Riesgo nutricional de pacientes hospitalizados en el Hospital de Especialidades Pediátricas "Omar Torrijos Herrera" / Nutritional screening of hospitalized patients at Hospital de Especialidades Pediátricas Omar Torrijos Herrera

Introducción: La desnutrición intrahospitalaria tiene grandes implicaciones socio-económicas para los países. Sus manifestaciones dependen del grado, tiempo de evolución, déficit ponderal y edad del niño. El objetivo de este estudio es conocer el riesgo nutricional de los pacientes hospitalizados en la Sala de Medicina del Hospital de Especialidades Pediátricas. Métodos: Estudio descriptivo, transversal, pacientes de ambos sexos de 1 mes a 15 años de edad, ingresados a la sala de medicina del Hospital de Especialidades Pediátricas en noviembre de 2014. Se aplicaron dos métodos de tamizaje nutricional, Screening Tool for Assessment of Malnutrition in Paediatrics (STAMP) y Screening Tool for Risk On Nutritionational status and Growth (STRONGKIDS) y se estableció el riesgo nutricional de cada sujeto en estudio. Resultados: 147 pacientes participaron en el estudio. La edad promedio fue de 4,5 años (DE: 4,8), la mayoría eran lactantes (50,3%), con predominio del sexo masculino (56%). Se encontró desnutrición al momento del ingreso en el 12,8% y sobrepeso-obesidad en el 26,6%. STAMP clasificó al 18,3% de la muestra con riesgo nutricional elevado. Dicho método mostró una sensibilidad 57,8% y una especificidad del 87,5%. En cuanto a la prueba de tamizaje STRONGKIDS identificó a un 12,2% con riesgo elevado, con una sensibilidad de 47,3% y especificidad del 92,3%. La concordancia (k) entre STAMP y la evaluación nutricional fue de 0,38 y en el caso de STRONGKIDS fue de 0,41. Conclusiones: Podemos concluir que la prevalencia de desnutrición al momento del ingreso fue del 12,8%. Ambas pruebas de tamizaje nutricional mostraron una buena especificidad (>80%). El riesgo nutricional se correlaciona con las medidas antropométricas principalmente en STRONGKIDS.

Introduction: Malnutrition in hospitalized patients is a prevalent condition and is associated with many adverse outcomes. It depends on the degree, time of evolution, weight deficit and age of the child. There is a direct relationship between nutritional deterioration and longer hospitalization time, causing an increase in the frequency of complications and increased mortality. The objective of this study is to know the nutritional risk of hospitalized patients at Hospital de Especialidades Pediátricas Omar Torrijos Herrera. Methods and materials: Cross-sectional descriptive study with patients evaluated within 48 hours of admission. Patients were aged 1 month or older, both sexes, admitted to the medicine room at Hospital de Especialidades Pediátricas in November 2014. Nutritional risk was assessed by two nutritional screening methods: STAMP and STRONGKIDS. Nutritional status was classified through anthropometrics measurements. The study was approved by the Research Ethics Committee and the signing of the informed consent was required before its inclusion in the study. Results: We evaluated 147 patients aged 4.5 ± 4.8 years, 50.3% were infants and with a predominance of males (56%). The prevalence of malnutrition was 12.8% and for overweight-obesity was 26.6%. STAMP classified 18.3% of patients as high nutritional risk. This method showed a sensitivity of 57.8% and a specificity of 87.5%. Regarding, STRONGKIDS identified 12.2% of patients at high risk, with a sensitivity of 47.3% and specificity of 92.3%. The concordance (k) between STAMP and nutritional evaluation was 0.38 and in the case of STRONGKIDS it was 0.41. Conclusion: The prevalence of malnutrition at the time of admission was 12.8%. STAMP and STRONG KIDS demonstrated high specificity. Nutritional risk is correlated with anthropometric measures mainly in STRONGKIDS. Further studies are required to analyze these tools and nutritional interventions derived from them.

Asociación entre la conducta alimentaria y polimorfismos genéticos de la leptina y su receptor en niños obesos chilenos / Association between feeding behavior, and genetic polymorphism of leptin and its receptor in obese Chilean children

Introducción: La leptina (LEP) se produce principalmente en el tejido adiposo y actúa en el hipotálamo regulando la ingesta energética. Mutaciones en el gen LEP o en su receptor (LEPR) que generen obesidad monogénica son pocos frecuentes. Sin embargo, polimorfismos de LEP y LEPR han sido relacionados con la obesidad multifactorial, debido a la asociación encontrada con el peso corporal y la conducta alimentaria. Objetivo: Medir la asociación entre polimorfismos de LEP y LEPR con obesidad infantil y conducta alimentaria en niños obesos. Métodos: Se reclutaron 221 niños obesos Chilenos (IMC sobre el percentil 95). Los progenitores de 134 de esos niños también fueron reclutados, para determinar la asociación entre los polimorfismos de LEP y LEPR con la obesidad en un estudio de tríos caso-progenitor. La conducta alimentaria se midió a través del cuestionario de alimentación de tres factores versión progenitores (TFEQ-P19) y el de conducta alimentaria en niños (CEBQ). Resultados: No se observa una diferencia significativa entre los polimorfismos estudiados y la obesidad infantil, luego de la corrección por comparaciones múltiples. Por otro lado, se encontraron asociaciones significativas entre ciertos polimorfismos de LEP y LEPR con dimensiones de la conducta alimentaria tales como: 'lentitud para comer', 'alimentación emocional', 'disfrute de los alimentos' y 'alimentación sin control'. Conclusiones: Existiría una asociación entre polimorfismos de los genes LEP y LEPR con la conducta alimentaria en niños obesos Chilenos (AU)

Introduction: Leptin (LEP) is mainly produced in adipose tissue and acts in the hypothalamus to regulate energy intake. Mutations in the LEP gene or its receptor (LEPR) that produce monogenic obesity are infrequent. However, LEP and LEPR polymorphisms have been associated with obesity multifactorial, due to the association found with body weight and eating behavior. Aim: Measure the association between LEP and LEPR polymorphisms with childhood obesity and eating behavior. Methods: 221 Chilean obese children (BMI above the 95th percentile) were recruited. Parents of 134 of these children were also recruited to determine the association between LEP and LEPR polymorphisms with obesity in a case study-parent trio. Eating behavior was measured through the questionnaire of three factors progenitors’ version (TFEQ-P19) and eating behavior in children (CEBQ). Results: No significant difference between the studied polymorphisms and childhood obesity, after correction for multiple comparisons, was observed. The dimensions; 'Slow eating', 'emotional eating', 'enjoyment of food' and 'uncontrolling eating' were significant associated with certain polymorphisms of LEP and LEPR. Conclusions: There would be an association between polymorphisms of the LEP and LEPR genes with eating behavior in Chilean obese children (AU)

Reporte de un caso clínico único: agenesia de tráquea

Presentamos un caso de neonato masculino de 3 días de vida con antecedente de Síndrome antifosfolípido y polihidramnios. Nace vía cesárea 39 semanas, sin esfuerzo respiratorio, Apgar 3/7 que amerito intubación endotraqueal inmediata. No se logra colocar sonda nasogástrica. Se realizó cirugía por diagnóstico de atresia esofágica con fistula distal. En SOP se realiza toracotomía posterolateral derecha con disección esofágica extensa, se cambió tubo endotraqueal varias veces de posición observando paso al esófago proximal. Se sospechó Agenesia Traqueal con circuito de esófago que ventila pulmones a través de fistula en H, se decidió no cerrarla y se ligó esófago distal. Se realizó autopsia que evidenció ausencia de tráquea, comunicación de estructura que semejaba esófago proximal hacia unión de los bronquios derecho e izquierdo, adicionalmente presencia de otras malformaciones que incluía atresia duodenal con páncreas anular.

A case of male infant 3 days old with a history of antiphospholipid syndrome and polyhydramnios. Born via cesarean, 39 weeks of gestation without respiratory effort, Apgar 3-7 that required immediate endotracheal intubation. It was not possible to place a nasogastric tube. Surgery was performed for diagnosis of esophageal atresia with distal fistula. In operating room right posterolateral thoracotomy was performed with esophageal extensive dissection, the endotracheal tube is repeatedly changed position, showing the proximal esophagus step. Tracheal agenesis was suspected with esophageal circuit ventilating lungs through fistula in H, it was decided not to close and distal esophagus was ligated. Autopsy showed absence of trachea, communication structure that resembled proximal esophagus into joining the right and left bronchi, further presence of other malformations including duodenal atresia and annular pancreas was performed

Melanocortin-4 receptor polymorphism rs17782313: association with obesity and eating in the absence of hunger in Chilean children.

OBJECTIVE: The aim of this study was to assess the association between melanocortin-4 receptor (MC4R) rs17782313 alleles with obesity and eating behavior scores in Chilean children. METHODS: A case-control study was conducted with 139 normal-weight and 238 obese children (ages 6-12 y). MC4R rs17782313 genotypes were determined by quantitative-polymerase chain reaction allelic-discrimination assays. Eating behavior scores were evaluated in a subset of participants using the Chilean version of the Child Eating Behavior Questionnaire (CEBQ). Additionally, five normal-weight C-allele carriers of rs17782313 were matched by sex, age, and body mass index (BMI) to five TT homozygous children to carry out the Eating in the Absence of Hunger (EAH) test. RESULTS: The frequency of the C-allele of MC4R rs17782313 was higher in the obese group than in the control group, without achieving statistical significance (odds ratio, 1.4; 95% confidence interval, 0.8-2.4; P = 0.16). CEBQ scores of "enjoyment of food" were higher (P = 0.04) and "satiety responsiveness" were lower (P = 0.02) in children with CC genotype than in those with TT genotype matched by sex, age, and BMI. In the EAH test, all five non-obese carriers of the C-allele (three CC and two CT) showed increased sweet snack consumption compared with five matched (by sex-age-BMI) non-carriers after a preload meal, without achieving statistical significance (P = 0.06). CONCLUSION: MC4R polymorphism rs17782313 may contribute to childhood obesity, affecting enjoyment of food, satiety responsiveness, and possibly eating in the absence of hunger.

[Association between feeding behavior, and genetic polymorphism of leptin and its receptor in obese Chilean children]. / Asociación entre la conducta alimentaria y polimorfismos genéticos de la leptina y su receptor en niños obesos chilenos.

INTRODUCTION: Leptin (LEP) is mainly produced in adipose tissue and acts in the hypothalamus to regulate energy intake. Mutations in the LEP gene or its receptor (LEPR) that produce monogenic obesity are infrequent. However, LEP and LEPR polymorphisms have been associated with obesity multifactorial, due to the association found with body weight and eating behavior. AIM: Measure the association between LEP and LEPR polymorphisms with childhood obesity and eating behavior. METHODS: 221 Chilean obese children (BMI above the 95th percentile) were recruited. Parents of 134 of these children were also recruited to determine the association between LEP and LEPR polymorphisms with obesity in a case study-parent trio. Eating behavior was measured through the questionnaire of three factors progenitors' version (TFEQ-P19) and eating behavior in children (CEBQ). RESULTS: No significant difference between the studied polymorphisms and childhood obesity, after correction for multiple comparisons, was observed. The dimensions; "Slow eating", "emotional eating", "enjoyment of food" and "uncontrolling eating" were significant associated with certain polymorphisms of LEP and LEPR. CONCLUSIONS: There would be an association between polymorphisms of the LEP and LEPR genes with eating behavior in Chilean obese children.

Introducción: La leptina (LEP) se produce principalmente en el tejido adiposo y actúa en el hipotálamo regulando la ingesta energética. Mutaciones en el gen LEP o en su receptor (LEPR) que generen obesidad monogénica son pocos frecuentes. Sin embargo, polimorfismos de LEP y LEPR han sido relacionados con la obesidad multifactorial, debido a la asociación encontrada con el peso corporal y la conducta alimentaria. Objetivo: Medir la asociación entre polimorfismos de LEP y LEPR con obesidad infantil y conducta alimentaria en niños obesos. Métodos: Se reclutaron 221 niños obesos Chilenos (IMC sobre el percentil 95). Los progenitores de 134 de esos niños también fueron reclutados, para determinar la asociación entre los polimorfismos de LEP y LEPR con la obesidad en un estudio de tríos caso-progenitor. La conducta alimentaria se midió a través del cuestionario de alimentación de tres factores versión progenitores (TFEQ-P19) y el de conducta alimentaria en niños (CEBQ). Resultados: No se observa una diferencia significativa entre los polimorfismos estudiados y la obesidad infantil, luego de la corrección por comparaciones múltiples. Por otro lado, se encontraron asociaciones significativas entre ciertos polimorfismos de LEP y LEPR con dimensiones de la conducta alimentaria tales como: "lentitud para comer", "alimentación emocional", "disfrute de los alimentos" y "alimentación sin control". Conclusiones: Existiría una asociación entre polimorfismos de los genes LEP y LEPR con la conducta alimentaria en niños obesos Chilenos.

Association between eating behavior scores and obesity in Chilean children.

BACKGROUND: Inadequate eating behavior and physical inactivity contribute to the current epidemic of childhood obesity. The aim of this study was to assess the association between eating behavior scores and childhood obesity in Chilean children. DESIGN AND METHODS: We recruited 126 obese, 44 overweight and 124 normal-weight Chilean children (6-12 years-old; both genders) according to the International Obesity Task Force (IOTF) criteria. Eating behavior scores were calculated using the Child Eating Behavior Questionnaire (CEBQ). Factorial analysis in the culturally-adapted questionnaire for Chilean population was used to confirm the original eight-factor structure of CEBQ. The Cronbach's alpha statistic (>0.7 in most subscales) was used to assess internal consistency. Non-parametric methods were used to assess case-control associations. RESULTS: Eating behavior scores were strongly associated with childhood obesity in Chilean children. Childhood obesity was directly associated with high scores in the subscales "enjoyment of food" (P < 0.0001), "emotional overeating" (P < 0.001) and "food responsiveness" (P < 0.0001). Food-avoidant subscales "satiety responsiveness" and "slowness in eating" were inversely associated with childhood obesity (P < 0.001). There was a graded relation between the magnitude of these eating behavior scores across groups of normal-weight, overweight and obesity groups. CONCLUSION: Our study shows a strong and graded association between specific eating behavior scores and childhood obesity in Chile.