Increased emphasis is being given to nutritional assessment and the related protein-energy malnutrition findings in hospital populations. A nutritional survey conducted in the general medical ward of an urban teaching hospital showed forty-four percent of the patients assessed in a state of protein-energy malnutrition. A similar survey among patients in the surgical wards of the same hospital found fifty-nine percent of the patients assessed in a state of protein-energy malnutrition. Patients in chronic renal failure maintained on hemodialysis have been suspected of having protein-energy malnutrition due to their restricted dietary regimens. Blumekrantz and Kopple have found anthropometric and biochemical wasting or malnutrition in patients undergoing maintenance peritoneal or hemodialysis. This however, may have been due to inadequate protein and/or energy intake. Advances in the technique and frequency of hemodialysis treatments have allowed patients in chronic renal failure to be maintained on diets with a more liberal intake of protein than had been allowed in the past. The purpose of this study was to determine the incidence of protein-energy malnutrition in fifty adult subjects with chronic renal failure who were being maintained on hemodialysis, and who were on prescribed protein intakes of a least one ram of protein per kilogram of ideal body eight per ay. The subjects of the study had varying types of renal lesions and the frequency of their dialysis treatments was determine by the degree of deterioration of renal function. The subjects were eighteen years of age or older, male and female, representing various ethnic backgrounds, and were sedentary in terms of activity level.

Resumo: Diversos estudos, indicam que o cogumelo Agaricus brasiliensis é benéfico em várias condições clínicas, como na hepatite C. Várias espécies de cogumelos comestíveis têm sido exploradas quanto ao seu potencial medicinal e muitos pacientes passam a buscar a solução para suas patologias nas terapias complementares. Avaliar os efeitos da suplementação do Agaricus brasiliensis sobre o estado nutricional, a frequência e a intensidade dos efeitos adversos da terapia antiviral e a resposta bioquímica hepática em indivíduos com hepatite C em tratamento com Interferon peguilado e Ribavirina. Foi realizado um ensaio clínico prospectivo controlado casualizado duplo cego no Serviço de Hepatites Virais do Hospital das Clínicas da Faculdade de Medicina de Botucatu-UNESP. Os indivíduos do estudo foram submetidos a um protocolo de suplementação com cogumelo ou placebo por 24 semanas, e foram distribuídos aleatoriamente nos seguintes grupos: Grupo tratado com placebo (5g/dia n=14) e Grupo tratado com cogumelo (5g/dian= 9).Todas as análises foram obtidas antes e após os tratamentos (placebo ou cogumelo). O estado nutricional (dados antropométricos, de composição corporal, da bioquímica nutricional e do consumo alimentar), foi semelhante entre os grupos. Houve melhora da lesão hepática em ambos os grupos, com redução de transaminases (TGO/AST e TGP/ALT, p<0,05), mostrando a eficácia do tratamento antiviral.O uso do cogumelo mostrou-se benéfico na redução da frequência e intensidade dos efeitos adversos da terapia medicamentosa (mialgia, disgeusia, cefaléia, redução do desejo sexual, queda de cabelo, hipoanorexia, indisposição, boca seca e irritabilidade, p<0,05). Em pacientes com hepatite C, a suplementação de cogumelo Agaricus brasiliensis (5g) por 24 semanas mostrou-se eficiente em reduzir a frequência... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Several studies indicate that the Agaricus brasiliensis is beneficial in various clinical conditions, such as hepatitis C. Several species of edible fungi have been explored as to its potential medical and many patients now have to seek a solution to their condition in complementary therapies. Objective: To evaluate the effects of supplementation of Agaricus brasiliensis on the nutritional status, the frequency of adverse effects of antiviral therapy and liver damage in patients with hepatitis C treated with pegylated interferon and ribavirin. We performed a prospective trial randomized controlled double-blind in the service of Viral Hepatitis Hospital of the Medical School of Botucatu, UNESP. Those in the study were subjected to a memorandum of supplementation with mushroom or placebo for 24 weeks, and were randomly distributed in the following groups: placebo-treated group (5g/dia n = 14) and mushroom-treated group (n 5g/dia- = 9). All tests were obtained before and after the treatments (placebo or mushroom). The nutritional status (anthropometric data, body composition, nutrition and biochemistry of food intake), was similar between the groups. There was improvement of liver damage in both groups, reducing transaminase (AST / ALT and AST / ALT, p <0.05), demonstrating the effectiveness of treatment antiviral use of the mushroom was shown to be beneficial in reducing the frequency and intensity of the adverse effects of drug therapy (myalgia, dysgeusia, headache, reduction in sexual desire, hair loss, hipoanorexia, malaise, dry mouth and irritability, p <0.05). In patients with hepatitis C, the supplementation of Agaricus brasiliensis (5) for 24 weeks proved to be effective in reducing the frequency and intensity of the adverse effects of drug therapy with pegylated interferon and ribavirin, and on the other hand, was inefficient for nutritional status and liver damage. / Orientador: Carlos Antonio Caramori / Coorientador: Maria Antonieta de Barros Leite Carvalhaes / Banca: Giovanni Faria Silva / Banca: Ana Lúcia T. Spinardi Barbisan / Banca: Lucienne de Souza Venâncio Lotufo Brant / Banca: Anderson Merliere Navarro / Doutor

The relationship between nutrition and HIV is multifactorial. Nutrition counseling provided by a Registered Dietitian (RD) has the potential for improving disease risk outcomes for PLWH. To determine barriers to access nutritional counseling with an RD in PLWH, and evaluate the relationship of this counseling on dietary intake, nutritional status, cardiovascular disease (CVD), and HIV-disease outcomes. This is a cross-sectional study of a consecutive convenience sample of 130 PLWH on stable ART from the MASH cohort. After consenting, participants completed a survey on types and frequency of nutritional services received in the last 12 months, and on barriers to access these services. Participants were assigned to groups according to their responses. Demographics, anthropometries, dietary intake, medical history and laboratory information were obtained. The Alternative Healthy Eating Index (AHEI) scores were calculated after obtaining two 24-hour dietary recalls, and Nutribase and SPSS 20 were used for analyses. Mean age was 47.7 years, 62.0% were male and 77.0% were Black; 48% percent were seeing an RD, with 48.3% of those visiting an RD³4 times within the year. Frequently identified barriers to nutritional services were difficulty in keeping appointments (33.8%) location (24.6%) and lack of referrals (23.8%) by medical personnel. Lack of referral was associated with lower CD4 cell count (r=-0.2, P=0.029). Compared to those who did not visit an RD, participants who did had higher AHEI scores (34.7 vs. 29.2, P < 0.001), lower waist circumference (35.5 vs. 38.5 in., P=0.003), and BMI (26.0 vs. 28.8 kg/m2, P=0.019), with higher proportion of participants within the normal range of BMI (48% vs. 25%, P=0.017). The group consulting an RD had significantly lower risk factors for CVD, with better lipid profiles for all biomarkers, and lower waist circumference (35.5 vs. 38.5 inches, P = 0.003) and systolic blood pressure (114.8 vs. 127.9 mmHg, P < 0.001). Other CVD risk factors such as ART and substance abuse, common in this population, were not significantly different between the groups. Our findings suggest that consulting with an RD is associated with better nutritional status, dietary intake and lower risk factors for CVD.

Genetic heterogeneity, lifestyle factors, gene-gene or gene-environment interactions are the determinants of T2D which puts Hispanics and populations with African ancestry at higher risk of developing T2D. In this dissertation, the genetic associations of PPARGC1A polymorphisms with T2D and its related phenotypes (metabolic markers) in Haitian Americans (cases=110, controls=116), African Americans (cases=120, controls=124) and Cuban Americans (cases=160, controls=181) of South Florida were explored. Five single nucleotide polymorphisms of gene PPARGC1A were evaluated in each ethnicity for their disease association. In Haitian Americans, rs7656250 (OR= 0.22, pp=0.03) had significant protective association with T2D but had risk association in African Americans for rs7656250 (OR=1.02, p=0.96) and rs4235308 (OR=2.53, p=0.03). We found that in Haitian American females, both rs7656250 (OR=0.23, pp=0.03) had protective association with T2D. In African American females, rs7656250 (OR=1.14, p=0.78) had risk association whereas in males, it had significant protective effect (OR=0.37, p=0.04). However, the risk association exhibited by rs4235308 was stronger in African American females (OR=2.69, p=0.03) than males (OR=1.16, p=0.72). In Cuban Americans, only rs7656250 showed significant risk association with T2D (OR=6.87, p=0.02) which was stronger in females alone (OR=7.67, p=0.01). We also observed significant differences among correlations of PPARGC1A SNPs and T2D phenotypes. Positive correlation was observed for log Hs-CRP with rs3774907 (pp=0.03) in Cuban Americans respectively. Correlation of log A1C with rs7656250 (p=0.02) was positive in Cuban Americans while it was negative for rs3774907 in Haitian Americans (ppPPARGC1A correlations with T2D and its phenotypes among the three ethnicities studied (ii) the associations of PPARGC1A SNPs showed significant effect modification by sex. The findings suggest that variations in effects of PPARGC1A gene polymorphisms among three ethnicities and between sexes may have biomedical implications for the development of T2D as well as the phenotypes related to T2D.

Adequacy of nutritional intake during the postoperative period, as measured by a change in weight-for-age z-scores from surgery to the time of discharge, was evaluated in infants (n = 58) diagnosed with a congenital heart defect and admitted for surgical intervention at Miami Children’s Hospital using a prospective observational study design. Parental consent was obtained for all infants who participated in the study. Forty patients had a weight available at hospital discharge. The mean preoperative weight-for-age z-score was -1.3 ±1.43 and the mean weight-for-age z-score at hospital discharge was -1.89 ±1.35 with a mean difference of 0.58 ±0.5 (P Nutritional intake during the postoperative period was inadequate based on a decrease in weight-for-age z-scores from the time of surgery until discharged home. Our findings suggested that limited fluid volume for nutrition likely contributes to suboptimal nutritional delivery during the postoperative period; however, inadequate nutrition prescription may also be an important contributing factor. Development of a nutrition protocol for initiation and advancement of nutrition support may reduce the delay in achieving patient’s nutritional goals and may attenuate the observed decrease in z-scores during the postoperative period.

Attempts to modify dietary habits of individuals in order to improve their nutrition do not seem to have met with success. Patterns established by individuals appear to continue throughout their lifetime. Diet patterns are influenced by society, families, and peer groups. From pre-school through adolescence environmental factors of influence are ever present. Influences may be the result of hereditary attitudes passed from generation to generation. However, the need for diet improvement seems primary. Research to discover methods or systems to affect such habits is needed from the science of nutrition. The continued failure of man to produce food for the subsistence of all mankind and the power of population overshadows the power of food production. The resulting problems of food shortages, malnutrition, starvation and disease compound the previously stated problems of attempted dietary change. The cost of developing animal protein exceeds the cost of cultivating plants. Therefore, nutritionists have encouraged decreasing consumption of animal protein and increasing consumption of plants to balance this factor. By this method they have helped to keep the cost of a nutritionally balanced meal within everyone’s reach. By increasing consumption of plant life, some diets could be improved. This increased plant consumption would also decrease the need for animal consumption. Synergistic combinations of vegetables have been found to be as nutritious as animal sources. With these thoughts in mind this research explores one technique which might be utilized in a hospital environment to accomplish one end--the increase in plant or vegetable consumption.

Lipid soluble carotenoids are micronutrients present in human milk that serve as precursors of vitamin A and also play an important role protecting cells from damage arising from photooxidative processes and reactive oxygen species. Fatty acids comprise about 3-5% of human milk and are mainly present as triglycerides. They are a major energy source for the infant and are necessary to support cell growth required for normal development and maturation of critical organs. Transport of carotenoids into milk has been little studied and there has been no previous investigation of the relationship of carotenoid transport with that of individual fatty acid secretion into milk. In the present study, levels of the carotenoids, lutein, zeaxanthin, b-cryptoxanthin, and b-carotene, in maternal serum, infant cord blood, and milk obtained from 74 Peruvian mothers were measured by HPLC methods. The fat content and fatty acid profile of maternal milk were determined by GC-FID and confirmed by GC-MS. Twenty nine fatty acids were identified and quantified after conversion to methyl esters. Statistical analysis was employed to investigate potential trends and relationships among the carotenoids in all three fluids as well as between carotenoids and fatty acids present. Concentrations of lutein in maternal serum and milk as well as maternal serum and infant cord blood were highly correlated (r =0.43, p

Miami-Dade County has approximately 27,000 people living with HIV (PLWH), and the highest HIV incidence in the nation. PLWH have reported several types of sleep disturbances. Caffeine is an anorexic and lipolytic stimulant that may adversely affect sleep patterns, dietary intakes and body composition. High caffeine consumption (>250 mg. per day or the equivalent of >4 cups of brewed coffee) may also affect general functionality, adherence to antiretroviral treatment (ART) and HIV care. This study assess the relationship of high caffeine intake with markers of disease progression, sleep quality, insomnia, anxiety, nutritional intakes and body composition. A convenience sample of 130 PLWH on stable ART were recruited from the Miami Adult Studies on HIV (MASH) cohort, and followed for three months. After consenting, questionnaires on Modified Caffeine Consumption (MCCQ), Pittsburg Insomnia Rating Scale (PIRS), Pittsburg Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), socio-demographics, drug and medication use were completed. CD4 count, HIV viral load, anthropometries, and body composition measures were obtained. Mean age was 47.89±6.37 years, 60.8% were male and 75.4% were African-Americans. Mean caffeine intake at baseline was 337.63 ± 304.97 mg/day (Range: 0-1498 mg/day) and did not change significantly at 3 months. In linear regression, high caffeine consumption was associated with higher CD4 cell count (β=1.532, P=0.049), lower HIV viral load (β=-1.067, P=0.048), higher global PIRS (β=1.776, P=0.046), global PSQI (β=2.587, P=0.038), and GAD-7 scores (β=1.674, P=0.027), and with lower fat mass (β=-0.994, P=0.042), energy intakes (β=-1.643, P=0.042) and fat consumption (β=-1.902, P=0.044), adjusting for relevant socioeconomic and disease progression variables. Over three months, these associations remained significant. The association of high caffeine with lower BMI weakened when excluding users of other anorexic and stimulant drugs such as cocaine and methamphetamine, suggesting that caffeine in combination, but not alone, may worsen their action. In summary, high caffeine consumption was associated with better measures of disease progression; but was also detrimental on sleep quality, nutritional intakes, BMI and body composition and associated with insomnia and anxiety. Large scale studies for longer time are needed to elucidate the contribution of caffeine to the well-being of PLWH.

The prevention of childhood obesity during the formative years is necessary because dietary patterns influenced by parents are developed early. A major obstacle to healthy feeding patterns in children is television advertising. The study tested three hypotheses. 1) Preschool children ages two to five years who watch more television are able to recognize/recall more food brands than those who view less television. 2) An increase in food brand recognition/recall in preschool children is associated with an overweight classification based on calculated Body Mass Index. 3) Children of parents who are unaware of the American Academy of Pediatrics (AAP) recommendations for television viewing per day in preschool children will exceed the recommended daily viewing time of two hours. Twenty-nine preschool children were assessed on their ability to match food brand logos with correct foods and identify specific brands from recall. Weight and\ height were measured to calculate their Body Mass Index-for age. Twenty-eight parents were asked to complete a validated survey and a one-week television diary. The results showed statistically significant differences in identifying food brands between children who had lower exposure to television (6.8±.5; 95% CI 5.95-7.55) compared to higher exposure (10.3±1.0; 95% CI 9.25-11.42). This effect was not significantly correlated with overweight status (n=5). No significant correlations were found between parent's knowledge of AAP recommendations and children's exposure to television. Impact of television advertisements on preschool children's response to food/brand logos due to daily exposure to advertising is still of critical interest and worthy of further exploration.

This study examined associations among the nutritional risks, the risk levels, and the ages of independently living elderly. The Checklist of the Nutrition Screening Initiative (NSI) was administered to a purposive sample of 1004 Northeast Florida elderly to estimate an age-profile at risk for malnutrition. Checklist nutritional scores (cumulative of ten risks) were grouped into risk levels of low (scores 0-2, 64.3%), moderate (3-5, 29.5%), and high (6 and greater, 24.2%). Within each level, Checklists were grouped by respondents' age into young-old (60-74), old-old (75-79), and fragile-old (80-102). Eight nutritional risks' distribution across risk levels was significantly greater in respondents of the high-risk level as compared to those in the moderate and low-risk levels. A significant difference was found in the distribution of age groups across levels (x2=9.742, df=4, P=.045), with a larger proportion of the fragile-old in the low risk level (53.6%) than either the old-old (42.5%) or the young-old (43.6%). Elderly at greatest risk for malnutrition are aged 74-75 years and report illness, multiple medicines, economic hardship, and reduced social contact. The distribution of the risk "multiple medicines" (x2=12.17, df=4, P=.016) was consistently significant across all risk levels and age groups.