[School meals: state of the art and recommendations]. / El comedor escolar: situación actual y guía de recomendaciones.

School meals contribute substantially to overall energy and nutrient intake adequacy of children, but also play an important role in the development of child food habits and the socialisation process. Evidence shows that school based environmental actions, which include changes in school meals and school food policies related to increased availability and access to healthy foods and drinks while in the school are effective to foster healthy eating practices among children. A growing number of children engage in school meals. Available information to date shows that the quality of the food on offer is not always consistent with dietary guidelines. Vegetables and fish are served less often than desirable and excess added fats are used in food preparations. Norms and regulations are very detailed regarding food safety issues and administrative management of the service, including subcontracting of catering providers and care staff. Nutrition and health promotion issues should also be included in regulations by means of nutrition recommendations for school meals along with information on food based dietary guidelines and portion sizes. School meals should be part of the educational project using a whole school approach.

Chronic gastric volvulus: is it so rare?

Gastric volvulus has traditionally been considered a rare entity in children, and standard texts on paediatrics typically make scant reference to it. In our experience, however, careful radiographic study of children with digestive symptoms reveals gastric volvulus to be more frequent than is commonly thought. We report 52 cases of this disorder, and discuss its diagnosis and treatment. Material and Methods. We performed a retrospective study of all children treated for chronic gastric volvulus in our department since 1976. Results. All 52 patients (27 boys, 25 girls) were term infants, mean age 2.8 months at diagnosis. The principal symptoms were crying and colic (90 %), vomiting and nausea (67 %). The mean age at onset of symptoms was 1.1 months. Diagnosis was in all cases on the basis of upper intestinal transit studies. The most frequent radiological signs were high greater curvature (87 %) and greater curvature crossing the oesophagus (83 %). Nine of the 52 children underwent primary surgery. The remaining 43 patients underwent conservative (i.e. postural) treatment; 11 of these patients showed no significant improvement and thus underwent surgery. We performed 20 surgical interventions (19 simple anterior gastropexies and one a percutaneous endoscopic gastrostomy). All patients showed good recovery after surgery. Conclusion. Careful examination of patients with vomiting, abdominal distension, gastro-oesophageal reflux, colic, crying, retarded growth, sleep problems, anxiety, and even repeated respiratory infections will reveal chronic gastric volvulus with greater frequency than has traditionally been thought. We believe that this entity is often undetected, and that, as a result, it is often inappropriately treated.

[Repercussion of mental retardation and associated cerebral palsy on skeletal maturation]. / Repercusión del retraso mental y de la parálisis cerebral asociada sobre la maduración sea.

INTRODUCTION: Mental retardation (MR) constitutes a clinical and social relevant condition accounting for 3% of the pediatric population. Studies focusing the repercussion of MR on nutritional status are scarce and, in occasions, have produced contradictory results. OBJECTIVE: To evaluate the nutritional status of mentally retarded children in our Region, on the basis of skeletal maturation. PATIENTS AND METHODS: Our sample comprise 128 mentally retarded children (81 boys and 47 girls) aged 0 17 years. In all children a nutritional and social family environment questionnaires and a valuation of a series of nutritional and anthropometric variables were performed. Additionally, bone age was assessed by means of left hand wrist radiograph in a subset of 53 children. A factorial analysis was carried out by means of the statistical package SPSS allowing the obtaining of 2 anthropometric factors and 3 biochemical factors that condensed the most information content. Results of the bone maturation were correlated with age, sex, presence of cerebral palsy (CP), severity of mental retardation, results of nutritional and sociofamilial questionnaire, antiepileptic treatment and nutritional status (anthropometric and biochemical factors). RESULTS: Although a good correlation exists between bone age and chronological age, 50% of mentally retarded children presented delay in their skeletal maturation. The bone maturation was higher in the boys than in the girls. The presence of CP induced an increase of 12% in the delay of the skeletal maturation. The severity of MR induced differences in the bone age. Both quality of diet and score of anthropometric factor I inversely correlated with bone maturation delay. Parent s age and geographical precedence but not antiepileptic therapy affected the bone maturation. CONCLUSIONS: Delay in the bone maturation occurs with high prevalence among mentally retarded children. The presence of CP, severity of MR, quality of the diet and sociofamilial and nutritional factors influenced in an outstanding way in the bone maturation.

[The impact of sociofamilial factors on nutritional status in mentally retarded children]. / Influencia de los factores sociofamiliares sobre el Estado Nutricional en los niños con retraso mental.

INTRODUCTION: Mental retardation (MR) constitutes a clinical and social relevant condition accounting for 3% of the pediatric population. Studies focusing the repercussion or MR on nutritional status are scarce and, in occasions, have produced contradictory results. OBJECTIVE: To evaluate the nutritional status of mentally retarded children in our region, on the basis of the influence of sociofamilial factors, including details of diet and appetite. PATIENT AND METHODS: Our sample comprise 128 mentally retarded children (81 boys and 47 girls) aged 0 17 years. In all children a nutritional and social family environment questionnaires and a valuation of a series of nutritional and anthropometric variables were performed. A factorial analysis was carried out by means of the statistical package SPSS allowing the obtaining of 2 anthropometric factors (AF) and 3 biochemical factors (BF) that condensed the most information content. Results of the nutritional and sociofamilial questionnaire were correlated with biochemical and anthropometric factors. RESULTS: Score of the factor AF1 declined with declining quality of diet and appetite. Mean AF1 score was lowest among children from inland rural areas, intermediate among children from urban areas and highest among children of coastal areas. Age of the parents and number of brothers also influenced the value of AF1 score. Score of AF1 was not significantly affected, however, by social class. Quality of diet, appetite, geographic origin, number of brothers an age of the parents showed a similar influence on BF1. Moreover, the score of BF1 declined with declining socioeconomic status. CONCLUSIONS: Feeding behaviour has a significant influence on nutritional status both in biochemical and anthropometric parameters, so it must be promptly evaluated in mentally retarded children. Biochemical parameters were the most influenced by variation of socioeconomic status. Children from coastal areas showed the highest scores of nutritional parameters. Age of the parents significantly influenced the nutritional state.

[Calcium intake and bone mineral density in a group of Spanish school-children]. / Ingesta de calcio y densidad mineral ósea en una población de escolares españoles (estudio CADO).

INTRODUCTION: There are limited data available on bone mass status in Spanish children and or whether the differences are associated with diet/hygiene habits or geographical variability. SUBJECTS AND METHODS: To determine this association a cross-sectional study was carried out in three different areas (northern, central and southern Spain) and included 1176 schoolchildren between 5 and 12 years old, randomly selected from schools in those areas. Bone density of the distal phalanges was measured by bone ultrasound. We examine the correlations between these data and calcium and vitamin D intake, physical activity and bone mass index. RESULTS: Of the 1176 children initially included, 1035 nutritional questionnaires were completed and bone ultrasound data were obtained on 991 of them. Eighteen percent of girls and 13% of boys had a calcium intake below 800 mg per day. More than 70% of children have a daily vitamin D intake under 2.5 mcg. Age and exercise showed a direct linear relationship with bone mineral density, and an inverse one for overweight. CONCLUSIONS: Both high physical activity and high calcium intake were associated with a higher bone mineral density, while overweight showed the opposite effect. Diet habits and exercise must be considered the main strategies to prevent adult osteoporosis during childhood.

Nutritional status of mentally retarded children in northwest spain: II. Biochemical indicators.

AIM: To evaluate the nutritional status of mentally retarded children in the region of Galicia, northwest Spain, on the basis of serum biochemistry variables. METHODS: The following serum biochemistry variables were determined in a sample of 128 mentally retarded children (81 boys and 47 girls): albumin, prealbumin, retinol-binding protein, transferrin, ferritin, ceruloplasmin, iron, calcium, phosphorus, copper, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, alkaline phosphatase, transaminases and carnitine. A preliminary statistical analysis indicated that most information content could be maintained taking into consideration only five of these variables. A factor analysis of the resulting 5 x 128 variables-by-subjects data matrix was then performed, identifying three factors (FB1, FB2 and FB3) that together explained 74% of total variance. Taking these factors as indicators of nutritional status, the data were then analysed for possible effects of age, gender, socioeconomic and family environment, IQ, presence/absence of cerebral palsy, quality of diet, appetite and use of antiepileptics. RESULTS: The analysis suggests that most subjects were in the normal nutritional range, but that about 37% showed either borderline or definite malnutrition. The FB1 score showed a significant, positive correlation with age, while FB2 score was negatively correlated with age. The FB1 score showed a significant positive correlation with socioeconomic class, and was significantly higher among children from inland-rural areas than among children from coastal or urban areas. The FB1 score was also positively correlated with parents' mean age. Finally, the results suggest that antiepileptic treatment with phenobarbital or diphenylhydantoin led to reductions in serum levels of calcium and phosphorus. CONCLUSION: Malnutrition as revealed by biochemical variables is highly prevalent among mentally retarded children, and the prevalence is affected by socioeconomic and family environment variables.

Nutritional status of mentally retarded children in north-west Spain. I. Anthropometric indicators.

AIM: To evaluate the nutritional status of mentally retarded children in the region of Galicia in north-west Spain, on the basis of anthropometric variables. METHODS: The following variables were determined in a sample of 128 mentally retarded children (81 M, 47 F): birthweight, bodyweight, height/length, head circumference, mid-arm circumference, mid-arm muscle circumference, triceps skinfold thickness, subscapular skinfold thickness, arm area, arm muscle area, arm fat area, arm lean-to-fat ratio, Shukla's nutrition index and Quetelet's body mass index (BMI). A preliminary statistical analysis indicated that most information content could be maintained considering only eight of these variables. A factor analysis of the resulting 8 x 128 (variables by subjects) data matrix was performed, identifying two factors (FA1 and FA2) that together explained 82% of total variance. Taking these factors as indicators of nutritional status, the data were analysed for possible effects of age, gender, socioeconomic and family environment, intelligence quotient (IQ), presence/absence of cerebral palsy, quality of diet, appetite and antiepileptic use. RESULTS: The analysis suggested that most subjects were in the normal nutrition range, but about 33% showed either borderline or definite malnutrition. Mean score on FA2 showed a significant negative correlation with age. Children with cerebral palsy had lower mean scores on both factors, and scores on both factors varied with IQ. Children with definite malnutrition had a significantly lower IQ than those in the normal nutrition range. Mean score on both factors varied with appetite and quality of diet. The mean FAI score of children from inland-rural areas was significantly lower than that of children from coastal or urban areas. Mean FA1 score increased with increasing age of the parents. The prevalence of obesity was 13% when obesity was defined on the basis of Shukla's nutrition index, and 19% when defined on the basis of FA1 score. CONCLUSION: Malnutrition as revealed by anthropometric variables occurs with a high prevalence among mentally retarded children. The prevalence increases with age, increasing IQ deficit and cerebral palsy.

Cerebrospinal fluid purine metabolites after complex febrile convulsions.

Adenosine monophosphate, inosine monophosphate, inosine, adenosine, guanosine, adenine, guanine, hypoxanthine, xanthine and uric acid were determined in cerebrospinal fluid (CSF) of 15 children after complex febrile seizures (CFS) and in 27 after simple febrile seizures (SFS), and compared with those in a control group of 63 children. There was no statistically significant difference between the groups for any of these metabolites, suggesting that CFS and SFS neither significantly disturb the metabolism of nucleotides, nucleosides or bases nor significantly deplete neuron adenosine triphosphate levels.

[Rotavirus: clinical and epidemiological study in hospitalized children under two years of age]. / Rotavirus: estudio clínico y epidemiológico en niños hospitalizados menores de dos años.

OBJECTIVE: Rotavirus (RV) remains as the leading cause of acute diarrheal disease in early infancy; nevertheless, there are few epidemiological studies in our geographical area. In order to better understand the clinical epidemiology of RV, we have carried out a revision of acute diarrheal illnesses in the area of Santiago de Compostela (Spain) in children younger than 2 years of age who needed hospitalization during a 12 month period. PATIENTS AND METHODS: In 155 children with suspected gastroenteritis, 339 stool samples were collected and separated into two groups depending upon the presence or not of RV antigen. RESULTS: In the group of RV-positive stool patients, the occurrence of vomiting, fever, need of intravenous fluid rehydration (p = 0.01), respiratory symptoms (p < 0.01), the incidence during winter, as well as the development of disaccharidase depression (p < 0.001), were more frequent as compared with the group of children of similar age who did not present RV in faeces. There was no difference between the two groups regarding the presence of other potential enteropathogen agents (p > 0.05). The incidence of RV-positive faeces per 100 hospitalized infants/year was 10.5 and that of infants with RV diarrhea who needed hospitalization was 5.5%/ year. CONCLUSIONS: There was no mortality related with gastroenteritis, but RV-infection remains an important cause of morbidity and socioeconomic burden. Nosocomially acquired hospital infections add to morbidity and the cost of hospitalization.

[Evaluation of medical and surgical treatment of intestinal invagination in children]. / Evaluación del tratamiento médico y quirúrgico de la invaginación intestinal en el niño.

Authors review 70 consecutive cases of intussusception treated from 1969 to 1984. Most patients (87.5%) were under one year, and male/female ratio was 2/1. Nutritional status was good as 75.7% were above 50 percentiles for age. There was a higher seasonal incidence in spring and summer. Most frequent presenting symptom were weeping/pain (87.1%), rectal bleeding (82.8%) and vomiting (78.5%). Typical symptomatology was present in only 48.5%. Plain X-ray of abdomen and ultrasonography are the best diagnostic aid (91.4% and 90%). Hydrostatic reduction was successful in 30.1% whereas 51 cases had to be operated with a resection rate of 27.5%. Half of the patients over two years had an organic leading point. Complications, 8.6% were related with age, clinical course and need for bowel resection.

Ingesta de calcio y densidad mineral ósea en una población de escolares españoles (estudio CADO) / Calcium intake and bone mineral density in a group of Spanish school-children

Introducción: Existen pocos datos publicados que hayan analizado el estado de la masa ósea de la población infantil española y si muestra diferencias motivadas por los hábitos higiénico-dietéticos o por la variabilidad geográfica. Pacientes y métodos: Para valorar esta relación planteamos un estudio transversal en tres zonas geográficas diferentes (norte, centro y sur de España) en 1.176 escolares de 5 a 12 años de edad, midiendo mediante osteosonografía la densidad ósea a niños en falanges distales. Se correlacionaron estos datos con la ingesta de calcio y vitamina D, el nivel de actividad física y el índice de masa corporal. La muestra se obtuvo de todos los colegios de cada área y los niños incluidos en el mismo fueron seleccionados aleatoriamente. Resultados: De los 1.176 niños estudiados, solo se obtuvieron encuestas nutricionales completas en 1.035 y datos de la osteosonografía en 991. Un 18% de las niñas y un 13% de los niños presentaron una ingesta de menos de 800mg/d de calcio. Más del 70% de los niños estudiados ingerían menos de 2,5mcg de vitamina D al día. Las variables edad, sobrepeso y ejercicio físico muestran una relación lineal con la densidad ósea, que en todos los casos es directa salvo para el sobrepeso, que presenta una relación inversa (a mayor complexión del niño/a, menor densidad ósea). Conclusiones: La mayor ingesta de calcio y una actividad física adecuada se asociaron a una densidad mineral ósea mejor, mientras que el sobrepeso mostró el efecto contrario. Es preciso adecuar los hábitos dietéticos y la actividad física de los niños en edad escolar como prevención primaria de la osteoporosis en la edad adulta (AU)

Introduction: There are limited data available on bone mass status in Spanish children and or whether the differences are associated with diet/hygiene habits or geographical variability. Subjects and methods: To determine this association a cross-sectional study was carried out in three different areas (northern, central and southern Spain) and included 1176 schoolchildren between 5 and 12 years old, randomly selected from schools in those areas. Bone density of the distal phalanges was measured by bone ultrasound. We examine the correlations between these data and calcium and vitamin D intake, physical activity and bone mass index. Results: Of the 1176 children initially included, 1035 nutritional questionnaires were completed and bone ultrasound data were obtained on 991 of them. Eighteen percent of girls and 13% of boys had a calcium intake below 800mg per day. More than 70% of children have a daily vitamin D intake under 2.5mcg. Age and exercise showed a direct linear relationship with bone mineral density, and an inverse one for overweight. Conclusions: Both high physical activity and high calcium intake were associated with a higher bone mineral density, while overweight showed the opposite effect. Diet habits and exercise must be considered the main strategies to prevent adult osteoporosis during childhood (AU)

El comedor escolar: situación actual y guía de recomendaciones / School meals: state of the art and recommendations

Los comedores escolares desempeñan una función nutricional y educativa importante, contribuyen a la adquisición de hábitos alimentarios y son marco de socialización y convivencia. Existe evidencia de que las intervenciones ambientales que incorporan modificaciones en la composición de los menús ofertados en el colegio y en las políticas reguladoras son efectivas para fomentar la adquisición de hábitos alimentarios saludables entre los escolares. Cada vez es mayor el número de usuarios de este servicio. La información disponible en este momento indica que la oferta dietética no siempre es consistente con las guías alimentarias para este colectivo. Los aportes insuficientes de verduras, hortalizas, frutas y pescados son los errores más frecuentes, junto con el empleo excesivo de grasas añadidas en las preparaciones culinarias. La normativa reguladora actual observa meticulosamente los aspectos higiénicos y sanitarios y de gestión económica administrativa, incluida la contratación de empresas suministradoras y personal cuidador. Es necesario que incorpore también los aspectos nutricionales, educativos y de promoción de salud de estos aportes a través de un marco formal de recomendaciones nutricionales para las comidas escolares que incluya información sobre guías alimentarias, tamaño de las raciones, dinámica del servicio y atención a necesidades especiales. El comedor escolar debería incorporarse a los proyectos educativos de los centros docentes y gestionarse con una visión integral y profesionalizada (AU)

School meals contribute substantially to overall energy and nutrient intake adequacy of children, but also play an important role in the development of child food habits and the socialisation process. Evidence shows that school based environmental actions, which include changes in school meals and school food policies related to increased availability and access to healthy foods and drinks while in the school are effective to foster healthy eating practices among children. A growing number of children engage in school meals. Available information to date shows that the quality of the food on offer is not always consistent with dietary guidelines. Vegetables and fish are served less often than desirable and excess added fats are used in food preparations. Norms and regulations are very detailed regarding food safety issues and administrative management of the service, including subcontracting of catering providers and care staff. Nutrition and health promotion issues should also be included in regulations by means of nutrition recommendations for school meals along with information on food based dietary guidelines and portion sizes. School meals should be part of the educational project using a whole school approach (AU)

Papel del pediatra en la prevención de la obesidad / Rol of a paediatricians in the prevention of obesity

La obesidad es una enfermedad crónica cuya incidencia y prevalencia están aumentando tanto en países desarrollados como en vías de desarrollo. Representa en la actualidad un problema importante de salud pública en nuestro medio. Las estrategias de prevención de la obesidad en la infancia deben establecerse en la escuela y la familia, las dos instituciones que ejercen mayor influencia en el niño. El propósito de este artículo es animar al pediatra a que participe activamente en la promoción de hábitos alimenticios saludables, para evitar la repercusión de la obesidad en la edad adulta

Obesity is a common health problem, which affects both the developed and in developed countries, where its incidence and prevalence are increasing during the last years. Prevention strategies for obesity in childhood must be established in school and family, the two institutions which have more influence during this period of life. The aim of this article is to encourage the paediatricians to promote healthy consumption habits, to avoid the complications of the obesity later on in life