RESUMO
BACKGROUND: At least 80% of children with cancer live in low- and middle-income countries where the prevalence of malnutrition and socioeconomic disadvantage is high. We examined the relationship between nutritional status (NS), assessed by arm anthropometry, and socioeconomic status (SES) in children diagnosed with cancer at Unidad Nacional de Oncologia Pediatrica (UNOP) in Guatemala over a three-year period. METHOD: Patients aged 0 to 18 years of age diagnosed between January 2015 and December 2017 were included. NS was evaluated by mid-upper arm circumference, triceps skin fold thickness, and serum albumin level, and subjects were classified as adequately nourished, moderately depleted, and severely depleted nutritionally. SES was measured by a 15-item instrument developed at UNOP. RESULTS: Of 1365 patients diagnosed in the study period, 1060 (78%) fulfilled the eligibility criteria. Only 6% of patients were classified as medium to high, the remainder as medium-low to extremely low SES. Almost 47% were severely depleted at diagnosis, 19% moderately depleted, and 34% adequately nourished. SES was shown to be a determinant of NS; with progressively lower SES, the probability of a decline in NS increased by a factor of 1.04 points (P < 0.0001). Leukemia and lymphoma were also important predictors of nutritional depletion with odds ratios of 6.08 (95% CI, 1.74-28.28; P = 0.008) for leukemias and 4.83 (95% CI, 1.33-23.03; P = 0.03) for lymphomas. CONCLUSION: Both low SES and a diagnosis of leukemia or lymphoma are strong predictors of poor NS at diagnosis in children with cancer in Guatemala.
Assuntos
Transtornos da Nutrição Infantil/fisiopatologia , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Classe Social , Fatores Socioeconômicos , Adolescente , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Feminino , Seguimentos , Guatemala/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Estado Nutricional , Prognóstico , Estudos RetrospectivosRESUMO
The micronutrient vitamin A refers to a group of compounds with pleiotropic effects on human health. These molecules can modulate biological functions, including development, vision, and regulation of the intestinal barrier. The consequences of vitamin A deficiency and supplementation in children from developing countries have been explored for several years. These children live in an environment that is highly contaminated by enteropathogens, which can, in turn, influence vitamin A status. Vitamin A has been described to modulate gene expression, differentiation and function of diverse immune cells; however, the underlying mechanisms are not fully elucidated. This review aims to summarize the most updated advances on elucidating the vitamin A effects targeting intestinal immune and barrier functions, which may help in further understanding the burdens of malnutrition and enteric infections in children. Specifically, by covering both clinical and in vivo/in vitro data, we describe the effects of vitamin A related to gut immune tolerance/homeostasis, intestinal barrier integrity, and responses to enteropathogens in the context of the environmental enteric dysfunction. Some of the gaps in the literature that require further research are also highlighted.
Assuntos
Transtornos da Nutrição Infantil/imunologia , Doenças Transmissíveis/metabolismo , Imunidade nas Mucosas , Enteropatias/metabolismo , Mucosa Intestinal/metabolismo , Desnutrição/metabolismo , Deficiência de Vitamina A/metabolismo , Vitamina A/metabolismo , Fatores Etários , Animais , Criança , Transtornos da Nutrição Infantil/metabolismo , Transtornos da Nutrição Infantil/fisiopatologia , Transtornos da Nutrição Infantil/terapia , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Doenças Transmissíveis/imunologia , Doenças Transmissíveis/fisiopatologia , Doenças Transmissíveis/terapia , Suplementos Nutricionais , Interações Hospedeiro-Patógeno , Humanos , Lactente , Enteropatias/imunologia , Enteropatias/fisiopatologia , Enteropatias/terapia , Mucosa Intestinal/imunologia , Mucosa Intestinal/fisiopatologia , Desnutrição/imunologia , Desnutrição/fisiopatologia , Desnutrição/terapia , Estado Nutricional , Permeabilidade , Transdução de Sinais , Vitamina A/administração & dosagem , Vitamina A/imunologia , Deficiência de Vitamina A/imunologia , Deficiência de Vitamina A/fisiopatologia , Deficiência de Vitamina A/terapiaRESUMO
The analysis of nutritional status is anthropologically important to address the complex interaction of biological, social, political, economic and cultural factors. To deepen the knowledge about contexts of occurrence of child malnutrition, we analyzed nutritional status in relation to socio-environmental conditions of residence in children between three and six years from Villaguay, Entre Ríos, Argentina. We performed a cross-sectional study of 1,435 school children of both sexes. Body weight and height were measured and prevalence of low height/age (LH/A), low weight/age (LW/A), low BMI/age (LBMI/A), overweight (Ow) and obesity (Ob) was calculated using World Health Organization reference charts. Socio-environmental information was obtained through a semi-structured survey and processed by Categorical Principal Component Analysis (CatPCA). Anthropometric data showed 1.5% LW/A, 5.2% LH/A; 0.6% LBMI/A, 20.9% Ow and 10.9% Ob. CatPCA allowed us to define four groups (G1-G4) with better (G2), middle (G1) and worst (G4) urban socio-environmental conditions and one with rural characteristics (G3). G4 presented the highest LH/A prevalence and G2 the highest Ow and Ob prevalence (P<0.05). It is concluded that since the distribution of malnutrition was not even it may dependent on the context in which children grow up. Thus, the higher the socio-economic level, the higher the incidence of overweight and obesity. Conversely, at the other end of the social scale, undernutrition and increasing weight excess remained major health problems.
Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Desnutrição/epidemiologia , Sobrepeso/epidemiologia , Argentina/epidemiologia , Estatura/fisiologia , Índice de Massa Corporal , Peso Corporal/fisiologia , Criança , Transtornos da Nutrição Infantil/etiologia , Transtornos da Nutrição Infantil/fisiopatologia , Pré-Escolar , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Desnutrição/etiologia , Desnutrição/fisiopatologia , Análise Multivariada , Estado Nutricional , Obesidade/epidemiologia , Obesidade/etiologia , Obesidade/fisiopatologia , Sobrepeso/etiologia , Sobrepeso/fisiopatologia , Prevalência , Fatores SocioeconômicosRESUMO
Con el objetivo de reducir la desnutrición crónica de niños que asisten 6 jardines infantiles en la Ciudad de Guatemala, se utilizó una bebida a base de soya y maíz como vehículo para el aporte de 21 micronutrientes con niveles elevados de hierro (12mg) y zinc (9mg) y se ofreció a 747 niños entre los 6 meses y 6 años. Se realizó seguimiento antropométrico cada 3m, Hb cada 6m y se registró el número de episodios de enfermedad diarreica aguda e infección respiratoria aguda a lo largo de la intervención. Un ANOVA longitudinal de medidas repetidas demostró que la media de la Hb mejoró de manera significativa a los 6 y 12m de recibir la bebida fortificada (11,26, 11,64, y 11,89g/dL, respectivamente), p<0,01; la prevalencia de anemia disminuyó 44,2% después de 12m, p<0,01; la media del puntaje z de talla para la edad también mejoró, -1,25 (0m) y -1,07 (12m), p<0.01; la prevalencia de retardo del crecimiento disminuyó 25% a los 12m. Se observó una disminución significativa en la prevalencia de infección respiratoria aguda y no se observaron cambios en la prevalencia de diarrea. Un estudio de aceptabilidad demostró que los niños consumen más del 98% del producto. Los resultados sugieren que la intervención con el atole fortificado mejora el estado nutricional y de salud de los niños. El producto es aceptado por los niños y el personal de los jardines infantiles(AU)
With the aim to reduce chronic undernutrition in children that attended 6 Guatemala City daycare centers, a corn and soy-based beverage was used as a vehicle to provide 21 micronutrients and high concentrations of iron (12mg) and zinc (9 mg) and was provided to747 children aged 6 to 72 months. Children were followed for anthropometry every 3m, hemoglobin every 6m, and episodes of acute diarrhea and respiratory tract infections were registered throughout the intervention. A longitudinal Repeated Measures ANOVA demonstrated that mean hemoglobin significantly improved at 6 and 12m of receiving the beverage (11.26, 11.64, and 11.89g/dL, respectively), p<0.01; the prevalence of anemia decreased by 44.2% after 12m, p<0.01; mean height-for-age z score improved from -1.25 (0m) to -1.07 (12m), p<0.01; the prevalence of stunting decreased by 25% after 12m. A significant decrease in the prevalence of acute respiratory infection was observed. No changes were observed in the prevalence of diarrhea. Moreover, an acceptability study showed that children consumed more than 98% of the atole. These results suggest that this nutrition intervention with the fortified atole improves the health and nutritional status of children. The product is widely accepted by the children and staff at the nurseries(AU)
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Transtornos da Nutrição Infantil/fisiopatologia , Diarreia Infantil/etiologia , Insuficiência de Crescimento/etiologia , Anemia/complicações , Ferro/administração & dosagem , Zea mays , Alimentos de Soja , Alimentos, Dieta e NutriçãoRESUMO
Malnutrition results in serious consequences for growth and cognitive development in children. We studied select child and maternal biologic factors, socioeconomic factors, enteric pathogenic burden and gut function biomarkers in 402 children 6-24 months of age in Northeastern Brazil. In this prospective case-control study, not being fed colostrum [odds ratio (OR): 3.29, 95% confidence interval (CI): 1.73-6.26], maternal age ≥18 years (OR: 1.88, 95% CI: 1.10-3.22) and no electric fan (OR: 2.46, 95% CI: 1.22-4.96) or bicycle (OR: 1.80, 95% CI: 1.10-2.95) in the household were positively associated, and higher birth weight (OR: 0.27, 95% CI: 0.19-0.38), larger head circumference (OR: 0.74, 95% CI: 0.66-0.82) and shortness of breath in the last 2 weeks (OR: 0.49, 95% CI: 0.27-0.90) were negatively associated with malnutrition. Subclinical enteric pathogen infections were common, and enteroaggregative Escherichia coli infections were more prevalent in malnourished children (P = 0.045). Biomarkers such as the lactulose-mannitol test, myeloperoxidase, neopterin and calprotectin were highly elevated in both malnourished and nourished children. Nourished children had a better systemic immune response than the malnourished children, as detected by elevated serum amyloid A-1 and soluble cluster of differentiation protein 14 biomarkers (P < 0.001). Serum amyloid A-1 and soluble cluster of differentiation protein 14 were also associated with better nutritional Z scores. Neonatal, maternal and socioeconomic factors were associated with malnutrition in children. There was a substantial subclinical enteric pathogen burden, particularly with enteroaggregative E. coli, in malnourished children.
Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/fisiopatologia , Desnutrição/epidemiologia , Desnutrição/fisiopatologia , Biomarcadores/sangue , Biomarcadores/metabolismo , Brasil/epidemiologia , Estudos de Casos e Controles , Transtornos da Nutrição Infantil/metabolismo , Transtornos da Nutrição Infantil/microbiologia , Pré-Escolar , Escherichia coli Enteropatogênica , Infecções por Escherichia coli , Proteínas de Ligação a Ácido Graxo/sangue , Humanos , Lactente , Inflamação , Desnutrição/metabolismo , Desnutrição/microbiologia , Estudos Prospectivos , Proteína Amiloide A Sérica/análiseRESUMO
Abstract Objective: To compare the autonomic behavior between malnourished children and a control group using analysis of heart rate variability (HRV). Method: Data were analyzed from 70 children who were divided into two groups: malnourished and eutrophic, according to the Z-score nutritional status for height and age. For analysis of HRV indices, heart rate was recorded beat to beat with the child in the supine position for 20 min. The analysis of these indices was performed using linear methods, analyzed in the time and frequency domains. Student's t-test for unpaired data and the Mann-Whitney test were used to compare variables between groups, with a significance level of 5%. Results: A reduction in systolic and diastolic blood pressure and an increase in heart rate were found in malnourished children compared to eutrophic children. The HRV indices suggested that malnourished children present reductions in both sympathetic and parasympathetic autonomic nervous system activity. The SDNN, rMSSD, NN50, pNN50, SD1, SD2, TINN, LF (ms2), and HF (ms2) indices were lower in malnourished children. Conclusion: Malnourished children present changes in cardiac autonomic modulation, characterized by reductions in both sympathetic and parasympathetic activity, as well as increased heart rate and decreased blood pressure.
Resumo Objetivo: Avaliar a modulação autonômica cardíaca de crianças desnutridas por meio da variabilidade da frequência cardíaca (VFC). Método: Foram analisadas 70 crianças com média de 3,71 anos, que foram distribuídas em dois grupos, de acordo com o estado nutricional: desnutridas (n = 35) e eutróficas (n = 35), seguindo o escore Z, para estatura e idade. Para análise dos índices da VFC, a frequência cardíaca foi captada batimento a batimento com as crianças em decúbito dorsal por 20 minutos. A análise desses índices foi feita por meio de métodos lineares, analisados nos domínios do tempo e da frequência. Teste t de Student para dados não pareados e teste de Mann-Whitney foram aplicados para comparar as variáveis entre os grupos, com nível de significância de 5%. Resultados: Redução da pressão arterial sistólica e diastólica e aumento na frequência cardíaca foram encontrados nas crianças desnutridas quando comparada com as eutróficas. Os índices da VFC sugerem que crianças desnutridas apresentam uma redução da modulação simpática e parassimpática do sistema nervoso autônomo. Os índices SDNN, rMSSD, NN50, pNN50, SD1, SD2, TINN, BF e AF em ms2 foram menores nas crianças desnutridas. Conclusão: Crianças desnutridas apresentam modificações na modulação autonômica cardíaca caracterizadas por depressão no componente simpático e no parassimpático, bem como aumento na frequência cardíaca e diminuição da pressão arterial.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Sistema Nervoso Autônomo/fisiologia , Transtornos da Nutrição Infantil/fisiopatologia , Frequência Cardíaca/fisiologia , Pressão Sanguínea/fisiologiaRESUMO
OBJECTIVE: To compare the autonomic behavior between malnourished children and a control group using analysis of heart rate variability (HRV). METHOD: Data were analyzed from 70 children who were divided into two groups: malnourished and eutrophic, according to the Z-score nutritional status for height and age. For analysis of HRV indices, heart rate was recorded beat to beat with the child in the supine position for 20min. The analysis of these indices was performed using linear methods, analyzed in the time and frequency domains. Student's t-test for unpaired data and the Mann-Whitney test were used to compare variables between groups, with a significance level of 5%. RESULTS: A reduction in systolic and diastolic blood pressure and an increase in heart rate were found in malnourished children compared to eutrophic children. The HRV indices suggested that malnourished children present reductions in both sympathetic and parasympathetic autonomic nervous system activity. The SDNN, rMSSD, NN50, pNN50, SD1, SD2, TINN, LF (ms2), and HF (ms2) indices were lower in malnourished children. CONCLUSION: Malnourished children present changes in cardiac autonomic modulation, characterized by reductions in both sympathetic and parasympathetic activity, as well as increased heart rate and decreased blood pressure.
Assuntos
Sistema Nervoso Autônomo/fisiologia , Transtornos da Nutrição Infantil/fisiopatologia , Frequência Cardíaca/fisiologia , Pressão Sanguínea/fisiologia , Pré-Escolar , Feminino , Humanos , MasculinoRESUMO
Abstract Objective: To evaluate the nutritional status of children with persistent cholestasis and to compare the anthropometric indices between children with and without liver cirrhosis and children with and without jaundice. Methods: Children with persistent cholestasis, i.e. increased direct bilirrubin or changes in the canalicular enzyme gamma-glutamyl transferase (GGT), were included. The anthropometric measures were weight (W), height or length (H), arm circumference (AC), triceps skinfold thickness (TST), arm muscle circumference (AMC), and body mass index (BMI). Results: Ninety-one children with cholestasis, with current median age of 12 months, were evaluated. W/age (A) and H/A indices below −2 Z-scores were observed in 33% and 30.8% of patients, respectively. Concerning the W/H index and BMI, only 12% and 16% of patients, respectively, were below −2 Z-scores. Regarding AC, 43.8% of 89 evaluated patients had some depletion. Observing the TST, 64% of patients had depletion, and 71.1% of the 45 evaluated patients had some degree of depletion regarding the ACM index. Conclusion: Evaluation using weight in patients with chronic liver diseases may overestimate the nutritional status due to visceromegaly, subclinical edema, or ascites. Indices that correlate weight and height, such as W/H and BMI, may also not show depletion because of the chronic condition in which there are depletion of both weight and height. TST, AC, and ACM are parameters that better estimate nutritional status and should be part of the management of patients with liver diseases and cholestasis.
Resumo Objetivo: Avaliar a situação nutricional de crianças com colestase persistente e comparar os índices antropométricos entre crianças com e sem cirrose hepática e crianças com e sem icterícia. Métodos: Foram incluídas crianças com colestase persistente, ou seja, aumento da bilirrubina direta ou alterações na enzima canalicular, gamaglutamiltransferase (GGT). As medidas antropométricas foram peso, estatura ou altura, circunferência do braço (CB), espessura da prega cutânea do tríceps (TST), circunferência muscular do braço (CMB) e índice de massa corporal (IMC). Resultados: Foram avaliadas 91 crianças com colestase, com idade média de 12 meses; 33% e 30,8% dos pacientes apresentaram índices P/I e A/I com escore Z abaixo de –2, respectivamente. Com relação ao índice P/A e IMC, somente 12% e 16% dos pacientes, respectivamente, apresentaram escore Z abaixo de –2. Com relação à CB, 43,8% de 89 pacientes avaliados apresentaram alguma depleção. Observando a TST, 64% dos pacientes que apresentaram depleção, 71,1% dos 45 pacientes avaliados apresentaram algum grau de depleção com relação ao índice de CMB. Conclusão: A avaliação do peso em pacientes com doenças hepáticas crônicas poderá superestimar a situação nutricional devido a visceromegalia, edema subclínico ou ascite. Os índices que correlacionam peso e altura, como P/A e IMC, também podem não mostrar depleção devido à doença crônica em que há depleção tanto do peso quanto da altura. A TST, BC e CMB são parâmetros que estimam melhor a situação nutricional e devem fazer parte de gestão de pacientes com doenças hepáticas e colestase.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Transtornos da Nutrição Infantil/fisiopatologia , Colestase/fisiopatologia , Icterícia/fisiopatologia , Cirrose Hepática/fisiopatologia , Dobras Cutâneas , Estatura , Peso Corporal , Transtornos da Nutrição Infantil/etiologia , Índice de Massa Corporal , Avaliação Nutricional , Colestase/complicações , Doença Crônica , Icterícia/complicações , Cirrose Hepática/complicaçõesRESUMO
Malnutrition constitutes a major public health concern worldwide and serves as an indicator of hospitalized patients’ prognosis. Although various methods with which to conduct nutritional assessments exist, large hospitals seldom employ them to diagnose malnutrition. The aim of this study was to understand the prevalence of child malnutrition at the University Hospital of the Ribeirão Preto Medical School, University of São, Brazil. A cross-sectional descriptive study was conducted to compare the nutritional status of 292 hospitalized children with that of a healthy control group (n=234). Information regarding patients’ weight, height, and bioelectrical impedance (i.e., bioelectrical impedance vector analysis) was obtained, and the phase angle was calculated. Using the World Health Organization (WHO) criteria, 35.27% of the patients presented with malnutrition; specifically, 16.10% had undernutrition and 19.17% were overweight. Classification according to the bioelectrical impedance results of nutritional status was more sensitive than the WHO criteria: of the 55.45% of patients with malnutrition, 51.25% exhibited undernutrition and 4.20% were overweight. After applying the WHO criteria in the unpaired control group (n=234), we observed that 100.00% of the subjects were eutrophic; however, 23.34% of the controls were malnourished according to impedance analysis. The phase angle was significantly lower in the hospitalized group than in the control group (P<0.05). Therefore, this study suggests that a protocol to obtain patients’ weight and height must be followed, and bioimpedance data must be examined upon hospital admission of all children.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Composição Corporal , Transtornos da Nutrição Infantil/epidemiologia , Impedância Elétrica , Índice de Massa Corporal , Brasil/epidemiologia , Transtornos da Nutrição Infantil/fisiopatologia , Estudos Transversais , Testes Diagnósticos de Rotina/métodos , Hospitalização/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Avaliação em Enfermagem , Avaliação Nutricional , Estado Nutricional/fisiologia , PrevalênciaRESUMO
Malnutrition constitutes a major public health concern worldwide and serves as an indicator of hospitalized patients' prognosis. Although various methods with which to conduct nutritional assessments exist, large hospitals seldom employ them to diagnose malnutrition. The aim of this study was to understand the prevalence of child malnutrition at the University Hospital of the Ribeirão Preto Medical School, University of São, Brazil. A cross-sectional descriptive study was conducted to compare the nutritional status of 292 hospitalized children with that of a healthy control group (n=234). Information regarding patients' weight, height, and bioelectrical impedance (i.e., bioelectrical impedance vector analysis) was obtained, and the phase angle was calculated. Using the World Health Organization (WHO) criteria, 35.27% of the patients presented with malnutrition; specifically, 16.10% had undernutrition and 19.17% were overweight. Classification according to the bioelectrical impedance results of nutritional status was more sensitive than the WHO criteria: of the 55.45% of patients with malnutrition, 51.25% exhibited undernutrition and 4.20% were overweight. After applying the WHO criteria in the unpaired control group (n=234), we observed that 100.00% of the subjects were eutrophic; however, 23.34% of the controls were malnourished according to impedance analysis. The phase angle was significantly lower in the hospitalized group than in the control group (P<0.05). Therefore, this study suggests that a protocol to obtain patients' weight and height must be followed, and bioimpedance data must be examined upon hospital admission of all children.
Assuntos
Composição Corporal , Transtornos da Nutrição Infantil/epidemiologia , Impedância Elétrica , Adolescente , Índice de Massa Corporal , Brasil/epidemiologia , Criança , Transtornos da Nutrição Infantil/fisiopatologia , Pré-Escolar , Estudos Transversais , Testes Diagnósticos de Rotina/métodos , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Lactente , Masculino , Avaliação em Enfermagem , Avaliação Nutricional , Estado Nutricional/fisiologia , Prevalência , Adulto JovemRESUMO
OBJECTIVE: To evaluate the nutritional status of children with persistent cholestasis and to compare the anthropometric indices between children with and without liver cirrhosis and children with and without jaundice. METHODS: Children with persistent cholestasis, i.e. increased direct bilirrubin or changes in the canalicular enzyme gamma-glutamyl transferase (GGT), were included. The anthropometric measures were weight (W), height or length (H), arm circumference (AC), triceps skinfold thickness (TST), arm muscle circumference (AMC), and body mass index (BMI). RESULTS: Ninety-one children with cholestasis, with current median age of 12 months, were evaluated. W/age (A) and H/A indices below -2 Z-scores were observed in 33% and 30.8% of patients, respectively. Concerning the W/H index and BMI, only 12% and 16% of patients, respectively, were below -2 Z-scores. Regarding AC, 43.8% of 89 evaluated patients had some depletion. Observing the TST, 64% of patients had depletion, and 71.1% of the 45 evaluated patients had some degree of depletion regarding the ACM index. CONCLUSION: Evaluation using weight in patients with chronic liver diseases may overestimate the nutritional status due to visceromegaly, subclinical edema, or ascites. Indices that correlate weight and height, such as W/H and BMI, may also not show depletion because of the chronic condition in which there are depletion of both weight and height. TST, AC, and ACM are parameters that better estimate nutritional status and should be part of the management of patients with liver diseases and cholestasis.
Assuntos
Transtornos da Nutrição Infantil/fisiopatologia , Colestase/fisiopatologia , Icterícia/fisiopatologia , Cirrose Hepática/fisiopatologia , Estatura , Índice de Massa Corporal , Peso Corporal , Criança , Transtornos da Nutrição Infantil/etiologia , Pré-Escolar , Colestase/complicações , Doença Crônica , Feminino , Humanos , Lactente , Icterícia/complicações , Cirrose Hepática/complicações , Masculino , Avaliação Nutricional , Dobras CutâneasRESUMO
BACKGROUND: Nearly one-half of Guatemalan children experience growth faltering, more so in indigenous than in nonindigenous children. OBJECTIVES: On the basis of ethnographic interviews in Totonicapán, Guatemala, which revealed differences in maternal perceptions about food needs in infant girls and boys, we predicted a cumulative sex difference in favor of girls that occurred at â¼6 mo of age and diminished markedly thereafter. We examined whether the predicted differences in age-sex patterns were observed in the village, replicated the examination nationally for indigenous children, and examined whether the pattern in nonindigenous children was different. DESIGN: Ethnographic interviews (n = 24) in an indigenous village were conducted. Anthropometric measurements of the village children aged 0-35 mo (n = 119) were obtained. National-level growth patterns were analyzed for indigenous (n = 969) and nonindigenous (n = 1374) children aged 0-35 mo with the use of Demographic and Health Survey (DHS) data. RESULTS: Mothers reported that, compared with female infants, male infants were hungrier, were not as satisfied with breastfeeding alone, and required earlier complementary feeding. An anthropometric analysis confirmed the prediction of healthier growth in indigenous girls than in indigenous boys throughout the first year of life, which resulted in a 2.98-cm height-for-age difference (HAD) between sexes in the village and a 1.61-cm HAD (P < 0.001) in the DHS data between 6 and 17 mo of age in favor of girls. In both data sets, the growth sex differences diminished in the second year of life (P < 0.05). No such pattern was seen in nonindigenous children. CONCLUSIONS: We propose that the differences in the HAD that first favor girls and then favor boys in the indigenous growth patterns are due to feeding patterns on the basis of gendered cultural perceptions. Circumstances that result in differential sex growth patterns need to be elucidated, in particular the favorable growth in girls in the first year of life.
Assuntos
Desenvolvimento Infantil , Transtornos da Nutrição Infantil/fisiopatologia , Métodos de Alimentação/efeitos adversos , Transtornos do Crescimento/etiologia , Transtornos da Nutrição do Lactente/fisiopatologia , Relações Mãe-Filho , Sexismo , Estatura , Transtornos da Nutrição Infantil/etnologia , Pré-Escolar , Etnopsicologia/métodos , Feminino , Gráficos de Crescimento , Transtornos do Crescimento/etnologia , Guatemala , Humanos , Indígenas Centro-Americanos/psicologia , Lactente , Transtornos da Nutrição do Lactente/etnologia , Recém-Nascido , Masculino , Relações Mãe-Filho/etnologia , Saúde da População Rural/etnologia , Fatores Sexuais , Sexismo/etnologiaRESUMO
OBJECTIVE: The objective of this study was to determine the association between preoperative nutritional status and postoperative outcomes in children undergoing surgery for congenital heart defects (CHD). METHODS: Seventy-one patients with CHD were enrolled in a prospective, 2-center cohort study. We adjusted for baseline risk differences using a standardized risk adjustment score for surgery for CHD. We assigned a World Health Organization z score for each subject's preoperative triceps skin-fold measurement, an assessment of total body fat mass. We obtained preoperative plasma concentrations of markers of nutritional status (prealbumin, albumin) and myocardial stress (B-type natriuretic peptide [BNP]). Associations between indices of preoperative nutritional status and clinical outcomes were sought. RESULTS: Subjects had a median (interquartile range [IQR]) age of 10.2 (33) months. In the University of California at San Francisco (UCSF) cohort, duration of mechanical ventilation (median, 19 hours; IQR, 29 hours), length of intensive care unit stay (median, 5 days; IQR 5 days), duration of any continuous inotropic infusion (median, 66 hours; IQR 72 hours), and preoperative BNP levels (median, 30 pg/mL; IQR, 75 pg/mL) were associated with a lower preoperative triceps skin-fold z score (P < .05). Longer duration of any continuous inotropic infusion and higher preoperative BNP levels were also associated with lower preoperative prealbumin (12.1 ± 0.5 mg/dL) and albumin (3.2 ± 0.1; P < .05) levels. CONCLUSIONS: Lower total body fat mass and acute and chronic malnourishment are associated with worse clinical outcomes in children undergoing surgery for CHD at UCSF, a resource-abundant institution. There is an inverse correlation between total body fat mass and BNP levels. Duration of inotropic support and BNP increase concomitantly as measures of nutritional status decrease, supporting the hypothesis that malnourishment is associated with decreased myocardial function.
Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Transtornos da Nutrição Infantil/complicações , Fenômenos Fisiológicos da Nutrição Infantil , Cardiopatias Congênitas/cirurgia , Transtornos da Nutrição do Lactente/complicações , Desnutrição/complicações , Estado Nutricional , Complicações Pós-Operatórias/etiologia , Adiposidade , Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos/mortalidade , Cardiotônicos/uso terapêutico , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/mortalidade , Transtornos da Nutrição Infantil/fisiopatologia , Pré-Escolar , Feminino , Guatemala , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/fisiopatologia , Humanos , Lactente , Transtornos da Nutrição do Lactente/diagnóstico , Transtornos da Nutrição do Lactente/mortalidade , Transtornos da Nutrição do Lactente/fisiopatologia , Recém-Nascido , Tempo de Internação , Modelos Lineares , Modelos Logísticos , Masculino , Desnutrição/diagnóstico , Desnutrição/mortalidade , Desnutrição/fisiopatologia , Análise Multivariada , Peptídeo Natriurético Encefálico/sangue , Projetos Piloto , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Pré-Albumina/análise , Estudos Prospectivos , Respiração Artificial , Fatores de Risco , São Francisco , Albumina Sérica/análise , Albumina Sérica Humana , Dobras Cutâneas , Fatores de Tempo , Resultado do TratamentoRESUMO
Chronic child undernutrition is a persistent problem in developing countries and has been the focus of hundreds of studies where the primary intent is to improve targeting of public health and economic development policies. In national level cross-sectional studies undernutrition is measured as child stunting and the goal is to assess differences in prevalence among population subgroups. Several types of regression modeling frameworks have been used to study childhood stunting but the literature provides little guidance in terms of statistical properties and the ease with which the results can be communicated to the policy community. We compare the results from quantile regression and ordinal regression models. The two frameworks can be linked analytically and together yield complementary insights. We find that reflecting on interpretations from both models leads to a more thorough analysis and forces the analyst to consider the policy utility of the findings. Guatemala is used as the country focus for the study.
Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/fisiopatologia , Pré-Escolar , Feminino , Guatemala/epidemiologia , Política de Saúde , Humanos , Lactente , Masculino , Modelos Estatísticos , Análise de RegressãoRESUMO
Son cuatro los nutrientes en que su deficiencia es importante en niños: hierro, yodo, vitamina A y zinc. Más o menos se calcula que hay 2 billones de personas en el mundo con algún grado de déficit de zinc. Los pacientes que están en riesgo de presentar deficiencias de zinc son los recién nacidos con bajo peso al nacimiento, bien sea prematuros, desnutridos in útero o hijos de madres desnutridas, en los cuales sus depósitos están reducidos. A diferencia de otros oligoelementos o micronutrientes, determinar el estado de déficit no es fácil. Los niveles séricos de zinc, están influenciados por factores no dietarios como infección, estrés o actividad física extenuante; al igual que por el ciclo circadiano.
Four nutrient deficiency that is important in children, iron, iodine, vitamin A and zinc. More or less it is estimated that 2 billion people in the world with some degree of zinc deficiency. Patients who are at risk for zinc deficiency are infants with low birth weight, either premature or malnourished in utero, undernourished mothers, in which their deposits are reduced. Unlike other trace elements or micronutrients, determine the deficit is not easy. Serum levels of zinc are not influenced by dietary factors such as infection, stress or strenuous physical activity, as well as by the circadian cycle.
Assuntos
Humanos , Masculino , Feminino , Zinco/administração & dosagem , Zinco/classificação , Zinco , Zinco/deficiência , Zinco/efeitos adversos , Zinco/farmacologia , Zinco/fisiologia , Zinco/metabolismo , Zinco/provisão & distribuição , Zinco , Ferro/administração & dosagem , Ferro/classificação , Ferro/farmacologia , Ferro/provisão & distribuição , Ferro , Transtornos da Nutrição Infantil/classificação , Transtornos da Nutrição Infantil/complicações , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/fisiopatologia , Transtornos da Nutrição Infantil/prevenção & controle , Transtornos da Nutrição Infantil/psicologia , Transtornos da Nutrição Infantil/reabilitaçãoRESUMO
OBJETIVO: Esclarecer as repercussões da deficiência de cobre, zinco e magnésio sobre o sistema imune de crianças desnutridas graves. FONTES DE DADOS: Foi realizada revisão bibliográfica mediante consulta às bases de dados Pubmed Medline, Lilacs e SciELO, selecionando-se publicações científicas recentes, da última década, e representativas do tema por meio dos descritores: desnutrição infantil, cobre, zinco, magnésio e sistema imune. SÍNTESE DE DADOS: Os micronutrientes são compostos orgânicos essenciais. Além de sua função regulatória, atuam de maneira decisiva na modulação da resposta imune. Sua deficiência pode ocorrer devido à ingestão inadequada ou associada a doenças específicas. Quando associada à desnutrição, a multideficiência de minerais pode acarretar disfunções imunológicas e aumento na suscetibilidade a infecções, afetando gravemente a eficácia de intervenções terapêuticas. Cobre, zinco e magnésio atuam como cofatores de enzimas responsáveis tanto por diversas atividades metabólicas como na resposta imune inata e adquirida, além do papel importante na maturação dos tecidos e células linfoides. Sua deficiência acarreta neutropenia e linfopenia, comprometendo a imunocompetência. CONCLUSÕES: As alterações ocasionadas pelos déficits séricos dos minerais cobre, zinco e magnésio comprometem o funcionamento do sistema imune, levando à imunossupressão. A reposição desses elementos no manejo da desnutrição grave, como preconizada pela Organização Mundial da Saúde, é essencial, uma vez que tais alterações podem ser reversíveis.
OBJECTIVE: To report the effects of the deficiency of copper, zinc and magnesium on the immune system of severely malnourished children. DATA SOURCE: A literature review was performed by consulting the databases Pubmed Medline, Lilacs and SciELO, using the descriptors: child malnutrition, copper, zinc, magnesium and immune system. Representative studies published during the last decade were chosen. DATA SYNTHESIS: Micronutrients are essential organic compounds. Besides their regulatory function, the minerals act on the modulation of the immune response. Their deficiency may be due to inadequate intake or associated with specific diseases. When combined with malnutrition, a multimineral deficiency can cause immune dysfunction and increased susceptibility to infections, altering the effectiveness of therapeutic interventions. Copper, zinc and magnesium act as co-factors of both enzymes responsible for several metabolic activities and associated to the innate and acquired immune response. These minerals also play an important role in the maturation of lymphoid tissues and cells. Their deficiency causes neutropenia and lymphopenia, decreasing the immunocompetence. CONCLUSIONS: Deficits of serum copper, zinc and magnesium affect the function of the immune system, leading to immunosuppression. The replacement of these elements in the management of severe malnutrition, as recommended by the World Health Organization, is essential, since such changes may be reversible.
Assuntos
Humanos , Criança , Cobre/deficiência , Cobre/imunologia , Deficiência de Magnésio/imunologia , Deficiência de Zinco , Sistema Imunitário , Transtornos da Nutrição Infantil/fisiopatologia , Transtornos da Nutrição Infantil/imunologiaRESUMO
The Institute of Nutrition of Central America and Panama (INCAP) has made major contributions to the study of the effects of malnutrition on learning. This report summarizes work on the relationship of nutrition to children's learning and development from the 1960's through 1998. The Oriente Longitudinal Study examined the effects of two types of supplementation for mothers and young children on their growth and development (an energy-only drink compared with a protein-energy drink) using a quasi-experimental design. Both drinks were supplemented with micronutrients, and were offered daily. As a result of the research on malnutrition and mental development, researchers could conclude by 1993 that supplementary feeding of infants and young children resulted in significant increases cognitive development and school performance through adolescence. The research also suggested that the pathways that link malnutrition with later development are not only through the neurological system but also operate through changes in child behavior which affect the kinds of care children receive. Other research on learning and development showed that families understood the concept of intelligence, demonstrated the link between micronutrients and cognitive development, and documented the amount of wastage or repetition and drop-out that occurs in Guatemalan schools.
Assuntos
Academias e Institutos/história , Transtornos da Nutrição Infantil/história , Cognição/fisiologia , Aprendizagem/fisiologia , América Central/epidemiologia , Criança , Desenvolvimento Infantil/fisiologia , Transtornos da Nutrição Infantil/complicações , Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/fisiopatologia , Pré-Escolar , Transtornos Cognitivos/complicações , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/história , Dieta , Suplementos Nutricionais , História do Século XX , Humanos , Lactente , Deficiências da Aprendizagem/complicações , Deficiências da Aprendizagem/etiologia , Deficiências da Aprendizagem/história , Estado NutricionalRESUMO
The ubiquity and consequences of childhood growth stunting (<-2 SD in height-for-age Z score, HAZ) in rural areas of low-income nations has galvanized research into the reversibility of stunting, but the shortage of panel data has hindered progress. Using panel data from a native Amazonian society of foragers-farmers in Bolivia (Tsimane'), we estimate rates of catch-up growth for stunted children. One hundred forty-six girls and 158 boys 2 < or = age < or = 7 were measured annually during 2002-2006. Annual Delta height in cm and in HAZ were regressed separately against baseline stunting and control variables related to attributes of the child, mother, household, and village. Children stunted at baseline had catch-up growth rates 0.11 SD/year higher than their nonstunted age and sex peers, with a higher rate among children farther from towns. The rate of catch up did not differ by the child's sex. A 10% rise in household income and an additional younger sibling lowered by 0.16 SD/year and 0.53 SD/year the rate of growth. Results were weaker when measuring Delta height in cm rather than in HAZ. Possible reasons for catch-up growth include (a) omitted variable bias, (b) parental reallocation of resources to redress growth faltering, particularly if parents perceive the benefits of redressing growth faltering for child school achievement, and (c) developmental plasticity during this period when growth rates are most rapid and linear growth trajectories have not yet canalized.
Assuntos
Desenvolvimento Infantil/fisiologia , Transtornos da Nutrição Infantil/etnologia , Transtornos da Nutrição Infantil/fisiopatologia , Indígenas Sul-Americanos , Fatores Etários , Estatura , Peso Corporal , Bolívia/epidemiologia , Criança , Pré-Escolar , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Fatores Sexuais , Fatores SocioeconômicosRESUMO
With insights from the developmental origins of health and disease paradigm (DOHaD), this study explores the impact of childhood nutritional stress on adult health outcomes in Jamaica. Jamaica experienced a lengthy period of political and economic instability beginning in the postcolonial period of the early 1960s. This study tests whether decreased government spending on public resources and limited access to imported food products during the early postcolonial period will be reflected in increased adiposity and body mass index among Jamaican adults. Ethnographic and anthropometric data were collected from individuals born between 1958 and 1988. Variability in health outcomes was assessed using Z-score values for body mass index and summed skinfold thickness measures. Age was employed as both a continuous and categorical independent variable. In partial correlation models controlling for economic status, body mass index values and summed skinfold thickness increased with age. Birth cohort and gender effects were also apparent. Women born between 1959 and 1968 had higher body mass index Z-score values than younger women. Both men and women born between 1959 and 1968 had significantly higher skinfold thickness measures than younger individuals. Individuals born between 1959 and 1968 were children during the immediate postcolonial era in Jamaica. Experiences of nutritional stress during critical developmental periods may have contributed to the observed age-related increases in adipose tissue and body mass index values. This study informs our understanding of the ways that fluctuations in the sociopolitical environment during development can mediate and contribute to poor adult health outcomes.
Assuntos
Transtornos da Nutrição Infantil/fisiopatologia , Nível de Saúde , Adiposidade/fisiologia , Adulto , Fatores Etários , Índice de Massa Corporal , Pesos e Medidas Corporais , Criança , Feminino , Humanos , Jamaica , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores SocioeconômicosRESUMO
Protein-energy malnutrition promotes adaptive hormonal changes that result in stunting. A previous study showed that stunted children had increased insulin sensitivity and diminished pancreatic beta-cell function. The objectives of the present study were to analyse the glucose, insulin, homeostasis model assessment of insulin sensitivity (HOMA-S) and homeostasis model assessment of pancreatic beta-cell function (HOMA-B) levels after nutritional recovery. The recovered group (n 62) consisted of malnourished children after treatment at a nutrition rehabilitation centre. At the beginning of treatment their age was 2.41 (sd 1.28) and 2.31 (sd 1.08) years, weight-for-age Z score - 2.09 (sd 0.94) and - 2.05 (sd 0.55) and height-for-age Z score - 1.85 (sd 1.11) and - 1.56 (sd 0.90), for boys and girls respectively. The control group consisted of well-nourished children without treatment (n 26). After treatment, boys of the recovered group gained 1.29 (sd 1.06) Z scores of height-for-age and 1.14 (sd 0.99) Z scores of weight-for-age, and girls, 1.12 (sd 0.91) and 1.21 (sd 0.74) Z scores respectively. No differences were found between control and recovered groups in insulin levels for boys (P = 0.704) and girls (P = 0.408), HOMA-B for boys (P = 0.451) and girls (P = 0.330), and HOMA-S (P = 0.765) for boys and girls (P = 0.456) respectively. The present study shows that the changes observed previously in glucose metabolism and insulin were reverted in children who received adequate treatment at nutritional rehabilitation centres and showed linear catch-up.