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1.
Artículo en Inglés | MEDLINE | ID: mdl-33818806

RESUMEN

BACKGROUND: Early identification of patients in the Pediatric Intensive Care Unit (PICU) at risk of nutritional status (NS) deterioration and poor outcomes is desirable. AIM: To identify factors associated with NS deterioration and prolonged PICU stay. METHODS: In a prospective cohort study in eight Brazilian PICUs, we enrolled children <18 years with PICU stay >72h. We used multivariable logistic regression to identify the clinical, laboratory, and nutritional variables at admission that were associated with outcomes. NS deterioration was defined as the reduction in weight-for-age, body mass index-for-age or mid-upper arm circumference-for-age z-score ≥1 during PICU stay. Prolonged PICU stay was defined as ≥13 days. RESULTS: We enrolled 363 eligible patients, median age 11.3 months (IQR:3.1-45.6) and 46% had at least one Complex Chronic Condition (CCC). NS deterioration was observed in 23% and was associated with CCC (OR:2.71, 95%CI:1.44-5.09), after adjusting for severity risk score, leukocyte count, obesity, and PICU site. Prolonged PICU stay (33% of the cohort) was associated with age <2 years (OR:1.95, 95%CI:1.03-3.66), fluid overload (>10%) over first 72 hours (OR:2.66, 95%CI:1.50-4.73) and hypoalbuminemia (<3.0 g/dL) (OR:2.05, 95%CI:1.12-3.76), after adjusting for CCC, severity risk score, undernutrition, early nutrition therapy, and PICU site. CONCLUSIONS: CCC at admission was associated with NS deterioration. Age <2 years, fluid overload, and hypoalbuminemia at PICU admission were associated with prolonged PICU stay. These factors must be further evaluated as part of an admission nutritional screening tool for critically ill children. This article is protected by copyright. All rights reserved.

2.
Arch. endocrinol. metab. (Online) ; 64(6): 695-703, Nov.-Dec. 2020. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1142203

RESUMEN

ABSTRACT Objective To evaluate the association between MetS, its components and insulin resistance (IR) with 25(OH)D and hsCRP. The moderator role of 25(OH)D in the association of MetS, its diagnostic components and IR with hsCRP were also explored. Materials and methods A cross-sectional study (2014/2015) with a population-based cohort in Southern Brazil (n = 605). Metabolic syndrome (MetS) diagnosis was defined based on the Joint Interim Statement, while the Homeostasis Model Assessment of insulin resistance (IR) (HOMA-IR) was used for determining IR. Serum concentrations of 25-hydroxy vitamin D [25(OH)D] (ng/mL) and high sensitivity C-reactive protein (hsCRP) (mg/L) were evaluated following standard protocols. 25(OH)D was categorized as sufficiency (>30 ng/mL), insufficiency (20-30 ng/mL) or deficiency (<20 ng/mL) to test its moderator role. Multiple linear regression was used to test the associations. The results were adjusted for possible confounders. Results and discussion Hypertriglyceridemia and IR were associated with lower 25(OH)D concentrations. However, except for systolic blood pressure, other MetS components and IR were associated with higher hsCRP. The association between elevated waist circumference (WC) and hsCRP was moderated by the 25(OH)D concentrations. The hsCRP median concentrations were more than two times higher among those with elevated WC and 25(OH)D insufficiency or deficiency. In this study, inadequate concentrations of 25(OH)D increased the adverse relationship between elevated WC and inflammation. 25(OH)D concentrations could be incorporated into the clinical protocols for monitoring individuals with abdominal obesity to identify those at a higher risk of complications.

3.
Artículo en Inglés | MEDLINE | ID: mdl-32609153

RESUMEN

OBJECTIVE: To evaluate the association between MetS, its components and insulin resistance (IR) with 25(OH)D and hsCRP. The moderator role of 25(OH)D in the association of MetS, its diagnostic components and IR with hsCRP were also explored. MATERIALS AND METHODS: A cross-sectional study (2014/2015) with a population-based cohort in Southern Brazil (n = 605). Metabolic syndrome (MetS) diagnosis was defined based on the Joint Interim Statement, while the Homeostasis Model Assessment of insulin resistance (IR) (HOMA-IR) was used for determining IR. Serum concentrations of 25-hydroxy vitamin D [25(OH)D] (ng/mL) and high sensitivity C-reactive protein (hsCRP) (mg/L) were evaluated following standard protocols. 25(OH)D was categorized as sufficiency (>30 ng/mL), insufficiency (20-30 ng/mL) or deficiency (<20 ng/mL) to test its moderator role. Multiple linear regression was used to test the associations. The results were adjusted for possible confounders. RESULTS AND DISCUSSION: Hypertriglyceridemia and IR were associated with lower 25(OH)D concentrations. However, except for systolic blood pressure, other MetS components and IR were associated with higher hsCRP. The association between elevated waist circumference (WC) and hsCRP was moderated by the 25(OH)D concentrations. The hsCRP median concentrations were more than two times higher among those with elevated WC and 25(OH)D insufficiency or deficiency. In this study, inadequate concentrations of 25(OH)D increased the adverse relationship between elevated WC and inflammation. 25(OH)D concentrations could be incorporated into the clinical protocols for monitoring individuals with abdominal obesity to identify those at a higher risk of complications.

4.
Clin Nutr ESPEN ; 38: 211-217, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32690160

RESUMEN

BACKGROUND & AIM: Oropharyngeal dysphagia (OD) can lead to a deficiency of antioxidant micronutrients. The aim of the present study was to investigate the relation between OD and nutritional status, antioxidant vitamins (ß-carotene, vitamin E and C) and serum markers of the inflammatory response [C-reactive protein, myeloperoxidase (MPO), nitric oxide metabolites (NOx), tumor necrosis factor-α, interleukin (IL)-1ß and IL-6] in adults and elderly. METHODS: A cross-sectional study was conducted with 69 individuals: 22 in the control group (CG) and 47 in the OD group (ODG). The ODG was subdivided into ODG-mild = normal oral feeding (OF, n = 14), ODG-moderate (OF-modified, n = 22) and ODG-severe (OF-suspended, n = 11). Associations were investigated using multiple linear regression. RESULTS: The body mass index (BMI) was higher in the ODG compared to the CG (p = 0.008), independently of sex, age, energy intake (EI) and score on the Functional Independence Measure. BMI was significantly lower in the ODG-severe compared to the ODG-mild (p = 0.012). OD was associated with lower concentrations of ß-carotene (p < 0.001) and vitamin C (p < 0.001), independently of sex, age and EI, and higher concentrations of MPO (p = 0.008) and NOx (p = 0.011), independently of sex, age and the presence of comorbidities. CONCLUSION: Adults and elderly with OD have lower levels of antioxidant vitamins (ß-carotene and vitamin C) and a high inflammatory response (MPO and NOx). The evaluation of antioxidant vitamins could be incorporated in nutritional status assessment in this population.

5.
Clin Nutr ESPEN ; 38: 218-222, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32690161

RESUMEN

BACKGROUND & AIMS: Oropharyngeal dysphagia (OD) and comorbidities can exert an influence on nutritional status and contribute to mortality. The aim of the present study was to examine relationships between high Charlson Comorbidity Index (CCI) scores and OD outcomes, including OD severity, feeding route, nutritional status and one-year mortality rate in adults and elderly individuals. METHODS: A longitudinal study, whose the final sample comprised 110 patients with OD and 75 of whom were evaluated for one-year mortality outcome. Swallowing (videofluoroscopy), nutritional status [body mass index (BMI)], CCI, type of feeding route, medications and hospitalization were evaluated. Multinomial logistic regression was performed to calculate the unadjusted and adjusted odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS: Overall sample of the study were adults and elders with a median age (years) of 61.3 [interquartile range (IQR): 58.4-64.2]. The median CCI was 2.3 (IQR: 2.1-2.6) and the mortality rate was 10.8%. Hospitalization was significantly associated with underweight (p = 0.013) and number of medications (p = 0.023). After adjustment, sex/age and nº-Medications/Hospitalization (nº-M/H), CCI ≥3 was associated with nasogastric tube feeding (OR 4.57, 95%CI 1.59-13.1 and OR 3.39, 95%CI 1.21-9.51 respectively) and swallowing performance (OR 0.73, 95%CI 0.59-0.90 and OR 0.74, 95%CI 0.61-0.90 respectively). CONCLUSIONS: A high CCI was associated with OD severity and feeding route, but not with nutritional status or mortality.

6.
Clin Nutr ESPEN ; 38: 229-235, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32690163

RESUMEN

BACKGROUND & AIMS: The relationship between vitamin D and oropharyngeal dysphagia (OD) is still poorly understood. The aim of this study was to evaluate 25-hydroxyvitamin D [25(OH)D] concentration in patients with OD and to verify its association to nutritional status, functional independence measure (FIM), time of clinical signs (TCS) and OD severity. This is a cross-sectional study conducted with outpatients. Body mass index (BMI), FIM, TCS, causes of OD, comorbidities, penetration-aspiration scale (PAS) and severity scale were evaluated. METHODS: A multiple linear regression and effect size were performed to evaluate the association between serum 25(OH)D concentration and independent variables. RESULTS: Forty-eight participants were included, with a mean age of 60.1 ± 15.3 years. The mean of the 25(OH)D concentration was 26.10 ± 12.0 ng/mL. The prevalence of hypovitaminosis D (<30 ng/mL) was 73%. In the multiple linear regression analysis (adjusted for sex, age, BMI, dietary intake and solar radiation), 25(OH)D concentration was significantly related with the TCS (p = 0.01, f2 = 0.48). Patients with hypovitaminosis D had a moderate effect (p = 0.08, δ = 0.36) for a lower FIM score. CONCLUSIONS: These findings indicate that serum 25(OH)D concentration may be related to the TCS and the functional capacity of patients with OD.

7.
Crit Rev Food Sci Nutr ; 60(20): 3367-3386, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31760758

RESUMEN

Proteins are essential macronutrients for the human diet. They are the primary source of nitrogen and are fundamental for body structure and functions. The plant protein quality (PPQ) refers to the bioavailability, digestibility, and amino acid composition. The digestibility specifies the protein quantity absorbed by an organism relative to the consumed amount and depends on the protein structure, previous processing, and the presence of compounds limiting the digestion. The latter are so-called antinutritional factors (ANF), exemplified by phytates, tannins, trypsin inhibitors, and lectins. Animal proteins are known to have better digestibility than plant proteins due to the presence of ANF in plants. Thus, the inactivation of ANF throughout food processing may increase the PPQ. New food processing, aiming to increase the digestibility of plant proteins, and new sources of proteins are being studied for the animal protein substitution. Here, it is presented the impact of processing on the protein digestibility and reduction of ANF. Several techniques, such as cooking, autoclaving, germination, microwave, irradiation, spray- and freeze-drying, fermentation, and extrusion enhanced the PPQ. The emerging non-thermal technologies impact on protein functionalities but require studies on the protein digestibility. How to accurately determine and how to improve the protein digestibility of a plant source remains a scientific and technological challenge that may be addressed by novel or combining existing processing techniques, as well as by exploring protein-enriched by-products of the food industry.


Asunto(s)
Digestión , Proteínas de Plantas , Aminoácidos , Animales , Proteínas en la Dieta , Manipulación de Alimentos , Humanos , Inhibidores de Tripsina
8.
Appl Physiol Nutr Metab ; 45(5): 539-546, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-31644883

RESUMEN

We investigate whether the adherence to healthy lifestyle recommendations (regular physical activity, healthy diet, reduced alcohol consumption, nonsmoking) moderates the relationship between cardiovascular disease (CVD) and its risk factors (obesity, diabetes, dyslipidemia, and hypertension) with clinical variables among adults. This cross-sectional population-based study comprised 862 adults (39.3 ± 11.4 years, 46.4% men) from Florianópolis, Brazil. Clinical variables were systolic (SBP) and diastolic blood pressure, waist circumference, body mass index (BMI), percentage of body fat, muscular strength, carotid intima-media thickness (IMT), high sensitive C-reactive protein, and lipid and glucose metabolism markers. Multiple linear regression adjusted for confounding factors was used. Reduced IMT and HbA1c were observed in males with CVD or its risk factors who adopted healthy lifestyle recommendations (p < 0.001), and lower SBP levels were observed in females without CVD or its risk factors (p = 0.034). Females with CVD or its risk factors who followed healthy lifestyle recommendations showed higher BMI (p = 0.035). Adherence to number of healthy lifestyle recommendations moderated cardiovascular health in adults with CVD and without CVD. Novelty The adherence to healthy lifestyle recommendations moderated the relationship between IMT and HbA1c with CVD or its risk factors among males. The lower values of SBP among females without CVD or its risk factors were moderated by the adherence to healthy lifestyle recommendations.

9.
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
10.
Nutrients ; 11(10)2019 Oct 04.
Artículo en Inglés | MEDLINE | ID: mdl-31590272

RESUMEN

Our objective was to investigate the relationship between dietary vitamin D intake and serum concentration of vitamin D (25(OH)D) on changes in body weight, waist circumference (WC), and body mass index (BMI), and to determine if this relationship changes between obese and non-obese individuals at baseline and those who have or do not have 25(OH)D deficiency. This was a prospective study with a sample of 572 individuals aged 25-65 years, who were participants in the cohort study EpiFloripa Adults. Changes in weight (in kg), BMI, and WC between 2012 and 2014 were evaluated as outcomes. The main exposure was the dietary intake of vitamin D (2012), and the 25(OH)D serum concentration was secondary. When the analyses were stratified by the presence of obesity in the baseline, among obese individuals it was observed that those in the extreme categories of vitamin D intake had an average gain of 3.0 kg in weight, 0.9 kg/m2 in BMI, and 1.7-2.7 cm in WC. When 25(OH)D serum concentration were incorporated into the analyses, it was observed that non-obese subjects not having 25(OH)D deficiency had a mean reduction of 2.3 cm in WC. In conclusion, the increases in body weight, BMI, and WC were higher over time in obese patients with deficient 25(OH)D serum concentration, regardless of dietary vitamin D intake.


Asunto(s)
Estado Nutricional , Obesidad/fisiopatología , Ingesta Diaria Recomendada , Deficiencia de Vitamina D/fisiopatología , Vitamina D/análogos & derivados , Vitaminas/administración & dosificación , Adulto , Anciano , Biomarcadores/sangre , Índice de Masa Corporal , Brasil/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Evaluación Nutricional , Obesidad/sangre , Obesidad/diagnóstico , Obesidad/epidemiología , Estudios Prospectivos , Vitamina D/sangre , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/diagnóstico , Deficiencia de Vitamina D/epidemiología , Vitaminas/sangre , Circunferencia de la Cintura , Aumento de Peso
11.
Scand J Med Sci Sports ; 29(7): 1006-1012, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30892730

RESUMEN

The objective of this study was to identify the association of phase angle with physical fitness in children and adolescents infected with HIV. Sixty-four children and adolescents infected with HIV (8-15 years old) were tested for vertical transmission. The electrical bioimpedance was used to obtain the phase angle. Body fat (BF) and lean soft tissue mass (LSTM) were measured by x-ray absorptiometry, and the manual grip strength was evaluated by dynamometry. The peak oxygen consumption (VO2 peak) was measured by respiratory change in a submaximal incremental test. Moderate-vigorous physical activity (MVP) and sedentary behavior were measured using accelerometers and were used as covariates. Multiple linear regression was used. The linear correlation analyses demonstrated that the phase angle was inversely proportional to relative BF (r = -0.26), but was not associated with absolute body fat (r = -0.02). The phase angle was directly associated with LSTM (r = 0.57), handgrip strength, and (r = 0.43) peak VO2 (r = 0.55). The phase angle was not associated with absolute BF (ß = -0.017, P = 0.413) and relative (ß = -0.014, P = 0.175). The phase angle presented a direct association with LSTM (ß = 0.041, P = 0.019) and peak VO2 (ß = 0.005; P = 0.019), regardless of age, sex, sexual maturation, MVPA, sedentary behavior, antiretroviral drugs, and viral load. No association was found between phase angle and handgrip strength (ß = 0.153; P = 0.199). It was concluded that phase angle was associated with LSTM and the aerobic fitness in HIV-infected children and adolescents.


Asunto(s)
Capacidad Cardiovascular , Impedancia Eléctrica , Infecciones por VIH/fisiopatología , Absorciometría de Fotón , Acelerometría , Adiposidad , Adolescente , Niño , Estudios Transversales , Ejercicio Físico , Femenino , Fuerza de la Mano , Humanos , Masculino , Dinamómetro de Fuerza Muscular , Consumo de Oxígeno , Conducta Sedentaria
12.
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
13.
Nutr Clin Pract ; 33(6): 831-842, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29786896

RESUMEN

BACKGROUND: In the absence of a gold standard technique for assessing nutrition status in patients receiving hemodialysis (HD), we aimed to determine the diagnostic accuracy of single-frequency (50 kHz) bioelectrical impedance analysis parameters, resistance/height (R/H), reactance/height (Xc/H), and impedance/height (Z/H), and their cutoff points for malnutrition. METHODS: The reference standards, Subjective Global Assessment (SGA), Malnutrition Inflammation Score, and Nutritional Risk Screening 2002, were performed at baseline and then once a year for 2 years. At least 2 assessments for each reference standard were performed during the monitoring period, and those patients who were assessed as malnourished on at least 2 consecutive occasions were classified as malnourished. RESULTS: A total 101 patients receiving HD were evaluated. R/H and Z/H demonstrated low to moderate accuracy to diagnose malnutrition in men and low accuracy in women, whereas the accuracy of Xc/H was uncertain. The cutoff points of bioelectrical impedance vector analysis (BIVA) parameters, determined based on the SGA to maximize sensitivity and specificity simultaneously, were: R/H ≥330.05 and ≥420.92 ohms/m for men and women, respectively; Z/H ≥332.71 and ≥423.19 ohms/m for men and women, respectively. In men, sensitivity based on the cutoff points of R/H and Z/H together ranged from 73% to 89% and specificity ranged from 49% to 50%. In women, sensitivity ranged from 58% to 80% and specificity from 48% to 55%. CONCLUSION: BIVA parameters demonstrated low to moderate accuracy in men and low accuracy in women for the diagnosis of malnutrition.


Asunto(s)
Impedancia Eléctrica , Fallo Renal Crónico/complicaciones , Desnutrición/diagnóstico , Evaluación Nutricional , Estado Nutricional , Diálisis Renal , Adulto , Anciano , Composición Corporal , Femenino , Humanos , Masculino , Desnutrición/etiología , Tamizaje Masivo , Persona de Mediana Edad , Valores de Referencia , Sensibilidad y Especificidad , Factores Sexuales
14.
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
15.
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
16.
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.

17.
PLoS One ; 13(1): e0190785, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29320547

RESUMEN

HIV-infected children and adolescents may be at risk for cardiovascular disease due to chronic inflammation and exacerbation of risk factors. The aim of this study was as follows: 1) compare cardiovascular risk factors, chronic inflammation, and carotid intima-media thickness (IMTc) between the HIV and control groups; 2) determine the association of HIV and antiretroviral (ART) regimens with cardiovascular risk factors, chronic inflammation, and IMTc; and 3) identify variables associated with elevated IMTc. Cross-sectional analysis of 130 children and adolescents, 8-15 years of age, divided into HIV-infected (n = 65) and healthy control (n = 65) participants. Body fat, blood pressure, glycemia, insulin, and glycated hemoglobin, total cholesterol and fractions (LDL-C and HDL-C), triglycerides, C-reactive protein (CRP), interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and the IMTc were measured. The results showed HIV-infected children and adolescents had higher levels of glycemia (87.9 vs. 75.9 mg.dL-1, p< 0.001), LDL-c (94.7 vs. 79.5 mg.dL-1, p = 0.010), triglycerides (101.2 vs. 61.6 mg.dL-1, p< 0.001), CRP (1.6 vs. 1.0 mg.L-1, p = 0.007), IL-6 (1.42 vs. 0.01 pg.mL-1, p< 0.001), TNF-α (0.49 vs. 0.01 pg.mL-1, p< 0.001), mean IMTc (0.526 vs. 0.499 mm, p = 0.009), and lower HDL-c (53.7 vs. 69.4 mg.dL-1, p< 0.001) compared to controls. Systolic blood pressure (ß = 0.006, p = 0.004) and TNF-α (ß = -0.033, p = 0.029) accounted for 16% of IMTc variability in HIV-infected children and adolescents. In patients using protease inhibitors-based ART, male gender (ß = -0.186, p = 0.008), trunk body fat (ß = -0.011, p = 0.006), glucose (ß = 0.005, p = 0.046), and IL-6 (ß = 0.017, p = 0.039) accounted for 28% of IMTc variability. HIV-infected children and adolescents may be at risk for premature atherosclerosis due to chronic inflammation and dyslipidemia. Interventions with the potential to improve lipid profile, mitigate inflammation, and reduce cardiovascular risk are needed.


Asunto(s)
Aterosclerosis/complicaciones , Dislipidemias/complicaciones , Infecciones por VIH/complicaciones , Inflamación/complicaciones , Adiposidad , Adolescente , Antirretrovirales/uso terapéutico , Aterosclerosis/diagnóstico por imagen , Aterosclerosis/epidemiología , Aterosclerosis/fisiopatología , Biomarcadores/sangre , Glucemia , Grosor Intima-Media Carotídeo , Niño , Estudios Transversales , Dislipidemias/diagnóstico por imagen , Dislipidemias/epidemiología , Dislipidemias/fisiopatología , Femenino , Infecciones por VIH/diagnóstico por imagen , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/fisiopatología , Humanos , Inflamación/diagnóstico por imagen , Inflamación/epidemiología , Inflamación/fisiopatología , Interleucina-6/sangre , Lípidos/sangre , Masculino , Inhibidores de Proteasas/uso terapéutico , Factores de Riesgo , Factores Sexuales
18.
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
19.
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
20.
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
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