Franceliane Jobim Benedetti

Assessment of nutritional status in children and adolescents with post-infectious bronchiolitis obliterans

OBJECTIVE To assess the nutritional status of children and adolescents with bronchiolitis obliterans and to analyze associations with clinical and nutritional factors. METHODS The study included 57 patients. Nutritional status was assessed using z scores for weight/age, stature/age, weight/stature in children, and stature/age and body mass index percentiles in adolescents. Body composition was assessed via tricipital skin folds, subscapular skin folds, and the sum of both plus the muscular circumference of the arm; pulmonary function was also investigated in subjects over 8 years old. RESULTS The high percentages of malnutrition and risk for malnutrition are noteworthy: 21.7 and 17.5%, respectively. Among children, weight/age and stature/age detected higher percentages of malnutrition (21.6 and 16.2%), while weight/stature underestimated this diagnosis. Among adolescents, body mass index detected a high percentage of malnutrition (25%) and of risk for malnutrition (20%). Body composition analysis detected 51% of patients with low muscle reserves, and the majority of patients had normal fat reserves. Compromised pulmonary function was associated with poor performance at exercise (r = 0.434; p = 0.024). Malnutrition and/or nutritional risk and low muscle reserves were significantly associated with the 6-minute walk test (p = 0.032; p = 0.030). There was no association between spirometry and the nutritional variables (p > 0.05). CONCLUSION These results emphasize the need for nutritional intervention, and suggest that, in addition to using weight and height indices for nutritional assessment, it is necessary to combine these with an analysis of body composition, so that a larger number of patients with malnutrition and/or at an increased risk for developing malnutrition may be identified and correctly managed.

Energy expenditure and estimated caloric intake in asthmatic adolescents with excess body weight.

OBJECTIVE To measure resting energy expenditure (REE) and to estimate caloric intake of asthmatic adolescents with excess body weight and compare results with those groups of eutrophic asthmatic adolescents and non-asthmatic adolescents with excess body weight. METHODS This cross-sectional study categorized 69 adolescents aged 10 to 18 y into three matched groups. Nutritional status was assessed using anthropometric and body composition measurements. Indirect calorimetry was used to measure energy expenditure, and caloric intake was estimated from dietary recalls. RESULTS In each group, there were 23 adolescents (10 girls) aged 12.39 ± 2.40 y. Results for each group were as follows. For asthmatic adolescents with excess body weight, body mass index (BMI) was 24.83 ± 2.73 kg/m(2), REEs were 1550.24 ± 547.23 kcal/d and 27.69 ± 11.33 kcal · kg(-1) · d(-1), and estimated caloric intake was 2068.75 ± 516.66 kcal/d; for eutrophic asthmatic adolescents, BMI was 19.01 ± 2.10 kg/m(2), REEs were 1540.82 ± 544.22 kcal/d and 36.65 ± 15.04 kcal · kg(-1) · d(-1), and estimated caloric intake was 2174.05 ± 500.55 kcal/d; and for non-asthmatic adolescents with excess body weight, BMI was 25.35 ± 3.66 kg/m(2), REEs were 1697.24 ± 379.84 kcal/d and 28.18 ± 6.70 kcal · kg(-1) · d(-1), and estimated caloric intake was 1673.17 ± 530.68 kcal/d. Absolute REE values between groups were not statistically different, even after correction for lean mass and fat mass (F = 0.186, P = 0.831). REE (kilocalories per kilogram per day) was significantly higher in the group of eutrophic asthmatic adolescents (P = 0.016). Estimated caloric intake was greater than REE only in the group of adolescents with asthma. CONCLUSION The REE was not significantly different among groups, and REE (kilocalories per kilogram per day) was higher in the group of eutrophic asthmatic adolescents. Estimated caloric intake was greater than REE in the group of adolescents with asthma.

Gasto energético em adolescentes asmáticos com excesso de peso: calorimetria indireta e equações de predição

OBJECTIVE: This study compared the energy expenditure measured by indirect calorimetry with that estimated by prediction equations in asthmatic and non-asthmatic adolescents. METHODS: This was a cross-sectional study with 69 adolescents aged 10 to 18 years. Three paired groups were compared (overweight, asthmatic adolescents, normal weight, asthmatic adolescents and overweight, non-asthmatic adolescents). Energy expenditure was estimated by indirect calorimetry and prediction equations. RESULTS: Each group consisted of 23 adolescents (10 females), with an average age of M=12.4, SD=2.4 years. In the group of overweight, asthmatic adolescents, the resting energy expenditure was M=1550.2, SD=547.2kcal/day; in the group of normal weight asthmatic adolescents, the resting energy expenditure was M=1540.8, SD=544.2kcal/day; and in the group of overweight, non-asthmatic adolescents, the resting energy expenditure was M=1697.2 SD=379.8kcal/day. The results were similar among groups even when adjusted for lean and fat mass (f=0.186; p=0.831). The total energy expenditure was also similar among groups, except that the Harris-Benedict formula underestimated the energy expenditure in normal weight asthmatic adolescents and overweight, non-asthmatic adolescents. CONCLUSION: The resting energy expenditure was not statistically different among groups of asthmatic and non-asthmatic adolescents, even when adjusted for lean mass and fat mass. For all three groups, the predictive equations were useful for estimating the resting energy expenditure and total energy expenditure.

Anthropometric indicators of general and central obesity in the prediction of asthma in adolescents: central obesity in asthma

OBJECTIVE to determine the prevalence of asthma risk associated with anthropometric indicators of excess weight and body fat distribution. METHODOLOGY cross-sectional study including adolescents between 10 and 19 years of age. The anthropometric indicator used to classify excess weight was the body mass index (BMI-Z); those used for abdominal adiposity were waist circumference (WC), waist-to-height ratio (WHtR) and the conicity index (CI). Asthma characteristics were evaluated using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The significance level was 5%, and the analyses were performed using Statistical Package for the Social Sciences (SPSS) Version 18.0. RESULTS adolescent students (n = 1362; 788 [57.9%] female) with a mean age of 15.65 ± 1.24 years were evaluated. A high prevalence of asthma, excess weight (BMI-Z) and excess abdominal adiposity (WC and WHtR) was observed in the females. Only CI values for excess abdominal adiposity were higher for males than for females. Adolescents with excess abdominal adiposity, as shown by the WHtR, had a 1.24 times higher risk of having asthma compared with non-obese adolescents. Boys with excess abdominal adiposity, as classified by CI, presented a 1.8 times greater risk of asthma. The risk of severe asthma was 3 times higher among adolescents who were classified as severely obese via the BMI-Z. CONCLUSION this study showed that excess body weight and abdominal obesity are associated with an increased risk of asthma and asthma severity in adolescents. Thus, additional BMI measurements are suggested for asthmatics.

Balanço energético em crianças e adolescentes com bronquiolite obliterante pós-infecciosa

OBJECTIVE: The aim of the study was to determine the energy expenditure and estimate the energy intake of children and adolescents with post-infectious bronchiolitis obliterans and compare them with those of healthy children and adolescents. METHODS: This cross-sectional study included 36 children and adolescents with bronchiolitis obliterans aged 8 to 18 years, and a control group with 36 healthy individuals matched for sex, age and body mass index. Anthropometric data were collected from all individuals. Energy expenditure was determined by indirect calorimetry, activity factor was estimated by a 24-hour record of physical activities, and energy intake was estimated by the 24-hour food recall. RESULTS: Data for the bronchiolitis obliterans and control groups are, respectively: body mass index of M=18.9, SD=4.0kg/m2 and M=18.8, SD=3.4kg/m2; resting energy expenditure of M=1717.6, SD=781.5kcal/day and M=2019.9, SD=819kcal/day; total energy expenditure of M=2677.5, SD=1514.0kcal/day and M=3396.1, SD=1557.9kcal/day; estimated energy intake of M=2294.1, SD=746.7kcal/day and M=2116.5, SD=612.1kcal/day. Resting energy expenditure (p=0.102) and total energy expenditure (p=0.051) did not differ between the groups, even when adjusted for lean mass. Total energy expenditure and intake of the bronchiolitis obliterans group did not differ significantly (p=0.202). Energy intake by the control group was lower than expected according to their total energy expenditure (p<0.001). CONCLUSION: The resting energy expenditure and total energy expenditure of the two groups were similar. The estimated energy intake of the control group was lower than their total energy expenditure. The bronchiolitis obliterans group had an appropriate energy balance.