Introdução: O câncer da confluência biliopancreática tem alta letalidade e prognóstico reservado, atribuído à associação da agressividade biológica e ao quadro clínico silencioso. A inflamação tem papel fundamental no desenvolvimento e na progressão da caquexia, induzida pela expressão de citocinas produzidas pelo tumor e/ou liberadas pelo sistema imunológico. Nos últimos anos, tem sido documentada a variabilidade na expressão gênica de citocinas que regulam os mecanismos envolvidos na caquexia neoplásica. Objetivos: Em amostras de sangue periférico de pacientes com neoplasia da confluência biliopancreática, avaliar a concentração da interleucina 6 (IL-6), fator de necrose tumoral alfa (TNF-?), interferon-gama (INF- ?) e interleucina 10 (IL-10), além da expressão gênica dessas citocinas, do receptor tipo 1 do fator de necrose tumoral (TNFR1), do receptor tipo 2 do fator de necrose tumoral (TNFR2), da zinco-alfa2-glicoproteina (ZAG) e do receptor ativado por proliferador de peroxissoma gama (PPAR-?). Além disso, o estudo visou identificar possíveis diferenças nos dados avaliados entre os pacientes classificados de acordo com a presença ou não de caquexia neoplásica. Casuística: O estudo transversal foi conduzido com 17 pacientes adultos de ambos os gêneros em pré-operatório imediato de neoplasia da confluência biliopancreática (Grupo Câncer), além de 15 indivíduos controles em pré-operatório de herniorrafia (Grupo Controle). Os pacientes com neoplasia foram classificados de acordo com a presença de caquexia (Subgrupo Caquexia, n=8) e aqueles sem diagnóstico de caquexia (Subgrupo Semcaquexia, n=9). Métodos: A ingestão alimentar e a composição corporal foram avaliadas em todos os voluntários. O questionário de fadiga foi aplicado nos indivíduos com neoplasia. O diagnóstico de caquexia foi feito a partir de critérios pré-estabelecidos. As citocinas inflamatórias IL-6, TNF-?, INF-? e IL-10 foram dosadas no sangue periférico. A expressão gênica dessas citocinas inflamatórias, dos receptores de TNF-?, da ZAG e do PPAR-? foi feita em sangue total. A análise estatística foi realizada com o auxílio de software Statistica, versão 8.0®. Resultados: Não houve diferença na ingestão energética [1827 (1489-2166) vs 1691 (1380-2003) kcal, p=0,56] e proteica [91,6 (74-109) vs 101 (89-114) g, p=0,30] dos indivíduos com câncer ou controles, exceto pela maior ingestão de lipídeos [69,0 (53,5-84,5) vs 42,7 (33,4-52,1) g, p=0,01] e menor consumo de vitamina A [382 (152-612) vs 1346 (1032-1659) ?g, p=0,001] no Grupo Câncer em relação ao Grupo Controle, respectivamente. Houve perda de peso em relação ao habitual em 15 dos 17 pacientes (13,1 ? 11,0%) antes do procedimento cirúrgico, embora as variáveis de composição corporal estivessem semelhantes entre os dois grupos de estudo. Os pacientes com neoplasia apresentavam menores concentrações plasmáticas de albumina [3,8 (3,5-4,0) vs 4,4 (4,3-4,5) g/dL, p<0,001], transferrina [166 (140-192) vs 241 (212-270) mg, p=0,001], ferro [80,8 (67,7-93,9) vs 107 (82-131) ?g/dL, p=0,003], zinco [79,9 (66-93,7) vs 97,4 (88-107) ?g%, p=0,001] e vitamina A [0,7 (0,6-0,8) vs 1,3 (1,0-1,5) umol/L, p<0,001], além de maiores níveis de glicemia [115 (118-193) vs 98,6 (82-115) mg/dL, p=0,003], proteína C reativa [2,7 (0,9-4,5) vs 0,2 (0,2-3,3) mg/dL, p<0,001], ferritina [985 (347-1623) vs 170 (85-255) ng/dL, p=0,003] e cobre [147 (122-177) vs 107 (92-121) ?g%, p=0,03] em relação aos controles, respectivamente. A concentração sérica das citocinas IL-6 [7,2 (4,2-10,1) vs 2,0 (1,4-2,5) pg/mL, p<0,001], TNF- ? [24,6 (18,7-30,5) vs 15,2 (11,3-19,1) pg/mL, p=0,02] e IL-10 [13,3 (8,5-18,2) vs 4,4 (2,8- 6,1) pg/mL, p<0,001] foram maiores no Grupo Câncer. O RNAm do INF-? (p=0,008), 8 TNFR1 (p=0,003), IL-10 (p=0,002) e PPAR-? (p=0,002) foram mais expressos nos pacientes com neoplasia. O Subgrupo Caquexia apresentou menor ingestão energética (p=0,03) e proteica (p=0,04), maior intensidade de fadiga (p=0,003), maior perda de peso (p=0,02) e menores níveis séricos de zinco (p=0,05). Dentre as citocinas, apenas a concentração de IL-6 (p=0,04) foi maior no Subgrupo Caquexia, enquanto que a expressão gênica do INF-? (p=0,04) foi maior nos pacientes com caquexia. Conclusões: Apesar da perda de peso, os marcadores de ingestão alimentar e composição corporal foram pouco alterados nos pacientes com neoplasia da confluência biliopancreática. As alterações laboratoriais foram evidentes nos pacientes com neoplasia, mostrando uma resposta inflamatória sistêmica. O aumento da expressão gênica da IL-10 sugere que as células do sangue periférico estão envolvidas no aumento sérico desta citocina. Apesar do aumento da concentração sérica do IL-6 e TNF-? nos pacientes com neoplasia, não houve aumento da expressão gênica dessas citocinas em sangue periférico. Tais dados sugerem que a IL-6 e o TNF-? são produzidos por outras células do sistema imune, distintas dos macrófagos circulantes. O aumento da expressão gênica de INF-? no sangue periféricos dos pacientes com neoplasia não foi acompanhado por maior concentração sérica dessa citocina, por possíveis mecanismos epigenéticos. Os genes do PPAR-? e do TNFR1 foram mais expressos nos pacientes com neoplasia. A caquexia foi definida em 8 pacientes, que apresentaram maior perda ponderal e menor ingestão nutricional. A concentração sérica de IL-6 foi maior no Subgrupo Caquexia, indicando a relação entre essa citocina e o estado caquético. Embora a concentração sérica de INF-? fosse semelhante entre sujeitos com ou sem caquexia, a expressão gênica dessa citocina foi maior nos pacientes caquéticos. / Introduction: Biliopancreatic confluence cancer has a high lethality and a reserved prognosis, attributed to the association of biological aggressiveness and the silent clinical picture. Inflammation plays a key role in the development and progression of cachexia, induced by the expression of cytokines produced by the tumor and/or released by the immune system. In recent years, it has been documented the variability in the genetics of cytokines regulating the mechanisms involved in neoplastic cachexia. Objectives: To evaluate the concentration of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-?), interferon-gamma (IFF-?) and interleukin 10 (IL-10) in samples of peripheral blood from patients with biliopancreatic confluence neoplasia, in addition to the gene expression of these cytokines, tumor necrosis factor receptor 1 (TNFR1), type 2 receptor tumor necrosis factor (TNFR2), zinc receptor alpha2-glycoprotein (ZAG) and peroxisome proliferator-activated gamma (PEAR-?). Besides, this study aimed to identify possible differences in the data among patients who were classified according to the presence or absence of neoplastic cachexia. Casuistic: The cross-sectional study was carried out with 17 patients of both genders in the immediate preoperative period of neoplasia of the biliopancreatic confluence (Cancer Group), in addition to 15 individual control in the preoperative period of hernia removal surgery (Control Group). Patients with neoplasia were classified according to the presence of cachexia (Subgroup Cachexia, n=8) and those without it (Subgroup Without-cachexia, n=9). Methods: Food intake and body composition were evaluated in all volunteers. The fatigue questionnaire was applied in individuals with neoplasia. The diagnosis of cachexia was based on pre-established criteria. Inflammatory cytokines IL-6, TNF-?, INF-? and IL-10 were measured in peripheral blood. The gene expression of inflammatory cytokines, TNF-?\' receptors, ZAG and PPAR were made in whole blood. Statistical analysis was performed using Statistica software, version 8.0®. Results: There was no difference in energy intake [1827 (1489-2166) vs 1691 (1380-2003) kcal, p=0.56] and protein [91.6 (74-109) vs 101 (89-114) g, p=0.30] of individuals with cancer or controls, except for the higher lipid intake [69.0 (53.5-84.5) vs 42.7 (33.4-52.1) g, p=0,01] and lower intake of vitamin A [382 (152-612) vs 1346 (1032-1659) ,µg, p=0.001] in the Cancer Group related to Control Group, respectively. There was weight loss from the usual in 15 of the 17 patients (13.1 + 11.0%) prior to the surgical procedure, although body composition variables were similar between the two study groups. Patients with neoplasia had lower plasma albumin concentrations [3.8 (3.5-4.0) vs 4.4 (4.3-4.5) g/dL, p <0.001], transferrin [166 (140-192) vs 241 (212-270) mg/dL, p=0,001], iron [80.8 (67.793.9) vs 107 (82-131) ,µg/dL, p=0.003], zinc [79.9 (66-93.7) vs 97.4 (88-107) µg%, p=0.001] and vitamin A [0.7 (0.6-0.8) vs 1.3 (1, 0-1.5) umol/L, p <0.001], as well as higher glycemia levels [115 (118-193) vs 98.6 (82-115) mg/dL, p=0.003], C-reactive protein 2.7 (0.9-4.5) vs 0.2 (0.2-3.3) mg/dL, p <0.001], ferritin [985 (347-1623) vs 170 (85-255) ng/dL, p=0.003] and copper ~147 (122-177) vs 107 (92-121) µg%, p=0.03] relative to the controls, respectively. The serum concentration of IL-6 cytokines [7.2 (4.2-10.1) vs. 2.0 (1.4-2.5) pg/mL, p <0.001], TNF-? [24.6 (18.7-30.5) vs 15.2 (11.3-19.1) pg/mL, p=0.02] and IL-10 [13.3 (8.5-18.2) vs 4.4 (2.8-6.1) pg/mL, p=0.008) were higher in the Cancer Group. The mRNA of INF-? (p=0.008), TNFR1 (p=0.003), IL-10 (p=0.002) and PPAR-? (p=0.002) were more expressed in patients with neoplasia. The Caquexy Subgroup had lower energetic (p=0.03) and protein intake (p=0.04), higher fatigue intensity (p=0.003), greater weight loss (p=0.02) and lower serum levels of zinc (p=0.05). Among the cytokines, only a concentration of IL-6 (p=0.04) was higher than the Cachexia Subgroup, whereas the gene expression of INF-? (p=0.04) was higher in patients with cachexia. Conclusions: Despite the weight loss, dietary intake markers and body composition were slightly altered in patients with biliopancreatic confluence neoplasia. In patients with neoplasia, laboratory findings were evident showing a systemic inflammatory response. The increasing gene expression of IL-10 suggests that peripheral blood cells are involved in the serum increase of this cytokine. Despite the increased concentration of IL-6 and TNF-? in neoplasia patients, there was no increase in gene expression in peripheral blood cytokines. These data suggest that IL-6 and TNF-? are produced by other cells of the immune system, other than circulating macrophages. The increasing gene expression of INF-? in the peripheral blood of patients with neoplasia was not accompanied by a higher serum concentration of this cytokine, due to possible epigenetic mechanisms. The PPAR-? and TNFR1 genes were more expressed in patients with neoplasia. Cachexia was defined in 8 patients, who presented greater weight loss and lower nutritional intake. The serum concentration of IL-6 was higher in the Cachexia Subgroup, indicating the relation between this cytokine and the cachectic state. Although the serum INF-? concentration was similar between individuals with or without cachexia, the gene expression of this cytokine was higher in cachectic patients

Objetivo: Avaliar a adequação da dieta de crianças de 12 a 32 meses em relação ao consumo de porções dos grupos alimentares e de energia, macro e micronutrientes. Métodos: estudo descritivo, com uma amostra de conveniência com crianças de 12 a 32 meses de Ribeirão Preto, SP, participantes de um amplo projeto temático denominado Projeto Brisa. Para a avaliação dietética foi utilizado o recordatório alimentar de 24 horas, os alimentos e preparações consumidos pelas crianças foram inseridos no software Virtual Nutri Plus para cálculo nutricional e transformados em porções relacionadas aos oito grupos da Pirâmide Alimentar Infantil. A variabilidade intrapessoal da dieta foi corrigida com a replicação de três R24h, em dias aleatórios, em uma subamostra de 20% da população do estudo. Esses dados foram submetidos ao Multiple Source Method (MSM) e obtida a dieta usual que foi analisada de acordo com a Estimated Average Requirement (EAR) e Tolerable Upper Intake Level (UL) das Dietary Reference Intake (DRIs) e expressa em proporção de crianças com ingestão de nutrientes abaixo ou acima dessas recomendações. As porções alimentares foram analisadas por meio dos guias alimentares infantis brasileiros. A associação entre os valores consumidos de energia, macro e micronutrientes e porções alimentares com as variáveis de interesse foi avaliada por meio do teste de qui-quadrado. Resultados: A amostra de 491 crianças foi estratificada em três faixas etárias, com predomínio de crianças entre 18 a 23 meses (52%), meninas (52,5%) eutróficas (92,9%), cujas mães tinham 9 a 11 anos de estudo (57,4%) e referiram cor da pele branca (55,2%); os prematuros representaram 22% da amostra estudada. Apenas 7,4% pertenciam a classes econômicas menos favorecidas. A alimentação das crianças apresentou consumo insuficiente de carboidrato e gordura, 38,5% e 29,5%, adequado de energia e excessivo de proteínas (79,8%). Entre os micronutrientes, Ferro, vitamina C e vitamina B12 tiveram os maiores percentuais de consumo adequado (98,6%, 97,0% e 94,9%, respectivamente), enquanto cálcio (27,3%), folato (74,8%) e vitamina E (37,7%) apresentaram maiores frequências de consumo insuficiente. A ingestão acima de UL foi mais expressiva em vitamina A (43,6%) e zinco (33,6%). O consumo de porções alimentares nas crianças mais novas, até 23 meses, foi insuficiente de carnes e ovos (42,7%), leites, queijos e iogurtes (47,7%) e excessivo dos grupos de cereais, pães e tubérculos, frutas e óleos e gorduras. Nas maiores de 24 meses o consumo insuficiente foi mais elevado no grupo dos cereais, pães e tubérculos (56,1%) e frutas (75,8%). O alto consumo insuficiente de verduras e legumes e excessivo de açúcares e doces foi encontrado em todas as crianças. Conclusão: A alimentação das crianças foi marcada por inadequações na ingestão de nutrientes, consumo insuficiente de verduras e legumes e excessivo de alimentos fontes de açúcares e doces. No entanto, a ingestão de ferro e vitamina A, micronutrientes mais deficientes no Brasil, apresentaram baixas taxas de consumo inadequado. O excesso de peso foi observado em apenas 35 (7,1%) e esteve associado ao maior consumo excedente de energia. / Objective: To assess dietary adequacy in 12-t0-32-month old children regarding the intake of portions of food groups and energy and of macro- and micronutrients. Methods: A descriptive study of a convenience sample of 12-to-32-month-old children from Ribeirão Preto, SP, participating in an ample thematic project denoted BRISA Project. The 24 hour food recall was used for assessment and the foods and preparations consumed by the children were inserted in the Virtual Nutri Plus software for nutritional calculation and transformed into portions related to the eight groups of the Infant Food Pyramid. Intrapersonal dietary variability was corrected with three R24h replication on random days in a 20% subsample of the study population. The data were submitted to the Multiple Source Method (MSM) and the usual diet was obtained and analyzed according to the Estimated Average Requirement (EAR) and the Tolerable Upper Intake Level (UL) from the Dietary Reference Intake (DRIs) and expressed as the proportion of children with nutrient intake below or above these recommendations. The food portions were analyzed using Brazilian infant food guides. The association of the energy, macro- and micronutrient values consumed and food portions with the variables of interest was determined by the chi-square test. Results: The sample of 491 children was stratified into three age ranges, with a predominance of children aged 18 to 23 months (52%), of normal weight (92.9%) girls (52.5%) whose mothers had 9 to 11 years of schooling (57.4%) and who reported white skin color (55.2%). Preterm babies represented 22% of the study sample. Only 7.4% belonged to less privileged economic classes. The children\'s diet showed insufficient carbohydrate and fat intake, 38.5% and 29.5%, adequate energy intake and excessive protein intake (79.8%). Among the micronutrients, iron, vitamin C and vitamin B12 showed the highest percentages of adequate intake (98.6%, 97.0% and 94.9%, respectively), whereas calcium (27.3%), folate (74.8%) and vitamin E (37.7%) showed higher frequencies of insufficient intake. Intake above UL was more expressive for vitamin A (43.6%) and zinc (33.6%). Among younger infants (up to 23 months of age), food portion intake was insufficient regarding meat and eggs (42.7%), milk, cheese and yogurt (47.7%), and excessive regarding cereals, breads and tubercles, fruits, oils and fats. Among children older than 24 months, insufficient intake was more marked regarding cereals, breads and tubercles (56.1%) and fruits (75.8%). A markedly insufficient intake of vegetables and legumes and excessive intake of sugars and sweets was observed in all children. Conclusion: The diet of the children studied was marked by inadequate nutrient intake, insufficient vegetable and legume intake and excessive intake of foods containing sugars and sweets. However, low rates of inadequate intake were observed for iron and vitamin A, the micronutrients more deficient in Brazil. Excess weight was observed in only 35 children (7.1%) and was associated with excessive energy intake.

Introdução - Estudos epidemiológicos em escolares mostram elevadas prevalências de excesso de peso e práticas alimentares não saudáveis, considerados como um problema de saúde pública. São escassas pesquisas de abrangência municipal apesar da importância das informações contínuas sobre a saúde da criança. Neste sentido, avaliar o consumo alimentar e o estado nutricional são necessários para verificar as transformações epidemiológicas deste grupo populacional possibilitando o norteamento e realinhamento das políticas de saúde no município. Objetivos - Avaliar o estado nutricional e o consumo alimentar dos escolares de 1º ao 4º ano da rede municipal de educação da cidade de São Paulo, segundo variáveis demográficas, vulnerabilidade social e hábitos de vida. Metodologia - Foi avaliada uma amostra probabilística de 3778 educandos de ambos os sexos, com idade entre 6 a 12 anos. As unidades educacionais foram selecionadas mantendo o critério de proporcionalidade da amostra de alunos ao tamanho das Diretorias Regionais de educação (DRE). Foram realizadas medidas antropométricas para determinar o estado nutricional e utilizou-se os indicadores IMC/idade e Altura/idade com base na distribuição de referência da WHO 2007. A alimentação dos educandos foi avaliada através do questionário estruturado do Sistema de Monitoramento do Consumo Alimentar e Atividade Física de Escolares (Sistema WEB- CAAFE). Utilizou-se a regressão logística para verificar associação entre os o excesso de peso ou obesidade e a idade e a vulnerabilidade social dos educandos, com o coeficiente expresso odds ratio (OR) e um intervalo de confiança de 95% (IC). A análise fatorial foi conduzida a fim de identificar os padrões alimentares dos escolares e a regressão logística univariada para verificar associação com fatores demográficos e de hábitos de vida. Resultados - A prevalência de déficit de altura foi 1,6%, de excesso de peso 38,7% e obesidade 18,6%. O excesso de peso e a obesidade mostrou-se mais prevalente entre os escolares do sexo feminino (p<0,001) e não apresentou diferença significativa entre as diferentes categorias de vulnerabilidade social. Os padrões alimentares encontrados foram 1º \"Não saudáveis\", 2º \"Tradicional\", 3º \"Preparações rápidas\", 4º \"Frutas, legumes e verduras\", 5º \"Café da manhã\". Na análise univariada verificou maior chance do consumo dos alimentos do padrão \"Não saudável\" aos finais de semana (OR 1,26; IC 1,16-1,37) e a prática do padrão 4º \"Frutas, legumes e verduras\" durante a semana (OR 0,91; IC 0,83-0,99). Conclusão - Foi possível caracterizar o estado nutricional e consumo alimentar dos escolares do município de São Paulo (SP). O estado nutricional dos escolares esteve marcado por prevalências elevadas de excesso de peso e obesidade, principalmente no sexo feminino e na faixa etária de 8 e 9 anos. O padrão com maior variabilidade encontrado foi o \"Não saudável\". / Introduction - Epidemiological studies in schoolchildren show high prevalence of overweight and unhealthy eating habits, which is considered a public health issue. Despite the importance of continuous information on children\'s health, there are scarce studies of municipal coverage. In this sense, assessing food intake and nutritional status is necessary to verify the epidemiological changes in this population group, enabling guidance and realignment of health policies in the city. Objectives - To assess nutritional status and dietary intake patterns in schoolchildren. Methodology - Random sample of 3778 students of both sexes was evaluated, aged between 6 and 12 years, from the 1st to the 4th school year. Schools were selected maintaining the student\'s sample size proportional to the size of their Regional Education Board (DRE). The nutritional status was determined by anthropometric measures the BMI-for-age and height-for-age indicators were used based on the WHO growth curves. Food consumption was evaluated through the structured questionnaire of the Monitoring System of Food Consumption and Physical Activity of Schoolchildren (WEB-CAAFE system). Logistic regressions were used to verify the association between overweight or obesity and age and social vulnerability of the students, with the coefficient expressed as odds ratio (OR) and a confidence interval of 95% (CI). A factorial analysis was conducted to identify the dietary patterns of the schoolchildren and a univariate logistic regression to verify association with demographic factors. Results - The prevalence of height deficit was 1.6%, overweight 38.7% and obesity 18.6%. Overweight and obesity were more prevalent among female students (p < 0.001) and showed no significant difference among the categories of social vulnerabilities. The dietary patterns found were 1st \"Unhealthy\", 2nd \"Traditional\", 3rd \"Quick Preparations\", 4th \"Fruits and vegetables\", 5th \"breakfast\". The univariate analysis showed a higher chance of eating food from the \"Unhealthy\" pattern at weekends (OR 1.26; IC 1.16 - 1.34) and \"Fruits and vegetables\" consumption during the week (OR 0.91; IC 0.82 - 0.99). Conclusion - The results allowed us to characterize the nutritional status and food intake of the schoolchildren in the city of São Paulo (SP), which is marked by high prevalence of overweight and obesity, particularly in females and in the age group of 8 and 9 years old. The unhealthy dietary was the pattern with the greatest variability.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2009. / Härtill 4 uppsatser.

Source: Dissertation Abstracts International, Volume: 70-03, Section: B, page: 1572. Adviser: R. Sue Day. Includes bibliographical references.

Background and hypothesis. Edentulous patients may be at risk for malnutrition and cardiovascular disease even with well made dentures. Improvements in methods used to assess nutritional status suggest that functional biomarkers such as plasma homocysteine (tHcy), in addition to traditional methods, will provide a better quality assessment. The hypothesis is that there is an association between functional biomarkers of nutritional status and traditional cardiovascular disease risk factors in a community dwelling edentulous elderly population. / Methods. This was a cross-sectional study of the baseline characteristics of a convenient sample of 254 edentulous community dwelling elderly over 65 years. Measurements included anthropometric, body composition, homocysteine, vitamins and relevant blood components. Correlations, multiple regression models and Adjusted Odds Ratios (AOR) for tertiles were used to assess the relationship between vitamins and other parameters with hyperhomocystenemia, defined as THcy value of &ge; 14mmol/L. The independent effect of edentulism on hyperhomocysteinemia was sought using the NHANES III data. / Results. The prevalence of hyperhomocysteinemia was 49.2%. Effect of folate on hyperhomocysteinemia was significant (p = 0.037). Low folate tertile group had a 2.45 times higher odds (CI: 1.23, 4.87) of hyperhomocysteinemia than patients in the higher tertile (p = 0.019). Groups with normal folate did not have higher odds of hyperhomocysteinemia regardless of levels of vitamin B6 or B12. AOR for vitamin B12 tertiles in relation to hyperhomocysteinemia were 2.36 (CI: 1.18, 4.75) and 2.12 (1.07, 4.22) for lower vs. high. A weak inverse relationship existed between tHcy and vitamin C (r= -0.11, p= 0.045). A borderline negative correlation existed between HDL and THcy adjusted for age (r = - 0.12; P = 0.05). Significant correlation existed between THcy and BMI (r = 0.15, P = 0.02), small waist circumference (r = 0.22; p = 0.0004) and waist/hip ratio (r = 0.23, p = 0.0003). In a multivariate analyses, edentulism was associated with hyperhomocysteinemia (p = 0.012). / Conclusions. In this sample, homocysteine levels appeared much higher than one would expect with folate fortification, and were related to several cardiovascular risk factors. Using data from NHANES III, edentulism was found to independently predict hyperhomocysteinemia. The inverse relationship between homocysteine and vitamin C and the effect of folate on hyperhomocysteinemia suggests that increasing dietary intake of fruit and vegetables in edentulous individuals might be beneficial. Furthermore, the latter are at risk of developing hyperhomocysteinemia, a condition associated with cognitive impairment, dementia and coronary artery disease risk.

Eating problems and nutritional status were studied in a consecutive series of 104 stroke patients admitted to emergency hospital care. During their stay in hospital eating problems were observed in 46 patients. Certain common types of eating problems were identified: aberrant eating behaviour as regards chewing,lokalization or swallowing, eating small amounts, hoarding of food in the mouth, leakage of food from the mouth and unawareness of eating problems. Poor nutritional status occurred in 16 % of the patients on admission and in 22 % on discharge from the stroke unit. A subgroup of 32 patients hospitalized for 21 days or longer was studied for three weeks. On at least one occasion during these three weeks a poor nutritional status was observed in 18 patients, of whom 17 had eating problems. All subjects who had eating problems during their hospital stay, plus those patients without eating problems but with neurological deficits and those living in a nursing home one year after the stroke (n=36) were selected for a longitudinal study 18 months after the onset of stroke. Eating problems were identified in 23 of these patients during their hospital stay while 21 had such problems when they were followed up. Two patients who could not eat due to severe dysphagia (after a stroke) for three years and 18 months respectively, were successfully trained to eat normally. One patient exhibited impaired oral and hypopharyngeal function and the other impaired hypo- pharyngeal function and a spastic crico-pharyngeal muscle. In both patients training in swallowing was the main remedical measure and one of them also had a myotomy of the spastic muscle. / <p>[2] s., s. 1-45: sammanfattning, s. 49-130: Härtill 6 uppsatser</p> / digitalisering@umu

Literature shows that nutritional deficiency and feeding behaviors in neurodevelopmentally disabled children is secondary to an underdeveloped gastrointestinal tract. Fifty (50) parents with children with autism responded to a Nutritional Perception Assessment that they believe their children are at adequate nutritional status. They reported confidence in their nutritional knowledge, yet admitted to concern about the nutritional status of their children. The survey revealed that parents are not seeing a registered dietitian for their nutritional advice, leading to the question of soundness in nutritional information received. A marginal correlation was found between belief in adequate nutritional status of children and the use of credible sources for nutritional information, p=0.0429. Data from twenty-five 24-hour recalls was entered into the MyPyramid Food Tracker to determine nutritional status, which was compared to Daily Recommended Intakes (DRIs), showing adequate nutrient consumption.

Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2010.

Thesis (M.Sc. (Dietetics))--North-West University, Potchefstroom Campus, 2010.