Uso de suplementos nutricionais por crianças vivendo com HIV: revisão narrativa / Use of dietary supplements by children living with HIV: narrative review / Uso de suplementos dietéticos por niños que viven con el HIV: revisión narrativa

Introdução: A suplementação nutricional em pessoas vivendo com HIV ainda é pouco difundida, sendo essencial o levantamento de evidências que apontem as terapêuticas mais eficientes para beneficiar a saúde desta população. Ao se tratar do público infantil, no qual a prevalência de carências nutricionais é elevada, o conhecimento acerca da suplementação nutricional é bastante profícuo. Objetivo: Analisar relatórios de pesquisa acerca dos efeitos do uso de suplementos nutricionais em crianças vivendo com HIV. Desenho do estudo e local: Uma revisão narrativa realizada na Universidade Federal do Maranhão, em Imperatriz, município localizado no oeste do estado do Maranhão. Método: Foi realizada uma busca nos bancos de dados Cochrane, PubMed, Scopus, WHO/OMS e biblioteca digital de teses e dissertações da USP entre setembro de 2021 a janeiro de 2022. Resultados: Foram incluídas 26 produções, as quais demonstraram que o uso de múltiplos nutrientes reduziu o tempo de hospitalização em crianças admitidas com diarreia ou pneumonia, melhorando a morbidade, concentração de hemoglobina e ganho ponderal. A oferta de ferro foi considerada satisfatória no combate à progressão da doença, vitamina A melhorou o quadro de diarreia persistente e vitamina D a habilidade motora neuromuscular. Conclusão: Os estudos sobre suplementação nutricional e a relação dos nutrientes com os diversos aspectos de saúde das crianças vivendo com HIV tem avançado. Logo, é necessário alargar as pesquisas no tema em contextos distintos, a fim de incrementar e gerar novas evidências, colaborando para uma conduta mais assertiva dos profissionais de saúde e consequente melhora no prognóstico dessas crianças.

Background: Providing nutritional supplementation to people living with human immunodeficiency virus (HIV) is a therapeutic intervention still not widespread, so it is essential to gather evidence supporting efficient therapies to benefit the health of this population. The prevalence of nutritional deficiencies is high in children; consequently, the knowledge about nutritional supplementation in this age group is quite fruitful. Objective: To analyze research reports on the effects of nutritional supplementation in children living with HIV. Design and setting: A narrative review was conducted at the Federal University of Maranhão, Imperatriz, west of the Maranhão State. Methods: The searches were performed in the Cochrane, PubMed, Scopus, and World Health Organization (WHO) databases and the São Paulo University's digital library of theses and dissertations from September 2021 to January 2022. Results: Twenty-six studies were included and showed that using multiple nutrients reduced the hospitalization time of children admitted with diarrhea or pneumonia, improving morbidity, hemoglobin concentration, and weight gain. The supply of iron was considered effective in combating the progression of the disease, vitamin A improved the condition of persistent diarrhea, and vitamin D improved neuromuscular motor skills. Conclusion: Studies have advanced on nutritional supplementation, the relationship between nutrients, and the different health aspects of children living with HIV. Therefore, it is necessary to expand research on the subject in different contexts to increase and generate new evidence, contributing to more assertive conduct of health professionals and consequent improvement in the prognosis of these children.

Antecedentes: La administración de suplementos nutricionales a las personas que viven con el virus de la inmunodeficiencia humana (VIH) es una intervención terapéutica aún poco extendida, por lo que es fundamental reunir pruebas que apoyen terapias eficaces en beneficio de la salud de esta población. La prevalencia de deficiencias nutricionales es elevada en niños, por lo que el conocimiento sobre la suplementación nutricional en este grupo de edad es bastante fructífero. Objetivo: Analizar los informes de investigación sobre los efectos de la suplementación nutricional en niños que viven con el VIH. Diseño y escenario: Se realizó una revisión narrativa en la Universidad Federal de Maranhão, Imperatriz, al oeste del Estado de Maranhão. Métodos: Las búsquedas se realizaron en las bases de datos Cochrane, PubMed, Scopus y Organización Mundial de la Salud (OMS) y en la biblioteca digital de tesis y disertaciones de la Universidad de São Paulo desde septiembre de 2021 hasta enero de 2022. Resultados: Se incluyeron 26 estudios que mostraron que el uso de múltiples nutrientes redujo el tiempo de hospitalización de los niños ingresados con diarrea o neumonía, mejorando la morbilidad, la concentración de hemoglobina y el aumento de peso. El aporte de hierro se consideró eficaz para combatir la progresión de la enfermedad, la vitamina A mejoró el cuadro de diarrea persistente y la vitamina D mejoró las habilidades motoras neuromusculares. Conclusiones: Los estudios han avanzado sobre la suplementación nutricional, la relación entre los nutrientes y los diferentes aspectos de la salud de los niños que viven con el VIH. Por lo tanto, es necesario ampliar las investigaciones sobre el tema en diferentes contextos para aumentar y generar nuevas evidencias, contribuyendo para una conducta más asertiva de los profesionales de salud y consecuente mejoría en el pronóstico de estos niños.

Vitamin A deficiency and association between serum retinol and IGF-1 concentrations in Brazilian children with Down syndrome

Abstract Objective: To determine the prevalence of vitamin A deficiency (VAD) and serum concentrations of retinol, correlating them with IGF-1 concentrations in preschoolers with DS. Methods: Cross-sectional study was conducted on 47 children with DS aged 24 to 72 months, in Ribeirão Preto, Brazil. VAD was determined by the relative dose-response (RDR) test. Retinol serum concentration ≤ 0.70 μmol/L and IGF-1 serum concentration below the 3rd percentile for sex and age were considered to represent deficiency. C-reactive protein (CRP) was determined at the beginning of the study. Weight, height, and information about fever and/or diarrhea were obtained at the beginning of the study. Results: VAD prevalence was 25.5% (12/47), and 74.5% (35/47) of the children had deficient retinol before the intervention. CRP was not associated with VAD. Mean IGF-1 were 103.5 ng/mL (SD = 913) for the group with VAD and 116.3 ng/mL (SD = 54.9) for the group with no VAD (p-value = 0.85); 8.5% (4/47) of the children showed deficient IGF-1, but without VAD. No association was observed between VAD and IGF-1 deficiency. A moderate positive correlation was observed between pre-intervention retinol and IGF-1 (ρ = 0.37; p-value = 0.01). Conclusion: a high prevalence of VAD and deficient retinol was observed and there was a positive correlation between serum retinol and IGF-1.

Coverage of vitamin A supplementation, deworming and immunisations: Associations with nutritional status among urban children younger than 5 years in Nelson Mandela Bay, Eastern Cape Province, South Africa

Background. Even though immunisation coverage is tracked through the district health system in South Africa (SA), limited information is available regarding interventions linked to the Expanded Programme on Immunisation (EPI) and the impact on the nutritional status of children <5 years of age.Objectives. To describe coverage of immunisations, vitamin A supplementation and deworming among children <5 years old in an urban area of Nelson Mandela Bay, Eastern Cape Province, SA. A secondary objective was to investigate whether a history of missed immunisations, vitamin A supplementation or deworming was associated with wasting or stunting in children.Methods. A descriptive study was conducted between September 2015 and February 2016, where cross-sectional anthropometrical data were collected from 1 513 children in 32 pre-schools, together with a retrospective analysis of the participants' Road-to-Health/clinic cards to collect data on immunisation, vitamin A and deworming. Participants were categorised into 3-month age intervals to facilitate data analysis. Ethical approval was obtained from the Nelson Mandela University Research Ethics Committee (Human). Results. Data of 1 496 children were included in the analysis. The prevalence of underweight was 2.5% (n=37), while 11.2% (n=167) were stunted and 1.1% (n=16) were wasted. There were associations between age category and delayed vitamin A supplementation (χ2=32.105; df=19; n=836; p=0.03) and deworming (χ2=45.257; df=17; n=558; p<0.001), but there was no association between delayed vaccinations and age category. There were no significant differences in anthropometrical indicators for children with delayed vitamin A supplementation, deworming and vaccinations compared with children in this sample who were up to date regarding the relevant indicators. However, weight-for-age, height-for-age and weight-for-height z-scores and stunting risk were associated with low birthweight (LBW) (odds ratio (OR) 4.658; p<0.001). Conclusion. Coverage of vitamin A supplementation and deworming but not immunisations was poorer among children in older age categories. A history of delayed vitamin A, deworming and vaccinations was not associated with the anthropometrical status of children. Children with LBW should be considered for more rigorous follow-up, as they are at higher risk of stunting.

Levels of fat-soluble vitamins A, D, and E and their influencing factors in children with obesity / 中国当代儿科杂志

OBJECTIVES@#To investigate the levels of fat-soluble vitamins A, D, and E in children with obesity and their influencing factors.@*METHODS@#A total of 273 children with obesity who attended the Department of Clinical Nutrition, Xi'an Children's Hospital, from January 2019 to April 2021 were enrolled as the obesity group. A total of 226 children with normal body weight who underwent physical examination during the same period were enrolled as the control group. Anthropometric parameters and body composition were measured for both groups, and the serum concentrations of vitamins A, D, and E were also measured.@*RESULTS@#Compared with the control group, the obesity group had significantly higher serum levels of vitamin A [(1.32±0.21) μmol/L vs (1.16±0.21) μmol/L, P<0.001] and vitamin E [(9.3±1.4) mg/L vs (8.3±1.2) mg/L, P<0.001] and a significant reduction in the level of 25-hydroxyvitamin D [(49±22) nmol/L vs (62±24) nmol/L, P<0.001]. In the obesity group, the prevalence rates of marginal vitamin A deficiency, vitamin D deficiency/insufficiency, and vitamin E insufficiency were 5.5% (15/273), 56.8% (155/273), and 4.0% (11/273), respectively. After adjustment for body mass index Z-score and waist-to-height ratio, serum vitamin A level was positively correlated with age (P<0.001), while vitamins E and 25-hydroxyvitamin D levels were negatively correlated with age in children with obesity (P<0.001). After adjustment for age, the serum levels of vitamin A, vitamin E and 25-hydroxyvitamin D were not correlated with degree of obesity, percentage of body fat, and duration of obesity in children with obesity, while the serum levels of vitamins A and E were positively correlated with waist-to-height ratio (P<0.001).@*CONCLUSIONS@#There are higher serum levels of vitamins A and E in children with obesity, especially in those with abdominal obesity, while serum vitamin D nutritional status is poor and worsens with age. Therefore, vitamin D nutritional status should be taken seriously for children with obesity, and vitamin D supplementation should be performed when necessary.

Limitations and advances in new treatments and future perspectives of corneal blindness / Limitações e avanços em novos tratamentos e perspectivas futuras na cegueira corneal

ABSTRACT This review is intended to describe the therapeutic approaches for corneal blindness, detailing the steps and elements involved in corneal wound healing. It also presents the limitations of the actual surgical and pharmacological strategies used to restore and maintain corneal transparency in terms of long-term survival and geographic coverage. In addition, we critically review the perspectives of anabolic agents, including vitamin A, hormones, growth factors, and novel promitotic and anti-inflammatory modulators, to assist corneal wound healing. We discuss the studies involving nanotechnology, gene therapy, and tissue reengineering as potential future strategies to work solely or in combination with corneal surgery to prevent or revert corneal blindness.(AU)

RESUMO O presente trabalho traz uma revisão das abordagens terapêuticas para a cegueira da córnea. O estudo detalha as etapas e os elementos envolvidos na cicatrização da córnea. Ele mostra as limitações das estratégias cirúrgicas e farmacológicas usadas para restaurar e manter a transparência da córnea em termos de sobrevida a longo prazo e alcance geográfico. As perspectivas dos agentes anabólicos, incluindo vitamina A, hormônios, fatores de crescimento e novos moduladores pró-mitóticos e anti-inflamatórios para auxiliar a cicatrização da ferida na córnea, são revisadas criticamente. Aqui, apresentamos estudos envolvendo nanotecnologia, terapia gênica e reengenharia de tecidos como possíveis estratégias futuras para atuar de maneira isolada ou combinada com a cirurgia da córnea para prevenir ou reverter a cegueira corneana.(AU)

Nutritional status and vitamin A and zinc levels in patients with kala-azar in Piauí, Brazil

Abstract INTRODUCTION: Malnutrition and kala-azar (or visceral leishmaniasis) are significant public health problems in different parts of the world. Immunity and susceptibility to infectious and parasitic diseases are directly linked to the host's nutritional state, but little is known about the interaction between nutrition and kala-azar. This study aimed to evaluate nutritional status with kala-azar and correlate these findings with the clinical and laboratory manifestations of the disease, and zinc and retinol levels. METHODS: This was a cross-sectional study of 139 patients with kala-azar. Nutritional status classification was performed according to international recommendations. Parametric or nonparametric tests were applied whenever indicated in a two-sided test with a 5% significance level. RESULTS: Weight loss and malnutrition were more frequent in adults. Body mass index-for-age, fat area of the arm, and upper arm muscle area were significantly associated with probability of death. The presence of human immunodeficiency virus, hepatomegaly, and splenomegaly was correlated with nutritional assessment. Blood leukocyte and lymphocyte, serum creatine, and vitamin A levels were significantly higher in adult men. Vitamin A levels were highly associated with the level of hemoglobin and C-reactive protein (CRP) in multivariate analysis. All patients had reduced plasma zinc levels, but this finding had no association with the outcome variables. CONCLUSIONS: Malnutrition was correlated with severe disease and was more prevalent in older people with kala-azar. Vitamin A deficiency was associated with hemoglobin and CRP. Zinc levels were reduced in patients with kala-azar.

Advances in metabolic engineering for vitamins production / 生物工程学报

Vitamins are organic substances that are essential for the maintenance of life activities. Generally, vitamins need to be obtained from the diet or from some synthetic source as the body cannot synthesize vitamins, or the amounts of the synthesized vitamins are insufficient. At present, vitamins are widely used in medicine, food additives, feed additives, cosmetics and other fields, and the global demand for vitamins is constantly growing. Vitamins can be produced from chemical or microbial synthesis. Chemical synthesis usually requires harsh reaction conditions, produces serious wastes, and creates great potential safety hazard. In contrast, microbial synthesis of vitamins is greener, safer, and requires much less energy input. This review summarizes the advances in metabolic engineering for vitamins production in the past 30 years, with a focus on production of water-soluble vitamins (vitamins B1, B2, B3, B5, B6, B7, B9, B12 and vitamin C precursors) and lipid-soluble vitamins (vitamin A, precursors of vitamin D, vitamin E and vitamin K). Moreover, the bottlenecks for fermentative production of vitamins are discussed, and future perspectives for developing next generation vitamins producing strains using synthetic biotechnology are prospected.

Parâmetros ósseos de codornas de corte suplementadas com diferentes níveis de vitamina A, de 15 a 35 dias de idade / [Parameters of bone of meat-type quail supplemented with different levels of vitamin A from 15 to 35 days of age]

Avaliou-se o efeito da utilização de níveis crescentes de vitamina A sobre os parâmetros ósseos de codornas de corte de 15 a 35 dias de idade. Foram utilizadas 1520 codornas, não sexadas, com peso médio inicial de 85±4,25g, distribuídas em um delineamento inteiramente ao acaso, totalizando oito tratamentos com cinco repetições e 38 codornas por unidade experimental. Os tratamentos consistiram de oito níveis de suplementação de vitamina A (0; 4.500; 6.000; 7.500; 9.000; 10.500; 12.000 e 13.500UI/kg da dieta). O período experimental foi de 15 a 35 dias de idade. Os ossos analisados apresentaram uma redução linear para o índice de Seedor, resistência óssea e teor de cinzas do fêmur e da tíbia de acordo com os níveis de suplementação de vitamina A. A suplementação de vitamina A para codornas de corte de 15 a 35 dias de idade mostrou resultados negativos para a qualidade óssea, com a necessidade de mais estudos sobre seu antagonismo com a vitamina D.(AU)

This study evaluated the effect of using increasing levels of vitamin A on bone parameters in meat-type quails from 15 to 35 days old. A total of 1520 unsexed quail with an average initial weight of 85g distributed in a completely randomized design, totaling eight treatments with five replicates and 38 quails per experimental unit were used. The treatments consisted of eight vitamin supplementation levels A (0; 4,500; 6,000; 7,500; 9,000; 10,500; 12,000 and 13,500IU / kg diet). The experimental period was 15 to 35 days of age. The bones analyzed showed a linear reduction to the Seedor index, bone strength and ash content of the femur and tibia according to vitamin supplementation levels Vitamin A supplementation for cutting quails from 15 to 35 days of age showed negative results for bone quality, with the need for more studies on its antagonism to vitamin D.(AU)

Análise ultraestrutural do colágeno de feridas cutâneas de coelhos tratadas com plasma rico em plaquetas de equino / Ultrastructural analysis of the collagen of rabbit skin wounds treated with platelet-rich equine plasma

O colágeno é sintetizado e segregado no espaço extracelular e organizados em fibrilas estriadas de acordo com o tipo de tecido. Utilizaram-se 24 coelhos brancos da raça Nova Zelândia, com idade de 12 meses e com 3,0kg de peso corporal, para avaliar a porcentagem de colágeno das feridas cutâneas tratadas com plasma rico em plaquetas de equino e pomada contendo gentamicina, sulfanilamida, sulfadiazina, ureia e vitamina A. Os animais foram separados em quatro grupos de igual número e submetidos à remoção de pele na região das linhas médias dorsal torácica (feridas tratadas) e lombar (feridas controle). As feridas torácicas foram tratadas com plasma rico em plaqueta de equino e pomada contendo gentamicina, sulfanilamida, sulfadiazina, ureia e vitamina A, e as do grupo controle somente com a pomada. Dos animais do grupo I, foi coletado tecido cutâneo, para a avaliação histológica e a ultraestrutural, com três dias de pós-operatório; dos animais do grupo II, com sete dias; do grupo III, com 14 dias; e do grupo IV, com 21 dias. Decorrido o período de avaliação de cada grupo, foi coletado fragmento de pele para avaliação da porcentagem de colágeno, bem como do diâmetro e da densidade da fibrila de colágeno por microscopia eletrônica de transmissão. O tratamento com PRP de equino associado à aplicação tópica da pomada mostrou-se eficaz na maturação das fibrilas colágenas e na antecipação do processo cicatricial.(AU)

Collagen is synthesized and secreted into the extracellular space and organized into striated fibrils according to the tissue type. This study evaluated the concentration of collagen in rabbit skin wounds treated with equine platelet-rich plasma (PRP) and ointment containing gentamicin, sulfanilamide, sulfadiazine, urea, and vitamin A. Twenty-four New Zealand white rabbits aged 2 to 12 months and weighing 3.0kg were included. The animals were allocated equally into four groups and the skin was removed from the thoracic dorsal midline (treated wound) and lumbar (control wound) regions. The thoracic wounds were treated with equine PRP and ointment containing gentamicin, sulfanilamide, sulfadiazine, urea, and vitamin A, and the control group was treated with the ointment alone. For histological and ultrastructural assessment, cutaneous tissue was collected on postoperative days 3 (group I), 7 (group II), 14 (group III), and 21 (group IV). After the evaluation period, in each group, a skin fragment was collected for analysis of the collagen concentration, as well as the collagen fibril diameter and density by transmission electron microscopy. The results indicated that treatment with equine PRP combined with topical application of the ointment was effective in facilitating the maturation of collagen fibrils and the wound healing process.(AU)

Evaluation of high-dose vitamin A treatment in postmolar patients with low and plateauing serum human chorionic gonadotropin levels / Avaliação de alta dose de vitamina A em pacientes pósmola hidatiforme, com valores baixos e em platô de gonadotrofina coriônica humana

Abstract Objective To compare the effect of high-dose vitamin A (HD Vit-A) use during postmolar follow-up of patients with low and plateauing (L&P) serum human chorionic gonadotropin (hCG) levels, from the moment serum hCG plateaued (P-hCG) to the first normal serum hCG value (< 5IU/L). Methods The present retrospective series case study compared two nonconcurrent cohorts of patients. Control group (CG): 34 patients with L&P serum hCG levels who underwent expectant management for 6 months after uterine evacuation, from 1992 to 2010; study group (SG): 32 patients in similar conditions who received 200,000 IU of Vit-A daily, from the identification of a P-hCG level to the first normal hCG value or the diagnosis of progression to gestational trophoblastic neoplasia (GTN), from 2011 to 2017. The present study was approved by the Ethics Committee of the institution where it was conducted. Results In both groups, the prevalence of persistent L&P serum hCG levels was < 5%. In the SG, hCG levels at plateau were higher (CG = 85.5 versus SG = 195 IU/L; p = 0.028), the rate of postmolar GTN was lower (CG = 29.4% versus SG = 6.3%, p = 0.034) and follow-up was shorter (CG = 14 versus SG = 10 months, p < 0.001). During GTN follow-up, there were no differences in GTN staging or treatment aggressiveness in both groups. High-dose Vit-A use did not have any relevant toxic effect. There were no GTN relapses or deaths. Conclusion The limited use of HD Vit-A seems to have a safe and significant effect on the treatment of postmolar patients with L&P serum hCG levels and may decrease the development of postmolar GTN in this population.

Resumo Objetivo Comparar o efeito de alta dose de vitamina A (VitA) no seguimento pósmolar de pacientes com gonadotrofina coriônica humana (hCG) sérica apresentando valoresbaixoseem platô(L&P). Métodos Estudo retrospectivo de série de casos comparando duas coortes não simultâneas. Grupo controle (CG): 34 pacientes com títulos de hCG sérico L&P submetidos a manejo expectante por 6 meses após o esvaziamento uterino, de 1992 a 2010; Grupo de Estudo (SG): de 2011 a 2017, 32 pacientes em condições semelhantes de hCG receberam Vit-A na dose de 200.000 IU por dia, do momento da identificação dohCG em platôate o primeirohCG normaloudiagnóstico de progressão para neoplasia trofoblástica gestacional (NTG). O presente estudo foi aprovado pelo Comitê de Ética da Instituição na qual foi desenvolvido. Resultados Em ambososgrupos, aprevalência de hCGL&P foi < 5%. No SG, os níveis de hCGemplatô forammaiores (CG = 85.5 versus SG = 195 IU/L; p = 0,028), e foram significantemente menores tanto a prevalência de NTG pós-molar (CG = 29.4% versus SG = 6.3%, p = 0,034) como o tempo de seguimento (CG = 14 versus SG = 10 meses, p < 0.001). Na evolução para NTG não houve diferença no estadiamento da Interna tional Federation of Gynecology and Obstetrics (FIGO, na sigla em inglês) ou na agressividade do tratamento. Com altas doses de Vit-A não houve qualquer efeito tóxico relevante. Não houve casos de recidiva de NTG ou de óbito. Conclusão O uso limitado de altas doses de Vit-A parace ser seguro e apresenta efeitos significativos na evolução de pacientes em controle pós-molar com títulos de hCG sérico L&P, e pode diminuir o desenvolvimento de NTG pós-molar nessa população.

Coverage and educational actions related to the national vitamin A supplementation program: a study in children from the state of Alagoas / Cobertura e ações educativas no âmbito do programa nacional de suplementação de vitamina A: estudo em crianças do estado de Alagoas

Abstract Objectives: To estimate the coverage of the National Vitamin A Supplementation Program (Programa Nacional de Suplementação de Vitamina A) in children from Alagoas, to identify factors associated with this coverage, and to analyze the adequacy of nutrition education actions. Methods: Household survey involving a representative probabilistic sample of children aged 6 to 59 months from Alagoas and their mothers (n = 509). Coverage was defined by the percentage of children with supplementation records in the last semester. The association between the independent variables (socioeconomic, demographic, and health) and the National Vitamin A Supplementation Program coverage was analyzed based on the prevalence ratio and its 95% CI. The mothers' knowledge of questions related to vitamin A was considered as an indicator of the adequacy of nutrition education actions. Results: Program coverage was 91.9% in children aged 6-11.9 months and 38.6% in children aged 12-59 months. In the adjusted analysis, the factors that were associated with greater coverage were: age between 6-11.9 months (PR = 2.50, 95% CI: 2.10-2.96), living in rural areas (PR = 1.45, 95% CI: 1.20-1.76) and living in a house with ≤ 4 rooms (PR = 1.33, 95% CI: 1.09-1.63). Only 26.1% of the mothers were able to mention some food source of vitamin A and only 19.2% were aware of the consequences of vitamin deficiency for health. Conclusions: The National Vitamin A Supplementation Program coverage is below the targets set by the Ministry of Health (except for children < 12 months). The factors associated with greater coverage indicate an adequate focus of the program. The nutrition education activities have not demonstrated satisfactory results. This information should guide actions to improve the program.

Resumo Objetivos Estimar a cobertura do Programa Nacional de Suplementação de Vitamina A em crianças de Alagoas, identificar fatores associados a essa cobertura e analisar a adequação das ações de educação nutricional. Métodos Inquérito domiciliar que envolveu amostra probabilística representativa das crianças de 6 a 59 meses de Alagoas e suas mães (n = 509). A cobertura foi definida pelo percentual de crianças com registro de suplementação no último semestre. A associação entre as variáveis independentes (socioeconômicas, demográficas e de saúde) e a cobertura do Programa Nacional de Suplementação de Vitamina A foi analisada com base na razão de prevalência e seu IC95%. O conhecimento das mães sobre questões relacionadas à vitamina A foi assumido como indicador da adequação das ações de educação nutricional. Resultados A cobertura do programa foi de 91,9% entre crianças de 6-11,9 meses e de 38,6% entre as de 12-59 meses. Na análise ajustada, os fatores que se associaram à maior cobertura foram ter idade entre 6-11,9 meses (RP = 2,50; IC95%: 2,10-2,96), residir em zona rural (RP = 1,45; IC95%: 1,20-1,76) e morar em domicílio com ≤ 4 cômodos (RP = 1,33; IC95%: 1,09-1,63). Somente 26,1% das mães souberam citar algum alimento fonte de vitamina A e apenas 19,2% conheciam as consequências da deficiência dessa vitamina para a saúde. Conclusões A cobertura do Programa Nacional de Suplementação de Vitamina A encontra-se aquém das metas estabelecidas pelo Ministério da Saúde (exceto para crianças < 12 meses). Os fatores associados à maior cobertura evidenciam adequada focalização do programa. As atividades de educação nutricional não ocorrem de forma satisfatória. Essas informações devem nortear ações de aperfeiçoamento do programa.

Associação entre insegurança alimentar e níveis de hemoglobina e retinol em crianças assistidas pelo Sistema Único de Saúde no Município do Rio de Janeiro, Brasil / Association between food insecurity and hemoglobin and retinol levels in children treated in the Brazilian Unified National Health System in the city of Rio de Janeiro, Brazil / Asociación entre inseguridad alimentaria y niveles de hemoglobina y retinol en niños asistidos por el Sistema Único de Salud en el municipio de Río de Janeiro, Brasil

Neste trabalho foi analisada a associação entre insegurança alimentar e níveis de hemoglobina e retinol em crianças de 6 a 59 meses de idade. Trata-se de um estudo seccional, realizado em 2014, com amostra representativa da população de crianças nessa faixa etária, atendidas em unidades básicas de saúde do Município do Rio de Janeiro, Brasil. Para a análise dos níveis de insegurança alimentar foi utilizada a Escala Brasileira de Insegurança Alimentar e, para a determinação de hemoglobina e de retinol sérico, foi realizada a punção venosa. A associação entre as variáveis foi avaliada por intermédio de modelos de regressão quantílica. Do total de crianças estudadas, 40,3% apresentavam insegurança alimentar e as prevalências de anemia e de deficiência de vitamina A foram 13,7% e 13%, respectivamente. Os resultados do estudo revelaram associação inversa, estatisticamente significativa, entre insegurança alimentar leve e níveis de retinol. Para os demais níveis de insegurança alimentar (moderada e grave), os resultados também sugerem a presença de associação inversa para hemoglobina e, quanto aos níveis de retinol, as estimativas pontuais parecem menores em crianças com insegurança alimentar grave, entretanto, estas estimativas não foram estatisticamente significativas. Esses resultados sugerem que a insegurança alimentar pode estar associada com carências de micronutrientes em crianças menores de 5 anos.

This study analyzed the association between food insecurity and hemoglobin and retinol levels in children 6 to 59 months of age. This was a cross-sectional study in 2014 with a representative sample of children in this age bracket treated at basic health units in the city of Rio de Janeiro, Brazil. Analysis of food insecurity levels used the Brazilian Food Insecurity Scale, and venipuncture was performed for measurement of serum hemoglobin and retinol levels. The association between variables used quantile regression models. Of all the children in the sample, 40.3% presented food insecurity, and the prevalence rates for anemia and vitamin A deficiency were 13.7% and 13%, respectively. The study's results revealed a statistically significant inverse association between mild food insecurity and retinol levels. For the other levels of food insecurity (moderate and severe), the results also suggest an inverse association for hemoglobin, and for retinol levels the point estimates appear smaller in children with severe food insecurity, but these estimates were not statistically significant. These results suggest that food insecurity may be associated with micronutrient deficiencies in children under 5 years.

En este estudio se analizó la asociación entre la inseguridad alimentaria y los niveles de hemoglobina y retinol en niños de 6 a 59 meses de edad. Se trata de un estudio seccional, realizado en 2014, con una muestra representativa de la población de niños en esta franja etaria, atendida en unidades básicas de salud del Municipio de Río de Janeiro, Brasil. Para el análisis de los niveles de inseguridad alimentaria se utilizó la Escala Brasileña de Inseguridad Alimentaria y, para la determinación de hemoglobina y de retinol sérico, se realizó una punción venosa. La asociación entre las variables se evaluó a través de modelos de regresión cuantílica. Del total de niños estudiados, un 40,3% presentaban inseguridad alimentaria y las prevalencias de anemia y de deficiencia de vitamina A fueron 13,7% y 13%, respectivamente. Los resultados del estudio revelaron una asociación inversa, estadísticamente significativa, entre inseguridad alimentaria leve y niveles de retinol. Para los demás niveles de inseguridad alimentaria (moderada y grave), los resultados también sugieren la presencia de una asociación inversa para la hemoglobina, y, en cuanto a los niveles de retinol, las estimaciones puntuales parecen menores en niños con inseguridad alimentaria grave, sin embargo, estas estimaciones no fueron estadísticamente significativas. Estos resultados sugieren que la inseguridad alimentaria puede estar asociada con carencias de micronutrientes en niños menores de 5 años.

Association between antioxidant vitamins and oxidative stress among patients with a complete hydatidiform mole

OBJECTIVES: This study aimed to evaluate the potential relationship between oxidative stress, dietary intake, and serum levels of antioxidants in patients with a complete hydatidiform mole (CHM) compared with controls. METHODS: This was an observational cross-sectional study conducted in Rio de Janeiro, Brazil. A total of 140 women were enrolled in this study and divided into four groups: 43 patients with CHM, 33 women who had had an abortion, 32 healthy pregnant women, and 32 healthy non-pregnant women. All participants underwent blood sampling, assessment using a semiquantitative food frequency questionnaire, and anthropometric measurement. Blood samples were collected after overnight fasting (10-12 h). Vitamin levels (A, C, and E) were determined by ultra-performance liquid chromatography, and gamma-glutamyl transferase levels were assessed using an automated quantitative analysis system (Dimension®, Siemens). RESULTS: Although all groups showed sufficient serum vitamin A and E levels, the participants had inadequate dietary intake of these vitamins. Conversely, all groups had an insufficient serum level of vitamin C, despite adequate intake. The gamma-glutamyl transferase values did not differ significantly among the groups. However, elevated serum levels of this enzyme were observed in several patients. CONCLUSIONS: All groups exhibited high levels of oxidative stress, as evaluated by gamma-glutamyl transferase levels, and had inadequate intake of antioxidant vitamins. Therefore, the high exposure to oxidative stress found in our study, even in healthy pregnant and non-pregnant women, may increase the incidence of CHM in this region.

Avaliação de fatores de risco associados à deficiência de vitamina A em idosos institucionalizados da cidade de João Pessoa-PB / Evaluation of risk factors associated with vitamin a deficiency in institutionalized elderly in the city of João Pessoa- PB

A deficiência de vitamina A e os distúrbios neurológicos em idosos constituem problemas de Saúde Pública que devem ter mais atenção por parte das políticas públicas do idoso institucionalizado, devido à sua gravidade e diversidade de causas. Assim, este estudo objetiva avaliar os fatores de risco associados à deficiência de vitamina A em idosos institucionalizados da cidade de João Pessoa-PB. Trata-se de um estudo transversal e analítico, em que foram selecionados 105 idosos, ≥60 anos, de cinco Instituições de Longa Permanência para Idosos. Avaliaram-se parâmetros sociodemográficos, clínicos, antropométricos, de retinolemia, de consumo de vitamina A, de estresse oxidativo e inflamação. Encontrou-se uma prevalência de deficiência de vitamina A (<1,05 micromol/L) em 30,5% da amostra (32 idosos). Em relação ao consumo de alimentos-fonte de vita- mina A, 68,6% (72 idosos) da amostra consumiam os de origem animal numa frequência maior do que 3x/semana, enquanto que os alimentos de origem vegetal eram consumidos por 64,8% (68 idosos) da amostra, nessa mesma frequência. A capacidade antioxidante total foi quantificada em 10±17 % e o malondialdeído 3,3±1µmol; a alfa glicoproteína ácida em 38±33 mg/dL (p>0,05). Os indivíduos esquizofrênicos possuem 7,75 (p =0,00; IC 95% = 2,56-26,59) vezes mais chances de serem deficientes de retinol sérico, independen- temente de outros fatores de risco. Assim, existe a necessidade de adoção de medidas de saúde pública e um maior controle desses fatores de risco que podem piorar/afetar a qualidade de vida dessa população idosa institucionalizada.(AU)

Vitamin A deficiency and neurological disorders in the elderly are Public Health problems that should be given more attention by public policies for institutionalized elderly people, due to their severity and diversity of causes. Thus, this study aims to assess the risk factors associated with vitamin A deficiency in institutionalized elderly in the city of João Pessoa-PB. This is a cross-sectional and analytical study, in which 105 elderly, ≥60 years old, from five Long Term Care Institutions for the Elderly were selected. Sociodemographic, clinical, anthropometric, retinolemia, vitamin A consumption, oxidative stress and inflammation parameters were evaluated. A prevalence of vitamin A deficiency (<1.05 micromol / L) was found in 30.5% of the sample (32 elderly). Regarding the consumption of vitamin A source foods, 68.6% (72 elderly) of the sample consumed those of animal origin at a frequency greater than 3x/week, while foods of plant origin were consumed by 64.8% (68 elderly) of the sample, at the same frequency. The total antioxidant capacity was quantified at 10 ± 17% and malondialdehyde 3.3 ± 1 µmol; alpha acid glycoprotein at 38 ± 33 mg / dL (p> 0.05). Schizophrenic individuals are 7.75 (p = 0.00; 95% CI = 2.56-26.59) times more likely to be serum retinol deficient, regardless of other risk factors. Thus, there is a need for the adoption of public health measures and greater control of these risk factors that can worsen/affect the quality of life of this institutionalized elderly population.(AU)

El enriquecimiento de la harina de maíz precocida y de la harina de trigo en Venezuela. Una gestión con éxito / Enrichment of precooked corn flour and of wheat flour in Venezuela. A successful experience

La crisis iniciada en Venezuela a mediados de 1983 provocó un manifiesto deterioro en la cantidad y calidad del consumo de alimentos por parte de los sectores de mas bajos recursos. Los porcentajes de adecuación más bajos respecto a los Requerimientos de Energía y Nutrientes de la Población Venezolana corresponden a hierro, vitamina A y en menor grado a vitaminas del complejo B. El Instituto Nacional de Nutrición inició en 1990 la factibilidad de enriquecer la harina de maíz precocida, HMP, responsable por un 40 % de las Calorías derivadas de los cereales y de un 15 - 16 % del total de calorías de la dieta, con hierro (fumarato ferroso), vitamina A, tiamina, riboflavina y niacina. En 1992 se propuso un perfil de enriquecimiento requerido para que 50 g de HMP cubriese un 25 % de los requerimientos de estos nutrientes, ya tomados en cuenta las pérdidas durante la preparación de la arepa. El conocimiento de esta medida como política oficial, causó cierta molestia en el sector privado. En Agosto 1992, por Decreto Presidencial No 2.492 se crea la Comisión para el Enriquecimiento Nutricional de los Alimentos, CENA, con el específico propósito del enriquecimiento de la HMP. Con los esfuerzos coordinados del sector oficial y de la industria privada, se pudo llegar a un consenso sobre el perfil de enriquecimiento de la HMP, el cual fue anunciado por la CENA. (por kg): vitamina A: 2.700 ER; tiamina: 3,1 mg; riboflavina: 2,5 mg; niacina: 51 mg; hierro: 50 mg. Comisión Venezolana de Normas Industriales. COVENIN. Harina de maíz precocida. (3 era. Revisión) 2135:1996. Obligatorio cumplimento. Desde febrero 1993 toda la HMP comercializada en Venezuela debe estar enriquecida. Harina de trigo. HT. En noviembre 1992, la Asociación Venezolana de Productores de Trigo, AVPT, presentó un proyecto no obligatorio de fortificación. En Marzo la CENA rechazó el carácter no obligatorio y de acuerdo con la AVPT se acordó un perfil de enriquecimiento para la HT: (por kg): tiamina: 1,5 mg; riboflavina: 2,0 mg; niacina: 20 mg; hierro: 20 mg (como fumarato ferroso). Comisión Venezolana de Normas Industriales. COVENIN. Harina de trigo (4 ta. Revisión) 217: 2001. Obligatorio cumplimiento. Desde agosto 1993 toda la HT comercializada en Venezuela debe estar enriquecida(AU)

TIn Venezuela a severe economic crisis beginning in 1983 provoked a progressive reduction of the quality and quantity of food consumed by the low socioecnomic strata of the population. The lowest adequacy percentages with respect to Venezuelan RDAs were for iron, vitamin A and to a lesser extent, for vitamin B complex. Being precooked corn flour, PCF, responsible for 40 % of the Calories derived from cereals and for 15 -16 % of the total calories intake in the diet, an excellent and unique vehicle for enrichment, the National Institute of Nutrition, NIN, started the investigations toward its fortification with iron (as ferrous fumarate), vitamin A, thiamin, riboflavin and niacin. In 1992 a fortification profile was developed in such a way that 50 g of PCF (amount needed for a 110 g ready-to-eat arepa) covered approximately 25 % of the RDAs for the mentioned nutrients, after taking into consideration the losses due to the cooking process. The announcement of this measure as an official policy, provoked some adverse reactions among the private sector. In August 1992, by Presidential Decree No 2.492, the Commission for the Nutritional Enrichment of Foods, CENA, was created with the specific task of reconciling efforts and carry forward the enrichment of the PCF. With the attendance of key representatives of the corn and wheat industries, the government and the media, the CENA announced the official fortification profile of the PCF (per kg) : vitamin A: 2,700 RE; thiamin: 3.1 mg; riboflavin: 2.5 mg; niacin: 51 mg; iron: 50 mg. Official Venezuelan Bureau of Standars (COVENIN), mandatory Standard No 2135-1996. Since February 1993 all the PCF sold in Venezuela must be enriched. Wheat flour. WF. The Venezuelan Wheat Producers Association, VWPA, presented in november 1992 a tentative and non compulsory fortification profile. In march the CENA voted against the non compulsory character of the fortification of WF and upon agreement with the VWPA, set in force the mandatory fortification profile as follow (per kg): thiamin: 1.5 mg; riboflavin: 2.0 mg; niacin: 20 mg; iron: 20 mg (as ferrous fumarate). COVENIN mandatory Standard No 217:2001. Since august 1993 all the WF sold in Venezuela must be enriched(AU)

Relationship of plasma vitamin A levels between neonates and pregnant women in third trimester / 北京大学学报(医学版)

OBJECTIVE@#To study the correlation of plasma vitamin A (VitA) levels between neonates and pregnant women in third trimester.@*METHODS@#A total of 688 pregnant women were recruited in Yuanshi and Laoting counties of Hebei Province, from May to June 2009. Venous blood samples of women before delivery and cord blood samples of newborns were collected and measured for retinol (retinol concentration was used to reflect VitA level) using high performance liquid chromatography assay. According to venous blood plasma retinol concentration, maternal VitA nutritional status was divided into deficiency (<0.70 μmol/L), marginal deficiency (0.70-<1.05 μmol/L), and sufficiency (≥1.05 μmol/L). According to cord blood plasma retinol concentration, neonatal VitA nutritional status was divided into deficiency (<0.35 μmol/L), marginal deficiency (0.35-<0.70 μmol/L), and sufficiency (≥0.70 μmol/L); neonatal VitA relative deficiency was further defined as cord blood plasma retinol concentration lower than the 10th percentile. VitA placental transport ratio was defined as retinol concentration in the neonates divided by that in pregnant women. Multivariable fractional polynomials (MFP) model and Pearson correlation were used to study the dose-response relationship between maternal and neonatal plasma VitA levels, Logistic regression model to estimate the effect of maternal VitA nutritional status on neonatal VitA deficiency, and MFP model and Spearman correlation to describe the relationship between maternal VitA level and VitA placental transport ratio.@*RESULTS@#The average retinol concentration of the pregnant women was (1.15±0.30) μmol/L, and the prevalence of VitA deficiency and marginal deficiency were 4.5% and 37.8%, respectively. Average retinol concentration of the neonates was (0.78±0.13) μmol/L, and no neonates were VitA deficiency, 28.2% of the neonates were marginal deficiency. After multivariable adjustment, the VitA level of the neonates was positively and linearly related to maternal VitA level (pm=1, P<0.05), with the corresponding Pearson correlation coefficient of 0.13 (P<0.01). As compared with the women with sufficient VitA, those with VitA deficiency (crude OR=2.20, 95%CI:1.04-4.66) and marginal deficiency (crude OR=1.43, 95%CI:1.01-2.02) had higher risks to deliver neonates with VitA marginal deficiency; while the risks turned to be non-significant after multivariable adjustment. The pregnant women with VitA deficiency had higher risk to deliver neonates with relative VitA deficiency before and after multivariable adjustment (crude OR=3.02, 95%CI:1.21-7.50; adjusted OR=2.76, 95%CI:1.05-7.22). The maternal VitA level was negatively and non-linearly correlated with placental transport ratio (pm= -0.5, P<0.05), with corresponding adjusted Spearman correlation coefficient of -0.82 (P<0.001).@*CONCLUSION@#There was a positive linear dose-response relationship between VitA levels of newborns and pregnant women in third trimester, indicating that neonatal VitA storing levels at birth was affected by maternal VitA nutritional status.

Evaluation of the dietary quality and nutritional status of elderly people using the Nutrition Quotient for Elderly (NQ-E) in Seoul / 한국영양학회지

PURPOSE: This study evaluated the dietary quality and nutritional status of elderly people using the Nutrition Quotient for Elderly (NQ-E).METHODS: The participants were 204 elderly people over 65 years of age (38 men and, 166 women) in Seoul. The dietary information was analyzed using a questionnaire of NQ-E, which consisted of 19 checklist items, and 24-recall test data. The NQ-E scores and its four factors, including ‘balance’, ‘moderation’, ‘diversity’, and ‘dietary behavior’ factors, were calculated according to general characteristics of the subjects. The subjects were divided into the ‘monitoring needed group’ (62 > NQ-E score) and the ‘good group’ (62 ≤ NQ-E score) according to their NQ-E score.RESULTS: The mean NQ-E score of the total subjects was 61.9, which was within the medium-high grade. The scores of balance, moderation, and dietary behavior factors were within the medium-high grade, while the score of the diversity factor was within the medium-low grade. The NQ-E score was 54.8 in the monitoring needed group and 69.3 in the good group. For the score of the diversity factor, the elderly living alone had a significantly lower score than the score for the elderly living with a spouse. The female subjects showed significantly higher scores of moderation and dietary behavior factors than did the male subjects. The daily intakes of vitamin A, thiamin, riboflavin, vitamin C and calcium in the monitoring needed group were significantly lower than those in the good group. The nutrient adequacy ratios (NAR) of vitamin A, thiamin, riboflavin, vitamin C and calcium in the monitoring needed group were significantly lower compared to the scores of the good group. The indexes of nutritional quality (INQ) of vitamin A, thiamin, riboflavin, vitamin C, calcium and potassium were less than 1 for all the subjects. The monitoring needed group had a significantly lower consumption of total foods, vegetables and mushrooms than the good group. As a result, the nutritional status of the monitoring needed group was significantly lower than that of the good group.CONCLUSION: The results of this study show that NQ-E would be a useful tool for assessing the dietary quality of the elderly. In conclusion, a focused-nutrition education program and a useful guideline are needed for promoting the health and nutritional status in elderly people.

Are women with breast cancer more likely to follow dietary recommendations and have sufficient vitamin A intake compared to healthy c ontrols? / ¿Es posible que las mujeres con cáncer de mama sigan las recomendaciones dietéticas y tengan una ingesta suficiente de vitamina A en comparación con las mujeres controles?

To evaluate differences in dietary habits among women with breast cancer versus healthy controls. We conducted a case-control study with 160 women with and without cancer, pairing 1:1. Socio-demographic variables and food consumption were investigated through three food recalls, which was corrected for energy variation using the residual method. Data analysis was performed using Kolmogorov- Smirnov, Student's t, Mann-Whitney/Wilcoxon Two-Sample tests and calculating odds ratios with level of significance of p<0.05. The majority (87.5%) of women with breast cancer did not follow dietary recommendations. Women with breast cancer (cases) had higher odds of not following dietary recommendations compared to controls (OR= 3.37, 95%CI= 1.50-7.58, p= 0.004). Regarding consumption of micro and macronutrients, breast cancer patients had increased odds of insufficient vitamin A intake compared to controls (OR= 2.46, 95%CI= 1.19-5.05, p<0.01). The results suggest the women with breast cancer are more likely to not follow dietary recommendation and have insufficient consumption of vitamin A compared to women without breast cancer.

Evaluar diferencias en los hábitos alimentarios de mujeres con cáncer de mama y mujeres normales. Estudio de casos y controles con 160 mujeres con y sin cáncer y emparejamiento de l:l. Se investigaron las variablessociodemográ-ficas y el consumo de alimentos mediante tres encuestas alimentarias, sometidas a la corrección de la variación de energía por el método residual. El análisis fueran realizados por Kolmogorov-Smirnov, t-Student, Mann-Whitney/Wilcoxon y Odds Ratio con nivel de significación: p<0,05. La mayoría de las mujeres con cáncer de mama (87,5%) no siguió las recomendaciones dietéticas. Las mujeres con cáncer de mama tuvieron un mayor riesgo de no seguir las recomendaciones dietéticas en comparación con los controles 3.37 (IC 95%= 1.50-7.58, p= 0.004). Con respecto al consumo de micro y macronutrientes, las mujeres concáncer de mama tuvieron un mayor riesgo de ingesta insuficiente de vitamina A en comparación con los controles (OR= 2.46, IC 95%= 1.19-5.05, p<0.0l). Los resultados sugieren que las mujeres con cáncer de mama tienen más riesgo de no seguir las recomendaciones dietéticas con un consumo insuficiente de vitamina A en comparación con las mujeres sin cáncer de mama.