Effect of treatment with growth hormone on body composition and metabolic profile of short children born small for gestational age.

OBJECTIVE: To assess the effect of recombinant growth hormone (rGH) on body composition and metabolic profile of prepubertal short children born small for gestational age (SGA) before and after 18 months of treatment. METHODS: It is a clinical, non-randomized, and paired study. Children born SGA, with birth weight and/or length <-2 standard deviations (SD) for gestational age and sex, prepubertal, born at full term, of both genders, with the indication for treatment with rGH were included. The intervention was performed with biosynthetic rGH at doses ranging from 0.03 to 0.05 mg/kg/day, administered subcutaneously, once a day at bedtime. Total lean mass (LM) and total fat mass (FM) were carried out using dual-energy X-ray absorptiometry (DXA), and the metabolic profile was assessed for insulin, glycemia, IGF-1 levels and lipid profile. RESULTS: Twelve patients (nine girls, 8.17±2.39 y) were evaluated; three patients dropped out of the study. There was an increase of LM adjusted for length (LMI) (p=0.008), LMI standard deviation score (SDS) adjusted for age and sex (p=0.007), and total LM (p<0.001). The percentage of body fat (BF%) and abdominal fat (AF) remained unaltered in relation to the beginning of treatment. Among the metabolic variables, blood glucose remained within normal levels, and there was a reduction in the number of participants with altered cholesterol (p=0.023). CONCLUSIONS: The effect of rGH treatment was higher on LM than in FM, with increased LM adjusted for length and standardized for age and sex. Glycemia remained within the normal limits, and there was a decreased number of children with total cholesterol above the recommended levels.

Effect of treatment with growth hormone on body composition and metabolic profile of short children born small for gestational age / Efeito do tratamento com hormônio de crescimento na composição corporal e no perfil metabólico de crianças nascidas pequenas para a idade gestacional com baixa estatura

ABSTRACT Objective: To assess the effect of recombinant growth hormone (rGH) on body composition and metabolic profile of prepubertal short children born small for gestational age (SGA) before and after 18 months of treatment. Methods: It is a clinical, non-randomized, and paired study. Children born SGA, with birth weight and/or length <-2 standard deviations (SD) for gestational age and sex, prepubertal, born at full term, of both genders, with the indication for treatment with rGH were included. The intervention was performed with biosynthetic rGH at doses ranging from 0.03 to 0.05 mg/kg/day, administered subcutaneously, once a day at bedtime. Total lean mass (LM) and total fat mass (FM) were carried out using dual-energy X-ray absorptiometry (DXA), and the metabolic profile was assessed for insulin, glycemia, IGF-1 levels and lipid profile. Results: Twelve patients (nine girls, 8.17±2.39 y) were evaluated; three patients dropped out of the study. There was an increase of LM adjusted for length (LMI) (p=0.008), LMI standard deviation score (SDS) adjusted for age and sex (p=0.007), and total LM (p<0.001). The percentage of body fat (BF%) and abdominal fat (AF) remained unaltered in relation to the beginning of treatment. Among the metabolic variables, blood glucose remained within normal levels, and there was a reduction in the number of participants with altered cholesterol (p=0.023). Conclusions: The effect of rGH treatment was higher on LM than in FM, with increased LM adjusted for length and standardized for age and sex. Glycemia remained within the normal limits, and there was a decreased number of children with total cholesterol above the recommended levels.

RESUMO Objetivo: Avaliar o efeito do hormônio de crescimento recombinante (rHC) na composição corporal e no perfil metabólico de crianças pré-púberes com baixa estatura, nascidas pequenas para a idade gestacional (PIG) antes e depois de 18 meses de tratamento. Métodos: Estudo clínico, não randomizado e pareado. Foram incluídas crianças nascidas PIG, com peso e/ou altura ao nascer <-2 desvios padrão (DP) para idade gestacional e sexo, pré-púberes, nascidas a termo, de ambos os sexos, com indicação de tratamento com rGH. A intervenção foi realizada com rGH biossintético com doses variando de 0,03 a 0,05 mg/kg/dia, administrado por via subcutânea, uma vez ao dia ao deitar-se. A massa magra total (LM) e a massa gorda total (MG) foram determinadas por meio de absorciometria de raios X de dupla energia (DXA), e o perfil metabólico foi avaliado com dosagens de insulina, glicemia, IGF-1 e perfil lipídico. Resultados: Doze pacientes (nove meninas, 8,17±2,39 anos) foram avaliados; três pacientes abandonaram o estudo. Houve aumento da LM ajustada para estatura (LMI) (p=0,008), LMI standard deviation scores (SDS) ajustada para idade e sexo (p=0,007) e LM total (p<0,001). O percentual de gordura corporal (GC%) e gordura abdominal (AF) permaneceu inalterado em relação ao início do tratamento. Entre as variáveis metabólicas, a glicemia manteve-se na normalidade, e houve redução do número de participantes com colesterol alterado (p=0,023). Conclusões: O efeito do tratamento com HCr foi maior na MM do que na MG, com o aumento da MM ajustada para altura e padronizada para idade e sexo. A glicemia permaneceu normal e houve redução do número de crianças com colesterol total acima do recomendado.

Application of bioelectrical impedance in newborns: an integrative review / Aplicación de la impedancia bioeléctrica en recién nacidos: revisión integradora

Objective: the objective of this study was to identify the use of bioelectrical impedance in newborns (NB), as this is an easy-to-apply and non-invasive method of measurement that can be used for distinguishing fat-free mass (FFM), fat mass (FM), and total body water (TBW). Method: this was an integrative review of the literature using the PUBMED/MEDLINE, EMBASE, Web of Science, and Virtual Health Library databases to search for original articles between 2010-2020. A total of 900 articles were retrieved; after checking for duplicity and applying the eligibility criteria, 9 were further analyzed. Results: about the results, five studies used single frequency bioimpedance, with a specific population of neonates, preterm and/or full term, and different clinical conditions. Resistance was the most studied bioelectric indicator, the phase angle is little explored, and four studies investigated body composition (FFM, FM and TBW). Studies found that preterm newborns had lower amounts of TBW, FFM, and FM than term newborns, and there were differences in body composition between sex. The phase angle was lower for preterm newborns. Babies fed babies with high protein formulas had increases in the FFM. Conclusion: there is a need for multicenter studies to define standardized methods to be used with this public. (AU)

Objetivo: el objetivo de este estudio fue identificar el uso de la impedancia bioeléctrica en recién nacidos (NB), ya que ese método es de fácil medición y no invasivo para la distinción de masa libre de grasa (MLG), masa grasa (MG) y agua corporal total (ACT). Método: esta fue una revisión integradora de la literatura utilizando PubMed/MEDLINE, EMBASE, Web of Science y Virtual Health Library para la búsqueda de artículos originales (2010-2020). En total, se encontraron 900 artículos, aunque tras la verificación de duplicidad y aplicación delos criterios de elegibilidad, solo 9 fueron para análisis. Resultados: cinco estudios utilizaron el dispositivo de monofrecuencia. Cada investigación se aplicó en una población específica de neonatos, prematuros y/o a término y diferentes condiciones clínicas. La resistencia fue el indicador bioeléctrico más estudiado, el ángulo de fase fue poco explorado y cuatro estudios investigaron la composición corporal. Dos estudios encontraron que los recién nacidos prematuros tienen menos cantidades de ACT, MLG y MG que los RNT y se observó diferencia en la composición corporal entre los sexos. El ángulo de fase fue inferior en prematuros. Los lactantes que se alimentaron con una fórmula con mayor contenido proteico tenían una mayor cantidad de MLG. Conclusión: se observa la necesidad de estudios multicéntricos para definir métodos estandarizados para ser utilizados con este público. (AU)

Application of bioelectrical impedance in newborns: an integrative review.

Introduction: Objective: the objective of this study was to identify the use of bioelectrical impedance in newborns (NB), as this is an easy-to-apply and non-invasive method of measurement that can be used for distinguishing fat-free mass (FFM), fat mass (FM), and total body water (TBW). Method: this was an integrative review of the literature using the PUBMED/MEDLINE, EMBASE, Web of Science, and Virtual Health Library databases to search for original articles between 2010-2020. A total of 900 articles were retrieved; after checking for duplicity and applying the eligibility criteria, 9 were further analyzed. Results: about the results, five studies used single frequency bioimpedance, with a specific population of neonates, preterm and/or full term, and different clinical conditions. Resistance was the most studied bioelectric indicator, the phase angle is little explored, and four studies investigated body composition (FFM, FM and TBW). Studies found that preterm newborns had lower amounts of TBW, FFM, and FM than term newborns, and there were differences in body composition between sex. The phase angle was lower for preterm newborns. Babies fed babies with high protein formulas had increases in the FFM. Conclusion: there is a need for multicenter studies to define standardized methods to be used with this public.

Introducción: Objetivo: el objetivo de este estudio fue identificar el uso de la impedancia bioeléctrica en recién nacidos (NB), ya que ese método es de fácil medición y no invasivo para la distinción de masa libre de grasa (MLG), masa grasa (MG)y agua corporal total. Método: esta fue una revisión integradora de la literatura utilizando PUBMED/MEDLINE, EMBASE, Web of Science y Virtual Health Library para la búsqueda de artículos originales (2010-2020). En total, se encontraron 900 artículos, aunque tras la verificación de duplicidad y aplicación de los criterios de elegibilidad, solo 9 fueron para análisis. Resultados: cinco estudios utilizaron el dispositivo de monofrecuencia. Cada investigación se aplicó en una población específica de neonatos, prematuros y/o a término y diferentes condiciones clínicas. La resistencia fue el indicador bioeléctrico más estudiado, el ángulo de fase fue poco explorado y cuatro estudios investigaron la composición corporal. Dos estudios encontraron que los recién nacidos prematuros tienen menos cantidades de ACT, MLG y MG que los RNT y se observó diferencia en la composición corporal entre los sexos. El ángulo de fase fue inferior en prematuros. Los lactantes que se alimentaron con una fórmula con mayor contenido proteico tenían una mayor cantidad de MLG. Conclusión: se observa la necesidad de estudios multicéntricos para definir métodos estandarizados para ser utilizados con este público.

Análise da efetividade de estratégia nutricional em mulheres com síndrome metabólica / Analysis of the efficaciousness of nutritional strategy in females with metabolic syndrome

O objetivo deste estudo foi analisar a efetividade de uma estratégia nutricional em mulheres obesas com Síndrome Metabólica (SM). Estudo longitudinal caso-controle estruturado com dois grupos, sendo mulheres obesas com diagnóstico clínico de SM (Grupo Caso) e mulheres obesas sem diagnóstico de SM (Grupo Controle), em acompanhamento nutricional na Clínica Escola de Nutrição da Unicentro. A coleta de dados ocorreu em duas etapas, com intervalos de um mês, sendo realizadas medidas antropométricas, análise do consumo alimentar e exames bioquímicos. A estratégia nutricional utilizada foram orientações nutricionais e plano alimentar individualizado. Foram avaliadas 20 mulheres, cada grupo com número equivalente. Pacientes com SM apresentaram valores de CC e glicemia em jejum superiores ao grupo controle (p<0,005), ingestão de ácidos graxos acima do recomendado. A intervenção nutricional foi efetiva em pacientes com SM, demonstrando em curto prazo melhora da qualidade da alimentação e do perfil sérico glicêmico e lipídico, redução de medidas antropométricas.

The efficaciousness of nutritional strategy in obese females with metabolic syndrome (MS) is evaluated. Current case-controlled longitudinal study was structured on two groups, with obese women with a clinical diagnosis of MS (Case Group) and obese females without MS (Control Group), within the context of nutritional follow-up in the Clinical Nutritional School of the Unicentro. Data were collected in two stages, at a month´s interval, with anthropometric measurements, analysis of food consumption and biochemical tests. Nutritional strategy comprised nutritional supervision and personal food planning. Twenty females were assessed for each group. MS patients had CC and glycaemia rates higher than those of control group (p<0.005) and ingestion of fatty acids above that recommended. Nutritional intervention was effective in patients with MS and revealed that in a short time there was an improvement in food quality, in glycemic and lipid serum and in anthropometric measurements.

Comparison of metabolic parameters in children and adolescents with and without insulin resistance / Comparação de parâmetros metabólicos em crianças e adolescentes com e sem resistência à insulina

ABSTRACT The aim of the study was to compare the behavior of metabolic parameters, blood pressure, and obesity indicators in children and adolescents with and without insulin resistance. Sixty-one overweight children (6 to 18 years) underwent anthropometric measurements of body mass (BM), height and waist circumference (WC), blood pressure (BP), bioimpedance (relative (%F) and absolute fat (BF)), and blood collection for determination of glucose, insulin, and lipid profile (TG, CT, HDL-C, LDL-C). The BMI z-score was used to classify nutritional status and the HOMA-IR index (> 2.5) for insulin resistance. Participants were divided into two groups, insulin resistant (IR, n= 27) and non-insulin resistant (NIR, n= 33). Regardless of age, children and adolescents with excess weight and IR presented higher BM, WC, BMI, %F and BF (kg), TG, and plasma insulin than their NIR counterparts, who in turn presented higher LDL-C. The groups did not differ in nutritional status (BMI z-score); however, in the comparison between the undesired proportions of the metabolic components, only three presented alterations with significant differences between the groups (TC, LDL-C, and TG). It is concluded that IR influences the development of dyslipidemias in this age group, especially TG.

RESUMO O objetivo do estudo foi comparar o comportamento de parâmetros metabólicos, pressão arterial e indicadores de obesidade em crianças e adolescentes com e sem resistência à insulina. Participaram do estudo 60 crianças e adolescentes com excesso de peso (6 a 18 anos)que foram submetidos amedidas antropométricas de massa corporal (MC), estatura ecircunferência da cintura (CC), pressão arterial (PA), bioimpedância[gordura relativa (%G) e absoluta (GC)] e coleta sanguínea para determinação das concentrações de glicose, insulina e perfil lipídico (TG, CT, HDL-C, LDL-C). O IMC z-scorefoi empregado para classificação do estado nutricional e o índice HOMA-RI (>2,5) para resistência à insulina.Os participantes foram divididos em dois grupos, resistentes (RI, n=27) e não resistentes à insulina (NRI, n=33).Independente da idade, crianças e adolescentescom excesso de peso e RI, apresentaram maior MC, CC, IMC, %G e GC (kg), TG e insulina plasmática do que contraparesNRI, que por sua vez, apresentaram valores mais elevados de LDL-C. Os grupos não diferiram para oestado nutricional(IMC z-score)porém, na comparação entre as proporções indesejadas dos componentes metabólicos, apenas três apresentaram alterações com diferenças significativas entre os grupos (CT, LDL-C e TG). Conclui-se que a RI apresenta-se com influência para o desenvolvimento de dislipidemias nessa faixa etária em especial o TG.

Ação de prebióticos e simbióticos na obstipação intestinal de indivíduos com paralisia cerebral / Action of prebiotics and symbiotic on constipation bowel in individuals with cerebral paralysis

Introdução: A adição de simbióticos em fórmulas alimentares é evidenciada como uma opção para melhorar a imunidade e reduzir os distúrbios gastrointestinais, como a obstipação intestinal em indivíduos com paralisa cerebral. Objetivo: Avaliar o funcionamento intestinal de indivíduos com paralisia cerebral que receberam intervenção nutricional por meio da suplementação de simbióticos e consumo de alimentos prebióticos. Métodos: O estudo foi realizado com crianças e adolescentes da Associação Pais e Amigos dos Excepcionais de Guarapuava-PR. Estudo de curta comunicação caracterizado por dois grupos: Grupo com suplementação de simbióticos, no qual foi orientado a suplementação diária de colônia 4x109 Bifidobacterium infantis, Bifidobacterium longum, Lactobacilus casei, Lactobacilus plantarum, Lactobacilus rhamnosus e 2g Frutooligossacarídeos, em forma de sachê e Grupo orientação nutricional com foco no consumo de alimentos prebióticos, o qual recebeu orientações nutricionais com o objetivo de consumo diário de alimentos com prebióticos. A coleta de dados foi realizada por meio de dois questionários e avaliação antropométrica no início das intervenções nutricionais e após 2 meses as intervenções. Resultados: Participaram do estudo 20 indivíduos, sendo 10 em cada grupo. Por meio da avaliação antropométrica identificou-se aumento de peso do grupo simbiótico e orientação nutricional. Observou-se melhora significante na consistência das fezes após 2 meses de avaliação no grupo simbióticos (p=0,002) e no grupo orientação nutricional (p=0,005). Conclusão: A suplementação com simbióticos como a orientação nutricional auxiliou no aumento da frequência de evacuações e melhorou a consistência das fezes nestes indivíduos

Introduction: The addition of symbiotics in dietary formulas is evidenced as an option to improve immunity and reduce gastrointestinal disorders such as intestinal constipation in individuals with cerebral palsy. Objetive: To assess the bowel function of individuals with cerebral palsy who received nutritional intervention through supplementation symbiotic and prebiotics food consumption. Methods: The study was conducted with children and adolescents of Parents and Friends of Exceptional Guarapuava- PR. Short communication study was characterized by two groups: Group with synbiotic supplementation, which was instructed to daily supplementation colony 4x109 Bifidobacterium infantis, Bifidobacterium longum, Lactobacillus casei, Lactobacillus plantarum, Lactobacillus rhamnosus and 2g Fructooligosaccharides, shaped sachet and Nutritional counseling group focusing on consumer prebiotic foods, which received nutritional guidelines with the aim of daily consumption of food with prebiotics. Data collection was performed by means of two questionnaires and anthropometric assessment at the beginning of nutritional interventions and 2 months after the intervention. Results: Through anthropometric assessment identified an increase in weight of the symbiotic group and nutritional counseling. There was significant improvement in stool consistency after 2 months of evaluation in the symbiotic group (p=0.002) and nutritional counseling group (p=0.005). Conclusion: The supplementation with both symbiotic as nutritional counseling assisted in increased frequency of bowel movements and improved stool consistency in these individuals

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[Nutritional profile and factors associated with malnutrition in Kaingáng children on the Mangueirinha Indigenous Reserve, Paraná State, Brazil]. / Perfil nutricional e fatores associados à ocorrência de desnutrição entre crianças indígenas Kaingáng da Terra Indígena de Mangueirinha, Paraná, Brasil.

The goal of this study was to evaluate the nutritional status of indigenous children and to investigate factors associated with nutritional deficits. Weight and height measurements were obtained for 141 Kaingáng children from 0 to 5 years of age living on the Mangueirinha Indigenous Reserve in Paraná State, Brazil. Data on maternal and infant conditions and socioeconomic characteristics were also gathered through face-to-face interviews. Based on World Health Organization criteria (2006), 24.8% of the children presented low height-for-age (HA), 9.2% low weight-for-age (WA), 2.1% low weight-for-height (WH), and 2.1% low weight according to body mass index for age (BMIA). Based on NCHS criteria (1977), 19.9% of the children presented low HA, 9.2% low WA, and 1.4% low WH. 6.4% were overweight according to BMIA. Low birth weight and non-masonry housing construction were associated statistically with nutritional deficits. The Kaingáng children are subject to poor living conditions, associated with deficits in their nutritional profile.

Perfil nutricional e fatores associados à ocorrência de desnutrição entre crianças indígenas Kaingáng da Terra Indígena de Mangueirinha, Paraná, Brasil / Nutritional profile and factors associated with malnutrition in Kaingáng children on the Mangueirinha Indigenous Reserve, Paraná State, Brazil

Este estudo objetivou avaliar o estado nutricional de crianças indígenas e verificar os fatores associados à ocorrência de agravos nutricionais. Foram avaliadas 141 crianças Kaingáng de 0 a 60 meses de idade da Terra Indígena de Mangueirinha, Paraná, Brasil, por meio das medidas de peso e altura ou comprimento. Realizaram-se entrevistas com a aplicação de um questionário sobre condições materno-infantis e sócioeconômicas. Segundo os parâmetros da Organização Mundial da Saúde (2006), 24,8 por cento das crianças apresentavam déficit de altura para idade (AI), 9,2 por cento baixo peso para idade (PI), 2,1 por cento baixo peso para altura (PA) e 2,1 por cento baixo peso segundo o índice de massa corporal para idade (IMCI). De acordo com o NCHS (1977), 19,9 por cento das crianças apresentaram baixa AI, 9,2 por cento baixo PI e 1,4 por cento baixo PA. O sobrepeso chegou a 6,4 por cento, segundo o IMCI. O baixo peso ao nascer e os materiais utilizados na construção das paredes das casas estiveram estatisticamente associados com déficits antropométricos. Este estudo mostra que as crianças Kaingáng estão inseridas em um contexto marcado por precárias condições de vida, que estão associadas com indicadores desfavoráveis do estado nutricional.

The goal of this study was to evaluate the nutritional status of indigenous children and to investigate factors associated with nutritional deficits. Weight and height measurements were obtained for 141 Kaingáng children from 0 to 5 years of age living on the Mangueirinha Indigenous Reserve in Paraná State, Brazil. Data on maternal and infant conditions and socioeconomic characteristics were also gathered through face-to-face interviews. Based on World Health Organization criteria (2006), 24.8 percent of the children presented low height-for-age (HA), 9.2 percent low weight-for-age (WA), 2.1 percent low weight-for-height (WH), and 2.1 percent low weight according to body mass index for age (BMIA). Based on NCHS criteria (1977), 19.9 percent of the children presented low HA, 9.2 percent low WA, and 1.4 percent low WH. 6.4 percent were overweight according to BMIA. Low birth weight and non-masonry housing construction were associated statistically with nutritional deficits. The Kaingáng children are subject to poor living conditions, associated with deficits in their nutritional profile.