RESUMO
INTRODUCTION: The protein-energy wasting (PEW) syndrome is a common complication in hemodialysis (HD) patients associated to morbidity and mortality. Our objective was to assess the prevalence of PEW and its association with erythropoietin resistance index (ERI) score, body composition by impedance, health-related quality of life, and muscle strength. METHODS: In this cross-sectional, observational, multicenter study, we included data from 191 HD patients from three HD clinics located in Mexico City, Mexico. Clinical and biochemistry variables, body composition, handgrip strength, and the KDQOL-SF36 questionnaire were collected for each patient. FINDINGS: Prevalence of PEW was 22% (n = 41/191), with a higher frequency in those with diabetes mellitus (59% vs. 49%, p = 0.04). Subjects with PEW had lower hemoglobin levels (9.5 + 1.6 g/dl vs. 10.3 + 1.7 g/dl; p = 0.005) and higher ERI scores (19.2 ± 11.2 vs. 15.6 ± 8.2; p = 0.04) compared with the non-PEW group. In analysis of body composition, PEW was associated to higher overhydration status (42.2 vs. 24.9 OH/kg; p = 0.009), higher extracellular water (263 ± 40 vs. 246 ± 32 ml/kg; p = 0.019), lower lean tissue index (12.2 ± 3.2 vs. 14.1 ± 3.7 ml/m2 ; p = 0.021), and lower fat tissue index (9.6 ± 5.7 vs. 12.3 ± 6.2 ml/m2 ; p = 0.043). Handgrip strength was lower in PEW patients (22.5 vs. 28.1 kg; p = 0.002). Finally, no significant differences were observed between groups in quality-of-life assessment. DISCUSSION: In this study, PEW was associated to poor responsiveness to erythropoiesis-stimulating agents, lower muscle strength, and higher overhydration status due to the increase in extracellular water which replaced the loss of tissue. Nevertheless, quality-of-life assessment was not different in patients with PEW compared with those without this complication.
Assuntos
Anemia , Desnutrição Proteico-Calórica , Desequilíbrio Hidroeletrolítico , Anemia/etiologia , Estudos Transversais , Força da Mão , Humanos , Força Muscular , Estado Nutricional , Desnutrição Proteico-Calórica/complicações , Qualidade de Vida , Diálise Renal/efeitos adversos , Água , Desequilíbrio Hidroeletrolítico/epidemiologia , Desequilíbrio Hidroeletrolítico/etiologiaRESUMO
Adults who had non-edematous severe acute malnutrition (SAM) during infancy (i.e., marasmus) have worse glucose tolerance and beta-cell function than survivors of edematous SAM (i.e., kwashiorkor). We hypothesized that wasting and/or stunting in SAM is associated with lower glucose disposal rate (M) and insulin clearance (MCR) in adulthood.We recruited 40 nondiabetic adult SAM survivors (20 marasmus survivors (MS) and 20 kwashiorkor survivors (KS)) and 13 matched community controls. We performed 150-minute hyperinsulinaemic, euglycaemic clamps to estimate M and MCR. We also measured serum adiponectin, anthropometry, and body composition. Data on wasting (weight-for-height) and stunting (height-for-age) were abstracted from the hospital records.Children with marasmus had lower weight-for-height z-scores (WHZ) (-3.8 ± 0.9 vs. -2.2 ± 1.4; P < 0.001) and lower height-for-age z-scores (HAZ) (-4.6 ± 1.1 vs. -3.4 ± 1.5; P = 0.0092) than those with kwashiorkor. As adults, mean age (SD) of participants was 27.2 (8.1) years; BMI was 23.6 (5.0) kg/m2. SAM survivors and controls had similar body composition. MS and KS and controls had similar M (9.1 ± 3.2; 8.7 ± 4.6; 6.9 ± 2.5 mg.kg-1.min-1 respectively; P = 0.3) and MCR. WHZ and HAZ were not associated with M, MCR or adiponectin even after adjusting for body composition.Wasting and stunting during infancy are not associated with insulin sensitivity and insulin clearance in lean, young, adult survivors of SAM. These data are consistent with the finding that glucose intolerance in malnutrition survivors is mostly due to beta-cell dysfunction.
Assuntos
Resistência à Insulina , Kwashiorkor , Desnutrição Proteico-Calórica , Desnutrição Aguda Grave , Adulto , Criança , Humanos , Lactente , Kwashiorkor/complicações , Desnutrição Proteico-Calórica/complicações , Insulina , Adiponectina , Desnutrição Aguda Grave/complicações , Transtornos do Crescimento , GlucoseRESUMO
This report describes the post-bariatric-surgery evolution of an obese patient who had low adherence to the diet and micronutrient supplementation. Four years after two bariatric surgeries, the patient was admitted due to transient loss of consciousness, slow thinking, anasarca, severe hypoalbuminemia, in addition to vitamin and mineral deficiencies. She had subcutaneous foot abscess but did not present fever. Received antibiotics, vitamins A, D, B12, thiamine, calcium, and parenteral nutrition. After hospitalization (twenty-eight days), there was a significant body weight reduction probably due to the disappearance of clinical anasarca. Parenteral nutrition was suspended after twenty-five days, and the oral diet was kept fractional. After hospitalization (weekly outpatient care), there was a gradual laboratory data improvement, which was now close to the reference values. Such outcome shows the need for specialized care in preventing and treating nutritional complications after bariatric surgeries as well as clinical manifestations of infection in previously undernourished patients.
Assuntos
Cirurgia Bariátrica , Desnutrição Proteico-Calórica/complicações , Infecções Estreptocócicas/complicações , Adulto , Deficiência de Vitaminas/complicações , Deficiência de Vitaminas/terapia , Cirurgia Bariátrica/efeitos adversos , Feminino , Humanos , Nutrição Parenteral , Complicações Pós-Operatórias , Desnutrição Aguda Grave/complicações , Desnutrição Aguda Grave/etiologia , Desnutrição Aguda Grave/terapia , Cooperação e Adesão ao TratamentoRESUMO
SUMMARY This report describes the post-bariatric-surgery evolution of an obese patient who had low adherence to the diet and micronutrient supplementation. Four years after two bariatric surgeries, the patient was admitted due to transient loss of consciousness, slow thinking, anasarca, severe hypoalbuminemia, in addition to vitamin and mineral deficiencies. She had subcutaneous foot abscess but did not present fever. Received antibiotics, vitamins A, D, B12, thiamine, calcium, and parenteral nutrition. After hospitalization (twenty-eight days), there was a significant body weight reduction probably due to the disappearance of clinical anasarca. Parenteral nutrition was suspended after twenty-five days, and the oral diet was kept fractional. After hospitalization (weekly outpatient care), there was a gradual laboratory data improvement, which was now close to the reference values. Such outcome shows the need for specialized care in preventing and treating nutritional complications after bariatric surgeries as well as clinical manifestations of infection in previously undernourished patients.
RESUMO Este relato descreve a evolução pós-cirurgia bariátrica de uma paciente obesa que apresentou baixa adesão à dieta e suplementação de micronutrientes. Quatro anos após duas cirurgias bariátricas, a paciente foi internada por perda transitória de consciência, raciocínio lento, anasarca, hipoalbuminemia grave, além de deficiências vitamínicas e minerais. Apresentava abscesso subcutâneo no pé, mas não apresentava febre. Recebeu antibióticos, vitaminas A, D, B12, tiamina, cálcio e nutrição parenteral. Após a internação (28 dias) houve redução significativa do peso corporal, provavelmente devido ao desaparecimento clínico da anasarca. A nutrição parenteral foi suspensa após 25 dias e a dieta oral foi mantida fracionada. Após a internação (atendimento ambulatorial semanal) houve uma melhora gradativa dos dados laboratoriais, que estavam próximos dos valores de referência. Tal desfecho mostra a necessidade de cuidados especializados na prevenção e tratamento de complicações nutricionais após cirurgias bariátricas, bem como manifestações clínicas de infecção em pacientes previamente desnutridos.
Assuntos
Humanos , Feminino , Adulto , Infecções Estreptocócicas/complicações , Desnutrição Proteico-Calórica/complicações , Cirurgia Bariátrica/efeitos adversos , Complicações Pós-Operatórias , Deficiência de Vitaminas/complicações , Deficiência de Vitaminas/terapia , Nutrição Parenteral , Desnutrição Aguda Grave/complicações , Desnutrição Aguda Grave/etiologia , Desnutrição Aguda Grave/terapia , Cooperação e Adesão ao TratamentoRESUMO
BACKGROUND: Parenteral nutrition (PN)-dependent adults and elderly individuals who are admitted to hospital treatment are potentially susceptible to mineral disorder complications due to depleted physiological reserves, loss of lean body mass, and increased fat mass, thus worsening inflammation. AIM: The purpose of this study is to evaluate the prevalence of hypophosphatemia, hypokalemia, and hypomagnesaemia prior and within the first 7 days of PN infusion. Furthermore, whether malnutrition and old age are associated with these disorders was also investigated. METHODS: This study included a historical cohort of adult patients, and 1,040 patients whose information was prospectively entered in the database were evaluated. RESULTS: Of the 781 patients, 27.3% were ≥65 years, 80.9% had undergone surgical treatment, 74.3% were in the intensive care unit, and 17.9% died during the hospitalization period. About 17.1% patients were malnourished. Protein energy malnutrition (PEM) was observed in 31.9% of the elderly patients and 27.1% of adults in general. Hypophosphatemia, hypokalemia, and hypomagnesemia were more prevalent before the start of PN infusion (D0: 214 [18.4%]), and new events were more common during the first 2 days of PN infusion (D1: 283 [23.1%]; D2: 243 [20.1%]. Elderly patients were more susceptible to developing hypophosphatemia (odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.29-2.19; p<0.001). Patients with PEM were also more susceptible to hypophosphatemia (OR: 3.75; 95% CI: 1.13-12.47; p=0.036). CONCLUSION: Hypophosphatemia, hypokalemia, and hypomagnesemia were frequently observed in hospitalized adults and elderly patients before and particularly during the first 2 days of PN infusion. Elderly patients and patients with PEM are more susceptible to developing hypophosphatemia.
Assuntos
Hipercalciúria/epidemiologia , Hipopotassemia/epidemiologia , Hipofosfatemia/epidemiologia , Nefrocalcinose/epidemiologia , Nutrição Parenteral Total/efeitos adversos , Erros Inatos do Transporte Tubular Renal/epidemiologia , Adulto , Idoso , Brasil/epidemiologia , Feminino , Hospitalização , Humanos , Pacientes Internados , Magnésio/metabolismo , Masculino , Pessoa de Meia-Idade , Minerais/metabolismo , Estado Nutricional , Prevalência , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/patologiaRESUMO
Maternal protein malnutrition during the critical stages of development (pregnancy, lactation and first infancy) can lead to adult hypertension. Studies have shown that renal and cardiovascular dysfunctions can be associated to the development of hypertension in humans and rats exposed to maternal protein malnutrition. The etiology of hypertension, however, includes a complex network involved in central and peripheral blood pressure control. Recently, the hyperactivity of the sympathetic nervous system in protein-restricted rats has been reported. Studies have shown that protein malnutrition during pregnancy and/or lactation alters blood pressure control through mechanisms that include central sympathetic-respiratory dysfunctions and epigenetic modifications, which may contribute to adult hypertension. Thus, this review will discuss the historical context, new evidences of neurogenic disruption in respiratory-sympathetic activities and possible epigenetic mechanisms involved in maternal protein malnutrition induced- hypertension.
Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Epigênese Genética , Hipertensão/genética , Hipertensão/fisiopatologia , Mães , Desnutrição Proteico-Calórica/complicações , Respiração , Animais , Humanos , Hipertensão/etiologiaRESUMO
La ingesta alimentaria y los hábitos nutricionales han sufrido un cambio muy importante en Venezuela en los últimos 18 meses aproximadamente. Objetivo: Describir la condición nutricional de las personas que acuden a hospitales del área metropolitana de Caracas. Métodos: estudio de casos, descriptivo y prospectivo. La muestra fué no probabilística de selección intencional, de pacientes de cualquier género y mayores de 18 años, atendidos en los hospitales HGO, HDL, HUC y HV durante un día escogido acordado y simultáneo: el 25 de mayo de 2018. Se procedió a atender el motivo de consulta y luego se aplicó una encuesta, incorporando, además en ella, el diagnóstico principal y el Índice de Masa Corporal (IMC). Resultados: Se evaluaron 322 pacientes, 130 del HV, 93 del HGO, 54 del HUC y 45 del HDL. El promedio de edad fue 48,63 años ±19,11 años DE, con 55,22% de mujeres. Refirieron un promedio de comidas de 2,90 ± 0,88 veces al día y en la semana consumían 2,17 ± 2,10 veces proteínas y 4,15 ± 2,51 veces vegetales. EL IMC promedio fue de 21,48 ± 9,93. Hubo 139 personas con desgaste orgánico (SDO) y en ellos la patología principal no justificaba este su presencia en 76 pacientes. Conclusiones: La calidad de la ingesta referida es inadecuada y existe un porcentaje alto de SDO en pacientes sin razones médicas para ello(AU)
Food intake and nutritional habits have experienced an important change in Venezuela in the last 18 months, approximately. Objective: To evaluate the nutritional status of the people who attended four hospitals of the metropolitan area of Caracas. Methods: case study, descriptive and prospective design. The sample was non-probabilistic and of intentional selection; the patients were of any gender over 18 years-old and came to HGO, HDL, HUC and HV hospitals. One accorded and simultaneous day was chosen: may 25,2018. The cause of consultation was assessed and afterwards, a survey was applied to evaluate the reason for consultation and then a survey was applied. It also included the main diagnoses and the Body Mass Index (BMI) was measured. Results: 322 patients were evaluated, 130 of the HV, 93 of the HGO, 54 of the HUC and 45 of the HDL. The average age was 48.63 years ± 19.11 years -old age, with 55.22% of women. They reported an average of 2.90 ± 0.88 meals a day and during the week they consumed proteins 2.17 ± 2.10 and 4.15 ± 2.51 times vegetables. The average BMI was 21.48 ± 9.93. Wasting Syndrome (WS) was found in 139 patients whose basic illness did not explain it 76. Conclusions: The quality and quantity of the food intake is inadequate and there is a high percentage of SDO in patients without a medical justification for this(AU)
Assuntos
Humanos , Masculino , Feminino , Peso Corporal , Estado Nutricional , Desnutrição Proteico-Calórica/complicações , Programas e Políticas de Nutrição e Alimentação , Vigilância Alimentar e NutricionalRESUMO
NEW FINDINGS: What is the central question of this study? In the present study, a reproducible model of maternal voluntary physical activity was developed to evaluate the adaptive response of physical activity by attenuating the effects of maternal undernutrition on physical features, reflex ontogeny and growth trajectory of offspring during development. What is the main finding and its importance? Maternal physical activity may induce neuronal maturation of sensorimotor connections impacting on the patterns of locomotor activity in malnourished offspring. Thus, physical activity should be considered as a therapeutic means of countering the effects of maternal undernutrition, by providing a useful strategy for enhancing the neuronal activity of children born to mothers who experience a restricted diet during pregnancy. This study evaluated the effects of maternal voluntary physical activity during pregnancy and lactation on somatic growth (SG), reflex ontogeny (RO) and locomotor activity (LA) of rats whose mothers were protein restricted. Virgin female Wistar rats were divided into the following six groups: control, normal protein (C-NP, n = 4); control, low protein (C-LP, n = 4); inactive, normal protein (I-NP, n = 8); inactive, low protein (I-LP, n = 7); very active, normal protein (VA-NP, n = 8); and very active, low protein (VA-LP, n = 6). Voluntary physical activity was recorded daily in dams. The LP groups were fed an 8% casein diet, whereas control groups were fed a 17% casein diet during pregnancy and lactation. Offspring were evaluated in terms of SG (body weight and length, latero-lateral skull axis and anteroposterior head axis) and RO (palmar grasp, righting, free-fall righting, negative geotaxis, cliff avoidance, auditory startle response and vibrissa placing). The LA was evaluated at 23, 45 and 60 days old in the open field. Voluntary physical activity was reduced during pregnancy and lactation independent of the maternal diet. Pups from LP dams showed delayed SG, reflex maturation and patterns of LA when compared with control pups. The C-LP and I-LP pups showed a delayed SG, RO and LA. Pups from VA-LP mothers showed no delay in SG and RO and presented a faster development of patterns of LA. Maternal voluntary physical activity attenuated the effects of LP diet on indicators of neurodevelopment and patterns of LA of offspring.
Assuntos
Sistema Nervoso/crescimento & desenvolvimento , Transtornos do Neurodesenvolvimento/prevenção & controle , Condicionamento Físico Animal/métodos , Efeitos Tardios da Exposição Pré-Natal , Desnutrição Proteico-Calórica/fisiopatologia , Fatores Etários , Fenômenos Fisiológicos da Nutrição Animal , Animais , Comportamento Animal , Modelos Animais de Doenças , Feminino , Idade Gestacional , Lactação , Fenômenos Fisiológicos da Nutrição Materna , Atividade Motora , Transtornos do Neurodesenvolvimento/etiologia , Transtornos do Neurodesenvolvimento/fisiopatologia , Estado Nutricional , Gravidez , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/psicologia , Ratos Wistar , VoliçãoRESUMO
La Displasia Ectodérmica Hipohidrótica (DEH) es una genodermatosis que se caracteriza por presentar alteraciones en las estructuras deri-vadas del ectodermo, frecuentemente se da la triada: hipohidrosis, hipotricosis e hipodoncia. El síndrome puede manifestarse como heren-cia autosómica dominante o recesiva y tam-bién como herencia ligada al sexo, la forma más frecuente es la de herencia recesiva relacionada al cromosoma X con sujetos de sexo masculino afectados y de sexo femenino portadores. Puede ocurrir a través de mutacio-nes autosómicas, de las cuales las del gen EDA1 son responsables del 58% de los casos. La DEH presenta tasa de mortalidad infantil entre 2% y 20%, dependiendo de la precocidad del diag-nóstico y de los protocolos de tratamiento. Este artículo presenta un paciente de 23 meses de edad quien había sido hospitalizado por otra-patología y se re rió al Instituto Hondureño de Seguridad Social (IHSS), por observar cabello hipopigmentado, escaso, no, ausencia de pestañas y cejas, dientes cónicos e hipohidro-sis: por lo que se diagnostica displasia ectodér-mica hipohidrótica, quedando pendiente la realización de biopsia de piel y exámenes genéticos debido a que no se cuenta con el equipo médico necesario. Por tal motivo, no se conoció el patrón de segregación...(AU)
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Humanos , Masculino , Lactente , Aberrações Cromossômicas , Desnutrição Proteico-Calórica/complicações , Ectoderma/anormalidades , Displasia Ectodérmica Hipo-Hidrótica Autossômica Recessiva/complicaçõesRESUMO
BACKGROUND: The use of enteral formulas with immunonutrients in patients with gastrointestinal malignancies susceptible to surgery can reduce postoperative morbidity, at the expense of reduced infectious complications, with the consequent reduction in hospital stay and health care costs. MATERIAL AND METHODS: Prospective randomized study. 84 patients operated on a scheduled basis for resectable colorectal cancer were recruited. In the group YES IN Impact © Oral was administered for 8 days (3 sachets a day), compared with the NOT IN group who did not receive it. RESULTS: 40.5% (17) patients without immunonutrition suffered infectious complications vs. 33.3% (14) of YES IN. In patients with rectal cancer NOT IN, 50% (8) suffered minor infectious complications (p=.028). In each group (YES IN, NOT IN, colon and rectal cancer) when infectious complications were observed, the variables total hospital stay and costs doubled, with significant differences. These variables showed higher values in the group NOT IN compared with those who received immunonutrition, although these differences were not statistically significant. CONCLUSIONS: NOT IN patients suffered infectious complications more frequently than YES IN, with significant results in the subgroup of patients with rectal cancer. The total hospital stay and costs were slightly higher in the group not supplemented, doubling in each category significantly (YES IN, NOT IN, colon and rectal cancer), when infectious complications were observed.
Assuntos
Adenocarcinoma/cirurgia , Neoplasias Colorretais/cirurgia , Nutrição Enteral , Custos de Cuidados de Saúde/estatística & dados numéricos , Cuidados Pré-Operatórios/métodos , Adenocarcinoma/complicações , Adenocarcinoma/economia , Adenocarcinoma/imunologia , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/complicações , Neoplasias Colorretais/economia , Neoplasias Colorretais/imunologia , Proteínas Alimentares/administração & dosagem , Nutrição Enteral/economia , Feminino , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/economia , Estudos Prospectivos , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/dietoterapiaRESUMO
Pancreatic beta cell (ß) dysfunction is an outcome of malnutrition. We assessed the role of the amplifying pathway (AMP PATH) in ß cells in malnourished obese mice. C57Bl-6 mice were fed a control (C) or a low-protein diet (R). The groups were then fed a high-fat diet (CH and RH). AMP PATH contribution to insulin secretion was assessed upon incubating islets with diazoxide and KCl. CH and RH displayed increased glucose intolerance, insulin resistance and glucose-stimulated insulin secretion. Only RH showed a higher contribution of the AMP PATH. The mitochondrial membrane potential of RH was decreased, and ATP flux was unaltered. In RH islets, glutamate dehydrogenase (GDH) protein content and activity increased, and the AMP PATH contribution was reestablished when GDH was blunted. Thus, protein malnutrition induces mitochondrial dysfunction in ß cells, leading to an increased contribution of the AMP PATH to insulin secretion through the enhancement of GDH content and activity.
Assuntos
Envelhecimento/patologia , Insulina/metabolismo , Desnutrição Proteico-Calórica/metabolismo , Animais , Intolerância à Glucose/complicações , Intolerância à Glucose/metabolismo , Intolerância à Glucose/patologia , Glutamato Desidrogenase/metabolismo , Resistência à Insulina , Secreção de Insulina , Ilhotas Pancreáticas/metabolismo , Ilhotas Pancreáticas/patologia , Camundongos Endogâmicos C57BL , Camundongos Obesos , Mitocôndrias/metabolismo , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/patologiaRESUMO
BACKGROUND: Hepatitis C is a liver disease that causes significant changes in metabolism, and also has an impact on nutritional status. OBJECTIVE: To evaluate the nutritional status and cardiovascular risk in patients with chronic hepatitis C. METHODS: This cross-sectional study investigated 58 patients with chronic hepatitis C, non-cirrhotic and were not under active pharmacological treatment. Patients with significant alcohol consumption (greater than 10 g ethanol/day) were excluded. Patients underwent nutritional assessment through anthropometric measurements and functional assessment using hand grip strength by dynamometry. The physical activity was assessed using the International Physical Activity Questionnaire. Patients also underwent clinical and laboratory evaluation. Cardiovascular risk was calculated by the Framingham score. RESULTS: The mean age of patients was 51.6±9.7 years, 55.2% were female, and 79.3% had genotype 1. The most prevalent degree of fibrosis was F1 (37.9%) followed by F2 (27.6%) and F3 (1.7%). The prevalence of overweight/obesity considering the body mass index was 70.7%. However, 57.7% of men and 68.8% of women were considered malnourished according to hand grip strength. These patients also had waist circumference (93.5±10.7 cm) and neck circumference (37.0±3.6 cm) high. Almost 60% of patients were considered sedentary or irregularly active. In relation to cardiovascular risk, 50% of patients had high risk of suffering a cardiovascular event within 10 years. CONCLUSION: Although most patients with hepatitis C presented overweight, associated with high cardiovascular risk, they also have reduced functional capacity, indicative of protein-caloric commitment. Therefore, body mass index can not be considered the only method of assessment for nutritional diagnosis of patients with liver disease. Adopting methods such as hand grip strength can be important for a better understanding of nutritional status of these patients.
Assuntos
Doenças Cardiovasculares/etiologia , Força da Mão/fisiologia , Hepatite C Crônica/complicações , Obesidade/complicações , Desnutrição Proteico-Calórica/complicações , Doenças Cardiovasculares/fisiopatologia , Estudos Transversais , Feminino , Hepatite C Crônica/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Obesidade/fisiopatologia , Prevalência , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/fisiopatologia , Fatores de RiscoRESUMO
BACKGROUND: Early childhood malnutrition affects 113 million children worldwide, impacting health and increasing vulnerability for cognitive and behavioral disorders later in life. Molecular signatures after childhood malnutrition, including the potential for intergenerational transmission, remain unexplored. METHODS: We surveyed blood DNA methylomes (~483,000 individual CpG sites) in 168 subjects across two generations, including 50 generation 1 individuals hospitalized during the first year of life for moderate to severe protein-energy malnutrition, then followed up to 48 years in the Barbados Nutrition Study. Attention deficits and cognitive performance were evaluated with the Connors Adult Attention Rating Scale and Wechsler Abbreviated Scale of Intelligence. Expression of nutrition-sensitive genes was explored by quantitative reverse transcriptase polymerase chain reaction in rat prefrontal cortex. RESULTS: We identified 134 nutrition-sensitive, differentially methylated genomic regions, with most (87%) specific for generation 1. Multiple neuropsychiatric risk genes, including COMT, IFNG, MIR200B, SYNGAP1, and VIPR2 showed associations of specific methyl-CpGs with attention and IQ. IFNG expression was decreased in prefrontal cortex of rats showing attention deficits after developmental malnutrition. CONCLUSIONS: Early childhood malnutrition entails long-lasting epigenetic signatures associated with liability for attention and cognition, and limited potential for intergenerational transmission.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Comportamento Animal , Disfunção Cognitiva/etiologia , Metilação de DNA , Epigênese Genética , Córtex Pré-Frontal/metabolismo , Desnutrição Proteico-Calórica/complicações , Adolescente , Adulto , Animais , Transtorno do Deficit de Atenção com Hiperatividade/genética , Barbados , Disfunção Cognitiva/genética , Metilação de DNA/genética , Modelos Animais de Doenças , Epigênese Genética/genética , Seguimentos , Humanos , Lactente , Pessoa de Meia-Idade , Inquéritos Nutricionais , Desnutrição Proteico-Calórica/genética , Ratos , Adulto JovemRESUMO
ABSTRACT Background Hepatitis C is a liver disease that causes significant changes in metabolism, and also has an impact on nutritional status. Objective To evaluate the nutritional status and cardiovascular risk in patients with chronic hepatitis C. Methods This cross-sectional study investigated 58 patients with chronic hepatitis C, non-cirrhotic and were not under active pharmacological treatment. Patients with significant alcohol consumption (greater than 10 g ethanol/day) were excluded. Patients underwent nutritional assessment through anthropometric measurements and functional assessment using hand grip strength by dynamometry. The physical activity was assessed using the International Physical Activity Questionnaire. Patients also underwent clinical and laboratory evaluation. Cardiovascular risk was calculated by the Framingham score. Results The mean age of patients was 51.6±9.7 years, 55.2% were female, and 79.3% had genotype 1. The most prevalent degree of fibrosis was F1 (37.9%) followed by F2 (27.6%) and F3 (1.7%). The prevalence of overweight/obesity considering the body mass index was 70.7%. However, 57.7% of men and 68.8% of women were considered malnourished according to hand grip strength. These patients also had waist circumference (93.5±10.7 cm) and neck circumference (37.0±3.6 cm) high. Almost 60% of patients were considered sedentary or irregularly active. In relation to cardiovascular risk, 50% of patients had high risk of suffering a cardiovascular event within 10 years. Conclusion Although most patients with hepatitis C presented overweight, associated with high cardiovascular risk, they also have reduced functional capacity, indicative of protein-caloric commitment. Therefore, body mass index can not be considered the only method of assessment for nutritional diagnosis of patients with liver disease. Adopting methods such as hand grip strength can be important for a better understanding of nutritional status of these patients.
RESUMO Contexto A hepatite C é uma doença hepática que provoca alterações importantes no metabolismo e também tem impacto no estado nutricional. Objetivo Avaliar o estado nutricional e o risco cardiovascular em pacientes com hepatite C crônica. Métodos Este estudo transversal investigou 58 pacientes com hepatite C crônica, não cirróticos e que não estavam sob tratamento farmacológico ativo. Pacientes com consumo de álcool significativo (maior de 10 g de etanol/dia) foram excluídos. Os pacientes realizaram avaliação nutricional, através de medidas antropométricas, e avaliação funcional, através da medida da força do aperto de mão pela dinamometria. A prática de atividade física foi avaliada através do Questionário Internacional de Atividade Física. Os pacientes também passaram por avaliação clínica e laboratorial. O risco cardiovascular foi calculado pelo escore de Framingham. Resultados A média de idade dos pacientes foi 51,6±9,7 anos, 55,2% eram do sexo feminino, e 79,3% apresentavam genótipo 1. O grau de fibrose mais prevalente foi F1 (37,9%), seguido por F2 (27,6%) e F3 (1,7%). A prevalência de sobrepeso/obesidade considerando o índice de massa corporal foi de 70,7%. No entanto, 57,7% dos homens e 68,8% das mulheres foram considerados desnutridos de acordo com a força do aperto de mão. Estes pacientes também apresentaram circunferência da cintura (93,5±10,7 cm) e circunferência do pescoço (37,0±3,6 cm) elevados. Quase 60% dos pacientes foram considerados sedentários ou irregularmente ativos. Em relação ao risco cardiovascular, 50% dos pacientes apresentou elevado risco de sofrer evento cardiovascular em 10 anos. Conclusão Apesar de grande parte dos pacientes com hepatite C apresentarem excesso de peso, associado a alto risco cardiovascular, os mesmos também apresentaram diminuição da capacidade funcional, indicativa de comprometimento proteico-calórico. Portanto, o índice de massa corporal não pode ser considerado o único método de avaliação para diagnóstico nutricional de pacientes com doença hepática. Adotar métodos como a força do aperto de mão pode ser importante para uma melhor compreensão do estado nutricional destes pacientes.
Assuntos
Humanos , Masculino , Feminino , Doenças Cardiovasculares/etiologia , Desnutrição Proteico-Calórica/complicações , Força da Mão/fisiologia , Hepatite C Crônica/complicações , Hepatite C Crônica/fisiopatologia , Obesidade/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Avaliação Nutricional , Prevalência , Estudos Transversais , Fatores de Risco , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/fisiopatologia , Pessoa de Meia-Idade , Obesidade/complicaçõesRESUMO
BACKGROUND: Prenatal protein malnutrition disrupts the pattern of maturation and development of the hippocampus and its neuroanatomy and increases inhibition of the granular cell layer of the fascia dentata. If local gamma-aminobutyric acid inter-neurons are partly responsible for inhibition of the hippocampus, it is reasonable to assume that there may be an increase in the gamma-aminobutyric acid cell population of prenatal protein malnutrition rats. OBJECTIVE: This experimental study was conducted to ascertain the effects of prenatal protein malnutrition on the density of GABAergic interneurons at the cornus ammonis and fascia dentata in rats. METHODS: Animals were investigated under two nutritional conditions: (i) prenatal protein malnutrition group fed 6% protein, and (ii) well-nourished control group fed 25% protein. Using an antibody for gamma-aminobutyric acid, immunoreactive cells (GABAergic) were assessed in the rostral-caudal direction of the dorsal hippocampus at four levels. RESULTS: (i) In 30-day-old rats with prenatal malnutrition, the fascia dentata had an average of 27% more GABAergic cells than the control group; this higher amount was not detectable at 90 days. (ii) There was a significant 18% increase in GABAergic neurons at level 1 of the cornus ammonis at 90 days of age. CONCLUSIONS: There was an increase in the population of interneurons in the fascia dentata and cornus ammonis in prenatal protein malnutrition rats. We conclude that prenatal hypoprotein malnutrition produces changes at 30 days in the fascia dentata. Results suggest that prenatal malnutrition also produces a delay in the programmed chronology of gamma-aminobutyric acid interneurons. Finally, in cornus ammonis, at 90 days of age, prenatal protein malnutrition showed an increase only at level 1; this effect may be evidenced in the long term, despite postnatal rehabilitation.
Assuntos
Hipocampo/patologia , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Desnutrição Proteico-Calórica/complicações , Ácido gama-Aminobutírico/metabolismo , Fatores Etários , Animais , Giro Denteado/metabolismo , Feminino , Interneurônios/metabolismo , Masculino , Gravidez , Ratos , Ratos WistarRESUMO
The aim of this study was to evaluate the effects of the protein-calorie malnutrition in BALB/c isogenic mice infected with Lacazia loboi, employing nutritional and histopathological parameters. Four groups were composed: G1: inoculated with restricted diet, G2: not inoculated with restricted diet, G3: inoculated with regular diet, G4: not inoculated with regular diet. Once malnutrition had been imposed, the animals were inoculated intradermally in the footpad and after four months, were sacrificed for the excision of the footpad, liver and spleen. The infection did not exert great influence on the body weight of the mice. The weight of the liver and spleen showed reduction in the undernourished groups when compared to the nourished groups. The macroscopic lesions, viability index and total number of fungi found in the footpads of the infected mice were increased in G3 when compared to G1. Regarding the histopathological analysis of the footpad, a global cellularity increase in the composition of the granuloma was observed in G3 when compared to G1, with large numbers of macrophages and multinucleated giant cells, discrete numbers of lymphocytes were present in G3 and an increase was observed in G1. The results suggest that there is considerable interaction between Jorge Lobo's disease and nutrition.
Assuntos
Lacazia , Lobomicose/complicações , Estado Nutricional , Desnutrição Proteico-Calórica/complicações , Animais , Modelos Animais de Doenças , Fígado/microbiologia , Fígado/patologia , Lobomicose/patologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Tamanho do Órgão , Desnutrição Proteico-Calórica/microbiologia , Desnutrição Proteico-Calórica/patologia , Baço/microbiologia , Baço/patologiaRESUMO
SUMMARY The aim of this study was to evaluate the effects of the protein-calorie malnutrition in BALB/c isogenic mice infected with Lacazia loboi, employing nutritional and histopathological parameters. Four groups were composed: G1: inoculated with restricted diet, G2: not inoculated with restricted diet, G3: inoculated with regular diet, G4: not inoculated with regular diet. Once malnutrition had been imposed, the animals were inoculated intradermally in the footpad and after four months, were sacrificed for the excision of the footpad, liver and spleen. The infection did not exert great influence on the body weight of the mice. The weight of the liver and spleen showed reduction in the undernourished groups when compared to the nourished groups. The macroscopic lesions, viability index and total number of fungi found in the footpads of the infected mice were increased in G3 when compared to G1. Regarding the histopathological analysis of the footpad, a global cellularity increase in the composition of the granuloma was observed in G3 when compared to G1, with large numbers of macrophages and multinucleated giant cells, discrete numbers of lymphocytes were present in G3 and an increase was observed in G1. The results suggest that there is considerable interaction between Jorge Lobo's disease and nutrition.
RESUMO O objetivo do estudo foi avaliar os efeitos da desnutrição protéico-calórica em camundongos isogênicos da linhagem BALB/c inoculados com Lacazia loboi, empregando parâmetros nutricionais e histopatológicos. Foram constituídos quatro grupos: G1- inoculados com restrição dietética; G2- não inoculados com restrição dietética; G3- inoculados sem restrição dietética; G4- não inoculados sem restrição dietética. Após instalada a desnutrição, os animais foram inoculados via intradérmica no coxim plantar e após quatro meses foram sacrificados para remoção do coxim plantar, fígado e baço. A infecção não exerceu grande influência no peso corporal dos camundongos. O peso do fígado e baço apresentou redução nos grupos desnutridos em comparação aos grupos nutridos. A lesão macroscópica, a viabilidade e o número total de fungos dos coxins plantares dos camundongos inoculados revelaram aumento no G3 quando comparado com o G1. Em relação à análise histopatológica dos coxins plantares observou-se aumento da celularidade global na composição do granuloma no G3 em relação ao G1, com grande número de macrófagos e células gigantes multinucleadas, discretos números de linfócitos estavam presentes em G3 e aumentados no G1. Os resultados sugerem que existe grande interação entre nutrição e doença de Jorge Lobo.
Assuntos
Animais , Masculino , Camundongos , Lacazia , Lobomicose/complicações , Estado Nutricional , Desnutrição Proteico-Calórica/complicações , Modelos Animais de Doenças , Fígado/microbiologia , Fígado/patologia , Lobomicose/patologia , Camundongos Endogâmicos BALB C , Tamanho do Órgão , Desnutrição Proteico-Calórica/microbiologia , Desnutrição Proteico-Calórica/patologia , Baço/microbiologia , Baço/patologiaRESUMO
BACKGROUND: during recent years consistent studies have characterized the relationship between moderate and severe protein-calorie malnutrition and the appearance of non-communicable diseases in adulthood like metabolic syndrome (MS). AIM: to analyze the relationship between moderate and severe protein-calorie malnutrition during the first 1 000 days of life and the MS in a cohort of adults from Curicó, Chile. MATERIAL AND METHODS: we studied 49 young adults who had suffered moderate to severe protein-calorie malnutrition during their first two years of life. Anthropometry, blood pressure measurement and laboratory tests were performed, and the burden of MS attributes was determined. RESULTS: the prevalence of MS was 14.3% with no significant differences by gender, showing a direct and significant association between burden of MS and body mass index, waist / height index, blood pressure, plasma levels of glucose and triglyceride, and an inverse association with HDL. CONCLUSION: systolic blood pressure and plasma level of triglyceride represented the most important risk factors for SM in this cohort. We found no association between the presence of protein-calorie malnutrition and MS.
Introducción: estudios consistentes durante los últimos años han caracterizado la relación entre la desnutrición calórico-proteica (DCP) y el desarrollo de enfermedades no transmisibles en la adultez, como el Síndrome Metabólico (SM). Objetivo: analizar la relación entre SM en la adultez y la DCP durante los primeros 1.000 días de vida en una cohorte de adultos recientemente generada en Curicó, Chile. Material y métodos: se analizaron 49 sujetos adultos jóvenes que durante sus primeros dos años de vida sufrieron desnutrición calórico-proteica moderada a severa mediante la realización de antropometría, medición de la presión arterial y exámenes de laboratorio. Se determinó la prevalencia del SM y la carga de sus atributos. Resultados: se obtuvo una prevalencia de SM del 14,3% sin diferencias significativas por género, con una asociación directa y notable entre la carga de SM, el índice de masa corporal (IMC), el índice cintura/talla, presión arterial y niveles plasmáticos de glicemia y triglicéridos (TG), y una asociación inversa con colesterol HDL. Conclusión: la presión arterial sistólica y el valor plasmático de TG representaron los factores de riesgo más importantes del SM en esta cohorte. No se encontró asociación entre la DCP en los 1.000 primeros días de vida y el SM en la adultez.
Assuntos
Síndrome Metabólica/etiologia , Síndrome Metabólica/metabolismo , Estado Nutricional , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/epidemiologia , Fatores Etários , Biomarcadores , Índice de Massa Corporal , Pesos e Medidas Corporais , Pré-Escolar , Chile/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Síndrome Metabólica/epidemiologia , Prevalência , Fatores de Risco , Adulto JovemRESUMO
The aim of this study was to evaluate the effects of the protein-calorie malnutrition in BALB/c isogenic mice infected with Lacazia loboi, employing nutritional and histopathological parameters. Four groups were composed: G1: inoculated with restricted diet, G2: not inoculated with restricted diet, G3: inoculated with regular diet, G4: not inoculated with regular diet. Once malnutrition had been imposed, the animals were inoculated intradermally in the footpad and after four months, were sacrificed for the excision of the footpad, liver and spleen. The infection did not exert great influence on the body weight of the mice. The weight of the liver and spleen showed reduction in the undernourished groups when compared to the nourished groups. The macroscopic lesions, viability index and total number of fungi found in the footpads of the infected mice were increased in G3 when compared to G1. Regarding the histopathological analysis of the footpad, a global cellularity increase in the composition of the granuloma was observed in G3 when compared to G1, with large numbers of macrophages and multinucleated giant cells, discrete numbers of lymphocytes were present in G3 and an increase was observed in G1. The results suggest that there is considerable interaction between Jorge Lobo's disease and nutrition
O objetivo do estudo foi avaliar os efeitos da desnutrição protéico-calórica em camundongos isogênicos da linhagem BALB/c inoculados com Lacazia loboi, empregando parâmetros nutricionais e histopatológicos. Foram constituídos quatro grupos: G1- inoculados com restrição dietética; G2- não inoculados com restrição dietética; G3- inoculados sem restrição dietética; G4- não inoculados sem restrição dietética. Após instalada a desnutrição, os animais foram inoculados via intradérmica no coxim plantar e após quatro meses foram sacrificados para remoção do coxim plantar, fígado e baço. A infecção não exerceu grande influência no peso corporal dos camundongos. O peso do fígado e baço apresentou redução nos grupos desnutridos em comparação aos grupos nutridos. A lesão macroscópica, a viabilidade e o número total de fungos dos coxins plantares dos camundongos inoculados revelaram aumento no G3 quando comparado com o G1. Em relação à análise histopatológica dos coxins plantares observou-se aumento da celularidade global na composição do granuloma no G3 em relação ao G1, com grande número de macrófagos e células gigantes multinucleadas, discretos números de linfócitos estavam presentes em G3 e aumentados no G1. Os resultados sugerem que existe grande interação entre nutrição e doença de Jorge Lobo
Assuntos
Animais , Camundongos , Desnutrição Proteico-Calórica/complicações , Estado Nutricional , Fígado/patologia , Lacazia , Lobomicose/complicações , Baço/microbiologia , Baço/patologia , Camundongos Endogâmicos BALB C , Desnutrição Proteico-Calórica/microbiologia , Desnutrição Proteico-Calórica/patologia , Fígado/microbiologia , Modelos Animais de Doenças , Tamanho do ÓrgãoRESUMO
An analysis was conducted to evaluate if the severity of caries is associated with protein-calorie malnutrition in preschool children. The cross-sectional study was performed on a retrospective cohort of 625 children aged 24-71 months attending daycare centers in São Luís, Maranhão. A hierarchical model was evaluated at five levels: 1.) Socio-economic variables (economic group, mother's educational level and skin color); 2) Access variables; 3) Low birth weight (LBW) and exclusive breastfeeding; 4) Weight per height at 12 months; and 5) Severity of caries and albumin (Alb) levels. The outcome was protein-calorie malnourishment (weight per height z score < -2). The prevalence of outcome was 5.0% and the prevalence of caries was 32%. At the first level, the variables were not associated with the outcome, but the economic group was maintained until the final model. The variables in the second and third levels were not significant. At the fourth level, weight for height at 12 months was not significant, but was maintained until the final model. In the last level, severity of caries was positively associated with malnourishment. The association between severity of caries and malnourishment suggest that oral health should be integrated with public health care policies for children.