The genetic predisposition increases the chances of schoolchildren maintaining higher adiposity levels after three years.

BACKGROUND: The behavior of anthropometrics and the relationship with genetic factors through a long-term perspective should be better explored. This study aims to verify the odds of maintaining the nutritional status classification after three years, according to the rs9939609 polymorphism (FTO gene). METHODS: It was a retrospective longitudinal study with 355 schoolchildren (7-17 years). Body mass index, body-fat percentage (BF%), and waist circumference (WC) were measured at baseline and follow-up. The FTO gene was evaluated from blood collection and genotyping performed by real-time polymerase chain reaction. Odds ratios and 95% confidence intervals were calculated. RESULTS: For those homozygous with the A allele, the odds of being at less favorable classification at follow-up were 2.29 (1.24; 4.22) and 4.05 (2.08; 7.86) times higher than expected for BF% and WC, respectively, whereas the odds of being in the more favorable classification at follow-up were 0.34 (0.12; 0.93) and 0.11 (0.01; 0.78) for BF% and WC, respectively. The odds of being at less favorable classification were higher for AA carriers with less favorable classification at baseline for BF% and WC compared to AT and TT carriers. CONCLUSIONS: Schoolchildren with a genetic predisposition to obesity and unfavorable anthropometric profile at baseline had more chances of maintaining their nutritional status after three years of follow-up.

The triglyceride-glucose index as an indicator of insulin resistance and cardiometabolic risk in Brazilian adolescents.

Objective: To set cutoff points for the triglyceride and glucose index (TyG) as a marker of insulin resistance (IR) for the pediatric population. Subjects and methods: This was a cross-sectional study with schoolchildren population-based data using data of 377 schoolchildren age 10 to 17 years of both sexes. We studied metabolic variables associated with IR indicators, such as fasting insulin and blood glucose, to calculate the homeostatic model assessment (HOMA-IR), and we studied triglycerides (TG) to determine the TyG index. We obtained TyG cutoff values for IR using the receiver operation characteristic (ROC), with definitions of sensitivity (Sen), specificity (Spe), and area under the ROC curve (AUC), with the HOMA-IR as reference. Results: The cutoff points of the TyG index for IR in adolescents are 7.94 for both sexes, 7.91 for boys, and 7.94 for girls, indicating moderate discriminatory power. When we also considered anthropometric variables of excess weight [TyG-BMI (body mass index)] and visceral fat [TyG-WC (waist circumference)], these indexes reached AUC values higher than 0.72, enhancing their potential use for a good diagnosis. Conclusion: TyG has proven to be a useful instrument for identifying IR in adolescent health screening, with high discrimination capacity when added to anthropometric variables, making it a feasible and inexpensive option.

Anthropometric Indicators of Body Composition Associated With Lipid and Glycemic Profiles in Overweight Brazilian Children and Adolescents From 2008 to 2020.

Background: Anthropometric indicators have been used to predict health problems. The objective was to determine which indicators present better correlation with dyslipidemia, hyperglycemia and peripheral insulin resistance, as well as the cutoff points capable of predicting lipid and glycemic alterations in Brazilian children and adolescents. Methods: A cross-sectional study conducted with 568 overweight individuals, aged between 5 and 18 years, living in Southeast and South Brazilian regions, submitted to anthropometric and body composition evaluation by bioimpedance, in addition to fasting laboratory tests [total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), fasting glycemia, and homeostasis model assessment-insulin resistance (HOMA-IR)]. Pearson's correlation was used to evaluate the association between anthropometric indicators and serum biomarkers. The ROC curve with Youden's J index was used to suggest anthropometric cutoff points with better ability to predict or rule out lipid and glycemic changes. Results: Cutoff points obtained for the z-score of body mass index (BMI), waist circumference (WC), and waist circumference for height (WC/H) showed high specificity (52 to 87%) and low sensitivity (23 to 59%), indicating greater ability to exclude changes in HDL-c, TG, and HOMA-IR levels. Cutoff points suggested for BMI ranged from +1.86 to +2.20 z-score. WC cutoff points ranged from +1.29 to +1.72, and, for the WC/H index, from +1.21 to +1.25. It was suggested the use of the following cutoff points to rule out changes in HDL-c, TG, and HOMA-IR values in clinical practice: BMI < z-score +2 and WC/H < z-score +1.29. In body fat percentage (BFP) analyses, the cutoff point < of 34% may be able to rule out changes in HDL-c (specificity of 70%), while the cutoff point > 36.6% may be able to predict changes in the HOMA-IR index (sensitivity of 76%). Conclusion: It is not yet possible to state which anthropometric parameter has the best correlation with lipid and glycemic alterations in overweight children and adolescents. We suggest considering BMI, WC, and WC/H cutoff points together to rule out changes in HDL-c, TG, and HOMA-IR, and use the BFP cutoff point to predict changes in HOMA-IR.

Clustering of cardiometabolic risk factors and the continuous cardiometabolic risk score in children from Southern Brazil: a cross-sectional study.

PURPOSE: The present study aimed to verify the clustering of cardiometabolic risk factors for cardiovascular diseases (CVD) and its relationship with the continuous cardiometabolic risk score (cMetS). METHODS: Cross-sectional study with 631 children aged 6 to 9 years. Cardiorespiratory fitness, glucose, systolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, triglycerides, and waist circumference were assessed. The number of children in whom the risk factors were not independently distributed was analyzed. Z-scores were computed for each risk factor to calculate the cMetS. RESULTS: There was a high proportion of children with clustering of risk factors for CVD. The clustering of risk factors was apparent in 11.3% of the children for four or more risk factors, and 21.9% had three or more risk factors. The cMetS showed a linear relationship with the increase in the number of risk factors. A cMetS value higher than 0.91 indicated clustering of cardiometabolic risk factors amongst children. CONCLUSION: The use of clustering of cardiometabolic risk factors identified a high proportion of children with the presence of relevant cardiometabolic alterations. A cMetS value higher than 0.91 (relative to an international standard) indicated higher clustering of cardiometabolic risk factors amongst children. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-021-00845-9.

FTO gene polymorphism and longitudinal changes in nutritional/obesity status in children and adolescents: Schoolchildren's health cohort study.

The fat mass and obesity-associated gene (FTO) has been extensively reported in the literature related to nutritional status, but there has been limited description of the genetic contribution to obesity risk during childhood and adolescence, especially in Latin Americans. This study aims to associate the rs9939609 polymorphism, of the FTO gene, with changes in nutritional status in Brazilian schoolchildren followed for 3 years. A longitudinal study was conducted with 355 schoolchildren, aged 7-15 years in 2011/2012 and subsequently re-evaluated in 2014/2015. Nutritional (obesity) status was classified by identifying those exceeding recommended thresholds for waist circumference (WC), waist-to-height ratio (WHtR), body mass index (BMI), and body fat percentage (BF%). The rs9939609 polymorphism was genotyped by a real-time polymerase chain reaction. Relative risk (RR with 95% confidence interval) of obesity status by FTO gene polymorphism was calculated by Poisson regression. The risk group was determined for genotypes with the allele A polymorphism, and regression models were adjusted for age, sex, height, ethnicity, and geographical location. Considering the longitudinal changes in status over the 3-year follow-up, the RR of developing a WC exceeding the threshold recommended (WC >75th age and sex-standardized percentile), or remaining with this condition, was higher in children with AT/AA genotype. For WC, the RR was 1.66 (1.07; 2.58) in crude analysis and 1.17 (1.01; 1.35) following adjustment for age (years), gender, ethnicity, and geographical location. The comparative risk of abdominal obesity, assessed by WHtR (not recommended threshold ≥0.50), was 53% and 8%, respectively, higher in AT/AA compared to TT genotype.Conclusion: This is one of the first longitudinal investigations to show a significant association between the A allele of the rs9939609 polymorphism and individuals with higher than recommended WC and WHtR measures in Brazilian children and adolescents. What is known: • The FTO has an effect on increases in body mass index (BMI) among children and adolescents. • It established the association between FTO and overweight/obesity in Caucasians. What is new: • The presence of the risk allele of rs9939609 (FTO gene) polymorphism is associated with increased abdominal fat in Brazilian schoolchildren. • Was detected an association between FTO gene polymorphism (rs9939609) with WC in follow-up cohort and changes in WC and WHtR follow-up over 3 years, during childhood and adolescence growth.

Neck circumference and cardiometabolic risk in children and adolescents: the moderator role of cardiorespiratory fitness.

BACKGROUND: The increased incidence of cardiometabolic risk factors has become a public health issue, especially in childhood and adolescence. Thus, early identification is essential to avoid or reduce future complications in adulthood. In this sense, the present study aimed to verify the influence of cardiorespiratory fitness (CRF) as a moderator in the association between neck circumference (NC) and cardiometabolic risk in children and adolescents. METHODS: Cross-sectional study that included 2418 randomly selected children and adolescents (52.5% girls), aged 6 to 17 years old. Anthropometric measurements, such as NC and body mass index (BMI), and CRF was measured by the six-minute running/walking test, as well as cardiometabolic risk (systolic blood pressure, glucose, HDL-C, and triglycerides), were assessed. RESULTS: For all age groups, NC showed a negative relationship with CRF. A significant interaction term was found for CRF x NC with cardiometabolic risk for children (6 to 9 years old), early adolescents (10 to 12 years old), and middle adolescents (13 to 17 years old). It was found that children who accomplished more than 1092.49 m in CRF test were protected against cardiometabolic risk when considering NC. In adolescents, protection against cardiometabolic risk was found when the CRF test was completed above 1424.14 m and 1471.87 m (early and middle stage, respectively). CONCLUSIONS: CRF is inversely associated with NC and acts as a moderator in the relationship between NC and cardiometabolic risk in children and adolescents. Therefore, this detrimental health impact linked to fatness might be attenuated by improving CRF levels.

Cutoff points for continuous metabolic risk score in adolescents from southern Brazil.

OBJECTIVE: There is no consensus on the best diagnostic criteria for metabolic syndrome (MetS) in the child and adolescent population. Thus, the present study aimed to establish cutoff points for a continuous metabolic risk score (cMetS) in adolescents from southern Brazil. METHODS: This was a cross-sectional study conducted between 2014 and 2015. The sample consisted of 1739 schoolchildren (985 girls), aged 10-17 years. cMetS was calculated by sum of the Z-score of the following parameters: waist circumference, systolic blood pressure, glucose, high-density lipoprotein cholesterol, triglycerides, and cardiorespiratory fitness. Three diagnostic criteria of MetS were used to create cut points for cMetS. RESULTS: The best cutoff point for cMetS was set at 3.40 for boys (sensitivity: 100.0%, specificity: 92.9%, AUC: 0.978) and 3.61 for girls (sensitivity: 100, 0%, specificity: 93.1%, AUC: 0.991). For these cutoff points, metabolic risk was found in 8.9% of adolescents (9.4% for boys and 8.5% for girls). A linear relationship was found between the mean values of cMetS and the number of components of MetS (mean cMetS -1.09 for no component present and 6.66 for 3 or more components). CONCLUSIONS: The use of cMetS is valid for adolescents and can detect a greater proportion of students with metabolic risk, compared to the current criteria for diagnosis of MetS.

Adductor muscle thickness of the thumb: A new and reliable parameter for nutritional assessment of pediatric inpatients.

BACKGROUND & AIMS: The adductor pollicis muscle thickness (APMT) is a promising method for evaluation of muscle loss and, consequently, malnutrition in adult and elderly patients. However, to date, there have been no studies of its applicability to the pediatric population. Within this context, we sought to evaluate the association of APMT with anthropometric variables, body mass index (BMI), pediatric Subjective Global Assessment (SGA) of nutrition, nutritional screening, and clinical outcomes in hospitalized pediatric patients. METHODS: This was a cross-sectional study of inpatients aged 4-8.9 years, recruited via convenience sampling from a pediatric hospital in Porto Alegre, Rio Grande do Sul, Brazil. Data collection took place between December 2014 and February 2016. Patients admitted to the intensive care unit, those unable to feed orally, and those with cerebral palsy or Down syndrome were excluded from the study. General and socioeconomic information was collected and the SGA Ped and STRONGkids were administered at hospital admission. Clinical data were collected from the electronic medical record. Anthropometric parameters and APMT were measured by properly calibrated examiners. Data analysis was carried out in SPSS version 21.0. The significance level was set at 5%. RESULTS: The sample consisted of 447 patients. Most (55.9%) were male; the mean age was 6.2 ± 1.4 years. Low APMT was significantly associated with underweight, short stature, low body fat percentage, and poor muscle reserve (p < 0.001). There were also significant associations of moderate and severe malnutrition (assessed by the SGA Ped) and high nutritional risk (assessed by the STRONGkids instrument) with reduced APMT (p < 0.001). Regarding clinical outcomes, a longer hospital stay was observed in patients with reduced APMT (p = 0.001). A receiver operating characteristic (ROC) curve, plotted considering the SGA Ped as the gold standard, suggested APMT cutoff points of 10.2 mm for boys and 9.5 mm for girls. Stratification by age yielded APMT cutoff points of 9.8 mm for boys younger than 6 years and 10.2 mm for those older than 6 years, and 9.2 mm and 9.8 mm for girls younger and older than 6 years, respectively. CONCLUSION: The APMT is an efficient parameter for the detection of malnutrition in hospitalized pediatric patients.

Comparison between different criteria for metabolic syndrome in schoolchildren from southern Brazil.

The metabolic syndrome (MetS), although more frequent in adults, is already evident in the infant-juvenile population. On the other hand, there are different criteria for the diagnosis, without a consensus of which is the best to be used in this population. The aim of this study was to evaluate the agreement between different criteria for diagnosis of MetS in adolescents from southern Brazil. A cross-sectional study consisting of a sample of 1200 subjects, 679 females, aged between 12 and 17 years. MetS was assessed by three different criteria: Cook (2003), Ferranti (2004), and International Diabetes Federation - IDF (2007). The agreement between the criteria was evaluated by the Kappa index. Low prevalence of MetS was found among schoolchildren (1.9% for Cook, 5.0% for Ferranti, and 2.1% for IDF). Regular (Ferranti - IDF: Kappa 0.382; p < 0.001) and moderate (Cook - Ferranti: Kappa 0.542; p < 0.001; Cook - IDF: Kappa 0.532; p < 0.001) agreement was demonstrated between the criteria. Elevated blood pressure was the most frequent condition in all the criteria, and the least frequent condition was in the glycemia (Cook and Ferranti) and high-density lipoprotein cholesterol levels. CONCLUSION: The low prevalence of MetS and the low agreement among the existing criteria suggest the elaboration of new criteria for the diagnosis of MetS in the child and adolescent population. What is Known: • There are different criteria for the diagnosis of the metabolic syndrome (MetS), without a consensus of which is the best to be used in the infant-juvenile population. What is New: • Low prevalence of MetS identified among schoolchildren and the low agreement among the existing criteria suggest the elaboration of new criteria for the diagnosis of MetS in the child and adolescent population.

Different Criteria for the Definition of Insulin Resistance and Its Relation with Dyslipidemia in Overweight and Obese Children and Adolescents.

PURPOSE: to compare cut off points corrected for age and gender (COOP) with fixed cut off points (FCOP) for fasting plasma insulin and Homeostatic model assessment-insulin resistance (HOMA-IR) for the diagnosis of IR in obese children and adolescents and their correlation with dyslipidemia. METHODS: A multicenter, cross-sectional study including 383 subjects aged 7 to 18 years, evaluating fasting blood glucose, plasma insulin, and lipid profile. Subjects with high insulin levels and/or HOMA-IR were considered as having IR, based on two defining criteria: FCOP or CCOP. The frequency of metabolic abnormalities, the presence of IR, and the presence of dyslipidemia in relation to FCOP or CCOP were analyzed using Fisher and Mann-Whitney exact tests. RESULTS: Using HOMA-IR, IR was diagnosed in 155 (40.5%) and 215 (56.1%) patients and, using fasting insulin, 150 (39.2%) and 221 (57.7%), respectively applying FCOP and CCOP. The use of CCOP resulted in lower insulin and HOMA-IR values than FCOP. Dyslipidemia was not related to FCOP or CCOP. Blood glucose remained within normal limits in all patients with IR. There was no difference in the frequency of IR identified by plasma insulin or HOMA-IR, both for FCOP and CCOP. CONCLUSION: The CCOP of plasma insulin or of HOMA-IR detected more cases of IR as compared to the FCOP, but were not associated with the frequency of dyslipidemia. As blood glucose has almost no fluctuation in this age group, even in the presence of IR, fasting plasma insulin detected the same cases of IR that would be detected by HOMA-IR.

Nutritional Assessment Score: A new tool derived from Subjective Global Assessment for hospitalized adults.

BACKGROUND & AIMS: There is no method to be used as a reference standard for nutritional assessment. This study aims to develop and verify the performance of a new tool, based on the Item Response Theory (IRT), from the Subjective Global Assessment (SGA) questionnaire, in hospitalized adult patients. METHODS: Retrospective cohort study, composed by secondary database, formed by patients included from October 2005 to June 2006. The new tool presented was developed through the usage of cumulative models from the IRT. Out of 1503 evaluated patients, 2/3 were randomly selected to the development sample of the new tool and 1/3 to the performance verification sample. RESULTS: After item adjustments, the "Nutritional Assessment Score" (NAS) was proposed, with reduced number of questions, and, in comparison to SGA, less polytomic items. NAS demonstrates association to variables that are clinically relevant (hospital mortality, long hospital stay, serum albumin and body mass index) and has shown itself to be more precise to patients with the worst degrees of nutritional status. CONCLUSIONS: Results point to the validation of the NAS in detecting, accurately, the nutritional status of hospitalized patients.

Association between overweight and obesity in schoolchildren with rs9939609 polymorphism (FTO) and family history for obesity.

OBJECTIVE: To determine the association between overweight/obesity in schoolchildren with FTO rs9939609 polymorphism (fatmass and obesity associated) and family history of obesity. METHODS: Cross-sectional study comprising a sample of 406 children aged 7-17 years in a city in southern Brazil. Overweight/obesity in schoolchildren was assessed by body mass index (BMI), and family history of obesity was self-reported by parents. Polymorphism genotyping was performed by real time PCR (polymerase chain reaction). The association between the nutritional status of schoolchildren with the presence of family obesity, stratified by polymorphism genotypes (AA [at-risk for obesity], AT, and TT), was assessed by prevalence ratio values (PR) through Poisson regression. RESULTS: Among schoolchildren with the AA genotype, 57.4% had overweight/obesity; the percentage was lower for the AT and TT genotypes (33.1% and 28.9%, respectively). Overweight/obesity in schoolchildren was associated with a family history of obesity, especially among children with the AA genotype. The prevalence was higher among those with an obese mother (PR: 1.28; p<0.001), obese maternal or paternal grandmother (PR: 1.22; p=0.047), and obese paternal grandfather (PR: 1.32; p<0.001). CONCLUSIONS: There is an association between the AA genotype of rs9939609 polymorphism and BMI among schoolchildren. The association between overweight/obesity in schoolchildren with a family history of obesity was found mainly among students with the AA genotype.

Dyslipidemia is Associated with Unfit and Overweight-Obese Children and Adolescents.

BACKGROUND: Both poor aerobic fitness and obesity, separately, are associated with abnormal lipid profiles. OBJECTIVE: To identify possible relationships of dyslipidemia with cardiorespiratory fitness and obesity, evaluated together, in children and adolescents. METHODS: This cross-sectional study included 1,243 children and adolescents (563 males and 680 females) between 7 and 17 years of age from 19 schools. Obesity was assessed using body mass index (BMI) measurements, and cardiorespiratory fitness was determined via a 9-minute run/walk test. To analyze the lipid profile of each subject, the following markers were used: total cholesterol, cholesterol fractions (high-density lipoprotein and low-density lipoprotein) and triglycerides. Data were analyzed using SPSS v. 20.0, via prevalence ratio (PR), using the Poisson regression. RESULTS: Dyslipidemia is more prevalent among unfit/overweight-obese children and adolescents compared with fit/underweight-normal weight boys (PR: 1.25; p = 0.007) and girls (PR: 1.30, p = 0.001). CONCLUSIONS: The prevalence of dyslipidemia is directly related to both obesity and lower levels of cardiorespiratory fitness.

BEHAVIOR OF ADIPOKINES AFTER A YEAR FOLLOW-UP IN THE OBESITY OUTPATIENT CLINIC FOR CHILDREN AND ADOLESCENTS.

OBJECTIVE: demonstrate adipokines progression, along 12 months, in obese children and adolescents who attend the Obesity Outpatient Clinic for Children and Adolescents of the HCPA. METHODS: children and adolescents in medical treatment for obesity were followed for 12 months, assessing anthropometry, blood pressure, waist circumference, lipid profile, fasting blood sugar and insulin, inter leukine- 6, tumor necrosis factor alpha, and adiponectin in two points in time: at inclusion and after 12 months follow-up in the Obesity Outpatient Clinic for Children and Adolescents. RESULTS: 27 children and adolescents were assessed with median age of 10.3 years. The mean BMI z-scores lowered during this period (p < 0.01), HDL-c increased in the period (p = 0.025). The medians of adipokines did not vary during the period: IL-6 (p = 0.470), TNF-α (p = 0.753) and adiponectin (p = 0.943). There was no correlation of IL-6 and TNF-α with central and global obesity along the 12-months follow-up. Adiponectin increased in 45% of the sample, the increase being more pronounced in females. CONCLUSION: children and adolescents in medical treatment for obesity, after one-year follow-up, did not improve their adiponectin profile.

Objetivo: demostrar la evolución de las adipocinas a lo largo de 12 meses en niños obesos usuarios del Ambulatorio de Obesidad Infantojuvenil. Metodología: se hizo el seguimiento de niños y adolescentes en tratamiento clínico para obesidad a lo largo de 12 meses. Se los evaluó en lo tocante a antropometría, presión arterial, circunferencia de cintura, perfil lipídico, glicemia e insulina en ayuno, interleucina 6, factor de necrosis tumoral alfa y adiponectina en dos instancias: inclusión y después de 12 meses de seguimiento en el Ambulatorio de Obesidad Infantojuvenil. Resultados: se evaluaron 27 niños y adolescentes con una media de edad de 10,3 años. Los valores promedio de la puntuación-z del IMC bajaron en el período (p < 0,01), el HDL-c aumentó sus niveles en este período (p = 0,025). Las medianas de las adipocinas no variaron a lo largo del período: IL-6 (p = 0,470), TNF- (p = 0,753) y adiponectina (p = 0,943). No hubo correlación entre la IL-6 y el TNF-con obesidad central y global a lo largo de los 12 meses de seguimiento. El 45% de la muestra aumentó sus valores de adiponectina, siendo mayor este aumento en el sexo femenino. Conclusión: los niños y adolescentes en tratamiento clínico para obesidad tras un año de seguimiento no mejoraron su perfil de adipocinas.

Food intake reported versus nursing records: is there agreement in surgical patients?

OBJECTIVES: To evaluate the agreement between oral feeding by patients and chart records of this acceptance. METHOD: Besides the food intake surveys of surgical patients, the nursing records of nutrition were evaluated. Is was considered good oral feeding: intake ≥ 75% of total calories prescribed at the day; medium acceptance: 50 to 74.9%; low acceptance: < 50% and NPO (nothing per oral). The Kappa coefficient was adopted to assess agreement. RESULTS: There were similar answers between patient and nursing records in 91.3% of NPO situations, 87.1% for good oral feeding, 17.8% for medium acceptance and 16.5% for low acceptance (Kappa = 0.45). CONCLUSION: Agreement between patient's reports and nursing records was moderate to low. A higher proportion of similar answers were observed when the patients related good oral feeding or NPO.

Objetivo: evaluar la concordancia entre la aceptacion de la dieta oral reportada por los pacientes y los registros en prontuario de esta aceptacion. Método: fueron evaluados el consumo de alimentos y los registros de la ingestion en prontuario por las enfermeras. Se considero "buena aceptacion": la ingesta de ≥ 75% de las calorias totales prescritas por dia, "regular aceptacion": de 50 a 74,9%; "baja aceptacion": < 50% y NPO (nada por la boca). Para la evaluacion de la concordancia fue utilizado el coeficiente Kappa. Resultados: la proporcion de respuestas coincidentes entre el relato del paciente y el registro de las enfermeras fue 91,3% en casos de NPO, 87,1% para "buena aceptacion", 17,8% para "regular aceptacion" y 16.5% para "baja aceptacion" (Kappa = 0,45). Conclusión: la concordancia entre los relatos de los pacientes y los registros de las enfermeras fue de moderada a debil. Hubo una mayor proporcion de respuestas coincidentes cuando los pacientes informaron "buena aceptacion" o cuando habia NPO prescrito.

[Feeding tube placement: auscultatory method and x-ray agreement]. / Sondagem enteral: concordância entre teste de ausculta e raio-x na determinação do posicionamento da sonda.

OBJECTIVE: to evaluate the correlation between the auscultation test and X-ray when detecting the position of an enteral feeding tube. METHODS: cross-sectional study in an intensive care unit in southern Brazil, in 2011. Clinical nurse and nurse researcher performed auscultation test recording the impressions regarding the placement of an enteral feeding tube in 80 patients. A doctor evaluated the X-ray. Kappa coefficient and PABAK reviewed the agreements. RESULTS: The X-ray showed that 70% of the enteral tubes were in the stomach, 27.4% in the duodenum, 1.3% in the esophagus, and 1.3% in the right lung. There was a weak correlation between clinical nurses and nurse researchers (PABAK=0.054; P=0.103), clinical nurses and X-rays (PABAK=0.188; P=0.111) and nurse researchers and X-rays (PABAK=0.128; P=0.107) . The auscultation test did not detect two risk conditions, enteral feeding tube in the esophagus and the bronchus. CONCLUSION: the auscultation test showed little agreement with the X-ray on the enteral feeding tube location.

Assessment of calcium intake by adolescents.

OBJECTIVE: To evaluate the daily calcium intake of adolescents in schools from Chapecó, Santa Catarina, Southern Brazil, to check if calcium intake is in accordance with the Dietary Reference Intakes (DRI), and to investigate variables associated with daily calcium intake. METHODS: Cross-sectional study approved by the Institutional Review Board and developed in 2010. Students of the 8th grade completed questionnaires with personal data and questions about the calcium-rich foods intake frequency. In order to compare students with adequate (1300mg) or inadequate intake of calcium/day (<1300mg), parametric and nonparametric tests were used. RESULTS: A total of 214 students with a mean age of 14.3±1.0 years were enrolled. The median daily calcium intake was 540mg (interquartile range - IQ: 312-829mg) and only 25 students (11.7%) had calcium intake within the recommendations of the DRI for age. Soft drink consumption ≥3 times/week was associated with a lower intake of calcium. CONCLUSIONS: Few students ingested adequate levels of calcium for the age group. It is necessary to develop a program to encourage a greater intake of calcium-rich foods in adolescence.

Clinical impact of systematic nutritional care in adults submitted to allogeneic hematopoietic stem cell transplantation.

BACKGROUND: The development of nutrition care programs for patients undergoing hematopoietic stem cell transplantation is necessity in view of the rapid and aggressive consequences frequently seen with this procedure. Patients require constant care to reduce complications and to contribute to the success of therapy. METHODS: In an attempt to ascertain the impact of systematic nutritional care on patients submitted to allogeneic hematopoietic stem cell transplantation, the present study assessed the nutritional and clinical status, use of parenteral nutrition, and complication and mortality rates in two groups of patients, who were submitted to transplantation between April 2003 and December 2004 (Non-intervention Group - NIG; n = 57) and between March 2006 and January 2008 (Intervention Group - IG; n = 34). RESULTS: There were no significant differences between groups in terms of clinical or nutritional profiles. Additionally, the length of hospital stay and complication and mortality rates were similar for both groups. However, time on parenteral nutrition during treatment was shorter for the IG [median 6.5 days (range: 1-28) for related donor recipients and 11 days (range: 1-21) for unrelated donor recipients] than for the NIG [median 20.5 days (range, 4-73) for patients submitted to myeloablative conditioning and 18.5 days (range: 11-59 days) for those submitted to nonablative conditioning]. CONCLUSION: The implementation of a nutritional follow-up and therapy protocol for adult patients submitted to hematopoietic stem cell transplantation shortens the duration of parenteral nutrition. It certainly has an impact on hospitalization costs and, potentially, on the rate of complications, even though this was not demonstrated in this study.

Energy expenditure and estimated caloric intake in asthmatic adolescents with excess body weight.

OBJECTIVE: To measure resting energy expenditure (REE) and to estimate caloric intake of asthmatic adolescents with excess body weight and compare results with those groups of eutrophic asthmatic adolescents and non-asthmatic adolescents with excess body weight. METHODS: This cross-sectional study categorized 69 adolescents aged 10 to 18 y into three matched groups. Nutritional status was assessed using anthropometric and body composition measurements. Indirect calorimetry was used to measure energy expenditure, and caloric intake was estimated from dietary recalls. RESULTS: In each group, there were 23 adolescents (10 girls) aged 12.39 ± 2.40 y. Results for each group were as follows. For asthmatic adolescents with excess body weight, body mass index (BMI) was 24.83 ± 2.73 kg/m(2), REEs were 1550.24 ± 547.23 kcal/d and 27.69 ± 11.33 kcal · kg(-1) · d(-1), and estimated caloric intake was 2068.75 ± 516.66 kcal/d; for eutrophic asthmatic adolescents, BMI was 19.01 ± 2.10 kg/m(2), REEs were 1540.82 ± 544.22 kcal/d and 36.65 ± 15.04 kcal · kg(-1) · d(-1), and estimated caloric intake was 2174.05 ± 500.55 kcal/d; and for non-asthmatic adolescents with excess body weight, BMI was 25.35 ± 3.66 kg/m(2), REEs were 1697.24 ± 379.84 kcal/d and 28.18 ± 6.70 kcal · kg(-1) · d(-1), and estimated caloric intake was 1673.17 ± 530.68 kcal/d. Absolute REE values between groups were not statistically different, even after correction for lean mass and fat mass (F = 0.186, P = 0.831). REE (kilocalories per kilogram per day) was significantly higher in the group of eutrophic asthmatic adolescents (P = 0.016). Estimated caloric intake was greater than REE only in the group of adolescents with asthma. CONCLUSION: The REE was not significantly different among groups, and REE (kilocalories per kilogram per day) was higher in the group of eutrophic asthmatic adolescents. Estimated caloric intake was greater than REE in the group of adolescents with asthma.

Role of enteral nutrition in the incidence of diarrhea among hospitalized adult patients.

OBJECTIVE: This study examined the risk of diarrhea as a result of providing enteral nutrition in the hospital setting, adjusting for other clinical and therapeutic factors. METHODS: Adults admitted to a general tertiary care university hospital, in clinical or surgical units, were enrolled in the study between June 2004 and May 2005 and prospectively followed during their hospital stay. For each patient treated with enteral nutrition (n = 302), a comparable non-treated patient from the same ward (who also received antibiotics previously) and was similarly cared for by the same hospital staff was included in the study (n = 302), constituting a double-cohort study. All patients were seen three times per week, on alternating days, until the occurrence of diarrhea or hospital discharge. Cox's regression analyses were applied for adjustments. RESULTS: The incidence of diarrhea was 18% for patients receiving enteral nutrition and 6% for non-treated patients (P < 0.01). In multivariate analyses, enteral nutrition was independently associated with diarrhea (hazard ratio 2.7, 95% confidence interval 1.6-4.7), even adjusting for age (hazard ratio 1.02, 95% confidence interval 1.00-1.03) and hospitalization during the summer months (hazard ratio 2.4, 95% confidence interval 1.5-3.9). Patients for whom strict adherence to delivery-set washing-and-changing procedures was observed (on >75% of days) presented a lower incidence of diarrhea (6.5% versus 20.3%, P = 0.02; and 5.9% versus 19.8%, P = 0.05, respectively). CONCLUSION: Providing enteral nutrition to the hospitalized elderly during the summer months is associated with a higher risk of diarrhea. Strategies aimed toward improvement in the quality of enteral nutrition practices should be evaluated to minimize this deleterious clinical outcome.