Clinical Evolution of Preschool Picky Eater Children Receiving Oral Nutritional Supplementation during Six Months: A Prospective Controlled Clinical Trial.

OBJECTIVE: To determine if oral nutritional supplementation of picky eater children has a beneficial effect in addition to nutritional guidance on anthropometric parameters, nutrient intake, appetite, physical activity, and health complications. METHODS: This is a randomized, single-blind, controlled clinical trial that included Brazilian picky eater children aged 24 to 60 months. The individuals were randomized into a control group (CG) (n = 17) and an intervention group (IG) (n = 18), and were followed up in seven meetings for 180 days (baseline plus one meeting every 30 days). The CG received nutritional guidance for food selectivity, while the IG received the same guidance plus oral nutritional supplementation. Anthropometric and nutrient intake assessments were carried out, and appetite, physical activity and health complications were investigated. RESULTS: In the IG, the z-score of weight and height increased significantly over time (p < 0.05), while the body fat percentage (BFP) and BMI z-score remained unchanged. The percentage of inadequate intake of vitamins D, C and folate reduced in the IG over time compared to the CG (p < 0.05). In the IG, the score assigned by parents to the appetite scale increased over time (p < 0.05). There was no difference between the groups in the scores on the physical activity and global health scales, and in the number of health complications. CONCLUSIONS: Picky eater children that were supplemented increased their weight not by gaining fat, but due to an increase in stature, as shown by BMI z-score and BFP, that remained unchanged. Furthermore, they showed a decrease in inadequate micronutrient intake during the intervention. An improvement in appetite was also observed over time, attesting to the benefit of supplementation.

Breastfeeding by chikungunya virus-infected dams confers resistance to challenge in the offspring.

Vertical transmission of Chikungunya virus (CHIKV) has been reported in humans, but the transmission routes have not been completely understood, and experimental animal models are needed to enable detailed investigation of the transmission and pathogenesis of congenital infections. The intertwining of immune response and virus components at the gestation/breastfeeding interfaces between mother and fetus/newborn may have effects during the offspring development. An experimental model of CHIKV was established by infecting pregnant BALB/c female mice that enabled confirmation that dams inoculated up to the 10th gestational day transmit CHIKV transplacentally to approximately 8.4% of the fetuses, resulting in severe teratogenic effects. CHIKV neutralizing antibodies were detected in sera from adult mice born to healthy females and breastfed by CHIKV-infected dams, while no neutralization was detected in sera from animals born to CHIKV-infected dams. Moreover, adult mice born to healthy dams and cross-fostered for breastfeeding by CHIKV-infected dams were resistant to challenge with CHIKV on the 90th day after birth. The animals also had reduced viral loads in brain and spleen as compared to controls. There was expression of fluorescent CHIKV non-structural protein, and detection of viral RNA by RT-PCR in breast tissue from infected dams. CHIKV RNA and proteins were also detected in breast milk retrieved from the stomachs of recently fed newborns. The experimental results were also complemented by the finding of CHIKV RNA in 6% of colostrum samples from healthy lactating women in a CHIKV-endemic area. Breastfeeding induces immune protection to challenge with CHIKV in mice.

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.

Anthropometric markers of abdominal adiposity and its relation to dyslipidemia and insulin resistance among overweight/obese schoolchildren and adolescents / Marcadores antropométricos de adiposidade abdominal e sua relação com dislipidemia e resistência à insulina em escolares e adolescentes com sobrepeso/obesidade

Objective: to assess the relationship between anthropometric indicators and laboratorial markers of cardiovascular risk in overweight/obese children and adolescents, in order to verify whether any anthropometric indicator has a better potential for use in screening cardiovascular risk in the population. Method: retrospective cross-sectional study enrolling 237 individuals aged 7 to 18 years. Body mass index (BMI), waist circumference (WC), waist circumference/height index (WC/H), glucose, HOMA-IR, total cholesterol (TC), LDL, HDL, triglycerides and TC/HDL and LDL/HDL indexes were obtained. Associations between anthropometric and laboratory markers were tested in contingency tables using the chi-square test. Correlations were tested by Spearman's correlation. Results: higher WC (Freedman cutoffs) was associated with lower levels of HDL and higher score in the TC/HDL and LDL/HDL indexes, but, using +2 z-scores as the cutoff, there were associations with low HDL and higher HOMA-IR. WC/H indicator (0.5 cutoff) was not associated with any of the outcomes, but, using +2 z-scores, an association was found with HOMA-IR. Z-scores of WC, WC/H and BMI showed positive correlation with HOMA-IR, TC/HDL and HOMA-IR, respectively. Negative correlations were found between WC and WC/H z-scores with HDL. WC and WC/H z-score were related to changes in HDL and HOMA-IR. Conclusions: there seems to be an advantage in using WC alone as a possible predictor of dyslipidemia and insulin resistance in children and adolescents. It is not possible to state that WC, WC/H or BMI measurements differ in their abilities to identify Brazilian children and adolescents with risk factors for cardiovascular diseases (AU)

Objetivo: avaliar a relação entre indicadores antropométricos e marcadores laboratoriais de risco cardiovascular em crianças e adolescentes com sobrepeso / obesidade, a fim de verificar se algum indicador antropométrico tem melhor potencial para uso no rastreamento de risco cardiovascular na população. Método: estudo transversal retrospectivo com 237 indivíduos com idades entre 7 e 18 anos. Índice de massa corporal (IMC), circunferência da cintura (CC), índice de circunferência da cintura / altura (CC / H), glicose, HOMA-IR, colesterol total (CT), LDL, HDL, triglicerídeos e índices CT/HDL e LDL/HDL foram obtidos. As associações entre marcadores antropométricos e laboratoriais foram testadas em tabelas de contingência por meio do teste do qui-quadrado. As correlações foram testadas pela correlação de Spearman. Resultados: CC mais elevado (pontos de corte de Freedman) foi associado a níveis mais baixos de HDL e maior pontuação nos índices TC/HDL e LDL/HDL, mas, usando +2 escores z como ponto de corte, houve associações com HDL baixo e HOMA-IR mais alto. O indicador CC/H (0,5 ponto de corte) não foi associado a nenhum dos desfechos, mas, usando +2 escores z, foi encontrada associação com o HOMA-IR. Os escores Z de CC, CC/E e IMC mostraram correlação positiva com HOMA-IR, TC/HDL e HOMA-IR, respectivamente. Correlações negativas foram encontradas entre CC e escores z de CC/H com HDL. CC e escore z de CC/H foram relacionados a mudanças em HDL e HOMA-IR. Conclusões: parece haver vantagem em usar a CC isoladamente como possível preditor de dislipidemia e resistência à insulina em crianças e adolescentes. Não é possível afirmar que as medidas de CC, CC/E ou IMC diferem na capacidade de identificar crianças e adolescentes brasileiros com fatores de risco para doenças cardiovasculares (AU)

Vitamin A deficiency and association between serum retinol and IGF-1 concentrations in Brazilian children with Down syndrome

Abstract Objective: To determine the prevalence of vitamin A deficiency (VAD) and serum concentrations of retinol, correlating them with IGF-1 concentrations in preschoolers with DS. Methods: Cross-sectional study was conducted on 47 children with DS aged 24 to 72 months, in Ribeirão Preto, Brazil. VAD was determined by the relative dose-response (RDR) test. Retinol serum concentration ≤ 0.70 μmol/L and IGF-1 serum concentration below the 3rd percentile for sex and age were considered to represent deficiency. C-reactive protein (CRP) was determined at the beginning of the study. Weight, height, and information about fever and/or diarrhea were obtained at the beginning of the study. Results: VAD prevalence was 25.5% (12/47), and 74.5% (35/47) of the children had deficient retinol before the intervention. CRP was not associated with VAD. Mean IGF-1 were 103.5 ng/mL (SD = 913) for the group with VAD and 116.3 ng/mL (SD = 54.9) for the group with no VAD (p-value = 0.85); 8.5% (4/47) of the children showed deficient IGF-1, but without VAD. No association was observed between VAD and IGF-1 deficiency. A moderate positive correlation was observed between pre-intervention retinol and IGF-1 (ρ = 0.37; p-value = 0.01). Conclusion: a high prevalence of VAD and deficient retinol was observed and there was a positive correlation between serum retinol and IGF-1.

Anthropometric markers of abdominal adiposity and its relation to dyslipidemia and insulin resistance among overweight/obese schoolchildren and adolescents / Marcadores antropométricos de adiposidade abdominal e sua relação com dislipidemia e resistência à insulina em escolares e adolescentes com sobrepeso/obesidade

ABSTRACT: Objective: to assess the relationship between anthropometric indicators and laboratorial markers of cardiovascular risk in overweight/obese children and adolescents, in order to verify whether any anthropometric indicator has a better potential for use in screening cardiovascular risk in the population. Method: retrospective cross-sectional study enrolling 237 individuals aged 7 to 18 years. Body mass index (BMI), waist circumference (WC), waist circumference/height index (WC/H), glucose, HOMA-IR, total cholesterol (TC), LDL, HDL, triglycerides and TC/HDL and LDL/HDL indexes were obtained. Associations between anthropometric and laboratory markers were tested in contingency tables using the chi-square test. Correlations were tested by Spearman's correlation. Results: higher WC (Freedman cutoffs) was associated with lower levels of HDL and higher score in the TC/HDL and LDL/HDL indexes, but, using +2 z-scores as the cutoff, there were associations with low HDL and higher HOMA-IR. WC/H indicator (0.5 cutoff) was not associated with any of the outcomes, but, using +2 z-scores, an association was found with HOMA-IR. Z-scores of WC, WC/H and BMI showed positive correlation with HOMA-IR, TC/HDL and HOMA-IR, respectively. Negative correlations were found between WC and WC/H z-scores with HDL. WC and WC/H z-score were related to changes in HDL and HOMA-IR. Conclusions: there seems to be an advantage in using WC alone as a possible predictor of dyslipidemia and insulin resistance in children and adolescents. It is not possible to state that WC, WC/H or BMI measurements differ in their abilities to identify Brazilian children and adolescents with risk factors for cardiovascular diseases. (AU)

RESUMO:Objetivo: avaliar a relação entre indicadores antropométricos e marcadores laboratoriais de risco cardiovascular em crianças e adolescentes com sobrepeso / obesidade, a fim de verificar se algum indicador antropométrico tem melhor potencial para uso no rastreamento de risco cardiovascular na população. Método: estudo transversal retrospectivo com 237 indivíduos com idades entre 7 e 18 anos. Índice de massa corporal (IMC), circunferência da cintura (CC), índice de circunferência da cintura / altura (CC / H), glicose, HOMA-IR, colesterol total (CT), LDL, HDL, triglicerídeos e índices CT/HDL e LDL/HDL foram obtidos. As associações entre marcadores antropométricos e laboratoriais foram testadas em tabelas de contingência por meio do teste do qui-quadrado. As correlações foram testadas pela correlação de Spearman. Resultados: CC mais elevado (pontos de corte de Freedman) foi associado a níveis mais baixos de HDL e maior pontuação nos índices TC/HDL e LDL/HDL, mas, usando +2 escores z como ponto de corte, houve associações com HDL baixo e HOMA-IR mais alto. O indicador CC/H (0,5 ponto de corte) não foi associado a nenhum dos desfechos, mas, usando +2 escores z, foi encontrada associação com o HOMA-IR. Os escores Z de CC, CC/E e IMC mostraram correlação positiva com HOMA-IR, TC/HDL e HOMA-IR, respectivamente. Correlações negativas foram encontradas entre CC e escores z de CC/H com HDL. CC e escore z de CC/H foram relacionados a mudanças em HDL e HOMA-IR. Conclusões: parece haver vantagem em usar a CC isoladamente como possível preditor de dislipidemia e resistência à insulina em crianças e adolescentes. Não é possível afirmar que as medidas de CC, CC/E ou IMC diferem na capacidade de identificar crianças e adolescentes brasileiros com fatores de risco para doenças cardiovasculares. (AU)

Vitamin A deficiency and association between serum retinol and IGF-1 concentrations in Brazilian children with Down syndrome.

OBJECTIVE: To determine the prevalence of vitamin A deficiency (VAD) and serum concentrations of retinol, correlating them with IGF-1 concentrations in preschoolers with DS. METHODS: Cross-sectional study was conducted on 47 children with DS aged 24 to 72 months, in Ribeirão Preto, Brazil. VAD was determined by the relative dose-response (RDR) test. Retinol serum concentration ≤ 0.70 µmol/L and IGF-1 serum concentration below the 3rd percentile for sex and age were considered to represent deficiency. C-reactive protein (CRP) was determined at the beginning of the study. Weight, height, and information about fever and/or diarrhea were obtained at the beginning of the study. RESULTS: VAD prevalence was 25.5% (12/47), and 74.5% (35/47) of the children had deficient retinol before the intervention. CRP was not associated with VAD. Mean IGF-1 were 103.5 ng/mL (SD = 913) for the group with VAD and 116.3 ng/mL (SD = 54.9) for the group with no VAD (p-value = 0.85); 8.5% (4/47) of the children showed deficient IGF-1, but without VAD. No association was observed between VAD and IGF-1 deficiency. A moderate positive correlation was observed between pre-intervention retinol and IGF-1 (ρ = 0.37; p-value = 0.01). CONCLUSION: a high prevalence of VAD and deficient retinol was observed and there was a positive correlation between serum retinol and IGF-1.

Pediatric multisystem inflammatory syndrome associated with COVID-19: urgent attention required.

OBJECTIVE: To identify epidemiological and clinical characteristics of multisystemic inflammatory syndrome associated with coronavirus infection as one of the severe forms of COVID-19 involvement in children and adolescents. METHODS: review was based on articles published in 2020 in the PubMed, Medline, Scopus, SciELO and Cochrane databases. SUMMARY: Multisystemic inflammatory syndrome is a serious clinical disorder that affects children and adolescents and is associated with the detection of previous exposure to SARS-CoV-2. It is characterized by the installation of a shock picture, with a significant increase in inflammatory markers such as presentations of Kawasaki Disease or shock syndrome related to Kawasaki Disease, or even toxic shock syndrome, with the clinical picture being characterized by fever of difficult control, rash, conjunctivitis, peripheral edema, generalized pain in the extremities and gastrointestinal symptoms. CONCLUSIONS: Although the vast majority of children with COVID-19 have mild symptoms, it is necessary to consider that some have a hyperinflammatory response. It is essential that health professionals receive information that can assist in the recognition of this clinical condition, differentiating it from other diagnoses, so that early and appropriate treatment is instituted.

Prevalence of childhood anaemia in Brazil: still a serious health problem: a systematic review and meta-analysis.

OBJECTIVE: To estimate the prevalence of anaemia in Brazilian children up to 83·9 months old. DESIGN: Systematic review and meta-analysis, using databases PubMed, Scopus, SciELO, Lilacs, Google Scholar, Periódicos Capes, Arca, Biblioteca Virtual em Saúde, Microsoft Academic Search and Cochrane Library using search terms: anaemia, prevalence, child and Brazil. PROSPERO Registration number: CRD42020208818. SETTING: Cross-sectional, cohort, case-control and intervention studies published between 2007 and 2020 were searched, excluding those who assessed children with an illness or chronic condition. The main outcome was anaemia prevalence. Random effects models based on the inverse variance method were used to estimate pooled prevalence measures. Sensitivity analyses removed studies with high contribution to overall heterogeneity. PARTICIPANTS: From 6790 first screened, 134 eligible studies were included, totalling 46 978 children aged zero to 83·9 months analysed, with adequate regions representativeness. RESULTS: Pooled prevalence of anaemia was 33 % (95 % CI 30, 35). Sensitivity analyses showed that withdrawal of studies that contributed to high heterogeneity did not influence national average prevalence. CONCLUSIONS: Childhood anaemia is still a serious public health problem in Brazil, exposing 33 % of Brazilian children to the anaemia repercussions. The main limitation of the study is the estimation of national prevalence based on local surveys, but a large number of studies were included, with representation in all regions of the country, giving strength to the results. In Brazil, more public policies are needed to promote supplementation, fortification and access to healthy eating to reduce the high level of anaemia among children.

Vitamin E deficiency and associated factors among Brazilian school children / Deficiência de vitamina E e fatores associados entre crianças escolares brasileiras

ABSTRACT: Objective: Brazilian national data show a significant deficiency in pediatric vitamin E consumption, but there are very few studies evaluating laboratory-proven nutritional deficiency. The present study aimed to settle the prevalence of vitamin E deficiency (VED) and factors associated among school-aged children attended at a primary health unit in Ribeirão Preto (SP). Methods: A cross-sectional study that included 94 children between 6 and 11 years old. All sub-jects were submitted to vitamin E status analysis. To investigate the presence of factors associated with VED, socio-economic and anthropometric evaluation, determination of serum hemoglobin and zinc levels, and parasitological stool exam were performed. The associations were performed using Fisher's exact test. Results: VED (α-tocopherol concentrations <7 µmol/L) was observed in seven subjects (7.4%). None of them had zinc deficiency. Of the total of children, three (3.2%) were malnourished, 12 (12.7%) were anemic, and 11 (13.5%) presented some pathogenic intestinal parasite. These possible risk factors, in addition to maternal-work, maternal educational level, and monthly income, were not associated with VED. Conclusions: The prevalence of VED among school-aged children attended at a primary health unit was low. Zinc deficiency, malnutrition, anemia, pathogenic intestinal parasite, maternal-work, maternal educational level, and monthly income were not a risk factor for VED. (AU)

RESUMO: Objetivo: Determinar a prevalência da deficiência de vitamina E (DVE) e os fatores associados a essa deficiência em escolares atendidos em uma unidade básica de saúde de Ribeirão Preto (SP). Métodos: Estudo transversal que incluiu 94 crianças entre 6 e 11 anos de idade, atendidas em uma unidade básica de saúde. Todos os indivíduos foram submetidos à análise do status de vitamina E. Para investigar a presença de fatores associados à DVE, foi realizada avaliação socio-econômica e antropométrica, determinação dos níveis séricos de hemoglobina e zinco, e exame parasitológico de fezes. As associações foram realizadas por meio do teste exato de Fisher. Resultados: A DVE (concentrações de α-tocoferol <7 µmol/l) foi observada em sete indivíduos (7,4%). Nenhum sujeito apresentou deficiência sérica de zinco. Do total de crianças, três (3,2%) eram desnutridas, 12 (12,7%) anêmicas e 11 (13,5%) apresentavam algum parasita intestinal patogênico. Estes possíveis fatores de risco, além do trabalho materno, escolaridade materna e renda mensal, não foram associados à DVE (p>0,05). Conclusão: A prevalência de DVE em escolares atendidos em uma unidade básica de saúde foi baixa. Desnutrição, anemia, parasitose intestinal, renda mensal e trabalho e nível educacional maternos não se apre-sentaram como fatores de risco para a DVE. (AU)

Uma experiência exitosa de meio século da Universidade de São Paulo junto à comunidade / A successful experience of half a century of the University of São Paulo with the community

A extensão constitui-se em parte indissociável das atividades universitárias e elo fundamental da interface da academia com a comunidade. A participação da universidade na assistência à saúde da comunidade talvez represente uma das faces mais visíveis e, ao mesmo tempo, sensíveis da extensão universitária. A atuação da Universidade de São Paulo (USP) no Centro Médico Social Comunitário "Vila Lobato" (CMSC "Vila Lobato") tem se constituído por uma experiência exitosa de meio século junto à comunidade servida por esta unidade básica de saúde de Ribeirão Preto. Alunos de graduação do curso de medicina e de nutrição e metabolismo da Faculdade de Medicina de Ribeirão Preto-USP (FMRP-USP) e, também, médicos residentes do Hospital das Clínicas da FMRP-USP têm prestado assistência à saúde à população local. Alunos de graduação de outras unidades do Campus de Ribeirão Preto da USP (odontologia, enfermagem e psicologia) também atuam no CMSC "Vila Lobato". Inúmeros projetos de pesquisa na área da saúde foram e continuam sendo desenvolvidos na unidade, beneficiando a comunidade. A experiência de meio século da USP junto ao CMSC "Vila Lobato" constitui-se por modelo bem-sucedido de extensão universitária, devendo não somente ser reconhecido de forma genuína no meio acadêmico, mas também estimulada. (AU)

The university extension program is inseparable from the university activities and also an essential connection between the academia and the community. The participation of the university in health care to the community may represent one of the most visible and at the same time sensitive aspects of university extension. The work of the University of São Paulo (USP) at the Community Social Medical Center "Vila Lobato" (CSMC "Vila Lobato") has been a successful experience of half a century in the community assisted by this primary health care unit of Ribeirão Preto. Undergraduate students of both Medicine and Nutrition and Metabolism courses from Ribeirão Preto Medical School-USP (RPMS-USP) and also resident physicians from the General Hospital of RPMS-USP have provided health care to the local population. Undergraduate students from other schools from USP at Ribeirão Preto (dentistry, nursing, and psychology) have also worked at the CSMC "Vila Lobato". Several research projects on health were carried out, and many others have been developed in the unit, benefiting the community. This experience of half a century of USP with the CSMC "Vila Lobato" is a successful model of university extension, and it should be recognized genuinely in the academic institutions and also stimulated. (AU)

Do all infants need vitamin D supplementation?

A high prevalence of vitamin D deficiency (VDD) in children has been observed worldwide, but there are few studies on the nutritional status of vitamin D (VD) in healthy infants. The main cause of deficiency in healthy children is breastfeeding without supplementation and lack or insufficiency of sun exposure. The aims of this study were to determine serum concentrations of 25(OH)D and verify its association with parathyroid hormone (PTH) concentrations and use of VD supplementation in healthy infants aged ≥ 6 to ≤ 24 months attended at two Primary Health Care Units in Ribeirão Preto city, São Paulo, Brazil. A cross-sectional, observational and analytical study was performed in which serum concentrations of 25(OH)D, PTH, alkaline phosphatase (AP), calcium (Ca), phosphorus (P) and albumin were determined in 155 healthy infants. Information on sun exposure, sociodemographic aspects of mothers and clinical and nutritional characteristics of infants were obtained through interviews with responsible infants's legal representatives. Ten infants (6%) presented deficient 25(OH)D serum concentration (≤20ng/ml) and 46 (30%), insufficient (21 to 29ng/ml). No changes in serum P, Ca and albumin concentrations were detected. Only one infant had an increase in PTH serum concentrations. 35% (55/155) of infants had high AP e 40% (22/55) presented insufficient serum concentrations of 25(OH)D but none presented deficient ones. There was a weak association between serum concentrations of 25(OH)D and PTH and an association between serum concentrations of 25(OH)D and P when adjusted for sex, age and BMI. There were no associations between inadequate serum concentrations of 25(OH)D (deficient ou insufficient), sun exposure and VD supplementation. This study found a low prevalence of deficient 25(OH)D serum concentration and high prevalence of insufficient ones which was not associated with changes in serum PTH, AP, P, Ca and albumin concentrations, VD supplementation and the formula volume intake.

Vitamin A intake of Brazilian mothers and retinol concentrations in maternal blood, human milk, and the umbilical cord.

Objectives To analyse intake of vitamin A (VA) and retinol concentrations in maternal blood, breast milk (BM), and the umbilical cord (UC) of newborns, and to determine the associations among these variables. Methods We performed a cross-sectional, epidemiological study of 180 mother-newborn dyads. Maternal and UC blood samples and BM were collected. VA intake by the mother over 30 days was assessed using a questionnaire. Results Mean retinol concentrations in maternal serum, the UC, and BM were 0.65 ± 0.27, 0.36 ± 0.18, and 2.95 ± 2.70 µmol/L, respectively. Retinol concentrations <0.70 µmol/L were found in 57.2% of maternal blood samples and in 94.9% of UC samples. A total of 27.9% of BM samples showed retinol concentrations <1.05 µmol/L. Mean VA intake by the mothers was 1041.33 ± 1187.86 µg retinol activity equivalents/day and was inadequate (<550 µg retinol activity equivalents/day) in 44.7%. Conclusions High proportions of insufficient retinol concentrations were observed in the UC, maternal blood, and BM. A high percentage of pregnant women had inadequate VA intake. Mothers with insufficient serum retinol concentrations had newborns with lower retinol concentrations in the UC. Higher retinol concentrations were observed in maternal blood and the UC with a higher VA intake.

Bioelectrical Impedance Vector Analysis in Healthy Term Infants in the First Three Months of Life in Brazil.

OBJECTIVE: Bioelectrical impedance vectorial analysis (BIVA) can be considered a favorable method for evaluation and monitoring of nutritional and hydration status without assumptions regarding body composition or requirement of prediction formulas. The present study aimed to determine bivariate tolerance intervals of the whole-body impedance vector for healthy term infants aged 1 to 3 months. METHODS: This is a descriptive cross-sectional study. Anthropometric and bioelectrical impedance data (800 mA-50 kHz) were obtained. Bivariate vector analysis was conducted with the resistance-reactance (RXc) graph method. BIVA software was used to construct the graphs. RESULTS: A total of 150 appropriate for gestational age infants (48.7% boys) who were exclusively breastfed and were 56.4 (SD = 23.1) days of age were studied. RXc tolerance ellipses (50, 75, and 95%) were constructed for boys and girls, but a general reference graph was defined for all infants considering the overlapping of ellipses between the genders. All graphs differed from those in national and foreign studies. CONCLUSION: New reference tolerance ellipses (95, 75, and 50%) for 1- to 3-month-old infants were constructed, pointing out the need for specific reference values of total body impedance vectors in different regions of Brazil. The RXc tolerance ellipses can be used for clinical practice and provide an easy method to evaluate and monitor body composition and hydration status.

Acute urinary retention in a pre-school girl with constipation / Retenção urinária aguda em pré-escolar feminina com constipação intestinal

Objective: To report a case of a preschool girl who developed acute urinary retention associated with constipation. Case description: A girl aged six years old presented a 24 h history of inability to urinate. She was went twice to the emergency room during this period. In the first admission, 12 h after the onset of the symptoms, she presented abdominal pain and acute urinary retention. After the drainage by urinary catheterization of 300 mL of clear urine, she presented relief of the symptoms and, as urinalysis had no change, the patient was discharged home. Twelve hours after the first visit, she returned to the emergency room complaining about the same symptoms. At physical examination, there was only a palpable and distended bladder up to the umbilicus with no other abnormalities. Again, a urinary catheterization was performed, which drained 450 mL of clear urine, with immediate relief of the symptoms. Urinalysis and urine culture had no abnormalities. During the anamnesis, the diagnosis of constipation was considered and a plain abdominal radiography was performed, which identified large amount of feces throughout the colon (fecal retention). An enema with a 12% glycerin solution was prescribed for three days. During follow-up, the child used laxatives and dietary modifications, this contributed to the resolution of the constipation. There were no other episodes of urinary retention after 6 months of follow-up. Comments: Acute urinary retention in children is a rare phenomenon and constipation should be considered as a cause.

Objetivo: Relatar um caso de criança que desenvolveu retenção urinária aguda associada à constipação intestinal. Descrição do caso: Menina, seis anos, havia 24 horas apresentara incapacidade de liberação de esfíncter vesical. Foi atendida por duas vezes em um serviço de emergência nesse período. Na primeira consulta, 12 horas após o início do quadro, apresentava dor abdominal e retenção urinária aguda e foi feita sondagem de alívio com saída de 300mL de urina clara. Houve alívio imediato dos sintomas e, como o exame de urina tipo 1 não apresentou alterações, a paciente recebeu alta. No segundo atendimento, 12 horas após a primeira consulta, apresentava as mesmas queixas. Ao exame físico, observou-se apenas bexiga palpável e distendida até a cicatriz umbilical, sem outras alterações. Nova sondagem vesical foi feita com saída de 450mL de urina clara, com alívio imediato dos sintomas. Nenhuma anormalidade foi observada no exame de urina tipo 1 e na urocultura. Durante a anamnese, foi levantada a hipótese diagnóstica de constipação intestinal. Foi feita radiografia simples de abdome, que identificou grande quantidade de fezes em todo o cólon (retenção fecal). Enema com solução glicerinada a 12% foi prescrito por três dias. Durante o seguimento a criança fez uso de laxativos e modificações na dieta que contribuíram para a resolução da constipação intestinal. Não houve repetição do quadro de retenção urinária aguda após seis meses de acompanhamento. Comentários: A retenção urinária aguda em crianças é um fenômeno raro e a constipação intestinal deve ser considerada como uma das causas.

[Acute urinary retention in a pre-school girl with constipation]. / Retenção urinária aguda em pré-escolar feminina com constipação intestinal.

OBJECTIVE: To report a case of a preschool girl who developed acute urinary retention associated with constipation. CASE DESCRIPTION: A girl aged six years old presented a 24 hour history of inability to urinate. She was went twice to the emergency room during this period. In the first admission, 12 hours after the onset of the symptoms, she presented abdominal pain and acute urinary retention. After the drainage by urinary catheterization of 300 mL of clear urine, she presented relief of the symptoms and, as urinalysis had no change, the patient was discharged home. Twelve hours after the first visit, she returned to the emergency room complaining about the same symptoms. At physical examination, there was only a palpable and distended bladder up to the umbilicus with no other abnormalities. Again, a urinary catheterization was performed, which drained 450 mL of clear urine, with immediate relief of the symptoms. Urinalysis and urine culture had no abnormalities. During the anamnesis, the diagnosis of constipation was considered and a plain abdominal radiography was performed, which identified large amount of feces throughout the colon (fecal retention). An enema with a 12% glycerin solution was prescribed for three days. During follow-up, the child used laxatives and dietary modifications, this contributed to the resolution of the constipation. There were no other episodes of urinary retention after 6 months of follow-up. COMMENTS: Acute urinary retention in children is a rare phenomenon and constipation should be considered as a cause.

Epidemiological and clinical characteristics of injuries among adolescents attended at an emergency service in the city of Ribeirão Preto, São Paulo.

CONTEXT AND OBJECTIVE: Injuries are an important cause of morbidity during adolescence, but can be avoided through learning about some of their characteristics. This study aimed to identify the most frequent injuries among adolescents attended at an emergency service. DESIGN AND SETTING: Retrospective descriptive study on adolescents attended at the emergency service of the Teaching Health Center, Faculdade de Medicina de Ribeirão Preto (FMRP), between January 1, 2009, and September 30, 2009. METHODS: Age, sex, type of injury, site, day and time of occurrence, part of body involved, care received, whether the adolescent was accompanied at the time of injury and whether any type of counseling regarding injury prevention had been given were analyzed. RESULTS: Among 180 adolescents attended, 106 (58.8%) were boys and 74 (41.1%) were girls. Their ages were: 10 to 12 (66/36.6%), 12 to 14 (60/33.3%) and 14 to 16 years (54/30%). The injuries had occurred in public places (47.7%) and at home (21.1%). The main types were bruises (45.1%) and falls (39.2%), involving upper limbs (46.1%), lower limbs (31%) and head/neck (13.1%). The injuries occurred in the afternoon (44.4%) and morning (30%), on Mondays (17.7%) and Thursdays (16.6%). Radiological examinations were performed on 53.8%. At the time of injury, 76.1% of the adolescents were accompanied. Some type of counseling about injury prevention had been received by 39.4%. CONCLUSIONS: Although the injuries were of low severity, preventive attitudes need to be incorporated in order to reduce the risks and provide greater safety for adolescents.

Epidemiological and clinical characteristics of injuries among adolescents attended at an emergency service in the city of Ribeirão Preto, São Paulo / Características clínicas e epidemiológicas de lesões entre adolescentes atendidos em um pronto-socorro na cidade de Ribeirão Preto, São Paulo

CONTEXT AND OBJECTIVE: Injuries are an important cause of morbidity during adolescence, but can be avoided through learning about some of their characteristics. This study aimed to identify the most frequent injuries among adolescents attended at an emergency service. DESIGN AND SETTING: Retrospective descriptive study on adolescents attended at the emergency service of the Teaching Health Center, Faculdade de Medicina de Ribeirão Preto (FMRP), between January 1, 2009, and September 30, 2009. METHODS: Age, sex, type of injury, site, day and time of occurrence, part of body involved, care received, whether the adolescent was accompanied at the time of injury and whether any type of counseling regarding injury prevention had been given were analyzed. RESULTS: Among 180 adolescents attended, 106 (58.8 percent) were boys and 74 (41.1 percent) were girls. Their ages were: 10 to 12 (66/36.6 percent), 12 to 14 (60/33.3 percent) and 14 to 16 years (54/30 percent). The injuries had occurred in public places (47.7 percent) and at home (21.1 percent). The main types were bruises (45.1 percent) and falls (39.2 percent), involving upper limbs (46.1 percent), lower limbs (31 percent) and head/neck (13.1 percent). The injuries occurred in the afternoon (44.4 percent) and morning (30 percent), on Mondays (17.7 percent) and Thursdays (16.6 percent). Radiological examinations were performed on 53.8 percent. At the time of injury, 76.1 percent of the adolescents were accompanied. Some type of counseling about injury prevention had been received by 39.4 percent. CONCLUSIONS: Although the injuries were of low severity, preventive attitudes need to be incorporated in order to reduce the risks and provide greater safety for adolescents.

CONTEXTO E OBJETIVO: Lesões são importante causa de morbidade na adolescência, mas podem ser evitadas mediante o conhecimento de algumas de suas características. Este estudo visa identificar as lesões mais frequentes entre adolescentes atendidos em um serviço de pronto-atendimento. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo e descritivo sobre adolescentes atendidos no Pronto-Atendimento do Centro de Saúde Escola da Faculdade de Medicina de Ribeirão Preto (FMRP), entre 01/01/2009 e 30/9/2009. MÉTODOS: Analisou-se idade, sexo, tipo de lesão, local, dia e período do ocorrido, parte do corpo acometida, cuidados recebidos, se o adolescente estava acompanhado no momento da lesão e se havia recebido alguma orientação quanto à prevenção de acidentes. RESULTADOS: Dos 180 adolescentes 106 (58,8 por cento) eram rapazes e 74 (41,1 por cento) moças, com idades entre 10 a 12 anos (66/36,6 por cento), 12 a 14 anos (60/33,3 por cento) e 14 a 16 anos (54/30 por cento). 47,7 por cento das lesões aconteceram em locais públicos e 21,1 por cento, em casa. Os principais foram contusões (45,1 por cento) e quedas (39,2 por cento), acometendo membros superiores (46,1 por cento), membros inferiores (31 por cento) e cabeça/pescoço (13,1 por cento). As lesões ocorreram nos períodos da tarde (44,4 por cento) e manhã (30 por cento) e às segundas-feiras (17,7 por cento) e quintas-feiras (16,6 por cento). Foram realizados exames radiológicos em 53,8 por cento dos pacientes. No momento da lesão 76,1 por cento dos adolescentes estavam acompanhados. 39,4 por cento haviam recebido algum tipo de orientação sobre prevenção de lesões. CONCLUSÕES: Embora as lesões tenham sido de baixa gravidade, é necessário incorporar atitudes preventivas de modo a diminuir os riscos e proporcionar maior segurança aos adolescentes.

Dietary Intake, Anthropometric and Body Composition Assessment of Adolescents Enrolled in a Basic Health Unit in Ribeirão Preto, São Paulo, Brazil / Ingestão dietética, avaliação antropométrica e composição corporal de adolescentes atendidos em um Centro de Atenção Primária à Saúde em Ribeirão Preto, São Paulo, Brasil

Objectives: This study aimed to describe and compare the nutritional profile of three groups of adolescents of the same age and gender, diagnosed as overweight, obese and eutrophic as determined by the Body Mass Index (BMI). Materials and Methods: This is a cross-sectional, observational, comparative, and descriptive study in which adolescents were evaluated using anthropometric measurements suchas skinfolds, waist circumference, BMI and body composition assessed by bioelectric impedance. Asemi-quantitative questionnaire about eating frequency was applied to evaluate food intake. The sample was determined by convenience. A total of 517 adolescents were attended at the CMSCVL between October 2005 and December 2006. Of these, 141 (27.3%) agreed to participate and satisfied the inclusion criteria...

Objetivos: Este estudo teve como objetivo descrever e comparar o perfil nutricional de três grupos de adolescentes da mesma idade e sexo, com diagnóstico de sobrepeso, obesidade e eutrofia, determinado pelo Índice de Massa Corporal (IMC). Materiais e Métodos: Estudo transversal, observacional, comparativo, descritivo, no qual os adolescentes foram avaliados utilizando medidas antropométricas, tais como dobras cutâneas, circunferência da cintura, IMC e composição corporal avaliada pela impedância bioelétrica. Um questionário semi-quantitativo sobre a freqüência alimentar foi aplicado para avaliar a ingestão de alimentos. A amostra foi determinada por conveniência. Foram atendidos no CMSCVL, no período entre outubro de 2005 e dezembro de 2006, 517 adolescentes. Desse total, 141 (27,3%) concordaram em participar e estavam dentro dos critérios de inclusão...

Características clínicas e epidemiológicas de crianças acidentadas atendidas em um serviço de pronto-atendimento / Clinical and epidemiological characteristics of injuried children in a departament of emergengy care

Objetivo: Identificar os acidentes mais frequentes e suas características entre crianças atendidas em um pronto-socorro. Métodos: Estudo observacional e descritivo com dados de prontuários de crianças atendidas no Pronto-Atendimento do Centro de Saúde Escola da Faculdade de Medicina de Ribeirão Preto-USP, entre 1/1/2009 e 30/9/2009. Analisou-se idade, sexo, tipo de acidente, local, dia e período do ocorrido, parte do corpo acometida, cuidados recebidos e se a criança estava acompanhada no momento do acidente. Resultados: Foram atendidas 328 crianças, sendo 202 (61,5%) do sexo masculino e 126 (38,4%) do sexo feminino, com idades até 2 anos (105/32%), 2 a 7 anos (116/35,3%) e 7 a 10 anos (107/32,6%). Dos acidentes, 51,2% aconteceram em casa e 32% na rua. Os principais acidentes foram quedas (48,4%) e choques físicos (37,2%). As partes do corpo mais acometidas foram segmento cefálico (40%), membros superiores (31,4%) e membros inferiores (21,8%). Os acidentes ocorreram à tarde (36%), à noite (27,7%), aos domingos (24,6%) e aos sábados (14,6%). Dos acidentados, 46,6% receberam tratamento sintomático e 34,4% realizaram exames radiológicos. No momento do acidente, 90,5% das crianças estavam acompanhadas e 5,5% dos acidentados foram encaminhados para atendimento especializado. Conclusões: Embora os acidentes tenham sido de baixa gravidade, é necessário incorporar atitudes preventivas de modo a diminuir os riscos e proporcionar maior segurança às crianças.

Objective: To identify the most frequent accidents and their characteristics among children attending at an emergency care service. Methods: observational and descriptive study with medical records of children treated in emergency care of the Health Center School of Medicine Faculty of Ribeirão Preto of the Universidade de São Paulo, between January 1, 2009 and September 30, 2009. Were analyzed age, sex, type of accident, place, date and time of occurrence, body part affected, care received and whether the child was accompanied or not at the accident time. Results: Were treated 382 children: 202 (61.5%) were males and 126 (38.4%) females, with ages ≤ 2 years old (105/32%), from 2 to 7 years old (116/35,3%) and 7 to 10 years old (107/32,6%). A percentage of 51.2% of injuries occurred at home and 32% in the street. Major accidents were falls (48.4%) and physical shock (37.2%). The most affected parts of body were head segment (40%), upper limbs (31.4%) and lower limbs (21.8%). The accidents occurred at the afternoon (36%), at night (27.7%), on Sunday (24,6%) and Saturday (14.6%). A total of 46.6% of the victims received symptomatic treatment and 34.4% underwent radiological examinations. At the time of the accident, 90.5% of the children were accompanied and 5.5% were referred for specialized care. Conclusions: Although the accidents were of low gravity, it is necessary to incorporate preventive attitudes in order to reduce risks and provide greater safety to children.