Reduced cholesterol levels in renal membranes of undernourished rats may account for urinary Na⁺ loss.

PURPOSE: It has been demonstrated that reabsorption of Na⁺ in the thick ascending limb is reduced and the ability to concentrate urine can be compromised in undernourished individuals. Alterations in phospholipid and cholesterol content in renal membranes, leading to Na⁺ loss and the inability to concentrate urine, were investigated in undernourished rats. METHODS: Sixty-day-old male Wistar rats were utilized to evaluate (1) phospholipid and cholesterol content in the membrane fraction of whole kidneys, (2) cholesterol content and the levels of active Na⁺ transporters, (Na⁺ + K⁺)ATPase and Na⁺-ATPase, in basolateral membranes of kidney proximal tubules, and (3) functional indicators of medullary urine concentration. RESULTS: Body weight in the undernourished group was 73 % lower than in control. Undernourishment did not affect the levels of cholesterol in serum or in renal homogenates. However, membranes of whole kidneys revealed 56 and 66 % reduction in the levels of total phospholipids and cholesterol, respectively. Furthermore, cholesterol and (Na⁺ + K⁺)ATPase activity in proximal tubule membranes were reduced by 55 and 68 %, respectively. Oxidative stress remained unaltered in the kidneys of undernourished rats. In contrast, Na⁺-ATPase activity, an enzyme with all regulatory components in membrane, was increased in the proximal tubules of undernourished rats. Free water clearance and fractional Na⁺ excretion were increased by 86 and 24 %, respectively, and urinary osmolal concentration was 21 % lower in undernourished rats than controls. CONCLUSION: Life-long undernutrition reduces the levels of total phospholipids and cholesterol in membranes of renal tubular cells. This alteration in membrane integrity could diminish (Na⁺ + K⁺)ATPase activity resulting in reduced Na⁺ reabsorption and urinary concentrating ability.

El niño que no progresa de peso / Failure to thrive

Entre el 8 y 10% de los niños atendidos en atención primaria, presentan una falta de progreso en el peso. El diagnóstico diferencial incluye ingesta calórica inadecuada, inadecuada absorción y metabolismo aumentado. Se reconoce a un niño que no sube de peso por su historia alimentaria, historia médica, historia social, historia familiar y evaluación del apetito. Entre las diferentes causas de falla para crecer están baja talla constitucional, abuso sexual, maltrato infantil, depresión postparto, enfermedad celíaca y esofagitis eosinofílica, entre otros. Entre los pilares en el manejo del niño que no progresa de peso están enfoque terapéutico, apoyo nutricional, hábitos dietéticos y manejo especializado.

Between 8 and 10% of children seen in primary care, have a lack of progress in weight. The differential diagnosis includes inadequate caloric intake, inadequate absorption and increased metabolism. It is recognized that a child does not gain weight by diet history, medical history, social history, family history and evaluation of appetite. Among the various causes of failure to thrive are constitutional short stature, sexual abuse, child abuse, postpartum depression, celiac disease and eosinophilic esophagitis, among others. Among the mainstays in the management of child weight are not progressing therapeutic approach, nutritional support, dietary habits and specialized management.

Growth and nutritional status in children and adolescents with cystic fibrosis.

BACKGROUND: Growth retardation, delayed puberty and malnutrition are frequently observed in children suffering from cystic fibrosis. AIM: The aim of this study was to estimate growth and nutritional status in children with cystic fibrosis on the basis of body proportions and body mass index. SUBJECTS AND METHODS: Anthropometric data were collected from the medical histories of 62 patients treated in three cystic fibrosis treatment centers in Poland. Anthropometric parameters were expressed in terms of standard deviations away from age-specific and sex-specific reference means reported for the population of Poland. Two-way analysis of variance was used to determine whether the type of cystic fibrosis transmembrane conductance regulator (CFTR) mutation is correlated with age at the time of diagnosis and with body proportions. RESULTS: The type of mutation was significantly correlated with height, weight and transverse chest width. Growth retardation was greater in subjects diagnosed before they were 3 years old than in subjects diagnosed later. The children had infantile body proportions. Their legs were short and their trunks were long in comparison to their height. Almost 40% of the subjects suffered from malnourishment. CONCLUSION: Further study is needed to determine how growth in children with cystic fibrosis is affected by clinical practice and socio-economic factors.

Fatores de risco para ocorrência de restrição do ganho de peso extra-uterino de prematuros de muito baixo peso ao nascer / Risk factors for in-hospital undernutrition in preterm very low birthweight infants

A desnutrição em recém-nascidos prematuros de muito baixo peso ao nascer (MBPN) é um fenômeno universal e vem aumentando nas últimas décadas. A restrição do crescimento extra-uterino (RCEU) é um importante indicador do estado nutricional nestes pacientes. O objetivo deste estudo foi identificar os fatores de risco para RCEU durante a internação hospitalar. Foi realizado estudo de coorte retrospectiva que incluiu 188 recém-nascidos MBPN adequados para idade gestacional (AIG), no período de 2002 a 2004. A análise constituiu-se em um modelo de regressão linear longitudinal de efeitos mistos, sendo observada a diferença na taxa de variação do peso para crianças com e sem RCEU na alta hospitalar. Oitenta e sete (46%) dos recém-nascidos incluídos no estudo apresentaram RCEU na alta hospitalar. Influenciaram a taxa de variação do peso ao longo da internação hospitalar: o menor peso ao nascer, sexo masculino, menor Apgar de 50 minutos, o maior escore CRIB; persistência do canal arterial, doença metabólica óssea, hemorragia intracraniana, displasia broncopulmonar e sepse. O maior tempo em oxigenioterapia, as transfusões sanguíneas, o uso de diurético, o maior tempo para atingir dieta plena e de uso de nutrição parenteral também foram preditores do crescimento. A desnutrição de recém-nascidos prematuros MBPN nas Unidades Neonatais é um problema freqüente e influenciado tanto pelo cuidado neonatal quanto pelas características individuais de cada criança.

Undernutrition in preterm very low birth weight infants is a major problem andit has been raising during the past decades. Posnatal weight gain restriction (PWGR) is an important nutritional indicator in these patients. The aim of this study was to identify risk factors for PWGR during hospitalization. A retrospective cohort study was done and included 188 very low birth weight preterm and adequate for gestationalage infants, during 2002-2004. The analysis included longitudinal linear regression modeling, considering weight variation among children with and without PWGR at discharge. Eighty seven (46%) infants had PWGR at discharge. The following variables influenced (negative) weight variation during hospitalization: lower birthweight, sex, lower 5th minute Apgar, higher CRIB score, persistent ductus arteriosus, metabolic bone disease, intracranial hemorrhage, broncopulmonary dysplasia and sepsis. The longer oxygen exposure time, blood transfusions, diuretic use, the longer time to achieve enteral full feeding and of use of parenteral nutrition were also important growth predictors. Undernutrition among very low birth weight preterm infants is a frequent problem; it is influenced by neonatal care but also, by individual characteristics.