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clicando aqui - Conselho Regional de Nutricionistas
MITOS E VERDADES SOBRE
DIETAS DA MODA
RESUMO DA PALESTRA
Nutr. Ms. Bruna Pontin
Nutricionista Clínica
Profa da Universidade do Vale do Rio dos Sinos
Pesquisadora do Instituto Tecnológico em Alimentos para a Saúde itt NUTRIFOR
terça-feira, 13 de janeiro de 2015
POR QUE AINDA HÁ ESPAÇO SOBRE
DIETAS DA MODA?
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DIETAS DA MODA:
QUAIS AS EVIDÊNCIAS?
terça-feira, 13 de janeiro de 2015
Review
Meets Learning Need Codes 5000, 5110, and 5220
Advances in Celiac Disease and Gluten-Free Diet
MARY M. NIEWINSKI, MS, RD
J Am Diet Assoc. 2008;108:661-672.
and patients need comprehensive
ABSTRACT
Celiac disease is becoming an increasingly recognized
autoimmune enteropathy caused by a permanent intolerance to gluten. Once thought to be a rare disease of
childhood characterized by diarrhea, celiac disease is actually a multisystemic disorder that occurs as a result of
an immune response to ingested gluten in genetically
predisposed individuals. Screening studies have revealed
that celiac disease is most common in asymptomatic
adults in the United States. Although considerable scientific progress has been made in understanding celiac disease and in preventing or curing its manifestations, a
strict gluten-free diet is the only treatment for celiac
disease to date. Early diagnosis and treatment, together
with regular follow-up visits with a dietitian, are necessary to ensure nutritional adequacy and to prevent malnutrition while adhering to the gluten-free diet for life.
The purpose of this review is to provide clinicians with
current updated information about celiac disease, its diverse clinical presentation and increased prevalence, the
complex pathophysiology and strong genetic predisposition to celiac disease, and its diagnosis. This review focuses in detail on the gluten-free diet and the importance
from a skilled dietitian.
J Am Diet Assoc. 2008;108:661-672.
nutrition education
Recently, the quality of the gluten-free diet was challenged by Thompson, who
eliac disease is becoming an increasingly recognized
rationalized that in the general population, enriched
cereal endisorder.fortified
This diseasewheat-based
is a complex autoimmune
teropathy
causedof
by athiamin,
permanent riboflavin,
intolerance to gluproducts contribute a large percentage to the
daily
intake
ten in genetically susceptible individuals. Gluten is the
storage
protein
of wheat.
The alcohol-soluble
niacin, iron, and folic acid. Thompson main
found
that
many
gluten-free
cerealfraction (prolamin) of gluten, gliadin, is toxic in celiac disproducts contain inferior amounts of thiamin,
niacin,infolate,
and iron
ease, riboflavin,
as are similar proteins
barley (hordein)
and rye
(secalin) (1). Celiac disease is associated with maldigescompared with the enriched wheat productstionthat
are intended
to replace.
and they
malabsorption
of nutrients,
vitamins, and min-
C
erals in the gastrointestinal tract. Epidemiological studies in Europe and the United States indicate that celiac
disease is common and that the prevalence of celiac disease is approximately 1% in the general population (2-7).
Long delays between onset of symptoms and diagnosis
often occur (8), and the condition remains underdiagnosed. Currently, the only available treatment is lifelong
adherence to a gluten-free diet (4).
A recent dietary survey in the United States assessed the diets of adults with
celiac disease who were following a strict gluten-free diet. An analysis of 3-day
food records suggested inadequate intakes of fiber, iron, and calcium in ~ 50%
of females studied.
terça-feira, 13 de janeiro de 2015
CLINICAL PRESENTATION
Samuel Gee, MD, described the classical features of celiac
terça-feira, 13 de janeiro de 2015
RESEARCH
Commentary
Gluten-Free Diet: Imprudent Dietary Advice for the
General Population?
Glenn A. Gaesser, PhD; Siddhartha S. Angadi, PhD
ARTICLE INFORMATION
intolerance), is characterized by a heightened immunologic
J Am Diet Assoc. 2012;112:1330-33.
Article history:
Accepted 29 May 2012
Keywords:
reaction to gluten in genetically susceptible people.6 Clinical
diagnosis is generally based on responses to a gluten-free
diet.1 Common symptoms of gluten sensitivity, such as fatigue and headaches, and gastrointestinal distress, including
gas, bloating, and diarrhea, frequently improve with the
adoption of a gluten-free diet. The inherent subjectivity in
diagnosis and resolution of these symptoms likely contributes
to the popularity of gluten-free diets.
Celiac disease is a complex autoimmune enteropathy that
affects the small bowel after ingestion of gluten-containing
grains, including wheat, rye, and barley, in genetically susceptible people.7 Estimated prevalence of celiac disease is approximately 1%.8,9 The disease can manifest itself in a range of
clinical presentations, including malabsorption syndrome
and a spectrum of symptoms affecting multiple target organs.10 A strict gluten-free diet is an established remedy for
individuals with celiac disease because it has been shown to
lower incidence of related diseases, such as gastrointestinal
cancers.7-9,11 Lifelong adherence to a strict gluten-free diet,
devoid of proteins from wheat, rye, barley, and related cereals, remains the gold standard of treatment in celiac disease.7-9
There are some data to suggest that following a gluten-free
Apart from the demonstrated effectiveness of a glutenfree diet for treating the spectrum of gluten-related
disorders and the conditions mentioned above,
evidence-based
research
LUTEN-FREE
DIETING HAS GAINED
CONSIDERABLE supporting the merits of a
popularity in the general population.
Between
2004 and 2011 the market for gluten-free products
gluten-free diet as a healthier option for the general
grew at a compound annual growth rate of 28%,
with annual sales expected to reach approximately $2.6 billion in 2012.
As of April 20, 2012,
listed 4,765
population
isAmazon.com
lacking.
Wheat
Gluten
Gut microbiota
Fructan-type resistant starch
Copyright © 2012 by the Academy of Nutrition and Dietetics.
2212-2672/$36.00
doi: 10.1016/j.jand.2012.06.009
G
1-3
2
entries for the topic “gluten-free.” A Google search at the same
time for “gluten-free diet” produced more than 4.2 million
results. The number-one reason consumers cite for buying
gluten-free products is that they are perceived to be healthier
terça-feira, 13 de janeiro de 2015
3
Available online at www.sciencedirect.com
Journal of Nutritional Biochemistry 24 (2013) 1105 – 1111
Gluten-free diet reduces adiposity, inflammation and insulin resistance associated
with the induction of PPAR-alpha and PPAR-gamma expression☆,☆☆
Fabíola Lacerda Pires Soares a, b,⁎, Rafael de Oliveira Matoso b , Lílian Gonçalves Teixeira b , Zélia Menezes c ,
Solange Silveira Pereira a, b, Andréa Catão Alves b , Nathália Vieira Batista d , Ana Maria Caetano de Faria b ,
Denise Carmona Cara d , Adaliene Versiani Matos Ferreira e , Jacqueline Isaura Alvarez-Leite b
a
Departamento de Alimentos, Faculdade de Farmácia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
b
Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
c
Departamento de Fisiologia e Biofísica, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
d
Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
e
Departamento de Enfermagem Básica, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
Received 21 March 2012; received in revised form 20 July 2012; accepted 13 August 2012
Abstract13 de janeiro de 2015
terça-feira,
* food intake and lipid excretion were similar in both groups *
Journal of Nutritional Biochemistry 2013; 24; 1105–11.
terça-feira, 13 de janeiro de 2015
Journal of Nutritional Biochemistry 2013; 24; 1105–11.
terça-feira, 13 de janeiro de 2015
Journal of Cereal Science 58 (2013) 209e215
Contents lists available at SciVerse ScienceDirect
Journal of Cereal Science
journal homepage: www.elsevier.com/locate/jcs
Review
Does wheat make us fat and sick?q
Fred J.P.H. Brouns a, *, Vincent J. van Buul a, Peter R. Shewry b
a
Maastricht University, Faculty of Health, Medicine and Life Sciences, Department of Human Biology, Health Food Innovation Management, P.O. Box 616,
6200 MD Maastricht, The Netherlands
b
Rothamsted Research, Plant Biology and Crop Science, West Common, Harpenden, Hertfordshire AL5 2JQ, United Kingdom
a r t i c l e i n f o
a b s t r a c t
Article history:
Received 5 February 2013
Received in revised form
27 May 2013
Accepted 3 June 2013
After earlier debates on the role of fat, high fructose corn syrup, and added sugar in the aetiology of obesit
it has recently been suggested that wheat consumption is involved. Suggestions have been made th
wheat consumption has adverse effects on health by mechanisms related to addiction and overeating. W
discuss these arguments and conclude that they cannot be substantiated. Moreover, we conclude th
assigning the cause of obesity to one specific type of food or food component, rather than overconsumptio
and inactive lifestyle in general, is not correct. In fact, foods containing whole-wheat, which have bee
prepared in customary ways (such as baked or extruded), and eaten in recommended amounts, have bee
associated with significant reductions in risks for type 2 diabetes, heart disease, and a more favourable lon
term weight management. Nevertheless, individuals that have a genetic predisposition for developin
celiac disease, or who are sensitive or allergic to wheat proteins, will benefit from avoiding wheat and oth
cereals that contain proteins related to gluten, including primitive wheat species (einkorn, emmer, spel
and varieties, rye and barley. It is therefore important for these individuals that the food industry shou
develop a much wider spectrum of foods, based on crops that do not contain proteins related to glute
such as teff, amaranth, oat, quinoa, and chia. Based on the available evidence, we conclude that whol
wheat consumption cannot be linked to increased prevalence of obesity in the general population.
! 2013 The Authors. Published by Elsevier Ltd. All rights reserve
Keywords:
Whole-wheat
Risk-benefit
Gluten-free diet
Celiac disease
1. Introduction
terça-feira, 13 de janeiro de 2015
About 95% of the wheat that is grown and consumed globally
bread wheat (Triticum aestivum). Bread wheat is a relatively new
terça-feira, 13 de janeiro de 2015
Weight Changes during 2 Years According to Diet Group
terça-feira, 13 de janeiro de 2015
Metabolic Effects of Weight
Loss on a Very-Low-Carbohydrate
Diet Compared With an Isocaloric
High-Carbohydrate Diet in Abdominally Obese Subjects
Tay et al.
Metabolic Effects of VLCHF Diets
63
Jeannie Tay, BNUTRDIET (HONS),*† Grant D. Brinkworth, PHD,* Manny Noakes, PHD,*
Jennifer Keogh, MSC,* Peter M. Clifton, PHD*
Adelaide, Australia
y restricerent Objectives
bet time by
Background
uch that
Methods
ompared
ncentraquentResults
16
e HCLF
ery-lowweek 24,
Conclusions
one con.01), but
baseline,
ps (p #
J Am Coll Cardiol 2008;51:59–67.
ring
therecommendations
Current dietary
for weight management
in public interest in and use of a very-low-carbohydrate,
Figure 3 Body Weight Before and After Intervention
This study was designed to compare the effects of an energy-reduced, isocaloric very-low-carbohydrate, high-fat
(VLCHF) diet and a high-carbohydrate, low-fat (HCLF) diet on weight loss and cardiovascular disease (CVD) risk
outcomes.
Despite the popularity of the VLCHF diet, no studies have compared the chronic effects of weight loss and metabolic change to a conventional HCLF diet under isocaloric conditions.
A total of 88 abdominally obese adults were randomly assigned to either an energy-restricted (!6 to 7 MJ, 30%
deficit), planned isocaloric VLCHF or HCLF diet for 24 weeks in an outpatient clinical trial. Body weight, blood
pressure, fasting glucose, lipids, insulin, apolipoprotein B (apoB), and C-reactive protein (CRP) were measured at
weeks 0 and 24.
Weight loss was similar in both groups (VLCHF "11.9 # 6.3 kg, HCLF "10.1 # 5.7 kg; p $ 0.17). Blood pressure, CRP, fasting glucose, and insulin reduced similarly with weight loss in both diets. The VLCHF diet produced
greater decreases in triacylglycerols (VLCHF "0.64 # 0.62 mmol/l, HCLF "0.35 # 0.49 mmol/l; p $ 0.01) and
increases in high-density lipoprotein cholesterol (HDL-C) (VLCHF 0.25 # 0.28 mmol/l, HCLF 0.08 # 0.17
mmol/l; p $ 0.002). Low-density lipoprotein cholesterol (LDL-C) decreased in the HCLF diet but remained unchanged in the VLCHF diet (VLCHF 0.06 # 0.58 mmol/l, HCLF "0.46 # 0.71 mmol/l; p % 0.001). However, a
high degree of individual variability for the LDL response in the VLCHF diet was observed, with 24% of individuals reporting an increase of at least 10%. The apoB levels remained unchanged in both diet groups.
Under isocaloric conditions, VLCHF and HCLF diets result in similar weight loss. Overall, although both diets had
similar improvements for a number of metabolic risk markers, an HCLF diet had more favorable effects on the
blood lipid profile. This suggests that the potential long-term effects of the VLCHF diet for CVD risk remain a concern and that blood lipid levels should be monitored. (Long-term health effects of high and low carbohydrate,
weight loss diets in obese subjects with the metabolic syndrome; http://www.anzctr.org.au; ACTR No.
12606000203550). (J Am Coll Cardiol 2008;51:59–67) © 2008 by the American College of Cardiology
Foundation
terça-feira,
de janeiro de
2015
and
obesity13treatment
advocate
the consumption of a
high-fat (VLCHF) diet fueled by the epidemic of obesity
terça-feira, 13 de janeiro de 2015
Mean Change in Body Weight from Baseline to 2 Years According to Dietary
Macronutrient Content
PTN: 25 x 15%
LIP: 40 x 20%
HC: 65 x 35%
terça-feira, 13 de janeiro de 2015
Mean Change in Waist Circumference from Baseline to 2 Years According to
Dietary Macronutrient Content
PTN: 25 x 15%
LIP: 40 x 20%
HC: 65 x 35%
terça-feira, 13 de janeiro de 2015
may be to ings may suggest to some clinicians that drate restriction to recommend. In the
options,
to the degreeof
to which
a patient exhibits
run, however, sustained adherComparison
the Atkins,
Ornish,long
Weight
t food pref- features of the metabolic syndrome ence to a diet rather than diet type was
Watchers, and Zone Diets for Weight Loss
ascular risk
Strong association between
and
Disease
RiskinReduction
study
were Heart
adherence and clinically
Figure 3.
One-Year Changes
Body Weight as a Function of Diet Group anddiet
Dietary
significant weight loss =
dietary
as- AdherenceTrial
Level for All Study Participants
A Randomized
“sustained adherence to a
ect Michael
adherL. Dansinger, MD
Context The scarcity of data addressing the health effects of popular diets is an imdiet” rather than “following a
Assigned
Group
rovements
Joi Augustin Gleason, MS, RD
portant public health concern, especially
sinceDiet
patients
and physicians are interested
certain type of diet” is the key
in using popular
disease prevention. Ornish
Atkinsdiets as individualized
Weight for
Watchers
Zone eating strategies
John L. Griffith, PhD
articipants
to successful weight
Objective To assess adherence rates and the effectiveness of 4 popular diets (AtPP após
1 ano:
Harry P. Selker,
MD, MSPH
kins, Zone, Weight Watchers, and Ornish) for weight loss and cardiac risk factor refrom
the
4 2,1 MD
management.
a 3,3 Kg
Ernst
J. Schaefer,
duction.
Weight Change by Diet Type
Weight Change by Dietary Adherence
allenge the
15 BECOME IN- Design, Setting, and Participants A single-center randomized trial at an acaOPULAR DIETS HAVE
creasingly prevalent and con- demic medical center in Boston, Mass, of overweight or obese (body mass index: mean,
best for ev35; range, 27-42) adults aged 22 to 72 years with known hypertension, dyslipidemia,
r = –0.60, P <.001
r = 0.07, P = .40
troversial. More than 1000 diet or fasting hyperglycemia.
Participants were enrolled starting July 18, 2000, and ran10
diets can be
books are now available, with domized to 4 popular diet groups until January 24, 2002.
many popular ones departing substanA total of 160 participants were randomly assigned to either Atkins
ndings
do mainstream5 medical ad- Intervention
tially from
(carbohydrate restriction, n=40), Zone (macronutrient balance, n=40), Weight WatchCover
stories
for
major
news
vice.
ers (calorie restriction, n=40), or Ornish (fat restriction, n=40) diet groups. After 2 months
ry low
carmagazines, televised debates, and cau- of maximum effort, participants selected their own levels of dietary adherence.
0
statements by prominent
medi- Main Outcome Measures One-year changes in baseline weight and cardiac risk
thantionary
stancal authorities have fueled public in- factors, and self-selected dietary adherence rates per self-report.
enceterest
to the
and concern –5
regarding the
Results Assuming no change from baseline for participants who discontinued the study,
P
3
4,5
Absolute Change in Weight at 12 mo, kg
1
2
effectiveness and safety of such diets.6-8
Although some popular diets are
–10 medical adbased on long-standing
vice and recommend restriction of portion sizes and calories
–15 (eg, Weight
9
Watchers), a broad spectrum of alternatives has evolved. Some plans mini–20 without fat
mize carbohydrate intake
restriction (eg, Atkins diet),10 many
modulate macronutrient
and
–25 balance
11
glycemic load (eg, Zone diet), and others restrict fat (eg, Ornish diet).12 Given
13
–30
the growing obesity epidemic,
many
patients and clinicians are interested in
Atkins
using popular diets as individualized
eating strategies for disease preven34 14
tion. Unfortunately, data regarding the
relative benefits,
risks, effectiveness, and
JAMA.
2005;293:43-53.
mean (SD) weight loss at 1 year was 2.1 (4.8) kg for Atkins (21 [53%] of 40 participants
completed, P=.009), 3.2 (6.0) kg for Zone (26 [65%] of 40 completed, P=.002), 3.0
(4.9) kg for Weight Watchers (26 [65%] of 40 completed, P!.001), and 3.3 (7.3) kg for
Ornish (20 [50%] of 40 completed, P=.007). Greater effects were observed in study completers. Each diet significantly reduced the low-density lipoprotein/high-density lipoprotein (HDL) cholesterol ratio by approximately 10% (all P!.05), with no significant effects
on blood pressure or glucose at 1 year. Amount of weight loss was associated with selfreported dietary adherence level (r=0.60; P!.001) but not withAssigned
diet type (r=0.07;
P=.40).
Diet Group
For each diet, decreasing levels of total/HDL cholesterol, C-reactive protein, and insulin
Atkins
were significantly associated with weight loss (mean r=0.36, 0.37, and
0.39, respecZone
tively) with no significant difference between diets (P=.48, P=.57, P=.31,
respectively).
wing body
carbohyted fat rects on carles. Low
Conclusions Each popular diet modestly reduced body weight andWeight
several Watchers
cardiac
tently inrisk factors at 1 year. Overall dietary adherence rates were low, although
increased
Ornish
adherence
was
associated
with
greater
weight
loss
and
cardiac
risk
factor
reductions
and low–
forZone
each diet group.
Weight
Ornish
1
2
3
4
5
6
7
8
9
10
tently deJAMA. 2005;293:43-53
www.jama.com
Watchers
Mean Dietary Adherence Score Over 1 Year
Author Affiliations: Division of Endocrinology, DiaAging, Tufts University (Dr Schaefer and Ms Gleaels. Low
betes, and Metabolism (Drs Dansinger and
son), Boston, Mass.
Schaefer),
andforward
Institute for in
Clinical
Research
and
Corresponding
Author:
Michael in
L. Dansinger,
MD,
Baseline
values
were
carried
cases
of
missing
data. The
curve
the weight
change by diet type plot
cally been
Health Policy Studies (Drs Griffith and Selker), TuftsAtherosclerosis Research Laboratory, Tufts-New EnEngland Medicalfunction,
Center; and Lipid
Metabolism weighted,
gland Medical Center,
Box 216, Boston Dispensary
342, using 3 iterations to fit the
indicates the LowessNew
regression
a locally
least-squares
method
Laboratory,
Jean
Mayer
US
Department
of
Agricul750
Washington
St,
Boston,
MA
02111
(mdansinger
rm
reducFor editorial
comment
see pcurves
96.
terça-feira,
13 de janeiro
de 2015
data.
The
in tthe
plot indicate the quadratic regression functions
u r e Hweight
u m a n N u t rchange
i t i o n R e s e aby
r c h dietary
C e n t e r o n adherence
@tufts-nemc.org).
Dieta Cetogênica e Emagrecimento:
Vias Metabólicas Envolvidas
terça-feira, 13 de janeiro de 2015
Low-Carbohydrate Diets and All-Cause Mortality: A
Systematic Review and Meta-Analysis of Observational
Studies
Hiroshi Noto1,2*, Atsushi Goto1,2, Tetsuro Tsujimoto1,2, Mitsuhiko Noda1,2
1 Department of Diabetes and Metabolic Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan, 2 Department of Diabetes Research,
Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
Abstract
Objective: Low-carbohydrate diets and their combination with high-protein diets have been gaining widespread popularity
to control weight. In addition to weight loss, they may have favorable short-term effects on the risk factors of cardiovascular
disease (CVD). Our objective was to elucidate their long-term effects on mortality and CVD incidence.
Data sources: MEDLINE, EMBASE, ISI Web of Science, Cochrane Library, and ClinicalTrials.gov for relevant articles published
as of September 2012. Cohort studies of at least one year’s follow-up period were included.
Review methods: Identified articles were systematically reviewed and those with pertinent data were selected for metaanalysis. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) for all-cause mortality, CVD mortality and CVD incidence
were calculated using the random-effects model with inverse-variance weighting.
Results: We included 17 studies for a systematic review, followed by a meta-analysis using pertinent data. Of the 272,216
people in 4 cohort studies using the low-carbohydrate score, 15,981 (5.9%) cases of death from all-cause were reported. The
risk of all-cause mortality among those with high low-carbohydrate score was significantly elevated: the pooled RR (95% CI)
was 1.31 (1.07–1.59). A total of 3,214 (1.3%) cases of CVD death among 249,272 subjects in 3 cohort studies and 5,081 (2.3%)
incident CVD cases among 220,691 people in different 4 cohort studies were reported. The risks of CVD mortality and
incidence were not statistically increased: the pooled RRs (95% CIs) were 1.10 (0.98–1.24) and 0.98 (0.78–1.24), respectively.
Analyses using low-carbohydrate/high-protein score yielded similar results.
Conclusion: Low-carbohydrate diets were associated with a significantly higher risk of all-cause mortality and they were not
significantly associated with a risk of CVD mortality and incidence. However, this analysis is based on limited observational
studies and large-scale trials on the complex interactions between low-carbohydrate diets and long-term outcomes are
needed.
Citation: Noto H, Goto A, Tsujimoto T, Noda M (2013) Low-Carbohydrate Diets and All-Cause Mortality: A Systematic Review and Meta-Analysis of Observational
Studies. PLoS ONE 8(1): e55030. doi:10.1371/journal.pone.0055030
Editor: Lamberto Manzoli, University of Chieti, Italy
Received November 7, 2012; Accepted December 18, 2012; Published January 25, 2013
Copyright: ! 2013 Noto et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This study was supported by a Health Sciences Research Grant (Comprehensive Research on Diabetes/Cardiovascular and Life-Style Related Diseases
H22-019) from the Ministry of Health, Labour and Welfare of Japan. The funders had no role in study design, data collection and analysis, decision to publish, or
preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
PLoS
8(1): e55030.
* E-mail:2013;
[email protected]
terça-feira, 13 de janeiro de 2015
Figure 2. Adjusted risk ratios for all-cause mortality associated with low-carbohydrate d
carbohydrate score and (B) the low-carbohydrate/high-protein score. Boxes, estimated risk ratio
Prescrição de Dieta Detox:
Com que evidência mesmo?
Pesquisa realizada na madrugada do dia 06.11.2014
terça-feira, 13 de janeiro de 2015
E os termogênicos, hein?
terça-feira, 13 de janeiro de 2015
Termogênese
induzida pela
dieta
8%
17%
Gasto energético
com atividade
física
TMB
8%
32%
75%
Indivíduo sedentário಻
(1800 kcal/d)
60%
Indivíduo fisicamente ativo಻
(2200 kcal/d)
Am J Clin Nutr. 1984;40:995-1000.
terça-feira, 13 de janeiro de 2015
CONSELHO FEDERAL DE NUTRICIONISTAS
RESOLUÇÃO Nº 541, DE 14 DE MAIO DE 2014
Altera o Código de Ética do Nutricionista,
aprovado pela Resolução CFN nº 334, de
2004, e dá outras providências.
O Presidente do Conselho Federal de Nutricionistas (CFN),
no uso das atribuições que lhe são conferidas pela Lei n° 6.583, de 20
de outubro de 1978, regulamentada pelo Decreto n° 84.444, de 30 de
janeiro de 1980, e no Regimento Interno aprovado pela Resolução
6o.de(...)
VIdezembro
- analisar
CFN "Art.
nº 320,
2 de
de 2003, ouvidos os Conselhos
Regionais de Nutricionistas (CRN), e, tendo em vista o que foi
com rigor
deliberado
na 262ªtécnico-científico
Reunião Plenária, Ordinária, do CFN, esta realizadaqualquer
nos dias 22,
23 de
e 24prática
de fevereiro
tipo
ou de 2014, resolve:
Art. 1º. Os artigos 6°, 7°, 15, 16, 19 e 21 do Código de Ética
pesquisa, adotando-a
do Nutricionista,
aprovado pela Resolução CFN nº 334, de 10 de
maio de 2004, passam a vigorar com as seguintes redações: "Art. 6º.
houver
(...) Isomente
- realizar, quando
unicamente
em consulta presencial, a avaliação e o
diagnóstico
e a respectiva
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ournal of the American College of Cardiology
! 2014 The Expert Panel Members
Published by Elsevier Inc.
http://dx.doi.org/10
2013 AHA/ACC/TOS Guideline for the
q
Management of Overweight and Obesity in Adults
A Report of the American College of Cardiology/American Heart Association
Task Force on Practice Guidelines and The Obesity Society
Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation,
American Pharmacists Association, American Society for Nutrition, American Society for Parente
and Enteral Nutrition, American Society for Preventive Cardiology, American Society of Hypert
!"#$%&#'()*#$+(,,-./$01$'23(4501"#6$07$8".##$92(.7-51$07$:(5/;$<=>[email protected]$
Association of Black Cardiologists, National Lipid Association, Preventive Cardiovascular
!"#$%&'()*%+,-./012)/23)&4#)51-+2/.)16)&4#)78#+%,/2)*1..#9#)16)*/+3%1.19')
Nurses Association, The Endocrine Society, and
WomenHeart: The National Coalition for Women With Heart Disease
Expert Panel
Members
terça-feira, 13 de janeiro de 2015
Michael D. Jensen, MD, Co-Chair
Donna H. Ryan, MD, Co-Chair
Catherine M. Loria, PHD, FAH
Barbara E. Millen, DRPH, RD
Cathy A. Nonas, MS, RD
Matching Treatment Benefits With Risk Profiles (Reduction in Body Weight Effect on Risk Factors for CVD, Events, Morbidity and Mortality)
2. Counsel overweight and obese adults with cardiovascular risk factors (high BP,
hyperlipidemia, and hyperglycemia) that lifestyle changes that produce even modest,
sustained weight loss of 3%–5% produce clinically meaningful health benefits, and
greater weight losses produce greater benefits.
a. Sustained weight loss of 3%–5% is likely to result in clinically meaningful
reductions in triglycerides, blood glucose, hemoglobin A1c, and the risk of
developing type 2 diabetes;
b. Greater amounts of weight loss will reduce BP, improve LDL–C and HDL–C, and
reduce the need for medications to control BP, blood glucose, and lipids as well
as further reduce triglycerides and blood glucose.
Diets for Weight Loss (Dietary Strategies for Weight Loss)
3a. Prescribe a diet to achieve reduced calorie intake for obese or overweight individuals
who would benefit from weight loss, as part of a comprehensive lifestyle intervention.
Any one of the following methods can be used to reduce food and calorie intake:
a. Prescribe 1,200–1,500 kcal/d for women and 1,500–1,800 kcal/d for men
(kilocalorie levels are usually adjusted for the individual’s body weight);
b. Prescribe a 500-kcal/d or 750-kcal/d energy deficit; or
c. Prescribe one of the evidence-based diets that restricts certain food types (such
as high-carbohydrate foods, low-fiber foods, or high-fat foods) in order to create
an energy deficit by reduced food intake.
3b. Prescribe a calorie-restricted diet, for obese and overweight individuals who would
benefit from weight loss, based on the patient’s preferences and health status, and
preferably refer to a nutrition professional* for counseling. A variety of dietary
approaches can produce weight loss in overweight and obese adults, as presented in
CQ3, ES2.
A (Strong)
CQ1
I
A
A (Strong)
CQ3
I
A
A (Strong)
CQ3
I
A
Continued on the next page
overweight and obese patients. The CQs answered by
evidence-based recommendations summarize current
literature on the risks of overweight and obesity and the
benefits of weight loss. They also summarize knowledge on
the best diets for weight loss, the efficacy and effectiveness
of comprehensive lifestyle interventions on weight loss and
weight loss maintenance, and the benefits and risks of
terça-feira,
de janeiro deThis
2015 information will help PCPs decide
bariatric13surgery.
2.2. Chronic Disease Management Model for
Primary Care of Patients With Overweight and
ObesitydTreatment Algorithm
The Expert Panel provides a treatment algorithm,
Chronic Disease Management Model for Primary Care
of Patients With Overweight and Obesity (Figure), to
guide PCPs in the evaluation, prevention, and manage-
Obrigada!
Fonte da figura: https://www.facebook.com/NutricaoSemModismo?fref=ts
terça-feira, 13 de janeiro de 2015

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