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R
ibas
DF
et
al
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714
R
ev
A
ssoc
M
ed
B
ras
2016; 62(8):711-717
Recommendation
There is an absence of good quality evidence to show that
dietary guidance combined with physical activity, with
the interventions conducted in a domestic environment,
prevent obesity in the population aged 2 to 18 years.
Likewise, a calcium-rich diet in girls aged 9 years for 104
weeks did no present any benefit on weight, fat mass or
physical activity.
For children aged 6 to 24 months with anemia, month-
ly meetings with an explanation of micronutrients, and
guidance on preparations and recipes are recommended,
as well as, in severe cases, 6 months of iron- and zinc-en-
riched dietary supplementation, with one sachet to be
mixed with meals.
The home-based treatment with energy, protein, and
micronutrient dense paste is effective in situations where
malnutrition is chronic, especially in impoverished locations.
E
lderly
Malnourished frail elderly individuals were selected for
the study; they were willing to improve their health status
and receive home-based strength training and nutritional
counseling. The participants were visited by friends who
volunteered (≥ 50 years) twice per week, for 1 hour over 6
months. The control group only received visits at baseline
and after the 10
th
week, receiving guidance on nutrition
and physical activity until completing 3 months of the
study. The intervention group received the visits with
guidance on nutrition and physical activity. Nutritional
guidance (NG) covered the intake of fluids, the intake of
animal and vegetable protein, and energy intake through
simple booklets, ideas on how to enrich foods with protein,
recipes for high-protein and high-energy meals, a repre-
sentation of the variety of foods, and a food card showing
portion sizes. A game was used for the elderly people to
show the amount of food eaten the previous day. Moti-
vational interview techniques were also used, including
a section for setting individual targets and tools to enhance
self-efficacy.
10
(
B
)
All of the participants (> 65 years) residing in a nurs-
ing home were interviewed using the Mini Nutritional
Assessment (MNA) to evaluate their nutritional status
and other personal information. Anthropometric mea-
surements [height, weight, MAC and calf circumference
(CC) were also measured as indicators (baseline up to the
end of the fourth week of intervention], as well as labora-
tory tests for Hb, serum albumin and cholesterol. The
supplementation was 50 g/day of a soy protein preparation
providing approximately 9.5 g of protein, 250 kcal and
all essential micronutrients. The supplement was prepared
as a “hot drink’’ and served as part of an afternoon snack
for the intervention group (n=39). Supplementation was
suspended if the MNA score was > 24 or BMI > 24 kg/m
2
in the next measurement (every 4 weeks). The participants
in the control group (n=43) and those who were assigned
to the intervention group, but were not in the condition
stated above, received routine care and normal meals,
including an afternoon snack (usually hot soup). Thirty
of the 39 patients in the intervention group met the cri-
teria to receive the supplement at the start of the study.
Seventeen (17) remained on the supplement until the end
of the study, eight became eligible after the first 4 weeks,
five were well enough to not receive any supplement dur-
ing the entire 24 week period, while 13 progressed to the
point of removing the supplement between the 1
st
and
4
th
week. The intervention showed significant improve-
ment (or minimized the loss) of weight (12
th
week:
-0.19±1.40 kg; 24
th
week: 0.12±2.62 kg), BMI, MAC (12
th
week: 0.08±0.81 cm; 24
th
week: 0.17±1.02 cm), CC
(0.28±0.85 cm; 0.43±1.44 cm), albumin serum levels
(0.14±0.29 g/dL; 0.14±0.34 g/dL), and cholesterol con-
centration (2.12±20.3 mg/dL; 5.47±25.3 mg/dL), all with
p<0.05. In the control group, there was a decrease in these
indicators (p<0.05). The effect of the intervention strati-
fied in accordance with the initial nutritional status using
MNA as a risk of malnutrition (score between 17 and 23.5)
demonstrated an improvement of the same indicators
(weight: -0.11±1.47 kg, 0.01±2.96 kg; MAC: 0.25±0.81 cm,
0.36±1.04 cm; CC: 0.27±0.85 cm, 0.58±1.36 cm; albumin:
0.14±0.30 g/dL, 0.13±0.38 g/dL; cholesterol: 3.15±23.0
mg/dL, 9.20±26.1 mg/dL, 12
th
and 24
th
weeks, respec-
tively) (p<0.05), with no significant result for malnourished
participants (score < 16.5). Similar results were obtained
in other studies.
11,12
(
B
)
In a nursing home, residents with malnutrition or at
risk of malnutrition (MNA < 24 and BMI ≤ 22kg/m
2
, with
perceived low appetite, and/or ≥ 5% weight loss within 3
months or ≥ 10% in 6 months) were selected, with one
intervention group (IG) and one control group (CG). The
intervention group received two bottles of nutritional
supplement (125 mL/bottle containing 2.4 kcal/mL, 12
g of protein and 300 kcal/bottle) per day between meals,
in order to prevent a satiety effect on normal food intake,
over 12 weeks. The nursing home staff was instructed to
encourage residents to consume the amount offered, sup-
port the consumption of varied flavors, and provide
smaller portions more often. The control group received
the usual care, which included the provision of homemade
snacks or nutritional supplement when prescribed by the
physician or provided by family members. Visits were