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AIMS: To evaluate the association between dietary patterns, obesity, and glycemic control in children and adolescents with type 1 diabetes mellitus (T1DM). METHODS: A cross-sectional study was carried out in 2015 at a diabetes reference center in Rio de Janeiro. Sociodemographic data and those related to outpatient follow-ups were obtained from the medical records. The assessment of food consumption was performed using a 24 h food recall. Obesity was defined as body mass index-for-age (BMI-for-age) ≥ +1 z-score. Glycemic control was assessed using glycated hemoglobin (HbA1c). Dietary patterns were generated by factorial analysis, and each individual's adherence to these dietary patterns was determined by the factor loadings and then classified into terciles. RESULTS: The study population included 120 children and adolescents, among whom 5 dietary patterns were identified. The prevalence of obesity was 31.7% (n = 38), and 64.2% (n = 77) of the participants had inadequate glycemic control. We observed that individuals with higher adherence to dietary pattern five, characterized by a greater consumption of ultra-processed foods, had higher odds of having higher HbA1c levels (OR = 3.49; 95% CI = 1.18-11.16). CONCLUSIONS: Higher consumption of ultra-processed foods can be detrimental to glycemic control in children and adolescents. Thus, food intake monitoring is of paramount importance as part of the multidisciplinary care of patients with T1DM.

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[This corrects the article DOI: 10.1017/jns.2023.54.].

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OBJECTIVES: The aim of this study was to evaluate the association of the dietary inflammatory index (DII) with the nutritional status and metabolic control of children and adolescents with type 1 diabetes mellitus. METHODS: This was a cross-sectional study that examined data of children and adolescents ages 7 to 16 y diagnosed with type 1 diabetes mellitus. Dietary intake was assessed using a 24-h dietary recall, from which the DII was calculated. The outcomes were body mass index, lipid profiles (low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol), and glycated hemoglobin. The DII was evaluated in tertiles and in a continuous way. Multiple linear regression was adopted in the analysis, with P < 0.05 considered significant. RESULTS: Overall, 120 children and adolescents with a mean age of 11.7 (± 2.8) y were included, 53.3% (n = 64) of whom were girls. Excess weight was present in 31.7% participants (n = 38). The average DII was +0.25, ranging from -1.11 to +2.67. Higher values of selenium (P = 0.011), zinc (P = 0.001), fiber (P < 0.001), and other micronutrients were observed in the first tertile of the DII (diet with more antiinflammatory potential). The DII appeared as a predictor of body mass index (P = 0.002; ß = 0.23; 95% confidence interval [CI], 0.39-1.75) and non-high-density lipoprotein cholesterol (P = 0.034; ß = 0.19; 95% CI, -13.5 to 0.55). There was a tendency for DII to be associated with glycemic control (P = 0.09; ß = 0.19; 95% CI, -0.04 to 0.51). CONCLUSIONS: The inflammatory potential of the diet was associated with increased body mass index and aspects related to metabolic control in children and adolescents with type 1 diabetes mellitus.

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BACKGROUND: Changes in nutritional status are recognised as predictors of unfavourable outcomes in children and adolescents with cancer, particularly in developing countries. There have been no studies on children and adolescents with cancer from every region of Brazil or on the impact of nutritional status on clinical outcomes. The aim of this study is to assess the association between the nutritional status of children and adolescents with cancer and the prediction of clinical outcomes. METHODS: This was a longitudinal, multicentre, hospital-based study. An anthropometric nutritional assessment was performed, and the Subjective Global Nutritional Assessment (SGNA) was administered within 48 h of admission. Seven hundred and twenty-three patients (aged 2-18 years) were included in the sample, undergoing cancer treatment. They were recruited in 13 reference centres in the five macro-regions of Brazil between March 2018 and August 2019. The outcomes evaluated were readmission within 30 days and death within 60 days of admission. To identify predictors of 60-day survival, Cox regression and log-rank statistics were used to compare Kaplan-Meier curves between the strata. RESULTS: About 36.2% (n = 262) of the samples were malnourished according to the SGNA. Severe malnutrition by the SGNA (relative risk [RR] = 8.44, 95% confidence interval [CI]: 3.35-21.3, P = 0.001) and living in the North region (RR = 11.9, 95% CI: 3.34-42.7, P = 0.001) were associated with the poorest survival. The North (RR = 5.77, 95% CI: 1.29-25.8, P = 0.021), Northeast (RR = 1.46, 95% CI: 1.01-2.11, P = 0.041), Midwest (RR = 0.43, 95% CI: 0.20-0.095, P = 0.036), age group 10-18 years (RR = 0.65, 95% CI: 0.45- 0.94, P = 0.022) and haematologic malignancy (RR = 1.52, 95% CI: 1.10-2.10, P = 0.011) were predictors of readmission within 30 days. CONCLUSIONS: The prevalence of malnutrition was high and related to death. These results highlight the need to use the SGNA in clinical practice alongside classic anthropometric methods for the diagnosis of malnutrition, and the need to standardise care across all Brazilian regions, which should include nutritional care for children and adolescents with cancer.

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The aim of this study was to evaluate the association of overweight, obesity, excess central adiposity, hyperglycemia, and diabetes mellitus with tumor characteristics in breast cancer. In this retrospective cohort study that enrolled 2127 women with breast cancer, the independent variables collected were fasting blood glucose, body mass index, central adiposity (waist circumference and waist-to-hip circumference ratio (WHR)), and waist-to-height ratio. The tumor characteristics (infiltrating, ductal grade, hormone receptor-positive (HR+), human epidermal growth factor receptor, triple negative, size, lymph node involvement, and clinical stage) were the dependent variables. Most of the women were postmenopausal (73.5%), with an infiltrating tumor (83.0%), HR+ (82.0%), and overweight or obese (71.0%). For the premenopausal women, obesity was associated with grade 3 ductal tumor (odds ratio (OR): 1.70; 95% confidence interval (95% CI): 1.09-2.66), triple negative (OR: 1.37, 95% CI: 1.08-3.24), and size ≥ 2 cm (OR: 2.20, 95% CI: 1.36-3.56). For the postmenopausal women, obesity was associated with WHR, infiltrating tumor (OR: 1.73, 95% CI: 1.56-1.95), size ≥ 2 cm (OR: 1.38, 95% CI: 1.11-1.71), lymph node involvement (OR: 1.24, 95% CI: 1.02-1.56), and stages III-IV (OR: 1.76, 95% CI: 1.30-2.65). Excess body weight and central adiposity were associated with tumor aggressiveness characteristics in women with breast cancer, confirming the importance of nutritional status.

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Abstract Objective To evaluate the effect of the carbohydrate counting method (CCM) on glycemic control,maternal, and perinatal outcomes of pregnant women with pregestational diabetes mellitus (DM). Methods Nonrandomized controlled clinical trial performed with 89 pregnant women who had pregestational DMand received prenatal care in a public hospital in Rio de Janeiro, state of Rio de Janeiro, Brazil, between 2009 and 2014, subdivided into historic control group and intervention group, not simultaneous. The intervention group (n=51) received nutritional guidance from the carbohydrate counting method (CCM), and the historical control group (n=38), was guided by the traditionalmethod (TM). The Mann-Whitney test or the Wilcoxon test were used to compare intra- and intergroup outcomes andanalysis of variance (ANOVA) for repeated measures, corrected by the Bonferroni post-hoc test,was used to assess postprandial blood glucose. Results Only the CCM group showed a reduction in fasting blood glucose. Postprandial blood glucose decreased in the 2nd (p=0.00) and 3rd (p=0.00) gestational trimester in the CCM group, while in the TM group the reduction occurred only in the 2nd trimester (p=0.015). For perinatal outcomes and hypertensive disorders of pregnancy, there were no differences between groups. Cesarean delivery was performed in 82% of the pregnant women and was associated with hypertensive disorders (gestational hypertension or pre-eclampsia; p=0.047). Conclusion Both methods of nutritional guidance contributed to the reduction of postprandial glycemia of women and no differences were observed for maternal and perinatal outcomes. However, CCM had a better effect on postprandial glycemia and only this method contributed to reducing fasting blood glucose throughout the intervention. ReBEC Clinical Trials Database The present study was registered in the ReBEC Clinical Trials Database (Registro Brasileiro de Ensaios Clínicos, number RBR-524z9n).

Resumo Objetivo Avaliar o efeito do método de contagem de carboidratos no controle glicêmico, desfechos maternos e perinatais de gestantes com diabetes mellitus (DM) pré-gestacional. Métodos Ensaio clínico controlado não randomizado realizado com 89 gestantes com DM pré-gestacional atendidas em hospital público do Rio de Janeiro, RJ, Brasil, entre 2009 e 2014, divididas emgrupo controle histórico e grupo intervenção. O grupo intervenção (n=51) recebeu orientação nutricional combase nométodo de contagem de carboidratos (CCM) e o grupo controle histórico (n=38) foi orientado pelo método tradicional (MT). Os testes de Mann-Whitney ou de Wilcoxon foram usados para comparar os desfechos intra- e intergrupos e, para avaliar a glicemia pós-prandial, análise de variância (ANOVA, na sigla em inglês) para medidas repetidas foi usada. Resultados Somente o grupo com método CCM apresentou redução da glicemia de jejum. A glicemia pós-prandial diminuiu no 2° (p=0,00) e 3° (p=0,00) trimestres gestacionais no grupo com método CCM, e no grupo com método tradicional, a redução ocorreu apenas no 2° trimestre (p=0,015). Para os resultados perinatais e distúrbios hipertensivos da gravidez, não houve diferenças entre os grupos. O parto cirúrgico foi realizado em 82% das gestantes e esteve associado a distúrbios hipertensivos gestacionais (p=0,047). Conclusão Ambos osmétodos de orientação nutricional contribuírampara a redução da glicemia pós-prandial e não foram observadas diferenças para os resultados maternos e perinatais. No entanto, o método CCM apresentou melhor efeito sobre a glicemia pós-prandial e foi o único que induziu redução da glicemia de jejum.

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OBJECTIVE: To evaluate the effect of the carbohydrate counting method (CCM) on glycemic control, maternal, and perinatal outcomes of pregnant women with pregestational diabetes mellitus (DM). METHODS: Nonrandomized controlled clinical trial performed with 89 pregnant women who had pregestational DM and received prenatal care in a public hospital in Rio de Janeiro, state of Rio de Janeiro, Brazil, between 2009 and 2014, subdivided into historic control group and intervention group, not simultaneous. The intervention group (n = 51) received nutritional guidance from the carbohydrate counting method (CCM), and the historical control group (n = 38), was guided by the traditional method (TM). The Mann-Whitney test or the Wilcoxon test were used to compare intra- and intergroup outcomes and analysis of variance (ANOVA) for repeated measures, corrected by the Bonferroni post-hoc test, was used to assess postprandial blood glucose. RESULTS: Only the CCM group showed a reduction in fasting blood glucose. Postprandial blood glucose decreased in the 2nd (p = 0.00) and 3rd (p = 0.00) gestational trimester in the CCM group, while in the TM group the reduction occurred only in the 2nd trimester (p = 0.015). For perinatal outcomes and hypertensive disorders of pregnancy, there were no differences between groups. Cesarean delivery was performed in 82% of the pregnant women and was associated with hypertensive disorders (gestational hypertension or pre-eclampsia; p = 0.047). CONCLUSION: Both methods of nutritional guidance contributed to the reduction of postprandial glycemia of women and no differences were observed for maternal and perinatal outcomes. However, CCM had a better effect on postprandial glycemia and only this method contributed to reducing fasting blood glucose throughout the intervention. REBEC CLINICAL TRIALS DATABASE: The present study was registered in the ReBEC Clinical Trials Database (Registro Brasileiro de Ensaios Clínicos, number RBR-524z9n).

OBJETIVO: Avaliar o efeito do método de contagem de carboidratos no controle glicêmico, desfechos maternos e perinatais de gestantes com diabetes mellitus (DM) pré-gestacional. MéTODOS: Ensaio clínico controlado não randomizado realizado com 89 gestantes com DM pré-gestacional atendidas em hospital público do Rio de Janeiro, RJ, Brasil, entre 2009 e 2014, divididas em grupo controle histórico e grupo intervenção. O grupo intervenção (n = 51) recebeu orientação nutricional com base no método de contagem de carboidratos (CCM) e o grupo controle histórico (n = 38) foi orientado pelo método tradicional (MT). Os testes de Mann-Whitney ou de Wilcoxon foram usados para comparar os desfechos intra- e intergrupos e, para avaliar a glicemia pós-prandial, análise de variância (ANOVA, na sigla em inglês) para medidas repetidas foi usada. RESULTADOS: Somente o grupo com método CCM apresentou redução da glicemia de jejum. A glicemia pós-prandial diminuiu no 2° (p = 0,00) e 3° (p = 0,00) trimestres gestacionais no grupo com método CCM, e no grupo com método tradicional, a redução ocorreu apenas no 2° trimestre (p = 0,015). Para os resultados perinatais e distúrbios hipertensivos da gravidez, não houve diferenças entre os grupos. O parto cirúrgico foi realizado em 82% das gestantes e esteve associado a distúrbios hipertensivos gestacionais (p = 0,047). CONCLUSãO: Ambos os métodos de orientação nutricional contribuíram para a redução da glicemia pós-prandial e não foram observadas diferenças para os resultados maternos e perinatais. No entanto, o método CCM apresentou melhor efeito sobre a glicemia pós-prandial e foi o único que induziu redução da glicemia de jejum.

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BACKGROUND: The goals of nutrition therapy include providing adequate growth and development, avoiding a negative energy and nitrogen balance, and preventing complications. OBJECTIVE: To evaluate the nutrition therapy received by newborns at the neonatal intensive care unit (NICU) of a public maternity hospital in Rio de Janeiro, Brazil. METHODS: Retrospective longitudinal observational study in which data were collected on newborns admitted to NICU, in Rio de Janeiro, in 2016. The time that elapsed before commencement of parenteral and trophic enteral nutritional, time to reach full enteral nutrition, type of diet at the beginning of trophic enteral nutrition and at discharge from the NICU, and the relationship between birth weight and nutritional therapy were evaluated. RESULTS: Trophic enteral nutrition began after 24.42 (SD +20.23) hours, on average, and the mean time to reach full enteral nutrition was 10.0 (SD +5.51) days. Newborns with a birth weight below 1500 g had a longer hospital stay (p = .002), longer oxygen therapy (p = .009), a longer time before commencement of enteral feeding (p = .005), and took longer to reach full enteral feeding (p = .010). CONCLUSIONS: The institutional nutritional therapy practices were consistent with those proposed in the literature, but more support is needed for breastfeeding in this group.

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OBJECTIVES: Colostrum is the first secretion produced by the mammary glands and is present through the seventh day after birth. Colostrum has important immunomodulatory components and protective factors that contribute to the protection and development of newborns. The oropharyngeal administration of colostrum (OAC) has been proposed as a potential nutritional option for very low-birth-weight (VLBW) newborns (<1500 g). This study aimed to analyze the clinical outcomes of VLBW infants receiving OAC. METHODS: This is a retrospective longitudinal study with nonprobability sampling of VLBW infants on the OAC protocol. VLBW infants for whom no OAC data were available, who received no dose, or who died within the first 7 d of life were excluded. The Mann-Whitney test was used to compare quantitative variables and the Wilcoxon test to assess the evolution of anthropometric values with a significance level of 5% (P < 0.05). RESULTS: Enteral nutritional therapy was commenced after 1 d (median: 1 d; interquartile range [IQR], 1-1 d). Full enteral feeding was achieved after 11 d (median: 11.0 d; IQR, 9.0-16.0 d). Birth weight was recovered after 11 d (median: 11 d; IQR, 7.0-14.0 d). OAC was commenced at 3 d of life, and 32.5 doses (IQR, 21.0-44.0 d) were given in total. There were significant differences in the evolution of anthropometric characteristics during hospitalization, with a tendency to recover birth weight more quickly the higher the number of doses administered (P = 0.07). Time to full enteral feeding was significantly longer and time to recovery of birth weight significantly shorter when OAC was commenced ≤3 d after birth (P = 0.023). CONCLUSIONS: OAC was associated with a shorter time to recover birth weight and time to full enteral feeding.

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O Instituto de Nutrição Josué de Castro (INJC), da Universidade Federal do Rio de Janeiro (UFRJ), foi criado em 1946 como instituição de ensino e pesquisa na área de Nutrição. Este trabalho, submetido na categoria "Perspectivas", descreve a trajetória do ensino de Pós-Graduação (PG) no INJC, no ano do jubileu dos 75 anos do INJC. Para elaborar este relato, foram consultados artigos, livros, documentos, relatórios, atas e anotações do INJC e da UFRJ. O ensino de PG no INJC teve início no final da década de 1970, com a oferta de dois cursos de especialização. Em 1985, foi implantado o mestrado em Nutrição Humana. Atualmente, o INJC é a única instituição da área de Nutrição no Brasil que abriga um programa acadêmico de mestrado e doutorado, o Programa de Pós-Graduação em Nutrição, e um programa de mestrado profissional, o Programa de Pós-Graduação em Nutrição Clínica. A instituição oferece, ainda, seis cursos de especialização e integra quatro programas de residência multiprofissional da UFRJ. Indicadores favoráveis consistentes expressam o sucesso do esforço coordenado de docentes e discentes dos Programas de PG em iniciativas que privilegiam a obtenção de financiamento, o desenvolvimento de projetos interdisciplinares intra e interinstitucionais e o incentivo à produção acadêmica de qualidade. A pós-graduação no INJC articula-se com o ensino de graduação e com a extensão, contribuindo para a formação qualificada de recursos humanos no campo da Alimentação e Nutrição. Aos 75 anos, o INJC, por meio do ensino de PG, reitera o papel social e acadêmico da universidade pública brasileira. (AU)

The Instituto de Nutrição Josué de Castro (Josué de Castro Nutrition Institute - INJC), at the Universidade Federal do Rio de Janeiro (Federal University of Rio de Janeiro - UFRJ) was created in 1946 as an education and research institution in the field of nutrition. This work, presented in the Perspectives modality, describes the history of graduate education (GE) at INJC, in the year of INJC's 75th anniversary. This work is based on articles, books, documents, reports, minutes, and notes from UFRJ and INJC's Graduate Programs. GE at INJC began in the late 1970s, with the offer of specialization courses. In 1985, the Master's Degree Program in Human Nutrition was implemented. Currently, INJC is the only institution in the field of Nutrition in Brazil that hosts academic master's and doctoral programs, the Graduate Program in Nutrition, and a professional master's program, the Graduate Program in Clinical Nutrition. The institution also offers six specialization courses and integrates four multi-professional internship programs within UFRJ. Consistent favorable indicators express the success of the coordinated efforts of faculty and students of GE Programs in initiatives that prioritize attraction of funding, the implementation of intra- and inter-institutional interdisciplinary projects, and qualified academic production. Graduate education at INJC is linked to undergraduate education and to university outreach programs, contributing to high-quality education and training of human resources in the field of food and nutrition. After 75 years, INJC, through graduate education, reaffirms the social and academic role of Brazilian public universities. (AU)

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