Diss. (sammanfattning) Uppsala : Univ., 2001. / Härtill 5 uppsatser.

Thesis (MNutr (Human Nutrition))--Stellenbosch University, 2008. / Background Critical illness is associated with increased production of reactive oxygen species and oxidative stress, and low levels of most micronutrients with resultant diminished endogenous antioxidant defences. Micronutrient supplementation is thought to be beneficial to the critically ill patient by ameliorating oxidative stress and by improving clinical outcome. Objectives This systematic review assessed the effects of micronutrient supplementation on adults recovering from critical illness. Primary outcomes included clinical endpoints [mortality, infectious complications, length of intensive care unit and hospital stay (LICU and LOS)]. Secondary outcomes included descriptions of practice issues, micronutrient status, morbidity, course of the acute phase response and oxidative stress. Search strategy An electronic bibliographic database search was carried out, bibliographies of retrieved articles were reviewed and personal files searched to obtain additional citations. Databases were searched from inception until 29 February 2008. Selection criteria Randomized controlled trials (RCTs) of micronutrient supplementation (by any route) in adult critically ill patients, given in addition to their routine care, were included. Data collection and analysis Two authors independently extracted data and assessed trial quality. For the primary outcomes the random-effects model was used to estimate overall relative risk / mean difference and effect size due to the presence of study heterogeneity. Selected exploratory analyses were undertaken. Differences at the level of p<0.05 was considered to be statistically significant. The secondary outcomes were sparse and variably recorded such that this data was not formally aggregated. Main results Fifteen RCTs involving 1714 participants and 18 RCTs involving 1849 participants were included for the primary and secondary objectives respectively. The quality of the RCTs, as reported, was disappointing, particularly for allocation concealment. Fourteen trials (n=1468) of micronutrient supplementation showed a statistically significant reduction in overall mortality [relative risk (RR) 0.78, 95% confidence interval (CI) 0.67-0.90, I2=0%, p=0.0009]. An asymmetrical funnel plot necessitates caution when directly interpreting these results. Six RCTs (n=1194) indicated a statistically significant reduction in 28 day mortality (RR 0.75, 95% CI 0.63-0.88, I2=0%, p=0.0006) (symmetrical funnel plot). Micronutrient supplementation in this systematic review was not associated with a reduction in infectious complications, LICU or LOS. In sub-group analyses, single nutrients were associated with borderline statistical significance (RR 0.82, 95% CI 0.66-1.01, I2=0%, p=0.06) in terms of mortality, whist a sensitivity analysis of combined micronutrients indicated a significant reduction in mortality (RR 0.69, 95% CI 0.54-0.90, I2=2%, p= 0.006). This review did not find clear evidence that parenteral is superior to enteral administration in terms of clinical outcomes. The secondary outcomes confirmed that timing, duration and dosing are key factors to ensure optimal clinical benefit. Conclusion This review does suggest potential benefit of micronutrient supplementation in critically ill adults for some clinical outcomes (especially mortality), but also highlights that caution is warranted as nutrient interactions and risk of toxicity are not clearly defined in critical illness. More large multi-centre randomized trials are necessary to assess the effects of different types and doses of micronutrient supplementation in selected groups of patients with different types of critical illness.

Orientador: Gustavo Henrique de Almeida Teixeira / Coorientador: Vivian da Silva Santos / Banca: José Dalton Cruz Pessoa / Banca: José Fernando Durigan / Resumo: O palmiteiro juçara (Euterpe edulis Mart.) é endêmico do bioma conhecido por Mata Atlântica, sendo seus frutos semelhantes ao do açaizeiro (Euterpe oleracea Mart.), porém mais ricos em antocianinas e em alguns elementos químicos, o que os tornam um importante produto para a alimentação das comunidades tradicionais. Todavia, durante o processamento, os frutos passam por diferentes etapas para a extração de sua polpa, o que podem afetar a bioacessibilidade dos micronutrientes. Objetivos: O objetivo geral deste trabalho foi verificar a bioacessibilidade de micronutrientes no mesocarpo dos frutos e polpa de juçara e, por objetivos específicos: i. verificar o efeito das diferentes etapas do processamento na bioacessibilidade dos micronutrientes presentes no mesocarpo dos frutos e polpa de juçara ii. determinar a bioacessibilidade in vitro dos micronutrientes pelo método da digestão gastrointestinal (IVG) seguida de análise por espectrômetro de emissão óptica com plasma indutivamente acoplado (ICP-OES). Métodos: Em cada etapa do processamento foi colhido o mesocarpo dos frutos e/ou polpa para a determinação da bioacessibilidade dos micronutrientes utilizando o método da digestão gastrointestial in vitro (IVG). Os elementos cálcio (Ca), magnésio (Mg), ferro (Fe), manganês (Mn), cobre (Cu) e zinco (Zn) foram determinados por ICP-OES. O experimento foi conduzido segundo um delineamento em blocos casualizado (DBC), onde os blocos foram constituídos pelas origens (Uba... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Juçara palm tree (Euterpe edulis Mart.) is endemic from a biome know as Atlantic Forest, and its fruit are similar to açaí (Euterpe oleracea Mart.), but richer in anthocyanin and chemical elements, which make them a important food produce for the local population. However, during its processing, the fruit are subjected to different unit operation to extract their pulp and it can affect the chemical elements biaccessibility. Objectives: The general object of this study was to verify the chemical elements bioaccessibility in fruit and juçara pulp and, the specific objectives were: i. verify if the different unit operations affect the chemical elements bioaccessibility, and ii. determine the in vitro chemical elements bioacessibiity using the in vitro gastrointestinal method (IVG) followed by ICP-OES determination. Methods: For each unit operation during juçara processing fruit and/or pulp were collected to determine the chemical elements bioacessibility using the in vitro gastrointestinal method (IVG). It was determined the chemical elements Ca, Mg, Fe, Mn, Cu and Zn using Inductively coupled plasma atomic emission spectroscopy (ICP-AES). The experiment was conducted according to randomized complete blocks design (CBD), where the blocks were constituted by the origens (Ubatuba I, Ubatuba II, Jaboticabal I, Jaboticabal II and Américo Brasiliense) with four treatments (i. fresh harvested fruits, ii. fruits which were washed, iii. fruits after softened in water, iv. processed pulp). Results: It was not possible to determine the bioaccessibility of Ca and Zn. The chemical elements Mg, Mn, Cu, and Fe bioaccessibility reduced during processing. Conclusion: Juçara fruit processing affected the content and bioaccessibility of the chemical elements, and it was observed a sharp increment in the content of macro and microelements... (Complete abstract click electronic access below) / Mestre