Soporte nutricional especializado en un paciente con úlceras por presión: un informe de caso / Specialized nutritional support in a patient with pressure ulcers: a case report

Las úlceras por presión son lesiones de la piel y/o del tejido subyacente. El soporte nutricional adecuado constituye parte del tratamiento de estas lesiones. El objetivo de este reporte es demostrar la eficacia del soporte nutricional como factor coadyuvante en la recuperación de éstas. Paciente masculino de 29 años de edad que ingresó al hospital con diagnóstico de neuroinfección. Durante su estadía desarrolló una úlcera en la región sacra. Fue tratado con nutrición enteral por sonda nasoentérica que incluyó dieta y soporte nutricional hiperproteicos enriquecido con glutamina y arginina; posteriormente se brindó colágeno hidrolizado. A los 36 días tras la aparición de la úlcera, ésta es recuperada. Luego de 4 meses, el paciente fue dado de alta. La intervención nutricional fue crucial en la recuperación de la úlcera. Se enfatiza la necesidad de prevenirlas a través de un monitoreo oportuno y adecuado.

Pressure ulcers are injuries to the skin and / or the underlying tissue. Opportune nutritional support is part of the treatment of these injuries. This report aims to demonstrate the efficacy of nutritional support as a contributing factor in this ulcer recovery. A 29-year-old male patient was admitted to the hospital with a diagnosis of neuroinfection. During his stay, he developed a pressure ulcer in the sacral region. He was treated with enteral nutrition via a nasoenteric tube that included a hyperprotein diet and nutritional support enriched with glutamine and arginine; subsequently, hydrolyzed collagen was provided. Thirty-six days after the development of the pressure ulcer, it has recovered. After four months, the patient was discharged. The nutritional intervention was crucial in the recovery of UPP. The need to prevent this type of ulcers through timely and adequate monitoring is emphasized.

A Brazilian regional basic diet-induced chronic malnutrition drives liver inflammation with higher ApoA-I activity in C57BL6J mice

Malnutrition is still considered endemic in many developing countries. Malnutrition-enteric infections may cause lasting deleterious effects on lipid metabolism, especially in children living in poor settings. The regional basic diet (RBD), produced to mimic the Brazilian northeastern dietary characteristics (rich in carbohydrate and low in protein) has been used in experimental malnutrition models, but few studies have explored the effect of chronic RBD on liver function, a central organ involved in cholesterol metabolism. This study aimed to investigate whether RBD leads to liver inflammatory changes and altered reverse cholesterol metabolism in C57BL6/J mice compared to the control group, receiving a standard chow diet. To evaluate liver inflammation, ionized calcium-binding adapter protein-1 (IBA-1) positive cell counting, interleukin (IL)-1β immunohistochemistry, and tumor necrosis factor (TNF)-α and IL-10 transcription levels were analyzed. In addition, we assessed reverse cholesterol transport by measuring liver apolipoprotein (Apo)E, ApoA-I, and lecithin-cholesterol acyltransferase (LCAT) by RT-PCR. Furthermore, serum alanine aminotransferase (ALT) was measured to assess liver function. RBD markedly impaired body weight gain compared with the control group (P<0.05). Higher hepatic TNF-α (P<0.0001) and IL-10 (P=0.001) mRNA levels were found in RBD-challenged mice, although without detectable non-alcoholic fatty liver disease. Marked IBA-1 immunolabeling and increased number of positive-IBA-1 cells were found in the undernourished group. No statistical difference in serum ALT was found. There was also a significant increase in ApoA mRNA expression in the undernourished group, but not ApoE and LCAT, compared with the control. Altogether our findings suggested that chronic RBD-induced malnutrition leads to liver inflammation with increased ApoA-I activity.

Caracterización clinicoepidemiológica de niños con desnutrición proteicoenergética / Clinical and epidemiological characterization of children with protein-energetic malnutrition

Se realizó un estudio descriptivo, longitudinal y prospectivo de 76 niños desnutridos atendidos en consulta de nutrición del Policlínico Jimmy Hirzel de Bayamo, provincia de Granma, en el período 2014-2016, con vistas a caracterizarles según variables relacionadas con las madres, los niños y las familias, para lo cual se emplearon métodos teóricos, empíricos y estadísticos. En la casuística predominaron los niños con las características siguientes: nacidos con bajo peso (71,1 por ciento), con alimentación complementaria inadecuada (61,8 por ciento), con infecciones agudas reiteradas (75,0 por ciento), hijos de madres con enfermedades asociadas con el embarazo (90,8 por ciento), con bajo nivel de conocimiento sobre la enfermedad (67,1 por ciento), así como procedentes de familias con ingreso económico medio (81,6 por ciento) y con hacinamiento (55,3 por ciento). Se concluyó que la mayoría de los niños desnutridos presentaron antecedentes prenatales, natales y posnatales a tener en cuenta para el desarrollo de la desnutrición, los cuales pueden ser prevenibles o modificables.

A descriptive, longitudinal and prospective study of 76 undernourished children assisted in the Nutrition Service of Jimmy Hirzel Polyclinic in Bayamo, Granma province was carried out in the period 2014-2016, with the aim of characterizing them according to variables related to the mothers, the children and the families, for which theoretical, empiric and statistical methods were used. The children with the following characteristics: born underweight (71.1 percent), inadequate complementary feeding (61.8 percent), repeated acute infections (75.0 percent), children which mothers had associated diseases with pregnancy (90.8 percent), with low level of knowledge on the disease (67.1 percent), as well as coming from families with middle economic incomes (81.6 percent) and crowding (55.3 percent) prevailed in the case material. It was concluded that most of the undernourished children presented prenatal, natal and postnatal history to kept in mind for the development of malnutrition, which can be preventable or modifiable.

Impact of deficient nutrition in bone mass after bariatric surgery / Impacto da deficiência nutricional na massa óssea após cirurgia bariátrica

Background : Essential nutrients are considered for the prevention of the bone loss that occurs after bariatric surgery. Aim : Evaluate nutrients involved in bone metabolism, and relate to serum concentrations of calcium, vitamin D, and parathyroid hormone, and the use of supplements and sun exposure on the bone mass of patients who had undergone gastric bypass surgery. Methods : An observational study, with patients who had undergone the surgery 12 or more months previously, operated group (OG), compared to a control group (CG). Results : Were included 56 in OG and 27 in the CG. The mean age was 36.4±8.5 years. The individuals in the OG, compared to CG, consumed inadequate amounts of protein and daily calcium. The OG had a higher prevalence of low sun exposure, lower levels of 25OH Vitamin D (21.3±10.9 vs. 32.1±11.8 ng/dl), and increased serum levels of parathyroid hormone (68.1±32.9 vs. 39.9±11.9 pg/ml, p<0.001). Secondary hyperparathyroidism was present only in the OG (41.7%). The mean lumbar spine bone mineral density was lower in the OG. Four individuals from the OG had low bone mineral density for chronological age, and no one from the CG. Conclusion : The dietary components that affect bone mass in patients undergoing bariatric surgery were inadequate. The supplementation was insufficient and the sun exposure was low. These changes were accompanied by secondary hyperparathyroidism and a high prevalence of low bone mass in lumbar spine in these subjects.

Racional : Alguns nutrientes são essenciais para a prevenção da perda de massa óssea que ocorre após a cirurgia bariátrica. Objetivo : Avaliar nos pacientes que foram submetidos à cirurgia bariárica pela técnica de bypass gástrico os nutrientes envolvidos no metabolismo ósseo e sua relação com: a concentração sérica de cálcio; a vitamina D e paratormônio; o uso de suplementos alimentares e a exposição solar. Métodos : Estudo observacional com pacientes que foram previamente submetidos à cirurgia, 12 meses ou mais que compuseram o grupo operado (OG), em comparação a um grupo controle (GC). Resultados : Foram avaliados 56 pacientes no OG e 27 no GC. A média de idade foi de 36,4±8,5 anos. Os indivíduos do OG, em comparação com o CG, consumiram diariamente quantidades insuficientes de proteína e cálcio. O OG apresentou maior prevalência de baixa exposição solar, níveis mais baixos de 25OH vitamina D (21,3±10,9 vs 32,1±11,8 ng/ dL) e aumento dos níveis séricos de paratormônio (68,1±32,9 vs 39,9±11,9 pg/ml, p<0,001). Hiperparatiroidismo secundário foi presente apenas no OG (41,7%). A densidade mineral óssea da coluna lombar foi significativamente menor no OG. Quatro indivíduos do OG tiveram baixa densidade mineral óssea comparado com a idade cronológica, e nenhum do CG. Conclusão : Os componentes da dieta que afetam a massa óssea em pacientes submetidos à cirurgia bariátrica estavam inadequados. A suplementação alimentar foi insuficiente e a exposição solar baixa. Estas alterações foram acompanhadas de hiperparatireoidismo secundário e alta prevalência de baixa massa óssea em coluna lombar nestes pacientes.

Impact of acute undernutrition on growth, ileal morphology and nutrient transport in a murine model

Undernutrition represents a major public health challenge for middle- and low-income countries. This study aimed to evaluate whether a multideficient Northeast Brazil regional basic diet (RBD) induces acute morphological and functional changes in the ileum of mice. Swiss mice (∼25 g) were allocated into two groups: i) control mice were fed a standard diet and II) undernourished mice were fed the RBD. After 7 days, mice were killed and the ileum collected for evaluation of electrophysiological parameters (Ussing chambers), transcription (RT-qPCR) and protein expression (western blotting) of intestinal transporters and tight junctions. Body weight gain was significantly decreased in the undernourished group, which also showed decreased crypt depth but no alterations in villus height. Electrophysiology measurements showed a reduced basal short circuit current (Isc) in the undernourished group, with no differences in transepithelial resistance. Specific substrate-evoked Isc related to affinity and efficacy (glutamine and alanyl-glutamine) were not different between groups, except for the maximum Isc (efficacy) induced by glucose. Transcription of Sglt1 and Pept1 was significantly higher in the undernourished group, while SN-2 transcription was decreased. No changes were found in transcription of CAT-1 and CFTR, while claudin-2 and occludin transcriptions were significantly increased in the undernourished group. Despite mRNA changes, SGLT-1, PEPT-1, claudin-2 and occludin protein expression showed no difference between groups. These results demonstrate early effects of the RBD on mice, which include reduced body weight and crypt depth in the absence of significant alterations to villus morphology, intestinal transporters and tight junction expression.

The association of markers of oxidative-inflammatory status with malnutrition in hemodialysis patients with serum ferritin lower than 500 ng/mL / Associação dos marcadores do estado oxidativo e inflamatório com a desnutrição em pacientes hemodialisados com ferritina menor do que 500 ng/mL

INTRODUCTION: Enhanced inflammatory-oxidative status is well established in chronic kidney disease. OBJECTIVE: The objective of this study was to evaluate the oxidative- inflammatory status and iron indices in patients undergoing maintenance hemodialysis (HD) with serum ferritin lower than 500ng/mL, and to correlate them with nutritional status. METHOD: In a cross-sectional survey 35 HD patients (23 with normal nutritional status, 12 with Protein-Energy-Wasting syndrome, PEW), and healthy volunteers (n = 35) were studied. Serum concentration of iron, ferritin, transferrin saturation, malondialdehyde (MDA), protein carbonyl (PC), high-sensitive serum C -reactive protein (hs-CRP) and blood counts were determined. The nutritional status was determined by anthropometric and biochemical criteria. RESULTS: HD patients showed low values of hemoglobin and higher values of ferritin, MDA and PC when compared with healthy volunteers. HD subjects with PEW had higher values of PC and hs-PCR as compared to HD patients with normal nutritional status. A multiple logistic regression analysis showed that the independent variables PC (Wald Statistic 4.25, p = 0.039) and hs-CRP (Wald Statistic 4.83, p = 0.028) where related with the patients' nutritional condition. CONCLUSION: In HD patients with serum ferritin below 500 ng/mL was observed one association of the markers of oxidative stress and inflammation with poor nutritional status independently of serum ferritin, gender and age.

INTRODUÇÃO: Na doença renal crônica, a presença de um estado inflamatório-oxidativo aumentado está bem estabelecida. OBJETIVO: O objetivo do presente estudo foi avaliar o estado oxidativo e inflamatório e o perfil do ferro em pacientes submetidos à hemodiálise crônica de manutenção, com ferritina menor do que 500 ng/mL, e correlacioná-los com o estado nutricional. MÉTODO: Em estudo transversal, em 35 pacientes sob hemodiálise (23 com estado nutricional normal, 12 com desnutrição energético-proteica (DEP) e 35 voluntários sadios foram determinados os índices hematimétricos e as concentrações séricas do ferro, da ferritina e avaliada a saturação de transferrina. O estado oxidativo foi determinado por meio das concentrações séricas do malondialdeído (MDA) e da proteína carbonil (PC). Nos indivíduos sob hemodiálise o estado inflamatório foi avaliado por meio da proteína C reativa ultrassensível determinada no soro (hs-PCR). O estado nutricional foi determinado por critérios antropométricos e bioquímicos. RESULTADOS: Os pacientes da hemodiálise mostraram anemia e um estado oxidativo mais elevado do que os voluntários sadios. Os pacientes hemodialisados com DPE mostraram ferritina e um estado inflamatório-oxidativo mais elevado se comparados aos com boa condição nutricional. Em análise de regressão logística múltipla, os níveis séricos de PC e hs-CRP foram correlacionados com o estado nutricional. PC (Estatística Wald 4.25, p = 0,039), CRP (Estatística Wald 4.83, p = 0,028). CONCLUSÃO: Em indivíduos submetidos à hemodiálise, com ferritina menor do que 500 ng/mL. Observou-se uma associação entre os marcadores de estresse oxidativo e inflamatório com o estado nutricional, independentemente da idade, gênero e dos índices do ferro.

Apolipoprotein E4 influences growth and cognitive responses to micronutrient supplementation in shantytown children from northeast Brazil

OBJECTIVE: Apolipoprotein E4 may benefit children during early periods of life when the body is challenged by infection and nutritional decline. We examined whether apolipoprotein E4 affects intestinal barrier function, improving short-term growth and long-term cognitive outcomes in Brazilian shantytown children. METHODS: A total of 213 Brazilian shantytown children with below-median height-for-age z-scores (HAZ) received 200,000 IU of retinol (every four months), zinc (40 mg twice weekly), or both for one year, with half of each group receiving glutamine supplementation for 10 days. Height-for-age z-scores, weight-for-age z-scores, weight-forheight z-scores, and lactulose:mannitol ratios were assessed during the initial four months of treatment. An average of four years (range 1.4-6.6) later, the children underwent cognitive testing to evaluate non-verbal intelligence, coding, verbal fluency, verbal learning, and delayed verbal learning. Apolipoprotein E4 carriage was determined by PCR analysis for 144 children. RESULTS: Thirty-seven children were apolipoprotein E4(+), with an allele frequency of 13.9 percent. Significant associations were found for vitamin A and glutamine with intestinal barrier function. Apolipoprotein E4(+) children receiving glutamine presented significant positive Pearson correlations between the change in height-for-age z-scores over four months and delayed verbal learning, along with correlated changes over the same period in weight-for-age z-scores and weight-for-height z-scores associated with non-verbal intelligence quotients. There was a significant correlation between vitamin A supplementation of apolipoprotein E4(+) children and improved delta lactulose/mannitol. Apolipoprotein E4(-) children, regardless of intervention, exhibited negative Pearson correlations between the change in lactulose-to-mannitol ratio over four months and verbal learning and non-verbal intelligence. CONCLUSIONS: During development, apolipoprotein E4 may function concomitantly with gut-tropic nutrients to benefit immediate nutritional status, which can translate into better long-term cognitive outcomes.

Manejo del niño desnutrido severo / Management of severe malnourished children

La desnutrición (DNT) infantil es la responsable de aproximadamente tres a cinco millones de muertes anuales en niños menores de cinco años. Se define como DNT severa, cuando existe un adelgazamiento marcado y/o la presencia de edema nutricional, o cuando la circunferencia media del brazo es menor de 110 cm. El abordaje en el tratamiento del niño DNT severo, incluye manejo de la etapa aguda; rehabilitación nutricional y mantenimiento, y rehabilitación final y seguimiento. En la primera fase, se debe hacer énfasis en los problemas agudos; en la segunda etapa, hay que iniciar precozmente la alimentación del niño, según norma; y en última fase, entre los 2 a 7 días posteriores, se debe valorar aporte calórico, apetito, estado general.

Malnutrition (MNT) is responsable for child approximately three to five million anual deaths in children under five years. MNT is defined as severe when there is a a marked thinning and/or the presence of nutritional edema, or mid-arm circunference is less than 110 cm. The approach to trealing children with severe MNT, including the acute stage management, nutritional rehabilitation and mintenance, and final rehabilitation and monitoring. In the first phase, emphasis should be on the acute problems, the second stage is to start early infant feeding, according to standard, and in the final phase, from 2 to 7 days, calorie intake should be assessed, appetite, general condition.

Evolução do estado nutricional de pacientes desnutridos ou com excesso de peso candidatos a transplante pulmonar / Evolution of nutritional status in lung transplant candidates who are initially malnourished or overweight

Estudo retrospectivo, que avaliou a evolução do estado nutricional, por meio de antropometria, de candidatos a transplante pulmonar desnutridos ou com excesso de peso. Foram incluídos pacientes com índice de massa corpórea (IMC) < 17 kg/m² (desnutrido, n = 10) ou IMC > 27 kg/m² (sobrepeso, n = 20) no momento da avaliação inicial. Estes pacientes foram submetidos por três consultas com um nutricionista (intervenções nutricionais). Não houve diferenças significantes nas variáveis antropométricas após as intervenções no grupo desnutrido. Porém, os resultados do grupo sobrepeso mostraram o impacto positivo da intervenção nutricional no peso, IMC e circunferência da cintura dos pacientes.

A retrospective study using anthropometric data to assess the evolution of nutritional status in lung transplant candidates who are initially malnourished or overweight. We included patients with an initial body mass index (BMI) < 17 kg/m² (malnourished, n = 10) or > 27 kg/m² (overweight, n = 20). Each patient subsequently had three appointments with a nutritionist (nutritional interventions). In the malnourished group, there were no significant post-intervention changes in the anthropometric variables. In the overweight group, however, nutritional intervention had a positive impact on weight, BMI and waist circumference.

Efeito da desnutrição e etanol na morfologia de rins de ratos: uma revisão sistemática / Effects of malnutrition and ethanol in the morphology of kidneys of rats: a systematic review

Objetivo: revisar na literatura os efeitos da desnutrição e etanol na morfologia de rins de ratos. Método: Foi realizada uma revisão sistemática com busca de artigos na base de dados PubMed, SciELO e LILACS. Foram excluídos artigos contendo estudos com seres humanos e que não avaliassem os efeitos da desnutrição e do etanol nos rins e que não pesquisassem a morfologia renal. Resultados: para os efeitos da desnutrição, não foram encontrados artigos na base PubMed, porém foram encontrados 46 na LILACS e 2 na SciELO, totalizando 48 artigos, sendo descartados 46 artigos. Para os efeitos do etanol, foram encontrados 373 artigos na base PubMed, 13 na LILACS e 3 na SciELO, totalizando 389 artigos, sendo descartados 386 artigos. O total geral de artigos analisados foram de 437, sendo 5 selecionados para esta revisão. Conclusão: tanto a desnutrição, quanto o etanol provocam alterações na morfologia dos rins de ratos, porém ainda são bastante escassos esses estudos na literatura.

Objective: To review - in specialized literature - the effects of malnutrition and ethanol in the morphology of kidneys of rats. Methodology: A systematic review was held by searching articles in the PubMed, SciELO and LILACS database. Articles which contained studies with human beings, or did not evaluate the effects of malnutrition and ethanol in the kidneys, and those which did not research the renal morphology were excluded. Results: For the effects of malnutrition, no PubMed based articles were found; however, 46 LILACS and 2 SciELO based ones were found, which adds up to 48 articles; 46 of them were not considered. For the effects of ethanol, 373 PubMed based articles, 13 LILACS and 3 SciELO based ones were found, which adds up to 389 articles; 386 of them were not considered. The total amount of 437 articles was analyzed and 5 of them were selected for this review. Conclusion: Not only the malnutrition, but also the ethanol lead to alterations in the morphology of kidneys of rats, however, these studies are still scarce in specialized literature.

Avaliação do estado nutricional das crianças menores de cinco anos em uma Creche no Município de Florianópolis segundo a curva de referência da OMS 2006 e comparação do diagnóstico nutricional com a curva de referência do CDC 2000 / Valuation of nutricional status of children under five years old at a daycare center according to OMS 2006 growth reference and comparison of the nutricional diagnostic with the CDC 2000 growth reference

Objetivo: Avaliar o estado nutricional das crianças menores de cinco anos cuidadas em uma creche segundoa curva de referência da Organização Mundial de Saúde (OMS) 2006 e comparar o diagnóstico nutricionalcom a curva de referência do Centers for Disease Control and Prevention (CDC) 2000. Metodologia: Estudo observacional, transversal com crianças menores de cinco anos, matriculadas em uma creche no município de Florianópolis-SC, no mês de Agosto de 2007. A amostra foi composta por 63 crianças obedecendo critérios de inclusão e exclusão. O estado nutricional foi analisado mediante indicadores antropométricos: peso e estatura para idade e peso para estatura utilizando-se o escore z. Resultados: Observou-se ausência de desnutrição aguda e de baixa estatura. O sobrepeso foi encontrado em 7,9% das crianças, o risco de baixa estatura em 19%.36,8% das crianças eutróficas pelo CDC encontravamse com risco de sobrepeso pela OMS (p=0,00) e 40% das com risco de sobrepeso pelo CDC já eram consideradas com sobrepeso pela atual curva (p=0,00); 33,3% das crianças com estatura adequada pelo CDC possuíam risco de baixa estatura pela OMS (p=0,00). Conclusão: Foi encontrado alta prevalência de sobrepeso e risco de baixa estatura. A curva da OMS comparada à curva do CDC superestima o diagnóstico derisco de sobrepeso e sobrepeso assim como o risco de baixa estatura.

Objectives: To evaluate the nutritional status of children under five years old at a daycare center according to the World Health Organization (WHO) 2006 growth reference and compare the nutritional diagnostic whith the Centers for Disease Control ad Prevention(CDC) 2000 growth reference.Methodology: A transversal descriptive study was carried out with children under five years old enrolled ata daycare center at the municipality of Florianópolis-SC in August of 2007. The sample was composed by 63 children according to inclusion and exclusion criteria. The nutritional status was analyzed by antropometric indicators:weight and heigth for age and weigth for heigth using the z score system. Results: The wasting and stunting were not observed in this study. Overweight was found in 7,9% of children and the risc of stunting in 19%. 36,5% of childrenconsidered eutrofic according to the CDC were at risc of overweigth according to the actual reference (p=0,00);33,3% of children with adequate heigth according to CDC were at risc of stunting according to OMS (p=0,00).Conclusion: High prevalence of overweight and risc of stunting were found. The OMS reference comparedwith the CDC increased the diagnostic of risc of overweigth, overweigth as well as the risc of stunting.

Growth evaluation in infants with neonatal cholestasis

BACKGROUD: Chronic liver diseases in childhood often cause undernutrition and growth failure. To our knowledge, growth parameters in infants with neonatal cholestasis are not available AIM: To evaluate the nutritional status and growth pattern in infants with intrahepatic cholestasis and extrahepatic cholestasis. PATIENTS AND METHODS: One hundred forty-four patients with neonatal cholestasis were followed up at the Pediatric Gastroenterology Service of the Teaching Hospital, State University of Campinas, Campinas, SP, Brazil, in a 23-year period, from 1980 to 2003. The records of these patients were reviewed and patients were classified into two groups, according to their anatomical diagnosis: patients with intrahepatic cholestasis - group 1, and patients with extrahepatic cholestasis - group 2. Records of weight and height measurements were collected at 4 age stages of growth, in the first year of life: 1) from the time of the first medical visit to the age of 4 months (T1); 2) from the 5th to the 7th month (T2); 3) from the 8th to the 10th month (T3); and 4) from the 11th to the 13th month (T4). The weight-by-age and height-by-age Z-scores were calculated for each patient at each stage. In order for the patient to be included in the study it was necessary to have the weight and/or height measurements at the 4 stages. Analyses of variance and Tukey's tests were used for statistical analysis. Repeated measurement analyses of variance of the weight-by-age Z-score were performed in a 60-patient sample, including 29 patients from group 1 and 31 patients from group 2. The height-by-age data of 33 patients were recorded, 15 from group 1 and 18 from group 2 RESULTS: The mean weight-by-age Z-scores of group 1 patients at the 4 age stages were: T1=-1.54; T2=-1.40; T3=-0.94; T4=-0.78. There was a significant difference between T2 X T3 and T1 X T4. The weight-by-age Z-scores for group 2 patients were :T1=-1.04; T2=-1.67; T3=-1.93 and T4=-1.77, with a...

RACIONAL: As doenças hepáticas crônicas na infância freqüentemente levam à desnutrição e ao déficit de crescimento, sem haver referência de um padrão definido para colestase neonatal OBJETIVO: Avaliar o estado nutricional e o padrão de crescimento em crianças com colestase intra-hepática e colestase extra-hepática MATERIAL E MÉTODOS: Foram revistos os prontuários de 144 pacientes com colestase neonatal atendidos no Serviço de Gastroenterologia Pediátrica do Hospital de Clínicas da UNICAMP, Campinas, SP, durante o período de 1980 a 2003 e de acordo com o diagnóstico anatômico, classificados em dois grupos: grupo 1, pacientes com colestase intra-hepática e grupo 2, com colestase extra-hepática. Os valores de peso e estatura foram obtidos em quatro momentos: 1°) Na primeira consulta realizada até o 4° mês de vida, 2°) entre o 5° e o 7° mês, 3°) entre o 8° e o 10° mês e 4°) entre o 11° e 13° mês. Para cada paciente foi realizado o cálculo do Z-escore em relação ao peso para a idade e estatura para a idade nos momentos 1 a 4. Para o paciente ser incluído no estudo, era necessário ter as medidas de peso e/ou estatura nos quatro estágios. A estatística empregada foi a análise de variância e o teste de Tukey. Para análise de variância com medidas repetidas quanto ao escore-Z de peso para a idade, a amostra utilizada foi de 60 pacientes, sendo 29 do grupo 1 e 31 do grupo 2. Para estatura, a amostra utilizada foi de 33 pacientes, sendo 15 do grupo 1 e 18 do grupo 2. RESULTADOS: As médias dos escores-Z de peso para a idade nos quatro momentos da avaliação para os pacientes do grupo 1 foram: T1 =-1.54; T2 = -1.40; T3 = -0,94; T4 = -0.78, havendo diferença significante entre T2×T3 e entre T1×T4. Para os pacientes do grupo 2 foram: T1 = -1.04; T2 = -1.67; T3 =-1.93 e T4 = -1.77, havendo diferença significante entre T1×T2 e T1×T4. Houve também diferença significante entre as médias dos escores-Z de peso para a idade entre o grupo...

Diagnóstico do estado nutricional dos atletas da Equipe Olímpica Permanente de Levantamento de Peso do Comitê Olímpico Brasileiro (COB) / Diagnostico del estado nutricional de los deportistas del equipo olímpico nacional de levantamiento de pesas del Comité Olímpico Brasileño (COB) / Diagnosis of the nutritional status of the Weight Lifting Permanent Olympic Team athletes of the Brazilian Olympic Committee (COB)

Objetivou-se neste estudo diagnosticar o estado nutricional da Equipe Olímpica Permanente de Levantamento de Peso do Comitê Olímpico Brasileiro (COB). A amostra foi composta por 24 atletas, na faixa etária entre 16 e 23 anos, sendo 12 do sexo masculino (19,7 ± 2,4 anos) e 12 do feminino (19,2 ± 1,8 ano). Realizou-se o seguinte procedimento para o diagnóstico do estado nutricional: análise da adequação da ingestão de energia e dos macronutrientes - carboidratos (CHO), lipídios (LIP) e proteínas (PRO) -, por meio dos métodos Recordatório de 24 horas e Questionário de Freqüência de Consumo Alimentar, além da caracterização do perfil antropométrico. Os resultados da avaliação dietética indicaram que a distribuição energética entre os macronutrientes encontra-se adequada sendo de 54 ± 6,8 por cento (CHO); 28,5 ± 5,9 por cento (LIP); e 14,5 ± 3,4 por cento (PRO) para os homens e 56,3 ± 4,7 por cento (CHO); 28,6 ± 4,6 por cento (LIP); e 13,7 ± 2,4 por cento (PRO) para a equipe feminina. Entretanto, quanto ao consumo energético total, 83 por cento dos atletas estavam com ingestão energética abaixo dos valores recomendados, considerando o alto nível de atividade física, promovendo deficiência calórica diária. O percentual de gordura corporal dos atletas do sexo masculino (3,6 ± 0,7 por cento) indicou que todos estavam abaixo do padrão de referência, enquanto 58 por cento dos esportistas do sexo feminino apresentavam excesso de gordura (17,9 ± 5,8 por cento). Tem-se, como conclusão, que, apesar de os desportistas avaliados terem realizado distribuição energética adequada entre os macronutrientes, esta ainda não foi suficiente para suprir as exigências energéticas da modalidade, necessitando assim de orientação nutricional.

This study aimed to diagnose the nutritional status of the Weight Lifting Permanent Olympic Team Athletes of the Brazilian Olympic Committee (COB). The sample was composed of 24 athletes, aged 16-23 yr, 12 males (19.7 ± 2.4 yr) and 12 females (19.2 ± 1.8 yr). The following procedure was applied to diagnose the nutritional status: analysis of the adequability of energy and macronutrient intake - carbohydrates (CHO), lipids (LIP) and proteins (PRO) -, through the methods 24-hr diet records and the Food Consumption Frequency Questionnaire, besides anthropometrical profile characterization. The results obtained from the dietary evaluation showed that the energy distribution among the macronutrients was adequate, 54 ± 6.8 percent (CHO); 28,5 ± 5.9 percent (LIP); and 14.5 ± 3.4 percent (PRO) for the male team, and 56.3 ± 4.7 percent (CHO); 28.6 ± 4.6 percent (LIP); and 13.7 ± 2.4 percent (PRO) for the female team. However, regarding total energy intake, 83 percent of the athletes presented energy intake below the recommended values, considering the high level of physical activity, resulting in daily caloric deficiency. Body fat percentage of the male athletes (3.6 ± 0.7 percent) indicated that all of them were below the reference standard, while 58 percent of the female athletes had excess fat (17.9 ± 5.8 percent). It was concluded that although the athletes showed an adequate caloric distribution of macronutrients, it was still not sufficient to meet the energy requirements of their modality, thus these athletes should seek nutritional orientation.

El objetivo de este estudio fue diagnosticar el estado nutricional de los deportistas del equipo olímpico nacional de levantamiento de pesas del Comité Olímpico Brasileño (COB). La muestra estuvo compuesta por 24 deportistas, con edades entre 16 y 23 años, siendo 12 hombres (19,7 ± 2,4 años) y 12 mujeres (19,2 ± 1,8 años). Para diagnosticar el estado nutricional se empleó: análisis de la adecuación del consumo energético de macronutrientes, carbohidratos (CHO), lípidos (LIP) y proteínas (PRO), por medio de los métodos recordatorio de 24 horas y encuesta de frecuencia de consumo alimentar, además de establecer el perfil antropométrico. Los resultados indican que la distribución energética entre los macronutrientes esta adecuada, al registrarse 54 ± 6,8 por ciento (CHO); 28,5 ± 5,9 por ciento (LIP); 14,5 ± 3,4 por ciento (PRO) en los hombres y 56,3 ± 4,7 por ciento (CHO); 28,6 ± 4,6 por ciento (LIP); 13,7 ± 2,4 por ciento (PRO) en las mujeres. Sin embargo, el consumo energético total indica que 83 por ciento de los deportistas estaban con un consumo por debajo de los valores recomendados, considerando el alto nivel de actividad física, produciendo así una deficiencia energética diaria. El porcentaje de grasa corporal en los hombres (3,6 ± 0,7 por ciento) indica que todos estaban debajo de los valores de referencia; por otra parte, 58 por ciento de las mujeres presentaron exceso de grasa (17,9 ± 5,8 por ciento). Se puede concluir que los deportistas evaluados, mismo realizando la distribución energética entre los macronutrientes adecuada, no esta siendo suficiente para atender las necesidades de los deportistas, necesitando así, de una orientación nutricional.

The requirements of protein & amino acid during acute & chronic infections.

Nutrition and infection interact with each other in a synergistic vicious cycle, leading to an adverse nutritional status and increased susceptibility to infection. Infectious episodes result in hypermetabolism and a negative nitrogen balance which is modulated by hormones, cytokines and other pro-inflammatory mediators, and is compounded by a reduced food intake. The extent of the negative nitrogen balance varies with the type of infection and its duration; however, it is reasonable to suggest that the loss of body protein could be minimized by the provision of dietary nitrogen, although anorexia will limit this. Further, distinctions need to be made about the provision of nutrients or protein during the catabolic and anabolic or recovery phase of the infection, since the capacity of the body to retain protein is enhanced in the anabolic recovery phase. Meeting the increased requirement for protein (and other nutrients) in infection does not imply a complete therapeutic strategy. Infections need to be treated appropriately, with nutrition as an adjunct to the treatment. Prior undernutrition could also impair the body's response to infection, although the weight of the evidence would suggest that this happens more particularly in oedematous undernutrition. In general, the amount of extra protein that would appear to be needed is of the order of 20-25 per cent of the recommended intake, for most infections. In acute infections, this is particularly relevant during the convalescence period. Community trials have suggested that lysine supplementation to the level required for normal daily nutriture, in predominantly wheat eating or potentially lysine deficient communities, improves immune function among other functional nutritional parameters; however, there is as yet insufficient evidence to suggest a specific requirement for amino acids in infections over and above the normal daily requirement as based on recent evidence. Some clinical studies that have showed benefits with specific amino acids through selected clinical outcomes, however, these do not provide enough evidence for a firm recommendation.

Effect of undernutrition and subsequent rehabilitation on brain 5-HT (serotonin) profile of developing newborn rats.

For littermate comparison, undernutrition in half of the pups of a litter was induced by 12h maternal deprivation from day 5 to day 18 postnatal. Subsequently, undernourished suckling rats were rehabilitated. Brain 5-HT concentrations and its turnover rate were measured on different days of age up to the period of 3 months. Brain 5-HT concentration was approximately half of the adult level at birth and increased progressively, except with a steep fall on day 18 postnatal, to the adult level by day 25 postnatal and thereafter it did not vary much on different days of age. Undernourished newborn rats showed significantly low level of brain 5-HT on day 9 and significantly higher concentrations on day 12 and 18 postnatal, whereas, rehabilitated rats showed comparable brain 5-HT concentrations with that of their nourished littermates. It is concluded that undernutrition had affected the brain 5-HT concentration and its turnover rate. Brain 5-HT concentration was low during early phase and was more during late phase of undernutrition. Rehabilitation of undernourished rats restored the brain 5-HT concentration similar to that of their nourished littermates.