Abstract
AbstractNear 20% of the Portuguese population is aged 65 years or above, a value similar to most developed countries. This older adult population also suffers from obesity and obesity-related pathologies. The environment encompasses a set of obesity determinants and knowing the associations between the environment and obesity may help health professionals and caregivers to provide for the older adults.In this study, we aimed to relate anthropometric measures with socio-demographic data in older adults.This is a cross-sectional study using data from the Pronutrisenior project, collected in Vila Nova de Gaia, Portugal. The sample consists of 456 older adults, aged 65 to 92 years without cognitive impairment. The sample consisted of older adults living at their homes. Socio-demographic, clinical, geographical, and anthropometric data was collected. The statistical analysis used IBM-SPSS-22.0 and consisted on descriptive statistics, Pearson correlations and UniANOVA. Significantly results (p < 0.05) are reported.These older adults were mostly females (54.2%) with a mean age of 73.8 years (sd = 6.3), mean body mass index (BMI) of 29.1kg/m2 (sd = 4.8), mean waist-to-height ratio (WHtR) of 0.623 (sd = 0.073) and mean percentage of body fat mass (%BFM) of 40.7% (sd = 8.9%) for females and 30.2% (sd = 8.5%) for males. BMI, WHtR and %BFM were positively correlated. In this sample of older adults, higher values of these measures were associated to being female, younger, less educated; to having articular pains and respiratory problems, and not having insomnia, hypertension, chewing problems nor hearing problems; to drink more liquids but not consuming dairy products daily; to not take nutritional supplements but to take more medicines; to be without somebody to talk to and to be more dependent; and to live in a house without stairs to climb and to live near other older adults, and in a more urbanized area with streets with steeper slopes.In this sample of older adults, obesity is related with health characteristics and those are related with socio-demographic and geographical characteristics of the area of residence. Besides the identification of risk factors for the older adult population, this information may help designing health care policies that takes in consideration the physical and geographical characteristics of the neighbourhood of the area of residence of the older adults.

Abstract
AbstractMalnutrition is associated to a progressive decline in health, reduced physical and cognitive functional status and mortality. However, the malnutrition prevalence differs across countries. Previous studies reported 19% of malnourished elderly in Turkey and 1.3% in Portugal.We aimed to compare the nutritional status between between Portuguese and Turkish older adults using the Mini-Nutritional Assessment.This is a cross-sectional study using data from the Pronutrisenior project, collected in Vila Nova de Gaia, Portugal (n = 430), and a study in Ankara, Turkey (n = 162). The sample consisted of older adults living at their homes. Socio-demographic data, clinical data from the medical records, the full form of Mini-Nutrititional Assessment, MNA-FF and anthropometry (weight, height, BMI, mid-arm circumference and calf circumference) were collected.Turkish older adults lived more frequently with children, are more likely to be widow/widower, and have a higher probability of being housewife/househusband. A larger proportion of the Portuguese have tooth loss, diabetes, hypertension, oncologic diseases, kidney diseases, osteoarticular problems, or eye problems and a larger proportion of the Turkish have anemia. The BMI average is smaller in the Turkish sample, while the calf circumference average is larger. Turkish have a larger proportion of malnourished or at risk of malnutrition (4.9% and 31.5% vs. 1.2% and 24.0%, respectively). The average MNA-FF score is higher among the Portuguese, males and on people using denture, and without: toothloss, hypertension, CVD, anemia and oncological diseases. Moreover, higher MNA-FF scores were associated with younger ages, higher BMI and higher calf circumference.The effect size was larger for CVD and sex.The prevalence of malnutrition in European and American populations ranges from 1% to 15% in ambulatory living elders, more common among females as in this work. Other studies showed that higher BMI is related with lower malnutrition prevalence and higher prevalence of obesity-related chronic diseases. Tooth loss was more frequent in the Portuguese, which may be due to a higher intake of sweets or packaged food. Portuguese elders had lower calf circumferences but higher BMI, which may be related to lower muscle mass and/or higher fat mass. The differences between the Portuguese and the Turkish may be related to the different per capita gross national product, positively correlated with BMI and the consumption of processed foods. Anemia in Turkish elders may be related with BMI and their lower consumption of meat and the higher tea intake that may reduce iron absorption, as reported by other studies.

Abstract
AbstractMalnutrition is a serious health problem among older adults. The Mini Nutritional Assessment (MNA) is the most used tool to assess malnutrition among older adults. It was proposed that the Screening section could be used as a short form of the MNA (MNA-SF), but the study of the two forms show a wide range of agreement (71.8 to 93.3% and Cohen's kappa from 0.52 to 0.78). Nevertheless, most of the studies recommend the use of the MNA-SF, but in some this conclusion is not completely congruent with the results. The aims of this work were to study the agreement between the nutritional status classification using the MNA-SF and the MNA-FF among Portuguese older adults living in the community, to compare the scores in each question of the MNA-FF between participants correctly or incorrectly classified using the MNA-SF, and to develop a more sensible version of the MNA-SF. The current study is part of the PRONUTRISENIOR project. Data from 456 older adults (54.2% females) aged 65 to 92 years (mean = 73; SD = 6) living in the community (Vila Nova de Gaia, Portugal) were analyzed. The agreement between the two classifications is 82.7%, but Cohen's k shows a weak agreement (weighted k = 0.497; p < 0,001). MNA-SF showed a very low sensitivity (42.6%) detecting participants malnourished or at risk of malnutrition. Participants classified as normal using the MNA-SF despite at risk using the MNA-SF presented lower scores in two items from the Assessment section: number of full meals eaten daily and amount of fluid consumed per day. These two items were included in MNA-SF to obtain an extended short-version (MNA-SF8), which presented a sensitivity of 91.8% (and a specificity of 79.9%). The areas under the ROC curves were 0.858 and 0.929, respectively for MNA-SF and MNA-SF8. The addition of two items to the MNA-SF provides a more sensible tool to detect risk of malnutrition among elderly. These findings suggest that, among the studied population, general eating-related questions regarding (full meals and fluid intake) are relevant to assess malnutrition. Similar studies should be carried out among other populations in order to verify the possibility of their generalization. [The PRONUTRISENIOR project was financed by Iceland, Liechtenstein and Norway through the EEA Grants (PT06 – Public Health Initiatives, reference 81NU5).]

Abstract
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.

Abstract
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.

Abstract
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.