RESUMO
Addressing malnutrition in all its forms represents an integrated agenda addressing the root causes of malnutrition at all stages of the life course. The issue is not about choosing between addressing undernutrition in the poor versus overnutrition in the affluent. We must recognize that the interventions required to address stunting are different from those needed to reduce underweight and wasting. In most developing regions, there is a coexistence between underweight and stunting in infants and children, while in the adult population it may be overweight and stunting. Malnutrition in all its forms refers to both underweight and overweight. Underweight is defined by a low weight-for-age, a child is underweight because of wasting (low weight-for-height) or stunting (low length-for-age). Stunting refers to low height-for-age independent of their weight-for-age, some stunted children may have excess weight for their stature length. Overweight is excess weight-for-length/-height or high-BMI-for-age. The prevention of nutrition-related chronic diseases is a life-long process that starts in fetal life and continues throughout infancy and later stages of life. It requires promoting healthy diets and active living at each stage. The agenda requires that we tackle malnutrition in all its forms.
Assuntos
Índice de Massa Corporal , Efeitos Psicossociais da Doença , Promoção da Saúde , Desnutrição , Estado Nutricional , Obesidade , Magreza , Adulto , Estatura , Criança , Doença Crônica/prevenção & controle , Transtornos do Crescimento/dietoterapia , Transtornos do Crescimento/etiologia , Transtornos do Crescimento/prevenção & controle , Humanos , Lactente , Desnutrição/complicações , Desnutrição/dietoterapia , Desnutrição/prevenção & controle , Obesidade/dietoterapia , Obesidade/etiologia , Obesidade/prevenção & controle , Sobrepeso/dietoterapia , Sobrepeso/etiologia , Sobrepeso/prevenção & controle , Magreza/dietoterapia , Magreza/etiologia , Magreza/prevenção & controle , Síndrome de Emaciação/dietoterapia , Síndrome de Emaciação/etiologia , Síndrome de Emaciação/prevenção & controleRESUMO
BACKGROUND: Improved complementary feeding is cited as a critical factor for reducing stunting. Consumption of meats has been advocated, but its efficacy in low-resource settings has not been tested. OBJECTIVE: The objective was to test the hypothesis that daily intake of 30 to 45 g meat from 6 to 18 mo of age would result in greater linear growth velocity and improved micronutrient status in comparison with an equicaloric multimicronutrient-fortified cereal. DESIGN: This was a cluster randomized efficacy trial conducted in the Democratic Republic of Congo, Zambia, Guatemala, and Pakistan. Individual daily portions of study foods and education messages to enhance complementary feeding were delivered to participants. Blood tests were obtained at trial completion. RESULTS: A total of 532 (86.1%) and 530 (85.8%) participants from the meat and cereal arms, respectively, completed the study. Linear growth velocity did not differ between treatment groups: 1.00 (95% CI: 0.99, 1.02) and 1.02 (95% CI: 1.00, 1.04) cm/mo for the meat and cereal groups, respectively (P = 0.39). From baseline to 18 mo, stunting [length-for-age z score (LAZ) <-2.0] rates increased from ~33% to nearly 50%. Years of maternal education and maternal height were positively associated with linear growth velocity (P = 0.0006 and 0.003, respectively); LAZ at 6 mo was negatively associated (P < 0.0001). Anemia rates did not differ by group; iron deficiency was significantly lower in the cereal group. CONCLUSION: The high rate of stunting at baseline and the lack of effect of either the meat or multiple micronutrient-fortified cereal intervention to reverse its progression argue for multifaceted interventions beginning in the pre- and early postnatal periods.
Assuntos
Grão Comestível , Alimentos Fortificados , Transtornos do Crescimento/dietoterapia , Alimentos Infantis , Fenômenos Fisiológicos da Nutrição do Lactente , Carne , Micronutrientes/uso terapêutico , Anemia Ferropriva/complicações , Anemia Ferropriva/dietoterapia , Anemia Ferropriva/prevenção & controle , Desenvolvimento Infantil , República Democrática do Congo/epidemiologia , Grão Comestível/efeitos adversos , Grão Comestível/química , Escolaridade , Alimentos Fortificados/efeitos adversos , Alimentos Fortificados/análise , Transtornos do Crescimento/complicações , Transtornos do Crescimento/epidemiologia , Guatemala/epidemiologia , Humanos , Lactente , Alimentos Infantis/análise , Masculino , Carne/efeitos adversos , Micronutrientes/administração & dosagem , Micronutrientes/efeitos adversos , Mães/educação , Paquistão/epidemiologia , Áreas de Pobreza , Prevalência , Saúde da População Rural , Saúde da População Urbana , Zâmbia/epidemiologiaRESUMO
BACKGROUND: Children with edematous severe acute malnutrition (SAM) produce less cysteine than do their nonedematous counterparts. They also have marked glutathione (GSH) depletion, hair loss, skin erosion, gut mucosal atrophy, and depletion of mucins. Because GSH, skin, hair, mucosal, and mucin proteins are rich in cysteine, we hypothesized that splanchnic extraction and the efficiency of cysteine utilization would be greater in edematous than in nonedematous SAM. OBJECTIVE: We aimed to measure cysteine kinetics in childhood edematous and nonedematous SAM. DESIGN: Cysteine flux, oxidation, balance, and splanchnic uptake (SPU) were measured in 2 groups of children with edematous (n = 9) and nonedematous (n = 10) SAM at 4.4 ± 1.1 d after admission (stage 1) and at 20.5 ± 1.6 d after admission (stage 2) when they had replenished 50% of their weight deficit. RESULTS: In comparison with the nonedematous group, the edematous group had slower cysteine flux at stage 1 but not at stage 2; furthermore, they oxidized less cysteine at both stages, resulting in better cysteine balance and therefore better efficiency of utilization of dietary cysteine. Cysteine SPU was not different between groups but was â¼45% in both groups at the 2 stages. CONCLUSION: These findings suggest that children with edematous SAM may have a greater requirement for cysteine during early and mid-nutritional rehabilitation because they used dietary cysteine more efficiently than did their nonedematous counterparts and because the splanchnic tissues of all children with SAM have a relatively high requirement for cysteine. This trial was registered at clinicaltrials.gov as NCT00069134.
Assuntos
Cisteína/metabolismo , Dieta , Edema/metabolismo , Transtornos do Crescimento/metabolismo , Transtornos da Nutrição do Lactente/metabolismo , Desnutrição Proteico-Calórica/metabolismo , Aumento de Peso/fisiologia , Cisteína/uso terapêutico , Edema/etiologia , Feminino , Transtornos do Crescimento/dietoterapia , Transtornos do Crescimento/etiologia , Humanos , Lactente , Transtornos da Nutrição do Lactente/complicações , Transtornos da Nutrição do Lactente/dietoterapia , Masculino , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/dietoterapiaRESUMO
OBJECTIVE: To examine whether supplemental nutrition augments the anabolic actions of growth hormone (GH) in boys with constitutional delay of growth and maturation (CDGM). STUDY DESIGN: We conducted a randomized, controlled trial at an outpatient clinical research center. Subjects were 20 prepubertal boys (age, 9.3 ± 1.3 years) with CDGM (height standard deviation score, -2.0 ± 0.5; bone age delay, 1.8 ± 0.8 years; body mass index standard deviation score, -1.2 ± 1.0; peak stimulated GH, 15.7 ± 7.7 ng/mL), who were randomized (n = 10/group) to 6 months observation or daily nutritional supplementation, followed by additional daily GH therapy in all for another 12 months. t tests and repeated measures analyses of variance compared energy intake, total energy expenditure (TEE), growth, hormones, and nutrition markers. RESULTS: Energy intake was increased at 6 months within the nutrition group (P = .04), but not the observation group, and TEE was not statistically different within either group at 6 months. Addition of 6 months GH resulted in higher energy intake and TEE in the GH/nutrition group at 12 months (P < .01), but not in the GH group versus baseline. Height, weight, lean body mass, hormones, and nutrition markers increased comparably in both groups throughout 18 months. CONCLUSION: Boys with CDGM use energy at an accelerated rate, an imbalance not overcome with added nutrition. GH therapy increases growth comparably with or without added nutrition in these patients.
Assuntos
Suplementos Nutricionais , Transtornos do Crescimento/dietoterapia , Transtornos do Crescimento/tratamento farmacológico , Hormônio do Crescimento Humano/administração & dosagem , Criança , Terapia Combinada , Metabolismo Energético , Humanos , MasculinoRESUMO
AIM: The aim of this study was to determine the effects of early childhood stunting (height for age 2SD or more below reference values) and interventions on fine motor abilities at 11 to 12 years, and the relationship between fine motor abilities and school achievement and intelligence. METHOD: A cohort of stunted children who had participated in a randomized trial of psychosocial stimulation and/or nutritional supplementation in early childhood was compared with a group of non-stunted children. Fine motor abilities were assessed in 116 stunted (67 males, 49 females) and 80 non-stunted children (43 males, 37 females) at a mean age of 11 years 8 months (SD 4.3 mo) and 11 years 9 months (SD 3.8 mo) respectively. Testers were blind to the children's group assignment. RESULTS: Two fine motor factors were derived: rapid sequential continuous movements (RSCM) and dexterity. No effect of the early intervention was found. RSCM scores were lower in the stunted group than in the non-stunted group (p=0.01), but differences in dexterity were not significant (p=0.18) after adjusting for social background. Among stunted children, the RSCM score was significantly associated with IQ (p=0.04) and school achievement (all p<0.05). INTERPRETATION: Stunting in early childhood is associated with poor scores on tests of rapid sequential continuous hand movements in later childhood. Children with poorer scores are at greater risk for low IQs and low levels of school achievement.
Assuntos
Transtornos do Crescimento/complicações , Transtornos das Habilidades Motoras/complicações , Criança , Pré-Escolar , Estudos de Coortes , Escolaridade , Feminino , Seguimentos , Transtornos do Crescimento/dietoterapia , Transtornos do Crescimento/terapia , Mãos , Humanos , Lactente , Inteligência , Masculino , Destreza Motora , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
In 2004, Bogotá's Secretary of Education (SED) initiated a snack program in public primary schools. A midmorning food ration was provided free of charge to children to supplement 30 and 50% of their daily requirements of energy and iron, respectively. The purpose of this study, an observational investigation of 3202 children ages 5-12 y, was to examine whether the snack program improved children's nutritional and health status. We measured micronutrient levels (plasma ferritin and vitamin B-12, and erythrocyte folate), anthropometry, and reported morbidity during the first semester of the 2006 school year. After adjusting for socioeconomic status and other school interventions, children at schools receiving the snack (n = 1803) had greater increases in plasma vitamin B-12 (42 pmol/L; P < 0.0001) from baseline to 3 mo of follow-up than children at schools not receiving the snack (n = 1399). They also experienced a smaller decrease in height-for-age Z-scores than children who did not receive the snack (P = 0.001). Provision of the SED snack was associated with significantly fewer reported days with morbidity symptoms (e.g. cough with fever, diarrhea with vomiting), 44% fewer doctor visits (P = 0.02), and 23% fewer days of school absenteeism (P = 0.03). The snack was not related to ferritin or folate levels. In conclusion, provision of a school-administered snack was related to improved vitamin B-12 status and linear growth and decreased reported morbidity. Although provision of the snack was not related to BMI changes over a 4-mo period, snack components such as candy and sugar-sweetened beverages should be replaced with healthier options, as the rates of child overweight in Colombia are not negligible.
Assuntos
Serviços de Dietética , Transtornos do Crescimento/dietoterapia , Crescimento , Nível de Saúde , Estado Nutricional , Serviços de Saúde Escolar , Vitamina B 12/sangue , Estatura , Criança , Pré-Escolar , Colômbia/epidemiologia , Feminino , Transtornos do Crescimento/sangue , Transtornos do Crescimento/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Observação , Fatores SocioeconômicosRESUMO
PURPOSE: To test the effects of a low fat diet compared with a babassu fat diet on nutritional status in obstructive cholestasis in young rats. METHODS: We submitted 40 rats in 4 groups of 10 animals each from P21 (21st postnatal day) to P49 to two of the following treatments: bile duct ligation or sham operation and low fat diet (corn oil supplying 4.5% of the total amount of energy) or babassu fat diet (this fat supplying 32.7% and corn oil supplying 1.7% of the total amount of energy). Weight gain from P25 to P49 every 4 days was measured. The Verhulst's growth function was fitted to these values of weight gain. Growth velocity and acceleration at each moment were estimated using the same equation. Total food and energy intake from P21 to P49, energy utilization rate (EUR) from P25 to P49 and fat absorption rate (FAR) and nitrogen balance (NB) from P42 to P49 were measured. Two Way ANOVA and the S.N.K. test for multiple paired comparisons were employed to study the effects of cholestasis and those of the diets and their interaction (p<0.05) on those variables. RESULTS: In cholestatic animals, a higher growth velocity at P45, a higher growth acceleration at P41 and P45, a greater EUR, a greater FAR and a greater NB, were found with the low fat diet as compared with the babassu fat diet. CONCLUSION: A low fat diet lessens the growth restriction brought about by cholestasis and allows for an improved dietary energy utilization and a better protein balance than the babassu fat diet.
Assuntos
Colestase/fisiopatologia , Cocos/química , Dieta com Restrição de Gorduras , Gorduras na Dieta/administração & dosagem , Transtornos do Crescimento/dietoterapia , Crescimento , Estado Nutricional/efeitos dos fármacos , Análise de Variância , Animais , Colestase/complicações , Óleo de Milho/administração & dosagem , Modelos Animais de Doenças , Ingestão de Energia , Transtornos do Crescimento/etiologia , Masculino , Óleos de Plantas/química , Ratos , Ratos Wistar , Aumento de PesoRESUMO
PURPOSE: To test the effects of a low fat diet compared with a babassu fat diet on nutritional status in obstructive cholestasis in young rats. METHODS: We submitted 40 rats in 4 groups of 10 animals each from P21 (21st postnatal day) to P49 to two of the following treatments: bile duct ligation or sham operation and low fat diet (corn oil supplying 4.5 percent of the total amount of energy) or babassu fat diet (this fat supplying 32.7 percent and corn oil supplying 1.7 percent of the total amount of energy). Weight gain from P25 to P49 every 4 days was measured. The Verhulst's growth function was fitted to these values of weight gain. Growth velocity and acceleration at each moment were estimated using the same equation. Total food and energy intake from P21 to P49, energy utilization rate (EUR) from P25 to P49 and fat absorption rate (FAR) and nitrogen balance (NB) from P42 to P49 were measured. Two Way ANOVA and the S.N.K. test for multiple paired comparisons were employed to study the effects of cholestasis and those of the diets and their interaction (p<0.05) on those variables. RESULTS: In cholestatic animals, a higher growth velocity at P45, a higher growth acceleration at P41 and P45, a greater EUR, a greater FAR and a greater NB, were found with the low fat diet as compared with the babassu fat diet. CONCLUSION: A low fat diet lessens the growth restriction brought about by cholestasis and allows for an improved dietary energy utilization and a better protein balance than the babassu fat diet.
OBJETIVO: Testar os efeitos de uma dieta com baixo teor de gordura comparada a uma dieta com gordura de babaçu sobre o estado nutricional em ratos jovens com colestase obstrutiva. MÉTODOS: Submetemos 40 ratos divididos em quatro grupos de 10 animais a partir do P21 (21º dia pós-natal) até o P49 a dois dos seguintes tratamentos: ligadura e ressecção do ducto biliar comum ou operação simulada e dieta com baixo teor de gordura (óleo de milho fornecendo 4,5 por cento da quantidade total de calorias) ou dieta com gordura de babaçu (essa gordura fornecendo 32,7 por cento e óleo de milho fornecendo 1,7 por cento da quantidade total de calorias). Foi mensurado o ganho de peso a cada 4 dias do P25 ao P49. A função de crescimento de Verhulst foi ajustada aos valores de ganho de peso. A velocidade e a aceleração de crescimento nos mesmos momentos foram estimadas usando a mesma equação. Foram mensurados: quantidade de ração ingerida e ingestão energética total do P21 ao P49, utilização de energia do P25 ao P49, gordura absorvida e balanço de nitrogênio (BN) do P42 ao P49. A ANOVA com dois fatores e o método de S.N.K para comparações pareadas foram utilizados para estudar os efeitos, sobre as variáveis, da colestase e das dietas e sua interação (p<0,05). RESULTADOS: Em ratos com colestase e dieta com baixo teor de gordura, houve maior velocidade de crescimento no P45, maior aceleração de crescimento no P41 e P45, maior utilização de energia, maior percentual de gordura absorvida e maior BN do que em ratos com colestase e dieta com gordura de babaçu. CONCLUSÃO: A dieta com baixo teor de gordura atenua a restrição de crescimento provocada pela colestase e proporciona melhor aproveitamento da dieta e maior incorporação da proteína ingerida do que a dieta com gordura de babaçu.
Assuntos
Animais , Masculino , Ratos , Colestase/fisiopatologia , Cocos/química , Dieta com Restrição de Gorduras , Gorduras na Dieta/administração & dosagem , Crescimento , Transtornos do Crescimento/dietoterapia , Estado Nutricional/efeitos dos fármacos , Análise de Variância , Colestase/complicações , Óleo de Milho/administração & dosagem , Modelos Animais de Doenças , Ingestão de Energia , Transtornos do Crescimento/etiologia , Óleos de Plantas/química , Ratos Wistar , Aumento de PesoRESUMO
PURPOSE: To test the effects of a low fat diet compared with a babassu fat diet on nutritional status in obstructive cholestasis in young rats. METHODS: We submitted 40 rats in 4 groups of 10 animals each from P21 (21st postnatal day) to P49 to two of the following treatments: bile duct ligation or sham operation and low fat diet (corn oil supplying 4.5 percent of the total amount of energy) or babassu fat diet (this fat supplying 32.7 percent and corn oil supplying 1.7 percent of the total amount of energy). Weight gain from P25 to P49 every 4 days was measured. The Verhulst's growth function was fitted to these values of weight gain. Growth velocity and acceleration at each moment were estimated using the same equation. Total food and energy intake from P21 to P49, energy utilization rate (EUR) from P25 to P49 and fat absorption rate (FAR) and nitrogen balance (NB) from P42 to P49 were measured. Two Way ANOVA and the S.N.K. test for multiple paired comparisons were employed to study the effects of cholestasis and those of the diets and their interaction (p<0.05) on those variables. RESULTS: In cholestatic animals, a higher growth velocity at P45, a higher growth acceleration at P41 and P45, a greater EUR, a greater FAR and a greater NB, were found with the low fat diet as compared with the babassu fat diet. CONCLUSION: A low fat diet lessens the growth restriction brought about by cholestasis and allows for an improved dietary energy utilization and a better protein balance than the babassu fat diet.(AU)
OBJETIVO: Testar os efeitos de uma dieta com baixo teor de gordura comparada a uma dieta com gordura de babaçu sobre o estado nutricional em ratos jovens com colestase obstrutiva. MÉTODOS: Submetemos 40 ratos divididos em quatro grupos de 10 animais a partir do P21 (21º dia pós-natal) até o P49 a dois dos seguintes tratamentos: ligadura e ressecção do ducto biliar comum ou operação simulada e dieta com baixo teor de gordura (óleo de milho fornecendo 4,5 por cento da quantidade total de calorias) ou dieta com gordura de babaçu (essa gordura fornecendo 32,7 por cento e óleo de milho fornecendo 1,7 por cento da quantidade total de calorias). Foi mensurado o ganho de peso a cada 4 dias do P25 ao P49. A função de crescimento de Verhulst foi ajustada aos valores de ganho de peso. A velocidade e a aceleração de crescimento nos mesmos momentos foram estimadas usando a mesma equação. Foram mensurados: quantidade de ração ingerida e ingestão energética total do P21 ao P49, utilização de energia do P25 ao P49, gordura absorvida e balanço de nitrogênio (BN) do P42 ao P49. A ANOVA com dois fatores e o método de S.N.K para comparações pareadas foram utilizados para estudar os efeitos, sobre as variáveis, da colestase e das dietas e sua interação (p<0,05). RESULTADOS: Em ratos com colestase e dieta com baixo teor de gordura, houve maior velocidade de crescimento no P45, maior aceleração de crescimento no P41 e P45, maior utilização de energia, maior percentual de gordura absorvida e maior BN do que em ratos com colestase e dieta com gordura de babaçu. CONCLUSÃO: A dieta com baixo teor de gordura atenua a restrição de crescimento provocada pela colestase e proporciona melhor aproveitamento da dieta e maior incorporação da proteína ingerida do que a dieta com gordura de babaçu.(AU)
Assuntos
Animais , Masculino , Ratos , Colestase/fisiopatologia , Cocos/química , Dieta com Restrição de Gorduras , Gorduras na Dieta/administração & dosagem , Crescimento , Transtornos do Crescimento/dietoterapia , Estado Nutricional , Análise de Variância , Colestase/complicações , Óleo de Milho/administração & dosagem , Modelos Animais de Doenças , Ingestão de Energia , Transtornos do Crescimento/etiologia , Óleos de Plantas/química , Ratos Wistar , Aumento de PesoRESUMO
La importancia de los factores nutricionales en la etiología de la displasia broncopulmonar (DBP) esta sustentada por la estrecha relación entre los factores que predisponen a esta entidad y el desarrollo de falla nutricional. El objetivo de este manuscrito es revisar las bases científicas en las cuales se fundamenta la interacción de la nutrición y el desarrollo de la función pulmonar en el recién nacido de bajo peso al nacer; discutir la evidencia proveniente de estudios clínicos y/o revisiones sistemáticas que evalúen el efecto de prácticas nutricionales tendientes a disminuir la incidencia y la gravedad de la DBP, y la evaluación y el manejo nutricional de pacientes ya afectados con esta enfermedad. Intervenciones nutricionales dirigidas a incrementar el aporte de calorías y principalmente de proteínas con restricción del aporte hídrico desde el primer día de vida, evitar déficit de antioxidantes como vitamina E y selenio, administrar altas dosis de Vitamina A por vía intramuscular, tendrían un rol en prevenir o disminuir la severidad de la DBP. El incrementar el aporte de calorías con aportes proteicos superiores a 3 gr/kg/día, limitar el uso de diuréticos y corticoides, mantener buena oxigenación, promover alimentación ad-libitum e implementar equipos de apoyo nutricional al alta, reducirían el déficit nutricional y la falla de crecimiento asociada.
Assuntos
Humanos , Recém-Nascido , Displasia Broncopulmonar/dietoterapia , Displasia Broncopulmonar/etiologia , Displasia Broncopulmonar/metabolismo , Nutrição do Lactente , Recém-Nascido de muito Baixo Peso/metabolismo , Transtornos do Crescimento/complicações , Displasia Broncopulmonar/prevenção & controle , Alimentos Infantis , Músculos Respiratórios/metabolismo , Pulmão/fisiologia , Pulmão/metabolismo , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Transtornos do Crescimento/dietoterapia , Transtornos do Crescimento/etiologiaRESUMO
Physician behavior and caregiver retention of nutrition advice were examined as potential mediating factors in the success of a nutrition counseling efficacy trial in Pelotas, Brazil, which reduced growth faltering in children 12-24 mo old. After pair-matching on socioeconomic status and nutrition indicators, municipal health centers were randomly assigned to an intervention group, in which physicians were trained with an IMCI-derived (Integrated Management of Childhood Illness) nutrition counseling protocol, or to a control group, without continuing education in nutrition. In a substudy of the larger trial, direct observation of consultations, followed by home interviews with mothers, provided data on physician counseling behavior and mothers' retention of nutrition advice. Trained providers were more likely to engage in nutrition counseling (P < 0.013) and to deliver more extensive advice (P < 0.02). They also used communication skills designed to improve rapport and ensure that mothers understood the advice (P < 0.01). Mothers who received advice from trained providers had high rates of recalling the messages on specific foods (95 vs.27%; P < 0.01) and feeding practice and food preparation recommendations (90 vs. 20%; P < 0.01), whereas the proportions of the messages recalled on breast-feeding (60% vs. 30%) did not differ significantly (P < 0.20). The training course contained several elements that may explain why intervention group mothers were better able to recall nutrition advice. These include locally appropriate messages, tools for assessing individual problems, and counseling skills.
Assuntos
Ciências da Nutrição Infantil/educação , Aconselhamento , Transtornos do Crescimento/dietoterapia , Fenômenos Fisiológicos da Nutrição do Lactente , Papel do Médico , Brasil , Cuidadores , Comunicação , Educação Médica Continuada , Humanos , LactenteRESUMO
Introducción: los dos primeros años de vida postnatal constituyen un período crítico donde numerosas injurias pueden afectar el crecimiento y desarrollo con secuelas en etapas alejadas que no se pueden reparar. Para mejorar el diagnóstico y tratamiento integral del niño menor de dos años con retardo del crecimiento, se planificó este estudio prospectivo. Objetivo: aplicar un plan de estudio y tratamiento, poniendo en marcha una metodología sencilla con recursos locales accesibles a la población y analizar los factores que incidieron al inicio de la falla de crecimiento. Material y métodos: entre 1999 y 2001 ingresaron al estudio 40 niños de 6 a 24 meses que cumplieron criterios de inclusión. Fueron atendidos por un equipo interdisciplinario que los evaluó según un algoritmo diagnóstico, los trató con el plan terapéutico preestablecido y los siguió con controles adecuados a la severidad en forma personalizada. Resultados: la mediana de edad al ingreso fue de 11,6 meses. Habían sido alimentados con pecho directo exclusivo 3,5 meses en promedio, coincidiendo el enlentecimiento de la velocidad de crecimiento con el destete. La adhesión al tratamiento fue alta. A pesar de que sólo el 55 por ciento lo cumplió totalmente, la mediana de puntaje Z en el peso evolucionó de -2,41 al ingreso a -1,86 en la última evaluación. Conclusiones: la falla de crecimiento en la mayoría de los niños fue de causa nutricional, con mal manejo de los alimentos del destete. Se logró una buena evolución a partir de la captación. La metodología aplicada fue útil, pareciendo imprescindible y posible su aplicación en el primer nivel de atención. (AU)
Assuntos
Humanos , Lactente , Transtornos do Crescimento/dietoterapia , Transtornos do Crescimento/etiologia , Transtornos da Nutrição do Lactente/complicações , Transtornos do Crescimento/diagnósticoRESUMO
OBJECTIVE: To evaluate the intake of retinol and carotenoids, and their serum levels, as well as the impact of vitamin A supplementation on the anthropometry and body composition of children and adolescents with non-hormonal-related statural deficit. METHOD: Double-blind, randomized trial of 46 pre-pubertal patients, between 4 and 14 years of age, with normal growth rates. The subjects were divided into two groups, each with 23 individuals (Group I: Placebo; Group II: Vitamin A in a single megadose), and were evaluated at moments A and B with a six month interval. RESULTS: There were no statistically significant differences in serum retinol levels, anthropometry, growth velocity, or body composition, between moments A and B, in Group II. Carotenoids were significantly lower in Group I at moment B. The semi-quantitative food intake questionnaire showed that approximately 60.9% of the children and adolescents ingested less than half of the amounts of retinol and carotenoids recommended by the Food Guide Pyramid. Inadequate intake was more prevalent regarding vegetable and fruit carotenoid sources, with 75 and 70% of inadequacy, respectively. CONCLUSION: If one considers the inadequate food intake observed in the dietary evaluation in this study, it is possible that multiple micronutrient deficiencies could be involved in statural deficits. This could explain why vitamin A supplementation does not seem to influence growth in children and adolescents with statural deficit, as indicated by the present study. Thus in populations such as the one studied here, the supplementation with vitamin A should be integrated into comprehensive nutritional interventions, so as to possibly promote greater positive impact on linear growth.
Assuntos
Antropometria , Suplementos Nutricionais , Transtornos do Crescimento/dietoterapia , Transtornos do Crescimento/prevenção & controle , Vitamina A/farmacologia , Adolescente , Composição Corporal/efeitos dos fármacos , Composição Corporal/fisiologia , Carotenoides/administração & dosagem , Carotenoides/sangue , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Transtornos do Crescimento/sangue , Humanos , Masculino , Estado Nutricional , Fatores de Tempo , Vitamina A/administração & dosagem , Vitamina A/sangueRESUMO
The long-term benefits of early childhood supplementation and the extent to which catch-up growth occurs following linear growth retardation remain controversial. Stunted children (height-for-age < -2 SD of NCHS references, n = 122) recruited from a survey of poor neighborhoods in Kingston, Jamaica, participated in a 2-yr randomized, controlled trial of supplementation beginning at ages 9-24 mo. A group of 32 non-stunted children from the same neighborhoods was also followed. Four years after the intervention ended, when children were 7 to 8 y old, there were no effects of supplementation on any anthropometric measure. From the end of the trial until follow-up, the children who had been supplemented gained 1.2 cm less (P < 0.05) than the non-supplemented children, approximately the same amount as they had gained during the trial compared with the non-supplemented children. After adjustment for regression to the mean, the height-for-age of stunted children (supplemented and non-supplemented combined) increased from enrollment to follow-up by 0.31 Z-score (95% CI 0.17, 0.46). The height-for-age of the non-stunted children also increased (0.96 Z-score; 95% CI 0.70, 1.22). Our results suggest that some catch-up growth is possible even when children remain in poor environments. Long-term benefits of supplementation to growth may not be achieved when intervention begins after age 12 mo in children who have already become undernourished.
Assuntos
Alimentos Fortificados , Transtornos do Crescimento/dietoterapia , Crescimento , Antropometria , Transtornos da Nutrição Infantil/complicações , Pré-Escolar , Feminino , Humanos , Lactente , Jamaica , Estudos Longitudinais , Masculino , Pobreza , Análise de RegressãoRESUMO
The long-term benefits of early childhood supplementation and the extents to which catch-up growth occurs following linear growth retardation remain controversial. Stunted children (height-for-age < -2 SD of NCHS reference, n = 122) recruited from a survey of poor neighborhoods in Kingston, Jamaica, participated in a 2-yr randomized, controlled trial of supplementation beginning at ages 9-24 mo. A group of 32 non-stunted children from the same neighborhoods was also followed. Four years after the intervention ended, when children were 7 to 8 y old, there were no effects of supplementation on any anthropometric measure. From the end of the trial until follow-up, the children who had been supplemented gained 1.2 cm less (P < 0.05) than the non-supplemented children, approximately the same amount as they had gained during the trial compard with the non-supplemented children. After adjustment for regression to the mean, the height-for-age of stunted children (supplemented and non-supplemented combined) increase from enrollment to follow-up by 0.31 Z-score (95 percent CI 0.17, 0.46). The height-for-age of the non-stunted children also increase (0.96 Z-score; 95 percent CI 0.70, 1.22). Our results suggest that some catch-up growth is possible even when children remain in poor environments. Long-term benefits of supplementation to growth may not be achieved when intervention begins after age 12 mo in children who have already become undernourished.(AU)
Assuntos
Pré-Escolar , Feminino , Humanos , Masculino , Alimentos Fortificados , Crescimento , Transtornos do Crescimento/dietoterapia , Antropometria , Jamaica , Pobreza , Transtornos da Nutrição Infantil/complicações , Análise de Regressão , Estudos LongitudinaisRESUMO
Effects of supplementary feeding during early childhood on body size and composition at adolescence are examined in a population with marked growth failure in the first 3 y of life. The data came from a supplementation trial conducted in rural Guatemala from 1969 to 1977 and a 1988-89 follow-up study of the same subjects at adolescence. Two pairs of villages participated in the trial. One village from each pair received a high protein-energy supplement (Atole), which significantly improved dietary intakes, whereas the other village of the pair received a low-energy, no-protein supplement (Fresco), which did not impact appreciably on dietary intakes. Children from Atole villages grew better during the preschool period than children from Fresco villages. At adolescence, subjects from Atole villages were taller, weighed more and had greater fat-free masses than subjects from Fresco villages. Differences in height at adolescence were slightly reduced in magnitude relative to differences at 3 y of age. However, differences in weight were increased in adolescence relative to 3 y of age.
Assuntos
Composição Corporal , Constituição Corporal , Alimentos Fortificados , Transtornos do Crescimento/dietoterapia , Adolescente , Fatores Etários , Pré-Escolar , Feminino , Seguimentos , Transtornos do Crescimento/diagnóstico , Guatemala , Humanos , Masculino , Análise de RegressãoRESUMO
The relationship between physical growth and change in mental development on the Griffiths mental development scales was investigated in 127 stunted Jamaican children over a 2-year period. The role of nutritional supplementation in this relationship was examined. There were no consistent associations between changes in weight-for-height or head circumference and developmental change. Height gain over 2 years was significantly associated with change in mental age, and locomotor and hearing and speech subscale scores. Height gain in the first year predicted change in mental age, and hearing and speech in the second year. Some of the effect of supplementation on development was shared with linear growth. Therefore, nutrition probably explains part of the relationship between growth and development. However, supplementation also had effects on development independent of growth. The benefits of supplementation on development and the extent to which they were shared with growth varied among the subscales.
Assuntos
Desenvolvimento Infantil , Alimentos Fortificados , Transtornos do Crescimento/dietoterapia , Crescimento , Estatura , Feminino , Transtornos do Crescimento/fisiopatologia , Humanos , Lactente , Jamaica , Masculino , Fenômenos Fisiológicos da Nutrição , Análise de RegressãoRESUMO
The relationship between physical growth and change in mental development on the Griffiths mental development scales was investigated in 127 stunted Jamaican children over a 2-year period. The role of nutritional supplementation in this relationship was examined. There were no consistent associations between changes in weight-for-height or head circumference and developmental change. Height gain over 2 years was significantly associated with change in mental age, and locomotor and hearing and speech subscale scores. Height gain in the first year predicted change in mental age, and hearing and speech in the second year. Some of the effect of supplementation on development was shared with linear growth. Therefore, nutrition probably explains part of the relationship between growth and development. However, supplementation also had effects on development independent of growth. The benefits of supplementation on development and the extent to which they were shared with growth varied among the subscales (AU)
Assuntos
Humanos , Masculino , Feminino , Lactente , Desenvolvimento Infantil , Alimentos Fortificados , Transtornos do Crescimento/dietoterapia , Estatura , Transtornos do Crescimento/fisiopatologiaRESUMO
Infection and undernutrition in young children are thought to act synergistically. However, studies of the relationship between low height-for age (stunting) and morbidity in young children have had inconsistent findings and there are few adequate data on the effects of nutritional supplimentation on morbidity. 129 stunted and 21 non-stunted children aged between 9 and 24 months, from poor Kingston neighbourhoods, identified from a house to house survey, were studied. The stunted children were randomly assigned to supplementation or no supplementation. Every week for 24 months the mothers were asked about the occurrence of any symptoms of illness. Supplementation had no consistent effect on the incidence or duration of symptoms. The stunted children had significantly more attacks of diarrhoea, fever, anorexia and apathy than the non-stunted children. The difference remained after controlling for social background and previous attacks of diarrhoea. There was also some indication of more severe illness in the stunted than the non-stunted children (AU)