RESUMO
BACKGROUND: This study aimed to investigate the influence of the dietary approaches to stop hypertension (DASH) diet on gestational weight gain and perinatal outcomes in pregnant women with pre-existing diabetes mellitus (PDM). METHODS: A randomized, single-blind, controlled clinical trial was conducted with 68 pregnant women with PDM throughout prenatal care until delivery (18 weeks) at a public maternity hospital in Rio de Janeiro, Brazil (2016-2020). The standard diet adopted by the control group (standard diet group-SDG) contained 45-55% carbohydrates, 15-20% protein, and 25-30% lipids of the total energy intake. An adapted DASH diet, with a similar macronutrient composition, but with higher calcium, potassium, magnesium, fiber, and reduced saturated fat, was prescribed for the intervention group (DASH diet group-DDG). Student's t- or Mann-Whitney U tests were used to compare outcomes between groups. To assess the trajectory of gestational weight gain throughout the intervention between the study groups, linear mixed-effects regression models were used. RESULTS: The DDG had lower gestational weight gain at the fifth (p = 0.03) and seventh appointment (p = 0.04), with no difference in average total gestational weight gain (SDG: 10 kg [SD = 4]; DDG: 9 kg [SD = 5], p = 0.23). There was a trend for a lower length of stay of the newborns (p = 0.08) in the DDG without differences for other perinatal outcomes. CONCLUSIONS: The DASH diet promoted less variation in gestational weight gain without promoting a difference in total gestational weight gain, and there was no difference between the study groups for perinatal outcomes.
RESUMO
OBJECTIVES: To evaluate the effect of vitamin D supplementation on glycemic control in children and adolescents with T1DM. CONTENT: A systematic search was conducted of the Medline/PubMed, Web of Science, Embase, BVS/Lilacs, Cochrane Library, Scopus, Cinahl, Food Science, and FSTA databases. Two reviewers independently extracted article data and assessed quality. SUMMARY: A total of 1,613 eligible articles were retrieved, ten of which met the selection criteria: eight clinical trials, one retrospective cohort study, and one cross-sectional study. Regarding the cutoff points used to classify vitamin D status, most of the studies set deficiency at 25-hydroxyvitamin D <20 ng/mL, sufficiency at ≥30 ng/mL, and insufficiency as the interval between these values. Regarding intervention strategies, most used cholecalciferol for supplementation, but there was great variation in the dose and supplementation time. When evaluating the effect of vitamin D supplementation on HbA1c, a significant improvement in glycemic control was observed in 50% of the studies. However, only one of these studies was classified as being of positive methodological quality, with three having their quality classified as neutral and one as negative. OUTLOOK: There is yet no consistent evidence on the effect of vitamin D supplementation on glycemic control as an adjuvant in the treatment of children and adolescents with T1DM.
Assuntos
Diabetes Mellitus Tipo 1 , Deficiência de Vitamina D , Adolescente , Criança , Estudos Transversais , Diabetes Mellitus Tipo 1/tratamento farmacológico , Suplementos Nutricionais , Controle Glicêmico , Humanos , Estudos Retrospectivos , Vitamina D , Deficiência de Vitamina D/tratamento farmacológicoRESUMO
A anemia falciforme é a doença hemolítica crônica, de caráter hereditário mais comum no Brasil, sendo escassas as informações sobre o estado nutricional de micronutrientes em portadores dessa enfermidade no Brasil. Estudos internacionais vêm demonstrando correlação positiva entre deficiência de micronutrientes e evolução desfavorável da doença.O objetivo deste estudo foi realizar revisão sistemática sobre deficiência de micronutrientes em crianças e adolescentes com anemia falciforme.Foram selecionadas publicações nas bases científicas de dados Medline e Lilacs através do Pubmed e Scielo, disponíveis entre os anos de 1998 e 2008. Foram incluídas na análise as publicações realizadas com crianças e adolescentes portadores da forma homozigótica da doença (SS). A qualidade metodológica dos artigos foi avaliada segundo as recomendações de Strobe, sendo selecionados 11 estudos, sendo 2 transversais, 4 caso-controle e 5 de coorte, todos realizados nos Estados Unidos. A avaliação da concordância entre os avaliadores na classificação da qualidade dos artigos demonstrou ótima concordância (k = 1,00), com um total de 90,9 por cento de trabalhos com classificação B. Para a maioria dos nutrientes estudados (vit. A, D, B6, folato, cálcio e zinco), observou-se estado nutricional desfavorável entre os portadores de anemia falciforme, à exceção do ferro e vitamina B12, cujos resultados revelaram baixo ou nenhum nível de inadequação, seja bioquímica ou dietética. Tal constatação reforça a necessidade do cuidado nutricional no manejo desses pacientes, garantindo qualidade de vida para os portadores da doença.
Sickle cell anemia is a chronic hemolitic disease and very common in Brazil and there are few information about nutritional status of micronutrients in people with sickle cell anemia in this country. International studies have shown positive correlation between deficiency of micronutrients and worst evolution of the disease. The aim of this study was to carry out a systematic review about deficiency of micronutrients in children and adolescents with sickle cell anemia. The publications included were selected through scientific bases Medline and Lilacs, by Pubmed and Scielo, available between 1998 and 2008. In this analysis were included publications with children and adolescents with homozygotic type of the disease (SS). The methodological quality of scientific articles was evaluated according to STROBE recommendations: 11 publications were selected, 2 cross-sectionals, 4 case-controls and 5 cohort studies, all of them from United States of America. The level of concordance between data collected by different researchers showed a very good concordance (k = 1,00) and 90,9 percent of the studies were classified as B category. The analysis of results noticed an unfavourable nutritional status for the majority of the nutrients studied (vitamins A, D, B6, folic acid, calcium, zinc) except for iron and vitamin B12, which results showed low or none biochemical or dietetic inadequate levels. All these results confirm the need of nutritional care with these patients in order to reach a better quality of life for them.