The NEBio (Center for Bioethics Studies) of SPMI appreciated the text of the Consensus Feeding in Dementia at request of the authors. An opinion was prepared based on applicable ethical, moral, deontological and legal standards. NEBio concludes by the ethical adequacy of the proposals and of the submitted text and considered it an important contribution to clinical practice in end-of-life situations.

Introduction: The loss of muscle mass is becoming a very common problem among critically ill patients and it’s also strongly related to their prognosis and quality of life after leaving the intensive care unit. The purpose of this study was to evaluate the loss of muscle mass in the first five days, since the patient is admitted to the intensive care unit, and if there is a relationship between this muscle wasting and the nutritional support provided to patients. Methods: This prospective observational study enrolled adult patients admitted in the intensive care unit between January and March 2020. On the day of admission and on the fifth day of follow-up, an ultrasound evaluation of the thickness of the biceps brachii and quadriceps femoris was performed. During the five-day period we also analyzed the energy and protein support that was provided to the patients. Results: Thirty five patients were enrolled in this study with a mean age of 64±15, mostly male gender (62.9%). There was a loss of 1.77 mm in the thickness of the biceps brachii and 2.19 mm in the quadriceps femoris. We observed that the patients received an estimated daily nutritional support that corresponds to 20.0% of their energy and 24.9% of their protein needs.  Conclusion: It is feasible to objectively and non-invasively evaluate the muscle mass in critically ill patients and there was a significant decrease in muscle mass in the first days after admission. The nutritional support provided was significantly lower than recommended.

Helicobacter pylori (H. pylori) infection triggers a sequence of gastric alterations starting with an inflammation of the gastric mucosa that, in some cases, evolves to gastric cancer. Efficient vaccination has not been achieved, thus it is essential to find alternative therapies, particularly in the nutritional field. The current study evaluated whether curcumin could attenuate inflammation of the gastric mucosa due to H. pylori infection. Twenty-eight C57BL/6 mice, were inoculated with the H. pylori SS1 strain; ten non-infected mice were used as controls. H. pylori infection in live mice was followed-up using a modified 13C-Urea Breath Test (13C-UBT) and quantitative real-time polymerase chain reaction (PCR). Histologically confirmed, gastritis was observed in 42% of infected non-treated mice at both 6 and 18 weeks post-infection. These mice showed an up-regulation of the expression of inflammatory cytokines and chemokines, as well as of toll-like receptors (TLRs) and MyD88, at both time points. Treatment with curcumin decreased the expression of all these mediators. No inflammation was observed by histology in this group. Curcumin treatment exerted a significant anti-inflammatory effect in H. pylori-infected mucosa, pointing to the promising role of a nutritional approach in the prevention of H. pylori induced deleterious inflammation while the eradication or prevention of colonization by effective vaccine is not available.

Purpose of review: Any intensive therapy requires individual adaptation, despite the standardization of the concepts that support them. Among these therapies, nutritional care has repeatedly been shown to influence clinical outcome. In order to evaluate the risk of malnutrition among critically ill patients and to identify those patients who may benefit from medical nutrition therapy is imperative to have a validated screening tool to optimize nutritional care.The scope of this review is to analyze the recent literature on the management of nutritional scores for patients admitted to the ICU. Recent findings: Critically ill patient staying for more than 24-48 h in the ICU, if unable to eat, should be considered at risk for malnutrition. Several nutritional tools have been proposed but not all are validated to screening those patients. The limitations of existing screening tools are described. Summary: Nutritional scores should be routinely performed at ICU admission according to recommended guidelines. An approach to incorporate these tools into everyday clinical practice is suggested.

Introduction: The resting energy expenditure (REE) evolution after liver transplantation is not fully understood. Objective: To assess longitudinally the REE evolution in adults undergoing liver transplantation, in association with other nutritional measurements that characterize the metabolic profile. Methods: A single-center cohort of consecutive end-stage liver disease patients with indication for liver transplantation was recruited. REE, subjective global assessment (SGA), handgrip strength and body composition measurements were assessed before transplantation (T0) and at median nine (T1) and 36 (T2) days after transplantation. Mixed effects regression models were used for analysis. Results: Fifty-six patients with a mean age of 53.7 (8.5) years were included; 87.5% were males. In T0, 41% of patients were normometabolic, 37.5% were hypometabolic and 21.4% were hypermetabolic. After transplantation, the mean REE decreased progressively in patients initially hypermetabolic and the opposite occurred in those initially hypometabolic. The REE evolution was positively associated with body weight (β = 9.6, p < 0.001) and energy intake (β= 13.6, p = 0.005) in the whole sample; it was positively associated with body weight (β= 7.1, p = 0.018) and percentage of energy intake from lipids (β= 18.9, p = 0.003) in initially hypometabolic patients, and positively associated with body weight (β= 14.1, p < 0.001) and negatively associated with SGA-undernourishment (β = -171, p = 0.007) in initially normometabolic patients. Conclusion: Different REE evolutions after liver transplantation are associated with the preoperative metabolic status. In patients initially hypometabolic, the REE evolution is positively associated with body weight and percentage of energy intake from lipids, and in those initially normometabolic, it is positively associated with body weight and negatively associated with SGA-undernourishment.

PURPOSE: To compare the effect of parenteral versus enteral nutritional support in severe acute pancreatitis, with respect to efficacy, safety, morbidity, mortality and length of hospitalization. METHODS: The study was comprised of 31 patients, divided into a parenteral group (n=16) and an enteral group (n=15), who met severity criteria for abdominal tomography (Balthazar classes C, D, and E). The patients were compared by demographics, disease etiology, antibiotic prophylaxis, use or not of somatostatin, nutritional support, complications and disease progression. RESULTS: There was no statistical difference in the average duration of nutritional support, somatostatin, or antibiotics in the two groups. Imipenem was the drug of choice for prophylaxis of pancreatic infections in both groups. More complications occurred in the parenteral group, although the difference was not statistically significant (p=0.10). Infectious complications, such as catheter sepsis and infections of the pancreatic tissue, were significantly more frequent in the parenteral group (p=0.006). There was no difference in average length of hospitalization in the two groups. There were three deaths in the parenteral group and none in the enteral group. CONCLUSION: Enteral nutritional support is associated with fewer septic complications compared to parenteral nutritional support.

Abstract Background: Having appropriate dietary habits is part of the recommendations after ST-Elevation Myocardial Infarction (STEMI), however, the quality of intra-hospital nutritional counselling in the different health services has been minimally explored. Objective: To evaluate the quality of intra-hospital nutritional counselling among patients with STEMI in the public and private health systems in Sergipe. Methods: A cross-sectional, with data from the Via Crucis for the Treatment of Myocardial Infarction (VICTIM) Register, conducted from April to November of 2017, with individuals aged ≥ 18 years diagnosed with STEMI, in one public health service hospital and three private hospitals. The occurrence and quality of nutritional counselling were analyzed based on current guidelines and the administration of questionnaires. A significance level of 0.05 was adopted. Results: A total of 188 patients were analyzed; 80.3% were from the public health service facility. Among the interviewees, 57.6% of the public health service, and 70.3% of the private hospital patients received intra-hospital nutritional counselling (p = 0.191). The documentation of this practice, in medical records, was lower in the public service (2.6% vs. 37.8%, p < 0.001). A predominance of restrictive orientations was found in the public and private sectors, mainly regarding salt and fat, 52.3% and 70.3% respectively (p = 0.064). Patients from the private service were more counselling to introduce of cardioprotective foods, mainly fruit, vegetable/legume consumption (48.6% vs. 13.2%, p < 0.001). Among those who received counselling, nutritional knowledge was higher in the private sector (68.2% vs. 26.3%, p < 0.001). Conclusion: The intra-hospital nutritional counselling provided to patients with STEMI, in Sergipe, still presents poor quality in both services, especially in the public health system.

SUMMARY This article aims to make reference to some recent mourning aspects considered risk factors for cardiovascular disease, specifically the Takotsubo cardiomyopathy. The objective was to describe the stress from the death of a loved one combining it to the possibility of occurrence of Takotsubo cardiomyopathy through the perception of a traumatic event by the cortex, which triggers the subcortical brain circuit affecting the endocrine response. Given the growing acknowledgement of this cardiomyopathy, it is possible to contextualize the nutritional behaviours and decisions surrounding it, whose benefits must exceed the condition of temporary cardiac dysfunction and extend to food choices that have some influence in the limbic system. It is a descriptive analysis that aims to problematize the theme into reflections based on this experience, considering the foundation with the science of nutrition.

INTRODUÇÂO: O oferecimento de suporte nutricional adequado ao paciente crítico é condição essencial ao seu tratamento e pode influenciar significativamente a evolução de sua doença. OBJETIVO: Avaliar a adequação do suporte nutricional enteral calórico e proteico oferecido aos pacientes da unidade de terapia intensiva do Hospital Universitário da Universidade Federal de Mato Grosso do Sul (HU/UFMS) frente às suas necessidades estimadas. MÉTODOS: Estudo prospectivo observacional realizado na UTI do HU/UFMS no período de 14 de março a 12 de maio de 2011. Quatorze pacientes que mantiveram suporte nutricional enteral exclusivo por pelo menos 75% do tempo de internação na UTI foram acompanhados até alta da UTI ou óbito, totalizando 225 pacientes-dia. Os pacientes foram avaliados quanto ao estado nutricional na admissão e as suas necessidades calóricas e proteicas foram estimadas. A oferta da dieta enteral foi monitorada diariamente quanto à quantidade de calorias e proteínas. Indicadores de qualidade foram utilizados para avaliar a adequação do suporte nutricional oferecido. RESULTADOS: A Subjective Global Assessment identificou que 57% dos pacientes estavam moderadamente desnutridos ou suspeitos de estarem desnutridos e 7% gravemente desnutridos. O suporte nutricional enteral calórico e proteico foi oferecido com adequação de 94% e 80%, respectivamente, em relação às necessidades estimadas. Não houve diferenças significativas entre as variáveis de adequação do suporte nutricional enteral e o desfecho para alta da UTI ou óbito. Os pacientes que evoluíram para óbito eram mais desnutridos e apresentaram maior risco nutricional.

A glutamina, aminoácido dieteticamente não-essencial, tem sido tema de diversos estudos por sua participação em funções metabólicas, como integridade tecidual, controle do equilíbrio ácido-básico e transporte e doação de nitrogênio. A melhoria na eficiência e utilização dos nutrientes da dieta é de grande importância para o sucesso na produção animal, e a utilização da glutamina na alimentação permite o melhor entendimento da sua funcionalidade e eficiência no desempenho. O trabalho foi desenvolvido com o objetivo de avaliar planos de suplementação de glutamina em dietas de frangos de corte de 1 aos 42 dias de idade sobre o desempenho e as características de carcaça, cortes e vísceras. Foram utilizados 690 pintainhos de corte machos da linhagem Cobb distribuídos em delineamento em blocos casualizados com cinco planos de suplementação de glutamina: 0% de glutamina de 1 a 42 dias de idade; inclusão de 0,5% de glutamina de 1 a 7 dias e 0% de 8 a 42 dias; 1,0% de glutamina de 1 a 7 dias e 0% de 8 a 42 dias; 1,0% de glutamina de 1 a 7 dias, 0,5% de glutamina de 8 a 14 dias e 0% de 15 a 42 dias; 1% de glutamina de 1 a 14 dias, 0,5% de glutamina de 14 a 21 dias e 0% de 22 a 42 dias e 6 repetições de 23 aves cada. As aves foram submetidas a desafio sanitário por meio de cama reutilizada. Avaliou-se o peso corporal final, ganho de peso, consumo de ração, conversão alimentar e viabilidade criatória, dos períodos de 1 a 21e 1 a 42 dias. Aos 7, 14 e 21 dias foi abatida uma e aos 42 dias, foram abatidas 2 aves por repetição para determinação dos pesos absolutos e relativos de carcaça, de cortes (peito, coxa+sobrecoxa, asas, dorso, cabeça+pescoço e pés) e vísceras (proventrículo, moela, intestino, baço e bolsa cloacal). Constatou-se que as aves alimentadas com as dietas suplementadas com 1% de glutamina de 1 a 14 dias e 0,5% de glutamina de 14 a 21 dias apresentaram maior peso corporal final, ganho de peso e maior peso de carcaça, peito e dorso em relação aos demais planos de suplementação. O plano de suplementação de 0,5% de glutamina de 1 a 7 dias apresentou maior peso e rendimento de baço. Para aves criadas sob temperaturas elevadas, recomenda-se a suplementação de 1% de glutamina de 1 a 14 dias e 0,5% de glutamina de 14 a 21 dias e 0% de glutamina de 22 a 42 dias de idade, a qual proporciona maior peso corporal, ganho de peso, peso de carcaça, peito e rendimento de carcaça.