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2.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(4): 435-441, Oct.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1041361

RESUMO

ABSTRACT Objective: To determine the prevalence of hepatic steatosis (HS) in children and adolescents with cystic fibrosis (CF) and associate it with nutritional status. Methods: Cross-sectional study with children and adolescents with CF diagnosis. Weight and height were used to calculate the body mass index (BMI) and subsequent classification of the nutritional status. The midarm circumference (MAC), triceps skinfold thickness (TSF) and midarm muscle circumference (MAMC) were used to evaluate body composition. Abdominal ultrasonography was performed for diagnosis of HS. The statistical tests used were Student's t test, Mann-Whitney test and chi-square test with significance level of 5%. Results: 50 patients with CF were evaluated, 18 (36%) were diagnosed with HS (Group A) and 32 (64%) without HS (Group B). The mean age of Group A was 13,2±4,9 years old and Group B 11,7±4,9; for BMI, the value for Group A was 18,0±4,1 and Group B was 15,7±3,8; the TSF of Group A was 8,4±3,5 mm and Group B was 7,0±2,5 mm. For these variables, there was no significant difference between the groups. The mean of MAC and MAMC differed significantly between the groups, being higher in the HS group, with p values of 0,047 and 0,043. Conclusions: The frequency of HS in patients with CF is high and it is not related to malnutrition, according to the parameters of BMI, TSF and MAMC. The values of MAC and MAMC indicated a greater reserve of muscle mass in patients with HS.


RESUMO Objetivo: Determinar a prevalência de esteatose hepática (EH) em crianças e adolescentes com fibrose cística (FC) e associá-la com o estado nutricional. Métodos: Estudo transversal com crianças e adolescentes com diagnóstico de FC. Foram aferidos o peso e a altura para o cálculo do índice de massa corpórea (IMC) e classificação do estado nutricional. A circunferência do braço (CB), a dobra cutânea tricipital (DCT) e a circunferência muscular do braço (CMB) foram empregadas para avaliação da composição corporal. A ultrassonografia abdominal foi realizada para o diagnóstico de EH. Os testes estatísticos empregados foram o teste t de Student, o teste de Mann-Whitney e o teste do qui-quadrado, com nível de significância de 5%. Resultados: Dos 50 pacientes avaliados, 18 (36%) apresentaram EH (Grupo A) e 32 (64%) não (Grupo B). Para as médias de idade (Grupo A: 13,3±5,0 anos; e Grupo B: 11,7±5,0 anos), IMC (Grupo A: 18,0±4,1; e Grupo B: 15,7±3,8) e DCT (Grupo A: 8,4±3,5 mm; e Grupo B: 7,0±2,5 mm), não houve diferença significativa entre os grupos. A média da CB e da CMB diferiram significativamente entre os grupos, sendo mais elevada no grupo com EH, com valores p respectivos de 0,047 e 0,043. Conclusões: É alta a frequência de EH em pacientes com FC e ela não está relacionada com a desnutrição, segundo os parâmetros de IMC, DCT e CMB. Os valores de CB e CMB indicaram maior reserva de massa muscular nos pacientes com EH.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Estado Nutricional , Fibrose Cística/complicações , Desnutrição/complicações , Hepatopatia Gordurosa não Alcoólica/etnologia , Gestão de Riscos , Prevalência , Estudos Transversais , Fibrose Cística/fisiopatologia , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/epidemiologia
3.
J Stroke Cerebrovasc Dis ; 28(12): 104405, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31570264

RESUMO

BACKGROUND: Malnutrition in patients hospitalized with a stroke have been assessed using different nutritional screening methods but there is a paucity of data linking risk of malnutrition to clinical outcomes using a validated tool. AIMS: To identify the prevalence of malnutrition risk in patients after a stroke and assess the predictive value of the Malnutrition Universal Screening Tool (MUST) on clinical outcomes. PATIENTS AND METHODS: Using data from electronic records and the Sentinel Stroke National Audit Programme (January 2013 and March 2016), patients aged more than 18 years with confirmed stroke admitted to a tertiary care stroke unit were assessed for risk of malnutrition. The association between malnutrition risk and clinical outcomes was investigated and adjusted for confounding variables. RESULTS: Of 1101 patients, 66% were screened at admission. Most patients (n = 571, 78.5%) were identified as being at low risk, 4.1% (n = 30) at medium risk, and 17.4% (n = 126) at high risk of malnutrition. Compared with low risk, patients with medium or high risk of malnutrition were more likely to have a longer hospital stay (IRR 1.30, 95% confidence interval [CI] 1.07, 1.58), and had greater risk of mortality (10.9% versus 3.5%, 95% CI .03, .13). CONCLUSIONS: Prevalence of malnutrition assessed by MUST in patients after a stroke was relatively low, but nearly a third of patients were not screened. Patients classified as being at medium or high risk of malnutrition were more likely to experience negative outcomes. Early identification of this population may improve outcome if appropriate care is provided.


Assuntos
Desnutrição/diagnóstico , Avaliação Nutricional , Estado Nutricional , Acidente Vascular Cerebral/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Precoce , Registros Eletrônicos de Saúde , Feminino , Humanos , Tempo de Internação , Masculino , Desnutrição/mortalidade , Desnutrição/fisiopatologia , Desnutrição/terapia , Auditoria Médica , Pessoa de Meia-Idade , Admissão do Paciente , Valor Preditivo dos Testes , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Fatores de Tempo , Reino Unido/epidemiologia
4.
Nutrients ; 11(9)2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31527411

RESUMO

During the past decade, the concept of sustainability has been added to the factors involved in food security. This has led to a more comprehensive and holistic approach to sustainable food systems which considers drivers-environment, geopolitics, demographics, policy regulations, socio-cultural-economic factors, science and technology and infrastructure. The outcomes, similarly, involve many dimensions-environment, food security and nutrition, health and socio-cultural-economic aspects. This article discusses the Mediterranean diet in the context of sustainable food systems and shows (as in all parts of the world) that there is food insecurity in every country as monitored by the Global Nutrition Index. Three recent, major reports published in 2019 suggest what measures need to be taken to improve sustainable food systems. All environmental analyses agree on the need to promote more plant-based diets-achieved practically by using "more forks than knives". The Mediterranean Diet pattern is a case study for a sustainable diet. It has the best scientific evidence for being healthy, together with economic and socio-cultural benefits. A major challenge is that it is not consumed by the majority of the population in the Mediterranean region, and any solution must involve equity-the socially just allocation of resources. The task now is implementation with multi-stakeholder involvement, in the knowledge that "a well fed nation is a healthy nation is a sustainable and productive nation".


Assuntos
Conservação dos Recursos Naturais , Dieta Mediterrânea , Comportamento Alimentar , Abastecimento de Alimentos , Desnutrição/prevenção & controle , Política Nutricional , Valor Nutritivo , Conservação dos Recursos Naturais/legislação & jurisprudência , Abastecimento de Alimentos/legislação & jurisprudência , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Humanos , Desnutrição/epidemiologia , Desnutrição/fisiopatologia , Política Nutricional/legislação & jurisprudência , Estado Nutricional , Formulação de Políticas
5.
Nutrients ; 11(9)2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31527523

RESUMO

: Undernutrition is a major public health problem leading to 1 in 5 of all deaths in children under 5 years. Undernutrition leads to growth stunting and/or wasting and is often associated with environmental enteric dysfunction (EED). EED mechanisms leading to growth failure include intestinal hyperpermeability, villus blunting, malabsorption and gut inflammation. As non-invasive methods for investigating gut function in undernourished children are limited, pre-clinical models are relevant to elucidating the pathophysiological processes involved in undernutrition and EED, and to identifying novel therapeutic strategies. In many published models, undernutrition was induced using protein or micronutrient deficient diets, but these experimental models were not associated with EED. Enteropathy models mainly used gastrointestinal injury triggers. These models are presented in this review. We found only a few studies investigating the combination of undernutrition and enteropathy. This highlights the need for further developments to establish an experimental model reproducing the impact of undernutrition and enteropathy on growth, intestinal hyperpermeability and inflammation, that could be suitable for preclinical evaluation of innovative therapeutic intervention.


Assuntos
Transtornos da Nutrição Infantil/fisiopatologia , Enterite/fisiopatologia , Transtornos da Nutrição do Lactente/fisiopatologia , Síndromes de Malabsorção/fisiopatologia , Desnutrição/fisiopatologia , Estado Nutricional , Fenômenos Fisiológicos da Nutrição Animal , Animais , Transtornos da Nutrição Infantil/metabolismo , Transtornos da Nutrição Infantil/microbiologia , Pré-Escolar , Modelos Animais de Doenças , Metabolismo Energético , Enterite/metabolismo , Enterite/microbiologia , Microbioma Gastrointestinal , Humanos , Lactente , Transtornos da Nutrição do Lactente/metabolismo , Transtornos da Nutrição do Lactente/microbiologia , Fenômenos Fisiológicos da Nutrição do Lactente , Mucosa Intestinal/metabolismo , Mucosa Intestinal/microbiologia , Mucosa Intestinal/fisiopatologia , Síndromes de Malabsorção/metabolismo , Síndromes de Malabsorção/microbiologia , Desnutrição/metabolismo , Desnutrição/microbiologia , Permeabilidade
6.
Nutrients ; 11(9)2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31500109

RESUMO

BACKGROUND: Lack of evidence on the burden and risk factors for malnutrition among children with cerebral palsy (CP) in Vietnam limits evidence-based interventions. We aimed to define the nutritional status of children with CP in Vietnam. MATERIALS AND METHODS: The study utilized data from active prospective hospital-based surveillance modelled on the Pediatric Active Enhanced Disease Surveillance system. Children (0-18 years) with CP attending the National Children's Hospital Hanoi, Vietnam between June-November 2017 were included. Data on demographic, clinical and rehabilitation status were collected following detailed neurodevelopmental assessment. Anthropometric measurements were taken. Nutritional status was determined using the World Health Organization guideline. RESULTS: Of 765 children (the mean (SD) age was 2.6 (2.5) years; 35.8% were female), 28.9% (n = 213) were underweight and 29.0% (n = 214) stunted. The odds of underweight were significantly higher among children aged >5 years and/or having a monthly family income of <50 USD. Underweight and/or stunting was high among children with quadriplegia (81%, n = 60 and 84.5%, n = 87) and/or Gross Motor Functional Classification System (GMFCS) level IV-V (62.5%, n = 45 and 67.0%, n = 67). Nearly one-third of intellectually impaired and more than half of hearing-impaired children were underweight and/or stunted. CONCLUSIONS: Poor economic status and increased motor severity increased vulnerability to malnutrition. Our findings will inform nutritional rehabilitation programs among these vulnerable children.


Assuntos
Paralisia Cerebral/epidemiologia , Transtornos da Nutrição Infantil/epidemiologia , Fenômenos Fisiológicos da Nutrição Infantil , Crianças com Deficiência , Transtornos da Nutrição do Lactente/epidemiologia , Desnutrição/epidemiologia , Estado Nutricional , Adolescente , Desenvolvimento do Adolescente , Fenômenos Fisiológicos da Nutrição do Adolescente , Fatores Etários , Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/psicologia , Paralisia Cerebral/reabilitação , Criança , Desenvolvimento Infantil , Transtornos da Nutrição Infantil/fisiopatologia , Transtornos da Nutrição Infantil/reabilitação , Pré-Escolar , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/fisiopatologia , Humanos , Lactente , Transtornos da Nutrição do Lactente/fisiopatologia , Transtornos da Nutrição do Lactente/reabilitação , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Masculino , Desnutrição/fisiopatologia , Desnutrição/reabilitação , Atividade Motora , Inquéritos Nutricionais , Estudos Prospectivos , Magreza/epidemiologia , Magreza/fisiopatologia , Vietnã/epidemiologia
7.
Rev Assoc Med Bras (1992) ; 65(7): 952-958, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31389504

RESUMO

PURPOSE: In this prospective observational study, we aimed to investigate the role of the maximum compressed (MC) and uncompressed (UC) thickness of the quadriceps femoris muscle (QFMT) measured by ultrasonography (USG) in the detection of nutritional risk in intensive care patients (ICPs) with different volume status. METHODS: 55 patients were included. Right, left, and total ucQFMT and mcQFMT measurements were obtained by a standard USG device within the first 48 hours after ICU admission. Clinical examination and the USG device were used to determine the volume status of the patients. SOFA, APACHE II, modified NUTRIC scores, and demographic data were collected. RESULTS: There was a significant difference between the nutritional risk of patients in terms of left, right, and total mcQFMT measurements (p=0.025, p=0.039; p=0.028, respectively), mechanical ventilation requirement (p=0.014), presence of infection (p=0.019), and sepsis (p=0.006). There was no significant difference between different volume statuses in terms of mcQFMT measurements. In the multi-variance analysis, mcQFMT measurements were found to be independently associated with high nutritional risk (p=0.019, Exp(B)=0.256, 95%CI=0.082-0.800 for modified NUTRIC score ≥ 5), and higher nutritional risk (p=0.009, Exp(B)=0.144, 95%CI=0.033-0.620 for modified NUTRIC score ≥ 6). a Total mcQFMT value below 1.36 cm was a predictor for higher nutritional risk with 79% sensitivity and 70% specificity (AUC=0.749, p=0.002, likelihood ratio=2.04). CONCLUSION: Ultrasonographic measurement of total mcQFMT can be used as a novel nutritional risk assessment parameter in medical ICPs with different volume statuses. Thus, patients who could benefit from aggressive nutritional therapy can be easily identified in these patient groups.


Assuntos
Estado Nutricional/fisiologia , Músculo Quadríceps/diagnóstico por imagem , Músculo Quadríceps/patologia , Ultrassonografia/métodos , APACHE , Idoso , Idoso de 80 Anos ou mais , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Modelos Logísticos , Masculino , Desnutrição/diagnóstico por imagem , Desnutrição/patologia , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Avaliação Nutricional , Terapia Nutricional/métodos , Estudos Prospectivos , Músculo Quadríceps/fisiopatologia , Valores de Referência , Respiração Artificial/efeitos adversos , Medição de Risco , Sensibilidade e Especificidade
8.
Nutrients ; 11(8)2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31398886

RESUMO

Cellular pathways such as inflammation or oxidative stress are the cause and triggers of disease-related malnutrition (DRM), but the influence of these markers on endoplasmic reticulum (ER) stress is unknown. The objective of this study was to analyze the relationship between mitochondrial function and ER stress parameters in a DRM population. The study population was composed of 82 outpatient subjects, of whom 45 were diagnosed with DRM and 37 were confirmed to be normonourished according to the American Society for Parenteral and Enteral Nutrition ASPEN criteria. We evaluated anthropometrical and biochemical parameters, pro-inflammatory cytokines in serum. Oxidative and ER stress markers were analyzed in leukocytes. DRM patients showed significant reductions in albumin and transferrin concerning the normonourished group, and also displayed higher levels of hsCRP, IL6, and TNFα, and the soluble adhesion molecules VCAM-1 and ICAM-1. Besides, oxygen consumption and mitochondrial membrane potential were reduced and Radical Oxygen Species ROS production was enhanced in DRM patients. In the case of ER markers, protein and mRNA expression revealed that CHOP, ATF6, and the P-eIF2α signal were enhanced in malnourished patients compared to control subjects. Correlation studies supported a relationship between weight loss and increased inflammation, mitochondrial dysfunction, and compromised function of the ER. Our results demonstrate that ER stress signaling pathways are influenced by inflammation and mitochondrial function in the leukocytes of a DRM population.


Assuntos
Estresse do Retículo Endoplasmático/fisiologia , Retículo Endoplasmático/fisiologia , Leucócitos/fisiologia , Desnutrição/fisiopatologia , Estresse Oxidativo/fisiologia , Adulto , Idoso , Antropometria , Citocinas/sangue , Feminino , Humanos , Masculino , Desnutrição/sangue , Desnutrição/etiologia , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Pacientes Ambulatoriais
9.
Nutrients ; 11(8)2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31412681

RESUMO

Oncology treatment-related diarrhea and malnutrition appear together in oncological patients because of the disease itself, or the treatments that are administered for it. Therefore it is essential to carry out a nutritional treatment. Enteral nutrition formulas, containing peptides and medium chain triglycerides, can facilitate absorption in cases of malabsorption. There are few references to the use of enteral nutrition in the clinical society guidelines of patient management with oncology treatment-related diarrhea (OTRD). A bibliographic review of the studies with oligomeric enteral nutrition in OTRD found only nine studies with chemotherapy (all with the same oligomeric formula in which oral mucositis improves, while the rest of the outcomes show different results), and eight studies with radiotherapy (with different products and very heterogeneous results). We hereby present our action algorithm to supplement the diet of OTRD patients with an oligomeric enteral nutrition formula. The first step is the nutritional assessment, followed by the assessment of the functional capacity of the patient's intestine. With these two aspects evaluated, the therapeutic possibilities available vary in degrees of complexity: These will range from the usual dietary recommendations, to supplementation with oral oligomeric enteral nutrition, along with complete enteral nutrition with oligomeric formula, and up to potentially total parenteral nutrition.


Assuntos
Algoritmos , Antineoplásicos/efeitos adversos , Protocolos Clínicos , Diarreia/terapia , Nutrição Enteral/métodos , Alimentos Formulados , Desnutrição/terapia , Estado Nutricional , Lesões por Radiação/terapia , Diarreia/induzido quimicamente , Diarreia/fisiopatologia , Nutrição Enteral/efeitos adversos , Alimentos Formulados/efeitos adversos , Humanos , Absorção Intestinal , Desnutrição/induzido quimicamente , Desnutrição/fisiopatologia , Valor Nutritivo , Estado de Hidratação do Organismo , Lesões por Radiação/etiologia , Lesões por Radiação/fisiopatologia , Radioterapia/efeitos adversos , Fatores de Risco , Resultado do Tratamento
10.
Nutr Metab Cardiovasc Dis ; 29(10): 1101-1109, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31383499

RESUMO

BACKGROUND AND AIMS: Malnutrition is associated with adverse outcomes in patients with chronic disease. We screened malnutrition among patients of very advanced age with nonvalvular atrial fibrillation (AF) by malnutrition scores and investigated the associations between malnutrition and clinical outcomes. METHODS AND RESULTS: This retrospective observational study included 461 patients aged ≥80 years with nonvalvular AF. Malnutrition was screened using the Controlling Nutritional Status (CONUT), Prognostic Nutritional Index (PNI), and Geriatric Nutritional Risk Index (GNRI) scores. The primary endpoints were composite events, including thromboembolic events and all-cause death. Malnutrition was present in 62.9%, 5.0%, and 21.9% of patients according to the CONUT, PNI, and GNRI scores, respectively. During a median 27-month follow-up, 130 (28.2%) patients had composite events. Kaplan-Meier curves revealed that patients with moderate to severe malnutrition had the worst clinical outcomes (log-rank P < 0.05 for all scores). Multivariate Cox proportional hazards analysis showed that moderate to severe malnutrition was an independent predictor of composite events [hazard ratio (HR): 2.051, 95% confidence interval (95%CI): 1.143-3.679, P = 0.016 for CONUT score; HR: 3.374, 95%CI: 1.898-5.998, P < 0.001 for PNI score; HR: 2.254, 95%CI: 1.381-3.679, P = 0.001 for GNRI score]. Addition of the CONUT or GNRI score to a baseline prediction model for composite events significantly improved the net reclassification improvement and integrated discrimination improvement (all P < 0.05). CONCLUSION: Moderate to severe malnutrition was an independent predictor of adverse outcomes among patients of very advanced age with nonvalvular AF. Screening for malnutrition might provide useful information regarding prognosis and risk stratification.


Assuntos
Fibrilação Atrial/complicações , Desnutrição/complicações , Estado Nutricional , Fatores Etários , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Feminino , Avaliação Geriátrica/métodos , Humanos , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Avaliação Nutricional , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença
11.
Nutrients ; 11(8)2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31362417

RESUMO

INTRODUCTION: Peripheral artery disease (PAD) occurs at an advanced stage of atherosclerosis and its comorbidities are associated with poor prognoses. Malnutrition is related to the severity of atherosclerosis in patients with cardiovascular disease and it predicts mortality. The Controlling Nutritional Status (CONUT) score is calculated from serum albumin concentration, peripheral lymphocyte count and total cholesterol concentration, and it robustly represents the nutritional status of hospitalized patients. This study aimed to determine the prognostic value of the CONUT score in patients with peripheral artery disease (PAD) who were undergoing endovascular therapy (EVT). METHODS AND RESULTS: This study included 628 PAD patients who underwent EVT between 2013 and 2017 and were assigned to low (CONUT score 0: n = 81), mild (CONUT score 1-2: n = 250), moderate (CONUT score 3-4: n = 169), and high (CONUT score ≥ 5: n = 128) risk groups. The study's primary endpoint was any death. Patients in the groups with higher CONUT scores were more likely to have chronic kidney disease (p < 0.001), impaired left ventricular ejection fractions (p < 0.001), and critical limb ischemia (p < 0.001) on admission. During follow-up, 95 patients (15%) died. Kaplan-Meier analyses revealed that the patients with higher CONUT scores had lower survival rates (p < 0.001; log-rank trend test). Multivariate Cox regression analyses showed that following adjustments for the confounding factors, a higher CONUT score was significantly associated with any death (hazard ratio, 1.15; 95% confidence interval, 1.03-1.30). CONCLUSION: The simple index CONUT score at the time of EVT may predict long-term mortality in PAD patients.


Assuntos
Procedimentos Endovasculares/mortalidade , Desnutrição/mortalidade , Estado Nutricional , Doença Arterial Periférica/terapia , Idoso , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Avaliação Nutricional , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
12.
Nutr Metab Cardiovasc Dis ; 29(11): 1230-1236, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31427048

RESUMO

BACKGROUND AND AIMS: The Great Leap Forward Famine during 1959-1961 was the world's largest famine, and its adverse long-term effects might be more apparent in the coming decade with ageing of the exposed populations. The aim of this study was to examine whether the Chinese Famine modified the effect of hyperglycaemia on cardiovascular disease (CVD). METHODS AND RESULTS: We used data of 4337 adults born between 1952 and 1964 collected from the China Health and Retirement Longitudinal Study (CHARLS). Logistic regression was used to estimate the odds ratios (ORs) and confidence intervals (CIs) between hyperglycaemia and CVD. The prevalence of CVD showed significant difference among different famine exposure cohorts (P = 0.0156). After multivariable adjustment, the ORs (95% CIs) were as follows: 1.46 (0.94, 2.26) for late childhood, 1.76 (1.06, 2.90) for mid childhood, 1.40 (0.86, 2.27) for early childhood, 2.55 (1.30, 5.02) for the foetal cohort and 1.10 (0.63, 1.95) for the non-exposed cohort. There was a significant interaction between hyperglycaemia and famine exposure for CVD (P = 0.0374). In addition, the subgroup analyses showed that the effect of hyperglycaemia on CVD in the foetal exposure cohort was significantly higher than those in any of the other famine-exposed cohorts, especially in those who lived in rural areas (OR: 4.67, 95% CI: 1.70-12.84), those who lived in severe famine areas (OR: 5.01, 95% CI: 1.22-20.66) and those who were men (OR: 3.66, 95% CI: 1.01-13.33). CONCLUSION: Exposure to the Chinese Famine, especially during the foetal stage of life, aggravated the association between hyperglycaemia and CVD.


Assuntos
Glicemia/metabolismo , Doenças Cardiovasculares/epidemiologia , Transtornos da Nutrição Infantil/epidemiologia , Hiperglicemia/epidemiologia , Acontecimentos que Mudam a Vida , Desnutrição/epidemiologia , Efeitos Tardios da Exposição Pré-Natal , Fatores Etários , Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Criança , Desenvolvimento Infantil , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/fisiopatologia , Pré-Escolar , China/epidemiologia , Feminino , Idade Gestacional , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Estudos Longitudinais , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Fenômenos Fisiológicos da Nutrição Materna , Pessoa de Meia-Idade , Gravidez , Prevalência , Prognóstico , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
13.
Saudi J Kidney Dis Transpl ; 30(4): 924-931, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31464251

RESUMO

Nutrition is essential for children with end-stage renal disease, especially for those suffering from peritoneal dialysis (PD). Although the number of PD children has increased annually at the Vietnam National Hospital of Pediatrics, studies about the diet and nutritional deficiencies status of PD children is still limited. The aim of this study was to describe the actual diet and status of nutritional deficiencies of PD patients. This cross-sectional study was conducted on 31 PD children aged 2-15 years old using the 24-h dietary recall and biochemical parameters in blood (albumin, hemoglobin, calcium, sodium, potassium, and chloride). The energy intake was lowest in children over 13-year-old with only 32.9% of dietary reference intakes (DRIs). Carbohydrate intake among 10-15-year-old children was 38.1% of DRIs. Daily consumption of sodium was 65.6% and 33%-35% of DRIs for children under and over three-year-old, respectively. In comparison with DRIs, daily consumption of magnesium, iron, and calcium of over 10-year-old children was lower than that of younger children. In terms of vitamins, B-group vitamins, Vitamin C achieved the recommended levels except Vitamin A (63.0%) and Vitamin D (20.0%). The prevalence of children with serum albumin concentration lower than the normal range was 45.2% and prevalence of anemia was 51.6%. The proportion of children with decreased plasma calcium, sodium, and potassium levels was 83.8%, 77.4%, and 12.9%, respectively. PD children's diet lacks energy, protein, lipid, carbohydrate, as well as micronutrients. The prevalence of nutritional deficiencies is remarkably high in PD children.


Assuntos
Transtornos da Nutrição Infantil/fisiopatologia , Fenômenos Fisiológicos da Nutrição Infantil , Dieta/efeitos adversos , Falência Renal Crônica/terapia , Desnutrição/fisiopatologia , Estado Nutricional , Valor Nutritivo , Diálise Peritoneal/efeitos adversos , Adolescente , Fenômenos Fisiológicos da Nutrição do Adolescente , Criança , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Estudos Transversais , Ingestão de Energia , Feminino , Hospitais Pediátricos , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/fisiopatologia , Masculino , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Prevalência , Fatores de Risco , Vietnã/epidemiologia
14.
Nutrients ; 11(8)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31443186

RESUMO

In critically ill patients, malnutrition is known to increase morbidity and mortality. We investigated the relationship between nutritional support and 28-day mortality using the modified NUTrition RIsk in the Critically ill (NUTRIC) score in patients with sepsis. This retrospective cohort study included patients with sepsis admitted to the medical intensive care unit (ICU) between January 2011 and June 2017. Nutritional support for energy and protein intakes at day 7 of ICU admission were categorized into <20, 20 to <25, and ≥25 kcal/kg and <1.0, 1.0 to <1.2, and ≥1.2 g/kg, respectively. NUTRIC scores ≥4 were considered to indicate high nutritional risk. Among patients with low nutritional risk, higher intakes of energy (≥25 kcal/kg) and protein (≥1.2 g/kg) were not significantly associated with lower 28-day mortality. In patients with high nutritional risk, higher energy intakes of ≥25 kcal/kg were significantly associated with lower 28-day mortality compared to intakes of <20 kcal/kg (adjusted hazard ratio (aHR): 0.569, 95% confidence interval (CI): 0.339-0.962, p = 0.035). Higher protein intakes of ≥1.2 g/kg were also significantly associated with lower 28-day mortality compared to intakes of <1.0 g/kg (aHR: 0.502, 95% CI: 0.280-0.900, p = 0.021). Appropriate energy (≥25 kcal/kg) and protein (≥1.2 g/kg) intakes during the first week may improve outcomes in patients with sepsis having high nutritional risk.


Assuntos
Proteínas na Dieta/administração & dosagem , Ingestão de Energia , Desnutrição/terapia , Estado Nutricional , Apoio Nutricional/métodos , Valor Nutritivo , Sepse/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Desnutrição/diagnóstico , Desnutrição/mortalidade , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Apoio Nutricional/efeitos adversos , Apoio Nutricional/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sepse/diagnóstico , Sepse/mortalidade , Sepse/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
15.
Nutrients ; 11(9)2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31443528

RESUMO

Severe food restriction (FR) impairs cardiac performance, although the causative mechanisms remain elusive. Since proteins associated with calcium handling may contribute to cardiac dysfunction, this study aimed to evaluate whether severe FR results in alterations in the expression and activity of Ca2+-handling proteins that contribute to impaired myocardial performance. Male 60-day-old Wistar-Kyoto rats were fed a control or restricted diet (50% reduction in the food consumed by the control group) for 90 days. Body weight, body fat pads, adiposity index, as well as the weights of the soleus muscle and lung, were obtained. Cardiac remodeling was assessed by morphological measures. The myocardial contractile performance was analyzed in isolated papillary muscles during the administration of extracellular Ca2+ and in the absence or presence of a sarcoplasmic reticulum Ca2+-ATPase (SERCA2a) specific blocker. The expression of Ca2+-handling regulatory proteins was analyzed via Western Blot. Severe FR resulted in a 50% decrease in body weight and adiposity measures. Cardiac morphometry was substantially altered, as heart weights were nearly twofold lower in FR rats. Papillary muscles isolated from FR hearts displayed mechanical dysfunction, including decreased developed tension and reduced contractility and relaxation. The administration of a SERCA2a blocker led to further decrements in contractile function in FR hearts, suggesting impaired SERCA2a activity. Moreover, the FR rats presented a lower expression of L-type Ca2+ channels. Therefore, myocardial dysfunction induced by severe food restriction is associated with changes in the calcium-handling properties in rats.


Assuntos
Sinalização do Cálcio , Cálcio/metabolismo , Restrição Calórica , Cardiopatias/etiologia , Desnutrição/complicações , Mitocôndrias Cardíacas/metabolismo , Contração Miocárdica , Miócitos Cardíacos/metabolismo , Músculos Papilares/metabolismo , Adiposidade , Animais , Canais de Cálcio Tipo L/metabolismo , Modelos Animais de Doenças , Cardiopatias/metabolismo , Cardiopatias/patologia , Cardiopatias/fisiopatologia , Masculino , Desnutrição/metabolismo , Desnutrição/patologia , Desnutrição/fisiopatologia , Mitocôndrias Cardíacas/patologia , Miócitos Cardíacos/patologia , Músculos Papilares/patologia , Músculos Papilares/fisiopatologia , Ratos Endogâmicos WKY , ATPases Transportadoras de Cálcio do Retículo Sarcoplasmático/metabolismo , Perda de Peso
16.
Nutr Metab Cardiovasc Dis ; 29(11): 1237-1244, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31378624

RESUMO

BACKGROUND AND AIMS: Undernutrition in early life may have a lifelong effect on adult health. The conclusions on the association of exposure to famine with the risk of hypertension were inconsistent. The aim of this study was to examine the association of exposure to the Chinese famine with incident hypertension. METHODS AND RESULTS: Data were obtained from the China Health and Nutrition Survey. All included participants were divided into five birth cohorts: no exposure, born in or after 1962 (N = 2 088); fetal exposure, between 1959 and 1961 (N = 880); early childhood exposure, between 1956 and 1958 (N = 1 214); mid-childhood exposure, between 1953 and 1955 (N = 1 287); and late childhood exposure, between 1949 and 1952 (N = 1 445). Hypertension was defined as SBP/DBP ≥140/90 mmHg, use of hypertensive medications, or a self-reported diagnosis. A total of 6 914 participants were included. The exposure to famine decreased the incidence of hypertension (P = 0.0018, 0.0001, <0.0001, and <0.0001; HR: 0.715, 0.686, 0.622, and 0.527, respectively) in males. Similarly, the exposure to famine might also decrease incident hypertension in the rural areas (P = 0.0013, <0.0001, <0.0001, and <0.0001; HR: 0.735, 0.706, 0.679, and 0.539, respectively). There were interaction effects between famine severity and exposure to famine in early (P = 0.024) and late childhood (P = 0.009). CONCLUSION: Exposure to the Chinese famine decreased the incidence of hypertension, especially in males and in the rural areas. Furthermore, the exposure postponed the age at the onset of hypertension.


Assuntos
Pressão Sanguínea , Transtornos da Nutrição Infantil/epidemiologia , Hipertensão/epidemiologia , Acontecimentos que Mudam a Vida , Desnutrição/epidemiologia , Efeitos Tardios da Exposição Pré-Natal , Adulto , Fatores Etários , Criança , Desenvolvimento Infantil , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/fisiopatologia , Pré-Escolar , China/epidemiologia , Feminino , Idade Gestacional , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Incidência , Estudos Longitudinais , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Fenômenos Fisiológicos da Nutrição Materna , Pessoa de Meia-Idade , Gravidez , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Fatores de Tempo
17.
BMC Res Notes ; 12(1): 431, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315661

RESUMO

OBJECTIVE: To assess determinants of chronic energy deficiency in adults living with HIV in Shebel Berenta District Anti-Retroviral Therapy (ART) site health centers, East Gojjam, Amhara region, Ethiopia, 2017. An institutional based unmatched case control study design was employed and simple random sampling was used to select the desired sample size for both cases and controls. Data were entered to Epi-Data 3.1, exported to SPSS version 20 for analysis. Binary logistic regression was used to identify the determinants of chronic energy malnutrition among Human Immune Deficiency Virus positive adult patients. RESULTS: A total of 473 (118 cases and 355 controls) People Living with Human Immune Deficiency Virus (PLHIV) adult patients were participated. PLHIV who started ART at world health organization (WHO) clinical stage I (AOR: 0.285, CI 0.10, 0.81), rural residents (AOR: 0.38, CI 0.17, 0.83), had family size ≤ 3 (AOR: 0.114, CI 0.03, 0.48) and changed their feeding style (AOR: 0.075, CI 0.038, 0.150) decreased the risk of chronic energy deficiency. However, the baseline CD4 cell < 200/mm3 (AOR: 13.398; CI 4.83, 37.19), monthly family income ≤ 500 Ethiopia Birr (AOR: 6.9, CI 1.07, 44.62) and interrupted treatment (AOR: 2.28, CI 1.02, 5.09) were increasing the risk of chronic energy deficiency. Therefore; the government and partners should focus on the above determinants to improve the nutritional status of the clients.


Assuntos
Antirretrovirais/uso terapêutico , Metabolismo Energético , Infecções por HIV/tratamento farmacológico , HIV-1/efeitos dos fármacos , Adolescente , Adulto , Estudos de Casos e Controles , Etiópia , Feminino , Infecções por HIV/metabolismo , Infecções por HIV/virologia , HIV-1/fisiologia , Humanos , Modelos Logísticos , Masculino , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Estado Nutricional , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
18.
Nutrients ; 11(7)2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31261779

RESUMO

Little is known about the prevalence of anaemia and associated factors in school children in Vietnam. In this cross-sectional study, we aimed to determine the prevalence of anaemia and its subtypes, and the associations of types of anaemia with demographic, socio-economic and anthropometric factors among 6-9-year-old primary school children in rural areas of Hai Phong City, Vietnam. Haemoglobin (Hb) and mean corpuscular volume (MCV) were measured, and demographic, socio-economic and anthropometric data were collected in 893 children from eight primary schools. The prevalence of anaemia (Hb < 115 g/L) was 12.9% (95% CI: 8.1%, 19.9%), microcytic anaemia (Hb < 115 g/L and MCV < 80 fL) was 7.9% (95% CI: 5.3%, 11.6%) and normocytic anaemia (Hb < 115 g/L and MCV 80-90 fL) was 5.3% (95% CI: 2.9%, 9.5%). No child presented with macrocytic anaemia (Hb < 115 g/L and MCV > 90 fL). Children who were underweight, wasted, or in anthropometric failure (either underweight, stunted or wasted) were more likely to be anaemic (all p ≤ 0.004), and specifically, to have normocytic anaemia (all p ≤ 0.006), than those who were not underweight, wasted or in anthropometric failure. Stunted children were more likely to be anaemic (p = 0.018) than those who were not stunted. Overweight/obese children were less likely to be anaemic (p = 0.026) or have normocytic anaemia (p = 0.038) compared with children who were not overweight/obese. No anthropometric status indicator was associated with the risk of microcytic anaemia. No demographic or socio-economic factor was associated with any type of anaemia. Anaemia remains a public health issue in rural areas in Hai Phong City, Vietnam, and future approaches for its prevention and control should target undernourished primary school children.


Assuntos
Anemia/epidemiologia , Transtornos da Nutrição Infantil/epidemiologia , Fenômenos Fisiológicos da Nutrição Infantil , Desnutrição/epidemiologia , Estado Nutricional , Saúde da População Rural , Fatores Socioeconômicos , Estudantes , Fatores Etários , Anemia/sangue , Anemia/diagnóstico , Anemia Macrocítica/sangue , Anemia Macrocítica/diagnóstico , Anemia Macrocítica/epidemiologia , Biomarcadores/sangue , Criança , Desenvolvimento Infantil , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/fisiopatologia , Estudos Transversais , Feminino , Hemoglobinas/análise , Humanos , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Vietnã/epidemiologia
19.
Nutrients ; 11(7)2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31284369

RESUMO

Even though limited evidence is available, the relationship between morbidity and under-nutrition among children under-five is likely to be a strong two-way association. This study aims to explore this vicious cycle by employing longitudinal data of four periods within a 24 month follow-up, whereby morbidity was captured between two subsequent anthropometric measures. Malnutrition was classified according to z-scores of anthropometric measures and morbidity by number of sick days experienced inbetween. Mixed-effects models were used to assess this relation, where dependency of morbidity and nutritional status were interchanged; models were adjusted for province, age, gender, wealth index score, maternal education level, diet, and Water, Sanitation, and Hygiene indicators. Stunting and wasting prevalences were 29.9% and 8.9%, respectively, where 21.3% of the children hadmultiple anthropometric failures. Children identified as wasted were 35% more likely to experience prolonged illness periods (OR: 1.35, 95% CI: 1.02-1.56). Those experiencing high proportion of sick days were found to be 64% more likely to become stunted (OR: 1.64, 95% CI: 1.18-2.29). This study suggests that the link between wasting and stunting could be partly explained by acute illness, where wasting increases the likelihood of prolonged epiosed of illness, which increases the risk of stunting.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Fenômenos Fisiológicos da Nutrição Infantil , Transtornos do Crescimento/epidemiologia , Desnutrição/epidemiologia , Estado Nutricional , Fatores Etários , Camboja/epidemiologia , Desenvolvimento Infantil , Transtornos da Nutrição Infantil/diagnóstico , Transtornos da Nutrição Infantil/fisiopatologia , Pré-Escolar , Feminino , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/fisiopatologia , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Estudos Longitudinais , Masculino , Desnutrição/diagnóstico , Desnutrição/fisiopatologia , Prevalência , Medição de Risco , Fatores de Risco , Fatores de Tempo
20.
Medicine (Baltimore) ; 98(27): e16290, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277161

RESUMO

Patients who become malnourished during hospitalization because of illness or treatment often receive intervention from a nutrition support team (NST). The NST intervention not only enhances the nutritional status but also decreases medical expenses and catheter-related complications. However, the impact of the NST intervention on the home discharge of hospitalized community-dwelling older adults remains unclear. Hence, this study aims to investigate factors related to home discharge in malnourished community-dwelling older adults.In this retrospective longitudinal cohort study, examined 191 community-dwelling older adults aged ≥65 years (108 males; mean age: 80.9 ±â€Š7.8 years) who received the NST intervention. All participants were categorized into two groups based on whether they were home discharged or not (home discharge group and non-home discharge group). We performed intergroup comparisons using serum albumin (Alb) as an index of the nutritional status and functional independence measure (FIM: motor and cognitive items) as an index of activities of daily living (ADL). Furthermore, we constructed a prognostic model of home discharge using the logistic regression analysis.The home discharge group had 94 participants, with a home discharge rate of 50.8%. Baseline body mass index (BMI), motor-FIM score, and cognitive-FIM score were significantly higher in the home discharge group compared with the non-home discharge group (P = .002, P < .001, P < .001, respectively). In the home discharge group, BMI declined significantly, Alb elevated significantly, and both motor-FIM and cognitive-FIM score enhanced significantly by the completion of the NST intervention (P < .001, P < .001, P < .001, P = .005, respectively). The adjusted logistic regression analysis extracted the baseline BMI (odds ratio [OR], 1.146; 95% confidence interval [CI]: 1.034-1.270), baseline motor-FIM score (OR, 1.070; 95% CI: 1.036-1.105), and extent of change in the motor-FIM score (OR, 1.061; 95% CI: 1.026-1.098) as independent factors that predict home discharge.This study highlights the significance of higher baseline BMI, higher baseline ADL level, ADL enhancements, and improvements in the nutritional status by the NST intervention in malnourished community-dwelling older adults considering home discharge.


Assuntos
Atividades Cotidianas , Desnutrição/terapia , Estado Nutricional , Apoio Nutricional/métodos , Alta do Paciente/tendências , Recuperação de Função Fisiológica/fisiologia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Desnutrição/fisiopatologia , Prognóstico , Estudos Retrospectivos
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