Incidencia de desnutrición en el departamento de ambulatorios con algunos factores asociados, del Hospital Universitario de Kerbala / Incidence of Malnutrition in Outpatient Department of Kerbala Teaching Hospital with some Associated Factors

Objetivos: evaluar la incidencia de la desnutrición global en el Departamento de externos del Hospital de Enseñanza de Kerbala y los factores asociados que incluyen el sexo de los pacientes, el empleo paterno y el tipo de alimentación. Métodos: mediante el uso de M.U.A.C, que es una prueba antropométrica de detección simple para la desnutrición. El estudio transversal aleatorizado de 1000 niños entre los 6-59 meses había tomado en el estudio. Del Departamento de Outpatiente del Hospital de Enseñanza de Kerbala. Datos registrados con respecto al género de pacientes, empleo paternal y tipo de alimentación en aquellos menos de 2 años. Pacientes viejos. Resultados: La incidencia general de desnutrición global fue del 6,9% en el Departamento de Overpatismo del Hospital de Enseñanza de Kerbala. Existe una fuerte asociación entre la desnutrición y el tipo de alimentación durante los primeros 2 años y hubo alguna asociación entre el empleo de padres y la desnutrición.

Objectives: To evaluate the incidence of global malnutrition in outpatient department of Kerbala teaching hospital and the associated factors which include sex of patients, paternal employment and type of feeding. Methods: By using M.U.A.C which is simple screening anthropometric test for malnutrition. Randomized Cross sectional study of 1000 child between the age of 6-59 months had taken in the study. From outpatient department of Kerbala teaching hospital. Data recorded regarding gender of patients, paternal employment and type of feeding in those less than 2 yrs. old patients. Results: Overall incidence of global malnutrition was 6.9% in outpatient department of Kerbala teaching hospital. There is strong association between malnutrition and type of feeding during first 2 years and there was some association between employment of parents and malnutrition.

Incidencia de desnutrición y factores sociodemográficos asociados, en pacientes de del hospital universitario de Karbala / Incidence of malnutrition and sociodemographic factors associated, in patients from the Karbala Teaching Hospital

Antecedentes: La desnutrición es un importante problema de salud en el grupo de edad de pediatría que contribuye a aumentar la mortalidad y morbilidad de los pacientes ingresados. Pacientes y método: Estudio descriptivo, aleatorizado, transversal de 2965 casos entre 6 y 60 meses de los cuales 500 casos tenían desnutrición desde el 15 de noviembre de 2019 al 31 de enero de 2020, datos hospitalarios para evaluar la incidencia de desnutrición aguda severa y desnutrición aguda moderada y leve. Desnutrición y su relación con algunos factores sociodemográficos (trabajo paterno, peso al nacer, tipo de alimentación, edad, sexo). Resultados: la incidencia de desnutrición aguda severa es 1%, la incidencia de desnutrición aguda moderada es 10% y desnutrición leve 27% de la muestra de pacientes tomada 469 pacientes existe una fuerte relación de todos los grados de desnutrición con la edad paterna y bajo nacimiento peso con alguna relación con el tipo de alimentación. Conclusiones: si bien la incidencia de desnutrición aguda severa ha disminuido en los últimos años en el hospital universitario de Karbala, existe un marcado aumento en la incidencia de desnutrición aguda moderada y desnutrición leve con su impacto en la salud pediátrica general en cuanto a morbilidad y mortalidad se deben tomar esfuerzos para manejar la desnutrición aguda moderada y desnutrición leve ofreciendo asesoramiento y apoyo nutricional especialmente en personas que no son Empleadores gubernamentales.

Background: Malnutrition is a major health problem in pediatrics age group contribute to increase mortality and morbidity of admitted patients. Patients and method: A descriptive randomized cross sectional study of 2965 cases between 6 -60 months from which 500 cases had malnutrition from15th of November 2019 to 31st of January 2020 hospital-based data to evaluate incidence of sever acute malnutrition and moderate acute malnutrition and mild malnutrition and its relation to some sociodemographic factors (paternal job, birth weight, type of feeding, age, sex). Results: the incidence of severe acute Malnutrition is 1%, the incidence of moderate acute malnutrition is 10% and mild malnutrition 27% from the sample of patients taken 469 patients there is a strong relationship of all degree of malnutrition to paternal age and low birth weight with some relation to type of feeding. Conclusions: while the incidence of severe acute malnutrition has been decreased last years In Karbala teaching hospital, there is marked increase in incidence of moderate acute malnutrition and mild malnutrition with their impact on general pediatric health regarding morbidity and mortality efforts should be taken to manage the moderate acute malnutrition and mild malnutrition by offering nutritional advice and support especially in people who are not governmental Employer.

Manejo nutricional da cirrose hepática e suas complicações em pacientes hospitalizados / Nutritional management of liver cirrhosis and its complications in hospitalized patients

ABSTRACT BACKGROUND: Cirrhosis is a chronic and progressive liver disease that occurs from prolonged hepatocellular injury. Malnutrition causes complications in cirrhosis patients that worsen the condition to liver failure. Both are closely linked and increase the chances of morbidity and mortality. Regular nutritional screening and monitoring is prime concern for such patients including comprehensive dietary history, laboratory tests, and evaluation of muscle loss and strength capabilities to determine the degree of frailty. For efficient assessment of liver cirrhosis patients Subjective Global Assessment has been used worldwide. The nutritional objectives for such individuals should be to regain liver functions, to prevent complications associated, and to overcome nutritional deficiencies causing malnutrition. METHODS: We conducted a literature review using PubMed, Google Scholar and Science Direct for this purpose, a total of 130 articles were reviewed out of which 80 (from the past 5 years) including originally published research, review articles and abstracts were also included. Exclusion criteria of the selected studies was year of publication, irrelevancy and animal studies based on the purpose of current study. The aim of this study was to check nutritional management in patients having complications of liver cirrhosis. RESULTS: According to the guidelines, for the conservation of normal nutritional status of the malnourished patients', energy should be provided 35 kcal/kg/day while to prevent hypoalbuminemia and maintain the protein stores in the body, 1.5 g/kg/day protein has been recommended. Carbohydrates and fats for cirrhosis patients are recommended 50% to 60% and 10% to 20% of the total dietary intake respectively. CONCLUSION: Initial identification and prevention of malnutrition have the probability to lead to better health outcomes, prevention of complications of the disease, and improving quality of life.

RESUMO CONTEXTO: A cirrose hepática é uma doença crônica e progressiva que ocorre por lesão hepatocelular prolongada. A desnutrição causa complicações em pacientes com cirrose que pioram a condição para insuficiência hepática. A cirrose e a desnutrição estão intimamente ligadas e aumentam as chances de morbidade e mortalidade. O rastreamento e monitoramento nutricional regulares são as principais preocupações para esses pacientes, incluindo histórico alimentar abrangente, testes laboratoriais e avaliação de capacidades de perda muscular e força para determinar o grau de fragilidade. Para uma avaliação eficiente de pacientes com cirrose hepática, a Avaliação Global Subjetiva tem sido usada em todo o mundo. Os objetivos nutricionais desses indivíduos devem ser recuperar as funções hepáticas, prevenir complicações associadas e superar deficiências nutricionais que causam desnutrição. MÉTODOS: Realizada uma revisão de literatura usando PubMed, Google Scholar e Science Direct para este fim, e um total de 130 artigos foram revisados dos quais 80 (dos últimos 5 anos), incluindo pesquisas publicadas originalmente. Artigos de revisão e resumos também foram incluídos. Os critérios de exclusão dos estudos selecionados foram ano de publicação, irrelevância e estudos em animais com base na finalidade do estudo atual. O objetivo deste estudo foi verificar o manejo nutricional em pacientes com complicações da cirrose hepática. RESULTADOS: De acordo com as diretrizes, para a conservação do estado nutricional normal dos pacientes desnutridos, a energia deve ser fornecida 35 kcal/kg/dia, enquanto para prevenir hipoalbuminemia e manter os estoques de proteínas no corpo, 1,5 g/kg/dia de proteína foi recomendada. Carboidratos e gorduras para pacientes com cirrose são recomendados de 50% a 60% e 10% a 20% da ingestão alimentar total, respectivamente. CONCLUSÃO: A identificação inicial e a prevenção da desnutrição têm a probabilidade de levar a melhores desfechos de saúde, prevenção de complicações da doença e melhoria da qualidade de vida.

Comprometimento do apetite e fatores associados em pessoas idosas hospitalizadas com câncer / Impairment of appetite and associated factors in older adults hospitalized with cancer

Resumo Objetivo Investigar o comprometimento do apetite em pessoas idosas hospitalizadas com câncer e sua associação com estado nutricional e presença de caquexia. Métodos Estudo transversal realizado com pessoas idosas de ambos os sexos, diagnosticadas com neoplasia maligna, de julho de 2017 a março de 2019 em um hospital universitário. A amostra final foi composta por 90 pacientes. O comprometimento do apetite foi identificado pelo Questionário de Apetite e Sintomas para Pacientes com Câncer (CASQ) e o estado nutricional pela Avaliação Subjetiva Global Produzida pelo Próprio Paciente (ASG-PPP). A presença de caquexia foi avaliada pela perda de peso >5% nos últimos 6 meses; ou índice de massa corporal (IMC) <20 kg/m2 e perda de peso >2%; ou índice de músculo esquelético apendicular consistente com sarcopenia e perda de peso >2%. Resultados Houve predomínio de indivíduos do sexo masculino (56,7%), autodeclarados não brancos (56,7%), com tumores localizados no trato gastrointestinal (75,6%) e mediana de idade de 67 anos. 75,6% dos indivíduos apresentaram comprometimento do apetite, 57,8% suspeita de desnutrição ou desnutrição de algum grau, 54,4% caquexia e 92,2% necessidade de intervenção nutricional. Houve associação entre as categorias do CASQ com estado nutricional (p=0,001) e presença de caquexia (p=0,050). Após análise de regressão logística, a desnutrição permaneceu associada ao comprometimento do apetite [OR: 4,68 (IC 95%: 1,50-14,56), p=0,008]. Conclusão A presença de desnutrição aumentou as chances de comprometimento do apetite, o que reforça a necessidade da triagem e intervenção nutricional precoces, a fim de reduzir e/ou evitar os agravos nutricionais.

Abstract Objective To investigate appetite impairment in older adults hospitalized with cancer and its association with nutritional status and cachexia. Method A cross-sectional study, conducted with older adults men and women diagnosed with malignant neoplasia from July 2017 to March 2019 at a university hospital. The final sample consisted of 90 patients. Appetite was evaluated using the Cancer Appetite and Symptom Questionnaire (CASQ) and nutritional status was determined using the Patient-Generated Subjective Global Assessment (PG-SGA). Presence of cachexia was assessed by weight loss >5% in the last 6 months; or body mass index (BMI) <20 kg/m2 and weight loss >2%; or appendicular skeletal muscle index consistent with sarcopenia and weight loss >2%. Results There was a predominance of male (56.7%) self-declared non-white individuals (56.7%), with tumors in the gastrointestinal tract (75.6%) and median age of 67.0 years. 75.6% of the individuals have impaired appetite, 57.8% suspected malnutrition or malnutrition of some degree, 54.4% cachexia and 92.2% needed nutritional intervention. There was significant association between CASQ categories with nutritional status (p= 0.001) and presence of cachexia (p=0.050). After logistic regression analysis, malnutrition remained associated with impaired appetite assessed by CASQ score [OR: 4.68 (CI 95%: 1.50-14.56), p=0.008] Conclusion The presence of malnutrition increased the chances of appetite impairment, which reinforces the need for early nutritional screening and intervention, in order to reduce and/or avoid nutritional problems.

Diagnóstico nutricional de pessoas que vivem com HIV/AIDS: revisão de protocolos nacionais e internacionais / Nutritional diagnosis of people living with HIV/AIDS: a review of national and international protocols

Resumo A infecção pelo HIV é preditora de diversas alterações metabólicas e de composição corporal, além de quadro de desnutrição, anemia e hipovitaminoses. Existem assim, especificidades de diagnóstico e tratamento conforme o estágio da doença e o ambiente ambulatorial ou hospitalar. O objetivo desse trabalho é apresentar arcabouço teórico e conceitual sobre a realização do diagnóstico nutricional em pessoas que vivem com HIV/AIDS. Buscou-se evidências científicas atuais nacionais e internacionais publicadas em artigos científicos, livros recentes, protocolos, consensos e diretrizes. O diagnóstico nutricional engloba vários aspectos e habilidades clínicas e conhecimentos específicos sobre essa morbidade. Assim, devido sua complexidade e abrangência, compreende: história clínica e situação clínica atual, consumo alimentar, dados antropométricos, composição corporal, bioquímicos, pressão arterial e exame físico. Foi demonstrado o processo de diagnóstico nutricional de forma a fornecer subsídios para as equipes de saúde na identificação de parâmetros que possibilitem instituir um plano de cuidado nutricional que promova, previna e recupere as alterações detectadas nas pessoas que vivem com HIV/AIDS.

Abstract HIV infection is a predictor of several metabolic and body composition alterations, in addition to malnutrition, anemia, and hypovitaminosis. There are thus specificities of diagnosis and treatment depending on the stage of the disease and the outpatient or hospital environment. The scope of this narrative review was to update the conceptual and theoretical framework regarding the nutritional diagnosis of people living with HIV/AIDS. Current national and international scientific evidence published in scientific articles, recent books, protocols, consensuses, and guidelines were analyzed. The nutritional diagnosis encompasses several clinical aspects and abilities and specific knowledge about HIV/AIDS, such as: clinical history and current clinical situation, food consumption, anthropometric data, body composition, and biochemistry, blood pressure and physical examination. The nutritional diagnosis process was demonstrated in order to provide subsidies for the health teams in the identification of parameters that make it possible to establish a plan for nutritional care to promote, prevent and recuperate the alterations detected in people living with HIV/AIDS.

Determinación del estado nutricional mediante el ángulo de fase en pacientes en hemodiálisis / Determination of nutritional status by phase angle in hemodialysis patients

Resumen Introducción: La bioimpedancia eléctrica multifrecuencia (BIE) evalúa con precisión la composición corporal. Objetivo: Investigar el estado nutricional y su relación con el índice de masa corporal (IMC) o el ángulo fase obtenido por BIE en pacientes con enfermedad renal terminal (ERT) en hemodiálisis. Método: En 99 pacientes en hemodiálisis (43.6 ± 17.2 años, 58.8 % varones) se evaluó IMC, BIE y puntuación de desnutrición (DMS, Dialysis Malnutrition Score). La independencia de las asociaciones del IMC y el ángulo fase con el DMS se determinó con regresión lineal múltiple. Resultados: El riesgo de desnutrición (DMS > 13) se incrementó gradualmente entre los sujetos con IMC y ángulo fase normales (44.4 %), IMC bajo (45.8 %), ángulo fase bajo (64.0 %) y en aquellos con ambos parámetros anormales (68.0 %). El ángulo fase fue la única variable asociada independientemente con el estado nutricional de los pacientes (coeficiente beta estandarizado −0.372, p < 0.001), lo que explicó 13.8 % de la variación en el DMS. Conclusiones: El ángulo fase se asocia inversa e independientemente con el riesgo de desnutrición en pacientes con ERT, lo que sugiere que la composición corporal evaluada por BIE pudiera ser mejor que el IMC en la valoración clínica de pacientes con esta enfermedad.

Abstract Introduction: Multi-frequency bio-impedance analysis (BIA) accurately evaluates body composition. Objective: To assess nutritional status and its relationship with body mass index (BMI) or with BIA-obtained phase angle in patients with end-stage renal disease (ESRD) on hemodialysis. Method: BMI, BIA and dialysis malnutrition score (DMS) were assessed in 99 patients on hemodialysis (43.6 ± 17.2 years of age, 58.8% males). Multivariate linear regression analysis was used to determine BMI and phase angle independent associations with DMS. Results: Malnutrition risk (DMS > 13) showed a gradual increase among patients with normal BMI and phase angle (44.4%), low BMI (45.8%), low phase angle (64.0%), and in those with both parameters at abnormal ranges (68.0%). The phase angle was the only variable that was independently associated with patient nutritional status (standardized coefficient beta −0.372, p < 0.001), accounting for 13.8% of DMS variation. Conclusion: Phase angle is inversely and independently associated with malnutrition risk in patients with ESRD, which suggests that BIA-assessed body composition might be better than BMI in the clinical assessment of patients with ESRD.

Estudio comparativo del estado nutricional de niños y niñas residentes en cuatro partidos de la provincia de Buenos Aires (Argentina), en el marco de la transición nutricional / Comparative study of the nutritional status of children living in four counties of the province of Buenos Aires (Argentina), in the context of nutrition transition

RESUMEN El objetivo fue evaluar y comparar el estado nutricional en poblaciones infanto-juveniles residentes en cuatro partidos de la provincia de Buenos Aires y observar si existen diferencias vinculadas a los contextos ambientales y socioeconómicos particulares, en el marco de la transición nutricional. Entre los ciclos lectivos 2008-2012, se relevó el peso y la talla y se calculó el índice de masa corporal de 7.873 escolares, entre 4 y 12 años de edad, residentes en los partidos de La Plata, Brandsen, Magdalena y Punta Indio. La información acerca del contexto de residencia se obtuvo mediante encuesta estructurada y autoadministrada. Alrededor del 40% de los escolares presentó malnutrición, y prevalecieron el sobrepeso en La Plata, la obesidad en Punta Indio y la desnutrición en Magdalena. El estado nutricional se vinculó con las condiciones socioambientales de residencia y dio cuenta de que estas poblaciones se ubican en distintas etapas del proceso de transición nutricional.

ABSTRACT The aim of this study was to evaluate and compare the nutritional status of child populations living in four counties of the province of Buenos Aires to observe differences related to particular environmental and socioeconomic contexts in the framework of the nutrition transition. During the school years corresponding to the 2008-2012 period, weight and height were measured and body mass index was calculated for 7,873 school children between the ages of 4 and 12 years from the counties of La Plata, Brandsen, Magdalena and Punta Indio. Information about the contexts of residence was obtained using self-administered structured surveys. About 40% of schoolchildren presented malnutrition, with a prevalence of overweight in La Plata, obesity in Punta Indio and undernutrition in Magdalena. The nutritional status of the study populations was associated with the socioenvironmental conditions of residence, indicating that these populations are at different stages of the nutrition transition process.

The relationship between malnutrition and quality of life in haemodialysis and peritoneal dialysis patients

SUMMARY BACKGROUND One of the most important factors affecting the quality of life of chronic kidney disease (CKD) patients is nutrition. Prevention of malnutrition increases patients' quality and length of life. In this study, we aimed to determine the frequency of malnutrition, quality of life, and the relationship between them in patients with end-stage renal disease (ESRD). METHOD The study was conducted with a total of 60 CKD patients including 50 haemodialysis patients and 10 peritoneal dialysis patients. Patients' data associated with socio-demographics, body mass index (BMI), waist circumference, triceps skin-fold thickness (TSFT), pre-dialysis systolic and diastolic blood pressure, Kt/V and urea reduction ratio (URR) values, laboratory parameters, Mini-Nutritional Assessment-Short Form (MNA-SF) and European Quality of Life 5-Dimensions (EQ5D) scale were recorded. FINDINGS Of the total 60 patients; 27 were male (45%), 33 were female (55%), 83.3% were receiving haemodialysis treatment (HD), and 16.7% were receiving peritoneal dialysis treatment (PD). The mean MNA-SF score was 10.4 ± 2.8 in the HD group and 10.5 ± 2.9 in the PD group; there was no difference between the scores of the HD and PD groups. The mean EQ5D score was 0.60 ± 0.29 in the HD group and 0.68 ± 0.33 in the PD group, no significant difference was found between the HD group and the PD group. The quality of life was found lower in malnourished group (p=0.001). CONCLUSION The quality of life needs to be increased by early diagnosis and treatment of malnutrition in patients at risk.

RESUMO INTRODUÇÃO O estado nutricional é um dos principais determinantes da qualidade de vida de pacientes com doença renal crônica (DRC) e a prevenção da desnutrição aumenta o tempo e a qualidade de vida nessa população. O objetivo do presente estudo foi determinar a prevalência de desnutrição, a qualidade de vida e a inter-relação entre esses fatores em pacientes com DRC em terapia dialítica. MÉTODOS Incluímos 60 pacientes com DRC estágio 5 sob terapia dialítica (50 pacientes em hemodiálise [HD] e 10 em diálise peritoneal [DP]). Os pacientes foram analisados com relação aos seus dados sociodemográficos, índice de massa corporal (IMC), circunferência abdominal, dobra cutânea triciptal, pressão arterial sistólica e diastólica pré-diálise, Kt/V e índice de remoção de ureia, parâmetros laboratoriais, miniavaliação nutricional (MNA) e questionário EuroQol-5 Dimensions (EQ-5D). RESULTADOS Do total de pacientes, havia 27 homens (45%) e 33 mulheres (55%), 83,3% em HD e 16,7% em DP. O MNA médio foi 10,4 ± 2,8 nos pacientes em HD e 10,5 ± 2,9 naqueles em DP, não havendo diferença significativa entre os grupos. O EQ-5D médio foi 0,60 ± 0,29 nos pacientes em HD e 0,68 ± 0,33 naqueles em DP, não havendo diferença estatisticamente significativa entre os grupos. A qualidade de vida foi pior nos pacientes desnutridos (p=0,001). CONCLUSÃO O diagnóstico e o tratamento precoce da desnutrição são necessários para melhorar a qualidade de vida dessa população.

Malnutrition associated with inflammation in the chronic renal patient on hemodialysis

SUMMARY INTRODUCTION Malnutrition-Inflammation-Atherosclerosis Syndrome is very frequent in patients with chronic kidney disease on haemodialysis. In these patients, the inflammation associated with malnutrition is observed by the Malnutrition-Inflammation Score. OBJECTIVE To analyse the relationship between malnutrition-inflammation-atherosclerosis syndrome and anthropometric and biochemical parameters of patients on haemodialysis. METHODS A cross - sectional study was performed at the Haemodialysis Clinic of the Barão de Lucena Hospital, Recife, Brazil, between July and August 2016, with patients cared at the clinic for at least six months. Patients with amputees, hospitalized, visually impaired, HIV positive, with catheters in the neck, ascites and/or oedema, and those who were unable to provide information at the time of the interview were excluded. The patients were submitted to anthropometric evaluation for the classification of the nutritional status by waist circumference, neck circumference, body mass index, waist-to-hip ratio and waist-to-height ratio. Nutritional status related to inflammation was measured by the Malnutrition-Inflammation Score and nutritional status assessment using biochemical indicators that used urea, creatinine and albumin. RESULTS Twenty-seven individuals of both genders, adults and elderly, aged 51.3 ± 13.3 years old participated in the study. The anthropometric evaluation showed that most of the population presented cardiovascular risk. The biochemical evaluation reported low frequencies of malnutrition. Malnutrition-Inflammation-Atherosclerosis syndrome was evidenced in 3.7% of the patients. The Malnutrition-Inflammation Score had a moderate negative correlation with body mass index, waist circumference, neck circumference, waist-to-height ratio and creatinine. CONCLUSION The correlation seen among the parameters suggests that most of the parameters evaluated can be used as an indirect indicator of malnutrition-inflammation-atherosclerosis syndrome.

RESUMO INTRODUÇÃO A síndrome Desnutrição-Inflamação-Aterosclerose é frequente nos pacientes com doença renal crônica em hemodiálise, acarretando perda de proteínas corporais e produção de citocinas pró-inflamatórias. OBJETIVO Verificar, entre os indicadores nutricionais estudados, aqueles que melhor se correlacionam com a síndrome Desnutrição-Inflamação-Aterosclerose em pacientes submetidos à hemodiálise. MÉTODOS O estudo foi transversal, realizado na Clínica de Hemodiálise do Hospital Barão de Lucena, no Recife (PE), entre julho e agosto de 2016, com pacientes atendidos há pelo menos seis meses. Foram excluídos pacientes amputados, internados, com deficiência visual, cateter no pescoço, HIV positivo, ascite e/ou edema e aqueles incapazes de prestar informações no momento da entrevista. Os pacientes foram submetidos à avaliação antropométrica para a classificação do estado nutricional pela circunferência da cintura, perímetro do pescoço, índice de massa corporal, relação cintura-quadril e relação cintura-estatura. O estado nutricional relacionado à inflamação foi mensurado pelo escore Desnutrição-Inflamação e a avaliação do estado nutricional pelos indicadores bioquímicos: ureia, creatinina e albumina. RESULTADOS Participaram do estudo 27 indivíduos de ambos os sexos, adultos e idosos, com idade de 51,3 ± 13,3 anos. A avaliação antropométrica mostrou que a maior parte da população apresentava risco cardiovascular. A avaliação bioquímica relatou baixas frequências de desnutrição. Foi evidenciada síndrome Desnutrição-Inflamação-Aterosclerose em 3,7% dos pacientes. O escore Desnutrição-Inflamação apresentou correlação moderada negativa com o índice de massa corporal, circunferência da cintura, perímetro do pescoço, relação cintura-estatura e creatinina. CONCLUSÃO A correlação observada entre os parâmetros sugere que a maioria dos parâmetros avaliados pode ser utilizada como indicador indireto da síndrome Desnutrição-Inflamação-Aterosclerose.

Socioeconomic context of the community and chronic child malnutrition in Colombia / Contexto socioeconómico de la comunidad y desnutrición crónica infantil en Colombia

ABSTRACT OBJECTIVE To analyze the influence of the socioeconomic context of the community on chronic child malnutrition in Colombia. METHODS We estimated multilevel logistic models using data from the National Demographic and Health Survey in Colombia in 2010. The final sample included 11,448 children under the age of five gathered in 3,528 communities. In addition, we used the Principal Component Analysis with polychoric correlations for the construction of composed indicators of wealth, autonomy of the woman, and the use and access to the health system. RESULTS The average level of community wealth was significantly and independently associated with chronic malnutrition in early childhood, more than the socioeconomic status of the household itself. At the individual and household level, the probability of chronic malnutrition was higher for children from mothers with low levels of autonomy and use and access to the health system, mothers who had their first child in adolescence, and mothers who live in homes in the lowest wealth quintiles. In contrast, children from mothers with a body mass index > 25 and with at least secondary education (versus no education) were less likely to suffer from chronic malnutrition. CONCLUSIONS Research, programs, and interventions need to take into account the physical, economic, and social context of communities to contribute with the improvement of the nutritional status of early childhood in Colombia.

RESUMEN OBJETIVO Analizar la influencia del contexto socioeconómico de la comunidad sobre la desnutrición infantil crónica en Colombia. MÉTODOS Utilizando datos de la Encuesta Nacional de Demografía y Salud en Colombia en 2010, se estimaron modelos logísticos multinivel. La muestra final incluyó 11.448 niños menores de cinco años anidados en 3.528 comunidades. Además, se utilizó el Análisis de Componentes Principales usando correlaciones policóricas para la construcción de indicadores compuestos de riqueza, autonomía de la mujer y el uso y acceso al sistema de salud. RESULTADOS El nivel de riqueza promedio de la comunidad resultó significativa e independientemente asociado con la desnutrición crónica en la primera infancia, por encima y más allá del propio estatus socioeconómico del hogar. A nivel individual y del hogar, la probabilidad de desnutrición crónica fue mayor para niños de madres con bajos niveles de autonomía y uso y acceso al sistema de salud, que han tenido su primer hijo en la adolescencia y que viven en hogares en los quintiles más bajos de riqueza. En contraste, niños de madres con un índice de masa corporal > 25 y con al menos educación secundaria (versus sin educación) tuvieron menor probabilidad de padecer desnutrición crónica. CONCLUSIONES Investigaciones, programas e intervenciones que tengan en cuenta el contexto físico, económico y social de las comunidades son necesarias para contribuir a mejorar el estado nutricional de la primera infancia en Colombia.

Deglutição orofaríngea, nutrição e qualidade de vida no indivíduo com doença pulmonar crônica / Oropharyngeal deglutition, nutrition, and quality of life in individuals with chronic pulmonary disease

RESUMO Objetivo descrever a eficácia e segurança da deglutição, o risco nutricional e a qualidade de vida em deglutição e relacionar o risco nutricional com a qualidade de vida dos indivíduos com doença pulmonar crônica. Método 17 indivíduos com diagnóstico de doença pulmonar crônica foram avaliados por meio do Volume-Viscosity Swallow Test (V-VST), Quality of Life in Swallowing Disorders (SWAL-QOL), Mini Nutritional Assessment (MNA) e índice de massa corpórea. Resultados foi encontrada alteração de eficácia da deglutição em nove (52,94%) dos indivíduos e eficácia+segurança em dois (11,77%). Todos os indivíduos estavam eutróficos na avaliação nutricional. Houve relação entre o risco nutricional com os domínios 3 (r=-0,803; p=0,05) e 5 (r=0,636; p=0,026) do SWAL-QOL. Conclusão houve alteração de eficácia e segurança da deglutição, no entanto não foi encontrado risco nutricional evidente na amostra avaliada. Ainda, houve relação entre o risco nutricional com a qualidade de vida em deglutição.

ABSTRACT Purpose Describe efficacy and safety of deglutition, nutritional risk, and quality of life in deglutition, and associate nutritional risk with quality of life in individuals with chronic pulmonary disease. Methods The participants were 17 individuals with chronic pulmonary disease evaluated using the following instruments: Volume-Viscosity Swallow Test (V-VST), Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire, Mini Nutritional Assessment (MNA), and body mass index (BMI). Results Changes in efficacy were observed in nine (52.94%) individuals and impairments in efficacy and safety were found in two (11.77%) individuals. All individuals were considered eutrophic by the nutritional assessment. Correlation was observed between nutritional risk and domains 3 (r=-0.803; p=0.05) and 5 (r=0.636; p=0.026) of the SWAL-QOL questionnaire. Conclusion Changes in efficacy and safety of deglutition were observed; however, no nutritional risk was evidenced in the sample evaluated. Correlation between nutritional risk and quality of life in deglutition was also observed.

Diagnóstico nutricional en lactantes menores con cardiopatía congénita: comparación de dos clasificaciones antropométricas / Nutritional assessment in infants with congenital heart disease: comparison of two anthropometric classifications

INTRODUCCIÓN: Los niños con cardiopatía congénita (CC) presentan alto porcentaje de malnutrición por déficit, siendo difícil la interpretación de su estado nutricional. OBJETIVO: Describir el estado nutricional de lactantes con CC utilizando dos clasificaciones antropométricas y realizar una comparación entre ellas. PACIENTES Y MÉTODO: Estudio de cohorte no concurrente. Se estudiaron menores de 12 meses sometidos a cirugía de CC. Se excluyeron prematuros, pequeños para la edad gestacional, portadores de síndrome genético u otra enfermedad con compromiso nutricional. Se registraron datos demográficos, diagnóstico de CC, peso y talla de ingreso. Se realizó evaluación nutricional comparando estándares OMS según clasificación norma ministerial (CNM) y una Clasificación Antropométrica Integrada (CAI) que define desnutrición si (ZT/E)≤-2 y/o (ZP/T)≤-2, riesgo de desnutrición ZP/T entre -1 a -1,9, eutrofia ZP/T entre -0,9 a +0,9, sobrepeso entre +1 a +1,9 y obesidad ZP/T≥+2. RESULTADOS: Se incluyeron 387 intervenciones, 219 (56,6%) varones, mediana de edad 3,1 meses (RIC:0,4;6,4). Un 26,4% tenían talla baja. Utilizando CNM 55 sujetos presentaron dos diagnósticos por superposición de ZP/E y ZP/T, con CAI no hubo superposición. Al comparar CNM con CAI se encontró diferencia en desnutrición 28,9% versus 38,5%(p = 0,001), riesgo de des nutrición 27,4% versus 16,3%(p = 0,01) y obesidad 4,9% versus 3,3%(p = 0,03) respectivamente. Se encontró correlación entre ZP/E y ZP/T, r = 0,6(p < 0,001) y entre ZP/E y ZT/E, r = 0,6(p < 0,001). Conclusiones: Los niños con CC presentan alto porcentaje de desnutrición y talla baja. Utilizando las mismas mediciones antropométricas CAI no presentó superposición de diagnósticos y detectó más desnutrición. El P/E es útil como tamizaje, pero insuficiente en malnutrición crónica.

INTRODUCTION: Children with congenital heart disease (CHD) present a high percentage of undern utrition and the interpretation of their nutritional assessment is difficult. OBJECTIVE: To describe the nutritional status of infants with CHD using two anthropometric classifications and compare them. PATIENTS AND METHOD: Non-concurrent cohort study. We studied children under 12 months under going cardiac surgery. We excluded preterm infants, small for gestational age, carriers of genetic syndrome or other disease with nutritional compromise. Demographic data, type of CHD, weight and height were recorded. Nutritional assessment was performed using WHO standards per health ministry criteria (HMC) and per an Integrated Anthropometric Classification (IAC), which defines undernutrition if height-for-age Z-score (ZT/E)≤-2 and/or weight-for-height (ZP/T)≤-2, risk of un dernutrition as ZP/T between -1 to -1,9, normal as ZP/T between -0.9 to +0.9, overweight as ZP/T between +1 to +1.9 and obesity as ZP/T≥+2. RESULTS: 387 interventions were included, 219 (56.6%) were males, median age 3.1 months (IQR:0.4;6.4). A 26.4% presented short stature. Using HMC classification 55 subjects presented two diagnoses by overlap of ZP/E and ZP/T, although with IAC there was no overlap. Comparing HMC with IAC, a difference was found in undernutrition, 28.9% versus 38.5% (p = 0.001), risk of undernutrition 27.4% versus 16.3%(p = 0.01) and obesity 4.9% ver sus 3.3% (p = 0.03) respectively. Correlation was found between ZP/E and ZP/T, r = 0.6(p < 0.001) and between ZP/E and ZT/E, r = 0.6 (p < 0.001). CONCLUSIONS: Children with CHD have a high per centage of undernutrition and short stature. Using the same anthropometric measurements IAC did not present overlapping diagnoses and detected more undernutrition. P/E is useful as screening, but insufficient in chronic undernutrition.

Estado nutricional e tempo de internação de pacientes adultos hospitalizados com diferentes tipos de câncer / Nutritional status and length of stay of adult hospitalized patients with different types of cancer

Introdução: O câncer é uma doença crônica não transmissível e afeta, de modo crescente, a população mundial. A presença da desnutrição é elevada e o estado nutricional tem um papel importante no desfecho clínico e na qualidade de vida de pacientes com câncer. O objetivo desse estudo foi identificar a prevalência dos tipos de câncer, alterações do estado nutricional e tempo de internação de pacientes adultos hospitalizados. Método: Estudo retrospectivo observacional com análise de 354 prontuários de pacientes (idade 60,6±13,8 anos; 34,2% do sexo feminino) com qualquer tipo de câncer, internados no Hospital de Clínicas de Porto Alegre. Resultados: Foi observada maior prevalência de quatro tipos de cânceres: próstata (48,8%), tireoide (26%), digestivo (19%) e ovário e mama (6,2%). Pacientes com câncer digestivo apresentaram maior tempo de internação (aproximadamente 10 dias), menor índice de massa corporal (IMC) (24,8±5,3 kg/ m²), maior prevalência de desnutrição (75%) e associação aos principais sintomas vinculados ao estado nutricional quando comparados aos pacientes com outros tipos de câncer. Indicadores do estado nutricional (IMC, presença da desnutrição, perda de peso e percentual de perda de peso em 6 meses) foram associados a um maior período de internação (p≤0,001). Conclusão: Pacientes com câncer digestivo demonstraram ter pior estado nutricional durante o seu período de internação, apresentando maior risco nutricional associado à presença da desnutrição e maior perda de peso, o que refletiu em maior tempo de permanência hospitalar.(AU)

Introduction: Cancer is a chronic disease and affect, increasingly, the world population. The presence of malnutrition is high and nutritional status plays an important role in clinical outcome and quality of life of cancer patients. The aim of this study was to identify the prevalence of cancers, nutritional status changes and length of stay of hospitalized adult patients. Methods: An observational retrospective study with analysis of 354 records of patients (age 60.6±13.8 years; 34.2% female) with any type of cancer, admitted to the Hospital de Clínicas de Porto Alegre. Results: Was observed a higher prevalence of four types of cancers: prostate (48.8%), thyroid (26%), digestive (19%) and ovarian and breast (6.2%). Patients with digestive cancer had longer hospital stay (about 10 days), lower body mass index (BMI) (24.8±5.3 kg/m²), a higher prevalence of malnutrition (75%) and association with the main symptoms linked nutritional status when compared to patients with other cancers. The indicators of nutritional status (BMI, presence of malnutrition, weight loss and percentage of weight loss at 6 months) were associated with increased hospital stay (p≤0.001). Conclusion: The patients with digestive cancer showed a poor nutritional status during their hospital stay, showing a higher nutritional risk associated with the presence of malnutrition and increased weight loss which resulted in a longer hospital stay time.(AU)

Frecuencia de riesgo de desnutrición según la Escala de Tamizado para Desnutrición (MST) en un servicio de Medicina Interna / Screening for malnutrition among hospitalized patients in a Colombian University Hospital

Background: On admission, 30 to 50% of hospitalized patients have some degree of malnutrition, which is associated with longer length of stay, higher rates of complications, mortality and greater costs. Aim: To determine the frequency of screening for risk of malnutrition in medical records and assess the usefulness of the Malnutrition Screening Tool (MST). Material and Methods: In a cross-sectional study, we searched for malnutrition screening in medical records, and we applied the MST tool to hospitalized patients at the Internal Medicine Wards of San Ignacio University Hospital. Results: Of 295 patients included, none had been screened for malnutrition since hospital admission. Sixty one percent were at nutritional risk, with a higher prevalence among patients with HIV (85.7%), cancer (77.5%) and pneumonia. A positive MST result was associated with a 3.2 days increase in length of hospital stay (p = 0.024). Conclusions: The prevalence of malnutrition risk in hospitalized patients is high, but its screening is inadequate and it is underdiagnosed. The MST tool is simple, fast, low-cost, and has a good diagnostic performance.

Morbimortalidad asociada al estado nutricional y vía de alimentación en niños con parálisis cerebral / Morbimortality associated to nutritional status and feeding path in children with cerebral palsy

Introducción: Los niños y adolescentes con Parálisis Cerebral (PC) tienen elevada prevalencia de desnutrición, asociada a peor pronóstico. Para la adecuada evaluación nutricional existen nuevas curvas de crecimiento (Brooks y Col) que han planteado puntos de corte del índice Peso/Edad asociados a mayor morbimortalidad. Objetivo: Evaluar si pacientes con PC, en dicha categoría de riesgo nutricional (RN), presentan mayor riesgo de hospitalización y muerte. Pacientes y Método: Estudio observacional y prospectivo de una cohorte de pacientes con PC, controlados en un centro ambulatorio de referencia. Se registró: datos demográficos, socioeconómicos, evaluación funcional motora y nutricional basal. En seguimiento durante un año se constataron hospitalizaciones y mortalidad. Investigación aprobada por la comisión de ética. Resultados: Se reclutaron 81 niños con PC, edad 131,6 ± 60,4 meses (25-313), 60% de sexo masculino, 77,5% no se movilizaba por sí mismo. Los 23 pacientes con RN (28,4%), presentaban menor masa muscular y masa grasa (p = 0,000). Durante el año de seguimiento, 29 pacientes requirieron hospitalización (35,8%) y 4 fallecieron (4,9%). El grupo con RN no tuvo mayor morbilidad ni mortalidad que los sin RN. Sin embargo, ambos riesgos fueron mayores en los pacientes gastrostomizados versus los alimentados por vía oral (RR: 2,98 IC 95%: 1.32-6.75 al combinar ambas variables). Conclusiones: En esta cohorte de niños y adolescentes con PC seguidos durante un año, aquellos definidos como de riesgo nutricional según nuevas curvas, tuvieron similar morbimortalidad a los que tenían estado nutricional aceptable. La morbimortalidad fue mayor en los gastrostomizados.

Introduction: Children and adolescents with cerebral palsy (CP) have a high prevalence of malnutrition associated to poor prognosis. For an adequate nutritional assessment, new growth curves (Brooks, 2011) are available, in which precise cut-off points in Weight/Age index correlate to increased morbidity and mortality rate. Objective: To evaluate risk of hospitalization and death in patients with CP, according to nutritional risk (NR). Patients and Method: Observational and prospective cohort study of patients with CP in an outpatient referral center. We registered demographic, socioeconomic data and nutritional assessment. During a one-year follow-up, hospitalizations and mortality were recorded. The correspondent committee extended an ethical approval. Results: 81 CP patients were recruit, age 131.6 ± 60.4 months (25-313), 60 % male, 77.5 % without independent mobility. The 23 NR patients (28.4%) had lower muscle and fat mass (p = 0.000). During the follow-up, 29/81 patients required hospitalization (35.8%) and 4/81 died (4.9%). There was not an increased risk of hospitalization and/or mortality in NR group, but both were significantly higher in gastrostomy-fed children (RR: 2,98 CI 95%: 1.32-6.75 combining both variables). Conclusions: In this study, children and adolescents with severe CP and nutritional risk had similar morbidity and mortality during a one-year follow-up, compared to those with acceptable nutritional status. Both risks were higher in gastrostomy-fed than the orally fed children.

Longitudinal assessment of nutritional risk in patients under chemo or radiotherapy / Avaliação longitudinal do risco nutricional em pacientes sob quimio ou radioterapia

Summary Objective: To compare nutritional risk in adult patients undergoing chemotherapy and radiotherapy in the beginning, middle, and end of oncologic treatment. Method: This prospective, comparative study included 83 adult patients, 44 undergoing chemotherapy (CT group) and 39 undergoing radiotherapy (RT group) at an oncology treatment center. Nutritional risk was determined by NRS-2002 in the beginning, middle, and end of therapy. Statistical analysis was performed using Statistica 8.0 software. Results: No differences in food intake or body mass index were observed between the CT (24.6±4.8 kg/m²) and RT groups (25.0±5.9 kg/m², p=0.75). Weight loss in the preceding 3 months was detected in 56.8% of CT group and 38.5% of RT group (p=0.09). The weight loss percentage compared with the usual weight within 3 months was greater (p<0.001) in the CT (11.4±6.5%) than in the RT group (3.9±6.8%). In the beginning of treatment, we observed high percentages of patients at moderate (18.2 vs. 15.4%, p=0.73) and high nutritional risk (61.4 vs. 48.7%, p=0.25), with no statistical difference between the CT and RT groups, respectively. During therapy, the nutritional risk remained unaltered in both groups. In the end of therapy, the majority of patients were at moderate (18.2 vs. 12.8%, p=0.50) or severe nutritional risk (50.0 vs. 51.3%, p=0.91), in the CT and RT groups, respectively, regardless of the type of oncologic treatment. Conclusion: The high prevalence of patients at moderate or high nutritional risk in the beginning of treatment indicates the need for an early and continuous follow-up of the nutritional status of patients undergoing oncologic treatment.

Resumo Objetivo: comparar o risco nutricional de pacientes adultos submetidos a quimio e radioterapia no início, no meio e ao término do tratamento oncológico. Método: estudo prospectivo e comparativo conduzido com 83 pacientes adultos de um centro de tratamento oncológico, sendo 44 sujeitos sob quimioterapia (grupo QTx) e 39 sob radioterapia (grupo RTx). O risco nutricional foi determinado pelo questionário NRS-2002 no início, ao meio e ao término da terapia. A análise estatística foi feita com o software Statistica 8.0. Resultados: não houve diferença no padrão de ingestão alimentar e no IMC (24,6±4,8 vs. 25±5,9 kg/m²; p=0,75) nos grupos QTx e RTx, respectivamente. Perda de peso nos 3 meses precedentes ocorreu em 56,8% dos pacientes sob quimioterapia e em 38,5% daqueles sob radioterapia (p=0,09). Os pacientes do grupo QTx apresentaram maior porcentagem de perda de peso em relação ao habitual em 3 meses (11,4±6,5 vs. 3,9±6,8%; p<0,001). No início do tratamento, houve alta taxa de risco nutricional moderado (18,2 vs. 15,4%; p=0,73) e grave (61,4 vs. 48,7%; p=0,25), sem diferença estatística entre os grupos QTx e RTx, respectivamente. No meio do tratamento, o risco nutricional foi mantido em ambos os grupos. Ao término da terapia, mais da metade dos pacientes apresentava risco nutricional moderado (18,2 vs. 12,8%; p=0,50) ou grave (50 vs. 51,3%; p=0,91), independentemente da modalidade de tratamento oncológico. Conclusão: a alta prevalência de risco nutricional moderado ou grave no início do tratamento aponta para a necessidade de abordagem nutricional precoce e permanente durante a terapia oncológica.

Trace elements in plasma and nutritional assessment in patients with compensated cirrhosis on a liver transplant list

ABSTRACT Background - In chronic liver disease, trace element levels in plasma are usually low. However, the specific cause and functional implications of this abnormality are yet not well understood. These element levels may decrease as a result of abnormal liver function in patients with cirrhosis and/or malnutrition. Objective - To evaluate the nutritional status and the profile of trace elements in plasma of patients with cirrhosis on a liver transplant list and to correlate them with disease severity. Methods - This cross-sectional study evaluated 31 male patients diagnosed with compensated liver cirrhosis on a waiting list for liver transplant. Nutritional status was objectively evaluated through anthropometry using Mendenhall score and Blackburn classification, subjectively through the Detsky questionnaire and severity of the disease by MELD and CTP score. Trace elements (Zn, Se, Cu, Ca, Fe, Mg and Mn) in plasma were analyzed by inductively coupled plasma mass spectrometry (ICP-MS). Statistical analysis was performed using Mann-Whitney test. Results - According to the nutritional assessment 19 (61.3%) were malnourished and 12 (38.7%) were overweight. Regarding disease severity 12 (39%) were classified as Child A, 17 (55%), Child B and 2 (6%) Child C, with 46.9% of patients with MELD score >17. The trace element analysis indicated that 31 (100%) had Mn levels above the reference range, 23 (74.2%) low levels of Cu, 29 (93.5%) with deficiency of Se, and 31 (100%) low levels of Ca and Mg. Disease severity did not show statistical difference between the studied trace elements, in contrast to the nutritional status, in which the malnourished group showed higher levels of Mn (P=0.01) and Fe (P=0.01) and low levels of Zn (P=0.03) when compared to the overweight group. Conclusion - The results showed that the trace elements in plasma are altered in chronic liver disease; without significant correlation to disease severity, but correlated to nutritional status. Malnutrition is present in the patients studied, nonetheless a new scenario with an increase in the prevalence of overweight was verified regardless of the degree of hepatic decompensation.

RESUMO Contexto - Na doença hepática crônica os níveis plasmáticos de oligoelementos normalmente apresentam-se baixos, mas a causa específica e implicações funcionais desta anormalidade ainda não estão bem esclarecidas. Estes elementos podem estar diminuídos em consequência da função hepática alterada em pacientes com cirrose e/ou desnutrição. Objetivo - Avaliar o estado nutricional e o perfil de oligoelementos plasmáticos dos pacientes com cirrose hepática em lista para transplante e correlacionar com a gravidade da doença. Métodos - Trata-se de um estudo transversal, no qual foram avaliados 31 pacientes do sexo masculino com diagnóstico de cirrose hepática compensada em lista de espera para transplante de fígado. O estado nutricional foi avaliado objetivamente por medidas antropométricas através do escore de Mendenhall e classificado segundo Blackburn, subjetivamente por um questionário sistematizado por Detsky e a gravidade da doença pelo escore MELD e CTP. Os oligoelementos plasmáticos (Zn, Se, Cu, Ca, Fe, Mg e Mn) foram analisados pelo método de espectrometria de massas com fonte de plasma indutivamente acoplado (ICP-MS). Para análise estatística foi utilizado o Teste de Mann-Whitney. Resultados - De acordo com a avaliação nutricional 19 (61,3%) estavam com desnutrição e 12 (38,7%) com sobrepeso. Em relação à gravidade da doença 12 (39%) foram classificados como Child A, 17 (55%), Child B e 2 (6%) Child C, sendo 46,9% dos pacientes com o escore MELD >17. Na análise dos oligoelementos 31 (100%) apresentaram níveis de Mn acima dos valores de referência, 23 (74,2%) níveis baixos de Cu, 29 (93,5%) com deficiência de Se, e 31 (100%) níveis baixos de Ca e Mg. Em relação à gravidade da doença não houve diferença estatística entre os oligoelementos estudados, já em relação ao estado nutricional o grupo desnutrido apresentou níveis maiores de Mn (P=0,01) e Fe (P=0,01) e níveis diminuídos de Zn (P=0,03) quando comparado ao grupo sobrepeso. Conclusão - Os resultados mostraram que os oligoelementos estão alterados na doença hepática crônica, sem associação significativa com a gravidade da doença, mas sim com o estado nutricional. A desnutrição está presente nos pacientes estudados, porém um novo cenário com aumento na prevalência de sobrepeso foi verificado independente do grau de descompensação hepática.

Prevalence of malnutrition in children with chronic hepatitis b infection

ABSTRACT Background - There have been limited studies investigating the impact of chronic hepatitis B virus infection on the growth of children. Objective - Our objective was to investigate the prevalence of malnutrition in children with chronic hepatitis B infection. Methods - The nutritional status of patients was retrospectively evaluated in the outpatient Clinic of Pediatric Gastroenterology between February and November 2014. During the study, biochemical laboratory parameters, duration of disease, liver biopsy scores, and medication were evaluated. Additionally body mass index and body mass index centiles were calculated. Results - Of the 96 patients in this study, 68 were male and 28 were female, and the mean age was 144.7±43.9 months and 146.1±47.3 months, respectively. According to body mass index centiles five (5.2%) patients were underweight, seven (7.3%) patients were overweight, and seven (7.3%) patients were obese. Conclusions - Moderate rates of malnutrition (including obesity) were found in chronic hepatitis B infection. Additional nutritional status information of healthy and sick children should be assessed in the infection's early period, and timely interventions should be initiated.

RESUMO Contexto - Há limitados estudos investigando o impacto da infecção crônica pelo vírus da hepatite B no crescimento das crianças. Objetivo - O objetivo deste estudo foi investigar a prevalência de desnutrição em crianças com infecção crônica da hepatite B. Métodos - O estado nutricional dos pacientes foi avaliado retrospectivamente em ambulatório de gastroenterologia clínica pediátrica, entre fevereiro e novembro de 2014. Durante o estudo, parâmetros bioquímicos do laboratório, duração da doença, classificação de biópsias hepáticas e medicação foram avaliadas. Além disso, o índice de massa corporal e suas porcentagens foram calculados. Resultados - Dos 96 pacientes, 68 eram do sexo masculino e 28 eram do sexo feminino e idade média era 144.7±43.9 e de 146.1±47.3 meses, respectivamente. De acordo com as porcentagens de índice de massa corporal, cinco (5,2%) pacientes estavam abaixo do peso, sete (7,3%) pacientes estavam com sobrepeso, e sete (7.3%) estavam obesos. Conclusão - Taxas moderadas de desnutrição (incluindo obesidade) foram encontradas em infecção crônica da hepatite B. Informação sobre o estado nutricional das crianças infectadas deve ser colhida inicialmente para que intervenções oportunas sejam tomadas.

Disability due to maternal common mental disorders (CMDs) as a risk factor for chronic childhood malnutrition: cross-sectional study / Incapacidade decorrente de transtornos mentais comuns (TMC) maternos como fator de risco para desnutrição crônica infantil: estudo transversal

ABSTRACT: CONTEXT AND OBJECTIVE: The disability associated with maternal common mental disorders (CMDs) is among the possible explanations for the association between chronic childhood malnutrition and CMDs. CMDs may impair the mother's ability to perform her role, particularly in deprived environments. The present study aimed to evaluate whether disability relating to CMDs could be part of the pathway of the association between childhood malnutrition and maternal CMDs. DESIGN AND SETTING: Cross-sectional study conducted in two institutions: one for malnourished children and another for eutrophic children living in a low-income community in the state of Alagoas, Brazil. METHOD: The cases consisted of 55 malnourished children aged from 12 to 60 months who were attending a nutritional rehabilitation center, with height-for-age z-scores < 2. The controls were 70 eutrophic children of the same age who were attending a day care center in the same area as the cases. The Self-Report Questionnaire made it possible to identify likely cases of maternal CMD. The Sheehan Disability Scale enabled evaluation of the associated disability. RESULTS: Chronic childhood malnutrition was significantly associated with maternal disability relating to CMDs (OR = 2.28; 95% CI: 1.02-5.1). The best logistic regression model using chronic childhood malnutrition as the dependent variable included the following independent variables: higher number of people living in the household; absence of the biological father from the household; and maternal disability relating to CMDs. CONCLUSIONS: If confirmed, the association between chronic childhood malnutrition and maternal disability relating to CMDs may be useful in helping to identify the causal chain between childhood malnutrition and maternal CMDs and to indicate environmental risk factors associated with chronic childhood malnutrition.

RESUMO: CONTEXTO E OBJETIVO: A incapacidade associada aos transtornos mentais comuns (TMCs) maternos está entre as explicações possíveis para a associação entre a desnutrição infantil crônica e os TMCs. Os TMCs podem comprometer a capacidade materna de desempenhar seu papel, especialmente em ambientes precários. O presente estudo objetivou avaliar se a incapacidade relacionada com TMCs pode fazer parte do processo de associação entre a desnutrição infantil e TMCs maternos. DESENHO E LOCALIZAÇÃO: Estudo transversal realizado em duas instituições, uma para crianças desnutridas e outra para crianças eutróficas vivendo em uma comunidade de baixa renda no estado de Alagoas, Brasil. METODOLOGIA: Casos foram 55 crianças desnutridas de 12 a 60 meses atendidas num centro de recuperação nutricional com escore z da idade para altura < 2. Controles foram 70 crianças eutróficas da mesma idade que frequentavam uma creche na mesma área do que os casos. O "Self-Report Questionnaire" permitiu identificar casos prováveis de TMCs maternos; a "Sheehan Disability Scale" possibilitou a avaliação de incapacidade associada. RESULTADOS: A desnutrição crônica infantil e a incapacidade maternal relacionada ao TMCs mostraram-se associados (OR = 2.28, IC 95% 1.02-5.1). O melhor modelo de regressão logística utilizando desnutrição crônica infantil como variável dependente incluiu um maior número de residentes na casa, ausência do pai biológico na residência e incapacidade materna relacionada ao TMCs como variáveis independentes. CONCLUSÕES: Se confirmada, a associação entre desnutrição crônica infantil e incapacidade materna relacionada a TMCs pode ser útil para ajudar a identificar a cadeia causal entre a desnutrição infantil e os TMCs maternos e indicar fatores de risco ambientais associados com a desnutrição crônica infantil.