Isabel Martin Parraga

The dietary adequacy of edentulous older adults

This study tested the null hypothesis that there are no differences in dietary patterns or adequacy between edentulous patients and individuals with nearly complete dentitions. The research design involved comparing the dietary patterns and adequacies of 34 edentulous subjects who regularly wear dentures with 38 subjects who had nearly complete dentitions. The subjects were between the ages of 51 and 83 years and were sampled from patients attending Case Western Reserve University Dental Clinic. Although edentulous subjects were more likely to claim that they had trouble chewing their food, they were not more likely to select easy-to-chew foods. On the other hand, the diet of dentate subjects tended to be superior to that of edentulous subjects, as indicated by a lower fat and cholesterol consumption and a higher consumption of protein and all of the vitamins and minerals (significantly or nearly significantly for vitamin A, ascorbic acid, calcium, and riboflavin).

Childhood stunting in Northeast Brazil: The role of Schistosoma mansoni infection and inadequate dietary intake

Objective: To evaluate the relationship between stunting, Schistosoma mansoni infection and dietary intake in schoolchildren.Design: This is a cross-sectional study. Two stool samples were obtained from each child and examined quantitatively for the presence of S. mansoni, Ascaris lumbricoides and Trichuris trichiuria eggs. Information on dietary intake, and demographic, biologic and socioeconomic variables was elicited during the in-home survey. Logistic regression was used to evaluate the association between stunting (height for age <−2s.d.), parasitic infection and food consumption.Setting: The study was carried out in the city of Nazaré, located in the Recôncavo region of the State of Bahia, northeastern Brazil.Subjects: The sample consisted of 461 children 7–14 y old, 228 boys and 233 girls, recruited from public schools.Results: Of the children studied, 55.1% presented with S. mansoni infection and 22.1% were stunted. The median protein, lipid and carbohydrates intake were 47.8, 36.0 and 248.2 g/day, respectively. The median caloric consumption was 1527.0 kcal (6388.97 kJ/day). The analysis indicated that children heavily infected (≥400 eggs/g of stool) with S. mansoni had a 2.74-fold (95% CI: 1.32–5.67) higher risk of stunting than uninfected children, and those with inadequate intake of lipid (<36 g/day) had a 1.83-fold (95% CI: 1.05–3.20) increased risk of stunting compared to those with adequate diets.Conclusion: Heavy S. mansoni infection and inadequate dietary intake of fat in schoolchildren play a significant and independent role in the development of stunting. This meaning that nutritional interventions in this age group in S. mansoni endemic areas must include the diagnosis and treatment of the infection associated with dietary measures.Sponsorship: This study was supported by the Thrasher Foundation. Sandra Maria Conceição Pinheiro is a National Council on Technological Development Scholarship Awardee (CNPq), #302228/81-0.

Fatores de risco para anemia por deficiência de ferro em crianças e adolescentes parasitados por helmintos intestinais

OBJETIVO: Investigar os fatores de risco para anemia por deficiencia de ferro em criancas e adolescentes (7 a 17 anos) infectados por helmintos. METODOS: Foi realizado um estudo transversal com 1709 criancas e adolescentes residentes na cidade de Jequie, Estado da Bahia, Brasil, que apresentavam infeccao leve ou moderada por Schistosoma mansoni, Ascaris lumbricoides, Trichuris trichiura e ancilostomideos. Foram obtidos dados sobre niveis de hemoglobina (hemoglobinometro portatil), consumo alimentar (inquerito recordatorio de 24 horas), infeccao parasitaria (metodo Kato-Katz), condicoes ambientais e domiciliares, renda e escolaridade dos responsaveis. Os fatores de risco para anemia na populacao foram estudados com base em um modelo hierarquico de causalidade. RESULTADOS: A prevalencia de infeccao por T. trichiura, A. lumbricoides, S. mansoni e ancilostomideos foi de 74,8, 63,0, 55,5 e 15,7%, respectivamente. Constatou-se que 32,2% das criancas e adolescentes eram anemicos. Depois do ajuste para variaveis de confusao, os resultados da analise multivariada mostraram que a renda familiar per capita abaixo de um quarto do salario minimo (27 dolares), o sexo masculino, a faixa etaria de 7 a 9 anos e a ingestao inadequada de ferro biodisponivel foram significativamente associados a anemia. CONCLUSOES: As acoes para controle da anemia no grupo de maior risco, conforme identificado no presente estudo, devem visar o aumento do consumo de alimentos ricos em ferro e da biodisponibilidade do ferro ingerido, bem como a melhoria das condicoes socio-ambientais.

Measuring Fitness of Kenyan Children with Polyparasitic Infections Using the 20-Meter Shuttle Run Test as a Morbidity Metric

Background To date, there has been no standardized approach to the assessment of aerobic fitness among children who harbor parasites. In quantifying the disability associated with individual or multiple chronic infections, accurate measures of physical fitness are important metrics. This is because exercise intolerance, as seen with anemia and many other chronic disorders, reflects the bodys inability to maintain adequate oxygen supply (VO2 max) to the motor tissues, which is frequently linked to reduced quality-of-life in terms of physical and job performance. The objective of our study was to examine the associations between polyparasitism, anemia, and reduced fitness in a high risk Kenyan population using novel implementation of the 20-meter shuttle run test (20mSRT), a well-standardized, low-technology physical fitness test. Methodology/Principal Findings Four villages in coastal Kenya were surveyed during 2009–2010. Children 5–18 years were tested for infection with Schistosoma haematobium (Sh), malaria, filaria, and geohelminth infections by standard methods. After anthropometric and hemoglobin testing, fitness was assessed with the 20 mSRT. The 20 mSRT proved easy to perform, requiring only minimal staff training. Parasitology revealed high prevalence of single and multiple parasitic infections in all villages, with Sh being the most common (25–62%). Anemia prevalence was 45–58%. Using multiply-adjusted linear modeling that accounted for household clustering, decreased aerobic capacity was significantly associated with anemia, stunting, and wasting, with some gender differences. Conclusions/Significance The 20 mSRT, which has excellent correlation with VO2, is a highly feasible fitness test for low-resource settings. Our results indicate impaired fitness is common in areas endemic for parasites, where, at least in part, low fitness scores are likely to result from anemia and stunting associated with chronic infection. The 20 mSRT should be used as a common metric to quantify physical fitness and compare sub-clinical disability across many different disorders and community settings.

Impact of polyparasitic infections on anemia and undernutrition among Kenyan children living in a Schistosoma haematobium-endemic area.

We measured prevalence of Schistosoma haematobium, Wuchereria bancrofti, Plasmodium falciparum, hookworm, and other geohelminths among school-aged children in four endemic villages in Kwale County, Kenya and explored the relationship between multiparasite burden, undernutrition, and anemia. In 2009-2010 surveys, cross-sectional data were obtained for 2,030 children 5-18 years old. Infections were most prevalent for S. haematobium (25-62%), hookworm (11-28%), and falciparum malaria (8-24%). Over one-half of children were anemic, with high rates of acute and chronic malnutrition. Associations with infection status showed significant age and sex differences. For boys, young age, low socioeconomic standing (SES), S. haematobium, and/or malaria infections were associated with greater odds of anemia, wasting, and/or stunting; for girls, heavy S. haematobium infection and age were the significant cofactors for anemia, whereas low SES and older age were linked to stunting. The broad overlap of infection-related causes for anemia and malnutrition and the high frequency of polyparasitic infections suggest that there will be significant advantages to integrated parasite control in this area.

Epidemiologia do desenvolvimento cognitivo de escolares em Jequié, Bahia, Brasil: procedimentos de avaliação e resultados gerais

Este artigo descreve metodologia, aplicacao e utilidade do teste das Matrizes Progressivas de Raven e do Teste de Sondagem Intelectual (TSI), comparando-os ainda com o rendimento escolar do aluno, em Jequie, Bahia. O Raven, que avalia o raciocinio nao-verbal, foi aplicado a 374 escolares (7 a 17 anos). Somente 231 TSI foram respondidos porque requeriam habilidades de leitura e escrita. Foram coletadas notas escolares para todos os participantes. Um questionario avaliando recursos da escola e perfil do professor foi respondido por duzentos professores. Os escores dos testes Raven e TSI apresentaram uma boa correlacao entre si (r = 0,53, p < 0,001) porem menor com as medias escolares (r = 0,22, p < 0,001 e r = 0,12, p < 0,07 respectivamente). Os escores do Raven e do TSI apresentaram baixas correlacoes com os conceitos escolares. A media de escores, tanto no teste Raven como no TSI, foi maior entre os meninos, sendo superior o desempenho das meninas nas notas escolares. De maneira geral o nivel de desempenho cognitivo encontrado esta aquem do esperado em criancas do grupo de idade analisada.

Lean Tissue Mass Wasting is Associated With Increased Risk of Mortality Among Women With Pulmonary Tuberculosis in Urban Uganda

OBJECTIVES We assessed the impact of wasting on survival in patients with tuberculosis by using a precise height-normalized lean tissue mass index (LMI) estimated by bioelectrical impedance analysis and body mass index (BMI). METHODS In a retrospective cohort study, 747 adult pulmonary patients with tuberculosis who were screened for HIV and nutritional status were followed for survival. RESULTS Of 747 patients, 310 had baseline wasting by BMI (kg/m(2)) and 103 by LMI (kg/m(2)). Total deaths were 105. Among men with reduced BMI, risk of death was 70% greater (hazard ratio [HR] 1.7, 95% confidence interval [95% CI] 1.03-2.81) than in men with normal BMI. Survival did not differ by LMI among men (HR 1.1; 95% CI 0.5-2.9). In women, both the BMI and LMI were associated with survival. Among women with reduced BMI, risk of death was 80% greater (HR 1.8; 95% CI 0.9-3.5) than in women with normal BMI; risk of death was 5-fold greater (HR 5.0; 95% CI 1.6-15.9) for women with low LMI compared with women with normal LMI. CONCLUSIONS Wasting assessed by reduced BMI is associated with an increased risk for death among both men and women whereas reduced LMI is among women with tuberculosis.

Relação entre os níveis de vitamina A e os marcadores bioquímicos do estado nutricional de ferro em crianças e adolescentes

OBJETIVO: Verificar a relacao entre vitamina A e os marcadores bioquimicos da situacao nutricional do ferro. METODOS: Participaram deste estudo 178 individuos com idade entre 7 e 17 anos, residentes na cidade de Jequie (BA). Os individuos foram submetidos a exame de sangue para dosagem de retinol e de marcadores bioquimicos do estado nutricional relativo ao ferro. Alem disso, foram realizados exames antropometricos, parasitologico de fezes e coletadas informacoes de consumo dietetico de ferro e das condicoes socio-ambiental e domiciliar da familia. Utilizou-se a analise de regressao linear multipla como tecnica estatistica para avaliar a associacao de interesse. RESULTADOS: Constatou-se associacao positiva e estatisticamente significante entre os niveis de retinol serico e a concentracao de hemoglobina (p=0,007), ferro serico (p=0,010) e transferrina saturada (p=0,027). Esses efeitos se mantiveram apos ajuste dos modelos pelas variaveis demograficas, infeccoes parasitarias (Schistosoma mansoni, Trichiura trichuris, Ascaris lumbricoides e ancilostomideos), consumo de ferro alimentar biodisponivel e condicoes ambientais e domiciliares. CONCLUSAO: A vitamina A parece contribuir para elevar o ferro orgânico da populacao, em especial, em areas onde a deficiencia de vitamina A e a anemia coexistem.

Low nutrient intake among adult women and patients with severe tuberculosis disease in Uganda: a cross-sectional study

BackgroundInformation regarding dietary nutrient intake during tuberculosis disease is lacking. We established the relationship between disease severity or wasting during pulmonary tuberculosis and nutrient intake.MethodsIn a cross-sectional study of 131 adults with or without pulmonary tuberculosis were screened for human immune-deficiency virus (HIV), wasting, disease severity using 13 item validated clinical TBscore, and 24-hour dietary intake recall.ResultsOf the 131 participants, 61 were males and 70 females. Overall men and women had similar age. In average 24-hour nutrient intake, the following nutrients: energy, protein, total fat, carbohydrate, calcium, vitamin A, and folate were low among patients with severe tuberculosis disease. Patients with moderate-to-severe clinical TBscore had lower average energy intake than patients with mild TBscores (6.11 vs. 9.27 MJ, respectively) (p<0.05). The average 24-hour nutrient intakes between wasted and non-wasted tuberculosis patients were comparable. Nutrient intake among men was higher when compared to women regardless of wasting and severity of tuberculosis. Among those with wasting, men had higher average energy intake than women (8.87 vs. 5.81 MJ, respectively) (p<0.05). Among patients with mild disease, men had higher average energy intake than women with mild disease (12.83 vs. 7.49 kcal, respectively) (p<0.001).ConclusionsFindings suggest that severity of pulmonary tuberculosis and female gender had reduced nutrient intake. Early tuberculosis diagnosis and nutritional support may be important in management of tuberculosis patients.

Wasting among Uganda men with pulmonary tuberculosis is associated with linear regain in lean tissue mass during and after treatment in contrast to women with wasting who regain fat tissue mass: prospective cohort study

BackgroundNutritional changes during and after tuberculosis treatment have not been well described. We therefore determined the effect of wasting on rate of mean change in lean tissue and fat mass as measured by bioelectrical impedance analysis (BIA), and mean change in body mass index (BMI) during and after tuberculosis treatment.MethodsIn a prospective cohort study of 717 adult patients, BMI and height-normalized indices of lean tissue (LMI) and fat mass (FMI) as measured by BIA were assessed at baseline, 3, 12, and 24 months.ResultsMen with wasting at baseline regained LMI at a greater rate than FMI (4.55 kg/m2 (95% confidence interval (CI): 1.26, 7.83 versus 3.16 (95% CI: 0.80, 5.52)) per month, respectively during initial tuberculosis therapy. In contrast, women with wasting regained FMI at greater rate than LMI (3.55 kg/m2 (95% CI: 0.40, 6.70) versus 2.07 (95% CI: -0.74, 4.88)), respectively. Men with wasting regained BMI at a rate of 6.45 kg/m2 (95% CI: 3.02, 9.87) in the first three months whereas women, had a rate of 3.30 kg/m2 (95% CI: -0.11, 6.72). There were minimal changes in body composition after month 3 and during months 12 to 24.ConclusionWasted tuberculosis patients regain weight with treatment but the type of gain differs by gender and patients may remain underweight after the initial phase of treatment.