Association of serum and erythrocyte zinc levels with breastfeeding and complementary feeding in preterm and term infants.

Zinc is an important nutrient involved in cell division, physical growth, and immune system function. Most studies evaluating the nutritional status related to zinc and prematurity were conducted with hospitalized preterm infants. These studies show controversial results regarding the prevalence of deficiency, clinical implications, and the effect of zinc supplementation on mortality, infectious diseases, and growth in these groups. This study aimed to compare serum and erythrocyte zinc levels in a group of preterm and full-term infants after 9 months of age, and related the zinc levels to dietary intake and anthropometric indicators in both groups. This cross-sectional study compared 43 preterm infants (24 to 33 weeks) aged 9-24 months to 47 full-term healthy infants. Outcome measures: anthropometric indicators and dietary intake. Blood sample for serum and erythrocyte zinc levels (ICP-MS, Inductively Coupled Plasma Mass Spectrometry). There was no difference between the groups regarding the mean of serum and erythrocyte zinc. Variables associated with higher serum zinc levels were breastfeeding at evaluation (ß = 20.11 µg/dL, 95% CI 9.62-30.60, p < 0.001) and the later introduction of solid foods (ß = 6.6 µg/dL, 95% CI 5.3-11.4, p < 0.001). Breastfeeding was also associated with higher erythrocyte zinc levels. The zinc levels were adequate in both groups, there was no association with anthropometric indicators or dietary intake and were slightly influenced by breastfeeding and time of solid food introduction.

Iron deficiency anemia in infants in Sousa (PB), Brazil: an association with nutritional status.

OBJECTIVE: The aim of this study was to describe the prevalence of anemia and iron deficiency anemia (IDA) in infants and verify the association of iron deficiency with nutritional status. METHODS: This cross-sectional and observational study included 104 infants aged between 7 and 9 months, assisted from August to September 2021 by the Family Health Strategy program in Sousa municipality (Paraíba, Brazil). Clinical and anthropometric data were collected, and a 24-h food recall questionnaire was applied using the DietPro software (version 5.0) in order to verify food consumption and assess iron intake. Variables associated with iron deficiency (p<0.05) were analyzed using multiple logistic regression. RESULTS: Anemia and IDA were observed in 40.4% and 19.2% of infants, respectively. Only one infant was taking prophylactic supplementation (ferrous sulfate). Infants with IDA presented reduced hemoglobin (p<0.001) and ferritin (p<0.001) and increased Z-scores of body mass index-for-age (Z-BMI) (p=0.027), weight-for-height (p=0.007), and weight-for-age (p=0.032). All Z-scores were inversely correlated with ferritin (Z-BMI [rho: -0.37; p<0.001], weight-for-height [rho: -0.37; p<0.001], and weight-for-age [rho: -0.29; p=0.002]). Ferritin was also directly correlated with daily iron intake (rho: 0.22; p=0.018). Finally, multiple logistic regression showed a significant and direct association of iron deficiency with weight-for-height Z-score (odds ratio: 2.86; 95% confidence interval: 1.38-5.64; p=0.004). CONCLUSION: About 60% of infants presented anemia or IDA. Iron deficiency was associated with the weight-for-height Z-score, showing the vulnerability of infants during the introduction of complementary feeding.

Iron deficiency anemia in infants in Sousa (PB), Brazil: an association with nutritional status

SUMMARY OBJECTIVE The aim of this study was to describe the prevalence of anemia and iron deficiency anemia (IDA) in infants and verify the association of iron deficiency with nutritional status. METHODS This cross-sectional and observational study included 104 infants aged between 7 and 9 months, assisted from August to September 2021 by the Family Health Strategy program in Sousa municipality (Paraíba, Brazil). Clinical and anthropometric data were collected, and a 24-h food recall questionnaire was applied using the DietPro software (version 5.0) in order to verify food consumption and assess iron intake. Variables associated with iron deficiency (p<0.05) were analyzed using multiple logistic regression. RESULTS Anemia and IDA were observed in 40.4% and 19.2% of infants, respectively. Only one infant was taking prophylactic supplementation (ferrous sulfate). Infants with IDA presented reduced hemoglobin (p<0.001) and ferritin (p<0.001) and increased Z-scores of body mass index-for-age (Z-BMI) (p=0.027), weight-for-height (p=0.007), and weight-for-age (p=0.032). All Z-scores were inversely correlated with ferritin (Z-BMI [rho: -0.37; p<0.001], weight-for-height [rho: -0.37; p<0.001], and weight-for-age [rho: -0.29; p=0.002]). Ferritin was also directly correlated with daily iron intake (rho: 0.22; p=0.018). Finally, multiple logistic regression showed a significant and direct association of iron deficiency with weight-for-height Z-score (odds ratio: 2.86; 95% confidence interval: 1.38-5.64; p=0.004). CONCLUSION About 60% of infants presented anemia or IDA. Iron deficiency was associated with the weight-for-height Z-score, showing the vulnerability of infants during the introduction of complementary feeding.

Selenium-related nutritional status in patients with common variable immunodeficiency: association with oxidative stress and atherosclerosis risk.

BACKGROUND: Common variable immunodeficiency (CVID) is an inborn errors of immunity, that leads to recurrent chronic infections and autoimmune/ inflammatory diseases and neoplasms. It is considered that these condition is related to persistent this immune-inflammatory stimulation and increased oxidative stress. A positive impact on the survival of patients with an inborn error of immunity was observed with advanced clinical care protocols, thus raising concerns about the risk of developing other associated chronic diseases, such as atherosclerosis. Studies suggest that selenium (Se) is a protective trace element against damage caused by oxidative stress. Thus, it is postulated that adequate consumption reduces the risk of some chronic diseases. RESULTS: Se median levels (ug/L) [45.6 (37.3-56.2) vs. 57.8 (46.0-66.0); p = 0.004] and GPX activity (U/L) [7682 (6548-8446) vs. 9284(8440-10,720); p = 0,002) were significantly lower in patients compared to controls. Inadequacy of Se levels was observed in 50% of the patients. There was a higher percentage of high values of C-reactive protein in the group of CVID patients compared to controls [8 (36.4%) vs. 2 (11.1%); p = 0.082]. Higher concentrations of oxidized LDL (45.3 mg/dL vs. 33.3 mg/dL; p = 0.016) and lower concentrations of Apo A-1 (98.5 mg/dL) vs. 117.0 mg/dL; p = 0.008) were observed in the CVID group compared to the control. There was a significant and positive correlation between Se plasma levels and apolipoprotein A-1 concentrations in CVID group (rho = 0.577; p = 0.001). Se values less than 46 µg / L (OR = 3.590; 95% CI 1.103 to 11.687; p = 0.034) and GPX activity below the 4th quartile (OR = 21.703; 95% CI 2.534 to 185.914; p = 0.005) were independently associated, after adjustment for age, overweight and dyslipidemia, with the CVID group (Table 5). CONCLUSION: This study showed an higher percentage of high us-CRP, lower values of plasma Se and GPX activity, higher concentrations of LDLox and lower levels of Apo A-1 in CVID patients in comparison to controls, suggesting oxidative stress and cardiovascular risk.These data point to the importance of assessing the Se status and cardiovascular risk in these patients.

Selenium levels and glutathione peroxidase activity in patients with ataxia-telangiectasia: association with oxidative stress and lipid status biomarkers.

INTRODUCTION: Ataxia-Telangiectasia (A-T) is a multi-system disorder that may be associated with endocrine changes, oxidative stress in addition to inflammation. Studies suggest that selenium is a trace element related to protection against damage caused by oxidative stress. OBJECTIVE: To describe the plasma levels of selenium and erythrocyte glutathione peroxidase activity in A-T patients and to relate them to oxidative stress and lipid status biomarkers. METHODS: This is a cross-sectional and controlled study evaluating 22 A-T patients (age median, 12.2 years old) matched by gender and age with 18 healthy controls. We evaluated: nutritional status, food intake, plasma selenium levels, erythrocyte glutathione peroxidase activity, lipid status, inflammation and oxidative stress biomarkers. RESULTS: Adequate levels of selenium were observed in 24/36 (66.7%) in this evaluated population. There was no statistically significant difference between the groups in selenium levels [47.6 µg/L (43.2-57.0) vs 54.6 (45.2-62.6) µg/dL, p = 0.242]. Nine of A-T patients (41%) had selenium levels below the reference value. The A-T group presented higher levels of LDL-c, non-HDL-c, oxidized LDL, Apo B, Apo-B/Apo-A-I1, LDL-c/HDL-c ratio, malondialdehyde [3.8 µg/L vs 2.8 µg/L, p = 0.029] and lower Apo-A-I1/HDL-c and glutathione peroxidase activity [7300 U/L vs 8686 U/L, p = 0.005]. Selenium levels were influenced, in both groups, independently, by the concentrations of oxidized LDL, malonaldehyde and non-HDL-c. The oxidized LDL (AUC = 0.849) and ALT (AUC = 0.854) were the variables that showed the greatest discriminatory power between groups. CONCLUSION: In conclusion, we observed the presence of selenium below the reference value in nearly 40% and low GPx activity in A-T patients. There was a significant, inverse and independent association between selenium concentrations and oxidative stress biomarkers. Those data reinforce the importance of assessing the nutritional status of selenium in those patients.

Terapia nutricional de paciente com ataxia-telangiectasia: relato de caso / Nutrition therapy of a patient with ataxia-telangiectasia: case report

Neste artigo relatamos a terapia nutricional de um paciente com ataxia-telangiectasia (A-T) utilizando a gastrostomia (GTM) como via alternativa para alimentação. Paciente do sexo masculino, 13 anos de idade, com diagnóstico clínico de A-T aos 6 anos. Aos 8 anos e 7 meses o paciente foi identificado com risco nutricional (ZIMC/I: -1,67). Após 1 ano, evoluiu de forma desfavorável (ZIMC/I: -2,51) apesar da intervenção nutricional, sendo indicada a GTM aos 9 anos e 11 meses. No entanto, em decorrência da dificuldade de aceitação dos pais, o procedimento foi realizado somente quando o adolescente completou 11 anos e 7 meses. Inicialmente foi prescrita para oferta pela GTM dieta enteral normocalórica e normoproteica, correspondendo a 45,8% da necessidade energética diária. Após um mês, com estabilidade metabólica, houve a transição para uma dieta enteral hipercalórica e hiperproteica, fornecendo 91,6% da necessidade energética diária. Após 6 meses com a GTM, verificou-se ganho de peso total de 3,3 Kg (ZIMC/I -2,97), após 1 ano de 4,7 Kg (ZIMC/I -2,59), e após 1 ano e 9 meses de 6,7 Kg (ZIMC/I -2,63). Apesar da desnutrição nos pacientes com A-T ter origem multifatorial, o uso da GTM como via alternativa para alimentação por esse paciente resultou em uma evolução favorável dos seus indicadores antropométricos, sendo relatadas poucas intercorrências com a sua utilização. Portanto, sugere-se que pacientes com A-T devam ser monitorados periodicamente por equipe multiprofissional visando à identificação precoce de potenciais agravos.

In this article we report the nutritional therapy of a patient with ataxia-telangiectasia (A-T) using percutaneous endoscopic gastrostomy (PEG) as an alternative way of feeding. The patient was a 13-year-old male diagnosed with A-T at the age of 6 years. At 8 years and 7 months, the patient was at nutritional risk (body mass index z-score [BMIZ]: -1.67). After 1 year, he had an unfavorable evolution (BMIZ: -2.51), despite nutritional intervention; then, a PEG was indicated when he was 9 years and 11 months. However, due to the difficulty of parental acceptance, the procedure was performed when the adolescent was 11 years and 7 months. At first, a standard energy and protein enteral formula was prescribed, reaching 45.8% of his daily energy requirement. After 1 month, with metabolic stability, there was a transition to a high-energy and protein enteral formula providing 91.6% of his daily energy requirement. After 6 months of PEG placement, the patient had a total body weight gain of 3.3 kg (BMIZ: -2.97); subsequently, body weight increased by 4.7 kg (BMIZ: -2.59) after 1 year, and by 6.7 kg (BMIZ: -2.63) after 1 year and 9 months. Despite the multifactorial origin of malnutrition in A-T patients, PEG placement as an alternative way of feeding for this patient resulted in favorable evolution of his anthropometric indicators, and only a few complications were reported with its use. Therefore, it is suggested that patients with A-T should be monitored periodically by a multidisciplinary team for early identification of potential damages.

Vitamin D plasma concentrations in pregnant women and their preterm newborns.

BACKGROUND: Vitamin D deficiency is a global public health issue. More than half of pregnant women are affected by vitamin D insufficiency/deficiency. Studies suggest an association between low vitamin D concentrations during pregnancy with intrauterine growth restriction and prematurity. This study aimed to describe the concentrations of 25(OH)D (25-hydroxyvitamin D) of mothers who delivered preterm newborns compared to women with full-term pregnancy deliveries, as well as to relate 25(OH)D blood concentrations of mothers with those of their newborns. METHOD: This cross-sectional study was conducted with 66 mothers who had given birth to preterm babies and their preterm newborns (PTNB, < 32 weeks), and 92 women who had given birth at the full-term of their pregnancy and their newborns (FTNB). Data were collected on the characteristics of mothers (gestational age, diseases, and habits) and newborns (anthropometry and adequacy for gestational age). Ten milliliters of blood were drawn from the mothers and the umbilical cord of newborns at birth to identify the 25(OH)D, parathyroid hormone, calcium, phosphorus, and alkaline phosphatase concentrations. RESULTS: Mothers in the PTNB group had significantly lower mean 25(OH)D blood levels (21.7 ± 10.8 ng/mL vs. 26.2 ± 9.8 ng/mL; p = 0.011) and were three times more likely to have insufficiency when compared to mothers in the FTNB group (OR = 2.993; 95%CI 1.02-8.74). Newborns in the PTNB group also had lower 25(OH)D concentrations compared to FTNB group (25.9 ± 13.9 ng/dL vs. 31.9 ± 12.3 ng/dL; p = 0.009). There was a directly proportional correlation between mother and newborn umbilical cord 25(OH)D concentrations in PTNB (r = 0.596; p <  0.001) and FTNB (r = 0.765; p <  0.001). CONCLUSION: Mothers who delivered preterm babies and their preterm newborns had lower 25(OH)D concentrations compared to women who had given birth at the full-term of their pregnancy. In both groups, 25(OH)D concentrations of the mothers correlated directly with those of the newborns, and this correlation was higher in the full-term birth group. Nevertheless, the recommended universal vitamin D supplementation in pregnant women to curb the risk of preterm birth is still incipient. More studies are required to clarify the particularities of vitamin D metabolism further and define the adequate 25(OH)D concentrations throughout pregnancy.

Vitamin D Postpartum Concentrations: Relationship with Nutritional Condition and Morbidities during Pregnancy.

OBJECTIVE: To evaluate postpartum vitamin D deficiency/insufficiency and to relate it to pregestational BMI, gestational weight gain, and sociodemographic variables. METHODS: This is a cross-sectional study with 225 full-term pregnant women. Data collected are as follows: maternal health, socioeconomic status, pregestational body mass index (BMI), and gestational weight gain. Laboratory evaluation included vitamin D [25(OH)D], calcium, phosphorus, magnesium, and alkaline phosphatase. RESULTS: The mean age of women was 25.6±6.6 years. Dark skin color, low education, and work in the urban region were predominant. Regular sun exposure, photoprotection, and vitamin D supplementation were reported by 144 (64.0%), 44 (19.6%), and 5 (2.2%) women, respectively. The mean plasma concentrations of 25(OH)D were 26.0±6.8 ng/mL. Levels compatible with deficiency (<20 ng/mL) and insufficiency (20-30 ng/mL) were observed in 43 (19.1%) and 124 (55.1%) women, respectively. The increase of 1 ng/mL in 25(OH)D concentrations was associated with an increase of 0.16 mg/dL (95%CI 0.19 to 2.02; p=0.018) for calcium. There were no associations with 25(OH)D concentrations with pregestational BMI and with gestational weight gain. CONCLUSIONS: The high frequency of postpartum vitamin D deficiency/insufficiency in women with a full-term pregnancy in a region with a large and permanent sun exposure reminds us of the need for intervention policies aimed at preventing vitamin D deficiency during pregnancy.

Is There Association between Vitamin D Concentrations and Body Mass Index Variation in Women Submitted to Y-Roux Surgery?

Objective: To evaluate vitamin D deficiency and body composition of women submitted to bariatric surgery and relate their body mass index variation after surgery to 25(OH)D concentrations. Method: A cross-sectional and controlled study was performed including 49 obese adult volunteer women, submitted to Roux-en-Y gastric bypass (RYGB group). Collected Data: Body mass index (BMI), self-declared ethnicity, economic condition, physical activity level, serum concentrations of 25-hydroxycholecalciferol (25(OH)D; radioimmunoassay), parathormone, and body composition by dual-energy X-ray absorptiometry (Hologic DXA-QDR-1000) were collected. Results: 25(OH)D deficiency was found in 27 (55.1%) and 8 (21.1%) in the RYGB and control groups (p=0.002). Secondary hyperparathyroidism was more frequent in the RYGB group compared to the control group (15 (30.6%) versus 1 (2.6%); p=0.001). There was no relation of the studied variables and body composition with 25(OH)D deficiency. 25(OH)D concentrations were correlated (r=-0.531; p < 0.001) with BMI reduction, regardless of vitamin D supplementation. Conclusion: Women submitted to bariatric surgery (RYGB) around three years ago had higher BMI and vitamin D deficiency, along with hyperparathyroidism, compared to the control group. There was no association between variables related to body composition and 25(OH)D concentrations. On the other hand, vitamin concentrations correlated negatively to BMI variation after undergoing surgery.

Uso de leite processado em altas temperaturas por paciente com alergia ao leite de vaca - relato de caso / Use of milk processed at high temperatures by a patient with cow's milk allergy: case report

Objetivo: Relatar a evolução clínica de um escolar com alergia ao leite de vaca (ALV) que fez uso de leite de vaca processado em altas temperaturas (LVPAT). Descrição: H.B.M., sexo masculino, 7 anos, com ALV IgE mediada diagnosticada com 1 ano e 3 meses. Aos 2 anos foi submetido a teste de provocação oral (TPO) aberto para leite de vaca (LV) in natura, evoluindo com urticária, congestão nasal e vômito após a primeira dose (1 mL). Mãe relatou alguns episódios de exposição acidental ao LV acompanhados de sintomas. As Imunoglobulinas E para LV e frações mantiveram-se elevadas (IgE leite total: 4,69 KU/L) até os 6 anos, quando a criança realizou TPO com LVPAT, sob a forma de bolo, evoluindo sem intercorrências. Passou a consumir diariamente uma porção do bolo contendo leite processado durante 6 meses. Aos 7 anos e com IgEs específicas mais baixas (IgE específica leite total: 2,2 KU/L), realizou TPO com LV in natura sem sintomas, sendo liberado na dieta. Comentários: O uso do leite de vaca processado em altas temperaturas em pacientes com ALV IgE mediada é uma estratégia promissora com impacto na tolerância futura ao alimento, tendo resultados favoráveis com ênfase na qualidade de vida e inclusão social. No entanto, vale ressaltar a importância da avaliação individualizada dos pacientes e a segurança da equipe na aplicação desses protocolos, além de levar em consideração que a alergia pode ser transitória, mesmo sem o uso do leite processado.

Objective: To report the clinical evolution of a school-age boy with cow's milk allergy CMA) who made use of cow's milk processed at high temperatures (CMPHT). Description: H.B.M., male, 7 years old, was diagnosed with IgE-mediated CMA at 1 year and 3 months of age. At 2 years of age, the patient underwent an open oral food challenge for raw cow's milk (CM) and developed urticaria, nasal congestion and vomiting after the first dose (1 mL). The mother reported some episodes of accidental exposure to CM, accompanied by symptoms. Specific IgEs against CM and its fractions remained elevated (total cow's milk: 4.69 KU/L) until 6 years of age, when the patient underwent a new oral food challenge for CMPHT, in the form of a cake, without symptoms. He then began to consume a portion of cake containing baked milk daily, for 6 months. At the age of 7 and with lower levels of specific IgEs (total cow's milk: 2.2 KU/L), he underwent another oral food challenge for raw CM, without symptoms. An unrestricted diet was then authorized. Comments: The use of cow's milk processed at high temperatures in patients with IgE-mediated cow's milk allergy is a promising strategy, with impact on future food tolerance, favorable results, with emphasis on quality of life and social inclusion. However, an individualized assessment of each patient is extremely important, as is the confidence of the team while applying these protocols. It should be taken into consideration that the allergy may be transient even without the use of processed milk.

Increased plasma selenium is associated with better outcomes in children with systemic inflammation.

OBJECTIVE: The aim of this study was to assess the effects of changes in plasma selenium on the outcome of critically ill children. METHODS: Plasma selenium was prospectively measured in 99 children with acute systemic inflammation. The exposure variables were selenium level on admission and on day 5 of stay in the intensive care unit (ICU) and the difference in selenium concentrations between day 5 post-admission and the ICU admission (delta selenium). Selenium was given only as part of enteral diets. Age, malnutrition, red cell glutathione peroxidase-1 activity, serum C-reactive protein, Pediatric Index of Mortality 2, and Pediatric Logistic Organ Dysfunction scores were analyzed as covariates. The outcome variables were ventilator-free days, ICU-free days, and 28-d mortality. RESULTS: Plasma selenium concentrations increased from admission (median 23.4 µg/L, interquartile range 12.0-30.8) to day 5 (median 25.1 µg/L, interquartile range 16.0-39.0; P = 0.018). After adjustment for confounding factors, a delta selenium increase of 10 µg/L was associated with reductions in ventilator days (1.3 d; 95% confidence interval [CI], 0.2-2.3; P = 0.017) and ICU days (1.4 d; 95% CI, 0.5-2.3; P < 0.01). Delta selenium >0 was associated with decreased 28-d mortality on a univariate model (odds ratio, 0.67; 95% CI, 0.46-0.97; P = 0.036). The mean daily selenium intake (6.82 µg; range 0-48.66 µg) was correlated with the increase in selenium concentrations on day 5. CONCLUSIONS: An increase in plasma selenium is independently associated with shorter times of ventilation and ICU stay in children with systemic inflammation. These findings raise the hypothesis that selenium supplementation could be beneficial in children with critical illnesses.

Complementary feeding of infants in their first year of life: focus on the main pureed baby foods.

OBJECTIVE: To evaluate the complementary feeding practices for infants, focusing on the main pureed baby foods, and verify adherence to the guidelines adopted in Brazil. METHODS: Through cross-sectional study, aspects of complementary feeding of 404 healthy infants between 4 and 9 months of age (São Paulo, Curitiba and Recife) were evaluated. Socio-demographic data, history and food habits were collected. Mothers described three recipes (preparations) usually used in key baby foods. The findings were compared with those recommended by the Brazilian Society of Pediatrics. RESULTS: The average age was 6.9 ± 1.6 months. Among infants, 241/404 (59.6%) were still breastfeeding. Among those who received another type of milk, 193/368 (52.4%) received whole cow's milk, while 151/368 (41.0%) drank infant or follow-on formulas. Regarding baby food recipes salted reported by mothers, it was seen that 30% and 60% contained meat and vegetables, respectively. The percentages less suitable for feeding in general were observed for use of cow's milk and added sugar, chocolate and cereal in feeding bottles; 79% and 80.5% of the families interviewed would adopted such practices. CONCLUSION: The early termination of exclusive/predominant breastfeeding and the practice of an inadequate transition diet have shown a picture of quantitatively and qualitatively inadequate feeding, with the risk of causing serious nutritional problems in later ages, such as anemia and vitamin A deficiency, or excess of nutrients, leading to obesity, diabetes and dyslipidemias.

Low plasma selenium concentrations in critically ill children: the interaction effect between inflammation and selenium deficiency.

INTRODUCTION: Low plasma selenium concentrations are frequent in critically ill patients. However, whether this is due to systemic inflammation, a deficient nutritional state or both is still not clear. We aimed to determine the factors associated with low plasma selenium in critically ill children while considering the inflammatory response and nutritional status. METHOD: A prospective study was conducted in 173 children (median age 34 months) with systemic inflammatory response who had plasma selenium concentrations assessed 48 hours after admission and on the 5th day of ICU stay. The normal reference range was 0.58 µmol/L to 1.6 µmol/L. The outcome variable was 'low plasma selenium', which was defined as plasma selenium values below the distribution median during this period. The main explanatory variables were age, malnutrition, sepsis, C-reactive protein (CRP), and clinical severity scores. The data were analyzed using a Binomial Generalized Estimating Equations model, which includes the correlation between admission and 5th day responses. RESULTS: Malnutrition and CRP were associated with low plasma selenium. The interaction effect between these two variables was significant. When CRP values were less than or equal to 40 mg/L, malnutrition was associated with low plasma selenium levels (odds ratio (OR) = 3.25, 95% confidence interval (CI) 1.39 to 7.63, P = 0.007; OR = 2.98, 95% CI 1.26 to 7.06, P = 0.013; OR = 2.49, 95% CI 1.01 to 6.17, P = 0.049, for CRP = 10, 20 and 40 mg/L, respectively). This effect decreased as CRP concentrations increased and there was loose significance when CRP values were >40 mg/L. Similarly, the effect of CRP on low plasma selenium was significant for well-nourished patients (OR = 1.13; 95% CI 1.06 to 1.22, P <0.001) but not for the malnourished (OR = 1.03; 95% CI 0.99 to 1.08, P = 0.16). CONCLUSIONS: There is a significant interaction between the magnitude of the inflammatory response and malnutrition on low plasma selenium. This interaction should be considered when interpreting plasma concentrations as an index of selenium status in patients with systemic inflammation as well as in the decision on selenium supplementation.

Complementary feeding of infants in their first year of life: focus on the main pureed baby foods / Alimentação complementar de lactentes no primeiro ano de vida: ênfase nas papas principais

Objective: to evaluate the complementary feeding practices for infants, focusing on the main pureed baby foods, and verify adherence to the guidelines adopted in Brazil. Methods: through cross-sectional study, aspects of complementary feeding of 404 healthy infants between 4 and 9 months of age (São Paulo, Curitiba and Recife) were evaluated. Socio-demographic data, history and food habits were collected. Mothers described three recipes (preparations) usually used in key baby foods. The findings were compared with those recommended by the Brazilian Society of Pediatrics. Results: the average age was 6.9±1.6 months. Among infants, 241/404 (59.6%) were still breastfeeding. Among those who received another type of milk, 193/368 (52.4%) received whole cow's milk, while 151/368 (41.0%) drank infant or follow-on formulas. Regarding baby food recipes salted reported by mothers, it was seen that 30% and 60% contained meat and vegetables, respectively. The percentages less suitable for feeding in general were observed for use of cow's milk and added sugar, chocolate and cereal in feeding bottles; 79% and 80.5% of the families interviewed would adopted such practices. Conclusion: the early termination of exclusive/predominant breastfeeding and the practice of an inadequate transition diet have shown a picture of quantitatively and qualitatively inadequate feeding, with the risk of causing serious nutritional problems in later ages, such as anemia and vitamin A deficiency, or excess of nutrients, leading to obesity, diabetes and dyslipidemias. .

Objetivo: avaliar as práticas relacionadas à alimentação complementar de lactentes, com ênfase nas papas principais, e verificar a concordância com as recomendações atualmente adotadas no Brasil. Métodos: por meio de estudo transversal, foram avaliados os aspectos da alimentação complementar de 404 lactentes saudáveis entre 4 e 9 meses de vida (São Paulo, Recife e Curitiba). Coletaram-se dados sociodemográficos de antecedentes e hábitos alimentares. As mães descreveram três receitas (preparações) que costumam utilizar nas papas principais. Os achados foram comparados ao preconizado pela Sociedade Brasileira de Pediatria. Resultados: a média de idade foi de 6,9±1,6 meses. Cerca de 241 lactentes (59,6%) permaneciam em aleitamento materno. Entre os que recebiam outro tipo de leite, 193 dos 368 (52,4%) recebiam leite de vaca integral, e 151 dos 368 (41%), fórmulas infantis ou de seguimento para lactentes. Em relação às receitas de papas salgadas relatadas pelas mães, foi possível observar que 30 e 60% delas continham leguminosas e carnes, respectivamente. Os piores percentuais de adequação na alimentação, em geral, foram observados para uso de leite de vaca e adição de açúcar, achocolatado e cereais em mamadeiras; 79 e 80,5% das famílias entrevistadas adotavam essas práticas. Conclusão: o abandono precoce do aleitamento materno exclusivo/predominante e a prática de uma dieta de transição inadequada têm mostrado um quadro de consumo quantitativa e qualitativamente inapropriado, com riscos de acarretar graves problemas nutricionais nas faixas etárias posteriores, como anemia e hipovitaminose A, ou excessos de nutrientes, como obesidade, diabete e dislipidemias. .

Práticas inadequadas da alimentação complementar em lactentes, residentes em Belém-PA / Inadequate suplementary feeding practices in infants living in Belém-PA

Objetivo: avaliar práticas alimentares de lactentes de quatro meses a um ano de vida, residentes em Belém-PA. Método: Estudo realizado através de questionários com antecedentes alimentares e recordatório alimentar de 24 horas em 320 lactentes de quatro a 12 meses de idade que não estavam em aleitamento materno exclusivo. Para o cálculo do tamanho amostral foi tomado como base o número de crianças com idade entre quatro e 12 meses, atendidas no mesmo período em 2010, prefixado um erro amostral de 5% e um poder estatístico de 80%, sendo estimado número de 320 lactentes. Resultados: verificou-se introdução precoce de suco de fruta, papa de fruta e papa salgada, cujas médias em meses foram respectivamente 5.5, 5.6 e 5.6, e introdução tardia de carnes e ovos. A introdução da alimentação da família foi de 8.0 meses em média. Alimentos consumidos em 24 horas nos lactentes de quatro meses de idade foram: refrigerante 0.6%, café 0.3%, açúcar 11.3% e mingau 3.4% e aos 12 meses notou-se elevado consumo de açúcar 82.5%, refrigerante 11.9%, café 4.1%, mingau 62.2%, achocolatados 22.2%, biscoitos recheados 28.1% e bolachas 29.1%. A média da introdução do leite de vaca foi de 5.0 meses. A média da duração do aleitamento materno não exclusivo em meses foi 7.7. Conclusão: é necessário melhorar os hábitos alimentares da população estudada, pois alimentos complementares de baixo valor nutritivo são introduzidos de forma precoce e alimentos mais ricos em proteínas e micronutrientes mais tardiamente

Objective: evaluate feeding practices of infants from four months to a year old, living in Belém, PA. Method: the study was conducted through questionnaires with a history of food and 24-hour dietary anamneses in 320 infants from four to 12 months-old, who were not exclusively breast fed. Sample size was calculated from the number of children aged between four and 12 months attended in the same period in 2010, a 5% sampling error and statistical power of 80% were prefixed, estimated number was 320 infant. Results: there was an early introduction of fruit juice, fruit paps and other paps, the respectively averages in months were 5.5, 5.6 and 5.6, and late introduction of meat and eggs. The introduction of family food was 8.0 months on average. Food consumed in 24 hours in infants of four months of age were soft drinks (0.6%); coffee (0.3%); sugar (11.3%) and porridge (3.4%); by 12-months-old, a high consumption of sugar was noted (82.5%), followed by soft drinks (11.9%), coffee (4.1%), porridge (62.2%), chocolate (22.2%), sandwich cookies (28.1%) and biscuit (29.1%). The average time of cows? milk introduction was 5.0 months and the non-exclusive breast milk duration was 7.7 months. Conclusion: it is necessary to improve the dietary habits in the studied population since low nutritious value supplementary foods are introduced precociously and richer protein and micronutrients foods later.

[Changes in bone metabolism markers in women after Roux-en-Y gastric bypass]. / Alterações de parâmetros relacionados ao metabolismo ósseo em mulheres submetidas à derivação gástrica em Y de Roux.

OBJECTIVE: To evaluate bone turnover markers and bone mineral density (BMD) in women after Roux-en-Y (RYGB) gastric bypass. SUBJECTS AND METHODS: In a cross-sectional study, 48 women post-RYGB after three years, and 41 healthy women were evaluated. EVALUATIONS: body mass index (BMI); physical activity; food intake; serum levels of calcium, phosphorus, magnesium, alkaline phosphatase, C-terminal telopeptide (CTX), intact parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), osteocalcin, urinary calcium and BMD. RESULTS: Significantly higher levels were observed for osteocalcin (p < 0.001), CTX (p < 0.001), and PTH (p < 0.001) in the RYGB group when compared with the control group; 25OHD deficiency/insufficiency was more frequent in the RYGB group (p = 0.010), even after adjusted for nutritional status, and it was associated with secondary hyperparathyroidism (p = 0.025); there was no difference in BMD between the groups. Energy (p = 0.036) and protein intake (p = 0.004) were lower in the RYGB group. CONCLUSION: Patients submitted to RYGB showed a significantly higher frequency of vitamin D deficiency, secondary hyperparathyroidism, and increase in bone remodeling markers, with no difference in BMD status.

Alterações de parâmetros relacionados ao metabolismo ósseo em mulheres submetidas à derivação gástrica em Y de Roux / Changes in bone metabolism markers in women after Roux-en-Y gastric bypass

OBJETIVO: Avaliar o metabolismo ósseo e a densidade mineral óssea (DMO) em mulheres adultas pós-derivação gástrica em Y de Roux (DGYR). SUJEITOS E MÉTODOS: Estudo transversal com 48 mulheres submetidas a DGYR há três anos e 41 saudáveis. Dados obtidos: índice de massa corporal (IMC), atividade física, consumo alimentar e DMO da coluna lombar, colo e fêmur total. Dosagem de cálcio, fósforo, magnésio, albumina, fosfatase alcalina, telopeptídeo-C (CTX), paratormônio (PTH), 25-hidroxivitamina D (25OHD), osteocalcina e cálcio urinário. RESULTADOS: Maiores alterações no grupo DGYR observadas nos níveis de osteocalcina (p < 0,001), CTX (p < 0,001) e PTH (p < 0,001). Deficiência de 25OHD foi a mais frequente no grupo DGYR (p = 0,010). Deficiência/insuficiência de 25OHD associou-se com hiperparatiroidismo secundário (p = 0,025). Não houve diferença entre os grupos em relação à DMO. A ingestão de energia (p = 0,036) e proteína (p = 0,004) foi maior no grupo controle. CONCLUSÃO: Em mulheres pós-DGYR, encontraram-se alta frequência de deficiência de vitamina D, hiperparatireoidismo secundário e elevação nos marcadores de remodelação óssea, sem alteração na DMO quando comparado com o grupo controle não obeso.

OBJECTIVE: To evaluate bone turnover markers and bone mineral density (BMD) in women after Roux-en-Y (RYGB) gastric bypass. SUBJECTS AND METHODS: In a cross-sectional study, 48 women post-RYGB after three years, and 41 healthy women were evaluated. Evaluations: body mass index (BMI); physical activity; food intake; serum levels of calcium, phosphorus, magnesium, alkaline phosphatase, C-terminal telopeptide (CTX), intact parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), osteocalcin, urinary calcium and BMD. RESULTS: Significantly higher levels were observed for osteocalcin (p < 0.001), CTX (p < 0.001), and PTH (p < 0.001) in the RYGB group when compared with the control group; 25OHD deficiency/insufficiency was more frequent in the RYGB group (p = 0.010), even after adjusted for nutritional status, and it was associated with secondary hyperparathyroidism (p = 0.025); there was no difference in BMD between the groups. Energy (p = 0.036) and protein intake (p = 0.004) were lower in the RYGB group. CONCLUSION: Patients submitted to RYGB showed a significantly higher frequency of vitamin D deficiency, secondary hyperparathyroidism, and increase in bone remodeling markers, with no difference in BMD status.

Nutrient intake of women 3 years after Roux-en-Y Gastric bypass surgery.

BACKGROUND: Nutritional deficiencies, especially micronutrient deficiencies, can occur in obese individuals. Surgical treatment may aggravate or cause these deficiencies, depending on the type of procedure, food intake and the use of multivitamins, minerals or other supplements. The objective of the study was to evaluate the nutrient intake of women who had undergone Roux-en-Y gastric bypass (RYGB) surgery. METHODS: A cross-sectional, controlled study was conducted among 44 women after RYGB (operated-group, OG; mean years post-operation = 3.4) and a control group of 38 healthy women (non-operated group, NOG) matched by age and economic condition. The women reported their dietary intake using a 4-day record. The Dietary Reference Intakes was used as a reference. RESULTS: The macronutrient contributions to dietary energy intake presented an acceptable distribution for proteins and carbohydrates. Lipid intake was high among women in the OG and the NOG (43.2 and 55.3 %, respectively). In the evaluation of micronutrients, a statistically significant difference was observed between the groups for iron, zinc and vitamins B1 and B12. Both groups were at high risk for inadequate calcium intake, and the OG was at risk for inadequate zinc, iron and vitamin B1 intake. CONCLUSIONS: The nutrient intake of women who had undergone RYGB is very similar to that of non-operated women, with the exception of a reduced intake of iron, zinc and vitamins B1 and B12, which may be due to the difficulty of consuming meat and a balanced diet. The findings of this study emphasize the importance of appropriate nutritional intervention and the regular use of multivitamin and mineral supplements for these patients.

Alimentação complementar: práticas inadequadas em lactentes / Complementary feeding: inappropriate practices in infants

OBJETIVO: Avaliar as práticas e o consumo alimentar de lactentes saudáveis de três metrópoles do Brasil. MÉTODOS: Por meio de estudo prospectivo, analisaram-se registros alimentares de 7 dias consecutivos de amostra intencional, por cotas e ponderada, das cidades de Curitiba, São Paulo e Recife, de 179 lactentes saudáveis, entre 4 e 12 meses, que não se encontravam em aleitamento materno (AM) exclusivo. As mães receberam orientação verbal e escrita, por nutricionista, visando a uniformização da anotação do registro alimentar. Para o cálculo de ingestão, utilizou-se o Programa de Apoio à Nutrição (NutWin). RESULTADOS: A mediana de idade dos lactentes foi de 6,8 meses (4,0-12,6 meses). Observou-se que 50,3 por cento já não recebiam AM. Destes, 12,0 e 6,7 por cento dos menores e maiores de 6 meses, respectivamente, utilizavam fórmulas infantis em substituição ao leite materno. A maioria dos lactentes, portanto, recebia leite de vaca integral. A diluição da fórmula infantil foi correta em apenas 23,8 e 34,7 por cento das crianças menores e maiores de 6 meses, respectivamente. Em relação à alimentação complementar, observou-se que a mediana de idade foi de 4 meses para sua introdução e de 5,5 meses para a alimentação da família. Verificou-se elevada inadequação quantitativa na ingestão de micronutrientes para lactentes de 6 a 12 meses que não recebiam AM, destacando-se as de zinco (75 por cento) e ferro (45 por cento). CONCLUSÃO: O presente estudo mostrou elevada frequência de práticas e consumo alimentar inadequados em lactentes muito jovens. É possível que essas práticas levem a aumento no risco de desenvolvimento futuro de doenças crônicas.

OBJECTIVE: To assess feeding practices and dietary intake of healthy infants in three Brazilian municipalities. METHODS: By means of a prospective study, we analyzed the food record of 7 consecutive days of an intentional sample (quota and weighted sampling) of 179 healthy infants, aged between 4 and 12 months, from the municipalities of Curitiba, São Paulo, and Recife, who were not being exclusively breastfed. Mothers received oral and written information provided by a nutritionist with the purpose of standardizing the feeding data. The computer program NutWin was used to calculate the dietary intake. RESULTS: The median of the infants' age was 6.8 months (4.0-12.6 months). We found that 50.3 percent of the infants were no longer being exclusively breastfed. Of these, 12.0 and 6.7 percent among the infants younger and older than 6 months, respectively, were fed with infant formulae instead of breast milk. Therefore, most infants received whole cow's milk. Infant formula dilution was correct in only 23.8 and 34.7 percent of the infants younger and older than 6 months old, respectively. With regards to complementary feeding, we found that the median age was 4 months for its introduction and 5.5 months for the introduction of family diet. There was high quantitative inappropriateness of micronutrient intake for infants between 6 and 12 months old who were not exclusively breastfed, mainly in terms of zinc (75 percent) and iron (45 percent). CONCLUSION: The present study showed a high frequency of inappropriate feeding practices and dietary intake in very young infants. These practices may lead to an increased risk of development of chronic diseases in the future.

Complementary feeding: inappropriate practices in infants.

OBJECTIVE: To assess feeding practices and dietary intake of healthy infants in three Brazilian municipalities. METHODS: By means of a prospective study, we analyzed the food record of 7 consecutive days of an intentional sample (quota and weighted sampling) of 179 healthy infants, aged between 4 and 12 months, from the municipalities of Curitiba, São Paulo, and Recife, Brazil, who were not being exclusively breastfed. Mothers received oral and written information provided by a nutritionist with the purpose of standardizing the feeding data. The computer program NutWin was used to calculate the dietary intake. RESULTS: The median of the infants' age was 6.8 months (4.0-12.6 months). We found that 50.3% of the infants were no longer being exclusively breastfed. Of these, 12.0 and 6.7% among the infants younger and older than 6 months, respectively, were fed with infant formulae instead of breast milk. Therefore, most infants received whole cow's milk. Infant formula dilution was correct in only 23.8 and 34.7% of the infants younger and older than 6 months old, respectively. With regards to complementary feeding, we found that the median age was 4 months for its introduction and 5.5 months for the introduction of family diet. There was high quantitative inappropriateness of micronutrient intake for infants between 6 and 12 months old who were not exclusively breastfed, mainly in terms of zinc (75%) and iron (45%). CONCLUSION: The present study showed a high frequency of inappropriate feeding practices and dietary intake in very young infants. These practices may lead to an increased risk of development of chronic diseases in the future.