[Cidade Leonor slum, São Paulo. II. Longitudinal clinical and anthropometric follow-up of infants during their first year of life]. / Observações sobre a favela da Cidade Leonor, São Paulo. II--Acompanhamento longitudinal clínico e antropométrico de crianças durante o primeiro ano de vida.

In this study, the authors performed a clinical and nutritional follow-up involving infants that live in a slum area of the City of São Paulo. The infants were followed since birth and up to the end of their first year of life. The nutritional status was evaluated considering the following criteria: weight/age, height/age, and weight/height indices. On the first visit, 38.6% of the infants already presented protein-calory malnutrition according to the weight/age index, and 31.1% presented early delay of growth. The application of the Seoane and Latham criteria showed that most infants had acute malnutrition, but chronic malnutrition was already present in 11.0% of the infants followed-up. The results of this study show the negative impact of an unfavorable environment on infants during their first year of life.

[Cidade Leonor slum, São Paulo. III. Environmental contamination and natural feeding practice]. / Observações sobre a favela da Cidade Leonor, São Paulo. III--Contaminação ambiental e a prática do aleitamento natural.

In this study the authors report the high rate of environmental contamination to which children living in slum areas are exposed. The authors performed a bacteriologic and parasitologic survey in children with acute diarrhea and in controls. Feeding habits were also recorded. The feeding habits revealed that 176 out of 520 children (33.8%) were never breast fed, whereas the remaining 344 (66.7%) were breast fed for an average of 2.2 months. The parasitologic survey was positive in 89% of the stool samples obtained from 83 children, mostly with multiple infections. The bacteriologic survey revealed the presence of enteropathogens and, in particular, invasive E. coli and Campylobacter in 46.7% of the children with acute diarrhea, and in 32.5% of the children in the control group. These findings allow the authors to state that environmental conditions of slum areas directly predispose to the appearance of the diarrhea-malnutrition binomial.

[Cidade Leonor slum, São Paulo. I. Evaluation of the nutritional status of children under 10 years of age]. / Observações sobre a favela da Cidade Leonor, São Paulo. I--Avaliação do estado nutricional das crianças menores de 10 anos.

The authors studied the nutritional status of 520 children living in slums in the City of São Paulo. The weight-for-age index revealed the following results: eutrophy, 46.9%; PCM I, 42.8%; PCM II, 9.9%; PCM III, 1.1%. The height-for-age index revealed the following results: eutrophy, 65.7% and PCM 34.2%. The weight-for-height index revealed the following results: eutrophy, 79.0%; PCM I, 15.9%; PCM II, 3.4%; PCM III, 1.5%. According to the Seoane-Latham criteria the authors found the following results: eutrophy, 43.1%; balanced chronic malnutrition, 19.0%; acute malnutrition, 24.6%; evolutive chronic malnutrition, 9.2%; and chronic malnutrition in recovery 4.0%.

Protracted diarrhea in infancy: clinical aspects and ultrastructural analysis of the small intestine.

Protracted diarrhea is a clinical entity characterized by diarrhea lasting greater than 2 weeks, starting before 3 months of age, with severe nutritional aggravation and negative stool culture for enteropathogens. This report deals with the ultrastructural abnormalities found in the intestinal mucosa of children with protracted diarrhea. Forty children (mean age 5.1 months) were studied. They were submitted to the following tests of intestinal function: D-xylose, triglyceride tolerance, small bowel biopsy (light and electron microscope), sigmoidoscopy, and sweat test. D-Xylose absorption and triglyceride tolerance test in these patients were both significantly lower than controls. Ultrastructural analysis of the small bowel of 12 patients showed various degrees of alterations, mainly shortening of the microvilli, increased number of multivesicular bodies, and vacuolation of mitochondria and endoplasmic reticulum. These lesions were totally reversible after clinical and nutritional recovery as could be proven in two children. The most common cause of protracted diarrhea in these patients was secondary carbohydrate intolerance and dietary protein cow's milk and soy bean intolerance, which resulted in colitis or malabsorption as a consequence of intestinal mucosa injury due to acute gastroenteritis.

Tolerance to glucose polymers in malnourished infants with diarrhea and disaccharide intolerance.

The response of infants with diarrhea and lactose intolerance to feedings containing soy protein and sucrose (Sobee), and/or to a carbohydrate free formula (RCF), to which glucose polymers (GP) were added, was assessed in twenty patients. They all were less than ten months of age and had varying degrees of malnutrition. Eleven had acute diarrhea and nine had chronic diarrhea. None of them had classical enteropathogenic strains and parasites in the stools. All had lactose intolerance when feedings were begun with cow's milk formula and some also had sucrose intolerance when fed sucrose containing soy formulas. They had persistent loose stools and excreted feces with an acid pH and with carbohydrates, thus they were given dietary treatment with RCF with GP. There were 9 patients with acute diarrhea and lactose intolerance (1 of them also had sucrose intolerance), who improved on RCF with GP feedings; but 2 patients (lactose and sucrose intolerant) failed to respond to this diet. There were six patients with chronic diarrhea and lactose intolerance (four of them also had sucrose intolerance), who improved on RCF with GP formula, but there were three patients who failed on this treatment. These data show that some infants with diarrhea, malnutrition, and lactose-sucrose intolerance may also develop intolerance to GP and require further dietary management with glucose as the source of carbohydrate in the diet.

Diarreia protraida. II. Alteracoes ultra-estruturais do intestino delgado. / Protracted diarrhea. II. Ultrastructural changes of small intestine

Estudos ultra-estruturais da mucosa do intestino delgado nao foram descritos em pacientes com diarreia protraida. Neste trabalho descrevemos as alteracoes ultra-estruturais do epitelio intestinal em 12 pacientes de 1 a 10 meses, portadores de diarreia de evolucao superior a duas semanas. A analise ultra-estrutural dos fragmentos do intestino delgado revelou que a grande maioria (11/12) das biopsias intestinais avaliadas durante a fase ativa da enfermidade mostravam alguma anormalidade.Diminuicao do numero e na altura das microvilosidades, presenca consideravelmente aumentada de corpos multivesiculares, inchaco e destruicao de mitocondrias e reticulo endoplasmico foram as alteracoes mais frequentemente observadas. Em dois pacientes a analise ultra-estrutural realizada apos a recuperacao clinica mostrou total regressao das lesoes inicialmente observadas

Diarreia protraida. I. Aspectos clinicos e funcionais do intestino delgado. / Protracted diarrhea. I. Clinical and functional aspects of the small intestine

Diarreia protraida e uma entidade clinica caracterizada por diarreia de mais de duas semanas, com inicio anterior aos tres meses de vida e intenso agravo nutricional e coprocultura negativa para bacterias enteropatogenicas. Neste trabalho estudamos 40 criancas com idade media de 5,1 meses que foram submetidas aos seguintes procedimentos: teste de absorcao da D-xilose, teste de sobrecarga de triglicerides, biopsia de intestino delgado, sigmoidoscopia e teste do suor. O teste de absorcao da D-xilose revelou: 1a. h - 19,5 +/- 10,6 mg% e 2a.19,5 +/- 9,6 mg%; o teste de sobrecarga de triglicerides revelou um incremento plasmatico medio de 25,6 +/- 14,2 mg%, ambos os testes significativamente mais baixos que o encontrado em controles (p < 0,001).Intolerancia secundaria aos carboidratos e intolerancia as proteinas da dieta (leite de vaca e soja) tanto como colite ou malabsorcao foram as causas mais comuns de diarreia protraida

[Tropical enteropathy: morphologic and functional changes of the small intestine and their effects on nutritional status]. / Enteropatia tropical: alterações morfológicas e funcionais do intestino delgado e suas repercussões sobre o estado nutricional.

Tropical enteropathy has been described in children and adults that live in developing countries. This disease may be symptomatic or may present without symptoms. We studied 66 patients with tropical enteropathy with special reference to the nutritional status and the intestinal function. The follow-up of the nutritional status revealed that 63 (95.49%) presented current malnutrition. The D-xylose absorption test was significantly lower than those found in the control group. The mean plasmatic triglyceride increment after the margarine load was significantly lower than that found in the control group. Carbohydrate tolerance tests revealed 51.3% lactose malabsorption, 35.07% sucrose malabsorption and 5% glucose malabsorption. Small bowel biopsy showed partial villous atrophy as the most frequent morphological characteristic observed. These children constitute an homogenous group representative of the majority of the population of the Third World.

Enteropatia tropical: alteracoes morfologicas e funcionais do intestino delgado e suas repercussoes sobre o estado nutricional.

Enteropatia tropical foi o termo introduzido para caracterizar individuos que vivem nos paises subdesenvolvidos e que apresentam anormalidades histologicas da mucosa jejunal e/ou alteracoes nos testes de absorcao. Foram estudados 66 pacientes portadores dessa afeccao com o objetivo de aferir possiveis alteracoes morfologicas e funcionais do intestino delgado associadas ao estado nutricional, que se revelou em 95,43% das criancas. O teste da D-xilosemia pos-absorcao revelou valores significativamente mais baixos que os encontrados em criancas normais. O incremento medio na concentracao plasmatica dos triglicerides, apos a sobrecarga de margarina, mostrou-se significativamente inferior ao do grupo controle. Os testes de sobrecarga de carboidratos, revelam intolerancia a lactose em 51,3% dos casos, a sacarose em 35,07% e a glicose em 5,0% Biopsia jejunal revelou distintos graus de alteracoes morfologicas, sendo a atrofia vilositaria parcial o padrao mais comum. O grupo de criancas estudado constituiu, no seu todo, um grupo homogeneo, representativo de populacoes carentes