Fábio Ancona Lopez

Nutrition and physical activity

OBJECTIVE: To review data about the nutrition of physically active children and adolescents. METHOD: Review of literature using MEDLINE and LILACS data base and the keywords sport or physical activity and nutrition and children or adolescents. RESULTS AND CONCLUSION: Involvement of children and adolescents in sports activities is important for their growth and development process, which should be regularly assessed. Na adequate diet should provide enough energy and nutrients so that young athletes can meet their requirements. The diet should suit the different stages of training, before, during and after competition. Hydration should be planned carefully as children present a less efficient thermoregulation than adults and can dehydrate more quickly, specially during sports practice. Female athletes can present menstrual alterations and inadequate bone growth due to excessive training associated with inadequate energy intake. Eating disorders are found among some groups of athletes. Physical activity should be encouraged as part of the treatment of overweight children.

Avaliação de duas classificações para excesso de peso em adolescentes brasileiros

Estudo transversal com 418 adolescentes entre dez e 19 anos, de escola particular da cidade de Sao Paulo, em 1998. O objetivo foi avaliar os valores criticos propostos para diagnostico de excesso de peso de adolescentes brasileiros. O percentual de gordura corporal foi medido pela absorcao de duplo feixe de energia. Utilizou-se como ponto de corte para excesso de adiposidade 25% para meninos e 30% para meninas. O indice de massa corporal foi classificado de acordo com Cole et al e Conde & Monteiro. O referencial brasileiro apresentou maior sensibilidade entre as meninas de menor (44,2% vs. 32,6%) e maior faixa etaria (18,9% vs. 17%), assim como entre os meninos de maior faixa etaria (83,3% vs 50%). A proposta de Conde & Monteiro apresentou maiores valores preditivos positivos e negativos e predisse com maior sensibilidade o excesso de adiposidade na populacao estudada.

High prevalence of malnutrition among patients with solid non-hematological tumors as found by using skinfold and circumference measurements

CONTEXT AND OBJECTIVE Malnutrition in cancer patients has many causes. Nutritional status is usually assessed from weight/height indices. These present limitations for the nutritional assessment of cancer patients: their weights include tumor mass, and lean mass changes are not reflected in weight/height indices. The objective was to evaluate differences between two anthropometric methods and compare deficits, in non-hematological tumor patients and hematological disease patients. DESIGN AND SETTING Cross-sectional study at Instituto de Oncologia Pediátrica, Universidade Federal de São Paulo. METHODS Children and adolescents were evaluated between March 1998 and January 2000. Traditional anthropometric measurements were obtained in the first month of treatment (induction therapy), by weight-for-height (W/H) using z-scores index for children and body mass index (BMI) for adolescents. Body composition evaluations consisted of specific anthropometric measurements: triceps skinfold thickness (TSFT), mid-upper arm circumference (MUAC) and arm muscle circumference (AMC). Data were analyzed to compare nutritional assessment methods for diagnosing malnutrition prevalence. The chi-squared test was used for comparative analyses between tumor patients and hematological disease patients. RESULTS Analysis was done on 127 patients with complete data. Higher percentages of deficits were found among tumor patients, by W/H z-scores or BMI and by MUAC and AMC. Higher percentages of deficits were shown by TSFT (40.2%) and MUAC (35.4%) than by W/H z-scores or BMI (18.9%). CONCLUSION Non-hematological tumor patients presented higher malnutrition prevalence than did hematological disease patients. Body composition measurements by TSFT and MUAC detected more patients with malnutrition than did W/H or BMI.

Nutrition education in public elementary schools of São Paulo, Brazil: the Reducing Risks of Illness and Death in Adulthood project

OBJETIVO: O objetivo deste estudo e analisar o desenvolvimento, implementacao e impacto de um programa de educacao nutricional sobre conhecimentos e atitudes relativos a habitos alimentares saudaveis. METODOS: Trata-se de estudo randomizado controlado, que envolveu estudantes e professores de oito escolas publicas. Tres dessas escolas foram submetidas a uma intervencao educativa, educacao nutricional, e as demais foram controle. Avaliaram-se os efeitos da educacao nutricional sobre conhecimentos e atitudes. RESULTADOS: Observou-se uma melhora na escolha alimentar dos estudantes e reducao no consumo de alimentos com alta densidade energetica. Tambem se observou melhora nos conhecimentos e atitudes de professores em relacao a prevencao da obesidade. CONCLUSAO: Mesmo com uma atitude positiva em relacao ao desenvolvimento desta proposta, houve falta de apoio por parte das escolas estudadas. Futuros estudos e um maior envolvimento dos setores de Educacao e Saude poderiam superar essas barreiras, melhorando os resultados de programas nas escolas voltados para a prevencao da obesidade.

Outcomes of obese children and adolescents enrolled in a multidisciplinary health program

OBJECTIVE: The study was designed to evaluate the impact of a multidisciplinary program on children and adolescents’ weight control.DESIGN: Retrospective study regarding changes in relative weight of all patients treated regularly in an out-patient care public service between January 1992 and December 1993.SUBJECTS: 198 children and adolescents (108 girls and 90 boys; mean age: 9.25 y; mean body mass index (BMI): 24.26 kg/m2, range 19.1–40.31).MEASUREMENTS: Anthropometric data collected at the visits were obtained until June 30 1994. BMI compared to reference data was used. Dual Photon X-ray Absorptiometry (DEXA) was used for 64 patients, to determine percent body fat.RESULTS: Relative weight at the last visit was significantly lower when compared with initial relative weight for the whole sample. Significantly better outcome of relative weight was obtained when six or more visits occurred for the whole sample, and for girls when the days’ interval between visits was shorter than 52 d. Variables such as percent body fat, body shape at the first visit, family obesity pattern, length of obesity and pubertal stage, did not significantly influence the outcome of relative weight for the subjects during the treatment.CONCLUSION: Results obtained indicated that good outcomes can be obtained in a program using nutrition education focused on small modifications of eating habits in order to avoid excess energy intake. The best predictors of weight improvement for children and adolescents participating in the program were the higher frequency of visits and shorter intervals between them.

Lipodystrophy, lipid profile changes, and low serum retinol and carotenoid levels in children and adolescents with acquired immunodeficiency syndrome

OBJECTIVE To assess serum retinol and levels of carotenoids in children and adolescents with acquired immunodeficiency syndrome (AIDS) and to correlate low serum retinol and carotenoid levels with the presence of lipodystrophy, lipid profile changes, lipid peroxidation, and insulin resistance. METHODS A cross-sectional, controlled observational study was carried out with 30 children and adolescents with AIDS (mean age 9.1 y) receiving antiretroviral therapy (median length of treatment 28.4 mo), including 30 uninfected healthy controls matched for age and gender. Clinical and laboratory assessments were performed to determine nutritional status, presence of lipodystrophy, serum concentrations of retinol, beta-carotene, lycopene, lipid profile (high-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triacylglycerols), lipid peroxidation (thiobarbituric acid-reactive substances), glycemia, and serum insulin (homeostasis model assessment for insulin resistance, cutoff point >3). Statistical analysis was done with chi-square test and Students t test. RESULTS Lipodystrophy was observed in 53.3% of patients with AIDS, and dyslipidemia was detected in 60% and 23% of subjects with human immunodeficiency virus and control subjects, respectively (P = 0.004). A higher prevalence of retinol deficiency (60% versus 26.7%, P = 0.009) and beta-carotene deficiency (23.3% versus 3.3%, P = 0.026) was found in the group with human immunodeficiency virus than in the control group. No correlation was found for low retinol and beta-carotene levels, changes in lipid and glucose metabolism, or lipodystrophy in children and adolescents with AIDS. CONCLUSION Despite the high frequency of dyslipidemia, lipodystrophy, and retinol and beta-carotene deficiencies, it was not possible to demonstrate a correlation of these findings with lipid peroxidation and insulin resistance. More studies are needed to investigate the causes of retinol and beta-carotene deficiencies in this population and the clinical consequences of these findings.

Fatores de risco associados ao desmame precoce e ao período de desmame em lactentes matriculados em creches

OBJECTIVE: To evaluate risk factors associated with weaning of infants enrolled in daycare centers. METHODS: Analytical cross-sectional study comprising 56 children aged nine to 18 months in five daycare centers of Sao Paulo. A pre-tested questionnaire was applied to their mother, including questions on demographics and socioeconomic issues, gestation and birth, illness, breastfeeding, complementary feeding (when and how new foods were introduced) and children activities in daycare centers. Factors associated with early weaning and short weaning period (defined as the difference between exclusive breastfeeding period and total breastfeeding period) were determined by bivariate analyses. Conceptual hierarchical multivariate analysis (logistic regression) was applied. RESULTS: In the multivariate analysis, the independent risk factors for early weaning were: family income 25 years (OR 4.91; 95%CI 1.35-17.95); mother living without a partner (OR 6.42; 95%CI 1.28-32.20); use of pacifier before 30 days of life (OR 8.75; 95%CI 1.90-40.23). Risk factors for insufficient weaning period were: attending public daycare centers (OR 3.20; 95%CI 0.77-14.29) and late start of prenatal care (OR 4.13; 95%CI 0.70-31.29). CONCLUSIONS: Characteristics related to family and to daycare centers are risk factors for breastfeeding weaning among institutionalized infants. Such factors approach is strategic to define nutrition and health actions for favoring breastfeeding practice and to qualify daycare centers as infant health and nutrition promoters.

Impacto do uso de cereal adicionado de ferro sobre os níveis de hemoglobina e a antropometria de pré-escolares

Anemia and energetic malnutrition are considered to be the major nutritional challenges in developing countries. The efficacy of the various programs implemented to solve these problems has been assessed by studies with enriched food products. The objective of the present study was to evaluate the daily acceptance of an iron-enriched cereal, as well as its effect on the anthropometric parameters and hemoglobin levels of children aged 1 to 4 years old. Fifty-four children enrolled at a public day care unit participated in the study. They were divided into two groups: Group I with 24 children (median age: 2 years and 2 months) and Group II with 30 children (median age: 3 years and 6 months). Their food intake, weight, height and serum hemoglobin levels were measured at the beginning and at the end of the study. During a period of two months, milk and bread, which made up the childrens breakfast and afternoon snack, were substituted by the enriched cereal in the form of porridge, which increased the iron intake in 2 to 3mg per day. The results showed that there was a significant increase in the weight for height rate of both groups, with improvement of nutritional condition in those children with acute malnutrition. With regard to serum hemoglobin levels, Group I showed an initial average level of 9.9 ± 2.0g/dl. The average level at the final evaluation, 11.4 ± 1.0g/dl, was significantly higher (p< 0.05) than at the start. Group II, with average serum hemoglobin level of 11.6 ± 0.9g/dl at the start, did not show a significant difference from the level at the end (11.9± 0.9g/dl).At the start of the study the incidence of anemia in Group I was of 81%. This value went down to 31.2% at the end of two months. For Group II, the incidence decreased from 20.8% to 12.5% at the end. The average daily intake of cereal during the first week was lower than in subsequent weeks. It is concluded that the product used in this study increased the serum hemoglobin levels of the children with anemia and contributed to the nutritional improvement of those who were malnourished. In addition, the cereal was well accepted by the children.

Evolution of nutritional status of infants infected with the human immunodeficiency virus

CONTEXT There are today only a limited number of studies defining growth parameters and nutritional status for HIV children. OBJECTIVE To study the nutritional status of infants infected with the human immunodeficiency virus. TYPE OF STUDY Longitudinal study. SETTING Department of Pediatrics, Faculty of Medical Sciences, UNICAMP, Campinas, Brazil. PARTICIPANTS One hundred and twenty-four children born to HIV infected mothers were evaluated from birth until the age of two years. They were subdivided into two groups: 71 infected children and 53 non-infected children. MAIN MEASUREMENTS Growth was evaluated in both groups by comparing Z-scores for weight/age (w/a), length/age (H/a) and weight/length (w/H) (using the NCHS curves as reference). RESULTS The Z-score analyses showed that there was a significant difference between the two groups for all the variables studied, except for the H/a value at 3 months of age and the W/H value at 21 months of age, which showed P > 0.05. CONCLUSIONS The growth of infected infants was observed to be severely affected in comparison with that of seroreversed infants in the same age groups. Although clinical manifestations may take time to appear, the onset of growth changes begin soon after birth.

Lipodystrophy in children and adolescents with acquired immunodeficiency syndrome and its relationship with the antiretroviral therapy employed.

OBJECTIVE To evaluate the presence of clinical lipodystrophy in children with the acquired immunodeficiency syndrome and to relate it to the antiretroviral regimen employed, to changes in lipid profile and to insulin resistance. METHODS This was a cross-sectional study that evaluated 30 children and adolescents (median age = 9.1 years) with the acquired immunodeficiency syndrome during 2004 and 2005. The following clinical and laboratory evaluations were performed: classification of HIV infection, anthropometric measurements (weight and height), serum glycemia, serum insulin and lipid profile (LDL-c, HDL-c, triglycerides). Lipodystrophy was diagnosed using clinical parameters. The chi-square test was used for statistical analysis. RESULTS All of the patients were taking antiretroviral therapy regularly (median duration of 28.4 months); 80% were on three drugs in combination (highly active therapy) and 30% were on protease inhibitors. Lipodystrophy and dyslipidemia were observed in 53.3 and 60% of the patients, respectively. Children on a highly active therapy regimen with protease inhibitors exhibited a higher percentage of mixed lipodystrophy; the difference between these children and the group on highly active therapy without protease inhibitors and the group not on a highly active therapy was statistically significant (44.4 vs. 16.7%; p = 0.004). There was no statistically significant association between the presence of lipodystrophy and sex, age (> 10 years), changes to the lipid profile or insulin resistance. CONCLUSIONS The elevated prevalence of dyslipidemia and lipodystrophy observed among children with acquired immunodeficiency syndrome, which exhibited a relationship with the antiretroviral regimen employed, may represent an increased risk for future complications, in particular cardiovascular problems.