Assessment of pre- and post-operative nutritional status in patients undergoing orthognathic surgery / Avaliação do estado nutricional pré e pós-operatório em pacientes submetidos à cirurgia ortognática

ABSTRACT: Introduction: The maxillofacial procedures for skeletal deformities are characterized by structural-morphological changes derived from unfavorable genetics with diagnosis performed during craniofacial growth. Orthognathic surgery requires a total restriction on chewing for 60 days, leading to loss of body weight in overweight and obese individuals, as well as in well-nourished patients. Objective: Evaluating the pre- and post-operative nutritional status of patients undergoing orthognathic surgery. Material and methods: This is an interventional study. The study group received supplementation with whey protein, L-arginine, L-glutamine, and fatty acid Omega-3, and both groups were assessed in terms of anthropometric and biochemical measurements. The evaluation of soft tissue healing was conducted after surgery. Results: It is possible to infer that the percentage of skeletal muscle mass tends to increase in the intervention group, however, the weight loss was greater (-4.88%). Uric acid increased post-operative in the control group (+37.64%). Conclusion: Oral nutritional supplementation used in the study seems promising for reducing the loss of skeletal muscle mass, but further studies involving a larger number of patients are needed to confirm the results. (AU)

RESUMO: Introdução: Os procedimentos maxilofaciais para deformidades esqueléticas são caracterizados por intervenções morfológicas estruturais, necessários por conta de genética desfavorável com diagnóstico feito durante o cresci-mento craniofacial. A cirurgia ortognática requer uma restrição total na mastigação por 60 dias, levando à perda de peso corporal em indivíduos com sobrepeso e obesos, bem como em pacientes bem nutridos. Objetivo: Avaliar o estado nutricional pré e pós-operatório dos pacientes submetidos à cirurgia ortognática. Material e métodos: Trata-se de um estudo de intervenção. O grupo de estudo recebeu suplementação com proteína de soro de leite, L-arginina, L-glutamina e ácido graxo ômega-3 e ambos os grupos foram avaliados em termos de medidas antropo-métricas e bioquímicas. A avaliação da cicatrização de tecidos moles foi realizada após a cirurgia. Resultados: É possível inferir que o percentual de massa muscular esquelética tendeu a aumentar no grupo de intervenção, porém a perda de peso foi maior (-4,88%). O ácido úrico aumentou no pós-operatório no grupo controle (+37,64%). Conclusão: A suplementação nutricional oral utilizada no estudo parece promissora para reduzir a perda de massa muscular esquelética, mas estudos adicionais envolvendo um número maior de pacientes são necessários para confirmar os resultados. (AU)

Impaired bone mineral accrual in prepubertal HIV-infected children: a cohort study

ABSTRACT OBJECTIVE: To evaluate bone mass accrual and determine the influence of clinical, anthropometric, dietary and biochemical parameters on bone mass. METHODS: A cohort study including 35 prepubertal HIV-infected children, between 7 and 12 years, attended at a referral center. At time 1 (T1) and time 2 (T2), patients were assessed according to clinical, anthropometric, dietary, biochemical parameters and bone mineral density (BMD). At T2, patients were divided into prepubertal and pubertal. RESULTS: Despite the increase in bone mass absolute values, there was no improvement in lumbar spine BMD (LSBMD) Z-score (p = 0.512) and worsening in total body BMD (TBMD) Z-score (p = 0.040). Pubertal patients (n = 19) showed higher bone mineral content (BMC) (p = 0.001), TBMD (p = 0.006) and LSBMD (p = 0.002) compared to prepubertal patients. After multivariate linear regression analysis, the predictors of bone mass in T1 were age, BMI and HAZ-scores for BMC; BMI Z-score, adequate serum magnesium concentration and dietary calcium intake for TBMD; adequate serum concentration of magnesium, BMI and HAZ-scores for LSBMD. In T2, age, total body fat and lean body mass (kg) for BMC; BMI Z-score and puberty for TBMD; dietary fat intake, BMI Z-score for BMD and puberty for LSBMD. CONCLUSION: HIV-infected children have compromised bone mass and the presence of puberty seems to provide suitability of these parameters. Adequate intake of calcium and fat appears to be protective for proper bone mass accumulation factor, as well as monitoring nutritional status and serum magnesium concentration.

Body Composition Changes and Predictors of Lipodystrophy in a Cohort of Pre-pubertal HIV- infected Children.

Aim: To evaluate body composition changes in HIV-infected patients and to identify the predictors of lipodystrophy over time. Methods: A cohort study, evaluated over two and a half years (Time 1: T1; Time 2: T2), including prepubertal HIV-infected children of both genders, between 7-12 years of age. Patient’s data such as transmission, use of prophylaxis for vertical HIV transmission, clinical and immunological classification of disease and current antiretroviral therapy were derived from the medical records. At T1, only subjects with pubertal stage 1 were included. Clinical, anthropometric, body composition and biochemical data were assessed. Patients were divided into two groups: with (LD+) and without lipodystrophy (LD-). Results: A total of 40 patients were enrolled, and 35 patients completed the study. Mean (SD) age was 9.6 (1.1) and 11.6 (1.2) years at T1 and T2, respectively. At T2, 16 (45.7%) children remained prepubertal. LD+ group (n = 8) showed a higher prevalence of short stature (p = 0.008) in T1; higher insulin (p = 0.010) and HOMA-IR (p = 0.013) and reduction of triceps skinfold thickness (p = 0.026) at T2. In both times, we observed lower concentrations of HDLc (p = 0.027), higher values of trunk to arm ratio (p = 0.002, p = 0.001) and lower values of limb to trunk ratio (p = 0.001) and gynoid fat (p= 0.001) in LD+ group. At T1, predictors of lipodystrophy were short stature (OR = 46.198, p = 0.019) and limb to trunk ratio (OR = 0.00009, p = 0.011); in T2, waist circumference (OR = 1.199, p = 0.025) and HDLc (OR = 0.835, p = 0.015). Presence of lipodystrophy was determinant of high insulin levels at T2. Conclusion: In a short period, LD+ group had significant changes in body fat distribution and also biochemical alterations associated to lipodystrophy syndrome.

Assessment of antioxidants status and superoxide dismutase activity in HIV-infected children

Objective: This study aims to assess the nutritional status of selenium, copper and zinc; and also the erythrocyte superoxide dismutase activity of HIV-infected children compared to a control group. Methods: A cross-sectional study was carried out with prepubertal HIV-infected children (n = 51) and their healthy siblings (n = 32). All biochemical measurements including plasma selenium, serum copper levels, serum and erythrocyte zinc levels and erythrocyte super-oxide dismutase activity were evaluated according to dietary, clinical and biochemical parameters. Results: Compared to the control group, the HIV-infected children had lower z-score values for height-for-age (p = 0.0006), higher prevalence of stunting (11.8%) (p = 0.047), lower selenium levels (p = 0.0006) and higher copper levels (p = 0.019). No difference was found concerning superoxide dismutase activity (p > 0.05). The HIV-infected group presented a higher proportion (45.1%) of children with zinc intakes below the estimated average requirement (p = 0.014); however, no association with zinc biochemical parameters was found. Conclusion: HIV-infected children have an inadequate selenium and copper nutritional status, which could influence the progression to AIDS. An adequate micronutrient status could improve the clinical conditions in these patients and minimize free radical production and cellular oxidative stress. .

Body composition and lipodystrophy in prepubertal HIV-infected children

OBJECTIVE: To identify lipodystrophy in prepubertal HIV-infected children using anthropometric parameters and body composition assessment. METHODS: Cross-sectional study including 40 prepubertal HIV-infected children of both genders seen at the Care Center of the Division of Pediatric Infectious Diseases - Universidade Federal de São Paulo, São Paulo city, Brazil, was carried out from August to December 2008. Age, clinical and immunological status, prophylaxis, transmission and highly active antiretroviral therapy were recorded. Body mass index z-score and height-for-age z-score were calculated to characterize the nutritional status. Circumferences were measured with flexible tape and skinfolds were assessed by an adipometry. Fat mass and lean mass were determined by dual-energy X-ray absorptiometry. Presence of clinical signs of lipodystrophy was assessed by a trained clinician. Data were analyzed using SPSS 12.0 software. RESULTS: The mean age and standard deviation were 9.8 (1.2) years, 50% were girls and 82.5% children from B and C categories. Clinical lipodystrophy and dislypidemia were present in 27.5% and 70%, respectively. The trunk to arm ratio and the limb to trunk ratio had positive association with lipodystrophy. Patients with lipodystrophy had short stature, higher triglycerides values and lower HDL-cholesterol. CONCLUSION: The ratios obtained by skinfolds and dual-energy X-ray absorptiometry measurements can be considered as indicators of preclinical lipodystrophy. The cutoff points have not been determined yet; however, continuous assessment may be useful to identify early body composition changes.

Vitaminas antioxidantes e prevenção da arteriosclerose na infância / Antioxidant vitamins and prevention of atherosclerosis in childhood

OBJETIVO: Revisar os potenciais efeitos antioxidantes das vitaminas A, C e E na prevenção do desenvolvimento da arteriosclerose na infância, com ênfase na prevenção da dislipidemia. FONTES DE DADOS: Pesquisa bibliográfica em revistas científicas, livros técnicos e publicações de órgãos oficiais dos últimos 20 anos. Utilizaram-se as bases de dados Lilacs, SciELo e Medline em português, inglês e espanhol, com as palavras-chave: "antioxidantes", "arteriosclerose", "dislipidemias", "peroxidação de lipídeos", "infância", "vitamina A", "vitamina C" e "vitamina E". SÍNTESE DE DADOS: A prevalência de dislipidemia na infância e na adolescência mostra frequência crescente, provavelmente relacionada às mudanças dos hábitos alimentares e à redução na prática de atividades físicas. O elevado nível plasmático da lipoproteína de baixa densidade (LDL-c) é fator de risco para o desenvolvimento da arteriosclerose. O consumo de frutas, verduras e legumes, ricos em antioxidantes, é um dos fatores de maior importância na prevenção da peroxidação lipídica. A baixa ingestão dessas fontes naturais de antioxidantes sugere a necessidade de intervenção nutricional para atingir as metas diárias de consumo de vitaminas A, C e E, não sendo preconizada a sua suplementação medicamentosa. CONCLUSÕES: O pediatra e o nutricionista devem orientar as famílias sobre o consumo de alimentos saudáveis, principalmente frutas, verduras e legumes, por seu potencial efeito antioxidante, especialmente nos primeiros anos de vida.

OBJECTIVE: To review the potential antioxidant effects of vitamins A, C and E in the prevention of atherosclerosis development during childhood, emphasizing the prevention of dyslipidemia. DATA SOURCES: Bibliographic search in scientific journals, technical books and official publications of the last 20 years. Lilacs, SciElo and Medline databases were searched for articles in Portuguese, Spanish and English using a combination of the following terms: "antioxidants", "atherosclerosis", "dyslipidemia", "lipid peroxidation", "childhood", "vitamin A", "vitamin C" and "vitamin E". DATA SYNTHESIS: There is an increasing prevalence of dyslipidemia in children and adolescents, probably related to changes in dietary habits and to the reduced practice of physical activities. The high plasma concentration of low-density lipoprotein (LDL-c) is a risk factor for atherosclerosis development. The consumption of nutrients rich in antioxidants, such as fruits and vegetables, is very important to prevent lipid peroxidation. The low intake of these natural antioxidants sources suggests the need for nutritional intervention to achieve the daily ingestion targets of vitamins A, C and E. Vitamin supplementation is not recommended. CONCLUSIONS: Children should be encouraged to increase ingestion of fruits and vegetables due to their potential antioxidant effect, especially in the first years of life.

Estado nutricional de crianças e adolescentes hospitalizados em enfermaria de cirurgia pediátrica / Nutritional status of children and adolescents hospitalized at the pediatric surgery unit

OBJETIVO: Avaliar o estado nutricional, o tempo de internação e as especialidades clínicas de pacientes internados na enfermaria de Cirurgia Pediátrica do Hospital São Paulo da Unifesp-EPM. MÉTODOS: Estudo transversal retrospectivo, com 749 crianças e adolescentes de ambos os gêneros acompanhados por equipe interdisciplinar durante o período de agosto de 2007 a julho de 2008. Foram coletados dados antropométricos, dias de internação e procedimento cirúrgico segundo a especialidade. Para a classificação do estado nutricional, utilizou-se o escore Z do índice de massa corporal (Z IMC) e da estatura/idade (Z E/I) segundo a curva da Organização Mundial de Saúde (OMS, 2007). As crianças foram classificadas segundo diagnóstico estabelecido previamente à cirurgia. Utilizou-se o programa STATA 8.0 para análise dos dados e aplicou-se o teste ANOVA e comparações múltiplas de Bonferroni, considerando-se significante p<0,05. RESULTADOS: A mediana de idade foi sete anos (0 a 18), predominando o gênero masculino (59 por cento) e as internações para cirurgia otorrinolaringológica (18 por cento). Dos pacientes internados, 66 por cento tinham estatura adequada para idade, 43 por cento eutróficos e 31 por cento obesos/sobrepeso. Os pacientes desnutridos permaneceram mais dias internados quando comparados aos obesos/sobrepeso (7,2 versus 4,1 dias; p=0,035). Os lactentes apresentaram maior tempo de internação (p=0,006) e menor valor de Z IMC, comparados aos outros grupos etários (p=0,001). Os lactentes com programação de cirurgia cardíaca apresentaram Z IMC menor em relação às demais especialidades (p=0,002). CONCLUSÕES: O perfil dos pacientes internados condiz com a atual transição nutricional, aumento da prevalência de obesidade concomitante à desnutrição. Entretanto, a desnutrição ainda constitui fator agravante para a permanência hospitalar.

OBJECTIVE: To evaluate the nutritional status, duration of hospital stay and clinical specialties of patients hospitalized in the Pediatric Surgery Unit of São Paulo Hospital, Unifesp-EPM. METHODS: This cross-sectional retrospective study enrolled 749 children and adolescents of both genders admitted to the Pediatric Surgery Unit during the period of August 2007 to July 2008. The following data were collected: anthropometric variables, duration of hospital stay and surgical procedures. For nutritional status classification, the Z score for body mass index (Z BMI) and height-for-age (Z H/A) were used according to the World Health Organization growth chart (WHO, 2007). The children were classified according to the surgical procedures performed. Results were compared by ANOVA followed by Bonferroni multiple comparisons test, being significant p<0.05. Statistical analysis was carried out through STATA 8.0 software. RESULTS: Patients' mean age was seven years old (0 to 18), 59 percent were males and 18 percent had ear, neck or throat surgery. Among the hospitalized patients, 66 percent had appropriated height for age, 43 percent were eutrophic and 31 percent obese/overweight. The malnourished patients presented longer hospital stay than the obese/overweight patients (7.2 versus 4.1 days; p=0,035). Infants had prolonged hospital stay (p=0,006) and less Z BMI values in comparison to the other age groups. (p=0,001). Infants that needed cardiac surgery presented lower Z BMI in relation to the others (p=0,002). CONCLUSIONS: The patients profile in the Pediatric Surgery Unit followed the nutritional pattern observed in Brazil, with increasing prevalence of obesity together with malnutrition. However, malnutrition is still an aggravating factor for prolonged hospital stay.

The influence of sardine consumption on the omega-3 fatty acid content of mature human milk

OBJECTIVES: The purpose of this study was to investigate what effect the intake of sardines, rich in omega-3 series polyunsaturated fatty acids, has on the composition of breastmilk. METHODS: This was a prospective study of 31 nursing mothers under observation at the Hospital Guilherme Alvaro. Each was given 2 kg of fresh sardines twice with a 15-day interval. Milk was sampled and a 24-hour dietary recall questionnaire was applied on days 0, 15 and 30. Milk was assayed for fatty acid content by gas chromatography. Statistical analysis of the results was performed using nonparametric tests with significance set at p < 0.05. RESULTS: The results demonstrate that the nutritional intake of the nursing mothers was adequate at all three sample points. With regard to the omega-3 series fatty acid content of the breastmilk, it was observed that regular consumption and shorter intervals between intake and milk collection resulted in higher concentrations of docosapentaenoic acid and docosahexaenoic acid at 15 and 30 days into the study. Fatty acids from the omega-3 and omega-6 series exhibited a significant correlation, r2 was 0.58 and 0.59 at 15 and 30 days, respectively. CONCLUSION: These results suggest that incorporating fish into the diets of nursing mother during lactation, in the form of 100 g of sardines two or three times a week, contributes to an increase in omega-3 series fatty acids.

Investigação de alteraçoes no perfil lipídico de criançãs e adolescentes obesos / Changes in lipid profile in obese children and adolescents

Alterations in plasmatic lipid profile are known to be risk factors for atherosclerotic disease and have been associated with obesity. This research was designed in order to study the incidence of these alterations in obese children and adolescents according to two different reference patterns. Analyses of seric levels of Total Cholesterol (CT) and fractions and of Triglycerides (TG) were done. The sample included 74 obese children and adolescents with average age equal to 11 years and 10 months for boys and 10 years and 9 months for girls and with mean weight/height ratio (W/H) equal to 151 and 149 for boys and for girls, respectively. Plasmatic lipid values obtained were classified according to the American Heart Position Statement Circulation (AHPSC) and to Kwiterovich reference patterns. It was observed that patients with abnormal seric HDL-cholesterol (HDL) levels had a significantly greater (W/H) then the other group. It was also noticed that a greater number of individuals presented abnormal or borderline plasmatic lipid levels (91.9), specially HDL (93.6) and TG (67.6), according to Kwiterovich than AHPSC. Obesity showed to be an important factor in determining lipid profile values and should be included as a variable to indicate screening of these lipoproteins in childhood and adolescence.

Fatores de risco para doença aterosclerótica em estudantes de uma Universidade privada em Säo Paulo - Brasil / Risk factors for atherosclerosis in students of a private University in Säo Paulo - Brazil

Objective - To characterize the risk profile for atherosclerosis (AS) in adolescents and young adults of a private university in São Paulo. Methods - Clinical, nutritional, and laboratory parameters were evaluated in 209 students of both genders aged 17 to 25 years. In addition to determination of the lipid profile, the association of its abnormal values with other risk factors for AS was also investigated. Results - Increased levels of total cholesterol, LDL-C and triglycerides (TG) were observed in 9.1 per cent, 7.6 per cent and 16.3 per cent of the students, respectively, and decreased levels of HDL-C in 8.6 per cent of them. Prevalence of the remaining risk factors analyzed was elevated: sedentary life style (78.9 per cent); high intake (35.9 per cent); smoking, hypertension (15.8 per cent) and obesity (7.2 per cent). There was an association between elevated LDL-C and TG levels and sedentary life style and body mass index. Conclusion - The high prevalence of risk factors for AS in young individuals draws attention to the need for adoping preventive plans.

Conhecimentos e crendices populares de puérperas na prática da amamentaçäo / Mother's knowledge and popular beliefs regarding breast-fedding practices

Säo vários os fatores que interferem no declínio da amamentaçäo. Apesar de as mäes saberem que o leite humano é o melhor alimento para suas crianças, costumam abandonar essa prática em momentos precoces. Como consequência deste abandono têm-se se verificado prejuízos tais como anemia, desnutriçäo e alta incidência de mortalidade infantil. O objetivo deste trabalho foi realizar um levantamento do conhecimento de nutrizes da Maternidade Amparo Maternal sobre amamentaçäo, bem como verificar a presença de crendices entre puérperas de baixo nível sócio-econômico. Para esse fim, foram entrevistadas, através de um formulário, 185 mäes, sendo 84 primíparas e 101 multíparas. Quanto à escolaridade, a maioria havia estudado apenas de 4 a 8 anos (46,5 por cento). A presença de crenças foi observada na maioria das mäes (59,0 por cento), sendo que nas multíparas evidenciaram-se mais crenças que prejudicam a amamentaçäo (10,3 por cento), destas, 84 por cento eram inadequadas. Considerando que a presença de crendices pode atuar positiva ou negativamente no processo de amamentaçäo, propöe-se que se realizem mais estudos que comprovem o papel dos alimentos em inibir ou estimular a lactaçäo

Concentraçäo de lactose em colostro: estudo em adolescentes e adultas, eutróficas e desnutridas / Lactose in the colostrum. Studie in adolescents and adults, eutrophic and malnourished

Estudos sobre composiçäo química do leite humano säo fundamentais para o esclarecimento dos mecanismos de síntese de nutrientes e para o incentivo do aleitamento materno. O presente estudo faz parte de uma linha de pesquisa que investiga a influência das diferentes condiçöes maternas, gestacionais e do recém-nascido sobre a composiçäo do leite secretado. Foram estudadas 43 puérperas, classificadas como de baixo nível sócio-econômico, agrupadas segundo idade (adolescentes e adultas) e estado nutricional (eutróficas e desnutridas). O colostro foi coletado até 48 horas após o parto para dosagem de lactose. Os resutados mostraram näo haver diferenças significantes entre os valores dos grupos estudados, que apresentaram as seguintes médias: adolescentes eutróficas: 5,30 ñ 1,38 g/dl; adolescentes desnutridas: 5,06 ñ 1,40 g/dl; adultas eutróficas: 5,30 ñ 0,96 g/dl e adultas desnutridas: 5,22 ñ 1,88 g/dl. Conclui-se, portanto, que as variáveis maternas investigadas (adolescência e desnutriçäo) näo säo fatores limitantes para secreçäo de lactose no colostro