Fiber intake, constipation, and overweight among adolescents living in Sao Paulo City.

OBJECTIVE: This study evaluated the dietary fiber intake of adolescents in the metropolitan area of Sao Paulo city and any association between low dietary fiber intake with constipation and overweight. METHODS: In total, 716 adolescents were included within the study, of whom 314 attended private school and 402 attended public school. Evaluation of fiber intake was based on a 24-h daily intake record and a frequency questionnaire. Data concerning bowel movements and height and weight measurements were also taken. RESULTS: Fiber consumption, below that recommended ("age + 5"), was found in 61.8% and 41.4% (P = 0.000) of girls attending private and public schools, respectively, and in 44.1% and 25.6% of boys (P = 0.001). Adolescents who did not eat beans on more than 4 d/wk presented a higher risk of fiber intake below that recommended (age + 5; P < 0.05), with odds ratios ranging from 10.4 to 14.2 according gender and private or public schooling. Dietary fiber intake below that recommended was associated with a greater risk (P < 0.05) toward overweight in students attending public schooling (odds ratios 2.84 and 2.95 for males and females, respectively). Low dietary fiber intake was not associated with constipation. CONCLUSION: Intake of beans more than four times per week is associated with the appropriate level of fiber intake. Dietary fiber intake below the recommendation was not associated with constipation but was associated with being overweight among those students attending public schooling.

The influence of sardine consumption on the omega-3 fatty acid content of mature human milk.

OBJECTIVES: The purpose of this study was to investigate what effect the ingestion of sardines, rich in omega-3 series polyunsaturated fatty acids, has on the composition of breastmilk. METHODS: This was a prospective study of 31 nursing mothers under observation at the Hospital Guilherme Alvaro. Each was given 2 kg of fresh sardines twice with a 15-day interval. Milk was sampled and a 24-hour dietary recall questionnaire was applied on days 0, 15 and 30. Milk was assayed for fatty acid content by gas chromatography. Statistical analysis of the results was performed using nonparametric tests with significance set at p < 0.05. RESULTS: The results demonstrate that the nutritional intake of the nursing mothers was adequate at all three sample points. With regard to the omega-3 series fatty acid content of the breastmilk, it was observed that regular consumption and shorter intervals between ingestion and milk collection resulted in higher concentrations of docosapentaenoic acid and docosahexaenoic acid at 15 and 30 days into the study. Fatty acids from the omega-3 and omega-6 series exhibited a significant correlation, r2 was 0.58 and 0.59 at 15 and 30 days, respectively. CONCLUSION: These results suggest that incorporating fish into the diets of nursing mother during lactation, in the form of 100 g of sardines two or three times a week, contributes to an increase in omega-3 series fatty acids.

High prevalence of malnutrition among patients with solid non-hematological tumors as found by using skinfold and circumference measurements.

CONTEXT AND OBJECTIVE: Malnutrition in cancer patients has many causes. Nutritional status is usually assessed from weight/height indices. These present limitations for the nutritional assessment of cancer patients: their weights include tumor mass, and lean mass changes are not reflected in weight/height indices. The objective was to evaluate differences between two anthropometric methods and compare deficits, in non-hematological tumor patients and hematological disease patients. DESIGN AND SETTING: Cross-sectional study at Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo. METHODS: Children and adolescents were evaluated between March 1998 and January 2000. Traditional anthropometric measurements were obtained in the first month of treatment (induction therapy), by weight-for-height (W/H) using z-scores index for children and body mass index (BMI) for adolescents. Body composition evaluations consisted of specific anthropometric measurements: triceps skinfold thickness (TSFT), mid-upper arm circumference (MUAC) and arm muscle circumference (AMC). Data were analyzed to compare nutritional assessment methods for diagnosing malnutrition prevalence. The chi-squared test was used for comparative analyses between tumor patients and hematological disease patients. RESULTS: Analysis was done on 127 patients with complete data. Higher percentages of deficits were found among tumor patients, by W/H z-scores or BMI and by MUAC and AMC. Higher percentages of deficits were shown by TSFT (40.2%) and MUAC (35.4%) than by W/H z-scores or BMI (18.9%). CONCLUSION: Non-hematological tumor patients presented higher malnutrition prevalence than did hematological disease patients. Body composition measurements by TSFT and MUAC detected more patients with malnutrition than did W/H or BMI.

Anthropometric indices and exclusive breastfeeding in the first six months of life: a comparison with reference standards NCHS, 1977 and WHO, 2006.

BACKGROUND: There is a gap in knowledge on the growth of children exclusively breastfed during the fifth and sixth months of life. This study aimed to assess the growth of infants who were exclusively breastfed for the first 6 months of life and compare the distributions of anthropometric measures based on the National Center for Health Statistics (NCHS, 1977) and World Health Organization (WHO, 2006) curves. METHODS: Cross-sectional study that measured the weight and length of 360 healthy and exclusively breastfed infants who were enrolled in a primary care program in Belem, Brazil from October 2006 to December 2008. The children were evenly grouped into age groups from 1 to 6 months of age. RESULTS: The mean weights were higher than the NCHS, 1977 mean weight for all of the studied groups regardless of gender and showed greater similarity to the WHO, 2006 mean weight, especially when standard deviations were considered. Regarding length, although the average length at birth was smaller, females had higher averages in the second and sixth months compared with the reference curves (p < 0.05). CONCLUSIONS: Exclusive breastfeeding in the first 6 months of life provides adequate physical growth, resulting in height and weight gain curves that are similar to or greater than the NCHS, 1977 and WHO, 2006 curves. The greater mean weight at the fifth and sixth months of life suggests that the second-quarter growth curves of children who are exclusively breastfed are greater than those of children who receive other types of food.

Lipodystrophy, lipid profile changes, and low serum retinol and carotenoid levels in children and adolescents with acquired immunodeficiency syndrome.

OBJECTIVE: To assess serum retinol and levels of carotenoids in children and adolescents with acquired immunodeficiency syndrome (AIDS) and to correlate low serum retinol and carotenoid levels with the presence of lipodystrophy, lipid profile changes, lipid peroxidation, and insulin resistance. METHODS: A cross-sectional, controlled observational study was carried out with 30 children and adolescents with AIDS (mean age 9.1 y) receiving antiretroviral therapy (median length of treatment 28.4 mo), including 30 uninfected healthy controls matched for age and gender. Clinical and laboratory assessments were performed to determine nutritional status, presence of lipodystrophy, serum concentrations of retinol, beta-carotene, lycopene, lipid profile (high-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triacylglycerols), lipid peroxidation (thiobarbituric acid-reactive substances), glycemia, and serum insulin (homeostasis model assessment for insulin resistance, cutoff point >3). Statistical analysis was done with chi-square test and Student's t test. RESULTS: Lipodystrophy was observed in 53.3% of patients with AIDS, and dyslipidemia was detected in 60% and 23% of subjects with human immunodeficiency virus and control subjects, respectively (P = 0.004). A higher prevalence of retinol deficiency (60% versus 26.7%, P = 0.009) and beta-carotene deficiency (23.3% versus 3.3%, P = 0.026) was found in the group with human immunodeficiency virus than in the control group. No correlation was found for low retinol and beta-carotene levels, changes in lipid and glucose metabolism, or lipodystrophy in children and adolescents with AIDS. CONCLUSION: Despite the high frequency of dyslipidemia, lipodystrophy, and retinol and beta-carotene deficiencies, it was not possible to demonstrate a correlation of these findings with lipid peroxidation and insulin resistance. More studies are needed to investigate the causes of retinol and beta-carotene deficiencies in this population and the clinical consequences of these findings.

Lipodystrophy in children and adolescents with acquired immunodeficiency syndrome and its relationship with the antiretroviral therapy employed.

OBJECTIVE: To evaluate the presence of clinical lipodystrophy in children with the acquired immunodeficiency syndrome and to relate it to the antiretroviral regimen employed, to changes in lipid profile and to insulin resistance. METHODS: This was a cross-sectional study that evaluated 30 children and adolescents (median age = 9.1 years) with the acquired immunodeficiency syndrome during 2004 and 2005. The following clinical and laboratory evaluations were performed: classification of HIV infection, anthropometric measurements (weight and height), serum glycemia, serum insulin and lipid profile (LDL-c, HDL-c, triglycerides). Lipodystrophy was diagnosed using clinical parameters. The chi-square test was used for statistical analysis. RESULTS: All of the patients were taking antiretroviral therapy regularly (median duration of 28.4 months); 80% were on three drugs in combination (highly active therapy) and 30% were on protease inhibitors. Lipodystrophy and dyslipidemia were observed in 53.3 and 60% of the patients, respectively. Children on a highly active therapy regimen with protease inhibitors exhibited a higher percentage of mixed lipodystrophy; the difference between these children and the group on highly active therapy without protease inhibitors and the group not on a highly active therapy was statistically significant (44.4 vs. 16.7%; p = 0.004). There was no statistically significant association between the presence of lipodystrophy and sex, age (> 10 years), changes to the lipid profile or insulin resistance. CONCLUSIONS: The elevated prevalence of dyslipidemia and lipodystrophy observed among children with acquired immunodeficiency syndrome, which exhibited a relationship with the antiretroviral regimen employed, may represent an increased risk for future complications, in particular cardiovascular problems.

Suplementação oral em pacientes pediátricos com câncer / Nutritional supplementation in pediatric patients with cancer

The aim of this work was to evaluate the impact of nutritional supplementation on the nutritional status and on the compliance with the nutritional therapy in pediatric oncology patients. A total of 116 episodes classified as nutritional risk in accordance to z score (weight for height)in children and body mass index in adolescents were followed up. In order to establish the nutritional evolution, the following items were analyzed: triceps skin fold thickness, mid upper arm circumference and muscle arm circumference. These items were evaluated in three moments: week 3, 8 and 12. Patients were randomized in two groups to receive industrialized or handmade nutritional supplementation. A positive outcome was observed in the period between weeks 0 and 12: the triceps skin fold thickness increased in 77% of the industrialized oral supplementation group versus 64% of the handmade oral supplementation group, respectively (P<0.02). Comparing the groups for non-compliance with the treatment, rates of 28% in industrialized oral supplementation versus 33% in handmade oral supplementation group were observed. The results suggestthat the industrialized nutritional supplementation could improve the nutritional status in these patients during the oncologic treatment. Due to the recent institution of the nutritional therapy protocol in Brazil, these results are important, considering that the compliance in this sample was70%. Probably, the valorization of the nutritional therapy by the multidisciplinary team will contribute to the increase the compliance with the nutritional protocol.

El objetivo del trabajo fue evaluar el impacto delos suplementos alimenticios orales en el estado nutricional y en la adherencia a la terapia nutricional en pacientes pediátricos con cáncer. Fueron acompañados 116 pacientes en riesgo nutricional, de acuerdo con: score z (peso para estatura), para niños e índice de masa corporal, para adolescentes. Para apreciar la evolución nutricional fueron utilizados: pliegue cutáneo triciptal, circunferencia braquial y circunferencia muscular delbrazo. Esas variables fueron evaluadas en tres momentos: semanas 3, 8 y 12. Los pacientes fueron distribuidos en forma aleatoria para los suplementos industrializados o artesanales. Los resultados mostraron una evaluación favorable para el estado nutricional en el periodo entre las semanas: 0 y 12: el pliegue cutáneo triciptal presentó un aumento en 77% para el grupo suplemento industrializado y 64% para el grupo suplemento artesanal respectivamente (p<0,02). Comparando los abandonos entre los grupos, se observó en el grupo suplemento industrializado 28,32% y32,65% en el grupo suplemento artesanal. Estos datos sugieren que el suplemento industrializado puede tener un efecto benéfi co en la recuperación nutricional durante el tratamiento oncológico. Delante de la reciente institución de terapia nutricional protocolada en Brasil , los resultados se muestran representativos, ya que la adherencia fue de 70% en la muestra. Probablemente, lavalorización de la terapia nutricional por el equipo multidisciplinar, contribuirá para el aumento en la adherencia a los protocolos nutricionales.

O objetivo do trabalho foi avaliar o impacto da suplementação oral no estado nutricional e na adesão à terapia nutricional em pacientes pediátricos com câncer. Foram acompanhados 116 pacientes em risco nutricional, segundo o escore z (peso para estatura), para crianças; e índice de massa corporal para adolescentes. Para apreciar a evolução nutricional foram utilizadas: prega cutânea triciptal, circunferência braquial e circunferência muscular do braço. Essas variáveis foram avaliadas em três momentos: semana 3, 8 e 12.Os pacientes foram randomizados para suplementação oral industrializada ou artesanal. Houve evolução favorável no estado nutricional no período entre as semanas 0 e 12: a prega triciptal apresentou aumento em 77% do grupo suplemento industrializado e 64% do grupo suplemento ar tesanal, respectivamente (p<0,02). Comparando os abandonos entre os grupos, observou-se no grupo de suplemento industrializado 28,32% versus 32,65% no grupo suplemento artesanal. Os resultados sugerem que o suplemento industrializado pode ter um efeito benéfico na recuperação nutricional durante o tratamento oncológico. Diante da recente instituição da terapia nutricional protocolada no Brasil, tais resultados mostram-se representativos, já que a adesão foi de 70% da amostra. Provavelmente, a valorização da terapia nutricional pela equipe multidisciplinar, contribuirá para o aumento da adesão aos protocolos nutricionais.

Fatores de risco associados ao desmame precoce e ao período de desmame em lactentes matriculados em creches / Risk factors associated to early weaning and to weaning period of infants enrolled in daycare centers

OBJETIVO: Avaliar os fatores de risco no processo de desmame de lactentes matriculados em creches. MÉTODOS: Estudo analítico transversal com 56 crianças de nove a 18 meses de idade matriculadas em cinco creches de São Paulo. As mães das crinaças responderam ao questionário pré-testado que abordava questões demográficas, socioeconômicas, de gestação e nascimento, morbidade, aleitamento materno, alimentação complementar (quando/como foram introduzidos novos alimentos) e atividades da criança na creche. Os fatores associados ao desmame precoce e menor período de desmame (variável definida pela diferença entre tempo de aleitamento exclusivo e tempo de aleitamento total) foram avaliados em análises bivariadas. As variáveis com p<0,10 foram ajustadas em modelo conceitual hierárquico de regressão logística. RESULTADOS: Na análise multivariada, foram determinados os seguintes fatores de risco independentes para desmame precoce: renda familiar <3 salários mínimos (OR 3,73; IC95 por cento 1,23-11,34); idade da mãe >25 anos (OR 4,91; IC95 por cento 1,35-17,95); mãe morar sem companheiro (OR 6,42; IC95 por cento 1,28-32,20) e uso de chupeta antes dos 30 dias de vida (OR 8,75; IC95 por cento 1,90-40,23). Os fatores de risco para tempo insuficiente de desmame foram: frequentar creche pública (OR 3,20; IC95 por cento 0,77-14,29) e início tardio do pré-natal (OR 4,13; IC95 por cento 0,70-31,29). CONCLUSÕES: Características relacionadas à família e à instituição creche são fatores de risco para o desmame de crianças institucionalizadas. A abordagem desses determinantes para definir ações de saúde e nutrição é estratégica para favorecer a prática do aleitamento e qualificar o papel da creche como promotora de saúde e nutrição infantil.

OBJECTIVE: To evaluate risk factors associated with weaning of infants enrolled in daycare centers. METHODS: Analytical cross-sectional study comprising 56 children aged nine to 18 months in five daycare centers of São Paulo. A pre-tested questionnaire was applied to their mother, including questions on demographics and socioeconomic issues, gestation and birth, illness, breastfeeding, complementary feeding (when and how new foods were introduced) and children activities in daycare centers. Factors associated with early weaning and short weaning period (defined as the difference between exclusive breastfeeding period and total breastfeeding period) were determined by bivariate analyses. Conceptual hierarchical multivariate analysis (logistic regression) was applied. RESULTS: In the multivariate analysis, the independent risk factors for early weaning were: family income <3 minimum wage (OR 3.73; 95 percentCI 1.23-11.34); mother's age >25 years (OR 4.91; 95 percentCI 1.35-17.95); mother living without a partner (OR 6.42; 95 percentCI 1.28-32.20); use of pacifier before 30 days of life (OR 8.75; 95 percentCI 1.90-40.23). Risk factors for insufficient weaning period were: attending public daycare centers (OR 3.20; 95 percentCI 0.77-14.29) and late start of prenatal care (OR 4.13; 95 percentCI 0.70-31.29). CONCLUSIONS: Characteristics related to family and to daycare centers are risk factors for breastfeeding weaning among institutionalized infants. Such factors approach is strategic to define nutrition and health actions for favoring breastfeeding practice and to qualify daycare centers as infant health and nutrition promoters.

Perfil comportamental de crianças e adolescentes com síndrome de Prader-Willi e obesidade exógena / Behavioral profile of children and adolescents with Prader-Willi syndrome and exogenous obesity / Perfil conductual de niños y adolescentes con síndrome de Prader-Willi y obesidad exógena

O presente estudo teve como objetivo comparar o perfil comportamental de dois grupos distintos de crianças e adolescentes portadores de obesidade. Dez participantes apresentavam diagnóstico de obesidade exógena (OE) e dez tinham síndrome de Prader- Willi (SPW). A SPW é uma doença genética cujo sintoma comportamental de maior gravidade é a hiperfagia. Os dois grupos foram pareados por sexo e idade, com idade média de 12 anos. Na avaliação do perfil comportamental, foi usado o inventário dos comportamentos de crianças e adolescentes de 6 a 18 anos (CBCL/6-18). Os principais resultados apontaram que, de modo geral, os participantes com obesidade de causas exógenas obtiveram melhores resultados do que os diagnosticados com SPW. Em comparações, em que utilizaram análises de variância (ANOVA) univariadas, observaram-se diferenças estatisticamente significantes entre os grupos de SPW e OE nas escalas: escola (p = 0,001), problemas sociais (p = 0,012), problemas de pensamento (p = 0,001), problemas de atenção (p = 0,048), comportamento de quebrar regras (p = 0,019), comportamento agressivo (p = 0,003) e transtorno de conduta (p = 0,001). As diferenças encontradas sugerem a necessidade de estratégias de atendimento psicológico para o grupo com SPW.

The objective of present study was compared the behavioral profile of two different groups of children and adolescents with obesity. Ten subjects presented diagnoses of exogenous obesity and ten Prader-Willi syndrome. The Prader-Willi syndrome is a genetic disease which the main behavioral symptom is hyperphagia. The samples were paired by sex and age, with mean age of 12 years. In the evaluation of behavioral profile was utilized Child Behavior Checklist (CBCL/6-18). In the most cases children with exogenous obesity have obtained better results than the referred with Prader-Willi Syndrome. Into the comparison by mean of ANOVA univariate identified significant differences between the groups in the scales: school (p = 0.001), social problems (p = 0.012), thought problems (p = 0.001), attention problems (p = 0.048), rule-breaking behavior (p = 0.019); aggressive behavior (p = 0.003) and conduct problems (p = 0.001). The differences suggested the need of counseling psychological strategies in the Prader-Willi syndrome group.

El presente estudio tuvo como objetivos comparar el perfil comportamental de dos grupos distintos de niños y adolescentes portadores de obesidad. Diez participantes apresentaban diagnóstico de obesidad exógena y diez con síndrome de Prader-Willi. El síndrome de Prader-Willi es una enfermedad genética que tiene como un de los síntomas comportamentales de mayor gravedad el desarrollo de la hiperfagia. Los dos grupos fueron pareados por sexo y por edad, con edad media de 12 años. Para la evaluación del perfil comportamental fué usado el inventário de los comportamientos de niños y adolescentes de 6 a 18 años (CBCL/6-18). Los principales resultados apuntaron que de modo general, los participantes con obesidad de causas exógenas obtuvieron mejores resultados que los diagnosticados con síndrome de Prader-Willi. En comparaciones utilizando ANOVAS univariadas, fueron observadas diferencias estadisticamente significativas entre los grupos en las escalas: escuela (p = 0,001), problemas sociales (p = 0,012), problemas de pensamiento (p = 0,001), problemas de atención (p = 0,048), comportamiento de romper reglas (p = 0,019), comportamiento agresivo (p = 0,003) y trastornos de conducta (p = 0,001). Los datos sugieren la necesidad de estrategias de atención psicológica para el grupo con síndrome de Prader-Willi.

Lipodistrofia em crianças e adolescentes com síndrome da imunodeficiência adquirida e sua relação com a terapia antirretroviral empregada / Lipodystrophy in children and adolescents with acquired immunodeficiency syndrome and its relationship with the antiretroviral therapy employed

OBJETIVO: Avaliar a presença de lipodistrofia clínica em crianças com síndrome da imunodeficiência adquirida e relacioná-la com o esquema antirretroviral utilizado, alterações do perfil lipídico e resistência insulínica. MÉTODOS: Por meio de estudo transversal, foram avaliadas 30 crianças e adolescentes (mediana de idade = 9,1 anos) com síndrome da imunodeficiência adquirida, no período entre 2004 e 2005. As avaliações clínico-laboratoriais incluíram: classificação da infecção pelo HIV, medidas antropométricas (peso e estatura), glicemia e insulina séricas e perfil lipídico (LDL-c, HDL-c, triglicérides). A lipodistrofia foi definida por parâmetros clínicos. O teste do qui-quadrado foi utilizado na análise estatística. RESULTADOS: Todos os pacientes recebiam terapia antirretroviral regularmente (mediana de tempo de uso = 28,4 meses), 80 por cento utilizavam três drogas em associação (terapia fortemente ativa) e 30 por cento usavam inibidores de protease. Lipodistrofia e dislipidemia foram observadas em 53,3 e 60 por cento dos pacientes, respectivamente. Crianças que utilizavam terapia fortemente ativa com inibidor de protease apresentaram maior percentual de lipodistrofia mista, com diferença estatisticamente significante em relação ao grupo com terapia fortemente ativa sem inibidor de protease e ao grupo sem terapia fortemente ativa (44,4 versus 16,7 por cento; p = 0,004). Não se observou diferença estatisticamente significante entre presença de lipodistrofia e gênero, idade (> 10 anos), alterações do perfil lipídico e resistência insulínica. CONCLUSÕES: A elevada prevalência de dislipidemia e lipodistrofia verificada nas crianças com síndrome da imunodeficiência adquirida, mostrando relação com o esquema antirretroviral empregado, pode significar um risco elevado para o desenvolvimento futuro de complicações, especialmente as cardiovasculares.

OBJECTIVE: To evaluate the presence of clinical lipodystrophy in children with the acquired immunodeficiency syndrome and to relate it to the antiretroviral regimen employed, to changes in lipid profile and to insulin resistance. METHODS: This was a cross-sectional study that evaluated 30 children and adolescents (median age = 9.1 years) with the acquired immunodeficiency syndrome during 2004 and 2005. The following clinical and laboratory evaluations were performed: classification of HIV infection, anthropometric measurements (weight and height), serum glycemia, serum insulin and lipid profile (LDL-c, HDL-c, triglycerides). Lipodystrophy was diagnosed using clinical parameters. The chi-square test was used for statistical analysis. RESULTS: All of the patients were taking antiretroviral therapy regularly (median duration of 28.4 months); 80 percent were on three drugs in combination (highly active therapy) and 30 percent were on protease inhibitors. Lipodystrophy and dyslipidemia were observed in 53.3 and 60 percent of the patients, respectively. Children on a highly active therapy regimen with protease inhibitors exhibited a higher percentage of mixed lipodystrophy; the difference between these children and the group on highly active therapy without protease inhibitors and the group not on a highly active therapy was statistically significant (44.4 vs. 16.7 percent; p = 0.004). There was no statistically significant association between the presence of lipodystrophy and sex, age (> 10 years), changes to the lipid profile or insulin resistance. CONCLUSIONS: The elevated prevalence of dyslipidemia and lipodystrophy observed among children with acquired immunodeficiency syndrome, which exhibited a relationship with the antiretroviral regimen employed, may represent an increased risk for future complications, in particular cardiovascular problems.

The influence of sardine consumption on the omega-3 fatty acid content of mature human milk

OBJECTIVES: The purpose of this study was to investigate what effect the intake of sardines, rich in omega-3 series polyunsaturated fatty acids, has on the composition of breastmilk. METHODS: This was a prospective study of 31 nursing mothers under observation at the Hospital Guilherme Alvaro. Each was given 2 kg of fresh sardines twice with a 15-day interval. Milk was sampled and a 24-hour dietary recall questionnaire was applied on days 0, 15 and 30. Milk was assayed for fatty acid content by gas chromatography. Statistical analysis of the results was performed using nonparametric tests with significance set at p < 0.05. RESULTS: The results demonstrate that the nutritional intake of the nursing mothers was adequate at all three sample points. With regard to the omega-3 series fatty acid content of the breastmilk, it was observed that regular consumption and shorter intervals between intake and milk collection resulted in higher concentrations of docosapentaenoic acid and docosahexaenoic acid at 15 and 30 days into the study. Fatty acids from the omega-3 and omega-6 series exhibited a significant correlation, r2 was 0.58 and 0.59 at 15 and 30 days, respectively. CONCLUSION: These results suggest that incorporating fish into the diets of nursing mother during lactation, in the form of 100 g of sardines two or three times a week, contributes to an increase in omega-3 series fatty acids.

Nutrition education in public elementary schools of São Paulo, Brazil: the Reducing Risks of Illness and Death in Adulthood project

OBJECTIVE: The objective of this article was to analyze the development, implementation and impact of a nutrition education program on the knowledge and attitudes associated with healthy eating habits. METHODS: Controlled randomized trial comprising teachers and children of eight public schools; three of them were submitted to educational activities and the remaining ones were kept as controls. Effects of nutrition education were measured in terms of knowledge and attitudes. RESULTS: The results revealed an improvement in the food choice among students and a reduction in the intake of foods with high energy density. An improvement in the knowledge and attitudes of the teachers towards the prevention of obesity was also observed. CONCLUSION: Even with a positive attitude regarding the development of this proposal, there was a lack of support from the studied schools. Future studies and a greater involvement by the Health and Education sectors could overcome such barriers, improving the results of school-based programs to prevent obesity.

High prevalence of malnutrition among patients with solid non-hematological tumors as found by using skinfold and circumference measurements

CONTEXTO E OBJETIVO: Em pacientes com câncer, a desnutrição tem múltiplas causas. Medidas antropométricas de peso e estatura são o método mais utilizado para avaliação do estado nutricional. Infelizmente, esse método é limitado em pacientes com câncer, pois o peso inclui o tumor e a relação peso/estatura não leva em conta alterações específicas de tecido magro. O objetivo deste estudo é avaliar diferenças entre medidas antropométricas e de composição corporal em crianças e adolescentes com câncer. TIPO DE ESTUDO E LOCAL: Estudo de corte transversal realizado no Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo — Escola Paulista de Medicina, São Paulo, Brasil. MÉTODOS: Crianças e adolescentes com câncer com idade acima de um ano foram avaliadas de março de 1998 a janeiro de 2000. Medidas antropométricas tradicionais foram coletadas no primeiro mês de tratamento oncológico (terapia de indução) por meio do escore-z de peso para estatura (P/E) nas crianças e índice de massa corpórea (IMC) nos adolescentes. A avaliação da composição corporal foi composta por medidas de prega cutânea triciptal (PCT), circunferência do braço (CB) e circunferência muscular do braço (CMB). Os dados foram analisados comparando-se as prevalências de desnutrição entre os métodos de avaliação nutricional. O teste do qui-quadrado e o grau de associação foram usados para comparar as taxas entre portadores de tumores sólidos e hematológicos. RESULTADOS: 139 pacientes foram avaliados, 127 tinham dados completos para análise. O estudo demonstrou maior percentual de déficit nos portadores de doenças sólidas não-hematológicas pelo P/E ou IMC, CB, e CMB. A análise global também sugere que a PCT (40%) e a CB (35%) demonstraram maior percentual de déficit quando comparadas ao escore-z de P/E ou IMC (19%). CONCLUSÃO: Pacientes com tumores sólidos apresentaram maior prevalência de desnutrição. As medidas de composição corporal por meio da PCT e CB detectaram mais pacientes desnutridos do que o P/E e o IMC.

Prevalência de desnutrição em crianças com tumores sólidos / Malnutrition prevalence in children with solid tumors

OBJETIVO: Avaliar a prevalência de desnutrição entre crianças com tumores sólidos em tratamento num centro oncológico brasileiro. MÉTODOS: Foram avaliados 44 pacientes durante o primeiro mês de tratamento, por meio de medidas antropométricas e, de acordo com recomendações da Organização Mundial de Saúde, seguindo os escores-Z de peso/idade, estatura/idade e peso/estatura para o diagnóstico nutricional. RESULTADOS: De acordo com os escores-Z de peso/idade, estatura/idade e peso/estatura, encontramos, respectivamente, 16 por cento, 7 por cento e 16 por cento de desnutrição entre as 44 crianças. De acordo com os diagnósticos de câncer, 27 por cento dos portadores de tumores cerebrais, 25 por cento dos pacientes com neuroblastomas e 11 por cento com tumores de Wilms, apresentaram desnutrição energético-protéica. CONCLUSAO: Há uma elevada prevalência de desnutrição na população estudada, que pode estar relacionada à doença, ao tratamento e aos fatores socioeconômicos, como também à falta de um protocolo nutricional para identificar e tratar precocemente a desnutrição em crianças com tumores sólidos.

Atuação ambulatorial do profissional de educação física no atendimento a crianças e adolescentes obesos / Outpatient performance of the physical education professional caring for the obese children and adolescents

A freqüência da obesidade na infância e adolescência aumentou nos últimos anos. Essa situação tem preocupado a área da saúde, não só pelas conseqüências promovidas pela obesidade na população em geral, mas pela imposição de prejuízos biopsicossociais, ainda na infância. O tratamento é bastante complexo, pois sua causa é multifatorial, exigindo atenção interdisciplinar. O presente trabalho teve como objetivo relatar o papel do professor de educação física na equipe de atendimento ambulatorial de crianças e adolescentes obesos. A atividade física, depois da taxa metabólica basal, é considerada o segundo maior componente do gasto energético diário. Diversos estudos demonstraram que a atividade física associada ao controle alimentar leva a melhores resultados do que essas ações isoladas. O aumento da atividade física é muito benéfico no tratamento de crianças e adolescentes obesos, pois permite maior ingestão alimentar e auxilia a preservar a massa magra. Entretanto, o exercício físico deve ser adaptado às condições de excesso de peso e de crescimento ósseo. Além desses cuidados, o profissional depara-se com a dificuldade de manter crianças e adolescentes em programa de exercício regular. Desse modo, a prescrição do aumento de movimento corporal após a anamnese da rotina diária de cada paciente foi a solução encontrada para, inicialmente, colocá-los em contato com o próprio corpo. Paralelamente, o professor de educação física auxilia a criança a encontrar um tipo de esporte que mais lhe agrade, dentro daqueles permitidos pelo seu excesso de peso e fase de crescimento. Geralmente, recomendamðse atividades que tenham baixo impacto, como nadar, caminhar e andar de bicicleta. O professor de educação física, como educador, deve fazer parte do atendimento multidisciplinar de crianças e adolescentes obesos.

The prevalence of childhood and adolescent obesity has increased in recent years. This fact has raised concern in the health care field because obesity in general causes many health problems in the population at large, and also because obesity has many bio-psycho-social implications during childhood. The treatment of obesity is very complex since this disease has multifactorial causes, requiring an interdisciplinary response from health care professionals. This study was conducted to evaluate the role of physical education teachers in a group of professionals treating obese children and adolescents. Physical activity, after basal metabolic rate, is considered the second largest component of daily energy expenditure. Various studies have shown that physical activity with control of food intake produces the best results in treating weight loss compared to either of these treatments used independently. The increase of physical activity is very beneficial in the treatment of obese children and adolescents since it allows for a greater intake of food and at the same time maintains lean body mass. However, the type of physical activity should be adapted to the conditions of each child given that the obese person has an excess amount of weight along with the presence of active bone growth. Besides these precautions, the professional often has to deal with the difficulty of keeping the child or adolescent in an active, regular program of physical activity. It was found that promoting an increase in overall physical activity through a detailed, personal evaluation of his/her daily routine allows each patient to become more in touch with his/her own body. At the same time physical education teachers assist the child to find a type of sport that is enjoyable to him/her, but within the constraints of his/her excess weight and period of growth. It is generally recommended that the activities of the obese child or adolescent be low impact, such as swimming, walking, or riding a bicycle. The physical education teacher is an educator and thus should used his/her abilities in the multidisciplinary treatment of obese children and adolescents.

Retinol sérico de adolescentes de uma escola da cidade de São Paulo / Retinol blood levels in high school students of São Paulo, Brazil

OBJETIVO: Investigar os níveis séricos de retinol de 218 adolescentes de ambos os sexos com idade entre 10 e 19 anos, matriculados em colégio da rede privada de ensino da cidade de São Paulo, foi o objetivo deste trabalho. MÉTODOS: Para a avaliação da condição nutricional dos adolescentes, utilizaram-se as medidas antropométricas de peso e altura e também a história dietética. A dosagem de retinol foi realizada pela técnica de espectrofotometria, considerando como níveis séricos inadequados valores <1,05µmol/L (30µg/dL). RESULTADOS: A média de ingestão, de acordo com a faixa etária, foi maior que a recomendação, porém com altos valores de desvios padrão, em ambos os sexos. A prevalência de adolescentes com níveis séricos de vitamina A abaixo do adequado foi de 30 por cento em ambos os sexos e a análise da correlação de índice de Massa Corporal com os níveis séricos de retinol não mostrou significância, como também a análise da correlação entre a densidade de ingestão de vitamina A e níveis séricos de retinol. CONCLUSAO: Os achados deste estudo sugerem a necessidade da realização de mais investigações sobre vitamina A no período da adolescência, para verificar se o nível sérico baixo desse nutriente é um fator de risco para a saúde do adolescente ou é reflexo da captação acelerada que ocorre para atender necessidades metabólicas.

Evolution of nutritional status of infants infected with the human immunodeficiency virus

CONTEXT: There are today only a limited number of studies defining growth parameters and nutritional status for HIV children. OBJECTIVE: To study the nutritional status of infants infected with the human immunodeficiency virus. TYPE OF STUDY: Longitudinal study. SETTING: Department of Pediatrics, Faculty of Medical Sciences, UNICAMP, Campinas, Brazil. PARTICIPANTS: One hundred and twenty-four children born to HIV infected mothers were evaluated from birth until the age of two years. They were subdivided into two groups: 71 infected children and 53 non-infected children. MAIN MEASUREMENTS: Growth was evaluated in both groups by comparing Z-scores for weight/age (w/a), length/age (H/a) and weight/length (w/H) (using the NCHS curves as reference). RESULTS: The Z-score analyses showed that there was a significant difference between the two groups for all the variables studied, except for the H/a value at 3 months of age and the W/H value at 21 months of age, which showed P > 0.05. CONCLUSIONS: The growth of infected infants was observed to be severely affected in comparison with that of seroreversed infants in the same age groups. Although clinical manifestations may take time to appear, the onset of growth changes begin soon after birth

Impacto do uso de cereal adicionado de ferro sobre os níveis de hemoglobina e a antropometria de pré-escolares / Effect of the use of iron-enriched cereal on the serum hemoglobin levels and anthropometric values of preschool children

A anemia na infância tem sido considerada um dos grandes desafios nutricionais nos países em desenvolvimento, seguida da desnutrição energética. Têm-se discutido muito a eficácia dos alimentos enriquecidos no combate a esse problema. O objetivo desse trabalho foi avaliar a aceitação diária de cereal adicionado de ferro e o seu impacto nos parâmetros antropométricos e nos níveis de hemoglobina de crianças de 1 a 4 anos de idade. foram estudadas 54 crianças de uma creche municipal, de duas salas, sendo o grupo I constituído de 24 crianças com média de idade de 2 anos e 2 meses e o grupo II constituído de 30 crianças de 3 anos e 6 meses. Essas crianças foram avaliadas, no início e no final da intervenção, quanto à ingestão alimentar, peso estatura e níveis de hemoglobina sérica. Durante o período de dois meses, o café da manhã e o lanche da tarde, que eram constituídos de leite e pão, foram substituídos pelo cereal adicionado de ferro na forma de mingau, o que proporcionou aumento de 2 a 3mg de ferro por dia. Os resultados mostraram que houve aumento significante na adequação do índice P/E das crianças com desnutrição atual. Quanto aos níveis de hemoglobina sérica, o grupo I, cujo valor médio inicial foi de 9,9 + - 2,0g/dl, apresentou valor médio significantemente mais alto ao final do estudo, 11,4 + - 1,0g/dl (p<0,005). O grupo II, cuja média de hemoglobina sérica foi de 11,6 + - 0,9g/dl, não apresentou diferenças significantes ao final do estudo apresentando média de 11,9 + - 0,9g/dl. A prevalência de anemia no grupo I ao primeiro exame foi de 81,0 por cento, reduzindo-se para 31,2 por cento no final de dois meses. Já para o grupo II a prevalência inicial foi de 20,8 por cento, reduzindo-se para 12,5 por cento. A avaliação da aceitação do produto mostrou que na primeira semana a ingestão média foi menor do que nas semanas seguintes até o final do estudo. Assim, pode-se concluir que o produto utulizado neste estudo teve impacto positivo nos níveis de hemoglobina sérica das crianças que apresentavam anemia, contribuindo também para a recuperação nutricional, no caso dos desnutridos

Avaliação da composição corporal por antropometria: crianças com síndrome da imunodeficiência humana / Composition body evaluation by anthropometry: human immunodeficiency virus infected children

Foram tomadas medidas antropométricas de peso, altura, circunferência braquial e pregas cutâneas de 36 crianças infectadas pelo vírus da imunodeficiência humana (HIV), de baixo nível socioeconômico, com idades entre 18 e 59 meses (13 soropositivas assintomáticas e 23 soropositivas sintomáticas). Observou-se no grupo de crianças assintomáticas 7,7 por cento com índice altura/idade abaixo do percentil 3, não sendo diagnosticado desnutrição pelos outros índices antropométricos. Das crianças sintomáticas, 8,7 por cento e 34,8 por cento encontraram-se abaixo do percentil 3 para o índice peso/altura e altura/idade, respectivamente. Quando comparadas a um grupo controle similar de crianças não infectadas, as medidas de avaliação de gordura corporal foram significativamente menores, mas para a medida de massa muscular não havia diferença. As crianças infectadas foram avaliadas em relação a um padrão internacional e observou-se diferenças altamente significantes, também para a massa muscular, neste caso, somente no grupo das sintomáticas. Conclui-se que as crianças estudadas apresentavam alta prevalência de stunting, sendo o wasting somente observado em algumas crianças sintomáticas. E, contrário à literatura, as alterações observadas na composição corporal devem-se principalmente à deficiência de reserva adiposa e, em menor grau, somente no grupo sintomático, deficiência das reservas protéicas.

Novos conceitos e propostas na assistência nutricional da criança com câncer / New concepts in the nutritional support in children with cancer

A desnutrição no paciente com câncer é um fator desfavorável para a implementação do tratamento antineoplásico, que prejudica a resposta global dessa terapia. Assim, com o objetivo de discutir os métodos de suporte nutricional em crianças com câncer, os autores revisam e atualizam os conceitos sobre o assunto, relatando sua experiência.