditional practitioners, and medical experts were interviewed. Their explanations of nutritional problems were verbally recorded and analysed using methods of cognitive analyses.
Nutritional concepts and their interpretations given in the mothers' explanations matched that of the traditional theory of Siddha medicine, prevalent in South India. With an increase in formal education, there was an increase in the use of concepts derived from modern biomedical theory. However, the mothers exhibited little understanding of the underlying mechanisms involved. Implications of these findings for designing nutrition and health education are discussed, in relation to knowledge reorganization to replace harmful concepts and relations with beneficial ones.

In a context of extreme poverty and food insecurity, 213 pregnant women belonging to the Ngäbe-Buglé indigenous community in rural Panama were assessed for respiratory, oral, skin, urogenital infections and intestinal parasites, and for iron, folic acid, vitamin B12, A and D deficiencies in a cross sectional study. Fetal wellbeing was assessed through simple measurements available in the field (fundal height -FH, fetal cardiac rate -FCR and fetal movements -FM as perceived by the mothers). Infections and micronutrient deficiencies were extremely prevalent, with all mothers affected by at least one condition and most affected by several. Inflammation indicated by high levels of C-reactive protein (CRP) was found in 16.5% of the mothers. CRP was significantly higher in women with oral infection and/or respiratory infections alone or in combination with genital infection or hookworm infection. CRP was significantly lower in women with lower levels of iron and vitamin B12, in women with vitamin D levels above 75 nmol/L and vitamin A levels above 20 μg/dL. Intra-uterine growth retardation was found in 7% of the fetuses, 27% of fetuses were categorized as large for gestational age, but the majority was found as adequate for gestational age (66%). Fetal cardiac rate and fetal movements were within normal limits. Indicators of infections, micronutrient deficiencies, and maternal inflammation were associated in a complex manner with our simple measures of fetal wellbeing. FH was negatively associated with higher percent of monocytes accompanied by higher mean corpuscular volume in the second trimester, and with vitamin D in the third trimester, while controlling for gestational age, maternal body mass index and wood smoke exposure. Indicators of infection also entered regression models for FCR and FM, indicating early fetal responses to mild-moderate extra-uterine maternal infections.
Une étude transversale ayant pour but d'évaluer l'état immunitaire et la présence d'infections respiratoires, orales, cutanées, urinaires et parasitaires, ainsi que l'état nutritionnel, notamment les déficiences en vitamines B12, A, D, en fer et folate. Cette étude fut menée auprès de 213 femmes enceintes de la communauté rurale du Ngäbe-Buglé au Panama vivant dans l'extrême pauvreté et l'insécurité alimentaire. L'état de santé du fœtus a été évalué usant des mesures disponibles lors des visites prénatales, incluant la hauteur utérine (HU), la fréquence cardiaque fœtale (FCF) et les mouvements fœtaux (MF) tel qu'estimés par la mère. La présence d'inflammation, signalée par une augmentation de la protéine-C réactive (PCR), fut observée chez 16.5% des mères. De plus, la PCR était significativement plus élevée chez les mères souffrant d'infections orales et/ou respiratoires, soit séparément, soit accompagnées d'infections génitales ou d'anchylostomes. Chez les femmes ayant une concentration plasmique abaissée en fer ou vitamine B12, en vitamine A au-dessus 20 μg/dL ou en vitamine D au-dessus de 75 nmol/L, la PCR était significativement inférieure. Un retard de croissance intra-utérin fut décelé chez 7% des fœtus, 27% naquirent gros pour leur âge gestationnel et 66% naquirent avec d'un poids normal. La FCF et les MF se révélèrent être dans les limites normales. Les marqueurs d'infections, de déficiences en micronutriments et d'inflammation maternelle étaient associés de façon complexe aux mesures de bien être fœtal. Après avoir contrôlé pour l'âge gestationnel, l'indice de masse corporelle de la mère et l'exposition à fumée de bois, nous avons observe que l'HU est négativement associée au pourcentage de monocytes et au volume corpusculaire moyen d'hémoglobine lors du deuxième trimestre, ainsi qu'a fœtus la vitamine D lors du troisième trimestre. Les marqueurs d'infection furent évalues usant des modèles de régression multiples pour la FCF et les MF, et ceux-ci indiquèrent une réponse fœtale précoce face aux infections maternelles extra-utérines légères a modérées.

Trabalho Complementar apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciada em Ciências da Nutrição
Objetivos: Pretendem-se estudar as deficiências em micro e macro nutriente que o alcoolismo provoca e o seu tratamento nutricional. Métodos: Foi realizada uma revisão da literatura, onde se avaliaram os efeitos do álcool a nível das deficiências nutricionais que pode originar. A pesquisa foi realizada no motor de busca Pubmed, no site da Organização Mundial de Saúde e na biblioteca online Scielo, incidindo nas publicações dos últimos 12 anos. Resultados: O alcoolismo influencia o metabolismo dos hidratos de carbono, originando hipoglicemia. A nível do metabolismo das proteínas ocorre uma diminuição da absorção dos aminoácidos essenciais, após o consumo de álcool. No metabolismo lipídico, o álcool quando consumido em excesso, leva a uma acumulação de lípidos no fígado, condição comumente conhecida como esteatose hepática. O alcoolismo origina também deficiências vitamínicas e minerais. Para tratar estes défices nutricionais é necessária a intervenção de um profissional, tendo o nutricionista um papel fundamental. Conclusão: Indivíduos alcoólicos crónicos tendem a sofrer de desnutrição, tanto a nível de micronutrientes como de macronutrientes, o que pode levar a determinadas patologias como pelagra, síndrome Wernicke-Korsakoff, entre outras, sendo essencial a reposição destes nutrientes com a suplementação e o aporte energético adequados a cada individuo.
Objectives: We intend to study the deficiencies in micro and macro nutrients that alcoholism causes and its nutritional treatment. Methods: A literature review was carried out, in which were evaluated the effects of alcohol on the level of nutritional deficiencies that may originate. The research was carried out on the Pubmed search engine, on the World Health Organization website and on the Scielo online library, focusing on publications from the last 12 years. Results: Alcoholism influences the metabolism of carbohydrates, causing hypoglycemia. In terms of protein metabolism, there is a decrease in the absorption of essential amino acids after alcohol consumption. In lipid metabolism, alcohol, when consumed in excess, leads to an accumulation of lipids in the liver, a condition commonly known as fatty liver. Alcoholism also causes vitamin and mineral deficiencies. In order to treat these nutritional deficits, the intervention of a professional is necessary, with the nutritionist having a fundamental role. Conclusion: Chronic alcoholic individuals tend to suffer from malnutrition, both in terms of micronutrients and macronutrients, which can lead to certain pathologies such as pellagra, Wernicke-Korsakoff syndrome, among others, and the replacement of these nutrients with supplementation and contribution is essential. appropriate to each individual.
N/A

INTRODUÇÃO: O cuidado nutricional é parte essencial para o acompanhamento integral da crescente população idosa, principalmente quando na presença de doenças crônicas e neurodegenerativas e morbidades psiquiátricas. A Mini Avaliação Nutricional (MAN®), tem sido utilizada para este fim, e em algumas situações, informações adicionais a essa ferramenta são necessárias. OBJETIVOS: Caracterizar o estado nutricional de idosos acompanhados em ambulatório de neuropsiquiatria geriátrica. MÉTODOS: Foi obtida uma amostra de conveniência selecionada aleatoriamente entre pacientes idosos com diagnóstico de depressão (DEP), doença de Alzheimer (DA) e outros transtornos psiquiátricos (OTP). O estado nutricional foi avaliados através da MAN®, pelo índice de massa corporal (IMC= peso/altura2) e pelas circunferências do braço (CB) e panturrilha (CP). Os dados referentes ao consumo de medicamentos também foram obtidos, considerando-se como polifarmácia o consumo de mais de três medicamentos/dia. Os dados de diagnóstico médico e exames laboratoriais foram obtidos do prontuário médico. Foram avaliados 217 indivíduos no total, distribuídos conforme o diagnóstico clínico: grupo DEP= 107 (49,3%); grupo DA=59 (27,2%) e grupo OTP=51 (23,5%). RESULTADOS: O escore da MAN® identificou risco nutricional em 67,3%, 69,5% e 54,9%, e desnutrição em 14,0%, 13,6% e 27,5% dos pacientes em DEP, DA e OTP respectivamente. O baixo peso, avaliado pelo IMC foi observado em 29,0% (DEP), 24,1% (DA) e 45,1% (OTP) dos avaliados. A prevalência de anemia foi de 11,2% (DEP), 10,2% (DA) e 19,6% (OTP); sendo mais frequente em mulheres em DEP e OTP e em homens em DA. A média para vitamina D em todos os grupos encontrava-se na insuficiência. A presença de colesterol total acima dos intervalos de normalidade foi de 47,0% (DEP), 36,3% (DA) e 31,8% (OTP). Foi observada hiperglicemia em 52,9% (DEP), 48,1% (DA) e 41,6% (OTP) dos pacientes. A polifarmácia foi observada em 18,7% (DEP), 15,2% (DA) e 19,6% (OTP). Não houve associação significativa entre o uso de medicamentos e o estado nutricional, embora tenha sido apontado um direcionamento ao risco de desnutrição com o uso de medicamentos para o tratamento da depressão (inibidores seletivos de receptação de serotonina), demências (inibidores de colinesterase), cloridrato de omeprazol e indutores do sono. CONCLUSÕES: o risco nutricional e a desnutrição são prevalentes na população estudada, independente do grupo específico de doença neuropsiquiátrica ou demência. Esses achados demandam e justificam um monitoramento nutricional permanente para esses indivíduos, uma vez que vem acompanhados de outras deficiências específicas que comprometem a saúde de forma geral, como a anemia e insuficiência de vitamina D. A elaboração de planos educativos envolvendo os pacientes, cuidadores e a equipe médica, poderá contribuir para a melhora dessas condições.
INTRODUCTION: Nutritional care is an essential part for the integral follow - up of the growing elderly population, especially in the presence of chronic and neurodegenerative diseases and psychiatric morbidities. The Mini Nutrition Assessment (MAN®) has been used for this purpose, and in some situations, additional information to this tool is necessary. OBJECTIVES: To characterize the nutritional status of elderly patients in a geriatric neuropsychiatry clinic. METHODS: A randomly selected convenience sample was obtained among elderly patients diagnosed with depression (DEP), Alzheimer\'s disease (AD) and other psychiatric disorders (OTP). The nutritional status was evaluated through MAN®, body mass index (BMI = weight / height2) and circumference of arm (CB) and calf (CP). The data referring to the consumption of medicines were also obtained, considering as polypharmacy the consumption of more than three medications/day. The data of medical diagnosis and laboratory tests were obtained from the medical record. A total of 217 individuals were evaluated, distributed according to the clinical diagnosis: DEP = 107 (49.3%); Group DA = 59 (27.2%) and OTP group = 51 (23.5%). RESULTS: The MAN® score identified nutritional risk in 67.3%, 69.5% and 54.9%, and malnutrition in 14.0%, 13.6% and 27.5% of the patients in DEP, DA and OTP respectively. Low weight, evaluated by BMI, was observed in 29.0% (DEP), 24.1% (AD) and 45.1% (BTP) of the evaluated patients. The prevalence of anemia was 11.2% (DEP), 10.2% (AD) and 19.6% (OTP); Being more frequent in women in DEP and OTP and in men in AD. The mean for vitamin D in all groups was in the insufficiency. The presence of total cholesterol above the normality intervals was 47.0% (DEP), 36.3% (DA) and 31.8% (OTP). Hyperglycemia was observed in 52,9% (DEP), 48,1% (AD) and 41,6% (OTP) of the patients. Polypharmacy was observed in 18.7% (DEP), 15.2% (DA) and 19.6% (OTP). There was no significant association between drug use and nutritional status, although there was a trend towards malnutrition with the use of drugs to treat depression (selective serotonin reuptake inhibitors), dementias (cholinesterase inhibitors), Omeprazole hydrochloride and sleep inducers. CONCLUSIONS: nutritional risk and malnutrition are prevalent in the population studied, regardless of the specific group of neuropsychiatric disease or dementia. These findings demand and justify a permanent nutritional monitoring for these individuals, since they are accompanied by other specific deficiencies that compromise health in general, such as anemia and insufficiency of vitamin D. The elaboration of educational plans involving patients, caregivers and The medical team, could contribute to the improvement of these conditions.

Background: Children in South Africa are still affected by micronutrient deficiencies and children living in farm communities are especially vulnerable. African Leafy Vegetables (ALVs) are well endowed with micronutrients such as iron, zinc and vitamin A and might contribute to the nutritional status of children. However, these vegetables have been perceived as “poor people’s food” and over the years knowledge of and use of ALVs has decreased. Aim: This study assessed the potential contribution of ALVs to the nutritional status of children in a semi-rural farm community. Method: In this cross-sectional study, anthropometric indices, serum iron, zinc and retinol concentrations were determined in school children aged 5−13 years (n=155). Dietary intake of iron, zinc and vitamin A was evaluated by three 24-hour diet recalls of children (n=154). The iron, zinc and β-carotene content of selected ALVs was determined. Knowledge of and use of ALVs by primary caregivers was established using focus group discussions (FGDs). Descriptive statistics, independent t-tests, the Pearson Chi-Square Test and Mann-Whitney U Test were used. Anthropometric data were analysed using the World Health Organization Reference 2007 data. Dietary data were analysed using FoodFinder (version 3). Qualitative data from FGDs were translated, transcribed and color-coded to generate emerging themes. Results: Stunting (11%) was the most prevalent anthropometric indicator of malnutrition. This was supported by the low socio-economic status of households. Deficiency prevalence in iron (serum ferritin <15 μg/L; 15.5%) and vitamin A (serum retinol <20 μg/dL; 3.2%) was low. Zinc deficiency was the most prevalent (serum zinc <65 μg/dL; 74.8%) deficiency. Median dietary intake of iron, zinc and vitamin A was generally above the Estimated Average Requirement. ALVs were potentially good sources of iron, zinc and β-carotene and could contribute substantially to the Recommended Dietary Allowance for these nutrients in children, without taking into account inhibiting factors that might affect the bioavailability. Iron content of the ALVs studied ranged from 1.4−3.2 mg/100 g edible portion. Amaranthus cruentus was the best source of iron. Zinc content of the ALVs ranged from 0.7−1.4 mg/100g edible portions, with Cleome gynandra having the highest zinc composition. The β-carotene content of the ALVs ranged from 182−314 μg RAE/100 g edible portion, with both Amaranthus cruentus and Cleome gynandra being the best sources. Knowledge of ALVs and their use was indigenous and was transferred between generations. Caregivers had positive attitudes towards the use of ALVs. Conclusion: Although the prevalence of deficiencies was not severe (with exception of zinc deficiency), micronutrient deficiencies exist in the rural farm community studied. ALVs are potentially good sources of iron, zinc and β-carotene and might contribute to the nutritional status of school children. Knowledge of ALVs and the positive attitude and perceptions regarding their use by primary caregivers implied a potentially positive future response to interventions promoting consumption of ALVs in order to contribute to the alleviation of micronutrient deficiencies.
Thesis (MSc (Nutrition))--North-West University, Potchefstroom Campus, 2013.

Introdução: Apesar de não ser puramente disabsortiva, o Bypass Gástrico em Y de Roux pode provocar alteração da absorção de muitas vitaminas e minerais. Considerando ainda o fato de existirem poucos estudos que relatem o estado geral destes indivíduos, sobretudo com relação aos parâmetros nutricionais em longo prazo, observou-se à necessidade do desenvolvimento de um estudo que verifique a prevalência das carências nutricionais e a efetividade da técnica empregada, bem como o estado geral destes pacientes e suas inter-relações com outros fatores, para especialmente direcionar com maior efetividade as condutas a serem empregadas no pós-operatório pela equipe multidisciplinar. Métodos: 8 homens e 67 mulheres de uma amostra inicial de 130 pacientes compareceram a entrevista. Estes pacientes foram operados pela técnica de Bypass Gástrico em Y de Roux, possuíam entre 18-65 anos e tinham mais que 5 anos de pós-operatório. Foram coletados os seguintes dados: IMC pré e pós-operatório, perda do excesso de peso, queixa de sintomas gastrointestinais, além de dados referente a deficiências nutricionais através da análise de sangue pelos métodos padrões. Resultados: O IMC inicial foi de 56,5 +/- 10 Kg/m2. Após 2 anos, o IMC médio havia caído para 29,4 +/-6 e após 87 meses após a cirurgia, este era de 34,3 +/-10 Kg/m². Uma associação inversa entre perda do excesso de peso (PEP) e tempo de pósoperatório foi observada (P= 0,27; p=0,0183). Após 2 anos apenas 1,33 % (n=1) não atingiu a PEP esperada de 50% do excesso de peso e no momento da entrevista, 30,6% (n=23) não haviam conseguido mantê-la. As deficiências mais comumente verificadas foram as deficiências de vitamina B12 (61,82%) e D (60,53%). Baixos níveis de hemoglobina também foram verificados (50,82%). Vômitos e Síndrome de Dumping foram às queixas gastrointestinais mais observadas 66,19% e 56,76%. Verificou-se correlações significantes entre baixos níveis de hemoglobina e o sexo feminino (p=0,011), % de PEP e ocorrência de vômito com deficiência de vitamina B12 (p=0,028) e (p=0,022). Conclusão: O BGYR é eficiente na promoção e manutenção de perda de peso em longo prazo. Especial atenção deve ser dada aos grupos de maior risco para desenvolvimento de deficiências nutricionais, mulheres em idade fértil, perda de peso excessiva e naqueles que apresentam vômitos freqüentes.
Background: The goal of this study is determining both the efficacy of the surgery and the prevalence of nutritional deficiencies in the long term after the Roux-en Y Gastric Bypass and search for relations of theses deficiencies with other factors. Methods: 8 men and 67 women consecutives patients, who had 5 years or more after the surgery were assessed during regular visits. Pre and Post-operative BMI, excess weight loss and gastrointestinal symptoms were registered. Nutritional deficiencies were accessed by standard laboratory assays. Result: The initial BMI was 56,5 +/- 10 Kg/m2. After 2 years, the mean BMI had dropped to 29,4 +/-6 and by and average of 87 months it was 34,3 +/-10 Kg/m². A inverse association beetwen Excess Weight Loss (EWL) and time of postoperative was verified (P= 0,27; p=0,0183). After 2 years only 1,33 % (n=1) had not achieve a EWL of at least 50%. At the end, 30,6% (n=23) could not maintain this EWL. The more commom nutricional deficiencies are vitamin B12 (61,82%) and D (60,53%). Low levels of hemoglobin (50,82%) was also verified. Vomiting and dumping syndrome was reffered in 66,19% and 56,76%. Significant correlation and with clinical signify was observed between low hemoglobin levels and femine sex (p=0,011), % of weight loss and the B12 deficiency (p=0,028) and vomiting and deficiency of B12 (p=0,022). Conclusion: The RYGB is efficient to promotes and maintain the weight. Special attention should be given to patients with massive weight loss, frequent vomiting and women in reprodutive age.

O desenvolvimento infantil tem sido considerado como um processo, que envolve modificabilidade, transformação e interação com o ambiente social. A trajetória desse desenvolvimento, mesmo antes do nascimento, pode ser exposta a múltiplos e contínuos eventos adversos, os fatores de risco, que podem e, normalmente, ocorrem em conjunto, potencializando a gravidade das suas conseqüências. Entre os fatores de risco mais estudados, estão as carências nutricionais, enfoque do presente estudo, cujos objetivos foram: 1- avaliar o desenvolvimento mental e psicomotor de crianças com carências nutricionais, através das Escalas Bayley de Desenvolvimento Infantil; 2- verificar se existe relação entre os resultados nas escalas mental e psicomotora das Escalas Bayley, com alguns fatores potenciais de risco ao desenvolvimento infantil. A amostra foi constituída por 59 crianças de ambos os sexos, com faixa etária entre 4 e 42 meses, que freqüentavam duas creches do município de Ribeirão Preto. Foram realizadas entrevistas individuais com os pais ou responsáveis e as crianças foram submetidas às avaliações clínico-nutricional, hematológica, e do desenvolvimento infantil, utilizando-se as Escalas Bayley de Desenvolvimento Infantil - Segunda Edição. De acordo com a avaliação clínico-nutricional e hematológica as crianças foram distribuídas em dois grupos: Controle e Carente Nutricional, segundo o z-escore proposto pela Organização Mundial de Saúde e níveis sanguíneos de hemoglobina. A análise dos dados mostrou que desnutrição e anemia ferropriva são ocorrências comuns para uma grande proporção (46%) destas crianças. A análise estatística demonstrou não haver diferença significante entre os índices médios dos dois grupos, tanto na avaliação do desenvolvimento mental, quanto psicomotor. Os valores médios do Índice de Desenvolvimento Mental (IDM) e Índice de Desenvolvimento Psicomotor (IDP), de ambos os grupos, encontraram-se na classificação de desenvolvimento normal. No entanto, em ambos os grupos, metade das crianças apresentou desempenho prejudicado na avaliação mental e, cerca de um terço, também mostrou prejuízo na avaliação psicomotora. Entre os antecedentes selecionados para análise (escolaridade do pai e da mãe; número de habitantes na casa; número de filhos; ordem de nascimento da criança; idade da mãe na época da gestação; problemas durante a gestação; condições alimentares da mãe durante a gestação; duração do período de amamentação; condições alimentares da criança em sua residência; condições de saúde da criança), as crianças cujos pais tinham maior nível de escolaridade, apresentaram valores de IDM maiores. O fator escolaridade pode estar relacionado à maior estimulação ambiental, ao maior acesso à informação, gerando também melhores cuidados oferecidos às crianças. Os dados obtidos, no presente estudo, sugerem que nutrição e ambiente estão em interação, sendo que os prováveis efeitos do insulto nutricional são dependentes do contexto sócio-ambiental em que ocorrem. Além disso, demonstram que vários fatores ambientais e sócio-econômicos podem, por si só, levar a prejuízos no desenvolvimento infantil. Tais fatores, associados a alguma carência nutricional, podem se mostrar poderosos confundidores dos resultados na avaliação do desenvolvimento infantil
The child development has been considered as a process that involves modification, transformation and interaction with the social environment. The trajectory of development, even before the birth, can be exposed to multiples and continuous adverse events, the risk factors, that cannot and, usually, happen together, increasing the severity of its consequences. Among the studied risk factors, there are the nutritional deficiences, focus of the present study, whose objectives were: 1 - to evaluate the mental and psychomotor development of children with nutritional deficiences, through the Bayley Scales of Infant Development; 2 - to verify relationship among the results in the mental and psychomotor scales of the Bayley Scales, with some potential factors of risk to the child development.The sample was constituted by 59 children of both gender, from 4 to 42 months of age, that have attended at two day care of the municipal district of Ribeirão Preto. Individual interviews were accomplished with the parents or responsible person, and the children were submited to the evaluations clinical-nutritional, hematological, and of the child development, through Bayley Scales of Infant Development - Second Edition. In agreement with the clinical-nutritional and hematological evaluation, the children were distributed in two groups: Control and Nutritional Deficient, according to the z-score proposed by the World Organization of Health and hemoglobin values.The analysis of the data showed that malnutrition and iron-deficiency anemia are common occurrences for a great proportion (46%) of these children. The statistical analysis demonstrated no significant difference among the medium indexes of the two groups, so much in the evaluation of the mental development, as psicomotor. The medium values of Mental Development Index (MDI) and Psychomotor Development Index (PDI), of both groups, met in the classification of normal development. However, in both groups, the children\'s half presented mildly delayed performance in the mental evaluation and, about a third, also presented delayed in the psicomotor evaluation. Among the antecedents selected for analysis (level of education of the parents; number of inhabitants in the house; number of children; order from birth of the child; the mother\'s age at the time of the gestation; problems during the gestation; the mother\'s alimentary conditions during the gestation; duration of the breast-feeding period; the child\'s alimentary conditions in its residence; conditions of the child\'s health), the children whose parents had larger level of education, presented values of larger MDI. The factor level of education can be related to the largest environmental stimulation, to the largest access to the information, also generating better cares offered to the children. The obtained data, in the present study, they suggest that nutrition and environment are in interaction, and the probable effects of the nutritional insult are dependent of the social and environmental context in that happen. Furthermore, they demonstrate that several environmental and socioeconomic factors can, by itself, to take the damages of the child development. Such factors, associated to some nutritional lack, can be shown powerful confounders of the results in the evaluation of the child development

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CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
INTRODUCTION: The Politics of Brazilian Food and Nutrition 2012 ensures: "Food and nutrition are the basic requirements for the promotion and protection of health, enabling the full potential of human growth and development, quality of life and citizenship". OBJECTIVE: Develop curves of nutritional deficiencies through research of consumer trends, food pattern and adult nutritional Maroons of riparian areas in the Lower Amazon Oriximiná Municipality, Pará. METHODS: Cross-sectional, descriptive and analytical with descriptive and inferential statistics. RESULTS: A sample of 274 individuals, of whom 50.2% were female. The mean age 41.6 ± 15.3 years, weight 63.2 ± 10.9 kg, height 156.7 ± 8.9 cm and body mass index (BMI) of 25.8 ± 3.9 kg / m . The majority (47.7%) had completed 4 years of schooling and 6.3% were illiterate. Among the foods consumed (5 or more times a week): cassava flour, fish, soybean oil, sugar and coffee (infusion) and consumed less than 5 times per week to cassava and banana; Among foods are rarely eaten rice, beans, beef, pork, poultry and game, eggs, milk, soft drinks and snacks / chips. Performed three meals per day 93.8% and only 5.5% and 0.7% carried four five meals, respectively. Food consumption per capita of the last 24 hours shows that the cassava flour was the most consumed by all communities (average 201.0 g) followed by rice (16,0 g) and Beju (9,0 g). Only one community reported consumption of vegetables and vegetable consumption and the mean at 0.34 g; Fruits with higher consumption: banana (11,0 g), chestnut of Pará (6,0 g) and acerola juice in the form of (13,0 g); Only four communities beans consumed, amounting to an average of 8,0 g. In the group of meat, draws attention to high fish consumption in all communities, and the average per capita consumption of this food in 517.0 g. The average energy consumption of 1572.5 ± 546.8 Kcal. The percentage intakes of carbohydrates, proteins and lipids, total calories, were similar between the sexes, with no statistical difference. The values of consumption trend (shown in curves) showed that there was highly significant adjustment to Energy (p = 0.01032 *), protein (p <0.001 *), fat (p = 0.0032 *), Carbohydrate (p = <0.001 *) , cholesterol (p = 0.0213 *), calcium (p <0.001 *), iron (p = 0.0022 *) and zinc (p <0.001 *), however, each type of nutrient with its specific characteristic for Excess or Deficiency as tracks age; Tended to lack of consumption: energy (kcal), fat (%), calcium, zinc, and iron Carbohydrate varied with sex, protein and cholesterol were overweight throughout the sample. CONCLUSION: Dietary intake is monotonous, with inadequate macronutrients and micronutrients and low in fiber to the reference set; demonstrating not meet the caloric balance and nutritional needs of the sample. There is a need for new design methodologies to estimate the nutritional needs of traditional Amazonian, living in socially vulnerable, which take into consideration the specificity of livelihood and access to food.
INTRODUÇÃO: A Política Nacional de Alimentação e Nutrição 2012 assegura: A alimentação e nutrição constituem requisitos básicos para a promoção e a proteção da saúde, possibilitando a afirmação plena do potencial de crescimento e desenvolvimento humano, com qualidade de vida e cidadania . OBJETIVO: Elaborar curvas de carências nutricionais através da investigação das tendências de consumo, padrão alimentar e nutricional de adultos quilombolas de áreas ribeirinhas do Baixo Amazonas no Município de Oriximiná, Pará. METODOLOGIA: Estudo transversal, descritivo e analítico com estatística descritiva e inferencial. RESULTADOS: Amostra de 274 indivíduos, sendo 50,2% do sexo feminino. A média de idade 41,6 ±15,3 anos; peso 63,2 ±10,9 kg, estatura 156,7 ±8,9cm e Índice de Massa Corpórea (IMC) de 25,8 ±3,9 kg/m. A maioria (58,0%) tinha até quatro anos de escolaridade e 6,3% eram analfabetos.Entre os alimentos consumidos (Cinco ou mais vezes por semana): a farinha de mandioca, peixes,óleo de soja, açúcar e café (infusão) e os consumidos menos de cinco vezes por semana a macaxeira e a banana; Entre os alimentos raramente consumidos estão o arroz, o feijão, as carnes bovina, suína, de aves e de caça, ovos, leite, refrigerantes e salgados/frituras. Realizavam três refeições por dia 93,8% e somente 5,5% e 0,7% realizavam quatro e cinco refeições, respectivamente. O consumo alimentar per capita das últimas 24 horas, evidencia que a farinha de mandioca foi a mais consumida por todas as comunidades (média 201,0g); Apenas uma comunidade referiu o consumo de hortaliças, verduras e legumes ficando a média de consumo em 0,3g; Frutas com maior consumo: banana (11,0g), castanha do Pará (6,0g) e acerola na forma de suco (13,0g); Somente quatro comunidades consumiram feijão, perfazendo a média de 8,0g. No grupo das carnes, chama a atenção o elevado consumo de peixe em todas as comunidades, ficando o consumo médio per capita deste alimento em 517,0g. O consumo médio de energia 1572,5 ± 546,8 Kcal. As ingestões percentuais de carboidratos, proteínas e lipídios, no total de calorias, foram semelhantes entre os sexos, não havendo diferença estatística. Os valores de tendência de consumo (representados nas curvas) mostraram que houve ajuste altamente significante para Energia (p=0.01032*), Proteína (p<0.001*), Gordura (p=0.0032*), Carboidrato (p=<0.001*), Colesterol (p=0.0213*), Cálcio (p<0.001*), Ferro (p=0.0022*) e Zinco (p<0.001*), entretanto, cada tipo de nutriente com sua característica específica para Excesso ou Carência conforme as faixas etárias; Apresentou tendência de consumo para carência: energia (k/cal), gordura (%), cálcio, zinco;Carboidrato e ferro variaram com o sexo; A proteína e o colesterol apresentaram excesso em toda a amostra. CONCLUSÃO: O consumo alimentar é monótono, com inadequação de macronutrientes e micronutrientes, e baixo teor de fibras para os referencia estabelecidas; demonstrando não atender ao balanço calórico e as necessidades nutricionais da amostra estudada. Há necessidade da concepção de novas metodologias para estimar as necessidades nutricionais de populações tradicionais amazônicas que vivem em situação de vulnerabilidade social, que levem em consideração a especificidade do modo de vida e o acesso ao alimento.

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Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES
Morbid obesity, a chronic and multifactorial disease, causes metabolic disorders and increases the risk of morbidity. Its prevalence has been increasing, with alarming data in Brazil and elsewhere. Globally, Brazil ranks second in number of bariatric surgeries, but surgical treatment is a challenge for the patients and the teams that provide care for these patients. Given the above, the present study aimed to assess changes in nutritional status and identify nutritional deficiencies before and 10 years after Roux-en-Y gastric bypass. This retrospective study lasted two years and included 166 patients submitted to Roux-en-Y gastric bypass at a private clinic. The statistical analyses included the chi-square, Fisher?s, Mann-Whitney, and Wilcoxon tests, analysis of variance (ANOVA), and generalized estimating equations. The significance level was set at 5%. At the ten-year follow-up, the percentage of excess weight loss (%EWL), body mass index (BMI), and weight regain were 51.64?18.03 (p<0.0001), 32.53?4.83 kg/m2 (p<0.0001), and 41% (p<0.0001), respectively, and the lipid and blood glucose profiles had improved (p<0.0001). Iron-deficiency anemia was found in 37.5% and 45.0% of the patients who attended the 10-year follow-up based on ferritin levels <15 ug/L and <30 ug/L, respectively. The effect of time was significant for hemoglobin, ferritin, iron overload (p<0.0001), and hematocrit (p=0.0007). Vitamin D deficiency was found in 29 patients (82.86%), and high parathormone (PTH), in 13 (41.94%). The effect of time was significant for PTH (p=0.0059). In conclusion, gastric bypass was a surgical success and improved the metabolic profile. Weight regain increased over time. The nutritional outcomes were iron-deficiency anemia and vitamin D deficiency associated with secondary hyperparathyroidism. These findings reaffirm the importance of multidisciplinary care and monitoring of nutritional deficiencies for the treatment of morbid obesity.
A obesidade m?rbida considerada uma doen?a cr?nica e multifatorial, que ocasiona desordens metab?licas e aumenta o risco de morbidade, vem crescendo, com dados alarmantes no Brasil e no Mundo. O Brasil ? o segundo Pa?s que mais realiza cirurgia bari?trica, sendo o tratamento cir?rgico, um desafio para os pacientes e para as equipes envolvidas no cuidado destes pacientes. Diante do exposto, o presente trabalho teve como objetivo avaliar a evolu??o do estado nutricional e identificar as defici?ncias nutricionais no pr? e no p?s-operat?rio de pacientes submetidos ao bypass g?strico em Y-de-Roux, com 10 anos de seguimento. O estudo realizado em dois anos, com delineamento retrospectivo longitudinal, envolveu 166 pacientes submetidos ao bypass g?strico em Y-de-Roux, em uma cl?nica privada. Na an?lise estat?stica, utilizou-se os testes Qui-Quadrado, Fisher, Mann-Whitney, Anova, Wilcoxon e Equa??es de Estimativas Generalizadas. O n?vel de signific?ncia adotado foi de 5%. Os resultados deste estudo, ap?s 10 anos de seguimento, demostraram percentual de perda do excesso de peso (%PEP) de 51,64?18,03 (p<0,0001); Indice de Massa Corporal (IMC) de 32,53?4,83 kg/m2 (p<0,0001); reganho de peso de 41% (p<0,0001). O perfil lip?dico e glic?mico diminuiu ao longo de 10 anos de seguimento (p<0,0001). Dos pacientes que permaneceram no estudo at? o final de 120 meses, 37,5% e 45,0%, apresentaram diagn?stico de anemia ferropriva, considerando-se os crit?rios utilizados de ferritina <15 ug/L e ferritina <30 ug/L, respectivamente. O efeito do tempo foi significativo para a hemoglobina, ferritina e sobrecarga de ferro, (p<0,0001) e hemat?crito (p=0,0007). Em rela??o ao metabolismo do c?lcio, 82,86% (29), apresentaram n?veis de defici?ncia de vitamina D e 41,94% (13) apresentaram PTH elevado. O efeito do tempo foi significativo para o PTH (p=0,0059). Em conclus?o, pacientes submetidos ao bypass g?strico, apresentaram sucesso cir?rgico e melhora do perfil metab?lico. O reganho de peso aumentou com o tempo de seguimento. A anemia ferropriva e a defici?ncia de vitamina D, associada ao hiperparatireoidismo secund?rio, foram desfechos nutricionais encontrados Tais achados reafirmam a import?ncia do cuidado multidisciplinar e ? aten??o ?s defici?ncias nutricionais para o tratamento da obesidade m?rbida.

A avaliação do estado nutricional das plantas de milho usualmente é feita através de análises químicas ou pela diagnose visual das folhas da planta, esta última, sujeita a erros de interpretação já que a ausência de algum nutriente na planta gera um padrão de mudança específico na superfície da folha que depende do nível de ausência do nutriente. As dificuldades que apresentam neste processo e sua importância na agricultura, criam a necessidade de pesquisar sistemas automáticos para a avaliação do estado nutricional de plantas. Desta forma, este mestrado teve como objetivo principal o desenvolvimento de um sistema de visão artificial para verificar a possibilidade de identificação de níveis dos macronutrientes Cálcio, Enxofre, Magnésio, Nitrogênio e Potássio em plantas de milho através da análise da superfície das folhas usando métodos de visão computacional. Este projeto realiza uma revisão bibliográfica do estado da arte dos métodos de extração de características de cor, textura em escala de cinza e textura colorida utilizadas em processamento de imagens. A alta similaridade entre os sintomas produzidos pelas deficiências e a pouca similaridade entre amostras de uma mesma deficiência motivou o desenvolvimento de novos métodos de extração de características que pudessem fornecer dados necessários para uma correta separação entre as classes. Os resultados obtidos demonstraram que o sistema desenvolvido possibilita a predição de deficiências nutricionais em estágios iniciais do crescimento da planta usando unicamente a textura da superfície da folha como fonte de informação
The evaluation of the nutritional status of corn plants is usually done through chemical analysis or by visual diagnosis of the plant leaves. Visual diagnosis is subject to misinterpretation as the lack of some nutrient in the plant generates a specific pattern of change in the leaf surface that depends on the degree on which the nutrient is absent on the plant. The difficulties present in this process and its importance in agriculture creates the necessity to search automated systems for the assessment of nutritional status of plants. Thus, this dissertation had as main objective the development of an artificial vision system to verify the possibility of identifying levels of macronutrients calcium, sulfur, magnesium, potassium and nitrogen in corn plants by analyzing the surface of the leaves using computer vision methods. This project performs a review of the literature of the state of the art methods for feature extraction of color, grayscale and colored texture used in image processing. The high similarity between the symptoms caused by deficiencies and low similarity between samples of the same deficiency motivated the development of new methods for extracting features that could provide the data needed for a correct separation between classes. The results showed that the system enables the prediction of nutritional deficiencies in an initial stage of plant growth using only texture of the leaf surface as a source of information

Trabalho Complementar apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciado em Ciências da Nutrição
A obesidade é na actualidade considerada uma epidemia global. A sua prevalência tem aumentado continuamente até taxas alarmantes, quer nos países desenvolvidos quer nos países em vias de desenvolvimento. A cirurgia bariátrica é considerada a forma de tratamento mais eficaz no que se refere à morbilidade dos pacientes obesos. Este tipo de cirurgia apresenta vantagens evidentes na saúde, embora as suas limitações também sejam evidentes, principalmente no que diz respeito às deficiências nutricionais após a realização da mesma. Desta forma, a possibilidade de ocorrência de deficiências nutricionais deve ser devidamente considerada pelos profissionais envolvidos de forma conseguir uma melhor e mais rápida recuperação do estado nutricional do doente. Os objectivos desta revisão bibliográfica são, classificar e caracterizar os principais tipos de cirurgias; elucidar as vantagens e limitações deste tipo de intervenções; revisão de critérios a seguir para um follow-up adequado assim como recomendações dietéticas e alimentares que advêm da cirurgia bariátrica. Obesity is nowadays considered a global epidemic. Its prevalence has increased steadily up to alarming rates, whether in developed or in developing countries. Bariatric surgery is considered the most effective treatment in terms of morbidity obese patients. This type of surgery offers advantages in health, but also its limitations are apparent, particularly with regard to nutritional deficiencies after the completion thereof. Thus, the possibility of nutritional deficiencies should be properly considered by the professionals involved in order to achieve a better and faster recovery of the patient's nutritional status. The objectives of this literature review are to characterize and classify the main types of surgeries; elucidate the advantages and limitations of this type of intervention, revising criteria to follow for a follow-up as appropriate dietary recommendations and food that come from bariatric surgery.

Introdução: A composição corporal nos seres humanos se altera com a idade, mas as causas e consequências dessas mudanças são apenas em parte compreendidas. Uma mudança que é cada vez mais reconhecida por ter efeitos importantes na velhice é a perda de tecidos moles, particularmente de massa muscular esquelética, denominada \"sarcopenia\". Recentemente, tem sido demonstrada a relação entre a composição corporal e estado nutricional do paciente com a evolução e prognóstico em certas doenças. Existem várias estratégias e métodos para avaliação da sarcopenia, incluindo-se a tomografia computadorizada (TC) e a ressonância magnética (RM). Objetivos: Comparar variações das medidas lineares e de área do músculo psoas entre TC e RM, avaliar a variação inter-observador das medidas obtidas e identificar as ações para implantação desta medida nos relatórios de exame, instituindo protocolo de avaliação de sarcopenia para todos pacientes submetidos à TC ou RM de abdome em serviço de imagem. Materiais e métodos: Estudo retrospectivo de pacientes que foram submetidos à TC e RM do abdome, com um intervalo entre os exames de até 7 dias, tendo sido incluídos 47 indivíduos par análise. Os exames foram analisados buscando obtenção das medidas lineares e de área do músculo psoas por dois observadores independentes, utilizando o software de visualização DICOM OsiriX®. Resultados: Não foi observada diferença estatisticamente significante entre as medidas lineares, bem como entre as medidas de área para o mesmo observador na comparação entre TC e RM, com alta concordância entre os métodos. Houve excelente concordância entre os dois observadores para as medidas lineares e de área nos dois métodos. Conclusões: As medidas lineares e de área dos músculos psoas obtidas na TC e na RM são comparáveis, com alta concordância na avaliação pareada, indicando a possibilidade de serem utilizadas de maneira intercambiável na avaliação de sarcopenia. Houve excelente concordância entre os observadores para as medidas lineares e de área dos músculos psoas obtidas na TC e na RM, indicando alta reprodutibilidade.
Introduction: Body composition in humans changes with age, but the causes and consequences of these changes are understood only in part. One change is increasingly recognized to have significant effects on aging is loss of soft tissue, particularly skeletal muscle, called \"sarcopenia\". It has been recently demonstrated the relationship between body composition and nutritional status of the patient with the evolution and prognosis in certain diseases. There are several strategies and methods for evaluation of sarcopenia, including computed tomography (CT) and magnetic resonance imaging (MRI). Purposes: To compare variations of linear measurements and the psoas muscle area between CT and MRI to evaluate the inter-observer variation in measurements obtained and identify the actions to implement this measure in the examination reports, establishing sarcopenia evaluation protocol for all patients undergoing CT or MRI of the abdomen in image service. Methods: Retrospective study of patients who underwent CT and MRI of the abdomen, with an interval between examinations of up to 7 days and were included 47 subjects pair analysis. The tests were analyzed seeking obtain measures and the psoas muscle area by two independent observers, using the visualization software DICOM OsiriX®. Results: There was no statistically significant difference between the linear measurements, and between the area measurements for the same observer in the comparison between CT and MRI with high concordance between the methods. There was excellent agreement between the two observers for linear and area for both methods. Conclusions: The linear measurements and area of the psoas muscles obtained from CT and MRI are comparable with high concordance in paired assessment, indicating the possibility of being used interchangeably in the evaluation of sarcopenia. There was excellent agreement between observers for linear and area of the psoas muscles obtained from CT and MRI, indicating high reproducibility.

Carências nutricionais são ocorrências comuns em grande proporção de crianças do mundo e reconhecidamente um dos grandes problemas da saúde pública brasileira. Alguns estudos têm relatado que os escores mental e motor de crianças com carências nutricionais são mais baixos do que aqueles obtidos pelas crianças sem carências. As Escalas Bayley, publicadas pela primeira vez em 1969 e revisadas em 1993, constituem-se em instrumento adequado para a avaliação de crianças de um a quarenta e dois meses de idade, e são amplamente utilizadas em estudos que avaliam efeitos de carências nutricionais. Desta forma, o objetivo deste trabalho foi verificar a aplicabilidade da Escala de Avaliação do Comportamento Infantil (BRS), uma das três escalas que constituem as Escalas Bayley, na avaliação de crianças de creche com carência nutricional. A amostra foi constituída por 50 crianças de ambos os sexos, com idades que variaram entre 7 e 41 meses, provenientes de duas creches filantrópicas do município de Ribeirão Preto – SP. Um grupo de 23 crianças com deficiência proteico-calórica ou de ferro, consideradas de leve a moderada, segundo o Z-score < +1, proposto pela OMS e níveis de hemoglobina acima de 8 mg/dL, foi comparado a outro de 27 crianças sem estas deficiências. Através da avaliação do comportamento foram obtidos índices referentes ao comportamento geral, o controle emocional, a atenção/exitabilidade, a orientação/engajamento e a qualidade motora das crianças. Tais índices são apresentados em forma de percentil, sendo possível, segundo Bayley (1993), a classificação em: comportamento dentro dos limites normais (índice ? percentil 26), ou seja, esperado para sua idade; comportamento questionável (índice entre o percentil 11 e o 25), que sugere possível prejuízo e merece maior investigação; e comportamento não-ótimo (índice ? percentil 10), que evidencia atraso ou prejuízo em uma ou mais áreas importantes. Os resultados obtidos revelaram que o grupo controle era de maior faixa etária (30 meses) que o grupo carente nutricional (23 meses), e que as crianças do grupo controle apresentavam um comportamento geral frente a situação de teste melhor que do que as crianças do grupo carente nutricional (p=0.03), principalmente no fator Orientação/Engajamento (p=0.01): Afeto positivo (p=0.03), Energia (p=0.005), Entusiasmo acerca das tarefas (p=0.04), Engajamento social (p=0.03); e nos itens Afeto negativo (p=0.04) e Movimento lento e atrasado (p=0.005). Estes resultados são consistentes com aqueles já apresentados na literatura, nos quais as crianças com carências nutricionais são descritas como menos ativas, mais inibidas e tímidas, menos responsivas, atentas, vocalizando e movimentando-se menos. Concluiu-se que os itens relacionados à avaliação comportamental, aplicados e cotados como proposto originalmente, foram sensíveis para diferenciar grupos com e sem alterações nutricionais leves ou moderadas, embora as Escalas Bayley do Desenvolvimento Infantil requeiram ainda adaptação às condições sociais e culturais brasileiras. Tais resultados sugerem ainda que esta escala pode ser útil em outras condições clínicas, assim como para a avaliação do desempenho de grupos pós procedimentos de recuperação nutricional.
Nutritional deficiencies are common occurrences among a large proportion of children all over the world and are recognized to be one of the great public health problems in Brazil. Some studies have reported that the mental and motor scores of children with nutritional deficiencies are lower than those of children with no deficiencies. The Bayley Scales, first published in 1969 and revised in 1993, are an appropriate instrument for the evaluation of children aged one to forty months and are widely used in studies that evaluate the effects of nutritional deficiencies. Thus, the objective of the present study was to determine the applicability of the Behavioral Rating Scale (BRS), one of the three scales forming the Bayley Scales, for the evaluation of day-care center children with nutritional deficiencies. The sample consisted of 50 children of both sexes aged 7 to 41 months, from two philanthropic day-care centers in the municipality of Ribeirão Preto – SP. A group of 23 children with protein-calorie or iron deficiency considered to be mild to moderate according to a Z-score < +1 proposed by the WHO and with hemoglobin levels above 8 mg/dL, was compared to a group of children without these deficiencies. Indices referring to general behavior, emotional control, attention/excitability, orientation/engagement, and motor quality of the children were obtained by behavioral evaluation. These indices are presented in percentile form and, according to Bayley (1993), it is possible to classify them as behavior within normal limits (index ? 26th percentile), i.e., expected for age, questionable behavior (index between the 11th and 25th percentile), suggesting possible impairment and requiring more investigation, and non-optimal behavior (index ? 10th percentile), which demonstrates delay or impairment in one or more important areas. The results obtained revealed that the control group was in an older age range (30 months) than the group with nutritional deficiency (23 months), and that the children in the control group presented a better general behavior in the test situation than the children in the group with nutritional deficiency (p=0.03), especially regarding the Orientation/Engagement factor (p=0.01): Positive affect (p=0.03), Energy (p=0.005), Enthusiasm about tasks (p=0.04), Social engagement (p=0.03); and in the items Negative affect (p=0.04) and Slow and delayed movement (p=0.005). These results are consistent with those reported in literature studies in which children with nutritional deficiencies are described as less active, more inhibited and shy, less responsive and attentive, and vocalizing and moving less. We conclude that the items related to behavioral evaluation, applied and scored as originally proposed, were sensitive in differentiating between groups with and without mild or moderate nutritional alterations, although the Bayley Scales for Childhood Development still require adaptation to the Brazilian social and cultural conditions. These results also suggest that this scale can be useful for other clinical conditions and for the evaluation of performance of groups submitted to procedures or nutritional recovery.

Cu, Zn superoxide dismutase (SOD1) is a dimeric, β-sandwich, metalloenzyme responsible for the dismutation of superoxide. Mutations covering nearly 50% of the amino acid sequence of SOD1 have been found to acquire a toxic gain-of-function leading to amyotrophic lateral sclerosis. A hallmark of this disease is the presence of insoluble aggregates containing SOD1 found in the brain and spinal cord. While it is unclear how these aggregates or smaller, precursor oligomeric species may be the source of the toxicity, mutations leading to increased populations of unstable, partially folded species along the folding pathway of SOD1 may be responsible for seeding and propagating aggregation. In an effort to determine the responsible species, we have systematically characterized the stability and folding kinetics of five well studied ALS variants: A4V, L38V, G93A, L106V and S134N. The effect of the amino acid substitutions was determined on a variety of different constructs characterizing the various post-translational maturation steps of SOD1: folding, disulfide bond formation and Zn binding. Zn was found to bind progressively tighter along the folding pathway of SOD1, minimizing populations of monomeric species. In contrast, ALS variants were found to have the greatest perturbation in the equilibrium populations of the folded and unfolded state for the most immature, disulfide-reduced metal-free SOD1. In this species, at physiological temperature, four out of five ALS variants were >50% unfolded. Finally the energetic barriers in the folding and unfolding reaction were studied to investigate the unusually slow folding of SOD1. These results reveal that both unfolding and refolding are dominated by enthalpic barriers which may be explained by the desolvation of the chain and provide insights into the role of sequence in governing the folding pathway and rate.

The effects of single and combined dietary protein and zinc restrictions on the outcome of primary and challenge infections with the intestinal nematode Heligmosomoides polygyrus in mice were examined using a 3 x 2 factorial design that combined three levels of dietary protein (24% - control; 7% - marginal; 3% - low) with 2 levels of dietary zinc (60 mg/kg - control; 3 mg/kg - marginal). Protein and zinc restrictions, at these levels, produced independent effects on final worm burdens. While mice fed both marginal and low protein diets, and marginal zinc diets had significantly higher worm burdens in a primary infection, the response to a challenge infection was only impaired in animals fed the low protein diet. Eosinophilia was significantly reduced by zinc restriction in the primary infection and by the lowest level of protein restriction in the challenge infection. The magnitude of the serum IgG1 concentration was significantly lowered by protein restriction in both the primary and challenge infections. The impaired response to a challenge immunizing protocol in the animals fed the 3% protein diet, along with the reduced eosinophilia and IgG1 response, indicates a negative effect of protein deficiency on the host immune response to an intestinal nematode infection.

BACKGROUND: Bariatric surgery (BS) is the most effective long-term therapy for the treatment of severe obesity. Benefits of BS include a reduction of overall and cardiovascular mortality, incidence of first occurrence of fatal- or nonfatal-cardiovascular events, prevention and remission of type 2 diabetes mellitus, and improved quality of life. Nonetheless, BS is associated with potential complications amongst which micronutrient deficiencies are relevant. AIM: Against this background, the overall aim of this PhD project was to better understand the increased risk for nutritional deficiencies and protein status in subjects undergoing BS. METHODS: We prospectively evaluated the nutritional status of obese individuals prior to BS, and following the drastic reduction of daily energy intake, anatomical changes, and massive weight loss associated with the two currently most commonly performed surgical techniques [gastric bypass (GBP) and sleeve gastrectomy (SG)]. Additionally, to gain insight specifically on how to address the high prevalence of vitamin D (VD) deficiency, we performed two open-label, prospective studies aiming at evaluating the efficacy and safety of achieving 25-hydroxy VD (25(OH)D) levels ≥75 nmol/L with two different supplementation algorithms. Similarly, we gained insight on the reported high prevalence of iron deficiency by characterizing iron status with the evaluation of indices of systemic inflammation. Finally, we performed two observational prospective studies to evaluate the effects of dietary protein intake (PI) on fat free mass (FFM, as assessed from bioelectrical impedance or DEXA) and protein status changes after BS-induced weight loss. As further step in this research path, a randomized control trial proposal has been designed to determine the effect of two levels of PI (standard versus high) after BS on the nitrogen balance, body composition, energy expenditure, perceived satiety, and plasma levels of branched chain amino acids (BCAA) and insulin sensitivity, as well as the feasibility of protein supplementation up to one year after BS. This translational research protocol integrates mechanistic, metabolic, and energy homeostasis outcomes. Preliminary results of a pilot study of that trial are presented as part of this thesis project to demonstrate feasibility of the protocol. RESULTS: Nutritional deficiencies are commonly found in a Mediterranean severely obese population undergoing BS, with those deficiencies being more prevalent than in normal weight individuals. Of note, SG- and GBP-patients experience similar long-term changes in dietary intake. Indeed, when micronutrient intake from supplements was not taken into account, mean daily dietary intake of all evaluated micronutrients was below current dietary reference intakes (DRIs). Interestingly, SG and GBP carry comparable post-surgical nutritional risk. Low VD and elevated PTH levels were the most prevalent nutritional abnormalities after BS. In clinical practice, a single fixed high dose (2,000 IU) of VD supplementation is as effective and safe as an individualized daily dose of cholecalciferol to achieve 25(OH)D levels ≥75 nmol/L after BS. When considering hs-CRP as inflammatory marker, impaired iron status could be identified in two thirds of BS candidates. Protein supplements are helpful in achieving the PI goal after BS, with PI thresholds of >60 g/d or 1.1 g/kg Ideal Body Weight/day being associated with better FFM retention. The results of our pilot study support feasibility for a larger Randomized Control Trial with to address the association between PI and NB, BCAA, body compositions changes, REE, glucose homeostasis, and satiety after BS. CONCLUSION: Our data underscores the need for the evaluation of nutritional parameters prior to- and following-BS. We deem results of this PhD project significantly contribute to improve knowledge in the area of nutrition and body composition after BS.
INTRODUCCIÓN: La cirugía bariátrica (CB) es el método más eficaz para el tratamiento de la obesidad grave a largo plazo. Sin embargo, la CB se asocia a déficits de micronutrientes. OBJETIVO: aumentar el conocimiento del riesgo de deficiencias nutricionales y del estado proteico en sujetos candidatos a CB. MÉTODOS: Se evaluó prospectivamente el estado nutricional de los pacientes antes y después de la CB (bypass gástrico (BPG) y gastrectomía tubular (GT)]. Se evaluó, mediante dos estudios prospectivos la eficacia y la seguridad de normalizar los niveles de 25-hydroxy VD (25 (OH) D) mediante dos algoritmos de suplementación distintos. Obtuvimos información sobre la alta prevalencia de deficiencia de hierro al caracterizar el estado de hierro con la evaluación de índices de inflamación sistémica. Finalmente, se realizaron dos estudios observacionales prospectivos para evaluar los efectos de la ingesta proteica (IP) sobre la masa libre de grasa (MLG) y los cambios en el estatus proteico después de la pérdida de peso inducida por BS. Finalmente, se diseñó un estudio aleatorizado y controlado para determinar el efecto de dos niveles de IP (estándar versus alto) después de CB sobre el balance de nitrógeno, la composición corporal, el gasto energético, saciedad y los niveles plasmáticos de aminoácidos de cadena ramificada, así como el efecto de la suplementación proteica a largo plazo. RESULTADOS: Los déficits nutricionales son frecuentes en nuestra población candidata a CB. La GT y BPG conllevan un riesgo nutricional comparable. Una dosis fija (2.000 UI) de suplementos de VD es tan eficaz y segura como una dosis diaria individualizada para normalizar niveles. Al considerar hs-CRP como marcador inflamatorio, el déficit de hierro podría ser identificado en dos tercios de los candidatos a CB. Los suplementos proteicos son útiles para alcanzar el objetivo proteico tras CB. IP de> 60 g / día o 1,1 g / kg de peso ideal / día se asocia con una mejor retención de MLG. Los resultados del estudio piloto apoyan la viabilidad del protocolo propuesto. CONCLUSIÓN: Nuestros datos subrayan la necesidad de la evaluación de parámetros nutricionales antes y después de la CB. Consideramos que los resultados de este proyecto contribuyen significativamente a mejorar el conocimiento en el área de nutrición y composición corporal después de la CB.

Una característica metabòlica important de les arrels de les plantes és l'exsudació a la rizosfera d'una àmplia varietat de compostos. La regulació de la síntesi i exsudació activa d'aquests, permet que la seva acció es produeixi en el lloc, moment i temps adequats i, per tant, confereix a la planta la capacitat de reaccionar davant de variacions de l'entorn eludint possibles efectes adversos, com canvis osmòtics, atac de patògens o l'escassetat de nutrients, entre d'altres. Part dels compostos exsudats són producte del metabolisme secundari i el seu paper ha estat molt estudiat en la regulació de la comunitat microbiana del sòl, en el foment de simbiosis beneficioses i en la inhibició del creixement de plantes competidores. Menys investigada ha estat la influència d'aquests compostos en la disponibilitat de nutrients de la rizosfera. En aquesta Tesis Doctoral s'investiga l'exsudació radicular de compostos fenòlics i flavines en resposta a la deficiència de ferro (Fe), micronutrient molt abundant en els sòls i generalment poc disponible. Tot i que aquesta resposta es coneix des de fa dècades en espècies no gramínies, la identitat i la quantitat de compostos exsudats, els mecanismes de transport i les seves funcions a la rizosfera, són poc coneguts. Per aquest estudi s’ha utilitzat l'espècie model Arabidopsis thaliana, i dues espècies d'interès agronòmic, el tomàquet (Solanum lycopersicum) i la remolatxa (Beta vulgaris var. saccharífera). L'estudi constitueix el primer anàlisi exhaustiu i simultani de compostos fenòlics i flavines acumulats a les arrels i exsudats al medi de cultiu com a resposta de les plantes a la deficiència de Fe. S'aplica una aproximació analítica basada en la separació dels compostos per cromatografia líquida d'alta eficàcia i la seva detecció per la combinació d'espectroscòpia de fluorescència i d'ultravioleta-visible amb espectrometria de masses de diferents modalitats. En arrels de A. thaliana i tomàquet, la deficiència de Fe indueix la síntesi i acumulació de compostos fenòlics de tipus cumarina, i no afecta la concentració de flavines. La planta de remolatxa no respon a la deficiència de Fe produint cumarines sinó que, d'acord al que ja s'ha conegut, sintetitza i acumula flavines a les arrels, i les exsuda al medi, principalment com a sulfats de riboflavina. El temps d'exposició a la deficiència de Fe i/o el pH del medi de cultiu afecta la producció de cumarines en A. thaliana i tomàquet. Els perfils de compostos de tipus cumarina produïts per les dues espècies també difereixen. Encara que les dues produeixen cumarines simples amb les substitucions oxigenades -OH, -OCH3 i -O-hexosil, el grau d'oxigenació és diferent. Així, en tomàquet predominen les cumarines tetra-oxigenades com trihidroximetoxicumarina enfront de les tri- i dioxigenades com la fraxetina i l’escopoletina, respectivament, mentre que a A. thaliana són di- i tri-oxigenades i es produeixen conjuntament amb cumarinolignans de tipus cleomiscosina. Les cumarines s'acumulen a les arrels tant en formes de hexòsid com aglicona, amb la forma predominant depenent de cada cumarina i/o espècie vegetal. El perfil de compostos de tipus cumarina presents en el medi de cultiu és diferent a l'observat a les arrels, presentant-se en forma aglicona i sent majoritàries l’escopoletina i la fraxetina. Aquesta exsudació de cumarines en A. thaliana està intervinguda per la proteïna transportadora AtABCG37. La retirada de les cumarines i flavines exsudades del mitjà de A. thaliana i de remolatxa té un impacte negatiu en la nutrició fèrrica d'aquestes espècies. La cumarina tipus catecol fraxetina i les flavines en forma reduïda permeten la dissolució d'òxid fèrric -forma característica del Fe als sòls- a pHs rellevants des del punt de vista agronòmic. A més, es demostra que les arrels de les plantes de remolatxa deficients en Fe poden utilitzar les flavines endògenes extracel•lulars per promoure la dissolució reductiva d'òxids fèrrics. El treball conclou que l'exsudació radicular de compostos de tipus cumarina en plantes de A. thaliana i de flavines en plantes de remolatxa, permet augmentar la concentració de Fe soluble en sòls amb baixa disponibilitat d'aquest nutrient i, per tant, millora la nutrició fèrrica d'aquestes espècies.
Una característica metabólica importante de las raíces de las plantas es la exudación a la rizosfera de una amplia variedad de compuestos. La regulación de la síntesis y exudación activa de éstos permite que su acción se produzca en el lugar, momento y tiempo adecuados y, por consiguiente, confiere a la planta la capacidad de reaccionar ante variaciones del entorno eludiendo posibles efectos adversos, como cambios osmóticos, ataque de patógenos o escasez de nutrientes, entre otros. Parte de los compuestos exudados son producto del metabolismo secundario y ha sido muy estudiado su papel en la regulación de la comunidad microbiana del suelo, en el fomento de simbiosis beneficiosas y en la inhibición del crecimiento de plantas competidoras. Menos investigada ha sido, sin embargo, la influencia de estos compuestos en la disponibilidad de nutrientes en la rizosfera. En esta Tesis Doctoral se investiga la exudación radicular de compuestos fenólicos y flavinas en respuesta a la deficiencia de hierro (Fe), micronutriente muy abundante en los suelos y generalmente poco disponible. Aunque esta respuesta se conoce desde hace décadas en especies no gramíneas, la identidad y la cantidad de compuestos exudados, los mecanismos de transporte y sus funciones en la rizosfera, son poco conocidos. Para este estudio se han utilizado la especie modelo Arabidopsis thaliana, y dos especies de interés agronómico, tomate (Solanum lycopersicum) y remolacha (Beta vulgaris var. saccharífera). El estudio constituye el primer análisis exhaustivo y simultáneo de compuestos fenólicos y flavinas acumulados en raíces y exudados al medio de cultivo como respuesta de las plantas a la deficiencia de Fe. Se aplica una aproximación analítica basada en la separación de los compuestos por cromatografía líquida de alta eficacia y su detección por la combinación de espectroscopía de fluorescencia y de ultravioleta-visible con espectrometría de masas de diferentes modalidades. En raíces de A. thaliana y tomate, la deficiencia de Fe induce la síntesis y acumulación de compuestos fenólicos de tipo cumarina, y no afecta a la concentración de flavinas. Remolacha no responde a la deficiencia de Fe produciendo cumarinas sino que, de acuerdo a lo ya conocido, sintetiza y acumula flavinas en raíz, y las exuda al medio, principalmente como sulfatos de riboflavina. El tiempo de exposición a la deficiencia de Fe y/o el pH del medio de cultivo afecta a la producción de cumarinas en A. thaliana y tomate. Los perfiles de compuestos de tipo cumarina producidos por ambas especies también difieren. Aunque las dos producen cumarinas simples con las sustituciones oxigenadas -OH, -OCH3 y -O-hexosil, el grado de oxigenación es diferente. Así, en tomate predominan las cumarinas tetra-oxigenadas como trihidroximetoxicumarina frente a las tri- y di-oxigenadas como fraxetina y escopoletina, respectivamente, mientras que en A. thaliana son di- y tri-oxigenadas y se producen junto con cumarinolignanos de tipo cleomiscosina. Las cumarinas se acumulan en raíz tanto en formas hexósido como aglicona, con la forma predominante dependiendo de cada cumarina y/o especie vegetal. El perfil de compuestos de tipo cumarina presentes en el medio de cultivo es diferente al observado en las raíces, presentándose en forma aglicona y siendo mayoritarias escopoletina y fraxetina. Esta exudación de cumarinas en A. thaliana está mediada por la proteína transportadora AtABCG37. La retirada de las cumarinas y flavinas exudadas del medio de A. thaliana y de remolacha tiene un impacto negativo en la nutrición férrica de estas especies. La cumarina tipo catecol fraxetina y las flavinas en forma reducida permiten la disolución de óxido férrico -forma característica del Fe del suelo- a pHs relevantes desde el punto de vista agronómico. Además, se demuestra que las raíces de las plantas de remolacha deficientes en Fe pueden utilizar flavinas endógenas extracelulares para promover la disolución reductiva de óxidos férricos. El trabajo concluye que la exudación radicular de compuestos de tipo cumarina en plantas de A. thaliana y de flavinas en plantas de remolacha permite aumentar la concentración de Fe soluble en suelos con baja disponibilidad de este nutriente y, por lo tanto, mejora la nutrición férrica de estas especies.
A remarkable metabolic feature of plant roots is the ability to secrete a vast array of compounds into the rhizosphere. The regulation of the synthesis and active secretion of these compounds allows their action to occur at the precise site and time required, enabling plants the ability to cope with changes in the local environment, thus avoiding possible adverse effects such as osmotic changes, pathogen attack, low nutrient supply, etc. A part of the secreted compounds are produced by the secondary metabolism, and their role in the regulation of the soil microbial community, the promotion of beneficial symbiotic associations and the inhibition of the growth of competing plant species has been extensively investigated. However, the influence of these compounds in rhizosphere nutrient availability has been less studied. The aim of this study was to investigate the root exudation of phenolic compounds and flavins induced by the deficiency of iron (Fe), an abundant but generally poorly soluble micronutrient in soils. Although these root responses have been reported in different non-graminaceous species for decades, the identity of the compounds, their transport outside the roots and their role in the rhizosphere are largely unknown. The study used the model plant species Arabidopsis thaliana and two crop species, tomato (Solanum lycopersicum) and sugar beet (Beta vulgaris var. saccharífera). The present Thesis includes the first thorough and systematic analysis of the phenolic compounds and flavins accumulated and secreted by roots in response to Fe deficiency. The analytical approach used is based on the separation of the compounds by high performance liquid chromatography and their detection by a combination of fluorescence and UV-visible spectroscopy and different types of mass spectrometry. In A. thaliana and tomato, Fe deficiency induced the synthesis and accumulation of coumarin-type phenolic compounds and did not affect the root production of flavins. Conversely, sugar beet did not produce phenolic compounds in response to Fe deficiency, but instead synthesizes and accumulates flavins -mainly riboflavin sulfates- in roots, and also exports them to the growth medium. The time of Fe deficiency exposure and/or the pH of the culture medium affect the production of coumarins in A. thaliana and tomato, and the coumarin profile was different in both species. Although the two species produce simple coumarins with the oxygen-containing substituents hydroxyl, methoxyl and -Ohexosyl in the benzene ring, the number of such substituents was different. In tomato, tetraoxygenated coumarins such as trihydroxymethoxycoumarin were predominant over the tri- and di-oxygenated coumarins (such as fraxetin and scopoletin, respectively), whereas A. thaliana produced only tri- and di-oxygenated coumarins, along with cleomiscosin-type coumarinolignans. The root coumarins were in hexoside and aglycone forms, with the prevalent form being dependent on the coumarin and/or the plant species. The coumarin profile of the culture medium differed from that found in roots: the coumarins were in the aglycone form, and the predominant ones were scopoletin and fraxetin. This Thesis revealed that the transporter AtABCG37 is involved in the secretion of coumarins in A. thaliana. This study also showed that the depletion of coumarin-type phenolics and flavins in the culture medium of Fe-deficient A. thaliana and sugar beet plants, respectively, has a negative impact on the plant Fe nutritional status. The catechol coumarin fraxetin and the reduced forms of flavins promoted the dissolution of ferric oxide –the major form of Fe in soils- at agronomically relevant pH values. In addition, other results of this study provide support for the view that roots of Fedeficient sugar beet plants can use endogenous extracellular flavins to dissolve ferric oxide. This Thesis concludes that the root secretion of coumarin-type compounds by A. thaliana and of flavins by sugar beet allows for increasing the concentration of soluble Fe in soils with low Fe availability, therefore improving the Fe nutritional status in these species.

Um sistema de visão artificial (SVA) para diagnose nutricional de milho, baseado em análise de imagens de folhas foi recentemente proposto pelo GCC-IFSC e Agrárias-FZEA/USP. O objetivo do estudo foi avaliar o estado nutricional do milho cultivado em casa de vegetação em solução nutritiva, com deficiência e suficiência nutricionais induzidas de nitrogênio (N), fósforo (P), potássio (K) e manganês (Mn) utilizando visão artificial, e posteriormente em campo visando validar o diagnóstico pelo sistema de visão artificial desenvolvido. As doses dos nutrientes foram constituídas pela omissão, 1/5, 2/5 e a dose completa, combinadas em três estádios de desenvolvimento do milho (V4, V7 e R1), com quatro repetições. O experimento foi individual para cada elemento. Em cada época foram coletadas imagens de folhas indicativas do estádio (FI), folhas velhas (FV) para o N, P e K e folhas novas para o Mn, que foram primeiramente digitalizadas em 1200 dpi, e em seguida encaminhadas para serem analisadas quimicamente. Também foram avaliadas nas plantas, as variáveis biométricas (altura, diâmetro do colmo e número de folhas) e determinar as produções de massa seca da parte aérea e do sistema radicular, além da determinação dos teores de nutrientes. A omissão de N, P e K proporcionaram deficiências nutricionais características nas folhas do milho, quando cultivado em casa de vegetação. As modificações nas folhas do milho, com as doses dos nutrientes estudadas, possibilitaram a obtenção de imagens necessárias para o desenvolvimento do SVA, em casa de vegetação. A utilização das imagens da casa de vegetação para treinar o SVA visando à validação de imagens do campo, gerou confusão na interpretação, levando a erros de classificação, entretanto, o uso desta tecnologia para diagnose nutricional do milho, tanto em casa de vegetação, como no campo, é promissora.
An artificial vision system (AVS) for nutrient diagnosis of corn, based on analysis of images of leaves was recently proposed by SCG-IFSC and Agrarian-FZEA/USP. The objective was evaluate the nutritional status of maize grown in a greenhouse in nutrient solution with induced nutritional deficiency and sufficiency of nitrogen (N), phosphorus (P), potassium (K) and manganese (Mn) using artificial vision, and correlate the results obtained with foliar analysis, and then the field in order to validate the diagnosis by artificial vision system developed. Doses of nutrients were established by omission, 1/5, 2/5 and full dose, combined into three developmental stages of corn (V4, V7 and R1), with four replications. The experiment was for each individual element. Images of leaves were collected in each epoch indicating the stage (FI), old leaves (FV) for N, P and K and Mn for new leaves, which were first scanned at 1200 dpi, then sent to be analyzed chemically. The biometric variables (height, stem diameter and number of leaves) were also evaluated, and the dry matter production of shoots and roots was determined, besides the determination of nutritional content. The omission of N, P and K caused typical nutrient deficiencies provided in the leaves of maize when grown in a greenhouse. The changes in the leaves of maize, with doses of nutrients studied, allowed the imaging necessary for training SVA in a greenhouse. The use of images of the greenhouse to train the SVA aiming to validate images of the field has led to confusion in the interpretation leading to errors of classification, however the use of this technology for nutrient diagnosis of corn, both in the greenhouse and in the field, is promising.

BACKGROUND: Bariatric surgery is effective for weight loss, but is associated with deficiencies of several micronutrients. Among these, deficiencies in iron and vitamin B12 have been well-described in the literature. While it is known that blood levels of several micronutrients differ between racial groups, it is currently unknown whether the impact of bariatric surgery on micronutrient levels is also race-specific. We addressed this question in reference to vitamin B12 and iron because of the known racial differences in these micronutrients and their impact on red blood cell indices. The aim of our study was to determine whether there are differences in levels of ferritin and vitamin B12, as well as in hemoglobin (HGB) and hematocrit (HCT) levels, between African-Americans (AA), Hispanic-Americans (HA), and Caucasian-Americans (CA) after Roux-en-Y gastric bypass (RYGB) surgery. METHODS: A retrospective medical record review of 1,046 (201 AA, 106 HA, and 344 CA), who underwent bariatric surgery at Boston Medical Center (BMC) between 2004 and 2015 was conducted. Analysis of variance and linear mixed modeling was used to compare adjusted mean changes in biomarkers of anemia, vitamin B12, and ferritin between racial groups before RYGB and up to a period of 4+ years after the surgery. RESULTS: There were significant decreases in all racial/ethnic groups in mean HCT and HGB within the first year following surgery. Mean HCT from baseline to time point 1 (6months-1 year post-operatively) decreased by 3.3% for AA’s (p<0.001), 3.2% for HA’s (p<0.001), and 5% (p<0.001) for CA’s. Mean HCT and mean HGB for the entire sample decreased from baseline to the end of the observation period by 4.4% and 1.45 g/L, respectively. AA's had lower levels of HCT and HGB throughout the observation period compared to HA's and CA's in both the unadjusted and adjusted models. CA's had the highest levels of these blood markers. Decreases in ferritin were also significant, with a decrease from baseline to the end of the observation period of 27.8 μg/L for AA's (p=0.004), a decrease of 49.6 μg/L for HA's (p<0.001), and 54.5 μg/L (p<0.001) for CA's. In comparison with HA's and AA's, CA's had a higher ferritin level at baseline (p=0.715 and p=0.028, respectively). However, when adjusted for age, sex, and initial BMI, CA's had lower ferritin levels throughout much of the observation period compared to HA's and AA's. After an initial increase at 6 months- 1 year post-operatively (time point 1), mean B12 levels remained fairly stable throughout the observation period with levels only slightly declining for AA’s and HA’s over the observation period. Levels remained higher than baseline for all racial/ethnic groups with mean B12 levels at the end increasing by 144.6 ng/L for AA’s (p<0.001), 70.4 ng/L for HA’s (p=0.186), and 182.2 ng/L for CA’s (p<0.001). Though CA’s saw the greatest increase in mean B12 levels from baseline, AA’s had the highest mean B12 levels over the entire observation period, with significantly different levels compared to HA’s and CA’s at time points 1 (p=0.003 and p=0.028, respectively) and 3 (p=0.050 and p=0.042, respectively). Additionally, when other factors significantly affecting mean HCT, HGB, ferritin, and B12 were analyzed and adjusted for in the mixed model, AA’s continued to have the lowest HCT and HGB levels throughout much of the observation period, with CA's having the highest mean levels. For mean B12, even after adjusting for pre-BMI and sex, levels remained highest in AA’s compared to HA’ and CA’s. CONCLUSIONS: Our data demonstrate that ferritin levels, as well as red blood cell indices, decrease after RYGB and blood markers of anemia occur despite supplementation and post-operative follow-up care. We also show that ethnic minorities exhibit more exaggerated decreases in HCT and HGB, suggesting greater risk of anemia after RYGB in these groups. Thus, it is critical to consider race/ethnicity when providing treatment for patients undergoing gastric bypass surgery. However, future prospective studies are needed to further the preliminary results of this study.

Introdução: A obesidade é considerada uma epidemia mundial do século XXI e a cirurgia bariátrica é a melhor arma terapêutica para a perda de peso e para a resolução de comorbilidades relacionadas com a obesidade. Os procedimentos cirúrgicos mais usados são o sleeve gástrico (SG) e o bypass gástrico em Y-de-Roux (RYGB). Contudo, as deficiências nutricionais continuam a representar um dos efeitos laterais mais significativos da cirurgia bariátrica, podendo acarretar severas consequências para estes pacientes. Objetivo: Comparar a incidência de deficiências nutricionais em pacientes submetidos a sleeve gástrico e bypass gástrico em Y-de-Roux. Métodos: Analisou-se, retrospetivamente, o estado nutricional dos 505 pacientes consecutivos submetidos a sleeve gástrico e bypass gástrico em Y-de-Roux, na nossa instituição, entre janeiro e dezembro de 2019. Foram colhidos dados relativos ao período pré-operatório e aos 6 e 12 meses após a cirurgia dos níveis séricos de vitamina B12, ácido fólico, vitamina D, cálcio, PTH, magnésio, hemoglobina, ferro, ferritina e transferrina. Resultados: O grupo submetido a RYGB apresentou significativamente uma maior perda de excesso de peso. Analisando as medianas dos valores dos vários nutrientes, foram identificadas múltiplas diferenças entre as duas técnicas cirúrgicas, como por exemplo, na vitamina B12, na hemoglobina e na ferritina, todas apresentando valores superiores no grupo do SG, durante todo o período de estudo. A deficiência nutricional mais acentuada foi da vitamina D, embora não tenha apresentado diferenças significativas entre o RYGB e o SG (62.05% vs 74.24% pré-operatoriamente; 29.64% vs 24.03% aos 6 meses; 22.41% vs 31.48% aos 12 meses). Quanto à vitamina B12, a prevalência da sua deficiência foi maior no grupo do RYGB, em comparação com o SG (17.46% vs 4.69%, p<0.001 aos 6 meses e 16.74% vs 0.93%, p<0.001 aos 12 meses). Conclusão: Tanto o RYGB como o SG se associam a múltiplas deficiências nutricionais, embora difiram nos mecanismos causadores das mesmas. Assim, torna-se crucial identificar, prevenir e tratar essas deficiências de forma eficiente e tendo em consideração o procedimento cirúrgico a que cada paciente foi submetido.
Background: Obesity is a worldwide epidemic and bariatric surgery is the best recognized treatment option for sustained weight reduction and obesity-related comorbidities. The most used procedures are sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Nutritional deficiencies can have severe consequences and remain one of the most significant side effects of bariatric surgery. Objective: To compare the incidence of nutritional deficiencies in patients undergoing RYGB and SG. Methods: Retrospective analysis of the nutritional status of 505 consecutive patients submitted to either RYGB and SG, between January and December 2019. Data was collected regarding preoperative, 6- and 12-months after surgery levels of vitamin B12, folic acid, vitamin D, calcium, PTH, magnesium, hemoglobin, iron, ferritin and transferrin. Results: The RYGB group presented significantly higher excess weight loss. Regarding the median values of the nutrients, there were multiple significant differences between the two surgical techniques, such as for vitamin B12, hemoglobin and ferritin, all superior in the SG group, throughout the study period. The most marked deficiency was for vitamin D, although with no significant difference between RYGB and SG (62.05% vs 74.24% preoperatively; 29.64% vs 24.03% at 6 months; 22.41% vs 31.48% at 12 months). Vitamin B12 deficiency was significantly higher in the RYGB group (17.46% vs 4.69%, p<0.001 at 6 months and 16.74% vs 0.93%, p<0.001 at 12 months). Conclusion: Both RYGB and SG were associated with several nutritional deficiencies, despite differing in the causing mechanisms. It is crucial to efficiently assess, prevent and manage these deficiencies, according to the surgical procedure.

Introdução: A obesidade é considerada uma epidemia mundial do século XXI e a cirurgia bariátrica é a melhor arma terapêutica para a perda de peso e para a resolução de comorbilidades relacionadas com a obesidade. Os procedimentos cirúrgicos mais usados são o sleeve gástrico (SG) e o bypass gástrico em Y-de-Roux (RYGB). Contudo, as deficiências nutricionais continuam a representar um dos efeitos laterais mais significativos da cirurgia bariátrica, podendo acarretar severas consequências para estes pacientes. Objetivo: Comparar a incidência de deficiências nutricionais em pacientes submetidos a sleeve gástrico e bypass gástrico em Y-de-Roux. Métodos: Analisou-se, retrospetivamente, o estado nutricional dos 505 pacientes consecutivos submetidos a sleeve gástrico e bypass gástrico em Y-de-Roux, na nossa instituição, entre janeiro e dezembro de 2019. Foram colhidos dados relativos ao período pré-operatório e aos 6 e 12 meses após a cirurgia dos níveis séricos de vitamina B12, ácido fólico, vitamina D, cálcio, PTH, magnésio, hemoglobina, ferro, ferritina e transferrina. Resultados: O grupo submetido a RYGB apresentou significativamente uma maior perda de excesso de peso. Analisando as medianas dos valores dos vários nutrientes, foram identificadas múltiplas diferenças entre as duas técnicas cirúrgicas, como por exemplo, na vitamina B12, na hemoglobina e na ferritina, todas apresentando valores superiores no grupo do SG, durante todo o período de estudo. A deficiência nutricional mais acentuada foi da vitamina D, embora não tenha apresentado diferenças significativas entre o RYGB e o SG (62.05% vs 74.24% pré-operatoriamente; 29.64% vs 24.03% aos 6 meses; 22.41% vs 31.48% aos 12 meses). Quanto à vitamina B12, a prevalência da sua deficiência foi maior no grupo do RYGB, em comparação com o SG (17.46% vs 4.69%, p<0.001 aos 6 meses e 16.74% vs 0.93%, p<0.001 aos 12 meses). Conclusão: Tanto o RYGB como o SG se associam a múltiplas deficiências nutricionais, embora difiram nos mecanismos causadores das mesmas. Assim, torna-se crucial identificar, prevenir e tratar essas deficiências de forma eficiente e tendo em consideração o procedimento cirúrgico a que cada paciente foi submetido.
Background: Obesity is a worldwide epidemic and bariatric surgery is the best recognized treatment option for sustained weight reduction and obesity-related comorbidities. The most used procedures are sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Nutritional deficiencies can have severe consequences and remain one of the most significant side effects of bariatric surgery. Objective: To compare the incidence of nutritional deficiencies in patients undergoing RYGB and SG. Methods: Retrospective analysis of the nutritional status of 505 consecutive patients submitted to either RYGB and SG, between January and December 2019. Data was collected regarding preoperative, 6- and 12-months after surgery levels of vitamin B12, folic acid, vitamin D, calcium, PTH, magnesium, hemoglobin, iron, ferritin and transferrin. Results: The RYGB group presented significantly higher excess weight loss. Regarding the median values of the nutrients, there were multiple significant differences between the two surgical techniques, such as for vitamin B12, hemoglobin and ferritin, all superior in the SG group, throughout the study period. The most marked deficiency was for vitamin D, although with no significant difference between RYGB and SG (62.05% vs 74.24% preoperatively; 29.64% vs 24.03% at 6 months; 22.41% vs 31.48% at 12 months). Vitamin B12 deficiency was significantly higher in the RYGB group (17.46% vs 4.69%, p<0.001 at 6 months and 16.74% vs 0.93%, p<0.001 at 12 months). Conclusion: Both RYGB and SG were associated with several nutritional deficiencies, despite differing in the causing mechanisms. It is crucial to efficiently assess, prevent and manage these deficiencies, according to the surgical procedure.

The bariatric surgery is regarded as the most effective treatment method of dangerous forms of obesity. Since the bariatric surgery is closely related to nutrition, it is thus necessary to emphasize the importance of good nutritional knowledge of patients that have undergone this type of surgery. The aim of this thesis was to examine the nutritional knowledge of patients that are at least one year after the surgery, or reoperation. To get relevant data, patients were examined using an anonymous questionnaire. The survey indicates that the patients have insufficient knowledge regarding the recommended protein intake. Furthermore, the examination exhibited, surprisingly, that men have statistically worse knowledge than women do as well as that the majority of patients does not know what the dumping syndrome is. The survey confirmed that the patients operated more than two and a half years ago have worse nutritional knowledge than the ones operated within such a period of time. Moreover, the examination did not identify problems regarding the correct food preparation, post- operational diet, and inappropriate eatables. In addition, it was discovered that about fifty percent of all the examined patients have sufficient knowledge of the post-bariatric surgery eating habits. Since the importance of...

An essential part of bioarchaeology is the study of diet and nutrition and its effects on the general health of a person. Interpretation of nutritional and metabolic disease related pathologies often provide additional insight into the daily social and cultural practices of people. It is therefore also an essential part of understanding differences amongst past populations from archaeological contexts and provides an alternative means for cross referencing historical accounts. In this study the skeletal remains of 36 Chinese indentured mine labourers, who worked and died on the Witwatersrand mines during the period AD 1904-1910, were assessed for any signs of metabolic or nutritionally related signs of disease. Historical information suggests that these indentured Chinese labourers came from poverty stricken communities in China where disease and malnutrition were often encountered. Once in South Africa they were again subjected to the harsh living and working conditions associated with mining. Analyses suggest that all 36 individuals were males between the ages of 16 and 45 years, with the majority being of young adult age (20-34 years). Pathology that could be observed included a high prevalence of nutrition-related changes and linear enamel hypoplasia which suggests that the Chinese miners had been subjected to long periods of malnutrition and illness throughout childhood continuing into adulthood. Nevertheless, a large proportion of lesions associated with malnutrition showed some degree of healing. A high frequency of traumatic lesions, specifically peri-mortem fractures, was observed and may have contributed to the death of many of the Chinese miners. It therefore seems that even though the healing of pathological lesions associated with malnutrition indicated a period of improved nutritional intake, possibly during their time on the Witwatersrand mines, the high prevalence of peri-mortem fractures attests to the hazardous working conditions associated with deep-level mining. In order to aid in the interpretation of skeletal pathology associated with metabolic and nutritional diseases non-specific signs of disease observed in a cadaver skeletal sample with known causes of death (related to specific metabolic or nutritional diseases) were compared to pathology observed in the Chinese miners. This provided pathological patterns which enabled a better interpretation of the pathology observed in the Chinese skeletal remains.
Dissertation (MSc)--University of Pretoria, 2014.
am2014
Anatomy
unrestricted

D. Tech. (Food Service Management, Department of Hospitality, Tourism and PR Management, Faculty of Human Sciences)|, Vaal University of Technology|
Background South Africa is one of the developing countries faced with the co-existence of undernutrition and overnutrition, often experienced within the same household. On the one hand, hunger, undernutrition and micronutrient deficiencies are linked to poverty and household food insecurity. Simultaneously, South Africans are exposed to ‘nutrition in transition’, where overweight and chronic diseases of lifestyle, such as diabetes mellitus, cardiovascular diseases and cancer are on the rise as part of the overnutrition profile. Sound nutrition is important throughout the lifecycle to combat under- and overnutrition and nutrition-related diseases. In urban areas, the grandmother or another senior female family member is often responsible for caring for the children in the household during the day. This includes physical, emotional and nutritional care. It is therefore essential for the caregiver to have good nutrition knowledge, to provide not only in her own needs, but also in those of the children. A nutrition education programme is one strategy for improving the nutrition knowledge of caregivers of children. Objective The primary objective in this study was to develop, tailor, implement and evaluate a nutrition education programme (NEP) for Sesotho-speaking females and caregivers of children in the Boipatong Township in the Vaal Region of South Africa and to test its impact in the short and longer term. Nutrition knowledge regarding four South African food-based dietary guidelines (FBDGs) was empirically tested before and after the intervention and then compared to a control group. In addition, dietary intake was assessed to detect any changes after the intervention in the medium term. Methodology In this both quantitative and qualitative methodologies were applied. Two frameworks, the United Nations Children’s Fund (UNICEF) Framework of Malnutrition (2004) and the Food and Agriculture Organisation (FAO) Framework for Nutrition Education (1997), gave structure to the planning, implementation and evaluation of the research project. This study’s nutrition education programme was based on a socio-ecological model to guide behavioural change in terms of healthy food choices. In the preparation phase, a situational analysis was performed by means of a cross-sectional analytical design using descriptive statistics. Socio-demographic and self-reported health information was obtained. Nutrition knowledge, based on the South African food-based dietary guidelines (FBDGs), was measured, and dietary intake was assessed and compared with the estimated average requirements (EARs) for their age categories. Phase two, the formulation phase, used an experimental design. The acceptability and understanding of the existing national nutrition education (NE) material for individuals with low living standards (LSM) was investigated in this phase of the nutrition education programme (NEP). A culturally tailored booklet was developed in English, translated into Sesotho, pilot tested and implemented as part of the nutrition education programme. Lesson plans were developed and pilot tested. A non-randomised control trial was used in the implementation and evaluation phases. The effect of the nutrition education programme on nutrition knowledge was quantitatively measured in a pre- and post-test design at each discussion session in the short term, using paired t-tests in the experimental group of caregivers. The evaluation phase tested the impact of the nutrition education in the longer term. Nutrition knowledge was measured quantitatively in a before-after intervention test design by means of a self-completed structured questionnaire, based on the four South African FDBGs included in the programme. A control group who was not subjected to any intervention was used to complete the same questionnaire before and after the intervention in the same time period as the experimental group. In the experimental group, dietary intake was assessed before and after the intervention to detect changes in dietary intake. No dietary intake was measured in the control group, as changes could be attributed to influences beyond the control of this study. Two randomly selected focus groups of the experimental group were run to provide deeper insight into their perceptions regarding the acceptability and understanding of the NEP and NE material. Results The situational analysis of the preparation phase revealed a poor community that displayed typical patterns of nutrition in transition, at risk of malnutrition. The median age of the sample of caregivers was 44 years (IQR 32-62). Income and consumption poverty was confirmed by 80.5 percent of households spending R300 or less on food, with 75 percent of households having between four and seven people living in the dwelling. Dietary results were indicative of food poverty and poor food choices, possibly due to monetary constraints. A low energy intake (median 5323 kJ/day; IQR 3369-7949), was observed. Only 13.9 percent reached the estimated energy requirement (EER) of 7855 kJ per day for their age category. The overall mean average requirements of the diet was 0.7 but the possiblity of micronutrient deficiencies could not be excluded with a MAR of 0.6 for vitamins and minerals respectively. The median nutrition knowledge was 50 percent (IQR 42-54%) The lowest score was obtained for the FBDG ‘Enjoy a variety of food’ (33.4%; 95% CI 1.1), followed by the FBDG on animal protein (40.3%; 95% CI 1.0). It was decided to augment these two FBDGs with the plant protein FBDG (54.3%; 95% CI 1.8). Despited a relatively good knowledge measured in the caregivers, none of the plant protein food items appeared in the top 20 food items most frequently consumed. The formulation phase included the testing of existing nutrition education material. Messages were well understood (60.5%). However, caregivers found the images contained in the pamphlets and the design of the pamphlets confusing. A definite need was identified for new, culturally acceptable NE material in the caregivers’ home language, Sesotho (74%). During the implementation phase the lectures were presented and the change in the short-term nutrition knowledge of the FBDGs was measured at every session by means of a pre-post-test design. The median age of the caregivers was 63 years (52-78). A significant change in nutrition knowledge was found for each FBDG in terms of the mean number of questions answered correctly by the participants between the results of each pre- and post-test. In the evaluation phase, the impact of the NEP was measured in the Boipatong experimental group and compared, regarding nutrition knowledge, to a control group in the longer term (three months after completion of the intervention). Median nutrition knowledge before the intervention was 49 percent (IQR 46-57) compared to 70 percent (IQR 68-73) after the intervention – an increase of 21 percent. In contrast, the control group showed an increase of only five percent. The results showed that the eating habits of many of the caregivers still fell substantially short of internationally recognised standards (estimated energy requirement (EER) and estimated average requirement (EAR)), and this could contribute to undernutrition as well as to an increased risk of diet-related chronic disease. A median kilojoule intake of 4788 kJ (IQR 3415-6596) per day before and 4651 kJ (IQR 3369-6664) per day after the intervention was registered. Carbohydrate foods remained an important source of energy. Calcium presented a major concern, as none of the participants reached the EAR despite a slight increase in the intake of milk (volume and frequency) after the intervention, as validated by the top 20 food lists and as measured by a nutrient average requirement (NAR) of 0.1 to 0.7 before and after the intervention respectively. The mean average requirements (MAR) remained relatively stable, at 0.7 (median) before the intervention and 0.6 after the intervention. The NEP thus had an insignificant positive effect on dietary intake, except for calcium, iodine and vitamin C intake, which showed significant increases. No relationships could be found between the MAR as an indicator of dietary quality and nutrition knowledge. However, this does not mean that an NEP is not a suitable strategy. Changes in food choices and dietary intake should be measured in the longer term, since lifestyle changes are challenging to adopt when people, especially those in deprived communities, do not have the financial means to make healthy food choices. Conclusion When planning nutrition education strategies to improve the health status of communities in deprived areas, one is faced with the difficulty of households with a low socio-economic status and poor dietary intake, which increases the risk of food and nutrition insecurity. The nutrition education programme, developed, tailored and implemented as an intervention strategy to address an identified need of caregivers, was effective in improving nutrition knowledge. Four of the South African dietary guidelines were used in the nutrition education programme tailored to the specific profile that emerged from the situational analysis and the development of supportive nutrition education material. Lesson plans and the Sesotho and English booklets are available for use in other nutrition education programmes. The study contributed to the understanding of food choices of the urban community of Boipatong as well as of the nutrient inadequacies observed. Nutrition knowledge alone is not enough to bring about changes in food choices when the means to do so are lacking. Poverty and nutrition are closely linked and thus difficult to separate.

Background - Food and nutrition insecurity severely compromises the quality of life in farm communities in South Africa. Although food‐based approaches are more sustainable strategies to address malnutrition, most other strategies only target the alleviation of single micronutrients. Synergies between nutrients demand a wider scope; food‐based strategies need to focus on improving both overall diet quality and the well‐being of rural and urban populations. Agricultural biodiversity is crucial in such strategies to improve food security and health. This thesis aims to investigate the effect of African leafy vegetables (ALVs) on the alleviation of micronutrient deficiencies in school children residing in the North West Province of South Africa. Methods - Four focus group discussions assessed primary caregivers’ (n=29) knowledge, perceptions and use of indigenous and traditional plants. Thereafter, the research focused on the leaves of Amaranthus cruentus (amaranth), Cleome gynandra (spiderplant), Cucurbita maxima (pumpkin) and Vigna unguiculata (cowpea). Sensory acceptability to children of selected ALV dishes, prepared in a traditional way (n=98) and prepared with gravy, was assessed (n=80). The nutrient composition and the bio‐accessibility of iron and zinc in these ALVs were determined. A randomised controlled trial to investigate the effect of consumption of these ALVs on the iron, vitamin A en zinc status of primary school children (grade R – grade 4) followed. Children of two rural farm schools were randomly allocated per grade and school to receive either daily (five days/week) 300 gram cooked ALVs with the school meal starch (N=86) or the normal school meal (N=81) for three months. Results - Caregivers were positive about using ALVs, transferring knowledge from generation to generation. Children found dishes made with ALVs, prepared in the traditional way as well as with gravy, acceptable in terms of colour, smell and taste. ALVs contributed 11.6 ‐ 15.8 mg iron and 1.4 ‐ 3.7 mg zinc per meal. Amaranth‐and‐spiderplant has the highest amount of bio‐accessible iron (0.42 mg iron). All dishes contain 0.3 mg bio‐accessible zinc. At baseline, intervention and control children were deficient for Hb <11.5 g/dL (16.0% and 10.5%), serum ferritin <15 μg/L (16.3% and 18.5%), serum retinol <20 μg/dL (7.0% and 2.5%) and serum zinc <65 μg/dL (75.6% and 75.3%). No significant estimated intervention effect was found. Conclusion - Caregivers possessed knowledge of ALVs and were positive about their use. Based on dialyzable iron and zinc, the contribution of the ALV dishes towards dietary requirements is more substantial for iron than zinc. The randomised controlled trial showed that ALVs unable to improve serum retinol, serum ferritin or hemoglobin in mildly deficient children or those with low status zinc. Furthermore, despite the low zinc status in our population, ALV consumption did not improve serum zinc concentrations. Based on the more theoretical and indirect study results, including both caregivers’ and children’ positive image of ALVs, and the nutrient composition and iron and zinc bio‐accessibility of the ALVs, these selected vegetables do have the potential to contribute to the micronutrient intake of school children. However, the importance of ALVs might not necessary be to serve as a strategy for micronutrient deficiency alleviation, but rather in the diversification of the diet in resource‐poor settings and thereby contribute to the micronutrient intake.
PhD (Nutrition), North-West University, Potchefstroom Campus, 2014

Moçambique apresenta das percentagens mais elevadas do mundo de malnutrição crónica (MC) em crianças menores de 5 anos e Nampula, é a província de Moçambique com maior prevalência. A MC tem um impacto negativo no desenvolvimento físico e cognitivo da criança difícil de recuperar e, em idade pré-escolar, a criança poderá já ter a sua capacidade cognitiva comprometida por carências nutricionais anteriores. O acesso à refeição escolar traz benefícios a curto e a longo prazo no sucesso das crianças, potenciando o seu desempenho cognitivo e abrindo espaço ao ensino da alimentação e da nutrição saudável. A escola impõese assim como um meio privilegiado para oferecer conhecimento e alimento. O principal objetivo da investigação foi o de estudar a existia de inadequação do conteúdo nutricional (valor energético, macronutrientes e micronutrientes) das refeições de 3 pré-escolas do distrito da Ilha de Moçambique (Centro Infantil da Ilha de Moçambique, Escolinha Pérola do Lumbo e Escolinha Filipe Magaia), através da comparação com as recomendações nutricionais para crianças dos 24 aos 72 meses de idade. Foi realizada uma avaliação nutricional às crianças e um inquérito aos seus encarregados de educação/representantes legais (EE/RL) (n=125). Procedeu-se ainda com a caraterização e avaliação da composição nutricional das refeições das 3 pré-escolas (n=25), através da comparação com as referências nutricionais para 20% e 30% das necessidades diárias. Posteriormente, foram elaboradas sugestões com o propósito de adequar o conteúdo nutricional das refeições às necessidades diagnosticadas. Constatou-se que, 29,6% das crianças manifestou ter algum tipo de malnutrição, sendo que, 24% apresentou malnutrição crónica. Aferiu-se ainda que, em média, 83,5% dos EE/RL frequentou a escola (8,1% frequentou o ensino superior), o número de pessoas por agregado foi de 6, 75,3% da amostra era islâmica, o idioma dominante em casa era o Émakua (78,23%) e 75,96% dos agregados tinha eletricidade. Relativamente à diversidade e frequência alimentar das crianças verificou-se que, 85,12% e 80,3% cumpriu com os requisitos, respetivamente. Quando foram comparadas as composições nutricionais das refeições para 20% das necessidades diárias (uma refeição), as três escolas apresentaram inadequações face aos valores de referência. Todavia, a Escola de Magaia foi a que apresentou menores inadequações. Por outro lado, ao comparar com as recomendações para 30% das necessidades diárias (2 refeições) verificou-se que, as refeições não estavam tão aquém das recomendações, porém, ainda assim se observaram inadequações, principalmente em relação à vitamina A. Espera-se que, a longo prazo as sugestões elaboradas sejam tidas em consideração para que as refeições escolares sejam um veículo de saúde e informação
Mozambique has presented one of the world’s highest proportion of children under five years old suffering from stunting and Nampula province accounted for the highest prevalence rates. In fact, stunting may affect both the children’s physical and cognitive development which is then becomes hard to recover. Additionally, for pre-school aged children they may already have their cognitive ability compromised by previous nutritional deficiencies. For this reason, school meals programmes may bring short-term and long-term benefits for children encouraging the healthy eating education. The school therefore is a major mean to provide knowledge and food. The research aimed primarily to study the existence of inadequate nutritional content (energy, macronutrients and micronutrients) of the meals provided by three preschools located in Ilha de Mozambique district (Centro Infantil da Ilha de Moçambique, Escolinha Pérola do Lumbo e Escolinha Filipe Magaia). The work was based on the nutritional recommendations for children aged from 24 to 72 months. A nutritional assessment was carried out on school children and it was performed a survey to the children’s parents/legal guardians (P/LG) (n=125). In addition, a comparison was also made between the nutritional composition of the three preschools’ meals (n=25) and the nutritional references regarding to 20% and 30% of the daily requirements. Finally, based on the diagnosed needs, recommendations and suggestions were prepared to improve the nutritional content of the meals provided. The children presented 29,6% of some type of malnutrition and 24% was diagnosed with stunting. According to the survey, on average, 83,5% of P/LG attended school (8,1% attended higher education), the number of people per household was 6, 75,3% of the sample was Islamic, the dominant language at home was the Émakua (78,23%) and 75,96% of the households had electricity. Regarding the diversity and feeding frequency of the children, 85,12% and 80,3% met the requirements, respectively. Moreover, when the nutritional compositions of the meals were compared to 20% of the daily requirements (1 meal), the 3 schools presented inadequacies against the reference values. However, Escola de Magaia was the one that presented the lowest amount of inadequacies. Comparing to the recommendations for 30% of daily requirements (2 meals), Escola do Lumbo and Centro Infantil exhibited more adequate meals, nevertheless, there were still inadequacies, especially in vitamin A values. It is expected that the recommendations provided throughout the work project may be taken into consideration for school meals to become a vehicle for health improvement and information.

Cette étude s’inscrit dans le cadre du projet « Pôle francophone africain sur le Double Fardeau Nutritionnel » (DFN) du laboratoire TRANSNUT, centre collaborateur OMS sur la transition nutritionnelle du Département de Nutrition de l’Université de Montréal, en collaboration avec ses partenaires au Burkina Faso, à savoir l’Institut de Recherche en Sciences de la Santé (IRSS) et l’Institut Supérieur des Sciences de la Population (ISSP). Elle est l’une des premières à s’intéresser au double fardeau de la malnutrition en Afrique francophone. Cette étude avait pour objectif de démontrer l’existence du double fardeau de la malnutrition parmi les adultes de Ouagadougou au Burkina Faso, d’en donner l’ampleur et d’identifier ses liens avec les facteurs du mode de vie. Plus spécifiquement, elle visait à décrire les carences nutritionnelles, les facteurs de risque cardiométabolique (FRCM), et la typologie du double fardeau de la malnutrition; examiner les caractéristiques du mode de vie des adultes et leurs liens avec le double fardeau de la malnutrition selon les conditions économique, et enfin d’examiner l’association entre inflammation subclinique, les carences nutritionnelles et les FRCM selon les facteurs du mode de vie. Ces objectifs faisaient suite à nos principales hypothèses qui stipulaient que : parmi les adultes de Ouagadougou, le phénotype de double fardeau de la malnutrition le plus fréquemment observé est l’association de surpoids/obésité avec une ou plusieurs carences nutritionnelles, surtout chez les femmes, puis qu’une alimentation de piètre qualité, en lien avec de mauvaises conditions socioéconomiques et de vie est associée tant aux FRCM qu’aux carences nutritionnelles, contribuant ainsi au double fardeau de malnutrition, et enfin qu’un état d’inflammation subclinique joue un rôle de médiateur entre le mode de vie et aussi bien les carences nutritionnelles que les FRCM. Afin de répondre à ces objectifs, une étude transversale descriptive et analytique a été conduite auprès d’un échantillon aléatoire de 330 adultes âgés de 25 à 60 ans recrutés au sein de l’Observatoire de Population de Ouagadougou, situé à la partie nord de la ville. Cet échantillon a été subdivisé en terciles du score de possessions matérielles, proxy du statut socioéconomique, avec 110 personnes respectivement dans chaque strate de niveau socioéconomique bas, moyen et élevé. Chaque participant a fourni des données sociodémographiques, anthropométriques, cliniques et comportementales; il a aussi fourni un échantillon de sang. Les principales variables de l’étude étaient les suivantes : l’âge, les conditions socioéconomiques (insécurité alimentaire, éducation et proxy du revenu), le mode de vie (les apports alimentaires et la qualité de l’alimentation, l’activité physique, la consommation d’alcool et de tabac, la perception de l’image corporelle, le stress psychosocial); l’inflammation subclinique; les FRCM [surpoids/obésité, tension artérielle élevée (TAE) ou hypertension artérielle (HTA), hyperglycémie, dyslipidémie et insulino-résistance]; les carences nutritionnelles (maigreur, anémie, carence en fer et en vitamine A). Des phénotypes de double fardeau de la malnutrition ont été identifiés en combinant FRCM et carences nutritionnelles. Les résultats ont montré une prévalence élevée de surpoids/obésité, d’obésité abdominale, d’hypertension artérielle, d’hyperglycémie, de résistance à l’insuline et du taux de lipoprotéine de haute densité (HDL-C) bas, respectivement de 24,2 %, 12,5 %, 21,9 %, 22,3 %, 25,1 % et 30,0 %. En utilisant les seuils plus sensibles de la Fédération Internationale du Diabète (FID), l’obésité abdominale, la tension artérielle élevée (TAE), l’hyperglycémie était respectivement de 23,5 %; 36,1 % et 34,5 %. Des carences nutritionnelles étaient également présentes, l’anémie, la carence en fer et en vitamine A, ainsi que la maigreur atteignant respectivement 25,5 %, 15,4 %, 12,7 % et 9,7 % de la population étudiée. Les femmes étaient significativement plus touchées que les hommes autant par les FRCM que par les carences nutritionnelles. Le double fardeau de la malnutrition touchait 23,5 % des personnes et même 25,8 % avec les seuils de la FID pour l’obésité abdominale, la TAE, et l’hyperglycémie. Les deux principaux phénotypes observés étaient : l’association de « surpoids/obésité avec au moins une carence en micronutriment », touchant 7,8 % (11,8 % ♀ vs. 3,4 % ♂) des personnes et l’association d’au moins un FRCM autre que le surpoids/obésité avec au moins une carence en micronutriment, qui touchait 9.0 % (12,4 % ♀ vs. 5,4 % ♂) des personnes. La prévalence de ces phénotypes était plus élevée en utilisant les seuils de la FID plutôt que les seuils de l’OMS. Près de 72,9 % des personnes ou 81,2 % (seuils de la FID) avaient au moins un FRCM. Nous avons identifié à partir de l’analyse typologique, deux schémas alimentaires; « urbain » et « traditionnel », dans cette étude. Les carences nutritionnelles étaient davantage associées au schéma alimentaire « traditionnel », alors que les FRCM se retrouvaient dans les deux schémas alimentaires. Le schéma « urbain » regroupait significativement plus d’hommes et de personnes de niveau socioéconomique élevé, alors que les personnes de niveau socioéconomique bas et les femmes étaient proportionnellement plus nombreuses dans le schéma « traditionnel ». Le temps dévolu aux activités sédentaires était significativement plus important que celui consacré aux activités d’intensité modérée à vigoureuse. L’activité physique était inversement associée à l’indice de masse corporelle (IMC), au tour de taille (TT), à la masse grasse corporelle, à la tension artérielle systolique (TAS) et diastolique (TAD), à la triglycéridémie et au taux de lipoprotéine de faible densité (LDL-C). L’IMC et le TT augmentaient en outre avec le temps de sédentarité. Ainsi, le double fardeau de malnutrition était associé au statut socioéconomique bas, au sexe féminin et à la sédentarité. Nous avons aussi trouvé que 39,4 % des personnes avaient une inflammation subclinique qui était associée de façon indépendante et positive à la ferritinémie, à l’IMC, au TT et à la masse grasse corporelle, et négativement au HDL-C. L’exploration du stress psychosocial et de l’image corporelle a révélé une association entre le stress psychosocial, l’HTA et une perception positive de l’embonpoint. Les personnes ayant peut-être accusé un retard de croissance à l’enfance (d’après l’indice de Cormic) étaient significativement plus touchées par le surpoids/obésité, l’obésité abdominale et la résistance à l’insuline. Ces résultats nous ont permis d’atteindre nos objectifs, mais aussi de vérifier nos hypothèses de recherche. Comme on peut le constater, les FRCM sont une réalité à Ouagadougou, qui se compliquent par leur coexistence avec des carences en micronutriments dont la prévalence est tout aussi importante. Une transition nutritionnelle est en cours dans cette ville et contribue au bouleversement des comportements alimentaires et du style de vie favorisant l’émergence de ce double fardeau, dans un contexte où le passé nutritionnel de la population offre des conditions idéales pour un niveau de risque particulièrement élevé pour ces FRCM. Cependant, l’évolution de cette prévalence pourrait être inversée ou tout au moins ralentie si des actions étaient entreprises dès maintenant.
This study is a part of a project on the double burden of malnutrition in sub-Saharan Africa, developed and implemented by TRANSNUT, a WHO collaborating centre on nutrition changes and development, of the Department of Nutrition, Université de Montréal, in collaboration with its partners in Burkina Faso (Institut de Recherche en Sciences de la Santé and Institut Supérieur des Sciences de la Population). The study is among the first to focus on the double burden of malnutrition in French speaking Africa and aimed to describe the occurrence of the double burden among adults living in Ouagadougou, Burkina Faso, by determining its prevalence and to what extent it was related to life style factors. More specifically, the study aimed to: 1) describe nutrition deficiencies, cardio-metabolic risk factors (CMRF) and double burden phenotypes, to 2) examine the relationship between lifestyle characteristics and the double burden of malnutrition, and finally, 3) to examine the relationship between subclinical inflammation and both CMRF and nutrition deficiencies. We hypothesised that: ‘among the adults of Ouagadougou, the more frequent phenotype of double burden of malnutrition is the association of overweight/obesity with at least one micronutrient deficiency, which is more prevalent in women’; ‘an inadequate quality of the diet related to poor socioeconomic and living conditions is associated to both CMRF and micronutrients deficiencies’ and finally, that ‘subclinical inflammation is a mediator variable between lifestyle and both CMRF and nutrition deficiencies’. We carried out a population based cross-sectional study, descriptive and analytical, with a random sample of 330 adults aged 25-60y, selected from the population observatory of Ouagadougou located in the northern district. This sample was stratified in three income groups using household assets as a proxy of socioeconomic status, with 110 subjects in the following three income strata: low, middle and high. Each subject provided sociodemographic, anthropometric, clinical and lifestyle data and a blood sample for the assessment of the following study variables: age, and socioeconomic conditions (food insecurity, education and income); lifestyle factors (dietary intake and diet quality, physical activity, alcohol and tobacco consumption, body image perception, and psychosocial stress); subclinical inflammation; CMRF (overweight/obesity, high blood pressure or hypertension, hyperglycaemia, dyslipidemia, insulin resistance); nutritional deficiency markers ( underweight, anaemia, iron and vitamin A deficiencies); the double burden of malnutrition phenotypes featured by combining CMRF with nutrition deficiencies factors. We reported a high prevalence of overweight/obesity, abdominal obesity, hypertension, hyperglycaemia, insulin resistance and low concentration of high density lipoprotein cholesterol (HDL-C), which was 24.2%, 12.5%, 21.9%, 22.3%, 25.1%, and 30.0% respectively. When using International Diabetes Federation (IDF) cut-offs for abdominal obesity, high blood pressure, and hyperglycaemia, their prevalence were 23.5%, 36.1%, and 34.5% respectively. Anaemia, iron and vitamin A deficiencies and underweight were found in 25.5%, 15.4%, 12.7%, and 9.7% of subjects, respectively. Women were more affected by both CMRF and deficiencies than men. When combining CMRF and deficiencies within the same individual, the double burden of malnutrition was reported in 23.5% of subjects and even in 25.8% of them when IDF cut-offs for abdominal obesity, high blood pressure, and hyperglycaemia were used. Two main phenotypes were reported: the co-occurrence of ‘overweight/obesity with at least one micronutrient deficiency’, with a prevalence rate of 7.8% (11.8 % ♀ vs. 3.4 % ♂); and the co-occurrence of ‘CMRF other than overweight/obesity with at least one micronutrient deficiency’, with a prevalence rate of 9.0% (12.4 % ♀ vs. 5.4 % ♂). This prevalences was higher when using IDF cut-offs instead of WHO cut-offs. Finally, 72.9% of the subjects exhibited at least one CMRF and even 81.2% of the subjects when using IDF cut-offs. We also identified in this study population two dietary patterns: “urban” and “traditional”. Nutritional deficiencies were associated with ‘traditional’ dietary pattern, whereas CMRF were found in both patterns without statistical difference. The “urban” dietary pattern was significantly more common in men, high income subjects, whereas low income subjects and women were significantly more numerous in the ‘traditional’ one. Time devoted to sedentary activities was significantly higher than time spent in moderate to vigorous activities. Time in moderate to vigorous activities was significantly and negatively associated with body mass index (BMI), waist circumference (WC), and body fat mass, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceridemia, and low density lipoprotein cholesterol (LDL-C), while BMI and WC were associated to sedentary time. The double burden of malnutrition was associated to low income status, women, and sedentary time. We reported that 39.4% of the subjects exhibited subclinical inflammation, which was independently and positively associated with serum ferritin, BMI, WC, body fat mass, and negatively to HDL-C. Body image evaluation revealed that overweight was perceived as desirable body image among the study subjects. Psychosocial stress was associated with hypertension and subjects who probably faced stunting during infancy (using Cormic Index) exhibited significantly higher prevalence of overweight/obesity, abdominal obesity and insulin resistance. The results allowed us to achieve the study objectives and confirm our hypotheses. CMRF represents an overwhelming issue in adults of Ouagadougou complicated with their coexistence with nutritional deficiencies, also highly prevalent. A nutrition transition is at play in the city, contributing to lifestyle changes favorable to the double burden of malnutrition in such a context where the early life nutritional conditions of the subjects may put them at further enhancement of CMRF. The progression of this prevalence can still be averted or at least be slowed if suitable actions were taken from now.

Cette étude s’inscrit dans le cadre du projet « Pôle francophone africain sur le Double Fardeau Nutritionnel » (DFN) du laboratoire TRANSNUT, centre collaborateur OMS sur la transition nutritionnelle du Département de Nutrition de l’Université de Montréal, en collaboration avec ses partenaires au Burkina Faso, à savoir l’Institut de Recherche en Sciences de la Santé (IRSS) et l’Institut Supérieur des Sciences de la Population (ISSP). Elle est l’une des premières à s’intéresser au double fardeau de la malnutrition en Afrique francophone. Cette étude avait pour objectif de démontrer l’existence du double fardeau de la malnutrition parmi les adultes de Ouagadougou au Burkina Faso, d’en donner l’ampleur et d’identifier ses liens avec les facteurs du mode de vie. Plus spécifiquement, elle visait à décrire les carences nutritionnelles, les facteurs de risque cardiométabolique (FRCM), et la typologie du double fardeau de la malnutrition; examiner les caractéristiques du mode de vie des adultes et leurs liens avec le double fardeau de la malnutrition selon les conditions économique, et enfin d’examiner l’association entre inflammation subclinique, les carences nutritionnelles et les FRCM selon les facteurs du mode de vie. Ces objectifs faisaient suite à nos principales hypothèses qui stipulaient que : parmi les adultes de Ouagadougou, le phénotype de double fardeau de la malnutrition le plus fréquemment observé est l’association de surpoids/obésité avec une ou plusieurs carences nutritionnelles, surtout chez les femmes, puis qu’une alimentation de piètre qualité, en lien avec de mauvaises conditions socioéconomiques et de vie est associée tant aux FRCM qu’aux carences nutritionnelles, contribuant ainsi au double fardeau de malnutrition, et enfin qu’un état d’inflammation subclinique joue un rôle de médiateur entre le mode de vie et aussi bien les carences nutritionnelles que les FRCM. Afin de répondre à ces objectifs, une étude transversale descriptive et analytique a été conduite auprès d’un échantillon aléatoire de 330 adultes âgés de 25 à 60 ans recrutés au sein de l’Observatoire de Population de Ouagadougou, situé à la partie nord de la ville. Cet échantillon a été subdivisé en terciles du score de possessions matérielles, proxy du statut socioéconomique, avec 110 personnes respectivement dans chaque strate de niveau socioéconomique bas, moyen et élevé. Chaque participant a fourni des données sociodémographiques, anthropométriques, cliniques et comportementales; il a aussi fourni un échantillon de sang. Les principales variables de l’étude étaient les suivantes : l’âge, les conditions socioéconomiques (insécurité alimentaire, éducation et proxy du revenu), le mode de vie (les apports alimentaires et la qualité de l’alimentation, l’activité physique, la consommation d’alcool et de tabac, la perception de l’image corporelle, le stress psychosocial); l’inflammation subclinique; les FRCM [surpoids/obésité, tension artérielle élevée (TAE) ou hypertension artérielle (HTA), hyperglycémie, dyslipidémie et insulino-résistance]; les carences nutritionnelles (maigreur, anémie, carence en fer et en vitamine A). Des phénotypes de double fardeau de la malnutrition ont été identifiés en combinant FRCM et carences nutritionnelles. Les résultats ont montré une prévalence élevée de surpoids/obésité, d’obésité abdominale, d’hypertension artérielle, d’hyperglycémie, de résistance à l’insuline et du taux de lipoprotéine de haute densité (HDL-C) bas, respectivement de 24,2 %, 12,5 %, 21,9 %, 22,3 %, 25,1 % et 30,0 %. En utilisant les seuils plus sensibles de la Fédération Internationale du Diabète (FID), l’obésité abdominale, la tension artérielle élevée (TAE), l’hyperglycémie était respectivement de 23,5 %; 36,1 % et 34,5 %. Des carences nutritionnelles étaient également présentes, l’anémie, la carence en fer et en vitamine A, ainsi que la maigreur atteignant respectivement 25,5 %, 15,4 %, 12,7 % et 9,7 % de la population étudiée. Les femmes étaient significativement plus touchées que les hommes autant par les FRCM que par les carences nutritionnelles. Le double fardeau de la malnutrition touchait 23,5 % des personnes et même 25,8 % avec les seuils de la FID pour l’obésité abdominale, la TAE, et l’hyperglycémie. Les deux principaux phénotypes observés étaient : l’association de « surpoids/obésité avec au moins une carence en micronutriment », touchant 7,8 % (11,8 % ♀ vs. 3,4 % ♂) des personnes et l’association d’au moins un FRCM autre que le surpoids/obésité avec au moins une carence en micronutriment, qui touchait 9.0 % (12,4 % ♀ vs. 5,4 % ♂) des personnes. La prévalence de ces phénotypes était plus élevée en utilisant les seuils de la FID plutôt que les seuils de l’OMS. Près de 72,9 % des personnes ou 81,2 % (seuils de la FID) avaient au moins un FRCM. Nous avons identifié à partir de l’analyse typologique, deux schémas alimentaires; « urbain » et « traditionnel », dans cette étude. Les carences nutritionnelles étaient davantage associées au schéma alimentaire « traditionnel », alors que les FRCM se retrouvaient dans les deux schémas alimentaires. Le schéma « urbain » regroupait significativement plus d’hommes et de personnes de niveau socioéconomique élevé, alors que les personnes de niveau socioéconomique bas et les femmes étaient proportionnellement plus nombreuses dans le schéma « traditionnel ». Le temps dévolu aux activités sédentaires était significativement plus important que celui consacré aux activités d’intensité modérée à vigoureuse. L’activité physique était inversement associée à l’indice de masse corporelle (IMC), au tour de taille (TT), à la masse grasse corporelle, à la tension artérielle systolique (TAS) et diastolique (TAD), à la triglycéridémie et au taux de lipoprotéine de faible densité (LDL-C). L’IMC et le TT augmentaient en outre avec le temps de sédentarité. Ainsi, le double fardeau de malnutrition était associé au statut socioéconomique bas, au sexe féminin et à la sédentarité. Nous avons aussi trouvé que 39,4 % des personnes avaient une inflammation subclinique qui était associée de façon indépendante et positive à la ferritinémie, à l’IMC, au TT et à la masse grasse corporelle, et négativement au HDL-C. L’exploration du stress psychosocial et de l’image corporelle a révélé une association entre le stress psychosocial, l’HTA et une perception positive de l’embonpoint. Les personnes ayant peut-être accusé un retard de croissance à l’enfance (d’après l’indice de Cormic) étaient significativement plus touchées par le surpoids/obésité, l’obésité abdominale et la résistance à l’insuline. Ces résultats nous ont permis d’atteindre nos objectifs, mais aussi de vérifier nos hypothèses de recherche. Comme on peut le constater, les FRCM sont une réalité à Ouagadougou, qui se compliquent par leur coexistence avec des carences en micronutriments dont la prévalence est tout aussi importante. Une transition nutritionnelle est en cours dans cette ville et contribue au bouleversement des comportements alimentaires et du style de vie favorisant l’émergence de ce double fardeau, dans un contexte où le passé nutritionnel de la population offre des conditions idéales pour un niveau de risque particulièrement élevé pour ces FRCM. Cependant, l’évolution de cette prévalence pourrait être inversée ou tout au moins ralentie si des actions étaient entreprises dès maintenant.
This study is a part of a project on the double burden of malnutrition in sub-Saharan Africa, developed and implemented by TRANSNUT, a WHO collaborating centre on nutrition changes and development, of the Department of Nutrition, Université de Montréal, in collaboration with its partners in Burkina Faso (Institut de Recherche en Sciences de la Santé and Institut Supérieur des Sciences de la Population). The study is among the first to focus on the double burden of malnutrition in French speaking Africa and aimed to describe the occurrence of the double burden among adults living in Ouagadougou, Burkina Faso, by determining its prevalence and to what extent it was related to life style factors. More specifically, the study aimed to: 1) describe nutrition deficiencies, cardio-metabolic risk factors (CMRF) and double burden phenotypes, to 2) examine the relationship between lifestyle characteristics and the double burden of malnutrition, and finally, 3) to examine the relationship between subclinical inflammation and both CMRF and nutrition deficiencies. We hypothesised that: ‘among the adults of Ouagadougou, the more frequent phenotype of double burden of malnutrition is the association of overweight/obesity with at least one micronutrient deficiency, which is more prevalent in women’; ‘an inadequate quality of the diet related to poor socioeconomic and living conditions is associated to both CMRF and micronutrients deficiencies’ and finally, that ‘subclinical inflammation is a mediator variable between lifestyle and both CMRF and nutrition deficiencies’. We carried out a population based cross-sectional study, descriptive and analytical, with a random sample of 330 adults aged 25-60y, selected from the population observatory of Ouagadougou located in the northern district. This sample was stratified in three income groups using household assets as a proxy of socioeconomic status, with 110 subjects in the following three income strata: low, middle and high. Each subject provided sociodemographic, anthropometric, clinical and lifestyle data and a blood sample for the assessment of the following study variables: age, and socioeconomic conditions (food insecurity, education and income); lifestyle factors (dietary intake and diet quality, physical activity, alcohol and tobacco consumption, body image perception, and psychosocial stress); subclinical inflammation; CMRF (overweight/obesity, high blood pressure or hypertension, hyperglycaemia, dyslipidemia, insulin resistance); nutritional deficiency markers ( underweight, anaemia, iron and vitamin A deficiencies); the double burden of malnutrition phenotypes featured by combining CMRF with nutrition deficiencies factors. We reported a high prevalence of overweight/obesity, abdominal obesity, hypertension, hyperglycaemia, insulin resistance and low concentration of high density lipoprotein cholesterol (HDL-C), which was 24.2%, 12.5%, 21.9%, 22.3%, 25.1%, and 30.0% respectively. When using International Diabetes Federation (IDF) cut-offs for abdominal obesity, high blood pressure, and hyperglycaemia, their prevalence were 23.5%, 36.1%, and 34.5% respectively. Anaemia, iron and vitamin A deficiencies and underweight were found in 25.5%, 15.4%, 12.7%, and 9.7% of subjects, respectively. Women were more affected by both CMRF and deficiencies than men. When combining CMRF and deficiencies within the same individual, the double burden of malnutrition was reported in 23.5% of subjects and even in 25.8% of them when IDF cut-offs for abdominal obesity, high blood pressure, and hyperglycaemia were used. Two main phenotypes were reported: the co-occurrence of ‘overweight/obesity with at least one micronutrient deficiency’, with a prevalence rate of 7.8% (11.8 % ♀ vs. 3.4 % ♂); and the co-occurrence of ‘CMRF other than overweight/obesity with at least one micronutrient deficiency’, with a prevalence rate of 9.0% (12.4 % ♀ vs. 5.4 % ♂). This prevalences was higher when using IDF cut-offs instead of WHO cut-offs. Finally, 72.9% of the subjects exhibited at least one CMRF and even 81.2% of the subjects when using IDF cut-offs. We also identified in this study population two dietary patterns: “urban” and “traditional”. Nutritional deficiencies were associated with ‘traditional’ dietary pattern, whereas CMRF were found in both patterns without statistical difference. The “urban” dietary pattern was significantly more common in men, high income subjects, whereas low income subjects and women were significantly more numerous in the ‘traditional’ one. Time devoted to sedentary activities was significantly higher than time spent in moderate to vigorous activities. Time in moderate to vigorous activities was significantly and negatively associated with body mass index (BMI), waist circumference (WC), and body fat mass, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceridemia, and low density lipoprotein cholesterol (LDL-C), while BMI and WC were associated to sedentary time. The double burden of malnutrition was associated to low income status, women, and sedentary time. We reported that 39.4% of the subjects exhibited subclinical inflammation, which was independently and positively associated with serum ferritin, BMI, WC, body fat mass, and negatively to HDL-C. Body image evaluation revealed that overweight was perceived as desirable body image among the study subjects. Psychosocial stress was associated with hypertension and subjects who probably faced stunting during infancy (using Cormic Index) exhibited significantly higher prevalence of overweight/obesity, abdominal obesity and insulin resistance. The results allowed us to achieve the study objectives and confirm our hypotheses. CMRF represents an overwhelming issue in adults of Ouagadougou complicated with their coexistence with nutritional deficiencies, also highly prevalent. A nutrition transition is at play in the city, contributing to lifestyle changes favorable to the double burden of malnutrition in such a context where the early life nutritional conditions of the subjects may put them at further enhancement of CMRF. The progression of this prevalence can still be averted or at least be slowed if suitable actions were taken from now.

The prevalence of Protein-Energy Malnutrition (PEM) in South Africa has been welldescribed in previous research studies and yet little is known about the nutritional status of toddlers in the Vosloorus Township. Using the research questions as the conceptual framework for the study, an exploratory descriptive survey was conducted to determine. • What factors give rise to malnutrition in the Vosloorus Township? • Why do toddlers on the PEM Programme fail to achieve their expected target weight? Data was collected by means of structured interviews from a sample of 50 mothers in the Vosloorus Township whose toddlers were on the PEM Programme. The fmdings indicated that the poor socio-economic conditions of the majority of households, especially unemployment, low levels of education and ignorance, contributed towards the development of malnutrition amongst toddlers and their failure to thrive on the PEM Programme. Recommendations to reduce levels of malnutrition and transform existing nutrition programmes were made.
Health Studies
M.A. (Nursing Science)