Relación de la caries dental y el índice de masa corporal en población infantil / Relationship between dental caries and body mass index in children

La nutrición y salud bucal son temas de interés en salud pública por su alto impacto en el bienestar y desarrollo de las personas. Existe una alta prevalencia e incidencia de caries y malnutrición en los primeros años de vida. Determinar la relación entre el índice de caries en dentición primaria y permanente e índice de masa corporal en niños de 5 a 11 años en las unidades de salud de San Miguel Tepezontes y Panchimalco en el año 2019. Investigación cuantitativa con una muestra de 265 niños de 5 a 11 años. Se evaluó el índice de masa corporal y el índice de caries; se hizo un análisis estadístico descriptivo e inferencial, realizando la prueba estadística de correlación de Spearman. Se encontró que el índice de caries es de 2,11 en dentición permanente con una prevalencia de 70,5 % y el índice de caries de 7,02 en dentición primaria con una prevalencia de un 94,98 %. El coeficiente de correlación de Spearman entre índice de masa corporal e índice de caries en dentición permanente fue de 0,226, que indica una correlación positiva baja y el índice de masa corporal e índice de caries en dentición primaria fue - 0,158, que indica una correlación negativa muy baja. Existe relación entre el índice de caries en ambas denticiones y el índice de masa corporal

Nutrition and oral health are topics of interest in public health due to their high impact on the well-being and development of people. There is a high prevalence and incidence of caries and malnutrition in the first years of life. To determine the relationship between the caries index in primary and permanent dentition and body mass index in children aged 5 to 11 years in the health units of San Miguel Tepezontes and Panchimalco in the year 2019. Quantitative research with a sample of 265 children from 5 to 11 years. Body mass index and caries index were evaluated; A descriptive and inferential statistical analysis was performed, performing the Spearman correlation statistical test. It was found that the caries index is 2.11 in permanent dentition with a prevalence of 70.5% and the caries index is 7.02 in primary dentition with a prevalence of 94.98%. Spearman's correlation coefficient between body mass index and caries index in permanent dentition was 0.226, indicating a low positive correlation, and body mass index and caries index in primary dentition was -0.158, indicating a negative correlation. very low. There is a relationship between the caries index in both dentitions and the body mass index

Malnutrición por exceso durante la gestación: análisis de tendencia secular y de factores asociados, Región de La Araucanía, Chile / Secular trend for overweight and excessive weight gain during pregnancy in a Southern Chilean region

BACKGROUND: Overweight during pregnancy has increased in Chile. In the region of La Araucanía it occurs in 67% of pregnancies, which exceeds the national indicators. AIM: To analyze the secular trend during eight years of the nutritional status at the beginning of gestation, the excessive weight gain during pregnancy, and its association with individual factors in pregnant women cared the public health system of two Southern Chilean neighboring cities. MATERIAL AND METHODS: This is an analytical observational study with a cross-sectional and longitudinal trend design. We used an anonymized database with 17,270 reproductive data of urban pregnant women who were cared between 2009 and 2016. Trend analysis was performed to evaluate secular changes (nptrend < 0.05) in nutritional indicators and logistic regression to determine the association with individual characteristics. RESULTS: In the study period, overweight at the beginning of pregnancy increased by 13.1 percentage points. Forty percent of pregnant women with normal initial body mass index, were overweight or obese at the end of pregnancy. The excessive weight gain decreased slightly (z=-3.33, p = 0.001), but unevenly in both cities. Adolescent pregnancy, a low education and low socio-economic level of household together with previous overweight and a family or personal history of chronic diseases are associated with excessive gestational weight gain. Conclusions: The results show social inequality. Female malnutrition by excess is a problem that must be addressed through a robust public policy, centered on primary health care level and with a focus on social determinants. Prenatal care provides a window of opportunity to intervene.

Prevalencia de malnutrición por exceso en niños, niñas y adolescentes en pandemia, en centro médico de la Escuela de Medicina de la Universidad de Tarapaca / Prevalence of malnutrition due to excess in children, girls and adolescents during pandemic, in a medical center of the School of Medicine of the University of Tarapacá

INTRODUCCIÓN: La malnutrición por exceso afecta aproximadamente a 337 millones de niños, niñas y adolescentes en el mundo. Entre los aspectos multifactoriales asociados a la obesidad, destaca el contexto Pandemia por COVID-19, el cual ha aumentado las cifras de obesidad infantil. Por otro lado, la obesidad es considerada un factor de riesgo para desarrollar de forma grave la enfermedad por COVID-19. Este estudio busca analizar el efecto de la pandemia en los índices de malnutrición por exceso en los niños, niñas y adolescentes atendidos en el centro médico de la carrera de medicina de la Universidad de Tarapacá durante el año 2021 y compararlos con estudios previos realizados en Chile. METODOLOGÍA: La investigación tiene un enfoque analítico, transversal, retrospectivo y observacional. El estudio se basó en la revisión de fichas clínicas de 1094 pacientes entre 2 y 17 años atendidos en el Centro Médico de la Escuela de Medicina de la Universidad de Tarapacá en la ciudad de Arica. Los datos obtenidos fueron almacenados en plantilla Excel para ser ingresados en un programa estadístico. RESULTADOS: Del total de 1094 fichas analizadas, 611 pacientes (55,8%) se encontraron en un estado nutricional concordante con malnutrición por exceso, predominando en el sexo masculino (54,7%) y a mayor edad mayor malnutrición por exceso, encontrando mayor prevalencia de obesidad y obesidad severa en los(las) adolescentes. DISCUSIÓN: La malnutrición por exceso ha adquirido las características de epidemia y es un problema frecuente de los países en vías de desarrollo, convirtiéndose en un problema de salud pública. En este estudio se demuestra un aumento en los niveles de malnutrición por exceso durante el año 2021, comparando los resultados obtenidos en relación a la realidad nacional y regional en los años 2019 y 2020.

INTRODUCTION: Malnutrition due to excess affects approximately 337 million children and adolescents in the world. Among the multifactorial aspects associated with obesity, the COVID-19 Pandemic context stands out, which has warned the figures of childhood obesity. On the other hand, obesity is considered a risk factor for severely developing COVID-19 disease. This study seeks to analyze the effect of the pandemic on the rates of malnutrition due to excess in children and adolescents treated at the medical center of the University of Tarapacá during the year 2021 and compare them with previous studies carried out in Chile. METHODOLOGY: The research has an analytical, cross-sectional, retrospective and observational approach. The study was based on the review of clinical records of 1094 patients between 2 and 17 years of age treated at the Medical Center of the School of Medicine of the University of Tarapacá in the city of Arica. The data obtained was stored in an Excel template to be entered into a statistical program. RESULTS: Of the total of 1094 records analyzed, 611 patients (55.8%) were found to be in a nutritional state consistent with malnutrition due to excess, predominating in males (54.7%) and at older ages, finding a higher prevalence of obesity and severe obesity in adolescents. DISCUSSION: Malnutrition due to excess has acquired the characteristics of an epidemic and is a frequent problem in developing countries, becoming a public health problem. This study demonstrates an increase in the levels of malnutrition by excess during the year 2021, comparing the results obtained in relation to the national and regional reality in the years 2019 and 2020.

Situación de sobrepeso y obesidad en Honduras: revisión bibliográfica / Situation of overweight and obesity in Honduras: bibliographic review

Actualmente el número de personas obesas en el mundo duplica el número de personas con bajo peso. Honduras es un país altamente afectado por la pobreza y altos niveles de inseguridad alimentaria. Los problemas de nutrición incluyen desnutrición, deficiencia de micronutrientes y creciente prevalencia de sobrepeso y obesidad, esta última contribuyendo al aumento de enfermedades no transmisibles, menor calidad de vida y la mayor carga al sistema de salud y economía del país. Objetivo: evidenciar el problema de sobrepeso y obesidad debido malnutrición por exceso que se vive en Honduras y la necesidad de promover estrategias adecuadas para enfrentarlo. Material y métodos: mediante la búsqueda científica en las bases de datos PubMed, Dialnet, SciELO, Science-Direct, Redalyc y Elsevier, con palabras clave: obesity, overweight, food insecurity, malnutrition, Honduras. Se identificaron 52 documentos siendo seleccionados 39, algunos a partir de investigaciones realizadas en Honduras, en su mayoría en los últimos 10 años, así como fuentes nacionales y de organismos oficiales. Conclusiones: a medida que ha aumentado la prevalencia de obesidad y su relación de otras enfermedades no transmisibles, resalta la necesidad de implementar el marco legal referente a su prevención y control, así como la integración de acciones, dentro de las políticas nacionales para ser más efectivos en su combate, ya que en la actualidad son insuficientes. La participación multisectorial, es de vital importancia para fortalecer las acciones en todos los ámbitos competentes, tanto a nivel poblacional como individual, evaluando las actuales y promoviendo la creación de más estrategias a favor del control y reducción de la obesidad, encaminadas a garantizar la seguridad alimentaria y nutricional de la persona...(AU)

Malnutrición en una población de escolares en Santiago, República Dominicana / Malnutrition of an elementary school population in Santiago, Dominican Republic

Introducción: la malnutrición infantil representa uno de los problemas de salud pública más importantes de la República Dominicana (RD) y el mundo. A pesar de esto, actualmente, no existen estudios en la RD que describa el estado nutricional en los niños de la escuela primaria. Material y métodos: este estudio transversal describió las principales variables antropométricas en niños de 1ero a 6to de primaria en Santiago, RD, además de determinar la relación existente entre la antropometría y variables sociodemográficas. Resultados: de los 2,271 estudiantes estudiados, la media del peso fue 33,2 ± 11,4 kg, la talla fue 1,36 ± 0,13 m. La media del percentil fue 65,33 %. El 3.92 % (n=89) estuvo en bajo peso, el 17.57 % (n=399) estuvo en sobrepeso y el 22.94 % (n=521) estuvo en obesidad. Conclusión: el sobrepeso y la obesidad infantil fueron los trastornos más comunes en zonas rurales y urbanas, y tanto en centros privados como públicos

Introduction: Child malnutrition represents one of the most important public health issues in the Dominican Republic (DR) and the whole world. Despite this reality, there are currently no studies in the DR that describe the nutritional status in primary school children. Material and method: This cross-sectional study described the main anthropometric variables in children from elementary schools in Santiago, RD, in addition to determining the relationship between anthropometry status and some sociodemographic variables. Results: 2,271 participants were analyzed; the mean weight was 33.2 ± 11.4 kg, height was 1.36 ± 0.13 m. The mean percentile was 65.33%. 3.92% (n=89) were underweight, 17.57% (n=399) were overweight, and 22.94% (n=521) were obese. Conclusion: Childhood overweight and obesity was the most prevalent disorder, both in rural and urban areas, and both in private and public centers

Referencias de índice de masa corporal. Precisión diagnóstica con área grasa braquial en escolares argentinos / Body mass index references. Diagnostic accuracy with the upper-arm fat area in Argentine schoolchildren

El índice de masa corporal (IMC) es una eficaz herramienta para detectar la sobrecarga ponderal en niños y adolescentes, asociado a la adiposidad corporal. Objetivo. Analizar la concordancia, sensibilidad y especificidad de tres referencias internacionales de IMC/edad (OMS, IOTF y CDC) para diagnosticar el exceso ponderal y conocer su precisión diagnóstica para identificar el exceso de adiposidad con relación al área grasa braquial (AGB) en población infanto juvenil de Argentina. Materiales y métodos. Se realizó un estudio multicéntrico, descriptivo-comparativo y transversal entre 2003 y 2008, en 22.658 niños y adolescentes argentinos de 4 a 13 años de edad. A partir del peso, talla, circunferencia del brazo y pliegue tricipital, se calcularon IMC y AGB. Se analizó la concordancia, sensibilidad y especificidad de referencias de IMC/edad (OMS, CDC, IOTF) y la precisión diagnóstica (curvas ROC) para identificar exceso de adiposidad, a partir del AGB, así como el punto de corte óptimo (PCO). Resultados. Las tres referencias tuvieron buena concordancia. La mayor sensibilidad correspondió a OMS y la mayor especificidad a IOTF. El área bajo la curva (ABC) fue mayor en Z-IMC/IOTF en varones y en Z-IMC/OMS en mujeres. Los PCO mostraron discrepancias, siendo mayores con OMS. Conclusión. Las tres referencias muestran similar precisión diagnóstica para detectar alta reserva calórica, con puntos de corte óptimo para las puntuaciones Z-IMC menores a 2 Z scores. Esto resulta relevante para la identificación de exceso de adiposidad en poblaciones, en relación con la implementación de políticas públicas de prevención de enfermedades crónicas no transmisibles(AU)

The body mass index (BMI) is an effective tool to detect weight overload in children and adolescents, associated with body adiposity. Objective. To analyze the concordance, sensitivity and specificity of three international BMI/age references (WHO, IOTF and CDC) to diagnose excess weight and to know their diagnostic accuracy to identify excess adiposity in relation to the brachial fat area (BFA) in Argentine child-youth population. Materials and methods. A multicenter, descriptive- comparative and cross-sectional study was carried out between 2003 and 2008 in 22.658 Argentine children and adolescents between aged 4 to 13 years. From the weight, height, arm circumference and tricipital fold, BMI and BFA were calculated. The concordance, sensitivity, and specificity of BMI / age references (WHO, IOTF, CDC,) were analyzed and the diagnostic precision (ROC curves) to identify excess adiposity, from the BFA, as well as the optimal cut-off point (OCP). Results. The three references had good agreement, the highest sensitivity corresponded to WHO and the highest specificity to IOTF. The area under the curve (AUC) was greater in Z-BMI/IOTF in men and in Z-BMI/WHO in women. The OCPs showed discrepancies, being higher with WHO. Conclusion. The three references show similar diagnostic accuracy to detect high caloric reserve, but with cut-off points for Z-BMI scores less than 2 Z scores. This is relevant for the identification of excess adiposity in populations in relation to the implementation of public policies for the prevention of chronic non-communicable diseases(AU)

Patients with Post-Covid-19 Syndrome are at risk of malnutrition and obesity: findings of outpatient follow-up / Pacientes com Síndrome Pós-Covid-19 apresentam risco de desnutrição e obesidade: achados de um ambulatório de seguimento

ABSTRACT Objective To evaluate the nutritional and functional status, swallowing disorders, and musculoskeletal manifestations of patients with Post-Covid-19 Syndrome, stratified by the Appendicular Skeletal Muscle Mass Index. Methods This is a cross-sectional study with patients diagnosed with Post-Covid-19 Syndrome after discharge from the intensive care unit of a university hospital. The evaluated outcomes were: nutritional status (Mini Nutritional Assessment, bioimpedance and anthropometry), swallowing disorders (Dysphagia Risk Evaluation Protocol), functional status (Post-Covid-19 Functional Status Scale), and musculoskeletal manifestations. According to the Appendicular Skeletal Muscle Mass Index, patients were stratified in terms of loss or not loss of muscle mass. Results Thirty-eight patients were included in the study, 20 stratified into the no loss of muscle mass group (17 females; 49.45±12.67 years) and 18 into the loss of muscle mass group (18 males; 61.89±12.49 years). Both groups were at risk of malnutrition (Mini Nutritional Assessment scores between 17-23.5 points; No Loss of Muscle Mass Group: 21.82±3.93; Loss of Muscle Mass Group: 23.33±3.41) and obesity (No Loss of Muscle Mass Group: 33.76±6.34; Loss of Muscle Mass Group: 30.23±3.66). The groups differed in terms of bioimpedance parameters (except fat mass) and age. However, there were no differences in swallowing alterations, functional status, and musculoskeletal manifestations. Conclusion Patients with Post-Covid-19 Syndrome, stratified according to the Appendicular Skeletal Muscle Mass Index, were at risk of malnutrition and obesity. The persistence of fatigue, weakness, myalgia and arthralgia at 6 months after hospital discharge is noteworthy. These findings emphasize the importance of comprehensive care for patients with Post-Covid-19 Syndrome.

RESUMO Objetivo Avaliar o estado nutricional, status funcional, alterações de deglutição e manifestações musculoesqueléticas de pacientes com Síndrome Pós-Covid-19, estratificados pelo Índice de Massa Muscular Esquelética Apendicular. Métodos Estudo transversal composto por pacientes diagnosticados com a Síndrome Pós-Covid-19 que estiveram internados na Unidade de Terapia Intensiva de um hospital universitário. Os desfechos avaliados foram: estado nutricional (Mini Avaliação Nutricional; bioimpedância e antropometria), alterações de deglutição (Protocolo Fonoaudiológico de Avaliação do Risco de Disfagia), status funcional (Post-Covid-19 Functional Status Scale) e manifestações musculoesqueléticas. Os pacientes foram classificados, quanto à perda de massa muscular conforme o Índice de Massa Muscular Esquelética Apendicular, em grupo sem e com perda de massa muscular. Resultados Foram inseridos no estudo 38 pacientes, 20 no grupo sem perda de massa muscular (17 deles do sexo feminino; 49,45±12,67 anos) e 18 no grupo com perda de massa muscular (todos do sexo masculino; 61,89±12,49 anos). Os pacientes de ambos os grupos apresentaram risco de desnutrição (escores Mini Avaliação Nutricional entre 17-23.5 pontos; Grupo Sem Perda de Massa Muscular: 21,82±3,93; Grupo Com Perda de Massa Muscular: 23,33±3,41) e obesidade (Grupo Sem Perda de Massa Muscular: 33,76±6,34; Grupo Com Perda de Massa Muscular: 30,23±3,66). Os grupos diferiram quanto aos parâmetros da bioimpedância (exceto massa gorda) e idade. Entretanto, não foram observadas diferenças na deglutição, status funcional e manifestações musculoesqueléticas. Conclusão Os pacientes com Síndrome Pós-Covid-19, estratificados conforme o Índice de Massa Muscular Esquelética Apendicular, apresentaram risco de desnutrição e obesidade. Destaca-se a persistência de fadiga, fraqueza, mialgia e artralgia após seis meses da alta hospitalar. Esses achados ressaltam a importância do cuidado integral ao paciente com a Síndrome Pós-Covid-19.

Undernutrition and obesity trends in Brazilian adults from 1975 to 2019 and its associated factors / Tendências de subnutrição e obesidade em adultos brasileiros entre 1975 e 2019 e fatores associados / Tendencias de desnutrición y obesidad en adultos brasileños desde 1975 a 2019 y sus factores asociados

Nutritional status has evolved in a dual trend worldwide: underweight has become a minor or local issue while overweight or obesity has risen to play a major role in the global burden of disease. In 2014, Brazil was ranked as the third country with the highest absolute number of obese men. Our aim was to estimate trends of underweight and obesity among Brazilian adults using a comprehensive set of surveys from 1974 to 2019. The data used in the study originate from subjects aged ≥ 18 in six Brazilian national surveys, presented in chronological order: Brazilian National Survey on Household Expenses (ENDEF 1974-1975); Brazilian National Survey on Health and Nutrition (PNSN 1989); Brazilian Household Budget Survey (POF 2002-2003, 2008-2009); and Brazilian National Health Survey (PNS 2013 and 2019). All six surveys were designed to sample household complexes that were representative of the Brazilian population. Body mass index was calculated (kg/m2). The nutritional status of individuals was classified following the standards. We have modeled obesity trend according to income and education strata. The trajectories of underweight and obesity over time in Brazil draw the classical "X" of nutrition transition. From 1975 to 2019 underweight has decreased from 9.1% to 2.5% among men and 12.2% to 3.4% among women. On the other hand, obesity trajectories have scaled up from 3% to 22% among men and from 9% to 30% among women. The increase in obesity rate is directly and negatively proportional to income quintiles. Sociodemographic (income and education) improvement is associated with an increase in obesity. All public policies intending to stop the obesity spread in Brazil have been ineffective or too small to be effective.

O estado nutricional tem evoluído em duas direções no mundo: o baixo peso se tornou uma questão menor ou local, enquanto o sobrepeso ou obesidade passou a ter papel preponderante na carga global de doença. Em 2014, o Brasil ocupou terceiro lugar no mundo em número absoluto de homens obesos. O estudo teve como objetivo estimar as tendências nas taxas de baixo peso e obesidade entre adultos brasileiros, tendo como base um conjunto abrangente de inquéritos entre 1974 e 2019. Os dados utilizados no estudo se referem a indivíduos com 18 anos ou mais em seis pesquisas nacionais, apresentadas em ordem cronológica: Estudo Nacional de Despesa Familiar (ENDEF 1974-1975); Pesquisa Nacional sobre Saúde e Nutrição (PNSN 1989); Pesquisa de Orçamentos Familiares (POF 2002-2003, 2008-2009) e Pesquisa Nacional de Saúde (PNS 2013 e 2019). Todos os 6 inquéritos foram desenhados para obter amostras de complexos de domicílios que fossem representativas da população brasileira. O ídice de massa corporal foi calculado (kg/m2). O estado nutricional dos indivíduos foi classificado de acordo com as normas da Organização Mundial da Saúde. Modelamos a tendência da obesidade de acordo com as faixas de renda e escolaridade. As trajetórias de baixo peso e obesidade no Brasil ao longo do tempo mostram a forma clássica em "X" da transição nutricional. Entre 1975 e 2019, a taxa de baixo peso diminuiu de 9,1% para 2,5% entre homens e de 12,2% para 3,4% entre mulheres. Inversamente, as trajetórias da obesidade aumentaram de 3% para 22% entre homens e de 9% para 30% entre mulheres. O incremento na obesidade está relacionado diretamente e de maneira negativamente proporcional aos quintis de renda. A melhoria sociodemográfica (de renda e escolaridade) está associada ao aumento da obesidade. Todas as políticas públicas para interromper a expansão da obesidade no Brasil têm sido ineficazes, ou pequenas demais para ser eficazes.

El estatus nutricional ha evolucionado en una doble tendencia alrededor del mundo: el bajo peso se ha convertido en un problema menor o local, mientras que el sobrepeso o la obesidad ha aumentado desempeñando un papel importante en la carga global de la enfermedad. En 2014, Brasil se situó como el tercer país con la mayor carga absoluta de hombres obesos. Nuestro objetivo fue estimar las tendencias de bajo peso y obesidad entre brasileños adultos, utilizando un conjunto completo de encuestas desde 1974 a 2019. Los datos usados en el estudio procedieron de individuos con ≥18 años en 6 encuestas nacionales brasileñas, presentadas en orden cronológico: Estudio Nacional sobre Gasto Familiar (ENDEF 1974-1975); Encuesta Nacional de Salud y Nutrición (PNSN 1989); Encuestas sobre Presupuesto Familiar (POF 2002-2003, 2008-2009); y Encuesta Nacional de Salud (PNS 2013 y 2019). Las 6 encuestas se diseñaron para las muestras complejas de hogares que eran representativas de la población brasileña. Se calculó el indice de masa corporal (kg/m2). El estatus nutricional de los individuos se clasificó siguiendo los estándares de la Organización Mundial de la Salud. Hemos modelado la tendencia a la obesidad según el nivel de ingresos y educación. Las trayectorias de bajo peso y obesidad a lo largo del tiempo en Brasil dibujaron la clásica "X" de transición nutricional. Desde 1975 a 2019, ha decrecido el bajo peso de 9,1% a 2,5% entre hombres y de 12,2% a 3,4% entre mujeres. Las trayectorias de obesidad, en cambio, escalan desde el 3% al 22% entre hombres, y desde el 9% al 30% entre mujeres. El incremento en la tasa de obesidad es directamente y negativamente proporcional a los quintiles de ingresos. La mejora sociodemográfica (ingresos y educación) está asociada con un incremento en la obesidad. Todas las políticas públicas puestas en práctica para intentar detener la propagación de la obesidad en Brasil han sido inefectivas o demasiado pequeñas para ser efectivas.

Adequação calórico proteica da terapia nutricional enteral em pacientes críticos / Caloric-protein adequacy of enteral nutritional therapy in critical patients

A doença crítica promove um estado hipercatabólico associado a uma resposta inflamatória intensa. Admite-se que essas alterações contribuem para o aumento do gasto de energia e para a elevação do catabolismo proteico. Objetivo: analisar a adequação calórico-proteica da terapia de nutrição enteral e o seu impacto no desfecho clínico de pacientes críticos. Método: Trata-se de um estudo longitudinal prospectivo realizado com 36 pacientes internados em unidades de terapia intensiva. A adequação da oferta calórico-proteica foi obtida pela relação percentual a partir do quarto dia de implementação da terapia nutricional. Realizou-se o teste de Shapiro Wilk para averiguar a normalidade dos dados e a partir disso, foi aplicado o teste de Mann-Whitney ou de t-Student não pareado. Foi realizada a análise de regressão logística com estimativa de seu coeficiente. Para a regressão estimou-se o intervalo de confiança de 95% e nível de significância de 5%. Foi utilizado o software STATA® versão 14.0 nesta análise. Resultados: Ao avaliar 36 pacientes verificou-se que a sobrevida foi menor entre os indivíduos que apresentaram o menor percentual de adequação calórica (p=0,010) e proteica (p=<0,001). Observou-se que oferta proteica impactou mais expressivamente os desfechos clínicos, ao aumento de 1% na média de adequação proteica as chances de óbito diminuíram 21%. Conclusão: O menor percentual de adequação calórico-proteica foi associado a menor sobrevida de pacientes críticos. Ainda, observou-se que o percentual de adequação proteica se associou mais expressivamente aos desfechos clínicos nessa amostra

The critical illness promotes a hypercatabolic state associated with an intense inflammatory response. It is recognized that those changes contribute to the rise of consumption of energy expenditure and to protein metabolism rise. Objective: to analyze the adequacy caloric-protein of enteral nutrition therapy and its impact on the clinical outcome of critical patients. Method: This is a prospective longitudinal study conducted with 36 hospitalized patients in intensive care units. The caloric-protein adequacy was acquired by percent ratio from the fourth day of nutritional therapy implementation. The Shapiro Wilk test was performed to check the data normality and based on that the Mann-Whitney test or unpaired Student t test was applied. The logistic regression analysis was performed with an estimate of its coefficient. For regression, it was estimated the confidence interval of 95% and significance level of 5%. In this analysis was utilized the STATA® software version 14.0. Results: In the evaluation of 36 patients, it was found that survival was lower among the individuals who had the lower percentage of caloric adequacy (p=0,010) and protein (p=<0,001). It was observed that the protein supply impacted expressively the clinical outcome with an increase of 1% in the average protein adequacy, the chances of death decreased by 21%. Conclusion: The lower percentage of caloric-protein adequacy was associated with lower mortality of critical patients. In addition, in this sampling, it was observed that the protein adequacy percentual joined expressively in the clinical outcome

Guia rápido para o acompanhamento de gestantes e crianças com desnutrição na atenção primária à saúde / Quick guide for monitoring pregnant women and children with malnutrition in Primary Health Care

A desnutrição é um problema de saúde pública que acomete a população brasileira, especialmente pessoas de maior vulnerabilidade social e biológica. De acordo com os dados do Sistema de Vigilância Alimentar e Nutricional (SISVAN), em 2020, 14,2% das gestantes apresentaram baixo peso para a idade gestacional, 6,1% das crianças menores de 5 anos estavam com magreza acentuada ou magreza e 13,0% delas com baixa estatura para a idade. O cenário é preocupante, tendo em vista as consequências da desnutrição em curto e longo prazo. A desnutrição associa-se à maior mortalidade e morbidade, é um fator de risco para infecções - como doenças diarreicas e respiratórias - e contribui para um inadequado crescimento e desenvolvimento na primeira infância1. Entre os múltiplos fatores para a prevenção da desnutrição, a alimentação adequada e saudável é essencial para garantir o pleno crescimento e desenvolvimento, com destaque para os primeiros 1.000 dias de vida, que englobam o período gestacional, e os primeiros 2 anos de vida da criança. Uma alimentação em quantidade ou qualidade insuficiente nessas fases da vida associa-se à múltipla carga de má nutrição, caracterizada pela coexistência de desnutrição, excesso de peso e carências nutricionais, como a anemia e a deficiência de vitamina A. No contexto atual, vem observando-se aumento nas prevalências de insegurança alimentar e nutricional (IAN), o que indica maior número de famílias brasileiras sem acesso regular e permanente à alimentação de qualidade e em quantidade suficiente, sendo essa situação diretamente relacionada com a ocorrência da má nutrição3. Considerando a importância do diagnóstico de desnutrição, assim como que a vigilância alimentar e nutricional e a promoção de uma alimentação adequada e saudável para gestantes e crianças são essenciais para evitar consequências imediatas e em longo prazo para a saúde, este protocolo tem como principal objetivo apoiar os gestores e profissionais de saúde dos municípios na qualificação do cuidado da gestante e da criança com desnutrição leve e moderada no âmbito da Atenção Primária à Saúde (APS).

Frequency of vitamin d deficiency in patients with lumbar spinal stenosis and its relationship with obesity, depression, and pain intensity: a cross-sectional study / Frequência da deficiência de vitamina D em pacientes com estenose espinhal lombar e sua relação com obesidade, depressão e intensidade da dor: um estudo transversal

ABSTRACT Objective This study was conducted to determine the frequency of vitamin D deficiency in patients with lumbar spinal stenosis and to define the relationship between vitamin D levels and obesity, depression, and pain intensity. Methods This study was conducted with 69 patients (Male = 32, Female = 37) diagnosed with lumbar spinal stenosis. The participants' 25(OH)D levels were measured by radioimmunoassay. In addition, bone metabolic status, including bone mineral density and bone turnover markers, was also evaluated. The Beck Depression Inventory was used to determine the depression statuses of the patients, while the McGill Melzack Pain Questionnaire was administered to measure pain intensity. The results were evaluated at a significance level of p<0.05. Results Vitamin D deficiency (<20 ng/mL) was found in 76.8% of the patients. Binary logistic regression analysis showed a significantly higher frequency of vitamin D deficiency in patients who: 1) had higher body mass indexes (OR 3.197, 95% CI 1.549-6.599); 2) fared higher in Beck's depression score (OR 1.817, 95% CI 1.027-3.217); and 3) were female rather than male (OR 1.700, 95% CI 0.931-3.224) (p<0.05). Conclusion In this study, vitamin D deficiency was prevalent in lumbar spinal stenosis patients. In addition, obese, depressed, and female individuals have higher risks of vitamin D deficiency.

RESUMO Objetivo Este estudo foi realizado para determinar a frequência de deficiência de vitamina D em pacientes com estenose espinhal lombar e para definir a relação entre os níveis de vitamina D e obesidade, depressão e intensidade da dor. Métodos Este estudo foi realizado com 69 pacientes (homens = 32, mulheres = 37) diagnosticados com estenose espinhal lombar. Os níveis de 25(OH)D dos participantes foram medidos por radioimunoensaio. Além disso, o estado metabólico ósseo, incluindo densidade mineral óssea e marcadores de remodelação óssea, também foi avaliado. O Inventário de Depressão de Beck foi usado para determinar os estados de depressão dos pacientes, enquanto o Questionário de Dor McGill Melzack foi aplicado para medir a intensidade da dor. Os resultados foram avaliados a um nível de significância de p<0,05. Resultados A deficiência de vitamina D (<20 ng/mL) foi encontrada em 76,8% dos pacientes. A análise de regressão logística binária mostrou uma frequência significativamente maior de deficiência de vitamina D nos seguintes pacientes: 1) com maior índice de massa corporal (OR 3,197, 95% IC 1,549-6,599); 2) com maior pontuação na escala de depressão de Beck (OR 1,817, 95% IC 1,027-3,217) e 3) do sexo feminino em vez de masculino (OR 1,700, 95% IC 0,931-3,224) (p<0,05). Conclusão Neste estudo, a deficiência de vitamina D foi prevalente em pacientes com estenose espinhal lombar. Além disso, pessoas obesas, deprimidas e mulheres correm maior risco de deficiência de vitamina D.

Double burden of malnutrition as a risk factor for overweight and obesity

ABSTRACT OBJECTIVE To assess the longitudinal effect of double burden of malnutrition (DBM) on the risk of developing child and adolescent overweight or obesity. METHODS Analysis of the Peruvian Young Lives Study, younger cohort: baseline (2002) and 4 follow-ups (2006-2007, 2009-2010, 2013-2014, and 2016-2017). Outcomes were the incidence of overweight and obesity as defined by the World Health Organization standards. The exposure comprised a variable with 4 categories: non-stunted child with a non-overweight mother (reference group), non-stunted child with an overweight mother, stunted child with a non-overweight mother, and stunted child with an overweight mother (i.e., DBM). Poisson regression models were built to assess the association of interest, and relative risks (RR) and 95%CI were reported. RESULTS Data from 2,034 children; 50.0% were girls and the mean age was 12.0 (3.6) months at baseline. Non-stunted children with an overweight mother had greater risk (RR = 1.64; 95%CI: 1.35-1.99) of developing overweight, compared with the risk for stunted children with a non-overweight mother (RR = 1.38; 95%CI: 1.10-1.72), and for those with DBM (RR = 1.28; 95%CI: 1.02-1.61). When compared with the reference group, obesity risk was greater among non-stunted children with an overweight mother (RR = 2.33; 95%CI: 1.68-3.22), greater among stunted children with a non-overweight mother (RR = 2.59; 95%CI: 1.75-3.84), and greater among those with DBM (RR = 2.14; 95%CI: 1.39-3.28). CONCLUSIONS DBM is a risk factor for childhood overweight and obesity in Peru. Dual-duty policies tackling both undernutrition in children and overweight in mothers are needed to reduce DBM and its future effects in Peru.

Talla baja y sobrepeso en menores de 5 años que habitan la Sierra Tarahumara, México / Stunting and overweight in children under 5y who inhabit the Sierra Tarahumara in northern Mexico

La doble carga de la desnutrición y el exceso de peso (o mala nutrición) es uno de los indicadores que mejor ilustra las inequidades en salud que existen en zonas indígenas de México. Por otro lado, existe escasa evidencia del estado de nutrición en población Tarahumara. Objetivo: Estimar indicadores del estado de nutrición y su asociación con factores sociodemográficos en población indígena Tarahumara menor de 5 años. Métodos: Estudio transversal en 21 localidades indígenas de la Sierra Tarahumara en Chihuahua, México, que analizó información sociodemográfica, de salud y antropométrica en población infantil de 6 a 59 meses de edad (n=323). Se estimaron índices antropométricos y su asociación con variables de interés mediante regresión logística múltiple. Un valor de p ≤0,05 fue considerado como estadísticamente significativo. Todos los análisis se realizaron en el paquete estadístico Stata v14.2. Resultados: Se encontraron altas prevalencias de talla baja (44,4%), emaciación (5,3%), bajo peso (11,9%) y sobrepeso (15,2%). El sexo masculino se asoció significativamente con talla baja (Razón de Momios (RM)=2,5; 1,45-4,34), mientras que, ninguna escolaridad de la madre (RM=0,39; 0,15-0,99) y ser beneficiario de un programa local de nutrición por más de 2 años se asoció con sobrepeso (RM=2,97; 1,26 -6,97). Conclusión: Se encontraron indicadores de mala nutrición en la muestra estudiada; éstos hallazgos podrían sugerir la existencia de inequidad y rezago en salud y nutrición de población infantil indígena Tarahumara. Se requieren más estudios que puedan orientar programas y acciones de salud y nutrición para atender a esta población de forma prioritaria(AU)

The double burden of malnutrition and excess weight (or poor nutrition) is one of the indicators that best illustrates the health inequities that exist in indigenous areas of Mexico. On the other hand, there is scarce evidence of the nutritional status of the Tarahumara population. Objective: To estimate indicators of the nutritional status and its association with sociodemographic factors in the Tarahumara indigenous population under 5 years of age. Methods: A cross-sectional study in 21 indigenous localities of the Sierra Tarahumara in Chihuahua, Mexico, which analyzed sociodemographic, health and anthropometric information in children from 6 to 59 months of age (n=323). Anthropometric indices and their association with variables of interest was estimated by multiple logistic regression. A value of p ≤0.05 was considered statistically significant. All analyzes were performed using the Stata v14.2 statistical package. Results: It were founded high prevalences of short stature (44.4%), emaciation (5.3%), underweight (11.9%) and overweight (15.2%). Male sex was significantly associated with short stature (Odds Ratio (OR) = 2.5; 1.45-4.34), while no education of the mother (OR = 0.39; 0.15-0.99) and being a beneficiary of a local nutrition program for more than 2 years it was associated with being overweight (OR = 2.97; 1.26-6.97). Conclusion: Indicators of malnutrition and overweight were founded in the sample studied; these findings suggest inequity and delays in health and nutrition of the indigenous Tarahumara child population. More research is required that can guide health and nutrition programs and actions to serve this indigenous population as a priority(AU)

Vulnerabilidad social, un blanco fatal de la coinfección tuberculosis-VIH en Cali / Social vulnerability, a fatal scenario for TB-HIV coinfection

Resumen Objetivo: Describir la proporción, características clínicas, demográficas y programáticas de casos fatales de coinfección TB/VIH de Cali-Colombia, en 2017. Material y Método: Estudio de corte transversal, con información de las bases de datos del programa de tuberculosis, las historias clínicas y unidades de análisis de mortalidad disponibles. Resultados: Se depuraron 257 casos fatales por TB, el 24,5% (63/257) falleció con coinfección TB/VIH. La mediana de edad fue 43 años (Rango Intercuartílico: 30-52), 73% (46/63) eran hombres, 76,2% (48/63) no pertenecían al régimen contributivo, 28,6% eran habitantes de calle. 81,2% (39/48) eran casos nuevos de TB, 76,6% (37/47), inició tratamiento; al 74,6% (47/63) se les realizó unidad de análisis de mortalidad. La presentación pulmonar fue frecuente (75,9%-44/58), en 60% de los registros se observó desnutrición (Índice de Masa Corporal <20), en 39,7% (25/63) dependencia al alcohol, tabaco o farmacodependencia. Conclusiones: La mortalidad asociada a TB/VIH es prevenible, pero en 2017 representó la cuarta parte de la mortalidad por TB en Cali. Hombres adultos con condiciones de vulnerabilidad social, diagnosticados en estados avanzados de enfermedad, fueron blanco de fatalidad. Mejorar los sistemas de información e integrar los programas de TB/VIH, deben ser estrategias prioritarias para la salud pública en Colombia.

Abstract Objective: To describe the proportion, clinical, demographic and programmatic characteristics of fatal cases of TB/HIV coinfection from Cali-Colombia, in 2017. Material and Method: Cross-sectional study, with information from the TB program databases, clinical records and mortality analysis units available. Results: 257 TB fatal cases were cleared in Cali in 2017, 24.5% (63/257) of these died with TB/HIV coinfection. The median age was 43 years (Interquartile Range: 30-52), 73% (46/63) were men, 76.2% (48/63) did not belong to the contributory health regimen, 28.6% were homeless. 81.2% (39/48) were new TB cases, 76.6% (37/47) started treatment; 74.6% (47/63) had mortality analysis register. Pulmonary presentation was frequent (75.9% -44 / 58), in 60% of the registries malnutrition was observed (Body Mass Index <20), in 39.7% (25/63), dependence on alcohol, tobacco or drug dependence was registered. Conclusions: Mortality associated with TB/HIV is preventable, but in 2017 it represented a quarter of the TB mortality in Cali. Adult men with conditions of social vulnerability, diagnosed in advanced stages of disease, were fatally targeted. Improving information systems and integrating TB/HIV programs should be priority strategies for public health in Colombia.

Impact of nutritional and physical activity interventions on the cognitive and academic achievement of schoolchildren

The objective of this review is to present the impact of nutritional education, physical activity and support network interventions on the nutritional status, cognitive and academic achievement of students under 18 years of age. According to the literature, multicomponent interventions that address diet, physical activity, and involve parents concluded to be more effective in combating obesity and enhancing academic achievement in young people. Therefore, the implementation of public policies that commit to intervene in a timely manner in the first stages of the life cycle, would have a considerably beneficial impact on health(AU)

El objetivo de esta revisión es dar a conocer el impacto de las intervenciones de educación nutricional, actividad física y redes de apoyo en el estado nutricional, rendimiento cognitivo y académico de estudiantes menores de 18 años. De acuerdo con la literatura, las intervenciones de carácter multicomponente que abordan alimentación, actividad física, e involucran a los padres concluyeron ser más efectivas para combatir la obesidad y potenciar el rendimiento académico en jóvenes. Por lo tanto, la implementación de políticas públicas que permitan intervenir de forma oportuna las primeras etapas del ciclo vital, tendrían un impacto considerablemente beneficioso para la salud(AU)

Vitamin D deficiency in children and adolescents with obesity: a meta-analysis

Abstract Objective To evaluate the prevalence of vitamin D deficiency in obese children and adolescents when compared to eutrophic controls. Methods Systematic review with meta-analysis covering studies with patients aged 0-18 years old diagnosed with obesity and vitamin D deficiency and control group of eutrophic patients. The studies were retrieved in the PubMed, Embase, and LILACS databases in December 2019. The search used the terms "obesity" in combination with "pediatric population" and "vitamin D". Results Through the search 3155 articles were retrieved; and after analysis, 20 studies were selected according to the study objectives. A total of 24,600 children and adolescents were included. Through meta-analysis, the relative risk for the association between obesity and vitamin D deficiency in the pediatric population was 1.41 (95% CI: 1.26-1.59) (I² = 89%, p < 0.01). Conclusion Children and adolescents with obesity have higher risk of vitamin D deficiency.

Avaliação do estado nutricional em relação à presença de cárie dentária em crianças de 4 a 6 anos do município de Cajamar - São Paulo / Evaluation of the nutritional status in relation to the presence of dental caries in children aged 4 to 6 years in the city of Cajamar - São Paulo

Este artigo tem como objetivo avaliar o estado nutricional em relação à presença de cáries dentárias em crianças de 4 a 6 anos de idade, do município de Cajamar, São Paulo. Trata-se de estudo transversal com crianças entre 4 a 6 anos (n=1642), acompanhadas pelo Programa Saúde na Escola (PSE) do Município de Cajamar, São Paulo. A classificação do estado nutricional foi baseada no Índice de Massa Corporal (IMC) e a avaliação das condições bucais, por meio do índice ceo-d e critério para Risco de Cárie. A análise do estado nutricional, faixa etária e sexo conforme o número de cáries, foi feita por meio dos testes Mann-Whitney U e Kruskal-Wallis (p<0,05). Observou-se maior prevalência de meninos entre 4 a 6 anos. Em todas as faixas etárias a prevalência de excesso de peso foi de aproximadamente 30% e eutrofia em torno de 70%. 65% (n=1068) das crianças não apresentavam risco de cárie (A) e 28,8% (n=475), alto risco (D, E e F). Das 1162 crianças sem cáries, 0,2% eram magras (n=2), 67,2% (n=781) eutróficas e 32,7% (n=380) possuíam excesso de peso. A frequência de 1 a 5 cáries maior entre meninas e de 6 ou mais cáries, entre meninos. Segundo estado nutricional, o número médio do número de cáries foi de 2,17 para magreza, 0,93 para eutrofia e 0,65 para excesso de peso (p<0,010). Conclui-se que houve diferença entre número cáries e estado nutricional, na qual crianças com déficit nutricional apresentavam maior número de cáries dentárias comparadas às eutróficas ou com excesso de peso, sugerindo-se a inclusão do estado nutricional na avaliação odontológica.

This article aims at evaluating the nutritional status in relation to the presence of dental caries in children aged 4 to 6 years in the city of Cajamar, in the state of São Paulo. It is a cross-sectional study with children aged 4 to 6 years (n=1642) accompanied by the School Health Program of the City of Cajamar, São Paulo. The nutritional status classification was based on the Body Mass Index (BMI) and the evaluation of oral conditions, through the ceo-d index, and criteria for risk for caries. The analysis of the nutritional status, age, and sex according to the number of caries was made through the Mann-Whitney U and Kruskal-Wallis tests (p<0.05). A higher prevalence was observed among boys aged 4 to 6 years. In all age groups, there was a prevalence of 30% of overweight children, and eutrophy of approximately 70%. A total of 65% (n=1068) of the children presented no risk of caries (A), whereas 28.8% (n=475) showed high risk (D, E, and F). Among the 1162 children with no caries, 0.2% were thin (n=2); 67.2% (n=781) eutrophic; and 32.7% (n=380) were overweight. Girls presented a higher frequency of 1 to 5 caries while boys presented frequency of having 6 or more caries. According to the nutritional status, the average number of caries was 2.17 for thin individuals; 0.93 for eutrophic individuals; and 0.65 for overweight individuals (p<0.010). It could be concluded that there was a difference between the number of caries and the nutritional status, in which children with nutritional deficit presented a higher number of dental caries when compared to eutrophic or overweight ones, suggesting the inclusion of the nutritional status in the dental evaluation.

Serum Levels of Vitamin D in Children with or without Isolated Distal Radius Fractures: A Prospective Clinical Study / Níveis séricos de vitamina D de crianças com ou sem fraturas isoladas da extremidade distal do rádio: Um estudo clínico prospectivo

Abstract Objective To compare the serum levels of vitamin D and minerals in children with or without isolated distal radius fractures. Methods The present prospective clinical study included 50 children (aged between 5 and 15 years) with isolated distal radius fractures who were admitted to our emergency unit between February and May 2018 as the study group (group A), and 50 healthy children with no history of fracture as the control group (group B). Peripheral venous blood samples were obtained and analyzed for measurements of 25-hydroxyvitamin D (25(OH)D), calcium (Ca), magnesium (Mg), phosphorus (P), alkaline phosphatase (ALP), and parathyroid hormone (PTH) in both groups. Patient characteristics and peripheral venous blood samples were compared between the groups. Results The mean age, height, weight, body mass index (BMI) and gender distribution were similar in both groups. There were no statistical differences in the blood analyses, including Ca, Mg, P, ALP, and PTH. However, the serum levels of 25(OH)D were statistically lower in group A when compared to group B (p < 0.001), and the number of patients with 25(OH)D insufficiency was statistically higher in group A than in group B (p = 0.012). Conclusion Children with isolated distal radius fracture should be informed about vitamin D deficiency, and, in children with low levels of vitamin D, supplementation may be considered.

Resumo Objetivo Comparar os níveis séricos de vitamina D e minerais de crianças com ou sem fraturas isoladas da extremidade distal do rádio. Métodos Este estudo clínico prospectivo incluiu 50 crianças (com idade entre 5 e 15 anos) com fratura isolada distal do rádio que deram entrada em nossa unidade de emergência entre fevereiro e maio de 2018 como grupo de estudo (grupo A), e 50 crianças saudáveis sem histórico de fratura como grupo controle (grupo B). Foram obtidas e analisadas amostras de sangue venoso periférico para medições de 25-hidroxivitamina D (25(OH)D), Cálcio (Ca), Magnésio (Mg), Fósforo (P), fosfatase alcalina (FA) e hormônio da paratireoide (HPT) em ambos os grupos. As características dos pacientes e as amostras de sangue venoso periférico foram comparadas entre os grupos. Resultados A média de idade, altura, peso, índice de massa corporal (IMC) e distribuição de gênero foram semelhantes em ambos os grupos. Não houve diferenças estatísticas nas análises sanguíneas, incluindo Ca, Mg, P, FA e HPT. No entanto, os níveis séricos de 25(OH)D foram estatisticamente menores no grupo A do que no grupo B (p < 0,001), e o número de pacientes com insuficiência de 25(OH)D foi estatisticamente maior no grupo A do que no grupo B (p = 0,012). Conclusão Crianças com fratura isolada distal do rádio devem ser informadas sobre deficiência de vitamina D, e, em crianças com baixos níveis de vitamina D, a suplementação pode ser considerada.