Desnutrição na cirrose: associação com a etiologia e disfunção hepatocelular / Malnutrition in cirrhosis: association with etiology and hepatocellular dysfunction

ABSTRACT BACKGROUND: The protein-energy malnutrition alters the prognosis of patients with cirrhosis. Its prevalence may vary according to the etiology of liver disease, it´s severity and the evaluation of the method applied. The infection by the hepatitis C virus (HCV) and alcoholism are the main etiologies of cirrhosis and result in a significant morbidity and mortality. OBJECTIVE: To evaluate the nutritional status of patients with cirrhosis according the liver disease etiology and severity. METHODS: It is a prospective study, in which the sample was for convenience and consisted of patients with cirrhosis, infected by HCV or alcoholic etiology. The nutritional status evaluation was carried out through anthropometry, food consumption, bioelectrical impedance (BIA) and subjective global assessment (SGA). The anthropometric data evaluated were weight, height, body mass index (BMI), triceps skinfold (TSF), circumference of the arm (CA), non-dominant handshake strength (FAM) and the adductor pollicis muscle thickness (APM). Patients were classified according to the severity of liver disease, using the Child-Pugh and Model for End-stage Liver Diseases (MELD) scores. RESULTS: Ninety patients with cirrhosis were evaluated, 47 with HCV and 43 with alcoholic etiology. The prevalence of protein-calorie malnutrition ranged from 10.9% to 54.3% in the HCV group and from 4.7% to 20.9% in the alcoholic group, depending on the method used for evaluation. The group with HCV infection presented a higher malnutrition prevalence in comparison to the alcoholic in the following evaluations: TSF (P<0.001), phase angle (PA) (P=0.016) and SGA (P=0.010). PA values were lower in patients with viral cirrhosis (5.68±1.05) when compared to those with alcoholic etiology (6.61±2.31) (P=0.016). When all patients were analyzed, regardless of etiology, an inversely correlation was observed among Child-Pugh score and PA values (P=0.018). CONCLUSION: HCV cirrhosis showed worse nutritional parameters in comparison to alcoholic etiology; however, the PA was associated with worse liver function in both etiologies.

RESUMO CONTEXTO: A desnutrição proteico-calórica altera o prognóstico dos pacientes com cirrose. Sua prevalência pode variar de acordo com a etiologia da hepatopatia, gravidade da doença e o método de avaliação empregado. A infeção pelo vírus da hepatite C (VHC) e o alcoolismo, estão entre as principais etiologias da cirrose e acarretam significativa morbidade e mortalidade. OBJETIVO: Avaliar o estado nutricional do paciente com cirrose de acordo com a etiologia e gravidade da hepatopatia. MÉTODOS: Estudo prospectivo, em que a amostra foi por conveniência constituída de pacientes com cirrose, infectados pelo vírus da hepatite C (VHC) ou etiologia alcoólica. A avaliação do estado nutricional foi realizada através da antropometria, consumo alimentar, bioimpedância elétrica (BIA) e da avaliação subjetiva global (ASG). Os dados antropométricos avaliados foram: peso, altura, índice de massa corporal (IMC), prega cutânea triciptal (PCT), circunferências do braço (CB), força do aperto de mão não dominante (FAM) e a espessura do músculo adutor do polegar (MAP). Os pacientes foram classificados de acordo com a gravidade da hepatopatia, através do escore Child-Pugh e Model for End-stage Liver Diseases (MELD). RESULTADOS: Foram avaliados 90 pacientes com cirrose, 47 com etiologia pelo VHC e 43 com etiologia alcoólica. A prevalência de desnutrição proteico-calórica variou de 10,9% a 54,3% no grupo do VHC e de 4,7% a 20,9% no grupo dos alcoolistas, dependendo do método utilizado para avaliação. O grupo com infecção pelo VHC apresentou maior prevalência de desnutrição em relação ao de etiologia alcoólica nas seguintes avaliações: PCT (P<0,001), ângulo de fase (AF) (P=0,016) e ASG (P=0,010). Os valores do AF foram menores nos pacientes com cirrose viral (5,68±1,05) quando comparados aos com etiologia alcoólica (6,61±2,31) (P=0,016). Quando analisados todos os pacientes, independente da etiologia da hepatopatia, observou-se uma correlação inversamente proporcional entre a classificação de Child-Pugh e os valores de AF (P=0,018). CONCLUSÃO: A cirrose pelo VHC demonstrou piores parâmetros nutricionais em relação à etiologia alcoólica; entretanto, em ambas etiologias o AF foi associado com pior função hepática em ambas etiologias.

Estado nutricional de pacientes críticos en un hospital universitario de España / Nutritional state of critically-ill patients in Spain university hospital

Introducción: debido a las circunstancias especiales de los pacientes críticos, resulta complicado determinar el aporte energético. Objetivo: determinar la prevalencia del estado nutricional de los pacientes críticos ingresados en la Unidad de Cuidados Intensivos del Hospital Universitario de Burgos (España), y si se les aportó el 60 por ciento de los requerimientos energéticos al cuarto día de ingreso. Métodos: estudio observacional, descriptivo y de prevalencia. Fueron incluidos 47 pacientes, a los que se realizó una evaluación nutricional al ingreso, mediante antropometría, escalas nutricionales validadas y calculando el aporte energético que precisaban. Resultados: el porcentaje de desnutrición al ingreso, según el Índice de Masa Corporal era de un 6,38 por ciento (1,3; 17,5), siendo superior en el sexo masculino. Con la Valoración Global Subjetiva, se obtuvo un resultado de 31,91 por ciento (19,1; 47,1) de sospecha de malnutrición, y un 8,51 por ciento (2,4; 20,4) de malnutrición. El porcentaje de riesgo de desnutrición con la Mini Nutritional Assessment, fue de 36,17 por ciento (22,7; 51,5), y de desnutrición de un 17,02 por ciento (7,6; 30,8). Según la ecuación de Ireton-Jones, a un 77 por ciento de los pacientes se les administró, al menos, el 60 por ciento de los requerimientos energéticos al cuarto día, mientras que con la de Harris-Benedict se obtuvo un 70 por ciento. Conclusiones: la elevada prevalencia de desnutrición y de riesgo de desnutrición en el paciente crítico, evidencia la importancia que supone realizar una valoración nutricional integral para adecuar los requerimientos individualmente. Resulta apropiado suplementar la nutrición enteral con la parenteral si no alcanzan los requerimientos energéticos necesarios(AU)

Introduction: Due to the special circumstances of critically-ill patients, the energy input is difficult to determine. Objective: To determine the prevalence of nutritional status of critically-ill patients admitted to the Intensive Care Unit of the University Hospital in Burgos, Spain, and whether 60 percent of the energy requirements were given on the fourth day of admission. Methods: Observational, descriptive and prevalence study. We included 47 patients, who underwent nutritional assessment at admission, using anthropometry, validated nutritional scales and calculating the energy input they needed. Results: The percentage of malnutrition at admission according to body mass index was 6.38 percent (1.3, 17.5), being higher in males. With subjective global assessment, we obtained a result of 31.91 percent (19.1, 47.1) of suspected malnutrition and 8.51 percent (2.4; 20.4) of malnutrition. The percentage of risk for malnutrition with the mini-nutritional assessment was 36.17 percent (22.7, 51.5), and malnutrition was 17.02 percent (7.6, 30.8). According to the Ireton-Jones equation, 77 percent of the patients were given at least 60 percent of energy requirements on the fourth day, while the Harris-Benedict rate was 70 percent. Conclusions: The high prevalence of undernutrition and risk for malnutrition in critically-ill patients shows the importance of performing an integral nutritional assessment to adapt individual requirements. Supplementing enteral nutrition with the parenteral one is appropriate if they do not meet necessary energy requirements(AU)

Adequação calórico-proteica da terapia nutricional enteral em pacientes cirúrgicos / Protein-calorie adequacy of enteral nutrition therapy in surgical patients

OBJETIVO: Avaliar a adequação calórico-proteica da terapia nutricional enteral (TNE) empregada em pacientes cirúrgicos. MÉTODOS: Estudo prospectivo, realizado em pacientes cirúrgicos que receberam TNE de março a outubro de 2011. Os pacientes foram avaliados antropometricamente e pela avaliação subjetiva global (ASG). Os valores de calorias e proteínas prescritos e administrados e as causas de interrupção da dieta foram registrados diariamente. O valor de 90% foi utilizado como referencial de adequação. A diferença entre o prescrito e o administrado foi verificada pelo teste t de Student. RESULTADOS: Uma amostra de 32 pacientes, com idade de 55,8 ± 14,9 anos, apresentou 40,6 a 71,9% de desnutrição dependendo da ferramenta utilizada. A neoplasia gástrica e as gastrectomias foram o diagnóstico e as cirurgias mais frequentes. Dos pacientes, 50% conseguiram atingir suas necessidades calórico-proteicas. A adequação da dieta recebida em relação à prescrita foi de 88,9 ± 12,1% e de 87,9 ± 12,2% para calorias e proteínas, respectivamente, com um déficit significativo (p < 0,0001) de 105,9 Kcal/dia e de 5,5 g de proteína/dia. Dos pacientes, 59,4% estavam adequados quanto a calorias e 56,2% quanto a proteínas. As causas de suspensão da dieta ocorreram em 81,3%, sendo o jejum para procedimentos (84,6%) e náuseas/vômitos (38,5%) as causas mais observadas no pré e no pós-operatório, respectivamente. CONCLUSÃO: A inadequação calórico-proteica foi frequente, podendo ser atribuída às intercorrências e suspensões da dieta durante a TNE, o que pode ter dificultado que a amostra atingisse suas necessidades nutricionais. Isto pode contribuir para o declínio do estado nutricional do paciente cirúrgico, que frequentemente já está comprometido, conforme observado neste estudo.

OBJECTIVE: To evaluate the protein-calorie adequacy of enteral nutrition therapy (ENT) in surgical patients. METHODS: A prospective study was performed in surgical patients who received ENT from March to October 2011. Patients were evaluated anthropometrically and by subjective global assessment (SGA). The amount of calories and protein prescribed and administered were recorded daily, as well as the causes of discontinuation of the diet. A 90% value was used as the adequacy reference. The difference between the prescribed and administered amount was verified by Student's t-test. RESULTS: A sample of 32 patients, aged 55.8 ± 14.9 years, showed a malnutrition rate of 40.6% to 71.9%, depending on the assessment tool used. Gastric cancer and gastrectomy were the most common diagnosis and surgery, respectively. Of the patients, 50% were able to meet their caloric and protein needs. The adequacy of the received diet in relation to the prescribed one was 88.9 ± 12.1% and 87.9 ± 12.2% for calories and proteins, respectively, with a significant difference (p < 0.0001) of 105.9 kcal/day and 5.5 g protein/day. 59.4% of the patients had adequate caloric intake and 56.2% had adequate protein intake. Causes of diet suspension occurred in 81.3%, with fasting for procedures (84.6%) and nausea/vomiting (38.5%) being the most frequently observed causes in pre- and postoperative periods, respectively. CONCLUSION: Inadequate caloric and protein intake was common, which can be attributed to complications and diet suspensions during ENT, which may have hampered the sample reached their nutritional needs. This may contribute to the decline in the nutritional status of surgical patients, who often have impaired nutrition, as observed in this study.

Evaluación nutricional de pacientes cirróticos compensados / Nutritional assessment of compensated cirrhotic patients

Introducción: la malnutrición proteico-energética es la complicación más frecuente en pacientes cirróticos, la valoración nutricional es difícil y la atención en este sentido es deficiente. Objetivo: evaluar el estado nutricional de los pacientes con cirrosis hepática. Métodos: se realizó un estudio observacional descriptivo de 19 pacientes, de ambos sexos, entre 15 y 60 años de edad, con diagnóstico de cirrosis hepática compensada, atendidos en el Hospital Clinicoquirúrgico 10 de Octubre, desde enero de 2008 a enero de 2009, para evaluar el estado nutricional. Se utilizaron variables como: edad y sexo, antropométricas (peso, talla, circunferencia del brazo e Índice de masa corporal), de laboratorio y dietéticas. Resultados: predominó el sexo masculino y el grupo de 45 a 54 años de edad. El mayor número de pacientes estuvo entre 6 meses y un año del diagnóstico. Se encontró un porcentaje elevado de desnutrición, según índice de masa corporal, la circunferencia del brazo fue el indicador antropométrico menos afectado. La anemia se presentó en más del 50 porciento y el 26 porciento tuvo linfopenia. Se evidenció que al disminuir la frecuencia de comidas al día, aumentó la frecuencia e intensidad de la malnutrición. Conclusiones: la frecuencia de malnutrición proteico-energética en la población cirrótica estudiada fue elevada, con mayor índice de malnutrición en casos de origen alcohólico, además se comprobó que el estado nutricional del paciente cirrótico no puede ser valorado al margen de factores dietéticos

Introduction: protein-energy malnutrition is the most common complication in cirrhotic patients. Nutritional assessment is difficult and care is deficient. Objective: evaluate the nutritional status of patients with liver cirrhosis. Methods: an observational descriptive study was conducted of 19 patients of both sexes aged 15-60 diagnosed with compensated liver cirrhosis, cared for at 10 de Octubre Clinical Surgical Hospital from January 2008 to January 2009, with the purpose of evaluating their nutritional status. The variables studied were age and sex, anthropometric measurements (weight, height, arm circumference and body mass index), laboratory data and dietary information. Results: there was a prevalence of the male sex and the 45-54 age group. Most patients were between 6 months and one year from diagnosis. Malnutrition was found to be high, based on body mass index. Arm circumference was the least affected anthropometric indicator. Anemia was present in more than 50 percent, and 26 percent had lymphopenia. It was found that as the frequency of meals a day decreased, there was an increase in the frequency and intensity of malnutrition. Conclusions: protein-energy malnutrition was high in the cirrhotic population studied, with higher malnutrition rates in cases of alcoholic origin. It was also found that the nutritional status of cirrhotic patients can only be assessed with reference to dietary factors

Segurança alimentar e nutricional de crianças menores de dois anos de famílias de trabalhadores rurais Sem Terra / Food and nutrition safety of children under two years of age in families of landless rural workers

To date little is known of health, nutrition and food safety conditions of children living in rural camps and settlements. The present cross-sectional descriptive study seeks to present and discuss such conditions for children under two years of age in families of landless rural workers in the Central Western region of the State of Paraná. The study was conducted with a total of 337 children under two years of age in families living in two rural settlements and two rural camps. The main variables related with protein-energy malnutrition were assessed. Results indicated that the prevalence of protein-energy malnutrition was 4.7 percent in settlements and 10 percent in camps. Home location, home type and the possibility of producing food for private consumption were the distal variables that influenced most the nutritional status of the pediatric population analyzed. This study established that the search for nutritional and food safety must consider the right of accessing resources and proper means to produce safe and healthy foods in order to enable adequate feeding compatible with the habits and practices of the region.

De modo a conhecer melhor as condições de saúde, de nutrição e de segurança alimentar das crianças que residem em assentamentos e acampamentos rurais, o presente trabalho avaliou menores de dois anos de idade de famílias de trabalhadores rurais Sem Terra, localizados na região centro-oeste do estado do Paraná. Foi conduzido estudo descritivo de delineamento transversal, que considerou como unidade as famílias com crianças nessa faixa etária residentes em dois assentamentos rurais e dois acampamentos rurais, totalizando 337 crianças. A avaliação mostrou que a prevalência de desnutrição energético-protéica foi de 4,7 por cento nos assentamentos e 10,0 por cento nos acampamentos. As variáveis distais que mais influenciaram o estado nutricional da população pediátrica analisada foram: o local e o tipo de moradia, e a possibilidade de produção de alimentos para auto consumo. Assim, verificou-se que a busca pela Segurança Alimentar e Nutricional tem que passar pelo direito de acesso aos recursos e meios para produzir alimentos seguros e saudáveis que possibilitem uma alimentação condizente com os hábitos e práticas da região.

[Comparison of various methods for determination of protein-energy malnutrition with subjective global assessment in hemodialysis patients]

Protein-energy malnutrition [PEM] is prevalent among hemodialysis patients. So far, no study has compared various methods for determination of PEM, including subjective global assessment [SGA], dialysis malnutrition score [DMS], malnutrition inflammation score [MIS], and body mass index [BMI], in hemodialysis patients. The present study was designed to determine sensitivity, specificity, accuracy, positive and negative predictive values, as well as positive and negative likelihood ratios of DMS, MIS and BMI in comparison with SGA as the most common method for determination of PEM in hemodialysis patients. A total of 291 hemodialysis patients were randomly selected by systematic sampling from among 2302 eligible adult hemodialysis patients in Tehran hospitals. The nutritional status of the patients was assessed by completing SGA, DMS and MIS forms and determining BMI. In addition, after a 12- to 14-hour fast, 4-mL blood samples were obtained from each patient before dialysis for measurement of serum urea, creatinine, albumin and total iron binding capacity. Based on SGA, DMS, MIS, and BMI, the prevalence of mild-to-moderate PEM in Tehrani hemodialysis patients was, respectively, 60.5%, 61.5%, 54%, and 16.5%, and that of severe PEM 1%, 1.5%, 1%, and 1%. In comparison with SGA, the sensitivity, specificity, accuracy, area under the receiver operating characteristic [ROC] curve, positive and negative predictive values, and positive and negative likelihood ratios were, respectively, 94%, 88%, 92%, 97%, 93%, 92%, 7.8, and 0.07 for DMS; 87%, 96%, 91%, 97%, 97%, 83%, 22.0, and 0.13 for MIS; and 23%, 91%, 50%, 64%, 80%, 43%, 2.5, and 0.85 for BMI. The results of the present study indicate that the DMS and MIS are almost similar to SGA, in identifying malnutrition in hemodialysis patients, while BMI is not an appropriate index in this regard. In addition, it appears that the DMS is a more appropriate alternative method for SGA in routine hospital assessments

Impact of NGO run mid day meal program on nutrition status and growth of primary school children.

Objective. To study the impact of wholesome mid day meal (MDM) program run by an NGO on the growth of the primary school students in rural area of Mathura district. Methods. This intervention study involved children enrolled in Government run rural primary schools in Mathura district in Uttar Pradesh from March 06 through August 07. A wholesome, nutritionally balanced MDM provided by an NGO for the students in the 6 primary schools was selected as intervention group. Control group consisted of children in 8 schools which received locally prepared MDM by village panchayats. Height, weight, change in height/month, change in weight/month, prevalence of protein-energy malnutrition and prevalence of signs of vitamin deficiencies, were measured. Results. Food was provided for 221 days in one year. Within group and between groups repetitive measures were compared using generalized estimating equation (GEE). Within both intervention and control groups height and weight had significantly increased (p < 0.05), while there was no significant difference between the groups. There was no change in prevalence of malnutrition within either of the groups. Reduction in vitamin A deficiency signs was 38% more in intervention group (p < 0.001). Prevalence of Vitamin D deficiency reduced by 50% more in intervention group. No such differences between groups were observed for vitamin B complex and vitamin C. Conclusions. MDM provided by the NGO has no better impact on growth of the primary school children, however, it reduced prevalence of vitamin deficiency significantly in comparison to the MDM run by Village Panchayats.

Frequency of pneumonitis among malnourished autopsied adults / Frequência de pneumonite em adultos subnutridos autopsiados

The objective of this study was to investigate whether malnourished autopsied adults would present higher frequency of pneumonitis than non-malnourished ones would. All of the autopsied adults (n = 175; age > 18 years) with complete records, including weight and height data, were included. Pneumonitis was observed more frequently in malnourished individuals (59.1 percent) than in non-malnourished individuals (41.3 percent). This study showed that the percentage of pneumonitis among autopsied adults was high, in addition to an increased risk of pneumonitis among these individuals.

O objetivo deste estudo foi verificar se adultos subnutridos autopsiados teriam maior freqüência de pneumonite que adultos não-subnutridos. Todos os adultos autopsiados ((nº = 175); idade > 18 anos) com dados completos, incluindo peso e estatura, foram incluídos. Pneumonite foi observada com maior frequência em subnutridos (59,1 por cento) do que em não-subnutridos (41,3 por cento). Este estudo mostrou uma alta porcentagem de pneumonite entre os adultos autopsiados, além do aumento do risco de pneumonite entre estes.

Desnutrição calórico-proteica do tipo kwashiorkor desencadeada por alergia à proteína do leite de vaca / Kwashiorkor-type malnutrition due to cow's milk protein allergy

A enteropatia induzida por proteína alimentar, uma das formas de apresentação de hipersensibilidade alimentar, tem na alergia à proteína do leite de vaca a causa mais comum dessa síndrome. Ocorre comumente em lactentes, e o diagnóstico depende de uma anamnese minuciosa associada a uma resposta clínica favorável à retirada do antígeno. No presente relato, paciente do sexo feminino de 1 ano e 8 meses, interna para investigação de desnutrição calórico-proteica grave com história de vômitos, diarreia sanguinolenta e perda ponderal pronunciada a partir dos 8 meses de idade. Amamentação exclusiva no primeiro mês de vida e fórmula láctea do segundo ao quarto mês; desde então, com leite de vaca integral. Na admissão, chorosa, irritada, emagrecida, desidratada, cabelos despigmentados e quebradiços, em anasarca e com hepatomegalia. Exames laboratoriais revelaram anemia megaloblástica, leucocitose e hipoalbuminemia. Hipóteses diagnósticas: doença celíaca, fibrose cística e alergia à proteína do leite de vaca. Realizada endoscopia digestiva alta com biópsia: discreto aumento de eosinófilos na lâmina própria em mucosa gástrica e duodenal e esofagite crônica discreta com raros eosinófilos intraepiteliais. Teste do suor negativo. Estabelecido o diagnóstico de alergia à proteína do leite de vaca desencadeando um quadro de desnutrição calórico-proteica grave do tipo kwashiorkor e iniciada dieta com hidrolisado proteico. A alergia à proteína do leite de vaca é uma apresentação clínica frequente de alergia alimentar em lactentes e pré-escolares, sendo as repercussões gastrintestinais e nutricionais significativas nessa faixa etária. Dessa forma, o diagnóstico de alergia à proteína do leite de vaca deve ser considerado em pacientes com desnutrição calórico-proteica, uma vez que a desnutrição primária, por ingestão insuficiente, tenha sido excluída.

Dietary protein-induced enteropathy is one of the presentations of food allergy, and cow's milk protein allergy (CMPA) is its most common cause, frequently affecting infants. Diagnosis depends on thorough history associated with favorable clinical response to the antigen with drawal. This case report describes the case of a twenty-month-old female patient admitted to investigate protein-energy malnutrition (PEM) with severe vomiting, bloody diarrhea and significant weight loss since eight months of age. She was breastfed during the first month of life, receiving infant formula up to the fourth month and, since then, whole cow's milk. At admission, the patient was very irritable, crying, angry, dehydrated, with severe weight loss, brittle and depigmented hair, edema and hepatomegaly. Laboratory tests showed megaloblastic anemia, leukocytosis and hypoalbuminemia. Diagnostic hypotheses: celiac disease, cystic fibrosis and CMPA. Esophagogastroduodenoscopy with biopsy showed slight increase in intra-epithelial eosinophils in the duodenum and chronic mild esophagitis with rare eosinophil infiltrate. Sweat test was negative. Diagnosis of kwashiorkor-type malnutrition triggered by CMPA was made, and hydrolyzed protein diet was started with favorable clinical outcome. CMPA is a prevalent clinical presentation of food allergy in infants and preschool children, and nutritional consequences are also important in these age groups. Therefore, CMPA diagnosis should always be considered in patients with PEM, provided the primary malnutrition secondary to insufficient food intake is excluded.

Variables asociadas a la calidad de la dieta en preescolares de Hidalgo, México / Associated factors with diet quality in preschool children from Hidalgo, Mexico

Nutrition and health are both associated with the nutritional status of individuals. In this paper we evaluate the quality of the diet and its association with relevant socioeconomic aspects in preschool children from Hidalgo, México. We obtained data for children 24-59 months of age on weight, height, food intake using 24-hr recall and socioeconomic data. The data was processed in PLANUT 3.0, ANTHRO 2005 and STATA 9.0. The median value of calorie intake was 1090 and 933 Kcall day for boys and girls respectively; higher intakes were observed in urban areas. The group presented deficiencies in calorie intake, retinol, calcium, iron and zinc. Variables that showed significant association with percent adequacy were motherís use of indigenous language, beneficiaries of food programs and weekly food expenditure. The most relevant problems were chronic under nutrition in rural communities (23.9%) and obesity in urban areas (10.6%). Differences in the quality of the diet and nutritional status between rural and urban areas in Hidalgo, México reflect the socioeconomic inequalities in social groups and smaller regions.

La alimentación es el principal factor que determina el estado de nutrición y salud. En este trabajo se pretende evaluar la calidad de la dieta y su asociación con factores socioeconómicos relevantes en preescolares del Estado de Hidalgo, México. Se obtuvieron datos de peso y talla, dieta por recordatorio de 24 horas y datos socioeconómicos de niño(a)s de 24 a 59 meses. Los datos se procesaron en PLANUT 3.0, ANTHRO 2005 y STATA 9.0. La mediana de consumo fue de 1090 para niños y 933 Kcal en niñas, siendo mayor el consumo de energía en localidades urbanas. El grupo estudiado presentó importantes deficiencias en el consumo de energía, retinol, calcio, hierro y zinc. Las variables que mostraron significativa asociación con porcentaje de adecuación fueron uso de lengua indígena en la madre, beneficiarios de programas alimentarios y gasto semanal en alimentos. Los problemas más relevantes fueron la desnutrición crónica en localidades rurales (23,9%) y la obesidad en urbanas (10,6%). Los contrastes de la calidad de la dieta y estado de nutrición entre localidades rurales y urbanas del estado de Hidalgo, México, reflejan la desigualdad socioeconómica entre grupos sociales y micro regiones.

Current prevalence and predictors of protein-energy malnutrition among schoolchildren in rural Peninsular Malaysia.

A cross-sectional study was carried out to determine the current prevalence of protein-energy malnutrition (PEM) among Orang Asli schoolchildren and to investigate the potential predictors of malnutrition. A total of 241 (120 males and 121 females) Orang Asli schoolchildren age 7-12 years living in remote areas of Pos Betau, Pahang participated voluntarily in this study. Anthropometric and socioeconomic data were collected and the children were screened for intestinal parasitic infections. The overall prevalences of mild and significant underweight conditions were 52.3% and 37.3%, respectively, and the prevalences of mild stunting and wasting were 43.6% and 43.1%, respectively, while the prevalences of significant stunting and wasting were 43.6% and 5.6%, respectively. There was a significant association between gender (male) and malnutrition (p = 0.029). The results also showed a higher prevalence of stunting among children age < or = 10 years than in older children (p = 0.001). Other independent variables, including socioeconomic status and intestinal parasitic infections, had no significant associations with malnutrition indices. PEM is prevalent among schoolchildren in rural Malaysia and therefore of public health concern since PEM diminishes immune function and impairs cognitive function and educational performance. School-based programs of prevention through health education and interventions should be considered as an essential part of measures to improve the quality of life of schoolchildren in rural Malaysia.

Correlation between clinical features and degree of immunosuppression in HIV infected children.

We conducted this study to find out correlation of CD4% with clinical status in 102 HIV infected antiretroviral naive children. Mean age of presentation was 4.8 years. Perinatal transmission was the commonest mode of transmission (94%). Fever (53%), chronic diarrhea (36%), and cough (29%) were the commonest presenting symptoms. Protein energy malnutrition was seen in 56.7% of children. 33.3% children were asymptomatic, whereas 45.1% were in WHO clinical stages III and IV at the time of presentation. The most common opportunistic infection was tuberculosis. CD4% correlated significantly with the deterioration of the WHO clinical stages (P<0.01) and increasing grades of protein energy malnutrition (P< 0.05).

Pobreza, desnutrição e obesidade: inter-relação de estados nutricionais de indivíduos de uma mesma família / Poverty, malnutrition and obesity: interrelationships among the nutritional status of members of the same family

A desnutrição crônica na infância e a obesidade associada à baixa estatura na fase adulta podem ter determinantes comuns de natureza biológica e socioambiental. Tendo em vista o fornecimento de subsídios para o entendimento dessa relação, é objetivo deste trabalho verificar a distribuição intrafamiliar de estados nutricionais em famílias pauperizadas e os fatores de natureza social e biológica envolvidos. Trata-se de um estudo realizado em população pauperizada, com renda mensal familiar inferior a 70 dólares, em dois municípios do Estado de São Paulo, Monteiro Lobato e Santo Antônio do Pinhal. Foram estudadas 215 crianças entre 6 e 71,11 meses, suas mães (197), pais (167) e irmãos entre 6 e 18 anos (560). A metodologia constou de uma análise de regressão logística múltipla hierarquizada. A escolaridade materna, o número de cômodos do domicílio, a idade menor dos 24 meses, os problemas ao nascer, associaram-se ao déficit estatural das crianças; da mesma forma, a baixa estatura da mãe, principalmente quando acompanhada de obesidade. Verificou-se, também, forte associação entre o déficit estatural das crianças com a desnutrição crônica nos irmãos escolares/adolescentes (6 a 18 anos). Os indivíduos com idade menor ou igual a 24 meses apresentaram maior risco de atraso no crescimento.

Chronic malnutrition in infancy and obesity associated with short stature in adulthood may share common biological and socio-environmental determinants. An analysis of intra-family nutrition status distribution patterns may provide elements for understanding the risk factors common to these physiological conditions. The purpose of this study is to ascertain how the intra-family distribution of nutritional conditions in pauperized families occurs, examining related social, environmental and biological factors. An impoverished population (income less than US$ 70) was studied in two rural areas of São Paulo State, Brazil: Monteiro Lobato and Santo Antônio do Pinhal. The sample consisted of members of these families, with 215 children younger than 71.11 months; mothers (197), fathers (167) and siblings (6 to 18 years of age). A hierarchical logistic regression analysis model was prepared. The mothers' educational levels, the number of rooms in the home, age below 24 months and problems at birth, were all associated with height deficits in children, together with short maternal stature, especially when associated with obesity. Additionally, a marked association was noted between height deficits in these children and chronic malnutrition among their older siblings (6 to 18 years old). Children aged 24 months or less presented more severe risks of delayed growth.

Avaliação bioquímica de vitamina A em escolares de uma comunidade rural / Biochemical assessment of vitamin A in schoolchildren from a rural community

OBJETIVO: Investigar a prevalência de deficiência de vitamina A em escolares de área rural do Distrito Federal e correlacionar com índices de anemia e desnutrição. MÉTODOS: Do total de 179 alunos, o estudo incluiu 155 escolares (5 a 18 anos), cujos pais autorizaram a participação na coleta de sangue. A concentração de retinol plasmático foi determinada por cromatografia líquida de alta resolução, e os níveis plasmáticos de vitamina A inferior a 20 µg/dL foram considerados como inadequação ou deficiência de vitamina A. A hemoglobina foi dosada em contador de células automatizado, e a anemia foi caracterizada para crianças e adolescentes com valor sérico menor que 11,5 e 12,0 g/dL, respectivamente. O estado nutricional foi avaliado com o índice escore z para peso/altura, altura/idade e percentil do índice de massa corporal. RESULTADOS: Os resultados mostraram que 33,55 por cento dos escolares pesquisados apresentavam deficiência de vitamina A, com prevalência de 35,44 por cento entre crianças (5-9 anos) e de 31,58 por cento entre adolescentes (10-18 anos). Não foi encontrada correlação entre a prevalência de deficiência de vitamina A e prevalência de anemia ou desnutrição. A deficiência de vitamina A foi homogênea entre as idades e gêneros. CONCLUSÕES: A elevada prevalência de deficiência de vitamina A em crianças e adolescentes desta escola rural estudada identifica um problema de saúde pública na região. Esses resultados apontam para a necessidade de inclusão de faixas etárias maiores de 5 anos no grupo de risco de hipovitaminose A e sua inserção nas políticas públicas de combate à hipovitaminose A.

OBJECTIVE: To investigate the prevalence of vitamin A deficiency among schoolchildren from a rural area in the Distrito Federal, Brazil, and to correlate this with rates of anemia and malnutrition. METHODS: From a total of 179 students, the study recruited 155 schoolchildren (5 to 18 years), whose parents gave permission for blood tests. Plasma retinol concentration was assayed by high resolution liquid chromatography, and levels of plasma vitamin A lower than 20 µg/dL were defined as abnormal or deficient in vitamin A. Hemoglobin was measured by an automated cell counter, and anemia was defined as serum concentrations of less than 11.5 and 12.0 g/dL for children and adolescents, respectively. Nutritional status was assessed using z scores for weight/height, height/age and body mass index percentiles. RESULTS: The results indicated that 33.55 percent of the schoolchildren tested had a vitamin A deficiency, with a prevalence of 35.44 percent among children (5-9 years) and 31.58 percent among adolescents (10-18 years). No correlation was observed between the prevalence of vitamin A deficiency and prevalence rates of anemia or malnutrition. Both sexes and all ages were homogeneous for vitamin A deficiency. CONCLUSIONS: The elevated prevalence of vitamin A deficiency among the children and adolescents attending this rural school identify a public health problem in the region. These results indicate that age groups from 5 years onwards should be included in those at risk of hypovitaminosis A and that they should be included in public policies aimed at combating hypovitaminosis A.

Soporte nutricional en pacientes sometidos a cirugía gastrointestinal / Nutritional support to patients undergoing gastrointestinal surgery

La depleción nutricional ha demostrado ser el principal determinante en el desarrollo de complicaciones postoperatorias. Los pacientes sometidos a cirugía gastrointestinal están en riesgo de sufrir depleción nutricional debido a ingesta inadecuada, estrés quirúrgico e incremento del gasto metabólico. La presencia de íleo postoperatorio y la integridad de la nueva anastomosis han llevado a mantener un ayuno con administración de líquidos parenterales hasta que el paciente comience con ruidos intestinales o elimine gases. Sin embargo, se ha visto que la nutrición postoperatoria enteral precoz es efectiva y bien tolerada. La alimentación enteral se asocia también con beneficios clínicos tales como la reducción en la incidencia de complicaciones infecciosas postoperatorias y una mejoría en la cicatrización de los tejidos. Los estudios indican que la reducción significativa de morbimortalidad asociada a nutrición parenteral total se limita a aquellos pacientes severamente desnutridos portadores de neoplasias gastrointestinales. Un metaanálisis ha mostrado que la nutrición enteral se asocia con menores complicaciones sépticas, reducción de costos y menor estadía hospitalaria si se la compara con la nutrición parenteral, por lo que debería ser de elección cuando sea posible. Parece no haber claras ventajas en mantener a los pacientes con "nada por boca" después de una reseccción gastrointestinal electiva. La nutrición enteral siempre es beneficiosa. La evidencia a favor del soporte nutricional preoperatorio es limitada, pero sugiere que si los pacientes desnutridos son adecuadamente alimentados por 7-10 días previos a la cirugía, los resultados postquirúrgicos pueden mejorar. Se están explorando los beneficios potenciales de la glutamina sobre el intestino y el sistema inmune en pacientes sometidos a cirugía gastrointestinal. Hasta la fecha se ha demostrado que la nutrición parenteral enriquecida con glutamina reduce la estancia hospitalaria y los costos en paciente...

Nutritional status of Kamar tribal children in Chhattisgarh.

OBJECTIVE: Assessment of the nutritional status among 309 Kamar children (161 boys and 148 girls) aged 4-12 years. METHODS: In this cross-sectional study, 24-hours dietary recall method was used to assess dietary intakes of children. Height and weight were recorded and children were classified by WHO criterion (Z-score) using nutritional indices i.e. weight for age, height for age and weight for height. NCHS data were used as reference. Mean energy and protein intake per day were measured and compared with Recommended Dietary Allowances (RDA) of Indian standards. RESULTS: More than 90 percent of children (both boys and girls) in the age group of 4-6 years suffered by underweight (<-2 SD weight for age), which was comparatively lower in 7-9 and 10-12 years age group children. 84.51 percent of boys suffered by stunting (<-2 SD height for age), which was much higher than girls (47.54%) in 4-6 years age group. Similarly, 80 percent of 4-6 years age group children were affected by wasting (<-2 SD weight for height). The consumption of energy and protein were also much lower among Kamar children than the RDA of India throughout the ages. CONCLUSION: Undernutrition in the form of underweight, stunting and wasting and low consumption of dietary intake (energy and protein) was found to be widely prevalent among Kamar tribal children. Therefore, an urgent dietary intervention programme is necessary. Further studies are required to investigate into problem and to supplement the key nutrients which are required to ensure a good nutritional status in children.

Nutritional profile and inflammatory status of stable chronic haemodialysis patients at Nephrology Department, Military Hospital Rawalpindi

Protein-energy malnutrition [PEM] is common in the haemodialysis population. Identification and management of these patients can result in significant reduction in morbidity and mortality. Aim of the study was to find the prevalence of PEM in otherwise stable haemodialysis patients at Military Hospital Rawalpindi at a single point in time with the help of established biochemical and physical markers. Height, dry weight and body mass index [BMI] were recorded for 64, stable, 14-75 year-old patients who were on haemodialysis for >/= 3 months. Blood samples were drawn [pre-dialysis] for complete blood count, serum C-reactive protein, serum total protein, serum albumin and serum Creatinine. Ideal body weights and BMI were obtained from Pakistan Army Selection and Recruitment standards. Out of 64 patients 43 [67%] were males. Mean age was 44.5 +/- 14.3 yr. Mean haemoglobin was 8.84 +/- 2 g/dl. Fifty-seven patients [89%] had haemoglobin

Nutritional status of children under five in three state foster care institutions in Sri Lanka.

This study evaluated the prevalence of protein energy malnutrition (PEM) in children under five years (n = 52), in three randomly selected, State operated foster care institutions in Sri Lanka. The prevalence of PEM, was (51.9%), underweight (63.5%) and wasting (25.0%) was found to be considerably higher than the national prevalence (13.5%, 29.4%, 14.0%, respectively). Based on this preliminary evidence, it is recommended that a study representative of all institutionalised children in both State and private facilities be conducted to identify deficiencies and recommend improvements to institutional care in Sri Lanka.

Childhood illnesses and malnutrition in under five children in drought affected desert area of western Rajasthan, India.

The study was undertaken to asses the impact of drought on childhood illnesses and nutrition in under five children of rural population using three stage sampling design. The study has been carried out in 24 villages belonging to 6 tehsils of Jodhpur district which was a drought affected desert district of Western Rajasthan in 2003. A total of 914 under five children (0-5 years) could be examined for their childhood illnesses, malnutrition, dietary intake and clinical signs of nutritional deficiency. Childhood illnesses observed at the time of drought were respiratory (7.5 %), gastroentrological (7.5%), and 5.6% fever (viral, malaria and jaundice), higher in males than females. Children suffered from recent and long term malnutrition were 39% and 26% respectively as per National Centre for Health Statistics (NCHS) standards. The extent of malnutrition was significantly higher in females than in males (p<0.01). Vitamin A & B complex deficiencies were 0.7% and 3/% respectively. The protein energy malnutrition (PEM) was observed in 44.4%. Overall mean calorie and protein intake deficit was observed to be very high (76.0 & 54.0 %). The comparison of present drought results with earlier studies in normal and drought conditions showed higher prevalence of PEM and deficiencies of calories & proteins in their diet. Respiratory, gastroentrological and fever were main childhood illnesses observed and were higher in males at the time of drought. PEM, vitamin A & B- complex deficiencies, anemia along with deficit in calories and proteins in their diet was observed higher in present study as compared to non desert areas, which may be due to the harsh environmental conditions in desert areas and paucity in the consumption of daily food intake. Due to inadequate consumption of daily food, the children were suffering from PEM resulting in several childhood illnesses. Effective measures making availability of adequate calories and proteins to all age groups especially to under five children through the ongoing nutrition programs needs to be ensured.

Fatores associados à desnutrição protéico-energética em crianças menores de seis anos em Barbacena, Minas Gerais, 2004 / Associated factors for energy protein malnutrition in children minor of six years old in Barbacena, Minas Gerais, 2004

Objetivo: Avaliar as características sócioeconômicas, estado nutricional e fatores associados à desnutrição em crianças no município de Barbacena, MG. Método: Numa amostra de 359 crianças menores de seis anos de idade, selecionadas aleatoriamente (universo = 3172), foi aplicada a antropometria e o exame clínico para se identificar a desnutrição. Definiu-se como desnutrida a criança que possuía índices antropométricos de menos 2 desvios-padrão (DP), na distribuição gráfica do NCHS (padrão antropométrico norte-americano), preconizado pela Organização Mundial de Saúde (OMS). Foi também usado o critério de menos 1 desvio-padrão, para efeito de comparação com outros estudos. Aplicou-se um questionário para os responsáveis pela criança, investigando características sociais, demográficas, econômicas e assistência materna das famílias. Os dados colhidos foram armazenados e analisados nos programas Epiinfo 6.04 b (1997) e Stata 7.0 (2001). Resultados: Os desnutridos abaixo de -2 DP foram 6,1% para o peso/altura (desnutridos agudos) e 9,2% para a altura/idade (desnutridos crônicos). Houve associação estatística entre a desnutrição crônica com as variáveis "sexo masculino", "condições inadequadas de moradia", "ausência de utensílios domésticos" e "pertencer à escola pública". A desnutrição aguda associou-se às variáveis "ausência da amamentação", "idade da mãe ≤ 20 anos" e "pai sem alfabetização". Por sua vez, o indicador peso/idade mostrou-se correlacionado às variáveis "nunca ter amamentado", "pai sem alfabetização", "número de pessoas no lar maior ou igual a 10", e "pertencer à escola pública". Conclusão: Em relação ao índice altura/ idade, 9,2% das crianças em Barbacena apresentavam desnutrição, sendo este valor significativamente superior às médias da região Sul, Sudeste e nacional de acordo com PNSN (Pesquisa Nacional de Saúde e Nutrição - 1989). Já no índice peso/altura, 6,1% das crianças apresentavam desnutrição aguda...

Objective: To evaluate the relationship of socioeconomic variables, nutritional status, and associated factors to infant malnutrition in Barbacena, MG, Brazil. Methods: In an aleatoric sample of 359 infants below six years old from a universe of 3172, anthropometric and clinical examination were made to identify malnutrition. Infants with anthropometric data less than two standard deviations (SD) on graphic distribution of NCHS (North America Anthropometric Standard) were classified as malnutrition. The 1 SD criterion was used to compare with others studies. A questionnaire was applied to investigate demographic and socioeconomic variables and maternal assistance to the families. All data were processed by Epiinfo 6.04 b(1997) e Stata 7.0 (2001) programs. Results: Malnutrition less than 2 SD was detected in 6.1% (acute malnutrition) and chronic malnutrition was detected in 9.2% of the sample. Static association occurs between chronic malnutrition and the variables: male sex, inadequate conditions of habitation, absence of domestic utilities, and student of public school. The acute malnutrition was associated with the variables: lack of breast-feeding, mother age ≤ 20 years old, and father's illiteracy. The indicator weight/age was associated with the variables: never breast-feed, father's illiteracy, home with 10 or more persons, and student of public school. Conclusions: In the indicator of height/ age, 9.2% of infants in Barbacena were malnourished. This index was above the mean of South, Southwest, and the whole country, according to the PNSN (National Program of Health and Nutrition - 1989)?. In the indicator of weight/height, 6.1% of the infants had acute malnutrition.