Calcium intake improvement after nutritional intervention in paediatric patients with osteogenesis imperfecta.

BACKGROUND: In several bone disorders, adequate calcium intake is a coadjuvant intervention to regular treatment. Osteogenesis imperfecta (OI) is a collagen disorder with a range of symptoms, ranging from fractures to minimum trauma, and it is typically treated with bisphosphonates. In the present study, we evaluate the impact of a nutritional intervention (NI) on dietary calcium intake and bone mineral density (BMD) in paediatric patients with OI. METHODS: A nonrandomised clinical trial was designed with a NI. Dietary calcium intake, anthropometry and clinical features were assessed at baseline, including anthropometry, basal metabolic rate (BMR), BMD. In addition, a food guidance form was developed and sent to patients by mail. After 12 months, clinical features of patients were reassessed and compared with the baseline data. RESULTS: Fifty-two children and adolescents were enrolled. Significant increases in total calcium intake (mg day-1 ), percentage of adequate calcium intake (%) and number of cups of milk ingested were observed after NI. We detected a positive correlation between the variation of BMD and milk consumption in patients treated with bisphosphonate. CONCLUSIONS: We observed an increase in calcium intake in patients with OI. This finding demonstrates the importance of nutrition therapy as part of a multidisciplinary treatment approach for bone health.

Comparison of NCHS, CDC and WHO growth charts in the nutritional assessment of hospitalized children up to five years old.

AIMS: This study evaluated the agreement of growth charts proposed by the National Center for Health Statistics (NCHS/1977), Centers for Disease Control and Prevention (CDC/2000) and World Health Organization (WHO/2006). METHODS: Were assessed children between 0 and 5 years old, hospitalized in the pediatric wards of a Brazilian school hospital. Z-score indexes: stature/age (S/A), weight/age (W/A) and weight/stature (W/S) was evaluated, in each of the three references (NCHS, CDC and WHO). ANOVA and test Bland & Altman and Lin plots were used in the comparison of the 3 charts. The agreement of the nutritional state categories was also evaluated, through kappa coefficient. The study was approved by the Institution's Research Ethics Committee. RESULTS: The study analyzed 337 children, whose median age was 0.52 (IQR: 0.21-1.65) years, 65.3% of them were below 1 year old, 60.2% were male and 50% hospitalized due to acute respiratory disease. Lower Z-scores of W/A and S/A were obtained with the WHO charts and lower W/S with the CDC chart. High correlation and agreement were observed among the criteria, but more patients were classified as presenting shortness through the WHO criteria. CDC and WHO criteria were more rigorous than the NCHS criteria for the diagnosis of underweight (W/A) and malnutrition (W/S). CONCLUSION: Despite the strong agreement of the 3 charts, the adoption of the WHO charts seems to be more helpful for the children's nutritional screening for admission, as it enables to detect a higher number of malnourished children or at nutritional risk, who will benefit from an early intervention.

Accuracy of nutritional assessment tools for predicting adverse hospital outcomes.

BACKGROUND AND AIMS: The ability of nutritional status assessment methods to predict clinical outcomes in hospitalized patients has not been completely evaluated. This study compared the accuracy of traditionally used nutritional tools and parameters in predicting death, infection, and length of hospital stay (LOS) in hospitalized adults. RESEARCH METHODS & PROCEDURES: Patients admitted at clinical and surgical wards were evaluated by body mass index, percentage of weight loss, Subjective Global Assessment, albumin, lymphocyte count, and followed until discharge. Clinical outcomes considered were in-hospital death, infection, and LOS. Overall accuracy of each method to predict these outcomes was assessed from ROC curves and C-statistic. RESULTS: Among 434 patients evaluated, 51% had a prolonged LOS, 23% developed infection, and 7.8% died during hospitalization. In univariate analysis, serum albumin was the strongest predictive parameter for death (Cstatistic: 0.77; CI95%: 0.69-0.86) and hospital infection (C-statistic: 0.67; CI95%: 0.61-0.74). For longer stay, lymphocyte count (C-statistic: 0.60; CI95%: 0.55-0.65) emerged as the most predictive variable. After adjustment for non-surgical hospitalization and cancer diagnosis, weight loss > 5% (OR: 1.58; CI95%: 1.06-3.35), and serum albumin < 3.5 g/dL (OR: 2.40; CI95%: 1.46-3.94) were associated to LOS. Albumin was the only independent variable related to infection (OR: 5.01; CI95%: 3.06-8.18) and, for hospital death, albumin (OR: 7.20; CI95%: 3.39-15.32) adjusted for age (OR: 1.03; CI95%: 1.01-1.06). CONCLUSIONS: Nutritional assessment methods evaluated were weakly predictors of hospital outcomes. Except for low serum albumin, isolated use of these methods adds little information in identifying the effect of nutritional status on clinically relevant outcomes.

Evolution of nutritional status of pediatric in patients of a tertiary care general hospital in Brazil.

UNLABELLED: JUSTIFICATION AND OBJECTIVE: Identify changes in the nutritional status of hospitalized children is fundamental for the early establishment of interventions. This study aims at describing the prevalence of undernutrition at admission and over the weeks of in-hospital stay in pediatric patients and evaluate the association between nutritional status and length of in-hospital stay. MATERIALS AND METHODS: A cohort study was carried out. It followed all the in-patients admitted to the general pediatric unit, composed of 72 beds, in the Hospital de Clínicas de Porto Alegre (HCPA), in the south of Brazil, from 20 march to 20 october in 2004. Patients who were between 1 month and 12 years of age and who had been admitted for clinical or/and surgical reasons were included. Those with Down Syndrome or without clinical condition and/or stature for weight measurement were excluded. Anthropometric data were collected up to 48 hours after admission and, weekly, up to hospital discharge (at admission, on 7th, 14th, and 21st day after admission). In children below 5 years of age, the standard defined by the World Heath Organization (WHO/2006) for the classification of the z-score for the stature/age (S/A), weight/age (W/A) and weight/stature (W/S) scores was used. In children from 5 to 10 years of age, the standards of the National Center for Health Statistics (NCHS, 1977) were used to classify the same rates as reference values. In children above 10 years of age, the classification of the Body Mass Index (BMI) was used (OMS/1995). In order to compare the z-scores over the four evaluation moments, analysis of variance (ANOVA) was used for repeated measurements, with Bonferroni's Post-Hoc test, and, for the evaluation of the in-hospital stay length, according to the nutritional status, Kaplan-Meier's survival curve, in the SPSS program, version 12.0, was used. RESULTS: 426 patients were included in the study. 57% of them were male and 50.7% were below one year of age. At admission, the prevalence of malnutrition was 10%, 18%, 21% and 14.7%, according to the W/S, W/A, S/A, and BMI criteria, respectively. Improvement of the nutritional status over the in-hospital stay was observed (at admission to 21st day) in children below 5 years (Z-score W/A: from -1.49 +/- 2.47 to -0.85 +/- 2.36, p = 0.001, and S/A: from -1.69 +/- 2.05 to -1.21 +/- 1.99, p = 0.007) and also in 5 to 10 years of age (S/A: from -0.43 +/- 1.31 to -0.30 +/- 1.37, p = 0.024). Undernourished patients, compared to nourished patients (according to the W/S rate for children below 10 years of age and BMI for above 10 years of age), showed a higher probability of remaining hospitalized (HR = 1.41; IC95%: 1.02-1.92). CONCLUSIONS: The prevalence of malnutrition by the W/S score was about half the prevalence found by the W/A and W/A indices, possibly reflecting a chronic impairment of the nutritional status. Undernutrition was confirmed as a health problem, once undernourished patients remained hospitalized for longer periods, which is a treatable problem as it was observed an improvement in the nutritional status rates over in-hospital stay.

Caroli's disease: report of 10 cases in children and adolescents in southern Brazil.

PURPOSE: The aim of this study was to describe the authors' experience with Caroli's disease in children and adolescents. METHODS: The authors reviewed the hospital charts of 10 children and adolescents with Caroli's disease diagnosed between 1968 and 1996. RESULTS: The median age at the onset of symptoms was 5.5 months and the median age at diagnosis was 12 months, both much lower than those reported in the literature. Clinical symptoms were compatible with the classical findings of Caroli's disease, but jaundice and hepatosplenomegaly occurred more frequently. There was an association with congenital renal malformation in eight cases (80%), congenital hepatic fibrosis in five cases, and choledochal cyst in two cases. One case presented the pure form of the disease.

[Follow-up of pediatric patients evaluated for liver transplantation]. / Evolução dos pacientes pediátricos avaliados para transplante hepático.

OBJECTIVE: To analyze the evolution of pediatric patients chosen for hepatic transplantation. METHODS: A review was made of the clinical charts of the first 65 children and adolescents with chronic liver disease, aged 5 months to 19 years (X = 6.8%), chosen for liver transplantation during the period of August 1994 to March 1996. Data refer to the patients' demographic characteristics, etiology of their liver disease, their psychosocial situation and of their parents, and their clinical and laboratorial evaluation. According to the severity of the disease, patients were classified as active (waiting for a donor), in evaluation, inactive (compensated liver disease), and excluded for psychosocial or medical conditions, or because of bad indication. RESULTS: Eight patients (12%) received transplantation, and one of them died. Seven (11%) died when in evaluation or waiting for a donor. Ten patients (15%) were excluded from the waiting list: 6 for social problems, and 4 for medical problems. No patient was excluded for bad indication. Six patients are in the active list, waiting for donor. The other 23 patients (35%) are in evaluation, and 11 (17%) are classified as inactive in the waiting list. CONCLUSIONS: Eleven patients (17%) were not operated on due to the advanced stage of the liver disease. We emphasize the necessity of organ donation, and the early contact of the patients with a reference center.

[The Steatocrit Test: a semiquantitative method to evaluate the fecal fat excretion--method standardization]. / Esteatócrito: um método semiquantitativo de avaliação de gordura fecal--padronização do teste.

The main objective of this study was to introduce among us this technique. In a first step, steatocrit was compared to Van de Kamer test for 30 fecal samples. A significant positive correlation was found. In a second step, a steatocrit value was determined for normal children aged 0 to 72 months. In children from 0 to 3 months of age, no influence was found of diet (whether exclusively maternal milk or artificial one) on steatocrit value. However, upto the age of 3 months a significant and negative correlation was found between age and steatocrit value. Finally, three age groups were identified with different steatocrit values, as follows: 0-1 month, 4.04%; 1-3 months, 1.38%, 3-72 months, 0.29%. Thus the steatocrit test for fecal fat excretion was again shown to be not only simple, rapid, painless and inexpensive but also a reliable one.