Association of eating frequency with anthropometric indices and blood pressure in children and adolescents: the CASPIAN-IV Study / Associação da frequência de alimentação com índices antropométricos e pressão arterial em crianças e adolescentes: o Estudo CASPIAN-IV

Abstract Objectives: This study was conducted to explore the association of eating frequency (EF) with anthropometric indices and blood pressure (BP) in children and adolescents. Methods: This nationwide cross-sectional study was performed on a multi-stage sample of 14,880 students, aged 6–18 years, living in 30 provinces in Iran. Parents were asked to report dietary intake of children as frequency of food groups and/or items. EF was defined as the sum of the daily consumption frequency of main meals and snacks. Association of EF with weight disorders, abdominal obesity, and elevated BP was assessed using different logistic regression models adjusted for potential confounding factors. Results: Eating more frequently (≥6 vs. ≤3) was found among students who were at younger age (11.91 vs. 13.29 years) (p < 0.001). Students who reported an EF of 4 (OR: 0.67, CI: 0.57–0.79), 5 (OR: 0.74, CI: 0.62–0.87), and 6 (OR: 0.54, CI: 0.44–0.65) had lower odds of being obese compared to those who had EF ≤ 3. Having EF of 4 (OR: 0.82, CI: 0.71–0.94), 5 (OR: 0.86, CI: 0.74–0.99), and ≥6 (OR: 0.73, CI: 0.63–0.85) was related to lower prevalence of abdominal adiposity. Conclusion: Higher EF was associated with lower mean values of anthropometric and BP measures, as well as with lower prevalence of generalized and abdominal obesity in children and adolescents. Longitudinal studies are needed to assess the long-term effects of EF on body composition in the pediatric age group.

Resumo Objetivos: Este estudo foi feito para explorar a associação da frequência de alimentação (FA) com índices antropométricos e pressão arterial (PA) em crianças e adolescentes. Métodos: Este estudo transversal nacional foi feito em uma amostra de várias etapas de 14.880 estudantes entre seis e 18 anos de 30 províncias do Irã. Foi pedido que os pais relatassem o consumo alimentar das crianças, como a frequência de grupos e/ou itens alimentares. A FA foi definida como a soma da frequência de consumo diária das principais refeições e lanches. A associação entre FA e disfunções do peso, obesidade abdominal e PA elevada foi avaliada com diferentes modelos de regressão logística ajustados pelos possíveis fatores de confusão. Resultados: Foi constatada uma alimentação mais frequente (≥ 6 em comparação com ≤ 3) entre estudantes mais novos (11,91 em comparação com 3,29 anos) (P < 0,001). Estudantes que relataram quatro [razão de chance (RC): 0,67; intervalo de confiança (IC): 0,57-0,79], cinco (RC: 0,74; IC: 0,62-0,87) e seis (RC: 0,54; IC: 0,44-0.65) refeições apresentaram menores chances de se tornar obesos em comparação com os que apresentaram FAs ≤ 3. FA de quatro (RC: 0,82; IC: 0,71-0,94), cinco (RC: 0,86; IC: 0,74-0,99) e ≥ sei (RC: 0,73; IC: 0,63-0,85) foi associada a menor prevalência de adiposidade abdominal. Conclusão: A FA mais alta foi associada à redução nos valores médios das medidas antropométricas e de PA, bem como à menor prevalência de obesidade generalizada e abdominal em crianças e adolescentes. São necessários estudos longitudinais para avaliar os efeitos de longo prazo da FA sobre a composição corporal na faixa etária pediátrica.

Controle neuronal e manifestações digestórias na paralisia cerebral / Digestive tract neural control and gastrointestinal disorders in cerebral palsy

OBJETIVOS: Abordar as peculiaridades do controle neuronal digestório e descrever as principais manifestações digestórias na paralisia cerebral, atentando-se à importância do diagnóstico precoce para intervenção interdisciplinar eficaz. FONTES DOS DADOS: Revisão sistemática de 1997 a 2012 das bases de dados MEDLINE, LILACS, SciELO e Cochrane Library. Incluem-se 70 artigos, como revisões relevantes, estudos observacionais, ensaios clínicos e estudos de prevalência. Excluíram-se pesquisas qualitativas. Os termos pesquisados foram: paralisia cerebral, disfagia, doença do refluxo gastroesofágico, constipação intestinal, infecção respiratória e gastrostomia. SÍNTESE DOS DADOS: O controle adequado do trato digestório depende do funcionamento e integridade do sistema nervoso. Como indivíduos portadores de paralisia cerebral possuem anormalidades estruturais evidentes no sistema nervoso central e periférico, estão mais propensos a desenvolver distúrbios do trato digestório, com repercussões nutricionais. As alterações vão desde imaturidade neurológica até interferência do estado de humor e capacitação dos cuidadores. Trata-se, portanto, de etiologia multifatorial. As desordens digestórias mais prevalentes são disfagia, doença do refluxo gastroesofágico e constipação intestinal, com consequentes quadros de infecções respiratórias de repetição e repercussão deletéria no estado nutricional. CONCLUSÕES: Indivíduos com paralisia cerebral apresentam alterações neurológicas do controle do sistema digestório, portanto manifestações digestórias são frequentes. As questões abordadas são fundamentais para profissionais das equipes interdisciplinares que atendem indivíduos com paralisia cerebral acerca da importância da anamnese ampla, exame clínico e complementar detalhado que incluam investigação das desordens gastrointestinais associadas e suas consequências. A detecção precoce dessas alterações digestórias pode respaldar medidas de reabilitação mais eficientes no sentido de melhoria da qualidade de vida desses indivíduos.

OBJECTIVES: To examine the neural control of digestive tract and describe the main gastrointestinal disorders in cerebral palsy (CP), with attention to the importance of early diagnosis to an efficient interdisciplinary treatment. SOURCES: Systematic review of literature from 1997 to 2012 from Medline, Lilacs, Scielo, and Cochrane Library databases. The study included 70 papers, such as relevant reviews, observational studies, controlled trials, and prevalence studies. Qualitative studies were excluded. The keywords used were: cerebral palsy, dysphagia, gastroesophageal reflux disease, constipation, recurrent respiratory infections, and gastrostomy. SUMMARY OF THE FINDINGS: The appropriate control of the digestive system depends on the healthy functioning and integrity of the neural system. Since CP patients have structural abnormalities of the central and peripheral nervous system, they are more likely to develop eating disorders. These range from neurological immaturity to interference in the mood and capacity of caregivers. The disease has, therefore, a multifactorial etiology. The most prevalent digestive tract disorders are dysphagia, gastroesophageal reflux disease, and constipation, with consequent recurrent respiratory infections and deleterious impact on nutritional status. CONCLUSIONS: Patients with CP can have neurological abnormalities of digestive system control; therefore, digestive problems are common. The issues raised in the present study are essential for professionals within the interdisciplinary teams that treat patients with CP, concerning the importance of comprehensive anamnesis and clinical examination, such as detailed investigation of gastrointestinal disorders. Early detection of these digestive problems may lead to more efficient rehabilitation measures in order to improve patients' quality of life.

Aspectos nutricionales en enfermedades respiratorias crónicas del niño / Nutritional aspect in children with chronic respiratory disease

Los niños con enfermedades respiratorias crónicas pueden presentar malnutrición, tanto por déficit como por exceso. El manejo integral de estos pacientes por un equipo de salud interdisciplinario favorece la prevención de los trastornos nutricionales, su diagnóstico precoz y manejo oportuno. En el niño existe una compleja interrelación entre nutrición, desarrollo, crecimiento y función pulmonar, al igual que con la capacidad de respuesta inmunológica a las infecciones, de manera que el optimizar el estado nutricional puede ser una valiosa herramienta terapéutica para una mejor evolución global.

Manifestações sistêmicas na doença pulmonar obstrutiva crônica / Systemic manifestations in chronic obstructive pulmonary disease

A doença pulmonar obstrutiva crônica é progressiva e está relacionada a uma resposta inflamatória anormal dos pulmões à inalação de partículas e/ou gases tóxicos, sobretudo a fumaça de cigarro. Embora acometa primariamente os pulmões, diversas manifestações extrapulmonares relacionadas a esta enfermidade têm sido descritas. O aumento do número de células inflamatórias, que resulta em produção anormal de citocinas pró-inflamatórias, e o desequilíbrio entre a formação de radicais livres e a capacidade antioxidante, resultando em sobrecarga oxidativa, provavelmente são mecanismos envolvidos na inflamação local e sistêmica. Além disso, a diminuição do condicionamento físico secundária às limitações ventilatórias pode estar envolvida no desenvolvimento de alterações musculares. A doença pulmonar obstrutiva crônica apresenta diversas manifestações sistêmicas que incluem a depleção nutricional, a disfunção dos músculos esqueléticos, que contribui para a intolerância ao exercício, e as manifestações relacionadas a co-morbidades comumente observadas nestes pacientes. Essas manifestações têm sido relacionadas à sobrevida e ao estado geral de saúde dos pacientes. Nesse sentido, esta revisão tem como objetivo discutir os achados da literatura relacionados às manifestações sistêmicas da doença pulmonar obstrutiva crônica, ressaltando o papel da inflação sistêmica, e algumas perspectivas de tratamento.

Desnutricão intra-uterina e suas alteracões no intestino delgado de ratos Wistar ao nascimento e após a lactacão / In-uterus malnutrition and its changes in the small bowel of Wistar rats at birth and after lactation

INTRODUÇAO: Os efeitos da desnutricão intra-uterina dependem da fase de desenvolvimento em que está o feto ou o órgão, sendo tanto mais intensos e permanentes quanto mais precocemente ocorrer e mais tarde se iniciar a recuperacão nutricional. OBJETIVOS: Avaliar alteracões no intestino delgado diante da desnutricão intra-uterina e após a lactacão em filhotes de ratas Wistar submetidas à restricão dietética na gestacão e comparar com o grupo controle. MATERIAL E MÉTODOS: As ratas prenhes foram divididas em dois grupos; o grupo controle recebeu dieta ad libitum enquanto o grupo com restricão alimentar recebeu 50 por cento dessa dieta. Ao nascimento as ninhadas foram avaliadas quanto ao número de filhotes e ao peso. Os filhotes foram sacrificados em até 24 horas após o nascimento e avaliados individualmente. Na morfometria do intestino delgado estudou-se: altura total da mucosa, altura da vilosidade, espessura da vilosidade e altura do enterócito. Após a lactacão as mesmas medidas foram realizadas e comparadas entre os grupos. RESULTADOS: Ao nascimento, o peso individual, o comprimento do corpo e o do intestino foram menores no grupo com restricão alimentar. Tais resultados mantiveram-se após a lactacão, exceto o comprimento do corpo, que se mostrou semelhante nos dois grupos. A morfometria observou-se, após o nascimento, que todas as variáveis estudadas foram significativamente menores no grupo de filhotes de mães com restricão alimentar. Após a lactacão houve recuperacão da espessura da vilosidade, porém as demais variáveis permaneceram menores. DISCUSSAO E CONCLUSÕES: A restricão de 50 por cento da dieta materna durante a gestacão leva a baixo ganho de peso e produz conceptos menores, com menor comprimento do intestino em relacão a grupo controle e morfometria microscópica revelando medidas menores estatisticamente significativas. A maioria dessas alteracões se mantém após a lactacão e apresenta uma correlacão positiva com o peso dos animais.

Impact of lactational performance on bone mineral density in marginally-nourished Bangladeshi women.

This cross-sectional study, carried out during July 1997-June 1998, evaluated the effects of prolonged breast-feeding and lactational amenorrhoea on bone mineral density (BMD) in 400 marginally-nourished Bangladeshi women aged 20-81 years. A bone densitometer was used for measuring BMD in the distal and ultra-distal end of radius and ulna. The results showed that the women who breastfed for 60 months or less had a higher mean BMD compared to those who breastfed for 61-120 months and for over 120 months. There was a significantly higher BMD in the women who had a shorter duration of lactational amenorrhoea compared to those having a longer duration of lactational amenorrhoea. BMD was significantly and negatively correlated with total duration of lactational amenorrhoea (slope -0.024, p<0.05) after controlling for parity, physical workload, and total duration of breast-feeding. The study concluded that there was a negative correlation between longer duration of breast-feeding and BMD, but it was not found when other factors were controlled in multivariate analysis. The duration of lactational amenorrhoea, which is a proxy indicator of breast-feeding, showed a negative correlation with BMD. It is recommended that all lactating women be given diet with adequate calcium to support breast-feeding for maintaining good nutrition of their bones.

Respostas metabólicas e cardiorrespiratórias ao exercício máximo e submáximo em meninas eutróficas e com desnutriçäo pregressa / Metabolic and cardiovascular responses to maximal and submaximal exercise in eutrophic and stunted girls

OBJETIVO: verificar se a desnutriçäo pregressa, além de causar déficit na estatura de meninas também poderia estar causando uma limitaçäo funcional à capacidade de realizaçäo de exercício máximo e submáximo em bicicleta ergométrica. CASUÖSTICA: 24 meninas, 12 eutróficas de idade (média + or - DP) 9,13 + or - 0,79 anos; peso 27,64 + or - 3,64 kg; e altura 131,31 + or - 6,04 cm; e 12 com desnutriçäo pregressa; idade 9,75 + or - 1,10 anos; peso 25,16 + or - 2,33 kg; e altura 125,06 + or - 3,90 cm. METODOLOGIA: Avaliaçäo clínica e teste ergoespirométrico em bicicleta ergométrica, a partir do qual foram obtidas as variáveis metabólicas e cardiorrespiratórias analisadas. Protocolo de teste: 2 minutos iniciais a 25 watts, seguidos de incrementos de 15 watts a cada 2 minutos, até a exaustäo. RESULTADOS: Testes de esforço máximo: näo foram observadas diferenças entre o grupo de meninas eutróficas (E) e o grupo de meninas com desnutriçäo pregressa (D) para nenhuma das variáveis analisadas: VO2max l/min., VO2max ml/min/kg, VEmax , R, FCmax, por centoFCmax prev e Watts max. Teste de esforço submáximo: foram observadas diferenças entre os grupos para as seguintes variáveis: VO2 l/min LA, por cento VO2max , FC LA, por cento FCmax LA, VE LA, por cento VEmax LA. Näo foram encontradas diferenças entre os grupos para: VO2 ml/min/kg LA e Watts LA. CONCLUSAO: O restabelecimento da relaçäo peso para estatura em meninas com desnutriçäo pregressa, considerado como critério de eutrofia, é válido também para indicar ausência de limitaçäo funcional da capacidade de realizaçäo de exercício

The effects of glutamine-supplemented diet on the intestinal mucosa of the malnourished growing rat

Glutamine is the most abundant amino acid in the blood and plays a key role in the response of the small intestine to systemic injuries. Mucosal atrophy is an important phenomenon that occurs in some types of clinical injury, such as states of severe undernutrition. Glutamine has been shown to exert powerful trophic effects on the gastrointestinal mucosa after small bowel resection or transplant, radiation injury, surgical trauma, ischemic injury and administration of cytotoxic drugs. Since no study has been performed on the malnourished animal, we examined whether glutamine exerts a trophic effect on the intestinal mucosa of the malnourished growing rat. Thirty-five growing female rats (aged 21 days) were divided into 4 groups: control - chow diet; malnutrition diet; malnutrition+chow diet; and malnutrition+glutamine-enriched chow diet (2 percent). For the first 15 days of the experiment, animals in the test groups received a malnutrition diet, which was a lactose-enriched diet designed to induce diarrhea and malnutrition. For the next 15 days, these animals received either the lactose-enriched diet, a regular chow diet or a glutamine-enriched chow diet. After 30 days, the animals were weighed, sacrificed, and a section of the jejunum was taken and prepared for histological examination. All the animals had similar weights on day 1 of experiment, and feeding with the lactose-enriched diet promoted a significant decrease in body weight in comparison to the control group. Feeding with both experimental chow-based diets promoted significant body weight gains, although the glutamine-enriched diet was more effective. RESULTS: The morphological and morphometric analyses demonstrated that small intestinal villous height was significantly decreased in the malnourished group, and this change was partially corrected by the two types of chow-based diet. Crypt depth was significantly increased by malnutrition, and this parameter was partially corrected by the two types of chow-based diet. The glutamine-enriched diet resulted in the greatest reduction of crypt depth, and this reduction was also statistically significant when compared with control animals. CONCLUSIONS: Enteral glutamine has some positive effects on body weight gain and trophism of the jejunal mucosa in the malnourished growing rat

Skeletal muscle endurance is reduced in chronically energy deficient adults.

Fifty eight adult males (well nourished; WN = 25, underweight; UW = 13, chronically energy deficient; CED = 20), aged 18 to 30 yr underwent an assessment of skeletal muscle function using a load cell based handgrip dynamometer coupled to a polygraph. WN subjects had higher handgrip strengths than either the UW or CED subjects (P < 0.05), though not when corrected for forearm muscle area or forearm volume. CED subjects fatigued faster than WN subjects during sustained maximal isometric contraction (P < 0.05) as well as during prolonged isotonic exercise (P < 0.05). During the latter, the onset of fatigue in the CED subjects was also faster than that in their anthropometrically similar UW controls. These data are consonant with reports of decreased productivity in undernourished adults during real life tasks.

Spirometric impairments in undernourished children.

The present study elucidates the effect of undernutrition on pulmonary functions in children. The study was carried out in healthy normals, wasted, wasted and stunted children. Spirometry was performed with Vitalograph Compact-II spirometer. Wasted, wasted and stunted children showed lower lung volumes, forced mid expiratory flow time and inspiratory flow rates than healthy normals. Wasted and stunted children had lower VC, FVC and FIF50% than wasted children. The reduction in lung volumes and flow rates in wasted children may be due to ventilatory muscle wasting. But in wasted and stunted children along with muscular wasting diminished skeletal growth is also a reason for lower lung functions. No airflow limitation was observed in undernourished children.

A study of transcranial magnetic stimulation in older (>3 years) patients of malnutrition.

Transcranial magnetic stimulation was performed in 40 subjects. Twenty patients in the age group of 3 to 8 years and having different grades of malnutrition were included in the 'study group' whereas 20 normal children having no complaints comprised the 'control group'. The coil of the magnetic stimulator was applied tangentially over the vertex to stimulate the cortex. The motor evoked potential (MEP) was obtained using root stimulation by applying the coil at the cervical and lumbosacral spines. Recordings were made from the abductor pollicis brevis (APB) and extensor digitorum brevis (EDB) muscles of both sides. Cortical threshold, latency and amplitude of motor evoked potential and central conduction time were recorded. Malnourished children showed significantly increased cortical threshold, prolonged cortical latency and central conduction time and reduction in amplitude of MEP. Observed delay in central motor conduction in malnourished children suggests asymptomatic involvement of corticospinal pathways.

Estudio sobre el niño desnutrido: VII El volumen sanguíneo y el del plasma en el preescolar desnutrido / Studies in malnourished children: Blood and plasma volumes in malmourished preschool child

Se presenta el estudio del volumen sangíneo y del plasma de 70 niños desnutridos. Se hace una comparación con los valores reportados para el niño sano, encontrando que los desnutridos presentan un aumento de ambos volúmenes (sanguíneo y del plasma), expresados éstos en cc por kilo de peso corporal. Esto es, a mayor desnutrición mayor volumen sanguíneo por kilo de peso. En virtud de los hallazgos histológicos en el hígado de los niños desnutridos y de los trabajos de Himsworth, se presenta como hipótesis de trabajo la posibilidad de que una de las causas que produce el aumento del volumen del plasma se deba a la presencia del factor vasopresor que se origina en las células hepáticas en su sufrimiento

Undernutrition and adolescent growth among rural Indian boys.

OBJECTIVE: To evaluate impact of undernutrition on various adolescent growth parameters among rural Indian boys. DESIGN: Adolescent boys covering 8-18 yr age group were observed longitudinally for a period of 3 years. SETTING: Adolescent boys (n=673) from seven different villages within 30 to 40 km from Pune were studied. METHOD: Six monthly measurements on weight (upto 50 g) and height (upto 0.1 cm) were recorded and age assessment was done from school records with reasonable accuracy. RESULTS: Stunted and underweight boys were lighter (by 4 kg) and shorter (by 8 cm) at 10 yr age compared to their normal counterparts but this difference increased to 12 kg and 10 cm respectively by adulthood. Undernourished boys however, revealed significant height gains at later ages especially beyond 14+ yr, compared to normals suggesting slow, gradual but continual growth. Undernutrition delayed age at take-off and age at PHV by about 2 yr, and lowered attained height at PHV (by 5 cm) and adult height (by 7 cm). CONCLUSION: Normal and maluourished children from the same rural community show wide differences in their adolescent growth performance. Nutritional deprivation thus seems to affect almost all growth parameters and final adult size too.

Comparative effects of prenatal and postnatal undernutrition on learning and memory in rats.

Effects of pre- and post-natal undernutrition on learning and memory parameters were studied in albino rats. Prenatal undernutrition was induced in rat pups by restricting the mother's diet by 50% during the entire gestation period, whereas postnatal undernutrition was induced in rat pups by restriction of their diet by rotating them between lactating and non-lactating maternalised females for 12 hr each day during suckling period from 2nd day to 18th day after birth. At 2.5 to 3 months of age all the rat offsprings were subjected to (i) original and reversal discrimination learning, (ii) passive avoidance, and (iii) active avoidance and its retention tests. The results indicate that both pre- and post-natal undernutrition in rat pups caused significant deficits in original and reversal discrimination learning, retention of passive avoidance after one week retention interval, and retention of active of avoidance learning. However, both pre- and post-natal undernutrition did not show significant effect on acquisition of active avoidance and retention of passive avoidance after 24 hr retention interval.

Diet induced thermogenesis with oral & intravenous feeding in chronically undernourished human subjects.

The parasympathetic nervous system (PNS) has been shown to be important in the mediation of diet induced thermogenesis (DIT). Chronically energy deficient (CED) subjects have a high resting parasympathetic tone, which could lead to a greater than expected DIT. DIT was studied in chronically energy deficient adult men and healthy age-matched volunteers (6 controls, 7 CED subjects) with an isocaloric (600 kcal) meal given by the oral and intravenous (i.v.) routes on two consecutive days, on a crossover basis. The resting metabolic rate (RMR) and the DIT were measured over 6 h, along with cardiovascular, biochemical and anthropometric parameters. Anthropometrically (height, weight, fat free mass, body mass index, mid upper arm circumference and sum of skinfolds), the CED group differed significantly from the well-nourished control group. There were no significant differences between the two groups in the basal state for metabolic (RMR, oxygen consumption, respiratory quotient), cardiovascular [blood pressure (BP), heart rate, cardiac output], and biochemical (plasma glucose, insulin and norepinephrine) parameters. The CED group had a significantly higher DIT response for both meal types when compared to the controls, when expressed as an absolute value and as a percentage response. However, the response was not significant when corrected for the meal size and body weight. There were also no significant differences between the two meal types in each group for the metabolic, cardiovascular and biochemical parameters during the DIT period, although, in general, the oral meal gave a larger DIT response compared to the i.v. meal. Both groups predominantly oxidised fat during the fasted stage and switched to carbohydrate oxidation when fed. It appears that, the previously demonstrated higher tone in the PNS, does not make a significant contribution to the thermic response of a meal in these subjects.