Vitamin E deficiency in childhood: a narrative review.

Vitamin E is an important nutrient from the earliest stages of life. It plays key roles as an antioxidant and in the maintenance of the immune system, among others. Vitamin E deficiency (VED), which occurs more frequently in children, is rarely addressed in the literature. This narrative review aims to summarise the chemistry, biology, serum indicators and clinical trials that have evaluated the impact of fortification and other relevant aspects of vitamin E, in addition to the prevalence of its deficiency, in children worldwide. Vitamin E intake in recommended amounts is essential for this nutrient to perform its functions in the body. Serum α-tocopherol is the most widely used biochemical indicator to assess the prevalence of VED. VED has been associated with symptoms secondary to fat malabsorption and may lead to peripheral neuropathy and increased erythrocyte haemolysis. Reduced concentrations of α-tocopherol may be caused by the combination of diets with low amounts of vitamin E and inadequate consumption of fats, proteins and calories. The lowest prevalence of VED was found in Asia and the highest in North America and Brazil. High proportions of VED provide evidence that this nutritional deficiency is a public health problem in children and still little addressed in the international scientific literature. The planning, evaluation and implementation of health policies aimed at combatting VED in the paediatric population are extremely important.

Prevalence and factors associated with dyslipidemia in children aged 6 to 42 months in a Brazilian capital.

This study aimed to assess the prevalence and factors associated with lipid profile abnormalities of children aged 6 to 42 months in a Central-West Brazilian capital city. This cross-sectional study used data from the baseline of a cluster-randomized clinical trial conducted in parallel. It evaluated the lipid profile, usual nutrients intake (direct food-weighing method and 24-hour dietary recall), anthropometric parameters, and socioeconomic aspects of 169 children from early childhood education centers. Poisson regression with robust variance analysis was conducted. Of the total sample, 85% had dyslipidemia, 72% had high-density lipoproteins (HDL-c) levels below the desired range, 49% had increased triglycerides (TG), 17% exhibited elevated low-density lipoproteins (LDL-c), and 15% showed high total cholesterol (TC). An increase in the body mass index (BMI) for age z-score was associated with a higher prevalence of increased TG (PR = 1.22; 95%CI: 1.05-1.41; p = 0.009). Higher age in children was associated with an increased prevalence of high LDL-c (PR = 1.037; 95%CI: 1.01-1.07; p = 0.022) and TC (PR = 1.036; 95%CI: 1.00-1.07; p = 0.037), however it was a protective factor against low HDL-c (PR = 0.991; 95%CI: 0.98-1.00; p = 0.042). High energy intake was associated with low HDL-c (PR = 1.001; 95%CI: 1.00-1.00; p = 0.023). A higher prevalence of increased LDL-c (PR = 1.005; 95%CI: 1.00-1.01; p = 0.006) and decreased HDL-c (PR = 1.002; 95%CI: 1.00-1.00; p < 0.001) were associated with dietary cholesterol intake. Most of the children presented at least one alteration in serum lipids. Lipid profile abnormalities were associated with higher BMI, older age, and increased caloric and cholesterol intake.

Evaluation of dietary folate in children assisted in Family Health Strategy units: A cross-sectional study.

BACKGROUND AND AIMS: Folate is an indispensable nutrient in human food and its deficiency may affect growth and development, and influence the risk of infant morbidity and mortality. The objective was to analyze the consumption of folic acid and its association with socioeconomic, environmental, maternal and anthropometric data of children aged 12-14 months assisted in Family Health Strategy units in a Brazilian capital. METHODS: This is a cross-sectional study included in a pragmatic clinical trial conducted with 101 children. Food intake was analyzed by means of a 24-h recall, a simple and multiple linear regression analysis was performed in a hierarchical model, and the outcome variable Dietary Folate Equivalents (DFE) was calculated. A hierarchical model was used at three levels (distal: sociodemographic; medial processes: maternal characteristics; proximal: individual processes of the child) in the adjustment of the model, in which the variables presenting p < 0.20 in the crude analysis were inserted in the adjusted analysis, from distal to proximal block, in the increasing order of magnitude of association with the outcome. RESULTS: Regarding folic acid consumption, 10.9% (n = 11) of children presented deficiency according to the calculated DFE considering the evaluation by Estimated Average Requirement (EAR), and 42.6% (n = 43) had excessive intake according to the calculated DFE considering the evaluation by the Tolerable Upper Intake Levels (UL). After multiple linear regression analysis flour intake was associated with an increase in DFE intake by 2.05 µg (95% CI: 1.72-2.45) and the presence of at least one more child under 5 years of age with an increase in DFE intake by 0.77 µg (95% CI: 0.67-0.89), while receiving the Bolsa Família Program is associated with an increase in DFE intake by 1.39 µg (95% CI: 1.07-1.65) in the model adjusted for birthweight and maternal age, regardless of the child's age. CONCLUSION: Data from this study showed low prevalence of deficient consumption and high percentage of excessive consumption of folic acid in the children. In addition, receiving the Bolsa Família Program, consuming flour and the number of children under 5 years of age were positively associated with the calculated DFE.

Efeitos da restrição de carboidratos no manejo do diabetes mellitus: revisão de literatura científica / Effects of carbohydrate-restricted diets in the management of diabetes mellitus: review of scientific literature

O objetivo do presente estudo foi avaliar, por meio de uma revisão da literatura, evidências da utilização de dietas com restrição de carboidratos no manejo do diabetes mellitus (DM). As buscas eletrônicas e manuais foram até abril de 2019, e incluíram trabalhos publicados a partir de 2008. Foram excluídos estudos de pesquisas in vitro e em animais, revisões de literatura, livros, monografias, dissertações, teses, estudos de caso e relatos de caso. Os artigos remanescentes foram submetidos à análise de sua qualidade metodológica pela Escala JADAD cinco pontos. Um total de 19 estudos randomizados e com qualidade média de três pontos foram selecionados e analisados quanto aos tipos de dieta utilizadas, adesão, tipo de DM, tempo de intervenção, consumo reportado de carboidratos e resultados observados para os grupos controle e intervenção. Dentre os parâmetros escolhidos para mensurar os possíveis efeitos das dietas, destacaram-se alteração de peso e IMC, Hb1Ac, variabilidade ou controle glicêmico, perfil lipídico e alteração nas doses de insulina ou medicação utilizadas. Em quatro estudos não foram observadas vantagens significativas de uma dieta restrita em carboidratos, e 15 trabalhos relataram melhoras em um ou mais parâmetros. Tais resultados podem representar uma grande vantagem na adoção desta estratégia alimentar no manejo do DM e na prevenção de complicações da doença. Contudo, existem limitações nos estudos, que precisam ter suas hipóteses verificadas no longo prazo, e pesquisas adicionais devem ser realizadas para configurar uma estratégia oficial no controle do DM. (AU)

This study aimed to evaluate, through a literature review, evidence of the use of diets with carbohydrate restriction in the management of diabetes mellitus (DM). Electronic and manual searches were conducted until April 2019, including works published from 2008 onwards. Studies on in vitro and animal research, literature reviews, books, monographs, dissertations, theses, case studies and case reports were excluded. The remaining articles were submitted to analysis of their methodological quality by the five-point JADAD Scale. Nineteen randomized studies with an average quality of three points were selected and analyzed regarding the types of diet used, adherence, type of DM, time of intervention, reported consumption of carbohydrates and results observed for the control and intervention group. Among the parameters chosen to measure the possible effects of diets, weight and BMI changes, Hb1Ac, variability or glycemic control, lipid profile and changes in insulin doses or medication used stood out. In four studies, no significant advantages were observed from a carbohydraterestricted diet, and 15 studies reported improvements in one or more parameters. Such results can represent a great advantage in adopting this dietary strategy in the management of DM and in preventing complications of the disease. However, there are limitations in the studies, which need to have their hypotheses verified in the long term, and additional research must be carried out to configure an official strategy in the control of DM. (AU)

Avaliação do consumo de alimentos açucarados por crianças menores de 5 anos / Evaluation of the consumption of sugary foods by children under 5 years of age

Introdução: A alta ingestão de alimentos açucarados por crianças causa graves consequências a curto e a longo prazo. Este trabalho analisou a frequência de consumo de alimentos açucarados por crianças de 6 meses a 59 meses. Método: Estudo transversal, de base populacional e domiciliar.A amostra foi composta por 660 crianças com idade entre 6 e 59 meses. Foram investigadas as variáveis idade da criança, escolaridade da mãe, classe econômica e consumo alimentar. Utilizou-se o teste Qui Quadrado de Pearson e considerou-se p<0,05. Resultados: A maioria das crianças tinha idade superior a 24 meses (64,24%). A classe econômica mais prevalente na amostra foi a classe C (51,67%) e a maioria das mães (58,93%) tinha idade entre 20 e 30 anos de idade. Os alimentos açucarados mais consumidos diariamente pelas crianças foram açúcar (58,18%) e achocolatado em pó (43,64%). O consumo de alimentos açucarados apresentou associação positiva com idade da criança (p<0,05), classe econômica e a escolaridade da mãe. Conclusão: O consumo de alimentos açucarados foi alto nas crianças com idade acima de 24 meses. Todos os alimentos analisados tiveram relação positiva com a idade da criança. A escolaridade materna teve relação com o consumo de bolacha com recheio, café com açúcar, refrigerante, e suco artificial. E a renda familiar teve relação com café com açúcar, iogurte e suco artificial.(AU)

Introduction: A high intake of sugary foods by children causes severe consequences in the short and long term. This study was analyzed the frequency of consumption of sugary foods by children 6 months to 59 months. Methods: Cross-sectional study, population and household basis. The sample consist of 660 children aged 6 to 59 months. The variables age of the child were investigated, mother's education, economic class and food consumption. We used the Chi-Square test and Pearson was considered at p<0.05. Results: Most of the children were older than 24 months (64.24%). The most prevalent economic class in the sample was the class C (51.67%) and most mothers (58.93%) were aged between 20 and 30 years old. The more sugary foods consumed daily by children were sugar (58.18%) and chocolate powder (43.64%). The consumption of sugary foods showed a positive association with the child's age (p<0.05), economic class and mother's education. Conclusion: Consumption of sugary food was high in children over 24 months. All foods were analyzed positive relationship with the children age. Maternal education was related to the wafer consumption with stuffing, coffee with sugar, soda and artificial juice. Family's income was related to coffee with sugar, yogurt, and artificial juice.(AU)