Body composition in pediatric patients.

Undernutrition is highly prevalent in children who are critically ill and is associated with increased morbidity and mortality, including a higher risk of infection due to transitory immunological disorders, inadequate wound healing, reduced gut function, longer dependency on mechanical ventilation, and longer hospital stays compared with eutrophic children who are critically ill. Nutrition care studies have proposed that early interventions targeting nutrition assessment can prevent or minimize the complications of undernutrition. Stress promotes an acute inflammatory response mediated by cytokines, resulting in increased basal metabolism and nitrogen excretion and leading to muscle loss and changes in body composition. Therefore, the inclusion of body composition assessment is important in the evaluation of these patients because, in addition to the nutrition aspect, body composition seems to predict clinical prognosis. Several techniques can be used to assess body composition, such as arm measurements, calf circumference, grip strength, bioelectrical impedance analysis, and imaging examinations, including computed tomography and dual-energy x-ray absorptiometry. This review of available evidence suggests that arm measurements seem to be well-established in assessing body composition in children who are critically ill, and that bioelectrical impedance analysis with phase angle, handgrip strength, calf circumference and ultrasound seem to be promising in this evaluation. However, further robust studies based on scientific evidence are necessary.

Use of a symbiotic supplement in a child with short bowel Syndrome; a case report.

UNLABELLED: The short bowel syndrome (SBS) is due to loss of bowel after surgery. Characterized by generalized nutrients malabsorption, its signs and symptoms include electrolyte imbalance, deficiency of vitamins, minerals and nutrients that can lead to death. Parenteral and enteral nutrition have a key role in its treatment. OBJECTIVE: To describe the clinical course of a patient with SBS during continuous use of enteral nutrition supplemented with symbiotic. CASE REPORT: A seven-year-old male underwent an emergency laparotomy at 18 months old with a massive bowel resection, remaining about 20 cm of the small intestine and the entire colon. He was dependent of exclusive parenteral nutrition for over a year, leading to the occurrence of numerous infectious complications. Due to complications caused by prolonged use of central venous access, was unable to continue to receive the parenteral nutrition. Enteral nutrition by a nasogastric tube and supplemental symbiotic was the nutritional therapy option for him. The assessment of the volume of losses by the colostomy was measured daily. RESULTS: There was a significant reduction of losses by colostomy, especially in the first days after introduction of the enteral nutrition plus symbiotic supplementation, as well as significant decrease in gas production. CONCLUSION: Despite the lack of evidence for a formal recommendation on the use of symbiotic for SBS patients, its use in the nutritional therapy of this patient resulted in reduced electrolyte loss electrolyte and consequent improvement of his clinical and nutritional condition.

Use of a symbiotic supplement in a child with short bowel Syndrome; a case report / Uso de suplemento simbiótico en un niño con síndrome del intestino corto; caso clínico

The short bowel syndrome (SBS) is due to loss of bowel after surgery. Characterized by generalized nutrients malabsorption, its signs and symptoms include electrolyte imbalance, deficiency of vitamins, minerals and nutrients that can lead to death. Parenteral and enteral nutrition have a key role in its treatment. Objective: To describe the clinical course of a patient with SBS during continuous use of enteral nutrition supplemented with symbiotic. Case report: A seven-year-old male underwent an emergency laparotomy at 18 months old with a massive bowel resection, remaining about 20 cm of the small intestine and the entire colon. He was dependent of exclusive parenteral nutrition for over a year, leading to the occurrence of numerous infectious complications. Due to complications caused by prolonged use of central venous access, was unable to continue to receive the parenteral nutrition. Enteral nutrition by a nasogastric tube and supplemental symbiotic was the nutritional therapy option for him. The assessment of the volume of losses by the colostomy was measured daily. Results: There was a significant reduction of losses bycolostomy, especially in the first days after introduction of the enteral nutrition plus symbiotic supplementation, as well as significant decrease in gas production. Conclusion: Despite the lack of evidence for a formal recommendation on the use of symbiotic for SBS patients, its use in the nutritional therapy of this patient resulted in reduced electrolyte loss electrolyte and consequent improvement of his clinical and nutritional condition (AU)

El síndrome del intestino corto (SIC) se debe a una pérdida intestinal tras cirugía. Caracterizado por una mal absorción generalizada de nutrientes, sus signos y síntomas incluyen el desequilibrio electrolítico y la deficiencia de vitaminas, minerales y nutrientes que pueden acarrearla muerte. La nutrición parenteral y enteral tiene un papel clave en su tratamiento. Objetivo: Describir el curso clínico de un paciente con SIC durante el uso continuo de nutrición enteral suplementada con un simbiótico. Caso clínico: Un chico de siete años fue sometido a una laparotomía urgente a los 18 meses de edad con una resección intestinal masiva, quedando sólo 20 cm de intestino delgado y el colon al completo. Dependió de nutrición parenteral exclusiva durante más de un año, lo que le produjo numerosas complicaciones infecciosas. Debido a las complicaciones causadas por el uso prolongado de un acceso venoso central, no pudo continuar recibiendo la nutrición parenteral. La opción terapéutica para él fue la nutrición enteral a través de una sonda nasogástrica y un suplemento simbiótico. Se evaluaron a diario las pérdidas de volumen a través de la colostomía. Resultados: Hubo una reducción significativa de las pérdidas por la colostomía, especialmente en los primeros días de la introducción de la nutrición enteral y la suplementación simbiótica, así como un descenso significativo de la producción de gas. Conclusión: A pesar de la falta de evidencia de una recomendación formal para el uso de simbiótico en pacientes con SIC, su empleo en la terapia nutricional de este paciente produjo una reducción de la pérdida de electrolitos y la consiguiente mejoría de su situación clínica y nutricional (AU)

Síndrome metabólica na criança e no adolescente / Metabolic syndrome in the child and teenager

Análise da síndrome metabólica na criança e no adolescente, patologia cuja prevalência vem aumentando e com repercussão na idade adulta, impondo sua prevenção e controle desde a infância. O trabalho caracteriza a síndrome e estuda o papel de seus diversos componentes, abordando aspectos diagnósticos e terapêuticos.

Síndrome metabólica em adolescentes com sobrepeso e obesidade / Metabolic syndrome in obese and overweight adolescents

OBJETIVO: Estudar a prevalência da síndrome metabólica em adolescentes acompanhados em ambulatório de obesidade. MÉTODOS: Foram avaliados 84 adolescentes com idades entre dez e 19 anos, divididos em dois grupos, de acordo com o escore Z do índice de massa corpórea (Z IMC), sendo um o grupo de adolescentes com sobrepeso (GSP) e o outro, o grupo de adolescentes obesos (GOB). GSP: Z IMC>1 e <2 (1,6±0,2, 13M/13F), e GOB: Z IMC>2 (2,4±0,6, 32M/26F). Três ou mais dos critérios a seguir foram considerados no diagnóstico da síndrome metabólica e avaliados pelo teste do qui-quadrado entre os grupos: Z IMC>2; triglicérides em jejum >130mg/dL; lipoproteína de alta densidade <35mg/dL; glicemia em jejum >100mg/dL ou homeostatic model assessment index (HOMA) >2,5; elevação da pressão arterial acima do percentil 90 ajustada para gênero, estatura e idade. RESULTADOS: A prevalência da síndrome metabólica esteve significantimente elevada nos adolescentes obesos (GOB: 40 por cento versus GSP: 4 por cento, p=0,0008). O grupo GOB mostrou maiores valores referentes a insulinismo (54 por cento versus 19 por cento, p=0,003), HOMA (66 por cento versus 38 por cento, p=0,01) e trigliceridemia (21 por cento versus 4 por cento; p=0,04). CONCLUSÕES: É importante que o pediatra fique atento aos sinais de síndrome metabólica em adolescentes obesos. A detecção precoce pode ser feita por meio de simples parâmetros e permite a adoção de medidas preventivas para o desenvolvimento da doença cardiovascular em adolescentes.

OBJECTIVE: Evaluate the prevalence of metabolic syndrome in adolescents followed in an outpatient obesity clinic. METHODS: 84 adolescents (ten to 19 years old) were divided in two groups, one composed by overweight adolescents (OWG) and the other, by obese adolescents (OBG), according to Z scores of the body mass index (Z BMI). OWG: Z BMI>1 and <2 (1.6±0.2; 13M/13F) and OBG: Z BMI>2 (2.4±0.6; 32M/26F). Three or more criteria were considered to define the presence of metabolic syndrome and tested by chi-square: Z BMI>2; fasting triglycerides >130mg/dL; high-density lipoprotein cholesterol <35mg/dL; fasting glucose >100mg/dL or homeostatic model assessment index (HOMA) >2.5 and blood pressure above the 90th percentile, adjusted for age, gender and length. RESULTS: The prevalence of metabolic syndrome was significantly elevated in obese adolescents (OBG: 40 percent versus OWG: 4 percent, p=0.0008). The major differences between groups were observed regarding the presence in OBG adolescents of hyperinsulinism (54 percent versus 19 percent, p=0.003), HOMA (66 percent versus 38 percent, p=0.01) and hypertriglyceridemia (21 percent versus 4 percent, p=0.04). CONCLUSIONS: It is important to be aware of the early signs of metabolic syndrome in obese adolescents, which can be screened by simple techniques. As the syndrome correlates to chronic illnesses, early detection and adequate prevention by pediatricians is mandatory.

Tipos de aleitamento e crescimento no primeiro semestre de vida / Feeding patterns and growth during the first six months of age

Com o objetivo de comparar o crescimento de lactentes de familias de baixo nivel socio-economico durante os 6 primeiros meses de vida segundo o tipo de aleitamento recebido, a tendencia individual da evolucao ponderal nesta faixa etaria foi estimada em 104 lactentes acompanhados no Centro de Saude Escola "Prof. Samuel B. Pessoa" da FMUSP, de acordo com o polinomio de segundo grau: peso=a+b.idade+c.idade². A seguir estimou-se o peso medio nas idades de 1, 2, 3, 4, 5 e 6 meses das mesmas, subdivididas em tres grupos: grupo de aleitamento artificial (ART), n = 34. em cada uma destas idades as medias de cada grupo foram comparadas pelo teste t de "student"...