Osteometabolic profile and bone mass in the transition phase: ethnic differences in Brazilians treated with somatropin during childhood

Abstract Objective: The main growth hormone action is to promote linear growth increasing protein synthesis stimulation and osteoblastic activity. Peak bone mass extends from adolescence to 30 years of age. Several factors may influence this acquisition and prevent fracture risk in adulthood, such as genetic potential, GH, ethnicity, and lifestyle factors. This study aims to compare bone mass and osteometabolic profile of white and Afro-descendant Brazilian adolescents in the transition phase, who were treated with human recombinant growth hormone in childhood. Methods: The authors selected 38 adolescents from the Transition Outpatient Clinic of the University of São Paulo. Lumbar spine and total body bone mineral density (BMD) and bone mineral content (BMC), serum calcium, 25-OH-vitamin D and bone markers were analyzed at the rhGH withdrawal. Results: The mean age was 16.8 ± 1.6 years. There were 21 Afro-descendant and 17 whites. Thirty-four percent of the sample presented vitamin D insufficiency, 66% inadequate calcium intake and 44.7% physical inactivity. The Afro-descendants showed a lower lumbar spine and total body Z scores than those of the whites (p = 0.04 and p = 0.03, respectively), as well as their mean body weight (p = 0.03). There were no differences in the remaining osteometabolic parameters. Conclusion: As most adolescents had vitamin D insufficiency, low calcium intake, and physical inactivity, calcium, and cholecalciferol supplementation and lifestyle changes should be encouraged. The Brazilian Afro-descendant may be a vulnerable group for low bone mass, requiring

Osteometabolic profile and bone mass in the transition phase: ethnic differences in Brazilians treated with somatropin during childhood.

OBJECTIVE: The main growth hormone action is to promote linear growth increasing protein synthesis stimulation and osteoblastic activity. Peak bone mass extends from adolescence to 30 years of age. Several factors may influence this acquisition and prevent fracture risk in adulthood, such as genetic potential, GH, ethnicity, and lifestyle factors. This study aims to compare bone mass and osteometabolic profile of white and Afro-descendant Brazilian adolescents in the transition phase, who were treated with human recombinant growth hormone in childhood. METHODS: The authors selected 38 adolescents from the Transition Outpatient Clinic of the University of São Paulo. Lumbar spine and total body bone mineral density (BMD) and bone mineral content (BMC), serum calcium, 25-OH-vitamin D and bone markers were analyzed at the rhGH withdrawal. RESULTS: The mean age was 16.8 ± 1.6 years. There were 21 Afro-descendant and 17 whites. Thirty-four percent of the sample presented vitamin D insufficiency, 66% inadequate calcium intake and 44.7% physical inactivity. The Afro-descendants showed a lower lumbar spine and total body Z scores than those of the whites (p = 0.04 and p = 0.03, respectively), as well as their mean body weight (p = 0.03). There were no differences in the remaining osteometabolic parameters. CONCLUSION: As most adolescents had vitamin D insufficiency, low calcium intake, and physical inactivity, calcium, and cholecalciferol supplementation and lifestyle changes should be encouraged. The Brazilian Afro-descendant may be a vulnerable group for low bone mass, requiring special strategies to increase bone accrual and body weight. More studies are necessary to compare ethnic differences in this population.

Nutrition profile of children in Maranhão state. / Perfil nutricional de crianças no estado do Maranhão.

INTRODUCTION: Combating malnutrition is among the greatest health challenges and needs to be guided by the reality of each region. Studies that assess nutritional status are essential to support interventions, especially in children. OBJECTIVE: To analyze the nutritional status of under-five children attended by the family health strategyin the state of Maranhao. METHOD: Cross-sectional study with children of a sample of probabilistic and stratified representative for the state, six to 59 months. The variables age of the child, gender, household situation and Food Insecurity (Brazilian Scale of Food Insecurity) classification were collected through interviews. The z-score (Z) values ​of height for age, weight for height and Body Mass Index (BMI) for age were calculated.Thenutritional status of the children was classified according to the norms of the Ministry of Health. Statistical methods of correlation were used to analyze the data. RESULTS: Of the 956 children, 9.6% had low or very low height for age. According to the BMI for age overweight was observed in 23.2% of children. The rural children have on average less height and body mass index Z. In total 70.4% of children were food insecure with inverse correlation with height-for-age Z (r = -0,15, p < 0,0001) and no correlation with BMI z score for age (r = -0,05, p= 0,09). CONCLUSION: Chronic malnutrition can still be considered a public health problem despite the nutritional transition that already occurs in these families.

INTRODUÇÃO: O combate à má nutrição está entre os maiores desafios de saúde e precisa ser norteado conforme a realidade de cada região. Estudos que avaliem o estado nutricional são imprescindíveis para embasar intervenções, principalmente em crianças. OBJETIVO: Analisar o perfil epidemiológico nutricional de crianças menores de cinco anos atendidas pela Estratégia Saúde da Família (ESF) no Maranhão. MÉTODO: Estudo transversal com crianças de 6 a 59 meses, de uma amostra do tipo probabilística e estratificada, representativa para o estado. Foram coletadas, por entrevistas, as variáveis "idade da criança", "sexo", "situação do domicílio" e "classificação de Insegurança Alimentar" (Escala Brasileira de Insegurança Alimentar). Foi realizado o cálculo dos valores de escore z (Z) de estatura para a idade, peso para a estatura e índice de massa corpórea (IMC) para a idade. Oestado nutricional foi classificado segundo as normas do Ministério da Saúde. Para a análise dos dados foram utilizados métodos estatísticos de correlação. RESULTADOS: Das 956 crianças, 9,6% apresentaram estatura baixa ou muito baixa. Segundo o Z de IMC, o excesso de peso foi observado em 23,2% das crianças. As crianças da zona rural têm média Z de estatura e de IMC menor. No total, 70,4% das crianças apresentaram situação de insegurança alimentar, com correlação inversa com a estatura (r: -0,15; p < 0,0001) e sem correlação com o Z de IMC (r: -0,05; p = 0,09). CONCLUSÃO: A desnutrição crônica ainda pode ser considerada um problema de saúde pública no Maranhão, a despeito da transição nutricional que já ocorre nessas famílias.

Perfil nutricional de crianças no estado do Maranhão / Nutrition profile of children in Maranhão state

RESUMO: Introdução: O combate à má nutrição está entre os maiores desafios de saúde e precisa ser norteado conforme a realidade de cada região. Estudos que avaliem o estado nutricional são imprescindíveis para embasar intervenções, principalmente em crianças. Objetivo: Analisar o perfil epidemiológico nutricional de crianças menores de cinco anos atendidas pela Estratégia Saúde da Família (ESF) no Maranhão. Método: Estudo transversal com crianças de 6 a 59 meses, de uma amostra do tipo probabilística e estratificada, representativa para o estado. Foram coletadas, por entrevistas, as variáveis "idade da criança", "sexo", "situação do domicílio" e "classificação de Insegurança Alimentar" (Escala Brasileira de Insegurança Alimentar). Foi realizado o cálculo dos valores de escore z (Z) de estatura para a idade, peso para a estatura e índice de massa corpórea (IMC) para a idade. Oestado nutricional foi classificado segundo as normas do Ministério da Saúde. Para a análise dos dados foram utilizados métodos estatísticos de correlação. Resultados: Das 956 crianças, 9,6% apresentaram estatura baixa ou muito baixa. Segundo o Z de IMC, o excesso de peso foi observado em 23,2% das crianças. As crianças da zona rural têm média Z de estatura e de IMC menor. No total, 70,4% das crianças apresentaram situação de insegurança alimentar, com correlação inversa com a estatura (r: -0,15; p < 0,0001) e sem correlação com o Z de IMC (r: -0,05; p = 0,09). Conclusão: A desnutrição crônica ainda pode ser considerada um problema de saúde pública no Maranhão, a despeito da transição nutricional que já ocorre nessas famílias.

ABSTRACT: Introduction: Combating malnutrition is among the greatest health challenges and needs to be guided by the reality of each region. Studies that assess nutritional status are essential to support interventions, especially in children. Objective: To analyze the nutritional status of under-five children attended by the family health strategyin the state of Maranhao. Method: Cross-sectional study with children of a sample of probabilistic and stratified representative for the state, six to 59 months. The variables age of the child, gender, household situation and Food Insecurity (Brazilian Scale of Food Insecurity) classification were collected through interviews. The z-score (Z) values ​of height for age, weight for height and Body Mass Index (BMI) for age were calculated.Thenutritional status of the children was classified according to the norms of the Ministry of Health. Statistical methods of correlation were used to analyze the data. Results: Of the 956 children, 9.6% had low or very low height for age. According to the BMI for age overweight was observed in 23.2% of children. The rural children have on average less height and body mass index Z. In total 70.4% of children were food insecure with inverse correlation with height-for-age Z (r = -0,15, p < 0,0001) and no correlation with BMI z score for age (r = -0,05, p= 0,09). Conclusion: Chronic malnutrition can still be considered a public health problem despite the nutritional transition that already occurs in these families.

PEDIATRICIANS' REPRESENTATIONS ON DAIRY ALTERNATIVES WHEN WEANING IS UNAVOIDABLE. / REPRESENTAÇÕES DE PEDIATRAS ACERCA DAS ALTERNATIVAS DE ALIMENTOS LÁCTEOS DIANTE DO DESMAME INEVITÁVEL.

OBJECTIVE: To analyze pediatricians' representations on the nutritional alternatives that are adopted when weaning becomes inevitable. METHODS: This is a mixed cross-sectional analytical study with probabilistic sampling. Fifty-seven randomly selected pediatricians were interviewed with the use of a semi-structured script for thematic analysis. The technique of free evocations was used, and the terms were processed using software EVOC 2005. The thematic categories were established on software NVivo10, and their co-occurrence matrix was exported and analyzed in terms of their simple similarity hierarchy on software CHIC. RESULTS: In the pediatricians' representations, whole milk was cited as a foodstuff with high allergenic risk (35.1%) and nutritionally inappropriate, and they did not recommend its use if weaning occurred before 1 year of age. The infant formula, referred by 98.3% of the pediatricians as the best alternative at the moment of weaning, was cited by 38.1% of them owing to its nutritional adequacy. The points quoted as unfavorable to the use of the formula were the price, the possibility of causing allergy and the risk of the inadequate use of such a highly industrialized product. CONCLUSIONS: The pediatricians' representations show that they are sensitive to the importance of breast-feeding and at the same time, to the sociocultural difficulties inherent in the practice. Generally speaking, the interviewed pediatricians recommend the use of milk formulas, and not of whole cow's milk, if weaning occurs before the end of the first year of life.

OBJETIVO: Analisar as representações de pediatras sobre as alternativas alimentares adotadas quando o desmame se torna inevitável. MÉTODOS: Estudo transversal qualiquantitativo, analítico e com amostragem probabilística. Foram sorteados 57 pediatras, que participaram de uma entrevista com o uso de um roteiro semiestruturado para a análise temática. Foi utilizada a técnica de evocações livres, e os termos foram processados pelos softwares EVOC 2005. Estabeleceram-se as categorias temáticas no software NVivo 10, e sua matriz de coocorrência foi exportada e analisada pela hierarquia de similaridade simples no software CHIC. RESULTADOS: Nas representações dos pediatras, o leite integral foi evocado como um alimento com alto risco alergênico (35,1%) e nutricionalmente inadequado, e não se recomenda seu uso quando o desmame ocorre abaixo de 1 ano de idade. A fórmula infantil, referida por 98,3% dos pediatras como melhor opção no momento do desmame, foi evocada por 38,1%, em função de sua adequação de nutrientes. Os pontos desfavoráveis para o emprego da fórmula foram: o preço, a possibilidade de alergia e o risco da falta de critério na utilização de um produto altamente industrializado. CONCLUSÕES: As representações dos pediatras sugerem que eles estão sensíveis à importância do aleitamento materno e, ao mesmo tempo, às dificuldades socioculturais inerentes a essa prática. De modo geral, os pediatras entrevistados orientam o uso de fórmulas lácteas, e não o leite de vaca integral, se o desmame ocorre antes do fim do primeiro ano de vida.

REPRESENTAÇÕES DE PEDIATRAS ACERCA DAS ALTERNATIVAS DE ALIMENTOS LÁCTEOS DIANTE DO DESMAME INEVITÁVEL / PEDIATRICIANS’ REPRESENTATIONS ON DAIRY ALTERNATIVES WHEN WEANING IS UNAVOIDABLE

RESUMO Objetivo: Analisar as representações de pediatras sobre as alternativas alimentares adotadas quando o desmame se torna inevitável. Métodos: Estudo transversal qualiquantitativo, analítico e com amostragem probabilística. Foram sorteados 57 pediatras, que participaram de uma entrevista com o uso de um roteiro semiestruturado para a análise temática. Foi utilizada a técnica de evocações livres, e os termos foram processados pelos softwares EVOC 2005. Estabeleceram-se as categorias temáticas no software NVivo 10, e sua matriz de coocorrência foi exportada e analisada pela hierarquia de similaridade simples no software CHIC. Resultados: Nas representações dos pediatras, o leite integral foi evocado como um alimento com alto risco alergênico (35,1%) e nutricionalmente inadequado, e não se recomenda seu uso quando o desmame ocorre abaixo de 1 ano de idade. A fórmula infantil, referida por 98,3% dos pediatras como melhor opção no momento do desmame, foi evocada por 38,1%, em função de sua adequação de nutrientes. Os pontos desfavoráveis para o emprego da fórmula foram: o preço, a possibilidade de alergia e o risco da falta de critério na utilização de um produto altamente industrializado. Conclusões: As representações dos pediatras sugerem que eles estão sensíveis à importância do aleitamento materno e, ao mesmo tempo, às dificuldades socioculturais inerentes a essa prática. De modo geral, os pediatras entrevistados orientam o uso de fórmulas lácteas, e não o leite de vaca integral, se o desmame ocorre antes do fim do primeiro ano de vida.

ABSTRACT Objective: To analyze pediatricians’ representations on the nutritional alternatives that are adopted when weaning becomes inevitable. Methods: This is a mixed cross-sectional analytical study with probabilistic sampling. Fifty-seven randomly selected pediatricians were interviewed with the use of a semi-structured script for thematic analysis. The technique of free evocations was used, and the terms were processed using software EVOC 2005. The thematic categories were established on software NVivo10, and their co-occurrence matrix was exported and analyzed in terms of their simple similarity hierarchy on software CHIC. Results: In the pediatricians’ representations, whole milk was cited as a foodstuff with high allergenic risk (35.1%) and nutritionally inappropriate, and they did not recommend its use if weaning occurred before 1 year of age. The infant formula, referred by 98.3% of the pediatricians as the best alternative at the moment of weaning, was cited by 38.1% of them owing to its nutritional adequacy. The points quoted as unfavorable to the use of the formula were the price, the possibility of causing allergy and the risk of the inadequate use of such a highly industrialized product. Conclusions: The pediatricians’ representations show that they are sensitive to the importance of breast-feeding and at the same time, to the sociocultural difficulties inherent in the practice. Generally speaking, the interviewed pediatricians recommend the use of milk formulas, and not of whole cow’s milk, if weaning occurs before the end of the first year of life.

Anemia e nível de hemoglobina em gestantes de Cuiabá, Mato Grosso, Brasil, antes e após a fortificação compulsória de farinhas com ferro e ácido fólico, 2003-2006 / Anemia and hemoglobin levels in pregnant women from Cuiabá, Mato Grosso, Brazil, before and after the mandatory flour fortification with iron and folic acid, 2003-2006 / Anemia y niveles de hemoglobina en mujeres embarazadas de Cuiabá, Mato Grosso, Brasil, antes y después de la fortificación obligatoria de la harina con hierro y ácido fólico, 2003-2006

OBJETIVO: avaliar a prevalência de anemia e níveis de hemoglobina de gestantes, antes e após a fortificação compulsória de farinhas com ferro, e os fatores associados. MÉTODOS: foram comparadas duas amostras transversais independentes de gestantes de Cuiabá-MT, Brasil (2003 a 2006), alocadas em dois grupos - não fortificado (n=414) e fortificado (n=539); realizou-se análise de regressão logística e linear, com nível de significância de 5%. RESULTADOS: não houve diferença entre os grupos não fortificado e fortificado, na prevalência de anemia (22,2% e 27,8%, respectivamente; p=0,051) e no nível de hemoglobina (ambos com média de 11,7g/dL; p=0,058); maior prevalência de anemia e menor média de hemoglobina associaram-se com maior número de gestações anteriores, maior idade gestacional e baixo peso no início da gestação. CONCLUSÕES: não se encontrou efeito significativo da fortificação compulsória de farinhas, embora a avaliação da gestação indique alta prevalência de anemia e variáveis importantes a serem consideradas.

OBJECTIVE: to evaluate prevalence of anemia and hemoglobin levels among pregnant women before and after mandatory flour fortification with iron, and to investigate associated factors. METHODS: We compared two independent cross-sectional samples of pregnant women from Cuiaba-MT, Brazil (2003 to 2006), divided into two groups: not-fortified (n=414) and fortified (n=539); we conducted logistic and linear regression analysis, with a 5% significance level. RESULTS: there were no differences between the not-fortified and fortified groups with regard to the prevalence of anemia (22.2% and 27.8%, respectively; p=0.051) and hemoglobin level (mean=11.7g/dL; p=0.058); higher anemia prevalence and lower mean hemoglobin levels were associated with a higher number of previous pregnancies, greater gestational age and lower weight in early pregnancy. CONCLUSIONS: the study shows no significant effect of mandatory flour fortification with iron, but it highlights an important prevalence of anemia and associated factors that must be considered in the evaluation of anemia in pregnancy.

OBJETIVO: evaluar la prevalencia de anemia y niveles de hemoglobina en mujeres embarazadas antes y después de la fortificación obligatoria de la harina con hierro y los factores asociados. MÉTODOS: se compararon dos muestras transversales independientes de mujeres embarazadas de Cuiabá-MT, Brasil (2003-2006), divididos en dos grupos: no-fortificado (n=414) y fortificado (n=539); realizamos análisis de regresión logística y lineal, con nivel de significación de 5%. RESULTADOS: no hubo diferencia, entre los grupos, en la prevalencia de anemia (22,2% y 27,8%, respectivamente; p=0,051) o en la concentración de hemoglobina (media en ambos=11,7g/dL; p=0,058); mayor prevalencia de anemia y menor concentración de hemoglobina se asociaron con mayor número de embarazos previos, mayor edad y bajo peso al inicio del embarazo. CONCLUSIONES: no encontramos un efecto significativo de la fortificación obligatoria de harinas, sin embargo mostramos una alta prevalencia de anemia y variables importantes que deben ser consideradas en la evaluación de anemia en el embarazo.

Acupuntura em adolescentes com fibromialgia juvenil / Acupuncture in adolescents with juvenile fibromyalgia / Acupuntura en adolescentes con fibromialgia juvenil

Descrever a utilização da acupuntura em adolescentes com fibromialgia juvenil. MÉTODOS: Estudo retrospectivo realizado em pacientes com fibromialgia juvenil (critérios do Colégio Americano de Reumatologia) submetidos a, pelo menos, 11 sessões semanais de acupuntura. As avaliações antes e após acupuntura incluíram dados demográficos, características da dor musculoesquelética, número de pontos dolorosos (NPD), escala visual analógica (EVA) de dor, algiometria e índice miálgico (IM). Durante o estudo, os pacientes puderam usar analgésicos, amitriptilina e foram orientados a praticar atividade física aeróbica. Os resultados antes e após acupuntura foram comparados pelo teste não paramétrico de Wilcoxon. RESULTADOS: Dos 38 pacientes com fibromialgia juvenil acompanhados em oito anos consecutivos, 13 tinham todas as informações nos prontuários e nas fichas de acupuntura e foram avaliados. Destes 13, sete obtiveram melhora nos três parâmetros analisados (número de pontos dolorosos, EVA de dor e IM). As medianas do número de pontos dolorosos e da EVA de dor foram significativamente maiores antes do tratamento quando comparados ao final do tratamento com as sessões de acupuntura [14 (11-18) versus 10 (0-15), p=0,005; 6 (2-10) versus 3 (0-10), p=0,045; respectivamente]. Em contraste, a mediana do IM foi significativamente menor antes do tratamento [3,4 (2,49-4,39) versus 4,2 (2,71-5,99), p=0,02]. Nenhum dos pacientes com fibromialgia juvenil apresentou eventos adversos associados à acupuntura. CONCLUSÕES: Acupuntura é uma modalidade de Medicina Tradicional Chinesa que pode ser utilizada nos pacientes pediátricos com fibromialgia. Futuros estudos controlados serão necessários.

To describe the use of acupuncture in the treatment of adolescents with juvenile fibromyalgia. METHODS: Retrospective study of patients with juvenile fibromyalgia (American College of Rheumatology criteria) submitted at least to 11 weekly sections of acupuncture. The evaluations before and after acupuncture included: demographic data, musculoskeletal pain findings, pain visual analog scale (VAS), algometry, and myalgic index (MI). These patients could be treated with analgesics, amitriptyline and aerobic physical activity. The results before and after acupuncture were compared by non-parametric Wilcoxon test. RESULTS: 38 patients had juvenile fibromyalgia in eight consecutive years, 13 had all information in their medical and acupuncture records. Seven of the 13 patients improved in three parameters (number of tender points, pain VAS and MI). The median number of tender points and VAS was significantly higher before than after treatment with acupuncture sections [14 (11-18) vs. 10 (0-15), p=0.005; 6 (2-10) vs. 3 (0-10), p=0.045; respectively]. In contrast, the median MI was significantly lower before treatment [3.4 (2.49-4.39) vs. 4.2 (2.71-5.99), p=0.02]. None of the patients with juvenile fibromyalgia had adverse events associated with acupuncture. CONCLUSIONS: Acupuncture is a traditional chinese medicine modality that can be used in pediatric patients with fibromyalgia. Future controlled studies are necessary.

Describir el uso de acupuntura en adolescentes con fibromialgia juvenil. MÉTODOS: Estudio retrospectivo realizado en pacientes con fibromialgia juvenil (criterios del Colegio Americano de Reumatología) sometidos a al menos 11 sesiones semanales de acupuntura. Las evaluaciones antes y después de la acupuntura incluyeron datos demográficos, características del dolor musculoesquelético, número de puntos dolorosos (NPD), escala visual analógica (EVA) de dolor, algiometría e índice de mialgia (IM). Durante el estudio, los pacientes pudieron usar analgésicos, amitriptilina, y fueron orientados a practicar actividad física aeróbica. Los resultados antes y después de la acupuntura fueron comparados por la prueba no paramétrica de Wilcoxon. RESULTADOS: De los 38 pacientes con fibromialgia juvenil acompañados en ocho años consecutivos, 13 tenían todas las informaciones en los prontuarios y en las fichas de acupuntura y fueron evaluados. De estos 13, siete obtuvieron mejora en los tres parámetros analizados (número de puntos dolorosos, EVA de dolor e IM). Las medianas del número de puntos dolorosos y del EVA de dolor fueron significativamente mayores antes del tratamiento cuando comparados al final del tratamiento con las sesiones de acupuntura [14 (11-18) vs. 10 (0-15), p=0,005; 6 (2-10) vs. 3 (0-10), p=0,045; respectivamente]. Por otra parte, la mediana del IM fue significativamente menor antes del tratamiento [3,4 (2,49-4,39) vs. 4,2 (2,71-5,99), p=0,02]. Ninguno de los pacientes con fibromialgia juvenil presentó eventos adversos asociados a la acupuntura. CONCLUSIONES: Acupuntura es una modalidad de la Medicina Tradicional China que puede ser utilizada en los pacientes pediátricos con fibromialgia. Futuros estudios controlados serán necesarios.

Effects of vitamin E supplementation on renal non-enzymatic antioxidants in young rats submitted to exhaustive exercise stress.

BACKGROUND: Exercise stress was shown to increase oxidative stress in rats. It lacks reports of increased protection afforded by dietary antioxidant supplements against ROS production during exercise stress. We evaluated the effects of vitamin E supplementation on renal non-enzymatic antioxidants in young rats submitted to exhaustive exercise stress. METHODS: Wistar rats were divided into three groups: 1) control group; 2) exercise stress group and; 3) exercise stress + Vitamin E group. Rats from the group 3 were treated with gavage administration of 1 mL of Vitamin E (5 mg/kg) for seven consecutive days. Animals from groups 2 and 3 were submitted to a bout of swimming exhaustive exercise stress. Kidney samples were analyzed for Thiobarbituric Acid Reactive Substances to (TBARS) by malondialdehyde (MDA), reduced glutathione (GSH) and vitamin-E levels. RESULTS: The group treated with vitamin E and submitted to exercise stress presented the lowest levels of renal MDA (1: 0.16+0.02 mmmol/mgprot vs. 2: 0.34+0.07 mmmol/mgprot vs. 3: 0.1+0.01 mmmol/mgprot; p < 0.0001), the highest levels of renal GSH (1: 23+4 µmol/gprot vs. 2: 23+2 µmol/gprot vs. 3: 58+9 µmol/gprot; p < 0.0001) and the highest levels of renal vitamin E (1: 24+6 µM/gtissue vs. 2: 28+2 µM/gtissue vs. 3: 43+4 µM/gtissue; p < 0.001). CONCLUSION: Vitamin E supplementation improved non-enzymatic antioxidant activity in young rats submitted to exhaustive exercise stress.

Nutrition therapy in a pediatric intensive care unit: indications, monitoring, and complications.

BACKGROUND: Nutrition therapy (NT) is essential for the care of critically ill children. Inadequate feeding leads to malnutrition and may increase the patient's risk of morbidity and mortality. The aim of this study was to describe the NT used in a tertiary pediatric intensive care unit (PICU). METHODS: The authors evaluated NT administered to 90 consecutive patients who were hospitalized for 7 days in the PICU of Instituto da Criança, Hospital das Clínicas, Universidade de São Paulo, Brazil. NT was established according to the protocol provided by the institution's NT team. NT provided a balance of fluids and nutrients and was monitored with a weekly anthropometric nutrition assessment and an evaluation of complications. RESULTS: NT was initiated, on average, within 72 hours of hospitalization. Most children (80%) received enteral nutrition (EN) therapy; of these, 35% were fed orally and the rest via nasogastric or postpyloric tube. There were gastrointestinal complications in patients (5%) who needed a postpyloric tube. Parenteral nutrition (PN) was used in only 10% of the cases, and the remaining 10% received mixed NT (EN + PN). The average calorie and protein intake was 82 kcal/kg and 2.7 g/kg per day. Arm circumference and triceps skinfold thickness decreased. CONCLUSIONS: The use of EN was prevalent in the tertiary PICU, and few clinical complications occurred. There was no statistically significant change in most anthropometric indicators evaluated during hospitalization, which suggests that NT probably helped patients maintain their nutrition status.

Deficiência de ferro e desenvolvimento cognitivo / Iron deficiency and cognitive development

É aceito que a deficiência de ferro acarreta conseqüências deletérias para o desenvolvimento cognitivo, no entanto, é difícil quantificar esse papel uma vez que ele é determinado conjuntamente com fatores sócio-econômico-ambientais. Mesmo assim, o controle da anemia diminui uma fração do risco do subdesenvolvimento cognitivo e isso significa um avanço positivo na qualidade de vida. Tendo em mente a ampliação do conceito de saúde para o de preservação da vida com qualidade, as ações dirigidas à atenção à saúde devem ser incorporadas às ações governamentais programáticas mais abrangentes e intersetoriais. Este trabalho tem como objetivo fazer uma reflexão sobre o papel da escola no desenvolvimento global da criança destacando o atendimento das necessidades nutricionais de ferro tendo em vista evitar que a deficiência marcial seja um limitante para a capacitação social do indivíduo

Growth of very low birth weight infants fed with milk from a human milk bank selected according to the caloric and protein value.

OBJECTIVE: To describe growth and clinical evolution of very low birth weight infants fed during hospital stay with milk from a human milk bank according to the caloric-protein value. METHOD: Forty very low birth weight infants were included: 10 were fed milk from their own mothers (GI), and 30 were fed human milk bank > 700 cal/L and 2 g/dL of protein. Growth curves were adjusted using nonlinear regression to the measured growth parameters. RESULTS: full enteral diet was reached in 6.3 days by GI and in 10.8 by GII; a weight of 2 kg was reached in 7.3 weeks for GI and in 7.8 for GII. In GI, 3/10 (33.3%) and in GII, 7/30 (23.3%) developed sepsis. Necrotizing enterocolitis did not occur in GI, but in 3/30 (10.0%) in GII. GI presented with urinary calcium > 4 mg/L in 1/10 (10.0%), urinary phosphorus (Pu) <1 mg/L in 10/10 (100%), and Ca/Cr >0.6 ratio in 1/10 (10.0%) of the cases; in GII, no children presented alterations of the urinary calcium or the Ca and Cr ratio, and Pu was <1 mg/L in 19/30 (63.3%). In terms of growth the 50th percentile for GI was a weight gain of 12.1 g/day (GI) vs. 15.8 g/day (GII), a length gain of 0.75 cm/week (GI) vs. 1.02 cm/week (GII), and a head circumference gain of 0.74 cm/week (GI) vs. 0.76 cm/week (GII). CONCLUSIONS: Human milk bank allowed a satisfactory growth and good clinical evolution for very low birth weight infants.

Concentração de micronutrientes em mães e seus recém-nascidos por ocasião do parto / Mother's and newborn's plasmatic concentration of micronutrients at the moment of childbirth

Trata-se de estudo transversal com uma amostra sequencial de conveniência de 73 gestantes, não fumantes, sem intercorrências durante a gravidez e seus recém-nascidos normais, objetivando comparar concentrações plasmáticas de retinol, β caroteno, licopeno, α tocoferol e cobre entre mães e recém-nascidos. Colheu-se sangue da parturiente e do cordão umbilical (após dequitação) para dosagem dos micronutrientes. Retinol, β caroteno, licopeno e α tocoferol foram dosados por HPLC e o cobre por espectrofotometria de absorção atômica. Para análise foram separados 2 grupos:- grupo 1, 38 gestantes com suplementação vitaminico-mineral pelo menos no último trimestre da gravidez e grupo 2, 35 gestantes que não haviam recebido suplementação. As comparações estatísticas foram pelo teste t de Student ou pelo teste de Wilcoxon, com um α crítico de 0,05. Os dois grupos de mães eram símiles quanto a idade, paridade, IMC e a baixa ingestão de calorias e de micronutrientes. Os grupos de recém-nascidos não evidenciaram diferença quanto a sexo, peso, comprimento e perímetro cefálico. As concentrações plasmáticas maternas do grupo 1 foram maiores para o retinol(p = 0,0034) e a tocoferol(p = 0,0279). β caroteno, licopeno e cobre não evidenciaram diferenças entre os dois grupos de mães. Nos dois grupos de recém-nascidos as concentrações de retinol, tocoferol e cobre foram semelhantes e praticamente não houve concentrações detectáveis de licopeno e α caroteno. Em ambos os grupos retinol, a tocoferol e cobre apresentaram maiores concentrações nas mães do que nos recém-nascidos, p = 0,0003, p = 0,0001, p = 0,0001, respectivamente. Conclui-se que as concentrações nos recém-nascidos foram sempre menores do que as maternas, independentemente da ingestão e da suplementação durante a gravidez.(AU)

Cross sectional study of a sequential convenience sample of 73 non smokers' pregnant women with uncomplicated pregnancies and their normal newborns. The aim of the study was to compare plasmatic concentrations of retinol, β-carotene, licopen and α-tocopherol between mothers and their infants. Blood was obtained from parturient and umbilical cord for micronutrient analysis. HPLC was used for retinol, α-carotene, licopen and α-tocopherol analysis. Atomic absorption spectrophotometry was used for copper measurements. The sample was divided into 2 groups: group 1, with 38 women that had received vitamin and mineral supplementation during the last gestational trimester and group 2, with 35 women who have had no supplementation. Statistic comparison used Student t test or Wilcoxon test (alpha = 0.05). The groups of mothers were similar regarding age, parity, BMI and ingestion (low) of calories and micronutrients. The newborn groups had no differences according to sex, head circumference, weight and length. Plasmatic concentrations in group 1 of mothers were greater for retinol (p = 0.0034) and α-tocopherol (p = 0.0279). β-carotene, licopen and cupper showed no differences between the groups at mothers. In both newborn groups concentration of retinol, α-tocopherol and copper were quite similar and there was no clearly detectable licopen and ² carotene. In both, retinol, α-tocopherol and cupper showed larger concentration in mothers than in newborns (respectively p = 0.0003 and p = 0.0001). The conclusion is that newborn concentrations were systematically smaller than their mothers', independently of ingestion or supple-mentation during pregnancy.(AU)

Growth of very low birth weight infants fed with milk from a human milk bank selected according to the caloric and protein value

OBJECTIVE: To describe growth and clinical evolution of very low birth weight infants fed during hospital stay with milk from a human milk bank according to the caloric-protein value. METHOD: Forty very low birth weight infants were included: 10 were fed milk from their own mothers (GI), and 30 were fed human milk bank > 700 cal/L and 2 g/dL of protein. Growth curves were adjusted using nonlinear regression to the measured growth parameters. RESULTS: full enteral diet was reached in 6.3 days by GI and in 10.8 by GII; a weight of 2 kg was reached in 7.3 weeks for GI and in 7.8 for GII. In GI, 3/10 (33.3 percent) and in GII, 7/30 (23.3 percent) developed sepsis. Necrotizing enterocolitis did not occur in GI, but in 3/30 (10.0 percent) in GII. GI presented with urinary calcium > 4 mg/L in 1/10 (10.0 percent), urinary phosphorus (Pu) <1 mg/L in 10/10 (100 percent), and Ca/Cr >0.6 ratio in 1/10 (10.0 percent) of the cases; in GII, no children presented alterations of the urinary calcium or the Ca and Cr ratio, and Pu was <1 mg/L in 19/30 (63.3 percent). In terms of growth the 50th percentile for GI was a weight gain of 12.1 g/day (GI) vs. 15.8 g/day (GII), a length gain of 0.75 cm/week (GI) vs. 1.02 cm/week (GII), and a head circumference gain of 0.74 cm/week (GI) vs. 0.76 cm/week (GII). CONCLUSIONS: Human milk bank allowed a satisfactory growth and good clinical evolution for very low birth weight infants.