Background
Moderate acute malnutrition, also called moderate wasting, affects around 10% of children under five years of age in low- and middle-income countries. There are different approaches to addressing malnutrition with prepared foods in these settings; for example, providing lipid-based nutrient supplements or blended foods, either a full daily dose or in a low dose as a complement to the usual diet. There is no definitive consensus on the most effective way to treat children with moderate acute malnutrition.

Objectives
To evaluate the safety and effectiveness of different types of specially formulated foods for children with moderate acute malnutrition in low- and middle-income countries, and to assess whether foods complying or not complying with specific nutritional compositions, such as the WHO technical specifications, are safe and effective.

Search methods
In October 2012, we searched CENTRAL, MEDLINE, LILACS, CINAHL, BIBLIOMAP, POPLINE, ZETOC, ICTRP, mRCT, and ClinicalTrials.gov. In August 2012, we searched Embase. We also searched the reference lists of relevant papers and contacted nutrition-related organisations and researchers in this field.  

Selection criteria
We planned to included any relevant randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before-and-after studies (CBAs), and interrupted time series (ITS) that evaluated specially formulated foods for the treatment of moderate acute malnutrition in children aged between six months and five years in low- and middle-income countries.

Data collection and analysis
Two authors assessed trial eligibility and risk of bias, and extracted and analysed the data. We summarised dichotomous outcomes using risk ratios (RR) and continuous outcomes using mean differences (MD) with 95% confidence intervals (CI). Where appropriate, we combined data in meta-analyses using the random-effects model and assessed heterogeneity. The quality of evidence was assessed using GRADE methods.

Main results
Eight randomised controlled trials, enrolling 10,037 children, met our inclusion criteria. Seven of the trials were conducted in Africa. In general, the included studies were at a low risk of bias. There may have been a risk of performance bias as trial participants were aware which intervention group they were in, but we did not consider this likely to have biased the outcome measurement. We were unable to assess the risk of reporting bias in half of the trials and two trials were at high risk of attrition bias.

Any specially formulated food versus standard care - the provision of food increased the recovery rate by 29% (RR 1.29, 95% CI 1.20 to 1.38; 2152 children, two trials; moderate quality evidence), decreased the number dropping out by 70% (RR 0.30, 95% CI 0.22 to 0.39; 1974 children, one trial; moderate quality evidence), and improved weight-for-height (MD 0.20 z-score, 95% CI 0.03 to 0.37; 1546 children, two trials; moderate quality evidence). The reduction in mortality did not reach statistical significance (RR 0.44; 95% CI 0.14 to 1.36; 1974 children, one trial; low quality evidence).

Lipid-based nutrient supplements versus any blended foods (dry food mixtures, without high lipid content), at full doses - there was no significant difference in mortality (RR 0.93, 95% CI 0.54 to 1.62; 6367 children, five trials; moderate quality evidence), progression to severe malnutrition (RR 0.88, 95% CI 0.72 to 1.07; 4537 children, three trials; high quality evidence), or the number of dropouts from the nutritional programme (RR 1.14, 95% CI 0.62 to 2.11; 5107 children, four trials; moderate quality evidence). However, lipid-based nutrient supplements significantly increased the number of children recovered (RR 1.10, 95% CI 1.04 to 1.16; 6367 children, five trials; moderate quality evidence), and decreased the number of non-recovering children (RR 0.53, 95% CI 0.40 to 0.69; 4537 children, three trials; high quality evidence). LNS also improved weight gain, weight-for-height, and mid-upper arm circumference, although for these outcomes, the improvement was modest (moderate quality evidence). One trial observed more children with vomiting in the lipid-based nutrient supplements group compared to those receiving blended food (RR 1.43, 95% CI 1.11 to 1.85; 2712 children, one trial; low quality evidence).

Foods at complementary doses - no firm conclusion could be drawn on the comparisons between LNS at complementary dose and blended foods at complementary or full dose (low quality evidence).

Lipid-based nutrient supplements versus specific types of blended foods - a recently developed enriched blended food (CSB++) resulted in similar outcomes to LNS (4758 children, three trials; moderate to high quality evidence).

Different types of blended foods - in one trial, CSB++ did not show any significant benefit over locally made blended food, for example, Misola, in number who recovered, number who died, or weight gain (moderate to high quality evidence).

Improved adequacy of home diet - no study evaluated the impact of improving adequacy of local diet, such as local foods prepared at home according to a given recipe or of home processing of local foods (soaking, germination, malting, fermentation) in order to increase their nutritional content.

Authors' conclusions
In conclusion, there is moderate to high quality evidence that both lipid-based nutrient supplements and blended foods are effective in treating children with MAM. Although lipid-based nutrient supplements (LNS) led to a clinically significant benefit in the number of children recovered in comparison with blended foods, LNS did not reduce mortality, the risk of default or progression to SAM. It also induced more vomiting. Blended foods such as CSB++ may be equally effective and cheaper than LNS. Most of the research so far has focused on industrialised foods, and on short-term outcomes of MAM. There are no studies evaluating interventions to improve the quality of the home diet, an approach that should be evaluated in settings where food is available, and nutritional education and habits are the main determinants of malnutrition. There are no studies from Asia, where moderate acute malnutrition is most prevalent.

Specially formulated foods for treating children with moderate acute malnutrition in low‐ and middle‐income countries

Este artigo discute aspectos metodologicos dos estudos de consumo alimentar em criancas e adolescentes. Para compreender esses aspectos, descreve, em contexto mais amplo, a importância da Epidemiologia Nutricional no estudo descritivo da relacao da dieta com o surgimento das enfermidades, bem como origem historica, importância, vantagens, limitacoes e usos dos metodos empregados para medir a ingestao alimentar, especialmente em criancas e adolescentes, em estudos epidemiologicos populacionais. Apresenta ainda alguns trabalhos da literatura cientifica classica e contemporânea, demonstrando os resultados obtidos e algumas sugestoes para aperfeicoamento desses metodos. Finalmente, evidencia os aspectos mais relevantes que, por consenso de varios pesquisadores, competem como fatores limitantes ou facilitadores no emprego desses metodos, conferindo a esses, maior validade e reprodutibilidade nos estudos de consumo alimentar de criancas e adolescentes.

/pdf/estudos-de-consumo-alimentar-aspectos-metodologicos-gerais-e-3oxngqb7gm.pdf

Estudos de consumo alimentar: aspectos metodológicos gerais e o seu emprego na avaliação de crianças e adolescentes

This article discusses methodological as- pects of food consumption studies in children and adolescents. To reach the understanding of these methods it provides the value of Nutritional Epidemi- ology in a general context through a descriptive study of diet relation with the manifestation of disease as well as historical origin, value, advantage, con- straints and use of methods employed to measure food intake, especially in children and adolescents in pop- ulation epidemiological studies. In addition, it pre- sents classic and contemporaneous literature demon- strating results obtained and some suggestions to im- prove these methods. Finally, it discloses the more relevant aspects that by consensus of many re- searchers compete with constraining and facilitating factors in their use providing them with more validity and reproducibility concerning studies of food con-

/pdf/estudos-de-consumo-alimentar-aspectos-metodologicos-gerais-e-11fbj2uphs.pdf

Estudos de consumo alimentar: aspectos metodológicos gerais e o seu emprego na avaliação de crianças e adolescentes Food consumption studies: general methodological aspects and its use in the evaluation of children and adolescents aged

OBJETIVO: Analizar la asociacion del sobrepeso y de la obesidad con el amamantamiento materno y la alimentacion complementaria en preescolares. METODOS: Estudio transversal envolviendo 566 ninos matriculados en escuelas privadas en el municipio de Sao Paulo (Sureste de Brasil), 2004-2005. La variable dependiente fue sobrepeso y obesidad. Para la clasificacion del estado nutricional de los ninos fueron utilizadas las curvas de percentiles del indice de masa corporal para edad, clasificando como sobrepeso valores ?P85 y <P95, y como obesidad valores ?P95. Las variables explicativas analizadas fueron: caracteristicas sociodemograficas del nino y su familia; peso al nacer; estado nutricional de los padres; amamantamiento materno; alimentacion complementaria y alimentacion actual. El analisis de asociacion de las variables explicativas con el hecho, fue realizado por medio de regresion logistica simple y regresion logistica multiple con modelo jerarquizado. RESULTADOS: La prevalencia de sobrepeso y obesidad de la poblacion estudiada fue de 34,4%. Fueron factores de proteccion contra sobrepeso y obesidad, el amamantamiento materno exclusivo por seis meses o mas (IC 95% [0,38;0,86]; OR=0,57; p=0,02) y el amamantamiento materno por mas de 24 meses (IC 95% [0,05;0,37]; OR=0,13; p=0,00). CONCLUSIONES: Los resultados sugieren que el amamantamiento materno puede proteger los ninos contra sobrepeso y la obesidad, agregando otra ventaja a la leche materna.

/pdf/amamantamiento-materno-alimentacion-complementaria-sobrepeso-1twwv7y0bk.pdf

Amamantamiento materno, alimentación complementaria, sobrepeso y obesidad en preescolares

OBJECTIVE: This study described and discussed the introduction of processed foods to the diets of children attending the nurseries of daycare centers, considering the recommendation of the Ministry of Health for a healthy diet. METHODS: This cross-sectional study included 270 children attending nurseries of eight public and not-for-profit daycare centers in Sao Paulo city. A pre-coded and structured 11-question questionnaire was used to evaluate the introduction of processed foods. For each type of food analyzed, the corresponding age in months was recorded as well as assessed as to whether it was in agreement with the 8th step of the Dietary Guide. The chi-square test was used for determining the associations. The studied variables were mother's age, education level and working status and family income. RESULTS: The results showed that approximately 2/3 of the studied children under 12 months of age were offered foods with obesogenic potential, such as instant noodles, snacks, sandwich cookies, powdered juice, soft drinks and candy/lollipop/chocolate bars. Children born to younger mothers, with low education level and lower income are most vulnerable to the feeding error of introducing processed foods prematurely. CONCLUSION: These results show that educational and preventive actions should be proposed to build healthy eating habits from childhood. Efficient and in-depth campaigns aiming at promoting the consumption of fruits and vegetables are also needed, taking into consideration the cultural, behavioral and emotional factors associated with diet.

/pdf/introducao-de-alimentos-industrializados-e-de-alimentos-de-3k9nwvmjc3.pdf

Introdução de alimentos industrializados e de alimentos de uso tradicional na dieta de crianças de creches públicas no município de São Paulo

Objective: To evaluate the body image and nutritional status (NS) of older adults aged 80 and over and its relation with quality of life (QoL). Method: A cross-sectional, quantitative study, with no intervention, using non-probabilistic sampling, was conducted from October 2016 to September 2017 with 103 older individuals aged ≥80 years old from the state of Sao Paulo. NS was evaluated according to OPAS/SABE; body image was evaluated by the Kakeshita fifteen silhouette scale, and the WHOQoL-bref and WHOQoL-old were used to measure QoL. The Chi-square test was used to verify the association between the studied variables and sex. To compare QoL with nutritional status and body image, the ANOVA Factor test was used. The level of significance was 5% (p<0.05). Results: The majority of the interviewees were female (69.2%) and the average age was 82.75 (±2.98). When comparing the perception of QoL with NS, there was a significant difference (p=0.027) in the self-evaluation of QoL of obese older adults only. The QoL related to body image of both sexes presented a significant difference (p=0.020) in the environmental domain of the WHOQoL-bref in the evaluation of body satisfaction. Conclusion: The body image distortion identified by these older adults did not interfere with their perception of QoL. However, when NS was considered, overweight older adults had a higher perception of QoL.

/pdf/body-image-nutritional-status-and-quality-of-life-in-long-2t8z49tl0z.pdf

Body image, nutritional status and quality of life in long-lived older adults

Population aging, along with the increasing incidence of chronic diseases, has contributed to a global rise in the prevalence of chronic kidney disease (CKD). The aim of this study was to perform an integrative review of proposed treatments for elderly patients with non-dialysis phase CKD. A literature search was performed of studies written from January 2002 to May 2013, registered on the MEDLINE, LILACS, SciELO and Science Direct electronic databases, using the keywords: chronic kidney disease, treatment and elderly. Complete, freely available articles were included. Initially, 215 items were identified. After the eligibility phase, 13 articles were included in this integrative review. The therapeutic interventions recommended for the management of CKD include the control of hypertension, diabetes and dyslipidemia, changes to diet, weight reduction and abstinence from smoking. In terms of treatment, for many older people with CKD, an individualized patient-centered approach may be more effective than the traditional disease-oriented strategy. Referral to a nephrologist appears to be a beneficial procedure for the management of renal disease. While there was an apparent effort by researchers to institute more effective therapeutic approaches, there was little evidence of interventions that might improve survival rates of elderly patients with CKD. However, some interventions prevent exacerbation of the disease, and delay the progression of CKD. There is therefore a need to conduct long-term randomized controlled trials of elderly patients with CKD in order to identify the most effective therapeutic procedures for the control of this disease.

/pdf/doenca-renal-cronica-e-tratamento-em-idosos-uma-revisao-2dwb4hu7b7.pdf

Doença renal crônica e tratamento em idosos: uma revisão integrativa

Introduction: Aging is a worldwide phenomenon that has favored an increase in people aged 80 years and older. Objective: To assess the influence of nutritional status (NS), measures of frailty, and physical activity level (PAL) on the quality of life (QoL) of long-lived people. Method: The study was carried out from Oct 2016 to Sept 2017 with 103 individuals aged 80 years or more. NS was classified according to the PAHO Health, Well-Being and Aging (SABE) survey; waist circumference (WC) and calf perimeter (CP) was based on the WHO classification; handgrip strength (HGS) and gait speed (GS) used the classification proposed by Lauretani; PAL was classified according to the IPAQ short form; the WHOQoL-bref and WHOQoL-old were applied to measure QOL. Variables were assessed using the Mann-Whitney U and t-tests. Results: 69.2% were women, with an average age of 82.75 (± 2.98) years, and only WC showed a significant association (p

/pdf/evaluation-of-the-influence-of-nutritional-status-measures-4psk0ba11j.pdf

Evaluation of the influence of nutritional status, measures of frailty and level of physical activity on the quality of life of long-lived individuals

Study by means of an integrated review of the literature on risk factors for cardiovascular diseases and nutritional status in aging, with the aim of characterizing the analogous research produced in the period 2007-2014 The bibliographic structured from the original articles , the electronic databases SciELO, Lilacs, PubMed, Medline, Cochrane, identified 17 scientific articles. The results show that assessment of nutritional status, followed by chronic non-communicable diseases and nutritional risk in the elderly, successful by assessing the risk of cardiovascular diseases were prevalent concern in the current issue of the aging population, which has increased the burden of chronic noncommunicable diseases communicable diseases and their risk factors.

/pdf/doencas-cardiovasculares-e-estado-nutricional-no-3nrvq56j73.pdf

Rita Maria Monteiro Goulart

Papers

Body image, nutritional status and quality of life in long-lived older adults

Doença renal crônica e tratamento em idosos: uma revisão integrativa

Evaluation of the influence of nutritional status, measures of frailty and level of physical activity on the quality of life of long-lived individuals

Doenças cardiovasculares e estado nutricional no envelhecimento: produção científica sobre o tema

A relação entre estado nutricional e presença de doenças crônicas e seu impacto na qualidade de vida de idosos: revisão integrativa