Serum Trace Element Levels and Their Correlation with Picky Eating Behavior, Development, and Physical Activity in Early Childhood.

Trace elements are vital components for healthy growth, development, and physical activity. The aim of this study was to investigate the relationship between trace element (iron, zinc, copper) deficiencies and picky eating behavior, development level, and physical activity level. This cross-sectional study involved 203 children aged 4-7 years; picky eating behavior, development level, and physical activity level were assessed through questionnaires. Zinc deficiency has the highest prevalence (37.4%); 67.5% of the children were assessed as picky eaters. Children with picky eating behaviors, poor development level, or poor physical activity level have significantly lower zinc levels, and higher prevalence of zinc deficiency. Pearson's correlation coefficient indicated a positive correlation between serum zinc level and development scores (r = 0.221, p = 0.002) and physical activity scores (r = 0.469, p < 0.001). In multivariate analysis, zinc deficiency independently related to picky eating (OR = 2.124, p = 0.037, CI = 1.042-4.312), developmental level (OR = 0.893, p = 0.022, CI = 0.810-0.984), and physical activity level (OR = 0.785, p < 0.001, CI = 0.700-0.879). In conclusion, the prevalence of zinc deficiency in children aged 4-7 was high, especially in picky eaters. Zinc deficiency was significantly associated with low development and poor physical activity in early childhood.

Nutritional status and cytokine concentration during chemotherapy in Mexican children: A longitudinal analysis.

OBJECTIVE: The aim of this study was to assess whether the nutritional status of children with cancer is influenced by variations in cytokine concentrations observed during chemotherapy. We also evaluated whether this relationship could be modified by nutritional status at diagnosis and type of cancer. METHODS: Mexican children with lymphoma or solid tumors were evaluated at diagnosis and at 2- and 6-mo follow-up visits. Blood samples were obtained to determine serum prealbumin, tumor necrosis factor (TNF)-α, interleukin (IL)-6, leptin concentrations, and hemoglobin. Children were classified as undernourished (UN) or well nourished (WN), according to prealbumin concentration. The influence of each cytokine on prealbumin concentration was analyzed by time-series regression model. RESULTS: Fifty patients (ages 2-17 y) were enrolled. There were 17 children with lymphomas and 33 with solid tumors. At baseline, 56% were UN and 26% presented anemia; the frequencies of UN children were higher for those with lymphoma than for those with a solid tumor (P = 0.003). By nutritional status, UN children presented lower leptin (P = 0.002) but higher IL-6 concentrations (P = 0.009) than the WN group. Children with lymphoma presented lower prealbumin (P = 0.003), but higher TNF-α (P = 0.001) and IL-6 (P = 0.011) concentrations than those with solid tumors. At follow-up, the concentration of prealbumin increased and IL-6 decreased in children with lymphoma. Multivariate analysis demonstrated that decreases in prealbumin concentration at the end of follow-up were associated with increases in IL-6 and TNF-α concentration during chemotherapy. CONCLUSIONS: These results suggest that the cytokine responses during chemotherapy are related to nutritional status at the end of 6 mo of treatment regardless of the initial nutritional status and the type of cancer.

Estado nutricional-hematológico y parasitosis intestinal de niños escolares de 5 a 12 años de cuatro localidades rurales de Paraguay / Nutritional-hematological status and intestinal parasitosis of school children aged 5 to 12 years in four rural localities of Paraguay

El mundo, actualmente se enfrenta a una doble carga de malnutrición que incluye la desnutrición y la alimentación excesiva. A ello se suman las parasitosis intestinales que es una enfermedad frecuente con importante morbimortalidad en la población infantil, ligadas a la pobreza y malas condiciones higiénico-sanitarias. El objetivo de este trabajo fue describir el estado nutricional-hematológico y parasitológico de niños escolares de cuatro comunidades rurales de Paraguay. Estudio observacional descriptivo de corte transverso en el que participaron 102 niños de ambos sexos de 5 a 12 años de edad. Se realizó medición de peso y talla, utilizando balanza calibrada, y un altímetro fijado a la pared. Toma de muestra sanguínea por punción venosa para determinación de parámetros hematológicos, procesados en contador hematológico por impedancia. Muestras de heces de una sola toma fueron recogidas en frascos apropiados con formol al 10%, utilizándose 4 métodos: directo, flotación de Willis, Graham y de concentración. En relación al estado nutricional-hematológico se encontró que el 3,9% de los niños estaba con desnutrición moderada y el 9,8% presentó riesgo de desnutrición; anemia se observó en el 38,2% de los niños. En relación a la parasitosis, el estudio diagnóstico se realizó a 94 niños y se encontró que el 72,2% estaba parasitado, siendo Blastocystis hominis el más frecuente. Tanto la frecuencia de anemia como de parasitosis es alta en esta población, sin embargo no se pudo establecer una relación entre ellas(AU)

Aflatoxin exposure in Nigerian children with severe acute malnutrition.

Aflatoxin exposure is an important public health concern in sub-Saharan Africa as well as parts of Latin America and Asia. In addition to hepatocellular carcinoma, chronic aflatoxin exposure is believed to play a role in childhood growth impairment. The most reliable biomarker of chronic aflatoxin exposure is the aflatoxin-albumin adduct, as measured by ELISA or isotope dilution mass spectrometry (IDMS). In this report, we have used high resolution LC-MS/MS with IDMS to quantitate AFB1-lysine in an extremely vulnerable population of Nigerian children suffering from severe acute malnutrition. To increase the sensitivity and reliability of the analyses, a labelled AFB1-13C615N2-lysine internal standard was synthesized. AFB1-lysine concentrations in this population ranged between 0.2 and 59.2 pg/mg albumin, with a median value of 2.6 pg/mg albumin. AFB1-lysine concentrations were significantly higher in stunted children (median = 4.6 pg/mg) compared to non-stunted (1.2 pg/mg), as well as in children with severe acute malnutrition (4.3 pg/mg) compared to controls (0.8 pg/mg). The median concentrations were also higher in children with kwashiorkor (6.3 pg/mg) compared to those suffering from marasmus (0.9 pg/mg). This is the first report of the use of high-resolution mass spectrometry to quantitate AFB1-lysine in humans.

Assessment of Nutritional Status in Children With Cancer and Effectiveness of Oral Nutritional Supplements.

Malnutrition is a common consequence of cancer in children, but the most effective methods of nutrition intervention are under debate. We aimed to evaluate the nutritional status of children diagnosed with cancer, and to investigate the effect of oral nutritional supplements on anthropometric measurements, biochemical parameters, and outcome. A randomized clinical study of 45 newly diagnosed cancer patients was performed. Anthropometric and biochemical data and related factors were assessed at 0, 3, and 6 months after diagnosis. On initial anthropometric assessment, prevalence of malnutrition by weight or height was found to be lower as compared with body mass index (BMI), or weight for height (WFH), or arm anthropometry. Twenty-six of the patients (55%) received oral nutritional supplement. During the second 3 months after diagnosis, there was a statistically significant decrease in number of the patients with WFH <90th percentile and BMI <5th percentile (P = .003 and P = .04, respectively). Infectious complications occurred more frequently in malnourished patients during first 3 months, and survival of children who were malnourished at the 6th month was significantly lower than that of well-nourished children (P = .003). On laboratory assessment, serum prealbumin levels of the all subjects were below normal ranges, but no relation was found for serum prealbumin or albumin levels in patients who were malnourished or not at diagnosis. Nutritional intervention is necessary to promote normal development and increase functional status as a child receives intensive treatment. Protein- and energy-dense oral nutritional supplements are effective for preventing weight loss in malnourished children.

Reduced prevalence of Giardia duodenalis in iron-deficient Rwandan children.

OBJECTIVE: Acute symptomatic infection with Giardia duodenalis impairs iron absorption, but iron deficiency may protect against infections caused by various micro-organisms including parasites. We therefore examined the association of G. duodenalis infection and iron deficiency in 575 Rwandan children under 5 years of age. METHODS: Giardia duodenalis infection was diagnosed by triplicate microscopy and PCR assays, and iron deficiency was defined as a ferritin concentration <12 ng/ml. RESULTS: Largely asymptomatic G. duodenalis infection was seen in 65.3% of the children and iron deficiency in 17.4%. G. duodenalis infection was less common in iron-deficient children (51%) than in non-deficient children (68%, P = 0.002). In multivariate analysis, the odds of G. duodenalis infection were almost halved in iron-deficient children (adjusted odds ratio, 0.54; 95% confidence interval, 0.33-0.86). CONCLUSION: In this highly endemic setting, there was no evidence that Giardia infection impairs iron status. Rather, iron deficiency appeared to protect against infection with this parasite.

Hematologic and bone marrow changes in children with protein-energy malnutrition.

BACKGROUND: All systems in an organism are affected by protein-energy malnutrition (PEM), but one of the worst affected is the hematopoietic system. Today PEM remains a very serious problem in developing countries. We examined the relationships between clinical features, hematological, and bone marrow changes with severe PEM from Turkey. METHOD: We evaluated 34 (11 females and 23 males) consecutive cases of severe PEM, with no underlying diseases aged 3-20 months. The clinical nutritional conditions of the patients were determined using the Wellcome-Trust PEM classification. Ten of the patients were in the Marasmic-Kwashiorkor (M-K) group, 10 were in the Kwashiorkor (KW) group, and 14 were in the Marasmic (M) group. Full blood count, protein, albumin, serum iron (SI), iron-binding capacity (TIBC), ferritin, vitamin B12, folic acid, complement-3 (C3), complement-4 (C4), and bone marrow were investigated in all groups. RESULTS: Anemia was detected in 97% of patients. We determined serum iron levels were low in 67.6% of the patients, TS levels were low in 76.4% of the patients and ferritin levels were low in 20.5%. The level of vitamin B12 was normal in all patients. Bone marrow analysis showed erythroid series hypoplasia in 28.5% of patients in the M group, 50% in the KW group, and 30% in the M-K group. Marrow iron was absent in 58.8% of patients. CONCLUSION: The most common hematologic change in the children with PEM was anemia and major cause of anemia was iron deficiency in this study. Patients with severe PEM have normal Vit B12 and serum folate levels. Most of the patients with severe PEM had normal cellularity with megaloblastic and dysplastic changes in bone marrow due to the inadequate and imbalanced intake of protein and energy.

The assessment between IL-6 and IL-8 and anthropometric status in malnourished children.

PURPOSE: To evaluate the correlations between the pro-inflammatory interleukins IL-6 and IL-8 and the anthropometric measurements in malnourished vs. non-malnourished children. PATIENTS AND METHODS: We have examined 219 children from Pediatric Clinic I, University of Medicine and Pharmacy of Tirgu Mures, Romania, during January 1, 2012-March 1, 2013 and divided according to Body Mass Index (BMI kg/m(2)) in the following two groups: 164 with normal nutritional status - control group (BMI between -2SD and +2SD), and 55 children with malnutrition (BMI <-2SD). All the children were evaluated anthropometric: BMI, weight for age (W/A), height for age (H/A), mid-upper-arm circumference (MUAC), tricipital skinfold (TSF) and paraclinical: IL-6 and IL-8 levels. RESULTS: From 219 children, 25.1% were malnourished. The mean age was 5.16 years in malnourished. IL-6 and IL-8 mean levels were 2.54 pg/mL, respectively 6.83 pg/mL in malnourished and 6.02 pg/mL, respectively 9.06 pg/mL in non-malnourished. By statistically comparing IL-6 in malnourished group vs. control group, we observed decreased values (p<0.0001) and also significantly lower values for IL-8. We also obtained statistical differences between the two groups in BMI, W/A, MUAC and TSF. The BMI SD have an increasing trend line, from -4SD in newborn malnourished to -2SD in near 18-year-old malnourished; the trend line had only a slight ascension in non-malnourished children. CONCLUSIONS: The interleukin levels and BMI, W/A, MUAC and TSF are significantly lower in malnourished children than in non-malnourished. This functional impairment may be involved in the malnutrition to develop a specific immune response in these children.

IgA anti-tissue transglutaminase antibodies, first line in the diagnosis of celiac disease.

BACKGROUND: According to the 2008 celiac disease working group run by Dr. A. Fassano under the auspices of the Federation of International Societies of Pediatric Gastroenterology, Hepatology and Nutrition, celiac disease is a chronic immune-mediated enteropathy characterized by gluten sensitivity, which can affect any organ or system, having a wide range of clinical manifestations of variable severity. The serological diagnosis of celiac disease is based on high sensitivity and specificity tests. The measurement of IgA anti-tissue transglutaminase antibodies by ELISA is universally accepted in the screening of celiac disease. METHODS: Using the gold standard represented by IgA anti-endomysium antibodies in a group of 890 children investigated during 2008-2009, we aimed to evaluate IgA anti-tissue transglutaminase antibodies (tTG IgA), as well as to establish their prevalence in associated diseases. RESULTS: Following the measurement of tTG IgA in the entire group, we obtained: sensitivity 773%, positive predictive value 55.2%, specificity 93.1%, negative predictive value 973%, p = 0.000, and in tTG IgA associations we obtained the value 0.51 for the ROC curve area. We found associations of tTG IgA with type 1 diabetes mellitus (235% prevalence), protein-calorie malnutrition (0.89% prevalence), and intestinal malabsorption (0.56% prevalence). CONCLUSIONS: Our results have a high specificity and sensitivity in the screening of celiac disease, while requiring a second method of confirmation.

Helicobacter pylori infection does not influence the efficacy of iron and vitamin B(12) fortification in marginally nourished Indian children.

BACKGROUND/OBJECTIVES: Helicobacter pylori infection and iron and vitamin B(12) deficiencies are widespread in economically disadvantaged populations. There is emerging evidence that H. pylori infection has a negative effect on the absorption of these micronutrients. The aim of this study was to evaluate the effect of H. pylori infection on the efficacy of micronutrient (including iron and vitamin B(12))-fortified foods supplied for 1 year in marginally nourished children. SUBJECTS/METHODS: In all, 543 Indian children, aged 6-10 years, participated in a double-blind, randomized controlled intervention trial, receiving foods fortified with either high (100% Recommended Dietary Allowances (RDA)) or low (15% RDA) amounts of iron, vitamin B(12) and other micronutrients. The presence of H. pylori infection was diagnosed by the (13)C-labeled urea breath test at 11 months after the start of the intervention. Blood hemoglobin, serum ferritin (SF), total body iron and plasma vitamin B(12) were estimated at baseline and 12 months, and differences between these time points were assessed using an independent t-test. RESULTS: Overall, the prevalence of H. pylori infection in this group of children was 79%. Baseline hemoglobin, SF, body iron and vitamin B(12) concentrations were not associated with H. pylori infection. The response to the intervention (either high or low amounts of iron and vitamin B(12) fortification) in terms of change in iron markers and vitamin B(12) status did not differ between children with and without H. pylori infection. CONCLUSIONS: This study shows that the presence of H. pylori infection did not affect the efficacy of long-term iron and vitamin B(12) fortification in these marginally nourished children.

Correlación clínica- para-clínica en un escolar con hipertensión porta de etiología a esclarecer / Clinical-paraclinical in a school with portal hypertension to determine

La hipertensión porta (HTP) es el resultado del incremento de la presión dentro del sistema venoso porta. Se presenta con poca frecuencia en el paciente pediátrico pero es una de las mayores causas de morbilidad y mortalidad en el niño con enfermedad hepática. La mayoría de los pacientes con http presentan un estado hiperdinámico, lo cual aumenta el flujo venoso porta y mantiene la hipertensión. Puede ser secundaria a obstrucción a nivel prehepático, intrahepático o extrahehepático.

Portal hypertension (PH) is the result of increased pressure within the portal venous system. It occurs infrequently in the pediatric patient but it is a major cause of morbidity and mortality in children with liver disease. Most patients with PH have a hyperdynamic state, which increases venous flow and portal hypertension remains. May be secondary to obstruction at prehepatic, intrahepatic or extrahehepatic.

Stress and body mass index each contributes independently to tumor necrosis factor-alpha production in prepubescent Latino children.

This investigation extended prior work by determining if stress and body mass index (BMI) contributed independently to tumor necrosis factor-alpha (TNF-alpha) levels among prepubescent Latino children and if sex and family history of type 2 diabetes mellitus (T2DM) modified these relationships. Data were collected in South Florida from 112 nondiabetic school-aged Hispanic children, of whom 43.8% were obese (BMI >/= 95th percentile) and 51.8% presented with a family history of T2DM. Stressful life events were assessed via parental report using a life events scale. Plasma TNF-alpha levels were determined with enzyme-linked immunosorbent assay. The relative contributions of stress and BMI with TNF-alpha levels and the potential interaction effects of sex and family history of T2DM were analyzed with multiple linear regression analyses. Stress and BMI each accounted for a significant proportion of the unique variance associated with TNF-alpha. The association between stress and TNF-alpha was not modified by sex or family history of T2DM. These findings implicate BMI and stress as independent determinants of TNF-alpha (an inflammatory cytokine and adipocytokine) among Latino children. Future investigations should examine the potential roles of exercise, nutritional status, age, and growth hormone in explicating the relationship between TNF-alpha production and psychosocial distress and risk for infection among obese children.

Influence of infection on iron profile in severely malnourished children.

OBJECTIVE: To study the iron profile and find out an accurate diagnostic tool which reflects iron status in different types of infection in severely malnourished children aged 12 months to 71 months. METHODS: Hundred and Eight (108) children of whom 72 children were infected and 36 non infected severely malnourished children according to WHO criteria in the age group of 12-71 months were interrogated. 36 healthy control in the same age group were also interrogated. RESULTS: Mean serum iron, total iron binding capacity (TIBC), ferritin concentration in normal children were significantly higher (P<0.001) than non-infected severely malnourished children. On the other hand mean serum ferritin concentration was significantly higher (P<0.001) in infected group than non-infected group but still lower than normal. Mean serum TIBC concentration significantly reduced in severely malnourished children than normal children but no significant difference was observed between non-infected and infected group. Mean serum iron, and transferrin saturation were significantly reduced (P<0.05) in parasitic infestation. CONCLUSION: Severely malnourished children had reduced mean serum iron profile. Parasitic infestation influenced the marked reduction of mean serum iron concentration and transferrin saturation level. Mean serum iron concentration was reduced in acute respiratory infection(ARI) and parasitic infestation than other infections. Serum ferritin concentration was elevated in all types of infection as acute phase protein but still lower than normal. So Iron, TIBC and Transferin saturation <16% constitute good evidence for iron deficiency in both infected and non-infected severely malnourished children.

Ghrelin and other appetite-regulating hormones in paediatric patients with chronic renal failure during dialysis and following kidney transplantation.

BACKGROUND: Patients with renal insufficiency often suffer from cachexia and growth retardation due to low appetite and increased resting metabolic rate. The neuroendocrine hormone ghrelin, a growth hormone secretagogue, enhances food intake, but its role in the development of a cachectic state in renal insufficiency is unclear. Objective. The aim of our study was to investigate the plasma concentration of total ghrelin and other hormones involved in appetite regulation in children with preterminal chronic renal failure (CRF, n = 24), children undergoing dialysis (n = 19), children after renal transplantation (RTx, n = 59) and healthy controls (n = 10). RESULTS: Total ghrelin was significantly elevated in CRF patients (1370 +/- 182 pg/ml; mean +/- SEM) when compared to control subjects (682 +/- 106 pg/ml; P = 0.016) or patients following RTx (859 +/- 51 pg/ml; P = 0.002). Furthermore, a negative correlation between glomerular filtration rate and total ghrelin was observed in CRF and transplant recipients (r = 0.36, P = 0.0006). BMI SDS (standard deviation score) is lower in CRF patients compared to the other groups (P < 0.0001). Leptin, adiponectin, blood glucose, insulin, IGF-I, IGFBP-3 and growth hormone concentrations did not differ among groups. CONCLUSIONS: We observed elevated ghrelin levels in uraemic patients despite poor appetite, but the underlying reasons remain unclear. Normal ghrelin levels can be re-achieved following RTx.

Situación nutricional en pacientes pediátricos internados en un hospital público de la Ciudad de México / Nutritional situation of hospitalized pediatric patients in a public hospital in Mexico City / Estado nutricional de pacientes pediátricos internados em um hospital público da Cidade do México

A desnutrição é comum nos pacientes hospitalizados e tem importância especial nos pacientes pediátricos, já que pode comprometer seu desenvolvimento e crescimento. Por esta razão, é importante incluir a avaliação nutricional como parte da atenção ao paciente; esta prática deve ser realizada por meio de indicadores que reflitam o estado nutricional de maneira prática e simples. O objetivo deste estudo foi determinar a freqüência de desnutrição em pacientes pediátricos hospitalizados por meio de vários indicadores e relacionar ao tempo de internação da criança. A presença de desnutrição crônica, aguda ou crônica-agudizada foi avaliada nos pacientes hospitalizados no Serviço de Pediatria do Hospital Geral do México. Os pacientes foram divididos em grupos, de acordo com seu estado nutricional (desnutrição crônica, agudae crônica-agudizada) ou parâmetros bioquímicos inferiores à normalidade e foi realizada uma análise descritiva, assim como teste t Student para considerar a diferença entre médias em ambos os grupos com relação ao tempo de hospitalização. Foram avaliados 126 pacientes pediátricos. De acordo com os indicadores, foram observados: 21,2% pelo escore Z do peso para a estatura (desnutrição aguda), 32,3% e 37,2% pela estatura para a idade (desnutrição crônica) e peso para a idade, respectivamente; além de 13,8% de desnutrição crônica agudizada. Bioquimicamente, 13,5% das crianças apresentaram valores baixos de hemoglobina,32,2% do hematócrito, 31,9% da albumina e 23,7% das proteínas totais. Não houve diferença significativa entre pacientes desnutridos e com estado nutricional adequado em relação aotempo de hospitalização. A desnutrição é comum em pacientes hospitalizados. Este é um dado de grande importância no paciente do pediátrico, pois a desnutrição pode prejudicar seu crescimento e desenvolvimento ideais...

Malnutrition is a common issue among hospitalized patients. It has particular relevance in the children as it can compromise their optimal growth and development. Thus it is important to include nutritional assessment as part of the services given to the patient; this practice should be performed with practical and simple indicators of nutritional status. The aim of the study was to determine the frequency of malnutrition among hospitalized pediatric patients through various indicators and to relate nutrition status with the child’s length of stay. We evaluated the prevalence of chronic, acute or chronic-acute malnutrition in hospitalized patients at the Pediatrics ward at Hospital General de México. Patients were divided into groups according to their nutritional status (chronic, acute or chronic-acute malnutrition, according to their anthropometrical and biochemical parameters) and data was assessed descriptively and comparatively by Student ttests to determine mean differences between both groups (malnourished vs. well-nourished) inrelation to length of stay. We assessed 126 hospitalized pediatric patients. We found different types of malnutrition according to various indicators: 21.2% according to Z score of weight-for height(acute malnutrition), 32.3% and 37.2% by height-for-age (chronic malnutrition) andweight-for-age, respectively; in addition, we found 13.8% of chronic-acute malnutrition. Biochemical indicators showed that 13.5% of the population studied had abnormally low hemoglobin values, 32.2% low hematocrite values, 31.9% low albumin values and 23.7%total proteins values. We found no significant difference between malnourished and wellnourishedpatients in relation to length of stay. institutional healthsystem in order to assess and provide and adequate nutrition care attention to the patients toimprove their general condition and prognosis...

La desnutrición es común en los pacientes hospitalizados. Tiene especial importancia en los pacientes pediátricos, puesto que puede comprometer su desarrollo y crecimiento. Espor ello importante incluir la evaluación nutricia como parte de la atención al paciente; esta práctica debe llevarse a cabo a través de indicadores que reflejen el estado nutricio de manera práctica y sencilla. Es por ello que el objetivo de este estudio fue determinar la frecuencia de desnutrición en los pacientes pediátricos hospitalizados através de diversos indicadores y relacionarla al periodo de estancia intrahospitalaria del niño. Se evaluó la presencia de desnutrición crónica, aguda o crónica-agudizada en pacientes hospitalizados en el servicio de Pediatría del Hospital General de México. Los pacientes se dividieron engrupos de acuerdo a su estado nutricio (desnutrición crónica, aguda, crónica agudizadao parámetros bioquímicos inferiores a la normalidad) y se llevó a cabo un análisis descriptivo, así como diversas pruebas t para estimar la diferencia entre medias y comparar los dos grupos en relación al tiempo de hospitalización. Se evaluaron 126 pacientes pediátricos. Se observaron diferentes frecuencias de desnutrición de acuerdo a varios indicadores:21.2% de acuerdo al puntaje Z del peso para la talla (desnutrición aguda), 32.3% y37.2% por talla para la edad (desnutrición crónica) y peso para la edad, respectivamente; además se encontró un 13.8% de desnutrición crónico-agudizada...

Expression of cytokine mRNA in lymphocytes of malnourished children.

INTRODUCTION: Protein-calorie malnutrition represents a significant worldwide health problem and is associated with an increased risk for infections. The purpose of this study was to evaluate possible changes in type 1/type 2 responses balance in malnourished children. RESULTS: The data obtained in the present study showed that the expression levels of tumor necrosis factor-alpha, interleukin (IL)-4, and IL-10 were more highly, in contrast IL-2, gamma interferon, and IL-6 genes were expressed less in all groups of malnourished children compared with the well-nourished infected children. It is important to indicate that the data collected in the present work agree with the results obtained by different authors, who showed differences in the production of cytokines in malnourished children. CONCLUSION: In conclusion, the results suggest that alterations in the balance of type 1/type 2 immune responses exist in malnourished children, and this could be the reason that the immunological system of the malnourished children is incapable of eradicating infections.

Desnutrición mixta grave complicada: actualizacióndel tratamiento a propósito de un caso / Severe malnutrition complicated mixed: update the treatment of a case

La malnutrición afecta a más de 50 millones de niños de menos de 5 años en los países en desarrollo. Pese al tratamiento, la tasa de mortalidad llega al 50 % en algunos países. Hasta 1990, uno de cada cuatro niños con malnutrición grave fallecía durante el tratamiento. La tasa de letalidad no se modifi có durante los cinco últimos decenios (estudio de más de 60 países). Actualmente hay principios de tratamiento con fundamentos científi cos indiscutibles y la aplicación del protocolos recomendado por OMS - motivo de la presente actualización- reduce costos, letalidad hospitalaria, logra una rehabilitación integral y su aplicación ha originado una caída de la mortalidad a menos del 5% 1 .Se destaca la mortalidad asociada a desnutrición severa, aún pese al tratamiento y realizamos una actualización del tratamiento del desnutrido edematoso grave, presentando el caso de un niño de 1 año de edad, ingresado a la Unidad de Gastroenterología del Hospital del Niño de la Ciudad de La Paz, cuyo cuadro clínico tiene tres semanas de evolución con una enfermedad diarreica aguda (EDA), que se asocia a marcado compromiso del estado general y edema generalizado. El examen físico de ingreso clasifi ca al niño como desnutrido edematoso grave complicado y por su estado clínico crítico e inestabilidad hemodinámica, es transferido a la Unidad de Terapia Intensiva (UTI), donde pese al manejo especializado y oportuno, el niño fallece.

Malnutrition affects more than 5 million children under 5 years of age in developing countries. In spite of treatment, the mortality rate reaches 50% in some countries. Until 1990, one out of each of four children with severe malnutrition died during treatment .The rate of lethality did not change during the last fi ve decades (studies from over 60 countries). At the present, there exist principles of treatment with indisputable scientifi c bases, and the application of the protocol recommended by WHO - reason for the present actualization - reduces costs, lethality in the hospital, reaches a complete rehabilitation, and its application has originated a fall in mortality to less than 5%.We present the case of a one year-old little boy, admitted to the Gastroenterology Unit of the Children’s Hospital in La Paz whose condition had an evolution of three weeks with an acute diarrheic disease (EDA), associated to a very poor overall state and generalized oedema. The physical exam upon admission, classifi ed the child as mixed undernourished, and due to his critical condition and hemodynamic instability he was transferred to the Intensive Care Unit (UTI), where in spite of the specialized and appropriate treatment, the child died. We publish this case in order to point out the mortality associated withsevere malnutrition in spite of the treatment in the UTI, and we present an actualization of the treatment.

Inflammatory cytokine profile and circulating cortisol levels in malnourished children with necrotizing ulcerative gingivitis.

Necrotizing ulcerative gingivitis (NUG), a periodontal disease traditionally associated with stressful lifestyles in young adults in developed countries, is very prevalent in socioeconomically deprived Nigerian children. Random incident cases (153) of NUG, along with their neighborhood village counterparts of comparable age and without NUG, as control, were recruited for this study. Anthropometric evaluation revealed widespread malnutrition and poor health in both groups of children, with more severe stunting in NUG cases. The poor nutritional status of the village children, with and without NUG, was also confirmed by markedly reduced levels of circulating micronutrients. Compared with the neighborhood children, NUG victims showed significant (p < 0.05 or < 0.001) increases in serum levels of interleukin (IL)-8 (+ 233%), IL-18 (+ 30%), IL-6 (+ 190%), IL-1beta (+ 341%), IL-10 (+ 186%), with a small decrease in interferon (IFN)-gamma (-19%) and nonsignificant increases in soluble tumor necrosis factor (TNF) receptors (sTNFR-p55, p75). Associated with NUG was a significant, 38% (p < 0.05) increase in plasma cortisol above the already high levels observed in the neighborhood village children, as well as some micronutrient deficiencies. The findings suggest that NUG is associated with dysregulated cytokine production, with a complex interplay of elevated levels of pro- and anti-inflammatory mediators. Such changes may serve as the common link between the seemingly unrelated risk conditions (e.g. stressful life styles, smoking, microbial infections, diabetes, malnutrition, alcoholism) traditionally implicated in the genesis of NUG, and all known to promote an increase in the blood level of cortisol, as well as a Th(1) to Th(2) cytokine shift.

Preventing early, prolonged vitamin E deficiency: an opportunity for better cognitive outcomes via early diagnosis through neonatal screening.

OBJECTIVE: To evaluate whether early diagnosis of cystic fibrosis (CF) through newborn screening (NBS) and early vitamin E status are associated with cognitive function. STUDY DESIGN: We assessed cognitive function for 71 children without meconium ileus (ages 7.3-16.9 years) enrolled in the screened (S) or control (C) group of the Wisconsin CF Neonatal Screening Project. The Test of Cognitive Skills, 2nd edition generated the cognitive skills index (CSI; mean = 100, SD = 16). Vitamin E deficiency at diagnosis was defined as plasma alpha-tocopherol (alpha-T) below 300 microg/dL (<300E). Primary analyses evaluated CSI scores across the 4 levels of group (S or C) by using alpha-T status (<300E or >300E) with analysis of covariance. RESULTS: After adjusting for covariates, CSI in the C<300E group was significantly lower than each of the other groups (C>300E, S<300E, and S>300E; P < .05). The highest proportion of CSI scores >84 occurred in the C<300E group (41%). Patients in this group also had the lowest mean head circumference z-scores at diagnosis. CONCLUSIONS: Our results show that prolonged alpha-T deficiency in infancy is associated with lower subsequent cognitive performance. Thus, diagnosis via NBS may benefit the cognitive development of children with CF, particularly in those prone to vitamin E deficiency during infancy.

Increased production of tumor necrosis factor-alpha in whole blood cultures from children with primary malnutrition.

Because low tumor necrosis factor-alpha (TNF-alpha) production has been reported in malnourished children, in contrast with high production of TNF-alpha in experimental protein-energy malnutrition, we reevaluated the production of TNF-alpha in whole blood cultures from children with primary malnutrition free from infection, and in healthy sex- and age-matched controls. Mononuclear cells in blood diluted 1:5 in endotoxin-free medium released TNF-alpha for 24 h. Spontaneously released TNF-alpha levels (mean +/- SEM), as measured by enzyme immunoassay in the supernatants of unstimulated 24-h cultures, were 10,941 +/- 2,591 pg/ml in children with malnutrition (N = 11) and 533 +/- 267 pg/ml in controls (N = 18) (P < 0.0001). TNF-alpha production was increased by stimulation with lipopolysaccharide (LPS), with maximal production of 67,341 +/- 16,580 pg/ml TNF-alpha in malnourished children and 25,198 +/- 2,493 pg/ml in controls (P = 0.002). In control subjects, LPS dose-dependently induced TNF-alpha production, with maximal responses obtained at 2000 ng/ml. In contrast, malnourished patients produced significantly more TNF-alpha with 0.02-200 ng/ml LPS, responded maximally at a 10-fold lower LPS concentration (200 ng/ml), and presented high-dose inhibition at 2000 ng/ml. TNF-alpha production a) was significantly influenced by LPS concentration in control subjects, but not in malnourished children, who responded strongly to very low LPS concentrations, and b) presented a significant, negative correlation (r = -0.703, P = 0.023) between spontaneous release and the LPS concentration that elicited maximal responses in malnourished patients. These findings indicate that malnourished children are not deficient in TNF-alpha production, and suggest that their cells are primed for increased TNF-alpha production.