Changes in Age at Diagnosis and Nutritional Course of Celiac Disease in the Last Two Decades.

The frequency of celiac disease (CD) has increased along time, with relevant changes reported in geographical variations, clinical presentation and nutritional repercussions. In recent years, some celiac patients are presenting overweight/obesity, but it is unclear how frequent this is and to what extent undernutrition remains a concern. This is relevant because CD tends to be overlooked in overweight patients. With this in mind, we assessed age at diagnosis, clinical characteristics and nutritional status of 155 celiac patients diagnosed between 1994-2017 in four pediatric hospitals in Santiago, Chile. Since 2003, the number of patients diagnosed has increased (p < 0.0033), coinciding with antitransglutaminase and antiendomysial antibodies becoming available to public health systems. In 2000, 4.5% of patients were asymptomatic at diagnosis, suggesting that active search is not routinely applied. Gastrointestinal symptoms plus failure to thrive were significantly more frequent under 2 years (p = 0.0001). Nutritional status has improved at diagnosis and during follow up, but undernutrition remains more frequent in children <2 and <5 years (p < 0.002 and p < 0.0036, respectively). Overweight at diagnosis was reported in 2002 and obesity in 2010. After initiating treatment, since 2010, patients changing from undernourishment to overweight has sometimes been observed after only 6 months on a gluten-free diet.

The global school-based student health survey as a tool to guide adolescent health interventions in rural Guatemala.

BACKGROUND: Adolescents from rural areas in low-middle income countries face increasing physical and mental health challenges that are not well characterized or addressed due to resource limitations. We used the Global School-based Student Health Survey (GSHS) to describe adolescent health behaviors, and to inform prioritization of health promotion efforts in a resource-limited, rural, agricultural region in Guatemala. METHODS: In July 2015, a group of volunteers administered the GSHS to students from seven schools in four communities in the southwest Trifinio region of Guatemala. Prevalence and predictors of nutritional, mental, and sexual health behaviors were calculated from survey responses, and summarized in region- and school-level reports. Facilitated discussion of survey results with local leadership in January 2016 led to the identification of priorities for school-based health interventions. RESULTS: Five hundred fifty-four out of 620 (87%) students aged 12-18 years completed the survey. Prevalence of unhealthy dietary behaviors and body size was high: 61% reported high current soft drink intake, 18% were overweight, and 31% were moderate-severely stunted. In multivariable regression models, being food insecure was marginally associated with being underweight/stunted (OR = 1.95, 95%CI = 0.95-4.0). Boys were more likely than girls to report being sexually active (25% versus 6.4%, p < 0.001). Local school leadership identified food insecurity and sexual education as priority areas for intervention, and made plans for providing breakfast in schools, sexual education curriculum development and teacher training, and continued adolescent health reporting and evaluation. CONCLUSIONS: The GSHS is a rapid, cost-efficient, useful tool for surveillance of adolescent health behaviors in vulnerable, resource-limited populations. Results of a locally-administered GSHS informed school-based interventions to decrease food insecurity, early sexual initiation, and teen pregnancy in a rural Guatemalan region.

Effect of healthy and unhealthy habits on obesity: a multicentric study.

OBJECTIVE: Our aim was to characterize and compare eating patterns of university students in Chile, by sex and body weight, body mass index, and nutritional status. METHODS: This was a cross-sectional study. University students (n = 1454) of Chile were evaluated. A self-assessment survey was used to evaluate healthy eating habits using a questionnaire with values between 1 (do not consume) and 5 (consume) for a total of 9 to 45 points (higher values represent better eating habits). Unhealthy habits were assessed with six questions, including consumption of sugary soft drinks, alcohol, fried foods, fast food, and snacks and adding salt to foods without tasting first. RESULTS: Obese students had a lower consumption of healthy foods (P <0.05) compared with normal weight participants. Underweight male participants had higher unhealthy food consumption (P <0.05) and obese women had the lowest score (P <0.05). Protective factors for being overweight/obese were included (odds ratio [OR] = 0.5; 95% confidence interval [CI] 0.3-0.8), consumption of ≥2 servings of vegetables (OR = 0.5; 95% CI 0.4-0.7). Risk factors included consumption (more than 1 cup a day) of sugary soft drinks (OR = 1.5; 95% CI 1.0-2.1) and male sex (OR = 1.8; 95% CI 1.3-2.4). CONCLUSION: The consumption of vegetables and belonging to an undergraduate program in health sciences at a university contributed to protection against for obesity. On the other hand, male sex and consumption of sugary drinks were found to be risk factors for obesity.

Vitamin D status is associated with underweight and stunting in children aged 6-36 months residing in the Ecuadorian Andes.

OBJECTIVE: There is limited knowledge on vitamin D status of children residing in the Andes and its association with undernutrition. We evaluated the vitamin D status of children residing in a low socio-economic status (SES) setting in the Ecuadorian Andes and assessed the association between vitamin D status, stunting and underweight. We hypothesized that children who were underweight would have lower serum 25-hydroxyvitamin D (25(OH)D) levels and lower 25(OH)D levels would be associated with a higher risk of stunting. DESIGN: We conducted a cross-sectional secondary analysis of a randomized controlled trial, the Vitamin A, Zinc and Pneumonia study. Children had serum 25(OH)D concentrations measured. A sensitivity analysis was undertaken to determine a vitamin D cut-off specific for our endpoints. Associations between serum 25(OH)D and underweight (defined as weight-for-age Z-score≤-1) and stunting (defined as height-for-age Z-score≤-2) were assessed using multivariate logistic regression. SETTING: Children residing in five low-SES peri-urban neighbourhoods near Quito, Ecuador. SUBJECTS: Children (n 516) aged 6-36 months. RESULTS: Mean serum 25(OH)D concentration was 58·0 (sd 17·7) nmol/l. Sensitivity analysis revealed an undernutrition-specific 25(OH)D cut-off of <42·5 nmol/l; 18·6 % of children had serum 25(OH)D<42·5 nmol/l. Children who were underweight were more likely to have serum 25(OH)D<42·5 nmol/l (adjusted OR (aOR)=2·0; 95 % CI 1·2, 3·3). Children with low serum 25(OH)D levels were more likely to be stunted (aOR=2·8; 95 % CI 1·6, 4·7). CONCLUSIONS: Low serum 25(OH)D levels were more common in underweight and stunted Ecuadorian children.

Early pregnancy body mass index modifies the association of pre-pregnancy dietary patterns with serum polyunsaturated fatty acid concentrations throughout pregnancy in Brazilian women.

Dietary patterns (DPs) have been described as an important factor that may influence polyunsaturated fatty acid (PUFA) concentrations and body mass index (BMI) during pregnancy. We aim to evaluate the association between pre-pregnancy DPs and serum PUFA percentages throughout pregnancy considering early pregnancy BMI as a possible effect modifier. A prospective cohort of 154 pregnant women was followed (5th-13th, 20th-26th, and 30th-36th gestational weeks). Serum PUFA concentrations (total n-3 and total n-6, eicosapentaenoic + docosahexaenoic acids) were measured in each trimester and expressed as percentages. The n-6/n-3 ratio was calculated. Longitudinal linear mixed-effects models including interaction terms between DPs and early pregnancy BMI were employed. Serum PUFA percentages declined, whereas the n-6/n-3 ratio, monounsaturated, and saturated percentages increased throughout pregnancy for all BMI categories. Three pre-pregnancy DPs were identified by principal component analysis (common Brazilian, healthy, and processed). Overweight women with higher adherence to the common-Brazilian and to the healthy DPs presented reduced n-3 PUFA percentage and increased n-6 percentages and n-6/n-3 ratio compared to under or normal weight women. Obese women with higher adherence to the processed DP presented a more pronounced decrease of total n-3 percentage compared to under or normal weight women. Early pregnancy BMI modified the effect of pre-pregnancy DPs on PUFA profile throughout gestation. Higher adherence to the healthy pattern was associated with increased n-3 percentage, except for overweight women. Only for processed DP was the behaviour of PUFA the same for all BMI categories, showing a worse evolution profile, that is, increased n-6 and reduced n-3 fractions.

WHO body mass index for age charts overestimate thinness and overweight compared to international and US charts applied to indigenous and non-indigenous Mexican children

Assessments of whether children are thin (low body mass index for age) or overweight are based on body mass index (BMI for age and sex) charts published by the World Health Organization (WHO), the International Obesity Task Force (IOTF), and the US Centers for Disease Control and Prevention (CDC). We aimed to determine whether these charts indicated different prevalence of thinness and overweight (obesity included) in indigenous and non-indigenous school aged children from different regions and ethnic groups in Mexico. A probability proportional to size, cluster sampling method was employed in four regions of the country. We recruited 1,731 children aged 7.0-9.9 (507 indigenous from six ethnic groups and 1,224 non-indigenous). BMI was calculated according to age, and thinness and overweight classifications were compared according to cutoff values in the WHO, IOTF, and CDC references. The WHO reference generated the highest rates for thinness (12.5%) and overweight (30%) in children across regions and ethnic groups. The CDC reference estimated the lowest rates of thinness in children (5.5%), and the IOTF reference estimated the lowest rates of overweight (24.7%). Estimates of both thinness (8.3%) and overweight (13.4%) rates were lower in indigenous than non-indigenous groups (14.3% and 37.5%, respectively). The WHO BMI for age chart estimated higher rates of thinness and overweight in children compared to the CDC and IOTF charts. Because thinness as indicator of undernutrition status is relatively new, differences in body composition among indigenous and non-indigenous children may justify the need for more appropriate screening criteria to compare the growth status(AU)

La clasificación del estado nutricio de los niños con delgadez o con sobrepeso se realiza empleando el índice de masa corporal (IMC para la edad y el sexo) con las tablas de la OMS, IOTF y CDC. El objetivo de esta investigación fue determinar si estas referencias resultan en diferentes prevalencias de delgadez y sobrepeso (obesidad incluida) en niños escolares indígenas y no indígenas de diferentes regiones de México. Se empleó un muestreo por conglomerados en cuatro regiones del país. Se reclutaron 1,731 niños con edades entre 7,0-9,9 (507 indígenas de cinco grupos étnicos y 1,224 no indigenas) durante 2006 y 2008. El IMC se calculó y se clasificó como delgadez y sobrepeso con los puntos de corte sugeridos por las referencias internacionales. Cuando se compararon las clasificaciones, la referencia de OMS generó la prevalencia más alta de delgadez (12,5%) y sobrepeso (30%) en niños de todas las regiones y grupos étnicos. La referencia de los CDC estimó las prevalencias más bajas de delgadez (5,5%) y la referencia IOTF produjo las proporciones más bajas de sobrepeso (24,7%). Las proporciones de delgadez (8,3%) y sobrepeso (13,4%) fueron más bajas en niños indígenas que en los no indígenas (14.3% y 37.5%, respectivamente). La referencia de la OMS del IMC para la edad produjo las prevalencias más altas de delgadez y sobrepeso en comparación con los estándares de CDC y IOTF. Dado que la delgadez como indicador de desnutrición en niños es de uso reciente, las diferencias encontradas entre indígenas y mestizos pueden justificar el contar con mejores herramientas de tamizaje en estudios de crecimiento(AU)

Performance of Patient-Generated Subjective Global Assessment (PG-SGA) in Patients With Advanced Cancer in Palliative Care.

BACKGROUND: The purpose of this study was to evaluate the prognostic significance of the Patient-Generated Subjective Global Assessment (PG-SGA) in patients receiving palliative care for advanced cancer. METHODS: The PG-SGA was used to assess nutrition status of 120 patients admitted to the Palliative Care Unit at the National Cancer Institute in Brazil. RESULTS: According to the PG-SGA, 94.2% (n = 113) of the patients were evaluated as malnourished. The PG-SGA evaluated that xerostomia was the only symptom associated with a short survival (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.2-5.38; P = .014). Survival was found to be significantly higher in well-nourished (PG-SGA A) than malnourished (PG-SGA B [ P = .021] or C [ P = .013]) patients. Total PG-SGA score (hazard ratio [HR], 1.06; 95% CI, 1.001-1.09; P = .045) and Karnofsky Performance Status of 20%-30% (HR, 15.4; 95% CI, 1.63-92.9; P = .001) and 40%-50% (HR, 10.0; 95% CI, 1.22-64.9; P = .031) were found to be independent prognostic survival factors. CONCLUSION: The scored PG-SGA is an independent prognostic factor of survival and thus can be a useful tool for nutrition evaluation in palliative care.

Nutrition status of children in Latin America.

The prevalence of overweight and obesity is rapidly increasing among Latin American children, posing challenges for current healthcare systems and increasing the risk for a wide range of diseases. To understand the factors contributing to childhood obesity in Latin America, this paper reviews the current nutrition status and physical activity situation, the disparities between and within countries and the potential challenges for ensuring adequate nutrition and physical activity. Across the region, children face a dual burden of undernutrition and excess weight. While efforts to address undernutrition have made marked improvements, childhood obesity is on the rise as a result of diets that favour energy-dense, nutrient-poor foods and the adoption of a sedentary lifestyle. Over the last decade, changes in socioeconomic conditions, urbanization, retail foods and public transportation have all contributed to childhood obesity in the region. Additional research and research capacity are needed to address this growing epidemic, particularly with respect to designing, implementing and evaluating the impact of evidence-based obesity prevention interventions.

Association Between Nutrition Status and Survival in Elderly Patients With Colorectal Cancer.

BACKGROUND: Aging patients with cancer have a higher risk of mortality and treatment-associated morbidity than younger patients. Nutrition status may play an important role in cancer mortality. We aimed to evaluate the survival time of elderly patients with colorectal cancer and its association with body mass index (BMI), the patient-generated subjective global assessment (PG-SGA), and phase angle (PA). MATERIALS AND METHODS: BMI, PG-SGA, and PA were determined for all patients (n = 250) at first assessment. RESULTS: Seventy-one (28.4%) patients were in active oncologic treatment (group 1) and 179 (71.6%) were in remission (group 2). At the time of the analysis, 73 (29.2%) patients had died and 177 (70.8%) were censored. The mean (standard deviation) age was 70.9 (7.49) years; 17.2% were undernourished, 56% normal weight, and 26.8% were overweight. According to the PG-SGA, 35.2% of patients needed some nutrition intervention and 4.4% needed it urgently. The mean PA was 4.94 ± 1°. PG-SGA, tumor stage, and PA differed significantly ( P < .001) between the groups; BMI did not ( P = .459). Severe malnutrition (PG-SGA C), compared with PG-SGA A, was associated with a relative hazard of death of 12.04 (95% confidence interval [CI], 3.43-42.19, P < .001). PA >5° was associated with better prognosis: a relative hazard of 0.456 (95% CI, 0.263-0.792; P < .005). CONCLUSION: Among elderly patients with colorectal cancer, PA and PG-SGA were prognosis factors. PA >5° was associated with best survival and PG-SGA C with worst survival.

Children with access to improved sanitation but not improved water are at lower risk of stunting compared to children without access: a cohort study in Ethiopia, India, Peru, and Vietnam.

BACKGROUND: This study's purpose was to understand associations between water, sanitation, and child growth. METHODS: We estimated stunting (height-for-age Z score <-2 SD) and thinness (BMI-Z <-2 SD) risk ratios using data from 7,715 Ethiopian, Indian, Peruvian, and Vietnamese children from the Young Lives study. RESULTS: In unadjusted models, household access to improved water and toilets was often associated with reduced stunting risk. After adjusting for child, household, parent, and community variables, access to improved water was usually not associated with stunting nor thinness except in Ethiopia where access to improved water was associated with reduced stunting and thinness at 1y and 5y. In contrast, in both unadjusted and adjusted models, stunting at 1y was less common among children with good toilet access than among those without access and this difference persisted when children were 5y and 8y. For example, in adjusted estimates, Vietnamese 5y olds with access to improved toilets had relative stunting risk at 8y 0.62-0.68 that of 5y olds with no access to improved toilets. Water and toilets were rarely associated with thinness. CONCLUSIONS: Results from our study indicate that access to improved sanitation is more frequently associated with reduced stunting risk than access to improved water. However, additional studies are needed before drawing definitive conclusions about the impact of toilets relative to water. This study is the first to our knowledge to demonstrate the robust and persistent importance of access to improved toilets in infancy, not only during the first year but continuing into childhood. Additional longitudinal investigations are needed to determine concurrent and long-term associations of WASH with stunting and thinness.

Relation between neonatal malnutrition and gene expression: inflammasome function in infections caused by Candida Albicans.

PURPOSE: To investigate the effects of neonatal malnutrition followed by nutritional replacement on the signaling mechanisms developed by the inflammasome complex by analyzing the expression of the targeted TLR2, TLR4, NLRP3, caspase-1 and release of IL-1ß and IL-18 by alveolar macrophages infected in vitro with Candida albicans. METHODS: Male Wistar rats (n = 24), 90-120 days, were suckled by mothers whose diet during lactation contained 17 % protein in the nourish group and 8 % protein in the malnourished group. After weaning, both groups were fed a normal protein diet. Macrophages were obtained after tracheostomy, through the collection of bronchoalveolar lavage fluid. The quantification of the expression levels of targets (TLR2, TLR4, NLRP3 and caspase-1) was performed by real-time RT-PCR. Production of cytokines was performed by ELISA. RESULTS: The malnourished animals during lactation showed reduced body weight from the fifth day of life, remaining until adulthood. Further, the model applied malnutrition induced a lower expression of TLR4 and caspase-1. The quantification of the TLR2 and NLRP3, as well as the release of IL-1ß and IL-18, was not different between groups of animals nourished and malnourished. The system challenged with Candida albicans showed high expression levels of all targets in the study. CONCLUSIONS: The tests demonstrate nutritional restriction during critical periods of development, although nutritional supplementation may compromise defense patterns in adulthood in a timely manner, preserving distinct signaling mechanism, so that the individual does not become widely vulnerable to infections by opportunistic pathogens.

Bioelectrical impedance vector analysis as a useful predictor of nutritional status in patients with short bowel syndrome.

BACKGROUND & AIMS: Short bowel syndrome (SBS) represents a serious intestinal absorption disorder. Therefore, patients with SBS may have severe malnutrition and excessive mineral and fluid losses. Once the assessment of nutritional status is important in their follow-up, body composition measurements and especially total body water (TBW) must be repeatedly evaluated for the assessment of changes in hydration and nutritional care. The aim of this study was to investigate if bioelectrical impedance vector analysis (BIVA) is a useful predictor of nutritional and hydration status in SBS patients. METHODS: In this observational study, 22 participants (12 women), 11 with SBS and 11 gender, age and BMI-matched controls, were evaluated using the bioelectrical impedance measurements (BIA) and BIVA to assess nutritional and hydration status. RESULTS: Participants age was 53 ± 8 y (mean ± SD). Body water, fat mass and lean mass as assessed by BIA did not differ between the two groups. However, BIVA showed important differences between the groups regarding hydration and amount of soft tissue (p < 0.0001 for women and p = 0.0015 for men). The results also evidenced that women's vectors were related to cachexia, while men's vectors were divided into lean and cachexia quadrants. The use of BIVA analysis also evidenced hydration disturbance and losses of soft tissue. CONCLUSIONS: BIVA may represent a better predictor of nutritional status for analysis and interpretation of body composition in patients with short bowel syndrome. This trial was registered at ClinicalTrials.gov as NCT02113228.

Nutrition Risk Screening in Patients Admitted to an Adult Emergency Department of a Brazilian University Hospital.

BACKGROUND: The prevalence of malnutrition in emergency units is high, and data on the nutrition risk of patients admitted in these units are scarce. The aims of this study are to determine the nutrition risk profile of individuals admitted in an emergency unit and to identify clinical, anthropometric, and laboratory attributes according to nutrition risk classification. MATERIALS AND METHODS: A total of 234 individuals in an emergency unit from 1 university hospital in Brazil were enrolled in this cross-sectional study. The nutrition risk profile was determined using the Nutrition Risk Screening 2002. Sociodemographic, clinical, anthropometric, and laboratory data were collected. Comparisons between individuals "at risk" and "not at risk" and logistic regression analyzes were performed. RESULTS: The prevalence of nutrition risk at admission was 48.7%. Patients at risk were older ( P = .031), were less educated ( P = .022), had a lower body mass index ( P < .001), had higher concentrations of C-reactive protein (CRP; P = .007), had a higher CRP/serum albumin ratio ( P = .004), had lower concentrations of serum albumin ( P = .002), and had severe weight loss ( P < .001). Altogether, this profile resulted in a longer hospital stay ( P = .004), more complications ( P = .005), and greater use of antibiotics ( P = .024). In regression analyses, low serum albumin (odds ratio [OR], 2.75; 95% confidence interval [CI], 1.23-6.13) and, higher serum CRP (OR, 1.13; 95% CI, 1.00-3.72), use of antibiotics (OR, 13.3; 95% CI, 1.59-111.16) were predictors of long hospital stay. CONCLUSION: The prevalence of nutrition risk in emergency patients was high and its profile associated with worse clinical, laboratory, and anthropometric outcomes. The use of other laboratory and clinical variables may also be a good strategy for predicting adverse outcomes in emergency units.

Systemic inflammation, growth factors, and linear growth in the setting of infection and malnutrition.

OBJECTIVES: Deficits in weight gain and linear growth are seen frequently among children in areas where malnutrition and recurrent infections are common. Although both inflammation and malnutrition can result in growth hormone (GH) resistance, the interrelationships of infection, inflammation, and growth deficits in developing areas remain unclear. The aim of this study was to evaluate relationships between low levels of systemic inflammation, growth factors, and anthropometry in a case-control cohort of underweight and normal weight children in northern Brazil. METHODS: We evaluated data from 147 children ages 6 to 24 mo evaluated in the MAL-ED (Interactions of Malnutrition and Enteric Disease) case-control study following recruitment from a nutrition clinic for impoverished families in Fortaleza, Brazil. We used nonparametric tests and linear regression to evaluate relationships between current symptoms of infections (assessed by questionnaire), systemic inflammation (assessed by high-sensitivity C-reactive protein [hsCRP]), the GH insulin-like growth factor-1 (IGF-1) axis, and measures of anthropometry. All models were adjusted for age and sex. RESULTS: Children with recent symptoms of diarrhea, cough, and fever (compared with those without symptoms) had higher hsCRP levels; those with recent diarrhea and fever also had lower IGF-1 and higher GH levels. Stool myeloperoxidase was positively associated with serum hsCRP. hsCRP was in turn positively associated with GH and negatively associated with IGF-1 and IGF-binding protein-3 (IGFBP-3), suggesting a state of GH resistance. After adjustment for hsCRP, IGF-1 and IGFBP-3 were positively and GH was negatively associated with Z scores for height and weight. CONCLUSIONS: Infection and inflammation were linked to evidence of GH resistance, whereas levels of GH, IGF-1, and IGFBP-3 were associated with growth indices independent of hsCRP. These data implicate complex interrelationships between infection, nutritional status, GH axis, and linear growth in children from a developing area.

Family meals and eating practices among mothers in Santos, Brazil: A population-based study.

This study investigates family meals among mothers and explores associations between eating with family and sociodemographic characteristics, body mass index, and eating practices. A population-based cross-sectional study, using complex cluster-sampling, was conducted in the city of Santos, Brazil with 439 mothers. Frequency of family meals was assessed by asking if mothers did or did not usually have a) breakfast, b) lunch, and c) dinner with family. Linear regression analyses were conducted for the number of meals eaten with family per day and each of the potential explanatory variables, adjusting for the mother's age. Poisson regression with robust variance was used to analyze each factor associated with eating with family as classified categorically: a) sharing meals with family, b) not eating any meals with family. Only 16.4% (n = 72) of participants did not eat any meals with family. From the 83.6% (n = 367) of mothers that had at least one family meal per day, 69.70% (n = 306) ate dinner with their families. Mothers aged ≥40 years reported significantly fewer meals eaten with family compared to mothers aged 30-39 years (ß: -0.26, p = 0.04). Having family meals was 54% more prevalent among mothers with ≥12 years of education (PR for no meals eaten with family: 0.54, 95% CI: 0.30; 0.96, p = 0.03), when compared to mothers with less than nine years of education. Eating no meals with family was 85% more prevalent among mothers who reported that eating was one of the biggest pleasures in their lives (PR: 1.85, 95% CI: 1.21; 2.82, p = 0.004). We suggest the need for further research investigating the effects of family meals on mothers' health through nutritional and phenomenological approaches.

Recovery in Young Children with Weight Faltering: Child and Household Risk Factors.

OBJECTIVE: To examine whether weight recovery among children with weight faltering varied by enrollment age and child and household risk factors. STUDY DESIGN: Observational, conducted in an interdisciplinary specialty practice with a skill-building mealtime behavior intervention, including coaching with video-recorded interactions. Eligibility included age 6-36 months with weight/age

Dietary and anthropometric indicators of nutritional status in relation to Helicobacter pylori infection in a paediatric population.

It has been postulated that Helicobacter pylori infection could affect growth and appetite, consequently influencing body weight. Therefore, the association between H. pylori infection and the dietary and anthropometric indicators of nutritional status of a paediatric population were investigated. A total of 525 children (aged 4-16 years) who were referred to the gastroenterology unit of the Sor Maria Ludovica Children's Hospital from Buenos Aires, Argentina, were enrolled and completed an epidemiological questionnaire. H. pylori infection was diagnosed using the ¹³C-urea breath test (¹³C-UBT). Height and weight were assessed for calculation of anthropometric indicators. Energy and macronutrient intakes were estimated by 24 h dietary recall. Data analysis was performed using a χ² test, a Student's t test, a Mann-Whitney U test and linear and logistic regressions. The prevalence of H. pylori infection was 25·1 % (with a mean age of 10·1 (SD 3·1) years). A tendency towards lower energy, carbohydrate, protein and fat intakes was observed in infected patients; however, it was not associated with H. pylori infection in any of the evaluated age groups (4-8, 9-13 and 14-16 years). Underweight, stunting, overweight and obesity were also not associated with the infection. Although height-for-age and BMI-for-age Z scores tended to be lower in infected patients, the differences between H. pylori-positive and H. pylori-negative children were not statistically significant. In conclusion, H. pylori infection was not associated with dietary intake or with anthropometric indicators in the present population of children with gastrointestinal symptoms; however, an increased sample size would be needed to confirm the observed tendency towards lower dietary intake and lower anthropometric indicators of nutritional status in H. pylori-infected children.

Body mass index in the first year after kidney transplantation.

INTRODUCTION: Kidney transplant recipients (KTR) experience better appetite, partly due to the use of steroids, and are subjected to less severe dietetic restrictions, hence they tend to increase the uptake of calories, which favors weight gain posttransplantation. In this study, we evaluate the profile of body mass index (BMI) in the first year posttransplantation. METHODS: This was a retrospective study including 131 patients who received transplants between 1991 and 2011. We collected demographic and clinical data such as body weight and height, and calculated BMI pretransplantation and at 6 and 12 months posttransplantation. RESULTS: Mean age was 47.1 ± 13.1 years, 64.9% were male, and 29% of patients were diabetic. Pretransplantation mean BMI was 23.04 ± 4.08 kg/m(2), and at 6 and 12 months posttransplantation it increased to 24.55 ± 4.2 kg/m(2) and 24.65 ± 4.16 kg/m(2), respectively (P < .001). At 6 months, this significant weight gain occurred in all patients, even those malnourished, eutrophic, overweight, and obese at pretransplantation. Looking at pretransplantation malnourished patients, 30.8% remained malnourished 1 year after transplantation. Otherwise, 28.6% of pretransplantation overweight patients and 100% of pretransplantation obese patients could be classified as obese at 1 year posttransplantation. CONCLUSIONS: Increase in BMI is common in obese and nonobese KTR. This study highlights the importance of identifying subjects at risk for excessive weight gain posttransplantation, thus allowing an early nutritional intervention to prevent its complications.

Addressing the double burden of malnutrition with a common agenda.

Addressing malnutrition in all its forms represents an integrated agenda addressing the root causes of malnutrition at all stages of the life course. The issue is not about choosing between addressing undernutrition in the poor versus overnutrition in the affluent. We must recognize that the interventions required to address stunting are different from those needed to reduce underweight and wasting. In most developing regions, there is a coexistence between underweight and stunting in infants and children, while in the adult population it may be overweight and stunting. Malnutrition in all its forms refers to both underweight and overweight. Underweight is defined by a low weight-for-age, a child is underweight because of wasting (low weight-for-height) or stunting (low length-for-age). Stunting refers to low height-for-age independent of their weight-for-age, some stunted children may have excess weight for their stature length. Overweight is excess weight-for-length/-height or high-BMI-for-age. The prevention of nutrition-related chronic diseases is a life-long process that starts in fetal life and continues throughout infancy and later stages of life. It requires promoting healthy diets and active living at each stage. The agenda requires that we tackle malnutrition in all its forms.

Determinants of child malnutrition in rural and urban Ecuadorian highlands.

OBJECTIVE: To identify and compare the sociodemographic determinants of stunting, wasting and overweight among infants of urban and rural areas in the Ecuadorian highlands. DESIGN: Cross-sectional study. SETTING: Nabon (rural) and Cuenca (urban) cantons, Azuay Province, Ecuador. SUBJECTS: A total of 703 children aged 0-24 months and their caregivers (227 rural and 476 urban) recruited during the period from June to September 2008. RESULTS: Stunting prevalence was significantly higher in the rural area (37·4 % v. 17·7 %; P < 0·001) while wasting (7·1 %) and overweight (17·1 %) prevalence were more similar between areas. Determinants of stunting for the pooled sample were male gender (OR = 1·43; 95 % CI 1·06, 1·92; P = 0·02), preterm delivery (OR = 1·65; 95 % CI 1·14, 2·38; P = 0·008), child's age (OR = 1·04; 95 % CI 1·01, 1·07; P = 0·011), maternal education (OR = 0·95; 95 % CI 0·92, 0·99; P = 0·025) and facility-based delivery (OR = 0·57; 95 % CI 0·45, 0·74; P < 0·001). The latter was also a determinant of overweight (OR = 0·39; 95 % CI 0·25, 0·62; P < 0·001). Rural determinants of stunting were maternal height (OR = 0·004; 95 % CI 0·00004, 0·39; P = 0·018), diarrhoea prevalence (OR = 2·18; 95 % CI 1·13, 4·21; P = 0·02), socio-economic status (OR = 0·79; 95 % CI 0·64, 0·98; P = 0·030) and child's age (OR = 1·07; 95 % CI 1·02, 1·11; P = 0·005). Urban determinants were: maternal BMI for stunting (OR = 0·91; 95 % CI 0·84, 0·99; P = 0·027), cough prevalence (OR = 0·57; 95 % CI 0·34, 0·96; P = 0·036) and facility-based delivery (OR = 0·25; 95 % CI 0·09, 0·73; P = 0·011) for overweight, and hygiene for wasting (OR = 0·57; 95 % CI 0·36, 0·89; P = 0·013). CONCLUSIONS: Infant malnutrition was associated with different sociodemographic determinants between urban and rural areas in the Ecuadorian highlands, a finding which contributes to prioritize the determinants to be assessed in nutritional interventions.