Efecto biológico de la recuperación nutricional en las concentraciones séricas de citocinas inflamatorias en el niño desnutrido grave / Biological effect of nutritional recovery on serum concentrations of inflammation cytokines in the malnourished child

El niño con desnutrición grave tiene una disfunción de la respuesta inmune que puede aumentar de manera significativa la morbilidad y la mortalidad por infecciones. El objetivo de la presente investigación fue evaluar el efecto de la recuperación nutricional en las concentraciones séricas de citocinas inflamatorias; tales como: interleucina 12 (IL-12), interleucina 17 (IL-17), interferón gamma (IFN-γ) y factor de necrosis tumoral alfa (TNF-α). En un estudio de tipo prospectivo y longitudinal, se seleccionó la población con base a criterios clínicos y antropométricos, constituida por 24 niños desnutridos graves en edades comprendidas entre 1 y 2 años, quienes formaban parte de un programa de recuperación nutricional. La concentración sérica de las citocinas investigadas se determinó antes y después del tratamiento nutricional, empleando la técnica de Inmunoanálisis Enzimático (ELISA) de doble anticuerpo. Para establecer comparaciones se utilizó la t de Student, y se consideró una p<0,05 como estadísticamente significante. Se observó una diferencia en las concentraciones de IL-12, IL-17, IFN-γ y TNF-α antes y después del tratamiento (p<0,05), lo cual parece indicar que la desnutrición per se provoca un estado inflamatorio y que 2 meses de apoyo nutricional intensivo, favorecen no solo la recuperación clínica del niño desnutrido grave, sino también la recuperación de su respuesta inmunitaria en cuanto a la producción de mediadores solubles como son las citocinas.

Children with severe malnutrition have a dysfunction of the immune response that can significantly increase morbidity and mortality from infections. The aim of this investigation was to evaluate the effect of nutritional recovery in serum measurements of inflammatory cytokines; such as interleukin 12 (IL-12), interleukin 17 (IL-17), interferon gamma (IFN-γ) and tumor necrosis factor alpha (TNF-α). In a prospective and longitudinal study, 24 severe malnourished children aged between 1 and 2 years-old, who were part of a program of nutritional recovery, were selected based on clinical and anthropometric criteria. Serum measurements of cytokines were determined before and after dietary treatment, using the technique of sandwich Enzyme-Linked ImmunoSorbent Assay (ELISA). For comparisons, Student’s t test was used, considered p <0.05 as statistically significant. A difference was observed in the concentrations of IL-12, IL-17, IFN-γ and TNF-α before and after treatment (p <0.05), which suggests that malnutrition provokes an inflammatory state and two months of intensive nutritional support, not only promotes the clinical recovery of severe malnourished children, but also the recovery of the immune response with regard to the production of soluble mediators, such as cytokines.

Magnitude, tendência temporal e fatores associados à anemia em crianças do Estado da Paraíba / Magnitude, time trends and factors associate with anemia in children in the state of Paraíba, Brazil

OBJETIVO: Estimar a prevalência da anemia em crianças, sua tendência temporal e identificar fatores associados. MÉTODOS: Estudo de corte transversal, de base populacional, envolvendo 1.108 crianças, com idade entre seis e 59 meses, de ambos os sexos, do Estado da Paraíba, em 2007. A hemoglobina foi analisada em sangue venoso com contador automático. Foram considerados para anemia valores < 11,0 g/dL, forma leve 9-11g/dL, moderada 7-9 g/dL e grave < 7,0 g/dL. As condições socioeconômicas e demográficas das crianças foram obtidas por meio de questionário aos pais ou responsáveis. As proporções foram comparadas pelo teste do qui-quadrado de Pearson, e a associação entre as concentrações de hemoglobina e potenciais fatores de riscos foi testada pelo modelo de regressão de Poisson. A tendência temporal da anemia foi avaliada pelo incremento/redução na prevalência de anemia nos anos de 1982, 1992 e 2007. RESULTADOS: A prevalência de anemia foi de 36,5% (IC95% 33,7;39,3). Observa-se que 1,3% (IC95% 0,7;1,8) foi na forma grave, 11,1% (IC95% 9,4;13,5) na forma moderada e 87,6% (IC95% 79,1;91,2) na forma leve. Houve um incremento de 88,5% nos casos de anemia no período entre 1982 e1992 e uma estabilização na prevalência entre 1992 e 2007. A análise ajustada no modelo de Poisson mostrou maior suscetibilidade à anemia nas crianças de seis a 24 meses de idade, naquelas amamentadas por seis meses ou mais, que co-habitavam com mais de quatro pessoas no mesmo domicílio e moravam em casas com menos de cinco cômodos. CONCLUSÕES: A alta prevalência de anemia mostra que continua sendo um importante problema de saúde pública no Estado da Paraíba. Apesar da estabilização na prevalência entre 1992 e 2007, a anemia apresenta-se em elevado patamar, o que impõe medidas mais efetivas de prevenção e controle.

OBJECTIVE: To estimate the magnitude of the anemia, to analyze the time trends and investigate the factors associated with this disturbance in children in the state of Paraíba, Brazil. METHODS: A cross-sectional survey, of population-based, with 1108 children, aged 6 to 59 months, both sexes in the state of Paraíba. Hemoglobin (Hb) in venous blood was analyzed with an automatic counter. The social-economic and demographic characteristics of children were obtained by questionnaire. Proportions were compared by Pearson's chi-squared test, and the association between hemoglobin concentrations and potential risk factors was tested by regression model Poisson. The time trend of anemia was assessed by the increase/decreased in the prevalence of anemia, using as comparison the prevalence observed in the years 1982, 1992 and 2007. RESULTS: The prevalence of anemia (Hb < 11.0 g/dl) in the state of Paraíba was 36.5% (CI95% 33.7 to 39.3). It was observed that 1.3% (CI95% 0.7 to 1.8) were in severe form (Hb <7.0 g/dl), 11% (CI95% 9.4 to 13.5) in a moderate form and 87.6% (CI95% 79.1 to 91.2) in the mild form. There was an increase 88.5% in cases of anemia between the years 1982-1992 and stabilization in the prevalence between the years 1992-2007. The analysis adjusted Poisson model showed a greater susceptibility to anemia in children 6 to 24 months of age, those breastfed for six months or more, who co-inhabited with more than 04 people in the same household and lived in houses with less than 05 rooms. CONCLUSIONS: The results revealed that anemia remains an important public health problem in the state of Paraíba and despite having been shown an stabilization in the prevalence of anemia between 1992-2007, differently the prevalence observed between 1982-1992, this deficiency presents in high level, witch requires more effective measures of prevention and control.

Serum iron, zinc and copper status of severely malnourished children in Wad Medani, Sudan

To determine status of iron [Fe], zinc [Zn] and copper [Cu] in severely malnourished children in Wad Medani, Central Sudan. Atomic absorption spectrophotometry was used to assess the serum concentrations of iron, zinc and copper in ninety children- sixty severely malnourished children and thirty control. The children were selected randomly from patients admitted to the nutritional section at Wad Medani Children Teaching Hospital in Gezira State, Central Sudan. The age range of the studied children was 3-37 months. The malnourished children were diagnosed and classified into two groups: marasmus and kwashiorkor with 30 patients in each group. Their anthropometric measurements including weight and height were measured. Total serum protein, serum albumin, haemoglobin concentrations and haematocrit were determined using standard methods. Analysis of variance between the three groups showed highly significant differences in all measured biochemical parameters [p<0.001]. Positive and significant correlations were observed between serum albumin and zinc levels [r = 0.4, p=0.01], and between serum copper and haemoglobin levels [r = 0.3, p=0.01]. The nature of the association between these trace elements status and their implications for malnutrition pathophysiology are discussed. The association is established between trace elements [Fe, Zn, Cu] status and malnutrition in children suffering from marasmus and kwashiorkor in the Gezira state

Estados de deficiencia de hierro en niños entre 6 meses a cinco años de edad, hospitalizados en el Departamento de Pediatría, de octubre 2000 a enero 2001 / Iron deficiency conditions in children between 6 months to 5 years odl hospitalized in the pediatric department, from october 2000 to january 2001

Se realizó un estudio descriptivo de series de casos, en el Hospital Escuela "Oscar Danilo Rosales Argüello" durante el período de octubre 2000 a enero 2001, a todos los niños lactantes comprendidos entre los 6 meses a 5 años de edad, que ingresaron al servicio de pediatría, que cumplieron con los criterios de inclusión en el estudio. Niños moderadamente enfermos cuya patología no afecte los resultados ni su estado de salud, sin patologías hemorrágicas posquirúrgicas, ni crónicas, niños que no recibieron, tratamiento con suplementos vitáminicos y hierro. De los niños objetos de estudio se encontró que el 28 porciento (14) se encuentra en el primer estado de deficiencia de hierro, el 22 porciento (11) en el segundo estado y 38 porciento (19) en el tercer estado. Solamente el 12 porciento (6) resultaron sin ningúna anormalidad. Los niños menores de un año fueron los más afectados con (7) en estado I, cuatro (4) en estado II, cinco (5) en estado III. Los niños que presentaron deficiencia de hierro 18 (36 porciento) tenian deficit nutricional leve, 19 (38 porciento) el deficit nutricional era moderado, y 7 (14 porciento) con deficit nutricional severo

Zinc supplementation in protein energy malnutrition.

A pair-matched controlled study was done with 30 children (15 males, 15 females) of mild to moderate PEM in test and equal number in control groups, aged 8-24 months old. At the beginning, in both test and control groups parents were advised to provide sufficient amount of home cooked foods so that the child received on an average 100-150 Kcal/kg/day of energy and 2-3 g/kg/day of protein. Vitamin supplements were provided to all children in both groups. In addition, the test group received a supplementation of 5.625 mg of elemental zinc daily orally while controls received a placebo. Evaluation at the end of 3 months showed that children in test group had a weight gain of 3.742 +/- 0.488 kg against 2.035 +/- 0.383 kg of the control group. Similarly, weight velocity was 5.752 +/- 0.818 g/kg/day in test group against 3.153 +/- 0.617 g/kg/day of the control group. These differences in weight gain and weight velocity were highly significant (p < 0.001). Serum zinc levels, initially and at the end of study were 87.5 +/- 9.6 micrograms/dl and 121.0 +/- 10.1 micrograms/dl, respectively in test group in comparison to 91.2 +/- 9.8 micrograms/dl and 91.0 +/- 10.1 micrograms/dl in controls. This difference was also highly significant (p < 0.001). The daily total calorie intake remained comparable in both groups. Our observations suggest that zinc supplementation during nutritional rehabilitation of mild to moderate PEM hastens the recovery.