Célia Regina Moutinho de Miranda Chaves

Associação entre medidas do estado nutricional e a função pulmonar de crianças e adolescentes com fibrose cística

OBJECTIVE To evaluate the association between nutritional status measurements and pulmonary function in children and adolescents with cystic fibrosis. METHODS We evaluated the nutritional status of 48 children and adolescents (aged 6-18 years) with cystic fibrosis based on body mass index (BMI) and body composition measurements-mid-arm muscle circumference (MAMC) and triceps skinfold thickness (TST)-at a referral center in the city of Rio de Janeiro, Brazil. Pulmonary function was assessed by means of spirometry, using FEV1 to classify the severity of airway obstruction. We used Students t-tests for comparisons between proportions and linear regression analysis for associations between continuous variables. The level of significance was set at p < 0.05. RESULTS The evaluation of nutritional status based on BMI identified a smaller number of malnourished patients than did that based on MAMC (14 vs. 25 patients, respectively). Most of the patients presented mild pulmonary disease. Mean FEV1 was 82.5% of predicted. Pulmonary function was found to correlate significantly with BMI, MAMC and TST (p = 0.001, p = 0.001 and p = 0.03, respectively). All subjects with moderate or severe pulmonary involvement were considered malnourished based on BMI and body composition parameters. Of the 25 patients considered malnourished based on body composition (MAMC), 19 were considered well-nourished based on their BMI. CONCLUSIONS In the present study, all nutritional status measurements correlated directly with the pulmonary function of children and adolescents with cystic fibrosis. However, body composition measurements allowed earlier detection of nutritional deficiencies.

Prevalence of bone mineral disease among adolescents with cystic fibrosis

OBJECTIVE To evaluate the prevalence of bone mineral disease among adolescents with cystic fibrosis and to relate the findings with the variables studied. METHODS The study enrolled 37 adolescents who were assessed for: nutritional status according to height/age and body mass/age ratios; bone mineral density of the lumbar spine and entire body by densitometry with dual emission X-ray; daily dietary intake according to a 3-day dietary recall; and pulmonary function by the forced expiratory volume in one second test. RESULTS Mean age was 13.2 (+/-2.8) years. Nutritional status was adequate in 70.3 and 75.7% of patients according to the height/age and body mass/age indices, respectively; 54.1% of the patients exhibited reduced lumbar spine bone mineral density and 32.5% for the whole body. There was a positive correlation between bone mineral density and body mass index (p = 0.04). Lung disease and pancreatic insufficiency exhibited a correlation with altered bone mineral density. The dietary recall revealed adequate percentages of calcium, phosphorous and calories, according to the nutritional recommendations laid out in the European Cystic Fibrosis Consensus. The multivariate analysis indicated that these variables were not statistically significant. CONCLUSIONS There is a high prevalence of bone mineral disease among adolescents. Good nutritional status, pancreatic enzyme replacement and control of lung disease may have a protective effect on bone mass.

Acessibilidade a benefícios legais disponíveis no Rio de Janeiro para portadores de deficiência física

Segundo a OPAS, so 2% dos 85 milhoes de pessoas com deficiencia tem assistencia adequada na America Latina e 10% da populacao mundial vivem com deficiencia, mas sem acesso a direitos constitucionalmente adquiridos. A deficiencia precisa ser abordada em diferentes niveis: clinico, de reabilitacao, social e politico. Pobreza e deficiencia estao fortemente relacionadas. Estigma, discriminacao e incapacidade fisica e financeira limitam o acesso a educacao e saude, levando a cronificacao e agravamento da morbidade, aumentando os custos do tratamento, formando-se um ciclo vicioso que tem que ser quebrado. Embora a Constituicao Federal inclua direitos a pacientes deficientes, dando acesso a saude e educacao, eles nao sao obtidos e respeitados. Para compreender o problema, estudou-se o processo de obtencao de tres destes beneficios em pacientes com deficiencia fisica portadores de mielomeningocele em instituto de referencia no Rio de Janeiro. Os resultados mostram um baixo indice de obtencao. A burocracia e o custo das multiplas viagens foram as principais dificuldades para familias proximas ou abaixo da linha de pobreza e filhos com problemas de locomocao e doenca cronica. Outras dificuldades foram desinteresse profissional, descredito, sistema educacional despreparado e dificuldades de acesso.

Status of cis and trans Fatty Acids in Brazilian Adolescent Mothers and Their Newborns

STUDY OBJECTIVE The objective was to quantify cis and trans fatty acids in maternal plasma and infant cord plasma from adolescent mothers. DESIGN From 80 adolescent healthy mothers, we sampled postpartum maternal blood and umbilical cord blood at birth. Trans fatty acids (tFAs), linoleic (18:2), and arachidonic (AA, 20:4) acids of the n-6 family, and α-linolenic (18:3), eicosapentaenoic (20:5) and docosahexaenoic (22:6) acids of the n-3 family were analyzed by gas-liquid chromatography. Results were expressed as a percentage of total fatty acids. RESULTS Linoleic fatty acid was present in greater proportions in the maternal plasma than in that of the umbilical cord, whereas AA was present in greater proportions in the total lipids of umbilical cord blood. Docosahexaenoic acid was the long-chain polyunsaturated fatty acid of the n-3 family that was predominant in both maternal and umbilical cord plasma. The tFAs in the maternal plasma had a negative correlation with oleic acid and linoleic acid. Linolenic acid had a positive correlation with cephalic perimeter upon birth. A tendency for a negative correlation between trans isomers and gestational age at birth (P = .05) was observed. CONCLUSIONS Long-chain polyunsaturated fatty acids, which are important to fetal growth and development, were found in greater quantities in the cord blood of newborns of adolescents than in the maternal blood, indicating a priority of transfer of AA and docosahexaenoic fatty acids to the fetus. Despite the lower levels of tFAs found in maternal blood, we verified potential risk for premature birth.

Prevalência de doença mineral óssea em adolescentes com fibrose cística

OBJECTIVE: To evaluate the prevalence of bone mineral disease among adolescents with cystic fibrosis and to relate the findings with the variables studied. METHODS: The study enrolled 37 adolescents who were assessed for: nutritional status according to height/age and body mass/age ratios; bone mineral density of the lumbar spine and entire body by densitometry with dual emission X-ray; daily dietary intake according to a 3-day dietary recall; and pulmonary function by the forced expiratory volume in one second test. RESULTS: Mean age was 13.2 (±2.8) years. Nutritional status was adequate in 70.3 and 75.7% of patients according to the height/age and body mass/age indices, respectively; 54.1% of the patients exhibited reduced lumbar spine bone mineral density and 32.5% for the whole body. There was a positive correlation between bone mineral density and body mass index (p = 0.04). Lung disease and pancreatic insufficiency exhibited a correlation with altered bone mineral density. The dietary recall revealed adequate percentages of calcium, phosphorous and calories, according to the nutritional recommendations laid out in the European Cystic Fibrosis Consensus. The multivariate analysis indicated that these variables were not statistically significant. CONCLUSIONS: There is a high prevalence of bone mineral disease among adolescents. Good nutritional status, pancreatic enzyme replacement and control of lung disease may have a protective effect on bone mass.

Cohort study for monitoring cardiovascular risk factors in children using a primary health care service: methods and initial results

An awareness of the presence of cardiovascular disease risk factors since childhood is essential to guide health promotion policies. The aim of this paper is to present, together with the main results, a methodological proposal to estimate both incidence and prevalence of these factors over time and their associated socio-demographic aspects in a population attending a primary health care unit, within Brazilian Unified National Health System. An open cohort design was adopted, starting in 2004 with a sample of 356 children aged between 5 and 9. In the second wave, in 2008, 126 children were enrolled and 205 were reevaluated. Socioeconomic variables, food intake, physical activity, anthropometric measures (weight, height and waist size), lipidogram and glycemia were collected. Results indicate a high prevalence of dyslipidemia, and an increase of excess weight and sedentary activity between both surveys. Some 55% of children were found to have lower values of HDL-cholesterol. The methodological proposal was considered adequate for the monitoring of cardiovascular disease predictors in poor urban populations.

Avaliação e recomendações nutricionais para crianças e adolescentes com fibrose cística

OBJECTIVE: To review and discuss evidence on the nutritional status assessment and recommendations for nutritional management of children and adolescents with cystic fibrosis. DATA SOURCES: MEDLINE (PubMed version) and Latin American and Caribbean Center on Health Sciences Information (LILACS), from 1984 to 2009. The combination of the following keywords were applied: cystic fibrosis, nutritional status, child, and adolescent. DATA SYNTHESIS: Cystic fibrosis (CF) is a genetic disease, chronic, progressive, and fatal. It is caused by a defect in the transmembrane regulatory protein that regulates the flow of chlorine, sodium and water across the apical membrane of epithelial cells. CF patients are vulnerable to malnutrition resulting from the imbalance between food intake, energy expenditure and loss. New insights into the pathophysiology of the disease have resulted in significant changes in current recommendations for energy and especially lipids intake. There are many interrelated factors that affect the nutritional status of CF patients, such as genetic mutation, pancreatic insufficiency, bowel resection, loss of bile salts and acids, gastroesophageal reflux disease, lung inflammation and infections, diabetes, and emotional conditions. The importance of nutrition in the survival of CF patients is well established, as well as the association between malnutrition and deterioration of lung function. CONCLUSIONS: Nutritional monitoring and dietary counseling are key elements in the management of patients with CF aiming to control the symptoms and the progression of the disease in order to provide better quality of life.

Anemia em crianças e mulheres indígenas no Brasil: revisão sistemática

Iron-deficiency anemia can be considered the most important nutritional deficiency in Brazil. The scope of this article was to conduct a systematic review of the literature in order to describe the frequency of anemia in indigenous women and children in Brazil, and gather information on associated factors. A search of the PubMed, Scopus and Lilacs databases was conducted. Seventeen studies were selected. The rates of prevalence of anemia ranged from 23.1%-74.6%; 42.9%-92.3% and 29.6%-84%, for children aged 6 to 119 months, 6 to 23 months and 6 to 59 months, respectively. Two studies were conducted with women of childbearing age and rates of 67% were found among the Suruí and 16.1% among the Xukuru of Ororubá. The majority of authors attribute the prevalence of anemia to inadequate sanitary conditions, diets deficient in iron and essential micronutrients and a lack of access to basic health services. The findings highlight the importance of anemia among the indigenous peoples studied, which has been reflected by a substantial increase in research over the last twenty years.Iron-deficiency anemia can be considered the most important nutritional deficiency in Brazil. The scope of this article was to conduct a systematic review of the literature in order to describe the frequency of anemia in indigenous women and children in Brazil, and gather information on associated factors. A search of the PubMed, Scopus and Lilacs databases was conducted. Seventeen studies were selected. The rates of prevalence of anemia ranged from 23.1%-74.6%; 42.9%-92.3% and 29.6%-84%, for children aged 6 to 119 months, 6 to 23 months and 6 to 59 months, respectively. Two studies were conducted with women of childbearing age and rates of 67% were found among the Surui and 16.1% among the Xukuru of Ororuba. The majority of authors attribute the prevalence of anemia to inadequate sanitary conditions, diets deficient in iron and essential micronutrients and a lack of access to basic health services. The findings highlight the importance of anemia among the indigenous peoples studied, which has been reflected by a substantial increase in research over the last twenty years.

Estado nutricional e distribuição de gordura corporal em crianças e adolescentes com Fibrose Cística

OBJECTIVE assessing the nutritional status and body fat distribution in children and adolescents with cystic fibrosis. METHOD Fifty-six (56) 8-18 year old patients were assessed for fat distribution by dual energy X-ray absorptiometry, for nutritional status by height/age, and for body mass index to age and dietary intake by 24-hour dietary recall. RESULTS Approximately 50% of the sample showed adequate nutritional status. Most of it showed inadequate caloric and lipid intake. BMI/age was the nutritional indicator that best showed the increased percentage of trunk fat, android/gynecoidratio and trunk fat/total fat ratio. Patients with Pancreatic Insufficiency and eutrophic individuals showed higher median android/gynecoidratio. CONCLUSION Increased abdominal adiposity was evidenced by DXA. The BMI did not identify decreased lean body mass. However, when body mass was high, it was significant for abdominal adiposity. The anthropometric assessment of patients with cystic fibrosis should be associated with body composition and body fat distribution to obtain an earlier malnutrition and cardiometabolic risk factor diagnosis.

Motor delay in cystic fibrosis infants: an observational study

OBJECTIVE To verify the prevalence of delay in gross motor development in cystic fibrosis (CF) patients. STUDY DESIGN This is a cross-sectional observational study. A total of 15 children with CF were included in the analyses. The selection criteria was age between 6 and 42months. Data on demographic, anthropometric, clinical characteristics and severity score (Shwachman) were obtained from patient records. The Bayley Scales of Infant and Toddler Development® - III Edition (BSITD-III) was used to assess motor abilities. RESULTS Motor development delay was observed in 26.7% (n=4) of the children and, in 75% of these, there were statistically significant differences between gross and fine motor scores. Low stature, low weight and periods longer than 60days at hospital showed statistically significant association with motor delay (p=0.025, 0.032, 0.003, respectively). CONCLUSION The prevalence of motor delay in the studied sample was high, suggesting that biological and ambient conditions of risk present in CF contribute to early motor deficits. Thus, the observation of the motor development in these patients is important for planning an adequate intervention.