Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 18 de 18
Filtrar
1.
J Acad Nutr Diet ; 120(2): 219-229, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31522971

RESUMEN

BACKGROUND: There are few studies that assess the role of different nutritional assessment variables at pediatric intensive care unit (PICU) admission in predicting clinical outcomes. OBJECTIVE: To identify nutritional variables in the first 4 days of PICU stay that predict 60-day mortality and time to discharge alive from the PICU. DESIGN: Single-center prospective study in Southern Brazil, conducted between July 2013 and February 2016. At PICU admission, children with z scores <-2 for body mass index (BMI)-for-age, mid-upper arm circumference (MUAC)-for-age, and triceps skinfold thickness (TSF)-for-age were considered as undernourished. PARTICIPANTS/SETTING: There were 199 patients, aged <15 years, with PICU stay >48 hours. MAIN OUTCOME MEASURES: Sixty-day mortality and time to discharge alive from the PICU. STATISTICAL ANALYSIS PERFORMED: Cox regression model was applied to determine predictors of 60-day mortality and time to discharge alive from the PICU. RESULTS: Median age was 23.1 months (interquartile range=3.9 to 89.1), and 63% were male, with 18% prevalence of undernutrition at admission by BMI-for-age. Median PICU stay was 7 days (interquartile range=4 to 12), and 60-day mortality was 12%. After adjusting for sex, age, Pediatric Index of Mortality 2, and presence of complex chronic conditions, undernutrition based on BMI-for-age (hazard ratio [HR]=3.75; 95% CI=1.41 to 9.95; P=0.008), MUAC-for-age (HR=7.62; 95% CI=2.42 to 23.97; P=0.001), and TSF-for-age (HR=4.01; 95% CI=1.14 to 14.15; P=0.031) was associated with higher risk of 60-day mortality. Based on MUAC-for-age with the same adjustment model, undernourished children had longer time to discharge alive from the PICU (HR=0.45; 95% CI=0.21 to 0.98; P=0.045). CONCLUSIONS: Undernutrition at PICU admission based on different anthropometric variables was predictive of 60-day mortality and longer time to discharge alive from the PICU.


Asunto(s)
Trastornos de la Nutrición del Niño/mortalidad , Enfermedad Crítica/mortalidad , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Adolescente , Antropometría , Índice de Masa Corporal , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Alta del Paciente/estadística & datos numéricos , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Análisis de Regresión , Factores de Tiempo
2.
JPEN J Parenter Enteral Nutr ; 43(2): 281-289, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-29959852

RESUMEN

BACKGROUND: Loss of muscle mass in critically ill children can negatively impact outcomes. The aims of this study were to conduct a pilot randomized control trial (RCT) to examine the difference in protein delivery and nitrogen balance in critically ill children with enteral protein supplementation vs controls. We also aimed to assess the feasibility, safety, and tolerance of the pilot trial. METHODS: This is a 3-arm RCT in critically ill children eligible for enteral nutrition (EN) therapy. Patients were randomized to 1 of the 3 groups: (1) control (routine EN), (2) polymeric protein module added to EN to reach protein goal by day 4, or (3) oligomeric protein supplementation. Demographics, clinical characteristics, nutrition status, and daily nutrition intake variables were recorded. Protein delivery, nitrogen balance, feasibility variables, and rate of adverse events were the outcomes. RESULTS: After screening 286 consecutive patients admitted to the pediatric intensive care unit over 11 months, we enrolled and randomized 25 patients. Twenty-two patients (88% of the enrolled) completed the study procedures. Significantly higher protein prescription and actual protein intake within the first 5 days was achieved in the intervention groups, compared with the control group. Nitrogen balance was obtained in 15 patients. There was no significant difference between the groups for the rate of adverse effects and clinical outcomes. CONCLUSION: In our pilot trial, protein supplementation was safe and well tolerated. Our preliminary results suggest that a larger RCT is potentially feasible, with some modifications of the entry criteria. Trial enrollment was low, likely due to restrictive entry criteria.


Asunto(s)
Cuidados Críticos/métodos , Proteínas en la Dieta/administración & dosificación , Suplementos Dietéticos , Nutrición Enteral/métodos , Enfermedad Crítica , Nutrición Enteral/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Humanos , Lactante , Tiempo de Internación/estadística & datos numéricos , Masculino , Proyectos Piloto
3.
PLoS One ; 13(6): e0198457, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29933382

RESUMEN

The aim of the present study was to evaluate the effect of cystic fibrosis and antibiotic therapy on intestinal microbiota composition and intestinal inflammation in children and adolescents. A cross-sectional controlled study was conducted with 36 children and adolescents: 19 in the cystic fibrosis group (CFG) and 17 in the control group (CG) matched for age and sex. The CFG was subdivided based on the use of antibiotic therapy (CFAB group) and non-use of antibiotic therapy (CFnAB group). The following data were evaluated: colonization, antibiotic therapy, mutation, breastfeeding, use of infant formula, type of delivery, introduction of solid foods, body mass index, fecal calprotectin and intestinal microbiota composition (fluorescence in situ hybridization). Intestinal inflammation evaluated by fecal calprotectin was significantly higher in the CFG (median: 40.80 µg/g, IQR: 19.80-87.10, p = 0.040) and CFAB group (median: 62.95 µg/g, IQR: 21.80-136.62, p = 0.045) compared to the CG (median: 20.15 µg/g, IQR: 16.20-31.00), and the Bacteroides, Firmicutes, Eubacterium rectale and Faecalibacterium prausnitzii were significantly decreased (p < 0.05) in the CFG compared to the CG, whereas the bacteria Clostridium difficile, Escherichia coli and Pseudomonas aeruginosa were significantly increased in the CFG (p < 0.05). The main differences were found between the CG and CFAB group for Eubacterium rectale (p = 0.006), Bifidobacterium (p = 0.017), Escherichia coli (p = 0.030), Firmicutes (p = 0.002), Pseudomonas aeruginosa (p < 0.001) and Clostridium difficile (p = 0.006). The results of this study confirm intestinal inflammation in patients with CF, which may be related to changes in the composition of the intestinal microbiota.


Asunto(s)
Antibacterianos/efectos adversos , Bacterias/clasificación , Fibrosis Quística/microbiología , Microbioma Gastrointestinal/efectos de los fármacos , Bacterias/genética , Bacterias/aislamiento & purificación , Estudios de Casos y Controles , Niño , Preescolar , Estudios Transversales , Heces/microbiología , Femenino , Humanos , Lactante , Masculino , Filogenia
4.
Artículo en Portugués | LILACS | ID: biblio-1129913

RESUMEN

A atenção primária à saúde (APS) constitui espaço privilegiado de atuação de políticas públicas de saúde e representa o nível de atenção preferencial para os usuários do Sistema Único de Saúde (SUS) obterem o atendimento de suas necessidades. Diante da carência de melhor compreensão sobre este tema, buscou-se analisar a produção científica acerca da percepção dos usuários sobre suas necessidades no âmbito da APS no SUS, a partir da taxonomia de Matsumoto. Trata-se de uma revisão integrativa de literatura, na qual foram selecionados quatro artigos completos, disponíveis em língua portuguesa, como resultado da busca realizada nas bases de dados eletrônicas Lilacs e Medline, usando as palavras-chave "necessidades e demandas de serviços de saúde", "necessidades" e "necessidades de saúde", publicados entre 2009 e 2013. Os estudos analisados utilizam abordagem qualitativa (classificados com nível de evidência número 4), são de autoria de enfermeiros e apresentam o estado de São Paulo como local de pesquisa predominante. As categorias de necessidades de saúde expressas pelos usuários nos artigos contemplaram aquelas propostas por Matsumoto. Concluiu-se que os usuários da atenção primária do SUS compreendem suas necessidades no âmbito da APS e têm uma visão ampliada de que elas não estão atreladas apenas aos fatores biológicos, mas envolvem também a sua situação social, além do acesso que devem possuir a todos os serviços de saúde desde a porta de entrada.


Primary Health Care (PHC) is a privileged space for the performance of public health policies and represents the level of preferential care for users of the Unified Health System (SUS) to meet their health needs. In view of the lack of better understanding on this topic, we sought to analyze the scientific production about users' perceptions about their health needs within the scope of PHC in the SUS, based on the Matsumoto taxonomy. This is an Integrative Review of Literature, in which 4 complete articles were selected, available in Portuguese language, as a result of the search carried out with the electronic databases LILACS and MEDLINE, using the key expressions "Needs and Demands of Services of Health "," Needs "and" Health needs ", published between 2009 and 2013. The studies used a qualitative approach (classified with level of evidence number 4), were authored by nurses, and presented the State of São Paulo as research. The categories of health needs expressed by the users in the articles contemplated those proposed by Matsumoto. It was concluded that SUS primary health care users understand their health needs within PHC and have a broad view that they are not only linked to biological factors, but also involve their social situation, as well as the access they must have to all health services from the front door.


La Atención Primaria de Salud (APS) constituye un espacio privilegiado de actuación de políticas públicas de salud y representa el nivel de atención preferencial para que los usuarios del Sistema Único de Salud (SUS) obtengan la atención de sus necesidades de salud. Ante la falta de una mejor comprensión sobre este tema, se buscó analizar la producción científica acerca de la percepción de los usuarios sobre sus necesidades de salud en el ámbito de la APS, en el SUS, a partir de la taxonomía de Matsumoto. Es una revisión integradora de la literatura en la que se seleccionaron cuatro artículos completos, disponibles en inglés, como resultado de la búsqueda realizada en las bases de datos electrónicas MEDLINE y LILACS utilizando las palabras clave "Necesidades y demandas de servicios de salud", "Necesidades" y "Necesidades de salud", publicados entre 2009 y 2013. Los estudios utilizaron enfoque cualitativo (clasificados con nivel de evidencia número 4), fueron de autoría de enfermeros y presentaron el estado de São Paulo como el lugar de investigación predominante. Las categorías de necesidades de salud expresadas por los usuarios en los artículos contemplaron aquellas propuestas por Matsumoto. Se concluyó que los usuarios de la atención primaria del SUS comprenden sus necesidades de salud en el ámbito de la APS y tienen una visión ampliada de que ellas no están ligadas sólo a los factores biológicos, sino que involucra también su situación social, además del acceso que deben tener a todos los servicios de salud desde la puerta de entrada.


Asunto(s)
Humanos , Atención Primaria de Salud , Sistema Único de Salud , Salud Pública , Base de Datos
5.
Rev. paul. pediatr ; 36(1): 31-38, jan.-mar. 2018. tab, graf
Artículo en Portugués | LILACS | ID: biblio-902893

RESUMEN

RESUMO Objetivo: Avaliar a associação entre estado nutricional, função pulmonar e morbidade em coorte de 36 meses de crianças e adolescentes com fibrose cística (FC). Métodos: Coorte prospectiva de 36 meses, com crianças e adolescentes com FC e idade entre 1 e 15 anos. No tempo inicial, o estado nutricional foi determinado a partir dos indicadores: peso-para-estatura e índice de massa corporal-para-idade, para crianças <2 anos e ≥2 anos, respectivamente, e classificado em: falência nutricional, risco nutricional e estado nutricional aceitável; também foi determinado por meio do percentil 50°, de acordo com a curva de crescimento da World Health Organization (WHO). A função pulmonar foi avaliada pelo volume expiratório forçado no primeiro segundo (VEF1). A morbidade foi determinada pela presença de infecção e hospitalização por exacerbação pulmonar. Foi calculado risco relativo (RR) e intervalo de confiança (IC95%), considerando significante p<0,05. Resultados: Foram avaliadas 38 crianças e adolescentes (mediana de idade 3,8 anos). Os pacientes classificados em falência nutricional no início do estudo mostraram um RR de 5,00 (IC95% 1,49; 16,76) para o comprometimento da função pulmonar após 36 meses. Aqueles classificados abaixo do percentil 50° apresentaram RR de 4,61 (IC95% 0,89; 23,81) para o desfecho. O estado nutricional não foi fator de risco para morbidade. Conclusões: O déficit nutricional esteve associado ao comprometimento da função pulmonar, mas não com a morbidade em crianças e adolescentes com FC.


ABSTRACT Objective: To evaluate the association between nutritional status, lung function and morbidity in a 36-month cohort in children and adolescents with cystic fibrosis. Methods: Prospective cohort of children and adolescents with cystic fibrosis aged 1-15 years. At the baseline, the nutritional status was determined by weight-for-height and body mass index-for-age for children <2 years and ≥2 years, respectively, and classified as: nutritional failure, nutritional risk and acceptable; and by the 50th percentile, according to the World Health Organization (WHO) growth charts. Lung function was assessed by forced expiratory volume in one second (FEV1). Morbidity was determined by the presence of infection and hospitalization by pulmonary exacerbation. Risk ratio and 95% confidence interval (95%CI) were calculated, being significant when p<0.05. Results: We evaluated 38 children and adolescents (median age 3.8 years). Patients that were classified as having nutritional failure at baseline had a RR of 5.00 (95%CI 1.49; 16.76) to present impaired lung function after 36 months. Those classified bellow the 50th percentile had a RR of 4.61 (95%CI 0.89; 23.81) to present the same outcome. Nutritional status was not a risk factor for morbidity in this cohort. Conclusions: Nutritional deficit was associated with impaired lung function, but not with morbidity in children and adolescents with cystic fibrosis.


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Preescolar , Niño , Adolescente , Estado Nutricional , Fibrosis Quística/complicaciones , Fibrosis Quística/fisiopatología , Pulmón/fisiopatología , Factores de Tiempo , Volumen Espiratorio Forzado , Estudios de Cohortes
6.
Rev Paul Pediatr ; 36(1): 8, 2018.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-29412427

RESUMEN

OBJECTIVE: To evaluate the association between nutritional status, lung function and morbidity in a 36-month cohort in children and adolescents with cystic fibrosis. METHODS: Prospective cohort of children and adolescents with cystic fibrosis aged 1-15 years. At the baseline, the nutritional status was determined by weight-for-height and body mass index-for-age for children <2 years and ≥2 years, respectively, and classified as: nutritional failure, nutritional risk and acceptable; and by the 50th percentile, according to the World Health Organization (WHO) growth charts. Lung function was assessed by forced expiratory volume in one second (FEV1). Morbidity was determined by the presence of infection and hospitalization by pulmonary exacerbation. Risk ratio and 95% confidence interval (95%CI) were calculated, being significant when p<0.05. RESULTS: We evaluated 38 children and adolescents (median age 3.8 years). Patients that were classified as having nutritional failure at baseline had a RR of 5.00 (95%CI 1.49; 16.76) to present impaired lung function after 36 months. Those classified bellow the 50th percentile had a RR of 4.61 (95%CI 0.89; 23.81) to present the same outcome. Nutritional status was not a risk factor for morbidity in this cohort. CONCLUSIONS: Nutritional deficit was associated with impaired lung function, but not with morbidity in children and adolescents with cystic fibrosis.


Asunto(s)
Fibrosis Quística/complicaciones , Fibrosis Quística/fisiopatología , Pulmón/fisiopatología , Estado Nutricional , Adolescente , Niño , Preescolar , Estudios de Cohortes , Femenino , Volumen Espiratorio Forzado , Humanos , Lactante , Masculino , Factores de Tiempo
7.
Säo Paulo med. j ; 136(1): 29-36, Jan.-Feb. 2018. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-904131

RESUMEN

ABSTRACT BACKGROUND: Chronic lung infections, inflammation and depletion of nutritional status are considered to be prognostic indicators of morbidity in patients with cystic fibrosis. The aim of this study was to investigate the association between inflammatory markers and lung function, nutritional status and morbidity among children/adolescents with cystic fibrosis. DESIGN AND SETTINGS: Prospective three-year longitudinal study conducted in an outpatient clinic in southern Brazil. METHODS: Children/adolescents aged 1-15 years with cystic fibrosis were enrolled. Nutritional status was determined from weight-to-length and body mass index-to-age z-scores and was classified as acceptable, at risk or nutritional failure. Tumor necrosis factor-α, interleukin-1β, myeloperoxidase, C-reactive protein and C-reactive protein/albumin ratio were analyzed. Lung function was evaluated based on the forced expiratory volume in the first second and morbidity according to the number of hospitalizations for pulmonary exacerbation and infections by Pseudomonas aeruginosa. Lung function, nutritional status and morbidity were the outcomes. Odds ratios and 95% confidence intervals were to evaluate the effect of baseline inflammatory markers on the clinical outcomes after three years of follow-up and p-values < 0.05 were considered significant. RESULTS: We evaluated 38 children/adolescents with cystic fibrosis: 55% female; median age (with interquartile range), 3.75 years (2.71-7.00). Children/adolescents with high C-reactive protein/albumin ratio at baseline had odds of 18 (P = 0.018) of presenting forced expiratory volume in the first second ≤ 70% after three years. The other inflammatory markers were not associated with the outcomes. CONCLUSION: C-reactive protein/albumin ratio was associated with forced expiratory volume in the first second ≤ 70% after three years.

8.
Eur J Clin Nutr ; 72(5): 736-743, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29277839

RESUMEN

BACKGROUND/OBJECTIVES: Cystic fibrosis (CF) is characterized by excessive activation of immune processes. The aim of this study was to evaluate the effect of synbiotic supplementation on the inflammatory response in children/adolescents with CF. SUBJECTS/METHODS: A randomized, placebo-controlled, double-blind, clinical-trial was conducted with control group (CG, n = 17), placebo-CF-group (PCFG, n = 19), synbiotic CF-group (SCFG, n = 22), PCFG negative (n = 8) and positive (n = 11) bacteriology, and SCFG negative (n = 12) and positive (n = 10) bacteriology. Markers of lung function (FEV1), nutritional status [body mass index-for age (BMI/A), height-for-age (H/A), weight-for-age (W/A), upper-arm fat area (UFA), upper-arm muscle area (UMA), body fat (%BF)], and inflammation [interleukin (IL)-12, tumor necrosis factor-alpha (TNF-α), IL-10, IL-6, IL-1ß, IL-8, myeloperoxidase (MPO), nitric oxide metabolites (NOx)] were evaluated before and after 90-day of supplementation with a synbiotic. RESULTS: No significance difference was found between the baseline and end evaluations of FEV1 and nutricional status markers. A significant interaction (time vs. group) was found for IL-12 (p = 0.010) and myeloperoxidase (p = 0.036) between PCFG and SCFG, however, the difference was not maintained after assessing the groups individually. NOx diminished significantly after supplementation in the SCFG (p = 0.030). In the SCFG with positive bacteriology, reductions were found in IL-6 (p = 0.033) and IL-8 (p = 0.009) after supplementation. CONCLUSIONS: Synbiotic supplementation shown promise at diminishing the pro-inflammatory markers IL-6, IL-8 in the SCFG with positive bacteriology and NOx in the SCFG in children/adolescents with CF.


Asunto(s)
Fibrosis Quística/terapia , Simbióticos/administración & dosificación , Adolescente , Bifidobacterium animalis , Biomarcadores/sangre , Índice de Masa Corporal , Niño , Preescolar , Fibrosis Quística/sangre , Método Doble Ciego , Femenino , Humanos , Interleucina-6/sangre , Lactobacillus acidophilus , Lactobacillus paracasei , Masculino , Evaluación Nutricional , Estado Nutricional , Factor de Necrosis Tumoral alfa/sangre
9.
Sao Paulo Med J ; 136(1): 29-36, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29267535

RESUMEN

BACKGROUND: Chronic lung infections, inflammation and depletion of nutritional status are considered to be prognostic indicators of morbidity in patients with cystic fibrosis. The aim of this study was to investigate the association between inflammatory markers and lung function, nutritional status and morbidity among children/adolescents with cystic fibrosis. DESIGN AND SETTINGS: Prospective three-year longitudinal study conducted in an outpatient clinic in southern Brazil. METHODS: Children/adolescents aged 1-15 years with cystic fibrosis were enrolled. Nutritional status was determined from weight-to-length and body mass index-to-age z-scores and was classified as acceptable, at risk or nutritional failure. Tumor necrosis factor-α, interleukin-1ß, myeloperoxidase, C-reactive protein and C-reactive protein/albumin ratio were analyzed. Lung function was evaluated based on the forced expiratory volume in the first second and morbidity according to the number of hospitalizations for pulmonary exacerbation and infections by Pseudomonas aeruginosa. Lung function, nutritional status and morbidity were the outcomes. Odds ratios and 95% confidence intervals were to evaluate the effect of baseline inflammatory markers on the clinical outcomes after three years of follow-up and p-values < 0.05 were considered significant. RESULTS: We evaluated 38 children/adolescents with cystic fibrosis: 55% female; median age (with interquartile range), 3.75 years (2.71-7.00). Children/adolescents with high C-reactive protein/albumin ratio at baseline had odds of 18 (P = 0.018) of presenting forced expiratory volume in the first second ≤ 70% after three years. The other inflammatory markers were not associated with the outcomes. CONCLUSION: C-reactive protein/albumin ratio was associated with forced expiratory volume in the first second ≤ 70% after three years.


Asunto(s)
Proteína C-Reactiva/análisis , Fibrosis Quística/sangre , Mediadores de Inflamación/sangre , Interleucina-1beta/sangre , Peroxidasa/sangre , Albúmina Sérica/análisis , Factor de Necrosis Tumoral alfa/sangre , Adolescente , Biomarcadores/sangre , Niño , Fibrosis Quística/fisiopatología , Femenino , Humanos , Estudios Longitudinales , Masculino , Estado Nutricional , Estudios Prospectivos , Pruebas de Función Respiratoria
10.
Nutrition ; 33: 91-95, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27364223

RESUMEN

OBJECTIVES: Critically ill children admitted to the pediatric intensive care unit (PICU) often are malnourished. The aim of this study was to determine the role of nutritional status on admission as a predictor of the duration of mechanical ventilation in critically ill children. METHODS: This was a single-center, prospective cohort study, including consecutive children (ages 1 mo to 15 y) admitted to a PICU. Demographic characteristics, clinical characteristics, and nutritional status were recorded and patients were followed up until hospital discharge. Nutritional status was evaluated by anthropometric parameters and malnutrition was considered if the Z-scores for the parameters were ≤-2. Adjusted Cox's regression analysis was used to determine the association between nutritional status and duration of mechanical ventilation. RESULTS: In all, 72 patients were included. The prevalence of malnutrition was 41.2%, according to height-for-age Z-score, 18.6% according to weight-for-height Z-score, and 22.1% according body mass index-for-age Z-score. Anthropometrical parameters that predicted the duration of mechanical ventilation were weight-for-age (hazard ratio [HR], 2.73; 95% confidence interval [CI], 1.44-5.18); height-for-age (HR, 2.49; 95% CI, 1.44-4.28); and upper arm muscle area-for-age (HR, 5.22; 95% CI, 1.19-22.76). CONCLUSION: Malnutrition, based on a variety of anthropometric variables, was associated with the duration of mechanical ventilation in this cohort of critically ill children. Assessment of nutritional status by anthropometry should be performed on admission to the PICU to allow targeted nutritional rehabilitation for the subset of children with existing malnutrition.


Asunto(s)
Trastornos de la Nutrición del Niño/epidemiología , Enfermedad Crítica , Hospitalización , Desnutrición/epidemiología , Estado Nutricional , Respiración Artificial , Índice de Masa Corporal , Niño , Preescolar , Femenino , Humanos , Lactante , Unidades de Cuidado Intensivo Pediátrico , Tiempo de Internación , Masculino , Alta del Paciente , Modelos de Riesgos Proporcionales , Estudios Prospectivos
11.
Fisioter. Bras ; 18(4): f: 426-I:432, 2017.
Artículo en Portugués | LILACS | ID: biblio-906775

RESUMEN

Introdução: O sobrepeso e a obesidade infantil apresentam prevalência elevada no Brasil e podem estar ligadas a importantes alterações posturais adaptativas. Objetivo: Avaliar as principais alterações ortopédicas em crianças de 4 a 10 anos de idade, com sobrepeso e obesidade, de uma escola da rede pública da cidade de Patrocínio/MG; correlacionar essas alterações com o índice de massa corporal (IMC) e avaliar o pé de maior apoio plantar. Métodos: Estudo transversal realizado com 94 estudantes que utilizou a classificação de sobrepeso e obesidade segundo cálculo de IMC preconizado pela OMS. Para avaliação postural utilizou-se fotogrametria e os dados foram analisados no software de avaliação postural SAPO®. Para avaliação dos pés utilizou-se Plantigrama e índice de Chippaux-Smirak. Os dados foram analisados através de estatística descritiva e teste W de Shapiro-Wilk. Resultados: Na avaliação postural foi observada uma tendência à retificação lombar e joelhos valgos, porém não foram observadas diferenças significativas em relação às angulações médias de coluna vertebral e dos joelhos de acordo com o IMC e o gênero. A maioria das crianças apresentou pé plano e tinham maior apoio sob o pé direito. Conclusão: Foi observada uma maior prevalência de obesidade e sobrepeso entre os meninos. Na avaliação postural, observou-se que as crianças com sobrepeso e obesidade apresentaram tendência à retificação da lordose lombar, joelhos valgos e pés planos.(AU)


Introduction: Overweight and obesity in children have high prevalence in Brazil and may be related to important adaptive postural changes. Objective: To assess the main orthopedic disorders in children between 4 and 10 years old, with overweight and obesity, attending a public school in the city of Patrocinio/MG; to correlate these changes with BMI and assess the foot with more support. Methods: Cross-sectional study with 94 overweighted or obese students according to BMI calculation recommended by WHO. For postural evaluation was used photogrammetry and data were analyzed with the postural assessment software SAPO®. For evaluation of the feet we used Plantigrama and Chippaus-Smirak index. Data were analyzed using descriptive statistics and Shapiro-Wilk W test. Results: In the postural evaluation a tendency to lumbar rectification and valgus knees was observed, but no significant differences were observed in relation to the means spine and knee angulation according to BMI and gender. Most of the children had flat feet and greater support under the right foot. Conclusion: A higher prevalence of obesity and overweight was observed among boys. In the postural evaluation we observed that overweighted and obese children presented a tendency to rectify lumbar lordosis, valgus knees and flat feet. (AU)


Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Obesidad Pediátrica , Índice de Masa Corporal , Sobrepeso , Postura
12.
Nutr Clin Pract ; 31(5): 673-80, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27075179

RESUMEN

BACKGROUND: Optimal nutrition therapy (NT) delivery is associated with improved outcomes in critically ill children. However, avoidable barriers impede delivery of optimal energy and protein in the pediatric intensive care unit (PICU). This study aims to describe the gap between energy and protein prescription and actual intake. METHODS: Single-center prospective cohort study, including consecutive children (age: 1 month to 15 years) admitted to the PICU in southern Brazil. Demographics, clinical characteristics, and NT details were recorded. RESULTS: We enrolled 130 patients: 37% female; median (interquartile range) age, 29.43 months (4.03, 100.63); PICU length of stay, 6 days (4, 13). Median predicted energy expenditure by Schofield equation and prescribed and actual energy intake were 47.13 kcal/kg/d (38.60, 55.38), 31.94 kcal/kg/d (13.99, 51.90), and 25.06 kcal/kg/d (10.21, 46.92), respectively. On average, actual energy intake was 47% of the predicted energy expenditure, and 68% of patients were underfed. Actual protein intake was 49% of the estimated requirement. NT was interrupted in 64% of patients. CONCLUSIONS: There were significant gaps among the predicted requirement, prescription, and actual delivery of energy and protein in the PICU. Suboptimal prescription and multiple feeding interruptions resulted in underfeeding.


Asunto(s)
Cuidados Críticos/métodos , Proteínas en la Dieta/administración & dosificación , Ingestión de Energía/fisiología , Unidades de Cuidado Intensivo Pediátrico , Estado Nutricional , Apoyo Nutricional/métodos , Brasil , Niño , Preescolar , Estudios de Cohortes , Cuidados Críticos/estadística & datos numéricos , Enfermedad Crítica , Metabolismo Energético/fisiología , Femenino , Humanos , Lactante , Masculino , Apoyo Nutricional/estadística & datos numéricos , Estudios Prospectivos , Resultado del Tratamiento
13.
Nutr Clin Pract ; 31(3): 378-86, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26920645

RESUMEN

BACKGROUND: (1) To compare nutrition and hydration status between a group of children/adolescents with cystic fibrosis (CFG; n = 46; median age, 8.5 years) and a control group without cystic fibrosis (CG). (2) To examine the association of nutrition and hydration status with lung function in the CFG. MATERIAL AND METHODS: A cross-sectional study. Nutrition screening, anthropometric parameters, and bioelectrical impedance analysis (BIA) were assessed. The z scores for body mass index for age, height for age, mid upper arm circumference, triceps and subscapular skinfold thickness, mid upper arm muscle area, resistance/height, and reactance/height were calculated. Bioelectrical impedance vector analysis was conducted. Forced expiratory volume in 1 second <80% was considered lung function impairment. An adjusted logistic regression was applied (P < .05). RESULTS: In the CFG, lung function impairment was observed in 51.1%. All anthropometric parameters were lower, and the mean z-resistance/height and z-reactance/height were higher in the CFG (P < .05) compared with the CG. In the CFG, 43% were severely/mildly dehydrated, while none were in the CG (P = .007). In the CFG, there was an association between high nutrition risk-via nutrition screening (odds ratio [OR], 22.28; P < .05), lower values of anthropometric parameters, higher z-resistance/height (OR, 2.23; P < .05) and z-reactance/height (OR, 1.81; P < .05), and dehydration (OR, 4.94; P < .05)-and lung function impairment. CONCLUSIONS: The CFG exhibited a compromised nutrition status assessed by anthropometric and BIA parameters. Nutrition screening, anthropometric and BIA parameters, and hydration status were associated with lung function.


Asunto(s)
Composición Corporal/fisiología , Agua Corporal/fisiología , Fibrosis Quística/fisiopatología , Impedancia Eléctrica , Pulmón/fisiopatología , Estado Nutricional/fisiología , Adolescente , Niño , Estudios Transversales , Femenino , Humanos , Masculino
14.
Life Sci ; 109(1): 30-6, 2014 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-24931908

RESUMEN

AIMS: Recurrent infections and activation of the inflammatory response affect the prognosis of cystic fibrosis (CF). We investigated the relationship between inflammatory response, infection, and pulmonary function in CF. MAIN METHODS: A clinical-cross-sectional study was conducted with 86 subjects: control group (CG, n=31, the same age and sex of the CF group), and CF group (CFG, n=55, age: 1-16 years), further distributed into CFG negative or positive bacteriology (CFGB(-)/CFGB(+)), and CFG negative or positive Pseudomonas aeruginosa (CFGPa(-)/CFGPa(+)). Using the Wald test, multiple linear regression (95% confidence interval) was performed between CG and CFG, and between CG and each of the CF subgroups (CFGB(-)/CFGB(+) and CFGPa(-)/CFGPa(+)). The inflammatory markers evaluated were myeloperoxidase (MPO), adenosine deaminase (ADA) activities, interleukin-1beta (IL-1ß), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP), nitric oxide metabolites (NOx) levels, and total and differential leukocyte counts. KEY FINDINGS: After adjusting for sex and age, CFG compared to CG revealed an increase of MPO, IL-1ß (P<0.001 in all subgroups), and CRP: CFG (P=0.002), CFGB(-) (P=0.007), CFGB(+) (P=0.009), CFGPa(-) (P=0.004) and CFGPa(+) (P=0.020). NOx (P=0.001, P<0.001), leukocytes (P=0.002, P=0.001), and neutrophils (P=0.003, P<0.001) were increased in CFGB(+) and CFGPa(+), respectively. A negative correlation between FEV1 and leukocytes (P=0.008) and FEV1 and neutrophils (P=0.031) resulted in CFG. SIGNIFICANCE: The inflammatory response characterized by the increase of MPO, IL-1ß, and CRP is determinant for CF. Also leukocytosis due to neutrophilia determines the pulmonary function deficiency in this disease.


Asunto(s)
Fibrosis Quística/complicaciones , Neumonía/complicaciones , Infecciones por Pseudomonas/complicaciones , Pseudomonas aeruginosa/inmunología , Adolescente , Niño , Preescolar , Estudios Transversales , Fibrosis Quística/diagnóstico , Fibrosis Quística/inmunología , Fibrosis Quística/microbiología , Femenino , Humanos , Lactante , Pulmón/inmunología , Pulmón/microbiología , Masculino , Neumonía/diagnóstico , Neumonía/inmunología , Neumonía/microbiología , Infecciones por Pseudomonas/diagnóstico , Infecciones por Pseudomonas/inmunología , Pseudomonas aeruginosa/aislamiento & purificación
15.
J Burn Care Res ; 30(5): 859-66, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19692922

RESUMEN

The aim of this study was to investigate the effect of supplementation of vitamin E, vitamin C, and zinc on the oxidative stress in burned children. In a prospective double-blind placebo controlled pilot study, 32 patients were randomized as no supplementation (n = 15) or antioxidant supplementation (n = 17) groups. Supplementation consisted of the antioxidant mixture of vitamin C (1.5 times upper intake level), vitamin E (1.35 times upper intake level), and zinc (2.0 times recommended dietary allowance) administered during 7 days starting on the second day of admittance into the hospital. Energy requirement was calculated by the Curreri equation, and protein input was 3.0 g/kg of ideal body mass index (percentile 50). Total antioxidant capacity of plasma and malondialdehyde were used to monitor oxidative stress. The time of wound healing was evaluated as the main clinical feature. Patients (age 54.2 +/- 48.9 months, 65.6% males), who exhibited 15.5 +/- 6.7% of total burn area, showed no differences in age and sex, when compared with controls. Intake of the administered antioxidants was obviously higher in treated subjects (P = .005), and serum differences were confirmed for vitamin E and C, but not for zinc (P = .180). There was a decrease in lipid peroxidation (malondialdehyde level) (P = .006) and an increase in vitamin E concentrations in the antioxidant supplementation group (P = .016). The time of wound healing was lower in the supplemented group (P < .001). The antioxidant supplementation through vitamin E and C and the mineral zinc apparently enhanced antioxidant protection against oxidative stress and allowed less time for wound healing.


Asunto(s)
Ácido Ascórbico/uso terapéutico , Quemaduras/tratamiento farmacológico , Estrés Oxidativo/efectos de los fármacos , Vitamina E/uso terapéutico , Zinc/uso terapéutico , Adolescente , Análisis de Varianza , Distribución de Chi-Cuadrado , Niño , Preescolar , Método Doble Ciego , Femenino , Humanos , Masculino , Proyectos Piloto , Placebos , Estudios Prospectivos , Estadísticas no Paramétricas , Resultado del Tratamiento , Cicatrización de Heridas/efectos de los fármacos
16.
Rev. nutr ; 20(6): 693-702, nov.-dez. 2007. tab
Artículo en Portugués | LILACS | ID: lil-475112

RESUMEN

Na queimadura, os radicais livres são produzidos durante a reposição de fluídos, alterando numerosos componentes, como os ácidos nucléicos, os lipídios e as proteínas. Sendo assim, se, por um lado, essa restauração do fluxo sanguíneo é, em geral, necessária para recuperar a função celular normal, por outro lado a reintrodução do sangue oxigenado nos tecidos isquêmicos contribui para uma produção excessiva de radicais livres derivados do oxigênio, exacerbando a lesão mediada pela isquemia. O papel dos neutrófilos ativados na célula após a queimadura também tem recebido atenção especial. A partir do sistema NADPH oxidase os neutrófilos aderidos podem produzir uma explosão de radical superóxido, produzindo um dano tecidual importante. A queimadura, além de aumentar a produção de radicais livres, também é capaz de impedir os mecanismos de defesa antioxidante, submetendo o paciente queimado ao estresse oxidativo, o qual se constitui em fator perpetuante da resposta inflamatória sistêmica, levando à piora progressiva do estado metabólico. Com esses dados, objetiva-se revisar os principais estudos com a suplementação de antioxidantes em pacientes críticos, com ênfase em pacientes queimados, e descrever os possíveis benefícios dessa intervenção.


In burn injuries, free radicals are produced during fluid replacement, altering multiple components of the organism such as nucleic acids, lipids and proteins. Thus, if on the one hand restoring blood flow is generally necessary to recover normal cell function, on the other hand oxygen reperfusion into ischemic tissues triggers massive production of oxygen free radicals, therefore further exacerbating ischemic injury. The role of neutrophiles activated in the cell after burns has also received special attention. By means of the NADPH-oxidase system, adherent neutrophiles may release superoxide radicals inflicting major tissue damage. The burn injury not only increases the production of free radicals but it is also capable of impairing the antioxidant defense mechanism, subjecting the burned patient to oxidative stress, which can be a perpetuating factor of the inflammatory response and lead to progressive metabolic deterioration. Therefore, the purpose of this work is to provide updated information on antioxidant supplementation in burned patients and describe the benefits of this intervention.


Asunto(s)
Antioxidantes , Quemaduras , Suplementos Dietéticos , Radicales Libres
17.
Rev. nutr ; 14(2): 95-101, maio-ago. 2001. tab
Artículo en Portugués | LILACS | ID: lil-320169

RESUMEN

A mucoviscidose é uma doença que afeta o estado nutricional por interferir na ingestäo e absorçäo adequadas de nutrientes. Este estudo avaliou 22 pacientes mucoviscidóticos atendidos no ambulatório de Nutriçäo do Hospital Infantil Joana de Gusmäo em Florianópolis, SC, no período de agosto de 1998 a janeiro de 1999. O estado nutricional foi determinado através de medidas antropométricas e dados de consumo alimentar. Quanto ao estado nutricional, 42,9 por cento dos menores de 2 anos e 28,6 por cento dos maiores de 10 anos estavam desnutridos; na faixa etária de 2 a 10 anos näo houve nenhuma criança desnutrida.Quanto ao consumo alimentar, 33,3 por cento atingiram a recomendaçäode energia e 95,2 por cento atingiram a recomendaçäo de proteina. Podemos concluir que a mucoviscidose afeta o estado nutricional das crianças em períodos críticos de crescimento e desenvolvimento, e que a qualidade da dieta destes pacientes pode ser melhorada através de um cuidado nutricional adequado


Asunto(s)
Humanos , Niño , Niño , Fibrosis Quística , Ingestión de Alimentos , Ciencias de la Nutrición , Evaluación Nutricional
18.
Rev. Hosp. Clin. Fac. Med. Univ. Säo Paulo ; 54(1): 21-4, fev. 1999. tab
Artículo en Inglés | LILACS | ID: lil-240776

RESUMEN

Lactentes criticamente enfermos frequentemente apresentam desnutricao calorico-proteica em decorrencia de demandas aumentadas por sepse e falencia respiratoria. A glutamina e atualmente classificada como um aminoacido condicionalmente essencial, de interesse especial para pacientes graves. A imunomodulacao, a protecao intestinal, e a prevencao da deplecao proteica estao entre os argumentos citados a favor de sua utilizacao. Tendo como proposito averiguar a tolerancia e o impacto clinico da glutamina em lactentes graves, efetuou-se um estudo piloto prospectivo e randomizado com nove casos...


Asunto(s)
Humanos , Masculino , Femenino , Glutamina/administración & dosificación , Nutrición de los Grupos de Riesgo , Fenómenos Fisiológicos Nutricionales del Lactante , Proyectos Piloto , Sepsis/prevención & control
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...