Rocksane de Carvalho Norton

C-reactive protein as an indicator of low intensity inflammation in children and adolescents with and without obesity.

OBJECTIVES To determine the levels of high sensitivity C-reactive protein (hsCRP) in children/adolescents with and without obesity and their correlation with body mass index (BMI) and clinical and laboratory variables. METHODS A cross-sectional study comparing two parallel groups, one a group of overweight or obese children/adolescents (obesity group, n = 131) and the other a control group of children/adolescents without obesity (control group, n = 114). High sensitivity nephelometry was used to determine hsCRP concentrations. RESULTS The obesity group exhibited greater hsCRP concentrations than the control group (p < 0.0005). There were relationships between hsCRP and BMI (p < 0.0001) and hsCRP and triglycerides (p = 0.05). The relationship between hsCRP and triglycerides was attenuated by adjustment for BMI, losing its statistical significance (p = 0.10). CONCLUSIONS The hsCRP concentrations increased as BMI increased. The majority of individuals who were not overweight exhibited hsCRP concentrations of less than 2 mg/L.

Proteína C reativa como indicador de inflamação de baixa intensidade em crianças e adolescentes com e sem obesidade

OBJECTIVES: To determine the levels of high sensitivity C-reactive protein (hsCRP) in children/adolescents with and without obesity and their correlation with body mass index (BMI) and clinical and laboratory variables. METHODS: A cross-sectional study comparing two parallel groups, one a group of overweight or obese children/adolescents (obesity group, n = 131) and the other a control group of children/adolescents without obesity (control group, n = 114). High sensitivity nephelometry was used to determine hsCRP concentrations. RESULTS: The obesity group exhibited greater hsCRP concentrations than the control group (p < 0.0005). There were relationships between hsCRP and BMI (p < 0.0001) and hsCRP and triglycerides (p = 0.05). The relationship between hsCRP and triglycerides was attenuated by adjustment for BMI, losing its statistical significance (p = 0.10). CONCLUSIONS: The hsCRP concentrations increased as BMI increased. The majority of individuals who were not overweight exhibited hsCRP concentrations of less than 2 mg/L.

Estado nutricional e prevalência de anemia em crianças que freqüentam creches em Belo Horizonte, Minas Gerais

ABstRAct Objective: Assess the prevalence of anemia and the nu-tritional status of children with 7-74 months old, enrolled in day care centers. Methods: This cross-sectional study enrolled children of 25 day care centers of the eastern district of Belo Horizonte city, Minas Gerais, Brazil. Anthropometric parameters were evalu-ated and hemoglobin count was done by a portable hemoglobi-nometer. The cutoff level for anemia was 11.0g/dL for children less than 60 months, and 11.5g/dL for those older than 5 years old. Nutritional status was assessed by anthropometric indexes: weight-for-age, height-for-age and weight-for-height and classi-fied in 3 groups: below -2 Z score (malnutrition/height deficit), -2 to -1 Z score (nutritional risk for malnutrition/height deficit) and above or equal to -1 Z score. Statistical analysis included: chi-square, chi-square with linear trend, analysis of variance (ANOVA) followed by Tukey test, being significant p <0.05. Results: 402 children, with a median age of 46.3 months, were assessed. The overall anemia prevalence was 28.8%. The

Gastroesophageal reflux and asthma in childhood: a study on their relationship using esophageal PH monitoring

OBJECTIVES This study aims at verifying the prevalence of gastroesophageal reflux in asthmatic children, and at determining the sensitivity and specificity of the reflux index for the diagnosis of gastroesophageal reflux disease. METHODS Sixty-nine children, aged 1-5 years, with asthma, were studied by 24-hour pH monitoring. The patients were randomly selected. RESULTS Ages varied from 12.4 to 63.1 months, mean age = 30.79 months, and 62.3% were males. Gastroesophageal reflux was observed in 68.1% of the children. The patients were divided into two groups, moderate and severe asthma, and gastroesophageal reflux was diagnosed in 58.5 and 82.1% of the cases, respectively. Occult gastroesophageal reflux occurred in 31.8% of the cases. The reflux index showed an sensitivity of 89.4%, specificity of 95.5%, positive predictive value of 97.7% and negative predictive value of 80.8%. CONCLUSIONS The results of this study indicate a relationship between gastroesophageal reflux and asthma, and suggest that the reflux index as a single parameter of pH monitoring has good sensitivity and specificity for the diagnosis of gastroesophageal reflux disease.

Prevenção primária de doenças cardiovasculares na obesidade infantojuvenil: efeito anti-inflamatório do exercício físico

Nowadays, juvenile obesity and physical inactivity are pandemic conditions which relate to a greater future risk of cardiovascular diseases. From an inflammatory point of view, they have attracted massive scientific attention. The beginning of the events related to atherosclerosis may occur in childhood, generating endothelial and metabolic dysfunction; however, the symptoms usually only appear later on, in adulthood. The fat tissue is recognized as being metabolically active, stimulating the production of inflammatory cytokines, such as the tumoral necrosis factor, interleukines 1, 6 and 10, C-reactive protein, among others. There is plenty of evidence that the serum levels of these citokines are higher in overweight individuals, including children and adolescents. Early prevention as young as possible is the best way to avoid future consequences of obesity. In this context, the potential benefits of regular physical exercise have been surprising. Researchers have shown evidence of anti-inflammatory responses, including lower levels of interleukine 6, C-reactive protein, leptin, besides higher levels of adiponectins after engagement in regular physical activity. However, we still have few controlled randomized studies addressing the relations between obesity, inflammation and exercise for the pediatric population. There are controversial findings in this field, and many of them come from adult studies. Thus, the purpose of the present review is to evaluate the metabolic role of physical exercise in juvenile obesity, aiming at heart protection.

Congenital generalized lipodystrophy

OBJETIVO: Apresentar as principais caracteristicas clinicas e bioquimicas da lipodistrofia generalizada congenita, desordem rara e pouco conhecida dos pediatras. DESCRICAO: Nos ambulatorios de Doencas Nutricionais e de Endocrinologia do Servico de Pediatria do Hospital das Clinicas da UFMG, foram identificados oito pacientes com lipodistrofia generalizada congenita. As caracteristicas clinicas comuns a todos os casos foram hipertrofia muscular, lipoatrofia generalizada e aparencia acromegalica. Manifestacoes clinico-laboratoriais associadas incluiram acantose nigricans em cinco pacientes, hepatoesplenomegalia em seis, hipertrigliceridemia com baixas concentracoes de HDL em sete, hipertrofia cardiaca em um e diabetes melito secundario em dois pacientes. Todos os pacientes estao em controle clinico e dietetico, visando a correcao ou prevencao dos disturbios metabolicos. COMENTARIOS: As caracteristicas fenotipicas da lipodistrofia generalizada congenita sao bem identificadas, possibilitando o diagnostico clinico na maioria dos casos. Trata-se de uma sindrome rara que ilustra a importância do funcionamento normal do tecido adiposo para a maioria dos processos metabolicos vitais do organismo. O seu melhor conhecimento podera abrir novos horizontes em estudos de doencas mais prevalentes como o diabetes melito e a obesidade.

Comparison between pre-thickened and home-thickened formulas in gastroesophageal reflux treatment

OBJECTIVE The purpose of this study was to compare the effectiveness of a pre-thickened infant formula (Nan AR) with a conventional homemade formula in the reduction of regurgitation and vomiting in infants with gastroesophageal reflux.\par METHODS A hundred children, under 12 months, not exclusively breast feeding, were select for the study. Forty-eight were treated with conventional formula with starch and 52 with pre-thickened infant formula.\par RESULTS There was no statistically significant difference between the two groups in the improvement or cure of symptoms, each treatment having been effective.\par CONCLUSION Thickened formulas, pre-thickened or home-thickened, have shown the same efficacy in the management of gastroesophageal reflux in children.Objetivo: o presente estudo foi realizado com o objetivo de comparar a eficacia de uma formula infantil pre-espessada (Nan AR) com formula convencional, de espessamento caseiro, com amido de milho, na reducao de episodios de regurgitacoes e vomitos de lactentes com refluxo gastroesofagico (RGE). Metodos: foram estudadas 100 criancas, menores de 12 meses de idade, que nao faziam uso de leite materno exclusivo. Por sorteio, 48 receberam formula convencional, e 52 receberam formula infantil pre-espessada (Nan AR), com comparacao dos resultados clinicos apos 3 meses. Resultados: nao houve diferenca estatisticamente significativa na melhora ou cura dos sintomas entre os dois grupos, tendo sido ambos os tratamentos eficazes. Conclusoes: o espessamento dietetico, seja com formulas infantis especiais, seja com medidas caseiras, tem eficacia semelhante no tratamento do refluxo gastroesofagico do lactente.

Selenium intake and nutritional status of children with phenylketonuria in Minas Gerais, Brazil

OBJECTIVE To evaluate selenium dietary intake and nutritional status of patients with phenylketonuria. METHODS The study prospectively evaluated 54 children with phenylketonuria, from 4 to10 years old. The study was performed before and after the use of a selenium-supplemented amino acid mixture. The second phase of the study was performed after, at least, 90 days of use of the supplementation. Selenium nutritional status was assessed through the analysis of biochemical parameters: serum free thyroxin and selenium and glutathione peroxidase in erythrocytes. Selenium dietary intake was evaluated by the administration of the Food Frequency Questionnaire. RESULTS Mean age of the children was of 7.0±1.8 years, and 35.2% were female. Mean time of supplementation of selenium, on special formula, was 122.2±25.1 days. The selenium-supplemented amino acid mixture represented 72.9% of the daily supply of the mineral. Upon supplementation, mean concentrations of serum selenium and glutathione peroxidase in erythrocytes increased significantly (p < 0.05). The average daily intake of selenium increased significantly (p < 0.001), reaching the levels recommended by the Dietary Reference Intakes. The concentration of free thyroxin, in serum, presented significant reduction (p < 0.001) in all patients during the second phase of the study, and returned to normal limits in those who had changed levels. CONCLUSIONS Selenium supplementation through protein replacement is effective to improve and adapt the nutritional status of selenium in patients with phenylketonuria.

A prevalência do uso de sonda nasogástrica em bebês portadores de fissura de lábio e/ou palato

PURPOSE: To investigate the prevalence of the use of nasogastric tube in babies with cleft lip and/or palate, and to correlate its use with type of cleft, maternity hospital (private or public) and city of origin, and age at the first visit to a cleft center. METHODS: The sample consisted of data collected from 137 babies of both genders with cleft lip and/or palate, without any other associated anomalies, born full-term, who attended their first consultation at a specialized cleft center with ages between zero and 12 months (median=33 days). Statistical analyses used the coefficient of contingency test (p<0,05). RESULTS: From the subjects, 61% were male and 39% were female; 51% presented cleft lip and palate, 35% cleft palate, and 14% cleft lip. Regarding place of birth, 36% were born in private and 64% in public maternity hospitals; 60% were born in the city of Belo Horizonte (Minas Gerais, Brazil), 15% in other cities of the metropolitan area, and 25% in other cities at the state of Minas Gerais (Brazil). The use of nasogastric tube was reported in 23% of the cases. There was no association between the type of cleft or maternity and the use of the tube, but the later was more frequent within the metropolitan area (p=0,007). CONCLUSION: The prevalence of the use of nasogastric tube in babies with cleft lip and/or palate was considered high since they were born full-term and without any other associated anomalies that would indicate the need of the tube. The use of nasogastric tube was more frequent in babies born at the metropolitan area of Belo Horizonte, when compared to other cities in the state of Minas Gerais (Brazil).

[Late hemorragic disease of the newborn: case report]

OBJECTIVE: In this study the authors review this subject, and call attention for the late hemorrhagic disease of the newborn, due to the severity and higher risk of mortality and neurological sequelae.METHODS: In this article, four cases of children, age raging from 12 to 21 days, with late hemorrhagic disease associated with vitamin K deficiency were reported. RESULTS: All newborns had multiple hemorrhagic manifestations of the disease. The systems more affected were digestive tract, urinary system, umbilical cord, respiratory system and nervous system.CONCLUSION: Three forms of hemorrhagic disease of newborn have been related with vitamin K deficiency. However, late vitamin K deficiency bleeding is not common and may not be diagnosed by pediatrician. This form of disease can be prevented by vitamin K prophylaxis administration after birth.