Padrão de refeições realizadas por adolescentes que frequentam escolas técnicas de São Paulo / Pattern of meals eaten by adolescents from technical schools of São Paulo, SP, Brazil

OBJETIVO: Avaliar e caracterizar o consumo de refeições realizadas por adolescentes. MÉTODOS: Estudo transversal com 71 adolescentes do ensino médio de escolas técnicas de São Paulo. Foi utilizado um questionário que avalia atitudes alimentares de ado-lescentes. As variáveis estudadas foram: frequência, local, com quem realiza as refeições e substituição de refeições por lanches. Os dados foram analisados descritivamente e o teste do qui-quadrado comparou as variáveis segundo gênero, considerando nível de significância de 5 por cento. RESULTADOS: Do total, 58 por cento eram do gênero feminino. A maioria relatou realizar as principais refeições em casa (88 por cento café da manhã, 91 por cento almoço e 96 por cento jantar). Quanto à frequência do consumo, 49 por cento realizavam todos os dias o café da manhã, 65 por cento o almoço e 51 por cento o jantar. Os adolescentes consumiam tanto o café da manhã (48 por cento) quanto o almoço (39 por cento) sozinhos, enquanto o jantar (77 por cento) era realizado com os pais, havendo, para o jantar, diferença entre gêneros (p=0,022). Observou-se que 29 por cento substituíam o almoço por lanches e, destes, 17 por cento o faziam uma a duas vezes por semana. No jantar, uma porcentagem maior de adolescentes o subs-tituía por lanche (62 por cento), sendo a frequência de substituição de uma a duas vezes por semana para 42 por cento deles. CONCLUSÕES: Apesar de os adolescentes realizarem as re-feições em casa, as mesmas não são feitas diariamente nem acompanhadas pelos pais.

OBJECTIVE: To evaluate and characterize the meal con-sumption of adolescents. METHODS:This cross-sectional study enrolled 71 high school students from technical schools of São Paulo (SP), Brazil. A questionnaire to assess food attitudes of adoles-cents was applied to the students. The variables studied were: frequency, location, with whom they had meals and the replacement of lunch and/or dinner for snacks. Data were analyzed descriptively. The chi-square test was used to compare variables by gender, being significant p<0.05. RESULTS: Among 71 adolescents, 58 percent were female. The majority reported eating the main meals at home (88 percent breakfast, 91 percent lunch, 96 percent dinner). Regarding the frequen-cy of meal consumption, 49 percent have breakfast, 65 percent lunch, and 51 percent have dinner every day. Adolescents not only eat breakfast (48 percent) but also lunch (39 percent) alone, while the dinner (77 percent) is a family meal. Eating meal with parents differed between genders (p=0.022). Snacks replaced lunch for 29 percent of the adolescents. Among these, 17 percent replace lunch once or twice a week. Snacks replace dinner for 62 percent of the studied population and 42 percent of them once or twice a week. CONCLUSIONS: Although young people eat their meals at home, these meals are not taken daily or in the company of their parents.

OBJETIVO: Evaluar y caracterizar el consumo de comidas realizadas por adolescentes. MÉTODOS: Estudio transversal con 71 adolescentes de la secundaria de escuelas técnicas de São Paulo (Brasil), prove-nientes de un estudio transversal. Se utilizó un cuestionario que evalúa actitudes alimentares de adolescentes. Las variables estudiadas fueron: frecuencia, local, con quién realiza las co-midas y la sustitución de comidas por meriendas. Los datos fueron analizados descriptivamente y se utilizó la prueba del Chi-Cuadrado para comparaciones de las variables según gé-nero, considerando un nivel de significancia de 5 por ciento. RESULTADOS: Del total, 58 por ciento eran del género femenino. La mayoría relató realizar las principales comidas en casa (88 por ciento desayuno, 91 por ciento almuerzo, 96 por ciento cena). Respecto a la frecuencia del consumo, 49 por ciento desayunaban, 65 por ciento almorzaban y 51 por ciento cenaban todos los días. Los adolescentes consumían tanto el desayuno (48 por ciento) como el almuerzo (39 por ciento) solos, mientras que la cena (77 por ciento) era realizada con los padres, siendo verificada, para esta última, diferencia entre géneros (p=0,022). Se observó que un 29 por ciento sustituía el almuerzo por meriendas, con diferencia entre géneros (p=0,057) y, de éstos, el 17,4 por ciento lo hacía de 1 a 2 veces por semana. En la cena, un porcentaje más grande de adolescentes la sustituía por merienda (62 por ciento), siendo para 42 por ciento de ellos la frecuencia de sustitución de 1 a 2 veces por semana. CONCLUSIONES: A pesar de que los adolescentes realizan las comidas en casa, éstas no eran realizadas diariamente y tampoco acompañadas por los padres.

Consumo de bebidas e refrigerantes por adolescentes de uma escola pública / Beverage and soft drink consumption by adolescents from a public school

OBJETIVO: Avaliar o consumo de bebidas e refrigerantes por adolescentes de uma escola pública de São Paulo (SP). MÉTODOS: Participaram do estudo 71 adolescentes com idade entre 14 e 17 anos, de ambos os gêneros, matriculados no ensino médio em uma escola técnica da região metropolitana de São Paulo. Avaliaram se o tipo de bebida consumida durante as refeições, os locais onde se consome refrigerante e o motivo que leva ao consumo. RESULTADOS: A bebida mais consumida durante as refeições foi o suco de frutas industrializado (38,1 por cento), seguido do refrigerante do tipo comum (28,6 por cento) e do suco de frutas natural (22,2 por cento). Os locais do consumo de refrigerantes foram a casa (38,2 por cento), seguida da escola (22,1 por cento). O principal fator apontado para o consumo de refrigerantes foi o sabor (75,4 por cento). CONCLUSÕES: O consumo de bebidas açucaradas foi frequente entre adolescentes, especialmente o refrigerante. Essas bebidas são disponíveis e consumidas tanto em casa como na escola e consideradas saborosas. Os programas de educação nutricional devem pensar em como priorizar o consumo de outras bebidas, além de controlar a comercialização de refrigerantes nas escolas, com o objetivo de estimular o consumo de bebidas mais saudáveis para essa faixa etária.

OBJECTIVE: To evaluate the consumption of beverage and soft drinks by adolescents of a public school in São Paulo, Brazil. METHODS: 71 adolescents (aged between 14 to 17 years old) from both genders, attending a technical school in the metropolitan area of São Paulo, answered the following questions: the kind of beverage taken during meals, the places where soft drinks were consumed and the main reason related to this intake. RESULTS: The most frequent consumed beverage was the industrialized fruit juice (38.1 percent), followed by regular soft drinks (28.6 percent) and natural fruit juices (22.2 percent). The main place where soft drinks were consumed was home (38.2 percent), followed by school (22.1 percent). The main reason associated with soft drink intake was the flavor (75.4 percent). CONCLUSIONS: Sweet beverage intake was frequent among adolescents, specially soft drinks. These beverages are available and consumed at home and at school, and they were considered tasteful. Nutritional education programs should discuss how to prioritize the intake of other beverages and how to control the sale of these products at schools, aiming to stimulate the intake of more healthy beverages by adolescents.

OBJETIVO: Evaluar el consumo de bebidas y refrescos por adolescentes de una escuela pública de São Paulo. MÉTODOS: Participaron del estudio 71 adolescentes con edad entre 14 y 17 años, de ambos géneros, matriculados en la secundaria en una escuela técnica de la región metropolitana de la ciudad de São Paulo. Se evaluó el tipo de bebida consumida durante las comidas, los locales donde se consumen refrescos y el motivo que lo lleva al consumo. RESULTADOS: La bebida más consumida durante las comidas fue el jugo de frutas industrializado (38,1 por ciento), seguido por el refresco de tipo común (28,6 por ciento) y por el jugo de frutas natural (22,2 por ciento). Los locales del consumo de refrescos fueron la casa (38,2 por ciento), seguido por la escuela (22,1 por ciento). El principal factor señalado para el consumo de refrescos fue el sabor (75,4 por ciento). CONCLUSIONES: El consumo de bebidas con azúcar, especialmente los refrescos, fue frecuente entre adolescentes. Esas bebidas son disponibles y consumidas tanto en casa como en la escuela y son consideradas sabrosas. Los programas de educación nutricional deben pensar en cómo priorizar el consumo de otras bebidas, además de controlar la comercialización de esos productos en las escuelas, con el objetivo de estimular el consumo de bebidas más sanas para esa franja de edad.

Pathologic basis of echogenic cystic lesions in the human placenta: role of ultrasound-guided wire localization.

OBJECTIVE: The sonographic appearance of the placenta is normally homogenous throughout the second trimester. A variety of abnormalities in placental texture have been described, some of which may be pathologic and associated with adverse clinical outcomes. We characterized the pathologic basis of one lesion termed echogenic cystic lesions (ECLs) that may be a prognostic marker in intrauterine growth restriction (IUGR). STUDY DESIGN: We retrospectively correlated placental pathology in 50 pregnancies that had a total of 84 ECLs documented by ultrasound prior to delivery. Six additional women with placental ECLs prospectively underwent immediate post-delivery ultrasound-guided wire localization of 9 lesions followed by placental pathology. Obstetric outcome data were recorded. RESULTS: Severe pre-eclampsia (20%) and extreme IUGR (18%) were common outcomes. Of 93 ECLs identified, 46 (49%) gross lesions were found by placental pathology. Inter-villous thrombosis was the most significant lesion found (30/46, 65%) compared to all other lesions (35%; Z-Test, p = 0.007). Ultrasound guidance identified 8/9 (89%) lesions of which 6/8 (67%) were inter-villous thrombosis. Associated lesions (infarction, 36%; advanced villous maturation, 27%) and small placental weight (<10th centile, 38%) were present in 50%, but did not increase the risk of adverse perinatal outcome. CONCLUSIONS: ECLs are most commonly due to inter-villous thrombosis. The adverse clinical outcomes may be mediated by associated lesions not readily detectable by ultrasound. Ultrasound-guided wire localization is a promising research tool for future large-scale cohort studies needed to define the clinical utility of placental ultrasound findings.

Genetic polymorphisms in the fibrinolytic system of placentas with massive perivillous fibrin deposition.

Massive perivillous fibrin deposition (MPFD) and maternal floor infarction (MFI) of the placenta are rare related conditions associated with poor perinatal outcome including antepartum stillbirth. The diseases are characterized by pathologic accumulation of fibrinoid deposits that surround the placental villi (in the case of MFI predominantly in the basal regions adjacent to the decidual plate). These findings suggest either overproduction and/or defective clearance of fibrinoid within the intervillous space. Recently genetic polymorphisms of the plasminogen activator inhibitor-1 (PAI-1) gene have been found in association with impaired fibrinolysis in the pelvis predisposing to endometriosis. We hypothesized that polymorphisms in one or more of four genes that regulate fibrinolysis were associated with MPFD and MFI placentas. We retrospectively identified 20 consecutive cases of MPFD/MFI from our placental pathology database and generated 2 random gestational age-matched controls for each case. Clinical charts were reviewed. DNA was extracted from archived paraffin blocks of placental tissue from cases and controls. Single nucleotide repeat polymorphisms (SNPs) in loci within PAI-1 gene, thrombin activated fibrinolysis inhibitor (TAFI) gene, plasminogen activator urokinase (u-PA) gene and plasminogen activator tissue (t-PA) gene were studied using PCR methods. Outcomes in the study group included perinatal death (8), preterm IUGR (6), preeclampsia (4) and only 3 normal term deliveries. A spectrum of placental ultrasound abnormalities was observed. No SNP polymorphism was found to associate with MPFD/MFI. MPFD/MFI are associated with significant abnormal perinatal outcomes but have not been shown to be mediated by polymorphisms in candidate genes that are predicted to impair fibrinolysis in our study.

Ultrastructure of lamellar bodies in congenital surfactant deficiency.

Congenital surfactant deficiency (CSD) is a newly identified neonatal lung disorder associated with a variety of molecular defects affecting surfactant synthesis and secretion in alveolar type II cells. The authors present ultrastructural findings of abnormal lamellar bodies in lung biopsies from 4 infants with CSD. All were term infants presenting shortly after birth with severe respiratory failure that was unresponsive to conventional therapy and all died within the first month of life. Lung biopsies were performed between 8 and 25 days of age. Biochemical and molecular studies in 2 unrelated male infants identified SP-B deficiency, one case with 121 ins 2 mutation and the second with a 209 + 4 A > G mutation. Light microscopy in both cases showed features of alveolar proteinosis. Ultrastructurally, alveolar type II cells lacked mature lamellar bodies, and their cytoplasm contained numerous pleomorphic inclusions with membranous and vesicular structures not seen in normal type II cells. The other 2 infants were a pair of siblings in whom molecular studies identified mutations in ABCA3 transporter gene. Light microscopy showed features of acinar dysplasia and desquamative interstitial pneumonitis. TEM studies revealed absence of mature lamellar bodies in type II cells and instead showed a mixture of cytoplasmic electron-dense inclusions with concentric membranes and distinctive electron dense aggregates. The ultrastructural changes in alveolar type II cells correlated well with specific gene defect. In SP-B deficiency, the absence of mature lamellar bodies is consistent with the postulated role for this protein in the formation of lamellar bodies. The lack of mature lamellar bodies in the ABCA3 gene mutations is due to the dysfunction of this endogenous lipid transporter that targets surfactant lipid moieties to the lamellar bodies. The findings demonstrate the importance of TEM studies of lung biopsies from infants with CSD as it is a critical adjunct in the diagnosis of neonatal lung disease and in defining the underlying cellular defects.

Prognostic value of placental ultrasound in pregnancies complicated by absent end-diastolic flow velocity in the umbilical arteries.

Our objective was to evaluate the utility of gray-scale placental ultrasound for the detection of pathological lesions in the placentas of preterm pregnancies with abnormal fetoplacental blood flow (defined by absent or reversed end-diastolic flow velocities [ARED] in the umbilical arteries) before 32 weeks of gestation. Sixty consecutive structurally and chromosomally normal singleton pregnancies were evaluated. Pre-defined criteria were used to describe placental appearances using gray-scale real-time ultrasound. Proximal uterine artery Doppler waveforms were recorded using pulsed and color Doppler ultrasound. Each patient had a thrombophilia profile. Following delivery, a single perinatal pathologist reviewed each placenta at a gross and microscopic level blinded to the placental ultrasound findings. Placental shape or texture was abnormal on gray-scale ultrasound in 43/59 (73%) and echogenic cystic lesions (ECL) were found in 16 (27%). Uterine artery Doppler was abnormal in 47/60 (78%) cases. Thirty-eight pregnancies were subsequently delivered by planned Caesarean section in the fetal and/or maternal interest (birthweights 540-2300 g, mean gestational age 30.6 weeks) and 21 pregnancies resulted in the vaginal delivery of a stillborn fetus where fetal weight and/or gestational age did not justify Caesarean section (birthweights 85-600 g, mean gestational age 24.9 weeks). ECL had a low positive predictive value for both villous infarcts (63%) and for focal/massive perivillous fibrin deposition (40%). Nevertheless, the combination of abnormal uterine artery Doppler and abnormal gray-scale findings (abnormal placental morphology or ECL) was strongly predictive of stillbirth (17/21; sensitivity 81%, PPV 52%, p = 0.006 Fisher's exact test). Pregnancies with ARED in the umbilical arteries have a high perinatal mortality associated with pathology of the placental villi. Ultrasound examination of the placenta and its maternal blood supply may contribute to the perinatal management of these pregnancies.

Ultrasound diagnosis of severe thrombotic placental damage in the second trimester: an observational study.

OBJECTIVES: To screen women with uteroplacental insufficiency between 18 and 26 weeks' gestation for sonographic evidence of destructive placental lesions, to observe the effect of low molecular-weight heparin (LMWH) in these cases, and to compare the outcome with similar but untreated controls. METHODS: We screened 180 women at high risk for placental damage using 16-week maternal serum screening (alpha-fetoprotein and human chorionic gonadotropin), placental shape and texture, and uterine artery Doppler waveforms at the 18-20-week level II examination. Serial gray-scale examinations of placental texture were performed at 22, 24 and 26 weeks. LMWH was offered to women with ultrasound evidence of destructive placental lesions in the absence of intrauterine growth restriction and/or pre-eclampsia. RESULTS: We prospectively identified six women (3.3%) with abnormal maternal serum screening and uterine artery Doppler in whom abnormal placental texture (echogenic cystic lesions) suggestive of destructive lesions in the placental parenchyma was found either at the 18-20-week ultrasound examination (n = 4), or by 26 weeks of gestation (n = 2). All six received LMWH and had live births (gestational age at delivery, 33-37 weeks; birth weight, 1000-3200 g). A further 14 women were referred with similar multiparameter evidence of placental damage at or after 26 weeks, outside the screening study. All had significant fetal growth restriction and were therefore not offered heparin. In 9/14 cases there was a perinatal death. Ischemic and/or thrombotic placental pathology was confirmed in each case, but no maternal thrombophilia disorders were identified in the 20 women. CONCLUSIONS: Integrated biochemical and ultrasound testing of placental function at 16-20 weeks of gestation, followed by serial placental gray-scale ultrasound, may be an effective method of identifying a subset of pregnancies at high risk of adverse pregnancy outcome due to destructive lesions in the placental parenchyma. This strategy of identifying thrombo-occlusive placental lesions before the development of pregnancy complications may prove useful in the design of trials to study the effectiveness of LMWH in the prevention of clinical complications resulting from thrombo-occlusive placental disease.