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AbstractIntroduction:According to the World Health Organization obesity it's the result of an abnormal or excessive body fat accumulation, which presents a high risk for the health. Bariatric surgery appears as an alternative to the conventional treatment for the morbid obese individuals. However, this type of intervention causes changes in the anatomy and physiology of the gastrointestinal tract, which may lead to the development of nutritional deficiencies in patients, in particular anemia.Aim:To evaluate micronutrient deficiencies in patients submitted to bariatric surgery in preoperative and postoperative periods, in particular iron, ferritin, and B12 vitamin.Methods:In this longitudinal study, we evaluated, retrospectively and prospectively, patients who attended the nutrition appointment at a central hospital. We completed a preexisting database containing anthropometric and biochemical data, adding biochemical data, at various periods: pre at 6th, 12th, 18th, 24th, 30th and 36th months post-surgery.Results:from the 121 patients submitted to bariatric surgery, 79,3% were female. The prevalence or iron deficiency reached 15%, ferritin deficiency reached almost 10% and B12 vitamin deficiency reached 18%. Furthermore there were deficiencies in other nutrients, e.g., vitamin D, magnesium and zinc. There was more than 85% adhesion to take the multivitamin supplementation and frequent use of specific supplementation.Conclusion:The prevalence of nutritional deficiencies is high, with a tendency to persist over time even with use of multivitamin supplementation, leading to the need for complementary supplementation, in particular to prevent the risk of anemia. Hence, periodic and long term monitoring is fundamental.

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AbstractEating behaviour refers to quantitative and qualitative features of the selection and decision on the foods to be consumed. Knowledge on determinants of eating behaviour increases the success of actions and interventions aiming to promote healthy eating habits and to prevent diseases. Several constructs facilitate the comprehension of health-related changes, among which the Locus of Control (LoC) and Stages of Change (SoC). Our aim was to study the relationships between several dimensions of eating behaviour with the health LoC and SoC towards healthy eating among Portuguese higher education students. Data from 267 higher education students (63.7% females) aged 18 to 27 years were assessed regarding health LoC (Health Locus of Control Scale; Ribeiro, 1994), SoC towards healthy eating (question and items from Kearney et al. (1999), adapted to refer specifically to the adoption of healthy eating) and eating behaviour. Emotional and external eating were measured using the Dutch Eating Behavior Questionnaire, flexible and rigid control of eating behaviour was measured with the Portuguese version of the subscales proposed by Westenhoefer et al. (1999), the Portuguese version of the Binge Eating Scale was used to assess binge eating severity, and eating self-efficacy was measured using the General Eating Self-Efficacy Scale. BMI was calculated using self-reported weight and height. No significant associations were found between BMI and health LoC. In the female subsample, i-LoC assessed through the factor “locus of control” was negatively associated with binge eating and positively with eating self-efficacy. However, we also found a negative association between eating self-efficacy and i-LoC assessed by the factor “other powerful”. Among men, none of the eating behaviour dimensions presented an association with health LoC. Regarding SoC, participants in the maintenance stage presented lower external eating and binge eating (both sexes), lower emotional eating and higher eating self-efficacy (women) and dietary restraint (higher rigid control among men but higher flexible control among women), when compared to those in the pre-contemplation/ contemplation stages. Our results suggest that SoC and LoC may be useful to achieve deeper knowledge on eating behaviour. Their assessement may also help designing early and sex-directed (namely regarding the different types of dietary restraint) programs and interventions focusing eating behaviour.

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AbstractIntroductionIrritable Bowel Syndrome (IBS) is a functional and multifactorial gastrointestinal disorder characterized by pain, abdominal distention and motility changes, currently diagnosed based on the Rome IV criteria. The efficacy of classic pharmacological, psychological and dietary treatments for this condition are generally low. The Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAP) are short chain carbohydrates poorly absorbed at the intestinal level, fermentable by the microbiota and presumably involved in IBS-associated symptomatology.AimsTo evaluate the efficacy, feasibility and acceptability of a FODMAP-restricted feeding approach in the relief of symptomatology and in the improvement of the quality of life of patients with IBS, determining the reintroduction of the FODMAP food subgroup(s) involved in the symptom exacerbation.Materials and MethodsAfter assessing the existence of initial emotional disorders through the Hospital Anxiety and Depression Scale (HADS) and eating habits, through dietary history, patients diagnosed with IBS were put on a FODMAP-restricted diet for 6 weeks. During this period, the weekly evolution of symptom frequency was assessed. At the end, tests were undertaken to discover the global evolution of the symptoms through the Irritable Bowel Syndrome - Global Assessment Scale (IBS-GAI), the severity of symptomatology through the Irritable Bowel Syndrome - Severity Scoring System (IBS-SSS) and quality of life through Irritable Bowel Syndrome - Quality of Life (IBS-QoL).Subsequently, participants tested their tolerance to various FODMAP subtypes with weekly and isolated reintroduction of these in their diet.ResultsIn the 36 participants, with a mean age of 38.8 years, there was a reduction in the total consumption of FODMAP from 22.1 g to 2.1 g (p < 0.001). A moderate or substantial improvement in the IBS-GAI was observed in 88.9%. An average reduction of 235 points in the IBS-SSS (p < 0.001) and a mean increase of 28.7 in the IBS-QoL (p < 0.001) was achieved. The initial anxiety and depression levels were not associated with IBS-SSS and presented an inverse association with the IBS-QoL. There was significant improvement in all symptomatology during the 1st week of total FODMAP restriction, except for constipation with an amelioration observed at the 6st week. There was a frequency of intolerance ranging from 30.8% for fructans to 80.8% for lactose with the reintroduction of the FODMAP subtypes.ConclusionA FODMAP-restricted diet, implemented over a period of 6 weeks, is effective in reducing the severity and frequency of GI symptoms and improving the quality of life of portuguese patients with IBS.

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Introduction: Disease-related undernutrition is highly prevalent and requires timely intervention. However, identifying undernutrition often relies on physician judgment. As Internal Medicine wards are the backbone of the hospital setting, insight into the prevalence of nutritional risk in this population is essential. We aimed to determine the prevalence of nutritional risk in Internal Medicine wards, to identify its correlates, and to assess the agreement between the physicians' impression of nutritional risk and evaluation by Nutritional Risk Screening 2002. Material and Methods: A cross-sectional multicentre study was performed in Internal Medicine wards of 24 Portuguese hospitals during 2017. Data on demographics, previous hospital admissions, primary diagnosis, and Charlson comorbidity index score were collected. Nutritional risk at admission was assessed using Nutritional Risk Screening 2002. Agreement between physicians' impression of nutritional risk and Nutritional Risk Screening 2002 was tested by Cohen's kappa. Results: The study included 729 participants (mean age 74 +/- 14.6 years, 51% male). The main reason for admission was respiratory disease. Mean Charlson comorbidity index score was 5.8 +/- 2.8. Prevalence of nutritional risk was 51%. Nutritional risk was associated with admission during the previous year (odds ratio = 1.65, 95% confidence interval: 1.22 - 2.24), solid tumour with metastasis (odds ratio = 4.73, 95% confidence interval: 2.06 - 10.87), any tumour without metastasis (odds ratio = 2.04, 95% confidence interval:1.24 - 3.34), kidney disease (odds ratio = 1.83, 95% confidence interval: 1.21 - 2.75), peptic ulcer (odds ratio = 2.17, 95% confidence interval: 1.10 - 4.25), heart failure (odds ratio = 1.51, 95% confidence interval: 1.11 - 2.04), dementia (odds ratio = 3.02, 95% confidence interval: 1.96 - 4.64), and cerebrovascular disease (odds ratio = 1.62, 95% confidence interval: 1.12 - 2.35). Agreement between physicians' evaluation of nutritional status and Nutritional Risk Screening 2002 was weak (Cohen's kappa = 0.415, p < 0.001). Discussion: Prevalence of nutritional risk in the Internal Medicine population is very high. Admission during the previous year and multiple comorbidities increase the odds of being at-risk. Subjective physician evaluation is not appropriate for nutritional screening. Conclusion: The high prevalence of at-risk patients and poor subjective physician evaluation suggest the need to implement mandatory nutritional screening.

Abstract
In this paper we propose and analyze a game theoretical model regarding the dynamical interaction between government fiscal policy choices toward innovation and training (I&T), firm's innovation, and worker's levels of training and education. We discuss four economic scenarios corresponding to strict pure Nash equilibria: the government and I&T poverty trap, the I&T poverty trap, the I&T high premium niche, and the I&T ideal growth. The main novelty of this model is to consider the government as one of the three interacting players in the game that also allow us to analyse the I&T mixed economic scenarios with a unique strictly mixed Nash equilibrium and with I&T evolutionary dynamical cycles.