Dietas vegetarianas en niños, niñas y adolescentes: revisión bibliográfica / Vegetarian diets in children and adolescents: a literature review / Dietas vegetarianas em crianças e adolescentes: revisão bibliográfica

Las dietas vegetarianas han alcanzado en los últimos tiempos un gran protagonismo como modalidad de alimentación de nuestra población, incluyendo la población pediátrica. Constituyen una opción de alimentación válida si se planifican adecuadamente. Los padres que optan ofrecer a sus hijos este tipo de dietas deben conocer sus riesgos y potenciales beneficios. El médico del primer nivel de atención que asiste a niños, niñas y adolescentes (NNA) tiene una formación limitada sobre nutrición, sin embargo debe supervisar que la alimentación de esta población sea la adecuada. Es necesario conocer los alimentos que integran las dietas vegetarianas, así como las necesidades calóricas, de nutrientes críticos y suplementación de estos NNA según su edad. Realizar una adecuada planificación, es el gold standard para mantener un adecuado estado nutricional, crecimiento y desarrollo. El objetivo de esta publicación es revisar los principios de este tipo de dietas, sus beneficios y riesgos, y se establecen algunas consideraciones y recomendaciones prácticas para su abordaje desde la Atención Primaria de la Salud.

Vegetarian diets have recently reached a great protagonism as a way of feeding our population, including the pediatric population. They are a valid feeding option if properly planned. Parents who choose to offer their children this type of diet should know its risks and potential benefits. The primary care physician who assists children and adolescents (NNA) has limited training in nutrition; however, you must supervise that the diet of this population is adequate. It is necessary to know the foods that make up vegetarian diets, as well as the caloric needs, of critical nutrients and supplementation of these children according to their age. Carrying out adequate planning is the gold standard to maintain adequate nutritional, growth and development status. The objective of this publication is to review the principles of this type of diet, its benefits and risks, and establish some practical considerations and recommendations for its approach from Primary Health Care.

A alimentação vegetariana tem atingido recentemente um grande protagonismo como forma de alimentação de nossa população, inclusive a pediátrica. Ela é uma opção de alimentação válida se devidamente planejada. Os pais que optam por oferecer a seus filhos esse tipo de dieta devem estar conscientes de seus riscos e potenciais benefícios. O médico de atenção primária que assiste crianças e adolescentes (NNA) tem treinamento limitado em nutrição; no entanto, deve-se supervisionar se a alimentação dessa população é adequada. É necessário conhecer os alimentos que compõem a dieta vegetariana, bem como as necessidades calóricas, de nutrientes críticos e de suplementação dessas crianças de acordo com a sua idade. Realizar um planejamento adequado é fundamental para manter o estado nutricional, de crescimento e de desenvolvimento adequado. O objetivo deste paper é revisar os princípios desse tipo de dieta, seus benefícios e riscos, e estabelecer algumas considerações práticas e recomendações para sua abordagem desde a perspectiva da Atenção Primária à Saúde.

Deficiências de micronutrientes após cirurgia bariátrica: análise comparativa entre gastrectomia vertical e derivação gástrica em Y de Roux / Micronutrient deficiencies following bariatric surgery: a comparative analysis between sleeve gastrectomy and Roux-en-Y gastric bypass

RESUMO Objetivo: comparar a prevalência das deficiências de micronutrientes nos pacientes submetidos à gastrectomia vertical (GV) e à derivação gástrica em Y de Roux (DGYR). Métodos: estudo comparativo de 576 pacientes submetidos à cirurgia bariátrica, 338 através de GV e 238 de DGYR e avaliados quanto às dosagens séricas de hemoglobina, ferro, ferritina, zinco e vitamina B12. Estas dosagens foram realizadas nos períodos pré-operatório e três, seis, 12 e 24 meses após a cirurgia, para análise e comparação das deficiências de micronutrientes entre as técnicas. Resultados: o grupo submetido à GV foi composto por 48 homens e 290 mulheres, com IMC médio de 39,4±2,6Kg/m2 e média de idade de 37,2±11 anos; o grupo submetido à DGYR foi composto por 77 homens e 161 mulheres, com IMC médio de 42,7±5,9Kg/m2 e média de idade de 41,9±11,1 anos. Após 24 meses, déficit de hemoglobina se fez presente em 24,4% dos pacientes submetidos à GV e 40% da DGYR (p=0,054); deficiência de ferro em 6,6% da GV e 15% da DGYR (p=0,127); déficit de ferritina em 17,8% da GV e 23,7% da DGYR (p=0,399); deficiência de zinco em 6,6% da GV e 30% da DGYR (p=0,002) e deficiência de B12 em 6,6% da GV e 8,7% da DGYR (p=0,844). Conclusão: pacientes submetidos à GV apresentaram níveis séricos de ferro e zinco superiores aos pacientes submetidos à DGYR, e a prevalência de déficit deste último micronutriente foi significativamente maior no grupo da DGYR.

ABSTRACT Objective: to compare the prevalence of micronutrient deficiencies in patients submitted to sleeve gastrectomy (SG) and Roux- en-Y gastric bypass (RYGB). Methods: this is a comparative study of 576 patients submitted to bariatric surgery, 338 to SG and 238 to RYGB, and evaluated for hemoglobin, iron, ferritin, zinc and vitamin B12 serum levels. We performed these dosages in the preoperative period and at three, six, 12 and 24 months after surgery, for analysis and comparison of micronutrient deficiencies among the techniques. Results: the SG group consisted of 48 men and 290 women, with a mean BMI of 39.4±2.6kg/m2, and a mean of age of 37.2±11 years; the group RYGB consisted of 77 men and 161 women, with mean BMI 42.7±5.9kg/m2, and a mean age of 41.9±11.1 years. After 24 months, hemoglobin deficiency was present in 24.4% of the patients submitted to SG and in 40% of the RYGB individuals (p=0.054); iron deficiency was present in 6,6% of SG patients and in 15% of RYGB ones (p=0.127); ferritin deficiency occurred in 17.8% of the SG group and in 23.7% of RYGB one (p=0.399); the Zinc deficiency incidence was 6.6% in SG and 30% in RYGB (p=0.002); and B12 deficiency took place in 6.6% the SG patients and in 8.7% of RYGB ones (p=0.844). Conclusion: patients undergoing SG had serum levels of iron and zinc superior to the ones undergoing RYGB, the prevalence of the latter micronutrient deficit being significantly higher in the RYGB group.

Health & nutritional status of HIV infected children in Hyderabad, India.

Background & objectives: Information on nutritional status of HIV infected children from India is lacking and is required before taking up nutritional supplementation trials. Thus, the aim of the present study was to assess the growth and morbidity status of HIV infected children over a period of one year in a city in southern India. methods: This was an observational study carried out between July 2009 and February 2011, at two orphanages in Hyderabad, India. Seventy seven HIV-positive children aged between 1 and half and 15 years, both on and not on antiretroviral therapy (ART) were included. Nutritional status was assessed longitudinally for one year by weight gain, linear growth and body composition. Serum samples were analyzed for haemoglobin, micronutrients, CD4 and CD8 counts. Dietary intakes were assessed by institutional diet survey and morbidity data were recorded every day for 12 months. Results: Mean energy intakes were less than recommended dietary allowance (RDA) in all age groups. Iron and folate intakes were less than 50 per cent of RDA; 46 (59.7%) children were stunted, 36 (46.8%) were underweight and 15 (19.5%) had low BMI for age. Anaemia was observed in 35 (45.5%) children. Micronutrient deficiencies such as vitamin D (40/77; 51.9%), vitamin A (11/77; 14.3%), folate (37/77; 48.1%), iron (38/77; 49.3%) were widely prevalent. HIV viral load was higher in children not on ART and those with morbidity. Respiratory (36.6%) and dermatological illnesses (18.8%) were the commonest presentations. Interpretation &conclusions: Acute, chronic malnutrition and micronutrient deficiencies were common in HIV infected children, especially in those not on ART and having morbidity. With severe malnutrition being an alarming consequence of HIV, prophylactic nutritive care should be considered for integration into HIV care strategies besides initiation of ART to improve the nutritional status and quality of life of these children.

Iron, zinc, copper and magnesium nutritional status in Mexican children aged 1 to 11 years / Estado nutricio de hierro, zinc, cobre y magnesio en niños mexicanos de 1 a 11 años de edad

OBJECTIVE: To describe the micronutrient nutritional status of a national sample of 1-11 year old Mexican children surveyed in 2006 in National Health and Nutrition Survey (ENSANUT 2006) and their association with dietary and sociodemographic factors. MATERIALS AND METHODS: Serum samples were used (n=5 060) to measure the concentrations of ferritin, transferrin receptor, zinc, copper and magnesium. RESULTS: Prevalence of deficiencies in 1-4 and 5-11y old children were for iron (using low ferritin) 26.0 and 13.0%; zinc, 28.1 and 25.8%, respectively; and copper, ≈30% in both age groups. Magnesium low serum concentrations (MLSC), were found in 12.0% and 28.4% of the children, respectively. Being beneficiary of Liconsa (OR=0.32; C.I.95%, 0.17-0.61) or belonging to higher socioeconomic status (OR=0.63; C.I.95%, 0.41-0.97) were protective against iron deficiency. Increasing age (OR=0.59; C.I.95%, 1.19-1.32) and living in the Central Region (OR=0.59; C.I.95%, 0.36-0.97) were protective against MLSC. CONCLUSIONS: Deficiencies of iron and zinc are serious public health problems in Mexican children.

OBJETIVO: Describir el estado nutricio de micronutrimentos en niños de 1-11 años de edad de la Encuesta Nacional de Salud y Nutrición 2006 y su asociación con factores dietéticos y sociodemográficos. MATERIAL Y MÉTODOS: Se usaron muestras séricas (n=5060) para medir las concentraciones de ferritina, receptor de transferrina, zinc, cobre y magnesio. RESULTADOS: La prevalencias de deficiencias en niños de 1-4 y de 5 a 11 años fueron para ferritina, 26.0 y 13%; zinc, 28.1 y 25.8% respectivamente y cobre ≈30% en ambos grupos. Las concentraciones bajas de magnesio (CBM) fueron 12.0 y 28.4%, respectivamente. Ser beneficiario de Liconsa (RM=0.32; IC 95%: 0.17-0.61) y pertenecer al nivel socioeconómico alto (RM=0.63; IC, 95%: 0.41-0.97) fueron protectores para deficiencia de hierro. La edad (RM=1.26; IC, 95%: 1.19-1.32) y vivir en la región Centro (RM=0.59; IC, 95%: 0.36-0.97) fueron protectores para CBM. CONCLUSIONES: Las deficiencias de hierro y zinc son serios problemas de salud pública en niños mexicanos.

Overview of the nutritional status of selected micronutrients in Mexican children in 2006 / Estado nutricional de algunos micronutrientes en niños mexicanos en 2006

OBJETIVE: To present an overview of micronutrient status of Mexican children in 2006. MATERIALS AND METHODS: Data on iron, zinc, folate and vitamin B12 deficiencies and low serum copper and magnesium were gathered and critically analyzed from the 2006 National Health and Nutrition Survey. RESULTS: Iron deficiency is still the main nutritional deficiency in children (13%-26%). Zinc deficiency was high in all age groups (≈25%) but reduced 5.6 PP in children <5 y from 1999 to 2006. Folate deficiency was 3.2% and vitamin B12 deficiency 7.7% in children. Low serum magnesium and copper were high (22.6% and 30.6%, respectively). CONCLUSIONS: The prevalence of iron deficiency seems to be lowering, and zinc deficiency has reduced in Mexican children. A high prevalence of copper and magnesium deficiencies warrants further research on their public health implications.

OBJETIVO: Presentar un panorama del estado de micronutrimentos de niños mexicanos en 2006. MATERIAL Y MÉTODOS: Los datos sobre deficiencias de hierro, zinc, folatos, vitamina B12 y concentraciones bajas de cobre y magnesio se analizaron a partir de la Encuesta Nacional de Salud y Nutrición 2006. RESULTADOS: La deficiencia de hierro fue la más importante en niños (13-26%). La deficiencia de zinc fue alta en todos los grupos de edad (≈25%) y disminuyó entre 1999 y 2006 5.6 pp en niños. La deficiencia de folatos fue de 3.2% y la de vitamina B12 de 7.7%. Las concentraciones bajas de magnesio y cobre fueron altas (22.6 y 30.6%, respectivamente). CONCLUSIONES: La deficiencia de hierro pareció disminuir y la de zinc se redujo en niños mexicanos. La alta prevalencia de deficiencias de cobre y magnesio merecen más investigación para entender sus implicaciones en salud pública.

Association of Homocysteine Levels With Blood Lead Levels and Micronutrients in the US General Population / 예방의학회지

OBJECTIVES: Even though several epidemiological studies have observed positive associations between blood lead levels and homocysteine, no study has examined whether this association differs by the levels of micronutrients, such as folate, vitamin B6, and vitamin B12, which are involved in the metabolism of homocysteine. In this study, we examined the interactions between micronutrients and blood lead on homocysteine levels. METHODS: This study was performed with 4089 adults aged > or =20 years old in the US general population using the National Health and Nutrition Examination Survey 2003-2004. RESULTS: There were significant or marginally significant interactions between micronutrients and blood lead levels on mean homocysteine levels. Positive associations between blood lead and homocysteine were clearly observed among subjects with low levels of folate or low vitamin B6 (p-trend 15 micromol/L) as the outcome, there were similar patterns of interaction, though p-values for each interaction failed to reach statistical significance. CONCLUSIONS: In the current study, the association between blood lead and homocysteine differed based on the levels of folate, vitamin B6, or vitamin B12 present in the blood. It may be important to keep sufficient levels of these micronutrients to prevent the possible harmful effects of lead exposure on homocysteine levels.

Análise da associação do consumo de frutas, legumes e verduras e de micronutrientes com marcadores de estado oxidativo, inflamatório e de resistência á insulina em indivíduos de risco cardiometabólico / Analysis of the association of fruits and vegetables and micronutrients intakes with markers of oxidative and inflammatory status and insulin resistance in individuals at cardiometabolic risk

dietéticos, nível de atividade física (AF), uso de tabaco e estresse psicossocial, os quais predispõem ao aumento de doenças crônicas não-transmissíveis. Dieta rica em frutas, legumes e verduras (FLV) pode atenuar os efeitos sobre o risco cardiometabólico, havendo evidências consistentes de benefícios na prevenção da obesidade, dislipidemia e diabetes tipo 2. O consumo de FLV, fontes de vitaminas e minerais essenciais para a homeostase corporal está aquém do desejado. Estes alimentos contribuem para um perfil cardiometabólico favorável, atenuando o estresse oxidativo, inflamação e resistência à insulina. Objetivo: Este estudo analisou a associação entre o consumo FLV e de certos micronutrientes com marcadores do estado oxidativo, inflamatório e de resistência à insulina em indivíduos de risco cardiometabólico. Métodos:Nesta análise transversal foram incluídos 205 participantes (65 por cento mulheres; média de idade de 54,1 anos) do Estudo de Prevenção de Diabetes do CS-Escola da FSP-USP, com pré-diabetes ou de síndrome metabólica sem diabetes. Foram submetidos a questionários e coletas de sangue. Entre as dosagens, a superóxido dismutase (SOD) e a LDL oxidada (LDLox) serviram para indicar o estado anti/pró-oxidativo. O nível de AF foi medido pela versão longa do IPAQ. Três recordatórios alimentares de 24h foram empregados para cálculo da ingestão de micronutrientes e de FLV. Três categorias de consumo de FLV consumidas foram criadas considerando-se a recomendação internacional e a ingestão de micronutrientes estratificada segundo tercis de consumo, analisados por ANOVA. Coeficiente de Pearson e regressão linear múltipla foram também empregados. Resultados: Os participantes consumiram uma média de 1800 kcal/dia e 3,7 porções/1000 kcal de FLV. Ao longo das categorias de ingestão de FLV, os valores médios de circunferência da cintura (p=0,06) e pressão arterial diastólica (p=0,05) tenderam a diminuir e adiponectina (p=0,05) a aumentar. Indivíduos no tercil mais ...

Serum copper and zinc levels in mothers and cord blood of their newborn infants with neural tube defects: A case-control study.

Objectives: To measure the cord blood and maternal serum levels of folic acid, vitamin B12, zinc, copper, selenium and lead in infants born with neural tube defect (NTD), and to examine a possible relationship between the nutriture of these micronutrients and occurrence of neural tube defect. Design: Case-control study. Methods: Maternal serum and cord blood samples were obtained at delivery from 70 healthy mothers and 74 mothers who had a newborn with NTD. Results: The mean (± SD) maternal serum zinc level in the NTD group was significantly lower than that of the control group (835.6 µg/L ±333.8 µg/L vs. 1035.7 µg/L ± 299.8 µg/L, P=0.004, respectively). The mean maternal and cord serum copper levels in the NTD group were significantly higher when compared to the control group (2831.1 µg/L ± 1017 µg/L vs. 2402 µg/L ± 744.2 µg/L; P=0.03; and 789.8 µg/L vs 517.2 µg/L, P<0.001, respectively). There was a negative correlation between the cord levels of folic acid and copper in the NTD group with the respective maternal serum levels (r=-0.289; P=0.018). Conclusions: High maternal serum levels of copper and lower level of zinc during pregnancy associated with NTD in newborn.

Consumo alimentar e concentrações séricas de micronutrientes: associação com lesões neoplásicas e câncer cervical / Diet and serum micronutrientes: association with cervical neoplasia and cancer

Objetivos. O câncer cervical é o segundo câncer mais comum entre as mulheres em todo o mundo. A infecção por Papilomavirus (HPV) do tipo oncogênico é causa necessária. Estudos internacionais sugerem importante papel de carotenóides e tocoferóis séricos e dietéticos na redução do risco para lesões precursoras, mas os resultados dos estudos prévios são inconsistentes. Indivíduos e métodos. O presente estudo de casos e controles de base hospitalar conduzido na cidade de São Paulo analisou a associação entre concentrações séricas de carotenóides (licopeno, ß-caroteno), tocoferóis (α- e γ-), consumo alimentar e casos incidentes, com confirmação histopatológica, de neoplasia intraepitelial cervical (NIC) graus 1,2,3 e câncer cervical. O estudo incluiu 453 mulheres do grupo controle (sem lesões do colo uterino) e 4 grupos de casos (NIC1, n=140; NIC2, n=126; NIC3, n=231; câncer cervical, n=108) recrutadas em dois hospitais públicos de referência entre 2003 e 2005. Resultados. A concentração sérica de licopeno foi inversamente associada á NIC1, NIC3 e câncer cervical com os seguintes Odds Ratio (OR) (intervalo de confiança de 95 por cento), respectivamente: 0,53 (0,27-1,00; p de tendência=0,05); 0,48 (0,22-1,04; p de tendência=0,05) e 0,18 (0,06-0,52; p de tendência=0,002) quando comparado o maior com o menor tercil após ajuste de variáveis de confusão e grupos de HPV. O maior tercil de ß-caroteno sérico foi inversamente associado ao câncer quando comparado ao menor: OR ajustado = 0,36 (0,13-1,03; p de tendência=0,04). Maiores concentrações de α- e γ-tocoferóis foram inversamente associadas a NIC3 com redução do risco em 50 por cento, após ajustes por covariáveis e HPV. Maior tercil de consumo do grupo de folhas verde-escuras, legumes e frutas de cor alaranjada ou amarela escura foi inversamente associado ao risco para NIC3: OR ajustado comparado ao menor foi 0,52 (0,27-1,00; p de tendência=0,05). Conclusão. Os resultados do presente estudo sugerem...

Study of some micronutrients in patients with helicobacter pylori infection

Helicobacter pylon [HP] plays a fundamental role in gastric inflammation and gastric adenocarcinoma. A number of studies have suggested that HP infection may affect the homeostasis of different important micronutrients. Is to study iron, copper, selenium, vitamins A, E, and C in serum and gastric biopsies in patients with HP infection to clarify the effect of HP infection on the homeostasis of these micronutrients. This work included 35 patients, classified into two groups: group I consisted of 25 patients positive for HP as detected by rapid urease test, while group II consisted of 10 patients negative for HP. All patients had undergone esophagogastroduodenoscopy. Multiple antral biopsies were taken for rapid urease test, PCR for urease and Cag genes, and for histopathological examination. Trace elements were studied in serum as well as in gastric biopsies. Results showed that serum iron and serum ascorbic acid were significantly lower in group I than in group II [62. 5 +/- 10.5 versus 78.5 +/- 19.68 u micro/dl] [p=0.045] and [32.5 +/- 4.25 versus 115.5 +/- 29.8 mg/I] [p=0.0001] respectively. In gastric biopsies it was found thai copper, vitamin A and vitamin C were significantly lower in groupl than in group II [20.8 +/- 4.21 versus 28.6 +/- 7.98miicro g/mg [p=0.0098], 170. 6 +/- 2 and 6 versus 189.6+50.1 ug/gm [p=0.042], 422.6 +/- 49.8 versus 552.6 +/- 68.2 mg/gm] [p=0.01] respectively. Only tissue selenium was higher in group 1 than in group 11[20.3 +/- 3.98 versus 14.65 +/- 2.98 micro g/gm] [p=0.01]. HP infection is associated with disturbed metabolism of iron, copper, selenium, vitamin A and vitamin C. Moreover, the progression of HP pathological outcome from superficial gastritis to chronic atrophic gastritis is associated with disturbed homeostasis of some micronutrients, most notably vitamin C and selenium. This disturbance is more pronounced in patients with Cag positive strains than in Cag negative strains of HP

Micronutrients and its correlation with mental performance among schoolchildren in Bario, Sarawak: a preliminary study

Children who are born in a community with insufficient micronutrients, particularly iodine in remote rural areas are associated with low intellectual functions and mental retardation. The aim of this cross-sectional study is to determine the mental performance of the schoolchildren in Bario, a highland settlement of the Kelabit people in the district of Baram, Sarawak and to determine its correlation with the availability of iodine in the environment, as well as other micronutrients such as selenium, copper and manganese. A total of 25 schoolchildren in Bario age ranging from 7 to 12 years old participated in the study. Mental performance of the schoolchildren were tested using TONI-2 (Test of Nonverbal Intelligence--second edition), a cognitive ability measures with a response format which eliminates language and reduces motoric and cultural factors. The iodine levels from several wells, soils and salt found in Bario were determined using HPLC (software version 3.05.01) whilst serum levels of selenium, copper and manganese were measured using Graphite Furnace Atomic Absorption Spectrophotometer (GFAAS). The results showed that the median and mode scores of intelligence quotient for Bario were 82 and 75, respectively, whilst median and mode scores of intelligence percentile were 11.0 and 5.0, respectively. The maximum score achieved were at the average level with the quotient score between 90-110. It was found that salt produced from one of the wells in Bario contained high quantity of iodine. Based on standards established by the Trace Elements Laboratory, Roben Institute, University of Surrey, United Kingdom, schoolchildren in Bario are having sufficient blood levels of copper and a high selenium and manganese levels. Despite the remoteness of the study area, the schoolchildren in Bario, Sarawak showed higher mental performance compared to other isolated areas. This is probably correlated with the high micronutrients availability, particularly iodine, found naturally in Bario.