The effect of serum magnesium levels and serum Endothelin-1 levels on bone mineral density in protein energy malnutrition / Efecto de los niveles séricos de magnesio y los niveles séricos de Endotelina-1 sobre la densidad mineral osea en la malnutrición calórico-proteica

An inadequate and imbalanced intake of protein and energy results in protein-energy malnutrition (PEM). It is known that bone mineral density and serum magnesium levels are low in malnourished children. However, the roles of serum magnesium and endothelin-1 (ET-1) levels in the pathophysiology of bone mineralization are obscure. Thus, the relationships between serum magnesium and ET-1 levels and the changes in bone mineral density were investigated in this study. There was a total of 32 subjects, 25 of them had PEM and seven were controls. While mean serum ET-1 levels of the children with kwashiorkor and marasmus showed no statistically significant difference, mean serum ET-1 levels of both groups were significantly higher than that of the control group. Serum magnesium levels were lower than normal value in 9 (36%) of 25 malnourished children. Malnourished children included in this study were divided into two subgroups according to their serum magnesium levels. While mean serum ET-1 levels in the group with low magnesium levels were significantly higher than that of the group with normal magnesium levels (p < 0.05), mean bone mineral density and bone mineral content levels were significantly lower (p < 0.05). In conclusion, many factors play a role in the pathophysiology of changes in bone mineral density in malnutrition. Our study suggested that lower magnesium levels and higher ET-1 levels might be important factors in changes of bone mineral density in malnutrition. We recommend that the malnourished patients, especially with hypomagnesaemia, should be treated with magnesium early.

El consumo inadecuado y desbalanceado de proteínas y calorías energía conduce a la malnutrición calórico-proteica (MCP). Se sabe que la densidad mineral ósea y los niveles séricos de magnesio son bajos en los ninos malnutridos. Sin embargo, no está claro el papel que desempenan los niveles séricos de magnesio y los niveles séricos de endotelina-1 (ET-1) en la patofisiología de la mineralización del hueso. Por consiguiente, las relaciones entre los niveles séricos de magnesio y los niveles séricos de ET-1, y los cambios en la densidad mineral ósea, constituyen el objeto de investigación de este estudio. Hubo un total de 32 sujetos; 25 de ellos tenían DCP y 7 eran considerados. Si bien los niveles séricos promedios de ET-1 de los ninos con kwashiorkor y marasmo no mostraron diferencia estadística significativa, los niveles séricos promedio de ET-1 de ambos grupos fueron significativamente más altos que los del grupo de control. Los niveles séricos de magnesio estuvieron por debajo del valor normal en 9 (36%) de 25 ninos malnutridos. Los ninos malnutridos incluidos en este estudio fueron divididos en dos sub-grupos según sus niveles de magnesio en suero. Mientras que los niveles séricos promedio de ET-1 en el grupo con niveles bajos de magnesio fueron significativamente más altos que los del grupo con niveles normales de magnesio (p < 0.05), la densidad mineral ósea promedio y los niveles promedio del contenido mineral óseo fueron significativamente más bajos (p < 0.05). En conclusión, muchos factores juegan un papel en la patofisiología de los cambios en la densidad mineral ósea por la malnutrición. Nuestro estudio sugirió niveles más bajos de magnesio y niveles más altos de ET-1 podrían ser factores importantes en los cambios de densidad mineral ósea en la malnutrición. Se recomienda que los pacientes malnutridos, especialmente a causa de hipomagnesemia, sean tratados con magnesio lo más pronto posible.

Reduced pancreatic β-cell mass is associated with decreased FoxO1 and Erk1/2 protein phosphorylation in low-protein malnourished rats

A low-protein diet leads to functional and structural pancreatic islet alterations, including islet hypotrophy. Insulin-signaling pathways are involved in several adaptive responses by pancreatic islets. We determined the levels of some insulin-signaling proteins related to pancreatic islet function and growth in malnourished rats. Adult male Wistar rats (N = 20 per group) were fed a 17 percent protein (normal-protein diet; NP) or 6 percent protein (low-protein diet; LP), for 8 weeks. At the end of this period, blood glucose and serum insulin and albumin levels were measured. The morphometric parameters of the endocrine pancreas and the content of some proteins in islet lysates were determined. The β-cell mass was significantly reduced (≅65 percent) in normoglycemic but hypoinsulinemic LP rats compared to NP rats. Associated with these alterations, a significant 30 percent reduction in insulin receptor substrate-1 and a 70 percent increase in insulin receptor substrate-2 protein content were observed in LP islets compared to NP islets. The phosphorylated serine-threonine protein kinase (pAkt)/Akt protein ratio was similar in LP and NP islets. The phosphorylated forkhead-O1 (pFoxO1)/FoxO1 protein ratio was decreased by 43 percent in LP islets compared to NP islets (P < 0.05). Finally, the ratio of phosphorylated-extracellular signal-related kinase 1/2 (pErk1/2) to total Erk1/2 protein levels was decreased by 71 percent in LP islets compared to NP islets (P < 0.05). Therefore, the reduced β-cell mass observed in LP rats is associated with the reduction of phosphorylation in mitogenic-related signals, FoxO1 and Erk proteins. The cause/effect basis of this association remains to be determined.

Serum and hair zinc in severely malnourished Bangladeshi children associated with or without acute lower respiratory infection.

Objective. To assess the zinc status in Bangladeshi children suffering from severe protein energy malnutrition (severe PEM), acute lower respiratory infection (ALRI), PEM presented with ALRI and to evaluate the relationship of zinc status with aforementioned clinical conditions. Methods. We assessed zinc status by simultaneous estimation of serum and hair zinc of Bangladeshi children less than 5 yr of age suffering from severe PEM, ALRI, severe PEM presented with ALRI and compared them with zinc status of wellnourished healthy children (control) in a hospital based cross sectional four cell study. Zinc concentration was estimated by Flame atomic absorption spectrophotometry. Results. The number of children enrolled in severe PEM, ALRI, ALRI with PEM and control were 47, 35, 32 and 38 respectively (total number 152). Both serum and hair zinc in univariate analysis were found significantly (p<0.05) low in severe PEM, ALRI and severe PEM associated with ALRI. However, in multivariate analysis, when serum and hair zinc were included in the same model, both serum and hair zinc were found to have significant negative association with PEM (p=0.002 & 0.013 respectively) and with ALRI only when ALRI was associated with PEM (p=0.043 and 0.034 respectively). Conclusion. Severe PEM and PEM with ALRI were significantly associated with low zinc status.

Alterations in the intestinal wall due to protein malnutrition in rats: Evaluation of the rupture strength and the tissue's collagen / Alterações da parede intestinal na carência de proteína no rato: Avaliação da força de ruptura e do colágeno tecidual

PURPOSE: To study the effect of protein malnutrition on the intestinal wall of rats by evaluating alterations in the rupture force and dosing tissue collagen in the ileum and distal colon. METHODS: One hundred and twenty rats, that had an average weight of 100g, were used. They received water and a standard diet with 20 percent protein during 7 days for adaptation to the diet itself and to environmental conditions. After that period, the animals were randomly distributed in two groups of 60 rats each: Group 1 - the animals received a control diet with 20 percent casein for 21 days; Group 2 - hypoprotein diet with 2 percent casein for 21 days. After the adaptation period, 12 animals of each group were sacrificed at 5 moments: the beginning of experimental period (M0), 4° day (M1), 7° day (M2), 14° day (M3) and 21° day (M4). The diet to the other rats was maintained until the last sacrifice. The following variables were evaluated: body weight, blood albumin rate, tissue's hydroxyproline, hydroxyproline/total protein ratio and rupture strength in the intestinal wall of the ileum and the distal colon. RESULTS: It was observed that the rupture strength in the ileum segment and distal colon was lower in malnourished animals (Group 2); the loss of mechanical resistance was higher in the distal colon segment than in the ileum probably due to the smaller concentration of tissue collagen in the distal colon. CONCLUSION: Protein malnutrition induces the loss of mechanical resistance of the ileum and distal colon and may be associated with a smaller percentage of collagenous tissue formation in the intestinal wall.

OBJETIVO: Avaliar o efeito da desnutrição protéica na parede intestinal do rato através da medida de força de ruptura e dosagem do colágeno tecidual no íleo e cólon distal. MÉTODOS: Foram utilizados 120 ratos, pesando em média 100g, que receberam durante 07 dias uma dieta padrão, contendo 20 por cento de caseína para adaptação dos animais as condições do biotério. Após esse período os animais foram divididos em dois grupos de 60, o controle denominado grupo um que recebeu a dieta padrão, e o grupo teste denominado grupo dois, que recebeu dieta hipoprotéica contendo 2 por cento de caseína. Os dois grupos receberam suas respectivas dietas por um período de 21 dias. Após esse período iniciou-se o sacrifício seqüencial dos animais em ambos os grupos, em número de 12 animais em cada momento, correspondendo ao dia Zero (MO), 4º dia (M1), 7º dia (M2), 14º dia (M3), e 21º dia (M4) sendo mantida a mesma dieta até o final do sacrifício. Em cada momento foram avaliados o peso corpóreo, albumina sanguínea, hidroxiprolina tecidual, relação hidroxiprolina/proteína tecidual e a força de ruptura no segmento ileal e cólico dos animais. RESULTADOS: Observou-se que a força de ruptura do segmento ileal e do cólon distal foi menor nos animais desnutridos (Grupo 2). A perda da resistência mecânica foi maior no segmento do cólon distal do que no segmento ileal, provavelmente pela menor concentração do colágeno tecidual no cólon distal. CONCLUSÃO: A desnutrição protéica induz a diminuição da resistência mecânica no íleo e no cólon distal associado a diminuição do colágeno tecidual na parede intestinal.

Efeito da desnutrição protéica pré e pós-natal sobre a morfologia, a diferenciação e o metabolismo do tecido muscular estriado esquelético em ratos / The effects of prenatal and postnatal malnutrition on the morphology, differentiation, and metabolism of skeletal striated muscle tissue in rats

OBJETIVO: Estudar características morfológicas, metabolismo e habilidades contráteis do músculo submetido a desnutrição protéica pré e pós-natal. MÉTODOS: Distribuição dos animais em dois grupos: controle, dieta normoprotéica (GC; n = 15; 5/5/5) e desnutrido, dieta hipoprotéica (GD; n = 15; 5/5/5), observados respectivamente no sétimo, 14º e 28º dia do período experimental. Foram avaliados massa corporal total, peso, habilidades contráteis e a morfologia do músculo tibial anterior. Amostras de tecidos com 8 m de espessura de ratos com idades de 7, 14 e 28 dias, corados por hematoxilina e eosina, e outros submetidos aos métodos histoquímicos nicotinamida adenina tetrazólio redutase (NADH-TR) e miofibrilar (m-ATPase) (pH = 4,4). RESULTADOS: Os pesos corporal e muscular apresentaram-se menores nos grupos desnutridos. Aos 7 dias de desnutrição, o músculo apresentou fibras com menor diâmetro, maior polimorfismo e maior teor de tecido conjuntivo endomisial. Nas histoquímicas, tipos de fibras sem delimitação segura. Aos 14 dias de desnutrição, fibras menores, mais polimórficas, muitas com núcleos centrais e moderado teor de tecido conjuntivo endomisial. Quanto à contração, a reação m-ATPase evidenciou fibras lentas e rápidas. A reação NADH-TR revelou os tipos de fibras slow oxidative, fast oxidative glycolytic e fast glycolytic. Aos 28 dias de desnutrição, fibras menores, agrupadas com contornos variáveis. Quanto ao tipo de contração e metabolismo, os três tipos de fibras apresentaram limites de reconhecimento indistinto. CONCLUSÃO: Os resultados experimentais sugerem que, além da redução no número de fibras, a desnutrição promove um retardamento na diferenciação das características morfológicas, metabólicas e contráteis dos tipos de fibras musculares esqueléticas em ratos na fase de crescimento.

OBJECTIVE: To study the contractile properties, metabolism and morphological characteristics of muscles submitted to prenatal and postnatal protein malnutrition. METHODS: Animals were distributed into two groups: Control, normoprotein diet (CG; n = 15; 5/5/5), and Malnourished, hypoprotein diet (MG; n = 15; 5/5/5), and examined on the 7th, 14th, and 28th days of the experiment. Total body mass, weight, and the contractile properties and morphology of the anterior tibial muscle were assessed. Several 8 µm-thick tissue samples were taken from 7, 14, and 28 day old rats and stained with HE or subjected to NADH-TR or m-ATPase (pH = 4.4) techniques. RESULTS: Body and muscle weight were lower in the malnourished group. On the 7th day of malnutrition, muscle samples exhibited fibers with smaller diameter, higher polymorphism and higher endomysial conjunctive tissue content. Histochemical methods were unable to precisely determine the types of fiber present. On the 14th day, there were smaller muscle fibers, more polymorphism, many of them with central nuclei and moderate endomysial conjunctive tissue content. With reference to contractile properties, the m-ATPase reaction identified both slow and fast fibers. The NADH-TR reaction revealed the following types of fiber: slow oxidative (SO), fast oxidative glycolytic (FOG) and fast glycolytic (FG). On the 28th day smaller, bunched muscle fibers varying shapes. All three types of fiber exhibited unclear recognition limits with respect to contraction and metabolism. CONCLUSION: Our experimental results suggest that, in addition to the reduction in numbers of fibers, malnutrition retards the differentiation of the morphological, metabolic, and contractile characteristics of skeletal muscle fibers in growing rats.

A exposição crônica ao álcool e a desnutrição interferem no desenvolvimento do fígado durante o período perinatal? / Chronic exposure to alcohol and malnutrition affect the development of the liver during the perinatal period? / La exposición crónica al alcohol y la malnutrición afectan el desarrollo del hígado durante el período perinatal?

Estudos têm demonstrado os efeitos do alcoolismo e desnutrição isolados ou em associação. Baseando-se nessas informações, o presente estudo avaliou, por meio da histoquímica e análise digital de imagens, o perfil histológico do fígado de ratos Wistar gerados por matrizes submetidas a dois tratamentos nutricionais: dieta padrão do biotério (Labina, 23% de proteína) e dieta hipoprotéica (Dieta Básica Regional - DBR 8% de proteína) e ingestão crônica de etanol (3,0g/kg do peso corporal) ou água destilada, originando 4 grupos experimentais (Controle GC, Etanol-GE, Desnutrido-GO e Etanol-Desnutrido-GED). Avaliou-se a evolução ponderal dos filhotes em três períodos: 3º (P3), 25º (P25) e 40º (P40) dias de vida. Observou-se em P3 que apenas GE tinha peso significativamente menor, quando comparado com os demais grupos. Em P25 e P40, o GE e GED apresentaram significativa redução de peso, quando comparados com os grupos GC e GD, tendo o GED peso menor. Na análise morfométrica, foram medidas as áreas de depósito de colágeno perivascular, número de infiltrados inflamatórios no parênquima hepático e permitiu observar que o depósito de colágeno perivascular e intersticial teve aumento estatisticamente significativo no GE, quando comparado com os outros grupos. A exposição ao etanol e desnutrição protéica experimental causou a vacuolização dos hepatócitos, em grande parte do parênquima, e a ocorrência de infiltrados inflamatórios intersticiais e perivasculares no grupo etanol. Em resumo, nossos resultados revelam que há interferência do álcool e da desnutrição protéica, de forma isolada ou em associação...

Studies have shown the effects of malnutrition and alccolismo alone or in combination. Based on this information, this study examined, by immunohistochemistry and digital image analysis, histological profile of the liver of rats generated by arrays subjected to two nutritional treatments: standard diet of the vivarium (Labina, 23% protein) and low protein diet (Regional Basic Diet - DBR 8% protein) and chronic ingestion of ethanol (3.0 g/kg body weight) or distilled water, resulting in four experimental groups (Control GC, GE, Ethanol, and Ethanol-GO Malnourished -Malnourished-GED). We evaluated the weight gain of pups in three periods: 3 (P3), 25 (P25) and 40 (P40) days old. It was observed that only in P3 GE had significantly lower weight compared with the other groups. In P25 and P40, GE and GED showed significant weight reduction when compared with the GC and GD, taking the GED less weight. In morphometric analysis, we measured the areas of perivascular collagen deposition, number of inflammatory infiltrates in the liver parenchyma and has observed that the collagen deposition and perivascular interstitial had a statistically significant increase in SG, when compared with other groups. Ethanol exposure and experimental protein malnutrition caused vacuolization of hepatocytes, mainly the parenchyma, and the occurrence of interstitial and perivascular inflammatory infiltrates in the ethanol group. In summary, our results show that there is interference of alcohol and malnutrition, alone or in combination...

Los estudios han demostrado los efectos de la malnutrición y alccolismo solo o en combinación. Con base en esta información, este estudio examinó, mediante técnicas de inmunohistoquímica y análisis de imágenes digitales, el perfil histológico del hígado de las ratas generado por las matrices sometido a dos tratamientos nutricionales: dieta estándar del vivero (Labina, 23% de proteína) y la dieta baja en proteínas (Dieta Básica Regional - DBR proteínas 8%) y la ingestión crónica de etanol (3,0 g/kg de peso corporal) o agua destilada, lo que resulta en cuatro grupos experimentales (control de GC, GE, etanol, etanol y desnutridos-GO -desnutridos-GED). Se evaluó la ganancia de peso de las crías en tres períodos: 3 (P3), 25 (P25) y de edad 40 (P40) días. Se observó que sólo en P3 GE tenía un peso significativamente menor en comparación con los otros grupos. En P25 y P40, GE y GED mostraron una reducción significativa de peso en comparación con el GC y GD, tomando el peso de GED menos. En el análisis morfométrico, que mide las áreas de depósito de colágeno perivascular, el número de infiltrados inflamatorios en el parénquima hepático y ha observado que el depósito de colágeno intersticial y perivascular había un aumento estadísticamente significativo en la SG, en comparación con otros grupos. la exposición del etanol y la desnutrición proteica experimental causada vacuolización de hepatocitos, sobre todo el parénquima, y la presencia de infiltrado inflamatorio intersticial y perivascular en el grupo de etanol. En resumen, nuestros resultados muestran que hay una interferencia del alcohol y la malnutrición, solo o en combinación...

Tratamiento de pacientes pediátricos con diagnóstico de desnutrición grave de acuerdo a resultados de estudio metabólico renal / Treatment of paediatric patients with diagnosis of serious malnutrition of agreement to results of metabolic renal study

El objetivo del presente estudio fue realizar pruebas metabólicas renales a niños desnutridos graves hospitalizados, las cuales sirvieron de guía en el tratamiento de estos pacientes. La investigación fue de tipo experimental (terapéutica), se evaluaron 176 pacientes entre febrero 2002-2004. Edad entre 6 meses y 5 años, desnutrición grave primaria, ambos sexos, con acidosis metabólica, hipercloremia y anión gap urinario positivo. A los 85 restantes se les realizó estudio metabólico inicial resultando 30 con acidosis metabólica hiperclorémica y anión gap urinario positivo. A estos se les realizó prueba de sobrecarga con bicarbonato al 5 porciento y se dividieron en dos grupos: los primeros 15 tratados de acuerdo a los resultados del estudio, y los segundo 15 que recibío el tratamiento convencional. Resultados: El grupo de edad mas frecuente fueron los lactantes con distribución similar para ambos sexos. La acidosis metabólica se observó en 35,2 por ciento de la muestra evaluada. 40 por ciento luego de la prueba de sobrecarga en bicarbonato al 5 porciento resultó con acidosis tubular renal distal, con incidencia significativa (p<0.0001). 66.7 por ciento presentó hipercalciuria: 50 por ciento hiperuricosuria y 40 por ciento ambas alteraciones. La diferencia del promedio de peso entre el ingreso y egreso fue estadísticamente significativa en ambos grupos. La diferencia del valor medio de la albúmina sérica el egreso entre los pacientes tratados según resultados y tratamiento convencional fue significativa (p<0.05). El valor medio de los días de hospitalización fue de 17.3 días en los tratados y 20.4 en los no tratados, con un ahorro de 624.175,80 bolivares por cada paciente. Discusión y Conclución: La acidosis metabólica es frecuente en la desnutrición infantil grave, la cual, de acuerdo a los resultados observados obedece a una disfunción tubular renal distal.

Evaluation of nutritional status of nonhospitalized patients with liver cirrhosis

BACKGROUD: Protein-calorie malnutrition is a frequent finding in patients with chronic liver disease, but investigations of nutritional status have been rarely performed in individuals seen at outpatient clinics AIM: To evaluate the nutritional status of patients with alcoholic and nonalcoholic cirrhosis, attended for the first time at a reference outpatient clinic for liver diseases. PATIENTS AND METHODS: A total of 300 consecutive patients attended at the outpatient clinics of a reference center for liver diseases were investigated. Anthropometric evaluation was performed by the usual parameters: triceps skinfold, arm circumference and arm muscle circumference. Biochemical parameters included creatinine/height index, serum albumin and lymphocytes count. The nutritional diagnosis was based on the PCM score proposed by Mendenhall et al. Food intake was retrospectively evaluated using 24-hour dietary recall data. RESULTS: About 71 percent of the patients studied were chronic alcohol abusers, whereas in 29 percent cirrhosis was of nonalcoholic etiology. Independently of the disease etiology 75.3 percent of the patients showed some degree of protein-calorie malnutrition, which was moderate or severe in 38.3 percent of them. More advanced protein-calorie malnutrition degrees were associated with lower energy and protein intake. The prevalence of moderate or severe protein-calorie malnutrition was higher in patients classified as Child-Pugh C than in patients classified as Child-Pugh A (21 percent x 58 percent, respectively). Regarding sexual differences, fat reserves, evaluated by triceps skinfold, were more depleted in females than in males (48.6 percent x 26.6 percent) regardless of the etiology of the cirrhosis, whereas muscle reserves (arm muscle circumference) were more depleted in males (43.4 percent x 13.4 percent) regardless of the etiology of cirrhosis. In contrast, cirrhosis of alcoholic etiology was determinant in reducing arm...

RACIONAL: A desnutrição calórica e protéica é achado freqüente em pacientes com doença hepática. Poucas investigações da desnutrição calórica e protéica têm sido realizadas em pacientes atendidos em ambulatório OBJETIVO: Avaliar o estado nutricional de pacientes com cirrose hepática (alcoolistas e não-alcoolistas), atendidos na primeira consulta em ambulatório de referência para doenças hepáticas. PACIENTES E MÉTODOS: Trezentos pacientes consecutivamente atendidos pela primeira vez em ambulatório de doenças hepáticas foram incluídos neste estudo. Os mesmos foram submetidos a avaliação nutricional que constou de antropometria: dobra cutânea do tríceps, circunferência do braço e circunferência muscular do braço, e bioquímica: índice creatinina/altura, albumina sérica e contagem total de linfócitos. O diagnóstico do estado nutricional foi baseado pelo escore de desnutrição calórica e protéica proposto por Mendenhall e colaboradores e a ingestão alimentar por recordatório de 24 h RESULTADOS: Setenta e um porcento dos pacientes cirróticos estudados foram de causa alcoólica e 29 por cento não-alcoólica. Independentemente da causa, a prevalência de desnutrição calórica e protéica foi de 75,3 por cento, sendo que 38.3 por cento deles já a apresentavam moderada e grave. Os pacientes com desnutrição calórica e protéica moderada e grave apresentavam pior ingestão de proteína e energia. A prevalência de moderada e grave foi mais elevada nos pacientes classificados como Child-Pugh C do que nos pacientes classificados como Child-Pugh A (21 por cento x 58 por cento, respectivamente). Em função das variáveis sexo e causa, as reservas de gordura, avaliadas pela dobra cutânea do tríceps, estiveram mais depletadas em mulheres cirróticas que nos homens cirróticos (48,6 por cento x 26,6 por cento). Já as reservas musculares, avaliadas por circunferência muscular do braço, estiveram mais depletadas em homens cirróticos (43,4 por cento x 13,4 por cento), independentemente...

Aspectos funcionais, microbiológicos e morfológicos intestinais em crianças infectadas pelo vírus da imunodeficiência humana / Functional, microbiological and morphological intestinal findings among human immunodeficiency virus infected children

RACIONAL: O trato gastrointestinal é freqüentemente acometido nas crianças infectadas pelo vírus da imunodeficiência humana, com importantes repercussões no seu estado nutricional e sobrevida. A maioria dos estudos relacionados a esse tema foi desenvolvida com adultos, sendo menos investigado o problema nas crianças OBJETIVOS: Estudar aspectos digestivo-absortivos, microbiológicos e morfológicos intestinais em crianças infectadas pelo vírus da imunodeficiência humana MATERIAL E MÉTODOS: Onze crianças infectadas pelo vírus da imunodeficiência humana, menores de 13 anos, pertencentes às categorias clínicas A, B ou C, divididas em dois grupos: cinco pacientes com relato atual ou recente de diarréia e seis pacientes sem diarréia nos 30 dias que antecederam à inclusão no estudo. Investigação proposta: biopsia de intestino delgado e reto para análise morfológica e microbiológica, coprocultura, protoparasitológico de fezes, pesquisa de rotavírus, micobactérias e Cryptosporidium; teste da D-xilose RESULTADOS: Todos os pacientes testados (9/11) apresentavam má absorção da D-xilose (8,4-24,4 mg/dL). Os achados histopatológicos de intestino delgado foram inespecíficos, representados em sua maioria, por enteropatia grau I a II (6/10). Em todos os casos foi constatado aumento do infiltrado celular do córion. As alterações histopatológicas do reto também foram inespecíficas, com presença de aumento do infiltrado celular do córion. A pesquisa de microorganismos enteropatogênicos só foi positiva em dois casos, sendo identificado Mycobacterium avium intracellulare e Cryptosporidium nas fezes CONCLUSÕES: Demonstrou-se alta prevalência (100 por cento) de má absorção intestinal em crianças infectadas pelo vírus da imunodeficiência humana, com ou sem diarréia. Não foi possível estabelecer correlações quanto à presença de agentes enteropatogênicos, má absorção intestinal, alterações morfológicas intestinais e ocorrência ou não de diarréia. Não houve correlação...

BACKGROUD: Gastrointestinal tract disorders are frequent among human immunodeficiency virus infected children, with important repercussions on nutrition and survival. Most studies related to this subject were restricted to adults, being less investigated the problem in the children. AIMS: To study intestinal digestion, absorption, microbiological and morphological findings among human immunodeficiency virus infected children. MATERIAL AND METHODS: Eleven human immunodeficiency virus infected children under 13 years old, belonging to clinical categories A, B or C, separated in two groups: five patients with current or recent episode of diarrhea and six patients without diarrhea in the last 30 days preceding entering in study. Investigation proposed: microbiological and morphological analysis of small intestine and rectum biopsy; stool exams for bacterium, parasite, rotavirus, Mycobacterium species and Cryptosporidium; D-xylose test RESULTS: All tested subjects (9/11) had low D-xylose absorption (8,4 _ 24,4 mg d/L). Small intestinal mucosa histology findings were nonspecific, represented, in majority, of grade I/II enteropathy (6/10). Increased cellular infiltration of the chorion was observed in all specimens. Rectum histology alterations were also nonspecific, with chorion increased cellular infiltration. Mycobacterim avium intracellulare and Cryptosporidium were the solely microorganisms founded, both in stool CONCLUSIONS: Our study demonstrated high prevalence (100 percent) of intestinal malabsorption among human immunodeficiency virus infected children, despite the occurrence or not of diarrhea. It was not possible to establish relationships between the presence of microorganisms, intestinal malabsorption, intestinal morphologic findings and the occurrence or not of diarrhea. There was no correlation between D-xylose and intensity of villous atrophy.

Efecto de la diarrea sobre la utilización de nutrientes en ratas con desnutrición proteico-calórica o proteica / Effect of diarrhea on nutrient utilization in protein deficient or protein-calorie deficient rats

La diarrea magnifica los efectos de la desnutrición. En consecuencia, aquí se estudió el efecto de la diarrea sobre dos tipos de desnutrición (proteica y proteico-calórica). El experimento incluyó 42 ratas jóvenes de la cepa Sprague Dawley que se distribuyeron en tres grupos (14 ratas/grupo). Durante los primeros 16 días del experimento, el primer grupo recibió una dieta control ad-libitum, el segundo recibió la misma dieta pero su consumo se redujo en un 50% y el tercer grupo recibió una dieta deficiente en proteína. Al final de este período había ratas bien nutridas (controles) y con desnutrición proteica y calórico-proteica. Luego, a la mitad de estas ratas en cada grupo, se les produjo diarrea con lactosa y todas las ratas continuaron con su dieta y el régimen de alimentación preasignado durante una semana. Así, durante este período había ratas controles así como con deficiencia proteica o calórico-proteica que tenían diarrea y grupos idénticos que no tenían diarrea. Los resultados mostraron que la diarrea causó una disminución del consumo y del crecimiento en las ratas del grupo control y deficiente en proteína. Sin embargo, el grupo con deficiencia calórico-proteica no redujo su consumo ni disminuyó su crecimiento en respuesta a la diarrea. La consecuencia de esto fue que la diarrea produjo desnutrición en el grupo control y aumentó la desnutrición en el grupo deficiente en proteína, pero no tuvo un efecto adicional en el grupo con deficiencia calórico-proteica. Además, la reducción en la absorción aparente del nitrógeno y de la grasa asociada con la diarrea, fue mayor en las ratas deficientes en proteína. Este grupo también presentó las actividades más bajas de disacaridasas intestinales. Esto resultados muestran que la diarrea tiene un efecto negativo mayor en ratas con deficiencia proteica que con deficiencia calórico-proteica.

Diarrhea increases the effects of malnutrition. Accordingly, the effect of diarrhea on two types of malnutrition (protein deficiency and protein-calorie deficiency) was studied. The experiment included 42 young Sprague Dawley rats. The rats were distributed into three groups with 14 rats per group. During the first 16 of the experiment, the first group was fed a control diet ad libitum, the second received the same diet but with food intake reduced in 50% whereas the third group was offered a protein deficient diet. Thus, at the end of this period there were well-fed rats (control), as well as protein and protein-calorie malnourished rats. Then one half of the rats in each group were given lactose to produce diarrhea and all rats continued with their previously assigned diet and feeding regime during one more week. Therefore, during this period there were control rats, protein deficient rats and protein-calorie deficient rats with and without diarrhea. The results showed that diarrhea caused a substantial reduction in food intake and growth in the well-fed rats and also in the group fed the protein deficient diet. However, the protein-calorie deficient group did not reduce its intake nor its growth rate. As a result, diarrhea caused malnutrition in the control group and increased malnutrition in the protein deficient but it did not have an additional effect in the protein-calorie deficient rats. The apparent absorption of lipids and nitrogen measured in these rats showed that the absorption reduction caused by diarrhea was more pronounced in the protein deficient group. This group also had the lowest activities of intestinal disaccharidases. These results showed that diarrhea had a more detrimental effect in protein deficient than in protein-calorie deficient rats.

Medición del gasto energético basal o en reposo / Basal or rest energy expenditure determination

Las funciones vitales del organismos requieren un determinado gasto energético, que debe ser compensado por los alimentos y bebidas de la dieta. Así. Las necesidades energéticas se definen como la cantidad de energía necesaria para mantener la salud, el crecimiento y un nivel apropiado de actividad física. En situaciones de equilibrio, el ajuste entre la energía ingerida y el consumo energético diario se alcanza a través de diferentes mecanismos, que regulan el apetito y el gusto energético, evitando grandes variaciones en el peso a lo largo del tiempo y, por tanto, la destrucción calórica y obesidad. La medición del gasto energético aporta un dato objetivo en el manejo nutricional de pacientes hospitalizados y ambulatorios. Una de las metodologías utilizadas para realizar la medición es la calorimetría directa o indirecta. La base teórica de la calorimetría asegura exactitud y confiabilidad cuando la medición se realiza bajo condiciones adecuadas. La calorimetría indirecta constituye el método de aplicación más frecuente en clínica, adaptándose para ser usado en todo tipo de pacientes mientras que la calorimetría directa es reservada para estudios de investigación y desarrollo.

Estado nutricional e absorção intestinal de ferro em crianças com doença hepática crônica com e sem colestase / Nutritional status and intestinal iron absorption in children with chronic hepatic disease with and without cholestasis

OBJETIVO: Avaliar a ingestão alimentar, a ocorrência de desnutrição energético-protéica e de anemia e a absorção intestinal de ferro em crianças com doença hepática crônica. CASUíSTICA E MÉTODOS: Foram estudados 25 pacientes com doença hepática crônica, sendo 15 com colestase e 11 sem colestase. A idade variou entre 6,5 meses e 12,1 anos. A absorção intestinal de ferro foi avaliada pela elevação do ferro sérico uma hora após a ingestão de 1 mg/kg de ferro elementar e pela resposta à ferroterapia oral. A absorção intestinal de ferro foi comparada com um grupo de crianças com anemia ferropriva. RESULTADOS: A ingestão média de energia e proteínas nos pacientes com doença hepática com colestase foi maior do que nos pacientes sem colestase. O déficit nutricional foi mais grave nos pacientes com colestase, predominando os déficits de estatura-idade e peso-idade. A anemia foi freqüente tanto nas crianças com doença hepática com colestase (11/14; 78,6 por cento) como nas sem colestase (7/11; 63,6 por cento). Na doença hepática com colestase, observou-se menor (p < 0,05) absorção intestinal de ferro (90,6±42,1 µg/dl), em comparação com o grupo com anemia ferropriva (159,6±69,9 µg/dl). No entanto, o grupo com colestase apresentou resposta à ferroterapia oral. Os pacientes com doença hepática sem colestase apresentaram absorção intestinal de ferro semelhante à das crianças com anemia ferropriva. CONCLUSÃO: A doença hepática crônica com colestase associa-se com maior comprometimento nutricional. Apesar das crianças com colestase apresentarem evidência de má absorção intestinal de ferro, apresentaram resposta à ferroterapia oral, provavelmente, pela coexistência de deficiência de ferro.

Effect of protein malnutrition on the intestinal absorption of monosaccharides in rats in vivo.

The present study was planned to elucidate the role of protein malnutrition on the intestinal absorption of monosaccharides particularly--glucose and xylose, in inbred female albino rats. The experimental rats were fed with protein deficient diet containing 3% protein, whereas the control rats were given a diet containing 18% protein. The study on intestinal absorption of monosaccharides was conducted on both the groups of rats after the 7th and 15th day of receiving respective diets. The results indicated no significant impairment of glucose absorption of experimental rats fed 3% diet for 7 days as compared to the controls. However a 42% decrease in glucose absorption was observed when the animals were fed with the same diet for 15 days. The impairment was significant in all segments of intestine suggesting diminution in the absorption capacity of small intestine in malnutrition perhaps as a result of some permanent injury to mucosal cells of small intestine. Regarding xylose absorption, in experimental rats an increase of intestinal uptake was noticed in most of the segments of small intestine as compared to control rats.

Effect of malnutrition on the digestive enzymes of the upper gastrointestinal tract of young rhesus monkeys.

The present study was planned to observe the effect of protein-energy malnutrition on the gastric and duodenal mucosa. The activities of digestive enzymes (i.e. lactase, sucrase, maltase, trehalase, glucoamylase, leucine aminopeptidase, alkaline phosphatase and gamma-glutamyl transpeptidase) from the gastric (fundus, body and antrum) and duodenal mucosa [i.e. first (D1) and second (D2) part of the duodenum] were determined in 6 control, 6 protein-energy malnourished (PEM) and 6 rehabilitated young rhesus monkeys. There was a significant increase in the activity of the lactase enzyme in the antrum, and D1 and D2 portions of the duodenum of PEM monkeys, while the activity of all other enzymes was significantly increased in the D1 and D2 portions only. The increase in the activity of the above-mentioned enzymes became normal upon rehabilitation. There was no change in the enzyme activities of the gastric mucosa in mild-to-moderate PEM states. This study demonstrates that even mild-to-moderate malnutrition states affect the activity of enzymes in the gastric and duodenal mucosa. Enzyme activity recovers on rehabilitation.

The use of protein hydrolysate improves the protein intestinal absorption in undernourished mice infected with Schistosoma mansoni

Patients residing in endemic areas for schistosomiasis in Brazil are usually undernourished and when they develop the hepatosplenic clinical form of the disease should usually receive hospital care, many of them being in need of nutritional rehabilitation before specific treatment can be undertaken. In the mouse model, investigations carried out in our laboratory detected a reduced aminoacid uptake in undernourished animals which is aggravated by a superimposed infection with Schistosoma mansoni. However, in well-nourished infected mice no dysfunction occurs. In this study, we tried to improve the absorptive intestinal performance of undernourished mice infected with S. mansoni by feeding them with hydrolysed casein instead of whole casein. The values obtained for the coefficient of protein intestinal absorption (cpia) among well-nourished mice were above 90 percent (either hydrolysed or whole protein). In undernourished infected mice, however, the cpia improved significantly after feeding them with hydrolysed casein, animals reaching values close to those obtained in well-nourished infected mice

Nutritional supplementation according to energy and protein requirements in malnourished HIV-infected patients

To evaluate the effects of nutritional supplements on nitrogen and energy balances, body composition and immune parameters, HIV-infected malnourished adult outpatients were prospectively studied. Forty-six patients (4 females and 42 males; 37 +/- 12 y) were supplemented with a polymeric diet (PD) or regular foods (RF) on two consecutive 45-day periods on a crossover design. Weight, skinfold thicknesses, plasma albumin (PA), CD4 and CD8 lymphocyte counts (LC), resting energy expenditure (REE) and urinary nitrogen excretion were measured at baseline, 45 and 90-day. Food intake was weekly recorded by food surveys. Thirty-five patients completed the protocol (18 in Group 1:PD-->RF; 17 in Group 2:RF-->PD). In both groups, weight, fat free mass (FFM), energy balance (EB) and nitrogen balance (NB) increased significantly after PD, whereas LC and PA remained unchanged in both groups. The best results in terms of weight gain were obtained in the PD group and PD plus zidovudine subgroup (n = 8) during the first 45 days (weight gain/FFM gain: 4.8/2.6 kg and 6.8/3.1 kg, respectively). Nutritional supplement with PD, according to the EB and NB goals, was well tolerated and permitted to achieve a significant weight and FFM gain over a 90-day follow-up.

Protein-calorie malnutrition: decrease in the peritonial macrophage's respiratory burst

Protein malnutrition and disease are frequently associated. It modifies both the organism's specific and non-specific immune response to infectious agents. However, the exact mechanisms underlying these findings have not yet been clearly elucidated. In this study, we examined the respiratoy burst capacity in resident and activated peritoneal macrophages obtained from adult male mice who were fed either a control (20 porcent protein) or a low-protein (4 porcent protein) diet. The activated macrophages were obtained after an intra-peritoneal administration of sodium caseinate. Through chemiluminescence assays using either luminol or lucigenin, the kinetics and production...

Ensaio de adesão e detecção de RNA mensageiro de fibronectina em macrofágos peritoniais de camundongos submetidos à desnutrição proteíca experimental / Test of adhesion and detection of messenger RNA of mice peritoneal macrophages fibronectin submitted to experimental protein malnutrition

Muito dos mecanismos que comprometem o sistema imune em estados de desnutrição ainda estão para ser esclarecidos. O estado nutricional influencia na evolução de pacientes internados, na infância e em idosos. No nosso trabalho estudamos um modelo experimental de desnutrição proteíca, na qual fornecemos uma ração hipoproteíca para camundongos Swiss (4 porcento de proteina) para induzir a desnutrição protéica e estudar a função dos macrófagos peritoniais. Observamos alterações na adesividade, com expressão reduzida de fibronectina, uma molécula adesiva da matriz extracelular. No entanto o RNAm apresenta-se com tendência a apresentar valores maiores no desnutrido, o qual ao ser estimulado com...

Acidos grasos de fosfolipidos en plasma y eritrocitos de lactantes desnutridos alimentados con leche materna o fórmulas / Fatty acids of plasma and erythrocyte phospholipids in malnourished infants well-fed by breast feeding or formula

Los ácidos grasos polinsaturados (AGP) derivados de los ácidos grasos esenciales (AGE) tienen importantes roles en la formación y mantenimiento de estructuras de membrana, jugando un papel trascendente en la síntesis de lípidos estructurales y en el desarrollo neural. Se han señalado anormalidades en las funciones neurológicas de lactantes alimentados con fórmulas con respecto a lactantes alimentados con leche materna y se conoce el efecto de la desnutrición calórico-proteica sobre la composición en AGP de algunos tejidos. En este trabajo se estudió el efecto de diferentes fórmulas comerciales sobre la composición en ácidos grasos de los fosfolípidos de plasma y eritrocitos. Se seleccionaron tres grupos de lactantes desnutridos por causa socioeconómicoculturales nacidos a término: dos recibieron fórmulas (una de ellas sólo aportó ácidos linoleicos y alfa- linolénicos y la otra contenía además agragados ácidos grasos polinsaturados de mayor longitud de cadenas derivados de ambas series: n-3 y n-6 y el tercer grupo, alimentado con leche materna, se consideró como control. Se determinó la composición de ácidos grasos de los fosfolipídos de plasma y eritrocitos por cromatografía gas-líquido. Los resultados mostraron, en lactantes alimentados con fórmulas, mayor proporción de ácidos saturados y monoetilénicos, y menor porcentaje en el total de ácidos polinsaturados con respecto a los alimentados con leche materna. Estas diferecias son más marcadas en los que recibieron fórmulas sin suplemento AGP. Seconcluye que en lactante desnutridos el uso de fórmulas enriquecidasen ácidos grasos polinsaturados logra restaurar en parte, el perfil de ácidos grasos en fosfolipídos de plasma y eritrocitos, que se asemeja al de los que reciben leche materna, y es diferente a los alimentados con fórmulas comunes.

Alterations in proteins of bone marrow extracellular matrix in undernourished mice

The objective of the present study was to determine the effect of protein malnutrition on the glycoprotein content of bone marrow extracellular matrix (ECM). Two-month-old male Swiss mice were submitted to protein malnutrition with a low-protein diet containing 4 percent casein as compared to 20 percent casein in the control diet. When the experimental group had attained a 20 percent loss of their original body weight, we extracted the ECM proteins from bone marrow with PBS buffer, and analyzed ECM samples by SDS-PAGE (7.5 percent) and ECL Western blotting. Quantitative differences were observed between control and experimental groups. Bone marrow ECM from undernourished mice had greater amounts of extractable fibronectin (1.6-fold increase) and laminin (4.8-fold increase) when compared to the control group. These results suggest an association between fluctuations in the composition of the hematopoietic microenvironment and altered hematopoiesis observed in undernourished mice