A condição bucal e a falta de condições mastigatórias adequadas têm sido implicadas como indicadores de risco para má alimentação e desnutrição. Indivíduos com um número menor de dentes ou edêntulos são considerados menos propensos a comer alimentos ricos em nutrientes, como vegetais, frutas, carne e grãos integrais. Há evidências que a condição bucal alterada causa restrições dietéticas através da dificuldade em mastigar, comprometendo o estado nutricional e bem-estar dos indivíduos. Esta dissertação é composta por dois estudos, uma revisão sistemática da literatura com meta- análise e um estudo transversal. A revisão sistemática da literatura com meta-analise avaliou e comparou o estado de saúde bucal (perda de dentes, uso de prótese e DMFT) em idosos bem-nutridos, em risco de desnutrição e indivíduos desnutridos. Dois pesquisadores analisaram a inclusão dos títulos, resumos, leitura completa (MPT e FWMGM), outros dois fizeram a extração de dados dos artigos (PSA e MPT) e se um consenso não fosse possível, um terceiro pesquisador estaria incluído neste processo. De 110 artigos lidos na íntegra, 26 foram incluídos na revisão sistemática, dos quais 23 eram transversais. Foi demonstrado que os sujeitos com estado nutricional normal tinham um número significativamente maior de pares de dentes / Unidades Funcionais de Dentes (FTU) em comparação com aqueles que estavam desnutridos ou em risco de desnutrição. As meta-análises não mostraram associação estatisticamente significante entre edentulismo e uso de prótese, pois o risco relativo combinado foi de 1,072 (IC 95% 0,957 - 1,200, p = 0,230) e 0,874 (IC 95%: 0,710 - 1,075, p = 0,202). Por outro lado, o desvio padrão médio do número médio de dentes presentes foi de -0,141 (IC 95% -0,278 - 0,005, p = 0,042) em indivíduos com desnutrição / risco de desnutrição. O estudo transversal avaliou a condição bucal e o estado nutricional de pacientes que se encontravam internados nas enfermarias do Hospital de Clínicas de Porto Alegre (HCPA), no período de dezembro de 2015 e junho de 2016. O presente estudo incluiu 394 participantes com idade média de 63.43±10.76 entre os indivíduos diabéticos (87 mulheres e 110 homens) e 59,85±15,18 entre os não diabéticos (93 mulheres e 104 homens). Os indivíduos diabéticos (18,33±12,79) permaneceram em média mais tempo internados do que os indivíduos não diabéticos (16,53±14,54). As variáveis sexo, número de dentes, tempo de internação e capacidade funcional mastigatória estavam associadas à desnutrição na análise uni-variada. Na análise multivariada, sexo, número de dentes e tempo de internação mantiveram-se associados à desnutrição. Apresente dissertação conclui que existe associação entre a condição bucal e a desnutrição. Indivíduos com perdas dentárias apresentam maior risco desnutrição, o que foi demostrado tanto na meta análise quanto no estudo transversal. / The oral condition and the lack of adequate masticatory conditions have been implicated as risk indicators for malnutrition and malnutrition. Individuals with fewer teeth or edentulous are considered less likely to eat foods rich in nutrients such as vegetables, fruits, meat and whole grains. There is evidence that altered oral status causes dietary restrictions through difficulty in chewing, compromising the nutritional status and well-being of individuals. This dissertation is composed of two studies, a cross-sectional study and a systematic review of the literature with meta-analysis. The cross-sectional study evaluated the oral condition and nutritional status of patients hospitalized in the Hospital das Clinicas de Porto Alegre (HCPA), from December 2015 to June 2016. The present study included 394 middle-aged participants Of 63.43 ± 10.76 among diabetic subjects (87 women and 110 men) and 59.85 ± 15.18 among non-diabetics (93 women and 104 men). Diabetic individuals (18.33 ± 12.79) remained on average longer hospitalized than non-diabetic individuals (16.53 ± 14.54). The variables gender, number of teeth, length of hospital stay and functional masticatory capacity were associated with malnutrition in the univariate analysis. In the multivariate analysis, sex, number of teeth and length of stay remained associated with malnutrition. The systematic review of the literature with meta-analysis evaluated and compared the state of oral health (tooth loss, prosthesis use and FWD) in well-nourished elderly, at risk of malnutrition, and malnourished individuals. Two researchers analyzed the inclusion of titles, abstracts, full reading (MPT and FWMGM), two others extracted data from articles (PSA and MPT) and if a consensus was not possible, a third researcher would be included in this process. Of 110 articles read in full, 26 were eligible for inclusion. Twenty-six studies were included in the systematic review, of which 23 were cross-sectional. It was shown that subjects with normal nutritional status had significantly more pairs of teeth / functional tooth units (FTU) compared to those who were malnourished or at risk of malnutrition. The meta-analyzes did not show a statistically significant association between edentulism and prosthesis use, since the combined relative risk was 1.072 (95% CI 0.957-1.1200, p = 0.230) and 0.874 (95% CI: 0.710-0.075, p = 0.202 ). On the other hand, the mean standard deviation of the mean number of teeth present was -0.141 (95% CI -0.278-0.005, p = 0.042) in subjects with malnutrition / risk of malnutrition. The present dissertation concludes that there is an association between the oral condition and malnutrition. Individuals with dental losses present a greater risk of malnutrition, which was demonstrated both in the meta-analysis and in the cross-sectional study.

A condição bucal e a falta de condições mastigatórias adequadas têm sido implicadas como indicadores de risco para má alimentação e desnutrição. Indivíduos com um número menor de dentes ou edêntulos são considerados menos propensos a comer alimentos ricos em nutrientes, como vegetais, frutas, carne e grãos integrais. Há evidências que a condição bucal alterada causa restrições dietéticas através da dificuldade em mastigar, comprometendo o estado nutricional e bem-estar dos indivíduos. Esta dissertação é composta por dois estudos, uma revisão sistemática da literatura com meta- análise e um estudo transversal. A revisão sistemática da literatura com meta-analise avaliou e comparou o estado de saúde bucal (perda de dentes, uso de prótese e DMFT) em idosos bem-nutridos, em risco de desnutrição e indivíduos desnutridos. Dois pesquisadores analisaram a inclusão dos títulos, resumos, leitura completa (MPT e FWMGM), outros dois fizeram a extração de dados dos artigos (PSA e MPT) e se um consenso não fosse possível, um terceiro pesquisador estaria incluído neste processo. De 110 artigos lidos na íntegra, 26 foram incluídos na revisão sistemática, dos quais 23 eram transversais. Foi demonstrado que os sujeitos com estado nutricional normal tinham um número significativamente maior de pares de dentes / Unidades Funcionais de Dentes (FTU) em comparação com aqueles que estavam desnutridos ou em risco de desnutrição. As meta-análises não mostraram associação estatisticamente significante entre edentulismo e uso de prótese, pois o risco relativo combinado foi de 1,072 (IC 95% 0,957 - 1,200, p = 0,230) e 0,874 (IC 95%: 0,710 - 1,075, p = 0,202). Por outro lado, o desvio padrão médio do número médio de dentes presentes foi de -0,141 (IC 95% -0,278 - 0,005, p = 0,042) em indivíduos com desnutrição / risco de desnutrição. O estudo transversal avaliou a condição bucal e o estado nutricional de pacientes que se encontravam internados nas enfermarias do Hospital de Clínicas de Porto Alegre (HCPA), no período de dezembro de 2015 e junho de 2016. O presente estudo incluiu 394 participantes com idade média de 63.43±10.76 entre os indivíduos diabéticos (87 mulheres e 110 homens) e 59,85±15,18 entre os não diabéticos (93 mulheres e 104 homens). Os indivíduos diabéticos (18,33±12,79) permaneceram em média mais tempo internados do que os indivíduos não diabéticos (16,53±14,54). As variáveis sexo, número de dentes, tempo de internação e capacidade funcional mastigatória estavam associadas à desnutrição na análise uni-variada. Na análise multivariada, sexo, número de dentes e tempo de internação mantiveram-se associados à desnutrição. Apresente dissertação conclui que existe associação entre a condição bucal e a desnutrição. Indivíduos com perdas dentárias apresentam maior risco desnutrição, o que foi demostrado tanto na meta análise quanto no estudo transversal. / The oral condition and the lack of adequate masticatory conditions have been implicated as risk indicators for malnutrition and malnutrition. Individuals with fewer teeth or edentulous are considered less likely to eat foods rich in nutrients such as vegetables, fruits, meat and whole grains. There is evidence that altered oral status causes dietary restrictions through difficulty in chewing, compromising the nutritional status and well-being of individuals. This dissertation is composed of two studies, a cross-sectional study and a systematic review of the literature with meta-analysis. The cross-sectional study evaluated the oral condition and nutritional status of patients hospitalized in the Hospital das Clinicas de Porto Alegre (HCPA), from December 2015 to June 2016. The present study included 394 middle-aged participants Of 63.43 ± 10.76 among diabetic subjects (87 women and 110 men) and 59.85 ± 15.18 among non-diabetics (93 women and 104 men). Diabetic individuals (18.33 ± 12.79) remained on average longer hospitalized than non-diabetic individuals (16.53 ± 14.54). The variables gender, number of teeth, length of hospital stay and functional masticatory capacity were associated with malnutrition in the univariate analysis. In the multivariate analysis, sex, number of teeth and length of stay remained associated with malnutrition. The systematic review of the literature with meta-analysis evaluated and compared the state of oral health (tooth loss, prosthesis use and FWD) in well-nourished elderly, at risk of malnutrition, and malnourished individuals. Two researchers analyzed the inclusion of titles, abstracts, full reading (MPT and FWMGM), two others extracted data from articles (PSA and MPT) and if a consensus was not possible, a third researcher would be included in this process. Of 110 articles read in full, 26 were eligible for inclusion. Twenty-six studies were included in the systematic review, of which 23 were cross-sectional. It was shown that subjects with normal nutritional status had significantly more pairs of teeth / functional tooth units (FTU) compared to those who were malnourished or at risk of malnutrition. The meta-analyzes did not show a statistically significant association between edentulism and prosthesis use, since the combined relative risk was 1.072 (95% CI 0.957-1.1200, p = 0.230) and 0.874 (95% CI: 0.710-0.075, p = 0.202 ). On the other hand, the mean standard deviation of the mean number of teeth present was -0.141 (95% CI -0.278-0.005, p = 0.042) in subjects with malnutrition / risk of malnutrition. The present dissertation concludes that there is an association between the oral condition and malnutrition. Individuals with dental losses present a greater risk of malnutrition, which was demonstrated both in the meta-analysis and in the cross-sectional study.

Motivation and study design: Iron deficiency is a common condition in infancy, particularly in lower socio-economic groups. In Cape Town it remains a problem in spite of public health measures taken against it: a recent survey found a prevalence of iron deficiency anaemia of 34% in healthy 1-year old term infants who had ready access to a municipal health clinic where iron fortified milk formula is sold at subsidized prices. The consequences of iron deficiency extend beyond anaemia- to involve all organ systems including the immune system. Since Helen Mackay's report in 1928 of a striking decrease in incidents of infection in infants treated with iron, clinicians have assumed that iron deficiency predisposes to infection. Despite a sound theoretical basis for this belief, the clinical evidence for the assumption is poor as studies to date have displayed methodological deficiencies. On the other hand, iron is also essential for the growth of micro-organisms. As such, supplemental iron may predispose to infection. Indeed, there is much laboratory and clinical evidence to show that excess iron can result in the recrudescence of quiescent infections and increase the virulence of newly acquired infections. Thus, the competition between host and parasite may sometimes hinge on the relative availability of iron and it has been speculated that excess iron in infant milk formula may increase susceptibility to infectious diarrhoeal disease. The problem addressed by this thesis was to determine the utility of increasing the level of iron fortification of infant milk formula. Three questions were posed: Does increasing the level of iron fortification of conventional infant milk formula improve the iron nutrition of normal infants fed on the formula? Does increased iron fortification of infant milk formula alter immunity as reflected by incidence of infection and laboratory tests of immune function? Are there any handful effects of increasing the quantity of iron in conventional infant milk formula? A double blind randomized trial was carried out in 1983 and 1984 to answer these questions. A group of 149 healthy, well-nourished infants from a lower socio-economic community of so called Cape Coloureds were followed from the age of 3 months to 1 year. Half of the infants, the Control group, were given a commercially available infant milk formula (Lactogen Full Protein) which has 8.3 mg Fe/ 100 g formula and 37 mg ascorbic acid/ 100 g. The other half of subjects, the Test group, were given the same milk formula but fortified with iron to a concentration of 40 mg Fe/ 100 g. The children were examined every 3 or 4 weeks and any infection or history of infection was noted. Laboratory tests were done at the start of the trial and again on completion. During the trial, laboratory tests were performed only if clinically indicated. The tests included full blood count and differential analysis, red cell zinc protoporphyrin, plasma ferritin, plasma and hair zinc and lymphocyte subtyping with monoclonal antibodies. Within each group, half of the infants were randomly selected for assay of neutrophil bactericidal activity. The other half were assayed for lymphocyte blastogenic response to stimulation with phytohaemagglutinin. Tests of delayed cutaneous hypersensitivity to Candida antigen and PPD were done and all children and their mothers had antibodies to tetanus and polio determined. Results: 74 infants in the Control group started the trial and 62 completed it. In the Test group, 75 infants began and 70 completed the study. Intake of milk and solid foods was not quantified, but the ages of weaning and of introduction of new foods were determined. The Control and Test groups did not differ significantly on any test item. The mean age of completion of weaning was 3.60 months for the Control group and 4.04 months for the Test group. The Control group was first given meat or fish at a mean age of 5.19 months; the Test. group had meat or fish introduced to their diets at a mean age of 4.36 months. These differences were not statistically significant. The children in the Control group were lighter and shorter than the Test group at the end of the year. Mean standard deviation scores for weight were 0.23 and 0.48 respectively (P = 20%), while for length the SD scores were -0.13 and 0.06 (P = 20%).

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Call number: LD2668 .T4 1954 B5 / Master of Science

The introduction of Primary Health Care (PHC) in Saudi Arabia has given nurses excellent opportunities and more responsibility to provide health education and advice in health promotion activities. Provision of appropriate and affordable dietary advice is an important role of the nurses in the Primary Health Care Centres (PHCC). Maternal nutrition is an essential element for the health status of the child, the family and the wider society. Many studies have suggested that there is a relationship between good nutritional intake during pregnancy and the successful outcome of the pregnancy. The present study was conducted to explore the knowledge and understanding of Saudi women and nurses in PHCC regarding nutritional intake during pregnancy. The study also looked at the effect of a short education programme on the nurses' nutritional knowledge and their subsequent practice. The aims of the study were to identify the understanding of Saudi women of pregnancy and nutritional intake during pregnancy, and to evaluate the effect of a short nutritional programme on diploma nurses. To achieve the aims, data collection was carried out in three phases. Phase one used semi-structured interview (tape recorded) on 10 pregnant women, selected randomly, to elicit the general understanding pregnant women had on pregnancy and pregnancy related areas. Phase two used a structured interview schedule on 100 pregnant women attending PHCC, selected systematically, to assess nutritional knowledge and their perception of nutritional advice given by the nurses in PHCC. Phase three was divided into two stages. The first stage used a self-administered questionnaire on 20 diploma nurses working in antenatal clinics in PHCC to assess their nutritional knowledge in relation to pregnancy. The questionnaire was used as both a pre-test and post-test instrument. Thereafter, based on the findings from phase one and two, a 20-hour continuing education (CE) programme was developed by the researcher on maternal nutrition for the diploma nurses. The second stage was to implement the programme to the nurses in five days. The effect of the programme was evaluated by an immediate post-test on nurses' knowledge and a follow-up post-test (after six months) to assess any lasting changes. Data analysis was carried out using content analysis for phase one. For the phase two and three, SPSS programme was used. Chi square was used to look for any association between knowledge scores and personal variables, paired Hest was used to assess the difference between pre-test and post-test. The results from the study showed that the majority of women attending the PHCC were illiterate or had little formal education, had a high pregnancy rate and had poor nutritional knowledge in relation to pregnancy. They preferred female health professional care and they preferred to have female doctors attending their antenatal care rather than the nurses. There was no significant difference between nurses' and women's nutritional knowledge. The results also showed a significant correlation between poor nutritional knowledge scores of the women and certain factors: the scores correlated positively with the level of education and negatively with the number of pregnancies. Regarding the programme, the results showed a significant increase in the nurses' nutritional knowledge scores from pre-test to post-test at p< 0.05, indicating that participants demonstrated increased nutritional knowledge as a result of participation in the programme. There was no significant difference between the initial post-test and the six-month follow-up. No significant relationships were identified between the nurses' scores and their age and years of experiences. The study also indicated that nurses in PHCC were not giving adequate nutritional advice to pregnant women in the views of these women and in my own observation. The findings suggest that frequent continuing education is essential for nurses in PHCC in Saudi Arabia to improve their skills and nutritional knowledge to be able to provide better care for women.

The statistical correlations between habitual diet and plasma risk factors for coronary heart disease CHD were analyzed using multiple regression. Thirty-one male subjects between 30-56 years kept complete dietary records for 7 days. Daily means of nutrient consumption were calculated using a computerized data base. Fourteen independent variables (total kilocalories, protein %, carbohydrate %, fat %, ethanol %, caffeine, P/S ratio, cholesterol, age, weight, height , weight**.75, Body Mass Index, kilocalories/weight**.75) were created. Plasma samples were analyzed and the following simple (total plasma cholesterol (TC), VLDL-C, LDL-C, HDL2-C, HDL3-C, apo A-I, apo A-II, apo B) and derived (VLDL-C+LDL-C, LDL-C/TC, LDL-C/HDL-C, HDL-C, HDL2-C/HDL3-C, HDL-C/TC, apo B/apo A-I, apo B/apo A-II, apo A-Il/apo A-I) dependent variables were created. Dependent variables were individually regressed against the entire set of independent variables. An F-value of 4.00 to enter an independent variable in the model and of 3.99 to remove one were used to achieve significance of p<05. Age appeared in 5 regression models (TC, apo B, apo B/apo A-I, apo B/apo A-II, apo A-Il/apo A-I) and was positively correlated with increased risk for CHD. Total kilocalories appeared in 4 models (LDL-C, apo B, VLDL-C+LDL-C, LDL/TC) and was negatively correlated with risk. Fat % appeared in 4 models (VLDL-C+LDL-C, LDL/TC, LDL-C/HDL-C, HDL-C/TC) and was associated with increased risk. Body Mass Index was entered in 2 models (HDL2-C, HDL-C) and was positively correlated with risk. P/S ratio was negatively correlated with risk in the three models (HDL2, apo A-I, HDL-C) in which it appeared. The independent variable carbohydrate % was negatively associated with risk in 2 models, LDL-C and apo B. Kcal/wt**.75 was also negatively correlated with risk in the VLDL-C, LDL-C/TC and HDL-C/TC models. One independent variable, EtOH %, was positively associated with risk in the apo A-II and apo A-II/apo A-I models. Two dependent variables did not have any independent predictors (HDL3-C, HDL2-C/HDL3-C) entered in their regression models. Six independent variables did not appear in any regression model (protein %, caffeine, cholesterol, weight, height, weight**.75). Independent variables positively correlated with increased risk for CHD were therefore fat %, ethanol %, age, and Body Mass Index. Independent variables correlated with decreased risk for CHD were total kilocalories, carbohydrate %, P/S ratio, and kilocalories/weight**.75. / Graduation date: 1985

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