Impact of Oropharyngeal Administration of Colostrum in Preterm Newborns' Oral Microbiome.

The initial colonization of the human microbiota is of paramount importance. In this context, the oropharyngeal administration of colostrum is a safe, viable, and well-tolerated practice even by the smallest preterm infants. Therefore, this study evaluated the effects of oropharyngeal administration of colostrum on the establishment of preterm infants' oral microbiota. A longitudinal observational study was carried out with 20 premature neonates, divided into two groups: one receiving the protocol (Oropharyngeal Administration of Colostrum; OAC) and the other one receiving Standard Caare (SC). Saliva samples were collected from the newborns weekly during the study period (from the day of birth until the 21st day of life) for analysis of oral microbiota through 16S rRNA gene sequencing. We observed that the colonization of the oral microbiota of preterm newborns preseanted a higher relative abundance of Staphylococcus on the 7th day of life, mainly in the OAC group. Additionally, an increased abundance of Bifidobacterium and Bacteroides was observed in the OAC group at the first week of life. Regarding alpha and beta diversity, time was a key factor in the oral modulation of both groups, showing how dynamic this environment is in early life.

Prevalencia de desnutrición en niños al ingreso hospitalario en 9 países latinoamericanos y análisis de sus factores asociados

RESUMEN Introducción: La desnutrición continúa siendo una causa frecuente de aumento de la morbimortalidad, especialmente en pacientes hospitalizados. Objetivo: Evaluar la tasa de desnutrición infantil observada al ingreso hospitalario en nueve países latinoamericanos y estimar el impacto de diversas condicionantes que pueden incidir en su desarrollo. Materiales y Métodos: Estudio descriptivo, transversal de niños de ambos sexos, de 0 a 18 años de edad, hospitalizados en nueve países latinoamericanos (Argentina, Chile, Cuba, Guatemala, México, Panamá, Paraguay, Uruguay y Venezuela). La información se obtuvo mediante encuesta y antropometría efectuada durante las primeras 48 horas de ingresados. Para la evaluación nutricional se evaluó el peso y la talla de los niños de acuerdo a los estándares de la Organización Mundial de la Salud (OMS). El análisis estadístico se realizó en el programa SPSS versión 24. Resultados: Del total de 5.366 pacientes, 45,2% eran mujeres y 46,5% menores de 2 años. Un 50,2% eran eutróficos, un 15,4% presentaba riesgo de desnutrir o desnutrición leve, un 12,5% desnutrición, un 14,2% sobrepeso o riesgo de obesidad, y un 7,7% obesidad. El 20,5% eran de talla baja. Los niños con 4 o más hospitalizaciones previas tuvieron mayor riesgo de presentar malnutrición por déficit (OR = 1,7). Las patologías cardiológicas presentaron un OR = 1,8 de presentar malnutrición por déficit. Conclusiones: La prevalencia de desnutrición en niños al ingreso hospitalario es moderada y se relaciona especialmente a patología cardiológica y a los antecedentes de varias hospitalizaciones previas.

ABSTRACT Introduction: Malnutrition continues to be a frequent cause of increased morbidity and mortality, especially in hospitalized patients. Objective: To evaluate the observed infant malnutrition rate at hospital admission in nine Latin American countries and to estimate the impact of various conditions that may affect their development. Materials and Methods: This was a descriptive, cross-sectional study of children of both sexes, from 0 to 18 years of age, hospitalized in nine Latin American countries (Argentina, Chile, Cuba, Guatemala, Mexico, Panama, Paraguay, Uruguay and Venezuela). The information was obtained through a survey and anthropometry carried out during the first 48 hours after admission. For the nutritional evaluation, the weight and height of the children were evaluated according to the standards of the World Health Organization (WHO). Statistical analysis was performed using SPSS version 24. Results: Of the total of 5,366 patients, 45.2% were female and 46.5% were under 2 years of age. 50.2% were eutrophic, 15.4% had a risk of malnutrition or mild malnutrition, 12.5% malnutrition, 14.2% overweight or at risk of obesity, and 7.7% were obese. 20.5% were short. Children with 4 or more previous hospitalizations had a higher risk of presenting deficiency malnutrition (OR = 1.7). Patients with cardiological pathologies presented an OR = 1.8 of presenting deficiency malnutrition. Conclusions: The prevalence of malnutrition in children at hospital admission is moderate and is especially related to cardiac pathology and a history of several previous hospitalizations.

Hidden Realities of Infant Feeding: Systematic Review of Qualitative Findings from Parents.

A growing, global conversation, regarding realities and challenges that parents experience today is ever-present. To understand recent parent's attitudes, beliefs, and perceptions regarding infant feeding, we sought to systematically identify and synthesize original qualitative research findings. Following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) framework, electronic databases were searched with a priori terms applied to title/abstract fields and limited to studies published in English from 2015 to 2019, inclusive. Study quality assessment was conducted using the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed. Of 73 studies meeting inclusion criteria, four major themes emerged. (1) Breastfeeding is best for an infant; (2) Distinct attitudes, beliefs, and perceptions of mothers that breastfeed, and those that could not or chose not to breastfeed, are evident; (3) Infant feeding behaviors are influenced by the socio-cultural environment of the family, and (4) Parent's expectations of education and support addressing personal infant feeding choices from health care providers are not always met. This systematic review, guided by constructs within behavioral models and theories, provides updated findings to help inform the development of nutrition education curricula and public policy programs. Results can be applied within scale-up nutrition and behavioral education interventions that support parents during infant feeding.

Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children.

BACKGROUND: Nutrition markers may be useful for diagnosis and monitoring and, also, as additional indicators of estimating death risk. We tested the association of body composition indicators (mid-upper arm circumference and phase angle) with pediatric intensive care unit (PICU) length of stay and mortality in critically ill pediatric patients. METHODS: Data from children aged 2 months-18 years were collected, and bioelectrical impedance was performed to obtain phase angle. Severity was evaluated by scoring the Pediatric Index of Mortality. Descriptive statistics were reported for nominal variables. Receiver operating characteristic curve was used to analyze the association of phase angle with 30-day mortality and to find the best cutoff. Survival probabilities and PICU length of stay were estimated using the Kaplan-Meier method. RESULTS: We evaluated 247 children with a median age of 4.8 years whose main cause of admission was sepsis. Survival curves showed higher survival in patients with phase angle >2.8° compared with patients with phase angle ≤2.8° (P < .0001). Kaplan-Meier time-to-event analysis showed that children with lower phase angle values were more likely to remain in the PICU (hazard ratio, 1.84; P = .003). Lower survival was also observed in patients who presented mid-upper arm circumference values ≤5th percentile (P < .03). CONCLUSIONS: Mid-upper arm circumference and phase angle were associated with mortality and morbidity in critically ill children, suggesting that these parameters may be useful not only for nutrition diagnosis and monitoring, but also as an additional indicator in estimating prognosis.

Caracterização da evolução clínica dos recém-nascidos com gastrosquise em uma unidade de terapia intensiva neonatal de referência da américa latina / Characteristics of the clinical development of a newborn with gastroschisis in an intensive care unit in latin america

INTRODUCTION: Congenital malformations are major diseases observed at birth. They are the second most common cause of death in the neonatal population, the first one being prematurity. OBJECTIVE: To characterise the clinical outcome of newborns with gastroschisis (GS) in a neonatal intensive care unit. METHODS: A retrospective observational clinical study in 50 infants with GS using the association of intestinal abnormalities, impossibility of primary closure of the abdominal defect and reoperation necessity as classification criteria for the disease. The significance level was p < 0.05. RESULTS: The hospitalisation to primary surgery occurred with a median age of 2 hours. Fourteen percent of children were subjected to a primary silo interposition and 24% had associated intestinal malformation. Nineteen newborns (NB) required more than one surgery. The median length of stay was 33 days, higher in patients with complex GS (56 days). All NB recovered from urine output 48 hours after surgery and 40% had hyponatraemia and oligoanuria in this period. There was no difference between the natraemia and fasting time (p = 0.79). Weight gain was similar in both groups with total parenteral nutrition and became significantly higher in patients with simple GS after enteral feeding (p = 0.0046). These NB evolved 2.4 times less cholestasis. Late-onset sepsis occurred in 58% of patients and was related to the infection of the central venous catheter in 37.9% of cases. Mortality was higher in infants infected with complex GS and the overall mortality rate was 14%. CONCLUSION: Clinical characterisation of newborns with gastroschisis depends on the complexity and the knowledge and conduct of morbidities to reduce mortality.

INTRODUÇÃO: As malformações congênitas fazem parte das principais doenças observadas ao nascimento. Entre as causas de óbito no período neonatal as malformações foram a segunda causa, sendo ainda a primeira, a prematuridade. OBJETIVOS: Caracterizar a evolução clínica dos recém-nascidos (RN) com gastrosquise (GTQ) em uma unidade de terapia intensiva neonatal e descrever as morbidades renal, nutricional e infecciosa relacionados ao manejo clínico pós-natal na unidade de terapia intensiva neonatal MÉTODO: Foi realizado estudo observacional retrospectivo em 50 RN com GTQ, utilizando a associação de anormalidades intestinais, impossibilidade de fechamento primário do defeito abdominal e necesidade de reoperação como critérios de classificação para a doença. O nível de significância foi p < 0,05. RESULTADOS: A admissão hospitalar para cirurgia primária ocorreu com mediana de idade de 2 horas. O total de 14% das crianças foram submetidas a uma interposição de silo primária e 24% apresentaram malformação intestinal associada. Dezenove RN necessitaram mais de uma intervenção cirúrgica. A mediana do tempo de estadia foi de 33 dias, sendo maior nos pacientes com GTQ complexa (56 dias). Todos os RN recuperaram o débito urinário a partir de 48 horas do pós-operatório e 40% apresentaram hiponatremia e oligoanúria nesse período. Não houve diferença entre a natremia e o tempo de jejum (p = 0,79). O ganho ponderal foi similar em ambos os grupos com nutrição parenteral total e tornou-se significativamente maior nos pacientes com GTQ simples após a alimentação enteral (p = 0,0046). Esses RN evoluíram 2,4 vezes com menos colestase. Sepse tardia ocorreu em 58% dos pacientes e foi relacionada à infecção do CVC em 37,9% dos casos. A mortalidade foi maior nos RN infectados com GTQ complexa e a taxa global de mortalidade foi de 14%. CONCLUSÃO: A caracterização clínica dos RN com GTG depende da complexidade e do conhecimento e condução das morbidades para diminuir a mortalidade.

Consumo de frutas no Brasil e prevalência de obesidade / Fruit intake and obesity Fruit and vegetables consumption and obesity in Brazil

INTRODUCTION: Obesity affects more than half of the adult population and correlates with the development of chronic and psychosocial diseases. The consumption of fruits and vegetables (FV) is a protective factor for obesity, but their consumption is often below the recommendations. OBJECTIVE: To identify the level of fruit consumption in human development cycles, as well as the data on the association of fruit consumption with excess weight in Brazil. METHODS: A non-systematic literature review on the Virtual Health Library (VHL) databases for the period 2005 to 2015. A total of 23 studies were selected in the English and Portuguese languages, according to the study design and population group. Only cohorts and cross sections studies in Brazil were selected. Appropriate FV consumption was considered to be 400 g/day or a frequency of 5 servings/day (3 servings/day of fruits), and overweight was evaluated according to each age group and development cycle. RESULTS: The average consumption for pregnant women was found to be 350 g/day; an inverse relationship was found between total fibre consumption and gestational weight gain. The average consumption of FV for children and adolescents has remained between 30% and 40%, consumption falling with increasing age. Vigitel data between 2006 and 2014 shows an increase in the prevalence of adequate consumption of FV for adults and seniors according to gender, age and education. Appropriate consumption tripled during this period. There was an association between fruit consumption and weight loss, increased risk of obesity, abdominal obesity, hypertriglyceridemia and presence of metabolic syndrome (SM). CONCLUSIONS: The prevalence of adequate consumption of FV is low in all regions of Brazil and among all age groups, the highest prevalence is among women and increases with the advance of age, higher education level and higher socioeconomic status. Adequate fruit consumption correlates to weight loss and/or weight gain control of individuals.

INTRODUÇÃO: A obesidade atinge mais da metade da população adulta brasileira e se correlaciona com o desenvolvimento de doenças crônicas e psicossociais. O consumo de frutas, legumes e verduras (FLV) é fator de proteção para obesidade, porém seu consumo está frequentemente abaixo das recomendações. OBJETIVO: Identificar a situação de consumo de frutas no Brasil nos ciclos de desenvolvimento humano, bem como dados de associação do consumo com excesso de peso. MÉTODO: Revisão de literatura não sistemática nas bases de dados BVS, do período de 2005 a 2015. Foram selecionados 23 trabalhos em língua portuguesa e inglesa, segundo desenho e grupo populacional. Foram selecionados apenas coortes e cortes transversais realizados no Brasil. Foi considerado consumo de FLV adequado de 400g/dia ou frequência de 5 porções/dia (3 porções/dia de frutas), e excesso de peso segundo cada faixa etária e ciclo de desenvolvimento. RESULTADOS E DISCUSSÃO: O consumo médio encontrado para gestantes foi de 350g/dia. Foi encontrada relação inversa entre o consumo de fibras totais e o ganho ponderal gestacional. A média de consumo adequado de crianças e adolescentes se manteve entre 30 e 40%, com redução de consumo conforme aumento da idade. Dados da Vigitel entre 2006 e 2014 demonstram aumento na prevalência de consumo adequado de FLV por adultos e idosos conforme sexo, idade e escolaridade. O consumo adequado triplicou neste período. Houve associação entre o consumo de frutas e a perda de peso, risco aumentado de obesidade, obesidade abdominal, hipertrigliceridemia e presença de SM. CONCLUSÕES: Há evidências de baixas prevalências de consumo adequado de FLV em todas as regiões do Brasil e grupos etários, maiores entre as mulheres e conforme o avanço da idade, escolaridade e nível socioeconômico. O consumo adequado de frutas se correlaciona à perda de peso e/ou controle do ganho ponderal dos indivíduos.

Interventions for promoting the initiation of breastfeeding.

BACKGROUND: Despite the widely documented health advantages of breastfeeding over formula feeding, initiation rates remain relatively low in many high-income countries, particularly among women in lower income groups. OBJECTIVE: To evaluate the effectiveness of interventions which aim to encourage women to breastfeed in terms of changes in the number of women who start to breastfeed. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2007), handsearched the Journal of Human Lactation, Health Promotion International and Health Education Quarterly from inception to 15 August 2007, and scanned reference lists of all articles obtained. SELECTION CRITERIA: Randomized controlled trials, with or without blinding, of any breastfeeding promotion intervention in any population group except women and infants with a specific health problem. DATA COLLECTION AND ANALYSIS: One review author independently extracted data and assessed trial quality, checked by a second author. We contacted investigators to obtain missing information. MAIN RESULTS: Main results: Eleven trials were included. Statistical analyses were conducted on data from eight trials (1553 women). Five studies (582 women) on low incomes in the USA with typically low breastfeeding rates showed breastfeeding education had a significant effect on increasing initiation rates compared to standard care (risk ratio (RR) 1.57, 95% confidence interval (CI) 1.15 to 2.15, P = 0.005). Subgroup analyses showed that one-to-one, needs-based, informal repeat education sessions and generic, formal antenatal education sessions are effective in terms of an increase in breastfeeding rates among women on low incomes regardless of ethnicity and feeding intention. Needs-based, informal peer support in the antenatal and postnatal periods was also shown to be effective in one study conducted among Latina women who were considering breastfeeding in the USA (RR 4.02, 95% CI 2.63 to 6.14, P < 0.00001). AUTHORS' CONCLUSIONS: This review showed that health education and peer support interventions can result in some improvements in the number of women beginning to breastfeed. Findings from these studies suggest that larger increases are likely to result from needs-based, informal repeat education sessions than more generic, formal antenatal sessions. These findings are based only on studies conducted in the USA, among women on low incomes with varied ethnicity and feeding intention, and this raises some questions regarding generalisability to other settings.

O impacto da introdução precoce de terapia nutricional enteral na redução da morbimortalidade na terapia intensiva pediátrica: uma revisão sistemática / Early enteral nutrition therapy and mortality in a pediatric intensive care unit

OBJETIVO: Avaliar o impacto da introdução precoce de terapia nutricional enteral na redução da morbimortalidade em unidades de terapia intensiva pediátrica. MÉTODOS: Pesquisa bibliográfica nas bases de dados PubMed, Lilacs e Embase dos últimos 10 anos, em língua inglesa e população-alvo de indivíduos de 1 mês de idade a 18 anos, internados em unidades de terapia intensiva pediátrica, usando as palavras-chave: Critical Care, Nutritional Support e Nutrition Disorders or Malnutrition. RESULTADOS: Apesar dos avanços na qualidade dos cuidados clínicos, a prevalência de desnutrição em crianças hospitalizadas permanece imutável nos últimos 20 anos (15-30%) e tem implicações no tempo de internação, curso da doença e morbidade. A desnutrição é comum e é com frequência pouco reconhecida e então, não tratada. A terapia nutricional é parte essencial no tratamento dos pacientes pediátricos gravemente doentes que apresentam estado de hipercatabolismo proteico, que pode ser minimizado com um plano terapêutico nutricional efetivo. Neste estudo, foram revisadas publicações que mostraram que ainda há uma escassez de pesquisas controladas e randomizadas com bom tratamento estatístico em relação à terapia nutricional enteral com desfecho relacionado à morbimortalidade. As diretrizes atuais para terapia nutricional desses pacientes são amplamente baseadas na opinião de experts e em dados extrapolados de estudos em adultos, bem como de estudos realizados em crianças saudáveis. CONCLUSÃO: A evidência científica na utilização de terapia nutricional enteral na melhora da evolução dos pacientes pediátricos gravemente doentes ainda é escassa e são necessários novos estudos focados nisso, além de diretrizes mais bem-formuladas.

OBJECTIVE: To assess the impact of early introduction of enteral nutrition therapy in reducing morbidity and mortality in pediatric intensive care unit. METHODS: Search in the literature of the last 10 years, in English and the target population of individuals aged 1 month to 18 years admitted to pediatric intensive care units in the databases PubMed, Lilacs and Embase using the keywords: Critical Care, Nutritional Support and Nutrition Disorders or Malnutrition. RESULTS: Despite advances in the quality of clinical care, the prevalence of malnutrition in hospitalized children remains unchanged in the last 20 years (15-30%) and has implications for the time of admission, course of illness and morbidity. Malnutrition is common and is often poorly recognized and therefore, untreated. Nutritional therapy is an essential part in the treatment of pediatric patients who have severely ill hypercatabolic state protein, which can be minimized with an effective nutritional treatment plan. In this study, we reviewed publications which have shown that there is still a paucity of randomized and controlled studies with good statistical treatment in relation to enteral nutritional therapy with outcomes related to morbidity and mortality. The current guidelines for nutritional therapy in these patients are largely based on expert opinion and data extrapolated from adult studies and studies in healthy children. CONCLUSION: The scientific evidence on the use of enteral nutrition therapy in improving the development of critically ill pediatric patients is still scarce and further studies are needed focusing on it, and better guidelines must be formulated.

Impact of early enteral nutrition therapy on morbimortality reduction in a pediatric intensive care unit: a systematic review.

OBJECTIVE: To assess the impact of early introduction of enteral nutrition therapy in reducing morbidity and mortality in pediatric intensive care unit. METHODS: Search in the literature of the last 10 years, in English and the target population of individuals aged 1 month to 18 years admitted to pediatric intensive care units in the databases PubMed, Lilacs and Embase using the keywords: Critical Care, Nutritional Support and Nutrition Disorders or Malnutrition. RESULTS: Despite advances in the quality of clinical care, the prevalence of malnutrition in hospitalized children remains unchanged in the last 20 years (15-30%) and has implications for the time of admission, course of illness and morbidity. Malnutrition is common and is often poorly recognized and therefore, untreated. Nutritional therapy is an essential part in the treatment of pediatric patients who have severely ill hypercatabolic state protein, which can be minimized with an effective nutritional treatment plan. In this study, we reviewed publications which have shown that there is still a paucity of randomized and controlled studies with good statistical treatment in relation to enteral nutritional therapy with outcomes related to morbidity and mortality. The current guidelines for nutritional therapy in these patients are largely based on expert opinion and data extrapolated from adult studies and studies in healthy children. CONCLUSION: The scientific evidence on the use of enteral nutrition therapy in improving the development of critically ill pediatric patients is still scarce and further studies are needed focusing on it, and better guidelines must be formulated.

Fluid intake patterns: an epidemiological study among children and adolescents in Brazil.

BACKGROUND: Energy from liquids is one of the most important factors that could impact on the high prevalence of children and adolescents obesity around the world. There are few data on the liquid consumption in Brazil. The aim of this study is to evaluate the volume and quality of liquids consumed by Brazilian children and adolescents and to determine the proportion of their daily energy intake composed of liquids. METHODS: A multicenter study was conducted in five Brazilian cities; the study included 831 participants between 3 and 17 years of age. A four-day dietary record specific to fluids was completed for each individual, and the volume of and Kcal from liquid intake were evaluated. The average number of Kcal in each beverage was determined based on label information, and the daily energy intake data from liquids were compared with the recommendations of the National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária- ANVISA), the Brazilian food regulation authority, according to each subject's age. RESULTS: As the children aged, the volume of carbonated beverages that they consumed increased significantly, and their milk intake decreased significantly. For children between the ages of 3 and 10, milk and dairy products contributed the greatest daily number of Kcal from liquids. Sugar sweetened beverages which included carbonated beverages, nectars and artificial beverages, accounted for 37% and 45% of the total Kcal from liquid intake in the 3- to 6-year-old and 7- to 10- year-old groups, respectively. Among adolescents (participants 11- to 17- years old), most of the energy intake from liquids came from carbonated beverages, which accounted for an average of 207 kcal/day in this group (42% of their total energy intake from liquids). Health professionals should be attentive to the excessive consumption of sugar sweetened beverages in children and adolescents. The movement toward healthier dietary patterns at the individual and population levels may help to improve programs for preventing overweight and obesity in children and adolescents. CONCLUSION: From childhood to adolescence the daily volume of liquid ingested increased reaching a total of 2.0 liters on average. Of this volume, the daily volume of milk ingested decreased while the carbonated drinks, sweetened, nectars and artificial beverages increased significantly. The proportion of water remained constant in about 1/3 of the total volume. From 3 to 17 years of age the energy intake from carbonated beverages increased by about 20%. The carbonated drinks on average corresponded to a tenth of the daily requirements of energy of adolescents.

A 10-month anthropometric and bioimpedance evaluation of a nutritional education program for 7-14 year old students

A prevalência do excesso de peso na infância aumentou nas últimas décadas. Considerando a relevância da escola na promoção da saúde, intervenções educativas individualizadas neste ambiente são necessárias. O presente estudo teve por objetivo determinar a influência de um programa de educação nutricional na promoção de hábitos alimentares saudáveis e no estado nutricional de alunos em idade escolar. Avaliaram-se 416 crianças e adolescentes, entre 7 e 14 anos, que frequentavam duas escolas públicas de educação complementar. A intervenção por 10 meses, realizada em uma das escolas, baseou-se na prática de atividades em educação nutricional destinadas a alunos, responsáveis legais e equipe escolar, com substanciais modificações do cardápio. Avaliou-se o peso, estatura, IMC, massa magra e massa gorda, nos grupos de intervenção (escola 1) e controle (escola 2). No início do estudo registrou-se respectivamente excesso de peso em ambas as escolas (34,0 e 28 por cento) e também de obesidade (16,9 e 10,4 por cento); com redução significativa desta última ao final do estudo (p = 0,001). Em relação ao crescimento dos alunos, este foi normal para a faixa etária nas duas escolas, sendo superior na escola 1 (p = 0,04). A composição corporal obtida por impedância bioelétrica registrou aumento da massa magra nas escolas 1 e 2 (p < 0,01), acompanhada de aumento da massa gorda apenas na escola 2 (p = 0,01). Estes resultados correlacionados à redução significativa do IMC, às proporções corporais, e ao crescimento estatural atingido pelos alunos da casa 1, indicam que a alimentação adotada foi benéfica.(AU)

Over the past several decades, an increasing prevalence of excessive weight has been observed among children. Considering the importance of schools in promoting health, the implementation of individualized educational interventions in a school setting is necessary. The present study aimed to determine the influence of a nutritional education program in promoting the healthy eating habits and nutritional status of school-aged students. A total of 416 children and adolescents between 7 and 14 years of age who were enrolled in 2 complementary public schools were evaluated. A 10-month intervention in one of the schools was based on a nutritional education program targeting the students, legal guardians and school staff and involved substantial changes in the school meal menu. Weight, height, BMI, lean mass and body fat mass were evaluated in both the intervention (school 1) and the control (school 2) groups. At the beginning of the study, both school 1 and 2 exhibited a prevalence of overweight (34.0% and 28%, respectively) and obese students (16.9% and 10.4%, respectively); obesity was significantly reduced by the end of the study (p = 0.001). The growth of the students was considered normal for the age range in both schools, although it was slightly larger in school 1 (p = 0.04). Measurements of body composition, which were collected using bioelectrical impedance, indicated an increase in lean mass in both schools (p < 0.01) with an increase in body fat mass being observed only in school 2 (p = 0.01). These results, which are related to a significant reduction of the BMI, a change in bodily proportions and an increase in height growth for the students of school 1, indicate the beneficial aspects of the adopted diet.(AU)

A 10-month anthropometric and bioimpedance evaluation of a nutritional education program for 7 - to 14-year-old students / Avaliação antropométrica e por bioimpedância de um programa de educação nutricional para escolares na faixa etária de 7-14 anos durante o período de 10 meses

Over the past several decades, an increasing prevalence of excessive weight has been observed among children. Considering the importance of schools in promoting health, the implementation of individualized educational interventions in a school setting is necessary. The present study aimed to determine the influence of a nutritional education program in promoting the healthy eating habits and nutritional status of school-aged students. A total of 416 children and adolescents between 7 and 14 years of age who were enrolled in 2 complementary public schools were evaluated. A 10-month intervention in one of the schools was based on a nutritional education program targeting the students, legal guardians and school staff and involved substantial changes in the school meal menu. Weight, height, BMI, lean mass and body fat mass were evaluated in both the intervention (school 1) and the control (school 2) groups. At the beginning of the study, both school 1 and 2 exhibited a prevalence of overweight (34.0 percent and 28 percent, respectively) and obese students (16.9 percent and 10.4 percent, respectively); obesity was significantly reduced by the end of the study (p = 0.001). The growth of the students was considered normal for the age range in both schools, although it was slightly larger in school 1 (p = 0.04). Measurements of body composition, which were collected using bioelectrical impedance, indicated an increase in lean mass in both schools (p < 0.01) with an increase in body fat mass being observed only in school 2 (p = 0.01). These results, which are related to a significant reduction of the BMI, a change in bodily proportions and an increase in height growth for the students of school 1, indicate the beneficial aspects of the adopted diet.(AU)

A prevalência do excesso de peso na infância aumentou nas últimas décadas. Considerando a relevância da escola na promoção da saúde, intervenções educativas individualizadas neste ambiente são necessárias. O presente estudo teve por objetivo determinar a influência de um programa de educação nutricional na promoção de hábitos alimentares saudáveis e no estado nutricional de alunos em idade escolar. Avaliaram-se 416 crianças e adolescentes, entre 7 e 14 anos, que frequentavam duas escolas públicas de educação complementar. A intervenção por 10 meses, realizada em uma das escolas, baseou-se na prática de atividades em educação nutricional destinadas a alunos, responsáveis legais e equipe escolar, com substanciais modificações do cardápio. Avaliou-se o peso, estatura, IMC, massa magra e massa gorda, nos grupos de intervenção (escola 1) e controle (escola 2). No início do estudo registrou-se respectivamente excesso de peso em ambas as escolas (34,0 e 28 por cento) e também de obesidade (16,9 e 10,4 por cento); com redução significativa desta última ao final do estudo (p = 0,001). Em relação ao crescimento dos alunos, este foi normal para a faixa etária nas duas escolas, sendo superior na escola 1 (p = 0,04). A composição corporal obtida por impedância bioelétrica registrou aumento da massa magra nas escolas 1 e 2 (p < 0,01), acompanhada de aumento da massa gorda apenas na escola 2 (p = 0,01). Estes resultados correlacionados à redução significativa do IMC, às proporções corporais, e ao crescimento estatural atingido pelos alunos da casa 1, indicam que a alimentação adotada foi benéfica.(AU)

A 10-month anthropometric and bioimpedance evaluation of a nutritional education program for 7-14 year old students

A prevalência do excesso de peso na infância aumentou nas últimas décadas. Considerando a relevância da escola na promoção da saúde, intervenções educativas individualizadas neste ambiente são necessárias. O presente estudo teve por objetivo determinar a influência de um programa de educação nutricional na promoção de hábitos alimentares saudáveis e no estado nutricional de alunos em idade escolar. Avaliaram-se 416 crianças e adolescentes, entre 7 e 14 anos, que frequentavam duas escolas públicas de educação complementar. A intervenção por 10 meses, realizada em uma das escolas, baseou-se na prática de atividades em educação nutricional destinadas a alunos, responsáveis legais e equipe escolar, com substanciais modificações do cardápio. Avaliou-se o peso, estatura, IMC, massa magra e massa gorda, nos grupos de intervenção (escola 1) e controle (escola 2). No início do estudo registrou-se respectivamente excesso de peso em ambas as escolas (34,0 e 28 por cento) e também de obesidade (16,9 e 10,4 por cento); com redução significativa desta última ao final do estudo (p = 0,001). Em relação ao crescimento dos alunos, este foi normal para a faixa etária nas duas escolas, sendo superior na escola 1 (p = 0,04). A composição corporal obtida por impedância bioelétrica registrou aumento da massa magra nas escolas 1 e 2 (p < 0,01), acompanhada de aumento da massa gorda apenas na escola 2 (p = 0,01). Estes resultados correlacionados à redução significativa do IMC, às proporções corporais, e ao crescimento estatural atingido pelos alunos da casa 1, indicam que a alimentação adotada foi benéfica.

Over the past several decades, an increasing prevalence of excessive weight has been observed among children. Considering the importance of schools in promoting health, the implementation of individualized educational interventions in a school setting is necessary. The present study aimed to determine the influence of a nutritional education program in promoting the healthy eating habits and nutritional status of school-aged students. A total of 416 children and adolescents between 7 and 14 years of age who were enrolled in 2 complementary public schools were evaluated. A 10-month intervention in one of the schools was based on a nutritional education program targeting the students, legal guardians and school staff and involved substantial changes in the school meal menu. Weight, height, BMI, lean mass and body fat mass were evaluated in both the intervention (school 1) and the control (school 2) groups. At the beginning of the study, both school 1 and 2 exhibited a prevalence of overweight (34.0% and 28%, respectively) and obese students (16.9% and 10.4%, respectively); obesity was significantly reduced by the end of the study (p = 0.001). The growth of the students was considered normal for the age range in both schools, although it was slightly larger in school 1 (p = 0.04). Measurements of body composition, which were collected using bioelectrical impedance, indicated an increase in lean mass in both schools (p < 0.01) with an increase in body fat mass being observed only in school 2 (p = 0.01). These results, which are related to a significant reduction of the BMI, a change in bodily proportions and an increase in height growth for the students of school 1, indicate the beneficial aspects of the adopted diet.

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

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

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

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

Rest energy expenditure is decreased during the acute as compared to the recovery phase of sepsis in newborns.

BACKGROUND: Little is known with respect to the metabolic response and the requirements of infected newborns. Moreover, the nutritional needs and particularly the energy metabolism of newborns with sepsis are controversial matter. In this investigation we aimed to evaluate the rest energy expenditure (REE) of newborns with bacterial sepsis during the acute and the recovery phases. METHODS: We studied nineteen neonates (27.3 +/- 17.2 days old) with bacterial sepsis during the acute phase and recovery of their illness. REE was determined by indirect calorimetry and VO2 and VCO2 measured by gas chromatography. RESULTS: REE significantly increased from 49.4 +/- 13.1 kcal/kg/day during the acute to 68.3 +/- 10.9 kcal/kg/day during recovery phase of sepsis (P < 0.01). Similarly, VO2 (7.4 +/- 1.9 vs 10 +/- 1.5 ml/kg/min) and VCO2 (5.1 +/- 1.7 vs 7.4 +/- 1.5 ml/kg/min) were also increased during the course of the disease (P < 0.01). CONCLUSION: REE was increased during recovery compared to the sepsis phase. REE of septic newborns should be calculated on individualized basis, bearing in mind their metabolic capabilities.

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

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

Challenges of nutritional assessment in pediatric ICU.

PURPOSE OF REVIEW: The nutritional assessment of children in the pediatric ICU is unique in view of the metabolic changes of the underlying disease. This review addresses the use and limitations of anthropometry and laboratorial and body composition markers in the diagnosis of the nutritional status of such patients. RECENT FINDINGS: The presence of inflammatory activity leads to body composition changes (lean mass reduction) and undernutrition. Nutritional assessment in pediatric ICU must prioritize anthropometric and laboratory markers that can differentiate body composition to detect specific macronutrient and micronutrient deficiencies and assessment of the inflammatory activity. SUMMARY: Nutritional assessment is one of the main aspects of the pediatric intensive care patient and is the most important tool to avoid hospital undernutrition. There is currently no gold standard for nutritional assessment in the pediatric ICU. The results of anthropometric and laboratory markers must be jointly analyzed, but individually interpreted according to disease and metabolic changes, in order to reach a correct diagnosis of the nutritional status and to plan and monitor the nutritional treatment.