Patricia de Carvalho Padilha

Associação entre o estado nutricional pré-gestacional e a predição do risco de intercorrências gestacionais

PURPOSE: to analyze the association between maternal pre-gestational nutritional status and maternal outcomes - hypertensive disorders of pregnancy, gestational diabetes, vitamin A deficiency, and anemia - and the newborn outcome - low birth weight. METHODS: cross-sectional study, with 433 adult puerperal women (> 20 years old) and their newborns, attending the Maternidade Escola of Universidade Federal do Rio de Janeiro (UFRJ). Data was collected through interviews and access to their medical records. Maternal pre-gestational nutritional status was established through pre-gestational body mass index according to the cut-offs for adult women defined by the World Health Organization (WHO), in 1995. The association between gestational outcomes and pre-gestational nutritional status was estimated through odds ratio (OR) and a 95% confidence interval (95%CI). RESULTS: frequency of pre-gestational weight deviation (low weight, overweight and obesity) was 31.6%. Considering the pre-gestational nutritional status, overweight and obese women presented a lower weight gain than eutrophic and low-weight women (p<0.05). Women with pre-gestational obesity presented a higher risk of developing hypertensive disordens of pregnancy (OR=6.3; 95%CI=1.9-20.5) and those with low pre-gestational weight were more likely to give birth to low birth weigh infants (OR=7.1; 95%CI=1.9-27.5). There was no evidence of the association between pre-gestational nutritional status and the development of anemia, vitamin A deficiency and gestational diabetes. The mean weight gain among overweight and obese pregnant women was significantly lower when compared to eutrophic and low-weight pregnant women (p=0.002, p=0.049, p=0.002, p=0.009). CONCLUSIONS: the high number of women with pre-gestational weight deviation reinforces the importance of a nutritional guidance that favors a good nutritional state and reduces the risks of maternal and newborn adverse outcomes.

Análise crítica de estudos brasileiros sobre deficiência de vitamina A no grupo materno-infantil

Objetivo: Apresentar uma analise critica de estudos da literatura sobre a deficiencia de vitamina A (DVA) no Brasil, segundo o indicador bioquimico retinol serico, considerandose o impacto negativo da DVA na saude reprodutiva e no desenvolvimento infantil. Fontes de dados: os bancos de dados Medline e BVS, no periodo de 1994 a 2007, foram rastreados com a combinacao de descritores: “vitamin A deficiency”, “Brazil”, “pregnant”, “children” e “retinol serum level”. A inclusao dos artigos foi realizada com base em criterios de elegibilidade referentes a populacao, desenho do estudo e idioma, enfatizando-se estudos com gestantes, puerperas, nutrizes, lactentes e pre-escolares que nao apresentassem doencas cronicas naotransmissiveis ou infecciosas. Sintese dos dados: dos 27 artigos selecionados, 25 eram estudos transversais, um era caso-controle e um estudo longitudinal. Identificou-se que 71% e 25% dos trabalhos com gestantes e criancas, respectivamente, adotaram valores de retinol serico <1,05µmol/L como ponto de corte. Todos os estudos apontaram a DVA como um problema de proporcao preocupante. Reconhece-se a emergente insercao dos adolescentes no grupo de risco potencial para DVA e da antropometria como variavel independente para tal defici encia nutricional. Conclusoes: Aponta-se uma necessidade de incluir estrategias de intervencao adicionais a suplementacao, reavaliar pontos de corte na interpretacao do diagnostico da DVA e refletir sobre a pertinencia da inclusao de novas areas e grupos com risco potencial para DVA em programas de intervencao.

[Pica: epidemiology and association with pregnancy complications].

PURPOSE to verify the occurrence ratio of pica in pregnant women and its impact on the mother and newborn health. METHODS prospective study with 227 adult pregnant women and their newborns treated at the Maternity School of Universidade Federal do Rio de Janeiro, between 2005 and 2006. Pica has been considered as the ingestion of inedible substances or atypical food combinations. The data was collected was done by medical chart review and interview. RESULTS Pica was referred to by 14.4% of the women, 42.1% of whom practiced it daily. The onset occurred in the second gestational trimester in 46.7% of the cases, and, in the third trimester, in 30% of them. Among the alleged reasons, 65% of the women were unable to give them, 15% declared relief of nausea and heartburn and 10% reported reduced stress and anxiety. The practice in the previous gestation/puerperium was referred to by 15% of the women. Pica was not associated with the maternal anthropometric condition, the skin color, the marital status, the maternal schooling and the presence of parasitosis. There was no difference between the average of the total family income and the number of gestations for the women who did or did not have pica. Pica was associated with gestational anemia (p<0.009) and gestational intercurrences (OR=3.5; CI95%=1.6-7.9). As for the baby, pica did not interfere in the health parameters at birth: weight, gestational age and intercurrences. CONCLUSIONS pica must be investigated at prenatal assistance and recognized as a risk factor for the mothers health.

The performance of various anthropometric assessment methods for predicting low birth weight in pregnant women

OBJECTIVES: to assess the performance of various anthropometric methods for the evaulation of the nutritional status of pregnant women as a means of predicting low birth weight (LBW). METHODS: a descriptive cross-cutting study carried out among 433 pregnant women (>20 years) attending a Public Maternity Hospital in Rio de Janeiro, Brazil. The adequacy of the weight gain at the end of the pregnancy was evaluated in accordance with the proposals of the Institute of Medicine and the Brazilian Ministry of Health. The sensitivity, specificity and accuracy of the adequacy of weight gain at the end of the pregnancy or nutritional state of mother as a predictor of low birth weight were calculated. RESULTS: the sensitivity of the various methods varied from 63.1% to 68.4% and the specificity from 71.2% to 75.1%. The adapted Institute of Medicine proposal drawn up by the Brazilian Ministry of Health, according to the classification of the pre-delivery nutritional status of the mother according to the World Health Organization cutoff points showed itself to be the most accurate (74.5%), this being the most adequate method for nutritional triage for reason of its association with low birth weight (OR=4.10; 95%CI=1.53-10.92). CONCLUSIONS: the best proposals for this population are those of the Institute of Medicine and the Brazilian Ministry of Health. Further studies aiming to ascertain the most appropriate methods of anthropometric evaluation for different populations should be encouraged.

Effect of the use of probiotics in the treatment of children with atopic dermatitis: a literature review

INTRODUCTION Atopic dermatitis (AD) is a disease that mainly affects the pediatric population involving chronic and repetitive inflammatory skin manifestations. Its evolution is known as atopic march, which is characterized by the occurrence of respiratory and food allergies. AIM To carry out a classical review of the state-of-theart scientific literature regarding the effect of probiotics on the treatment of children with AD. METHODS Searches were conducted in Medline and Lilacs through the portals PubMed (http://www.ncbi.nlm. nih.gov/pubmed/) and SciELO (http://www.scielo.br). There was a selection of the available publications in the period from 2001 to 2011, using the keywords atopic dermatitis and probiotics (in English and in Portuguese). RESULTS After applying the inclusion and exclusion criterias, we selected 12 case-control studies which were conducted in four European countries and Australia. The methodological quality of the studies was assessed according to the STROBE recommendations. Assessment of agreement among researches in classifying the quality of the articles showed excellent agreement (k = 1.00, 95%) with a total of 9 papers at B level. The majority of the studies (75%) indicated a beneficial biological effect of probiotics on AD, including protection against infections, enhancement of the immune response, inflammation reduction and changes in gut the flora. The remaining studies showed no beneficial effects according to the outcomes of interest. CONCLUSION The majority of the studies in the scientific literature in this review showed improvements in some inflammatory parameters and in intestinal microbiota and not exactly, changes in clinical parameters. However, the biological effects observed in most of them suggest the possibility of benefits of the use of probiotics as an adjuvant in the treatment of AD.

Anthropometric assessment of nutritional status in Brazilian pregnant women

Se reviso la literatura disponible publicada entre 1957 y 2007 sobre la evaluacion antropometrica de embarazadas y se analizaron criticamente las metodologias recomendadas. Las mediciones antropometricas constituyen el metodo mas frecuentemente empleado debido a su reconocida utilidad para prevenir la morbimortalidad perinatal, predecir la salud del nino y promover la salud de la madre. Ha habido un intenso debate sobre el aumento optimo de peso durante la gestacion, que ha llevado a cambiar las recomendaciones nutricionales. Hasta la decada de 1960 se sugeria limitar el aumento de peso gestacional como una forma de evitar un resultado obstetrico desfavorable. Se reconoce que la metodologia recomendada por el Instituto de Medicina (1990/1992) es la mas aceptada en todo el mundo y ha servido de estandar de referencia en muchos estudios, sin embargo, tambien se presentan otros metodos (que utilizan modelos graficos e indicadores basados en el indice de masa corporal y la tasa peso-altura gestacionales). Para contribuir a la salud materno-infantil se necesitan estudios que validen los indicadores de alteraciones nutricionales durante el em barazo y que tengan elevados valores de sensibilidad y es pecificidad con respecto a los desenlaces obstetricos inde seables, y determinar un estandar universal del aumento de peso durante la gestacion.

A investigação da cegueira noturna no grupo materno-infantil: uma revisão histórica

The aim of this study was to provide a historical review of night blindness, a functional indicator of vitamin A deficiency. The scientific literature published in the period from 1929 to 2005 was reviewed, using Medline, Lilacs, SciELO, National and International Health and Micronutrients Comities databases. The key words used were: night blindness, xerophthalmia, pregnancy, postpartum women, newborn, children, vitamin A deficiency, micronutrient. The importance of the functional indicator of vitamin A deficiency has been consecrated in 1996 by the World Health Organization through the recommendation of a standardized interview to investigate cases of night blindness. The method is characterized by methodological easiness, low cost and it allows the monitoring of the nutritional status of people and communities, and evaluation of the efficacy of interventions. Recent studies suggest that this indicator is also useful for diagnosing subclinical vitamin A deficiency among pregnant women and postpartum women, since the agreement with biochemical indicators is expressive. Along the years, this indicator has also been recognized as an important instrument to predict the risk of morbidity and mortality in the mother-child dyad.

Deficiências de micronutrientes em crianças e adolescentes com anemia falciforme: uma revisão sistemática

A anemia falciforme e a doenca hemolitica cronica, de carater hereditario mais comum no Brasil, sendo escassas as informacoes sobre o estado nutricional de micronutrientes em portadores dessa enfermidade no Brasil. Estudos internacionais vem demonstrando correlacao positiva entre deficiencia de micronutrientes e evolucao desfavoravel da doenca.O objetivo deste estudo foi realizar revisao sistematica sobre deficiencia de micronutrientes em criancas e adolescentes com anemia falciforme.Foram selecionadas publicacoes nas bases cientificas de dados Medline e Lilacs atraves do Pubmed e Scielo, disponiveis entre os anos de 1998 e 2008. Foram incluidas na analise as publicacoes realizadas com criancas e adolescentes portadores da forma homozigotica da doenca (SS). A qualidade metodologica dos artigos foi avaliada segundo as recomendacoes de Strobe, sendo selecionados 11 estudos, sendo 2 transversais, 4 caso-controle e 5 de coorte, todos realizados nos Estados Unidos. A avaliacao da concordância entre os avaliadores na classificacao da qualidade dos artigos demonstrou otima concordância (k = 1,00), com um total de 90,9% de trabalhos com classificacao B. Para a maioria dos nutrientes estudados (vit. A, D, B6, folato, calcio e zinco), observou-se estado nutricional desfavoravel entre os portadores de anemia falciforme, a excecao do ferro e vitamina B12, cujos resultados revelaram baixo ou nenhum nivel de inadequacao, seja bioquimica ou dietetica. Tal constatacao reforca a necessidade do cuidado nutricional no manejo desses pacientes, garantindo qualidade de vida para os portadores da doenca.

Consistência das informações de um estudo sobre o impacto da assistência nutricional no atendimento pré-natal

OBJETIVO: Avaliar a consistencia dos dados obtidos no estudo Avaliacao do impacto da assistencia nutricional pre-natal no resultado obstetrico, por analise da confiabilidade das informacoes e perdas de seguimento ocorridas. METODOS: Trata-se de um estudo de intervencao, prospectivo, em uma coorte de gestantes. O grupo pre-intervencao (GI) foi constituido de 225 puerperas adultas (1999-2001) e o grupo intervencao (GII), de 208 gestantes adultas (2005-2006) e seus respectivos recem-nascidos, atendidos em Maternidade Publica do Rio de Janeiro. Visando a padronizacao dos procedimentos de coleta de dados, os pesquisadores receberam treinamento, reciclagem e foram supervisionados. Alem disso, elaborou-se um manual de instrucoes para consulta no trabalho de campo, foi feito um estudo piloto para testar os instrumentos; a analise da consistencia dos dados foi semanal. Para avaliar a confiabilidade da obtencao das informacoes, foram aplicadas as estatisticas Kappa (k) e o Indice de Concordância Intraclasse (ICC). RESULTADOS: As perdas de seguimento do GII foram de 8,4%. Houve boa padronizacao dos procedimentos de obtencao das informacoes em ambos os grupos, com ICC>0,92 e k>0,65 no GI e, para o GII, ICC>0,94 e k>0,71. Destaca-se a alta concordância entre o peso pre-gestacional informado e o aferido no primeiro trimestre (ICC=0,961). CONCLUSOES: Os resultados sugerem que as estrategias adotadas no presente estudo contribuiram para o baixo percentual de perdas de seguimento e garantia da qualidade dos dados, permitindo a reprodutibilidade dos resultados.

Phase angle assessment in critically ill cancer patients: Relationship with the nutritional status, prognostic factors and death

Purpose: To evaluate the relationship between phase angle (PA) and nutritional status and the prognostic significance of PA in critically ill cancer patients. Methods: 31 patients that had been admitted to the intensive care unit (ICU) of a center on oncology were evaluated. Their PA was obtained from their bioelectrical impedance within 48 h of the ICU admission. The logistic regression analysis of Cox was used in order to identify the independent predictors of the outcomes. Results: Negative and significant correlations were observed between the PA and the following variables: the length of hospital ward stay, the length of ICU stay, the total time of hospital stay, the mechanical ventilation time, and the acute physiology and chronic health evaluation II (APACHE II) scores. A positive correlation was ascertained between the PA and albumin. PA was significantly associated with death. Patients with a PA ≤3.8° presented a significantly shorter survival time than those with a PA >3.8°. Conclusion: PA was a prognostic marker in this population, independently of previously established prognostic factors. PA can represent a clinically feasible approach for the initial identification of critically ill cancer patients who require an early and specialized nutritional intervention. HighlightsThe negatively correlated PA with length of hospital ward stayThe negatively correlated PA with length of ICU stay and APACHE II scoresThe negatively correlated PA with the total time of hospital stayA positive correlation was ascertained between the PA and albumin.PA was significantly associated with death.