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Each individual is unique, with genetic factors that interact with a particular environment. Therefore, the daily energy requirements should be calculated individually and have to consider the several factors which influence them: basal metabolic rate, diet-induced thermogenesis, physical activity, specific diseases, among other factors. Food provides macronutrients: carbohydrates, proteins and lipids, as well as micronutrients: vitamins, minerals and oligoelements, which should be eaten daily in the recommended amounts during the life cycle, e.g. pregnancy, childhood, adolescence, adulthood and aging. Health professionals can use the "Roda dos Alimentos Portuguesa" to teach and guide the population on how to eat, whether they are healthy or ill individuals, in order to meet their nutritional needs. Through this tool it is possible for everyone to understand and to practice a diet that is: 1) complete (eating foods from all groups), 2) balanced (to respect the proportions of each food group, adjusting the recommended portions/amounts for each individual), and 3) diversified (to choose different foods within each group). Some studies show that food marketing and advertising influence the consumers' choices since childhood. There is already some Regulation in this field, especially about nutrition and health claims. However, a permanent supervision of food marketing is necessary, to ensure compliance with the European Regulation from EFSA. It is crucial to teach and to encourage people to carefully read the food labels before purchasing. Health professionals should also be aware, academically and professionally, about the basics principles of Food and Health Promotion. The unique and essential role of the Professionals of Nutrition needs to be valued and recognized, and these professionals have to be integrated in sufficient number, in the multidisciplinary teams of the National Health Service, whether in Hospitals or Health Care Centers for the ambulatory population. These are the interventions and attitudes that make a difference and that are actually effective in preventing and/or treating many chronic diseases. Hence it is possible to improve health and quality of health services provided to the population (public health scope) and that of patients (clinical practice scope) as well as to optimize costs in health.

Background & Aims: Adequate dietary intake might prevent cognitive decline among ageing subjects; hence, the relationships between dietary intake and cognitive function in a sample of non-institutionalized active elderly were assessed., Methods: Total 187 subjects aged over 65. Dietary intake was assessed using a three-day record and cognitive function using the mini-mental state examination (MMSE). After 8.5+/-3.5 months of follow-up, cognitive function was re-assessed in 110 subjects., Results: A considerable portion of the subjects presented a low intake of several key nutrients. At baseline, no differences were found between subjects with normal or low MMSE score regarding all dietary parameters. At follow-up, 63 subjects (57%) showed a mild improvement of their MMSE score; their consumption of calcium and of n-3 fatty acids was higher (p<0.01 and p<0.03, respectively) than subjects without improvement. Similarly, multivariate logistic regression showed subjects whose consumption of calcium was above the dietary reference intake had a significantly higher odds ratio (OR) of improving their MMSE (OR=5.41; 95% CI: 1.44-20.29), whereas no effect was found for n-3 fatty acids (OR=2.48; 95% CI: 0.46-13.36)., Conclusion: Increased calcium consumption is related to improved cognitive function; the exact effect of n-3 fatty acids intake remains to be assessed.

Objective: Non-alcoholic fatty liver disease is a common condition that can progress to endstage liver disease. The steatotic liver seems to be particularly susceptible to oxidative stress damage. The aim of this study was to evaluate the redox state in patients with non-alcoholic steatohepatitis (NASH) and its correlation with dietary intake., Material and Methods: Plasma concentrations of 4-hydroxynonenal (4-HNE), 8-hydroxydeoxyguanosine (8-OHdG), reduced and oxidized glutathione (GSH and GSSG), vitamins A and E, total antioxidant status (TAS), glutathione peroxidase (GSH-Px) and reductase (GSH-Red) erythrocyte activities were compared between 43 NASH patients and 33 healthy controls. 4-HNE, GSH-Px, GSH-Red and TAS were evaluated by spectrophotometry, 8-OHdG by ELISA assay, GSH and GSSG by fluorimetric assay and vitamins A and E by high performance liquid chromatography. Dietary habits were also evaluated in these patients., Results: GSH levels (21.1 +/- 18.3 versus 33.1 +/- 22.2 microM, p = 0.01) and GSH/GSSG ratio (0.9 +/- 0.7 versus 1.5 +/- 0.8, p = 0.01) were lower and TAS (832 +/- 146 versus 630 +/-140 microM, p < 0.001) and vitamin E (47.1 +/- 14.9 versus 34.5 +/- 7.3 microM, p < 0.001) were higher in NASH patients, although there was no difference in GSH-Px and GSH-Red activities, 8-OHdG and 4-HNE levels between groups. After adjusting for total energy consumption, a negative correlation was found with total and saturated fat intake and GSH/GSSG ratio, and a positive correlation with carbohydrates, fiber, monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), specifically N-3 PUFA, and vitamins E, C, selenium and folate., Conclusions: Our data suggest an impaired glutathione metabolism towards an oxidant status in NASH patients, correlating with a higher intake of saturated fat and a lower intake of carbohydrates. Plasmatic concentrations of oxidative stress cellular markers did not translate to hepatic oxidative damage.

Objective: To assess trends of food intake in Portugal., Design: Analysis of three cross-sectional studies: 1987, 1995-1996 and 1998-1999., Setting: Representative samples of free-living individuals., Subjects: 64 734 men and 71 282 women., Interventions: Food intake was assessed by questionnaires inquiring the number of meals and which foodstuffs (fish, meat, milk, rice/pasta/potatoes, soup, vegetables and fruit) had been consumed the day before., Results: Age-adjusted average number of meals decreased from 3.3+/-0.1 in 1987 to 2.9+/-0.1 in 1998-1999 in both genders (P<0.001). In men, the percentage of subjects consuming meat, milk and potatoes/rice/pasta increased from 73, 66 and 91% in 1987 to 83, 74 and 95% in 1998-1999, respectively. The percentage of subjects consuming soup and fish decreased from 70 and 56% in 1987 to 62 and 53% in 1998-1999, respectively. In women, the percentage of subjects consuming meat, milk, potatoes/rice/pasta and vegetable increased from 70, 66, 89 and 71% in 1987 to 78, 77, 93 and 83% in 1998-1999, respectively. The percentage of subjects consuming soup and fish decreased from 70 and 55% in 1987 to 64 and 53% in 1998-1999, respectively. These trends were more pronounced in the younger age, which also displayed a higher frequency of snacking. Multivariate analysis adjusting for age group, region and educational level showed that the consumption of meat, milk and vegetables increased and the consumption of soup, fish and fruit decreased in 1998-1999 relative to 1995-1996., Conclusions: Within a decade, the Portuguese dietary pattern has changed considerably, shifting from a traditional, south European to a more Westernized, protein-rich diet., Sponsorship: The Unidade de Nutrição e Metabolismo of the Instituto de Medicina Molecular is partially funded by a grant from the FCT (Fundação para a Ciência e a Tecnologia) ref. RUN 437.

Background/aims: This study aimed at evaluating whether patients with non-alcoholic steatohepatitis (NASH) had a specific dietary pattern and how it compared with data representative from the same geographical region individuals., Subjects and Methods: Clinical, biochemical and anthropometrics: weight, height, body mass index (BMI) and waist circumference were collected in 45 NASH patients. Diet history was assessed using a validated semi-quantitative food frequency questionnaire, analysed with the Food Processor Plus, and was compared, after adjustment for BMI, with data from a sample of 856 free-living individuals, frequency matched for sex and age., Results: Patients' mean age was 49.6+/-10.6 years, 26 F: 19 M, BMI: 31.2+/-5.0 kg/m2. Comparison of their diet history with control data (C) revealed that carbohydrate consumption was lower in patients (P): P-243.6+/-5.7 g vs. C-261.5+/-1.6 g, P<0.05, and most patients had very low fibre intake. Conversely, total fat consumption was higher in patients: P-79.7+/-1.7 g vs. 73.0+/-0.4, P<0.01. A significantly higher intake of n-6 fatty acids (P=0.003) and n-6/n-3 ratio was found in patients, P<0.001., Conclusions: Our results suggest that the quality and combination of carbohydrates and fat intake may be more relevant than their isolated amount; an increased fat intake with an excessive amount of n-6 fatty acids can be implicated in promoting necro-inflammation, and provides further grounds for individualized dietary therapy.

Background: Food and nutrition as major causes of colorectal cancer (CRC) are still debatable., Aim of the Study: This cross-sectional study in a Portuguese population aimed to characterize and identify "high-risk" diets/life-styles and explore their associations with colorectal cancer., Methods: In 70 colorectal cancer patients and 70 sex, age-matched subjects without cancer history, we evaluated: diet history and detailed nutrient intake (DIET-PLAN5 2002, UK), alcohol (amount, type, years), smoking (number packages/year, years), physical activity, co-morbidities and body mass index. Age-adjusted Relative Risks were calculated, Proportional Hazards models adjusted the analysis for multiple risk factors., Results: Smoking was a risk factor (1.90). Increased colorectal cancer risk regarding the lowest vs the highest intake quartile emerged for: vitamin B12 (3.41), cholesterol (3.15), total fat (2.87), saturated fat (1.98), animal protein (1.95), energy (1.85), alcohol (1.70), iron (1.49), refined carbohydrates (1.39). Reduced colorectal cancer risk for the highest vs the lowest intake quartile was found for: n-3 fatty acids (0.10), insoluble fiber/folate (0.15), flavonoids/vitamin E (0.25), isoflavones/beta-carotene (0.30), selenium (0.36), copper (0.41), vitamin B6 (0.46)., Conclusion: Our results corroborated well-established risk factors and identified emergent nutrients. Prolonged excessive intake of macronutrients and some micronutrients concurrent with marked deficits of fiber and protective compounds were dominant in colorectal cancer and more significant than alcohol and smoking. The interaction diet-colorectal cancer is consistent and the relevance of new nutrients is emerging.

Purpose: To investigate the impact of dietary counseling or nutritional supplements on outcomes in cancer patients: nutritional, morbidity, and quality of life (QoL) during and 3 months after radiotherapy., Patients and Methods: A total of 111 colorectal cancer outpatients referred for radiotherapy, stratified by staging, were randomly assigned: group 1 (G1; n = 37), dietary counseling (regular foods); group 2 (G2; n = 37), protein supplements; and group 3 (G3; n = 37), ad libitum intake. Nutritional intake (diet history), status (Ottery's Subjective Global Assessment), and QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0) were evaluated at baseline, at the end, and 3 months after radiotherapy., Results: At radiotherapy completion, energy intake increased in G1/G2 (P < or = .04), G1 more than G2 (P = .001), and decreased in G3 (P < .01). Protein intake increased in G1/G2 (P < or = .007), G1 less than G2 (not significant), and decreased in G3 (P < .01). At 3 months, G1 maintained nutritional intake and G2/G3 returned to baseline. After radiotherapy and at 3 months, rates of anorexia, nausea, vomiting, and diarrhea were higher in G3 (P < .05). At radiotherapy completion, in G1 all QoL function scores improved proportionally to adequate intake or nutritional status (P < .05); whereas in G2 only three of six function scores improved proportionally to protein intake (P = .04), and in G3 all scores worsened (P < .05). At 3 months, G1 patients maintained/improved function, symptoms, and single-item scores (P < .02); in G2, only few function and symptom scales improved (P < .05); in G3, QoL remained as poor as after radiotherapy. In G1/G2, respectively, improvement/deterioration of QoL correlated with better or poorer intake or nutritional status (P < .003)., Conclusion: During radiotherapy, both interventions positively influenced outcomes; dietary counseling was of similar or higher benefit, whereas even 3 months after RT, it was the only method to sustain a significant impact on patient outcomes.

Aims: Under-nutrition is a major source of morbidity and mortality in cancer patients. This prospective, cross-sectional study aimed to evaluate the relative contributions of cancer staging, duration and diet on patients' nutritional deterioration., Materials and Methods: We included 205 consecutive patients (133 men and 72 women) with head and neck, gastro-oesophageal, colon and rectum cancer, age 53 +/- 12 (33-86) years, referred for radiotherapy (primary, adjunctive to surgery, combined with chemotherapy or with palliative intent). We registered clinical variables, nutritional status (percentage of weight loss, Patient-Generated Subjective Global Assessment and body mass index), nutritional requirements, usual diet intake (diet history) and current intake (24-h recall)., Results: In stage III and IV, we observed a significant decrease of usual and current energy and protein intake (P=0.002), which were not observed in stage I and II. Reduction in nutritional intake was influenced by disease duration (P=0.04), but when the latter was evaluated in a multivariate analysis, current dietary intake was associated only with staging (P=0.004), thus disclosing a distinct pattern of nutritional intake between stages and diagnosis. Using a general linear model, advanced staging showed the most significant association with nutritional depletion (P=0.0001). We also found significant associations for tumour location (P=0.001), disease duration (P=0.002), nutritional intake (P=0.003) and previous surgery or chemotherapy (P=0.02). Percentage weight loss showed a consistently superior performance with regard to clinical variables and ability to detect mild to extreme nutritional changes. Patient-Generated Subjective Global Assessment had a very high sensitivity and specificity, and a strong capacity for detecting patients at nutritional risk compared with body mass index., Conclusions: Nutritional depletion is multifactorial, dependent mainly on the tumour burden of the host. Percentage weight loss is a sensitive and specific tool that can screen and identify malnutrition effectively. Its joint use with Patient-Generated Subjective Global Assessment, which establishes boundaries for nutritional therapy, will optimise the efficacy of nutritional assessment and support in cancer patients.

Objectives: Relationships of nutritional status with ethanol consumption and diet were studied in 33 chronic alcoholics with no clinical or laboratory evidence of liver disease., Methods: Nutritional assessment included subjective global assessment, weight-height index, body mass index, and serum albumin measurements. Dietary intake included estimates of daily intake of substrates, folic acid, vitamins B1, B5, B6, and B12. Circulating concentrations of folate, pyridoxal-phosphate and vitamin B12 were evaluated as well., Results: Only 18.1% of patients were considered malnourished, with body mass indices lower than those with an average or good nutritional status (p < 0.0001). Body weight was under 90% of the ideal in 8/33 (24%) patients. Serum albumin values were within normal range in all patients. In terms of calories provided by nonalcoholic substrates, protein, or vitamin intake, we observed no differences between well and poorly nourished individuals. However, malnourished alcoholics consumed significantly more ethanol (p = 0.01) and an inverse correlation was found between ethanol intake and weight-height index (r = -0.35; p = 0.03). Low circulating concentrations of pyridoxal-phosphate and red blood cell folate were found in 51.5% and 60.6% of alcoholics, respectively. These were not correlated with vitamin dietary intake or ethanol consumption, but there was a trend toward malnourished patients to present lower concentrations of red blood cell folate (p = 0.13)., Conclusions: Although over malnutrition is infrequent in this group of chronic alcoholics, specific vitamin deficiencies are present in a substantial proportion of patients and are more likely related to alcohol consumption.