Aline Maria Luiz Pereira

Oral vitamin intake in children receiving long-term dialysis

OBJECTIVE To evaluate dietary and oral supplement vitamin intake in children submitted to dialysis (peritoneal dialysis and hemodialysis). DESIGN Prospective clinical trial in a 12-month follow-up period. SETTING Children with end-stage renal disease (ESRD) who attended the pediatric nephrology clinic of Universidade Federal de São Paulo-Escola Paulista de Medicina (UNIFESP-EPM), São Paulo, Brazil. PATIENTS Thirty children (18 girls, 23 in peritoneal dialysis, 7 in hemodialysis) with age 9.3 +/- 7.4 years. INTERVENTION METHODOLOGY: Six successive assessments of both anthropometric indexes and 3-day dietary diaries in children receiving a daily dose of oral water-soluble vitamin supplement. MAIN OUTCOME MEASURES Anthropometric indexes (weight/age [W/A], height/age [H/A], midarm muscle area/age [MAMA/A], and fat area/age [FA/A]) and dietary adequacy-% recommended dietary allowance (RDA) (computerized nutritional analysis from 3-day dietary intake diary). RESULTS Anthropometric indexes analysis showed that 53% of children were <-2.0 standard deviation score (SDS) of W/A, 63% were <-2.0 SDS of H/A, and 43.3% were <-1.65 SDS of MAMA/A, suggesting growth deficit and low muscle wasted. Total caloric intake was lower than 100% of RDA in 90% of children. Dietary intake of water-soluble vitamins was <100% of RDA in the majority of children, as follows: vitamin C (24/30), B1 (28/30), B2 (22/30), B3 (27/30), B6 (26/30), B12 (1/30), pantothenic acid (24/30), and folic acid (9/30). The combined dietary and vitamin supplement intake resulted in excessive oral intake for almost all the vitamins. CONCLUSION Dietary intake of water-soluble vitamins is lower than the RDA in the majority of children with ESRD; supplementation is necessary to reach the RDA. The use of the available vitamin supplement resulted in vitamin intakes that exceeded the RDA for almost all of the vitamins. However, we do not know if these intakes exceeded the childrens requirements, nor whether they had any clinically significant harmful effects.

Abdominal circumference measurement by ultrasound does not enhance estimating the association of visceral fat with cardiovascular risk.

OBJECTIVES To evaluate the association between visceral fat and cardiovascular risk factors and to compare the ultrasonographic measurements of abdominal visceral fat with abdominal circumference (AC). METHODS This observational cross-sectional study categorized pubertal and postpubertal adolescents into a control group (n = 49) and an obese group (n = 46). Weight, height, AC, blood pressure, biochemical tests (lipid profile, triacylglycerols, fasting glucose for insulinemia, and serum uric acid), and ultrasound to measure visceral fat were assessed. RESULTS We found significant differences in the vascular risk variables between the groups, except for total cholesterol and fasting blood glucose level. We also observed that 31 subjects in the control group presented abnormalities in cardiovascular risk factors. The correlations between abdominal visceral fat (measured by ultrasound or the AC) and cardiovascular risk factors were significant. In the entire sample, AC presented better sensitivity and specificity than the ultrasound-measured abdominal visceral fat for identifying the presence of a cluster of at least three cardiovascular risk factors (areas under the receiver operating characteristics curve 0.87 and 0.73, respectively). CONCLUSION Ultrasonographic measurements of visceral fat were correlated with cardiovascular risk factors, but this association was also demonstrable with AC measurements. Our results suggest that the measurement of visceral fat by ultrasound is unnecessary for the diagnosis of cardiovascular risk in well-nourished or obese adolescents.

Cardiovascular risk factors in pediatric patients after one year of renal transplant

OBJETIVO: Identificar la frecuencia de diabetes mellitus y la presencia de factores de riesgo cardiovascular en pacientes pediatricos despues de un ano de trasplante renal. METODOS: Estudio retrospectivo, de orden documental y exploratorio, realizado de enero de 2000 a enero de 2006, abarcando 111 fichas de pacientes pediatricos (0 a 18 anos incompletos) sometidos a trasplante renal en el Hospital del Rinon e Hipertension y en el Hospital Sao Paulo de la Universidad Federal de Sao Paulo. RESULTADOS: Fueron analizados 111 pacientes, 50,5% utilizaban anti-hipertensores antes del trasplante renal. Un ano despues este numero cayo para 28%. En el pre-trasplante, 13,5% pacientes presentaron sobrepeso y despues de un ano no hubo alteracion importante (12,6%). El numero de pacientes obesos aumento 50% despues de un ano de trasplante renal. Aproximadamente 1% de los ninos desarrollaron diabetes mellitus despues del trasplante renal. CONCLUSION: La presencia de exceso de peso (sobrepeso y obesidad), hipertension arterial y diabetes mellitus son frecuentes en pacientes pediatricos despues del trasplante renal.

Growth and Dietary Intake Assessment of Children With Chronic Renal Failure During Predialysis Management

■ Objective: To assess the growth and dietary intake of children with chronic renal failure during predialysis management. ■ Design: Anthropometric and nutrition intake screening. ■ Setting: Pediatric nephrology clinic serving a low socioeconomic-level Brazilian population. ■ Participants: 14 children (8 male, 6 female); age range, 3 months to 12 years, 9 months; creatinine clearance range, .32 to.85 mL/s/1.73 m 2 (19 to 51 mL/min/1.73 m 2 ). ■ Main outcome measures: Weight, height, arm circumference, and computerized nutritional analysis from 3-day food intake diary. ■ Results: Waterlow classification indicated 3 cases of wasting, 9 of stunting, and 2 of stunting and wasting; weight/age ratio below the 10th percentile in 12 cases; caloric intake 57% below and protein 92.8% above recommendations. ■ Conclusion: There is an immediate need to begin a nutritional therapy and growth assessment program for children with CRF in Brazil.

Fatores de risco cardiovascular em pacientes pediátricos após um ano de transplante renal

OBJETIVO: Identificar la frecuencia de diabetes mellitus y la presencia de factores de riesgo cardiovascular en pacientes pediatricos despues de un ano de trasplante renal. METODOS: Estudio retrospectivo, de orden documental y exploratorio, realizado de enero de 2000 a enero de 2006, abarcando 111 fichas de pacientes pediatricos (0 a 18 anos incompletos) sometidos a trasplante renal en el Hospital del Rinon e Hipertension y en el Hospital Sao Paulo de la Universidad Federal de Sao Paulo. RESULTADOS: Fueron analizados 111 pacientes, 50,5% utilizaban anti-hipertensores antes del trasplante renal. Un ano despues este numero cayo para 28%. En el pre-trasplante, 13,5% pacientes presentaron sobrepeso y despues de un ano no hubo alteracion importante (12,6%). El numero de pacientes obesos aumento 50% despues de un ano de trasplante renal. Aproximadamente 1% de los ninos desarrollaron diabetes mellitus despues del trasplante renal. CONCLUSION: La presencia de exceso de peso (sobrepeso y obesidad), hipertension arterial y diabetes mellitus son frecuentes en pacientes pediatricos despues del trasplante renal.

Factores de riesgo cardiovascular en pacientes pediátricos después de un año de trasplante renal

OBJETIVO: Identificar la frecuencia de diabetes mellitus y la presencia de factores de riesgo cardiovascular en pacientes pediatricos despues de un ano de trasplante renal. METODOS: Estudio retrospectivo, de orden documental y exploratorio, realizado de enero de 2000 a enero de 2006, abarcando 111 fichas de pacientes pediatricos (0 a 18 anos incompletos) sometidos a trasplante renal en el Hospital del Rinon e Hipertension y en el Hospital Sao Paulo de la Universidad Federal de Sao Paulo. RESULTADOS: Fueron analizados 111 pacientes, 50,5% utilizaban anti-hipertensores antes del trasplante renal. Un ano despues este numero cayo para 28%. En el pre-trasplante, 13,5% pacientes presentaron sobrepeso y despues de un ano no hubo alteracion importante (12,6%). El numero de pacientes obesos aumento 50% despues de un ano de trasplante renal. Aproximadamente 1% de los ninos desarrollaron diabetes mellitus despues del trasplante renal. CONCLUSION: La presencia de exceso de peso (sobrepeso y obesidad), hipertension arterial y diabetes mellitus son frecuentes en pacientes pediatricos despues del trasplante renal.