Dietary iron intake over two post-fortification periods in Brazil: data from the National Dietary Surveys 2008-2009 and 2017-2018.

We aimed to assess the dietary Fe intake and the prevalence of inadequate Fe intake over two post-fortification periods in Brazil. The intake was analysed according to sex, life stage, geographic region and stratum of family income per capita. Excluding pregnant and lactating women, this population-based study included 32 749 and 44 744 participants aged ≥ 10 years from the National Dietary Survey-Brazilian Household Budget Surveys 2008-2009 and 2017-2018, respectively. The National Cancer Institute method was used to predict usual dietary Fe intakes. The prevalence of Fe intake inadequacy was estimated following a probabilistic approach for women of childbearing age or with the Estimated Average Requirement cut-off point method. Over an interval of 10 years, the mean Fe intake remained almost unchanged for most sex-age groups, except for women of childbearing age. In this specific group, the prevalence of Fe intake inadequacy was > 20 % in 2008-2009 and have increased to > 25 % in 2017-2018, with the highest reductions in mean Fe intake found in the highest income strata and richest Brazilian regions. Meanwhile, the highest prevalence of Fe intake inadequacy (> 40 %) occurred among the poorest women aged 31-50 years from the lowest family income stratum, irrespective of the study period. Beans were the main Fe source, while fortified breads, pastas, pizzas, cakes and cookies contributed approximately 40 % of the Fe intake. The results provide important insights into the long-standing dietary impacts of food fortification, which can guide future (re)formulation of effective public health strategies to combat Fe deficiency.

Official Position of the Brazilian Association of Bone Assessment and Metabolism (ABRASSO) on the evaluation of body composition by densitometry-part II (clinical aspects): interpretation, reporting, and special situations.

OBJECTIVE: To present an updated and evidence-based guideline for the use of dual-energy x-ray absorptiometry (DXA) to assess body composition in clinical practice. MATERIALS AND METHODS: This Official Position was developed by the Scientific Committee of the Brazilian Association of Bone Assessment and Metabolism (Associação Brasileira de Avaliação Óssea e Osteometabolismo, ABRASSO) and experts in the field who were invited to contribute to the preparation of this document. The authors searched current databases for relevant publications in the area of body composition assessment. In this second part of the Official Position, the authors discuss the interpretation and reporting of body composition parameters assessed by DXA and the use of DXA for body composition evaluation in special situations, including evaluation of children, persons with HIV, and animals. CONCLUSION: This document offers recommendations for the use of DXA in body composition evaluation, including indications, interpretation, and applications, to serve as a guiding tool in clinical practice and research for health care professionals in Brazil.

Folate and vitamin B12 status: temporal evaluation after mandatory fortification in Brazil.

OBJECTIVES: To perform temporal evaluation of folate and vitamin B12 status and their associated factors in a Brazilian population exposed to mandatory fortification. METHODS: Data from the cross-sectional population-based studies 2008 and 2015 Health Surveys of São Paulo, including individuals ≥ 20 years, both sexes, N = 549 in 2008 and N = 610 in 2015. Folate and vitamin B12 biomarkers status, B-complex supplements and medications use, and dietary intake were assessed. RESULTS: Serum folate concentrations increased in the entire population, adults and older adults in 2015 compared to 2008, while serum vitamin B12 concentration increased only in older adults. B-complex supplement use raised in 2015, reflecting in serum vitamins status. Overall serum vitamin B12 deficiencies (<200 pg/mL) were 23.2% and 21.2%, while serum folate deficiencies (<4 ng/mL) were 4.1% and 1.5% in 2008 and 2015, respectively. The lowest quintile of serum folate (≤8.7 ng/mL) was positively associated with smoking and oral contraceptive use, while the highest quintile (≥17.8 ng/mL) was inversely associated with smoking and positively with B-complex supplement use. The odds of having vitamin B12 deficiency was inversely associated with B-complex supplement use, higher serum folate median, higher dietary vitamin B12 intake and positively associated with using oral contraceptive. CONCLUSION: Overall deficiency of folate has decreased in 2015, being almost non-existent. Low vitamin B12 status presented similar proportions in the overall population comparing both periods, except for older adults. Different predictive variables were identified to better understand vitamins status outcomes in the most recent period of the study.

Prevalence of inadequate intake of folate in the post-fortification era: data from the Brazilian National Dietary Surveys 2008-2009 and 2017-2018.

The objectives were to compare the evolution of dietary folate intake, to estimate the prevalence of folate inadequacy (POFI) and the contribution of food groups to folate intake (dietary folate plus folic acid from fortified foods) in two post-fortification periods in the Brazilian population, according to life stages, geographic regions and per capita income. Population-based study including representative data from the National Dietary Survey - Brazilian Household Budget Surveys (NDS-HBS) 2008-2009 and 2017-2018, with a total of 32 749 (2008-2009) and 44 744 (2017-2018) individuals aged ≥ 10 years old, excluding pregnant and lactating women. The National Cancer Institute method was used to estimate the distributions of usual dietary folate intake. POFI was estimated according to estimated average requirement cut-off point method. After 10 years of the first NDS-HBS, POFI has increased in all sex-age groups, except for 10-13 years. POFI among women of reproductive age was around 30 and 40 % in 2008-2009 and 2017-2018. Higher POFI was observed in the North region. The top five food groups contributors to folate intake in Brazil were beans, breads, pasta and pizza, cakes and cookies and non-alcoholic beverages groups in both periods, differing in the rank order of the last two groups. Although being a country that has adopted mandatory folic acid flour fortification for almost two decades, increased POFI was observed in 2017-2018. This study brings significant scientific information, which can help understand folate dietary data in different contexts and consequently guide the approach for public health fortification strategies.

Official Position of the Brazilian Association of Bone Assessment and Metabolism (ABRASSO) on the evaluation of body composition by densitometry—part II (clinical aspects): interpretation, reporting, and special situations

Abstract Objective: To present an updated and evidence-based guideline for the use of dual-energy x-ray absorptiometry (DXA) to assess body composition in clinical practice. Materials and methods: This Official Position was developed by the Scientific Committee of the Brazilian Association of Bone Assessment and Metabolism ( Associação Brasileira de Avaliação Óssea e Osteometabolismo , ABRASSO) and experts in the field who were invited to contribute to the preparation of this document. The authors searched current databases for relevant publications in the area of body composition assessment. In this second part of the Official Position, the authors discuss the interpretation and reporting of body composition parameters assessed by DXA and the use of DXA for body composition evaluation in special situations, including evaluation of children, persons with HIV, and animals. Conclusion: This document offers recommendations for the use of DXA in body composition evaluation, including indications, interpretation, and applications, to serve as a guiding tool in clinical practice and research for health care professionals in Brazil.

Unmetabolized folic acid is associated with TNF-α, IL-1ß and IL-12 concentrations in a population exposed to mandatory food fortification with folic acid: a cross-sectional population-based study in Sao Paulo, Brazil.

PURPOSE: The study assessed associations between inflammatory markers, as cytokines, adhesion molecules and unmetabolized folic acid (UMFA) among a population exposed to mandatory fortification. METHODS: Data were collected from a cross-sectional population-based survey (n = 302) conducted in São Paulo City, Brazil. UMFA was assayed by a modified affinity-HPLC method with electrochemical detection to measure the different forms of the folate in plasma. We used a commercial test kit to analyze cytokines and adhesion molecules. Multiple logistic regressions were applied to investigate the association between inflammatory markers and UMFA. Multiple models were adjusted for sex, age, self-reported skin color, BMI and smoking status. RESULTS: The prevalence of detectable UMFA in this population was high (81.2%), with median concentration of 1.67 nmol/L. The odds ratios (95% CIs) for having higher immunological markers levels among individuals in the highest tertile of UMFA were 0.44 (0.24; 0.81) for TNF-α, 0.92 (0.49; 1.75) for CRP, 1.32 (0.70; 2.48) for ICAM, 0.99 (0.54; 1.81) for VCAM, 0.45 (0.25; 0.83) for IL-1ß, 0.74 (0.40; 1.38) for IL-6, 1.34 (0.73; 2.44) for IL-8, 0.65 (0.36; 1.18) for IL-10 and 0.49 (0.27; 0.89) for IL-12. CONCLUSION: UMFA concentrations were inversely associated with elevated proinflammatory markers (TNF-α, IL-1ß and IL-12). These results signalize a link between folate metabolism and the inflammatory status of adults in an apparently folate-replete population.

DNA methylation and one-carbon metabolism related nutrients and polymorphisms: analysis after mandatory flour fortification with folic acid.

There is a growing research interest in determining whether changes in the global status of DNA methylation are related to the environment, in particular, to one-carbon metabolism. So, our aim was to investigate the effect of dietary methyl-group donor intake (methionine, folate, choline, betaine, vitamins B2, B6 and B12), biomarkers (total folate, unmetabolised folic acid (FA), 5-methyltetrahydrofolate, homocysteine, vitamins B6 and B12 concentrations) and genetic variants (polymorphisms involved in one-carbon metabolism) on global DNA methylation in a population exposed to mandatory flour fortification with FA. A cross-sectional study of health and living conditions was conducted among a representative sample of residents in São Paulo, Brazil. The mean of global DNA methylation was lower in young people than in adults and the elderly (P = 0·049). No differences between genotypes of polymorphism and global DNA methylation mean were identified. We observed that the increase in betaine intake led to an absolute change in percentage of DNA methylation (ß = 0·0005, P = 0·024) using multiple regression. Betaine intake alone was associated with an absolute change in percentage of global DNA methylation. The study did not find an association between global DNA methylation and folate status even in a population exposed to mandatory flour fortification with FA.

Prevalence of inadequate intake of folate after mandatory fortification: results from the first National Dietary Survey in Brazil.

PURPOSE: Our aim was to estimate the prevalence of folate inadequacy (POFI) according to life stage, socio-economic status, and geographical regions after the mandatory fortification of wheat and maize flour in Brazil. METHODS: This was a population-based study. Data from two non-consecutive food records from the National Dietary Survey/Household Budget Survey 2008-2009 were used to estimate the usual dietary folate intake in µg dietary folate equivalents (DFEs). The National Cancer Institute method was used to account for within-person variance and the Estimated Average Requirement (EAR) cut-point method was used to calculate the POFI. The survey included 32,749 individuals, 15,700 males and 17,049 females, over 10 years old. Pregnant women, lactating women, and individuals with unreliable energy intake data were excluded. RESULTS: Overall POFI was 31.5% and mean dietary folate intake was 411.1 µg DFE. The lowest POFI occurred in the youngest age group of 10-13 years in both sexes, while the highest POFI was observed in the group ≥ 71 years. In women of childbearing age, POFI was around 32%. The lowest income strata had the highest POFI. The most developed regions (South and Southeast) had the lowest POFI compared to less developed regions. CONCLUSIONS: Our data show that folate inadequacy is still prevalent in Brazil mainly in low-income groups and less developed regions. Actions need to be taken to ensure that women of childbearing age, who presented a high prevalence of inadequate folate intake, achieve the recommended daily intake of 400 µg DFEs.

Association between Serum Unmetabolized Folic Acid Concentrations and Folic Acid from Fortified Foods.

OBJECTIVE: To investigate the association between serum unmetabolized folic acid (UMFA) concentrations and folic acid from fortified foods and nutrients known as dietary methyl-group donors (folate, methionine, choline, betaine and vitamins B2, B6 and B12) in participants exposed to mandatory fortification of wheat and maize flours with folic acid. METHODS: Cross-sectional study carried out with 144 healthy Brazilian participants, both sexes, supplement nonusers. Serum folate, UMFA, vitamin B12 and total plasma homocysteine (tHcy) were biochemically measured. Dietary intake was assessed by 2 non-consecutive 24-hour dietary recalls (24-HRs) and deattenuated energy-adjusted nutrient data were used for statistical analysis. RESULTS: Ninety eight (68.1%) participants were women. Median (interquartile range) age was 35.5 (28.0-52.0) years. Elevated serum folate concentrations (>45 nmol/L) were found in 17 (11.8%), while folate deficiency (<7 nmol/L) in 10 (6.9%) participants. No one had vitamin B12 deficiency (<148 pmol/L). An elevated serum UMFA concentration was defined as > 1 nmol/L (90th percentile). UMFA concentrations were positively correlated with folic acid intake and negatively correlated to choline, methionine and vitamin B6 intakes. Participants in the lowest quartile of UMFA concentrations had lower dietary intake of total folate (DFEs) and folic acid, and higher dietary intake of methionine, choline and vitamin B6 than participants in the highest quartile of UMFA. Folic acid intake (OR [95% CI] = 1.02 [1.01-1.04)] and being a male (OR [95% CI] = 0.40 [0.19-0.87) were associated with increased and reduced odds for UMFA concentrations > 0.55 nmol/L (median values), respectively. CONCLUSION: UMFA concentrations were directly influenced by folic acid intake from fortified foods in a healthy convenience sample of adult Brazilians exposed to mandatory flour fortification with folic acid.

A Daily Dose of 5 mg Folic Acid for 90 Days Is Associated with Increased Serum Unmetabolized Folic Acid and Reduced Natural Killer Cell Cytotoxicity in Healthy Brazilian Adults.

Background: The effects of high-dose folic acid (FA) supplementation in healthy individuals on blood folate concentrations and immune response are unknown.Objective: The aim of the study was to evaluate the effects of daily consumption of a tablet containing 5 mg FA on serum folate; number and cytotoxicity of natural killer (NK) cells; mRNA expression of dihydrofolate reductase (DHFR), methylenetetrahydrofolate reductase (MTHFR), interferon γ (IFNG), tumor necrosis factor α (TNFA), and interleukin 8 (IL8) genes; and concentrations of serum inflammatory markers.Methods: This prospective clinical trial was conducted in 30 healthy Brazilian adults (15 women), aged 27.7 y (95% CI: 26.4, 29.1 y), with a body mass index (in kg/m2) of 23.1 (95% CI: 22.0, 24.3). Blood was collected at baseline and after 45 and 90 d of the intervention. Serum folate concentrations were measured by microbiological assay and HPLC-tandem mass spectrometry [folate forms, including unmetabolized folic acid (UMFA)]. We used real-time polymerase chain reaction to assess mononuclear leukocyte mRNA expression and flow cytometry to measure the number and cytotoxicity of NK cells.Results: Serum folate concentrations increased by ∼5-fold after the intervention (P < 0.001), and UMFA concentrations increased by 11.9- and 5.9-fold at 45 and 90 d, respectively, when compared with baseline (P < 0.001). UMFA concentrations increased (>1.12 nmol/L) in 29 (96.6%) participants at day 45 and in 26 (86.7%) participants at day 90. We observed significant reductions in the number (P < 0.001) and cytotoxicity (P = 0.003) of NK cells after 45 and 90 d. Compared with baseline, DHFR mRNA expression was higher at 90 d (P = 0.006) and IL8 and TNFA mRNA expressions were higher at 45 and 90 d (P = 0.001 for both).Conclusion: This noncontrolled intervention showed that healthy adults responded to a high-dose FA supplement with increased UMFA concentrations, changes in cytokine mRNA expression, and reduced number and cytotoxicity of NK cells. This trial was registered at www.ensaiosclinicos.gov.br as RBR-2pr7zp.

Impaired bone mineral accrual in prepubertal HIV-infected children: a cohort study

ABSTRACT OBJECTIVE: To evaluate bone mass accrual and determine the influence of clinical, anthropometric, dietary and biochemical parameters on bone mass. METHODS: A cohort study including 35 prepubertal HIV-infected children, between 7 and 12 years, attended at a referral center. At time 1 (T1) and time 2 (T2), patients were assessed according to clinical, anthropometric, dietary, biochemical parameters and bone mineral density (BMD). At T2, patients were divided into prepubertal and pubertal. RESULTS: Despite the increase in bone mass absolute values, there was no improvement in lumbar spine BMD (LSBMD) Z-score (p = 0.512) and worsening in total body BMD (TBMD) Z-score (p = 0.040). Pubertal patients (n = 19) showed higher bone mineral content (BMC) (p = 0.001), TBMD (p = 0.006) and LSBMD (p = 0.002) compared to prepubertal patients. After multivariate linear regression analysis, the predictors of bone mass in T1 were age, BMI and HAZ-scores for BMC; BMI Z-score, adequate serum magnesium concentration and dietary calcium intake for TBMD; adequate serum concentration of magnesium, BMI and HAZ-scores for LSBMD. In T2, age, total body fat and lean body mass (kg) for BMC; BMI Z-score and puberty for TBMD; dietary fat intake, BMI Z-score for BMD and puberty for LSBMD. CONCLUSION: HIV-infected children have compromised bone mass and the presence of puberty seems to provide suitability of these parameters. Adequate intake of calcium and fat appears to be protective for proper bone mass accumulation factor, as well as monitoring nutritional status and serum magnesium concentration.

Impaired bone mineral accrual in prepubertal HIV-infected children: a cohort study.

OBJECTIVE: To evaluate bone mass accrual and determine the influence of clinical, anthropometric, dietary and biochemical parameters on bone mass. METHODS: A cohort study including 35 prepubertal HIV-infected children, between 7 and 12 years, attended at a referral center. At time 1 (T1) and time 2 (T2), patients were assessed according to clinical, anthropometric, dietary, biochemical parameters and bone mineral density (BMD). At T2, patients were divided into prepubertal and pubertal. RESULTS: Despite the increase in bone mass absolute values, there was no improvement in lumbar spine BMD (LSBMD) Z-score (p=0.512) and worsening in total body BMD (TBMD) Z-score (p=0.040). Pubertal patients (n=19) showed higher bone mineral content (BMC) (p=0.001), TBMD (p=0.006) and LSBMD (p=0.002) compared to prepubertal patients. After multivariate linear regression analysis, the predictors of bone mass in T1 were age, BMI and HA Z-scores for BMC; BMI Z-score, adequate serum magnesium concentration and dietary calcium intake for TBMD; adequate serum concentration of magnesium, BMI and HA Z-scores for LSBMD. In T2, age, total body fat and lean body mass (kg) for BMC; BMI Z-score and puberty for TBMD; dietary fat intake, BMI Z-score for BMD and puberty for LSBMD. CONCLUSION: HIV-infected children have compromised bone mass and the presence of puberty seems to provide suitability of these parameters. Adequate intake of calcium and fat appears to be protective for proper bone mass accumulation factor, as well as monitoring nutritional status and serum magnesium concentration.

Assessment of antioxidants status and superoxide dismutase activity in HIV-infected children

Objective: This study aims to assess the nutritional status of selenium, copper and zinc; and also the erythrocyte superoxide dismutase activity of HIV-infected children compared to a control group. Methods: A cross-sectional study was carried out with prepubertal HIV-infected children (n = 51) and their healthy siblings (n = 32). All biochemical measurements including plasma selenium, serum copper levels, serum and erythrocyte zinc levels and erythrocyte super-oxide dismutase activity were evaluated according to dietary, clinical and biochemical parameters. Results: Compared to the control group, the HIV-infected children had lower z-score values for height-for-age (p = 0.0006), higher prevalence of stunting (11.8%) (p = 0.047), lower selenium levels (p = 0.0006) and higher copper levels (p = 0.019). No difference was found concerning superoxide dismutase activity (p > 0.05). The HIV-infected group presented a higher proportion (45.1%) of children with zinc intakes below the estimated average requirement (p = 0.014); however, no association with zinc biochemical parameters was found. Conclusion: HIV-infected children have an inadequate selenium and copper nutritional status, which could influence the progression to AIDS. An adequate micronutrient status could improve the clinical conditions in these patients and minimize free radical production and cellular oxidative stress. .

Assessment of antioxidants status and superoxide dismutase activity in HIV-infected children.

OBJECTIVE: This study aims to assess the nutritional status of selenium, copper and zinc; and also the erythrocyte superoxide dismutase activity of HIV-infected children compared to a control group. METHODS: A cross-sectional study was carried out with prepubertal HIV-infected children (n=51) and their healthy siblings (n=32). All biochemical measurements including plasma selenium, serum copper levels, serum and erythrocyte zinc levels and erythrocyte superoxide dismutase activity were evaluated according to dietary, clinical and biochemical parameters. RESULTS: Compared to the control group, the HIV-infected children had lower z-score values for height-for-age (p=0.0006), higher prevalence of stunting (11.8%) (p=0.047), lower selenium levels (p=0.0006) and higher copper levels (p=0.019). No difference was found concerning superoxide dismutase activity (p>0.05). The HIV-infected group presented a higher proportion (45.1%) of children with zinc intakes below the estimated average requirement (p=0.014); however, no association with zinc biochemical parameters was found. CONCLUSION: HIV-infected children have an inadequate selenium and copper nutritional status, which could influence the progression to AIDS. An adequate micronutrient status could improve the clinical conditions in these patients and minimize free radical production and cellular oxidative stress.

Nutritional status and metabolic disorders in HIV-exposed uninfected prepubertal children.

OBJECTIVE: The objective of the study was to assess the nutritional status and metabolic alterations in HIV-exposed uninfected (HIVe) children compared with HIV-unexposed (HIVn) children. METHODS: A cross-sectional study was carried out with 76 children distributed into two groups: HIVe (n = 31) and HIVn (n = 45). Biochemical data (hematologic test, lipid profile, insulin resistance, hepatic profile, and C-reactive protein) were evaluated. Anthropometric parameters and body composition analyses were performed. RESULTS: The groups were similar regarding body mass index-for-age z-scores (P = 0.297) and height-for-age z-scores (P = 0.666). HIVe had a higher dyslipidemia prevalence (38.7% versus 11.1%; P = 0.010), altered total cholesterol (TC) values (19.4% versus 2.2%; P = 0.016) higher LDL-C mean levels (97.8 mg/dl versus 86 mg/dl; P = 0.028), borderline low-density lipoprotein cholesterol (LDL-C) (40% versus 14%; P = 0.011) and TC (41.9% versus 20%; P = 0.038) compared with HIVn. CONCLUSION: Despite the similar nutritional status between groups, our data clearly demonstrated a higher prevalence of dyslipidemia, altered TC, higher LDL-C levels and also LDL-C and TC borderline values in HIVe children.

Body composition in prepubertal, HIV-infected children: a comparison of bioelectrical impedance analysis and dual-energy X-ray absorptiometry.

BACKGROUND: The aim of this study was to compare bioelectrical impedance analysis (BIA) equations developed for healthy pediatric populations and for HIV-infected children using dual-energy X-ray absorptiometry (DXA) as the gold standard. MATERIALS AND METHODS: A cross-sectional study was carried out with 40 prepubertal, HIV-infected children who regularly attended the Pediatric Infectious Disease Clinic at the Universidade Federal de São Paulo, São Paulo, Brazil. The study was conducted from August to November 2008. Demographic data, clinical parameters, immunological status, and use of antiretroviral therapy were obtained from the patients' medical records. We performed anthropometric parameters and body composition analyses, analyzed body composition by BIA and DXA, and compared the results obtained from BIA through using equations for both healthy and HIV-infected populations. RESULTS: The mean ± SD age of the study population was 9.8 ± 1.2 years. Half of the population were females, and 82.5% of the children were clinically classified as B and C. Total body fat, by both absolute mass and by percentage, exhibited high homogeneity between the results obtained from BIA and DXA. However, there was no concordance in fat-free mass. The equation for healthy children showed good sensitivity and specificity when comparing the percentage of total body fat measured by DXA. CONCLUSION: BIA provides reliable data on total body fat but not fat-free mass when compared with DXA. The BIA equation developed for healthy pediatric populations can be used to determine total body fat in HIV-infected children.

Body composition and lipodystrophy in prepubertal HIV-infected children

OBJECTIVE: To identify lipodystrophy in prepubertal HIV-infected children using anthropometric parameters and body composition assessment. METHODS: Cross-sectional study including 40 prepubertal HIV-infected children of both genders seen at the Care Center of the Division of Pediatric Infectious Diseases - Universidade Federal de São Paulo, São Paulo city, Brazil, was carried out from August to December 2008. Age, clinical and immunological status, prophylaxis, transmission and highly active antiretroviral therapy were recorded. Body mass index z-score and height-for-age z-score were calculated to characterize the nutritional status. Circumferences were measured with flexible tape and skinfolds were assessed by an adipometry. Fat mass and lean mass were determined by dual-energy X-ray absorptiometry. Presence of clinical signs of lipodystrophy was assessed by a trained clinician. Data were analyzed using SPSS 12.0 software. RESULTS: The mean age and standard deviation were 9.8 (1.2) years, 50% were girls and 82.5% children from B and C categories. Clinical lipodystrophy and dislypidemia were present in 27.5% and 70%, respectively. The trunk to arm ratio and the limb to trunk ratio had positive association with lipodystrophy. Patients with lipodystrophy had short stature, higher triglycerides values and lower HDL-cholesterol. CONCLUSION: The ratios obtained by skinfolds and dual-energy X-ray absorptiometry measurements can be considered as indicators of preclinical lipodystrophy. The cutoff points have not been determined yet; however, continuous assessment may be useful to identify early body composition changes.

Body composition and lipodystrophy in prepubertal HIV-infected children.

OBJECTIVE: To identify lipodystrophy in prepubertal HIV-infected children using anthropometric parameters and body composition assessment. METHODS: Cross-sectional study including 40 prepubertal HIV-infected children of both genders seen at the Care Center of the Division of Pediatric Infectious Diseases - Universidade Federal de São Paulo, São Paulo city, Brazil, was carried out from August to December 2008. Age, clinical and immunological status, prophylaxis, transmission and highly active antiretroviral therapy were recorded. Body mass index z-score and height-for-age z-score were calculated to characterize the nutritional status. Circumferences were measured with flexible tape and skinfolds were assessed by an adipometry. Fat mass and lean mass were determined by dual-energy X-ray absorptiometry. Presence of clinical signs of lipodystrophy was assessed by a trained clinician. Data were analyzed using SPSS 12.0 software. RESULTS: The mean age and standard deviation were 9.8 (1.2) years, 50% were girls and 82.5% children from B and C categories. Clinical lipodystrophy and dislypidemia were present in 27.5% and 70%, respectively. The trunk to arm ratio and the limb to trunk ratio had positive association with lipodystrophy. Patients with lipodystrophy had short stature, higher triglycerides values and lower HDL-cholesterol. CONCLUSION: The ratios obtained by skinfolds and dual-energy X-ray absorptiometry measurements can be considered as indicators of preclinical lipodystrophy. The cutoff points have not been determined yet; however, continuous assessment may be useful to identify early body composition changes.

Estado nutricional de crianças e adolescentes hospitalizados em enfermaria de cirurgia pediátrica / Nutritional status of children and adolescents hospitalized at the pediatric surgery unit

OBJETIVO: Avaliar o estado nutricional, o tempo de internação e as especialidades clínicas de pacientes internados na enfermaria de Cirurgia Pediátrica do Hospital São Paulo da Unifesp-EPM. MÉTODOS: Estudo transversal retrospectivo, com 749 crianças e adolescentes de ambos os gêneros acompanhados por equipe interdisciplinar durante o período de agosto de 2007 a julho de 2008. Foram coletados dados antropométricos, dias de internação e procedimento cirúrgico segundo a especialidade. Para a classificação do estado nutricional, utilizou-se o escore Z do índice de massa corporal (Z IMC) e da estatura/idade (Z E/I) segundo a curva da Organização Mundial de Saúde (OMS, 2007). As crianças foram classificadas segundo diagnóstico estabelecido previamente à cirurgia. Utilizou-se o programa STATA 8.0 para análise dos dados e aplicou-se o teste ANOVA e comparações múltiplas de Bonferroni, considerando-se significante p<0,05. RESULTADOS: A mediana de idade foi sete anos (0 a 18), predominando o gênero masculino (59 por cento) e as internações para cirurgia otorrinolaringológica (18 por cento). Dos pacientes internados, 66 por cento tinham estatura adequada para idade, 43 por cento eutróficos e 31 por cento obesos/sobrepeso. Os pacientes desnutridos permaneceram mais dias internados quando comparados aos obesos/sobrepeso (7,2 versus 4,1 dias; p=0,035). Os lactentes apresentaram maior tempo de internação (p=0,006) e menor valor de Z IMC, comparados aos outros grupos etários (p=0,001). Os lactentes com programação de cirurgia cardíaca apresentaram Z IMC menor em relação às demais especialidades (p=0,002). CONCLUSÕES: O perfil dos pacientes internados condiz com a atual transição nutricional, aumento da prevalência de obesidade concomitante à desnutrição. Entretanto, a desnutrição ainda constitui fator agravante para a permanência hospitalar.

OBJECTIVE: To evaluate the nutritional status, duration of hospital stay and clinical specialties of patients hospitalized in the Pediatric Surgery Unit of São Paulo Hospital, Unifesp-EPM. METHODS: This cross-sectional retrospective study enrolled 749 children and adolescents of both genders admitted to the Pediatric Surgery Unit during the period of August 2007 to July 2008. The following data were collected: anthropometric variables, duration of hospital stay and surgical procedures. For nutritional status classification, the Z score for body mass index (Z BMI) and height-for-age (Z H/A) were used according to the World Health Organization growth chart (WHO, 2007). The children were classified according to the surgical procedures performed. Results were compared by ANOVA followed by Bonferroni multiple comparisons test, being significant p<0.05. Statistical analysis was carried out through STATA 8.0 software. RESULTS: Patients' mean age was seven years old (0 to 18), 59 percent were males and 18 percent had ear, neck or throat surgery. Among the hospitalized patients, 66 percent had appropriated height for age, 43 percent were eutrophic and 31 percent obese/overweight. The malnourished patients presented longer hospital stay than the obese/overweight patients (7.2 versus 4.1 days; p=0,035). Infants had prolonged hospital stay (p=0,006) and less Z BMI values in comparison to the other age groups. (p=0,001). Infants that needed cardiac surgery presented lower Z BMI in relation to the others (p=0,002). CONCLUSIONS: The patients profile in the Pediatric Surgery Unit followed the nutritional pattern observed in Brazil, with increasing prevalence of obesity together with malnutrition. However, malnutrition is still an aggravating factor for prolonged hospital stay.