RESUMO
Obesity is an epidemic with important health repercussions in addition to high treatment-related costs. Between 2006 and 2007 the WHO developed new assessment tools, which aren't being globally used. In fact, there is no unified problem management across the hemisphere. Objectives: To update obesity epidemiology, to promote application of WHO's standards, to review new findings on physiopathology (i.e., fatty tissue as endocrine organ, intestinal microbiota), to update epidemiological information, and to provide management guidelines that can be integrated in clinical care. Methods: LAPSGHAN called up its members to collaborate in preparing this review article under the direction of an editor/coordinator, who selected the contents and literature with the best evidencetogether with the members. Each member prepared a separate document for each content. The chosen contents were later collated, unified, and edited. Results. This documents highlights the following: 1) Although extreme obesity is increasing in the US, overweight and obesity prevalence has stabilized, while in other countries it is alarmingly increasing; 2) New information regarding role of fatty tissue as endocrine organ and self-regulator of obesity; 3) The promising role of microbiota; and 4) Guidelines for children handling during consultation and follow-up. Conclusions: There is no widespread implementation of standards and guidelines from the World Health Organization (WHO). There is no agreement as to whether z-scores or percentiles should be used, especially regarding children under 2 due to their changing body complexion. The most accepted tool to assess overweight, obesity and severe obesity is the Body Mass Index (BMI). This document provides recommendations on how to approach clinical care with affected children.
Assuntos
Avaliação Nutricional , Obesidade , Tecido Adiposo/fisiologia , Criança , Microbioma Gastrointestinal , Humanos , América Latina/epidemiologia , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/etiologia , Obesidade/terapia , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Sobrepeso/etiologia , Sobrepeso/terapia , Fatores de Risco , Sociedades Médicas , Organização Mundial da SaúdeRESUMO
En los últimos años, ha sido alarmante la cantidad de información que revela un aumento de la obesidad infantil y al mismo tiempo, aumento de la incidencia de la enfermedad del hígado graso no alcohólico (EHGNA), una patología progresiva que abarca un espectro de enfermedades del hígado, desde una simple esteatosis hasta esteatohepatitis no alcohólica (EHNA). Los datos relacionados con la supervivencia en niños son escasos, pero estos asocian firmemente EHGNA con un mayor riesgo de morbilidad hepática y no hepática y mortalidad en comparación con la población general. Recientemente se ha reconocido, la asociación entre EHGNA y la enfermedad cardiovascular en niños. La obesidad es un factor de riesgo importante para la enfermedad, EHGNA pediátrico se está convirtiendo en un problema mundial, en paralelo con el dramático aumento de la obesidad en todo el mundo. EHGNA es más común en niños obesos, tiene el potencial para avanzar a la insuficiencia y fibrosis hepática. No está claro por qué algunos pacientes presentan esta transformación o esta susceptibilidad, probablemente relacionada con una interacción entre un huèsped genéticamente susceptible y el medio ambiente circundante. Actualmente, el tratamiento es en gran medida conservador e incluye la modificación del estilo de vida: reducción de peso saludable mediante la dieta y el ejercicio. En esta revisión, se resumen los conocimientos actuales sobre la EHGNA en los niños y tiene como objetivos concientizar a la comunidad médica acerca de un problema oculto de salud pública, determinar las deficiencias actuales en la literatura y proporcionar directrices para futuras investigaciones.
During the last years, the incidence of obesity and Non-Alcoholic Fatty Liver Disease (NAFLD) in children has increased in an alarming way. NAFLD is a progressive disease that encompasses a spectrum of liver diseases ranging from simple steatosis to Nonalcoholic Steatohepatitis (NASH). The data related to survival in children are scarce, but these data are strongly associated with an increased risk of NASH, non-liver disease and mortality compared with the general population. The association between NAFLD and cardiovascular disease in children has been recognized recently. Obesity is a major risk factor for the disease. Pediatric NAFLD is becoming a global problem, in parallel with the dramatic worldwide increase in obesity. NAFLD is more common in obese children and it has the potential to progress to hepatic fibrosis and liver failure. It is unclear why some patients develop this transformation and this susceptibility, probably related to an interaction between a genetically susceptible host and the environment. Currently, treatment is largely conservative and includes lifestyle modification, achievable by healthy weight loss with diet and exercise. In this review, current knowledge on NAFLD in children is summarized with the aims to raise awareness in the medical community about a hidden public health problem, to identify existing gaps in the literature and to provide directions for future research.
RESUMO
Introducción: Como consecuencia de la desnutrición, se producen alteraciones que comprometen la respuesta antioxidante y la inmunocompetencia. El objetivo del presente estudio es evaluar el efecto de la recuperación nutricional sobre las concentraciones séricas de Oxido Nítrico (NO), Malonaldehído (MDA) y TNF-α en el desnutrido grave. Metodología: Se estudiaron prospectivamente 47 niños con edades comprendidas entre 2 meses y 8 años, distribuidos en 27 niños con desnutrición grave de tipo mixto y 20 controles, que asistieron al Servicio de Educación y Recuperación Nutricional del Hospital Chiquinquirá de Maracaibo-Venezuela. El NO y el MDA determinaron por ensayo de Diazotización y derivados del ácido tíobarbitúrico respectivamente, y el TNF-α mediante la técnica de ELISA. Resultados: Las concentraciones de NO y MDA no mostraron diferencias estadísticamente significativas con los controles, no obstante se encontró un descenso en estas concentraciones cuando se compararon con las obtenidas al inicio de la terapia (p ≤ 0,0001 para NO y p ≤ 0,001 para MDA. Los valores séricos de TNF-α presentaron significancia estadística en relación con los controles y al inicio del tratamiento (p < 0,0001). Conclusión: La terapia de recuperación nutricional incide en la disminución de las concentraciones séricas de NO, MDA y TNF-α, debido probablemente a la suplementación de vitaminas y micronutrientes administrados durante dicho tratamiento.
Introduction: Alterations involving antioxidant response and immunological competence are consequences of malnutrition. The aim of this study is to assess the effect of nutritional recovery on serum concentrations of nitric oxide (NO), malonaldehyde (MDA) and TNFα in the severely malnourished child. Methods: 47 children were prospectively studied (2 months to 8 years old): 27 children with mixed type severe malnutrition and 20 controls who attended the Department of Education and Nutritional Recovery at the Chiquinquirá Hospital in Maracaibo-Venezuela. NO and the MDA were determined by Diazotization trial and derivatives of the barbituric acid respectively; TNF-α was assessed by the ELISA technique. Results: NO and MDA concentrations showed no significant difference with controls, although there was a significant decrease with respect to pre-treatment values (p ≤ 0,0001 for NO and p ≤ 0,001 for MDA. Values for TNF-α were significantly different from controls and pre-treatment values (p< 0,0001). Conclusions: Nutritional recovery therapy affects the decrease in serum concentrations of NO, MDA and TNF-α, probably due to the supplementation of vitamins and micronutrients during this treatment.