Assuntos
COVID-19/prevenção & controle , Transtornos da Nutrição Infantil/induzido quimicamente , Deficiência de Vitamina D/tratamento farmacológico , Vitamina D/análogos & derivados , Vitamina D/efeitos adversos , Biomarcadores/sangue , COVID-19/etiologia , Criança , Transtornos da Nutrição Infantil/sangue , Transtornos da Nutrição Infantil/diagnóstico , Chile , Feminino , Humanos , Lactente , Masculino , Vitamina D/sangue , Vitamina D/uso terapêutico , Deficiência de Vitamina D/complicaçõesRESUMO
OBJECTIVE: The aim of this study was to assess whether the nutritional status of children with cancer is influenced by variations in cytokine concentrations observed during chemotherapy. We also evaluated whether this relationship could be modified by nutritional status at diagnosis and type of cancer. METHODS: Mexican children with lymphoma or solid tumors were evaluated at diagnosis and at 2- and 6-mo follow-up visits. Blood samples were obtained to determine serum prealbumin, tumor necrosis factor (TNF)-α, interleukin (IL)-6, leptin concentrations, and hemoglobin. Children were classified as undernourished (UN) or well nourished (WN), according to prealbumin concentration. The influence of each cytokine on prealbumin concentration was analyzed by time-series regression model. RESULTS: Fifty patients (ages 2-17 y) were enrolled. There were 17 children with lymphomas and 33 with solid tumors. At baseline, 56% were UN and 26% presented anemia; the frequencies of UN children were higher for those with lymphoma than for those with a solid tumor (Pâ¯=â¯0.003). By nutritional status, UN children presented lower leptin (Pâ¯=â¯0.002) but higher IL-6 concentrations (Pâ¯=â¯0.009) than the WN group. Children with lymphoma presented lower prealbumin (Pâ¯=â¯0.003), but higher TNF-α (Pâ¯=â¯0.001) and IL-6 (Pâ¯=â¯0.011) concentrations than those with solid tumors. At follow-up, the concentration of prealbumin increased and IL-6 decreased in children with lymphoma. Multivariate analysis demonstrated that decreases in prealbumin concentration at the end of follow-up were associated with increases in IL-6 and TNF-α concentration during chemotherapy. CONCLUSIONS: These results suggest that the cytokine responses during chemotherapy are related to nutritional status at the end of 6 mo of treatment regardless of the initial nutritional status and the type of cancer.
Assuntos
Transtornos da Nutrição Infantil/sangue , Transtornos da Nutrição Infantil/complicações , Citocinas/sangue , Neoplasias/sangue , Neoplasias/tratamento farmacológico , Estado Nutricional , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , México , Neoplasias/complicaçõesRESUMO
El mundo, actualmente se enfrenta a una doble carga de malnutrición que incluye la desnutrición y la alimentación excesiva. A ello se suman las parasitosis intestinales que es una enfermedad frecuente con importante morbimortalidad en la población infantil, ligadas a la pobreza y malas condiciones higiénico-sanitarias. El objetivo de este trabajo fue describir el estado nutricional-hematológico y parasitológico de niños escolares de cuatro comunidades rurales de Paraguay. Estudio observacional descriptivo de corte transverso en el que participaron 102 niños de ambos sexos de 5 a 12 años de edad. Se realizó medición de peso y talla, utilizando balanza calibrada, y un altímetro fijado a la pared. Toma de muestra sanguínea por punción venosa para determinación de parámetros hematológicos, procesados en contador hematológico por impedancia. Muestras de heces de una sola toma fueron recogidas en frascos apropiados con formol al 10%, utilizándose 4 métodos: directo, flotación de Willis, Graham y de concentración. En relación al estado nutricional-hematológico se encontró que el 3,9% de los niños estaba con desnutrición moderada y el 9,8% presentó riesgo de desnutrición; anemia se observó en el 38,2% de los niños. En relación a la parasitosis, el estudio diagnóstico se realizó a 94 niños y se encontró que el 72,2% estaba parasitado, siendo Blastocystis hominis el más frecuente. Tanto la frecuencia de anemia como de parasitosis es alta en esta población, sin embargo no se pudo establecer una relación entre ellas(AU)
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Transtornos da Nutrição Infantil/sangue , Estado Nutricional , Anemia/sangue , Enteropatias Parasitárias/parasitologia , Estudos TransversaisRESUMO
OBJECTIVE: To test the hypothesis that low blood thiamine concentrations in malnourished critically ill children are associated with higher risk of 30-d mortality. METHODS: Prospective cohort study in 202 consecutively admitted children who had whole blood thiamine concentrations assessed on admission and on days 5 and 10 of intensive care unit (ICU) stay. The primary outcome variable was 30-d mortality. Mean blood thiamine concentrations within the first 10 d of ICU stay, age, sex, malnutrition, C-reactive protein concentration, Pediatric Index of Mortality 2 score, and severe sepsis/septic shock were the main potential exposure variables for outcome. RESULTS: Thiamine deficiency was detected in 61 patients within the first 10 d of ICU stay, 57 cases being diagnosed on admission and 4 new cases on the 5th d. C-reactive protein concentration during ICU stay was independently associated with decreased blood thiamine concentrations (P = 0.003). There was a significant statistical interaction between mean blood thiamine concentrations and malnutrition on the risk of 30-d mortality (P = 0.002). In an adjusted analysis, mean blood thiamine concentrations were associated with a decrease in the mortality risk in malnourished patients (odds ratio = 0.85; 95% confidence interval [CI]: 0.73-0.98; P = 0.029), whereas no effect was noted for well-nourished patients (odds ratio: 1.03; 95% CI: 0.94-1.13; P = 0.46). CONCLUSIONS: Blood thiamine concentration probably has a protective effect on the risk of 30-d mortality in malnourished patients but not in those who were well nourished.
Assuntos
Transtornos da Nutrição Infantil/mortalidade , Estado Terminal/mortalidade , Estado Nutricional , Deficiência de Tiamina/mortalidade , Tiamina/sangue , Brasil/epidemiologia , Criança , Transtornos da Nutrição Infantil/sangue , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Unidades de Terapia Intensiva Pediátrica , Masculino , Estudos Prospectivos , Deficiência de Tiamina/sangueRESUMO
UNLABELLED: It is not clear how frequent is copper deficiency in humans. Current copper markers are not sensitive enough to detect early copper deficiency and new markers are needed. CCS is a candidate to become a copper biomarker. OBJECTIVE: Measuring CCS mRNA relative expression in malnourished children and compare results (a) with those of the same children after nutritional recovery and (b) with well-nourished children. METHOD: On admission to the protocol and after 15 day nutritional treatment, severely (G1=18) and moderately (G2=10) malnourished children were compared with well-nourished healthy controls (G3=15), measuring anthropometric indicators, blood biochemistry, Cu, Fe and Zn serum concentrations, ceruloplasmin, C Reactive protein and mRNA abundance of CCS, SOD and MT2 in peripheral mononuclear cells. RESULT: In malnourished groups, mean serum copper concentration was below the cut-off on admission to hospital and increased after 15 days (t-test, p<0.01). On admission to protocol, CCS mRNA abundance in G1 and G2 was higher than in G3 (one way ANOVA, p<0.001). After 15 days, CCS expression decreased as expected (t-test, p<0.001). Initial SOD mRNA relative abundance was higher in study groups than controls and also between G1 and G2 (One way ANOVA, both p<0.01); after 15 days, G1 and G2 were not different (t-test, NS). MT2A abundance of transcripts did not follow a clear change pattern. CONCLUSION: CCS mRNA abundance responded as expected, being higher in malnourished children than in controls; nutritional recovery in these latter resulted in decreasing expression of the chaperone, supporting the hypothesis that CCS may be a copper biomarker.
Assuntos
Transtornos da Nutrição Infantil/sangue , Transtornos da Nutrição Infantil/enzimologia , Cobre/deficiência , Superóxido Dismutase/metabolismo , Pré-Escolar , Cobre/sangue , Feminino , Humanos , Lactente , Masculino , Superóxido Dismutase/análiseAssuntos
Masculino , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente/normas , Transtornos da Nutrição Infantil/complicações , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição Infantil/mortalidade , Transtornos da Nutrição Infantil/prevenção & controle , Transtornos da Nutrição Infantil/radioterapia , Transtornos da Nutrição Infantil/sangue , AntropometriaRESUMO
We assessed the involvement of vitamin A deficiency (VAD) and anaemia as co-morbidities associated with severe forms of protein-energy malnutrition in hospitalized children. In a descriptive case series study of 57 children, one clinical case of xerophthalmia was diagnosed: 44.0% had levels of serum retinol <20 µg/dL and 88.0% had Hb <11 g/dL, of whom 30.0% had haemoglobin levels below 7.0 g/dL.
Assuntos
Anemia Ferropriva/epidemiologia , Transtornos da Nutrição Infantil/complicações , Transtornos da Nutrição Infantil/epidemiologia , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/epidemiologia , Deficiência de Vitamina A/epidemiologia , Anemia Ferropriva/sangue , Anemia Ferropriva/diagnóstico , Transtornos da Nutrição Infantil/sangue , Transtornos da Nutrição Infantil/diagnóstico , Pré-Escolar , Comorbidade , Hemoglobinas/análise , Hospitalização , Humanos , Lactente , Micronutrientes/sangue , Micronutrientes/deficiência , Estado Nutricional , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/tratamento farmacológico , Índice de Gravidade de Doença , Deficiência de Vitamina A/sangue , Deficiência de Vitamina A/diagnóstico , Organização Mundial da Saúde , Xeroftalmia/epidemiologiaRESUMO
La hipertensión porta (HTP) es el resultado del incremento de la presión dentro del sistema venoso porta. Se presenta con poca frecuencia en el paciente pediátrico pero es una de las mayores causas de morbilidad y mortalidad en el niño con enfermedad hepática. La mayoría de los pacientes con http presentan un estado hiperdinámico, lo cual aumenta el flujo venoso porta y mantiene la hipertensión. Puede ser secundaria a obstrucción a nivel prehepático, intrahepático o extrahehepático.
Portal hypertension (PH) is the result of increased pressure within the portal venous system. It occurs infrequently in the pediatric patient but it is a major cause of morbidity and mortality in children with liver disease. Most patients with PH have a hyperdynamic state, which increases venous flow and portal hypertension remains. May be secondary to obstruction at prehepatic, intrahepatic or extrahehepatic.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Ascite/classificação , Esplenomegalia/classificação , Esplenomegalia/complicações , Hematemese/mortalidade , Hematemese/sangue , Hipertensão Portal/epidemiologia , Hipertensão Portal/mortalidade , Hipertensão Portal/patologia , Degeneração Hepatolenticular/classificação , Degeneração Hepatolenticular/diagnóstico , Fibrose Cística/classificação , Transtornos da Nutrição Infantil/etiologia , Transtornos da Nutrição Infantil/genética , Transtornos da Nutrição Infantil/mortalidade , Transtornos da Nutrição Infantil/sangueRESUMO
BACKGROUND: Cardiovascular disease (CVD) risks are increasingly being diagnosed in children and track into adulthood. Growth is associated with CVD risk in adulthood; however, its contribution to CVD risks in children facing the obesity epidemic is unclear. OBJECTIVE: The objective was to assess relations between growth from age 0 to 4 y and CVD status at 4 y in 323 Chilean children with normal birth weight. DESIGN: From health records we obtained weight and height every 6 mo from age 0 to 3 y and calculated body mass index (BMI; weight/height(2)). At age 4 y, we measured height, waist circumference, insulin, glucose, and plasma lipids; infant feeding information was provided by the mothers. Outcomes were metabolic score (waist-to-height ratio + glucose + insulin + triglycerides - HDL-cholesterol z scores/5), total cholesterol (TC):HDL cholesterol, and homeostasis model of assessment of insulin resistance. RESULTS: At 4 y, the prevalence of obesity was 13%. Changes in BMI, particularly from 6 to 24 mo, predicted a higher metabolic score (standardized regression coefficient = 0.29; 95% CI: 0.16, 0.42) but were unrelated to homeostasis model of assessment of insulin resistance and TC:HDL cholesterol. Height changes were not associated with CVD risks at the age of 4 y. Mode of infant feeding was unrelated to CVD status at 4 y; however, in children who were exclusively breastfed at 4 mo, an increase in BMI from 0 to 6 mo was positively associated with TC:HDL cholesterol at 4 y (standardized regression coefficient = 0.24; 95% CI: -0.02, 0.50), whereas in children who were partially or nonbreastfed at 4 mo, it was negatively associated with TC:HDL cholesterol at 4 y (standardized regression coefficient = -0.30; 95% CI: -0.52, -0.08). CONCLUSION: In children with normal birth weight and a high prevalence of obesity at 4 y, changes in BMI after 6 mo predicted a higher overall CVD risk at 4 y.
Assuntos
Índice de Massa Corporal , Tamanho Corporal , Doenças Cardiovasculares , Crescimento , Obesidade/sangue , Glicemia , Aleitamento Materno , Doenças Cardiovasculares/sangue , Transtornos da Nutrição Infantil/sangue , Transtornos da Nutrição Infantil/complicações , Pré-Escolar , Chile , Colesterol/sangue , HDL-Colesterol/sangue , Estudos de Coortes , Feminino , Humanos , Insulina/sangue , Resistência à Insulina , Masculino , Obesidade/complicações , Obesidade/epidemiologia , Fatores de Risco , Triglicerídeos/sangueRESUMO
A desnutrição é comum nos pacientes hospitalizados e tem importância especial nos pacientes pediátricos, já que pode comprometer seu desenvolvimento e crescimento. Por esta razão, é importante incluir a avaliação nutricional como parte da atenção ao paciente; esta prática deve ser realizada por meio de indicadores que reflitam o estado nutricional de maneira prática e simples. O objetivo deste estudo foi determinar a freqüência de desnutrição em pacientes pediátricos hospitalizados por meio de vários indicadores e relacionar ao tempo de internação da criança. A presença de desnutrição crônica, aguda ou crônica-agudizada foi avaliada nos pacientes hospitalizados no Serviço de Pediatria do Hospital Geral do México. Os pacientes foram divididos em grupos, de acordo com seu estado nutricional (desnutrição crônica, agudae crônica-agudizada) ou parâmetros bioquímicos inferiores à normalidade e foi realizada uma análise descritiva, assim como teste t Student para considerar a diferença entre médias em ambos os grupos com relação ao tempo de hospitalização. Foram avaliados 126 pacientes pediátricos. De acordo com os indicadores, foram observados: 21,2% pelo escore Z do peso para a estatura (desnutrição aguda), 32,3% e 37,2% pela estatura para a idade (desnutrição crônica) e peso para a idade, respectivamente; além de 13,8% de desnutrição crônica agudizada. Bioquimicamente, 13,5% das crianças apresentaram valores baixos de hemoglobina,32,2% do hematócrito, 31,9% da albumina e 23,7% das proteínas totais. Não houve diferença significativa entre pacientes desnutridos e com estado nutricional adequado em relação aotempo de hospitalização. A desnutrição é comum em pacientes hospitalizados. Este é um dado de grande importância no paciente do pediátrico, pois a desnutrição pode prejudicar seu crescimento e desenvolvimento ideais...
Malnutrition is a common issue among hospitalized patients. It has particular relevance in the children as it can compromise their optimal growth and development. Thus it is important to include nutritional assessment as part of the services given to the patient; this practice should be performed with practical and simple indicators of nutritional status. The aim of the study was to determine the frequency of malnutrition among hospitalized pediatric patients through various indicators and to relate nutrition status with the childs length of stay. We evaluated the prevalence of chronic, acute or chronic-acute malnutrition in hospitalized patients at the Pediatrics ward at Hospital General de México. Patients were divided into groups according to their nutritional status (chronic, acute or chronic-acute malnutrition, according to their anthropometrical and biochemical parameters) and data was assessed descriptively and comparatively by Student ttests to determine mean differences between both groups (malnourished vs. well-nourished) inrelation to length of stay. We assessed 126 hospitalized pediatric patients. We found different types of malnutrition according to various indicators: 21.2% according to Z score of weight-for height(acute malnutrition), 32.3% and 37.2% by height-for-age (chronic malnutrition) andweight-for-age, respectively; in addition, we found 13.8% of chronic-acute malnutrition. Biochemical indicators showed that 13.5% of the population studied had abnormally low hemoglobin values, 32.2% low hematocrite values, 31.9% low albumin values and 23.7%total proteins values. We found no significant difference between malnourished and wellnourishedpatients in relation to length of stay. institutional healthsystem in order to assess and provide and adequate nutrition care attention to the patients toimprove their general condition and prognosis...
La desnutrición es común en los pacientes hospitalizados. Tiene especial importancia en los pacientes pediátricos, puesto que puede comprometer su desarrollo y crecimiento. Espor ello importante incluir la evaluación nutricia como parte de la atención al paciente; esta práctica debe llevarse a cabo a través de indicadores que reflejen el estado nutricio de manera práctica y sencilla. Es por ello que el objetivo de este estudio fue determinar la frecuencia de desnutrición en los pacientes pediátricos hospitalizados através de diversos indicadores y relacionarla al periodo de estancia intrahospitalaria del niño. Se evaluó la presencia de desnutrición crónica, aguda o crónica-agudizada en pacientes hospitalizados en el servicio de Pediatría del Hospital General de México. Los pacientes se dividieron engrupos de acuerdo a su estado nutricio (desnutrición crónica, aguda, crónica agudizadao parámetros bioquímicos inferiores a la normalidad) y se llevó a cabo un análisis descriptivo, así como diversas pruebas t para estimar la diferencia entre medias y comparar los dos grupos en relación al tiempo de hospitalización. Se evaluaron 126 pacientes pediátricos. Se observaron diferentes frecuencias de desnutrición de acuerdo a varios indicadores:21.2% de acuerdo al puntaje Z del peso para la talla (desnutrición aguda), 32.3% y37.2% por talla para la edad (desnutrición crónica) y peso para la edad, respectivamente; además se encontró un 13.8% de desnutrición crónico-agudizada...
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Criança Hospitalizada , Hospitais Pediátricos , Pacientes Internados , Transtornos da Nutrição Infantil/complicações , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/metabolismo , Transtornos da Nutrição Infantil/sangue , Saúde da Criança InstitucionalizadaRESUMO
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.
Assuntos
Transtornos da Nutrição Infantil/sangue , Transtornos da Nutrição Infantil/terapia , Transtornos da Nutrição do Lactente/sangue , Transtornos da Nutrição do Lactente/terapia , Insulina/biossíntese , Antropometria , Glicemia/metabolismo , Índice de Massa Corporal , Estudos de Casos e Controles , Criança , Transtornos da Nutrição Infantil/fisiopatologia , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Ingestão de Alimentos/fisiologia , Ingestão de Energia/fisiologia , Feminino , Homeostase/fisiologia , Humanos , Lactente , Transtornos da Nutrição do Lactente/fisiopatologia , Células Secretoras de Insulina/fisiologia , Masculino , Estado Nutricional , PuberdadeRESUMO
La malnutrición afecta a más de 50 millones de niños de menos de 5 años en los países en desarrollo. Pese al tratamiento, la tasa de mortalidad llega al 50 % en algunos países. Hasta 1990, uno de cada cuatro niños con malnutrición grave fallecía durante el tratamiento. La tasa de letalidad no se modifi có durante los cinco últimos decenios (estudio de más de 60 países). Actualmente hay principios de tratamiento con fundamentos científi cos indiscutibles y la aplicación del protocolos recomendado por OMS - motivo de la presente actualización- reduce costos, letalidad hospitalaria, logra una rehabilitación integral y su aplicación ha originado una caída de la mortalidad a menos del 5% 1 .Se destaca la mortalidad asociada a desnutrición severa, aún pese al tratamiento y realizamos una actualización del tratamiento del desnutrido edematoso grave, presentando el caso de un niño de 1 año de edad, ingresado a la Unidad de Gastroenterología del Hospital del Niño de la Ciudad de La Paz, cuyo cuadro clínico tiene tres semanas de evolución con una enfermedad diarreica aguda (EDA), que se asocia a marcado compromiso del estado general y edema generalizado. El examen físico de ingreso clasifi ca al niño como desnutrido edematoso grave complicado y por su estado clínico crítico e inestabilidad hemodinámica, es transferido a la Unidad de Terapia Intensiva (UTI), donde pese al manejo especializado y oportuno, el niño fallece.
Malnutrition affects more than 5 million children under 5 years of age in developing countries. In spite of treatment, the mortality rate reaches 50% in some countries. Until 1990, one out of each of four children with severe malnutrition died during treatment .The rate of lethality did not change during the last fi ve decades (studies from over 60 countries). At the present, there exist principles of treatment with indisputable scientifi c bases, and the application of the protocol recommended by WHO - reason for the present actualization - reduces costs, lethality in the hospital, reaches a complete rehabilitation, and its application has originated a fall in mortality to less than 5%.We present the case of a one year-old little boy, admitted to the Gastroenterology Unit of the Childrens Hospital in La Paz whose condition had an evolution of three weeks with an acute diarrheic disease (EDA), associated to a very poor overall state and generalized oedema. The physical exam upon admission, classifi ed the child as mixed undernourished, and due to his critical condition and hemodynamic instability he was transferred to the Intensive Care Unit (UTI), where in spite of the specialized and appropriate treatment, the child died. We publish this case in order to point out the mortality associated withsevere malnutrition in spite of the treatment in the UTI, and we present an actualization of the treatment.
Assuntos
Humanos , Masculino , Lactente , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/etiologia , Transtornos da Nutrição Infantil/fisiopatologia , Transtornos da Nutrição Infantil/sangueRESUMO
Serum prealbumin concentration (PALB) and albumin concentration (ALB) were evaluated as markers of undernutrition in 107 children with cerebral palsy (CP) age 2 to 18 years. PALB and ALB were rarely below the normal reference ranges and showed little to no correlation with anthropometric measures (eg, skinfolds, midarm fat area), growth (height), severity of CP (eg, feeding dysfunction, motor impairment), or general health.
Assuntos
Paralisia Cerebral/complicações , Transtornos da Nutrição Infantil/diagnóstico , Pré-Albumina/metabolismo , Albumina Sérica/metabolismo , Adolescente , Antropometria , Biomarcadores , Criança , Transtornos da Nutrição Infantil/sangue , Transtornos da Nutrição Infantil/etiologia , Pré-Escolar , Feminino , Humanos , Masculino , Avaliação Nutricional , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: To evaluate whether early diagnosis of cystic fibrosis (CF) through newborn screening (NBS) and early vitamin E status are associated with cognitive function. STUDY DESIGN: We assessed cognitive function for 71 children without meconium ileus (ages 7.3-16.9 years) enrolled in the screened (S) or control (C) group of the Wisconsin CF Neonatal Screening Project. The Test of Cognitive Skills, 2nd edition generated the cognitive skills index (CSI; mean = 100, SD = 16). Vitamin E deficiency at diagnosis was defined as plasma alpha-tocopherol (alpha-T) below 300 microg/dL (<300E). Primary analyses evaluated CSI scores across the 4 levels of group (S or C) by using alpha-T status (<300E or >300E) with analysis of covariance. RESULTS: After adjusting for covariates, CSI in the C<300E group was significantly lower than each of the other groups (C>300E, S<300E, and S>300E; P < .05). The highest proportion of CSI scores >84 occurred in the C<300E group (41%). Patients in this group also had the lowest mean head circumference z-scores at diagnosis. CONCLUSIONS: Our results show that prolonged alpha-T deficiency in infancy is associated with lower subsequent cognitive performance. Thus, diagnosis via NBS may benefit the cognitive development of children with CF, particularly in those prone to vitamin E deficiency during infancy.
Assuntos
Transtornos da Nutrição Infantil/prevenção & controle , Transtornos Cognitivos/prevenção & controle , Fibrose Cística/diagnóstico , Triagem Neonatal/organização & administração , Deficiência de Vitamina E/prevenção & controle , Adolescente , Fatores Etários , Análise de Variância , Estudos de Casos e Controles , Criança , Transtornos da Nutrição Infantil/sangue , Transtornos da Nutrição Infantil/etiologia , Pré-Escolar , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Fibrose Cística/complicações , Fibrose Cística/terapia , Diagnóstico Precoce , Humanos , Lactente , Recém-Nascido , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Índice de Gravidade de Doença , Vitamina A/sangue , Deficiência de Vitamina E/sangue , Deficiência de Vitamina E/etiologia , Wisconsin , alfa-Tocoferol/sangueRESUMO
BACKGROUND: Little is known about the long-term evolution, nutrition status, growth, and eventual deficiencies of patients with short bowel syndrome (SBS) adapted to oral feeding after parenteral nutrition (PN). Because there are not absolute criteria for weaning from parenteral or enteral nutrition to oral feeding, new nutrient deficiencies may develop. Subtle nutrition deficits could induce subclinical immune deficiencies; therefore, we studied long-term growth, nutrition status, and the state of the immune system in 10 patients with SBS after weaning PN for at least 2 years. METHODS: Ten children with SBS (3-12 years old; mean, 7.4 years) who had not received PN for at least 2 years were studied. Anthropometric measurements, hemoglobin values, and indicators of iron, zinc, copper, folate and vitamin B(12) nutrition status were evaluated, along with immunoglobulins, lymphocyte subpopulations, and polymorphonuclear candidicidal activity. RESULTS: Weight-for-height was normal in 8 children; height-for-age was low in 5 children whose SBS was established early in life. Fat body mass was also low in 5 subjects. Four children presented macrocytosis, 2 with anemia. Low serum levels of vitamin B(12) (1 child), folates (4 children), and ferritin (2 children) were observed. Diminished candidicidal activity (4 children) was the only remarkable immunological abnormality. CONCLUSION: Many biologic and growth deficiencies are frequently seen in patients with SBS, even in children adapted to enteral feeding. This finding and the existence of previously unreported decreased candidicidal activity in some patients with SBS deserve long-term clinical and biologic follow up.
Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Nível de Saúde , Estado Nutricional , Síndrome do Intestino Curto/complicações , Síndrome do Intestino Curto/imunologia , Peso Corporal/fisiologia , Criança , Desenvolvimento Infantil , Transtornos da Nutrição Infantil/sangue , Transtornos da Nutrição Infantil/etiologia , Pré-Escolar , Ingestão de Alimentos , Feminino , Seguimentos , Indicadores Básicos de Saúde , Humanos , Masculino , Necessidades Nutricionais , Nutrição Parenteral , Síndrome do Intestino Curto/terapia , Resultado do Tratamento , DesmameRESUMO
Because low tumor necrosis factor-alpha (TNF-alpha) production has been reported in malnourished children, in contrast with high production of TNF-alpha in experimental protein-energy malnutrition, we reevaluated the production of TNF-alpha in whole blood cultures from children with primary malnutrition free from infection, and in healthy sex- and age-matched controls. Mononuclear cells in blood diluted 1:5 in endotoxin-free medium released TNF-alpha for 24 h. Spontaneously released TNF-alpha levels (mean +/- SEM), as measured by enzyme immunoassay in the supernatants of unstimulated 24-h cultures, were 10,941 +/- 2,591 pg/ml in children with malnutrition (N = 11) and 533 +/- 267 pg/ml in controls (N = 18) (P < 0.0001). TNF-alpha production was increased by stimulation with lipopolysaccharide (LPS), with maximal production of 67,341 +/- 16,580 pg/ml TNF-alpha in malnourished children and 25,198 +/- 2,493 pg/ml in controls (P = 0.002). In control subjects, LPS dose-dependently induced TNF-alpha production, with maximal responses obtained at 2000 ng/ml. In contrast, malnourished patients produced significantly more TNF-alpha with 0.02-200 ng/ml LPS, responded maximally at a 10-fold lower LPS concentration (200 ng/ml), and presented high-dose inhibition at 2000 ng/ml. TNF-alpha production a) was significantly influenced by LPS concentration in control subjects, but not in malnourished children, who responded strongly to very low LPS concentrations, and b) presented a significant, negative correlation (r = -0.703, P = 0.023) between spontaneous release and the LPS concentration that elicited maximal responses in malnourished patients. These findings indicate that malnourished children are not deficient in TNF-alpha production, and suggest that their cells are primed for increased TNF-alpha production.
Assuntos
Transtornos da Nutrição Infantil/sangue , Leucócitos Mononucleares/metabolismo , Fator de Necrose Tumoral alfa/biossíntese , Células Sanguíneas/imunologia , Células Sanguíneas/metabolismo , Estudos de Casos e Controles , Células Cultivadas , Criança , Transtornos da Nutrição Infantil/imunologia , Pré-Escolar , Feminino , Humanos , Lactente , Leucócitos Mononucleares/imunologia , Lipopolissacarídeos/imunologia , MasculinoRESUMO
BACKGROUND: Vitamin A deficiency (VAD) is endemic in Brazil and health professionals have difficulty in recognizing its subclinical form. In addition, serum retinol concentrations do not always represent vitamin A status in the organism. OBJECTIVE: To identify VAD in preschool children by the serum 30-day dose-response test (+S30DR) and to examine its potential as a tool for the assessment of vitamin A status in the community. DESIGN: A prospective transverse study in which blood samples were obtained from 188 preschool children for the determination of serum retinol concentrations and the children were submitted to ocular inspection and anthropometric measurements. Information about the presence of diarrhea and/or fever during the 15 days preceding the study was also obtained. The children received an oral dose of 200,000 IU vitamin A immediately after the first blood collection. A second blood sample was obtained 30-45 days after supplementation in order to determine the +S30DR. RESULTS: In all, 74.5% (140/188; 95% confidence interval: 68.3-80.7%) of the children presented +S30DR values indicative of low hepatic reserves. The mean serum retinol concentration was significantly lower before supplementation (0.92 and 1.65 micromol/l, respectively; P < 0.0001). No child presented xerophthalmia; 3.7% (7/188) of the children were malnourished. The presence of fever and/or diarrhea during the 15 days preceding the first blood collection did not affect the +S30DR value. CONCLUSIONS: The prevalence of VAD in the study group was elevated. +S30DR proved to be a good indicator of subclinical VAD in children from an underdeveloped country.
Assuntos
Transtornos da Nutrição Infantil/diagnóstico , Deficiência de Vitamina A/diagnóstico , Vitamina A/administração & dosagem , Vitamina A/sangue , Antropometria , Brasil/epidemiologia , Transtornos da Nutrição Infantil/sangue , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Suplementos Nutricionais , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Avaliação Nutricional , Estado Nutricional , Estudos Prospectivos , Estudos Soroepidemiológicos , Deficiência de Vitamina A/sangue , Deficiência de Vitamina A/epidemiologiaRESUMO
OBJECTIVE: To assess the nutritional status of Tarahumara children at indigenous boarding schools. DESIGN: Cross-sectional comprehensive nutritional survey. SETTING: The schools sampled were located in indigenous municipalities of the northern Mexican state of Chihuahua. SUBJECTS: The study was carried out in 2001 among 331 children aged 6-14 y from a sample of five schools. Anthropometric measurements, a thyroid exam and capillary haemoglobin levels were obtained from the children. Serum concentrations of ferritin, iron, total iron-binding capacity, vitamin B(12), folic acid and zinc were collected from a subsample of 100 children. RESULTS: The prevalence of wasting and overweight (children 6-9 y) was 1.1 and 4.6%, respectively, and of underweight, risk of overweight and overweight (10-14 y) was 3.2, 5.1 and 0.6%, respectively. Stunting (6-12 y) was present in 22.3% of the children. The total goitre rate was 5.4%. The prevalence of anaemia was 13% (boys 11.4, girls 14.5%). Overall, 24.2% of the children were iron deficient (depletion 11.1%, deficient erythropoiesis 3%, iron deficiency anaemia 10.1%). No child had folic acid values <3 ng/ml, but 20.2% had low (<200 microg/dl) and 27.3% marginal (200-300 microg/dl) vitamin B(12) levels, and 80.2% had low zinc concentrations (<60 microg/dl). CONCLUSIONS: Nutritional underweight and stunting were similar to those reported in rural localities at the national level, but overweight was less prevalent in children aged 10-14 y. Various micronutrient deficiencies was identified including zinc and vitamin B(12), but the prevalence of iron and folic acid deficiency was lower than expected. These results suggest that Tarahumara children attending boarding schools may be the better-off children from these extremely poor and marginalized areas. SPONSORSHIP: Swedish Agency for Research Cooperation with Developing Countries and the Mexican Social Security Institute.
Assuntos
Fenômenos Fisiológicos da Nutrição do Adolescente , Transtornos da Nutrição Infantil/epidemiologia , Fenômenos Fisiológicos da Nutrição Infantil , Deficiências Nutricionais/epidemiologia , Estado Nutricional , Adolescente , Anemia/epidemiologia , Antropometria , Criança , Transtornos da Nutrição Infantil/sangue , Estudos Transversais , Deficiências Nutricionais/sangue , Feminino , Nível de Saúde , Inquéritos Epidemiológicos , Humanos , Iodo/sangue , Iodo/deficiência , Ferro/sangue , Deficiências de Ferro , Masculino , México , Inquéritos Nutricionais , Obesidade/epidemiologia , Prevalência , Estudos SoroepidemiológicosRESUMO
Little is known about the selenium status of children living in the Andean regions of South America, which commonly have volcanic soil with low selenium content. Human selenium deficiency has been hypothesized to have a negative impact on immune function and to increase the risk of infection. The objective of this study was to evaluate the serum selenium concentrations of severely malnourished children living in urban and rural Andean Ecuador, and to compare them to a control group of normally nourished children from the same communities. Forty-three children, aged six to 36 months, with marasmus or kwashiorkor and 30 control children were enrolled from July to November 1993 in Quito, Ecuador. Serum selenium concentrations were lower in the children with marasmus (0.91 +/- 0.28 microM/L, n = 21) and kwashiorkor (0.37 +/- 0.15 microM/L, n = 22) than in those who were normally nourished (1.77 +/- 0.75 microM/L, n = 30, p < 0.001 for each difference). The serum selenium concentrations in children with kwashiorkor were significantly lower than those in children with marasmus (p < 0.001). All 22 of the children with kwashiorkor, 15 of the 21 children with marasmus, and five of the 30 normal children had serum levels < 1.08 microM/L (8.5 micrograms/dL) (chi 2 = 38.4, p < 0.00000001). In the Andean regions of Ecuador, selenium deficiency is prevalent in children with protein and caloric deficiency. Furthermore, 17% of Ecuadorian children with normal weight-for age-Z score are selenium-deficient.
Assuntos
Transtornos da Nutrição Infantil/sangue , Kwashiorkor/sangue , Desnutrição Proteico-Calórica/sangue , Selênio/sangue , Selênio/deficiência , Estudos de Casos e Controles , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Estudos de Coortes , Equador/epidemiologia , Feminino , Humanos , Lactente , Masculino , Estado Nutricional , População Rural , População UrbanaRESUMO
Lack of adequate food and in particular high quality protein, is one of the causes of malnutrition in children which could result in retarded growth. Iron deficiency is common in populations where protein sources are of vegetable origin; however in northern Mexico where the bean consumption is high, anemia is not a problem. The primary staples in the Mexican diet are corn tortillas and beans. The objective of this study was to evaluate the anthropometric condition of children 4-6 years old living in the city of Oaxaca, Oaxaca, Mexico and to determine the prevalence of anemia. Mean Z scores for children 4-6 years old living in poor conditions in the city of Oaxaca, Oaxaca, Mexico showed significant differences between socioeconomic groups (p<0.002) for height/age (H/A) and weight/age (W/A) (p<0.001) after adjusting for age and sex. Weight/height (W/H) was not different (p=0.30). By using the Waterlow classification system, 28.8% of the pre-school children of this study were stunted and only 0.9% were classified as wasted. There were no children that presented both stunting and wasting. Iron deficiency was very prevalent in both boys and girls, ranging from 56-79% depending on the indicator used. When classified by the combination of serum ferritin, % transferrin saturation and hemoglobin values, 23.7% of the children were classified as anemic, 11.9% in a state of iron deficiency and 13.6% with low iron reserves.