Cristiane Kochi

Tratamento da desnutrição em crianças hospitalizadas em São Paulo

AIM:To study anthropometric development, nutritional support and mortality rate of malnourished children hospitalized in a referral center METHODS: In a retrospective study we surveyed 98 hospitalized malnourished children (ZW<-2) with no chronic disease. Data collected was: birth weight, gestational age, length of exclusive breast feeding, diagnosis at admission, formula used (type, delivery route and feeding tolerance) and length of stay. Weight and height were controlled at admission and discharge. To classify and evaluate nutritional rehabilitation we used the Z-score: weight-for-age (ZW), height-for-age (ZH), weight-for-height (ZW/H). The nutritional therapy used was based on the World Health Organization (WHO) guidelines, with minor modifications. All chosen formulas were industrialized: lactose-free polymeric formula (PLF) for children with diarrhea, low lactose polymeric formula (PLL) for children without diarrhea and cows milk hydrolysate (CMH) for sepsis or chronic diarrhea. At the rehabilitation phase, all children were given the PLL formula. STATISTICAL ANALYSIS: Students t and chi-square tests. RESULTS: The median of age and length of stay were 9.8 months and 17 days, respectively and the mortality rate was of 2%. Diarrhea and/or pneumonia were diagnosed at admission in 81.6% of the children. An improvement of 17.3 % ZW, 82.7 % ZH and 92.2 % ZW/H was observed. PLF was more frequently given at admission (47.4%) while CMH was given to only 7.4% of the children. Twenty-four percent of the children were tube fed and 5.1 % received parenteral nutrition. Tolerance of the initial formula was considered good in 66.7% of cases. CONCLUSIONS: The WHO guidelines were effective in the nutritional therapy of severely malnourished hospitalized children, resulting in good nutritional rehabilitation with low mortality rates.

Impact of Vitamin A Megadose Supplementation on the Anthropometry of Children and Adolescents with Non-Hormonal Statural Deficit: a Double-blind and Randomized Clinical Study

OBJECTIVE To evaluate the intake of retinol and carotenoids, and their serum levels, as well as the impact of vitamin A supplementation on the anthropometry and body composition of children and adolescents with non-hormonal-related statural deficit. METHOD Double-blind, randomized trial of 46 pre-pubertal patients, between 4 and 14 years of age, with normal growth rates. The subjects were divided into two groups, each with 23 individuals (Group I: Placebo; Group II: Vitamin A in a single megadose), and were evaluated at moments A and B with a six month interval. RESULTS There were no statistically significant differences in serum retinol levels, anthropometry, growth velocity, or body composition, between moments A and B, in Group II. Carotenoids were significantly lower in Group I at moment B. The semi-quantitative food intake questionnaire showed that approximately 60.9% of the children and adolescents ingested less than half of the amounts of retinol and carotenoids recommended by the Food Guide Pyramid. Inadequate intake was more prevalent regarding vegetable and fruit carotenoid sources, with 75 and 70% of inadequacy, respectively. CONCLUSION If one considers the inadequate food intake observed in the dietary evaluation in this study, it is possible that multiple micronutrient deficiencies could be involved in statural deficits. This could explain why vitamin A supplementation does not seem to influence growth in children and adolescents with statural deficit, as indicated by the present study. Thus in populations such as the one studied here, the supplementation with vitamin A should be integrated into comprehensive nutritional interventions, so as to possibly promote greater positive impact on linear growth.

Vitamina A: nível sérico e ingestão dietética em crianças e adolecentes com déficit estatural de causa não hormonal

OBJETIVOS: Determinar a ingestao dietetica de vitamina A e os niveis sericos de carotenoides e retinol em criancas e adolescentes com deficit estatural sem causa hormonal, atendidos no Ambulatorio de Endocrinopediatria do Nucleo de Nutricao (NUNADI) da Secretaria de Estado da Saude de Sao Paulo. METODOS: Foram avaliados de maneira prospectiva 47 pacientes pre-puberes, entre 4 e 14 anos, com relacao a: antropometria, idade ossea, inquerito alimentar, bioimpedanciometria e nivel serico de retinol e carotenoides. RESULTADOS: A media do escore Z da estatura foi de -2,4; 20% dos pacientes eram desnutridos, 25,5% tinham inadequacao da massa gorda e maior atraso da idade ossea. Os niveis sericos de retinol e carotenoides foram inadequados em 21% dos pacientes, sendo que foi maior o percentual de inadequacao dos carotenoides nos pacientes que apresentavam deficit estatural mais acentuado. Nao houve relacao dos niveis sericos de retinol e carotenoides com a velocidade de crescimento. Em 82,9% dos inqueritos alimentares realizados, houve ingestao de vitamina A inferior a 50% do estabelecido na Pirâmide de Alimentos. CONCLUSAO: Baseados nestes resultados, concluimos que ha uma elevada prevalencia de desnutricao, comprometimento da idade ossea, inadequacao no nivel serico de carotenoides e ingestao de vitamina A em criancas com comprometimento estatural.

Risk of Atherosclerosis in Patients with Ataxia Telangiectasia

Background and Aims: Evaluate the nutritional status, plasma concentration of vitamin E and markers of cardiovascular risk in ataxia telangiectasia (AT) patients. Methods: Cross-sectional study with 13 patients with AT and 22 healthy controls, evaluating the following factors: nutritional status, food intake, lipid profile, plasma concentration of vitamin E, malondialdehyde and high sensitivity C-reactive protein, linking them with atherosclerosis risk in AT patients. Results: Average age was 14.6 in the AT group, 30.8% were malnourished and 23.1% had stunting. A greater impairment of lean body mass was found in these patients. Concentrations of triglycerides (TG), total cholesterol (CT), LDL-c, non-HDL cholesterol (NHDL-c) were significantly higher in patients and HDL-c, lower. Vitamin E/total lipids and vitamin E/TG ratios were lower in the AT group, and significant inverse correlation between these ratios and NHDL-c, CT/HDL-c, and LDL-c/HDL-c, log TG/HDL-c was observed in the AT group. Alanine aminotransferase correlated directly and significantly with NHDL-c, CT/HDL-c and LDL-c/HDL-c, in patients. Conclusion: The alterations of lipid metabolism biomarkers suggestive of atherosclerotic risk of male AT patients coupled with lower vitamin E/total lipids ratio and low lean body mass may complicate the clinical course of the disease and emphasizes the importance of multidisciplinary care, routine monitoring of cardiovascular biomarkers and appropriate nutritional guidance.