Maria Eugênia Farias Almeida Motta

Does birth weight affect nutritional status at the end of first year of life

OBJECTIVE To evaluate the association between low birth weight and nutritional status at the end of the first year of life. METHODS This was a nested case-control study within a cohort. The study was carried out at maternity hospitals in four cities in the Zona da Mata Meridional in Pernambuco state, Brazil. Newborn infants were recruited during the first 24 hours of life. Their weights were measured at birth and at the end of the first year of life. Household visits were made twice weekly during the first year of life to collect data on breastfeeding and occurrence of diarrhea. In the case-control study, each case (child at nutritional risk) was a child with weight-for-age index < the 10th percentile (n = 117) and each control was a child with weight-for-age index > or = the 10th percentile (n = 411). Hierarchical logistic regression analysis was used to investigate risk factors for nutritional status at 12 months. RESULTS Low birth weight and living in a household with no latrine were significantly associated with nutritional risk at the end of the first year of life. Children born weighing 1,500 g to 2,499 g had 29 times (95% CI = 9.77-87.49) the chance of being at nutritional risk at 12 months of life than those whose birth weights had been > 3,500 g (p < 0.001). Children living in households without a flush toilet had three times (95% CI = 1.54-6.22) the chance of nutritional risk at 12 months of life in relation to those that had a latrine with a septic tank at home (p = 0.01). CONCLUSION Low birth weight is an important risk factor of nutritional risk at the end of the first year of life. It is important to adopt strategies for its reduction and prevention.

A respiração oral em crianças e suas repercussões no estado nutricional

PURPOSE: identify nutritional state, masticatory function, respiratory mode, sense of smell and sense of taste among mouth breathing children. METHODS: nasal aeration, mastication, nutritional state of 77 mouth breathing children and 154 nasal breathers children between six and ten years were evaluated. RESULTS: mouth breathers exhibited alterations in the masticatory pattern when compared to the nasal-breathers, but did not have statistical significance in nutritional state. CONCLUSION: the oral-breathing children had more alteration in sleep, reduction in the ingestion of carbohydrate and increase in ingestion of lipids, however, no consistent data were found pointing out the association between mouth breathing and nutritional condition.

Determinants of impaired growth among hospitalized children: a case-control study

CONTEXT Protein energy malnutrition constitutes a public health problem, especially in less affluent countries. The identification of amenable predictive risk factors is of major importance for policy makers to plan interventions to reduce infant malnutrition. OBJECTIVE To identify risk factors for protein energy malnutrition among hospitalized low-income children aged 6 to 24 months. TYPE OF STUDY Case-control study. SETTING Two public hospitals in Recife, Brazil. PARTICIPANTS The cases were 124 infants with length-for-age below the 10th percentile of the National Center for Health Statistics curve and the controls were 241 infants with length-for-age equal to or above the 10th percentile who were recruited in the same infirmary. METHODS Cases and controls were compared in relation to a variety of sociodemographic, environmental and reproductive factors, and their healthcare, previous feeding practice and morbidity. Logistic regression analysis was used to investigate the net effect of risk factors on infant malnutrition, after adjusting for potential confounding variables. RESULTS The mothers age, possession of a TV set, type of water supply, family size and location of the home were significantly associated with child malnutrition in the bivariate analysis. However, these associations lost their significance after adjusting for other explanatory variables in the hierarchical logistic regression analysis. This analysis showed that low birth weight contributed the largest risk for impaired growth. Increased risks of infant malnutrition were also significantly associated with households that had no toilet facilities or refrigerator, high parity for the mother, no breastfeeding of the infant, inadequate vaccination coverage and previous hospitalization for diarrhea and pneumonia. DISCUSSION The literature shows that chronic malnutrition, as assessed by low length-for-age indexes, is often related to low income. However, this was not the case in this study, in which other variables had greater impact on child growth. CONCLUSIONS In view of the multiple causes of malnutrition, the interrelationship among its determinants should be taken into account when adopting strategies for its reduction and prevention.

Desnutricão e obesidade em crianças: delineamento do perfil de uma comunidade de baixa renda

OBJECTIVE: To establish the nutritional diagnosis of children living in a low-income community through anthropometric evaluation, detecting insufficient nutrition (low weight-for-age, wasting and stunting) and excessive nutrition (overweight and obesity). METHODS: A community-based survey identified children below 11 years living in a low-income community. Their weight and height (or lengths) were measured. The National Center for Health Statistics growth curve was used as reference. The cut-off points used were: low-weight-for-age z score of +2, according to weight-for-height. RESULTS: Prevalence rates were 3.8% for low weight for age, and 24% for low-weight-for-age risk factors; 1.2% for wasting, and 21.6% for wasting risk factors; 5% for stunting, and 14.3% for stunting risk factors; 10.1% for overweight, and 4.6% for obesity. CONCLUSIONS: Main nutritional issues were present in children from that community, with simultaneous occurrence of chronic malnutrition and obesity.

Allergy to cow’s milk proteins: what contribution does hypersensitivity in skin tests have to this diagnosis?

To cite this article: Costa AJF, Sarinho ESC, Motta MEFA, Gomes PN, de Oliveira de Melo SM, da Silva GAP. Allergy to cow’s milk proteins: what contribution does hypersensitivity in skin tests have to this diagnosis? Pediatr Allergy Immunol 2011; 22: e133–e138.

Mecanismos e fatores associados aos sintomas gastrointestinais em pacientes com diabetes melito

OBJECTIVES: To present the main mechanisms that cause gastrointestinal symptoms in patients with diabetes mellitus, their frequency, and controversies as to their occurrence in children and adolescents. SOURCES: Non-systematic review of the literature conducted in the MEDLINE/PubMed and SciELO databases (1983-2011), as well as relevant book chapters. The most relevant and up-to-date articles on the topic were selected. SUMMARY OF THE FINDINGS: Prevalence of diabetes mellitus has been increasing over the years in many countries. The complications caused by this disease in the digestive system, such as gastrointestinal symptoms (nausea, vomiting, abdominal pain, heartburn, dysphagia, constipation, diarrhea, and fecal incontinence) are well known. The pathogenesis of changes in the gastrointestinal functions in patients with diabetes mellitus is still being investigated at the same time as the role of the enteric nervous system and its neurotransmitters has gained significance. As a consequence of the complications in the digestive system, which damage the enteric nervous system, patients with diabetes mellitus may have specific gastrointestinal motility disorders, some of which may be of great relevance, such as diabetic gastroparesis, constipation, and diarrhea. Gastrointestinal dysfunction increases the morbidity of diabetes mellitus and worsens the quality of life of diabetic individuals. CONCLUSIONS: There are few studies addressing these problems in childhood and adolescence. Diabetes mellitus affects the digestive system over the years. Because this condition worsens the quality of life of diabetic individuals and leads to complications, attention must be paid to gastrointestinal symptoms when treating patients with diabetes mellitus.OBJECTIVES To present the main mechanisms that cause gastrointestinal symptoms in patients with diabetes mellitus, their frequency, and controversies as to their occurrence in children and adolescents. SOURCES Non-systematic review of the literature conducted in the MEDLINE/PubMed and SciELO databases (1983-2011), as well as relevant book chapters. The most relevant and up-to-date articles on the topic were selected. SUMMARY OF THE FINDINGS Prevalence of diabetes mellitus has been increasing over the years in many countries. The complications caused by this disease in the digestive system, such as gastrointestinal symptoms (nausea, vomiting, abdominal pain, heartburn, dysphagia, constipation, diarrhea, and fecal incontinence) are well known. The pathogenesis of changes in the gastrointestinal functions in patients with diabetes mellitus is still being investigated at the same time as the role of the enteric nervous system and its neurotransmitters has gained significance. As a consequence of the complications in the digestive system, which damage the enteric nervous system, patients with diabetes mellitus may have specific gastrointestinal motility disorders, some of which may be of great relevance, such as diabetic gastroparesis, constipation, and diarrhea. Gastrointestinal dysfunction increases the morbidity of diabetes mellitus and worsens the quality of life of diabetic individuals. CONCLUSIONS There are few studies addressing these problems in childhood and adolescence. Diabetes mellitus affects the digestive system over the years. Because this condition worsens the quality of life of diabetic individuals and leads to complications, attention must be paid to gastrointestinal symptoms when treating patients with diabetes mellitus.

Total IgE level in respiratory allergy: study of patients at high risk for helminthic infection

OBJECTIVE Eosinophilia and increased serum IgE levels are indicators of atopy; however, other factors can also play a key role, such as intestinal parasitic infections. This study assesses the relationship between total serum IgE, eosinophil count, and anti-Ascaris IgE in individuals with asthma and/or allergic rhinitis. METHODS A cross-sectional study was carried out in adolescents with asthma and/or allergic rhinitis. The patients had their total serum IgE, anti-Ascaris IgE and eosinophil count measured. RESULTS A total of 101 patients aged 12 to 21 years were assessed. Median IgE level was 660 IU/mL (P(25-75) 243.5-1500), and the eosinophil count corresponded to 510 cells/mm(3) (P(25-75) 284-811). Anti-Ascaris IgE was positive in 73% (74/101) of the individuals, but parasitological stool examination yielded positive results in only 33.7% (34/101). The correlation coefficients were the following: 0.34 (p = 0.001) between total IgE level and eosinophil count, 0.52 (p < 0.001) between total IgE level and anti-Ascaris IgE, and 0.26 (p = 0.01) between eosinophil count and anti-Ascaris IgE. The final multiple linear regression model pointed out that anti-Ascaris IgE contributed to a total serum IgE level with a coefficient of determination (adjusted R(2)) of 0.25 (F = 12.35; p < 0.001). This effect occurred regardless of eosinophil count and of the presence of intestinal helminthic infection. CONCLUSION In patients with respiratory allergy and increased total serum IgE levels living in areas where there is a high risk for helminthic infections, the quantification of anti-Ascaris IgE can be more useful and more insightful than the parasitological stool examination.

Determinants of physical inactivity among urban adolescents.

OBJECTIVE To investigate determinants of physical inactivity among adolescents aged 15 to 19 years in the city of Recife, northeastern Brazil. METHOD This case-control study involved 597 private school students aged 15 to 19 years selected by convenience sampling. Exclusion criteria were adolescents with diseases that interfered with or hindered anthropometric measurements, who were being treated with drugs or diet for excess weight or who had changed their physical activity over the past 30 days. The students were recruited according to physical activity, as determined by the International Physical Activity Questionnaire: cases - inactive (sedentary or insufficiently active); and controls - active (active and very active). The adolescents reported the number of hours per day of television watching and computer use to identify the number of sedentary hours/day. Anthropometry (weight and height) of the adolescents was measured by Gibsons technique and used to calculate the body mass index. Weight, height and educational level of mothers were self-reported. Data were analyzed by multiple logistic regression, using the SPSS software, version 11.5, in order to control for confounding variables. RESULTS Female adolescents were twice as likely to be inactive (odds ratio = 1.94; 95% confidence interval = 1.35-2.79) compared to male adolescents. Watching television for more than 1 hour/day showed increased risk for physical inactivity compared to less than 1 hour/day (odds ratio = 1.55; 95% confidence interval = 1.01-2.39). CONCLUSION Physical inactivity among adolescents was associated with females and longer time spent per day watching television.

Production of interleukin-10 in asthmatic children after Beta-1-3-glucan

BACKGROUND Beta-1-3 Glucan is a polysaccharide extracted from Saccharomyces cerevisiae with a possible immunomodulating action that may have a favourable action on asthma symptoms and other allergic diseases. An experimental study carried out using a murine respiratory model detected a decrease in pulmonary tissue eosinophilia, as well as an increase in Interleukin-10 (IL-10) after glucan use. METHODS This open, exploratory study with blind outcome evaluation included asthmatic children between 6 and 12 years of age with mild to moderate persistent asthma and inadequate disease control (rescue medication needed more than twice a week) in spite of inhaled budesonide 400 microg/day. After a four week run-in period, subcutaneous Beta-1-3-glucan injections were given weekly for the first four weeks and then every two weeks for the last four weeks. IL-10 levels, measured by the immunoenzymatic method (ELISA), were compared before and after glucan administration. RESULTS Twenty patients (14 male and 6 female) were included. Mean IL-10 levels were 6.4 pg/ml and 11.3 pg/ml before and after glucan, respectively (p = 0.02). There was also a reduction of asthmatic symptoms score at the end of study. CONCLUSIONS This is the first study which shows that subcutaneous particulate Beta-1-3-glucan increases serum IL-10 levels in asthmatics. The possibility of glucan being able to modulate allergic sensitisation and having a beneficial action in restoring Th2 function should be assessed by means of properly planned controlled clinical trials, as it may represent a new therapeutic strategy.

Oral food challenge test to confirm the diagnosis of cow's milk allergy.

OBJECTIVE To determine the prevalence of cows milk protein allergy in children with symptoms attributed to cows milk intake. METHODS Sixty-five children with symptoms attributed to cows milk intake were studied. Diagnosis was established after an open oral food challenge test carried out at least 15 days after an elimination diet and absence of symptoms, with a follow-up period of up to 4 weeks after the test. The children who remained asymptomatic after this period were considered negative for cows milk protein allergy (n = 30), while those whose symptoms reappeared were considered positive (n = 35). RESULTS The median age was 5 months (P 25-75% 2-9 months) in the case group and 7 months (P 25-75% 4-11 months) in the comparison group (p = 0.05). The test did not confirm cows milk protein allergy in 46.8% of the patients with symptoms attributed to cows milk intake. A delayed reaction occurred in 77.1% (27/35) of the cases testing positive, 18/27 in the first week, 3/27 in the second week, and 6/27 in the third week of follow-up. A statistically significant association was found between cutaneous manifestations and positive test result (p = 0.04). However, there was no association with digestive and respiratory symptoms. CONCLUSION Our results confirm the need of an oral food challenge test to determine which patients really have cows milk protein allergy and may therefore benefit from a diet free of cows milk.