RESUMEN
Abstract Objectives: The objective of the present study is to evaluate whether IL-6, TNF-α, IL-10 are associated with nutritional status in patients with cirrhosis secondary to biliary atresia and compare to healthy controls. Methods: The parameters used for nutritional assessment were the standard deviation scores of height-for-age and of triceps skinfold thickness-for-age. The severity of cirrhosis was evaluated using the Child-Pugh score and PELD/MELD. Serum cytokines were measured using Cytometric Bead Array flow cytometry. Results: IL-6, TNF-α, and IL-10 were significantly higher in the cirrhosis group when compared with the control group (2.4 vs. 0.24 (p < 0.001), 0.21 vs. 0.14 (p = 0.007), and 0.65 vs. 0.36 (p = 0.004), respectively. IL-6 and IL-10 were positively correlated with disease severity (0.450 [p = 0.001] and 0.410; [p = 0.002], respectively). TNF-α did not show a significant correlation with disease severity (0.100; p = 0.478). Regarding nutritional evaluation, IL-6 was negatively correlated with the standard deviation score of height-for-age (−0.493; p < 0.001) and of triceps skinfold thickness-for-age (−0.503; p < 0.001), respectively. IL-10 exhibited a negative correlation with the standard deviation score of height-for-age (−0.476; p < 0.001) and the standard deviation score of triceps skinfold thickness-for-age (−0.388; p = 0.004). TNF-α did not show any significance in both anthropometric parameters (−0.083 (p = 0.555) and −0.161 (p = 0.253). Conclusion: The authors suggest that, in patients with cirrhosis secondary to biliary atresia, IL-6 could be used as a possible supporting biomarker of deficient nutritional status and elevated IL-10 levels could be used as a possible early-stage supporting biomarker of deteriorating nutritional status.
Resumo Objetivos: Avaliar se há associações entre a IL-6, o TNF-α, a IL-10 e a estado nutricional em pacientes com cirrose secundária a atresia biliar e comparar com controles saudáveis. Métodos: Os parâmetros usados na avaliação nutricional foram desvio padrão de estatura para a idade e espessura da prega cutânea do tríceps para a idade. A gravidade da cirrose foi avaliada por meio da classificação de Child-Pugh e do PELD/MELD. As citocinas no soro foram medidas por citometria de fluxo - técnica de Cytometric Bead Array. Resultados: A IL-6, o TNF-α e a IL-10 foram significativamente maiores no grupo de cirrose em comparação com o grupo de controle [2,4 em comparação com 0,24 (p < 0,001)], [0,21 em comparação com 0,14 (p = 0,007)] e [0,65 em comparação com 0,36 (p = 0,004)], respectivamente. A IL-6 e a IL-10 demonstraram correlação positiva com a gravidade da doença (0,450; p = 0,001) e (0,410; p = 0,002), respectivamente. O TNF-α não mostrou relevância na gravidade da doença (0,100; p = 0,478). Com relação à avaliação nutricional, a IL-6 demonstrou correlação negativa com o desvio padrão de estatura para a idade (−0,493; p < 0,001) e o desvio padrão de espessura da prega cutânea do tríceps para a idade (−0,503; p < 0,001), respectivamente. A IL-10 demonstrou correlação negativa com o desvio padrão de estatura para a idade (−0,476; p < 0,001) e o desvio padrão de espessura da prega cutânea do tríceps para a idade (−0,388; p = 0,004), respectivamente. O TNF-α não mostrou relevância em ambos os parâmetros antropométricos [(−0,083; p = 0,555); (−0,161; p = 0,253)]. Conclusão: Assim, sugerimos que, em pacientes com cirrose secundária a atresia biliar, IL-6 pode ser usado como um possível biomarcador de suporte do estado nutricional deficiente e níveis aumentados de IL-10 podem ser usados como um possível biomarcador de suporte, em fase inicial, de deterioração do estado nutricional.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Atresia Biliar/sangre , Estado Nutricional , Interleucina-6/sangre , Factor de Necrosis Tumoral alfa/sangre , Interleucina-10/sangre , Cirrosis Hepática/sangre , Índice de Severidad de la Enfermedad , Atresia Biliar/complicaciones , Atresia Biliar/inmunología , Biomarcadores/sangre , Estudios de Casos y Controles , Evaluación Nutricional , Interleucina-6/inmunología , Factor de Necrosis Tumoral alfa/inmunología , Interleucina-10/inmunología , Cirrosis Hepática/etiología , Cirrosis Hepática/inmunologíaRESUMEN
OBJECTIVES: The objective of the present study is to evaluate whether IL-6, TNF-α, IL-10 are associated with nutritional status in patients with cirrhosis secondary to biliary atresia and compare to healthy controls. METHODS: The parameters used for nutritional assessment were the standard deviation scores of height-for-age and of triceps skinfold thickness-for-age. The severity of cirrhosis was evaluated using the Child-Pugh score and PELD/MELD. Serum cytokines were measured using Cytometric Bead Array flow cytometry. RESULTS: IL-6, TNF-α, and IL-10 were significantly higher in the cirrhosis group when compared with the control group (2.4 vs. 0.24 (p<0.001), 0.21 vs. 0.14 (p=0.007), and 0.65 vs. 0.36 (p=0.004), respectively. IL-6 and IL-10 were positively correlated with disease severity (0.450 [p=0.001] and 0.410; [p=0.002], respectively). TNF-α did not show a significant correlation with disease severity (0.100; p=0.478). Regarding nutritional evaluation, IL-6 was negatively correlated with the standard deviation score of height-for-age (-0.493; p<0.001) and of triceps skinfold thickness-for-age (-0.503; p<0.001), respectively. IL-10 exhibited a negative correlation with the standard deviation score of height-for-age (-0.476; p<0.001) and the standard deviation score of triceps skinfold thickness-for-age (-0.388; p=0.004). TNF-α did not show any significance in both anthropometric parameters (-0.083 (p=0.555) and -0.161 (p=0.253). CONCLUSION: The authors suggest that, in patients with cirrhosis secondary to biliary atresia, IL-6 could be used as a possible supporting biomarker of deficient nutritional status and elevated IL-10 levels could be used as a possible early-stage supporting biomarker of deteriorating nutritional status.
Asunto(s)
Atresia Biliar/sangre , Interleucina-10/sangre , Interleucina-6/sangre , Cirrosis Hepática/sangre , Estado Nutricional , Factor de Necrosis Tumoral alfa/sangre , Atresia Biliar/complicaciones , Atresia Biliar/inmunología , Biomarcadores/sangre , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , Lactante , Interleucina-10/inmunología , Interleucina-6/inmunología , Cirrosis Hepática/etiología , Cirrosis Hepática/inmunología , Masculino , Evaluación Nutricional , Índice de Severidad de la Enfermedad , Factor de Necrosis Tumoral alfa/inmunologíaRESUMEN
BACKGROUND: The nutritional status in patients with cirrhosis is not so easy to assess properly. Considering the relationship between brain-derived neurotrophic factor (BDNF) and energy homeostasis, the main aim of this study was to evaluate the concentration of BDNF in children and adolescents with cirrhosis due to biliary atresia (BA) and correlate it with their nutritional status. METHODS: Fifty-three children and adolescents with cirrhosis due to BA and 33 healthy controls were enrolled in this study. Nutritional status was evaluated using anthropometric parameters, and serum BDNF was measured by ELISA. Spearman coefficient was used to evaluate the correlation between variables. RESULTS: In the cirrhosis group, 28.8% were undernourished and in the control group, 100% were well-nourished. BDNF median values for the control and cirrhosis group were 28.5 and 9.0 pg/ml respectively. BDNF and platelets were positively associated with both Standard Deviation Score (SDS) for height-for-age ratio and SDS for triceps skinfold thickness-for-age ratio. CONCLUSIONS: Considering these associations, BDNF may be an indirect biomarker of nutritional status in children and adolescents with chronic liver disease. Further studies must be conducted to clarify the role of BDNF in this population.
Asunto(s)
Atresia Biliar/complicaciones , Factor Neurotrófico Derivado del Encéfalo/sangre , Cirrosis Hepática/sangre , Adolescente , Biomarcadores/sangre , Estudios de Casos y Controles , Niño , Servicios de Salud del Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estado Nutricional , Valor Predictivo de las Pruebas , Índice de Severidad de la EnfermedadRESUMEN
Introdução: A cirrose caracteriza-se por uma alteração crônica do parênquima hepático que frequentemente leva à desnutrição em crianças e adolescentes. A intervenção nutricional deve ser feita precocemente, o que requer um cuidadoso acompanhamento desses pacientes. Objetivos: Comparar os resultados da avaliação nutricional de crianças e adolescentes cirróticos realizada em dois períodos de tempo distintos. Métodos: Foram utilizados bancos de dados oriundos de duas pesquisas conduzidas com pacientes pediátricos com cirrose. Após a aplicação de critérios de inclusão e exclusão, 67 crianças e adolescentes foram avaliados em duas séries com intervalo de aproximadamente uma década entre elas. As duas séries tiveram as variáveis antropométricas estatura para idade (E/I) e dobra cutânea tricipital para idade (DCT/I) avaliadas de acordo com os padrões da Organização Mundial de Saúde. A gravidade da doença foi avaliada pelos modelos Pediatric End-stage Liver Disease (PELD)/ Model for End-stage Liver Disease (MELD) e pelo escore Child-Pugh. O nível de significância foi estabelecido em 5%. Resultados: Os resultados da avaliação do estado nutricional dos pacientes nas duas séries não mostraram diferença estatisticamente significativa. Na série 1, 22,6% dos pacientes apresentaram desnutrição, e 27,8% na série 2 (p = 0,955). Conclusões: Podemos concluir que nas duas séries avaliadas, separadas por aproximadamente uma década, o percentual de desnutrição e a gravidade da cirrose se mantiveram estáveis (AU)
Introduction: Cirrhosis is characterized by a chronic alteration of the liver parenchyma that often leads to malnutrition in children and adolescents. Nutritional intervention should be performed early, requiring careful follow-up of these patients. Objectives: To compare the nutritional assessment of cirrhotic pediatric patients performed in two separate periods of time. Methods: This research used two different databases originated from studies conducted with pediatric patients with cirrhosis. After applying inclusion and exclusion criteria, 67 children and adolescents were assessed in two series of tests performed within a time range of approximately a decade. Both series had standard deviation score for height-for-age (SDS-H/A), standard deviation score for triceps skinfold-for-age and (SDS-TSF/A), calculated according to the standards established by the World Health Organization. Disease severity was evaluated by the Pediatric End-stage Liver Disease (PELD)/Model for End-stage Liver Disease (MELD) and by the Child-Pugh score. Results were considered significant at p < 0.05. Results: The present study did not find any statistically significant difference for the nutritional status of the researched subjects in any of the series. In the first series, 22.6% of patients were undernourished, compared to 27.8% in the second one (p = 0.955). Conclusions: We can conclude that in both series of tests conducted with an interval of about a decade from each other the percentage of malnutrition and the severity of cirrhosis remained stable (AU)
Asunto(s)
Humanos , Preescolar , Niño , Adolescente , Cirrosis Hepática , Estado Nutricional , Desnutrición , Evaluación NutricionalRESUMEN
Resumo Objetivo Validar o questionário de Avaliação Nutricional Subjetiva Global (ANSG) para a população de crianças e adolescentes brasileiros. Métodos Estudo transversal, feito com 242 pacientes, de 30 dias a 13 anos, atendidos em unidades pediátricas de um hospital terciário, com doenças agudas e tempo de permanência mínima de 24 horas hospitalizados. Após autorização dos autores do estudo original foram cumpridas as seguintes etapas para obtenção da validação dos instrumentos de ANSG: tradução (backtranslation), validade de critério concorrente e preditiva e confiabilidade interobservador. As variáveis em estudo foram: idade, sexo, peso e comprimento ao nascer, prematuridade e antropometria (peso, estatura, índice de massa corporal, circunferência braquial, dobra cutânea tricipital e dobra cutânea subescapular). O desfecho principal considerado foi necessidade de internação/reinternação até 30 dias após a alta hospitalar. Os testes estatísticos usados foram: Anova, Kruskal-Wallis, Mann-Whitney, qui-quadrado e coeficiente Kappa. Resultados De acordo com a classificação do ANSG, 80% dos pacientes foram classificados como bem nutridos, 14,5% moderadamente desnutridos e 5,4% gravemente desnutridos. A validade concorrente mostrou fraca a regular correlação do ANSG com as medidas antropométricas usadas (p < 0,001). Quanto ao poder preditivo, o desfecho principal associado ao ANSG foi tempo de internação/reinternação. Os desfechos secundários associados foram: tempo de permanência na unidade após ANSG, peso e comprimento ao nascer e prematuridade (p < 0,05). A confiabilidade interobservador mostrou boa concordância entre os avaliadores (Kappa = 0,74). Conclusão Este estudo validou o método de ANSG nessa amostra de pacientes pediátricos hospitalizados e possibilitou seu uso para fins de aplicação clínica e de pesquisa na população brasileira.
Abstract Objective To validate the Subjective Global Nutritional Assessment (SGNA) questionnaire for Brazilian children and adolescents. Methods A cross-sectional study with 242 patients, aged 30 days to 13 years, treated in pediatric units of a tertiary hospital with acute illness and minimum hospitalization of 24 h. After permission from the authors of the original study, the following criteria were observed to obtain the validation of SGNA instruments: translation and backtranslation, concurrent validity, predictive validity, and inter-observer reliability. The variables studied were age, sex, weight and length at birth, prematurity, and anthropometry (weight, height, body mass index, upper arm circumference, triceps skinfold, and subscapular skinfold). The primary outcome was considered as the need for admission/readmission within 30 days after hospital discharge. Statistical tests used included ANOVA, Kruskal-Wallis, Mann-Whitney, chi-square, and Kappa coefficient. Results According to SGNA score, 80% of patients were considered as well nourished, 14.5% moderately malnourished, and 5.4% severely malnourished. Concurrent validity showed a weak correlation between the SGNA and anthropometric measurements (p < 0.001). Regarding predictive power, the main outcome associated with SGNA was length of admission/readmission. Secondary outcomes associated included the following: length of stay at the unit after SGNA, weight and length at birth, and prematurity (p < 0.05). The interobserver reliability showed good agreement among examiners (Kappa = 0.74). Conclusion This study validated the SGNA in this group of hospitalized pediatric patients, ensuring its use in the clinical setting and for research purposes in the Brazilian population.
Asunto(s)
Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Evaluación Nutricional , Desnutrición Proteico-Calórica/diagnóstico , Encuestas y Cuestionarios , Brasil , Estudios Transversales , Estado Nutricional , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Índice de Severidad de la EnfermedadRESUMEN
AIM: To evaluate the nutritional status and its association with proinflammatory cytokines in children with chronic liver disease. METHODS: We performed a cross-sectional study with 43 children and adolescents, aged 0 to 17 years, diagnosed with chronic liver disease. All patients regularly attended the Pediatric Hepatology Unit and were under nutritional follow up. The exclusion criteria were fever from any etiology at the time of enrollment, inborn errors of the metabolism and any chronic illness. The severity of liver disease was assessed by Child-Pugh, Model for End-stage Liver Disease (MELD) and Pediatric End Stage Liver Disease (PELD) scores. Anthropometric parameters were height/age, body mass index/age and triceps skinfold/age according to World Health Organization standards. The cutoff points for nutritional status were risk of malnutrition (Z-score < -1.00) and malnutrition (Z-score < -2.00). Interleukin-1ß (IL-1ß), IL-6 and tumor necrosis factor-α levels were assessed by commercial ELISA kits. For multivariate analysis, linear regression was applied to assess the association between cytokine levels, disease severity and nutritional status. RESULTS: The median (25(th)-75(th) centile) age of the study population was 60 (17-116)-mo-old, and 53.5% were female. Biliary atresia was the main cause of chronic liver disease (72%). With respect to Child-Pugh score, cirrhotic patients were distributed as follows: 57.1% Child-Pugh A, a mild presentation of the disease, 34.3% Child-Pugh B, a moderate stage of cirrhosis and 8.6% Child-Pugh C, were considered severe cases. PELD and MELD scores were only above the cutoff point in 5 cases. IL-6 values ââwere increased in patients at nutritional risk (34.9%) compared with those who were well-nourished [7.12 (0.58-34.23) pg/mL vs 1.63 (0.53-3.43) pg/mL; P = 0.02], correlating inversely with triceps skinfold-for-age z-score (rs = -0.61; P < 0.001). IL-6 levels were associated with liver disease severity assessed by Child-Pugh score (P = 0.001). This association remained significant after adjusting for nutritional status in a linear regression model. CONCLUSION: High IL-6 levels were found in children with chronic liver disease at nutritional risk. Inflammatory activity may be related to nutritional status deterioration in these patients.
Asunto(s)
Citocinas/sangre , Mediadores de Inflamación/sangre , Hepatopatías/diagnóstico , Desnutrición/etiología , Estado Nutricional , Adolescente , Factores de Edad , Biomarcadores/sangre , Distribución de Chi-Cuadrado , Niño , Fenómenos Fisiológicos Nutricionales Infantiles , Preescolar , Enfermedad Crónica , Estudios Transversales , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Lactante , Interleucina-6/sangre , Modelos Lineales , Hepatopatías/sangre , Hepatopatías/etiología , Hepatopatías/inmunología , Hepatopatías/fisiopatología , Masculino , Desnutrición/sangre , Desnutrición/diagnóstico , Desnutrición/inmunología , Desnutrición/fisiopatología , Análisis Multivariante , Evaluación Nutricional , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Regulación hacia ArribaRESUMEN
OBJECTIVE: To validate the Subjective Global Nutritional Assessment (SGNA) questionnaire for Brazilian children and adolescents. METHODS: A cross-sectional study with 242 patients, aged 30 days to 13 years, treated in pediatric units of a tertiary hospital with acute illness and minimum hospitalization of 24h. After permission from the authors of the original study, the following criteria were observed to obtain the validation of SGNA instruments: translation and backtranslation, concurrent validity, predictive validity, and inter-observer reliability. The variables studied were age, sex, weight and length at birth, prematurity, and anthropometry (weight, height, body mass index, upper arm circumference, triceps skinfold, and subscapular skinfold). The primary outcome was considered as the need for admission/readmission within 30 days after hospital discharge. Statistical tests used included ANOVA, Kruskal-Wallis, Mann-Whitney, chi-square, and Kappa coefficient. RESULTS: According to SGNA score, 80% of patients were considered as well nourished, 14.5% moderately malnourished, and 5.4% severely malnourished. Concurrent validity showed a weak correlation between the SGNA and anthropometric measurements (p<0.001). Regarding predictive power, the main outcome associated with SGNA was length of admission/readmission. Secondary outcomes associated included the following: length of stay at the unit after SGNA, weight and length at birth, and prematurity (p<0.05). The interobserver reliability showed good agreement among examiners (Kappa=0.74). CONCLUSION: This study validated the SGNA in this group of hospitalized pediatric patients, ensuring its use in the clinical setting and for research purposes in the Brazilian population.
Asunto(s)
Evaluación Nutricional , Desnutrición Proteico-Calórica/diagnóstico , Encuestas y Cuestionarios , Adolescente , Brasil , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estado Nutricional , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Índice de Severidad de la EnfermedadRESUMEN
INTRODUÇÃO: O Fator Neurotrófico Derivado do Cérebro (BDNF) é uma importante neurotrofina que está presente no tecido cerebral e periférico. O leite materno é considerado o alimento padrão ouro para o desenvolvimento cerebral, tornando o desmame precoce um fator de risco no desenvolvimento infantil. OBJETIVO: Avaliar a concentração de BDNF, IL6, IL10, TNF-α em crianças e correlacionar com a duração da amamentação. MÉTODOS: Trinta e sete crianças foram recrutadas e classificadas de acordo com a duração do aleitamento materno: < 6 meses (desmame precoce) e ≥ 6 meses. Foram realizadas duas consultas: a consulta basal em 2007 (T0) e a consulta de seguimento em 2011 (T1). Os níveis séricos de BDNF foram avaliados por ELISA sanduíche e os de citocinas por citometria de fluxo. RESULTADOS: Níveis séricos de BDNF em T0 foram significativamente menores no grupo amamentado por ≥ 6 meses (p=0,025), sendo que este não teve diferença entre os grupos em T1 (p=0,863). Níveis de IL6 apresentaram-se aumentados significativamente em T0 no grupo de desmame precoce (p=0,016). O IMC em T1 foi maior no grupo de desmame precoce (p=0,007). E em relação aos níveis de IL10 e TNF-α não houve diferenças significativas entre os grupos. CONCLUSÃO: Os resultados deste estudo mostraram semelhanças entre os níveis séricos de BDNF medidos a longo prazo, entre crianças amamentadas por < 6 meses e ≥ 6 meses, sugerindo que futuros estudos são necessários, com dosagens durante o período de amamentação para investigar o papel de marcadores neuroquímicos na duração do aleitamento materno e suas implicações no estado nutricional e cognição das crianças amamentadas.
BACKGROUND: The Brain-Derived Neurotrophic Factor (BDNF) is an important neurotrophin found in the brain and peripheral tissues. Breast milk is considered to be the gold standard food for brain development, making early weaning a risk factor in child development. AIM: To evaluate the concentration of BDNF, IL6, IL10, TNF-α in children and its correlation with the duration of breastfeeding. METHODS: Thirty-seven children were recruited and classified according to the duration of breastfeeding: <6 months (early weaning) and ≥ 6 months. There were two visits: the baseline interview in 2007 (T0) and the follow-up visit in 2011 (T1). BDNF levels were assayed using a sandwich ELISA, and cytokines were assayed with flow cytometry. RESULTS: Serum BDNF levels at T0 were significantly lower in the group breastfed for ≥ 6 months (p = 0.025), and they did not differ between groups at T1 (p = 0.863). IL-6 levels were significantly increased in the early weaning group at T0 (p = 0.016). Body mass index at T1 was higher in the early weaning group (p = 0.007). There was no significant difference in IL10 and TNF-α levels between groups. CONCLUSION: The results of this study showed similarities in serum BDNF levels over time between children who had been breastfed <6months and ≥ 6 months. This suggests that further studies, with measurements taken during the breastfeeding period, are needed to investigate the role of neurochemical markers in the duration of breastfeeding and its implications on nutritional status and cognition of breastfed children.
Asunto(s)
Humanos , Adolescente , Lactancia Materna , Factor Neurotrófico Derivado del Encéfalo/sangre , Leche Humana/fisiología , Índice de Masa Corporal , Peso Corporal , Causalidad , Citocinas , Obesidad/prevención & control , Factores de TiempoRESUMEN
OBJECTIVE: Ghrelin, leptin, and insulin concentrations are involved in the control of food intake and they seem to be associated with anorexia-cachexia in cirrhotic patients. The present study aimed to investigate the relationship between the nutritional status and fasting ghrelin, leptin and insulin concentrations in pediatric cirrhotic patients. METHODS: Thirty-nine patients with cirrhosis and 39 healthy controls aged 0-15 years matched by sex and age were enrolled. Severity of liver disease was assessed by Child-Pugh classification, and Pediatric for End Stage Liver Disease (PELD) or Model for End-stage Liver Disease (MELD) scores. Blood samples were collected from patients and controls to assay total ghrelin, acyl ghrelin, leptin and insulin by using a commercial ELISA kit. Anthropometry parameters used were standard deviation score of height-for-age and triceps skinfold thickness-for-age ratio. A multiple linear regression analysis was used to determine the correlation between dependent and independent variables. RESULTS: Acyl ghrelin was significantly lower in cirrhotic patients than in controls [142 (93-278) pg/mL vs 275 (208-481) pg/mL, P=0.001]. After multiple linear regression analysis, total ghrelin and acyl ghrelin showed an inverse correlation with age; acyl ghrelin was associated with the severity of cirrhosis and des-acyl ghrelin with PELD or MELD scores ≥15. Leptin was positively correlated with gender and anthropometric parameters. Insulin was not associated with any variable. CONCLUSION: Low acyl ghrelin and high des-acyl ghrelin concentrations were associated with cirrhosis severity, whereas low leptin concentration was associated with undernourishment in children and adolescents with cirrhosis.
Asunto(s)
Ghrelina/sangre , Insulina/sangre , Leptina/sangre , Cirrosis Hepática/sangre , Estado Nutricional , Adolescente , Estudios de Casos y Controles , Niño , Preescolar , Ayuno , Femenino , Humanos , Lactante , Recién Nacido , Cirrosis Hepática/fisiopatología , Masculino , Índice de Severidad de la EnfermedadRESUMEN
Introdução: A desnutrição é um importante fator que interfere no prognóstico de crianças e adolescentes com cirrose. Este estudo tem como objetivo avaliar o estado nutricional e a adequação da ingesta alimentar de crianças e adolescente com cirrose. Métodos: Estudo transversal, realizado com 39 crianças e adolescentes cirróticos com idade entre 0-15 anos. A gravidade da doença hepática foi avaliada pelo critério de Child-Pugh e escores Pediatric End-Stage Liver Disease e/ou Model for End-Stage Liver Disease. A classificação do estado nutricional foi determinada de acordo com os padrões WHO (2009) e Frisancho (2008). A avaliação da ingesta alimentar foi realizada a partir de um registro alimentar de três dias. Resultados: As médias e desvios padrão dos escores z para os parâmetros Peso/Idade (P/I), Índice de Massa Corporal/Idade (IMC/I), Estatura/Idade (E/I), Circunferência do Braço/Idade (CB/I) e Dobra Cutânea Tricipital/Idade (DCT/I) foram respectivamente -0,53 (±1,17), 16,8 (±2,53), -1,22 (±1,20), -1,04 (±1,61) e -0,99 (±1,67), caracterizando cerca de 44% como desnutridos; sendo que 69% destes eram desnutridos graves (abaixo do escore-z -3,00). A ingesta alimentar média dos cirróticos (33/39), excluindo aqueles em aleitamento materno, dieta enteral e/ou restrição dietética, comparada com a RDI para idade foi de 112% (±36), sendo que a maioria 78,4% (26/33) apresentou uma ingesta maior ou igual a 80% da recomendação para a idade. Conclusão: A associação de parâmetros antropométricos, clínicos e dietéticos deve ser utilizada para que se possa chegar a um diagnóstico nutricional coerente e intervenção nutricional efetiva.
Introduction: Malnutrition is an important factor affecting the prognosis of children and teenagers with cirrhosis. This study aims to evaluate the nutritional status and adequacy of food intake by children and adolescents with cirrhosis. Methods: Cross-sectional study of 39 cirrhotic children and adolescents aged 0-15 years. The severity of liver disease was evaluated by Child-Pugh scores and Pediatric End-Stage Liver Disease and/or Model for End-Stage Liver Disease. The nutritional status was determined according to WHO standards (2009) and Frisancho (2008). The evaluation of food intake was made by recording food intake for three days. Results: The means and standard deviations of z scores for the parameters weight/age (W/A), body mass index/age (BMI/A), Height/Age (H/A), arm circumference/age (A /I), and triceps skinfold/Age (TS/A) were respectively -0.53 (± 1.17), 16.8 (± 2.53), -1.22 (± 1.20), -1.04 (± 1.61), and -0.99 (± 1.67), characterizing about 44% as malnourished, 69% of whom as severely malnourished (z-score <3.00). The mean dietary intake of cirrhotic patients (33/39), excluding those in breast-feeding, enteral feeding and/or dietary restriction, as compared with the RDI for age was 112% (± 36), most of which (78.4% , 26/33) with an intake > 80% as recommended for their age. Conclusion: A combination of anthropometric, clinical and dietary factors should be used so that a coherent nutritional diagnosis and effective nutritional intervention can be made.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Evaluación Nutricional , Desnutrición , Fibrosis/complicaciones , Ingestión de Alimentos , Estado Nutricional , Estudios Transversales/métodosRESUMEN
OBJECTIVES: This study aimed to establish the relationship between total ghrelin, acyl ghrelin, des-acyl ghrelin, leptin, and insulin with anthropometry, gender, and age distribution in healthy children. RESULTS: Data from 111 healthy children aged 4 months to 10 years were studied. All the participants underwent a pre-study screening clinical evaluation and were separated in 3 age groups. All had blood collected to assay. Anthropometric parameters were measured according to World Health Organization. In order to determine the correlation between dependent and independent variables, a multiple linear regression analysis was used. Overall median age of subjects was 60.0 months. After multiple regression analysis, correlation between total ghrelin, acyl ghrelin and des-acyl ghrelin remained significant with age. Correlation between leptin values and age, body mass index-for-age ratio, height-for-age ratio, and female gender remained significant. There was no significant correlation between insulin and ghrelin, and between insulin and leptin in all age groups. There was an inverse significant correlation between total ghrelin and des-acyl ghrelin with leptin in the whole group. CONCLUSIONS: Ghrelin showed an inverse correlation with age and leptin showed a direct correlation with anthropometric parameters and female gender in healthy children. Insulin did not show any correlation.
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Ghrelina/sangre , Insulina/sangre , Leptina/sangre , Factores de Edad , Apetito , Glucemia , Niño , Preescolar , Ayuno/sangre , Femenino , Humanos , Lactante , Masculino , Valores de Referencia , Factores SexualesRESUMEN
As fissuras labiopalatinas são uma malformação do terço médio da face que se deve à falta de fusão dos processos maxilares e palatinos. Situam-se entre o terceiro e o quarto defeito congênito mais frequente. No Brasil, segundo a Organização Mundial da Saúde, há 13,9 casos em cada 10.000 nascimentos. Seus portadores, além de grave problema estético, apresentam distúrbios funcionais, desde a alimentação até a fonação, que são perfeitamente tratáveis. As maiores dificuldades dos bebês que apresentam essa anomalia são a alimentação, a respiração e o ganho de peso. Seu tratamento consiste em cirurgia, assim como acompanhamento interdisciplinar e diversos cuidados no pré e no pós-operatório
Cleft lip and palate is a malformation of the midface caused by the absence of fusion of the maxillary and palatine processes. It is the fourth most common birth defect. According to the World Health Organization, its prevalence in Brazil is 13.9/10,000 live births. In addition to causing severe aesthetic problems, cleft lip and palate also generates functional disorders such as eating and speech problems. Most of the functional disorders are treatable. The biggest challenges for babies who are born with this condition involve the eating process, breathing, and weight gain. Treatment consists of surgery, as well as interdisciplinary follow-up and several pre-and postoperative care measures
Asunto(s)
MedicinaRESUMEN
A anorexia e o hipermetabolismo são aspectos clínicos importantes em crianças com cirrose. Embora muitas das complicações da cirrose sejam semelhantes àquelas encontradas em adultos, a etiologia e a história natural da progressão da doença e o tratamento clínico em pacientes pediátricos podem ser significativamente diferentes. As alterações metabólicas da doença hepática crônica agravada pela anorexia e desnutrição podem ter implicações negativas no crescimento e desenvolvimento infantil. Crianças com cirrose de evolução progressiva são frequentemente desnutridas e, no entanto, os métodos comumente empregados para avaliação nutricional têm uso limitado nestes pacientes. Mesmo que a importância do estado nutricional sobre o prognóstico destes pacientes seja clara, poucos estudos sobre a terapia nutricional nas hepatopatias da infância têm sido realizados. A avaliação nutricional em crianças com cirrose hepática deve incluir uma completa história clínica e dietética, medidas antropométricas e parâmetros laboratoriais. A recomendação nutricional na cirrose infantil pode variar de acordo com o estado nutricional, idade e quadro clínico. Como a doença hepática crônica em crianças pode impactar significativamente sobre o estado nutricional e consequentemente no crescimento e desenvolvimento, o objetivo deste artigo é revisar os aspectos clínicos e fisiopatológicos envolvidos no diagnóstico e manejo nutricional da cirrose hepática em pacientes pediátricos.
Anorexia and hypermetabolism are disorders of paramount importance in children with cirrhosis. Although many complications caused by cirrhosis in children are similar to those found in adults, the etiologic spectrum and natural history of this disease progression and its clinical management in pediatric patients may be significantly different. The metabolic changes caused by chronic liver disease aggravated by anorexia and malnutrition can affect child growth and development. Malnutrition is common in children with cirrhosis and the methods commonly used for their nutritional assessment are limited. Although the importance of the nutritional status on the prognosis of these patients is clear, there are few studies about nutritional therapy in children with cirrhosis. Nutritional assessment in children with liver cirrhosis should include full clinical and nutritional history, anthropometric measurements, and laboratory parameters. The nutritional recommendation for cirrhosis in children may vary depending on age and nutritional and clinical status. Because chronic liver disease in children may have a significant impact on nutritional status, growth, and development, the objective of this study is to review the clinical and pathophysiological aspects involved in the diagnosis and nutritional management of liver cirrhosis in children.
Asunto(s)
Humanos , Lactante , Preescolar , Niño , Adolescente , Cirrosis Hepática/dietoterapia , Terapia Nutricional , Anorexia/etiología , Evaluación Nutricional , Caquexia/etiología , Cirrosis Hepática/complicaciones , Cirrosis Hepática/epidemiología , Cirrosis Hepática/etiología , Hormonas/fisiología , Hormonas/metabolismo , Inflamación/metabolismo , Metabolismo Energético/fisiología , Fenómenos Fisiológicos Nutricionales del LactanteRESUMEN
Tympanic membrane pathological findings such as perforations and tympanosclerotic plaques (along with conductive hearing loss and purulent drainage) are the most typical trademarks of either active or burned-out chronic otitis media. These findings are normally evaluated by an expert using visual subjective analysis. In this work, we present a computational semi-automated method to quantify these pathologies. We also present a validation study of the method using a subset of 39 cases randomly extracted from a set of more than 2000 cases (perforations and tympanosclerosis) of the Hospital de Clínicas de Porto Alegre. The validation was performed using Ground Truth images, generated by experts, and has shown promising results.
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Automatización , Perforación de la Membrana Timpánica/fisiopatología , Membrana Timpánica/fisiopatología , HumanosRESUMEN
The quantification of angiogenesis and metalloproteinases may be useful in cholesteatoma behavior assessment as markers of its aggressiveness. The objective of this study is to compare markers CD31, MMP2 and MMP9 in pediatric and adult patients. This study is based on cross-sectional studies of pediatric (
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Colesteatoma del Oído Medio/diagnóstico , Adolescente , Adulto , Factores de Edad , Niño , Colesteatoma del Oído Medio/patología , Colesteatoma del Oído Medio/cirugía , Tejido Conectivo/patología , Estudios Transversales , Oído Medio/irrigación sanguínea , Oído Medio/patología , Oído Medio/cirugía , Epitelio/patología , Matriz Extracelular/patología , Femenino , Humanos , Masculino , Metaloproteinasa 2 de la Matriz/análisis , Metaloproteinasa 9 de la Matriz/análisis , Persona de Mediana Edad , Neovascularización Patológica/diagnóstico , Neovascularización Patológica/patología , Otitis Media/diagnóstico , Otitis Media/patología , Molécula-1 de Adhesión Celular Endotelial de Plaqueta/análisis , Pronóstico , Adulto JovenRESUMEN
UNLABELLED: Chronic otitis media is generally associated with some degree of hearing loss, which is often the patient's chief complaint. This hearing loss is usually conductive, resulting from tympanic membrane rupture and/or changes in the ossicular chain due to fixation or erosion caused by the chronic inflammatory process. When cholesteatoma or granulation tissue is present in the middle ear cleft, the degree of ossicular destruction is even greater. An issue that has recently gained attention is additional sensorineural hearing loss due to chronic otitis media. While the conductive loss can be minimized through surgery, sensorineural hearing loss constitutes a permanent after effect, attenuated only through the use of a hearing aid. However, a few groups have reported a decrease in sensorineural function in these patients as well. This survey study performed at a referral center evaluates the occurrence of sensorineural hearing loss in ambulatory patients with this disease. We reviewed the files of patients with unilateral chronic otitis media. One hundred and fifty patients met the inclusion criteria: normal otoscopy and normal hearing in the contralateral ear. MAIN OUTCOME MEASURE: bone-conduction threshold averages were calculated for frequencies of 500, 1,000, 2,000, 3,000 and 4,000 Hz, with comparison between the normal ear and the ear with chronic otitis media. Thresholds were examined separately for each frequency. The bone-conduction threshold averages for the normal side were lower than those for the ear with chronic otitis media. The threshold shift was statistically significant for each frequency (P<0.0001, Student's t test). There were differences between the groups when analyzed for age (500 and 1,000 Hz) or the presence of cholesteatoma (1,000 Hz). This study shows that chronic otitis media is associated with a decrease in cochlear function.
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Pérdida Auditiva Sensorineural/diagnóstico , Pérdida Auditiva Sensorineural/epidemiología , Otitis Media/diagnóstico , Otitis Media/epidemiología , Adolescente , Adulto , Distribución por Edad , Audiometría de Tonos Puros , Umbral Auditivo/fisiología , Conducción Ósea/fisiología , Niño , Preescolar , Enfermedad Crónica , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Otitis Media con Derrame/diagnóstico , Otitis Media con Derrame/epidemiología , Otitis Media Supurativa/diagnóstico , Otitis Media Supurativa/epidemiología , Probabilidad , Pronóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Estadísticas no Paramétricas , Adulto JovenRESUMEN
Introdução: Desnutrição calórico-proteica em crianças menores de cinco anos é um dos maiores problemas de saúde pública nos países em desenvolvimento. Resulta da interação entre fatores como pobreza, infecções e baixa ingestão calórica e proteica. A avaliação do estado nutricional (EN) na admissão hospitalar é fundamental para estabelecer métodos para a recuperação e/ou manutenção do EN durante a internação e identificar os fatores de risco (FR) para desnutrição. Objetivo: O objetivo deste estudo foi classificar o EN de crianças e adolescentes e seus FR para desnutrição na admissão hospitalar. Métodos: Estudo transversal realizado com 387 indivíduos de 0 a 14 anos admitidos em unidades de internação pediátrica. Na avaliação antropométrica, mensurou-se peso e estatura. Os FR para desnutrição incluíam: antropometria, jejum >2 dias, alimentação enteral ou parenteral, disfagia, perda ponderal, vômitos ou diarreia nas últimas 24 horas, febre acima de 37,5º C e risco relacionado ao diagnóstico. O EN foi classificado segundo os critérios da Organização Mundial da Saúde, 2006. Resultados: Na classificação do EN (N=363) utilizamos escore Z (N=327; 85%) e índice de massa corporal (IMC; N=36; 9%), e 23 foram avaliados através de protocolos específicos. Encontramos 48% eutróficos, 27% desnutridos, 15% em risco nutricional, 6% com sobrepeso e 4% obesos. Em relação aos FR para desnutrição, 271 (70%) indivíduos apresentavam até 2 FR; 114 (29,5%) de 3 a 5 (p<0,001) e 2 (0,5%) 6 ou mais. Conclusão: A prevalência de desnutrição e de seus fatores de risco na admissão hospitalar encontrada em crianças e adolescentes foi bastante expressiva. Esse achado é muito relevante, já que a identificação do EN permite uma intervenção nutricional adequada com a prevenção de desfechos clínicos desfavoráveis.
Background: Protein-calorie malnutrition in children under five years is a major public health problem in developing countries. Results from the interaction between factors such as poverty, infections and low energy intake and protein. The assessment of the status (NS) at hospital admission is essential to establish methods for the recovery and/or maintenance of NS during hospitalization and to identify risk factors (RF) to malnutrition. Aim: The aim of this study was to classify the NS of the children and adolescents and their RF for malnutrition at admission. Methods: Cross sectional prospective study with 387 individuals 0 to 14 years admitted to hospital pediatric units. Anthropometric evaluation, measured in weight and height. Risk factors for malnutrition included: anthropometry, fasting > 2 days, enteral or parenteral feeding, dysphagia, weight loss, vomiting or diarrhea in the last 24 hours, fever over 37.5 C and the risk of the diagnosis. NS was classified according to criteria of the World Health Organization, 2006. Results: To classify the NS (N=363) Z score (N=327, 84.5%) and body mass index (BMI, N=36, 9.3%) were used, and 23 were assessed using specific protocols. We found 48% normal weight, 27% malnourished, 15% at nutritional risk, 6% overweight and 4% obese. About RF for malnutrition, 271 (70%) subjects had up to 2 RF, 114 (29.5%) from 3 to 5 (p <0.001) and 2 (0.5%) 6 or more. Conclusion: The prevalence of malnutrition and its risk factors found in children and adolescents at hospitalar admission was very high. This finding is relevant, since the identification of NS allows an appropriate nutritional intervention, preventing unfavourable clinical outcomes.
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Humanos , Preescolar , Niño , Adolescente , Evaluación Nutricional , Estado Nutricional , Trastornos de la Nutrición del Niño/complicaciones , Trastornos de la Nutrición del Niño/diagnóstico , Estudios Transversales , Desnutrición Proteico-Calórica , Admisión del PacienteRESUMEN
Objetivo: Descrever um protocolo de atendimento e acompanhamento nutricional através de níveis assistenciais em pediatria, para sistematizar e otimizar a assistência nutricional das crianças e adolescentes hospitalizados. Métodos: Foram padronizadas a avaliação antropométrica e a classificação do estado nutricional, bem como definidos os fatores de risco para desnutrição nas crianças e adolescentes hospitalizados. Foram estabelecidas três categorias de níveis assistenciais, que determinaram o tipo de atendimento e frequência do acompanhamento nutricional. Os critérios de avaliação, acompanhamento e reavaliação foram definidos conforme o nível assistencial. Para crianças em situações especiais foram criados protocolos específicos e para as desnutridas, critérios para reabilitação nutricional. Foi elaborada uma ficha de atendimento com acompanhamento nutricional pediátrico (FAANP), para ser preenchida a partir da admissão hospitalar. Conclusão: A utilização de um protocolo de atendimento por níveis assistenciais em pediatria proporcionou a padronização de procedimentos de avaliação nutricional e a otimização do acompanhamento de crianças e adolescentes, permitindo uma intervenção nutricional mais efetiva.
Aim: To describe a protocol of pediatric nutritional attendance by nutritional care level (NCL), and to optimize nutritional assistance. Methods: The anthropometric assessment and the classification of nutritional status were standardized, and risk factors were defined for undernourished children and adolescents during hospitalization. We established three categories of NCL which determined the kind and frequency of nutritional assistance. The evaluation criteria, attendance and reevaluation were defined in agreement to the assistance level. For children with special needs we created different protocols including nutritional rehabilitation criteria of the undernourished children. We elaborated records of pediatric nutritional attendance to be filled during the hospital admission. Conclusion: The use of a protocol of pediatric nutritional attendance by level of nutritional care provided the standardization of nutritional procedures assistance and improved the assistance of pediatric patients allowing a more effective nutritional intervention.
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Humanos , Masculino , Femenino , Niño , Adolescente , Adolescente Hospitalizado , Niño Hospitalizado , Estado Nutricional , Protocolos Clínicos/normas , Factores de RiesgoRESUMEN
OBJECTIVE: To study the contralateral ear of patients with chronic otitis media (COM). DESIGN: Transversal. SETTING: Tertiary referral center. PATIENTS: A total of 500 consecutive patients who had been diagnosed as having COM with or without cholesteatoma. INTERVENTIONS: Digital otoendoscopy was performed on both ears. MAIN OUTCOME MEASURE: Pathologic alterations in the contralateral ear. RESULTS: In 75.2% of the patients, the contralateral ear was found to have some structural abnormalities; 60.4% of the patients presented with COM without cholesteatoma, and in this group, 69.9% had an abnormal contralateral ear. In those with cholesteatoma, the contralateral ear was found to be abnormal in 83.3%. The most frequent finding in both groups was retraction of the tympanic membrane. CONCLUSIONS: Patients with COM in 1 ear have a high chance of presenting with some degree of disease in the contralateral side. We believe that our findings suggest that COM should be ideally approached not as a static pathological incident affecting 1 ear but rather as an on-going process that may affect both ears.
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Oído Medio/patología , Otitis Media/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Enfermedad Crónica , Femenino , Humanos , Lactante , Masculino , Persona de Mediana EdadRESUMEN
A Otite Média Crônica é definida pela presença de alterações teciduais inflamatórias irreversíveis na fenda auditiva. As lesões ossiculares são as mais prevalentes. OBJETIVO: Correlacionar o grau de comprometimento da cadeia ossicular, visualizada no transoperatório, com o grau histológico de inflamação e com a espessura da perimatriz de colesteatomas. TIPO DE ESTUDO: Estudo transversal. MÉTODOS: Descrições cirúrgicas de 71 pacientes foram revisadas. Colesteatomas coletados e fixados em formol 10 por cento e preparadas uma lâmina em Hematoxilina-Eosina e outra em Picrossírios. A leitura foi "cega", através de imagens digitais, no ImageProPlus. A análise estatística foi realizada através do coeficiente de Spearman, sendo considerados como estatisticamente significativos os valores de P≤0,05. RESULTADOS: Havia algum envolvimento da cadeia ossicular em 65 casos. O ossículo mais freqüentemente afetado era a bigorna, seguida pelo estribo e pelo martelo. Ao aplicarmos o coeficiente de Spearman entre o grau de comprometimento da cadeia ossicular com a idade do paciente à cirurgia, a espessura da perimatriz e o grau histológico de inflamação não foram detectadas correlações. CONCLUSÃO: Os nossos achados indicam que é praticamente universal o acometimento da cadeia ossicular na presença de colesteatoma. Não foi encontrada correção entre a erosão ossicular e os achados histológicos.
Chronic otitis media is hystopathologycaly defined as the presence of irreversible inflammatory tissue changes in the middle ear. Ossicular lesions represent the most prevalent change. AIM: to correlate the degree of ossicular chain changes seen during surgery with the inflammatory histological degree and the thickness of the cholesteatoma perimatrix. STUDY DESGN: Cross-sectional study. METHODS: Seventy-one descriptions of surgeries done in patients submitted to tympanomastoydectomy were reviewed. Cholesteatoma were collected and fixed in 10 percent formaldehyde. Two slides were made for each cholesteatoma, one stained with HE and another with picrossirius. Images were obtained from light microscopy and digitally processed and "blindly" analyzed using Image Pro-Plus Software. For statistical analysis we used Spearman's coefficient. Differences were considered statistically significant if P≤0.05. RESULTS: the ossicular chain was involved in 65 cases. The incus was the most frequently affected bone, followed by the stapes and the malleus. When the Spearman's coefficient was employed considering ossicular chain change degree with patient's age by the time of surgery, perimatrix thickness and histological degree of inflammation, correlations were not established. CONCLUSION: Our findings indicate that ossicular chain changes are practically universal when a cholesteatoma is present. We didn't find correlations related with bone erosion and cholesteatoma's histological findings.