Patrícia da Graça Leite Speridião

Ingestão de nutrientes e estado nutricional de crianças em dieta isenta de leite de vaca e derivados

OBJETIVO: Avaliar a ingestao alimentar e o estado nutricional de criancas em dieta isenta de leite de vaca e derivados. METODOS: Foram avaliadas 26 criancas, na primeira consulta realizada em ambulatorio de gastroenterologia pediatrica, que vinham recebendo dieta isenta de leite de vaca e derivados (media de idade = 19,1 meses) e 30 criancas com dieta normal, isto e, sem nenhum tipo de restricao alimentar (media de idade = 16,8 meses). Empregou-se o metodo do dia alimentar habitual para a obtencao dos dados sobre consumo alimentar. A ingestao alimentar foi comparada entre os grupos e em relacao as Dietary Reference Intakes (DRIs). O estado nutricional foi avaliado com base nos escores z de peso/idade, estatura/idade e peso/estatura. RESULTADOS: O grupo em dieta isenta de leite de vaca apresentou menor ingestao de energia (p = 0,005), proteinas (p < 0,001), lipidios (p < 0,001), calcio (p < 0,001) e fosforo (p < 0,001) quando comparado ao grupo controle. Houve maior numero de criancas no grupo em dieta isenta de leite de vaca com ingestao de energia, calcio e fosforo inferior as DRIs em comparacao ao grupo controle. As medias dos escores z dos grupos com dieta isenta de leite de vaca e controle, foram, respectivamente: estatura/idade -0,81±1,06 versus +0,42 ±1,25 (p < 0,001), peso/idade -1,03±1,21 versus +0,02 ±0,91 (p < 0,001) e peso/estatura -0,63 ±1,08 versus +0,30 ±1,11 (p = 0,004). CONCLUSOES: Durante a terapeutica de exclusao do leite de vaca e seus derivados, deve ser realizado, periodicamente, monitoramento da ingestao alimentar qualitativa e quantitativamente, a fim de se prevenir provaveis inadequacoes no atendimento as necessidades nutricionais, bem como prejuizo ao crescimento e desenvolvimento dessas criancas.

Dietary fiber, energy intake and nutritional status during the treatment of children with chronic constipation

The present prospective study was carried out to determine dietary fiber and energy intake and nutritional status of children during the treatment of chronic constipation. Twenty-five patients aged 2 to 12 years with chronic constipation were submitted to clinical evaluation, assessment of dietary patterns, and anthropometry before and after 45 and 90 days of treatment. The treatment of chronic constipation included rectal disimpaction, ingestion of mineral oil and diet therapy. The standardized diet prescribed consisted of regular food without a fiber supplement and met the nutrient requirements according to the recommended daily allowance. The fiber content was 9.0 to 11.9 g for patients aged less than 6 years and 12.0 to 18.0 g for patients older than 6 years. Sixteen patients completed the 90-day follow-up and all presented clinical improvement. The anthropometric variables did not change, except midarm circumference and triceps skinfold thickness which were significantly increased. Statistically significant increases were also found in percent calorie intake adequacy in terms of recommended daily allowance (55.5 to 76.5% on day 45 and to 68.5% on day 90; P = 0.047). Percent adequacy of minimum recommended daily intake of dietary fiber (age + 5 g) increased during treatment (from 46.8 to 52.8% on day 45 and to 56.3% on day 90; P = 0.009). Food and dietary fiber intake and triceps skinfold thickness increased during follow-up. We conclude that the therapeutic program provided a good clinical outcome.

Estado nutricional e absorção intestinal de ferro em crianças com doença hepática crônica com e sem colestase

OBJECTIVES: to evaluate food intake, occurrence of energy-protein malnutrition and anemia, and intestinal iron absorption in children with chronic liver disease. METHODS: The study included 25 children with chronic liver disease, 15 with cholestasis and 11 without cholestasis. The age varied between 6.5 months and 12.1 years. Intestinal iron absorption was evaluated by the increment of serum iron one hour after the ingestion of 1 mg/kg of elemental iron and by the response to oral iron therapy. Iron intestinal absorption was compared to a group with iron deficiency anemia (without liver disease). RESULTS: The mean intake of energy and protein in the cholestatic group was higher than in patients without cholestasis. The nutritional deficit was more severe in cholestatic patients, especially with regard to height-for-age and weight-for-age indices. Anemia was found in both cholestatic group (11/14; 78.6%) and noncholestatic group (7/11; 63.6%). The cholestatic group presented lower (p < 0.05) intestinal iron absorption (90.6±42.1 µg/dl) than the iron deficiency anemia group (159.6±69.9 µg/dl). However, cholestatic patients responded to oral iron therapy. The noncholestatic group showed intestinal iron absorption similar to the iron deficiency anemia group. CONCLUSIONS: The cholestatic group showed more severe nutritional deficits. Despite the evidence of lower iron intestinal absorption, cholestatic patients responded to oral iron therapy, probably, due to the coexistence of iron deficiency.

Desempenho de pais de crianças em dieta de exclusão do leite de vaca na identificação de alimentos industrializados com e sem leite vaca

OBJECTIVE: To investigate how well the parents of children on cows milk free diets perform at recognizing whether or not expressions describe and foods contain cows milk proteins. METHODS: Interviews were conducted with 24 parents of children on cows milk and by-products exclusion diets and 23 parents of children with no need for any type of exclusion diet. They were asked if they recognized 12 expressions relating to cows milk. They were then asked to classify 10 commercial food products in terms of whether or not they contained cows milk proteins. RESULTS: Terms that included the word milk were more often recognized by both groups of parents. The parents of children on exclusion diets recognized the terms cows milk protein, traces of milk and milk formulation or preparation most frequently (p < 0.05). Less than 25.0% of those interviewed recognized casein, caseinate, lactalbumin and lactoglobulin. Both groups correctly identified more of the commercial products containing cows milk than those free from milk. The median number of products containing cows milk (total = 5) correctly identified by the parents of children on exclusion diets (4.0) was greater than for the control group (3.0; p = 0.005). Reading at least one label was associated with a greater chance of correctly identifying more than five of the 10 products (odds ratio = 8.0). CONCLUSIONS: Despite having received guidance, the parents of children on exclusion diets were not fully prepared to manage these diets, indicating a need for improvements to the instruction provided when indicating exclusion diets.

The performance of parents of children receiving cow's milk free diets at identification of commercial food products with and without cow's milk.

OBJECTIVE To investigate how well the parents of children on cows milk free diets perform at recognizing whether or not expressions describe and foods contain cows milk proteins. METHODS Interviews were conducted with 24 parents of children on cows milk and by-products exclusion diets and 23 parents of children with no need for any type of exclusion diet. They were asked if they recognized 12 expressions relating to cows milk. They were then asked to classify 10 commercial food products in terms of whether or not they contained cows milk proteins. RESULTS Terms that included the word milk were more often recognized by both groups of parents. The parents of children on exclusion diets recognized the terms cows milk protein, traces of milk and milk formulation or preparation most frequently (p < 0.05). Less than 25.0% of those interviewed recognized casein, caseinate, lactalbumin and lactoglobulin. Both groups correctly identified more of the commercial products containing cows milk than those free from milk. The median number of products containing cows milk (total = 5) correctly identified by the parents of children on exclusion diets (4.0) was greater than for the control group (3.0; p = 0.005). Reading at least one label was associated with a greater chance of correctly identifying more than five of the 10 products (odds ratio = 8.0). CONCLUSIONS Despite having received guidance, the parents of children on exclusion diets were not fully prepared to manage these diets, indicating a need for improvements to the instruction provided when indicating exclusion diets.

Teste de desencadeamento aberto no diagnóstico de alergia à proteína do leite de vaca

OBJECTIVES: To report the results of open challenge tests performed in children fed with cows milk-free diet. DESCRIPTIONS: Cross-sectional study evaluating cows milk open challenge performed under supervision in a hospital setting during 2.5 hours and ambulatory follow-up for 30 days when no immediate reaction occurred. One hundred and twenty-one patients were included, with ages between 4 and 95 months. Cows milk open challenge tests were positive in 28 patients (23.1%). A clinical manifestation of cows milk allergy different from the one presented at diagnosis occurred in 12 (24.9%) patients with positive challenge. Positive challenge was more frequent (p = 0.042) in patients fed with extensively hydrolyzed formulae or amino acid-based formulae (30.3%) when compared to those fed with other exclusion diets (14.5%). CONCLUSION: Open challenge allowed the interruption of exclusion diet in a significant proportion of the patients.OBJECTIVE To report the results of open challenge tests performed in children fed with cows milk-free diet. DESCRIPTION Cross-sectional study evaluating cows milk open challenge performed under supervision in a hospital setting during 2.5 hours and ambulatory follow-up for 30 days when no immediate reaction occurred. One hundred and twenty-one patients were included, with ages between 4 and 95 months. Cows milk open challenge tests were positive in 28 patients (23.1%). A clinical manifestation of cows milk allergy different from the one presented at diagnosis occurred in 12 (24.9%) patients with positive challenge. Positive challenge was more frequent (p = 0.042) in patients fed with extensively hydrolyzed formulae or amino acid-based formulae (30.3%) when compared to those fed with other exclusion diets (14.5%). CONCLUSION Open challenge allowed the interruption of exclusion diet in a significant proportion of the patients.

Knowledge and practice of physicians and nutritionists regarding the prevention of food allergy

BACKGROUND & AIMS To evaluate the knowledge and practice of pediatricians, pediatric gastroenterologists, allergists and nutritionists regarding the primary prevention of food allergy. METHODS A descriptive, cross-sectional study that enrolled pediatricians (n = 80), pediatric gastroenterologists (n = 120), allergists (n = 100) and nutritionists (n = 220). A self-administered questionnaire concerning the current recommendations was used. RESULTS Despite the lack of current recommendations, 17.1% (n = 89) of all professionals, mainly nutritionists, recommended a maternal exclusion diet during pregnancy. More professionals in the sample group, 40.8% (n = 212), recommended a maternal exclusion diet during breastfeeding, and the rates of recommendation were higher in nutritionists and pediatricians compared to allergists and pediatric gastroenterologists (p < 0.001). Regarding the recommended timing of the introduction of complementary feeding, 41.9% (n = 218) of the professionals recommended modifying the age of introduction to prevent the development of food allergy. The majority of the professionals believed that prebiotics (61.2%; n = 318) and probiotics (44.4%; 231) prevent the development of food allergy. The recommended age of introduction for the main allergenic foods was 12 months. CONCLUSIONS This study revealed that there are gaps in the knowledge of professionals about the primary prevention of food allergy.

Effects of soy beverage and soy-based formula on growth, weight, and fecal moisture: experimental study in rats

OBJECTIVE To compare body growth, weight, and fecal moisture in recently weaned rats fed exclusively on infant soy formula and soy-based beverage. METHODS Three similar groups were formed (n=10/group) consisting of weanling Wistar rats, maintained in metabolic cages. One group was fed soy protein-based beverage, another with soy-based infant formula, and another with cows milk infant formula (control group). Water and diet were offered ad libitum. Body weight and length were measured. Stool was collected for three consecutive days. RESULTS Weight and length were lower (p = 0.001; p = 0.001) in the groups receiving soy protein-based beverage (73.16 ± 5.74 g; 23.94 ± 1.04 cm) and soy-based formula (71.11 ± 5.84 g; 24.74 ± 0.60 cm) in relation to the group receiving cows milk formula (84.88 ± 9.75 g; 26.01 ± 0.91 cm). Fresh fecal weight was greater (p < 0.001) in the soy-based beverage (3.44 ± 0.48 g) than in the soy-based formula (0.79 ± 0.20 g) and cows milk-based formula (0.42 ± 0.17 g). Fecal moisture was higher (p < 0.001) in the group receiving soy protein-based beverage (47.28 ± 9.02%) and soy-based formula (37.21 ± 13.20%) than in the group receiving cows milk formula (22.71 ± 10.86%). CONCLUSION The growth of rats fed soy protein-based beverage and soy-based formula was lower than those fed cows milk-based formula. The soy protein-based beverage resulted in significant increase in fecal weight and moisture.

Consumo alimentar de crianças e adolescentes com disfagia decorrente de estenose de esôfago: avaliação com base na pirâmide alimentar brasileira

Estudo de corte transversal, no qual foram incluidos consecutivamente 31 pacientes com estenose esofagica,sendo 18 (58,0%) caustica, 7 (22,6%) pos-cirurgica, 3 (9,7%) peptica e 3 (9,7%) sem causa definida. Empregou--se o recordatorio de 24 horas; os alimentos foram transformados em porcoes em funcao dos oito grupos dealimentos, conforme recomendado por Philippi. Utilizou-se o teste Kruskal-Wallis e Exato de Fisher, fixando em5% o nivel de rejeicao da hipotese de nulidade.

Food intake, growth and body composition of children and adolescents with autoimmune hepatitis.

Objective To evaluate the food intake, anthropometry, body composition, and sexual maturity of children and adolescents with autoimmune hepatitis. Methods Thirty-seven children and adolescents with autoimmune hepatitis were studied. A questionnaire was given to evaluate food intake over a 24-hour period. Weight, height, and skin-fold thickness were measured. Electric impedance and skin-fold using Slaughter formula were used to evaluate body composition. Sexual maturity was evaluated using the Tanner stage method. Cumulative intake of corticosteroids was determined based on medical records. Results Most of the subjects were females (83.3%). Food intake did not meet recommended dietary intakes for energy, calcium, and vitamin A for 43.2%, 94.6%, and 59.4% of the patients, respectively. All subjects were in their respective pubertal developmental stage. A lower Z score for height-for-age (<−2.0 standard deviation) was found in 3/37 (10.5%) of the patients. Body fat over 30% was found in female patients by bioimpedance (41.9%) and skin-fold (45.2%) evaluation. There was a positive correlation between the 2 methods of measuring body fat (r=+0.800; P<0.001). A larger reduction (P<0.005) in Z score for height-for-age was observed in patients that received a cumulative dose of corticosteroids of more than 10.0 g. Conclusions Food intake in children and adolescents with autoimmune hepatitis is below recommended standards especially for energy, calcium, and vitamin A. Cumulative dose of corticoids was associated with reduction of Z score for height-for-age.