Influência da inflamação subclínica sobre marcadores bioquímicos do estado nutricional de micronutrientes importantes no crescimento linear / Influence of subclinical inflammation on biochemical markers of important micronutrient in linear growth

O presente estudo teve como objetivo avaliar a influência da inflamação subclínica nas concentracões de retinol sérico, zinco sérico e hemoglobina e nas prevalências das respectivas carências nutricionais em crianças de 12 a 72 meses de idade, atendidas em creches estaduais. Foram analisadas as concentrações de zinco sérico, hemoglobina e retinol sérico considerando a presença/ausência de inflamação subclínica, bem como comparando os resultados considerando três grupos de estudo: população total, crianças sem inflamação subclínica e população total com as concentrações das crianças com inflamação subclínica corrigidas. As prevalências de anemia, deficiência de vitamina A e deficiência de zinco também foram comparadas nesses três grupos. A Proteína C-Reativa foi utilizada como marcador de inflamação subclínica. As crianças com inflamação subclínica (n = 22) apresentaram concentrações médias de retinol sérico e de zinco sérico significativamente menores do que aquelas sem inflamação (n = 193). Contudo, para a hemoglobina não foi observada significância estatística. Os valores médios e as prevalências das carências nutricionais não apresentaram diferenças quando comparadas a população total, as crianças sem inflamação e a população total após correção das concentrações sobre o estado nutricional de micronutrientes das crianças com inflamação. A fim de gerar dados fidedignos sobre o estado nutricional de micronutrientes, os dados desta pesquisa mostram a importância de se avaliar o efeito da inflamação subclínica nos marcadores bioquímicos disponíveis. O desenvolvimento de novas pesquisas é essencial para uma maior compreensão da temática.(AU)

The present study aimed to evaluate the influence of subclinical inflammation on concentrations of serum retinol, serum zinc and hemoglobin and in the respective prevalence of nutritional deficiencies in children 12-72 months of age, attending state day care centers. It were evaluated the concentrations of serum zinc, hemoglobin and serum retinol considering the presence/absence of subclinical inflammation, as well as comparing the results considering three groups: the total population, children without subclinical inflammation and total population with concentrations of children with subclinical inflammation corrected. The prevalence of anemia, vitamin A deficiency and zinc deficiency was also compared in these three groups. The C-reactive protein was used as a marker of subclinical inflammation. Children with subclinical inflammation (n = 22) showed mean concentrations of serum retinol and serum zinc significantly lower than those without inflammation (n = 193). However, for hemoglobin there was no statistical significance. Mean values and prevalence of nutritional deficiencies showed no differences when compared to the total population, children without inflammation and total population after correction of the concentrations on the nutritional status of children with micronutrient inflammation. In order to generate reliable data on the nutritional status of micronutrients, data from this survey demonstrate the importance of evaluating the effect of subclinical inflammation in available biochemical markers. The development of new research is essential for a better understanding of the thematic.(AU)

Triagem nutricional como instrumento preditor dedesfechos clínicos em pacientes cirúrgicos / Nutritional screening instrument as a predictor of clinical outcomes insurgical patients

Introdução: A Triagem de Risco Nutricional (NRS 2002) foi propostapara identificar pacientes em risco nutricional, que podem sebeneficiar de terapia nutricional precoce. Os pacientes cirúrgicosdesnutridos possuem maior chance de apresentar complicaçõesdurante a internação hospitalar e elevado índice de morbidade emortalidade, sendo, portanto fundamental o monitoramento adequadodo estado nutricional.Objetivo: Identificar, por meio de revisão de literatura, a eficáciado método de triagem NRS 2002 em predizer desfechos clínicos empacientes cirúrgicos.Métodos: Foi realizada busca de artigos publicados no período de2003 a 2013, utilizando-se palavras-chaves em conformidade aosDescritores em Ciências da Saúde, nos idiomas inglês, português eespanhol. A seleção foi baseada nos títulos, resumos e descritores.Resultados: A alta taxa de prevalência de desnutrição no ambientehospitalar associa-se a um pior prognóstico, como maior tempode internação, maiores taxas de complicações infecciosas e não infecciosas,além da mortalidade. Dessa forma, é imperativo que essacondição seja detectada precocemente, a fim de se evitar tais desfechosnegativos, principalmente em pacientes cirúrgicos.Considerações finais: A triagem nutricional NRS 2002 permite aidentificação precoce e o tratamento da desnutrição, atenuando osefeitos adversos associados à desnutrição e melhorando o prognósticoclínico durante a internação.

Introduction: Nutritional Risk Screening (NRS 2002) was proposedto identify patients at nutritional risk who may benefit fromearly nutritional therapy. Malnourished surgical patients are morelkely to have complications during hospital stay and higher morbidityand mortality hospitalization and are therefore fundamentalto proper monitoring of nutritional status.Objective: To identify, through literature review, the effectivenessof NRS 2002 screening method for predicting clinical outcomes insurgical patients.Methods: A search was conducted for articles published in the period2003-2013, using keywords in accordance to Health SciencesDescriptors in English, Portuguese and Spanish languages . The selectionwas based on the titles, abstracts and keywords.Results: A high prevalence of malnutrition in hospitals is associatedwith a worse prognosis, longer hospitalization, higher rates ofinfectious and non-infectious complications, and mortality. Thus,it is imperative that this condition is detected early in order to avoidsuch negative outcomes, particularly in surgical patients.Conclusion: The nutritional screening NRS 2002 allows for theearly identification and treatment of malnutrition, mitigating theadverse effects associated with malnutrition and improving clinicaloutcomes during hospitalization.

Impacto do hábito de jantar sobre o perfil dietético de pacientes em hemodiálise / Effects of customary dinner on dietetical profile of patients undergoing hemodialysis

OBJETIVO: Analisar os efeitos do comportamento alimentar, entre o hábito de jantar ou não jantar, no perfil de ingestão de macronutrientes e micronutrientes de pacientes com insuficiência renal crônica em hemodiálise. MÉTODO: Estudo transversal em uma clínica de diálise de Belo Horizonte, em Minas Gerais. Participaram do estudo 90 pacientes em tratamento hemodialítico. Foram coletados dados pessoais, clínicos e dietéticos (registro alimentar de três dias). Foi considerado jantar uma refeição completa e não jantar a sua ausência ou substituição por lanches. As estimativas das quantidades de nutrientes ingeridos foram feitas em software específico Dietwin®. RESULTADOS: Os valores de carboidrato, tiamina, riboflavina, ácido ascórbico, cálcio e selênio ingeridos não apresentaram diferença entre os grupos de pacientes que jantavam e não jantavam (p > 0,05). Os valores de Índice de Massa Corporal (IMC), energia, proteína, lipídeos, niacina, ácido pantotênico, piridoxina, ácido fólico, cobalamina, potássio, fósforo, zinco e magnésio ingeridos apresentaram diferença entre estes mesmos grupos (p < 0,05). Quanto às proporções de adequação desses nutrientes, o grupo dos que jantava apresentou maiores percentuais (p < 0,05), exceto para carboidratos, lipídeos, ácido pantotênico, ácido ascórbico, potássio, cálcio e zinco. Nenhum dos pacientes apresentou valores adequados de ingestão de piridoxina, ácido fólico e selênio. Energia, ácido pantotênico e zinco apresentaram baixos percentuais de adequação em ambos os grupos. CONCLUSÃO: Conclui-se que o hábito de jantar influencia positivamente no consumo de macro e micronutrientes em pacientes com insuficiência renal crônica submetidos à hemodiálise.

INTRODUCTION: To assess the effects of the habit of having evening dinner on the dietary macro- and micronutrient profile of chronic kidney failure patients on hemodialysis. METHODS: Cross-sectional study carried out at a dialysis clinic at the city of Belo Horizonte, state of Minas Gerais. The study comprised 90 patients undergoing hemodialysis. Personal, clinical, and dietary (three-day food record) data were collected. The habit of having dinner was considered as having a complete evening meal, and the lack of that habit was considered as not having it or replacing it by a fast meal. The amounts of nutrient intake were estimated in the specific software Dietwin®. RESULTS: The carbohydrate, thiamine, riboflavin, ascorbic acid, calcium, and selenium intake values showed no difference between the group having a complete evening meal and that not having it (p > 0.05). Both groups did not differ in the following: body mass index, and energy, protein, lipid, niacin, pantothenic acid, pyridoxine, folic acid, cobalamin, potassium, phosphorus, zinc, and magnesium intake values (p < 0.05). Regarding nutrient adequacy, the complete evening meal group performed better than the other group, except for carbohydrates, lipids, pantothenic acid, ascorbic acid, potassium, calcium, and zinc (p < 0.05). None of the patients showed the adequate pyridoxine, folic acid, and selenium intake values. Few patients in both groups showed adequate energy, pantothenic acid, and zinc intake values. CONCLUSION: The habit of having a complete evening meal influenced positively the micro and macronutrient intakes in chronic kidney failure patients on hemodialysis.

Periorificial and acral dermatitis in a newborn having milk intolerence.

A 2-week-old infant born at 36-week gestation developed diarrhea and metabolic acidosis when he was put on formula feeding. He was treated for sepsis and was screened for metabolic diseases. Blood and cerebrospinal fluid cultures were clear. The diarrhea and metabolic acidosis settled but recurred when formula feeding was resumed. He developed a florid erythematous rash involving the palms, feet, perioral and perineal regions. Zinc deficiency was confirmed and zinc replacement resulted in prompt resolution of the skin rash. The patient was put on Pepti-Junior and remained well. This case illustrates that zinc deficiency must be sought and treated in an infant with a typical rash involving the palms, feet and body orifices.

Assessment of IDD problem by estimation of urinary iodine among school children.

Iodine deficiency disorder (IDD) is a major micronutrient deficiency problem in Nepal. Urinary iodine estimation has been the gold standard employed for the assessment of iodine status and of IDD. This study was conducted with objective to assess the urinary iodine among the school children of Kavre, Lalitpur and Parsa districts. Attempts were made to relate urinary iodine with salt use and other sociodemographic variables. Altogether 190 urine samples (74 samples from Kavre, 89 from Parsa and 27 from Lalitpur district) were collected from school children aged 5-13 years. The urinary iodine was analyzed by using urinary iodine assay kit (Bioclone Australia Pvt Limited). It was found that 3.2% children had urine iodine concentration below 20 microg/l. Similarly, the percentage of children with urine iodine concentration 21-50 microg/l, 51-99 microg/l, 100-299 microg/l and above 300 microg/l were 14.2%, 10.5%, 43.7% and 28.4% respectively. Iodine deficient population of school children was 39.2% of Kavre, 19.1% of Parsa and 25.9% of Lalitpur. Overall, it was found that 27.9% children had urine iodine level less than the normal WHO levels. The median urine iodine level was 139.0 microg/l of Kavre, 266.7 microg/l of Parsa and 244.4 microg/l of Lalitpur school children. Urinary iodine excretion (UIE) median value among male students was 211.9 microg/l, among female students was 190.2 microg/l and the difference was statistically insignificant (P > 0.05). There was no significant correlation between consumed salt iodine level and urine iodine excretion level (P > 0.05). Short-term iodine supplementation programs should be arranged for iodine deficient children in the study districts. This study shows that IDD continues to be prevalent in the country as a major public health problem, which requires strengthening effective intervention program and other preventive measures.

Diagnóstico de carência energética em bovinos por testes de metabolismo ruminal / Diagnosis of energy deficiency in cattle by ruminal metabolism tests

Avaliou-se o metabolismo ruminal de bovinos submetidos ou não a dietas carentes em energia, por meio de provas bioquimicas e funcionais no fluido ruminal e urinário com finalidade diagnóstica. Para tal, foram utilizados 10 garrotes mestiços providos de cânula ruminal que foram divididos em dois grupos, ou seja: controle (C; n=4) dieta balanceada para ganho diário de 900 g e carência pronunciada de energia (CP; n=6) recebendo 30% a menos do nível de mantença em energia. Após os bovinos serem alimentados por 140 d foram coletadas amostras de fluido ruminal e urina antes da alimentação e nas 1ª, 3ª, 6ª e 9ª h seguintes. A carência energética provocou diminuição significativa nos teores ruminais de AGVs totais, ácidos propiônico e butírico, amônio, elevando-se o tempo da prova de redução do azul de metileno (RAM) e menor produção de gases no teste de fermentação de glicose (FG); o índice de excreção urinária de alantoína (IEVA) também foi menor. A carência provocou aumento na porcentagem molar de ácido acético. Não se verificou efeito dos tratamentos sobre o pH ruminal. Existiram correlações positivas de grande íntensidade entre FG e AGV s e amônia, e de média intensidade entre FG e amônia e lEVA, assim como de correlação negativa, de média íntensidade, entre RAM e AGV s, amônia, FG e lEVA. Com exceção do pH todas as análises estudadas detectaram alterações no metabolismo ruminal provocada pela carência energética. Porém, considerando-se a praticidade dos testes, recomenda-se a prova do RAM, seguida pela FG para um diagnóstico rápido e sensível deste quadro carencial.

Ten yearling crossbred rumen-cannulated steers were randomly divided in two equal groups for studying some ruminal metabolism tests in caule fed adequate or deficient diets on energy. The control group (C) was fed a diet to gain 900 g/BW / d, while to the very deficient group (VD) was given a diet with 30 % less than the maintenance level of dietary energy. On the 140th d ruminal fluid and urine samples were coliected at the basal and in the 1st, 3rd, 6th and 9th h after the morning feeding. The energy deficiency caused significant decrease in the ruminal levels of total volatile fatty acids (VFA), propionic and butyric acids, and ammonium, an increase in time of methilene blue reduction test (MBRT) and decrease in the gas production in the glucose fermentation test (GFT); the urinary aliantoin excretion rate (UAER) was also lower. The deficiency caused an increased in the molar proportion of acetic acid. There was no diet effect on the ruminal fluid pH. There were high positive correlation between GFT and VFAs and ammonium, medium positive correlation between MBRT and VFAs, ammonium, GFT and UAER. All studied variables were able to detect changes in the ruminal metabolism in caule fed energy deficient diet, but the rumen fluid pH. Nevertheless, as far as the feasibility is concerned the MBRT, foliowed by the GFT should be adopted to allow a rapid and sensible diagnosis of dietary energy deficiency.

Biotinidase deficiency presenting with dermal manifestations of acrodermatitis enteropathica

Biotin is a water-soluble vitamin and co-factor for activation of carboxylases apoenzymes. Biotinidase enzyme is essential for release of biotin from apoenzymes. Absence of biotinidase is an autosomal recessive trait with a prevalence of 1 in 60000. Clinical manifestations of biotinidase deficiency include dermatitis, alopecia, seizures, hypotonia, developmental delay, hearing loss, visual impairment and immunodeficiency. With early diagnosis and treatment with biotin supplements, it is possible to prevent clinical manifestations and neurological deficits. We report a case of biotinidase deficiency with seizures, developmental delay, acrodermatitis enthropathica manifestations and mild compensated acidosis

Assessment of iodine deficiency disorders in urban areas of Udaipur District, Rajasthan.

The present study was conducted on 6-12 years school going children of urban areas of Udaipur to assess the prevalence of iodine deficiency disorders. The study revealed a goiter prevalence of 8.4 percent and biochemical deficiency of nearly 8 per cent but the median iodine levels of the study population was 20 mcg/dL. Iodometric titration of salt samples collected from the beneficiaries revealed that more than 85 per cent of the salt samples had within or more than the stipulated levels of iodine 15 ppm. It appears that the population is in the transition phase from iodine deficiency to iodine sufficiency due to successful implementation of salt iodisation program.

Adhalin deficiency: an unusual cause of muscular dystrophy.

Childhood muscular dystrophies have a wide clinical spectrum, motor disability and are variably inherited. Although the phenotype may appear similar they may represent distinct genetic entities. Advances in immunohistochemistry, gene deletion and linkage studies have enabled precise characterization. We report a family with an early onset weakness and calf pseudo hypertrophy in 2 male sibs with an usually mild course. Deletion screening was negative for 24 exons of the DMD gene in both. Muscle immunohistochemistry revealed normal dystrophin I and II staining but complete absence for adhalin, a dystrophin associated glycoprotein. Classifying them as adhalinopathy. Severe childhood autosomal recessive muscular dystrophies (SCARMD) result from mutation in the sarcoglycan complex (59). Adhalinopathy is now used to describe SCARMD. The adhalinopathy described in our patients is the first report from India.

Feasibility study on the detection of ferritin using surface plasmon resonance.

Determination of ferritin concentration was performed using surface plasmon resonance technique. An anti-human ferritin antiserum from rabbits was immobilized on the protein-A coated sensor chip. The resonance change due to the binding of ferritin to the antibody was measured. It was found that the antigen-antibody binding of the ferritin could be monitored in real time. The detection of ferritin could be obtained in the range of 25-800 ng/ml. This dynamic range could be applied in various medical applications. Moreover, it was observed that the sensor chips could be regenerated. This offers an opportunity for multiple uses, which will reduce the unit operating cost.

Estado del hierro y desarrollo psicomotriz y conductual en niños / Psychomotor, conductual development, and iron status in children

A pesar de que el hierro es el cuarto elemento más abundante en la corteza terrestre y está contenido en la mayoría de los alimentos, se estima que 15 por ciento de la población mundial sufre anemia por deficiencia de hierro y 30 por ciento posee deficiencia de hierro sin anemia. Las causas de esa elevada frecuencia son principalmente deficiencias en la ingesta o absorción del hierro o elevadas pérdidas. El hierro en los alimentos es de 2 tipos: hemínico y no hemínico. La ingesta de apropiadas cantidades de alimentos con hierro hemínico o de alimentos fortificados con hierro previene la deficiencia. Las manifestaciones clínicas de la deficiencia de hierro varían dependiendo de la duración y la magnitud, desde discreta apatía o falta de interés por los juegos o irritabilidad, hasta palidez marcada de mucosas y tegumentos con hipoxia tisular e insuficiencia cardiaca, taquicardia y hepatomegalia. Se ha advertido desde hace 20 años que la deficiencia de hierro determina repercusión en el desarrollo infantil. Estudios recientes prueban que la anemia en los primeros meses de la vida causa déficit motor y mental según puntajes de diversos métodos de evaluación validados, los cuales persisten a largo plazo en los niños, aunque se corrija la deficiencia de hierro y se controlen los estudios por nivel de educación de la madre, estado social, peso al nacer y coeficiente intelectual de los padres. Se plantea por ello actualmente que la deficiencia de hierro durante los primeros meses o años de la vida puede causas daño neurológico permanente. En México programas gubernamentales y la industria alimentaria efectúan diversos esfuerzos para el control de la deficiencia de hierro, sin embargo insuficientes. Debido a que la deficiencia de hierro en los primeros 2 años de la vida determina lesión neurológica irreversible, la vigilancia y control del estado del hierro del organismo en mujeres gestantes y en los niños menores de 2 años debe constituirse en una prioridad impostergable de salud en México y otros países con condiciones similares.

Hematological parameters, ferritin and vitamin B12 in vegetarians.

Hematological parameters and serum ferritin were compared between 179 vegetarians and 58 control subjects using Hematology analyzer H3 and microparticle enzyme immunoassay, respectively. Serum Vitamin B12 was also compared between 68 vegetarians and 30 control subjects using microparticle enzyme immunoassay. It was found that hemoglobin, hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, white blood cells, neutrophils, serum ferritin and serum vitamin B12 in vegetarian were significantly lower than control subjects (P < 0.05). In addition, red cell distribution width and lymphocytes in vegetarians were significantly higher than control subjects (P < 0.05). There were 34 cases of iron deficiency in 179 vegetarians (19.%) which can be classified to iron depletion (4 cases), iron deficient erythropoiesis (12 cases) and iron deficiency anemia (18 cases). Vitamin B12 deficiency was found in 27 cases of 68 vegetarians (40%).

Factores condicionantes, base para la salud bucal / Conditioning factors, basis for oral health

Se detallan signos y síntomas de cuadros subclínicos de deficienias nutricionales, en pacientes atendidos en consultorios odontológicos. Descubrirlos a tiempo, permite efectuar acciones de protección y prevención de la salud, induciendo cambios en su alimentación. Lo importante es mejorar el nivel de vida, modificando de a poco, gradualmente, los malos hábitos higiénico dietéticos individuales para acostumbrarse a una alimentación variada y equilibrada, comiendo de todo moderadamente, evitando así los excesos

Importância do método utilizado para determinaçäo do hormônio de crescimento plasmático na interpretaçäo de testes de estímulo / Importance of the method used to plasma growth hormone determination in the interpretation of the stimulation tests

O desenvolvimento e a popularizaçao de novos e sensíveis imunoensaios para determinaçao do hormônio de crescimento humano (GH), leva-nos a questionar se existe correlaçao entre as concentraçoes plasmáticas de GH determinadas por radioimunoensaio (RIE) e pelos novos imunoensaios e se há necessidade do estabelecimento de novos níveis de corte nos testes de estímulo para diagnóstico de deficiência de GH (DGH). Com o objetivo de responder a estas questoes, foram analisadas 480 amostras de plasma, obtidas de 27 crianças com baixa estatura, submetidas a testes farmacológicos, e de 46 pacientes adultos com diagnóstico de hipopituitarismo ou acromegalia (basais e testes farmacológicos). O GH plasmático foi determinado simultaneamente por RIE e por método imunofluorométrico (IFMA). Observamos uma correlaçao positiva entre as duas determinaçoes (r = 0,94, p < 0,001), nao existindo diferença estatisticamente significativa entre ambas. Considerando-se os valores obtidos pelos dois métodos nas amostras correspondentes aos picos do GH plasmático nos testes farmacológicos das crianças com baixa estatura, nao observamos mudança no diagnóstico, quer se considere como critério níveis de corte de 7 ng/mL ou 10 ng/mL. Estes resultados indicam nao ser necessário o estabelecimento de novos níveis de corte para o diagnóstico da DGH por testes de estímulo. Entretanto, discrepâncias potenciais na quantificaçao do GH por diferentes métodos recomendam que o endocrinologista realize prévia comparaçao entre métodos na interpretaçao dos testes de DGH.

Evaluation of the different methods of assessing nutritional deficiency in school children in field surveys

A cross sectional survey of 846 school children [467 males and 379 females] in the age range from six to nine years in Suez Canal area and Sinai, was done to assess the different methods used in detecting nutritional deficiency in this age group. Hydroxyproline index was proved to be sensitive, valid and reliable. It also correlated highly with the body mass index. Arm muscle area and other derived anthropometric values were invariably consistent, while biochemical and hematological studies showed no significant difference between the control, under - or overweight children. Clinical examination was of limited value in detecting malnutrition in school children