Abordaje nutricional en pacientes con cirugía bariátrica

La cirugía bariátrica se establece como el tratamiento quirúrgico Gold estándar para la rápida reducción de peso, sin embargo, existe poca información sobre el adecuado manejo nutricional que debe tener el paciente antes y después de la operación. Objetivo. Analizar la influencia que tiene el abordaje nutricional en pacientes con obesidad sometidos a cirugía bariátrica. Metodología. Se trata de un estudio descriptivo, no experimental, basado en la aplicación del método PRISMA a través del cual se realizó una meticulosa revisión y análisis de investigaciones publicadas en bases de datos relevantes, considerando aquellas publicaciones con 5 años de antigüedad, que discutan sobre la nutrición en cirugía bariátrica. Resultados. Se identificaron 141 registros en las bases de datos, aplicando los criterios de selección, 35 de ellos se consideraron como fuentes importantes de información, sin embargo, en base al análisis de calidad metodológica y otros parámetros se llegaron a seleccionar 15 artículos con datos notables para esta revisión, se observó que a mayor restricción en la dieta mayor peso perdido, no obstante, menor adherencia y mayor pérdida de masa muscular. Conclusión. Mediante el análisis de información científica se llega a determinar que el abordaje nutricional tanto prequirúrgico como postquirúrgico, garantiza el éxito total de la cirugía, potenciando el resultado del procedimiento, además de permitir una compensación apropiada en cuanto a los requerimientos energéticos del paciente y así evitar deficiencias nutricionales.

Bariatric surgery is established as the Gold standard surgical treatment for rapid weight reduction, however, there is little information on the adequate nutritional management that the patient should have before and after the operation. Objective. To analyze the influence of the nutritional approach in patients with obesity undergoing bariatric surgery. Methodology. This is a descriptive, non-experimental study, based on the application of the PRISMA method through which a meticulous review and analysis of research published in relevant databases was carried out, considering those publications 5 years old, which discuss nutrition in bariatric surgery. Results. A total of 141 records were identified in the databases, applying the selection criteria, 35 of them were considered as important sources of information, however, based on the analysis of methodological quality and other parameters, 15 articles with remarkable data were selected for this review, it was observed that the greater the dietary restriction, the greater the weight lost, however, the lower the adherence and the greater the loss of muscle mass. Conclusion. Through the analysis of scientific information, it was determined that the nutritional approach, both pre-surgical and post-surgical, guarantees the total success of the surgery, enhancing the result of the procedure, besides allowing an appropriate compensation in terms of the patient's energetic requirements and thus avoiding nutritional deficiencies.

A cirurgia bariátrica está estabelecida como o tratamento cirúrgico padrão ouro para a redução rápida de peso; no entanto, há poucas informações sobre o manejo nutricional adequado do paciente antes e depois da operação. Objetivo. Analisar a influência da abordagem nutricional em pacientes com obesidade submetidos à cirurgia bariátrica. Metodologia. Trata-se de um estudo descritivo, não experimental, baseado na aplicação do método PRISMA, por meio do qual foi realizada uma meticulosa revisão e análise de pesquisas publicadas em bases de dados relevantes, considerando as publicações com 5 anos de idade, que discutem a nutrição na cirurgia bariátrica. Resultados. Foram identificados 141 registros nas bases de dados, aplicando os critérios de seleção, 35 deles foram considerados como fontes importantes de informação, porém, com base na análise da qualidade metodológica e outros parâmetros, 15 artigos com dados notáveis foram selecionados para esta revisão, observou-se que quanto maior a restrição alimentar, maior o peso perdido, porém, quanto menor a adesão e maior a perda de massa muscular. Conclusão. Por meio da análise de informações científicas, determinou-se que a abordagem nutricional, tanto no pré-cirúrgico quanto no pós-cirúrgico, garante o sucesso total da cirurgia, melhorando o resultado do procedimento, além de permitir uma compensação adequada em termos de necessidades energéticas do paciente e, assim, evitar deficiências nutricionais.

Utilidad del CANs SCORE para valoración clínica del estado nutricional del recién nacido de término / Utility of the CANs SCORE for clinical assessment of the nutritional the new born status of

Se conoce que la Desnutrición Fetal predispone a una mayor morbimortalidad perinatal, secundaria a sufrimiento fetal, aspiración de meconio, asfixia, hipoglucemia neonatal y síndrome de hiperviscosidad. También se asocia, a medio-largo plazo, a un mayor riesgo en comparación con la población general de presentar trastornos neurológicos o mentales (trastornos cognitivos y del aprendizaje), complicaciones endocrinológicas, metabólicas y cardiovasculares, por lo que sería conveniente identificar a estos recién nacidos precozmente, para promover una vigilancia e intervención adecuadas. Objetivo: demostrar la utilidad de la Evaluación Clínica Neonatal utilizando el CANs SCORE (Evaluación Clínica del Estado Nutricional), desarrollado y publicado por Mettcoff en 1994. Métodos: se realizó un estudio piloto transversal de marzo a junio de 2018, en el Hospital "Cochabamba", de nivel II, seleccionando 50 recién nacidos a término que presentasen signos clínicos para desnutrición según la escala de Mettcoff. Se realizaron mediciones antropométricas completas y exámenes de parámetros de laboratorio relacionados. Se utilizaron comparaciones de medias y correlaciones con valores del score-Z calculado mediante la herramienta Intergrowth- 21st, para evaluar los datos. Resultados: se encontraron diferencias estadísticamente significativas entre los parámetros antropométricos básicos evaluados como peso, talla, perímetro cefálico. Además, la evaluación mediante la escala de Mettcoff permitió la detección de DESNUTRICIÓN FETAL en recién nacidos que de otra manera se clasificarían como de peso adecuado para la Edad Gestacional (AEG). En el laboratorio los hallazgos fueron: disminución o aumento de las concentraciones de algunos de los parámetros bioquímicos evaluados; los más llamativos fueron la disminución de los niveles de albúmina sérica; también disminución de las concentraciones de calcio en más del 90% de la población estudiada y una elevación sistemática de los valores de creatinina en la mayoría, 80% de los casos. Conclusiones: el puntaje CANs es una herramienta clínica útil, sencilla y de fácil aplicación que permite identificar con mayor precisión el grado de desnutrición en recién nacidos y podría validarse estadísticamente en series más amplias y estudios sistemáticos.

It is known that Fetal Malnutrition predisposes to greater perinatal morbidity and mortality, secondary to fetal distress, meconium aspiration, asphyxia, neonatal hypoglycemia and hyperviscosity syndrome. It is also associated, in the medium-long term, with a higher risk compared to the general population of presenting neurological or mental disorders (cognitive and learning disorders), endocrinological, metabolic and cardiovascular complications, so it would be convenient to identify these newborns with DF early in life to promote appropriate surveillance and intervention. Objective:to demonstrate the usefulness of the Neonatal Clinical Assessment using the CANs SCORE (Clinical Assessment of Nutritional Status), developed and published by Mettcoff in 1994. Methods: a transversal pilot study was carried out from March to June 2018, in the second level Hospital "Cochabamba" , selecting 50 term neonates who had a positive score for malnutrition according to the Mettcoff scale. Complete anthropometric measurements and examinations of related laboratory parameters were performed. Comparisons of means and correlations were used to evaluate the data with Z-score values calculated using the Intergrowth -21st toolª. Results: statistically significant differences were found between the basic anthropometric parameters as weight, height, head circumference evaluated. Furthermore, the evaluation using the Mettcoff scale allowed the detection of FETAL MALNUTRITION in newborns who are otherwise classified as having adequate weight for Gestational Age (AEG). In the laboratory, the main findings were: decreased or increased concentrations of some of the biochemical parameters evaluated: the most striking findings being decreased serum albumin levels; also decreased calcium concentrations in 100% of the studied population and a systematic elevation of creatinine values in most of 90% of cases. Conclusions: the CANs score is a useful, simple and easy-to-apply clinical tool that allows the degree of malnutrition in Newborns to be identified with greater precision and it could be statistically validated in larger series and systematic studies.

Malnutrición en niños menores de 5 años indígenas y no indígenas de zonas rurales, Paraguay / Malnutrition in indigenous and non-indigenous children under five years of age in rural areas, Paraguay

Los menores de cinco años de edad se afectan por la falta de alimentos adecuados mucho más rápido que a edades superiores por las demandas del crecimiento. El objetivo fue evaluar la situación nutricional de niños menores de cinco años de comunidades rurales, indígenas y no indígenas. Previo consentimiento informado de los padres o tutores, fueron evaluados 226 niños menores de cinco años de ambos sexos, 117 indígenas y 109 no indígenas según indicadores antropométricos de malnutrición por defecto y por exceso. Se aplicó una encuesta para obtener información de las características sociodemográficas y hábitos alimentarios. En niños indígenas y no indígenas la prevalencia de desnutrición global fue de 2,4 % y 2,6 %, riesgo de desnutrición 22% y 5,1%, desnutrición crónica 35,9% y 12,8%, sobrepeso 28,9% y 12,9%, respectivamente. Se observó un consumo frecuente de frutas en ambas poblaciones, seguida del consumo de proteína vegetal en población indígena y de proteína animal en los no indígenas. El 69,2% de los niños indígenas y el 3,7% de los niños no indígenas vivían en la pobreza extrema. Los principales problemas nutricionales encontrados fueron la desnutrición crónica, el riesgo de desnutrición y el sobrepeso. Los niños más fuertemente afectados son los indígenas, que sobreviven en difíciles condiciones socioeconómicas.

Children under five years of age are affected by the lack of adequate food faster thanolder individuals due to growth demands. The objective was to evaluate the nutritional situation of indigenous and non-indigenous children under five years living in rural communities. After obtaining the informed consent of their parents, 226 boys and girls under five years, 117 indigenous and 109 non-indigenous children, were evaluated using nutritional indicators of malnutrition by defect and excess. A questionnaire was applied toobtain information about social-demographic characteristics and dietary habits. Inindigenous and non-indigenous children, the prevalences of global malnutrition were 2.4% and 2.6%, malnutrition risk 22% and 5.1%, chronic malnutrition 35.9% and 12.8%,overweight 28.9% and 12.9%. Frequent consumption of fruits was observed in both populations, followed by consumption of vegetable protein in indigenous population and animal protein in non-indigenous. 69.2% of indigenous children and 3.7% of non-indigenous children living in extreme poverty. The main nutritional problems found were chronic malnutrition, malnutrition risk and overweight. The most strongly affected children were theindigenous, who survive in difficult socio-economic conditions.

Association between socioeconomic and biological factors and infant weight gain: Brazilian Demographic and Health Survey - PNDS-2006/07 / Associação entre fatores socioeconômicos e biológicos e o ganho de peso de lactentes: Pesquisa Nacional de Demografia e Saúde (PNDS) de 2006/07

OBJECTIVE: To examine the associations between socioeconomic and biological factors and infant weight gain. METHODS: All infants (0-23 months of age) with available birth and postnatal weight data (n = 1763) were selected from the last nationally representative survey with complex probability sampling conducted in Brazil (2006/07). The outcome variable was conditional weight gain (CWG), which represents how much an individual has deviated from his/her expected weight gain, given the birth weight. Associations were estimated using simple and hierarchical multiple linear regression, considering the survey sampling design, and presented in standard deviations of CWG with their respective 95% of confidence intervals. Hierarchical models were designed considering the UNICEF Conceptual Framework for Malnutrition (basic, underlying and immediate causes). RESULTS: The poorest Brazilian regions (-0.14 [-0.25; -0.04]) and rural areas (-0.14 [-0.26;-0.02]) were inversely associated with CWG in the basic causes model. However, this association disappeared after adjusting for maternal and household characteristics. In the final hierarchical model, lower economic status (-0.09 [-0.15; -0.03]), human capital outcomes (maternal education < 4th grade (-0.14[-0.29; 0.01]), higher maternal height (0.02[0.01; 0.03])), and fever in the past 2 weeks (-0.13[-0.26; -0.01]) were associated with postnatal weight gain. CONCLUSION: The results showed that poverty and lower human capital are still key factors associated with poor postnatal weight gain. The approach used in these analyses was sensitive to characterize inequalities among different socioeconomic contexts and to identify factors associated with CWG in different levels of determination. .

OBJETIVO: Examinar as associações entre fatores socioeconômicos e biológicos e o ganho de peso de lactentes. MÉTODOS: Foram selecionados todos os lactentes (0-23 meses de idade) com dados de peso ao nascer e pós-natal avaliados na última pesquisa com representatividade nacional realizada no Brasil (2006/07) por amostragem probabilística complexa. A variável de resultado foi o Evolução Ponderal Condicional (CWG), que representa quanto um indivíduo desviou de seu ganho de peso esperado, considerando o peso ao nascer. As associações foram estimadas utilizando regressão linear simples e múltipla hierárquica, considerando o plano amostal da pesquisa e apresentadas em desvios padrão do CWG com seus respectivos intervalos de confiança de 95%. Os modelos hierárquicos foram estruturados considerando o Modelo Conceitual de Desnutrição da UNICEF (causas básicas, inerentes e imediatas). RESULTADOS: As regiões brasileiras mais pobres (-0,14 [-0,25; -0,04]) e a área rural (-0,14 [-0,26; -0,02]) foram inversamente associadas ao CWG no modelo de causas básicas. Contudo, essa associação desapareceu após o ajuste pelas características maternas e do ambiente familiar. No modelo hierárquico final, a baixa condição econômica (-0,09 [-0,15; -0,03]), as variáveis de capital humano (escolaridade materna < 5° ano (-0,14 [-0,29; 0,01])), maior estatura materna (0,02 [0,01; 0,03])) e febre nas duas semanas anteriores à pesquisa (-0,13 [-0,26; -0,01]) foram inversamente associadas ao ganho de peso pós-natal. CONCLUSÃO: Os resultados mostraram que a pobreza e baixo capital humano ainda são fatores fundamentais associados ao ganho de peso pós-natal abaixo de esperado. A abordagem utilizada em nossas análises foi sensível ao caracterizar desigualdades entre diferentes contextos socioeconômicos e ao identificar fatores associados ao CWG em diferentes níveis de determinação. .

Implicaciones nutricionales de las dietas de eliminación / Nutritional implications of elimination diets

Resumen:Introducción: La piedra angular del tratamiento de alergia alimentaria es la eliminación de los alimentos causantes. Sin embargo, los niños que restringen el consumo de alimentos básicos tienen un mayor riesgo de desnutrición.El objetivo del estudio fue identificar el estado nutricional de pacientes con dieta de eliminación e identificar la proporción de pacientes del grupo con verdadera alergia alimentaria.Métodos: Se realizó un estudio transversal de enero a octubre de 2014 en el Hospital Infantil de México Federico Gómez. Se incluyeron pacientes de 1 a 11 años con historia de eliminación de, al menos, uno de cinco alimentos (huevo, leche, trigo, maíz, soya) por un mínimo de 6 meses. Se realizó la valoración nutricional completa y se compararon los índices antropométricos con tablas de Z score para la edad. Se analizaron los datos por medio de estadística descriptiva, y posteriormente con prueba de Kruskal-Wallis y correlación de Spearman.Resultados: Los alimentos más frecuentemente eliminados fueron leche, soya, huevo, maíz y trigo. Al comparar el número de alimentos eliminados de la dieta con los distintos índices antropométricos evaluados, se encontró que entre mayor cantidad de alimentos eliminados, el score Z de peso para la edad (PE) y talla para la edad (TE), así como peso para la talla (PT) fueron menores, y el más afectado fue la reserva grasa. Solamente en el 5% de los niños se corroboró alergia alimentaria.Conclusiones: Nuestro estudio confirma la necesidad de una correcta asesoría nutricional en aquellos pacientes que cuenten con dietas de eliminación, así como el sobrediagnóstico que existe de alergia alimentaria.

Abstract:Background: The backbone of food allergy treatment is the restriction of causative foods. These interventions have shown that children who restrict the consumption of basic foods have a higher risk of malnutrition.The aim of the study was to identify the nutritional status of patients with elimination diet, characterizing their anthropometric indexes and identifying the percentage of patients in the group with true food allergies.Methods: A cross-sectional study was carried out from January to October 2014 at the Hospital Infantil de Mexico Federico Gomez. Patients 1 to 11 years of age with a history of elimination of at least one of five foods (eggs, milk, wheat, corn, soybeans) for a minimum of 6 months were included. Full nutritional assessment was performed by comparing the anthropometric indexes to z score for age. Data analysis used descriptive statistics. Kruskal-Wallis and Spearman correlation were performed.Results: The most frequent eliminated foods were milk, soy, eggs, corn, and wheat. Comparing the number of foods eliminated with different anthropometric indexes, with a greater amount of eliminated food, the z-score of weight/age (W/A), height/age (H/A) and weight/height (W/H) were lower and the most affected index was fat reserve. Only in 5% of children was food allergy confirmed.Conclusions The study confirms the need for nutrition counseling for patients who have elimination diets and overdiagnosis of food allergy.

Asociación entre violencia contra la mujer ejercida por la pareja y desnutrición crónica en sus hijos menores de cinco años en Perú / Association between violence against women inflicted by the partner and chronic malnutrition in their children under five years old in Peru

Objetivos: Evaluar la asociación entre violencia contra la mujer ejercida por su pareja y la prevalencia de desnutrición crónica en sus hijos menores de cinco años. Materiales y métodos. Análisis secundario transversal de la Encuesta Demográfica y de Salud Familiar (ENDES) del año 2011, realizada en el Perú y con representatividad nacional. La variable dependiente fue desnutrición crónica en el último hijo menor de cinco años. Las variables independientes fueron el autorreporte de violencia emocional, violencia física (leve o severa) y violencia sexual, ejercidas por el último compañero o esposo de la madre en los últimos 12 meses. Realizamos análisis univariados y multivariables utilizando modelos generalizados lineales (regresión log-binomial), teniendo en cuenta la naturaleza compleja de la muestra. Se ajustaron los modelos para variables sociodemográficas y de salud madre hijo. Se calcularon razones de prevalencias (RP) e intervalos de confianza al 95%. Resultados. Se analizaron datos de 5154 madres e hijos. La prevalencia de desnutrición crónica fue de 19,8% (IC 95%: 18,1-21,6). En el análisis multivariable se encontró una mayor prevalencia de desnutrición crónica en los hijos de madres con historia de violencia física severa RP 1,27% (IC 95%: 1,09-1,48). No hubo evidencia de asociación entre la prevalencia de desnutrición crónica y los otros tipos de violencia ejercida por la pareja. Conclusiones. El reporte de violencia física severa en el último año, por parte de las madres, estuvo asociado a un aumento en la prevalencia de desnutrición crónica en sus niños menores de cinco años.

Objectives: To assess the association between violence against women inflicted by their partner and the prevalence of chronic malnutrition in their children less than five years old. Materials and methods. A secondary cross-sectional analysis of the 2001 Peru Demographic and Health Survey performed in Peru, with national representativeness. The dependent variable was chronic malnutrition in the youngest child under five years old. The independent variables were emotional violence, physical violence (mild or severe) and sexual violence self-report; the violence was inflicted by the mother’s last partner or spouse in the last 12 months. Univariate and multivariate analysis was performed, generalized linear models (log-binomial regression) were used, and the nature of the sample was taken into account. Models for socio-demographic and mother-son health variables were adjusted. Prevalence ratios (PR) and confidence intervals were calculated. Results. Data from 5,154 mothers and children were analyzed. The prevalence of chronic malnutrition was 19.8% (CI 95%: 18.1-21.6). In the multivariate analysis, a higher prevalence of chronic malnutrition was found in the children whose mothers had a history of severe physical violence history: PR=1.27% (IC 95%: 1.09-1.48). There was no evidence of association between the prevalence of chronic malnutrition and other kinds of violence inflicted by a partner. Conclusions. The mothers’ report of physical violence in the last year was associated with an increased prevalence of chronic malnutrition in children under five years old.

Resultados perinatales en gestantes con bajo peso pregestacional / Perinatal outcomes in pregnant women with low weight prior pregnancy

Introducción: la malnutrición por defecto es crítica en el período gestacional al traer consigo resultados adversos para la salud materna, fetal y del recién nacido.Objetivo: determinar los resultados perinatales en gestantes con bajo peso pregestacional en Santa Cruz del Norte durante 2 años.Métodos: se realizó un estudio analítico observacional prospectivo entre julio de 2009 y junio de 2011 a partir de un universo de 152 embarazadas con bajo peso en el momento de la captación. Se escogió una muestra al azar de 112 gestantes que conformó el grupo estudio; se dispuso de un grupo control de 219 pacientes normopeso en el mismo período, escogidas al azar de los consultorios médicos siguiendo múltiples criterios. Los datos se recolectaron mediante revisión de las historias clínica y obstétrica y se procesaron empleando medidas estadísticas descriptivas e inferenciales.Resultados: en las pacientes con bajo peso pregestacional se observó de manera significativa la amenaza de parto pretérmino en 20,5 porciento; rotura prematura de las membranas en 17,9 porciento; ganancia insuficiente de peso en 43,8 porciento; restricción del crecimiento en 14,3 porciento; malformaciones congénitas en 2,7 porciento; parto pretérmino en 6,3 porciento y bajo peso al nacer en 8,9 porciento; el distrés respiratorio fue la complicación significativa del recién nacido con 10,7 porciento y la endometritis y sepsis urinaria, en las puérperas con 16,1 porciento y 5,4 porciento respectivamente.Conclusiones: los trastornos nutricionales por defecto al inicio de la gestación traen consigo un aumento en la morbilidad materna y perinatal al incrementar el riesgo de afecciones obstétricas, fetales, puerperales y del recién nacido

Introduction: default malnutrition is critical in the gestational period since it results adversely for maternal, fetal and newborn health.Objective: to determine the perinatal outcome in pregnant women with low weight prior pregnancy in Santa Cruz del Norte for 2 years.Methods: we performed a prospective observational analytical study from July 2009 to June 201. Our universe was 152 pregnant women with low weight when recruiting, a sample of 112 pregnant women were chosen to formed the study group and a control group of normal-weight 219 patients was formed randomly from the medical practices following multiple criteria. The data were collected by the review of clinical and obstetric records and they were processed using descriptive and inferential statistics.Results: significantly, patients with low pre-pregnancy weight were observed to have preterm labor (20.5 per cent), premature rupture of membranes (17.9 per cent), insufficient weight gain (43.8 per cent), growth restriction (14.3 per cent), congenital malformations (2.7 per cent), preterm delivery (6.3 per cent), and low birth weight (8.9 per cent). Respiratory distress was a significant complication in newborns (10.7 per cent), and endometritis and urinary sepsis in the postpartum women (16.1 per cent and 5.4 per cent respectively).Conclusions: nutritional disorders at the beginning of pregnancy bring an increase in maternal and perinatal morbidity, since the risk of obstetrical, fetal, postnatal and newborn conditions increased

Alimentação complementar: práticas inadequadas em lactentes / Complementary feeding: inappropriate practices in infants

Objetivo: Avaliar as práticas e o consumo alimentar de lactentes saudáveis de três metrópoles do Brasil. Métodos: Por meio de estudo prospectivo, analisaram-se registros alimentares de 7 dias consecutivos de amostra intencional, por cotas e ponderada, das cidades de Curitiba, São Paulo e Recife, de 179 lactentes saudáveis, entre 4 e 12 meses, que não se encontravam em aleitamento materno (AM) exclusivo. As mães receberam orientação verbal e escrita, por nutricionista, visando a uniformização da anotação do registro alimentar. Para o cálculo de ingestão, utilizou-se o Programa de Apoio à Nutrição (NutWin). Resultados: A mediana de idade dos lactentes foi de 6,8 meses (4,0-12,6 meses). Observou-se que 50,3% jánão recebiam AM. Destes, 12,0 e 6,7% dos menores e maiores de 6 meses, respectivamente, utilizavam fórmulas infantis em substituição ao leite materno. A maioria dos lactentes, portanto, recebia leite de vaca integral. A diluição da fórmula infantil foi correta em apenas 23,8 e 34,7% das crianças menores e maiores de 6 meses, respectivamente. Em relação à alimentação complementar, observou-se que a mediana de idade foi de 4 meses para sua introdução e de 5,5 meses para a alimentação da família. Verificou-se elevada inadequação quantitativa na ingestão de micronutrientes para lactentes de 6 a 12 meses que não recebiam AM, destacando-se as de zinco (75%) e ferro (45%). Conclusão: O presente estudo mostrou elevada frequência de práticas e consumo alimentar inadequados em lactentes muito jovens. É possível que essas práticas levem a aumento no risco de desenvolvimento futuro de doenças crônicas.

Objective: To assess feeding practices and dietary in-take of healthy infants in three Brazilian municipalities. Methods: By means of a prospective study, we analyzed the food record of 7 consecutive days of an intentional sample (quota and weighted sampling) of 179 healthy infants, aged between 4 and 12 months, from the municipalities of Curitiba, São Paulo, and Recife, who were not being exclusively breastfed. Mothers received oral and written information provided by a nutritionist with the purpose of standardizing the feeding data. The computer program NutWin was used to calculate the dietary intake. Results: The median of the infants' age was 6.8 months (4.0-12.6 months). We found that 50.3% of the infants were no longer being exclusively breastfed. Of these, 12.0 and 6.7% among the infants younger and older than 6 months, respectively, were fed with infant formulae instead of breast milk. Therefore, most infants received whole cow's milk. Infant formula dilution was correct in only 23.8 and 34.7% of the infants younger and older than 6 months old, respectively. With regards to complementary feeding, we found that the median age was 4 months for its introduction and 5.5 months for the introduction of family diet. There was high quantitative inappropriateness of micronutrient intake for infants between 6 and 12 months old who were not exclusively breastfed, mainly in terms of zinc (75%) and iron (45%). Conclusion: The present study showed a high frequency of inappropriate feeding practices and dietary intake in very young infants. These practices may lead to an increased risk of development of chronic diseases in the future.

Prevalence and Determinants of Chronic Malnutrition among Preschool Children: A Cross-sectional Study in Dhaka City, Bangladesh.

Chronic malnutrition is one of the major causes of morbidity and mortality among preschool children and the future productivity of nations. To understand the prevalence of chronic malnutrition and to identify the factors affecting height-for-age z-score (HAZ) among preschool children, a cross-sectional study was conducted among 380 randomly-selected children aged less than five years in Dhaka city, Bangladesh. Results of analysis of this study data revealed that the prevalence of stunting among preschool children in Dhaka city was 39.5%, with 25% severely stunted and 14% moderately stunted (p<0.001). Results of bivariate analysis revealed that socioeconomic and demographic factors were most significantly associated with the stunting of children. Children were found to be well-nourished if their parents had a tertiary-level education or higher and if the mother held a job and had good knowledge of nutrition. Well-nourishment of the children were also associated with the height of mothers (above 148 cm), good family educational background, normal birthweight, greater frequency of food intake (more than six times/day), and fewer fever episodes in the last six months. Results of multivariate linear regression models showed that height of mothers, birthweight of children, education of fathers, knowledge of mothers on nutrition, and frequency of feeding were the most significant factors that had an independent and direct influence on the stunting of children. To achieve the Millennium Development Goal target of 34% malnutrition prevalence by 2015, it is important to have specific government intervention to focus on the causes that directly influence the stunting of children.

Risk Factors of Mortality in Severely-malnourished Children Hospitalized with Diarrhoea.

This case-control study was conducted in the Dhaka Hospital of ICDDR,B to identify the risk factors of mortality in severely-malnourished children hospitalized with diarrhoea. One hundred and three severelymalnourished children (weight-for-age <60% of median of the National Center for Health Statistics standard) who died during hospitalization were compared with another 103 severely-malnourished children who survived. These children were aged less than three years and admitted to the hospital during 1997. On admission, characteristics of the fatal cases and non-fatal controls were comparable, except for age. The median age of the cases and controls were six and eight months respectively (p=0.05). Patients with low pulse rate or imperceptible pulse had three times the odds of death compared to the control group (p<0.01). The presence of clinical septicaemia and clinical severe anaemia had 11.7 and 4.2 times the odds of death respectively (p<0.01). Patients with leukocytosis (>15,000/cm3) had 2.5 times the odds of death (p<0.01). Using logistic regression, clinical septicaemia [adjusted odds ratio (AOR)=8.8, confidence interval (CI) 3.7-21.1, p=0.01], hypothermia (AOR=3.5, CI 1.3-9.4, p<0.01), and bronchopneumonia (AOR=3.0, CI 1.2-7.3, p<0.01) were identified as the significant risk factors of mortality. Severely-malnourished children (n=129) with leukocytosis, imperceptible pulse, pneumonia, septicaemia, and hypothermia had a high risk of mortality. The identified risk factors can be used as a prognostic guide for patients with diarrhoea and severe malnutrition.

Alimentação complementar: práticas inadequadas em lactentes / Complementary feeding: inappropriate practices in infants

OBJETIVO: Avaliar as práticas e o consumo alimentar de lactentes saudáveis de três metrópoles do Brasil. MÉTODOS: Por meio de estudo prospectivo, analisaram-se registros alimentares de 7 dias consecutivos de amostra intencional, por cotas e ponderada, das cidades de Curitiba, São Paulo e Recife, de 179 lactentes saudáveis, entre 4 e 12 meses, que não se encontravam em aleitamento materno (AM) exclusivo. As mães receberam orientação verbal e escrita, por nutricionista, visando a uniformização da anotação do registro alimentar. Para o cálculo de ingestão, utilizou-se o Programa de Apoio à Nutrição (NutWin). RESULTADOS: A mediana de idade dos lactentes foi de 6,8 meses (4,0-12,6 meses). Observou-se que 50,3 por cento já não recebiam AM. Destes, 12,0 e 6,7 por cento dos menores e maiores de 6 meses, respectivamente, utilizavam fórmulas infantis em substituição ao leite materno. A maioria dos lactentes, portanto, recebia leite de vaca integral. A diluição da fórmula infantil foi correta em apenas 23,8 e 34,7 por cento das crianças menores e maiores de 6 meses, respectivamente. Em relação à alimentação complementar, observou-se que a mediana de idade foi de 4 meses para sua introdução e de 5,5 meses para a alimentação da família. Verificou-se elevada inadequação quantitativa na ingestão de micronutrientes para lactentes de 6 a 12 meses que não recebiam AM, destacando-se as de zinco (75 por cento) e ferro (45 por cento). CONCLUSÃO: O presente estudo mostrou elevada frequência de práticas e consumo alimentar inadequados em lactentes muito jovens. É possível que essas práticas levem a aumento no risco de desenvolvimento futuro de doenças crônicas.

OBJECTIVE: To assess feeding practices and dietary intake of healthy infants in three Brazilian municipalities. METHODS: By means of a prospective study, we analyzed the food record of 7 consecutive days of an intentional sample (quota and weighted sampling) of 179 healthy infants, aged between 4 and 12 months, from the municipalities of Curitiba, São Paulo, and Recife, who were not being exclusively breastfed. Mothers received oral and written information provided by a nutritionist with the purpose of standardizing the feeding data. The computer program NutWin was used to calculate the dietary intake. RESULTS: The median of the infants' age was 6.8 months (4.0-12.6 months). We found that 50.3 percent of the infants were no longer being exclusively breastfed. Of these, 12.0 and 6.7 percent among the infants younger and older than 6 months, respectively, were fed with infant formulae instead of breast milk. Therefore, most infants received whole cow's milk. Infant formula dilution was correct in only 23.8 and 34.7 percent of the infants younger and older than 6 months old, respectively. With regards to complementary feeding, we found that the median age was 4 months for its introduction and 5.5 months for the introduction of family diet. There was high quantitative inappropriateness of micronutrient intake for infants between 6 and 12 months old who were not exclusively breastfed, mainly in terms of zinc (75 percent) and iron (45 percent). CONCLUSION: The present study showed a high frequency of inappropriate feeding practices and dietary intake in very young infants. These practices may lead to an increased risk of development of chronic diseases in the future.

Repercusión de la obesidad en la morbilidad obstétrica / Obesity repercussion on obstetric morbidity

OBJETIVOS: Identificar la relación existente entre la obesidad y las complicaciones en la gestación, calcular la incidencia de obesidad durante la gestación en el Policlínico Universitario "Juan Gualberto Gómez" del municipio Los Arabos, medir la ganancia media de peso de las pacientes obesas y relacionar la morbilidad durante la gestación, estableciendo una comparación con un grupo control.Métodos: se realizó un estudio observacional analítico transversal retrolectivo, se incluyeron en el estudio todas las gestantes que parieron durante los años 2006 y 2007, se obtuvo una muestra aleatoria sistemática en fase compuesta por 38 gestantes y que deben tener en común un índice de masa corporal >29 Kg/m², se confeccionó un grupo control compuesto por 38 pacientes con la característica de que su IMC debe ser el ideal. Se le aplicaron variables como: incidencia, ganancia media de peso y morbilidad durante la gestación. Para el análisis estadístico se le aplicó el Software Epidat 3.0. Resultados: la incidencia de obesidad en la gestación fue de 14,3 % (IC 95 %) 9,931-18,74. Se apreció en el grupo de obesas mayor frecuencia de enfermedad hipertensiva gravídica (EHG) con 17 pacientes, 44,7 % y un IC (95 %) 27,6-61,8. Infección Urinaria: 1 paciente (28,9 %) IC (95 %) 13,2-44,6, signo de más 7 pacientes (18,4 %), IC (95 %) 4,78-32,0, CIUR 4 pacientes (10,5 %), IC (95 %) 2,94-24,8, Polihidramnio 2 pacientes (5,2 %), IC (95 %) 0,64-17,7 E y Diabetes Mellitus Gestacional 1 paciente (2,6,%), IC (95,%) 0,06-13,8 E. Se observó un aumento exagerado medio de 2,2 kg a las 30 sem y 3 Kg al término de la gestación en el grupo de obesas.Conclusiones: obesidad, procreación tardía, enfermedad hipertensiva gravídica y aumento exagerado de peso tienen relación estrecha para causar morbilidad obstétrica

OBJECTIVES: To identify the relationship between obesity and pregnancy complications, to estimate the obesity incidence during pregnancy in patients from the "Juan Gualberto G¾mez" University Polyclinic from The Arabos municipality, to measure the weight gain in obese patients and to relate the morbidity during pregnancy, establishing a comparison with control group. METHODS: A retrospective, cross-sectional, analytical and observational study was conducted including all pregnants that gave birth during 2006 and 2007; we achieved a systemic randomized sample in the phase composed 38 pregnants and a common rate of body mass > 29 Kg/m²; a control group was created including 38 patients with a probable ideal BMI. Variables applied were: incidence, mean weight gain and morbidity during pregnancy. For statistical analysis we applied 3.0 Epidat Software. RESULTS: Obesity incidence during pregnancy was of 14.3 percent ,a 95 percent CI 9,931-18,74. In obese group we noted a great frequency of gravidity hypertensive disease (GHD) with 17 patients, 44.7 percent and a 95 percent CI 27.6-61.8. Urinary infection: one patient (28,9 percent) a 95 percent CI 13.2-44,6, + sing 7 patients (18.4 percent), a 95 percent CI 4.78-32.0, IUGR 4 patients (10.5 percent), 95 percent IC 2.94-24.8, polyhydramnios 2 patients (5.2 percent) a 95 percent CI 0.64-17.7 E and gestational diabetes mellitus in a patient (2.6 percent) a 95 percent CI 0.06-13.8 E. There was a mean exaggerated increase of 2.2 kgs at 30 weeks and 3 Kg at the pregnancy end in obese group. CONCLUSIONS: Obesity, late procreation, gravidic hypertensive disease and exaggerated weight increase have a close relation to cause obstetric morbidity

Detection of fetal malnutrition using “CAN score”.

Objective. Use of clinical assessment of nutrition status (CAN) score to assess the prevalence of fetal malnutrition among term newborns and to compare other anthropometric criteria used to assess fetal growth. Methods. Prospective study of 529 term healthy newborns assessed using CAN score .Complete anthropometric assessment and determination of weight for gestation was done. Using CAN score as a standard, the usefulness of birth weight, weight for gestation, length, head circumference (HC), mid arm circumference (MAC), MAC/HC ratio and Ponderal index to assess fetal nutrition was determined. Results. With a cut off value of 25, CAN score identified 148 (27.97%) malnourished neonates. 4% of appropriate for gestational age neonate were malnourished and 42.9 % of small for gestational age neonates were well nourished. When CAN score was taken as a standard, weight for gestation and MAC/HC had the highest sensitivity to identify malnourished neonates (92.5% & 90.5%). Conclusion. CAN score identifies malnourished neonates which can be missed by other methods and identifies well nourished neonates classified as growth retarded by other methods.

Promoção da saúde com mães de crianças desnutridas na zona rural / Health promotion with mothers of undernourished children from the rural area

A prática de bons hábitos alimentares é importante desde a infância, porém a mídia, a cultura e as condições socioeconômicas impõem normas para a prática alimentar, na maioria das vezes, divorciada da realidade. Este estudo objetivou descrever o perfil socioeconômico de crianças residentes na zona rural, além de avaliar as mudanças comportamentais das mães de crianças desnutridas ocorridas com a implementação de oficinas educativas. A pesquisa foi do tipo participante, com abordagem qualitativa. Realizouse no distrito de Tuína, situado no município de Massapê- CE, e as informantes foram nove mães de crianças desnutridas menores de quatro anos. A coleta de dados ocorreu por meio de observação participante, entrevista e oficinas educativas durante os meses de outubro/2006 a março/2007. Na análise de dados, foi utilizada a técnica de conteúdo do tipo categorial temática proposta por Bardin(2007). Os dados foram levantados durante a visita domiciliar,emergindo as seguintes categorias: hábito alimentar na zona rural e conceituando a desnutrição. Nas oficinas educativas, foram abordadas temáticas relacionadas à desnutrição infantil como: aleitamento materno, alimentação saudável, parasitoses intestinais, higiene e infecção intestinal. As mães possuem disponibilidade para cuidarem dosfilhos desnutridos, mas não detêm conhecimento suficiente, sendo necessárias estratégias de educação em saúde para a melhoria da qualidade de vida das crianças desnutridas.

Although good eating habits from childhood are important,the media promotes and cultural and socioeconomicfactors determine practices that are frequently detachedfrom reality. This study describes the socioeconomicprofile of children living in rural areas, and assesses thebehavioral changes of their mothers, occurring in responseto the implementation of educational workshops. Thiswas a participative research with a qualitative approach,undertook in the Tuina district, in the municipality ofMassapê - CE, Brazil. Nine mothers of malnourishedchildren younger than four years were the informants.Data collection occurred during participant observation,interviews and educational workshops in the period fromOctober/2006 through March/2007. Bardin`s thematiccategorical analysis (2007) was used. The following categoriesof data arose after home visits: eating habits in thecountryside and malnutrition concepts. The educationalworkshops addressed issues related to child malnutrition,such as breastfeeding, healthy eating, intestinal parasites,hygiene and intestinal infection. Although the mothersare available to look after their malnourished children,they are not knowledgeable enough, health educationstrategies to improve the quality of life of malnourishedchildren being necessary.

Hallazgos histopatológicos, hibridización in situ y estudio ultraestructural del Síndrome de Emaciación Multisistémico Porcino (PMWS) en granjas en Venezuela / Histopathological findings, in situ hybridization and ultrastructural study of Porcine Multisystemic Wasting Syndrome (PMWS) in pig farms in Venezuela

El síndrome multisistémico de emaciación post destete porcino (PMWS, por sus siglas en Inglés) ha tenido en años recientes extraordinaria importancia en la industria porcina en muchos países, particularmente en Canadá, Estados Unidos de América, Comunidad Europea, Asia y Sur América. El síndrome afecta a cerdos jóvenes, en edad comprendida generalmente entre las 8 y 14 semanas. El PMWS se caracteriza por emaciación, diarrea, ictericia y aumento de volumen de los linfonódulos. El circovirus porcino tipo 2 (PCV2, por sus siglas en inglés) ha sido descrito como el principal agente infeccioso en el PMWS y simultáneamente puede concurrir con otras enfermedades virales tales como: parvovirus porcino, virus del síndrome respiratorio y reproductivo porcino, además de otras entidades bacterianas. El diagnóstico del PMWS se basa en la edad de los cerdos, aspectos clínicos, emaciación, palidez de mucosas, hallazgos de necropsia, estudios histopatológicos, exámenes de hibridización in situ (HIS) en tejidos que revelan la presenciadel PCV2, además de estudios ultraestructurales. El objetivo principal de la presente investigación fue mostrar una mayor y actualizada casuística del PMWS en nuestro país. El presente estudio se realizó en 120 lechones de 8 a 16 semanas de edad, ubicados en 10 granjas porcinas de los estados Aragua y Carabobo, Venezuela. Los lechones presentaban pobre condición corporal, severa palidez, disnea, diarrea, dificultad respiratoria e hipertrofia de los linfonodos inguinales superficiales. Al realizar las necropsias se evidenció neumonía en grado variable e incremento del tamaño de los nódulos linfáticos inguinales, mesentéricos y traqueobronquiales, mientras que la histopatología revelaba depleción linfoide, con pérdida de la arquitectura de los linfonódulos con histiocitosis, células sincitiales e histiocitos con corpúsculos basófilos intensos intracitoplasmáticos, hallazgos altamente sugestivos del PMWS. Adicionalmente, se procesaron muestras de estos mismos tejidos mediante la técnica HIS, lo que permitió demostrar la presencia de PCV2 en todos los tejidos linfoides afectados y confirmar el diagnóstico de PMWS. El estudio ultraestrutural permitió observar las características del ente viral involucrado. Este es el primer trabajo que incluye métodos ultraestructurales para describir este síndrome en Venezuela.

Nowadays, the postweaning multisystemic wasting syndrome (PMWS) is an important disease in the swine industry, particularly in Canada, United States of America, Europe, Asia, and South America. The PMWS mainly affects pigs between 8 and 14 weeks of age. The PMWS is characterized by emaciation, diarrhea, icterus, and an enlargement of lymph nodes. The porcine circovirus type 2 (PCV2) has been described as the main infectious agent responsible for PMWS. It can concurrently occur with other viral diseases such as porcine parvovirus (PPV), porcine respiratory and reproductive viral syndrome, as well as other bacterial entities. The PMWS diagnosis is based on the pig’s age, clinical aspects, weight loss, macro and microscopic findings, presence of nucleic acids in tissues which reveal the existence of the PCV2, detected by an in situ hybridization (ISH) technique, and ultrastructural studies. This investigation studied the histological findings, in situ hybridization, and ultrastructural assessment of PMWS in pig farms in Venezuela. The main purpose of this study was to show a greater and updated cases of PMWS in our country. A total of 120 piglets ages 8 to 16 weeks, from 10 pig farms of the States of Aragua and Carabobo, Venezuela, were evaluated. The piglets showed poor body condition, pale appearance of mucous membranes, dyspnea, diarrhea, respiratory distress, and hypertrophy of superficial inguinal lymph nodes. At necropsy, diverse degrees of pneumonia, enlargement of superficial inguinal, mesenteric, and tracheobronquial lymph nodes were found, while the histological findings showed lymphoid depletion, loss of lymph nodes architecture, hystiocytosis, syncitial cells, and the presence of cytoplasmic inclusions in hystiocitic cells. All these findings were suggestive of PMWS. Furthermore, samples of the same tissues were processed through the ISH, which allowed showing the presence of PCV2 in all affected lymphoid tissues, confirming the diagnosis of PMWS. The ultrastructural study showed the characteristics of the virus involved. This is the first study in Venezuela that includes ultrastructural methods describing the PMWS.

Anemia ferropriva na infância: novas estratégias de prevenção, intervenção e tratamento / Iron deficiency anemia in infancy: new strategies for prevention, intervention and therapeutic

A anemia por deficiência de ferro é a doença nutricional mais prevalente no mundo, sobretudo na infância, constituindo-se sério problema de Saúde Pública. No Brasil, os dados disponíveis apresentam ampla variação de cunho regional, com tendência a aumento de prevalência em seus índices mais recentes. Neste estudo de revisão, seus aspectos epidemiológicos, fatores causais, grupos de risco e seus impactos sobre o indivíduo são salientados. Novas estratégias de prevenção e intervenções de caráter populacional são apresentadas como formas alternativas na sua abordagem, com resultados promissores.

lron deficiency anemia is the most prevalent nutritonal disorder of the world, speciafly on the infancy, becoming a Public Health 's serius problem. In Brazif, available works about the subject have wide regional variations, with the tendency of a prevalence's increase in these most recent representa tive datas. In this revision 's paper epidemiological aspects, cause factors, risk groups, individual consequences of iron deficiency and new pre- vention strategies was emphasized.