Resting Energy Expenditure Is Not Altered in Children and Adolescents with Obesity. Effect of Age and Gender and Association with Serum Leptin Levels.

In children and adolescents, obesity does not seem to depend on a reduction of resting energy expenditure (REE). Moreover, in this young population, the interactions between either age and obesity or between age and gender, or the role of leptin on REE are not clearly understood. To compare the levels of REE in children and adolescents we studied 181 Caucasian individuals (62% girls) classified on the basis of age- and sex-specific body mass index (BMI) percentile as healthy weight (n = 50), with overweight (n = 34), or with obesity (n = 97) and in different age groups: 8-10 (n = 38), 11-13 (n = 50), and 14-17 years (n = 93). REE was measured by indirect calorimetry and body composition by air displacement plethysmography. Statistically significant differences in REE/fat-free mass (FFM) regarding obesity or gender were not observed. Absolute REE increases with age (p < 0.001), but REE/FFM decreases (p < 0.001) and there is an interaction between gender and age (p < 0.001) on absolute REE showing that the age-related increase is more marked in boys than in girls, in line with a higher FFM. Interestingly, the effect of obesity on absolute REE is not observed in the 8-10 year-old group, in which serum leptin concentrations correlate with the REE/FFM (r = 0.48; p = 0.011). In conclusion, REE/FFM is not affected by obesity or gender, while the effect of age on absolute REE is gender-dependent and leptin may influence the REE/FFM in 8-10 year-olds.

Clinical and financial implications of hospital malnutrition in Spain.

OBJECTIVE: The aim of this review is to analyse the studies about cost and clinical implications that malnutrition causes in the Spanish hospitals. MATERIAL AND METHODS: The review of the literature was carried out through a bibliographic search in Web of Science following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria and analyse the cost of treatment of malnourished and anorexia nervosa (AN) patients RESULTS: Seventeen studies with economic data related to malnutrition were included. The employment of a nutritional screening is the first tool to determinate the prevalence. Malnutrition is related to an incremental cost due to a longer hospital stay, expensive treatment, and higher rate of readmissions. Malnourished patients present more clinical complications, more infections, and higher mortality. No studies were found with economic data of AN in Spain. CONCLUSIONS: The prevalence of malnutrition is over 20%, with the elderly patients being the most affected. Nutritional screening is not implanted in all Spanish hospitals in spite of its proven cost-effectiveness. The cost and the clinical implications of malnutrition make this disease a health national problem. The knowledge of the real cost of AN treatment would increase the interest of public institutions on the development of specific Nutritional Screening tools for an early detection of AN.

Estrutura da vigilância alimentar e nutricional na atenção básica em saúde no estado de Minas Gerais / Structure of the food and nutrition surveillance system in primary health care in the Minas Gerais state

A Vigilância Alimentar e Nutricional-VAN visa a monitorar o estado alimentar e nutricional da população com o propósito de prover informação contínua sobre as condições alimentares e nutricionais e seus fatores determinantes para tomada de decisão pelos gestores. As ações para sua operacionalização devem ser promovidas no âmbito da Atenção Básica do Sistema Único de Saúde, utilizando a estrutura disponível desse nível de atenção, incluindo os recursos humanos, financeiros, físicos e materiais. Este trabalho objetivou identificar e descrever a estrutura organizacional para a realização de ações de vigilância alimentar e nutricional em nível municipal, por meio de questionário estruturado, enviado aos 853 municípios de Minas Gerais, Brasil. Participaram da pesquisa 432 municípios, nos quais foi observado que a estrutura para a realização de ações de alimentação e nutrição avançou, desde a implantação da Vigilância Alimentar e Nutricional, no Sistema Único de Saúde, mas carece de adequações que possibilitem qualificar as ações de alimentação e nutrição realizadas, bem como aumentar a cobertura populacional.

The aim of the Food and Nutrition Surveillance is to monitor the food and nutritional status of the population, for decision making by managers. This enables continuous collection of information regarding food and nutritional conditions and their determining factors. To implement this system, programs should be promoted within the basic care provided by the Unified Health System (SUS) by using the structure available at this level of care that includes human, financial, and material resources. With the aid of a structured questionnaire sent to 853 municipalities in Minas Gerais, the aim of this study was to identify and describe the structure available at the municipal level for the implementation of food and nutrition surveillance programs. Around 432 municipalities participated in the survey, revealing that their structure for the implementation of food and nutrition programs, in terms of the availability of human, financial, and material resources, requiring adaptations and greater consideration by the administration.

[The Brazilian School Nutrition Program from the standpoint of students attending state schools in Minas Gerais, Brazil]. / O Programa Nacional de Alimentação Escolar sob a ótica dos alunos da rede estadual de ensino de Minas Gerais, Brasil.

The scope of this article is to analyze the Brazilian School Nutrition Program from the standpoint of students attending state schools in Minas Gerais. It is a qualitative and quantitative cross-sectional study with a sample of 1500 students, representing the population of the state schools of Minas Gerais, involving the administration of a semi-structured questionnaire. The data were analyzed using simple frequency, mean, standard deviation, Fisher's exact test, the chi-square test and logistic regression (p < 0.05, CI 95%). The effective acceptance of the program was 28.8% and the effective adhesion to the program was 45.1%. Program acceptance was significantly higher among males and students who consumed less extra-institutional food. Acceptance and adhesion to the program was significantly higher among the older students and those who reported participating in activities related to nutritional education. In total, 73.5% of the students suggested improvements in school food. Many of the program's norms and guidelines are not being implemented. The acceptance of school food was negatively influenced by the consumption of extra-institutional foods and positively influenced by food and nutritional education activities.

O Programa Nacional de Alimentação Escolar sob a ótica dos alunos da rede estadual de ensino de Minas Gerais, Brasil / The Brazilian School Nutrition Program from the standpoint of students attending state schools in Minas Gerais, Brazil

O objetivo deste artigo é analisar o Programa de Alimentação Escolar sob a ótica dos alunos atendidos na rede estadual de ensino de Minas Gerais. Trata-se de estudo transversal, quali-quantitativo, com amostra de 1500 alunos, representativa do universo da rede estadual de ensino de Minas Gerais, utilizando questionário semiestruturado analisado por meio de frequência simples, média, desvio padrão, teste exato de Fisher, teste qui-quadrado e regressão logística (p < 0,05; IC 95%). Houve efetiva aceitação de 28,8% e efetiva adesão de 45,1% ao Programa. A aceitação foi significativamente maior entre alunos do sexo masculino e entre aqueles que apresentaram menor consumo de alimentos extrainstitucionais. A aceitação e a adesão foram significativamente maiores entre alunos do grupo etário mais velho e entre aqueles que referiram participar de atividades de Educação Alimentar e Nutricional. No total, 73,5% dos alunos sugeriram melhorias para a Alimentação Escolar. Muitos princípios e diretrizes do programa não estão sendo cumpridos. A aceitação da Alimentação Escolar mostrou-se negativamente influenciada pelo consumo de alimentos extrainstitucionais e positivamente influenciada pelas ações de Educação Alimentar e Nutricional.

The scope of this article is to analyze the Brazilian School Nutrition Program from the standpoint of students attending state schools in Minas Gerais. It is a qualitative and quantitative cross-sectional study with a sample of 1500 students, representing the population of the state schools of Minas Gerais, involving the administration of a semi-structured questionnaire. The data were analyzed using simple frequency, mean, standard deviation, Fisher's exact test, the chi-square test and logistic regression (p < 0.05, CI 95%). The effective acceptance of the program was 28.8% and the effective adhesion to the program was 45.1%. Program acceptance was significantly higher among males and students who consumed less extra-institutional food. Acceptance and adhesion to the program was significantly higher among the older students and those who reported participating in activities related to nutritional education. In total, 73.5% of the students suggested improvements in school food. Many of the program's norms and guidelines are not being implemented. The acceptance of school food was negatively influenced by the consumption of extra-institutional foods and positively influenced by food and nutritional education activities.

[Iodine deficiency and associated factors in infants and preschool children in an urban community in the semiarid region of Minas Gerais State, Brazil, 2008]. / Deficiência de iodo e fatores associados em lactentes e pré-escolares de um município do semiárido de Minas Gerais, Brasil, 2008.

The aim of this study was to evaluate the prevalence of iodine deficiency in children aged 6 to 71 months in Novo Cruzeiro, Minas Gerais State, Brazil. A total of 475 children, allocated by stratified probability sampling, were analyzed with respect to the iodine concentrations in the salt consumed by the family and urinary iodine. Iodine deficiency was verified in 34.4% of the children, of which 23.5% showed slight deficiency, 5.9% moderate and 5% serious deficiency. A difference in the distribution of iodine deficiency was observed between the urban and the rural environments (p < 0.001) where average urinary iodine concentrations of 150.8 and 114.3µg/L respectively were found. A greater proportion of iodine deficiency was observed among children where the proportion of iodine in the salt consumed was below the recommended level. Although expressive, iodine deficiency in Novo Cruzeiro is not a public health problem according to World Health Organization (WHO), The limitrophe distribution of the urinary iodine associated with low iodine levels in salt suggests that efforts to control this deficiency are not yet complete.

Deficiência de iodo e fatores associados em lactentes e pré-escolares de um município do semiárido de Minas Gerais, Brasil, 2008 / Iodine deficiency and associated factors in infants and preschool children in an urban community in the semiarid region of Minas Gerais State, Brazil, 2008

O objetivo do estudo foi avaliar a prevalência de deficiência de iodo em crianças de 6 a 71 meses em Novo Cruzeiro, Minas Gerais, Brasil. Foram analisadas 475 crianças alocadas por amostragem probabilística estratificada em relação às concentrações de iodo no sal de consumo familiar e excreção urinária de iodo. Observou-se excreção deficiente de iodo em 34,4 por cento das crianças; entre as quais, 23,5 por cento apresentaram deficiência leve; 5,9 por cento, moderada; e 5 por cento, grave. Diferença na distribuição da deficiência de iodo urinário foi constatada entre o meio urbano e rural (p < 0,001), registrando concentrações medianas de iodúria de 150,8µg/L e 114,3µg/L, respectivamente. Observou-se alta proporção de deficiência entre crianças cujo teor de iodo no sal de consumo encontrava-se abaixo da recomendação. A deficiência de iodo em Novo Cruzeiro não constitui problema de saúde pública segundo a Organização Mundial da Saúde (OMS), embora apresente prevalência ainda expressiva. A distribuição limítrofe de iodúria associada a baixos níveis de iodo no sal sugere que as ações de controle dessa carência ainda não são completas no país.

The aim of this study was to evaluate the prevalence of iodine deficiency in children aged 6 to 71 months in Novo Cruzeiro, Minas Gerais State, Brazil. A total of 475 children, allocated by stratified probability sampling, were analyzed with respect to the iodine concentrations in the salt consumed by the family and urinary iodine. Iodine deficiency was verified in 34.4 percent of the children, of which 23.5 percent showed slight deficiency, 5.9 percent moderate and 5 percent serious deficiency. A difference in the distribution of iodine deficiency was observed between the urban and the rural environments (p < 0.001) where average urinary iodine concentrations of 150.8 and 114.3µg/L respectively were found. A greater proportion of iodine deficiency was observed among children where the proportion of iodine in the salt consumed was below the recommended level. Although expressive, iodine deficiency in Novo Cruzeiro is not a public health problem according to World Health Organization (WHO), The limitrophe distribution of the urinary iodine associated with low iodine levels in salt suggests that efforts to control this deficiency are not yet complete.

Association between nutritional status, environmental and socio-economic factors and Giardia lamblia infections among children aged 6-71 months in Brazil.

A cross-sectional study was conducted on a randomised sample of 405 children aged 6-71 months in Brazil to investigate the association between nutritional status, environmental and socio-economic factors and Giardialamblia infection. Data collection entailed an interview, anthropometric measurements and the collection of faeces and venous blood samples. The analysis was performed using multivariate logistic regression. The prevalence rate for G. lamblia was 26.3%. Nutritional status evaluation showed that 7.9% of the children had chronic malnutrition and 11.1% had acute malnutrition. The risk factors associated with infection by G. lamblia were an age of 2 years or older [odds ratio (OR)=2.4], living in a two-bedroom house or smaller (OR=2.3), living among a family of five or more people (OR=2.4) and living in a house without access to a sewerage system (OR=2.1). Non-participation in the social service programme was associated with a lower risk of infection (OR=0.2). The model adjusted for age, including only biochemical and nutritional variables, showed weak associations with G. lamblia infection for two variables: inadequate animal protein intake according to the Dietary Reference Intake recommendation and low haemoglobin concentration. The sociodemographic and environmental risk factors classically described were associated with G. lamblia infection, but nutritional variables were only weakly associated with it.