Excess body weight and dyslipidemia at well-child visit.

OBJECTIVES: Cardiovascular diseases are the main causes of death in the world. They are associated with the presence of risk factors such as obesity and dyslipidemia. Our objectives were to verify association between body mass index (BMI) and abnormalities in children's lipid profile evaluated during well-child visits, seeking to identify the frequency of each disorder in this population. METHODS: A cross-sectional study examined anthropometric data and laboratory results of children aged 2 to 9 (n=363) at a pediatric clinic between 2014 and 2017. Logistic and linear regression models were employed to assess associations between variables. RESULTS: Mean age was 6.3 ± 2.2 years; 187 (51.5 %) were male; 253 (69.7 %) were aged between 5 and 9 years old. A total of 114 (31.4 %) presented excess body weight and 53 (14.6 %) had obesity/severe obesity. Dyslipidemia was detected in 114 (34.4 %) children. Triglycerides was the most frequently altered lipid fraction (18.5 %), followed by HDL-c (16.8 %) and LDL-c (9.1 %). There was an association between hypertriglyceridemia (p=0.013) and low HDL-c (p=0.028) with obesity. BMI z-score showed a positive correlation with triglycerides (p=0.011) and a negative correlation with HDL-c (p=0.039). No association was observed between LDL-c and BMI. CONCLUSIONS: Excess body weight and dyslipidemia were seen in one-third of evaluated children. Elevations in triglycerides concentration were correlated with increased in BMI z-score. These findings point to the importance of monitoring nutritional status in well-child visits and performing universal screening for dyslipidemia in children, regardless of BMI.

Anthropometric Evaluation and Assessment of Food Intake of Parents of Pediatric Patients with Chronic Rheumatic Diseases.

INTRODUCTION: Parents' eating behavior, lifestyle, and food choices can interfere with their children's eating habits, bringing new perspectives for the development of beneficial interventions in the context of chronic rheumatic diseases. OBJECTIVES: The objective is to evaluate BMI, dietary intake, physical activity, and biomarkers of lipid metabolism in parents of children and adolescents with chronic rheumatic diseases and to verify the association with those of their children. METHODS: This is a cross-sectional study with 91 parents, and their respective children diagnosed with juvenile idiopathic arthritis (n = 30, 33.0%), juvenile systemic lupus erythematosus (n = 41, 45.0%), and juvenile dermatomyositis (n = 20, 22.0%). Anthropometric and dietary data, physical activity, lipid profile, and apolipoproteins A-I and B were evaluated. RESULTS: In total, 67% of parents and 27.5% of children were overweight; 80% of overweight children/adolescents also had parents with the same nutritional diagnosis. We found a moderate association of total fat intake (Cramer's V test = 0.254; p = 0.037), and a weak association of saturated fat intake (Cramer's V test = 0.219; p = 0.050) and cholesterol intake (Cramer's V test = 0.234; p = 0.025) between parents and their children. A high prevalence of dyslipidemia was observed for parents (82.4%) and children (83.5%), however, with no association between both. A weak association was found between parents and children (Cramer's V test = 0.238; p = 0.024) for triglycerides, and no association was found between parents and children concerning physical activity. CONCLUSION: The high frequency of overweight and dyslipidemia observed in parents, combined with the association between the fat intake by parents and their children with chronic rheumatic diseases, points to the importance of intervention strategies with the engagement and participation of families.

Lack of association of homocysteine concentrations with oxidative stress, alterations in carotid intima media thickness and endothelial reactivity in prepubertal children.

BACKGROUND AND AIMS: Our purpose was to assess the presence of risk factors for cardiovascular diseases (alterations in the lipid profile, fasting glycaemia, high arterial pressure values, oxidative stress, increased intima media thickness and impaired endothelium-dependent vasodilation) in prepubertal children with elevated homocysteine (Hcy) levels. METHODS: In a cross-sectional study, 35 children with Hcy levels ≥7.3 µmol/l were matched by gender and age with 29 children with Hcy levels ≤4.1 µmol/l. Our collected data included weight, height, waist circumference, systemic arterial pressure, lipid profile, fasting glycaemia and oxidative stress markers. A Doppler ultrasound was performed to measure the carotid intima media thickness and the endothelium-dependent vasodilation of the brachial artery. RESULTS: There were no statistically significant differences between the groups regarding the lipid profile and fasting glycaemia, blood pressure or oxidative stress. Overweight and obesity (body mass index z-score > +1) were more frequent in the group with Hcy ≥7.3 µmol/l when compared to the group with Hcy ≤4.1 µmol/l [13/35 (37.1%) vs. 4/29 (13.8%); p = 0.035]. After adjusting for nutritional status, there were no differences in the intima media thickness and endothelium-dependent vasodilation between children with high and low Hcy levels. CONCLUSIONS: Among the cardiovascular risk factors investigated in the present study, which was based on prepubertal children, only overweight and obesity were associated with increased Hcy concentrations (≥7.3 µmol/l).

Alimentação complementar: práticas inadequadas em lactentes / Complementary feeding: inappropriate practices in infants

Objetivo: Avaliar as práticas e o consumo alimentar de lactentes saudáveis de três metrópoles do Brasil. Métodos: Por meio de estudo prospectivo, analisaram-se registros alimentares de 7 dias consecutivos de amostra intencional, por cotas e ponderada, das cidades de Curitiba, São Paulo e Recife, de 179 lactentes saudáveis, entre 4 e 12 meses, que não se encontravam em aleitamento materno (AM) exclusivo. As mães receberam orientação verbal e escrita, por nutricionista, visando a uniformização da anotação do registro alimentar. Para o cálculo de ingestão, utilizou-se o Programa de Apoio à Nutrição (NutWin). Resultados: A mediana de idade dos lactentes foi de 6,8 meses (4,0-12,6 meses). Observou-se que 50,3% jánão recebiam AM. Destes, 12,0 e 6,7% dos menores e maiores de 6 meses, respectivamente, utilizavam fórmulas infantis em substituição ao leite materno. A maioria dos lactentes, portanto, recebia leite de vaca integral. A diluição da fórmula infantil foi correta em apenas 23,8 e 34,7% das crianças menores e maiores de 6 meses, respectivamente. Em relação à alimentação complementar, observou-se que a mediana de idade foi de 4 meses para sua introdução e de 5,5 meses para a alimentação da família. Verificou-se elevada inadequação quantitativa na ingestão de micronutrientes para lactentes de 6 a 12 meses que não recebiam AM, destacando-se as de zinco (75%) e ferro (45%). Conclusão: O presente estudo mostrou elevada frequência de práticas e consumo alimentar inadequados em lactentes muito jovens. É possível que essas práticas levem a aumento no risco de desenvolvimento futuro de doenças crônicas.

Objective: To assess feeding practices and dietary in-take of healthy infants in three Brazilian municipalities. Methods: By means of a prospective study, we analyzed the food record of 7 consecutive days of an intentional sample (quota and weighted sampling) of 179 healthy infants, aged between 4 and 12 months, from the municipalities of Curitiba, São Paulo, and Recife, who were not being exclusively breastfed. Mothers received oral and written information provided by a nutritionist with the purpose of standardizing the feeding data. The computer program NutWin was used to calculate the dietary intake. Results: The median of the infants' age was 6.8 months (4.0-12.6 months). We found that 50.3% of the infants were no longer being exclusively breastfed. Of these, 12.0 and 6.7% among the infants younger and older than 6 months, respectively, were fed with infant formulae instead of breast milk. Therefore, most infants received whole cow's milk. Infant formula dilution was correct in only 23.8 and 34.7% of the infants younger and older than 6 months old, respectively. With regards to complementary feeding, we found that the median age was 4 months for its introduction and 5.5 months for the introduction of family diet. There was high quantitative inappropriateness of micronutrient intake for infants between 6 and 12 months old who were not exclusively breastfed, mainly in terms of zinc (75%) and iron (45%). Conclusion: The present study showed a high frequency of inappropriate feeding practices and dietary intake in very young infants. These practices may lead to an increased risk of development of chronic diseases in the future.

Non-alcoholic fatty liver disease in overweight children and its relationship with retinol serum levels.

OBJECTIVES: To evaluate the frequency of non-alcoholic fatty liver disease, the retinol serum levels, lipid profile, and insulin resistance in overweight/obese children. To relate these biochemical variables with the risk of this disease in the population studied. METHODS: The study was cross-sectional and prospective, with 46 overweight/obese school children (28 female, 18 male; mean age 8.6 years). The control group consisted of 45 children, paired by age and gender. Hepatic steatosis, evaluated by ultrasound, was classified as normal, mild, moderate, or severe. Also evaluated were serum retinol levels; thiobarbituric acid reactive substances; lipid profile; and fasting glucose and serum insulin levels, used for the calculation of the Homeostasis Model Assessment. RESULTS: Hepatic ultrasound alterations were found in 56.5% and 48,9% of the overweight/obese and control group children, respectively. Presence of obesity was associated with high levels of triglycerides (OR = 4.6; P = 0.002). In the studied children, the risk of steatosis was related to a trend to a higher percentage of retinol inadequacy (OR = 2.8; p = 0.051); there was no association with thiobarbituric acid reactive substances, lipid profile, or insulin resistance. CONCLUSIONS: The high frequency of non-alcoholic fatty liver disease in both groups, evaluated by hepatic ultrasound, in low-socioeconomic level children, independent of nutritional condition and without significant association with insulin resistance, emphasizes that especially in developing countries, other risk factors such as micronutrient deficiencies (e.g. vitamin A) are involved.

Tratamento de crianças com desnutrição grave utilizando o protocolo da OMS: experiência de um centro de referência, São Paulo/Brasil / Treatment of severe malnourished children with WHO protocol: experience of a referral center in Sao Paulo, Brazil

O objetivo desse estudo foi descrever as principais causas de internaçao e doenças associadas em crianças gravemente desnutridas (DEP), avaliar a mortalidade, evoluçao antropométrica e terapia nutricional, utilizando protocolo da Organizaçao Mundial de Saúde - OMS). Em estudo retrospectivo, descritivo e transversal, avaliou-se 191 prontuários de crianças portadoras de DEP grave. Utilizou-se os indicadores antropométricos na forma de escore-z (peso/idade-ZP, estatura/idade-ZE e peso/estatura-ZPE) para classificaçao e avaliaçao da evoluçao nutricional durante a internaçao. As crianças foram divididas em 3 grupos (G): GI (desnutriçao primária-30,9 por cento), GII (desnutriçao secundária-51,7 por cento) e GIII (crianças que foram admitidas como GI e que durante a internaçao identificou-se alguma doença associada a DEP - 12 por cento). A terapia nutricional baseou-se nas normas da OMS, 1999, com algumas modificaçoes. Utilizou-se sempre fórmulas industrializadas: isenta de lactose (crianças com diarréia e na fase de estabilizaçao), baixo teor de lactose (crianças sem diarréia e na fase de recuperaçao) e hidrolisado de proteínas do soro de leite de vaca (crianças com diarréia cronica e/ou sepse). Análise estatística: teste t-student, qui-quadrado e regressao linear simples. A mediana de idade foi de 10,3 meses e o índice de letalidade de 4,2 por cento. As crianças do GI e GII eram mais velhas (11 vs 12 vs 7 meses,p=0,02) e permaneceram menos tempo internadas do que as do G III (20 vs 22 vs 37 dias,p=0,010). O risco de morte no GIII foi duas vezes maior (GIII>GII+GI; 8,7 por cento vs 3,6 por cento, p=0,25). Pneumonia, diarréia e baixo ganho ponderal foram os diagnósticos mais freqüentes a admissao. Sonda foi utilizada com maior frequencia no GII e GIII em relaçao ao GI (p=0,004). Nutriçao parenteral foi indicada em apenas 5,7 por cento das crianças (GII+GIII>GI,p=0,037). Intolerancia a dieta inicialmente instituída foi observada em apenas 20 por cento das crianças. O...

[Treatment of severe malnourished children with WHO protocol: experience of a referral center in São Paulo, Brazil]. / Tratamento de crianças com desnutrição grave utilizando o protocolo da OMS: experiência de um centro de referência, São Paulo/Brasil.

UNLABELLED: Mortality rate, anthropometric development and nutritional therapy with the use of World Health Organization guidelines (WHO) were assessed. In a cross-sectional retrospective study 191 hospitalized malnourished children were assessed. To classify and evaluate nutritional rehabilitation Z-score was used: weight-for-age (ZW), height-for-age(ZH) and weight-for-height(ZWH). The children were divided in three groups (G): GI (primary malnutrition--30,9%), GII (secondary malnutrition--51,7%) and GIII (children who were admitted as GI but during internation had an identified chronic disease--12%). Nutritional therapy used was based on WHO guidelines, with slight modifications. The formulas chosen were all industrialized: lactose-free polymeric formula (PLF) for children with diarrhea, low lactose polymeric formula (PLL) for children without diarrhea and cow's milk hydrolysate (H) for sepsis or chronic diarrhea. In the rehabilitation phase, all the children used PLL formula. STATISTICAL ANALYSIS: Student's, chi-square tests, simple linear regression. The median age and mortality rate were 10,3 months and 4,2%, respectively. The GI and GII children were older than GIII (11vs12vs7months,p=0,02) and had shorter length of stay (20vs22vs37days,p=0,010). Mortality risks in GIII were twice as frequent as in GI+GII. Pneumonia, diarrhea and poor weight gain were the main diagnosis at admission. Tubes were used more frequently in GII+GIII than GI (p=0,004). Parenteral nutrition was indicated in 5,7% of children, more often in GIII than GI+GII (p=0,037). Tolerance of the initial formula wasn't satisfactory in 20% of the children. An improvement of 87% ZWH, 74,1% ZW and 22% was observed. ZW in GI and ZWH in GIII were the indices that showed the most effective gain during hospital stay. The modified WHO guidelines were effective in the multiprofessional treatment of malnourished children, resulting in good nutritional rehabilitation with low mortality rates. A high percentage of children admitted as primary malnutrition who had a chronic disease diagnosed was observed. The late diagnosis may be responsible for the high length of stay, formula intolerance and mortality risk.