ABSTRACT
Após o reconhecimento de princípios evolutivos e da epigenética associada à plasticidade do desenvolvimento, a ciência de DOHaD (Origens Desenvolvimentistas da Saúde e Doença) floresceu. Segundo DOHaD, a exposição a condições adversas no início da vida, como a subnutrição, leva a respostas adaptativas para aumentar as chances de sobrevivência imediata e posterior, as quais podem aumentar o risco de doenças crônicas não transmissíveis (DCNT) no curso da vida. Outros insultos como obesidade (materna e paterna) na preconcepção e gestação, diabetes gestacional, aleitamento e a alimentação inadequada na infância podem induzir respostas não adaptativas e aumentar o risco de doenças, independentemente do ambiente posterior. A exposição à desreguladores endócrinos, substâncias tóxicas e poluentes também podem ter efeitos de longo prazo. Esses efeitos são mediados por alterações epigenéticas, as quais se tornam mais sensíveis nesse período crítico de desenvolvimento de intensa reorganização. Diante da transição nutricional e coexistência das diferentes formas de desnutrição nos países de baixa e média renda (PBMR); do aumento global das DCNT, cujo impacto social e econômico é maior nesses países; da fraca contribuição de fatores genéticos fixos na etiologia dessas doenças; e da ineficácia das atuais intervenções, a implementação de DOHaD representa uma estratégia potencial para beneficiar as futuras gerações. Considerando que a disseminação de DOHaD não têm acompanhado seu florescimento científico, esse trabalho teve como objetivo o desenvolvimento de um ebook direcionado para nutricionistas e um artigo relativo aos impactos da pandemia de COVID-19 na perspectiva de DOHaD, a fim de aproximar a ciência destes profissionais e fomentar sua implementação. Trata-se de uma revisão narrativa de literatura a partir artigos científicos em inglês e português, publicados nas bases de dados SciELO, PubMed e BVS, sem limite de data. O trabalho evidenciou que o desafio da dupla carga de doenças e das diferentes formas de desnutrição nos PBMR, foi agravado pela pandemia, tornando imperativo medidas de intervenção por seu provável impacto no ciclo intergeracional de DCNT e desenvolvimento dos países. A aproximação dessa ciência do nutricionista, propicia uma formação mais ampla e integrativa, através de capacitação técnica e habilidades interpessoais, capazes de acionar as fragilidades biopsicossociais, e melhor intervir, equacionando resultados de curto e longo prazo, a fim de interromper o ciclo intergeracional de DCNT, assim como otimizar o capital humano, a capacidade de produção e renda da futura geração. Conclui-se que o material desenvolvido é de grande valia, dado que a disseminação desse conhecimento deve se estender aos nutricionistas de todas as áreas e ser multiplicado
After evolutionary and epigenetics principles associated with the plasticity of development were recognized, DOHaD (Developmental Origins of Health and Disease) science flourished. According to DOHaD, the exposure to adverse conditions at the beginning of life, like undernutrition, leads to adaptive responses to increased immediate and later odds of survival, which may increase the risk of noncommunicable diseases (NCD) during life. Other conditions such as obesity (maternal and paternal) in preconception and pregnancy, gestational diabetes, lactation, and inadequate nourishment during infancy can induce non-adaptive responses and increased risk of diseases, regardless of the upcoming environment. The exposure to endocrine disruptors, and toxic and pollutant substances can also have long-term effects. Those effects are mediated by epigenetic changes, which become more sensitive during this critical period of development under intense reorganization. Considering the nutritional transition and coexistence of the different forms of undernutrition in the low- and middle-income countries (LMIC); the global increase of NCDs, with a higher social and economic impact in those countries; the weak contribution of fixed genetic factors in the etiology of those diseases; and the inefficacy of current interventions, the implementation of DOHaD represents a potential strategy to benefit future generations. Considering that the dissemination of DOHaD have not followed its scientific progress, the goal of the present work was to develop an e-book targeting nutritionists and an article about the impacts of the COVID-19 pandemic in the perspective of DOHaD, intended to drive the science closer to those professionals and foster its implementation. It is a narrative review of the literature regarding scientific articles published in English and Portuguese on the data bases SciELO, PubMed and BVS, with no date limit. The work has highlighted that the challenge of the double burden of the diseases and the several forms of undernutrition in the LMIC, was aggravated by the pandemic, making intervention measures imperative due to its likely impact on the intergenerational cycle of NCD and the development of countries. By inching closer to nutritionists this science provides larger and more integrative education through technical training and interpersonal abilities that help activate biopsychosocial fragilities, and better intervention; providing short- and long-term results aiming to interrupt the NCD intergenerational cycle, as well as optimize the human capital, the work and income capacity of the future generation. It is concluded that the material developed is of great value, given that the dissemination of this knowledge should reach all nutritionists from all areas and be multiplied
Subject(s)
Books , Libraries, Digital/trends , Pandemics , Nutritionists/psychology , Pregnancy , Diabetes, Gestational , Life , Malnutrition/classification , Famine, Occult , Epigenomics/organization & administration , Noncommunicable Diseases , Noncommunicable Diseases/classification , COVID-19/etiology , Literature , ObesityABSTRACT
Introducción: La desnutrición (DNT) es una de las complicaciones más tempranas que se presenta en niños con infección por VIH/SIDA, asociada a su morbimortalidad. Igualmente como consecuencia de la terapia antriretroviral y otros medicamentos utilizados, se han encontrado problemas de resistencia a la insulina y obesidad. Objetivo: Determinar la prevalencia de malnutrición (MNT) en niños con infección por VIH/SIDA por carga viral de la Clínica de VIH/SIDA del Hospital Universitario del Valle de Cali, Colombia (HUV) y su posible asociación con algunos factores de riesgo. Metodología: Estudio descriptivo, observacional de corte transversal, con análisis de casos y controles, a quienes se les tomaron datos como carga viral, %CD4, peso y talla. Se categorizó la carga viral (copias/ml) en: <400, ≥400-<300000, ≥30000-<1 millón y ≥1 millón; y el %CD4 en: <15%, ≥15%-<25% y ≥25%. Se consideró DNT global (déficit P/E≥10%), DNT crónica (déficit T/E≥5%), DNT aguda (déficit P/T≥10%) y sobrepeso (exceso P/T≥10%). Resultados: Fueron incluidos 111 niños entre 0 meses y 15 años de edad, con predominio del género masculino (51,3%), con modo de transmisión vertical en 91,8%. El 58.5% tenían entre ≥400-<300000 copias/ml de carga viral; y el 59% presentaron %CD4 ≥25%. La valoración nutricional evidenció DNT global en 64%, DNT aguda en 58%, DNT crónica en 22% y sobrepeso en 18%. Hubo riesgo de 1.7, 1.5 y 2.0 veces más de presentar DNT global, aguda y crónica, respectivamente, si la carga viral era ≥400 copias/ml. Conclusión: En niños con infección por VIH/SIDA por carga viral de la Clínica Pediátrica de VIH/SIDA del HUV de Cali, Colombia, la prevalencia de MNT fue superior al 18%, con una relación positiva superior a 1.5 veces entre carga viral y los diferentes tipos de DNT.
Introduction: Undernutrition (UNT) is a complication that occurs earlier in children with HIV/AIDS associated morbidity and mortality. Also as a result of anti-retroviral therapies and other drugs used, have encountered problems of insulin resistance and obesity. Objective: To determine the prevalence of malnutrition (MNT) in children diagnosed with HIV/AIDS by viral load in the Pediatric Clinic HIV/AIDS at the Hospital Universitario del Valle in Cali, Colombia (HUV) and its possible association with certain risk factors. Methodology: A descriptive cross-sectional study, with case-control analysis, whose data were taken as viral load, CD4%, weight and height. Were categorized viral load (copies / ml): <400, ≥ 400 - <300000, ≥ 30000 - <1 million and ≥ 1 million, and the %CD4 <15%, ≥ 15% - <25% ≥ 25%. UNT is considered global (low W/A≥10%), chronic (low H/A≥5%), acute (low W/H≥10%) and overweight (excess W/H≥10%). Results: We included 111 children from 0 months to 15 years old with male predominance (51.3%), mode of transmission in 91.8%. 58.5% were aged ≥ 400 - <300,000 copies/ml viral load, and 59% had CD4% ≥25%. Nutritional assessment showed 64% global UNT, 58% acute UNT, 22% chronic UNT and 18% overweight. Risk was 1.7, 1.5 and 2.0 times the present global, acute and chronic UNT, respectively, if the viral load was ≥ 400 copies / ml. Conclusion: In children diagnosed with HIV/AIDS by viral load of Pediatric Clinic HIV/AIDS at the HUV in Cali, Colombia, the prevalence of MNT was higher than 18%, with a positive relationship more than 1.5 times between viral load and the different types of UNT.
Subject(s)
Humans , Male , Female , Child , Malnutrition/classification , Malnutrition/diagnosis , Malnutrition/epidemiology , Malnutrition/etiology , Malnutrition/immunology , Malnutrition/mortality , Malnutrition/pathology , Malnutrition/drug therapy , Malnutrition/blood , Acquired Immunodeficiency Syndrome/classification , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/congenital , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/nursing , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/etiology , Acquired Immunodeficiency Syndrome/physiopathology , Acquired Immunodeficiency Syndrome/genetics , Acquired Immunodeficiency Syndrome/history , Acquired Immunodeficiency Syndrome/immunology , Acquired Immunodeficiency Syndrome/mortality , Acquired Immunodeficiency Syndrome/pathology , Acquired Immunodeficiency Syndrome/prevention & control , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/bloodABSTRACT
Entre el 8 y 10% de los niños atendidos en atención primaria, presentan una falta de progreso en el peso. El diagnóstico diferencial incluye ingesta calórica inadecuada, inadecuada absorción y metabolismo aumentado. Se reconoce a un niño que no sube de peso por su historia alimentaria, historia médica, historia social, historia familiar y evaluación del apetito. Entre las diferentes causas de falla para crecer están baja talla constitucional, abuso sexual, maltrato infantil, depresión postparto, enfermedad celíaca y esofagitis eosinofílica, entre otros. Entre los pilares en el manejo del niño que no progresa de peso están enfoque terapéutico, apoyo nutricional, hábitos dietéticos y manejo especializado.
Between 8 and 10% of children seen in primary care, have a lack of progress in weight. The differential diagnosis includes inadequate caloric intake, inadequate absorption and increased metabolism. It is recognized that a child does not gain weight by diet history, medical history, social history, family history and evaluation of appetite. Among the various causes of failure to thrive are constitutional short stature, sexual abuse, child abuse, postpartum depression, celiac disease and eosinophilic esophagitis, among others. Among the mainstays in the management of child weight are not progressing therapeutic approach, nutritional support, dietary habits and specialized management.
Subject(s)
Humans , Male , Female , Child , Growth/physiology , Growth/genetics , Malnutrition/classification , Malnutrition/complications , Malnutrition/congenital , Malnutrition/diagnosis , Malnutrition/diet therapy , Malnutrition/epidemiology , Malnutrition/genetics , Malnutrition/history , Malnutrition/mortality , Malnutrition/pathology , Malnutrition/prevention & controlABSTRACT
En muchas oportunidades, en los niños con cáncer, no se logra ofrecer toda la alimentación que el niño requiere por la boca, motivo por el cual son utilizadas algunas alternativas que han demostradas ser eficaces para evitar la malnutrición, como la nutrición enteral y la parenteral, las cuales deben ser determinadas por el pediatra o nutricionista infantl del niño. Cuando la nutrición enteral, no es suficiente, es requerida la nutrición parenteral, incluso en casa.
On many occasions, in children with cancer are not able to provide all nutrition required by the child's mouth, which is why some alternatives are used that have proven effective in preventing malnutrition, such as enteral nutrition and parenteral, which must be determined by the pediatrician or infant nutritionist. When enteral nutrition is insufficient, parenteral nutrition is required, even at home.
Subject(s)
Humans , Male , Female , Child , Neoplasms/classification , Neoplasms/diagnosis , Neoplasms/epidemiology , Neoplasms/pathology , Neoplasms/drug therapy , Enteral Nutrition/classification , Enteral Nutrition/methods , Parenteral Nutrition/classification , Parenteral Nutrition/methods , Malnutrition/classification , Malnutrition/diagnosis , Malnutrition/pathology , Malnutrition/drug therapy , Neoplasms/prevention & control , Neoplasms/rehabilitationABSTRACT
Bajo peso al nacer ha sido definido por la OMS como el peso al nacimiento menor de 2500 gramos. Los lactantes que nacen con bajo peso al nacer sufren de incidencia alta de morbilidad y mortalidad de enfermedades infecciosas y éstos tienen características típicas de desnutrición, pobre masa muscular, baja talla, en el periodo neonatal. Está asociado a alta mortalidad y morbilidad fetal y neonatal, dando como consecuencias un crecimiento retardado, un retraso o afectación del desarrollo cognitivo y enfermedades crónicas en la etapa de adulto. El periodo de crecimiento intrauterino y el desarrollo es de los factores que hacen más vulnerable el ciclo de vida del ser humano.
Low birth weight has been defined by WHO as a birth wieght less than 2500 grams. Infants born with lowbirth weight suffer from high incidence of morbidity and mortality of infectious diseases and these are typical features of malnutrition, poor muscle mass, low height, in ghe neonatal period. Is associated with high mortality and fetal and neonatal morbidity, leading to retarded growth consequences, delayed or impaired cognitive development and chronic diseases in the adult stage. The period of intrauterine growth and development is one of the factors that make it vulnerable life cycle of human beings.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Malnutrition/classification , Infant, Premature/metabolism , Infant, Low Birth Weight/growth & development , Malnutrition/diagnosis , Fetal Growth Retardation , Infant, Premature/growth & developmentABSTRACT
Se realizó un estudio descriptivo para evaluar la concordancia en la clasificación de niños colombianos con desnutrición según la referencia del National Center for Health Statistics (NCHS) y los estándares de la Organización Mundial de la Salud (OMS). Participaron 660 niños entre 0 y 59 meses con desnutrición aguda moderada (P/TZ<-2) y grave (P/TZ<-3 o edematizados), en recuperación nutricional hospitalaria entre 2000 y 2009. Se analizaron los indicadores talla para la edad (T/E) al ingreso y peso para la talla al ingreso (P/Tin) y egreso (P/Teg). Se compararon medias con la prueba t de Student pareada; la concordancia entre NCHS y OMS se estimó con Coeficiente de Correlación Intraclase (CCI) y el Índice Kappa; se evaluó el cambio de clasificación de los niños según el instrumento utilizado, con prueba de McNemar. Los instrumentos mostraron alta concordancia en los indicadores T/E (CCI=0,988; k=0,866) y P/Tin (CCI=0,901; k=0,578). Del total de niños clasificados con T/E normal por NCHS, 10,4% se clasificaron con retraso del crecimiento según OMS. Al ingreso 64,0% de los niños presentó desnutrición aguda moderada según NCHS, de éstos 44,8% clasificaron con emaciación severa según OMS, en consecuencia aumentó la emaciación severa de 36,0% hasta 63,3% con OMS. De los niños que egresaron 5% necesitarían más días de hospitalización si hubieran sido evaluados con OMS. En conclusión los estándares OMS captan más niños desnutridos y formas más severas de emaciación y baja talla, con su uso se espera hospitalizar más niños para recuperación nutricional y por más días.
A descriptive study was conducted to evaluate the concordance of National Center for Health Statistics reference (NCHS) used to classify undernourished children from Colombia with the WHO Child Growth Standards. We used data from children aged 6 to 59 months with acute malnutrition (Z <-2) and severe (Z <-3) who were admitted to the Unidad Vida Infantil nutrition program in Colombia. Indicators height-for-age, weight for-height were analyzed when they were admitted to the hospital and weight for-height leaving the hospital. A statistical method used to compare means was T-student. Correlation coefficient intraclass (CCI) and Kappa index evaluated the concordance between NCHS and OMS; McNemar method evaluated the changes on the nutritional classification for children according to growth devices used. Of the total number of children classified as normal by NCHS, 10.4% were classified as stunted by WHO. 64% of the children admitted to the hospital presented acute malnutrition according to NCHS, of these 44,8% presented severe emaciation according to OMS, indeed severe emaciation increased of 36,0% to 63,3% using OMS. 5% of children leaving the hospital could need to stay more days if they had been evaluated with OMS. Growth devices shown high concordance in height-for-age (CCI=0,988; k=0,866) and weight for-height (CCI=0,901; k=0,578). Concluded that OMS growth standards classified more malnourished children and more severe states, in addition more malnourished children could be hospitalized and they could stay more days.
Subject(s)
Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Malnutrition/classification , National Center for Health Statistics, U.S. , World Health Organization , Acute Disease , Age Factors , Body Height , Body Weight , Colombia , Nutrition Assessment , Reference Values , Severity of Illness Index , United StatesABSTRACT
La desnutrición (DNT) infantil afecta a cerca de una décima parte de los < 5 años de edad en todo el mundo y se asocia con la mitad de todas las muertes en este mismo grupo de edad. La deficiencia de macronutrientes puede ser el resultado de una dieta inadecuada, una mala absorción de los nutrientes ingeridos, o la presencia de una enfermedad inflamatoria crónica, donde se promueve su pérdida y un estado catabólico. El estado nutricional se evalúa con la puntuación z del peso (P) para la talla (T), y se expresa en unidades de desviación estándar (DE) de la media de la población de referencia. La DNT moderada se define como una puntuación z de P/T, entre 2 y 3 DE por debajo de la media (-2 a -3 DE). El compromiso del P/T, indica DNT aguda, la OMS propone su clasificación en moderada y severa, según valores de DE y la presencia de edema. La DNT severa también puede clasificarse como complicada o no complicada, según las comorbilidades asociadas. El kwashiorkor se asocia con una mayor tasa de mortalidad, y la complicación más frecuente es la infección bacteriana sistémica.
Malnutrition (UND) child affects about a tenth of <5 years of age worldwide and is associated with half of all deaths in this age group. Macronutrient deficiency can result from inadequate diet, poor absorption of ingested nutrients, or the presence of a chronic inflammatory disease, where loss and promotes a catabolic state. Nutritional status was evaluated with the weight z score (W) for height (H) and is expressed in units of standard deviation (SD) of the mean reference population. The UND moderate is defined as a z score W/H, between 2 and 3 SD below the mean (-2 to -3 SD). The commitment of the W/H, indicates acute UND, WHOproposed classification in moderate and severe, according to the values of SD and the presence of edema. The UND also be classified as severe or complicated uncomplicated by associated comorbidities. Kwashiorkor is associated with a higher mortality rate, and the most common complication is systemic bacterial infection.
Subject(s)
Humans , Male , Female , Child, Preschool , Anthropometry , Child Nutrition Disorders , Malnutrition/classification , Malnutrition/physiopathology , Malnutrition/therapy , Child NutritionABSTRACT
Background: Malnutrition is widely recognized as a major health problem in developing countries. It is wide spread in rural, tribal and urban slum areas. Growing children are most vulnerable to its consequences. Anthropometry is a simple field technique for evaluating physical growth and nutritional status of the children. Objective: To assess the nutritional status of under-fives'. Materials and Methods:This cross sectional study was conducted in Kakati-A sub-centre, under Primary Health Centre Vantamuri of Belgaum district. The sample size was 290. Data collection was done using pre-designed and pre-tested questionnaire. Statistical Analysis:Distribution of variables was assessed and comparison was done using chi square test and P value. Results: The prevalence of underweight, stunting and wasting was observed to be 26.55%, 31.38% and 7.59%, while severe degree of underweight, stunting and wasting was observed in 5.86%, 27.24% and 6.51% respectively according to World Health Organization (WHO) 2006 classification. According to the Indian Academy of Pediatrics (IAP) classification the prevalence of Grade I malnutrition was 121 (47.10%), Grade II was 29 (10.00%) and Grade III and IV were 4 (1.40%). Conclusion: Majority of the children's diet was not adequate for calories and proteins as per Indian Council for Medical Research (ICMR) guidelines. Less than half of children were underweight, nearly one third were stunted and one fifth of children were wasted. No child was found to be overweight or obese.
Subject(s)
Child, Preschool , Data Collection/methods , Guidelines as Topic , Humans , Infant , India/epidemiology , Malnutrition/statistics & numerical data , Malnutrition/classification , Nutritional Status/standards , Nutritional Status/statistics & numerical data , Rural Population , World Health OrganizationABSTRACT
Estudos sobre a desnutrição no ambiente hospitalar mostramque sua prevalência tem aumentado. Existem diversas ferramentasde rastreamento do risco nutricional e conhecer todos os seus aspectos éessencial para definição do melhor método para cada contexto.
Recent studies of hospital malnutrition have shown thatits prevalence increased in the last years. There are several tools for screening nutritional risk described and to know all its aspects is essentialto define the best method for each context.
Subject(s)
Humans , Malnutrition/classification , Inpatients , Malnutrition , Nutrition Assessment , TriageABSTRACT
INTRODUCCIÓN: La enfermedad por reflujo gastroesofágico (ERGE) se presenta con una amplia variedad de manifestaciones clínicas. OBJETIVO: Describir el estado nutricional de niños con ERGE según las tablas de la NCHS. METODOLOGÍA: Se realizó un estudio observacional, no experimental, descriptivo, de corte transversal en 51 niños del Hospital Infantil Club Noel de Cali, Colombia, con diagnóstico de ERGE, por clínica y paraclinica. Fueron tabulados datos como género, edad, peso y talla. La valoración del estado nutricional se realizó teniendo en cuenta el peso para la edad. Los datos fueron reportados como promedios y porcentajes. RESULTADOS: El grupo etario más afectado fueron los escolares en un 41%, y el estado nutricional según peso para la edad y las tablas de la National Center for Health and Statistics (NCHS) de los Estados Unidos estuvo comprometido en el 47% de los casos siendo más frecuente en el género masculino. CONCLUSIÓN: En este estudio, la ERGE afectó todos los grupos etarios pediátricos, siendo el grupo escolar el mas comprometido junto con el género masculino, con una prevalencia para desnutrición global del 47%.
INTRODUCTION: Gastroesophageal reflux disease (GERD) occurs with a wide variety of clinical manifestations. OBJECTIVE: To describe the nutritional status of children with GERD as measured by the NCHS. METHODOLOGY: An observational, not experimental, descriptive, cross-sectional in 51 children at Children's Hospital Club Noel in Cali, Colombia, diagnosed with GERD, by clinical and laboratories data. Data were tabulated as gender, age, weight and height. The assessment of nutritional status was performed taking into account the weight for age. Data were reported as averages and percentages. RESULTS: The age group most affected were school children by 41%, and nutritional status by weight for age and the tables of the National Center for Health and Statistics (NCHS) of the United States was involved in 47% of the cases being more frequent in males. CONCLUSION: In this study, GERD affected all pediatric age groups, being the most committed school group with male gender, with underweight prevalence of 47%.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Gastroesophageal Reflux/classification , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/diagnosis , Malnutrition/classification , Malnutrition/complications , Malnutrition/diagnosisABSTRACT
En la actualidad, las tablas del Center for Disease Control and Prevention (CDC) de los Estados Unidos, son utilizadas como parámetros internacionales para la evaluación del estado nutricional. Son varios parámetros a evaluar: peso para la talla, peso para la edad y talla para la edad. Según el estado nutricional portemporalidad se puede clasificar en eutrófico, desnutrición aguda, desnutrición crónico agudizada, y desnutrición crónico compensada. Otros parámetros a tener en cuenta son la velocidad de crecimiento, la talla final y la talla y peso estimado. Finalmente la evaluación de la composición corporal puede hacerse por hidrodensitometría, potasio corporal total, agua corporal total, impedancia bioelétrica, e imagen corporal.
Currently, the tables of the Center for Disease Control and Prevention (CDC) of the United States are used as international standards for the assessment of nutritional status. There are several parameters to evaluate: weight for height, weight for age and height for age. By temporality can be classified into eutrophic, undernutrition acute, undernutrition chronic exacerbated, and undernutrition chronic compensated. Other parameters to consider are the speed of growth, final height and estimated weight. Finally, evaluation of body composition can bema de by hydrodensitometry, total body potassium, total body wáter, impedance, and body image.
Subject(s)
Humans , Male , Adolescent , Female , Infant, Newborn , Infant , Child, Preschool , Child , Body Composition/physiology , Malnutrition/classification , Malnutrition/complications , Malnutrition/diagnosis , Body Weight/physiology , Weight by Height , Body Image , Body WaterABSTRACT
El campo de la inmunonutrición es relativamente nuevo y está siendo estudiado a nivel mundial por su gran aplicabilidad en la medicina. Se denomina resistencia específica o inmunidad a la capacidad del cuerpo humano para defenderse contra agentes invasores específicos, como bacterias, toxinas, virus y tejidos extraños; y se define estrés oxidativo como una situación en la que existe tanto un aumento en la velocidad de generación de especies reactivas del oxígeno como una disminución de los sistemas de defensa del organismo. La desnutrición calórica y proteica, que incluye también, invariablemente, la privación de vitaminas y minerales, puede causar una desnutrición primaria relacionada con la atrofia de órganos linfoides, lo cual conduce al desarrollo de infecciones oportunistas. Para poder entender el efecto de los farmaconutrimentos en el tubo digestivo y en el sistema inmunitario, hay que entender las bases fisiológicas de la inmunonutrición, lo cual requiere la integración de procesos de regulación a nivel del intestino.
The field of immunonutrition is relatively new and is being studied worldwide for its wide applicability in medicine. It is called the specific resistance or immunity to the human body's ability to defend against specific inaders such as bacteria, toxins, viruses and foreign tissue, and oxidative stress is defined as a situation in which there is both an increase in the rate of generation of reactive oxygen species as a decrease in the body's defense systems. Caloric and protein malnutrition, which also includes invariably deprived of vitamins and minerals can cause malnutritionrelated primary lymphoid organ atrophy, leading to the development of opportunistic infections. To understand the effect of pharmacology and nutrients in the digestive tract and immune system, one must understand the physiological basis of immunonutrition, which requires the integration of regularoty processes in the intestine.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Allergy and Immunology/classification , Allergy and Immunology/trends , Child Nutrition , Antigens/classification , Malnutrition/classification , Malnutrition/complications , Malnutrition/diagnosis , Immunosuppression Therapy/classification , Immunosuppression Therapy/methodsABSTRACT
La infección por VIH está asociada con un elevado riesgo de malnutrición. Los mecanismos por los cuales un paciente con SIDA pierde peso, pueden llegar a ser disminución de ingreso alimentario por falta de apetito; pérdida de las capacidades cognoscitiva, visual, auditiva, olfatoria ó por pérdida del estado de consciencia; aversión a los alimentos por cambio de sabores; dificultad ó dolor al deglutir, por enfermedades del esófago; náuseas ó vómito por gastritis medicamentosa ó por efectos adversos de los medicamentos; pérdidas alimentarías anormales ó mayor consumo de energía y nutrimentos causado por la enfermedad ó sus complicaciones, sin olvidar factores económicos y el social. Diversos factores aquejan una ingesta anormal en el paciente con VIH/SIDA. El síndrome de malabsorción intestinal, aparece en el 31% de los niños infectados. Las infecciones oportunistas pueden ocasionar fiebre, provocando un estado hipermetabólico, con incremento de las necesidades energéticas del organismo así como las pérdidas de nitrógeno por orina. Los factores psicosociales también contribuyen de manera importante al crecimiento subóptimo de niños infectados con VIH.
The mechanisms by which an AIDS patient loses weight, may become reduced food intake due to lack of appetite, loss of cognitive skills, visual, auditory, olfactory or loss of the state of consciousness, aversion to food for change flavors, difficulty or pain on swallowing, esophageal diseases, gastritis, nausea or vomiting from medications or adverse drugs effects, los sor abnormal eating more energy and nutrients caused by the disease or its complications, not to mention economic factors and social. Several factors facing an abnormal intake in patients with HIV/AIDS. Intestinal malabsorption síndrome, occurs in 31% of infected children. Opporunistic infecions can cause fever, causing a hypermetabolic state with increased energy needs and body nitrogen losses in urine. Psychosocial factors also contribute significantly to suboptimal growth of children infected with HIV.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Child Nutrition , HIV Infections/classification , HIV Infections/complications , HIV Infections/diagnosis , HIV Infections/diet therapy , HIV Infections/metabolism , Malnutrition/classification , Malnutrition/complications , Malnutrition/diagnosisABSTRACT
La desnutrición (DNT) infantil es la responsable de aproximadamente tres a cinco millones de muertes anuales en niños menores de cinco años. Se define como DNT severa, cuando existe un adelgazamiento marcado y/o la presencia de edema nutricional, o cuando la circunferencia media del brazo es menor de 110 cm. El abordaje en el tratamiento del niño DNT severo, incluye manejo de la etapa aguda; rehabilitación nutricional y mantenimiento, y rehabilitación final y seguimiento. En la primera fase, se debe hacer énfasis en los problemas agudos; en la segunda etapa, hay que iniciar precozmente la alimentación del niño, según norma; y en última fase, entre los 2 a 7 días posteriores, se debe valorar aporte calórico, apetito, estado general.
Malnutrition (MNT) is responsable for child approximately three to five million anual deaths in children under five years. MNT is defined as severe when there is a a marked thinning and/or the presence of nutritional edema, or mid-arm circunference is less than 110 cm. The approach to trealing children with severe MNT, including the acute stage management, nutritional rehabilitation and mintenance, and final rehabilitation and monitoring. In the first phase, emphasis should be on the acute problems, the second stage is to start early infant feeding, according to standard, and in the final phase, from 2 to 7 days, calorie intake should be assessed, appetite, general condition.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Malnutrition/classification , Malnutrition/complications , Malnutrition/diagnosis , Malnutrition/metabolism , Sepsis/classification , Sepsis/complications , Sepsis/diagnosisABSTRACT
Introducción: la malnutrición es un proceso mórbido serio con múltiples causas de índole clínica y socioeconómica. Tiene desenlaces desde el punto de vista de morbimortalidad, estancia hospitalaria prolongada así como de costos de atención en salud. Existen múltiples métodos directos e indirectos que pueden ser útiles en la detección temprana. La valoración global subjetiva (VGS) es uno simple y fácil de aplicar a los pacientes hospitalizados y es válida en la práctica clínica. Objetivo: determinar la frecuencia de malnutrición de los pacientes con patología quirúrgica hospitalizados en el servicio de cirugía general del Hospital de San José a través de la VGS. Métodos: se realizó un estudio descriptivo. Los criterios de inclusión fueron pacientes hospitalizados mayores de 18 años con una estancia mínima de 24 horas en el servicio de cirugía general, que no tuvieran asistencia del grupo de soporte nutricional, a los cuales se les aplicó la VGS. El análisis se realizó en STATA 10. Resultados: se estudiaron 281 casos. La frecuencia de malnutrición fue de 45,2%, siendo el 12,8% severa. La mediana de la edad fue 45 años. El 70% de los desnutridos tuvieron cirugía abdominal. La estancia fue más prolongada en los pacientes malnutridos. Conclusi ón: en este estudio se analizaron 281 pacientes durante seis meses, con una prevalencia de malnutrición del 45,2%, que es alta, pero se encuentra cerca de lo reportado en la literatura médica latinoamericana. La mayoría de los pacientes malnutridos fueron los posquirúrgicos dado por el aumento de su catabolismo.
Introduction: malnutrition is a serious morbid process caused by multiple clinical, social/economic factors. From the morbidity/ mortality point of view, it contributes to clinical outcomes, a longer hospital stay, as well as to health care costs. There are many direct and indirect useful methods for early detection. The Subjective Global Assessment (SGA) is a simple and easy method to apply on hospitalized patients and is valid in clinical practice. Objective: to determine the frequency of malnutrition on surgical patients hospitalized at the General Surgery Department at Hospital de San José using the SGA method. Methods: a descriptive study was performed. Inclusion criteria were: hospitalized patients, =18 years old, with at least a 24-hour hospital stay at the General Surgery Department, who did not receive assistance by the nutrition support group, who completed the SGA method survey. Data analysis was made by STATA 10. Results: 281 cases were studied. The frequency of malnutrition was 45.2%, and 12.8% were rated as severe. The mean age was 45 years. Seventy percent (70%) of malnourished patients had abdominal surgery. Hospital stay was longer in malnourished patients. Conclusion: 281 patients were analyzed during six months. The prevalence of malnutrition was 45.2%, which is high. However, this result is close to that reported in Latin American medical literature. Malnourishment resulting from increased catabolism was found mostly in post-operative patients.
Subject(s)
Humans , Male , Female , Young Adult , Postoperative Complications , Nutritional Status , Nutrition Assessment , General Surgery , Malnutrition/classificationABSTRACT
Introducción. Se han informado en trabajos de Argentina y otros países, estados de malnutrición en niños hospitalizados. La desnutrición puede alterar la inmunidad y, cuando es grave, aumentar las tasas de mortalidad en estos pacientes. El objetivo del presente trabajo es describir el estado nutricional de niños menores de 6 años, en el momento de la hospitalización en las Salas de Cuidados Mínimos de un hospital de niños de tercera complejidad. Población. Niños menores de 6 años (1-71,6 meses) internados en las Salas de Cuidados Mínimos del Hospital de Niños de la Santísima Trinidad, entre el 15 de octubre de 2003 y el 15 de enero de 2004, con cuadros médicos o quirúrgicos; agudos o potencialmente reversibles y crónicos. Material y métodos. Para evaluar el estado de nutrición en los pacientes que cumplieron con los criterios de inclusión (n= 439) se utilizaron antropometría comparada con estándares nacionales de Argentina y métodos de laboratorio, efectuados en el momento del ingreso al hospital. Se calculó prevalencia de: a)desnutrición con P/E< P3 y criterios de Waterlow modificado, b) sobrepeso y obesidad por peso relativo,c) parámetros bioquímicos anormales. Resultados. La prevalencia de desnutrición según valores de P/E < al percentilo 3, fue de 25,1 por ciento y según los criterios de Waterlow modificados, de 50,2 por ciento. De los pacientes desnutridos, 49,6 por ciento presentaron evolución aguda y 35,1 por ciento crónica; el 4,5 por ciento presentó desnutrición grave (60 por ciento con enfermedad crónica de base). Veintinueve (29) pacientes (9,1 por ciento) exhibieron sobrepeso u obesidad. Los valores de hemoglobina fueron bajos en 47,5 por ciento y los de albúmina en 3,1 por ciento de los pacientes. Conclusiones. Las prevalencias de desnutrición y anemia son altas entre los niños internados en el hospital. Las prevalencias de sobrepeso y obesidad son bajas en este grupo de pacientes.
Subject(s)
Child, Preschool , Child, Hospitalized , Malnutrition/classification , Nutritional Status , Cross-Sectional Studies , Epidemiology, Descriptive , Prospective StudiesABSTRACT
Objetivos: Avaliar o estado nutricional de crianças menores de cinco anos internadas na enfermaria Pediátricado Hospital Universitário Polydoro Ernani de São Thiago, em Florianópolis, em 1995 e 2005 e a evolução do estado nutricional durante a internação. Métodos: Estudo retrospectivo, observacional e descritivo com 216 crianças que estiveram internadas no HU em 1995 e 2005. O estado nutricional foi determinado por meio do escore Z do peso para idade e pesopara estatura, para as crianças menores e maiores de dois anos, respectivamente. Foram considerados desnutridos graves os que apresentavam escore Z menor que3, desnutridos moderados escore Z entre -2 e -3, eutróficos escore Z entre -2 e +2 e sobrepeso os com índicemaior que +2. Resultados: A prevalência de crianças com desnutrição grave na alta hospitalar em 1995 não se alterou, já em 2005, houve queda de 0,92 ponto percentual. Em 1995 também houve redução na prevalência de eutrofiade 75,93% para 72,22% e de sobrepeso de 4,63% para 3,70%. Em 2005, apesar das crianças apresentaremperda ponderal durante a hospitalização não houve redução na prevalência de eutrofia e de sobrepeso. Conclusões: A prevalência de desnutrição grave emoderada foi maior no ano de 1995. As crianças consideradas eutróficas prevaleceram em 2005. A prevalênciade sobrepeso na admissão foi a mesma nos dois anos. A desnutrição hospitalar continua sendo um importante problema clínico, entretanto pode-se observar uma melhora do estado nutricional das crianças internadas entre 1995 e 2005.
Objective: To evaluate the nutritional state of interned five year lesser children in the Unit of Pediatricsof the University hospital Polydoro Ernani of São Thiago, in Florianópolis, in 1995 and 2005 and evolution of the nutritional state during the internment.Method: Retrospective, observacional and descriptive study with 216 children who had been interned in the HU in 1995 and 2005. The nutricional state was determined through it Z-score of the weight for age and weight for stature, for the lesser and bigger children of two years, respectively. They had been considered unfed serious the ones that presented Z-score lesser that -3, unfed moderate Z-score between -2 and -3, eutrophic Z-score between -2 and +2 and overweight with bigger index that +2. Results: The prevalence of children with serious malnutrition in the high hospital in 1995 did not changed, already in 2005, had reduced of 0,92 percentile point. In 1995 also had reduction in the prevalence of eutrofia of 75,93% for 72,22% and overweight of 4,63% for 3,70%. In 2005, although the children to present ponderal loss during hospitalization did not have reduction in the prevalenceof eutrofia and overweight. Conclusions: The prevalence of serious and moderatemalnutrition was bigger in the year of 1995. The children considered euthrofics had prevailed in 2005. Theprevalence of overweight in the admission was the same one in the two years. The hospital malnutrition continues being an important clinical problem, however an improvementof the nutricional state of the children interned between 1995 and 2005 can be observed.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Child, Hospitalized , Hospitalization , Malnutrition , Nutrition Assessment , Child, Hospitalized/statistics & numerical data , Malnutrition/classification , Malnutrition/diagnosis , Malnutrition/pathology , Hospitalization/statistics & numerical data , Nutritional Transition , OverweightABSTRACT
As curvas de crescimento representam a distribuição das pessoas em relação aos valores obtidos para determinados índices ou medidas e são amplamente utilizadas na avaliação do estado nutricional. A referência populacional do National Center for Health Statistic-NCHS foi publicada em 1977 e a referência do Center for Diseases Control and Prevention-CDC publicada em 2000 ambas construídas com base na população norte-americana e a referência populacional da Organização Mundial da Saúde-OMS publicada em 2006 e construída com base na população de 6 países, incluindo o Brasil. O objetivo deste estudo foi descrever e identificar as principais semelhanças e diferenças entre as três populações de referência considerando as técnicas de construção e a classificação utilizando os dados obtidos do perfil nutricional das crianças que freqüentam as escolas do município de São Paulo. O estudo é transversal composto por 1012 alunos de 2 a 60 meses de idade e de ambos os gêneros, matriculados nas escolas municipais participantes do Programa Alimentação Saudável da Prefeitura do Município de São Paulo. As medidas antropométricas foram coletadas seguindo as técnicas de Jelliffe, 1968. As análises dos dados foram realizadas pelo software WHO Anthro 2005 e EPI INFO 3.3.2, considerando desvios no escore z < 2 para déficits e > +2 para obesidade. Os indicadores utilizados foram: peso para altura (P/A), altura para idade (A/I), peso para idade (P/I) e índice de massa corpórea para idade (IMC/I). A avaliação do estado nutricional identificou prevalências elevadas de excesso de peso 8,1%, 4,9% e 9,9%, segundo peso para altura no escore z > +2 pelas referências NCHS, CDC e OMS, respectivamente, indicando a obesidade como problema de saúde pública. No indicador altura para idade a referência do NCHS classifica déficit no escore z < 2 em 0,5%; 1,8% por CDC e 0,4% por OMS, isto mostra que o déficit crônico ainda existe. As análises por idade mostram-se inferior no intervalo de 24 a 60 meses no.
Subject(s)
Humans , Male , Female , Child , Nutrition Assessment , Malnutrition/classification , Cross-Sectional Studies , Infant Nutrition , Obesity/classification , Child Nutrition DisordersABSTRACT
As curvas de crescimento representam a distribuição das pessoas em relação aos valores obtidos para determinados índices ou medidas e são amplamente utilizadas na avaliação do estado nutricional. A referência populacional do National Center for Health Statistic-NCHS foi publicada em 1977 e a referência do Center for Diseases Control and Prevention-CDC publicada em 2000 ambas construídas com base na população norte-americana e a referência populacional da Organização Mundial da Saúde-OMS publicada em 2006 e construída com base na população de 6 países, incluindo o Brasil. O objetivo deste estudo foi descrever e identificar as principais semelhanças e diferenças entre as três populações de referência considerando as técnicas de construção e a classificação utilizando os dados obtidos do perfil nutricional das crianças que freqüentam as escolas do município de São Paulo. O estudo é transversal composto por 1012 alunos de 2 a 60 meses de idade e de ambos os gêneros, matriculados nas escolas municipais participantes do Programa Alimentação Saudável da Prefeitura do Município de São Paulo. As medidas antropométricas foram coletadas seguindo as técnicas de Jelliffe, 1968. As análises dos dados foram realizadas pelo software WHO Anthro 2005 e EPI INFO 3.3.2, considerando desvios no escore z +2 para obesidade. Os indicadores utilizados foram: peso para altura (P/A), altura para idade (A/I), peso para idade (P/I) e índice de massa corpórea para idade (IMC/I). A avaliação do estado nutricional identificou prevalências elevadas de excesso de peso 8,1%, 4,9% e 9,9%, segundo peso para altura no escore z > +2 pelas referências NCHS, CDC e OMS, respectivamente, indicando a obesidade como problema de saúde pública. No indicador altura para idade a referência do NCHS classifica...
Subject(s)
Male , Female , Humans , Child , Child Nutrition Disorders , Cross-Sectional Studies , Malnutrition/classification , Nutrition Assessment , Nutritional Physiological Phenomena , Obesity/classificationABSTRACT
El estado nutricional del individuo debe considerarse como una situación que hace parte de un contexto, donde interactúan múltiples factores como el empleo, la educación, el ingreso, la propaganda, la salud y la calidad de la vida de las personas; elementos que repercuten considerablemente sobre el funcionamiento integral del niño y posteriormente en su estado adulto. La capacidad de compra es la posibilidad que tiene una familia a acceder a los bienes y servicios básicos. El ingreso y la disponibilidad de alimentos en el mercado condicionan la cantidad de productos alimenticios que la familia puede adquirir. La pobreza está expresada en términos de baja capacidad adquisitiva y por la imposibilidad de satisfacer necesidades básicas; también está íntimamente ligada al nivel educativo y a la ocupación de las personas que aportan al presupuesto familiar. El presente es un estudio descriptivo, cuya población objeto son todas las personas menores de 14 años y las gestantes que residen en la Comuna del Río en Pereira. Se recolectó información de peso, talla, el global recordatorio de alimentos en las últimas 24 horas y algunos marcadores biológicos. El estado nutricional de los menores de 9 años evidencia que los mayores riesgos de desnutrición son agudos y globales, pero el riesgo es leve. Es importante el reporte del nivel de sobrepeso y obesidad: 10.6 por cien de los niños. La historia nutricional de los niños evaluada a través del indicador estatura edad, expresa que casi el 13 por cien de los niños es clasificado como desnutrido crónico, severo o moderado. Se encontró un alto porcentaje de adolescentes con bajo peso. Se presentaron diferencias en el comportamiento del estado nutricional con relación al género. Las niñas tuvieron una mayor frecuencia de estados nutricionales normales y los niños presentan más frecuencia de sobrepeso. Los niños de más bajo peso serían los de 10 y 11 años de edad, aunque este diagnóstico se presentó en todas las edades.