Phase Angle in Head and Neck Cancer: A Sex-Differential Analysis from Biological and Clinical Behavior to Health-Related Quality of Life.

Head and neck cancer (H&NC) is a diverse category of tumors related to malignancies in the common aerodigestive pathway, with high metabolic rate, poor nutritional and treatment outcomes, and elevated mortality despite the best standard treatment. Herein, we focus on determining how the phase angle (PA) differs across sex as a predictor of poor prognosis, low quality-of-life (QoL) scores, and mortality in patients with head and neck cancer. This follow-up study presents a sex-differential analysis in a prospective cohort of 139 head and neck cancer patients categorized by sex as male (n = 107) and female (n = 32). Patients were compared in terms of nutritional, biochemical, and quality-of-life indicators between low and normal PA in women (<3.9° (n = 14, 43.75%) and ≥3.9°) and men (<4.5° (n = 62, 57.9%) and ≥4.5°). Our results show that most patients were in locally advanced clinical stages (women: n = 21 (65.7%); men: n = 67 (62.6%)) and that patients with low PA had a lower punctuation in parameters such as handgrip strength, four-meter walking speed, albumin, C-reactive protein (CRP), and CRP/albumin ratio (CAR), as well as the worst QoL scores in functional and symptomatic scales in both the male and female groups. A comparison between sexes revealed significant disparities; malnourishment and tumor cachexia related to an inflammatory state was more evident in the women's group.

Nutritional stress timing differentially programs cognitive abilities in young adult male mice.

Objectives: The impact of chronic exposure to environmental adversities on brain regions involved in cognition and mental health depends on whether it occurs during the perinatal period, childhood, adolescence or adulthood. The effects of these adversities on the brain and behavior arise as a function of the timing of the exposure and their co-occurrence with the development of specific regions. Here we aimed to explore the behavioral phenotypes derived from two nutritional stress paradigms which differed in the timing of exposure: a low-protein perinatal diet during gestation and lactation and a low-protein diet during adolescence.Methods: Locomotor and exploratory activity, recognition memory and aversive memory were measured in CF-1 8-week-old male mice subjected to perinatal malnutrition (LP-P) or adolescent malnutrition (LP-A), and their respective controls with normal protein diet (NP-P and NP-A).Results: By using the open field test, we found that LP-P and LP-A mice showed reduced exploratory activity compared to controls, but no alterations in their locomotor activity. Recognition memory was impaired only in LP-P mice. Interestingly, aversive memory was not altered in LP-P mice but was enhanced in LP-A mice. Considering the stress-inoculation theory, we hypothesized that protein malnutrition during adolescence represents a challenging but still moderate stressful environment, which promotes active coping in face of later adversity.Conclusion: Our results indicate that while perinatal malnutrition impairs recognition memory, adolescent malnutrition enhances aversive memory, showing dissimilar adaptive responses.

Prisoner health status at three rural Haitian prisons.

Purpose Little is known about the health status of prisoners in low-income countries. In Haiti, prisons typically lack adequate medical care, clean water and food, though some prisoners receive additional food from visitors. The purpose of this paper is to characterize the physical and mental health of Haitian prisoners in three select prisons and examine the effects of having visitors and length of detention on health status. The authors hypothesized that prisoners with more visitors and shorter detention times would have better overall health status. Design/methodology/approach The authors conducted a cross-sectional study of 290 male inmates in three regional prisons in Haiti. Data were collected on prisoners' sociodemographic characteristics, number of visitors, length of detention, body mass index (BMI), self-reported physical and mental health status, and food insecurity. Findings Overall, prisoners at all three prisons had poor health outcomes. Prisoners with more visitors were significantly less likely to be underweight and more likely to have a higher BMI, better self-reported physical function and lower levels of food insecurity. The length of incarceration was negatively associated with physical function and self-rated health, but positively associated with BMI. These results suggest that prisoners who do not receive supplemental food from visitors are at increased risk for food insecurity and poor nutritional and physical health status. Originality/value These findings demonstrate the importance of supplemental food from visitors in stabilizing prisoner health in Haiti and emphasize the need for the provision of adequate nutrition to all prisoners. This study also suggests that policies that reduce incarceration times could improve health status among prisoners.

Physical exercise improves body weight gain and liver function in malnourished rats without disturbing the redox balance / O exercício físico melhora o ganho de peso corporal e a função hepática em ratos desnutridos sem perturbar o balanço de redox

ABSTRACT Objective To study the relationship between exercise and malnourishment because recent evidence suggests that exercise can cause the beneficial adaptation of antioxidant systems, whereas malnourishment can cause harmful adaptation of these systems. Methods Thirty-two female Fischer rats were equally divided into Sedentary Control, Trained Control, Sedentary Malnourished and Trained Malnourished groups. The training protocol consisted of swimming for 30 minutes continuously for 5 days/week for 8 weeks. Results It was demonstrated that aspartate aminotransferase and alanine aminotransferase activities increased in malnourished rats, but physical training reversed these effects by lowering the raised levels. The glutathione level was diminished by malnourishment whereas physical training increased the levels of liver carbonyl protein and increased the levels of thiobarbituric acid reactive substances that were diminished by malnourishment. In addition, Trained Malnourished rats had a higher average body weight than Sedentary Malnourished ones (62.77g vs. 55.08g, respectively). Conclusion The data show that exercise was able to reverse or reduce damage caused by malnourishment, such as weight loss and liver dysfunction by a pathway independent of the participation of enzymes involved in antioxidant defense and that there is no interaction between exercise and malnutrition.

RESUMO Objetivo Estudar a relação entre exercício e desnutrição, pois evidências recentes sugerem que o exercício físico pode causar a adaptação benéfica de sistemas antioxidantes, enquanto a desnutrição pode causar adaptação prejudicial a esses sistemas. Métodos Trinta e duas ratas Fischer foram igualmente divididas nos grupos Controle Sedentário, Controle Treinado, Desnutrido Sedentário e Desnutrido Treinado. O protocolo de treinamento consistiu em nadar por 30 minutos continuamente por 5 dias/semana por 8 semanas. Resultados Demonstramos que as atividades de aspartato aminotransferase e alanina aminotransferase aumentaram em ratos desnutridos, mas o treinamento físico reverteu esses efeitos. O nível de glutationa foi diminuído pela desnutrição, enquanto o treinamento físico aumentou os níveis de proteína carbonilada do fígado e aumentou os níveis de substâncias reativas ao ácido tiobarbitúrico que foram diminuídas pela desnutrição. Além disso, os ratos desnutridos treinados tiveram um peso corporal médio maior que os desnutridos sedentários (62,77g vs 55,08g, respectivamente). Conclusão Os dados mostram que o exercício foi capaz de reverter ou reduzir os danos causados pela desnutrição, como perda de peso e a disfunção hepática por uma via independente da participação de enzimas envolvidas na defesa antioxidante e que não há interação entre exercício e desnutrição.

Malnourishment and length of hospital stay among paediatric cancer patients with febrile neutropaenia: a developing country perspective.

OBJECTIVES: The prevalence of malnourishment among paediatric cancer patients undergoing chemotherapy in developing countries is poorly documented despite greater potential for malnourishment in such settings. We aimed to estimate the prevalence of malnourishment among paediatric cancer patients in Mexico City, and assess the association between malnourishment and length of hospital stay. METHODS: Individuals eligible for this study were paediatric cancer patients (aged <18 years) admitted to Hospital Infantil de Mexico Federico Gomez (Mexico City) with febrile neutropaenia. Our exposure of interest, malnourishment, was defined as an age-adjusted and sex-adjusted z-score<-2 (ie, 2 SDs below the expected mean of the WHO reference population). We estimated time ratios (TRs) and 95% confidence limits (CLs) for the association between malnourishment and length of hospital stay. RESULTS: Our study population comprised 111 paediatric cancer patients with febrile neutropaenia, of whom 71% were aged <10 years and 52% were males. The prevalence of malnourishment was 14%, equal to a 530% (standardised morbidity ratio=6.3; 95% CL 3.7, 10) excess of malnourishment compared with the world reference population. The median length of hospital stay for malnourished patients was 15 days, which corresponded with a 50% (TR=1.5, 95% CL 1.0, 2.3) relative increase in length of stay compared with patients who were not malnourished. Patients with body mass indices equal to the mean of the world reference population had the shortest length of stay. CONCLUSIONS: Future studies should explore potential interventions for malnourishment to reduce the length of hospital stay or other established adverse consequences of malnourishment.

Effects of chronic malnourishment and aging on the ultrastructure of pyramidal cells of the dorsal hippocampus.

OBJECTIVES: Malnourishment (M) produces permanent alterations during the development of the CNS and might modify the aging process. In pyramidal neurons (PN) of the hippocampus, which are associated with learning and memory performance, few studies have focused on changes at the subcellular level under chronic malnutrition (ChM) in young (Y, 2 months old) and aged (A, 22 months old) rats. The present work evaluated the extent to which ChM disrupts organelles in PN of the dorsal hippocampus CA1 as compared to controls (C). METHODS: Ultrastructural analysis was performed at 8000× and 20 000× magnification: Nucleus eccentricity and somatic, cytoplasmic, and nuclear areas were measured; and in the PN perikaryon, density indices (number of organelles/cytoplasmic area) of Golgi membrane systems (GMS, normal, and swollen), mitochondria (normal and abnormal), and vacuolated organelles (lysosomes, lipofuscin granules, and multivesicular bodies (MVB)) were determined. RESULTS: The density of abnormal mitochondria, swollen GMS, and MVB increased significantly in the AChM group compared to the other groups. The amount of lipofuscin was significantly greater in the AChM than in the YChM groups - a sign of oxidative stress due to malnutrition and aging; however, in Y animals, ChM showed no effect on organelle density or the cytoplasmic area. An increased density of lysosomes as well as nucleus eccentricity was observed in the AC group, which also showed an increase in the cytoplasmic area. DISCUSSION: Malnutrition produces subcellular alterations in vulnerable hippocampal pyramidal cells, and these alterations may provide an explanation for the previously reported deficient performance of malnourished animals in a spatial memory task in which aging and malnutrition were shown to impede the maintenance of long-term memory.

Participação do nicho endosteal na regulação da hemopoese de camundongos submetidos à desnutrição proteica / Endosteal niche participation in the hematopoiesis of mice submitted to protein malnourishment

O nicho endosteal da medula óssea abriga as células-tronco hemopoéticas (CTH) em quiescência/autorrenovação. As CTH podem ser classificadas em dois grupos: células que reconstituem a hemopoese em longo prazo (LT-CTH) e curto prazo (CT-CTH). Investigamos, neste trabalho, os efeitos da desnutrição proteica (DP) no tecido ósseo e a participação do nicho endosteal na sinalização osteoblasto-CTH. Para tanto, utilizamos camundongos submetidos à DP induzida pelo consumo de ração hipoproteica. Os animais desnutridos apresentaram pancitopenia e diminuição nas concentrações de proteínas séricas e albumina. Quantificamos as CTH por citometria de fluxo e verificamos que os desnutridos apresentaram menor porcentagem de LT-CTH, CT-CTH e de progenitores multipotentes (PMP). Avaliamos a expressão das proteínas CD44, CXCR4, Tie-2 e Notch-1 nas LT-CTH. Observamos diminuição da expressão da proteína CD44 nos desnutridos. Isolamos as células LT-CTH por cell sorting e avaliamos a expressão gênica de CD44, CXCR4 e NOTCH-1. Verificamos que os desnutridos apresentaram menor expressão de CD44. Em relação ao ciclo celular, verificamos maior quantidade de LT-CTH nas fases G0/G1. Caracterizamos as alterações do tecido ósseo femoral, in vivo. Observamos diminuição da densidade mineral óssea e da densidade medular nos desnutridos. A desnutrição acarretou diminuição da área média das seções transversais, do perímetro do periósteo e do endósteo na cortical do fêmur dos animais. E na região trabecular, verificou-se diminuição da razão entre volume ósseo e volume da amostra e do número de trabéculas, aumento da distância entre as trabéculas e prevalência de trabéculas ósseas em formato cilíndrico. Avaliamos a expressão de colágeno, osteonectina (ON) e osteocalcina (OC) por imuno-histoquímica, e de osteopontina (OPN) por imunofluorescência no fêmur e verificamos diminuição da marcação para OPN, colágeno tipo I, OC e ON nos desnutridos. Evidenciamos, pela técnica do Picrosírius, desorganização na distribuição das fibras colágenas e presença de fibras tipo III nos fêmures dos desnutridos, além de maior número de osteoclastos evidenciados pela reação da fosfatase ácida tartarato resistente. Os osteoblastos da região femoral foram isolados por depleção imunomagnética, imunofenotipados por citometria de fluxo e cultivados em meio de indução osteogênica. Observamos menor positividade para fosfatase alcalina e vermelho de alizarina nas culturas dos osteoblastos dos desnutridos. Avaliamos, por Western Blotting, a expressão de colágeno tipo I, OPN, osterix, Runx2, RANKL e osteoprotegerina (OPG), e, por PCR em tempo real, a expressão de COL1A2, SP7, CXCL12, ANGPT1, SPP1, JAG2 e CDH2 nos osteoblastos isolados. Verificamos que a desnutrição acarretou diminuição da expressão proteica de osterix e OPG e menor expressão gênica de ANGPT1. Avaliamos a proliferação das células LSK (Lin-Sca1+c-Kit+) utilizando ensaio de CFSE (carboxifluoresceína succinimidil ester). Foi realizada cocultura de células LSK e osteoblastos (MC3T3-E1) na presença e ausência de anti-CD44. Após uma semana, verificamos menor proliferação das LSK dos desnutridos. O bloqueio de CD44 das LSK do grupo controle diminuiu a proliferação destas em três gerações. Entretanto, nos desnutridos, esse bloqueio não afetou a proliferação. Concluímos que a DP promoveu alterações no tecido ósseo e nas CTH. Entretanto, não podemos afirmar que as alterações observadas no sistema hemopoético foram decorrentes de alterações exclusivas do nicho endosteal

The bone marrow endosteal niche hosts hematopoietic stem cells (HSC) in quiescence/self-renewal. HSC can be classified into two groups: cells capable of renewing indefinitely (LT-HSC) or repopulating in the short term (ST-HSC). In this work, we investigated the effects of protein malnutrition (PM) on bone tissue and the involvement of the endosteal niche in osteoblast-CTH signaling. Therefore, we used mice subjected to PM induced by the consumption of hypoproteic feed. Malnourished animals presented pancytopenia and decreased concentration of serum protein and albumin. We quantified the HSC by flow cytometry and found that the malnourished ones had lower percentage of LT-HSC, ST-HSC and multipotent progenitors (MPP). We assessed the expression of the CD44, CXCR4, Tie-2 and Notch-1 proteins in LT-HSC. We observed decreased expression of CD44 protein with the malnourished ones. We isolated the LT-HSC cells by means of cell sorting and assessed the gene expression of CD44, CXCR4 and NOTCH-1. We found that malnutrition had lower expression of CD44. Regarding the cell cycle, we see greater amount of LT-HSC in the G0 and G1 phases. We characterized the changes of the femoral bone tissue in vivo. We observed a decrease in the bone mineral density and medullar density in malnourished animals. As for malnourished animals, the femoral cortical region showed a significant decrease in tissue area, periosteal and endosteal perimeter. The femoral trabecular region of malnourished animals showed decreased bone volume/tissue volume ratio, decreased trabecular number, increased trabecular separation and prevalence of rod-like trabeculae. We investigated the expression of collagen, osteonectin (ON) and osteocalcin (OC) by means of immunohistochemistry and the expression of osteopontin (OPN) by immunofluorescence and we found that malnourished animals showed decreased labeling for OPN, type I collagen, OC and ON in the cortical region of the femur. Picrosirius staining was used to analyze disorganization of collagen fibers and presence of type III fibers in the femurs of the malnourished. Cortical and trabecular regions of malnourished animals presented a higher number of osteoclasts as shown by tartrate-resistant acid phosphatase reaction. Moreover, osteoblasts were isolated from the femoral region by immunomagnetic depletion and immunophenotyped by flow cytometry and cultured in osteogenic induction medium. Results proved less positive for alkaline phosphatase and alizarin red in the cultures of osteoblasts of malnourished animals. We assessed, by means of Western blotting, type I collagen expression, OPN, osterix, Runx2, RANKL and osteoprotegerin (OPG) and, by real time PCR, the expression of COL1A2, SP7, CXCL12, ANGPT1, SPP1, JAG2 and CDH2 with the isolated osteoblasts. We found that malnutrition led to osterix and OPG decreased protein expression and lower ANGPT1 gene expression. We evaluated LSK cell (Lin-Sca1+c-Kit+) proliferation by CFSE (carboxyfluorescein succinimidyl ester). LSK cells and osteoblasts (MC3T3-E1) cocultures were performed in the presence and absence of anti-CD44. After a week, we found lower proliferation of LSK in the malnourished. The LSK CD44 blocking in the control group decreased the proliferation of these three generations. However, as for the malnourished, such blockage did not affect proliferation. We concluded that the PM has promoted changes in bone tissue and the CTH. However, we can't claim that the alterations observed in hematopoietic system were due to endosteal niche-only changes

Efecto biológico de la recuperación nutricional en las concentraciones séricas de citocinas inflamatorias en el niño desnutrido grave / Biological effect of nutritional recovery on serum concentrations of inflammation cytokines in the malnourished child

El niño con desnutrición grave tiene una disfunción de la respuesta inmune que puede aumentar de manera significativa la morbilidad y la mortalidad por infecciones. El objetivo de la presente investigación fue evaluar el efecto de la recuperación nutricional en las concentraciones séricas de citocinas inflamatorias; tales como: interleucina 12 (IL-12), interleucina 17 (IL-17), interferón gamma (IFN-γ) y factor de necrosis tumoral alfa (TNF-α). En un estudio de tipo prospectivo y longitudinal, se seleccionó la población con base a criterios clínicos y antropométricos, constituida por 24 niños desnutridos graves en edades comprendidas entre 1 y 2 años, quienes formaban parte de un programa de recuperación nutricional. La concentración sérica de las citocinas investigadas se determinó antes y después del tratamiento nutricional, empleando la técnica de Inmunoanálisis Enzimático (ELISA) de doble anticuerpo. Para establecer comparaciones se utilizó la t de Student, y se consideró una p<0,05 como estadísticamente significante. Se observó una diferencia en las concentraciones de IL-12, IL-17, IFN-γ y TNF-α antes y después del tratamiento (p<0,05), lo cual parece indicar que la desnutrición per se provoca un estado inflamatorio y que 2 meses de apoyo nutricional intensivo, favorecen no solo la recuperación clínica del niño desnutrido grave, sino también la recuperación de su respuesta inmunitaria en cuanto a la producción de mediadores solubles como son las citocinas.

Children with severe malnutrition have a dysfunction of the immune response that can significantly increase morbidity and mortality from infections. The aim of this investigation was to evaluate the effect of nutritional recovery in serum measurements of inflammatory cytokines; such as interleukin 12 (IL-12), interleukin 17 (IL-17), interferon gamma (IFN-γ) and tumor necrosis factor alpha (TNF-α). In a prospective and longitudinal study, 24 severe malnourished children aged between 1 and 2 years-old, who were part of a program of nutritional recovery, were selected based on clinical and anthropometric criteria. Serum measurements of cytokines were determined before and after dietary treatment, using the technique of sandwich Enzyme-Linked ImmunoSorbent Assay (ELISA). For comparisons, Student’s t test was used, considered p <0.05 as statistically significant. A difference was observed in the concentrations of IL-12, IL-17, IFN-γ and TNF-α before and after treatment (p <0.05), which suggests that malnutrition provokes an inflammatory state and two months of intensive nutritional support, not only promotes the clinical recovery of severe malnourished children, but also the recovery of the immune response with regard to the production of soluble mediators, such as cytokines.

Deficiencia de vitamina A en niños con fibrosis quística / Vitamin A deficiency in children with cystic fibrosis

Introducción: la carencia subclínica de vitamina A es frecuente en niños y adolescentes con fibrosis quística, y tiene un origen multifactorial; contribuye al deterioro pulmonar y ensombrece el pronóstico de la enfermedad.Objetivo: caracterizar el estado de esta vitamina en niños y adolescentes fibroquísticos y su relación con el estado nutricional y algunas variables clínicas.Métodos: se realizó un estudio descriptivo, transversal (año 2014), de los 11 pacientes menores de 18 años atendidos en consulta multidisciplinaria del Hospital Pediátrico Centro Habana, que recibían suplementos diarios de vitamina A, como parte de la recomendación dietética y que se encontraban estables de su enfermedad, sin síntomas carenciales. Se evaluó el nivel de retinol sérico por cromatografía de alta resolución y se consideraron valores normales, según la OMS, entre 30 y 79 µg/dL, marginales entre 20 y < 30 µg/dL y deficiencia subclínica entre 10 y < 20 µg/dL. El estado nutricional se evaluó según percentil de índice de masa corporal, correspondiente a la población cubana según edad decimal y sexo. Se clasificó, además, a los enfermos, según mutación reportada, presencia de insuficiencia pancreática y enfermedad pulmonar típica, de acuerdo con registros clínicos.Resultados: en la muestra predominó la mutación del 508F (2 homocigotos y 6 heterocigotos) y la enfermedad típica con insuficiencia pancreática (10 de 11). En 7 niños (63,6 por ciento) se detectaron niveles bajos de vitamina A (4 marginales y 3 deficientes), con predominio en niños con bajo peso (80 vs. 50 por ciento en los eutróficos), prescolares (2 de 2) y adolescentes (3 de 5).Conclusiones: es importante el monitoreo de esta vitamina en el seguimiento de los enfermos de fibrosis quística(AU)

Introduction: subclinical Vitamin A deficiency is common in children and adolescents with cystic fibrosis of multifactoral origin; it influences the pulmonary deterioration and casts a shadow over the disease prognosis.Objective: to characterize the state of this vitamin in children and adolescents with cystic fibrosis and its association with the nutritional status and with some clinical variables.Methods: a cross-sectional and descriptive study was conducted in younger than 18 years-old children. They were seen at the multidisciplinary service of Centro Habana pediatric hospital, and received daily Vitamin A supplements as part of dietary recommendations; they were stable with no symptoms of shortage at the time of study. A high resolution chromatography evaluated the level of serum retinol, whose values, according to WHO standards, were considered normal when yielding 30-79 µg/dL, marginal from 20 to less than 30 µg/dL and subclinical deficiency ranging from 10 to lower than 20 µg/dL. The nutritional status was measured as body mass index percentiles of the Cuban population by decimal age and sex. Additionally, the patients were classified on the basis of reported mutation, pancreatic deficiency and typical pulmonary disease pursuant to the medical histories.Results: in the sample, the 508F mutation (2 homozygotic and 6 heterozygotic) and typical disease with pancreatic disease (10) prevailed. Seven children (63.2 percent) had low Vitamin A levels (4 marginal and 3 deficient), being low weighed children (80 vs. 50 percent in the eutrophic ones), preschool children (2 out of 2) and adolescents (3 out of 5) predominant(AU)

Deficiencia de vitamina A en niños con fibrosis quística / Vitamin A deficiency in children with cystic fibrosis

INTRODUCCIÓN: la carencia subclínica de vitamina A es frecuente en niños y adolescentes con fibrosis quística, y tiene un origen multifactorial; contribuye al deterioro pulmonar y ensombrece el pronóstico de la enfermedad. OBJETIVO: caracterizar el estado de esta vitamina en niños y adolescentes fibroquísticos y su relación con el estado nutricional y algunas variables clínicas. MÉTODOS: se realizó un estudio descriptivo, transversal (año 2014), de los 11 pacientes menores de 18 años atendidos en consulta multidisciplinaria del Hospital Pediátrico Centro Habana, que recibían suplementos diarios de vitamina A, como parte de la recomendación dietética y que se encontraban estables de su enfermedad, sin síntomas carenciales. Se evaluó el nivel de retinol sérico por cromatografía de alta resolución y se consideraron valores normales, según la OMS, entre 30 y 79 µg/dL, marginales entre 20 y < 30 µg/dL y deficiencia subclínica entre 10 y < 20 µg/dL. El estado nutricional se evaluó según percentil de índice de masa corporal, correspondiente a la población cubana según edad decimal y sexo. Se clasificó, además, a los enfermos, según mutación reportada, presencia de insuficiencia pancreática y enfermedad pulmonar típica, de acuerdo con registros clínicos. RESULTADOS: en la muestra predominó la mutación del 508F (2 homocigotos y 6 heterocigotos) y la enfermedad típica con insuficiencia pancreática (10 de 11). En 7 niños (63,6 %) se detectaron niveles bajos de vitamina A (4 marginales y 3 deficientes), con predominio en niños con bajo peso (80 vs. 50 % en los eutróficos), prescolares (2 de 2) y adolescentes (3 de 5). CONCLUSIONES: es importante el monitoreo de esta vitamina en el seguimiento de los enfermos de fibrosis quística.

INTRODUCTION: subclinical Vitamin A deficiency is common in children and adolescents with cystic fibrosis of multifactoral origin; it influences the pulmonary deterioration and casts a shadow over the disease prognosis. OBJECTIVE: to characterize the state of this vitamin in children and adolescents with cystic fibrosis and its association with the nutritional status and with some clinical variables. METHODS: a cross-sectional and descriptive study was conducted in younger than 18 years-old children. They were seen at the multidisciplinary service of Centro Habana pediatric hospital, and received daily Vitamin A supplements as part of dietary recommendations; they were stable with no symptoms of shortage at the time of study. A high resolution chromatography evaluated the level of serum retinol, whose values, according to WHO standards, were considered normal when yielding 30-79 µg/dL, marginal from 20 to less than 30 µg/dL and subclinical deficiency ranging from 10 to lower than 20 µg/dL. The nutritional status was measured as body mass index percentiles of the Cuban population by decimal age and sex. Additionally, the patients were classified on the basis of reported mutation, pancreatic deficiency and typical pulmonary disease pursuant to the medical histories. RESULTS: in the sample, the 508F mutation (2 homozygotic and 6 heterozygotic) and typical disease with pancreatic disease (10) prevailed. Seven children (63.2 %) had low Vitamin A levels (4 marginal and 3 deficient), being low weighed children (80 vs. 50 % in the eutrophic ones), preschool children (2 out of 2) and adolescents (3 out of 5) predominant. CONCLUSIONS: it is important to monitor Vitamin A in the follow-up of patients with cystic fibrosis.

Infrared LED light therapy influences the expression of fibronectin and tenascin in skin wounds of malnourished rats--a preliminary study.

The aim of this investigation was to evaluate the effect of infrared (λ 846±20nm) LED irradiation on the expression profile of the extracellular matrix protein components, tenascin and fibronectin on skin wounds induced in well nourished and malnourished rats. Eighteen albino rats (21 days old) were randomly divided into a well-nourished group (standard diet) and a malnourished group (regional basic diet). After receiving the diet for 70 days, skin wounds were created and the animals were subdivided into three groups: well-nourished control (n=6), malnourished control (n=6), and malnourished+LED irradiated (λ 846±20nm, 100mW, 4J/cm(2)) (n=6). The animals were sacrificed 3 and 7 days after injury and histological sections were immunostained for both proteins. They were examined for the presence, intensity, distribution and pattern of immunolabeling. At 3 days, the distribution of tenascin was shown to be greater in the wound bed of malnourished animals compared to the well-nourished group. The intensity and distribution of tenascin was shown to be lower in the malnourished LED irradiated group compared to the malnourished control. There was a significant difference regarding the presence of fibronectin in the malnourished and well-nourished groups after 7 days (p=0.03). The intensity of fibronectin was slight (100%) in the irradiated group and moderate to intense in the malnourished control group. The results of the present study indicate that infrared LED irradiation modulates positively the expression of tenascin and particularly fibronectin.

Análise da densidade energética de preparações servidas em uma Unidade de Nutrição e Dietética / Analysis of the energy density of preparations served in a Nutrition and Dietetics Unit

Given the special energy and nutrient needs and the malnourishment commonly seen in hospitalized patients, the energy density of a soft diet, low potassium diet, low sodium diet and bedtime fruit shakes and porridges offered to patients of a Nutrition and Dietetics Unit of Brasília, DF, was assessed. Data were collected by direct observation and technical cards regarding the preparation of foods and dishes were done to calculate the energy density (ED) of the preparations according to the "Food and energy-containing beverages method." The ED values were classified according to the CDC, 2005. Roughly 16.7% of the soft diets had an ED of 0.7 to 1.5kcal/g (low ED), 58.3% had an ED below 0.6kcal/g (very low ED) and 25% had an ED between 1.5 and 4.0kcal/g (average ED). The analysis of low-sodium and low-potassium diets showed that 20% had a low ED, 30% had a very low ED and 50% had an average ED. All fruit shakes and porridges had a low ED. The results show that the patients who receive the analyzed preparations are at risk of ingesting an amount of energy that is below their needs. The need for standardization, menu planning and attention to individual dietary requirements is evident within the studied nutrition and Dietetic Unit.

En función de las necesidades especiales de energía, nutrientes y de la mal nutrición que a menudo constatamos en pacientes internados, fue analizada la densidad energética de las preparaciones de la dieta pastosa, de las preparaciones de la dieta hipocalémica e hiposódica, de la leche batida con frutas y papillas servidas a los pacientes de una Unidad de Nutrición y Dietética de Brasilia (DF). Los datos se recolectaron por medio de observación directa y se elaboraron fichas técnicas de 12 preparaciones de dieta pastosa, nueve de la hipocalémica e hiposódica, cinco de leche con frutas y cuatro papillas en 3 días de la semana, para el cálculo de la densidad energética (DE) de acuerdo con el "Food and energy-containing beverages method". Las DE se clasificaron de acuerdo con el CDC de 2005. Se observó que un 16,7% de las preparaciones de la dieta pastosa presentaron DE entre 0,7 y 1,5kcal/g (DE baja), un 58,3% DE menor que 0,6kcal/g (DE muybaja) y un 25% DE entre 1,5 y 4,0 /g (DE media). El análisis de la dieta hiposódica y hipocalémica mostró que 20% presentaban DE baja, 30% DE muy baja y 50% DE media. Todas las leches con frutas y papillas presentaron DE baja. Los resultados indican que los pacientes que reciben las preparaciones analizadas corren el riesgo de ingerir una cantidad de energía inferior a sus necesidades energéticas, evidenciando la necesidad de una estandarización, planificación de menús y atención a los métodos dietéticos individualizados en la Unidad de Nutrición y Dietética estudiada.

Diante das necessidades especiais de energia, nutrientes e à má nutrição frequentemente observada em pacientes hospitalizados, foi analisada a densidade energética de preparações da dieta pastosa, das preparações da dieta hipocálica e hipossódica, e das vitaminas e mingaus servidos para todas as dietas aos pacientes de uma unidade de Nutrição e Dietética de Brasília - DF. Foram coletados dados por meio de observação direta e elaboradas fichas técnicas de 12 preparações da dieta pastosa, nove da hipocálica e hipossódica e cinco vitaminas e quatro mingaus em 3 dias da semana, para o cálculo da densidade energética (DE) de acordo com o "Food and energy-containing beverages method". As DE foram classificadas de acordo com o CDC, 2005. Observou-se que 16,7% das preparações da dieta pastosa apresentaram DE entre 0,7 e 1,5kcal/g (DE baixa), 58,3% DE menor que 0,6kcal/g (DE muito baixa) e 25% DE entre 1,5 e 4,0/g (DE média). A análise da dieta hipossódica e hipocálica mostrou que 20% apresentaram DE baixa, 30% DE muito baixa e 50% DE média. Todas as vitaminas e mingaus apresentaram DE baixa. Os resultados indicam que os pacientes que recebem as preparações analisadas correm o risco de ingerir uma quantidade de energia inferior às suas necessidades energéticas, ficando evidente a necessidade de padronização, planejamento de cardápios e atenção aos esquemas dietéticos individualizados dentro da Unidade de Nutrição e Dietética estudada.

Recién nacidos con bajo peso; causas, problemas y perspectivas a futuro

El bajo peso al nacimiento (BPN) es un problema de salud pública mundial, que impacta sobre la mortalidad neonatal e infantil. Entre los múltiples factores asociados al BPN se han señalado las características antropométricas, nutricionales, socioculturales y demográficas de la madre; los antecedentes obstétricos y condiciones patológicas que afectan la funcionalidad y suficiencia placentaria, así como las alteraciones propiamente fetales. Las repercusiones del BPN no se confinan sólo al período neonatal inmediato o al mediano plazo, ya que el retardo en el crecimiento y desarrollo puede continuar hasta la edad adulta, e incluso manifestarse sobre su descendencia. Junto con la prematuridad, el BPN es el factor predictivo, más fuertemente asociado a mortalidad. Los niños con BPN son un grupo heterogéneo que comprende tanto a aquellos de término con peso bajo para la edad gestacional, aquellos con retardo del crecimiento intrauterino, a los prematuros, como a los productos de embarazos múltiples. Cada uno de ellos tiene diferente etiología, evolución ulterior, secuelas, morbilidad y mortalidad. Dicha diversidad dificulta su estudio grupal. Este panorama nos muestra la dificultad para determinar la magnitud y tipo de secuelas neurológicas que podría presentar un paciente con BPN, ya que el proceso dependerá de las alteraciones prenatales, del momento en que se presente el daño y la causa que lo origina, el tipo de paciente, el nivel de atención que recibe antes, durante y después del parto y las posibilidades de rehabilitación, determinadas muchas veces por aspectos ajenos al ambiente médico.

Low birth weight (LBW) is a worldwide health problem that affects the newborn morbidity and mortality. Among the multiple issues mentioned associated with LBW are: anthropological, nutritional, sociocultural and demographic status of the mother; obstetrical data and pathology that influences the function and sufficiency of the placenta in addition to fetal abnormalities. Repercussions seen in LBW are not confined to the immediate neonatal period, since the delay in development and growth can persist up to adulthood and can be manifested into their offspring. Besides prematurity LBW is the strongest predictive factor associated with mortality. Newborns with LBW are an heterogeneous group that comprises neonates at term with low weight for gestational age, those with intrauterine growth retardation, prematures and those born from multiple pregnancies. Each 1 with a different etiology, medical attention received before, during and after birth and finally different possibility to receive rehabilitation, often related to socioeconomic issues outside from the medical realm.