Maria Luiza Martins Aléssio

Diagnosis of iron deficiency anemia in children of Northeast Brazil

OBJECTIVE To diagnose iron deficiency anemia in children. METHODS The study was conducted with a sample of 301 children aged six to 30 months attending public daycare centers in the city of Recife, Northeast Brazil, in 2004. The diagnoses of anemia were based on a combination of different hematological and biochemical parameters: hemoglobin, mean corpuscular volume, ferritin, C-reactive protein, transferrin saturation and transferrin receptor. The chi-square test and ANOVA were used in the statistical analysis. RESULTS Of all children studied, 92.4% had anemia (Hb<110 g/L) and 28.9% had moderate/severe anemia (Hb<90 g/L). Lower levels of hemoglobin were found in children aged 6-17 months. Iron deficiency was found in 51.5% of children using ferritin (<12 microg/L) as parameter. Taking into consideration the combination of hemoglobin level, ferritin and transferrin receptor, 58.1% had anemia with iron deficiency, 34.2% had anemia without iron deficiency and 2.3% had iron deficiency without anemia. Mean ferritin concentration was significantly higher in children with high C-reactive protein when compared with those with normal levels (22.1 vs. 14.8 microg/L). CONCLUSIONS The use of several biochemical and hematological parameters allowed to diagnosing iron deficiency anemia in two thirds of children, suggesting a need to identify other determinants of anemia without iron deficiency.OBJETIVO: Diagnosticar anemia por deficiencia de ferro em criancas. METODOS: O estudo foi desenvolvido com uma amostra de 301 criancas com idade entre seis e 30 meses, usuarias de creches publicas de Recife, PE, em 2004. Para o diagnostico da anemia utilizou-se a combinacao de diferentes parâmetros hematologicos e bioquimicos: hemoglobina, volume corpuscular medio, ferritina, proteina C-reativa, saturacao da transferrina e receptor da transferrina. Para a analise estatistica empregou-se o teste do qui-quadrado e ANOVA. RESULTADOS: Do total de criancas, 92,4% tinha anemia (Hb < 110g/L) e 28,9% apresentou anemia moderada/grave (Hb<90g/L). Niveis mais baixos de hemoglobina foram observados em criancas de seis a 17 meses. Encontrou-se deficiencia de ferro em 51,5% das criancas, utilizando-se a ferritina (< 12µg/L) como parâmetro. Considerando a combinacao da concentracao de hemoglobina, ferritina e do receptor de transferrina, 58,1% tinha anemia com deficiencia de ferro, 34,2% anemia sem deficit de ferro e 2,3% deficiencia de ferro sem anemia. A concentracao media de ferritina foi significativamente maior em criancas com proteina C-reativa aumentada quando comparada com aqueles com niveis normais (22,1 versus 14,8 µg/L). CONCLUSOES: A utilizacao de diversos parâmetros bioquimicos e hematologicos possibilitou diagnosticar anemia por deficiencia de ferro em dois tercos das criancas, revelando a necessidade de identificar outros determinantes de anemia sem deficiencia de ferro.

Saúde e nutrição de crianças de áreas urbanas da Zona da Mata Meridional de Pernambuco: resultados preliminares de um estudo de coorte

OBJECTIVES: to demonstrate social, economic features and demographics of the nutritional profile of children at birth and at 12 months old, in addition to comprehensive data on breast-feeding, diarrhea and vaccination status in the first year of life. METHODS: a sample of 652 newborns were selected from September 1997 to August 1998 and followed-up during the first 18 months of life. These children lived in the urban areas of four municipalities South of Pernambuco. Data collection was performed through house visits. RESULTS: approximately 60% of the families had a per capita income £ ½ of the minimum wage and 41% of the mothers had less than four years of schooling. The median of exclusive and total breast-feeding was of 0 and 94 days respectively. Diarrhea incidence was of two episodes/per child/per age (< -2 scores z) and at 12 months was of 6,8% and 11% respectively. Only 66% of the children had their vaccination schedule completed at 12 months old. CONCLUSIONS: the development of this prospective research will contribute to a more in-depth understanding of the health and nutrition problems of children and to adequate intervention planning in that area.

Cord blood essential fatty acid and alpha-tocopherol in full-term newborns in a Northeast Brazil area

Malnutrition of children during the first two years of life constitutes a public health concern in Brazil, particularly in the Northeast. Most of the nutrition data are concerned with protein-energy malnutrition and hypovitaminosis A. The purpose of this cross-sectional study was to assess the essential fatty acid (EFA) status, which is crucial in physical and mental development, and that of vitamin E which prevents against the oxidative loss of EFA physiological properties, in 81 full-term newborns. Blood samples were obtained from the residual blood of the umbilical cord (UC) at delivery. Fatty acid composition of UC plasma did not show any sign of EFA deficiency. The levels of docosahexanoic (DHA) and arachidonic acid (AA) appeared to be quite similar to those obtained in European populations. UC plasma vitamin E content was 6.31 +/- 1.99 mumol/L whereas the lipid-normalized vitamin E was 2.36 mumol/mmol of lipids. An interesting point was that newborns with vitamin E inferior to the median value (5.80 mumol/L) revealed significantly lower contents of linoleic acid and DHA in UC than newborns superior to the median value. Together with the absolute or normalized plasma level of vitamin E, this supports the observation that one quarter of the communitys newborns is deficient in vitamin E.

Selective Effect of a Diet-Induced Decrease in the Arachidonic Acid Membrane-Phospholipid Content on in vitro Phospholipase C and Adenylate Cyclase-Mediated Pituitary Response to Angiotensin II

Young rats were fed on an essential fatty acid (EFA)-deprived diet for 6 weeks after weaning. Their pituitary was removed and adenohypophyseal cells dispersed and maintained in culture. Membrane lipids were analyzed and basal and stimulated levels of hormone secretion were measured after 4-day incubation in a culture medium containing or not 160 microM arachidonic acid 20:4n-6 (AA) in order to obtain EFA-deficient or EFA-restored pituitary cells, respectively. In EFA-deficient cells membrane phosphoglycerides (PGL) were depleted in AA and adrenic acid 22:4n-6; the deficit was overcome by incubation in the presence of AA. Depletion diversely affected PGL classes. AA was highly depleted in choline phosphoglycerides (ChoPG), only moderately depleted in serine and ethanolamine phosphoglycerides (SerPG and EtnPG) and not depleted at all in inositol phosphoglycerides, suggesting preferential preservation of AA in that class of PGL. Restoration of AA by addition of the fatty acid to the culture medium was complete for ChoPG and EtnPG and only partial for SerPG. Depressed levels of AA and adrenic acid in PGL were compensated for by a concomitant increase in 20:3n-9 and 22:3n-9. Growth hormone and prolactin (PRL) secretion was assessed by radioimmunoassay and possible effects of a membrane AA deficit on hormone regulation were tested in cells challenged by either growth hormone-releasing hormone, thyrotropin-releasing hormone, angiotensin II (AII), vasoactive intestinal peptide (VIP) or dopamine. Neither basal nor stimulated growth hormone secretion was different from controls in EFA-deficient cells. PRL modulation by VIP or dopamine was not affected either in EFA-deficient cells. In contrast, the capacity of AII, but not of thyrotropin-releasing hormone, to release PRL was markedly decreased in EFA-deprived cells. It was restored by addition of AA to the incubation medium. Parallel depression of AII-induced inositol phosphates and cAMP accumulation was also observed after EFA deficiency. When tested on membranes, the paradoxical inhibition of adenylate cyclase by AII documented by previous observations was reinforced in EFA-deficient membranes. In contrast, binding of AII was not affected by EFA deficiency. It is concluded that under our experimental conditions EFA deficiency affects selectively coupling of the AII receptor to its effectors without alteration of binding. The effect could involve changes in receptor interactions with coupling proteins.

Biochemical, functional, and histochemical effects of essential fatty acid deficiency in rat kidney.

The present study was designed to examine the effects of EFA deficiency (EFAD) on biochemical, functional, and structural aspects of the kidney in growing and adult rats fed a normal or EFAD diet for 9 wk after weaning. Food and fluid intake (FI), urine volume, and Na+ and K+ excretions were measured weekly from weeks 4 to 8 by placing the rats in individual metabolic cages for 24 h. At week 9, Li+ and a 5% water load, respectively, were administered at 14 and 1.5 h prior to glomerular and proximal tubular function studies, as assessed by 3-h creatinine (CCr) and Li+ (CLi+) clearances. Hematocrit and urine volume; serum and urine [Cr], [Li+], [Na+], and [K+]; and renal FA distribution were also measured. Data [corrected to 100 g/body weight (bw) and presented as means ±SEM] were significant, at P<-0.05. Despite a similar ingestion of solids from weeks 4 to 7 (weeks 7 to 10 of life), the rats on the EFAD diet showed a decreased body weight from week 5. From weeks 4 to 8, Fl and urine volume were similar for both groups, but the Fl increased at week 6 in the EFAD group; 24-h Na+ and K+ excretions were similar at all weeks, except for an increase in the EFAD group for both ions at week 7. In the EFAD group, CCr and CLi+ decreased by 27 and 56.3%, respectively (385.7±33.4 vs. 280±21.1, and 21.0±2.1 vs. 9.2±1.1 μL/min/100 g; n=9 vs. 10), the latter result suggesting increased proximal reabsorption. The 3-h Na+ and K+ excretions were similar, but the Li+ decreased (0.78±0.06×10−2 vs. 0.32±0.03×10−2 μeq/min/100 g) in the EFAD group, giving additional support to the suggestion. Renal structure was normal and similar for both groups, but the EFAD group showed a more prominent proximal tubule brush border, together with heavier periodic acid-Schiff staining in all specimens from weeks 5 to 9. In the EFAD group, FA of the n−9 and n−7 series were higher, but most of the n−6 series were lower as a percentage of total lipids in the medulla and cortex. Medullary levels of 20∶4n−6 were maintained, 22∶4n−6 declined twice, arachidonic acid was maintained, and 20∶5n−3 was lower. The EFAD diet affected glomerular function, proximal tubular structure and function, and FA distribution in the rat kidney.

Diagnóstico de anemia por deficiência de ferro em crianças do Nordeste do Brasil

OBJECTIVE To diagnose iron deficiency anemia in children. METHODS The study was conducted with a sample of 301 children aged six to 30 months attending public daycare centers in the city of Recife, Northeast Brazil, in 2004. The diagnoses of anemia were based on a combination of different hematological and biochemical parameters: hemoglobin, mean corpuscular volume, ferritin, C-reactive protein, transferrin saturation and transferrin receptor. The chi-square test and ANOVA were used in the statistical analysis. RESULTS Of all children studied, 92.4% had anemia (Hb<110 g/L) and 28.9% had moderate/severe anemia (Hb<90 g/L). Lower levels of hemoglobin were found in children aged 6-17 months. Iron deficiency was found in 51.5% of children using ferritin (<12 microg/L) as parameter. Taking into consideration the combination of hemoglobin level, ferritin and transferrin receptor, 58.1% had anemia with iron deficiency, 34.2% had anemia without iron deficiency and 2.3% had iron deficiency without anemia. Mean ferritin concentration was significantly higher in children with high C-reactive protein when compared with those with normal levels (22.1 vs. 14.8 microg/L). CONCLUSIONS The use of several biochemical and hematological parameters allowed to diagnosing iron deficiency anemia in two thirds of children, suggesting a need to identify other determinants of anemia without iron deficiency.OBJETIVO: Diagnosticar anemia por deficiencia de ferro em criancas. METODOS: O estudo foi desenvolvido com uma amostra de 301 criancas com idade entre seis e 30 meses, usuarias de creches publicas de Recife, PE, em 2004. Para o diagnostico da anemia utilizou-se a combinacao de diferentes parâmetros hematologicos e bioquimicos: hemoglobina, volume corpuscular medio, ferritina, proteina C-reativa, saturacao da transferrina e receptor da transferrina. Para a analise estatistica empregou-se o teste do qui-quadrado e ANOVA. RESULTADOS: Do total de criancas, 92,4% tinha anemia (Hb < 110g/L) e 28,9% apresentou anemia moderada/grave (Hb<90g/L). Niveis mais baixos de hemoglobina foram observados em criancas de seis a 17 meses. Encontrou-se deficiencia de ferro em 51,5% das criancas, utilizando-se a ferritina (< 12µg/L) como parâmetro. Considerando a combinacao da concentracao de hemoglobina, ferritina e do receptor de transferrina, 58,1% tinha anemia com deficiencia de ferro, 34,2% anemia sem deficit de ferro e 2,3% deficiencia de ferro sem anemia. A concentracao media de ferritina foi significativamente maior em criancas com proteina C-reativa aumentada quando comparada com aqueles com niveis normais (22,1 versus 14,8 µg/L). CONCLUSOES: A utilizacao de diversos parâmetros bioquimicos e hematologicos possibilitou diagnosticar anemia por deficiencia de ferro em dois tercos das criancas, revelando a necessidade de identificar outros determinantes de anemia sem deficiencia de ferro.

Renal Effects of Essential Fatty Acid Deficiency in Hydropenic and Volume-Expanded Rats

The aim of this paper was to study the effects of essential fatty acid (EFA) on fractional sodium excretion (FENa+) and renal hemodynamics in rats during hydropenia (H) and acute volume expansion (VE), successively. Mean arterial pressure (MAP) and renal blood flow (RBF) were measured using a blood pressure transducer and a flow probe, respectively, both connected to a flowmeter. Glomerular filtration rate (GFR) was estimated by inulin clearance. The rats receiving coconut oil as only source of dietary lipids (the EFA-deficient group) presented lower levels of linoleic acid in cortex and medulla and lower body weight than the rats receiving soy oil in place of coconut oil (the control non-EFA-deficient group). During H, the EFA-deficient rats exhibited a lower level of renal vascular resistance resulting in a higher level of RBF and a higher urinary flow (V’) and FENa+, although GFR was lower than in the control group. During VE, the rats of the control group responded with increased MAP, RBF, V’ and FENa+, which were not found in the EFA-deficient group, suggesting an impaired hemodynamic adjustment in EFA deficiency. In conclusion, both experimental conditions revealed that EFA deficiency affects the renal hemodynamics.

Diagnóstico de anemia por deficiencia de hierro en niños del Noreste de Brasil

OBJECTIVE To diagnose iron deficiency anemia in children. METHODS The study was conducted with a sample of 301 children aged six to 30 months attending public daycare centers in the city of Recife, Northeast Brazil, in 2004. The diagnoses of anemia were based on a combination of different hematological and biochemical parameters: hemoglobin, mean corpuscular volume, ferritin, C-reactive protein, transferrin saturation and transferrin receptor. The chi-square test and ANOVA were used in the statistical analysis. RESULTS Of all children studied, 92.4% had anemia (Hb<110 g/L) and 28.9% had moderate/severe anemia (Hb<90 g/L). Lower levels of hemoglobin were found in children aged 6-17 months. Iron deficiency was found in 51.5% of children using ferritin (<12 microg/L) as parameter. Taking into consideration the combination of hemoglobin level, ferritin and transferrin receptor, 58.1% had anemia with iron deficiency, 34.2% had anemia without iron deficiency and 2.3% had iron deficiency without anemia. Mean ferritin concentration was significantly higher in children with high C-reactive protein when compared with those with normal levels (22.1 vs. 14.8 microg/L). CONCLUSIONS The use of several biochemical and hematological parameters allowed to diagnosing iron deficiency anemia in two thirds of children, suggesting a need to identify other determinants of anemia without iron deficiency.OBJETIVO: Diagnosticar anemia por deficiencia de ferro em criancas. METODOS: O estudo foi desenvolvido com uma amostra de 301 criancas com idade entre seis e 30 meses, usuarias de creches publicas de Recife, PE, em 2004. Para o diagnostico da anemia utilizou-se a combinacao de diferentes parâmetros hematologicos e bioquimicos: hemoglobina, volume corpuscular medio, ferritina, proteina C-reativa, saturacao da transferrina e receptor da transferrina. Para a analise estatistica empregou-se o teste do qui-quadrado e ANOVA. RESULTADOS: Do total de criancas, 92,4% tinha anemia (Hb < 110g/L) e 28,9% apresentou anemia moderada/grave (Hb<90g/L). Niveis mais baixos de hemoglobina foram observados em criancas de seis a 17 meses. Encontrou-se deficiencia de ferro em 51,5% das criancas, utilizando-se a ferritina (< 12µg/L) como parâmetro. Considerando a combinacao da concentracao de hemoglobina, ferritina e do receptor de transferrina, 58,1% tinha anemia com deficiencia de ferro, 34,2% anemia sem deficit de ferro e 2,3% deficiencia de ferro sem anemia. A concentracao media de ferritina foi significativamente maior em criancas com proteina C-reativa aumentada quando comparada com aqueles com niveis normais (22,1 versus 14,8 µg/L). CONCLUSOES: A utilizacao de diversos parâmetros bioquimicos e hematologicos possibilitou diagnosticar anemia por deficiencia de ferro em dois tercos das criancas, revelando a necessidade de identificar outros determinantes de anemia sem deficiencia de ferro.